NC Family Physician: Spring 2020

Volume 16 Issue 2 • Spring 2020

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Family Medicine in The Time of

COVID-19

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

2020 NCAFP MEETINGS AT A G L A N C E

Sports Medicine for the Active Patient

After-Office Hours CME Dinner Opportunity

Saturday, August 8, 2020 | 7:30 AM to 12:15 PM Greensboro High Point Marriott Airport Hotel Program Chair: Karl “Bert” Fields, MD, ABFM, CAQSM Estimated 4.00 CME Credits www.ncafp.com/sportsmedicine

Tuesday, September 29, 2020 | 6:00 PM to 8:30 PM ECU Family Medicine Center | Greenville, NC Estimated 1.5 CME Credits www.ncafp.com/cmedinnerecu

In-Person Attendee & Virtual Webcast Only Registration Options Available

Winter Family Physicians Weekend Wednesday, December 3 – Sunday, December 6, 2020 The Omni Grove Park Inn | Asheville, NC Program Chair: Victoria Kaprielian, MD Program Vice-Chair: Jay Patel, MD Estimated 25+ CME Credits www.ncafp.com/wfpw

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 Spring 2020

2019 ANNUAL REPORT

P. 9

PRESIDENT’S MESSAGE

PROFESSIONAL DEVELOPMENT

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Planning Underway for Two Great CME Opportunities

Family Medicine in the Time of COVID-19

CHAPTER AFFAIRS

6

A Brave New World

18

RESIDENTS & NEW PHYSICIANS

22

Older Children in Foster Care - An Opportunity for Family Medicine

MEMBERSHIP

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PRACTICE MANAGEMENT

Family Physicians Fight COVID on the Frontlines

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Is Now the Time to Renegotiate Your Lease Terms?

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Chapter Affairs 6 Membership 8 Professional Development 18 t 919.833.2110 •

fax

Residents & New Physicians 22 Medical Student Programs 24 Practice Management 26

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. David Rinehart 2019–2020 NCAFP President

~ THE 2020 PANDEMIC ~

Family Medicine in the Time of COVID-19 As I write this in early April, the news is full of talk of ventilator shortages, overcrowded hospitals and temporary hospitals being set up on soccer fields and in convention centers. On television, every few minutes a new infectious disease specialist or epidemiologist or ED physician is interviewed about their dire circumstances. We watch endless videos of health care workers in full protective attire moving sick patients around in hospitals. We listen carefully to Dr Birx and Dr Fauci. Everyone is trying to find a mask to wear. The whole country knows the acronym “PPE” and understands some basics about ventilators. The deaths are mounting rapidly. The spread seems to be inevitable.

Although a few family physicians are on the cutting edge of this pandemic and working with very sick hospital patients, most of us are not so involved with the intensive hospital care.

So, what is the role of Family Medicine during this unprecedented upheaval in our nation?

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Dr. Rinehart attended the University of Virginia and earned his BA in 1978 (Phi Beta Kappa) and his MD in 1982 (Alpha Omega Alpha). He completed his residency in Family Medicine at Charlotte Memorial Hospital in 1985 and was recognized as a national Mead Johnson Outstanding Resident. Dr. Rinehart has enjoyed 34 years of community-based Family Medicine practice with South Point Family Practice in Belmont, NC, 22 years as an independent group practice and 12 years as part of CaroMont Health. He has been a preceptor for dozens of medical students and nurse practitioner students over the years. Dr. Rinehart has held several leadership and committee positions within CaroMont Health including past Chair of the Physician Leadership Council and immediate past Co-Administrative Physician Lead of the Primary Care Service Line. He is a past Board Chair of Presbyterian Samaritan Counseling Center in Charlotte and has participated in medical mission trips in Honduras and Ethiopia. He has served for the past 18 years as team physician for the local high school football team and has held several leadership positions in his church including Chair of the daycare facility. Dr. Rinehart lives in Belmont with his wife of 40 years and has three grown children and two grandchildren.

Prevention As family physicians, we need to lead the way in evidence-based prevention measures for our patients. We do this by encouraging social distancing and CDC-approved isolation and quarantine measures. We do not ask patients to come to our offices if not absolutely required, although it will hurt our businesses. We follow PPE guidelines. We keep our offices clean and sanitized.

We follow social distancing as best we can if patients must come to our offices. We will be there to deliver the vaccine when it becomes available someday.

Patient Education We keep our patients informed about SARS-CoV-2, about how to socially distance, about how this is spread, what measures to take, how to quarantine

The North Carolina Family Physician

2019-2020

NCAFP Board of Directors

and isolate, how to safely manage to get groceries and other necessities. We encourage our patients to continue to manage their health with diet and exercise and supporting one another. We reach out through phone calls, portal messages, text messages, whatever way we have available. We will stay informed ourselves as to the latest guidelines and recommendations put forth by our public health experts and do our best to follow them and encourage our patients and colleagues to follow them.

Executive Officers President

David R. Rinehart, MD

President-Elect

Jessica Triche, MD

Secretary/Treasurer

Dimitrios “Takie” P. Hondros, MD

Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD

Treatment of Non-COVID-19 Conditions

Elizabeth B. Baltaro, MD

We will continue to follow our patients as they navigate their other health issues. We will find innovative ways to manage many more medical conditions at home than usual. We will be flexible with our requirements for office visits. We will extend many prescriptions when appropriate by weighing the risk of having patients out of social distancing with the benefit of person-to-person visits. We will treat some conditions by telemedicine that we would not have thought of a few months ago. We will be innovative and creative in treating our patients.

Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Brian McCollough, MD Mark McNeill, MD Ying Vang, MD

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director

Telehealth

Elizabeth Ferruzzi, MD (Novant)

We will embrace this technology, new for most of us, for the good of our patients and our staff. We will encourage our staff and patients as we all embark on a steep learning curve as to how this technology will transform parts of our practices.

Resident Director-Elect Clayton Cooper, MD, MBA (Duke)

Student Director Katelyn Turlington (WFSOM)

Leadership

Student Director-Elect

We are fortunate in North Carolina to have many dedicated family physician leaders involved in making some of the decisions in our state regarding this pandemic. Family physicians hold prominent leadership roles in NC Medicaid, are active in various committees developing pandemic policy within our health systems, share leadership on a NCIOM task force committee submitting recommendations about the allocation of scarce resources, and help lead CCNC and AHEC with practice support and telehealth teaching.

Hannah Smith (ECU)

AAFP Delegates & Alternates AAFP Delegate

Michelle F. Jones, MD

AAFP Delegate

Karen L. Smith, MD

AAFP Alternate

Richard W. Lord, Jr., MD, MA

AAFP Alternate

Robert L. Rich, Jr., MD

Protect Our Staff, Our Families, Ourselves We will practice careful protective measures to prevent viral spread for our patients, our staff, our families, and ourselves. It is evident that health care workers are very severely impacted by this pandemic, and we See ‘COVID’ on Back Cover

Spring 2020

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

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CHAPTER AFFAIRS

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

~ ACADEMY IN ACTION ~

A Brave New World By the time you are reading my quarterly column, it’s unclear what healthcare will look like in our state and country. I write this in early April as we prepare for a surge in COVID-19 cases in North Carolina. Yet, this magazine won’t hit your mail boxes until May. I am not sure anyone can predict what the next two months will look like, but one thing is clear: we are in unprecedented times.

So first, let me thank you for what you are doing. Family physicians are truly the frontlines of healthcare. And honestly, right now you are doing your job with one hand, maybe even two, tied behind your backs. You don’t have the Personal Protective Equipment you need. You are facing incredible financial strain as visits drop. And you are quickly switching to a world that is – at least temporarily -- built upon virtual visits to keep your healthy patients healthy and access your sick patients without further spreading disease, COVID-19 or otherwise.

It truly is a brave (and sometimes scary) new world.

Although honestly, I never feel like we can do enough to help someone as deserving as you, the state’s family physicians, our heroes of healthcare. But we are trying. Just to highlight a few things we have done: First, we have tried to step up our communications. In fact, you may be tired of hearing from me and the rest of the NCAFP team. Prior to this crisis, we did our e-newsletter, NCAFPNotes, every other week. During this pandemic, we are sending out two or three e-newsletters a week, as information changes. We try to get you the most up-todate information in as concise of a format as possible, and make sure we focus on the information that is most important to family physicians. There’s so much information out

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there, we try to distill it to fit your needs.

Also relevant to communications, while we had already planned to launch a new and improved website, we expedited the launch amid this pandemic. It has allowed us to put information in one place for you much quicker than we have in the past. And I hope you are using our COVID page at www.ncafp.com as your home for up-to-date information during this crisis.

Even though Personal Protective Equipment (PPE) is scarce throughout the nation, we have taken every opportunity to ask anyone we can to get PPE out to family physicians on the frontlines of care in North Carolina. Every call we have had with the state Department of Health and Human Services and with the State Office of Emergency Management, we have talked about your frontline needs.

And, trust me, that has been many, many calls. We’ve advocated with other payers to help get you PPE. We’ve looked for alternative means for PPE. As I write this, I can say we’ve not had great success, but we are still trying and hopefully relief will come soon.

Beyond NC DHHS, we have worked with NC AHEC and CCNC to bring you up-to-date information from the perspective of Medicaid, Public Health and others. Thanks to those organizations for scheduling weekly webinars to provide updates and counsel during this unprecedented time.

We are working to address your financial needs. As AAFP advocated with CMS and federal officials, we’ve advocated for financial relief at the state level, asking payers to step up and support primary care more than they ever have.

We’re asking the state to step up both through Medicaid and through the General Assembly, to fill gaps not yet addressed by federal legislation. And state officials listened and doubled the PMPM for serving as a medical home for Medicaid beneficiaries.

We sought your feedback and are acting on it. Over twenty percent of our “Active” membership category responded to a survey on the early impacts of COVID-19 that we jointly conducted with the NC Pediatric Society. As I write this, your NCAFP Executive Committee has met to examine the results and provide direction on a few strategies to meet your needs.

And finally, your Academy staff made a quick pivot to move our Spring Symposium from a live meeting in Char-

The North Carolina Family Physician

lotte to a virtual event totally based online. And we cut the price of the CME in half to make it as affordable as possible for you at a time when everyone’s finances are taking a hit. Your staff and our technology partners spent endless hours making sure this happened smoothly, and those efforts don’t come without a cost. And you stepped up, too. We had record registration for this symposium, with over 70 individuals registering after it became a virtual meeting. We are taking what we learned and hope to deliver education to you in new and different ways going forward.

NEW WEBSITE!!!

While I don’t know what the next few months will hold, I do know a few things, and I believe there are some positives to gain from this experience: Crisis brings out the best in good people, and it’s bringing out the best in our family physicians, developing innovative strategies to care for your patients.

I have always believed that Family Medicine should own telehealth, and I’ve seen that happen in recent weeks.

We shouldn’t let others see your patients virtually. We need you to maintain that continuity. You know your patients the best, and thus can provide the best virtual care.

Payers have at least temporarily stepped up and brought parity into telemedicine. We need to advocate for that on a permanent basis. And we need to ensure our members own the telemedicine space to care for your own patients, not allowing others to fragment care.

www.ncafp.com

I believe that our country is finally seeing what the lack of investment in primary care and public health bring.

We have reaped what we have sown. Our lack of investment in public health and primary care left us flat footed when this pandemic arose. Unfortunately, it’s likely not the last pandemic we will see, and I believe our country’s policy leaders are standing up and taking notice that our healthcare system must change. But it is incumbent upon all of us to take advantage of this opportunity and lead the charge to make that change. And I know you’ll join me and the entire NCAFP team in the fight for positive change.

Crisis breeds opportunity. Now is the time to put Family Medicine at the forefront of healthcare. We are here fighting to do just that. Let me know what you think.

Keep in touch. But most importantly stay healthy so you can take care of your patients and communities. Thank you for what you do every day, but especially for what you are doing in this time of crisis.

A Family Medicine Community Podcast ~ Hosted by NCAFP ~ www.ncafp.com/ncfmtoday

Spring 2020

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MEMBERSHIP

By Peter Graber NCAFP Communications

Family Physicians Fight COVID on the Frontlines Family physicians across North Carolina are mobilizing like never before in the battle to flatten the COVID-19 curve. Below is a sampling of efforts being made by several NCAFP members. Family physicians across the state have also continued to make key contributions within their communities, raising awareness of the importance of primary care and Family Medicine’s frontline role.

UNC’s Amir Barzin, MD – Dr. Barzin is at the helm of the UNC’s Respiratory Diagnostic Center and leads a team that are seeing from 70 to 150 people a day coming in for drive-through COVID-19 testing at the Ambulatory Care Center site in Chapel Hill.

Duke’s Clayton Cooper, MD - As rising chief resident, Dr. Cooper helped to set up Duke’s first drive through COVID-19 testing site at Duke Family Medicine and also continues to support Duke’s COVID-19 drive through testing efforts. Cooper has also been working with his residency program and clinic leadership to modify resident schedules to deploy residents where needed within the health system.

Asheville’s Jason Cook, MD - Dr. Cook’s medical device startup, Relaspen, has used its prototyping engineers and facilities to design and manufacture face shields that were then donated to local primary care groups and hospitals. The company was also See ‘Frontlines’ on Back Cover

The Silver Lining in the New Type of ‘House Call’

By Genevieve Brauning, MD

For the past three weeks, I have been mostly connecting with my patients through video visits. And I can now say that I am starting to appreciate an unexpected silver lining.

able family members in their homes to help. And in spite of so many hurdles, patients keep figuring it out.

During the past six years at my practice, I, like most family medicine doctors, have developed countless strong relationships with patients solely through face-to-face office visits. Until recently, I couldn’t envision truly knowing my patients without that in-person contact.

For me, and patients alike, it feels like a little miracle every time these visits actually connect, and we can finally see and hear each other. We mutually struggle with microphones, video cameras and bad lighting until suddenly we are connected in our own virtual face-to-face visit. At that connection moment, we typically find ourselves relieved and smiling and ready to get to business.

COVID-19 has changed that. Video visits have opened the door to a whole new level of getting to know someone.

Don’t get me wrong, the rapid transition to video visits has been riddled with challenges. I am not a millennial and am not particularly adept at the technology required to make each video visit function. Just setting them up has opened my eyes to the challenges some of my patients face. No smartphone. No home computer or tablet. No knowledge8

And through those visits, I have come to see a whole new side of people I thought I knew so well. I see a child or a spouse I have never met waving in the background and the patient saying, “Say hi to my doctor!” I see a pet jumping See Silver Lining on Back Cover

The North Carolina Family Physician

2019 ANNUAL REPORT

The State of the Academy When I started the year, I thought the task of leading the NCAFP would be overwhelming, but I was prepared to pick up the fighting gloves I brought out during my inaugural address and fight for Family Medicine!

2019 began with the realization that the NCAFP is amazing! Its focus on Family Medicine and promoting YOU in the process is truly remarkable.

Being the largest medical specialty-specific organization in our state, and through hard work over the years and the many relationship that have been built, it is also one of the most respected associations in North Carolina.

2019 was packed full of events.

The year kicked off with BCBS of NC investing $750,000 in medical student programs over the next three years. Its aim is to tackle the state’s shortage of primary care physicians. Funds will go to offer medical students enhanced shadowing and mentoring experiences, health and policy leadership development, educational sessions, and scholarly activities.

Our Academy’s Workforce Pipeline committee started, ‘The Road to Family Medicine Toolkit’ for outreach to various age/educational levels to increase interest and expose early learners to careers in Family Medicine. That committee was also able to provide input to the NC Office of Rural Health on J-1 Visa Waivers, and its loan repayment and incentive programs.

A key win for our Payer and System Advocacy efforts, was the increase in the Medicaid rate for E&M codes for primary care. That increase brought Medicaid payments up to Medicare parity for 2018 rates. Most primary care physicians saw a 25% increase in payments and the increases were retroactive to Jan 1, 2019.

NCAFP leaders also engaged with key payors, like WellCare, BCBS of NC, and United HealthCare. We held strategic conversations with major health systems like Novant, Cone, and Atrium that focused on scope of practice and reduction in administrative burden. To assist in our efforts, our Academy also developed a one-pager on the value of Family Medicine and used it with a number of health systems.

NCAFP’s Continuing Medical Education across the state was enhanced beyond our Spring Symposium and Winter Annual Meeting. Successful regional meetings began this year and we witnessed outstanding participation at our Winston-Salem, Wilmington and Raleigh events, with 65% of the participants being members who have not been to a major CME program the prior year.

Additionally, the NCAFP placed over 30 educational programs in other state chapters across the country by the close of 2019 through educational grants.

As you can see, 2019 was packed with exciting goals, challenges, and achievements. I hope you can find a place to make a difference and do something to fight for Family Medicine locally, regionally, statewide, or nationally.

Together, WE ARE FAMILY MEDICINE!

Alisa C. Nance, MD, RPh 2018-2019 NCAFP President

Dr. Nance attended the University of North Carolina - Chapel Hill, graduating in 1992 with a BS degree in Pharmacy. She attended Wake Forest University Medical School and graduated in 1996. She completed her residency training in 1999 at Memorial Hermann Southwest in Houston, TX, as Chief Resident. She worked with Piedmont Healthcare multi-specialty group in Mooresville, NC, from 19992018 and served on their Board of Directors for ten years. She was the Medical Director for Piedmont Healthcare and for Piedmont Community Health Collaborative, ACO, in 2016-2017. Dr. Nance opened her own practice, Nance Family Medicine, in 2005 and completed her Diplomat designation with the National Lipid Association in 2008.

She is now consulting and speaking on lipids and diabetes nationally. She lives in the hometown where she grew up, giving back to her community. She is married to her husband, Tom, and has two sons.

2018-2019 NCAFP Leadership Executive Officers President

Alisa C. Nance, MD, RPh

President-Elect

David R. Rinehart, MD

Secretary/Treasurer

Jessica L. Triche, MD

Board Chair

Tamieka M.L. Howell, MD

Past President (w/voting privileges)

Charles W. Rhodes, MD

Executive Vice President At Large Directors

Gregory K. Griggs, MPA, CAE

Talia M. Aron, MD Elizabeth B. Baltaro, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios P. Hondros, MD

FM Residency Directors

Brian McCollough, MD Jennifer Mullendore, MD Mackenzie Smith, MD Slade A. Suchecki, DO Ying Vang, MD

Mark L. Higdon, MD (Novant)

Resident Director

David S. Baker, MD (MAHEC-A)

Resident Director-Elect

Elizabeth Ferruzzi, MD (Novant) Cameron G. Smith (Campbell)

Student Director

Katelyn Turlington (WFSOM)

Student Director-Elect Medical School Representatives Chair

Chelley Kaye Alexander, MD (ECU)

Representative

Nicholas Pennings, DO (Campbell)

Representative

Anthony J. Viera, MD, MPH (Duke)

Representative

Margaret Helton, MD (UNC)

Representative

Richard W. Lord, Jr., MD, MA (Wake)

AAFP Delegates & Alternates AAFP Delegate

Michelle F. Jones, MD

AAFP Delegate

Karen L. Smith, MD

AAFP Alternate

Richard W. Lord, Jr., MD, MA

AAFP Alternate

Robert L. Rich, Jr., MD

National & International Family Medicine Leadership Viviana Martinez-Bianchi, MD Executive Committee WONCA - The World Organization of Family Doctors Erin Clark, (Campbell University) National FMIG Coordinator First osteopathic student to ever serve in this role.

Shannon Dowler, MD Member, AAFP Commission on Health of the Public and Science Thomas R. White, MD Member, AAFP Commission on Quality and Practice Christina Kelly, MD Member, Commission on Education Nichole Johnson, MD Elected Co-Convener of the LGBT Constituency for the AAFP’s National Conference of Constituency Leaders and an Alternate Special Constituency Delegate to the AAFP Congress of Delegates Victoria Boggiano, MD (UNC) Elected Alternate Resident Delegate to the AAFP Congress of Delegates at National Conference

Strategic Accomplishments Payer and System Advocacy •

Primary Care Medicaid rates raised to parity with 2018 Medicare rates – a 25% increase on average for primary care Evaluation & Management codes.

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Ongoing work with Margolis Center for Health Policy at Duke University – bringing payers and key stakeholders together to look at value-based payment models, metrics that matter, etc.

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Held strategic meetings with leaders of several health systems about the importance of Family Medicine in healthcare, including leadership of Cone, Novant, and Atrium health systems.

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Developed value-based payment model video in conjunction with Humana.

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Developed a series of one pagers on Family Medicine for use in advocacy efforts on behalf of the specialty.

Member Satisfaction and Practice Environment •

Significant education on new practice models, efficiency in practice, etc.

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Regional CME programs in Winston-Salem, Wilmington, and Raleigh, plus our Spring Symposium in Charlotte and Annual Meeting in Asheville. 65% of the attendees at regional events had not attended our Annual Meeting or Summer Meeting in recent years.

Workforce Pipeline •

Developed toolkit to provide presentations about healthcare/Family Medicine to various school-age children.

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Presented a Community Preceptor workshop held at Annual Meeting.

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Continued successful medical student interest programs.

25%

MEDICAID PAYMENT INCREASE ON E&M CODES

Continuing Medical Education Chapter Conferences & Events 2019 Spring Symposium Nichole L. Johnson, MD – Program Chair

• •

51+ AAFP CREDITS PRESENTED

8.00 AAFP Prescribed Credits 110 CME Attendees

2019 Street Drugs: Do’s & Don’ts | A CME Dinner Opportunity

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1.50 AAFP Prescribed Credits 50 CME Attendees

30 Minute Hot Topics | A CME Dinner Opportunity

• •

1,064

MEETING ATTENDEES

1.50 AAFP Prescribed Credits 26 CME Attendees

Essential Elements of Managing Common Chronic Diseases in Family Medicine Nicholas Pennings, DO – Program Chair

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4.00 AAFP Prescribed Credits 74 CME Attendees

2019 Winter Family Physicians Weekend Nichole Johnson MD – Program Chair Victoria Kaprielian MD – Program Vice-Chair

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CHAPTER PARTNERS

36.25 AAFP Prescribed Credits 804 CME Attendees

Collaborative Education • Worked with 19 AAFP chapters to present sessions on diabetes, HCV, Alzheimer’s, depression, influenza, HBV, and HIV. • Total Grant Funds of $1,941,606.80

12,139 LEARNERS REACHED

Membership & Member Services • • • •

Chapter Membership Profile

Top market share for an Extra Large Chapter – 88.1% Second Highest Active Member Retention Rate for an Extra Large Chapter – 95.9% Second Highest New Physician Retention Rate for an Extra Large Chapter – 92.3% Second Highest Resident to Active Member Conversion Rate for an Extra Large Chapter – 85.1%

NCAFP’s overall membership increased 2% from 2018. Since 2007, NCAFP Active membership has increased more than 28%.

Active..................................... 2,524 Student................................... 1,024 Life.............................................352 Resident....................................340 Inactive........................................28 Supporting...................................10 Transitional.................................... 5 TOTAL..................................4,283

Chapter Awards & Recognitions Aregai Girmay, MD Gaston, North Carolina

2019 North Carolina Family Physician of the Year Courage in the face of extreme personal challenges is the hallmark of North Carolina’s 2019 Family Physician of the Year, Gaston’s Dr. Aregai Girmay. In his journey to Family Medicine, Dr. Girmay overcame tremendous personal obstacles that included fleeing his home country of Ethiopia at 19, spending three years as a refugee before emigrating to the US. Dually-trained in Family Medicine and Obstetrics, Dr. Girmay is a leading women’s health advocate and a role model physician exemplifying personal health and wellness, and a deep committment to advancing his community.

AAFP Recognitions

• • •

Dr. Rivers Woodward, Resident at MAHEC - 2019 AAFP Excellence in GME Award Winner Dr. Brad Thompson, Resident at Cone - 2019-20 AAFP Foundation Emerging Leaders Institute Scholar Dr. Rana Alkhadi, Resident UNC - 2019-20 AAFP Foundation Emerging Leaders Institute Scholar

The NCAFP Foundation promotes the specialty of Family Medicine to medical students in North Carolina. In 2019, student experiences included early clinical exposure to rural Family Medicine, mentoring experiences, travel stipends to attend state and national conferences, a research poster contest, and support to Family Medicine Interest Groups for on-campus activities. Students can develop leadership skills by serving on one of the NCAFP’s two Boards or three committees, or they can participate in a policy and leadership rotation with the NCAFP. The NCAFP Foundation’s financial investment is also made evident through the Foundation’s Family Medicine Scholarship program.

Through these initiatives the NCAFP was able to reach hundreds of students in North Carolina in 2019.

2018-19 LEADERSHIP President Vice-President Secretary-Treasurer Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Academy President Academy President-Elect Corporate Trustee Corporate Trustee Corporate Trustee Resident Trustee Resident Trustee Student Trustee Student Trustee Trustee Emeritus

Shannon B. Dowler, MD, FAAFP William A. Dennis, MD Eugenie M. Komives, MD, FAAFP Lisa A. Cassidy-Vu, MD Christopher P. Danford, MD Cherrie C. Hart, MD R. Aaron Lambert, MD, FAAFP David E. Lee, MD Amy E. Marietta, MD, MPH Holly L. Stegall, MD Alisa C. Nance, MD, RPh, FAAFP David A. Rinehart, MD, FAAFP Rhett L. Brown, MD, FAAFP - Novant Health Steve Parker - Curi John R. Smith Jr., MD - BCBSNC N. Lucy Muhira, MD Kathryn S. Timberlake, MD Katherine H. Mulligan Hannah C. Smith Maureen E. Murphy, MD, FAAFP

2019 BY THE NUMBERS •

$1,365,284 balance of the Medical Student Endowment, effective 12/31/19.

• >$100,000 in direct financial support provided for student and resident programs.

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$19,075 NCAFP Foundation Raffle Fundraiser.

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$32,185 raised thru other individual and corporate contributions to the Foundation and Medical Student Endowment.

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1,024 medical student members at the end of 2019 (compared to 979 year-end 2018).

CORPORATE DONORS Blue Cross and Blue Shield of North Carolina Curi (formerly Medical Mutual) NC Area Health Education Centers Program

2019 Foundation Contributors NCAFP members and supporters of the Academy are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation.

The following individuals contributed to the Foundation in 2019.

Thank you for your continued support.

INDIVIDUAL DONORS Col / Dr. Robert Adams Dr. Chelley Alexander Dr. Susan Alexander Dr. James Allison Avance Care Dr. David Baker Dr. Ann Barham Dr. Perry Bartelt Dr. Mary Bengtson Dr. Holly Biola Mr. Brian Blank Dr. Karolen Bowman Dr. Rhett Brown Dr. Donna Capps Dr. Jewell Carr Dr. Lisa Cassidy-Vu Dr. Bianca Chun Dr. Wendy Coin Dr. Clayton Cooper Dr. John Corder Dr. Tiffany Covas Dr. Mark Crissman Dr. Sal D’Allura Dr. Wiley Davis Dr. William Dennis Dr. Andrea DeSantis Dr. Deanna Didiano Dr. Benjamin Dieter Dr. Allen Dobson Dr. Shannon Dowler Dr. Erin Ennis Dr. Kelly Erola Dr. Fernando Escabi-Mendez Dr. Folake Falaki Dr. Elizabeth Ferruzzi Dr. Conrad Flick Dr. Vickie Fowler Dr. Joanne Fruth Dr. Deepak Gelot Dr. Donald Goodman Mr. Gregory Griggs Dr. Shauna Guthrie Dr. David Hall Dr. Mary Hall Dr. Luredean Hamilton Brandon Dr. Maggie Hansell Dr. Revella Harmon Dr. Cherrie Hart Ms. Tracie Hazelett

Dr. Douglas Henley Dr. Mark Hester Dr. Melissa Hicks Dr. Mark Higdon Dr. Jonathan Hinson Dr. Brittany Hipkins Dr. Jeff Hoffman Dr. Dimitrios Hondros Dr. Troy Horan Dr. Tamieka Howell Dr. Nichole Johnson Dr. Jason Jones Dr. Victoria Kaprielian Mr. Jim Kay Dr. Michelle Keating Mr. Vincent Keenan Dr. Eugenie Komives Dr. Krista Kozacki Dr. Alyssa Krueger Dr. Sarita Lavani Dr. David Lee Dr. Katherine Lee Dr. Richard Lord Dr. Shelly Lowery Mr. Jonathan Luis Dr. John Mangum Dr. Amy Marietta Dr. Jenny Mathews Dr. Alfred May Dr. William McLean Dr. Michael McLeod Dr. James McNabb Dr. Stephen McNeill Dr. Darlyne Menscer Dr. Paul Meyer Dr. Jennifer Mullendore Ms. Katherine Mulligan Dr. Maureen Murphy Dr. Jacque Murray Dr. Alisa Nance Dr. Tommy Newton Dr. Steve North Dr. Steve Parker Dr. Pulak Patel Dr. Ryan Paulus Dr. Myron J Petruska Dr. Payton Rankin Dr. Demetria Rawlinson Dr. Charles Rhodes

Dr. Kathleen Rice Dr. Robert Rich Dr. Dave Richard Dr. David Rinehart Dr. Andres Rodriguez Dr. Carson Rounds Dr. John Rowe Dr. Melanie Sanders Dr. Charles Sawyer Dr. Karen Scherr Dr. Jennifer Schmidt Dr. Curtis Schultz Dr. Robert Scott Dr. Allen Shepard Dr. Jim Shepherd Dr. Jordan Shirley Dr. Benjamin Simmons Dr. Nadine Skinner Mr. Cameron Smith Ms. Hannah Smith Dr. Karen Smith Ms. Sandra Smith Dr. Neil Sparks Dr. Barbara Stagg Dr. Jessica Staton Dr. Holly Stegall Dr. Slade Suchecki Dr. Julian Taylor Dr. Heath Thornton Dr. Kate Timberlake Dr. Robert Toborg Dr. Keith Van Zandt Dr. Ying Vang Dr. Eugene Wade Dr. Thomas Ward Dr. Chip Watkins Dr. Jana Watts Dr. Beverly Wedda Dr. Adam Wenzlik Dr. Thomas White Dr. Gustav Wilde Dr. Daniel Wilkins Dr. Nicholas Wilkinson Dr. Meredith Williamson Dr. Melinda Wonsick Dr. Kazumi Yoshinaga Dr. Christopher Zagar

Three Servings of Milk Deliver A Unique Nutrient Package The Dietary Guidelines for Americans recommends three servings of dairy products each day.*

Milk’s essential nutrients can be difficult to replace in a healthy dietary pattern.

Three 8-ounce cups provide as much of each nutrient as: PROTEIN 50% DV 4 large (50 g) hardboiled eggs

PANTOTHENIC ACID (B5) 50% DV approx. 5 cups of chopped broccoli

VITAMIN A 45% DV

CALCIUM 70% DV

approx. 3 cups of sliced red peppers

approx. 17 cups of raw kale

PHOSPHORUS 60% DV

VITAMIN D 45% DV

approx. 3 cups of cooked red kidney beans

VITAMIN B12 140% DV approx. 1 lb of pork chops

6.5 oz of sardines (approx. 15 sardines)

NIACIN (B3) 35% DV approx. six large white mushrooms

RIBOFLAVIN (B2) 100% DV 0.8 cups of whole almonds *The 2015-2020 Dietary Guidelines for Americans recommends three servings of low-fat or fat-free dairy foods (milk, cheese, yogurt) for Americans 9 years and older.

Source: U.S. Department of Agriculture Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference Legacy Release, April 2018.

Calculations based on low-fat milk (USDA database #01082). Some milk may be a good source of selenium and/ or zinc. Other foods used: large egg (50 g), whole, cooked, hardboiled (#01129); kale, raw (#11233); beans, kidney, California red, mature seeds, cooked, boiled without salt (#16031); pork, fresh, loin, sirloin (chops), bone-in, separable, lean only, cooked, broiled (#10058); nuts, almonds, whole (#12061); peppers, sweet, red, raw, sliced (#11821) broccoli, raw, chopped (#11090); fish, sardine, Atlantic, canned in oil, drained solids with bone (#15088), mushrooms, large, white, raw (#11260). ©2018 National Dairy Council®

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP Manager, NCAFP Meetings & Events

~ UPCOMING EVENTS ~

Planning Underway for Two Fantastic CME Opportunities While we are all currently working hard and being mindful in our actions to help flatten the COVID-19 curve, the NCAFP CME Team still has our sights set on two fantastic live CME events scheduled for later this year. As the dates approach, we will keep you well informed on the in-person and virtual webcast plans for these programs. For now, take a look at what we have in the works and make your plans soon to join us this August and December for fantastic CME, networking, and fun.

Sports Medicine for the Active Patient Saturday, August 8, 2020 in Greensboro

By continuing our promise to provide relevant, timely topics that you’ve requested, we are delighted to host “Sports Medicine for the Active Patient” on Saturday, August 8, from 7:30 am to 12:15 pm in Greensboro.

We’ve tapped Dr. Karl “Bert” Fields to spearhead this lively program complete with eight 30-minute lectures and two question & answer panel sessions. Planned lecture topics include active adults with hypertension, active adults with osteoarthritis, new guidelines for concussions, pediatric sports injuries, common shoulder problems, common hand injuries, tennis and golfer’s elbow, and common running injuries. This unique half-day Saturday CME and networking opportunity will be held at the Greensboro High Point

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Marriott Airport Hotel and will include an estimated 4.00 CME credits. Additional guest speakers include Dr. Kevin Burroughs, Dr. Ryan Draper, Dr. Sara Neal, and Dr. Dominic McKinley. The NCAFP is excited to offer this fantastic CME opportunity via an In-Person Attendee option ($100 for Members) and a Virtual Webcast option ($50 for Members). Current NCAFP Board Members are reminded of the August Board Meeting also scheduled this same day from 12:30 pm to 2:00 pm immediately following the CME program.

Online registration and additional conference information can be found at www.ncafp.com/sportsmedicine.

Winter Family Physicians Weekend December 3rd - 6th, 2020 in Asheville

Planning for the annual Winter Family Physicians Weekend, scheduled for Thursday, December 3 – Sunday, December 6 at The Omni Grove Park Inn, is also

The North Carolina Family Physician

in full swing these days. Program chair Dr. Victoria Kaprielian and program vice-chair, Dr. Jay Patel, have prepared a full slate of timely topics that we are confident you’ll find helpful and informative for you and your patients. This year’s top-notch lecture topics include reproductive health, osteoarthritis and chronic low back pain, kidney disease, depression, chronic heart failure, HCV treatment, HPV related cancers, CGM and primary care, radon and lung cancer, well child-care, and many more. This always popular weekend in the Blue Ridge Mountains will include an estimated 25+ CME credits, various unique CME workshops and seminars, along with several optional informative product theaters. Save the dates now and watch your emails for additional information. In the meantime, please visit the conference site at www.ncafp.com/wfpw for the latest schedule updates and general information.

While these days are certainly like none we’ve ever experienced before, we remain positive, and we are incredibly thankful. Positive that the days will get better and grateful for people like you working tirelessly on the frontlines. We continue to look forward to supporting you with fantastic CME via interactive learning sessions (live and/or virtual), first-rate faculty, and timely requested topics. On behalf of the NCAFP, thank you for what you continue to do every day within your communities. Please continue to be safe and stay healthy. We appreciate you, and we cannot wait to see you again.

Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events via katkinson@ncafp.com or 919-214-9058 with any questions about this year’s programs.

Spring 2020

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NCAFP Delivers Spring Symposium Virtually Over 200 attendees enjoy high quality CME

By Brent Hazelett, MPA, CAE NCAFP Vice President & COO

It is often said that crisis breeds opportunity. When it became apparent that the April NCAFP Spring Symposium would not be possible in person, the NCAFP was faced with a decision to either cancel the event or provide the education virtually. The NCAFP Meetings Department, along with our partner audio visual team, EZAV, and Program Chair Dr. Takie Hondros, determined that it was very feasible to maintain the existing lineup of high-quality education in a virtual platform, allowing our members and attendees to receive up to eight hours of education from the comfort of their homes. With less than three weeks to prepare for this transition, the team worked tirelessly to ensure the event would be a success, delivering the high-quality CME that our members have come to expect from us.

Thankfully, based on the feedback of those that attended, we were able to succeed.

Much to our delight, over 200 attendees logged-in throughout most of the eight-hour event, participating in high quality topics such as insomnia, diabetes, HIV prevention, vaping, hyperkalemia, migraine, health equity and more. It turns out that having great speakers on timely topics is really beneficial, even when given over the internet. And people happily sent us pictures throughout the day of them learning from the comforts of home, which we loved seeing.

people are much more likely to ask a quick question during the presentation while they are thinking about it rather than after a live lecture. This was a pleasant surprise both for us, and the presenters. And it turns out that online learning isn’t necessarily for “younger” people. Over 60% of our attendees were over 50 years old – that’s awesome!

While we definitely encountered some challenges along the way, we learned and adapted on the fly.

In the end, I think everyone was pleased with the NCAFP’s first foray into virtual learning. We thoroughly enjoyed the positive kudos we received, as well as suggestions about how to improve, and we also enjoyed the fact that we reached people we might not necessarily ever see at our live events.

In fact, 13% of the attendees at the virtual event indicated they had never attended an NCAFP CME meeting pre-

Another thing we learned about virtual learning is that the question and answer part of the presentation is really good online. The presenter can answer a lot of questions in a relatively short period of time, and

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The North Carolina Family Physician

viously. We also had one participant indicate that while this was their first virtual CME, they never wanted to attend a live event again because they loved the virtual format and ease so much. While we hope there will always be people that crave live interaction and enjoy our live events, we are also more than happy to provide another way for our members to learn and earn credits, while saving money on travel costs and avoiding time away from their practice and their families.

As the NCAFP evaluates how to provide education in a fast-changing world, we already view virtual learning as another feather in the NCAFP cap and we thank all of you who joined us on this first adventure. We look forward to seeing you at our next event, whether in person or not. Thank you for all you do for the citizens of NC, and for all your support of the NCAFP.

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Contact Peter Graber with the NCAFP at pgraber@ncafp.com 21

disease burden, unemployment and untreated mental health.

RESIDENTS & NEW PHYSICIANS

Older Children in Foster Care — An Opportunity for Family Medicine

By A. Bradley Thompson, MD, MS PGY-2 Cone Health Family Medicine Residency Program

Did you know that foster children have an opportunity for insurance coverage beyond the age of 18?

Many children in the North Carolina foster care (FC) system face neglect or abuse that negatively impacts both their physical and mental health. For these patients, their primary care provider, usually a pediatrician or family physician, is first in line to handle the litany of health problems that often accompanies youth in foster care.

Fortunately, Medicaid covers medical expenses for foster youth until age 18, at which point participants may enroll in expanded coverage available to age 26.

Poor mechanisms exist to ensure robust re-enrollment into Medicaid when foster youth reach 18, and no standardized model exists to help the transfer of medical care from a pediatrician to an adult primary care medical home (PCMH). As a result, many former foster youths (FFYs) are lost to the healthcare system as they enter adulthood. Youth who have been in foster care experience higher rates of homelessness, chronic

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As family physicians, it positions us to assist this vulnerable patient population at this critical junction in their lives. Since we see patients from “womb to tomb,” our broad scope of practice gives us unparalleled exposure and experience to aid patients through this point of transition in their lives as they pass from adolescents to adulthood.

As part of a project sponsored by the American Academy of Family Physicians Foundation’s Family Medicine Leads/Emerging Leaders Institute, we developed a system that prepares Guilford County transitioned-aged foster youth (16-17 years old) for the next step in their medical lives as they transfer care from their pediatrician to an adult PCMH. As a secondary goal, we are offering them the choice to set up care at the Cone Family Medicine Center Residency Clinic.

In 2019, Dr. Thompson was selected by the AAFP Foundation to participate in the Emerging Leaders Institute.

His experiences with fostercare led to his project for that year-long program and he was scheduled to present his work at the STFM Annual Spring Conference, now re-scheduled for August. Dr. Thompson hails from North Carolina and has been educated in three of the state’s universities along the way. He completed his undergraduate degree at NC State, his master’s degree at Wake Forest and completed his medical school education at the University of North Carolina School of Medicine. He is currently a second-year resident at Cone Health Family Medicine Residency Program in Greensboro.

Using materials from Got Transitions, we developed a transition of care model that assesses a client’s “transition readiness” and then provides educational materials for areas of weakness. Referrals are placed to social workers who offer a link to social services and to a Medicaid-eligibility specialist to make sure re-enrollment into Medicaid occurs.

During this project, I conducted a gap analysis reviewing published literature and attending multiple meetings with the AAFP, NCAFP, American Academy of Pediatrics, Fostering Health NC (a branch of the NC Pediatric Society), SAYSO (a foster youth advocacy group), and Youth Villages (a non-profit dedicated to helping foster youth and former foster youth). Several barriers were identified including Medicaid re-enrollment policy issues, transience of the population, general mistrust from within the foster care community toward

The North Carolina Family Physician

NORTH CAROLINA’S

2020

Resident & Student Research Poster Presentation The NCAFP Foundation’s twenty-seventh annual Research Poster Presentation will be held at the Academy’s Winter Family Physicians Weekend this December 3-6, 2020.

the foster care system, trouble tracking and maintaining up-to-date medical records, HIPPA and privacy concerns, navigating the complex web of government regulations, and lack of understanding of the transition process by social workers and healthcare providers alike.

As a foster brother, my parents fostered several children. I understand the special healthcare needs that foster youth face. As a family physician, I recognize the exceptional opportunity to help find and transition this population into a permanent medical home and help make sure they receive the health coverage they have available through the age of 26.

I hope this article has given you a brief glimpse into the health challenges older foster youth face and how family physicians can aid in this process.

For questions about this model or transitioning children in foster care to an adult medical home, please e-mail the author at brad.thompson@conehealth.com

Spring 2020

The Foundation is interested in showcasing practice-based research, but poster presentations may address any topic relevant to Family Medicine.

Works-in-progress may also be submitted, but submissions must be of original work not yet published. Projects previously presented at medical schools’ or student “Research Days” are acceptable, as are concurrent submissions to other conferences such as NAPCRG and STFM.

Posters will be judged for awards with winners announced at the Annual Meeting in December. For complete details and link to submission form, please visit www.ncafp.com Please direct questions to Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2020.

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STUDENT INTEREST & INITIATIVES

Enthusiasm and Energy Abound at NC Family Medicine Day Annual residency recruitment event bursting with students This year’s Family Medicine Day – North Carolina’s Family Medicine residency recruitment conference co-sponsored by the NC AHEC Program and the NCAFP – attracted over 100 medical students when it was held in early March. The thirteenth-annual event showcased the state’s Family Medicine residency network and allowed medical students to interact with residents and faculty while they burnished their clinical skills and networked with other medical students.

The event’s keynote presentation was delivered by NCAFP Past President and current Medicaid Chief Medical Officer, Dr. Shannon Dowler,

Leadership Opportunities with the NCAFP and the AAFP May 31st, 2020 Application Deadline

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of Asheville. Dr. Dowler delivered an engaging talk titled, ‘Family Medicine: Choose Your Own Adventure,’ to a rapt ballroom comprised of medical students and residents from as far away as Georgia.

Attendees also heard comments by NCAFP President Dr. David Rinehart, and Residency Directors Constituency Chair, Dr. Mark Higdon.

The NCAFP would like to thank NCAHEC for their continued support to growing North Carolina’s FM workforce.

STATE LEVEL WITH THE NCAFP: Students and Residents interested in serving in a leadership role at the state level, can visit their student or resident page on the NCAFP website for more information, or contact Tracie Hazelett at the Academy’s office to inquire. Deadline to apply for all board and committee appointments for the 20202021 term is May 31st, 2020. For available positions and to meet the current student or resident leadership team, please visit www.ncafp.com.

NATIONAL LEVEL WITH THE AAFP: Although the AAFP deadlines are not until July, many national leadership options require support from the NCAFP; May 31st is the Chapter’s deadline for students and residents to submit their application for review by the NCAFP Nominating Committee for all elected positions and some appointed positions. Involvement at the Chapter level (this can be a former state if you are resident that attended medical school elsewhere) is required to be considered for a national position. Please note: there are a few appointed positions with a deadline of Aug. 5th.

Please refer to the NCAFP policy on AAFP Nominations at www.ncafp.com and the AAFP site for a complete list of available leadership positions: www.aafp.org/nc.

Please contact Tracie Hazelett at thazelett@ncafp.com for more information or if you have The North Carolina Family Physician questions on any of these opportunities.

2020 AAFP National Conference of Family Medicine Residents & Medical Students July 30 - August 1, 2020 in Kansas City At the time this magazine went to press, the AAFP is continuing plans for this summer’s annual event that brings thousands of students, residents and residency program faculty together. The deadline for students and residents to apply for the American Academy of Family Physicians Foundation’s Family Medicine Leads (FML) scholarships recently passed. However, if you are a medical student interested in Family Medicine, who missed that deadline or are not a recipient of an FML award, the NCAFP Foundation may be able to help offset your travel expenses to attend.

August 1st Deadline for NCAFP Foundation Family Medicine Scholarship Program The North Carolina Academy of Family Physicians Foundation has established a program to provide medical students considering careers as family physicians up to $5,000.00. Awardees will be selected based on sincere interest in the specialty of Family Medicine, leadership and community service characteristics, and some consideration given to financial need.

Medical students in their 3rd or 4th year of medical school effective 8/1/2020 are eligible to apply.

Notifications to scholarship recipients and disbursements will be made in the fall. For full details and application, visit: www.ncafp.com/students

jobs.ncafp.com

Deadline to apply for NCAFP Foundation funding is June 8, 2020, with notification of awards provided by June 15. Visit https:// www.ncafp.com/students/scholarshipsandfunding for more information and a link to the application.

As of publication time, the following message from the AAFP was posted on their website: Worry-free Registration We understand that in light of COVID-19 you may be hesitant to register for an in-person event, so we have updated our cancellation policy. You can cancel your National Conference registration at any time, for any reason up to the day before the meeting, and we will issue you a full refund of your registration fee.

Please note that this modified cancellation policy is subject to change, so book now to secure your worry-free registration.

For questions, contact Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

For complete conference details and most current information, please visit www.aafp.org/nc

Employers:

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PRACTICE MANAGEMENT

Is Now the Time to Renegotiate Your Lease Terms?

Cutting fixed costs can help the bottom line

most you could get for it? Exactly. You would sell it for the most you could. Your landlord will treat you the same way.

They will charge you the highest they can while giving you the least they can get away with.

#2: Determining Market Value By Asking What Your Neighbors Are Paying While reviewing the lease terms of a doctor who had been in a building for 20 years, we learned they were paying $30 per SF, and had not received any free rent or tenant improvement allowance in their last negotiation. When we posed the question: “Do you believe $30 per SF with no concessions is

Real estate is the second highest expense behind payroll for most healthcare practices. The benefits of capitalizing during lease negotiations can include a healthy raise through increased profitability, reduced debt, a nicer office and more.

While there are many key concepts and strategies you should always do prior to and during any lease or purchase negotiation, there are an equal or greater number of mistakes you should avoid. Here are three of the most common mistakes:

#1: Believing The Landlord Or Seller Will Simply Offer Their Best Terms Landlords and sellers are in business to make money. They are no more likely to voluntarily reduce lease rates or give up any extra money through concessions as you would be to voluntarily reduce your reimbursement from an insurance company or cut your patient fees if you didn’t have to.

While it sounds pleasant to hear a landlord talk about giving a ‘fair deal’ or ‘reasonable price’, your odds of getting either are bleak without truly understanding the market, entering the negotiation process with multiple other options and having the needed guidance to capitalize.

Trusting a landlord or seller without the help of professional representation will most likely result in the forfeiture of tens to hundreds of thousands of dollars that could have stayed in your checking account. Case and point: if you were about to sell your home and a fair price was $400,000… but your agent told you a buyer would pay $500,000… what would you list or sell it for? The “fair” price of $400,000… or the

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The North Carolina Family Physician

a good deal?”, their response was: “I believe so.” “Why,” we asked? Their response: “There are four other healthcare practices on this floor. We all know each other and talk about our leases. We are all paying $30 per SF and the landlord has told all of us they don’t give free rent or tenant improvement allowances.” Our response: “I understand the logic behind that approach… but what if I told you we just did a lease with a brand-new tenant on the first floor at $21 per SF ($1,800 per month in savings if it were your lease rate), while also obtaining 3 months of free rent and over $100,000 in tenant improvement allowance.”

The bottom line is the landlord got away with convincing five different practices the market was far higher than it re-

ally was, and they didn’t deserve any concessions. Imagine finding out that you have been overpaying by $1,800 per month for the last 5 to 10 years and forfeiting money that could have completely renovated your space? This scenario happens every day to uneducated tenants who consult with other uneducated tenants and compare terms that were the result of having no posture, no knowledge of the market and not applying leverage through representation.

#3: Not Knowing Market Availability and Comps The foundation of a successful negotiation starts with understanding what your other viable options are, how they compare to each other and how to execute on them. When dealing with landlords or sellers, many healthcare providers try to bluff their way into and through negotiations. A savvy landlord or seller can often read a bluff from a mile away.

Here is the problem with this approach: it communicates you are too busy; you don’t know who to hire and you don’t know what you could achieve. Trying to wing it in these scenarios will not work. This approach typically results in less respect from a landlord and the exact opposite results you were hoping for. Also, overly aggressive offers or unrealistic requests can compound the problem, as can emotional responses to the conflict inherent in most high-dollar negotiations. If you are going to be successful in your next negotiation, understanding market availability and comps is the first place to start. You can hire representation to do this for you, or you can invest dozens of hours yourself into the process.

These are just a sample of the more common mistakes you should seek to avoid when looking at your real estate decisions. Unfortunately, there are several more you need to avoid. Don’t be taken advantage of during your next purchase or lease negotiation. Hiring professional representation may help you level the playing field for you and your partners.

This article was contributed by CARR, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. For additional information, visit www.carr.us.

Spring 2020

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COVID from page 5

We will continue to work with public health officials as they provide evidence-based guidelines on how to manage our testing, treatment and overall management of our patients and staff. This is a time for the house of medicine, public health, insurance companies, government payers and society in general to work cooperatively to minimize the havoc that this pandemic is causing.

By the time this is published perhaps the worst of COVID-19 is behind us. My hope is that this pandemic will inspire tens of thousands of eager young people to want to solve future problems by becoming great new physicians and nurses.

They may aspire to become family physicians on the front lines, physician leaders, or public health experts. The health of our country will improve if many of them decide to become family physicians.

able to donate materials for face shields to the STEAM lab at UNC-Asheville, who were also making shields but had run out of certain materials.

educate patients on the power of telehealth, as well as rapidly modifying 100’s of policies and billing codes to allow for telehealth for physicians, behavioral health, PT/OT/ST, audiology, diabetes educators, lactation consultants, optometry, etc.

Medicaid’s Shannon Dowler, MD - NCAFP Past President Dr. Shannon Dowler, Chief Medical Officer for North Carolina Medicaid, is helping lead Medicaid’s COVID efforts, and is playing a key role in helping to

CCNC’s Thomas Wroth, MD – Dr. Wroth is helping spearhead Community Care of NC’s efforts around educating physicians on the financial assistance programs available to practices.

SILVER LINING from page 8

providing care to all patients. No one should hesitate to reach out for fear of wasting my time. I am grateful for every familiar face.

FRONTLINES from page 8

into an open lap, “Here’s Peanut. I was telling you I adopted a cat!” I see makeshift home offices, stockpiles of food, clean and dirty kitchens. I ask how they are faring during this “stay home” order and learn some of my elderly patients have no family in town to help with groceries or prescriptions. Or no one for working parents to rely on for child care while they juggle children and work from home.

The unique challenges of this pandemic are visible as I go virtually from house to house throughout my day.

Although I believe that moving forward there will forever be a role for video connection, a time will come when we will return to mostly in-person office visits. When that time comes, I’ll look back on this period and be grateful for what I have learned by meeting with people in their own homes. Anything that strengthens a relationship with a patient is a win for me as a family doc.

Non-Profit Org. US Postage

This article first appeared in the Raleigh News and Observer and the Charlotte Observer.

PAID

Dr. Genevieve Brauning is a family physician at Novant Health SouthPark Family Physicians in Charlotte.

Pontiac, Illinois Permit No. 592

I suspect my patients see the joy I get from connecting with them as well. We too, us doctors, are practicing social distancing and are struggling with the burdens of isolation. Some patients say, “I’m sorry to waste your time. I know you have very sick patients to help.” But thus far, the main role of a family physician continues to be

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Final Thoughts

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must do what we can to ensure our ability to stay healthy while also meeting the needs of our patients.