Family Physicians Fight COVID on the Frontlines

MEMBERSHIP

By Peter Graber NCAFP Communications

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.

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.

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

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.

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

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 1999- 2018 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 President-Elect Secretary/Treasurer Board Chair Past President (w/voting privileges) Executive Vice President Alisa C. Nance, MD, RPh

David R. Rinehart, MD

J essica L. Triche, MD Tamieka M.L. Howell, MD

Charles W. Rhodes, MD Gregory K. Griggs, MPA, CAE

At Large Directors

T alia M. Aron, MD Elizabeth B. Baltaro, MD Je well P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios P. Hondros, MD

Brian McCollough, MD Jennifer Mullendore, MD

Mack enzie Smith, MD Slade A. Suchecki, DO Ying Vang, MD

FM Residency Directors Resident Director Resident Director-Elect Student Director Student Director-Elect

Mark L. Higdon, MD (Novant) David S. Baker, MD (MAHEC-A) Elizabeth Ferruzzi, MD (Novant)

Camer on G. Smith (Campbell)

K atelyn Turlington (WFSOM)

Medical School Representatives

Chair Representative Representative Representative Representative

AAFP Delegates & Alternates

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate Ch elley Kaye Alexander, MD (ECU) N icholas Pennings, DO (Campbell) Anthony J. Viera, MD, MPH (Duke) M argaret Helton, MD (UNC) Richard W. Lord, Jr., MD, MA (Wake)

Michelle F. Jones, MD K aren L. Smith, MD Richard W. Lord, Jr., MD, MA 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 av erage for primary care Evaluation & Management codes.

Ongoing w ork 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.

Held str ategic meetings with leaders of several health systems about the importance of Family Medicine in healthcar e, including leadership of Cone, Novant, and Atrium health systems.

De veloped value-based payment model video in conjunction with Humana.

De veloped 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.

Regional CME programs in Winston-Salem, Wilmington, and Raleigh, plus our Spring Symposium in Charlotte and Annual Meeting in Ashe ville. 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.

Presented a Community Preceptor workshop held at Annual Meeting.

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 • 8.00 AAFP Prescribed Credits • 110 CME Attendees

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

• 1.50 AAFP Prescribed Credits • 50 CME Attendees

30 Minute Hot Topics | A CME Dinner Opportunity

• 1.50 AAFP Prescribed Credits • 26 CME Attendees

Essential Elements of Managing Common Chronic Diseases in Family Medicine

Nicholas Pennings, DO – Program Chair • 4.00 AAFP Prescribed Credits • 74 CME Attendees

2019 Winter Family Physicians Weekend

Nichole Johnson MD – Program Chair Victoria Kaprielian MD – Program Vice-Chair • 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

51 + AAFP CREDITS

PRESENTED

1,064 MEETING ATTENDEES

19 CHAPTER PARTNERS

12,139 LEARNERS REACHED

Membership & Member Services

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%

Chapter Membership Profile

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 Secr etary-Treasurer Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Ph ysician 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. K omives, MD, FAAFP

Lisa A. Cassidy- Vu, MD Christopher P . Danford, MD Cherrie C. Har t, MD R . Aaron Lambert, MD, FAAFP David E. Lee, MD Am y E. Marietta, MD, MPH Holly L . Stegall, MD Alisa C. Nance, MD , RPh, FAAFP

David A. Rinehar t, MD, FAAFP Rhett L . Brown, MD, FAAFP - Novant Health Ste ve Parker - Curi John R . Smith Jr., MD - BCBSNC N. Lucy Muhira, MD Kathryn S. Timberlake, MD Katherine H. Mulligan

Hannah C. Smith

Maur een 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.

$19,075 NCAFP Foundation Raffle Fundraiser.

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

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

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.

CORPORATE DONORS

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

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

CALCIUM

70% DV approx. 17 cups of raw kale

PHOSPHORUS

60% DV approx. 3 cups of cooked red kidney beans

VITAMIN B 12

140% DV

approx. 1 lb of pork chops

RIBOFLAVIN (B 2 )

100% DV

0.8 cups of whole almonds

PANTOTHENIC ACID (B 5 )

50% DV approx. 5 cups of chopped broccoli

VITAMIN A

45% DV

approx. 3 cups of sliced red peppers

VITAMIN D

45% DV

6.5 oz of sardines (approx. 15 sardines)

NIACIN (B 3 )

35% DV

approx. six large white mushrooms

*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®