We’re excited to share that the 2025 Winter Family Physicians Weekend is returning in a hybrid format on December 4-7, 2025! Whether you plan to join us in person at the beautiful Omni Grove Park Inn in Asheville or from your favorite corner of the living room couch, this year’s conference promises to keep you engaged, informed, and connected from start to finish.
Led by Program Chair Dr. Katie Haga and Program Vice Chair Dr. Amir Barzin, this year’s general session schedule is full of timely, rigorous, and relevant Family Medicine updates with practical tools you can begin using right away. You’ll hear from guest faculty experts on more than 20 essential clinical topics many of which you have requested!
Cardio, Metabolic & Renal Health
• Diabetes Management
• Lipid Management
• Obesity Care
• NAFLD/NASH
• Cardio-Renal-Metabolic Health
• CGM Advances
Infectious Diseases & Prevention
• HIV Care
• RSV Prevention
• UTI Management
Women’s Health
• Hypertension in Pregnancy
• Menopause
• Perinatal Substance Use
Pediatrics
• Pediatric GI Concerns
• Urgent & Emergent Pediatric Conditions
Gastroenterology & Pulmonology
• GERD
• Lung Cancer
Musculoskeletal Health
• Concussion
• Rheumatology
Mental & Behavioral Health
• Mood Disorders: Anxiety & Depression
• Adult ADHD
• Chronic Pain Management (Non-Opioid)
• Neuromuscular Disorders
Innovations & Emerging Topics
• Climate Change & Medicine
• Best FM Studies of 2025
Regulatory & Policy Discussions
• AAFP Update
• ABFM Update
• NCDHHS Update
Workshop & Seminars
• Hands-On Dermatology Workshop
• Care of Children Hybrid KSA
• Women’s Health Seminar
• Practice Management Seminar
• Personal Coaching Sessions
And Much, Much More!
Complete conference details, including the schedule of events, registration rates, and hotel information, are available now at www.ncafp.com/wfpw. Please contact Kathryn Atkinson, CMP, Director of CME & Events, at Katkinson@ncafp.com with any questions.
How I Prepared for a Potential Run for Office at the NC Institute of Public Leadership
PRESIDENT'S MESSAGE
4 The Three A's: Availability, Availability, and Availability
ADVOCACY
8 Your Legislative Update from the 2025-26 Long Session: A Tale of Two Budgets
CME OPPORTUNITIES
10 The 2025 Winter Family Physicians Weekend is Hybrid AND Packed with CME, Connection, and Celebration!
MEMBERSHIP SERVICES
22 Member Profile: Landon Irvin, MD
STUDENT INTEREST & INITIATIVES
26 “Moving and Motivating” - The 2025 Western NC Summer Immersion Program
RESIDENTS & NEW PHYSICIANS
28 I Studied Health Around the World to Practice Family Medicine in Robeson County
Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to kevin@ncafp.com.
PRESIDENT'S MESSAGE
By Mark McNeill, MD NCAFP 2024-2025 President
The Three A's
Availability, Availability, and Availability
My first job stateside out of residency was at a Family Medicine office in Clyde, NC named Midway Medical Center. There, I would be taking over the practice of Dr. Ned Lesesne, who was finishing a distinguished career of 30 years as a full-spectrum family physician in rural Haywood County. Those responsibilities were big shoes to fill for a new doc one year out of residency.
During our transition time during Dr. Lesesne's last few weeks, we started a discussion on how you build and sustain a successful practice. I shared with him what I had been taught in residency, which were “The 3 A’s” — availability, affability, and ability. I thought I just needed to be available to my patients, be nice, and show some competency, and then I would have a successful practice. Dr. Lesesne smiled, shook his head, and said, “No. It’s availability, availability, availability.” I remember thinking at the time that maybe it was indeed time for him to retire.
Availability is not the focal point of most offices these days. A few years into my career, we had consultants come to help us improve our bottom line and efficiency. The outside consultants emphasized that every patient upon leaving should get a follow-up appointment, so that our schedule would remain full in the future, leading to more productivity and revenue. The last things we wanted on our schedule in the future were open, unused slots ("excess inventory" in business parlance). A full schedule meant a healthy practice.
On the surface, that made sense. But there were some significant consequences to that logic. A full schedule leaves little room for work-ins and same-day sick visits. What increasingly happened was that the doctors’ schedules were always full, booked out weeks in advance. Patients found it so hard to get an appointment that they would end up at urgent
care with their care fragmented, or worse, unnecessarily in the emergency department.
Over time, I noted that on the rare days that my schedule was a bit lighter and had more open spots, it would fill up anyway with that pent-up demand for patients wanting same-day care. I also noted that having more variety in my day and doing some acute care in addition to chronic disease management made my day more fun and less draining. I started to wonder, Is there any way to have more days like this? Did I really need to have a booked up future schedule to be a productive doctor? If I were just available, patients (very grateful ones, by the way) would always show up. Was Dr. Lesesne right all along?
This led to a year when I looked around to see if offices could be run better. I stumbled upon the Ideal Medical Practice Model, innovated by Dr. L. Gordon Moore, that emphasized leaner, more efficient offices which resulted in less overhead and less need to have a packed schedule every day. Eventually, I would become connected with a local western North Carolina innovator, Dr. Steven Crane, who was doing exactly that by using this new innovation called "the portal" to run a more efficient office.
I had seen enough. I had to do it myself by opening my own lean, high-tech office which accepted traditional insurance, emphasized same-day and next-day availability, with intense use of our portal (or app) to facilitate it all. That emphasis on availability, same-day visits, and patient messages has been the driver of my successful office for the past 13 years. So yes, Dr. Lesesne was indeed right.
That doesn’t mean that being nice to our patients isn’t important. Of course, we should endeavor to be kind. But if your patient is ill and they can’t get in to see you for three weeks, they will go see the grumpy doctor at the urgent care down the road who can see them today. And competence? Well, patients assume that. They assume the grumpy doctor down the road is at least competent and will prefer that to seeing you in three weeks, even if you are the most clever doc in town.
Family Medicine is a relationship-based specialty. We aim to have strong therapeutic relationships with our patients. There are numerous ways to build that: being a good listener, making patients feel heard, being amiable, helping them feel better. At the end of the day though, nothing fosters loyalty and trust like just being available when your patient needs you. In my office, the patients generally schedule their own appointments through our portal because they can.
A few weeks ago, a long-standing patient came to see me the same day he needed to, with complaints of abdominal pain and hematuria. After an exam, labs, and some stat imaging, we confirmed the presence of a kidney stone. We got him feeling better quickly and kept him out of the emergency department. He thanked me profusely for “working him in that day.” I acknowledged his thanks and told him, "I'm always happy to be available.” But I still found his comment odd, given that he had scheduled the appointment himself on a slot that was otherwise going unused. I had not taken any special action on his behalf. All I had done was just set up a system 13 years ago that made it easier for him to serve himself. In his mind, however, I had been available when he really needed me, and that was something special.
This phrasing, “thank you for working me in,” was not unique to him. Countless patients have said it over the years. Patients have unfortunately become so accustomed to struggling to see their family doctor urgently that when it happens, it feels like a special event and "thank you for working me in" ends up being their phrase of gratitude.
Continues on next page
2024-2025
NCAFP Board of Directors
Executive Officers
President S. Mark McNeill, MD, FAAFP
President-Elect Benjamin F. Simmons, MD, FAAFP
Secretary/Treasurer
Deanna M. Didiano, DO
Immediate Past President Garett R. Franklin, MD, FAAFP
Executive Vice President Gregory K. Griggs, MPA, CAE
At-Large Directors
D. Landon Allen, MD, MPH, MBA, FAAFP
Stacey A. Blyth, MD
Joshua T. Carpenter, MD
Lisa A. Cassidy-Vu, MD, FAAFP
Kelley V. Lawrence, MD, IBCLC, FABM, FAAFP
Amanda R. Steventon, MD, FAAFP
Patrick S. Williams, MD, FAAFP
Courtland D. Winborne, MD
Academic Position
R. Aaron Lambert, MD, FAAFP
Resident Director
Stephanie P. Wilcher, MD, MPH
Resident Director-Elect
Irina Balan, MD
Student Director
Nicholas Wells
Student Director-Elect
Ryan Taylor
AAFP Delegates & Alternates
AAFP Delegate Tamieka Howell, MD, FAAFP
AAFP Delegate Rich Lord, MD, MA, FAAFP
AAFP Alternate Rhett Brown, MD, FAAFP
AAFP Alternate Thomas R. White, MD
NCAFP Committee Chairs
Workforce Committee Jay Patel, MD, MPH
Advocacy Committee Deanna M. Didiano, DO
Practice Environment Nichole Johnson MD, & Profesional Development MPH, FAAFP Committee
Academic Department Margaret Helton, MD, FAAFP Chairs
NCAFP Foundation President
Maureen Murphy, MD. FAAFP 2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
www.ncafp.com
Availability has other strengths too. Many of us are fairly far down the road of value-based care, and some of us are in down-side, risk-shared savings programs with Medicare and other insurances. If you can keep your patients out of the emergency department and the hospital unnecessarily, you will reduce costs and succeed in these value-based contracts. My office has excelled in them for over six years now, getting high marks in both quality and value. It would be nice if only my superior skills in medicine were driving that, but I know better than to think that my acumen is any better than that of my peers. It’s the same-day and next-day availability at my office which drives that value. I’m no better at Family Medicine than the next family doc down the street; they just aren’t as available as I get to be.
As much as I champion availability, it is clear why it is such a challenge these days. The reality is, there are numerous barriers to access in the modern Family Medicine office. While many of us are progressing in value-based care, fee-for-service still pays most of the bills. And in a fee-for-service world, it pays to see many patients a day. To consistently see many patients a day, you must fill up that schedule with follow-up appointments. We are also pressured more and more to become population health managers. Many offices manage that by getting patients with high-risk chronic diseases back in the office for frequent follow-up appointments, which fills up their schedules.
Most communities are short on family doctors. Not enough medical students go into Family Medicine, and too many of us burn out, retire too soon, or leave the specialty. This leaves those still practicing with swollen panels stretching to meet the needs of their community.
And let’s not forget the administrative burden we all face, including increasing numbers of prior authorizations. Who has time for same-day work-ins while you are trying to do all that?
That’s why it is so important that your Academy continues to fight for improved reimbursement, payment reform, reduced admin burden, and more medical students going into Family Medicine. Ultimately, these steps are what we need to get off the treadmill of full schedules and no availability. A great deal of my year as president so far has focused on these efforts. As an availability champion, I encourage you to prioritize availability a bit more in your office. While much has already been written on improving access in great management magazines like Family Practice Management and Medical Economics, I’ll float a final few practical ideas to ponder:
At my office, around 30% of appointments for the day are available on the same day. Rip the band-aid off by holding 30% of your appointments back for same-day availability! If you are worried that they will not fill up, believe me, they will. In most offices the pent-up demand is constant. Make it easy by offering or encouraging online self-scheduling, or by accepting walk-ins.
If you are constantly booked out, consider reducing your panel size. Let go of your worst-paying insurance. If you don’t have that power, at least close off your panel for a while. Natural patient attrition will lighten your load over time. Your remaining patients will make up any lost revenue by coming to you rather than the urgent care down the street or the subspecialist they didn’t really need.
While continuity is important, does everyone need a follow-up appointment? Maybe your elderly, high-risk patients do, but most of your patients can schedule their appointment at a future date when they know their schedule better. Hopping out of that pattern will free up lots of space on your schedule and reduce your number of no-shows.
It was with sadness that I learned Dr. Ned Lesesne had passed earlier this year. It got me thinking about his words of wisdom early on and how it took me years to truly realize them. Better late than never, I guess, but in my defense, I was struggling with the same accessibility barriers that others were. It was breaking out and starting my own practice that truly allowed me to get there, and it is with gratitude that I did. It shouldn’t take such radical moves to be accessible. Widespread, sustained flexibility will only come with better payment, movement away from fee-for-service toward alternative payment models, and with more medical students going into primary care.
In the meantime, however, any time you are at a decision point in your practice — be it a new hire, new technology, new quality program — I encourage you to always ask, what will this do to my availability? If it improves your availability, it is worthwhile. If it will hurt your availability (or if you're not sure), think twice before investing your precious time and resources. While there can be significant variation on the health needs of different communities, the need for access to quality primary care is a constant. If you keep availability at the center of your practice decisions, as the late Dr. Lesesne did, you will generally make the right choice. Your practice and your patients will be better off for it. Remember: “Availability, availability, availability!"
Mitigate Diagnostic Errors With AI
Some estimates suggest diagnostic errors affect nearly 12 million people annually in the U.S. Artificial intelligence (AI) can help you and your team avoid making them.
1. Clinical decision support systems: AI-powered CDSS integrated into an electronic health record can help identify potential diagnoses and rule out serious diagnoses. AI analyzes patient history and risk factors to flag high-risk conditions, enabling earlier intervention. And it can provide real-time recommendations, suggest differential diagnoses, and ensure adherence to evidence-based guidelines.
2. Scribes: AI scribes can help reduce clerical burden and improve workflow efficiency. The software uses automation to listen to clinician-patient interactions and generate clinical notes. It helps ensure accurate, structured, and comprehensive documentation so you can spend time on “clinical thinking” and arrive at an accurate diagnosis. Some AI scribes can even analyze clinical encounters and suggest diagnoses, treatment plans, or follow-up care reminders.
We Can Help
Curi offers AI consent forms and checklists, diagnostic error risk assessments, and more. Visit curi.com or call 800-328-5532 to speak with a Curi Advisory Risk Consultant.
Risk Reduction Strategies When Using AI
Despite the positives, there are concerns, as AI models can inherit biases or operate with inaccurate data.
To reduce risk:
• Develop policies around acceptable use of AI and permitted tools.
• Train clinicians on AI use and its limitations to maintain clinical judgment skills.
• Regularly validate AI outputs with clinician oversight.
Curi Claims, By the Numbers
In a subset of Curi malpractice claims across all healthcare settings, diagnostic error allegations rank:
in occurrence
in cost
ADVOCACY
By Shawn P. Parker, JD, MPA Senior Vice President & General Counsel
Your Legislative Update from the 2025-26 Long Session A Tale of Two Budgets
As of this writing, we have passed the midpoint of the long session of the 2025-26 biennial legislative session. As noted in my article from the spring issue of The North Carolina Family Physician, over 1,500 bills were filed.
Of those bills, one that deservedly garners the most
attention is Senate Bill 257: the 2025 Appropriations Act. First, let me add context: the state budget is a biennial budget, meaning it covers two fiscal years. In the long legislative session, the General Assembly crafts a two year-spending plan. In the short session, lawmakers return to consider adjustments to the second fiscal year. This session’s appropriation act can be considered one of the most important bills because, in addition to setting statewide policy, lawmakers use it to determine shared priorities for spending (and collecting) public dollars.
There are a few key aspects of state spending and tax decisions set out in our state constitution that impact the decision-making process. First, the constitution requires that the budget enacted by the General Assembly be balanced so that spending does not exceed revenues collected. Second, as noted above, the constitution requires the budget to cover two fiscal years, beginning on July 1 of each odd-numbered year. Additionally, the state constitution contains a cap on income tax rates for individuals and corporations. Though there is zero risk that this year’s proposal will exceed the current allowable tax rate, the specific tax rate for the next two years is an item of significant contention. And while the constitution requires the Appropriations Act to start on July 1, North Carolina’s legal framework prevents a government shutdown, allowing the state to continue operating under the previously approved budget of the prior legislative session, if the bill is not enacted by that date.
The budget act in modern times has more typically become law after July 1 providing retroactive appropriation of monies back to the start of the fiscal year. This is what we anticipate this year as well. In addition to the uncertainty of federal funding, there are key differences in spending priorities, tax policy, and specific policy initiatives which make current negotiations between the House and the Senate ripe with complexity. Below are some of the key components of each chamber’s version, as well as some major areas of interest for the NCAFP.
Senate Bill 257: 2025 Appropriations Act
Status: This year, the bill originated in the Senate. After it moved through the committee process, it was adopted on the Senate floor on April 17. The House reviewed the bill and substituted its version in late May, approving its version on May 22. The Senate voted not to concur with the changes, and the bill currently resides in a conference committee where 34 senators and 45 representatives will negotiate a final
conference report to be approved by both chambers.
Both the House and Senate versions of the budget set overall spending at $32.6 billion in the 2025-26 fiscal year and $33.2 million in the 2026-27 fiscal year. These are 5.8% and 2.1% year-over-year budget increases, respectively. An extension of the Primary Care Task Force, a legislative priority of the NCAFP, is included in both the Senate and House versions. It is noteworthy that the Task Force appears in each version with identical language: that means that our proposed version is agreed upon by both chambers.
The House and Senate both appropriated $500 million for a necessary Medicaid rebase for fiscal year 2025-26, which was $200 million below the amount requested by the North Carolina Department of Health and Human Services (NCDHHS). Both versions directed expedient implementation of Medicaid recipient work requirements and directed NCDHHS to potentially modify the number of Medicaid Managed Care standard plan contracts it awards at the next renewal.
In addition to some of the health care policy differences highlighted below, the most significant disagreement between the two chambers relates to the timing and amount of tax rate reductions, which were set in a previous year’s agreement. The Senate would accelerate reductions in the individual income tax rate, which is scheduled under existing law to decrease if certain annual state revenue triggers are reached. The House, concerned about revenue shortfalls, voted to limit the reduction to 3.99% and raise revenue thresholds contained in current law that state coffers must exceed before the rate automatically falls. The Senate appropriates $700 million for Hurricane Helene recovery, while the House handles recovery efforts to the tune of $450 million in legislation that is separate and apart from the budget Appropriations Act.
Other Highlights for Health Care Policy in the Senate Version:
• Provides full repeal of North Carolina’s Certificate of Need Law
• Appropriates $638M for the Duke/UNC Children’s Hospital
• Makes significant revisions to the Statewide Health Information Exchange Act
• Cuts 425 positions in NCDHHS (most in state facilities)
• Cuts all funding to Senior Health Insurance Information Program (which is designed to help seniors select Medicare Advantage or supplemental plans)
Other Highlights for Health Care Policy in the House Version:
While both versions include prior authorization reform in some capacity, the House version includes the full language of HB 434 – CARE First Act (which the NCAFP supports and summarized in the spring issue of The North Carolina Family Physician). The House version also:
• Requires insurance companies to include breast cancer prevention screenings
• Reduces the amount of funding for the Duke/UNC Children’s hospital (by about $100 million)
• Cuts GLP-1 medications for Medicaid patients (without diabetes diagnosis – estimated savings of $28 million over two years)
• Eliminates Medicaid Contingency Reserve and transfers the $970 million to the State Emergency Response and Disaster Relief Fund
• Cuts $10 million in NCDHHS vacant positions
While much of the negotiating over the conference report will occur in the corner offices of the House Speaker and Senate Pro Temporte, as well as in private caucus meetings, we will continue our legislative advocacy efforts to advance reforms to increase primary care payment, reduce administrative burden, and improve the professional environment for family physicians so that you can provide exceptional care to your patients and communities.
Please be on the look out for legislative and budgetary updates in future editions of our weekly NCAFPNotes e-newsletter.
The 2025 Winter Family Physicians Weekend is Hybrid AND Packed with CME, Connection, and Celebration!
By Kathryn Atkinson, CMP NCAFP Director of CME & Events
We’re excited to share that the 2025 Winter Family Physicians Weekend is returning in an interactive hybrid format on Dec. 4-7, 2025! Whether you plan to join us in person at the beautiful Omni Grove Park Inn (GPI) in Asheville or in the softest corner of your living room couch, this year’s conference promises to keep you engaged, informed, and connected from start to finish.
Led by Program Chair Dr. Katie Haga and Program Vice Chair Dr. Amir Barzin, this year’s general session schedule features timely, rigorous, and relevant updates in Family Medicine, along with practical tools you can begin using right away. You’ll hear from guest faculty experts on more than 20 essential clinical topics — many of which you have requested! The three-and-a-half-day agenda covers a wide range of subjects, including cardiovascular, metabolic, and renal health, infectious disease prevention, pediatrics, GI and pulmonary updates, cancer care, musculoskeletal conditions, mental and behavioral health, and more. (You can see the entire slate of topics on the inside cover of this magazine).
You’ll also hear updates from the American Academy of Family Physicians, the American Board of Family Medicine, and the NC Department of Health and Human Services.
Even with a robust schedule in the main lecture hall, your CME team made sure to also offer several highly requested optional workshops and seminars, including a hands-on dermatology workshop, a women’s health seminar, a pre-conference hybrid KSA on the care of children, and a practice management seminar. We’re also bringing back one of our most talked-about offerings: the confidential, 30-minute personal coaching sessions with long-time family physician and certified professional coach Dr. Dael Waxman. If you’re feeling stuck, burned out, or simply looking to reset and refocus, these one-on-one sessions are designed to help you reconnect with your purpose and explore meaningful next steps in both life and practice. Available Thursday through Saturday for NCAFP and AAFP members only, sessions are $50 and must be reserved during online registration.
On Saturday, conference attendees are invited to join fellow family physicians for a relaxed, no-stress lunch centered on connection and conversation. For just $30,
IMAGE COURTESY OF EXPLOREASHEVILLE.COM
enjoy a chef-prepared boxed lunch while exploring timely topics like telemedicine, maternal health, teaching, leadership, and more. Whether you’re hoping to dive deeper into conversation with like-minded peers or simply looking to share ideas and recharge, these roundtable discussions are a great way to build meaningful connections and walk away with fresh insights.
Plan to also celebrate many of your colleagues’ achievements and advancements when we honor our newest Degree of Fellow awardees and our Distinguished Family Physician of the Year. During the Presidential Gala, we’ll celebrate several of Family Medicine’s finest leaders with the installation of our 2025–2026 Board of Directors and the inauguration of our new NCAFP President, Dr. Benjamin “Frankie” Simmons. Wear your holiday best to the gala and count on a gourmet meal prepared by the GPI’s top chef, followed by music and dancing all evening long.
responds to complaints, investigates concerns, and makes disciplinary decisions — ensuring both accountability and fairness in the profession. The session is followed by a casual job fair featuring physician recruiters from across the state — no suits or scripts required!
Can’t make it to Asheville in person?
Don’t worry; there’s still plenty of room in the schedule for you to relax with family and friends while in Asheville. When you’re not in the lecture hall, head out to explore Asheville’s many quaint restaurants and shops or reserve that well-deserved spa appointment in the GPI’s world-renowned spa. Kick off your holiday spirit with a candlelight tour of the famous Biltmore House, or just relax in the resort’s Great Hall with a cozy beverage and your group of friends.
Medical students and Family Medicine residents will find several sessions and opportunities designed just for them. All are encouraged to participate in this year’s Research Poster Presentation Contest, with accepted posters displayed onsite and award opportunities available for both students and residents. Friday’s social networking hour is open to all students, residents, and early-career physicians and offers a great way to meet peers and mentors in a relaxed setting.
On Saturday, residents are invited to attend the can’t-miss Resident Workshop and Recruitment Fair. The afternoon kicks off with the NC Medical Board’s interactive Regulatory Immersion Series (RImS), where participants gain a behind-the-scenes look at how the Board evaluates and
With our hybrid option, you can still join the mainstage sessions live online for an unbeatable CME opportunity. While session recordings will be shared with conference registrants after the conference, on-demand viewing without event attendance for CME credit will not be available. In-person attendees will also receive web links to access virtual sessions, ensuring they do not miss any valuable content while in Asheville. All sessions are scheduled for Eastern Standard Time, and registration rates are the same for in-person and virtual attendees. For those attending in person, private links for making hotel reservations will be provided within your registration confirmation email. Only registered conference attendees may reserve rooms in the NCAFP’s discounted room blocks at the Omni Grove Park Inn, the Embassy Suites by Hilton Asheville Downtown (an overflow hotel), or the DoubleTree by Hilton Asheville Downtown (another overflow hotel).
Designed by family physicians for family physicians, the Winter Weekend is much more than just a chance to earn over 30 valuable CME credits. It’s a chance to sharpen your clinical skills, reconnect with the people who inspire you most, and reignite your passion for Family Medicine. So whether you join us in Asheville or online, we hope you’ll make the 2025 Winter Family Physicians Weekend the highlight of your year. We look forward to being with you this December!
Complete conference details, including the schedule of events, registration rates, and hotel information, are available now at www.ncafp.com/wfpw. Please contact me at Katkinson@ncafp.com with any questions.
How I Prepared for a Potential Run for Office at the NC Institute of Public Leadership
By Tamieka Howell, MD, FAAFP
For most of us who do not live in the world of politics and public service outside of medicine, there is such mystery in knowing how to run for public office or how to support someone who is running. Recently, I had the chance to delve deep into how one navigates running for public office.
For years, I have toyed with the idea of running for the local board of education, since I was unhappy with my local representative and my kids were in public school. I was raised by a public-school educator while also being a product of public schools. I have seen the importance of a good education for all, not just those who can afford it. I have also seen diminishing resources and pay for teachers, for infrastructure, and for those who support these.
But how do I, just a family doc, figure out running for public office? And how do I know that I really want to do this?
From February to May of this year, I participated in the North Carolina Institute of Public Leadership (IOPL) Fellows Program. It was a fantastic opportunity to understand the landscape and politics of public leadership and how to enter that space. Whether you are running for the local school board, town council, a seat in Raleigh, or a seat in DC, IOPL provides insight into how to be successful in those endeavors. This nonpartisan fellowship exposes participants to a variety of aspects of how to campaign, fundraise, build relationships, and serve their communities. Each class of fellows has participants from many backgrounds and many regions of North Carolina. My
classmates came with varied political or public leadership experiences, knowledge, and aspirations. In my class alone, we had one person running for their local town council, another serving as a city manager, and someone else considering a run for mayor in one of North Carolina’s biggest cities. One classmate had worked on several local and national campaigns, another was a state lobbyist, and many others had never visited their state lawmakers in Raleigh. The one thing in common was that we were all passionate about the issues affecting our communities. We all thirsted to understand how we could help. Could we help by being in the seat to make policy changes, or by actively supporting others to enter that seat and make those changes?
The educators who taught the fellowship include those who have run for office, those who have previously served in office, those currently in office, those who have managed campaigns, and others who have studied the landscape of politics for years. All of them gave us a broad but intricate view of the art of running for office.
Some of the lessons we learned included how to give stump speeches; the ethics of running and serving; and how to manage social media, budgets, and debates. There were sessions dedicated to fundraising and logistics of how money works, both in campaigning and lawmaking. Most importantly, we learned the logistical side of making sure that all fundraising is conducted legally.
The most humbling part of this experience was when I chose
Past NCAFP President Dr. Tamieka Howell.
to put aside differences with others who held different views from me and just listen to them, just to hear what they said. I attempted to find our middle ground on varying issues, to find a point where we could agree. Some issues remained non-negotiable, but in other subjects I had more latitude. After all, when you are campaigning and serving, you do want to win votes from both sides.
My favorite session was the evening we spent at Spectrum Studios in Raleigh. Under the lights with cameras rolling, we had debate-style interviews moderated by Tim Boyum. Mr. Boyum is a political anchor with Spectrum News 1, where he hosts a show called, “Tying It Together.” We received immediate feedback from him and our classmates, so that we can elevate our presence the next time we appear in a debate or on camera.
By the end of the program, our cohort made different choices. One classmate launched their campaign for Cary Town Council. The lobbyist decided that being a lobbyist was enough. Another decided that she has no desire to ever run for an office but will always continue her work towards affordable housing in her community. As for me? I am 8090% decided that I will make a run for Guilford County Board of Education District 2 in 2026.
I want to thank Greg Griggs, NCAFP Executive Vice President & CEO, and Shawn Parker, NCAFP General Counsel and Chief of Staff. They both supported my application to the fellowship. I also want to thank the NCAFP Executive Committee and numerous NCAFP friends who supported my fundraising efforts to sustain the IOPL program.
If you’re interested in this fellowship, the IOPL is recruiting the new class! Applications are due Aug. 1. You can get more information at https://iopl.org.
Dr. Tamieka Howell is a past NCAFP president and currently serves as a Delegate to the American Academy of Family Physicians Congress of Delegates.
NCAFP Members Enjoy Medical Education at the 2025 Hybrid Summer Symposium
By Kevin LaTorre NCAFP Communications & Membership Manager
On June 6 and 7, many NCAFP members learned together during the 2025 Hybrid Summer Symposium in Greensboro, NC. They earned up to 26.50 CME credit hours while also enjoying the usefulness and camaraderie of shared learning. “It was such a pleasure to be with those who joined us in person for a day of meaningful connection and high-value CME,” said NCAFP Events & CME Director Kathryn Atkinson, CMP. “It was a great program, and I am so grateful to the program chairs, Dr. Tom White and Dr. Deanna Didiano, and to their expert guest faculty who made it all possible.”
The Symposium combined four sessions of metabolic syndrome topics with four sessions of sports medicine topics, led by Dr. White and Dr. Didiano respectively. For each topic, the first three sessions gave attendees evidence-based lectures, while the fourth engaged them with case studies and a Q&A panel with the guest faculty members. This format helped the attendees collaborate with their teachers and with one another while weighing diagnoses and treatment options. “The interactive case studies were a great addition to the learning,” said Kathryn.
“I liked the audience participation component,” said one attendee in a post-event survey.
This NCAFP debuted a hybrid format at this year’s Summer Symposium.
This long-standing meeting became fully virtual after COVID-19. But as part of the NCAFP’s commitment to forming a network of family physicians across North Carolina, the 2025 Symposium offered in-person CME to make the Greensboro event a hybrid meeting. “We were happy to introduce a convenient hybrid option for those who pre-
ferred to attend virtually — an exciting new approach to our summer CME seminar that helped us meet members where they are and expand access to relevant, practice-focused education,” Kathryn said.
“The virtual option was very helpful,” said one attendee. “Plus, the price was very reasonable.”
Several attendees specifically requested that the hybrid options continue. “NCAFP has really seemed to master the hybrid in person and virtual attendee platform,” said one attendee. “Kudos!”
NCAFP members came together for education they can use immediately to better serve their patients.
The Summer Symposium attracted both new and old faces to Greensboro.
“I came to my first NCAFP meeting in 1995,” Dr. Deepak Gelot told NCAFP staff while checking in. Meanwhile, Dr. Derrick Anderson met his fellow NCAFP members and staff in person for the first time: “This was my first event, and it went well.”
The event’s topics gave attendees in-depth and useful
Didiano, to Ionis Pharmaceuticals for sponsoring the Symposium’s lunch, and to our guest faculty:
Dr. Michelle Keating
Dr. Dawn Cavinness
Dr. Thomas Barringer, III
Dr. Landon Irvin
Dr. Heath Thornton
Dr. Shane Hudnall
You can see all the fun attendees had at the Symposium in our image tableau on pg. 18.
Eggs Meet FDA's New Healthy D
The U.S. Food and Drug Administration (FDA)
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CHAPTER AFFAIRS
By Greg Griggs, MPA, CAE NCAFP Executive Vice President and CEO
Finding Meaning in Family Medicine
What brings meaning to the work of family physicians in our state, and what drains the meaning from your work? These are two questions we have been working to address over the past few years, hoping to improve the environment for family physicians in North Carolina.
Our efforts have now resulted in a qualitative investigation called “Meaningful and Meaningless Work Among North Carolina’s Family Physicians.” We plan to take what we learned and better advocate for you across multiple practice settings. We ultimately want to ask you, the members of NCAFP, to help determine how we can best use these findings to bring more meaning to your work. But first, a bit of background about how we got here.
GENESIS OF THE RESEARCH
In 2022, I was introduced to Tago L. Mharapara, PhD, at the NC Institute of Medicine Annual Meeting. At the time, Dr. Mharapara was in the United States on a Fullbright fellowship. In his time as a faculty member in the Department of Management at the Auckland University of Technology, he had already completed research on what brought meaning to the work of midwives in New Zealand, but he was looking to expand the reach of his research. Fortunately, Rachel Keever, MD, who was then serving in a senior leadership role with Carolina Complete Health Network, introduced me to Dr. Mharapara. One thing led to another, and we were soon talking about the need for better research on what brings meaning to the work of physicians, specifically family physicians.
Last year, Dr. Mharapara, along with his colleague, James Greenslade-Yeats, PhD, conducted a qualitative investigation into meaningful and meaningless work among North Carolina family physicians. As background: Dr. Mharapara
completed his doctorate at the University of Auckland, but he was no stranger to the United States (having completed his Master of Arts in Organizational Dynamics at the University of Oklahoma, as well as a BA in Psychology and Communications at St. John’s University).
RESEARCH METHODS
As part of the study, the researchers conducted 24 semi-structured interviews over Zoom that sought to answer three questions:
1. What characterizes the subjective experience of meaningful and meaningless work for our state’s family physicians?
2. How do family physicians enhance the meaningful aspects of their work and reduce or cope with the meaningless aspects?
3. How does the organization and funding of U.S. health care systems and organizations influence the experience of meaningful and meaningless work for family physicians?
NCAFP received outside funding from the American Board of Family Medicine to pay for gift cards as an incentive for taking part in the interviews and to fund personnel to transcribe the calls. Dr. Mharapara’s time and effort were subsidized by his university as part of his ongoing research.
The researchers analyzed interview transcripts thematically to identify patterns. Here are the patterns they identified from the interviews:
FINDINGS: MEANINGFUL WORK
MAKING A DIFFERENCE: In their findings, the researchers found that work “feels meaningful when it makes a positive difference to other people.” Whether family physicians were better managing a disease process, making a critical diagnosis, or helping patients navigate the complex health care system, it was their time with the patient that brought meaning to Family Medicine. To put it simply: “Interpersonal relationships are key to family physicians’ experiences of meaningfulness.”
CONTROL OVER TIME: The fact that control over time is “essential for meaningful work” is likely not surprising for you to hear. Time is needed to develop trust between a patient and their family physician. Participating physicians with low levels of control over their time described how this “undermines their ability to develop trust-based relationships with patients and, ultimately, to get anywhere in improving health outcomes.”
SCALING IMPACTS: Finally, the researchers learned that meaning is enhanced by scaling impacts. Some participating physicians have done this by taking on teaching duties, moving into leadership and administrative roles, or becoming involved in public health initiatives. But in all three of these instances, it is about building a better future and a better health care infrastructure – scaling the individual physician’s impact.
FINDINGS: MEANINGLESS WORK
WASTEFUL WORK: The flip side of meaningful work is meaningless work, which includes “wasteful work”: work that takes up time without contributing to the improvement of tangible health outcomes. Some examples mentioned by participants included unnecessary paperwork, box-ticking for compliance purposes, prior authorizations, and answering redundant questions. Meaningless tasks place an administrative burden on family physicians, consuming their most valued resource: time. Meaningless work absorbs not only the time that physicians have for their patients, but the time they would otherwise have for themselves and their families as well.
WORK DRIVEN BY PROFIT: When asked about what drives meaningless work, most participants said
profit-seeking motives. The researchers noted that family physicians find meaning in the human-to-human connections, while this meaningless work dehumanizes health care.
COPING WITH MEANINGLESS WORK IS HIGHLY INDIVIDUAL: Physicians in the study reported a range of strategies they use to cope with meaningless work. Examples included the use of technology for assistance with administrative tasks, or outsourcing such tasks to scribes. Some have left traditional practice models to go into direct primary care. Others have joined organizations to advocate for system change.
CONCLUSIONS
In their conclusions, the authors noted four specific things:
1. Their research highlights the importance of designing jobs and systems in ways that give family physicians control over their time. “Meaningful work requires time, while meaningless work wastes it,” the researchers state.
2. Meaningless work is commonly associated with spillover into family time and (even more concerning) burnout, making meaningless work not just wasteful but actively harmful. “This finding emphasizes the urgency of decreasing the administrative burden on family physicians and removing barriers to effective care, especially prior authorizations,” the researchers state.
3. Drivers of meaningless work are predominantly systemic and are controlled by interests outside the Family Medicine profession. This can be connected to both insurance companies and to managers who approach health care from solely a business perspective.
4. Finally, on a more hopeful note, the research shows how intrinsically motivated most family physicians are to find meaning in their work.
This qualitative research study was only a first step. We need your help to move our work even further.
First, please download and read the entire report at https:// www.ncafp.com/practice-resources. Second, email me and let me know how you think the NCAFP should use the findings of this report to bring more meaning to your work and to reduce the administrative burden that sucks the meaningfrom your work. You can reach me at ggriggs@ncafp.com.
Dr. Bailey Sanford and Dr. Benjamin "Frankie" Simmons.
Dr. Dawn Caviness and an attendee at the 2025 Summer Symposium.
Dr. Landon Irvin presents at the 2025 Summer Symposium.
Sheila Romanick, Julia Wood, NCAFP Workforce Initiatives Manager Perry Price, and Dr. Atif Mahmood.
Dr. Heath Thornton, Dr. Landon Irvin, and Dr. Shane Hudnall at the 2025 Summer Symposium.
Rep. Dr. Tim Reeder and NCAFP President Dr. Mark McNeill.
Dr. Michael Steinbacher, Dr. Alexandra Colt, and Dr. Dawn Caviness.
NCAFP General Counsel Shawn Parker with residents at the Mountain Area Health Education Center in Asheville.
Dr. Benjamin "Frankie" Simmons, Dr. Tamieka Howell, and another Summer Symposium attendee.
Dr. Mark McNeill with fellow Summer Symposium attendees.
Dr. Michelle Keating presents during the 2025 Summer Symposium.
Dr. Jan van Ravesteyn and Dr. Michael Steinbacher.
Dina Jacobs, Dr. Mamatha Sirivol, Dr. Kirsten Cox, and Brady Craft.
NCDHHS Secretary Dr. Devdutta Sangvai, Rep. Dr. Tim Reeder, and Dr. Tom Roth at the CCPN Clinician Conference.
Attendees at the 2025 Summer Symposium lunch.
Dr. Michelle Keating and Dr. Dawn Caviness.
Dr. Deanna Didiano presents at the 2025 Summer Symposium.
Dr. Shane Hudnall presents at the 2025 Summer Sympsoium.
Dr. Eugenie Komives, Dr. Karen L. Smith, and Dr. Mark McNeill at the NC Council of State Gala.
Dr. Conrad Flick, Dr. Vickie Fowler, Dr. Karen Smith, and NCAFP President Dr. Mark McNeill at the Governor's Inaugual.
Two attendees enjoying the NCAFP Networking Social.
Dr. Irina Balan and Dr. Stephanie Wilcher.
Dr. Dawn Caviness presents at the 2025 Summer Symposium.
Kathryn Atkinson, Dr. Maureen Murphy, Perry Price, Dr. Deanna Didiano, and Dr. Alexandra Colt.
Dr. Mark McNeill, Blue Cross NC President Dr. Tunde Sotunde, and Greg Griggs.
Dr. Thomas Baringer III and Dr. Thomas White.
Dr. Thomas Baringer III presents at the 2025 Summer Symposium.
Members of the NCAFP at the AAFP Advocacy Summit.
Student member Hannah Rayala at the AAFP Advocacy Summit.
Dr. Mark McNeill speaks at the AAFP Advocacy Summit. Dr. Thomas White presents at the 2025 Summer Symposium.
and other attendees
Dr. Bailey Sanford
at the 2025 Summer Symposium.
Dr. Benjamin "Frankie" Simmons, Dr. Andrea DeSantis, and other attendees at the AAFP Advocacy Summit.
Attendees at the AAFP Advocacy Summit enjoy a full team dinner.
NCAFP member Andrea Augustine (top-most) helps with wilderness medicine exercise.
NCAFP member Dr. Ryan Paulus helps teach the UNC Family Medicine Interest Group.
By Kevin LaTorre NCAFP Communications & Membership Manager
Member Spotlight: Landon Irvin, MD
Dr. Landon Irvin works as a family physician at the University of North Carolina (UNC) at Chapel Hill. In addition, he teaches as an assistant professor in the Family Medicine and Sports Medicine departments at UNC’s School of Medicine, where he completed his Sports Medicine fellowship immediately following residency.
Dr. Irvin chose Family Medicine because it prepared him for sports medicine and his other medical passions.
Dr. Irvin attended medical school at the Morehouse School of Medicine in Atlanta, GA, where he first enrolled thinking that he wanted to become an orthopedic surgeon. “I’m very sports-oriented,” he says, “and when I would watch ESPN growing up, orthopedic surgeons were always the ones getting interviewed. But I realized in my third year of medical school that I didn’t like the operating room.” Dr. Irvin realized instead that he liked working directly with the athletes. “It wasn’t until I did a summer internship in Pittsburgh that I learned that I wanted to spend my time with the athletes themselves,” he says.
Medicine is basically like a blank canvas where you can create your own masterpiece.” He completed his Family Medicine residency at Morehouse before applying for sports medicine fellowships around the country.
His visit to the UNC fellowship program convinced him that he had to attend there. “I just knew that it was my program when I visited,” Dr. Irvin says. “Thankfully, UNC thought so, too.” He explains that UNC offered the right mix of diversity, autonomous medicine, and access to student athletes: “it was a match made in heaven,” Dr. Irvin says.
"Family Medicine is basically like a blank canvas where you can create your own masterpiece."
Today, Dr. Irvin manages to practice both Family Medicine and sports medicine as a family physician.
His colleague at Morehouse, Macy McNair, then told him that Family Medicine was a great way to do that. “She told me there were many avenues for getting into sports medicine,” Dr. Irvin says. “She also encouraged me to go to my first Family Medicine symposium in my third year, and I was able to soak in everything. Family Medicine matched my personality.” When Dr. Irvin had a pivotal conversation with one of the Family Medicine residency directors at the symposium, he was convinced: “She told me that Family
He sees his patients at UNC Health in Chapel Hill, where Dr. Irvin says he is working to perfect a “50-50 split between Family Medicine and sports medicine.” His patient panel is already pretty close to that balance. “The first part of my clinical week is primary care,” Dr. Irvin says, “and the second part is sports medicine. I really enjoy both.”
Practicing both kinds of medicine means that Dr. Irvin sees the common concerns in both: “I’m seeing the
variety of things that fall under Family Medicine, but I’m also treating the general population for hip pain, knee pain, and muscular complaints,” Dr. Irvin says. He also has the flexibility to work as a team physician at nearby colleges and high schools. “I’ll be working with East Chapel Hill High School, North Carolina Central University, and Shaw University, which is work that I’m grateful to do,” he says.
“Family Medicine has been instrumental in getting me to work on my medical passions,” Dr. Irvin says. “Working with the UNC Family Medicine department has 1,000% helped me reach those goals.”
One of those goals? Teaching sports medicine to family physicians!
Dr. Irvin did exactly that at the 2025 Summer Symposium, teaching the “Beyond the Ache: Diagnosing and Managing Common Shoulder and Elbow Injuries” session there. The curriculum included the insights that family physicians
MEMBERS IN THE NEWS
By Kevin LaTorre NCAFP Communications & Membership Manager
Dr. Cristy Page Named Interim Dean at UNC School of Medicine and Interim CEO of UNC Health
In late April, Dr. Wesley Burks, current Dean of the UNC School of Medicine and CEO of UNC Health, announced his decision to step away from those roles effective Sept. 1 to focus on the state’s new Children’s Hospital and spend more time with his family.
NCAFP member Dr. Cristy Page (pictured), President of UNC Health Enterprises and Chief Academic Officer, has been named Interim Dean and Interim CEO of UNC Health by UNC System President Peter Hans. Dr. Page will take the position on Sept. 1.
need to understand fine pathophysiology, rotator cuff muscle injuries, lateral epicondylitis, and other topics which Dr. Irvin treats just about every week. “I just wanted attendees to glean good knowledge and grow comfortable with these health concerns,” Dr. Irvin says, “whether they don’t know any sports medicine, have completed a sports medicine fellowship, or are just interested in learning more.”
(You can read more about the Symposium on page 14.)
We’d like to thank Dr. Irvin for his patient care and for his teaching!
If you are providing unique service to your practice and community, please contact us at kevin@ncafp.com and let us know!
Dr. Christine Khandelwal Elected to FSMB Board of Directors
NCAFP member Dr. Christine Khandelwal was elected to the Federation of State Medical Boards (FSMB) Board of Directors! During the April 26 FSMB House of Delegates meeting in Seattle, WA, Dr. Khandelwal was chosen as an At-Large Board member from a field of eight candidates. During her three-year term, Dr. Khandelwal will help support the FSMB representing medical boards in the U.S. In this work, she joins NCAFP Senior VP and General Counsel Shawn Parker, JD, MPA, who currently serves on the Board as the FSMB Treasurer.
Dr. Khandelwal is a professor of Family Medicine and Director of Geriatrics and Palliative Medicine at the Campbell University School of Osteopathic Medicine. Prior to seeking election to the FSMB Board, she had previously served on the NC Medical Board until 2024 (including a term as president in 2023).
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NCAFP Members Helped Update AAFP Manual for OUD Treatment
In May, the American Academy of Family Physicians (AAFP) debuted an updated version of the Treating Opioid Use Disorder as a Chronic Condition guide. This practice manual for family physicians includes everything needed to prepare for screening, diagnosing, and treating opioid use disorder (OUD). It even includes the ins and outs of OUD clinical preparations, payment, and coding.
The guide draws from the expertise of NCAFP members at the Mountain Area Health Education Center (MAHEC) in Asheville! MAHEC – Asheville Family Medicine Chair Dr. Blake Fagan says, “The AAFP asked MAHEC to update their Opioid Use Disorder Manual for Family Physicians. We are proud that AAFP acknowledges the great work that North Carolina family physicians are doing in the OUD space.” We’re proud also! Dr. Fagan is a nationally recognized leader in treating OUD, and the larger MAHEC team gives stellar and crucial care for those suffering from opioid addiction.
Dr. Deepak Gelot Celebrated 30 Years at His Practice in Kings Mountain
In May, NCAFP member Dr. Deepak Gelot celebrated 30 years at his practice, Carolina Family Care, in Kings Mountain! In a recent article in The Kings Mountain Herald, reporter Loretta Cozart writes about the history of Carolina Family Care: “the Herald first announced his new practice on March 16, 1995, introducing Dr. Gelot to the community after he purchased the Mayse-Robinson medical building across from Kings Mountain Hospital. At that time, he aimed to establish a modern family practice equipped with state-of-the-art diagnostic equipment, welcoming new patients from the outset.”
Reflecting on the milestone, Dr. Gelot told Cozart, “I’ve been here for 30 years, serving many patients across three generations. My oldest patient is 108 years old.” The committed care Dr. Gelot has given to his community for such a long time is a milestone in its own right. Congratulations to Dr. Gelot and the Carolina Family Care team!
Our Own Kathryn Atkinson Appeared on the Business NC Podcast and in Convene Magazine
On May 21, NCAFP Director of CME and Events Kathryn Atkinson, CMP appeared on Chatter with NC! Speaking with Business NC publisher Ben Kinney, Kathryn discussed her professional journeys, how she came to prepare (and perfect!) business meetings, and even how much she enjoys country music from the 1990s! In addition to her work at the NCAFP, Kathryn is the President of the Association Executives of North Carolina, the professional society for association executives. She discusses both these roles with Kinney, which is why you’ll want to hear the episode for yourselves: listen now at https://businessnc.com/podcast/
Kathryn also appeared as a key source in a great article in Convene Magazine, where she discussed how she led the 2024 Winter Physicians Weekend in the wake of Hurricane Helene. “The last thing we wanted to do was move that meeting,” Kathryn said. The article goes on to describe how many other organizations cancelled meetings in Asheville, but the NCAFP persevered thanks to Kathryn’s leadership.
Dr. Devdutta Sangvai, Rep. Dr. Tim Reeder, and Dr. Tom Wroth Appear at Greensboro CCPN Meeting
On May 30, NC Department of Health and Human Services Secretary Dr. Devdutta Sangvai, NC Rep. Dr. Tim Reeder and dr. Tom Roth appeared on a panel! The panel (pictured above) was part of the Community Care Physician Network (CCPN) 2025 Clinician Conference: Bringing Value Home. The conference included panels, breakout sessions, and other educational offerings meant to equip primary care practices to care for their patients.
During their panel, Drs. Sangvai, Wroth, and Reeder came together to discuss the health policy that matters most to independent primary care practices in North Carolina. “We should think of medical practices as economic engines for our communities,” Rep. Dr. Reeder said during the panel.
“Moving and Motivating” The 2025 Western NC Summer Immersion Program
By Andrea Augustine, MPH MS4 at Duke University School of Medicine
My calling to Family Medicine came early in my medical school journey. With a background in public health and lived experience as a low-income, first-generation immigrant, I envisioned a career grounded in community — one that serves individuals and populations through equitable, accessible care. The AAFP National Conference (now called FUTURE), the AAFP Foundation’s Emerging Leader Institute, and my second-year rotations confirmed what I had already intuited: Family Medicine is my path. Now, as a fourthyear student preparing for residency, I find myself reflecting more deeply on the kind of physician I hope to become and discerning the core values and environments that will shape how I practice. That’s why the NCAFP’s Summer Immersion Program in western North Carolina could not have come at a better time.
The first week of my program happened at the Mountain Area Health Education Center (MAHEC) - Boone Residency. There, we were introduced to rural health through the lens of rural abundance. This concept stayed with me throughout my time in western NC — while hearing how communities came together after Hurricane Helene, feeling genuinely welcomed by clinic staff and patients, and reading on my host’s quiet patio with the mountains in view.
While we discussed the serious challenges rural communities face, we were also encouraged to recognize and build on the strengths these communities offer: their deeply rooted relationships, resilience, and resourcefulness. Through conversations with the NC Office of Rural Health and MAHEC Rural Fellowship directors, we were challenged to consider how those strengths could be harnessed to improve health outcomes.
I applied to the program with a few key questions in mind: What does training at a rural residency entail? How might it support my career goals? What does rural Family Medicine — particularly in non-academic models — look like? Could I see myself in that environment? I’m happy to report that the program answered all of these questions.
Another highlight of this first week was spending time with the MAHEC Boone residents. I shadowed them in hospital and clinic settings, where I gained valuable insight into the day-today of being a rural trainee. Getting to know the residents socially gave me and the other students a strong sense of the residency’s vibrant culture, whether we were at a local brewery, on a group outing to Grandfather Mountain, or helping one resident complete a community engagement project. Everyone seemed genuinely happy to be there together, and I realized how vital that kind of camaraderie is for thriving during residency. One of the most inspiring moments was visiting Seven Peaks Family Medicine, a nearby practice founded by three recent MAHEC Boone graduates. It was truly powerful to see how the relationships formed during residency evolved into the collaborative, sustainable practice at Seven Peaks. Thanks to training in wilderness medicine, point-of-care ultrasound, addiction care, and advocacy, our first week was packed with meaningful learning that enhanced my understanding of rural Family Medicine.
Dr. Landon Allen and Andrea Augustine at New River Family Wellness in Jefferson, NC.
During my second week, I transitioned over to Jefferson, where I joined Dr. Landon Allen at his direct primary care (DPC) practice, New River Family Wellness. Having never been exposed to DPC before, I was eager to explore this care model. Over the course of the week, I gained insight into the philosophy and practical realities of running a DPC practice. I especially appreciated hearing Dr. Allen’s motivations: how he stepped away from insurance companies and large health care systems to spend more time with patients, build stronger relationships, reach underserved patients, and provide holistic, individualized care. I also got a behind-the-scenes look at the business side of running an
independent practice, including budgeting, logistics, and troubleshooting. Dr. Allen routinely faces issues that demand creativity and hands-on problem-solving. Observing how he navigated them increased my appreciation for the breadth of skills required for independent practices.
What stood out most, though, was how deeply embedded Dr. Allen is in Jefferson. He began the week with a tour of town, helping me contextualize the local health care landscape and better understand the gap his practice fills. As we passed local businesses or community members, he
UNC and Wake Forest Family Medicine Interest Groups Receive AAFP Award
This past June, the Family Medicine Interest Groups (FMIGs) at both the University of North Carolina (UNC) School of Medicine and the Wake Forest University (WFU) School of Medicine received the Program Excellence award from the American Academy of Family Physicians (AAFP). Representatives from both programs received the awards during the AAFP FUTURE conference in Kansas City, MO, at the end of July.
The Program of Excellence award honors the interest groups whose members “encourage student interest in family medicine and family medicine programming,” according to the AAFP description. Both the UNC and WFU groups did exactly that.
“Our FMIG worked to expand our group’s reach, programming, and impact,” says UNC FMIG coordinator Kayla Bonnell. “Through these efforts, we’ve aimed to make the FMIG a welcoming, hands-on, and mission-driven space for students to explore Family Medicine and grow as future leaders in primary care.” The UNC FMIG also received this award in 2024. Bonnell says the group earned this national recognition for the second straight year by expanding its volunteer opportunities, increasing engagement with thirdand fourth-year students, and involving more pre-med undergraduate students. “We have highlighted the specialty’s
breadth through panels, lectures, and summer opportunity showcases,” Bonnell says.
The WFU group has done similar work in the past year. “Through interactive interest fairs, engaging lunch talks, and strategic tabling outside exam halls, we create meaningful opportunities for students to connect with the specialty,” says WFU faculty advisor Dr. Michelle Keating.
Through these activities and other ways of demonstrating the diverse clinical skills of Family Medicine, the WFU
ON-CAMPUS BRIEFS continues as "Summer Immersion" on back cover continues as "UNC and Wake Forest FMIG" on back cover
Members of the Wake Forest Medical School FMIG.
RESIDENTS & NEW PHYSICIANS
I Studied Health Around the World to Practice Family Medicine in Robeson County
By Dr. Ishan Sahu
As a kid growing up in Minnesota, I never imagined that a conference located in the beautiful Blue Ridge Mountains of North Carolina would change the trajectory of my life. Yet, during one summer, I traveled south as a delegate for the YMCA Conference on National Affairs. I found myself captivated by the deep sense of community that North Carolinians embodied. One of my first memories of North Carolina was stopping at the Ingles in Black Mountain and grabbing a Cheerwine. Those formative summers planted a seed in me: I knew I wanted to return to this state one day and contribute something meaningful.
That seed began to grow as I continued to develop a deep interest in global health. As a student at the University of Minnesota, I was awarded a grant to study health-seeking behaviors in the elderly population of rural India. Alongside my team, I spent weeks immersed in village life — listening, observing, and understanding how access, poverty, and cultural beliefs shaped decisions around health. Our project culminated in a publication earlier this year in the Journal of Family Medicine and Primary Care, titled “Morbidity profile and health seeking behavior of elderly in rural India: A cross-sectional study.” What we learned only reinforced what I had begun to understand instinctively: whether in rural India, urban America, or small-town North Carolina, primary care is the foundation of sus-
tainable health. It was this realization that solidified my commitment to this medicine and shaped my clinical priorities.
Throughout medical school, I sought opportunities to engage directly in primary care. I organized HIV screening clinics, participated in community health fairs, and supported outreach efforts in underserved neighborhoods. Then came the COVID-19 pandemic. I was living in New York City at the time — one of the early epicenters. Amid the chaos and uncertainty, I saw how even in a medically saturated city like New York City, access to care could quickly become fragile. Telehealth was only as effective as the infrastructure. Primary care physicians were overburdened and largely inaccessible. That moment made one thing abundantly clear: the resilience of our health care system depends on the strength of our community-based primary care.
Dr. Ishan Sahu just completed his residency training at the UNC Southeastern Family Medicine Residency in Lumberton. In addition, he has completed the NCAFP policy elective rotation and serves on the NCAFP Advocacy committee.
When the opportunity arose to return to North Carolina for residency, it felt like a full-circle moment. Before making the move, I learned everything I could about the community I would be serving: Robeson County.
Robeson County is among the most diverse counties in North Carolina and the U.S. It is home to the Lumbee Tribe, the largest state-recognized Native American tribe east of the Mississippi River. The population is a vibrant blend of Native American (about 40%), African American, and white residents. Yet, this cultural richness exists alongside significant health inequities. Over 30% of Robeson County residents live below the poverty line — nearly twice the national average. The county consistently ranks near the bottom in North Carolina’s health outcomes, with elevated rates of diabetes, hypertension, maternal health disparities, and substance use disorders. It is designated both a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA).
In a place like this, primary care is not simply a clinical service; it is a lifeline. It is preventive care, chronic disease management, maternal-child health, mental health support, and culturally competent care all in one. I’ve been honored to serve this community during my residency. Training here with limited resources has been challenging and has forced me to
become incredibly resourceful. Each patient encounter has reminded me that no matter how global my training or experiences, my calling lies in strengthening the front lines of care right here, where the need is greatest. This is evident throughout North Carolina and the U.S.
During residency I had the opportunity to travel to Nigeria to help develop curriculum for teaching residents. This work aided basic medical training like that which we receive here in the U.S. It was unbelievable to discover the similarities that rural Nigerians and North Carolinians share accessing their care. Now more than ever, I believe that primary care is the critical backbone of health in every community in America and requires investment, support, and advocacy.
This summer, I traveled to the Capitol to advocate for the future of health care in North Carolina and beyond. We need robust funding, fewer administrative barriers, and tangible support for those working in rural and underserved communities. It is vital that physicians — especially those of us in the American Academy of Family Physicians and NCAFP — make time to participate in advocacy events like White Coat Wednesday, even despite our demanding schedules. Our legislators need to hear our voices. No one else can speak to the frontline realities of primary care like we can. Please show up to advocate as you do every day for your patients.
Along this journey, I’ve had the incredible privilege of learning from some of the brightest and kindest mentors in North Carolina. Their example and encouragement have guided my path and reaffirmed that I am exactly where I need to be. North Carolina gave me a sense of direction years ago, and now it has given me a purpose.
North
Carolina Enjoyed a Promising Match Day!
50 years behind us. Your best future ahead.
CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS
AAFP Summary of HR 1: The One Big Beautiful Bill Act
From the American Academy of Family Physicians (AAFP):
As we’re all well aware, the House passed the Senate-passed version of H.R. 1, the One Big Beautiful Bill Act (although the Senate technically changed the name to “An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14.”), on July 3. President Trump signed the legislation into law on July 4.
Below is a summary of some of the provisions that the Academy has been closely following and which we anticipate will have an impact on our members/their patients and communities:
Medicaid
Eligibility verification: Requires states to conduct eligibility redeterminations at least every six months for Medicaid expansion adults.
Provider taxes: Prohibits the implementation of new provider taxes across states, and gradually phases down existing provider taxes in expansion states to 3.5% by FY 2032 (in comparison to the current limit of 6%). The new limit applies to taxes on all providers except nursing facilities and intermediate care facilities, and also applies to local government taxes in expansion states.
Rural Health Transformation Fund: Establishes a rural health transformation program that will provide $50 billion in grants to states between FY 2026 and 2030, to be used for payments to rural health care providers and other purposes. Uses of funds include promoting care interventions, paying for health care services, expanding the rural health workforce, and providing technical or operational assistance aimed at system transformation. While rural health clinics and community health centers are recognized in the list of “eligible facilities” for payment, standalone physician practices are not.
Work reporting requirements: Beginning in 2027, requires states to condition Medicaid eligibility for individuals ages 19-64 applying for coverage or enrolled through the ACA expansion group (or a waiver) on working or participating in qualifying activities for at least 80 hours per month. The legislation includes a list of exempted individuals, such as parents of children under 14 years, caregivers, individuals with a substance use disorder in treatment, and others. It also specifies that if a person is denied or disenrolled due to work reporting requirements, they are also ineligible for subsidized Marketplace coverage. States are not able to waive these requirements.
Family planning provider funding restrictions: Prohibits Medicaid funds to be paid to providers that are nonprofit organizations, essential community providers primarily engaged in family planning services or reproductive services, provide for abortions outside of the Hyde exceptions and received $8,000,000 or more in payments from Medicaid in 2023. This provision is largely targeted at Planned Parenthood.
Cost sharing requirements: Requires states to impose cost sharing of up to $35 per service on expansion population adults with incomes within 100-138% of the federal poverty line. It explicitly exempts primary care, mental health, and substance use disorder services from cost sharing, maintains existing exemptions of certain services from cost sharing, and limits cost sharing for prescription drugs to nominal amounts. It also excludes services provided by federally qualified health centers, behavioral health clinics, and rural health clinics.
Other Provisions
Medicare physician payment increase: Provides a temporary one-year increase of 2.5% to Medicare physician payment rates for 2026.
Changes to Supplemental Nutrition Assistance Programs (SNAP): Prevents any re-evaluations to SNAP benefits beyond inflation, which would not allow SNAP benefits to be updated based on changes to nutritional guidelines. It also implements state-federal cost sharing for states with payment error rates over 6%, which would apply to 47 states
Caps on Federal Student Loan Borrowing: Eliminates Grad PLUS loans and caps unsubsidized professional (e.g., medicine) borrowing at $50,000 per year ($200,000 lifetime). The AAFP, both individually and alongside other stakeholders, has strongly opposed this and other student loan-related provisions and expressed strong concern about their potential to further decimate the primary care workforce.
Several other concerning provisions were ultimately removed from the final text, in part thanks to the advocacy
of family physicians across the country. This includes recension of the proposal to exclude medical and dental residents from participating in the Public Service Loan Forgiveness Program (PLSF).The AAFP also actively opposed policy within various drafts of H.R. 1 that would have undermined the financial viability of independent practices.
A version of these comments was provided to AAFP Chapter Executives and Advocacy Staff on July 8, as a summary of the bill.
Empowering Independent Practices to Thrive!
We offer independent practices the opportunity to participate in our group as affiliates, receiving all the benefits of our large group without losing ownership or independence Continue to own your practice while participating in the benefits of our large group We
- Dr Jing Zhang (Waver y Primary
continued from pg. 27
often said, “That’s my patient” — a tangible reminder of how connected he is to the people he serves. Beyond clinical care, Dr. Landon also serves through local organizations and has become a trusted local voice in medicine and public health. Witnessing how a family physician can support the community far beyond the exam room was both moving and motivating.
I had plenty of extracurricular fun along the way, too! I went kayaking with Dr. Allen, played a tabletop RPG with my hosts, and discovered some amazing Thai food. Once again, I saw rural abundance in action: full of connection, warmth, and joy.
I’m incredibly grateful to the NCAFP, the NCAFP Foundation, MAHEC Boone, Dr. Landon Allen, Dr. Daniel Moore, Dr. Toria Knox, and everyone else who made this opportunity possible. It truly opened my eyes to the scope of Family Medicine (particularly in rural areas). I feel more prepared to take on the residency application process with an expanded interest in rural programs and a clearer vision of the environments where I can thrive. I also loved getting to know my fellow medical students from across the state and to share their interest in Family Medicine: shout out to Anna Pyne (Wake Forest), Tim Patron (East Carolina), and Jordan Gentry (Campbell)!
"UNC and Wake Forest FMIG" continued from pg. 27
FMIG has been able “to spark early interest and sustained engagement by showcasing the full scope and impact of Family Medicine throughout a medical career,” as Dr. Keating says. “Our FMIG leaders, Jaelen King and Samantha Aloysius, have been amazing leaders,” she adds. “They are truly passionate for expanding Family Medicine exposure and experiences within the school of medicine and the Winston-Salem community!”
One of the key pillars of the NCAFP is preparing the next generation of family physicians in North Carolina. That’s why we welcome this great news for both the UNC and WFU student groups. These medical student leaders are introducing their peers to the fulfilling work of Family Medicine. They also lead their group members to join NCAFP activities like the training workshops at Family Medicine Day, our summer precepting programs, and NCAFP Board or committee involvement.
Having participated in this summer program and other NCAFP programs (like Family Medicine Day and White Coat Wednesday), I feel even more committed to giving back however I can and to advocating for increased investment in these transformative opportunities at the NCAFP Foundation. I’m excited to share my experiences with my peers at Duke and with my fellow trustees on the AAFP Foundation Board of Trustees. I wholeheartedly encourage all North Carolina medical students to apply next year, even if rural medicine hasn’t been on your radar. It certainly wasn’t on mine until this experience, and I now look forward to continuing to explore all that Family Medicine has to offer in rural communities.
Andrea Augustine is a fourth-year medical student at the University of North Carolina School of Medicine. She has served on the NCAFP Foundation’s Board of Trustees and currently serves as the Student Trustee on the AAFP Foundation Board of Trustees.
Congratulations to the students, faculty, and advisors who have advanced Family Medicine at UNC and Wake Forest!
