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Volume 10 Issue 3 / Summer 2014

quarterly news in north carolina family medicine

The Medicaid Battle Rages Family Doctors Help Lead The Fight for Responsible Reform

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December 4-7, 2014 Asheville, NC See p. 12

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Inside 14

leader perspectives

Lessons Learned on The Appalachian Trail


President’s Message

Effective Reform Needn’t Be A Maserati


POlicy & advocacy

The Medicaid Battle Rages

chapter affairs

Dr. Mott Blair Runs for AAFP Board




A Terrific Winter Weekend Tradition

student interest

Medical Students Find Their ‘Medical’ Tribe


Exceptional Training Built on People

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President’s Message.......................... 4 Policy & Advocacy................................ 6 Chapter Affairs.................................... 10 Residents & New Physicians. CME Meetings & Education................. 12

Leader Perspectives............................ 14 Student Interest.................................. 20 .Residents .............. 24 & New Physicians Practice Enhancement........................ 30

THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. R aleig h , N o rt h C aro lin a 2 7 6 0 5

919.833.2110 • fax 919.833.1801 • http://www.ncafp.com MANAGING EDITOR & PRODUCTION

HAVE A NEWS ITEM WE MISSED? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please send via email to pgraber@ncafp.com.

P eter T. Gr a be r, Dir e c tor of Communic a tions

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2013-2014 NCAFP Board of Directors Executive Officers President William A. Dennis, MD President-Elect Thomas R. White, MD Vice President Rhett L. Brown, MD Secretary/Treasurer Charles W. Rhodes, MD Board Chair Shannon B. Dowler, MD Past President (w/voting privileges) Brian R. Forrest, MD Executive Vice President Gregory K. Griggs, MPA, CAE

President’s Message Dr. William A. Dennis 2013-2014 NCAFP President

District Directors District 1 - Jessica Triche, MD District 2 - Matthew M. Williams, MD District 3 - Eugenie M. Komives, MD

Effective Reform Needn’t Be a Maserati

District 4 - Tamieka Howell, MD District 5 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Holly Biola, MD At-Large Jennifer L. Mullendore, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD New Physicians Matthew G. Kanaan, DO NC Family Medicine Departments Brian A. Kessler, DO (Campbell) Family Medicine Residency Directors Geoffrey Jones, MD (MAHEC-Hendersonville) Resident Director Aaron George, DO (Duke) Resident Director-Elect Deanna M. Didiano, DO (Cabarrus) Student Director Julie Barrett (ECU) Student Director-Elect Christian A. Jasper, MPH (WFU)

Medical School Representatives & Alternates Chair (Campbell) Alternate (Duke) Alternate (ECU) Alternate (UNC) Alternate (Wake)

Brian A. Kessler, DO J. Lloyd Michener, MD Kenneth K. Steinweg, MD Warren P. Newton, MD, MPH Richard Lord, Jr., MD

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Mott P. Blair, IV, MD Karen L. Smith, MD, FAAFP Michelle F. Jones, MD Robert L. ‘Chuck’ Rich, Jr., MD

The NCAFP Family Medicine Councils Robert L. Rich, Jr., MD, Chair Advocacy Council Alisa C. Nance, MD, Chair CME Council Health of the Public Council Charles W. Rhodes, MD, Chair Rhett L. Brown, MD, Chair Practice Enhancement Council

I went out to dinner in Raleigh the other night at a place in North Hills. The restaurant was glitzy, trendy, avant garde and several other words we rarely use, and barely can spell, where I live. The inside was decorated in contemporary fashion, sleek, shiny and simple, but oh-sochic. The menu was as thick as an ICD-10 code book, with almost as many entries. The beer section alone had more than 150 choices! Apart from me, the patrons were dressed for the scene, outfits right out of the fashion magazines. If I had a daughter, I wouldn’t have let her out of the house wearing some of those dresses, but that’s the style these days. When we came out, a Maserati and a 2-seat Mercedes convertible were parked near the front entrance. People were everywhere, hundreds of them, maybe thousands, most of them in their 20s or early 30s. It looked like a Woodstock for young professionals. Almost made me want to be one again. Of course, I’d settle even for being a young amateur. Or just young. After dinner, as I pondered a series of encore visits till I can sample all 150 of those beers, we strolled across the parking lot and got into my Honda to return home (hey, I wasn’t driving!). In less than an hour we were in my driveway. But it seemed like we drove much more than 40 miles. There aren’t many young professionals in my hometown. No glitzy restaurants. Our beer choices are usually Bud and Bud Light, though once a waitress offered my friend what she said was “one of those new Chinese beers” - a Yuengling. In my hometown, the young people don’t come back home after they graduate from college. There are few jobs to come home to. Our unemployment rate usually stays in double digits. We are No.1, or close to it, in crime, dropouts, teen pregnancy, HIV rates, houses for sale, and most of the other categories you’d rather be last in. Our economic base - textiles, warehousing, tobacco - has gone with the wind over the past two decades. My hometown is totally unlike

Raleigh, which has more economic momentum than even the Great Recession could stop. We have economic momentum too, but like many other towns in Eastern North Carolina, we’re going in the opposite direction. In other words, the drive isn’t all that far, but we’re a LONG way from the big shining city. It strikes me that health care is similar in some ways. A good segment of the population has decent health insurance. These people are able to get the care they need, when they need it and where they need it, for the most part. But just down the street, many others have no insurance, or too little of it - at least without Medicaid. Sometimes even with Medicaid. In lots of towns like mine, these people are a majority. They’re doing the very best they can, but still they live from one month’s check to the next, with no hope of rescue in between. It is well-documented that poor health correlates with poor access to care - which is what you have when you’re, well, poor. And that of course is why Medicaid reform in North Carolina is so important. At this writing, the state House and Senate are still at odds over what shape reform will take. Every time I think they’re close to settling on a plan, they race off in a whole new direction. I wish I had a golden answer. It surely must be frustrating to balance a budget every year without knowing how much the biggest chunk is going to cost. And it is crucial to the taxpayers of this state, not to mention educators and other state employees, to spend the money we have prudently. Healthcare shouldn’t take the whole pie. Yet, the above must acknowledge that the health care slice would be significantly larger without organizations such as Community Care of North Carolina (CCNC), physician leaders, and front line docs who have worked together to keep our

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Medicaid growth rate at the lowest in the nation. So where do we go from here? The smart money would be wise not to bet on any one plan right now. What I would hope, though, is something similar to what we’ve heard about and pushed for - an approach based on quality care, stewardship of resources, creative thinking and teamwork - with ample physician input - continuing to build on the promising foundation already in place. What I know is that your Academy staff have worked relentlessly to keep us at the table, get us involved, and make sure we are heard. They have been remarkably successful. They, and you, helped turn the direction of reform 180 degrees from where it started just a few months ago. But there is a long way to go, with a special session on Medicaid reform in November.


Procedures Seminar Skin Biopsy Techniques & Joint Injections / Aspirations

Saturday, September 27, 2014 Embassy Suites Brier Creek, Raleigh, NC www.ncafp.com/cme/procedures-seminar

We aren’t asking for a Maserati in every driveway, but when it comes to healthcare, we think everybody deserves to live in a city that has a bit of shine.

We aren’t proposing a plan designed by Maserati, with glitz and glamour, frills and frou-frou. We do need something that will ensure care and access to all who need it. And to do that it will have to reimburse physicians adequately. We are willing to put “skin in the game,” but some are asking for muscle and bone too. Independent physicians, and even “CorpMed” too, cannot give but so much. Sooner or later they’ll have to cut their losses and close their doors to Medicaid patients. This is absolutely not a threat, just an economic fact of life - check out the states our Senate is modeling its ideas on. Our job as physicians is to know and provide the best medicine, be prudent about our ordering and prescribing, and work with our fellow physicians to give timely, thorough and coordinated care. CCNC has led the way in this approach, and has room to do more if allowed. We have shown that it works. The state’s job is to forge a Medicaid plan that is fair to its taxpayers, but ensures access to those who need it most. Some proposals on the table meet these goals; some don’t come close. We aren’t asking for a Maserati in every driveway, but when it comes to healthcare, we think everybody deserves to live in a city that has a bit of shine.

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Health Policy & Advocacy ncafp.com/advocacy

By: Joanna Spruill, JD NCAFP Director of Government Affairs & General Counsel


The Medicaid B

Family Physicians Play Frontline Role


t has been a grueling summer down at the legislature with most of NCAFP’s advocacy efforts focused on Medicaid reform. When the legislature abandoned the submitted plan for Medicaid reform, the plan that NCAFP and other stakeholders supported, Medicaid reform was suddenly back on the table. The Medicaid Reform Advisory Group sent their plan to the legislature this past March. However, many members of the General Assembly were not satisfied with the plan because they didn't believe it provided budget predictability or integrated care for the whole person. With the fight for responsible Medicaid reform renewed, NCAFP launched a series of grassroots events this summer to promote our message.

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Background: How did we get to where we are today?

predictability and sustainability of the Medicaid budget is a top priority.

Seventeen months ago, Governor Pat McCrory and the Department of Health and Human Services (DHHS) announced the need for comprehensive reform of the state’s $14 billion dollar Medicaid program. Due to overruns in the Medicaid budget, the General Assembly has had to allocate additional funds to the Medicaid budget over the past three years. These overruns are largely from inaccurate forecasting in the budget process and not from problems in healthcare delivery. However, lawmakers are frustrated with a program that appears to be unsustainable and unpredictable. Some legislators have lost confidence in DHHS and in their ability to accurately forecast a Medicaid budget. As a result,

Two competing plans for reform have surfaced: a plan that brings in commercial managed care companies to run the Medicaid program or a plan that transitions the system to an accountable care model where providers share in any savings or losses achieved. The fight between managed care and accountable care peaked this session with the release of each chamber's proposed budgets. The Senate proposal outlined a plan for commercial managed care and moved the Division of Medicaid out of DHHS to its own stand-alone agency. The House budget proposal was silent on reform and instead, the House ran their reform plan in a separate bill, House

Competing Plans for Reform


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Help Raise The Voice of Family Medicine in Raleigh NORTH CAROLINA


Empowering Family Medicine in North Carolina


d Battle Rages

ne Role in The Fight for Responsible Reform Bill 1181, calling for provider-driven reform that builds on the primary care medical home model. HB 1181 requires full capitation by 2020 and creates a glide path for physicians to steadily change over to that type of system. The NCAFP's Position NCAFP's position has been persistent and resolute over the past seventeen months. Our message throughout this process has been that reform should: Be designed collaboratively, with input from physicians, the medical community, and all stakeholders; build on our state's existing primary care infrastructure, namely our critically acclaimed care management program, Community Care of North Carolina; be physician-led; reward value over volume; and keep scarce healthcare dollars in our state where

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they can be invested and savings can remain in North Carolina. We have stressed that managed care would be devastating to primary care in North Carolina and that there would be significant up-front costs to transition to that type of system. While moving to full capitation by 2020 presents serious concerns, NCAFP has remained committed to moving reform forward in a positive direction and working with all stakeholders to find the optimal solution. Series of Grassroots Events To communicate our position, NCAFP has conducted an intense 17-month advocacy campaign utilizing a variety of strategies including, integrated mass media communications, paid and earned media, traditional lobbying,

CONTRIBUTE TODAY! Contributing to North Carolina’s political action committee for Family Medicine offers an easy, low-risk way for you to be part of the political process. Help raise the voice of Family Medicine in Raleigh. Contribute today at:

>> www.ncafp.com/fampac

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collaboration, and member engagement. This past spring, the Academy ramped up grassroots efforts and launched a series of events designed to engage family physicians with legislators and other key officials. Increase Chapter Visibility with Elected Officials -- May 21, 2014 Working with North Carolina’s JustusWarren Heart Disease & Stroke Prevention Task Force, NCAFP promoted family and preventive medicine and raised awareness of hypertension. NCAFP member physicians worked alongside medical students to provide free blood pressure screenings at the legislative complex. Academy members gave screenings to approximately 250 individuals, including a number of key legislative leaders. Governor McCrory issued a proclamation recognizing the day as "Hypertension/ High Blood Pressure Day." Grassroots Engagement of Resident Physicians -- May 28, 2014 Our second Wednesday event featured NCAFP resident physicians advocating on behalf of the future of Family Medicine in North Carolina. Residents from nearly all of North Carolina’s fourteen allopathic

training programs attended. Attendees visited legislators, spoke about issues including Medicaid reform, and provided leave-behind information on the Academy’s position. One participating resident also had the opportunity to serve as Physician of the Day on the floor of the North Carolina Senate - a rarity for a physician-intraining. This event unexpectedly coincided with the release of the Senate’s budget proposal, which not only shelved the existing reform plan in favor of full-risk, capitated plans, but also cut eligibility for the aged, blind, and disabled population, the medically needy population, and terminated the contract between DHHS and CCNC. Physician White Coat Wednesday at the General Assembly-- June 4, 2014 In response to the Senate's budget proposal, the NCAFP, worked alongside the North Carolina Medical Society, the North Carolina Pediatric Society and other key healthcare provider organizations, to amplify our message at the legislature.

OP-EDs 1

Over a hundred physicians participated in this White Coat Wednesday, making legislative visits and promoting an accountable care model of reform instead of privatized commercial care. The day began with an issue briefing and breakfast where DHHS Secretary Aldona Wos rallied physicians around accountable care reform. This event culminated with a press conference at the Governor's Mansion, a few blocks away from the legislature. Many family physicians stood behind Governor McCrory as he championed provider-led, accountable care reform. NCAFP chapter president Dr. William Dennis spoke alongside Governor McCrory supporting physician-led reform and the patient-centered medical home model. NC Medical Society President Dr. Dev Sangvai also spoke at the event. Subsequent press coverage of the event generated extensive earned media for Family Medicine and NCAFP in major media markets across the state. On the following day, chapter members made a series of phone calls to key legislative offices reinforcing the Academy’s position on reform. Members targeted House budget writers







NCAFP’s Medicaid Reform Advocacy Timeline 8 pages.indd 8

2 1 April, 2013 Gov. McCrory and State Medicaid leaders announce, “Partnership for a Healthy North Carolina” NCAFP and entire medical community react quickly and vocally, as McCrory Administration proposes managed care approach as preferred pathway to Medicaid system reform.


6 December, 2013

NCAFP Airs First TV Commercial, Launches Issue Website

NC Spin Tapes Special Healthcare Segment at NCAFP Annual Meeting

The NCAFP produces and airs a 30-second television commercial targeting state policy makers - the only state organization to do so. The ad runs alongside the state’s leading Sunday public policy broadcast for multiple weeks. Viewers are directed online to ‘Our NC Healthcare,’ an issues-oriented website designed to provide additional information supporting NCAFP’s position, including video clips, news coverage, and an online petition. Online petition helps to gather hundreds of signatures from patients, providers, and stakeholders from across the state. Social media is used to amplify messaging.

April, 2013 NCAFP Conducts Op-Ed Drive;Secures Numerous Placements; Builds Coalitions The NCAFP spearheads its first round of statewide Letters to the Editor and Op-Ed campaign targeting state dailies and community newspapers. Letters appear in numerous markets. Authors represent rural, urban, and suburban physicians. Residents and medical students contribute. Chapter leaders work to build coalitions and collaborative efforts with other medical associations.

May, 2013


5 June, 2013 Statewide Health Town Halls Begin State Medicaid leaders begin to hold a series of town hall forums discussing Medicaid reform. NCAFP representatives are active participants.

NC Spin, the state’s leading Sunday morning public policy show, tapes a special healthcare segment at the NCAFP’s annual meeting. The segment discusses key healthcare topics, including state Medicaid Reform. The segment later airs across state media markets in January, 2014. The Medicaid Reform Advisory Group also begins its series of public hearings.

August, 2013 Medicaid Reform Advisory Group Announced Legislature creates special advisory group tasked with creating formal Medicaid Reform proposal. Sets deadline for plan proposal of March, 2014.

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encouraging them to adopt a responsible Medicaid budget, one that preserved eligibility for our most vulnerable citizens and one that kept Medicaid out of the hands of commercial managed care. Thought Leader Follow-up To immediately follow the press conference and White Coat Wednesday event, NCAFP invited Dr. Paul Grundy, President of the Patient-Centered Primary Care Collaborative and IBM’s Director of IBM Global Healthcare Transformation, to provide key follow-up and reiterate our message. As a buyer of healthcare himself, Dr. Grundy promoted patientcentered medical homes and their importance in lowering healthcare costs. He spoke with key house leaders and with the DHHS Medicaid Reform team: Secretary Wos, Deputy Secretary for Health Services and Medicaid Director Robin Cummings, M.D., and Mardy Peal, Senior Advisor to the Secretary. The House responded to these grassroots efforts and passed a budget proposal that preserved Medicaid eligibility for our most vulnerable citizens, allowed DHHS to renew its contract with CCNC, and eliminated any reference to commercial

managed care. While the House proposal did still retain the 3% rate cuts that will go into effect next year for primary care without giving DHHS authority to implement shared savings with those funds, it did not include any additional rate cuts or a study on a provider tax, like the Senate's counterpart.

chapter and for Family Medicine. The chapter's overall grassroots campaign has raised the profile of Family Medicine, helped position NCAFP leaders and its members as trusted resources, and successfully reinforced the value of prevention and primary care to state legislative leaders. This visible advocacy campaign generated a significant amount of earned media exposure for Family Medicine across the state and built stronger relationships with legislators. The Senate and House are now scheduled to reconvene in November to work out their differences on Medicaid reform.


ith the two differing budget proposals, each chamber appointed members to a conference committee that was charged with reconciling the differences and presenting a compromise budget to both chambers. Once a conference committee was appointed and throughout budget negotiations, NCAFP issued Grassroots Actions Alerts, specifically targeting the conferees. Members living in districts represented by a legislator on the conference committee made phone calls and sent emails advocating for responsible Medicaid reform and a responsible Medicaid budget.

Great Participation by Members Successful grassroots events and outreach are not possible without the participation of our members. A huge thank to you to all of our members who took blood pressure, made legislative visits, emailed legislators, called legislators, and participated in our grassroots events. Grassroots advocacy is one of NCAFP's greatest strengths, and building relationships with legislators will not only serve our message today, but help us in our advocacy efforts in the future. Every visit, phone call, and email helps spread our message and keep our voice strong.

Successful Efforts Yield Results While the fight for reform is not over, NCAFP's advocacy efforts have yielded a number of positive outcomes for the




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January, 2014

March, 2014

June, 2014

NCAFP a Key Participant in Medicaid Reform Hearings

Formal Medicaid Reform Proposal Submitted to NC Legislature

The Medicaid Reform Advisory Group holds two more hearings where family medicine leaders share key testimony on reform approach. Medical students play an influential role, as well. Advisory group goes on to craft a final proposal containing many of the key elements advocated for by family physicians and the medical community.

The Medicaid Reform Advisory Group submits its formal proposal that utilizes Medicaid ACOs as the foundation of system reform. Proposal is viewed very favorably by the NCAFP and state’s provider associations.

Academy Helps Lead Major Advocacy Push; Chapter President Speaks with Governor at State Mansion


9 May, 2014 Academy Continues Advocacy Push; NC Senate Budget Proposal Surprisingly Shelves Previous Plan

Academy continues grassroots advocacy efforts at NC legislature. Unexpectedly, the NC Senate releases budget proposal completely shelving existing reform proposal. NCAFP ramps up new advocacy push.

isory mal ets deadh, 2014.

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The NCAFP and family doctors help lead over 100 physicians at a major advocacy push at NC General Assembly. The highlight of the event is press conference called by Governor McCrory that takes place on the steps of the state mansion. Chapter president Dr. William Dennis speaks alongside Governor calling for support of his reform plan.

June, 2014 Academy Airs New Television Commercial; Releases Op-Eds to Major State Newspapers Responding to Senate budget proposal, the NCAFP creates and airs a new television commercial and re-doubles its advocacy efforts. Refreshes issues website with updated content and approach. Continues to advocate in support of Governor’s Medicaid reform plan as submitted in March. Launches new round of letter writing campaign to major newspapers; several are published.

NCAFP chapter president Dr. William Dennis spoke to a crush of reporters after the Govenor’s press conference. This led to extensive media coverage for family medicine and the Academy’s position across the state.



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Chapter News & Affairs ncafp.com/academy

Dr. Mott Blair Runs for AAFP Board of Directors

NCAFP Past President Dr. Mott P. Blair, IV (‘03) is a candidate for the AAFP Board of Directors. Elections will take place this October in Washington, D.C. To provide members insight into Dr. Blair’s candidacy, the NC Family Physician asked him to share his thoughts on a number of key questions. To learn more about Dr. Blair, please visit www.blair4board.com

Why are you running for the AAFP Board? I believe that there is no question that what happens around the board table and in the legislative halls across this country impacts what happens to our patients in our exam rooms. To me, involvement in the Academy represents an extension of what I do for patients everyday. And furthermore, it represents an opportunity to improve care for all of our patients across this country. I believe that this service is worthwhile and I would be honored to have the opportunity to represent our members and our patients.

As a candidate for AAFP Board, what do you consider your key strengths? What unique abilities and experiences will help make you an effective representative for the specialty? My practice experience mirrors the experience of many of our members. Like many of my colleagues, I have been in both independent practice (for 20-years) and then transitioned to an employed position. I have had the exposure of being in a small practice meeting payroll and dealing with regulatory burdens to working within a large medical system as an employed physician.

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Both of these experiences have given me great insight into the challenges our members face. I have also undertaken leadership roles in political, non-profit and medical organizations. These experiences have helped me develop my skills as an active listener, team builder and consensus builder. These attributes are necessary for successful board leadership in meeting our members’ needs. It has also been an honor for me to serve as a mentor to countless high school, college and medical students. This has given me great insight into the reasons that current students are choosing Family Medicine, as well as an understanding of the barriers they face to moving toward a career in Family Medicine.

Advocacy continues to be hugely important for AAFP members and for the specialty. How has our prior experiences influenced your perspectives on advocacy and the best ways in achieving meaningful progress? I have been involved in advocacy efforts as an Academy member on both a local, statewide and national level. In 2010, when the last physician was retiring from the NC legislature, my colleagues called on me to run for the state house. Although the campaign was unsuccessful, the experience taught me a lot about the political process and influenced my ideas on how we can be more effective. I believe that as family physicians we have a unique role among the electorate. As a trusted voice to many patients and legislators, we have the opportunity to influence political decision making for the betterment of our patients. The key strategy for our Academy is involvement by our members. Establishing personal relationships with our elected representatives, voicing our concerns when appropriate and supporting our Political Action Committee are all important to


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make sure our collective voice is heard. I believe that in the long term we need to develop and nurture future political leaders from within our own ranks. I believe that it is paramount that we have our members representing the electorate and fellow physicians in the halls of legislatures countrywide.

How can the AAFP meet the needs of both employed physicians (a growing segment) and those who remain in independent practice? The practice environment has changed. More than 60% of us are now in some type of employed relationship - a great change over the last five years. Many of us now work for hospital systems. Some of us remain in small practices or independent practices. I have been in both models. I was in a small private practice for twenty years and then over the last five years have been an employed physician for a hospital system. There are clear needs unique to each situation, although there is still commonality, such as CME requirements and help with Maintenance of Certification. Independent practicing physicians still need help with all the myriad of issues involved in running a practice, such as contracting and practice management, but they also need help with new models of care like direct primary care and the Patient-Centered Medical Home. Many of us in employed models need help and guidance in employment contracts. In addition, as family physicians take leadership roles in larger organizations including health systems, we can benefit from leadership training from within the Academy. By our very nature and geographic distribution family physicians are a diverse group, and I believe that the AAFP can meet the needs of both.

Change seems to be happening everywhere in medicine today. How can the AAFP help members and chapters navigate these changes and prepare for what tomorrow may hold? In the small amount of spare time I have outside my practice, I am a sailor. I have learned that when navigating or piloting stormy waters, it is important to know where you are now, know where your destination is, and have a good idea of the course that you are steering to get there. All of this must occur while simultaneously monitoring the conditions of weather, wind and waves along that journey. I think this is a great analogy of where we are in Family Medicine. I think that we would all agree that central to the healthcare system of the future is having a personal family physician and a medical home. With health reform upon us there are many others who would want to fill that role. At a time when the future shows great promise for the central role of family physicians, we need to stay on course. It is the job of the AAFP to make sure that this happens, and it must be done on many different levels. Certainly governmental advocacy is first and foremost as we work to ensure that payment is fair for our new roles and that we are also training the workforce for the future of American healthcare. Many of the same ideas that develop at the national level are also being played out in state legislatures across the country. This is exactly where the AAFP can help our constituent chapters. Our members need help with change management as well. There are a lot of skill sets that our members will need to learn in the future, such as population health management. Our members continue to struggle with a myriad of reporting requirements, CME, Maintenance of Certification, etc. The Academy has a key role in helping our members navigate these uncharted waters.

What do you see as the biggest challenges facing the specialty of Family Medicine within the next 3-years? The three key challenges for our specialty are payment; workforce and dealing with the magnitude of change itself. When I talk to fellow family physicians, you generally hear two comments: “I did not go into medicine to do this” or in the case of a lot of independent family physicians, “I am not going to last much longer.” On one hand this represents the frustration of doctors in dealing with the evolving world of medicine. On the other, it shows the desperation of those who are trying to keep a practice afloat. I think the Academy has a responsibility to help both.


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CME Meetings & Education ncafp.com/education

NCAFP 2014 Winter Family Physicians Weekend December 4th-7th, 2014

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Registration: Early Bird Registration ends Wednesday, October 15, 2014. Online registration is available now at www.ncafp.com/wfpw Hotel Reservations: The Omni Grove Park Inn sleeping room block offers a variety of room types during your stay (cut-off date is Thurs. Oct. 30th). Run of the House Rooms are $215 per night, Resort View Rooms are $232 per night, Mountain View Rooms are $243 per night and Premium Rooms are $260 per night. Please call the hotel directly at 800-438-5800 or 828-252-2711. Additional discounted sleeping room rates are also available at the Renaissance Asheville Hotel (cut-off date is Sat. Nov. 1st) located at 31 Woodfin Street, Asheville, NC (phone 800-468-3571) for $159.00 per night and at the Crowne Plaza (cut-off date is Mon. Nov. 3rd) located at One Resort Drive, Asheville, NC  (phone 800-733-3211) for $125.00 per night. Be sure to the mention the NCAFP Room Block to receive the discounts. Please book early as rooms will fill up quickly.




Asheville in December is where you want to be! Join the NCAFP for our annual Winter Family Physicians Weekend at the wonderful Omni Grove Park Inn this December 4th 7th, 2014. This annual tradition is a great time for friends, family, and colleagues to gather for terrific CME and to enjoy a relaxing weekend in the Blue Ridge Mountains of North Carolina. Our Program Chair, Dr. Charles Rhodes and our Program Vice-Chair, Dr. Jennifer Mullendore, have assembled an impressive line-up of topics seen by primary care physicians in practice today. Evidencebased lectures on timely issues such as depression, diabetes, flu vaccinations, allergic rhinitis, pre-contraceptive and family planning, telemedicine, lung cancer, dental and oral health, overactive bladder and gout are just a few of the topics slated for the conference. Attendees will also enjoy additional optional quality CME workshops and seminars throughout the weekend, along with a SAMs Study Working Group on preventive health. Attendees, spouses and guests will all enjoy the NCAFP Foundation's Annual Silent Auction on Friday, December 5th as well as Saturday evening's Presidential Gala hosted by Dr. & Mrs. Thomas R. White. Complete with a fantastic meal prepared by the hotel chef, along with surprising fun, great music and dancing, this is sure to be a memorable night as Dr. White kicks-off his term as president of the NCAFP. The beautiful city of Asheville is sure to awaken everyone's holiday spirit. Make plans to bring the family and begin your holiday celebrations with a candlelight tour of the famous Biltmore House and its

dazzling decor. Visit the quaint downtown district, shop the various galleries and boutiques and check a few hard-to-find gifts off your holiday shopping list. Enjoy fourstar dining or casual southern cooking in the city's vibrant restaurant scene with its many farm-to-table restaurants and extraordinary sidewalk cafes. The festive ambiance and craftsman beauty of The Omni Grove Park Inn offers a perfect place to gather everyone near a beautifully lit Christmas tree or to pile the whole family into a giant merry sleigh, complete with reindeer, for your annual holiday card. You can also forget all your worries and relax with a fabulous spa treatment or enjoy a round of golf at the hotel's top-rated golf course. In the evenings, unwind and catch up with friends and family near the cozy giant fireplaces in the Omni's newly renovated Great Hall. This conference and its terrific location offers you a wonderful opportunity to earn useful CME, while also enjoying valuable quality time with friends and family. Information about registration and hotel reservations will be arriving in your mailbox soon. You may visit our website at www. ncafp.com/wfpw for additional schedule details and conference information. Or you may contact the NCAFP Meetings Department at 919-8332110 or via email at katkinson@ncafp.com. We look forward to seeing you in Asheville this December!





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2014 ncafp aNNUAL mEETING

A Terrific Winter Weekend Tradition in the Mountains




Great CME, Family, Fun & Friends is a Great Way to Kick-Off Your 2014 Holiday Season By: Kathryn Atkinson NCAFP Meetings & Events Manager

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Leader Insights & Perspectives

Lessons Learned \ Appalachian Trail on The

By Thomas R. White, MD NCAFP President-Elect

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Last year after an Academy leadership trip kayaking and what we learned from that t experience that work and play are often co improve the other. I like metaphors and tr ourselves in the midst of a crisis with Med clarification and guidance on a recent trek find some insights in this.

Recently my son Daniel (aka "Sherpa Boy") and I (a to-carry-some-of-his-heavy-load") spent three days was a short but physically challenging trip. We hik 27-miles round trip. There was time to talk, debate the changes and challenges we face in North Carol Medicaid. Here is what I learned:

1. Know Your Way

The Appalachian Trail (the AT) is 2181 miles long, Mt. Katahdin, Maine. Although one can enter and traditional for "thru hikers" (those brave strong souls requiring 4-6 months) to hike from South to North The distance from one town to another, and from with precise elevations and descriptions of the terra be very narrow and tortuous. However, about every on the trees and rocks to let the hiker know that he referred to as "blazes." Along the trail there are also These may lead to a spring for water, or a shelter fo the "white blazes" if you want to reach your ultimate


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blazes" actually are at best brief detours, at worst a way to become very lost, and not the way to arrive at Katahdin. So where are we going with Medicaid? Are we on the correct trail? The NCAFP in partnership with the NC Medical Society and the NC Pediatric Society have laid out a clear path: we acknowledge that change and improvement are needed, we want to preserve what we have that is effective and working, we want to build upon the firm foundation of CCNC, and ultimately deliver even higher quality care at a more reasonable cost. This is a logical, safe, and thoughtful path, marked by white blazes which can be trusted, and a path which is also embraced and supported by Governor McCrory and the Secretary of DHHS, Dr Aldona Wos. The Senate, on the other hand, is headed down a dangerous and potentially disastrous path. Their plan may have appeared to be guided by some seemingly desirable blazes, such as budget predictability and a more comprehensive approach to the patient. But their path is misguided, and it would lead to out of state for-profit managed care, a path many of us followed here in NC in the 1980s, and it was indeed a disaster. More recently other states have ventured down the managed care path, only to regret it. The Senate plan is a tempting trail of, at best, short-term gains. We need to follow the white blazes set forth by the House of Medicine and the Governor.

2. Be Prepared Before we embarked on our trip, we read and studied. We checked and rechecked the contents of our backpacks to make sure we had everything we would need for the next three days. Despite our efforts, we made some mistakes. We did not fully appreciate the difficulty of several segments of the trail, and in hindsight, we should have hiked fewer miles on day two. And we forgot our inflatable pillows, making for some uncomfortable nights. On the other hand, Sherpa Boy planned a wonderful couscous dinner with Parmesan cheese and olive oil for the second night, garnering the attention and envy of some guys who camped in the same site that evening.

leadership trip to Florida, I wrote a piece on ned from that team building exercise. It has been my ay are often complimentary and one can instruct and taphors and trying to connect the dots. As we find crisis with Medicaid in North Carolina, I sought some n a recent trek on the Appalachian Trail. I hope you

We cannot enter this fight for what we believe to be the better solution to the challenges of Medicaid without detailed preparation. We must know our position and be able to articulate it. We must have data, and present it convincingly. We also need to acknowledge that perhaps we could have prepared even better. We have not always told the story of CCNC (Community Care of North Carolina) to those who need to understand it best - that is, our own elected officials and the taxpayers of NC. We perhaps should have demonstrated long ago how CCNC could positively affect certain costly line items, such as mental health, long term care, personal care services, and medical equipment, none of which have been directly controlled by CCNC.

3. Follow Dependable Advice

rpa Boy") and I (aka "He-who-looks-tired-can-get-Sherpa-Boyspent three days and two nights on the Appalachian Trail. It ging trip. We hiked from Carvers Gap to US 19-E and back, me to talk, debate, laugh, and reflect. I had time to think about ce in North Carolina in health care, and specifically around

2181 miles long, stretching from Springer Mountain, Georgia to one can enter and exit the trail at any point along the way, it is brave strong souls who hike the entire trail in a single trip, usually m South to North. The trail has been mapped out in great detail. nother, and from one landmark to another, is well-documented, ptions of the terrain. The actual trail is not always obvious. It can wever, about every 200 feet it is marked with stripes of white paint ker know that he or she is on the correct path. These markings are trail there are also occasional side paths marked by "blue blazes." ter, or a shelter for sleeping, or to nowhere. The key is to follow ach your ultimate destination. One must remember that the "blue

In addition to studying and preparing beforehand, Daniel and I stopped other hikers on the trail, and asked them questions about the upcoming terrain, the approximate distance to the next landmark, and the weather report. When you encounter a smelly and unshaven hiker, but oozing of confidence and experience, you know you are getting good advice. We have learned in our camping trips, sometimes the hard way, to ask for and listen to advice. Likewise, we in the Academy are fortunate to have incredibly knowledgeable and experienced guides. They can keep us on the trail and help us be effective advocates. They serve as our invaluable “trekking poles.” The detailed grasp of the issues and photographic memory of Greg. The keen legal mind and enthusiasm of Joanna. The wisdom of Dr. Allen Dobson. The diligence of Dr. Rich. The passion of Dr. Dowler. The reasoned approach of Dr. Dennis. I could go on and on. I risk leaving out many of the valuable resources in our midst. We are all in this together. We are better together.

4. Watch Your Step There are many smooth, well-worn, easy-to-traverse segments of the AT. But, as we learned, there are many uphills and downhills with numerous rocks and roots. While these rocks and roots can be risky and treacherous, they can also serve as a stable place to plant your foot and actually propel forward, up, or down, more safely. Usually the rocks are Continues on next page


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Executive’s Desk

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

Insurance: It’s for Politics and Policy Too heavy and stable; sometimes they are wobbly. The roots can be your friend, or they can be slippery. Fortunately, we suffered no serious sprains or breaks. (Soreness the morning after? That's another story.) In my very limited experience in healthcare politics, I have learned there are many potential allies and opponents, as well as effective and less effective approaches. CCNC and we as an Academy, have laid down many stable stepping stones along the way and put down solid strong roots. These are the programs and approaches which have benefitted our state and our most vulnerable patients over the years. We should use these to carry us forward. But we must remember that some of the rocks and roots we have established in the past may no longer be relevant and as effective as we once thought. We have to be thoughtful and flexible and willing to change as we move forward.

5. Leave It Better Than You Found It There is an old rule which I first learned in Boy Scouts that says you should always leave a campsite in better condition than you found it. That involves having respect for Mother Nature, and leaving a presentable site for those who come after you. Likewise, we need to remind ourselves why we are involved in the fight over the future of Medicaid in North Carolina. It is not to simply win the debate, to prove that we know best, or to preserve CCNC for CCNC's sake. We are in this for the health and well-being of our patients, those we care for today, and those generations of the future. We sincerely believe that turning over Medicaid to companies whose primary loyalty is to their shareholders is a recipe for inadequate care for patients and fewer participating physicians in the future. That is not a campsite we want to leave to those who will follow us. Who knows where we will end up. We believe we know the proper and safe trail. It is wellmarked. We must be prepared. We have the right guides. We are aware of the need for proper footing. We understand why we are engaged. Let's put that heavy pack on our back and continue the journey. Hey, Sherpa Boy, stay close! I might need you!

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Invest in Your Political Action Committee - FAMPAC No one would drive a car without insurance, nor would we own a business without liability insurance. And we certainly encourage everyone to have health insurance. I dare say there’s not a physician who would practice without malpractice insurance. Unfortunately, all too often we fail to invest in political or policy insurance. Now, political insurance is not always as iron clad as other liability insurance (it may not pay the claim every time), but it’s still just as important.

Have you taken time to invest in political insurance? Do you have a personal relationship with your State House member and State Senator?

You’re probably asking, what’s Greg talking about? Has he lost his mind? Well the answer is no, not at least entirely. Just as we invest in malpractice insurance, health insurance and automobile insurance, there is a way to invest in political insurance: it’s called supporting your Political Action Committee and becoming involved in grassroots advocacy. A lot of it is simple: we must educate our elected officials. That can only happen by getting to know them, talking to them, and ultimately supporting them (financially and through other actions). And now it’s more important than ever. As of the next election, there will be NO physicians in the North Carolina General Assembly. That’s right: exactly zero physicians helping

make the decisions that impact your daily practice life and the healthcare of millions of North Carolinians. Those leading the healthcare committees in the General Assembly include a bail bondsman, a chemist, a public relations specialist, a statistician and fortunately at least one dentist. And these individuals -- for the most part -- don’t have a staff to spend time researching these issues on their behalf. So how do they learn about the issues and who do the learn from? For one, it’s the constituents they know. That means the local voters who have developed a personal relationship with them. And for better or worse, it’s those who have been active in their campaigns, whether it’s working to help get out the vote or making a financial contribution. This session alone we’ve faced many crucial issues about healthcare in North Carolina, the least of which is Medicaid reform. But Medicaid reform has not been the only one. Some related bills that have been considered included banning indoor tanning beds for anyone under 18, funding the tobacco QuitLine, issues impacting scope-of-practice and more. So I ask you: have you taken time to invest in political insurance? Do you have a personal relationship with your State House Member and State Senator? Have you given to a political campaign, or at least to the NCAFP Political Action Committee (FAMPAC)? I would encourage you to take your commitment to political insurance just as importantly as you take the decision to buy health insurance or malpractice insurance. This year, we’ve had one physician and one physician assistant in the General Assembly. Neither of them are running in November. As a result, our need for Family Medicine political insurance is greater than ever. So don’t ignore this one more important type of insurance: contribute to our PAC today and get to know your elected officials.

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MEMBERSHIP AAFP Website Contains Helpful Membership Tools and Information You may have noticed recently that the AAFP has a specific web address for just about anything. We understand that it can be quite confusing, not to mention, difficult to remember. A good one-stop web address you can use is www.aafp. org/myacademy. At that address you can update contact information, pay dues/access dues invoices, and renew subscriptions.

www.aafp.org/updatecontactinfo: Simple way to update contact information. Once updated here, no need to update it again with NCAFP--our records sync nightly with AAFP. www.aafp.org/checkmydues: Pay dues, print invoices, or set up installment plans. www.aafp.org/renewtoday: Renew your membership in minutes! www.aafp.org/rejoin: Explains the difference in reinstating vs. rejoining after a membership lapse. www.aafp.org/mycme: View/update CME transcript www.aafp.org/cmemember: Provides options for live and online CME. www.aafp.org/cme: Multiple post-test options. www.aafp.org/cmerfaq: CME reporting and re-election requirements FAQ. www.aafp.org/membership: Access to all things membership. www.aafp.org/experience: Special resources and discounts for members in their first seven years following residency completion.

There are a number of other web addresses that may be helpful,too. But please remember that you will need your AAFP ID# when viewing memberonly content.

When in doubt, you may always call AAFP between 9:00 a.m. - 6:30 p.m. EST, Toll-Free at 1-800-274-2237 or send an email to contactcenter@aafp.org. Or you may contact Tara Hinkle, NCAFP Membership Coordinator, at thinkle@ncafp.com or by phone at 919-833-2110/(NC toll free) 1-800-872-9482.

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From Hungry To Healthy The Importance of Increasing School Breakfast Participation

School breakfast plays a critical role in helping school children reach their full academic potential. This may be especially true for the 1 in 5¹ who live in a household faced with food insecurity. To help our nation’s children who need to move from hungry to healthy2, we are committed to increasing student participation in School Breakfast Programs. Collectively we will work together to: • Increase awareness of the critical impact School Breakfast Programs have on learning, nutrition security, diet quality and student health. • Provide resources to empower schools to champion school breakfast. • Inspire families and communities to embrace school breakfast. • Empower children to take action to help increase access to breakfast in their schools.

¹Food Insecurity in Households With Children: Prevalence, Severity, and Household Characteristics, 2010-11 by Alisha Coleman-Jensen, William McFall, and Mark Nord, Economic Information Bulletin No. (EIB-113) 59 pp, May 2013 2 Approximately 1% of households experience very low food security where children are hungry, skip a meal, or don’t eat for a whole day because of economic challenges at some time during the year.

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Student Interest & Initiatives ncafp.com/students

Franklin Niblock is a rising 2nd year medical student at University

By: Franklin Niblock (MS2) UNC-Chapel Hill

of North Carolina School of Medicine. Franklin obtained a Bachelor of Science in Health Policy in 2012 at UNC-Chapel Hill’s Gilling’s School of Global Public Health. Prior to entering

NCAFP’s Rural Health Experience — Helping North Carolina Medical Students in

medical school, he worked for the NC Office of Rural Health and Community Care.

Finding Their ‘Medical’ Tribes There’s no shortage of free pizza in medical school. The University of North Carolina School of Medicine contracts out with a local pizza parlor to make sure of that. Dozens of interest groups fill the daily lunch hour with PowerPoint presentations on “what it’s really like” in the specialty of (fill in the blank). Pizza provided for the first 30 students.


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Through my first year of medical school I haven’t missed more than a handful of meetings. I participated in meetings for specialties including Regenerative Medicine, Orthopedics, Dermatology, Psychiatry, and Family Medicine. I often attend meetings for specialties I would never consider, hoping to collect a few pearls of wisdom and fill up on free pizza. Thus far, I believe the best piece of advice I have gained came from a general surgeon, Dr. Elizabeth Dreesen. “We doctors are a kind of tribe,” she said to a room full of starry eyed firstyears. “Perhaps not the original definition of the word… We are connected not by blood, but by experience, and interests, and customs.” Dr. Dreesen would go on to stress the importance of finding your own tribe. I was a medical student for less than a week, but these words echoed in my mind: Find your tribe. Each interest group meeting I attended I began to focus less and less on what was being said, and more on how it made me feel. Can I envision these students as my future colleagues? Is this my tribe? The first year of medical school has an amazing ability to remove the

excitement from medicine. Between bouts of learning the Krebs cycle and the Brachial Plexus, it is easy to forget what you are working towards, and it is even more difficult to find time to make plans for your life past Monday’s exam. With the school year winding down, and with the roots of the Brachial Plexus quickly uprooting from my mind, I decided to apply for the NCAFP’s Rural Health Program in Western North Carolina. The program began, as all summer programs should, with a backyard cookout (Not to be confused with a Western North Carolina barbecue). Physicians, residents, and students from four of North Carolina’s medical schools gathered, swapped stories, and learned of their living arrangements for the following week. One of the highlights of the program was living with a local family physician. Soon after dinner, we headed off to our respective homes. The first week was based out of the Hendersonville Family Health Center, the center of the Hendersonville Family Medicine Residency Program. Students watched presentations on rural medicine, panels from physicians, residents, and patients, and participated in “field experiences.” We had the opportunity to follow providers on home visits, teach first aid at a summer

camp, and learn herbal remedies common to the Southern Appalachians on a wilderness hike. After our first week, our group of students scattered across Western North Carolina to shadow Family Medicine preceptors. Students were placed in clinics from Swain to Ashe counties. I spent my time with Dr. Jason Cook, a community-based family physician who works with Hot Springs Health Program, Mars Hill University Campus Health, and even the county jail. Dr. Cook described the medical landscape as we weaved down mountain roads between Asheville, Mars Hill, and Hot Springs. The most unique part of the NCAFP experience was getting to know the physicians, residents, staff and other health care providers of Western North Carolina clinics. Much was learned over pulled-pork barbecue, driving between clinic sites, rafting trips down the Nantahala and late night Trivial Pursuit. I began to picture myself as a local family physician—examining patients’ rashes at the grocery store, swapping in my starch white coat and tie for an open collar, and hosting backyard cookouts with my dedicated, compassionate colleagues. I could not help but think that I may have found my answer. This could be my tribe. This summer I traded in a lunch hour of PowerPoints and pizza for two weeks of incredible experiences and discussions with inspiring family physicians. And that may make all the difference. The NCAFP Foundation offered two other programs to 17 additional medical students this summer, including four-week clinical Externships and the first annual two-week rural health program in Eastern North Carolina.  More information about those student experiences in the next issue of the NCFP.


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Student Leadership Opportunities Deadline to Submit Materials for Elected Positions is November 21, 2014

Contribute to Help Make the 2014 Silent Auction a Success

Elections for new NCAFP student leaders for 2014-15 will take place during the Student Section meeting on Saturday December 6th at the NCAFP Winter Family Physicians Weekend in Asheville, NC. NCAFP student members will elect a Student Director-Elect for the Academy Board and two students to serve as Student Trustees on the NCAFP Foundation Board of Trustees. Deadline to submit materials for these elected positions is November 21, 2014. For more details please visit: www.ncafp.com/ students/leaders. If you have questions please contact Tracie Hazelett at 919-833-2110, ext. 120 or thazelett@ncafp.com.

For questions on contributing or to mail an item to the Foundation’s 2014 Silent Auction, please contact Tracie Hazelett at 919-8332110, ext. 120 or thazelett@ncafp.com.

The NCAFP Foundation’s 2014 Annual Silent Auction will take place Friday, December 5th during the Academy’s Winter Family Physicians Weekend at the Omni Grove Park Inn. The auction will be open 12:00 pm to 7:00 pm providing ample opportunity for attendees and guests to get their bidding wars going on terrific auction items.                    

We Can Shop for You! Please consider a contribution to this wonderful and extremely fun event. We can do the shopping for you if you prefer to make an easy cash contribution.  You can donate online at www.ncafp.com/contribute or you can send a check payable to the NCAFP Foundation. 100% of your contribution will go towards the purchase of Silent Auction items.  Prefer to do your own shopping? Visit Amazon.com, sign into your account and search for NCAFP Foundation 2014 Silent Auction wish list (you can also search by the name of Tracie Hazelett). This list will continue to grow and change as items come in during the next few months. Select, pay and you can even ship them directly to the NCAFP office. You have made a personal contribution from the comfort of your home! The direct link to the Amazon wish list is: http://amzn.com/w/25TMHO8Q6BI0S If donating something personally, or soliciting donations, we are seeking donations such as tickets to sporting events, restaurant gift certificates, weekend getaways, adventure packages, art, nice bottles of wine and other popular bidding items such as gift baskets. 

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Benefits of working for

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ConnectWithCentra.com For more information about opportunities, please contact Mikael Blido at 434.200.3153 or mikael.blido@centrahealth.com



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TOP Security OF MIND: ICD-10 Breaches on the Rise – Are You Covered? Security breaches are becoming a larger part of practicing mediThe U.S. Department of Health and Human Services (HHS) haso designated ICD-10 as a code set under the Health Notice to the HHS Secretary: Submit a cine than they should be. A 2013 HIMSS Leadership Survey Insurance Portability andreported Accountability (HIPAA). Physicians and other health providers will be required to use breach report formcare (www.hhs.gov/ocr/privacy/ (www.himss.org/LeadershipSurvey) that 19%Act of health hipaa/administrative/breachnotificationrule/ ICD-10 effective October 1, 2015. indicated their IT professionals from provider organizations brinstruction.html) to the Health and Human organization faced a security breach within the past year. Services (HHS) Secretary

As you are undoubtedly aware, in comparison to previous HIPAA mandates, the transition to ICD-10 is expected to be

The U.S. most Department of Health & Human Services disruptive for physicians, as theyfrequently are required to adjust documentation other processes. Previous HIPAA o Notificationand by Business Associate: If a publishes violations of HIPAA Privacy and Security Rules on business associate is the cause of the ICD-10 breach, will involve a mandates have allowed physicians to rely on billing services, vendors, and other partners; however, their site: www.hhs.gov. The latest release highlights two gather the identity of each affected individual higher of direct involvement. breachesmuch resulting from level lost and stolen physician unencrypted laptops with from the associate for notification purposes assessed fines and penalties totaling almost $2M in the aggregate. As Medical a result, the Officehas of Civil Rights has developed Mutual heard from(OCR) a number of our insured practices that they in order to prepare for the • Find and plugare theseeking hole thattraining caused the security six educational programs (www.hhs.gov/ocr/privacy/hipaa/ breach transition from ICD-9 to ICD-10. Some have hired outside consultants that have expertise with ICD-10 training for various understanding/training/) for health care providers on complimedical specialties, while others have attended educational seminars offered by the American Academy of Professional ance with various aspects of HIPAA Privacy and Security Rules. In today’s data-driven world, where sensitive patient Coders American Academy ofare Ophthalmic Executive (AAOE), and the Medical Group Management We encourage you(AAPC), to checkthe these out because: (1) they information is collected, stored, and communicated physiciantraining and surgeon practices in of all sizes Association (MGMA). Based on in the cost and toelectronically, implement ICD-10, is imperative order to prepare for informative, and; (2) if you are ever involved a breach andcomplexity you are especially vulnerable means to costlythat andhealth damaging have implemented these programs, or penalty the changeover to code your sets potential for new fine diseases and procedures. This conversion careliabilities providers and from data security breaches. Cybercrime, including identity could be significantly insurers willmitigated. have to replace the approximately 14,000 existing codes with roughly codes. theft, is the fastest growing 68,000 criminal new activity. Whether your data is compromised by a hacker, virus, cyber thief, or simply Implementing practices and procedures to avoid a medical data because of lost or stolen computers, laptops,resources flash drivesavailable or We recognize that we are not ICD-10 experts; however, we thought it would be helpful to compile to breach greatly reduces the risk of encountering one. In the event smart phones, the breaches can have serious ramifications. health care you providers daunting issue. While we may not be in a position to address all of your ICD-10 questions that you do, however, need toon bethis prepared to take action The cost to recreate compromised patient data is staggering, andthe concerns, please have peacetheofpublic, mind knowing that we are working the North Carolina Medical Society (NCMS) that lessens repercussions from patients, and and includes thewith expense of notifying customers—now of course,and a violation of HIPAA. To ease the HIPAA mandated by 46 transition states—possible and medical legal other organizations to identify andcompliance develop resourceslegally to support a smooth for ourfines, insured practices burden on our member practices, Medical Mutual, with input expenses. Your practice can suffer immense to and physician members. The NCMS website currently features a comprehensive listalso of ICD-10 learningdamage opportunities. its reputation and from the interruption to business. from outside counsel, created a HIPAA Survival Guide containing a comprehensive collection of forms, policies, and checklists Medical Mutual is sensitive to the impact that the ICD-10 delay has had on medical practices and physicians. This is (www.medicalmutualgroup.com/hipaa-final-rule-survival-guide). Traditional liability insurance products only cover “tangible” undoubtedly a cumbersome and costly process. Please visit the MedNotes blog to view periodic updates on this issue. assets. Electronic data is not considered “tangible” under the Does your practice have a checklist of what to do in case of typical policy definition. Cyberliability coverage fills that gap. a security breach? For additional information, visit us at www.medicalmutualgroup.com or call us of at:coverage 800.662.7917 There may be a small amount on a professional liability policy, but this amount can be quickly eroded. It is • If data is stolen, notify the local police and file a report highly recommended that all health care offices purchase separate cyberliability coverage. Medical Mutual provides cyberliability coverage (e-MDTM ) to all physician policyholders • Attempt to isolate and take down the data so the comprowith a $50,000 per claim limit. Coverage is offered for privacy mised information cannot be used breaches, HIPAA violations, credit monitoring, cyber extortion and terrorism, notification, and fines and penalties. • Follow the HIPAA Breach Notification Rule: (www.hhs. gov/ocr/privacy/hipaa/administrative/breachnotificationrule/) o Individual Notice: Notify all individuals affected by the security breach via first class mail, or if agreed upon before the breach, through email

For additional information on e-MDTM coverage, visit us at www.medicalmutualgroup.com/meddefense-emd or call us at 800.662.7917.

o Media Notice: If more than 500 patients are affected, provide notice to prominent local media outlets

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8/3/2014 The U.S. Department of Health and Human Services (HHS) has designated ICD-10 as a code set under the Health

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Residents & Chapter Affairs New Physicians ncafp.com/residents-newfps


n a perfectly routine Tuesday morning in early June, Dr. Ann Barham, Residency Director of the Wake Forest Family Medicine Residency Program, stopped just outside her office. Patiently waiting for her was soon-to-be-graduating third-year resident, Dr. Christina Jepson. Jepson looked a little anxious and a bit excited as Dr. Barham handed her an envelope marked 'CONFIDENTIAL.' Grinning from ear to ear, Dr. Jepson opened the envelope, unfolded its letter, and began reading aloud with Dr. Barham by her side. She half jokingly remarked that she had almost forgotten about this letter after writing it herself as an intern. But not really, of course; how could she have, especially after all she had been through with her team. Over the years, this simple but powerful act of writing a confidential note on their first day of internship – documenting their personal and professional hopes and fears - has become a much anticipated tradition for the program's newly-minted family physicians. For many, it's an opportunity to reflect just how far they've come. While Dr. Jepson read, you could hear a beautiful mix of emotions in her voice. Happiness, exhilaration, and even a hint of the bittersweet realization that residency was coming to an end. Beaming and a little emotional when she finished, Drs. Barham and Jepson spontaneously shared a big hug. Stories and scenes like these are a normal part of life at the Wake Forest Family Medicine Residency Program— a close-knit residency program where passion, mutual respect, and teamwork lie at the heart of everything. “The strength of our program is the people and our relationships, and especially the teamwork between residents, program staff and faculty,” noted Dr. Barham. “We attract physicians that are excited about Family Medicine, passionate about what they are doing, and most importantly, committed to helping the people around them." A Service Model Built on People Located in the heart of Winston-Salem,

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The Wake Forest Family Medicine Residency

Exceptional Training Built on People By: Peter Graber NCAFP Director of Communications

N.C., the Wake Forest Family Medicine Residency Program was founded in 1975. The program's founders (WFU School of Medicine and Northwest AHEC) envisioned its graduates playing key roles in communities across North Carolina by providing much needed Family Medicine and primary care services. With key funding provided by Northwest AHEC, the program's first Residency Director, NCAFP Past President Dr. Charles Duckett (1976), began with an 8-8-8 program. After an expansion in 1998 that added two additional training slots, Wake Forest is now one of the state's largest Family Medicine training centers, having graduated more than 345 family physicians. While a lot has changed in medicine these last four decades, Wake Forest has always kept two things constant: its

commitment to its people, and its desire to provide the most supportive learning environment possible. By seeking dedicated, service minded and committed professionals at every turn, program leaders have developed a training culture where everyone is passionate, engaged and excited to come to work every day. Wake Forest's success in creating this people-first atmosphere shows with stories like Dr. Jepson's. But it's also evident in countless other ways, including in the types of physicians it recruits and what happens after graduation. "We recruit from a large geographic area, but our graduates have tended to stay and keep ties," Dr. Barham pointed out. She went on to note that since 1978 approximately 58% of the program's graduates have chosen to practice in North


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Carolina, with scores of them maintaining active relationships with the department. Many attribute Wake's success on the program's people and its vibrant teambased culture. As a graduate of the program herself in 1999, Dr Barham explained that with patient-centered care, team-based care, and population health growing more important by the day, teams form the backbone of nearly everything. Success, in turn, ultimately relies on having the right people. "It really starts with who we try to recruit," said Barham. "We seek candidates who not only have met the rigors of medical school, but who also have a passion for serving, who have been leaders at their medical school and in their communities, and have positive attitudes. That's where it all starts." Best of Both Worlds Training

TOP: Drs. Ann Barham and Christina Jepson share a laugh. Bottom: (L-to-R) Wake Forest Family Medicine Residency Program leaders, including Mary Locke, Residency Coordinator, Dr. Rachel Bixler, Outgoing Chief Resident, and Dr. Ann Barham, Program Director.

Day-to-day, Wake Forest residents train in an environment that merges an academically progressive university setting with the changing frontline demands of community practice. During the intern year, residents join a busy inpatient service team at Wake Forest Baptist Medical Center. Like many large academic training centers, Baptist Medical Center orients residents to a fully-integrated hospital setting and brings them into close proximity to a range of sub-specialty services. According to Barham, Wake's residents are highly respected at Baptist because of their team philosophy, knowledge and passion. But Baptist Medical Center is only one of the hospitals where Wake's residents train. Program residents also get community hospital experience while working at Forsyth Medical Center, a 921-bed facility that provides medical, surgical, rehabilitative and behavioral health services. The program operates its own obstetrics service at Forsyth where residents deliver babies and provide care to newborns. This environment, combined with the academic medical center, is unique. "Our program merges the academic and community setting really well through this approach," Barham noted. For its out-patient experience, Wake Forest is closer to the community than many similar university-based programs. In 1992, program and department leaders made the strategic decision to move their clinic -- The Family Medicine Center -- to an off-campus location. This brought the program directly into the community and made the clinic feel more like a large urban/suburban practice than a purely Continues on next page


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academic one. Housed in the former beginning later this summer, an headquarters of Piedmont Airlines, experience she’s excited for largely Wake's Family Medicine Center is a because of how well-prepared she feels. 20,000 sqft. PCMH Level III facility “Wake’s rural curriculum offered me that's fully computerized. Residents the flexibility to tailor my experiences train by helping to lead robust clinical and electives to what I saw as a need for support teams that feature PAs, nurses, my practice life,’ she noted. She went clinical psychologists, and pharmacists. on to describe that in the community They also get access to a full complement where she will begin practice, there is of clinical and diagnostic support very little hospice and palliative care services, from lab work to X-rays. support. Wake's program enabled her These conveniences, combined with to design her electives around that area having the entire Wake Forest Family & to enhance her skills. Community Medicine Department in Wake Forest graduates have been the same building, creates an extremely supportive “We constantly hear from our environment. Residents love it. graduates and even some of our “We constantly candidates about how happy our hear from our resident’s are. In many cases, it’s graduates and even some of our the happiness and camaraderie candidates about that really stand out.” how happy our resident’s are," — Mary Locke, Residency Coordinator noted Mary Locke, the program’s longserving Residency Coordinator. “In many cases, it’s the entering a wide variety of roles in happiness and camaraderie that really recent years. From traditional fullstand out.” scope Family Medicine to in-patient only or even academic teaching roles, the program's alumni are filling every eamwork is integrated type of need. It's a great testament to into every facet of Wake how well -- and how adaptive -- the Forest's approach. program is at training its residents. Whether in its care "They're all so valuable and we like team huddles, ongoing that we're able to help our residents curriculum design personalize their curriculums. It helps meetings or in other ways, face-to-face them feel confident in taking their next collaboration and communication that steps," explained Dr. Barham. engages residents is constantly central. Supplanting their clinical skills Dr. Rachel Bixler, the program’s training, Wake residents are also outgoing Chief Resident explained that becoming well-versed in some vexing Wake's team-based approach is really a practice transformation issues. Topics result of the combined passions of the such as value-based payment, ICD-10, program's and department's people. and care quality are important topics “Residency is hard enough and you of interest across the specialty now, might as well enjoy the people you’re especially with community practice with,' Bixler described as she spoke leaders. Increasingly, Wake Forest about what made Wake Forest stand residents are being asked to provide out for her while she was interviewing perspectives and insight. programs. She went on to say that "We stay in touch with the community the program preserves that need by around us to know what their needs creating a collaborative environment are. That's teamwork that our residents infused with passion. “We have thirty love,' said Dr. Barham. residents, a full faculty and department Barham went on to outline a number who are passionate and love Family of opportunities on the horizon for the Medicine. Residency would be much program and the department. For now, different without that." program leaders are continuing to do Dr. Bixler absolutely loved her threewhat they do best: focusing on their years with the program, especially people and improving their teams. the opportunities it offered her to It's what has made the program so personalize her training. Bixler will be successful the last forty years. practicing in a small rural community


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Global Exchange: Experience Primary Care Beyond Our Borders By Dr. Aaron George NCAFP Resident Director

Reprinted with permission by the AAFP I recently had the privilege of spending a month in Vienna. And although the historic Austrian capital is known for its music and culture, this was no vacation. My trip was four weeks of intensive learning about primary care outside the United States. So how did I get there? Traditional global health rotations and clinical experiences typically involve physicians traveling to one clinic or hospital and interacting with a specific population. Although this allows unique regional learning opportunities and observation of care at a single location, alternative models are emerging. Our European counterparts in Family Medicine are transforming the global health rotation with the introduction of regional exchange programs. This has been led by the Vasco da Gama young doctors movement (vdgm.woncaeurope.org) of the World Organization of Family Doctors (Wonca) and has been enthusiastically embraced by young doctors movements in other Wonca regions. Recognizing that learning can extend beyond the clinical setting, the Family Medicine 360° exchange program (vdgm.woncaeurope.org) includes components that have the potential to shift perspectives about how health care See ‘Global Exchange’ on p. 29


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By: Dr. Deanna Didiano NCAFP Resident Director-Elect


Residents in White Coats Swarm the N.C. General Assembly: A Grassroots Effect! A former US senator once said, “There are three critical ingredients to democratic renewal and progressive change in America: good public policy, grassroots organizing and electoral politics.” It has been a very busy and exciting time for the North Carolina General Assembly, particularly for the future of healthcare and public education. By now the final state budget, or a vision of a compromise has likely been released and the fate of Medicaid and CCNC decided. This article is not about the

and Director of Government Affairs Joanna Spruill, JD. The briefing was eye opening, energizing, and thought provoking. I went home that night excited to script my talking points to the legislature. I had several heartfelt narratives about the impact Community Care of North Carolina has made on patients and their constituents. I planned to express the need for more state funding and support for the Office of Rural Health to recruit the best new physicians into the rural areas where greatest need for healthcare exists.

budget. This is about the commitment and passion of the resident physicians across North Carolina and their dedication to patient-centered care. In late May 2014, the NCAFP held a White Coat Wednesday event to help guide 16 residents from 12 different NC residency programs as they advocated at the NC General Assembly. This program opened with a session on the interworking of state government, and more importantly, state politics. The event began with Advocacy 101, a legislative briefing presented by the well-versed and passionate NCAFP Executive Vice President Greg Griggs

Finally, to promote the statewide Health Information Exchange (HIE) that will allow physicians and hospitals to provide cost-effective, patient-centered care by preventing duplicate testing, costly re-admissions, and coordinating population health. Throughout the day, 25 legislators met with our residents. We offered ourselves as healthcare experts and promoted patient-centered care through primary care-driven healthcare reform. Dr. Garrett Franklin, a current 3rd-year resident at Wake Forest, felt it was “eyeopening” to see that resident physicians are well-respected among legislators

and know they truly value our opinions. We really are experts in our field and know how quality medicine can be delivered at lower costs. We are wellrespected and our opinions count! Our lawmakers desperately want to know our thoughts and guidance through this process of Medicaid Reform. Their resources are more limited than one might think and every opportunity for us to help them is beneficial for everyone.” Dr. Franklin has even gone above and beyond to coordinate a visit by newlyappointed Senator from Forsyth County, Joyce Krawiec, with the Wake Forest Family Medicine Residency. He hopes to give her a different perspective of health care while energizing his fellow residents to be advocates for change. Going forward we asked our legislators to build on what is working and to advance the progress North Carolina has made in Medicaid reform. Community Care provides the framework for successful, cost-saving accountable care. Value over volume is the battle cry of this grassroots movement!  Recent graduate, Dr. Sonya Williams, of New Hanover Regional Medical Center, says “I feel strongly that in order to be a true advocate for your patients you need to also be a leader in your community and being a resource for local government leaders is a major part of our obligation as physicians.” We truly enjoyed our time at the NC General Assembly. We look forward to maintaining our involvement in healthcare advocacy, and becoming the future medical leaders in our North Carolina communities.


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GLOBAL EXCHANGE, cont. from p. 26 is delivered from a national and systemic standpoint. The primary goal is to support moving beyond unidirectional global health experiences and to increase interaction between young family physicians and physicians-in-training around the globe. The secondary goal of the 360° exchange program is to place participants in unique settings. Although trainees are expected to work with both rural and urban family physicians, they are also encouraged to meet with public health entities, government offices and officials, community partners and leaders, and other key players in the overarching health care system in that country. In this way, participants are exposed to a true cultural perspective of how care is delivered from the ground up. I had the opportunity to participate as the first U.S. resident in the 360° exchange program. I was fortunate to be selected and supported as an Andlinger fellow of the American Austrian Foundation through their collaboration with Duke University Medical Center. My rotation included four weeks of collaborating with the Center for Public Health in Vienna. I spent time in a variety of rural family physician offices, traveled with emergency medical services and observed home visits, and I also met with a host of academic, government and community leaders. I was fortunate to interact with rural family physicians from more than 20 countries.

Along the way, I was encouraged to evaluate regional social determinants of health, payment structures, system limitations, political implications and population perspectives on primary care. I left realizing that many of the problems we see in rural primary care in the United States -- such as payment disparities and diminishing student interest -- are shared around the world. Moving beyond diagnosis and treatment, I developed an appreciation for the truly important role of establishing the best point of access for initial patient care. The most successful interventions are those that are located closest to where the service is most needed. I witnessed the global phenomenon of distance decay, which means that the further an individual lives from a health care facility, the later that person will seek care and the worse his or her outcomes will be. My experiences abroad have genuinely influenced how I perceive the problems -- and solutions -- that are a part of healthcare in the United States. And I feel fortunate to have developed a network of friends in Family Medicine that extends around the world. I encourage U.S. primary care training programs to engage in the exchange program to move beyond simple observership in a unidirectional platform and to promote trainee awareness of global population health issues and increase international interaction. I am honored to be able to share my new perspectives on care delivery and population management and hope that our primary care

trainees will be able to participate with our Wonca counterparts in this opportunity to transform how we interact in global health care and global training. The great news is that the AAFP will be assisting in the exchange program, and you, too, can explore primary care in a different way. Whether you would be participating as a visiting resident or as a host physician or institution, the AAFP is eager to develop a network that will increase the role of the United States in international exchange opportunities. Participation would involve as many as four weeks of rotation time in an international setting or even within a different region of the United States. This is definitely a two-way street, and there are many leaders in the Vasco da Gama movement and other Wonca regional young doctors movements who are looking for reciprocal opportunities to experience health care in different parts of the world. A recently formed young doctors movement for the North America region, dubbed Polaris, could facilitate exchanges to or from North America by early next year. In the meantime, AAFP members seeking more information or hoping to participate in the exchanges may email Julie Wood, M.D., AAFP vice president for health of the public and interprofessional activities, or Alex Ivanov, M.B.A., manager for international Activities. I also would be happy to share my experiences and help connect you or your institution to international networks, so feel free to contact me if I can help in any way.

The Core Content Review of Family Medicine Why Choose Core Content Review? • • • •

CD and Online Versions available for under $200! Cost Effective CME For Family Physicians by Family Physicians Print Subscription also available North America’s most widely-recognized program for Family Medicine CME and ABFM Board Preparation.

• Visit www.CoreContent.com • Call 888-343-CORE (2673) • Email mail@CoreContent.com PO Box 30, Bloomfield, CT 06002

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Practice Enhancement

Important Dates Regarding NCQA PCMH Recognition Under 2011 Standards


Physicians Can Review CMS Payments Data Before it Goes Public in Late September Beginning this September, the Federal Government will roll out an extensive -- and publicly searchable -- online database that lists payments made to physicians and hospitals by drug and medical supply makers. The tool is the centerpiece of The Sunshine Act, a payments disclosure mandate created as part of the Affordable Care Act in 2010. The online tool is expected to allow patients to search for payments made to their healthcare provider, whether it be simple lunches or large, multiyear consulting contracts. Physicians can review this payment data

in advance of it being made publicly available. But to do so, physicians must register with CMS’ Enterprise Portal on or before August 27, 2014. Keep in mind that identity verification for the registration process can take some time, so CMS recommends completing registration as soon as possible and not waiting until the end of this initial 45-day review and dispute period. Once registered, a physician may delegate an authorized thirdparty to review/dispute on their behalf. For additional information and to start the 2-step process, visit https://www.cms.gov

Under the Sunshine Act, a reportable financial transaction includes any transfer of value, including gifts, cash, food, merchandise, travel, fees of any type, honoraria, charitable contributions, and/or current/prospective physician-held ownership and investments, as well as speaking fees or grants for research or continuing education. See the following page for complete information: http://www.aafp.org/advocacy/informed/legal/sunshine.html



Pre-Medical Apprenticeship is Professionally Rewarding and Helpful to My Practice By Glenn Withrow, M.D, A.B.F.P. I graduated from the UNC Family Medicine residency in 1985 and shortly after, I established The Family Doctor (www. ncfamilydoctor.com) in Chapel Hill. We are a traditional family practice with an auxiliary walk-in, urgent care clinic. Our clinical support staff consists of both RNs and Medical Assistants. We have taught medical students and physician assistant students from Duke, UNC, and The Brody School of Medicine at East Carolina University for short periods of time, ranging from one week to one month. Although we have enjoyed having these students and I think that they have benefited from the experience in our office, they are never with us long enough to get a real sense of what Family Medicine is really like.

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The National Committee for Quality Assurance (NCQA) released its latest generation of NCQA medical home standards, PCMH 2014, earlier this year. For Family Medicine practices surveying under the existing 2011 PCMH standards, the following dates apply: December 31, 2014 suggested last day to submit PCMH 2011 corporate survey tools for multisites; and March 31, 2015 - last day to submit PCMH 2011 survey tools.

NC Medical Board Releases New Policy and Position Statement on Use of Opioids for Pain The North Carolina Medical Board recently released an updated and revised position and policy statement for the use of opiates for the treatment of pain. While the majority of the updated policy applies to the treatment of chronic pain and the use of opioid analgesics, guidance for assessing and managing acute pain in primary care is also provided. In developing the updated policy, ‘the Board has relied heavily on the Federation of State Medical Board’s 2013 Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain, borrowed freely and taken material verbatim, with permission, from The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain.’ Physicians interested in reviewing the 58-page policy, can do so by visiting http://www.ncmedboard. org/position_statements .

N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes

In 1995, we established a Pre-Medical Internship. The internship serves two purposes. 1) It trains future health professionals in a variety of clinical skills (including vital signs, EKGs, venipuncture, laboratory and See ‘Pre-Medical’ on Back Cover

Several changes have been made to North Carolina’s Preferred Drug List (PDL) as of date of service May 17th, 2014. For a detailed explanation of the changes, visit https://www. nctracks.nc.gov/content/public/ providers/pharmacy.html


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STAY ON THE ROAD TO 10 STEPS TO HELP YOU TRANSITION The ICD-10 transition will affect every part of your practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. CMS can help you prepare. Visit the CMS website at www.cms.gov/ICD10 and find out how to: •

Make a Plan—Look at the codes you use, develop a budget, and prepare your staff

Train Your Staff—Find options and resources to help your staff get ready for the transition

Update Your Processes—Review your policies, procedures, forms, and templates

Talk to Your Vendors and Payers—Talk to your software vendors, clearinghouses, and billing services

Test Your Systems and Processes—Test within your practice and with your vendors and payers

Now is the time to get ready. www.cms.gov/ICD10

Official CMS Industry Resources for the ICD-10 Transition


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Pre-Medical, cont. from p. 30

they do not want to continue in the medical field after all. This, too, I consider a valuable learning experience for the student. Many of our Pre-Medical Interns return to visit our office after starting medical, PA or nursing school. They always comment that their experience at The

North Carolina Academy of Family Physicians, Inc. 1303 Annapolis Drive Raleigh, North Carolina 27608 Non-Profit Org. US Postage

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energy invested in their training before they become capable of radiology skills) and gives them interacting with our patients. The an opportunity to learn about other downside is the turnover wellness care, diseases, injuries that this creates as these students and mental health conditions. 2) leave us to continue their medical Once fully or near-fully trained, training. Our nursing supervisor we hire them as part-time or fullwill attest to this. Depending time Medical Assistant employees upon how many hours a student in our office. These devotes to the internship students often are pre(we require a minimum Since starting the Pre-Medical medical or pre-nursing of ten hours per week internship, we have trained about students at UNC who and at least three hours want to take off one per shift) and how fast 28 students for medical school, 23 to two years before they are as a learner, the students for physician assistant continuing their formal whole training process school, 6 for nursing school and one medical education. can take as little as two who went to physical therapy school As employees, to three months or as to get his doctorate. they are generally long as nine months highly motivated and to a year. However, we enthusiastic about usually start with vital Family Doctor was extremely patient care. We have found signs and learning to check-in beneficial to them as they that most are eager to learn patients so that the intern can furthered their medical and frequently ask for reading be helpful to us in some way education. They notice that assignments to help them as early as possible. Of course, they are comfortable dealing understand the diseases of the the longer that they stay with with all kinds of patients and patients that they are seeing. us before going back to school different medical situations; that Their intelligence, warmth (we’ve had some students, turned their knowledge of medications and compassion is noticed and Medical Assistants for as long as and vaccines usually exceeds appreciated by our patients. five years), the more it benefits that of their peers; and that Since starting the Pre-Medical our patients and our other staff. they find themselves ahead of internship, we have trained about I have found this the game in doing in-depth 28 students for medical school, 23 “apprenticeship” approach to patient interviews, physical students for physician assistant medical education to be extremely examinations and procedures school, 6 for nursing school and meaningful to me as well as to the that they have observed in our one who went to physical therapy students who intern with us. It office. school to get his doctorate. has become one of my greatest The downside to the program Occasionally, we have had Prerewards of being a family doctor. is the time requirements and the Medical Interns who discover that

6 Free CO*RE Webinars Coming This Year! The State Academies of Family Medicine are pleased to invite you to attend a FREE webinar on Extended-Release/Long-Acting Opioids: Achieving Safe Use While Improving Patient Care. We have scheduled 6 webinars during the next several months -- one of them should be perfect for your busy schedule. The 90-minute webinars meet the FDA requirements for ER/LA opiod risk management and mitigation strategies (REMS), and include cases, tools use and more. A post-activity assessment will help you gauge your increase in knowledge and competency. Upon completion of the assessment and evaluation you will receive 1.5 AAFP Prescribed credits and we'll send you both the faculty slides and additional resources you can use to improve your care of patients. June 23 – Monday September 23 – Tuesday November 11 – Tuesday

June 24 – Tuesday September 25 – Thursday November 13 – Thursday

REGISTER TODAY! If you have any questions, feel free to contact Shelly Rodrigues at srodrigues@familydocs.org

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