V11n3

THE NORTH CAROLINA

Volume 11 Issue 3 / Summer 2015

quarterly news in north carolina family medicine

NCAFP Leaders Go

ON THE ROAD!!

BOOK EARLY & Beat The Rush...

2015 NCAFP

winter FAMILY PHYSICIANS WEEKEND

2015 NCAFP

DEC. 3-6, 2015

winter

Asheville, NC

LEARN MORE AND REGISTER TODAY AT FAMILY PHYSICIANS WEEKEND WWW.NCAFP.COM/WFPW

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“Why can’t I?” They know what alcohol is, and no RS OLDON shouldn’t THE use it, even when many of their friends NCAFP Leaders Go

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ByNCAFP theLeaders timeVisitthey get to college, underage drinkin Member Practices to Gather Insight 14 in their lives and culture. Focus on the implication things like future job opportunities.

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President’s message

16

Membership

Lessonsthat Learned from UNC size does not Dr.fit Maryall Hall Leads STFM During with your c p in mind one in talking Coach Dean Smith an Exciting Time more you talk to your kids, and the more you really get to k auge what they need to hear.

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policy & advocacy

NCAFP’s Multifaceted Advocacy Approach Helps Members Engage

Meetings & education

2015 NCAFP Winter Meeting

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THE NORTH CAROLINA

Residents & new Physicains

International Mission Trips are Rewarding Experiences

Practice management

NC’s Anti-Underage Drinking Campaign Makes Progress

22 26

DEPARTMENTS President’s Message.......................... 4 Policy & Advocacy................................ 8 CME Meetings & Education................. 12 Chapter Affairs.................................... 14

Membership....................................... 16 Student Interest.................................. 18 Residents & New FPs.......................... 22 Practice Management......................... 26

TalkItOutNC.org

PUBLISHED BY 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 • www.ncafp.com MANAGING EDITOR, DESIGN and PRODUCTION

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

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.

PRESIDENT’S

By: Dr. Thomas R. White 2014-2015 NCAFP President

MESSAGE TO MEMBERS

Lessons Learned From Coach Dean Smith (Or has Tom White finally lost his marbles?)

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ast December, Debbie K. Savarino, the oldest daughter of Coach K, spoke at our annual meeting in Asheville.

With me being a Duke graduate and admittedly obnoxious Duke sports fan, it was a fitting talk, and one which was inspiring to all in attendance. So why now would I write this column about Coach K's rival?

Have I "turned coat" or even worse, have I lost all sense of right and wrong? No, and hopefully not.

Years ago I cared for a young man who developed a rare form of cancer. He was an avid sports fan, and a youth basketball and baseball coach, but more than anything, he was a UNC fan, a "dyed in the wool baby blue I hate Duke" Carolina fan. He idolized Dean Smith. And he always said his lifelong dream was to meet Coach Smith in person.

After his diagnosis of cancer, and once it became clear that he was losing the battle, my patient's wish came true. Thanks to the help of a friend with connections inside the UNC athletic department (you didn't think a Duke graduate could pull that off alone did you?), arrangements were made and I drove my patient to the Dean Dome to meet his idol.

Coach Smith spent over an hour with him, talking basketball and (probably)

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

memorable victories over Duke. Coach Smith was gracious, sensitive, and unselfish that day. I even had the honor of meeting him myself. (Which by the way I handled very clumsily. I realized as we were introduced that I had worn my Duke watch that day, and I kept trying to keep it covered with my sport coat sleeve.

Try doing that gracefully.)

I left Chapel Hill that day with new respect and appreciation of a coach whom I had always considered "the enemy." As you know, Dean Smith passed away in February of this year. We heard much about his life and career at the time. Books have been written and will be written about his coaching career as well as his other passions, such as civil rights and eliminating poverty. I have not read any of those books yet, but I watched enough games and followed his career closely enough (mostly with envy and resentment of his success against Duke) to learn some lessons worth sharing: Raise your hand in a fist when you are tired, and need to come out of the game.

(Again, Dr Dennis, "the fist" re-emerges!!!)

Show confidence in the least heralded players on the end of the bench, and they will surprise you with what they can do when they get their opportunity. Stay calm, even when the game looks out of reach. Never give up. Stretch the clock.

Miracles happen.

Create a family-like culture and an environment to which former players want to return to visit, contribute, and work.

When you receive a pass which enables you to score a basket, point to the player who made the assist.

I have to acknowledge, even as a Duke fan, that Dean Smith was one of the wisest and most innovative coaches in sports history. I believe we as family physicians and our Academy can still benefit from his coaching.

Many of you know that I took 2014 off from the practice of medicine as a "minisabattical." I was tired of the 25-patients -a-day treadmill and frustrated with my practice and what it had become. I raised my fist and came out of the game for awhile. I am back playing again, in a small, personalized, independent, direct primary care practice, and I have my wind and spirit back. Maybe more on that at another time.

Whether it be our negotiations with the Legislature, how we balance the past and the future, or how we construct our board and councils, our Academy can learn from Coach Smith as well.

Legislatively, our Academy works incredibly hard, often to the final vote, advocating for our members and our

2014-2015 NCAFP Board of Directors Executive Officers President Thomas R. White, MD President-Elect Rhett L. Brown, MD Vice President Charles W. Rhodes, MD Secretary/Treasurer Tamieka M.L. Howell, MD Board Chair William A. Dennis, MD Past President (w/voting privileges) Shannon B. Dowler, MD Executive Vice President Gregory K. Griggs, MPA, CAE District Directors District 1 - Jessica Triche, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Jason T. Cook, MD Photo courtesy of UNC Athletic Communications

At-Large Jennifer L. Mullendore, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD Osteopathic Family Physicians Mark Sakr, DO New Physicians Cody A. Wingler, MD NC Family Medicine Departments Brian A. Kessler, DO (Campbell)

patients. We don't and won't always win, but we continue to paddle the kayak forward. As I write, the Medicaid reform debate continues, but as that clock ticks down hopefully we will score all we can, and defend as best we can, to win whatever we can.

Last December we held our first "Past President's Breakfast" to honor the service of our past leaders and to learn from their wisdom. (Truthfully, it was set up so Dr. Dennis and I could get a free breakfast in the future, but I digress ...) While we value the past, we also need to bring in fresh blood and energy into positions of leadership. We must recognize that everyone has talents and abilities - often unrecognized. We need to give "new" people a chance to excel, and trust them, whether it be their first CME lecture, chairing a council, or trying something we have never done before.

And lastly, and maybe most important of all, we need to thank each other more, for "making the pass" and assisting us to look better than we really deserve. None of us excels without the help of our colleagues, our Academy staff, and our patients who grant us the privilege to be a family physician.

My patient passed away several months after his "dream come true" day with Coach Smith. Before we left Chapel Hill that day, we stopped at a store downtown that sells every imaginable UNC souvenir known to mankind. (If you think my stepping in the Dean Dome was hard for me, this was far more painful. Did you know you can actually buy a baby blue toilet seat? No, I did not. But I was tempted.) My patient did buy a gawdy Tar Heel folding chair, presumably to sit and watch UNC games on television, and yell at Coach K.

Family Medicine Residency Directors Geoffrey Jones, MD (MAHEC-Hendersonville) Resident Director Deanna M. Didiano, DO (Cabarrus) Resident Director-Elect Margarette Shegog, DO (MAHEC-A) Student Director Christian A. Jasper, MPH (WFU) Student Director-Elect Jeffrey Pennings (Campbell) Medical School Representatives & Alternates Chair (Campbell) Brian A. Kessler, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (UNC) Warren P. Newton, MD, MPH Alternate (Wake) Richard W. Lord, Jr., MD, MA

I suspect he is in that chair right now, laughing at me for writing this and admitting that his idol taught me a thing or two.

AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD, FAAFP AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. ‘Chuck’ Rich, Jr., MD

So now I'm pointing right back at him saying "thank you" for the privilege of being a family physician and having that relationship with him, and pointing a "thank you" to Coach Smith, for his philosophies and his leadership. I appreciate the assists.

The NCAFP Family Medicine Councils Advocacy Council Robert L. Rich, Jr., MD, Chair Brian Kessler, DO, Vice-Chair CME Council

So when DO we play Carolina again?

Alisa C. Nance, MD, Chair

Membership & Workforce Jessica Triche, MD, Chair Benjamin Simmons, MD, Vice-Chair

Go Duke!

Practice Management Council Joseph Pye, MD, Chair Thomas Wroth, MD, Vice-Chair Public Relations & Marketing William A. Dennis, MD, Chair Brian Blank, MD, Vice-Chair

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

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FOUNDATION

ncafp.com/foundation

The 2015 north carolina

Family Medicine Gala Supporting North carolina Medical Students Saturday, August 29, 2015 - Raleigh, NC There’s a terrific Family Medicine Gala Rural Health Experience, and the NCAFP happening later this month -- please Leadership Elective. In addition, the consider joining us in person or in spirit!

Foundation also provides yearly financial The NCAFP Foundation’s inaugural support directly to the state’s five Family Family Medicine Gala is scheduled for Medicine Interest Groups at each Saturday, Aug., 29, 2015 in Raleigh. The medical school. These programs impact Gala will be a fun and glamorous black students by helping them learn about student or by taking advantage of several tie (optional) event that will include Family Medicine and what it means to sponsorship opportunities available. food, spirits and a fantastic evening be a family physician.

To learn more or to make an spent honoring and roasting a legend Tickets to the Gala may be purchased online donation, simply visit in the field of Family Medicine in North online. NCAFP members wishing to www.ncafp.com/2015gala or contact the Carolina, Dr. Jim Jones. support the event but who cannot NCAFP Foundation’s Tracie Hazelett.

The goal of the Family Medicine Gala attend in-person can still be a part of is to help raise money for the NCAFP the celebration by sending a medical Foundation’s Family Medicine Interest Initiatives.

These initiatives play vital roles in helping to • Provided individual financial support to over 180 medical students totaling $108,400 for ensure the future direct clinical experiences and attendance at Family Medicine Meetings. of Family Medicine in NC by offering • Supported the Family Medicine Interest Groups at each NC medical school totaling nearly valuable, first-hand $15,000. clinical experiences for North Carolina • Provided rising second-year medical students with nearly 3,500 hours of clinical and medical students. didactic experiences.

Examples include programs such as the • NCAFP family physician members provided nearly 4,000 hours of preparation, teaching, mentoring NCAFP Foundation and leading medical students through our programs.

Externship Program, the NCAFP Foundation

Honoring Dr. James G. Jones

The Work of the NCAFP Foundation in 2014

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

This is something we do for ourselves.

Shannan Kirchner, MD | Port Townsend, Washington AT T E ND E D 201 4 A A FP ANNUAL MEETING

R E G I S T E R T O D AY DENVER

SEPT 29–OCT 3 a a f p . o rg /f m x

2015

HEALTH POLICY

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

ADVOCACY & GOVERNMENTAL AFFAIRS

NCAFP’S Multi-Faceted Advocacy Approach Makes It Easy for Members to Participate NCAFP takes a multi-faceted approach to advocacy. Not only are staff efforts part of our overall advocacy strategy, but engaging family physicians in grassroots activity and connecting lawmakers to family physicians, residents, and students are essential elements as well.

There are many ways to participate in our government affairs strategy and most are relatively easy. If you are looking for a way to increase your involvement with our advocacy efforts, read on for some ideas!

White Coat Wednesday: See Advocacy in Action in Raleigh During the current 2015 legislative long session, NCAFP held two White Coat Wednesdays, on April 15th and on June 10th. White Coat Wednesdays provide students, residents, and physicians an opportunity to meet with their elected officials and advocate on issues important to Family Medicine. NCAFP schedules the legislative meetings and provides participants with talking points and tips for making the most out of their visit. This year, members advocated for building on our primary care case management program and for supporting physician-led Medicaid reform. Participants also spoke on several bills that were particularly relevant at the time.

While there will not be any more White Coat Wednesdays this year, NCAFP will hold at least one next year during the General Assembly's ‘short session.’

White Coat Wednesdays usually coincide with a quick advocacy training and always include a briefing on the issues.

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

This grassroots event is a great way to meet your elected officials, as well as a way for members to continue to grow their relationship with legislators. If you

are new to advocacy and want to get more involved, signing up for a White Coat Wednesday is a great place to start.

Medicaid Reform Debate Continues At the time this publication went to press, the Medicaid Reform debate still waged on in Raleigh. The House passed a bill similar to the House’s version of Medicaid reform from last year, which kept reform in the hands of North Carolina providers. The House proposal, House Bill 372, would move our current fee-for-service Medicaid payment system to a fully capitated system and charge “Provider-led Entities” (PLEs) to form an organization that would receive a risk-adjusted, capitated rate for each Medicaid recipient enrolled in their health plan.

The Senate ultimately outlined their proposal for Medicaid reform in their budget then created a committee substitute to the House bill. The proposal, much like their proposal from last year, calls for both provider-led and commercial managed care organizations to receive capitated payments for each Medicaid recipient enrolled. Other differences between the two plans include: the timeline for implementation, the agency charged with running the Medicaid program, what covered services would be included with

ncafp.com/advocate

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(2) Primary Contact Program: Become a Trusted Resource for Legislators NCAFP's Primary Contact Program is not only a way for members who are experienced in advocacy to intensify their engagement, but it is also a way for members new to advocacy to learn more about our issues and become engaged.

The goal of the program is to connect lawmakers to family physicians in their district by building a network of family physicians willing to contact, educate, and inform state representatives about issues import to Family Medicine.

Primary Contacts are charged with cultivating a relationship with their elected official through meetings in district, emails, phone calls, and meetings in Raleigh.

Our program is easy, and NCAFP provides you with the tools needed to succeed. We help Primary Contacts set up meetings with their legislator and provide talking points for emails, phone calls, and meetings.

Other responsibilities that Primary Contacts may have include: • Responding to NCAFP's call to action alerts • Meeting with elected officials in their district • Submitting a Letter to the Editor

Let’s make NCAFP’s voice even

• Attending White Coat Wednesday • Recruiting others to participate Signing up to be a Primary Contact is a great way to promote Family Medicine across North Carolina. It is also a way for you to become more familiar with the issues and policies that affect your practice and your patients.

in Raleigh

(3) FamPAC: Contribute to Our Success NCAFP's Political Action Committee provides North Carolina family physicians a voice in our state legislature. FamPAC is a non-partisan Continues on next page

MEDICAID REFORM

Join Us Today!

the capitation payment, and whether it is built on the existing care management infrastructure.

The NCAFP government affairs team continues to monitor these negotiations and to advocate for a strong foundation of primary care and for building on our existing infrastructure of patient-centered medical homes.

For a full recap of this year’s legislative session, be sure to check out the Fall edition of this magazine — so long as the legislature adjourns by then!

FAMPAC Empowering Family Medicine

You belong on our team.

FAMILY MEDICINE

Contributing to FAMPAC is easy and can be done conveniently online.

Simply visit www.ncafp.com/fampac to make your contribution.

Carolinas HealthCare System, a national leader in the transformation of healthcare services, is actively seeking dynamic Family Medicine physicians to join our growing team throughout North and South Carolina.

political action committee that supports candidates who demonstrate concern for issues important to family physicians and your patients. It is the only state political action organization dedicated solely to promote family physicians and Family Medicine.

Physician Career Opportunities

General details include:  Primarily outpatient only with a few locations offering inpatient  Positions are Monday–Friday, 8 a.m.–5 p.m.  Comprehensive Care Teams At Carolinas HealthCare System, you will work as a key member of a supportive team that is responsive to your opinions and respects your expertise. With more than 1,000 primary care physicians across our System, we are One team dedicated to transforming the delivery of healthcare while providing a superior patient experience.

Our service area allows for an exceptional quality of life, giving you the option of living and working anywhere between the world-famous Carolina beaches and the breathtaking Blue Ridge mountain chain.

We offer a comprehensive compensation and benefits program designed to be competitive and responsive to the varied needs of our diverse workforce.

For more information about a career with Carolinas HealthCare System, please contact:

MICHELE ROCCO PHYSICIAN RECRUITER

Michele.Rocco@CarolinasHealthCare.org (800) 847-5084

EOE/AA

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

NCAFP has recently made contributing to FamPAC much easier. Instead of having to remember each year to contribute, contributors now have the option to make a re-occurring monthly payment.

If you have never contributed, here's a few reasons to support FamPAC today: • Legislation is continuously introduced that has the potential to affect your practice for better or for worse. Your FamPAC contributions allow family physicians to have a voice on this legislation.

• A strong PAC is essential to protect the medical home model and to ensure proper safeguards are put in place to protect practices and physicians in any Medicaid reform plan.

• Whether we have a strong PAC or not, groups with agendas counter to ours continue to build strong PACs and Family Medicine risks losing its voice on the issues that matter the most to our profession.

• Not everyone has the time or is comfortable taking an active role with legislators. Contributing to the FamPAC offers an easy and low-risk way for you to be part of the political process.

If you didn't contribute last year, the members who did contribute carried the financial burden, but all of the family physicians in our state benefitted from their efforts. Contributing to FamPAC is an easy way to start becoming more engaged in NCAFP's advocacy efforts.

(4) NCAFP Capitol Report: Subscribe to Learn More The easiest way to become more engaged in NCAFP's advocacy efforts is to subscribe to the NCAFP Capitol Report. The Capitol Report is a weekly email publication that summarizes important events that occurred at the General Assembly. It can include summaries of filed bills that affect Family Medicine, a recap of committee meetings, information on the budget process, updates on committee votes and floor votes, and sometimes calls to action. If you are looking to learn more about the issues and what happens on a weekly basis at the General Assembly, signing up for the Capitol Report is a great way to start!

Becoming more involved with our advocacy efforts is easy. Some ways may take more of an investment than others, but each is equally important to NCAFP's government affairs strategy. Having a strong network of engaged family physicians is key to educating lawmakers about our issues and making Family Medicine an integral part of our healthcare delivery system. For additional information on how to engage, contact Joanna Spruill, JD, at jspruill@ncafp.com.

Find Your Kind in an AAFP Member Interest Group The AAFP is committed to giving all members a voice within our increasingly diverse organization. Member interest groups (MIGs) have been created as a way to define, recognize, and support AAFP members with shared professional interests. MIGs support members interested in professional and leadership development and provide connections to existing AAFP resources, opportunities to suggest AAFP policy, and networking events with like-minded peers.

Current AAFP MIGs include: • Direct Primary Care • Emergency Medicine/Urgent Care • Global Health • Hospital Medicine • Independent Solo/Small Group Practice • Oral Health • Reproductive Health Care • Rural Health • Single Payer Health Care • Telehealth

Visit aafp.org/mig to learn more, join a MIG, or start your own.

EDUCATION

ncafp.com/cme By: Kathryn Atkinson NCAFP Meetings & Events Manager

25+ AAFP PRESCRIBED

CREDITS

2015 NCAFP

winter FAMILY PHYSICIANS WEEKEND

DEC. 3-6, 2015 Asheville, NC

J

oin the NCAFP for our annual Winter Family Physicians Weekend at the wonderful Omni Grove Park Inn this December 3rd-6th, 2015.

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.

Our Program Chair, Dr. Joseph Pye and our Program Vice-Chair, Dr. Nadine Skinner, have assembled an engaging line-up of topics. Evidence-based lectures on timely issues will cover topics such as: Talking Immunization with Your Adult Patients: Practical Strategies for Overcoming Barriers; Managing Postprandial Hyperglycemia; E-Cigs and the Changing Market; and Combined Target Approaches for the Treatment of Type 2 Diabetes: The Role of the Kidney. Additional topics include: Major Depression: Symptomatic Remission and Recovery; Obesity; Physician-Patient Collaborations in Care: Optimizing the Management of Uncontrolled Asthma and many more.

Pre-Conference SAMs Study Working Group on Hypertension Wed., Dec. 2nd from 3:00 pm - 9:00 pm

Arrive early in Asheville and take advantage of a great pre-conference

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

Featuring Pre-Conference SAMs Study Working Group on Wed., Dec. 2nd

SAMS Study Working Group opportunity!

Leading this 6-hour afternoon workshop (Wed., Dec. 2nd from 3:00 pm - 9:00 pm) are two top-rated SAMS instructors, Dr. Janice Daugherty and Dr. Jonathon Firnhaber. Attendees will review 60 core competency questions with this experienced family physician faculty, and decide the best answers with their colleagues. At the end of this course, attendees will be able to demonstrate knowledge in: Pharmacologic and nonpharmacologic management of hypertension; diagnosis and risk stratification of the hypertensive patient; recognition and management of hypertensive crisis and several other topic areas. The AAFP reports your answers directly to the ABFM on your behalf and participants earn CME by completing the SAM process. The fee is $150 for Conference Attendees and $200 for Non-Conference Attendees. Light refreshments and program materials will be provided. Online registration is available at www.ncafp.com/wfpw Hotel Reservations The NCAFP has blocked 80% of the Omni Grove Park Inn’s sleeping rooms for this event. Please book your rooms early as the hotel is likely to sell out for this event.

The Omni Grove Park Inn sleeping room

block offers a variety of room types during your stay. Run of the House Rooms are $220 per night, Resort View Rooms are $240 per night and Mountain View Rooms are $260 per night. There is a $5.00 per night resort fee (reduced from $25 for NCAFP guests). Please call the hotel directly at 800-438-5800 or 828-252-2711. Additional discounted sleeping room rates are available at the Renaissance Asheville Hotel located at 31 Woodfin Street, Asheville, NC (phone 800-468-3571) for $167.00 per night and at the Crowne Plaza, located at One Resort Drive, Asheville, NC (phone 800-733-3211) for $129.00 per night for double rooms and $144 for king rooms.

Be sure to the mention the NCAFP Room Block to receive these discounts. The Renaissance Asheville and the Crowne Plaza Hotel will offer a free shuttle service to the Omni Grove Park Inn to Winter Weekend Attendees staying at these locations. Please book early as rooms will fill up quickly.

Information about registration and hotel reservations will be arriving in your mailbox and via email soon. You may visit our website at www.ncafp.com/wfpw for additional schedule details, conference information and to register online, or you may contact Kathryn Atkinson at 919-833-2110 or via email at katkinson@ ncafp.com.

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

MOC-FP Part IV A P P R O V E D

Strategies & Models to Address Healthy Weight in Primary Care www.ncafp.com/obesity

CHAPTER

By: Tara Hinkle NCAFP Membership Coordinator

ncafp.com/chapter

AFFAIRS, UPDATES & BRIEFS

NCAFP Leaders Go

ON THE ROAD!!

NCAFP District 1 Director Dr. Jessica Triche with her sons at Loreta’s in Greenville, NC

NCAFP Leaders Visit Practices in Greenville and Greensboro

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ummer. Trips, visiting, food, and frozen yogurt. Even the NCAFP took advantage of extra daylight hours and made some memorable road trips this summer. NCAFP board members Drs. Tamieka Howell, Joseph Pye and Jessica Triche teamed up with NCAFP Executive Vice-President Greg Griggs, MPA, CAE, and NCAFP Membership Coordinator Tara Hinkle to coordinate visits to a number of member practices.

The goal of these visits is to get a glimpse into the world of NCAFP members and determine through feedback and dialogue how the NCAFP can best help address practice challenges.

First stop: Greenville

NCAFP IMG Constituency Director

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Dr. Joseph Pye led the way on three practice visits in the area. Practices that were visited included Vidant Employee Clinic, Vidant Family Medicine Greenville, and Firetower Primary Care.

“Visiting area family physicians to share fellowship and perspectives on important issues keeping us up at night was a huge value. We were warmly received, and while we left with unique perspectives into the practices we visited, we heard a lot of common concerns. Also common to the conversations was the request to return and talk more, which we’re already planning to accommodate,” explained Dr. Pye in describing the visits.

Dr. Pye currently serves as Medical Director, Health Informatics and Medical Director, Employee Clinic, for Vidant Health.

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

Later that evening, the group invited Pitt County Academy members to a family friendly social at a local frozen yogurt shop. While members who attended certainly seemed to enjoy themselves, it was the kids who stole the show with their creative dessert concoctions.

Williamston and Tarboro The next stops included practices in the towns of Williamston and Tarboro led

by NCAFP District 1 Director Dr. Jessica Triche. Dr. Triche met with NCAFP members from Martin Family Medicine and Vidant Multispecialty Clinic.

“This was truly a unique and rewarding experience, not only for us through the Academy, but we hope for the physicians we visited,” said Dr. Triche. “I’m a family

physician, too, but we sometimes get caught up in our own localized issues and we forget about the network of colleagues who may be going through similar things. Hearing the challenges -- from a large practice physician to a rural practice physician -- offered different perspectives on some familiar themes,” noted Dr. Triche in describing key takeaways from the experience.

Dr. Triche described an ambitious goal with the visits. “We hope that through these visits, we can start a conversation, offer tools and resources, and work toward some viable solutions so that we can focus on the joy that Family Medicine provides as opposed to the process it can become.”

Dr. Triche is currently practicing at Vidant Family Medicine, Chocowinity.

Greensboro & The Triad The final stops took us to the Triad.

There, NCAFP Secretary/Treasurer Dr. Tamieka Howell led a series of visits to five practices: Cornerstone Family Practice at Summerfield, Kernersville Family Medicine, Walkertown Family Medicine, Lebauer Healthcare at Stoney Creek, and Novant Ironwood Family Medicine.

“I was reminded of the family nature of our profession that goes beyond the obvious.

All of us are a family. We’re in this together.

I reconnected with colleagues I hadn’t seen in years, but we picked up right where we left off. It was interesting to hear some of their concerns and challenges and see new technologies they are using that may be of help to some of our members,” said Dr. Howell. “I was really excited to be a part of the experience, and I know the information shared will be a valuable resource as we tackle advocacy issues and consider ways in which we can better support our NCAFP family.”

Dr. Howell is currently practicing at Novant Health Ironwood Family Medicine.

If you are interested in the NCAFP making a stop at your practice in the future, please send an email to Tara Hinkle, NCAFP Membership Coordinator, at thinkle@ ncafp.com.

Executive’s Desk

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

How Can We Help You? NCAFP Working to Engage Members The primary goal of the NCAFP Membership and Workforce Council is to increase our direct engagement with our members. One way we are doing just that is through practice visits and listening tours across the state.

a few minutes, listen to your concerns and quickly let you get back to seeing patients.

On occasion when we are visiting practices, we will also schedule a casual, drop-in late afternoon or evening event, where you can talk directly with an Starting this summer, NCAFP Board NCAFP Board member and someone members will be partnering with me from your Chapter staff. For example, and other staff we scheduled a members for drop-in at a local periodic practice yogurt store in What is the NCAFP Membership visits. We won’t Greenville for and Workforce Council take much of area members your time, but to come by, say Led by chair Dr. Jessica Triche and want to come hello and have a Vice-Chair Dr. Frankie Simmons, the by, see your refreshing treat NCAFP Membership and Workforce practice, and on us.

Council has the goal of creating a culture gain a better of engagement among family physicians, residents and students. Objectives of the understanding We value your Council are to: of your needs. membership We have and want to • Maintain and grow NCAFP already visited help you in membership practices in the any way we Greenville area can. We hope • Increase and sustain NCAFP engageand around by bringing ment and participation with residency Greensboro, our Board programs and medical schools and we hope to and staff into schedule more your practice • Foster a diverse and involved leadervisits in the environment, ship within NCAFP that represents coming months. we can be much different schools of thought, geography, and employment type better equipped When we to help you in • Strive to ensure an adequate make practice the future. workforce of family physicians in NC visits, we’re not asking you to So if you get a If you would like to know more or become do anything, call or e-mail more involved in the Membership and other than from an NCAFP Workforce Council, please contact Tara help us better board member, Hinkle at thinkle@ncafp.com or Greg understand the please respond Griggs at ggriggs@ncafp.com. issues that keep and let us come you up at night. by to learn how If time permits, we can better we will update serve you. And you on some of the activities of the if you would like to schedule a visit to NCAFP and bounce our ideas off your practice or even help us schedule you as well. But if you are having a visits with other members in your area, busy day in the office (which most feel free to call me at 919-833-2110 or days are), we will simply visit for e-mail me at ggriggs@ncafp.com

MEMBERSHIP

By: Peter Graber NCAFP Director of Communications

NEWS, HIGHLIGHTS AND FEATURES

CHANGE

AND

PROMISE

Charlotte’s Dr. Mary Hall Leading STFM During an Exciting Period

C 16

arolinas HealthCare System’s Dr. Mary Hall was installed as President of the Society of Teachers of Family Medicine (STFM) this past April. Dr. Hall’s presidential term is a culmination of her 28-years of membership in STFM and follows her role as President-Elect last year, and chair of STFM’s Academic Family Medicine Advocacy Committee (AFMAC) from 2011-2014.

a demanding, yet promising time for STFM. With Family Medicine and the entire healthcare system reacting to a sea of change, organizations like STFM are having to quickly adapt. According to Dr. Hall, this environment has introduced several new challenges to STFM but has also brought new opportunities. It’s all part of helping to lead a dynamic organization committed to serving the specialty’s academic community.

Dr. Hall’s presidential term comes at

During

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

a

recent

interview

at

her

downtown Charlotte office, Dr. Hall pointed out that faculty workforce development is a dominant issue for STFM, especially with departments nationwide grappling with increasing shortages.

“Growing our academic faculty is crucial for Family Medicine. The reason why academic faculty are so crucial is because their impact is exponential,” explained Dr. Hall. “Our academic faculty train more physicians and build our workforce

ncafp.com/membership

internally -- they’re huge.” Dr. Hall would ideally like to see a greater percentage of residency graduates enter academic roles to help fill growing faculty needs.

Beyond pure head counts of faculty or even community physicians, however, is what Dr. Hall describes as the need to produce a Family Medicine workforce that serves their communities at the highest level. While this is already happening in many ways, the rapid fire changes buffeting Family Medicine, primary care and the healthcare delivery system are creating entirely new demands. Family physicians must now be as nimble and adaptable as they are clinicallyskilled. According to Hall, while PCMH is a major force now, what will the landscape look like in ten or fifteen years? Will today’s graduates or future ones have the skills to adapt?

“We need family doctors to be at the frontend of change. We want residents, students and faculty to know how to initiate, execute and sustain meaningful change as well,” explained Dr. Hall.

To help teaching practices realize this goal, Dr. Hall described how STFM’s Leading Change Taskforce created a new changeoriented fellowship known as the Leading Change Fellowship: Interprofessional Transformational Leadership. The fellowship works by having a residency program faculty member identify a non-FP or another team member and work with them to create a major change in their practice. While doing so, they interact with fellowship faculty, attend practice improvement symposia, and get to build their change leadership skills within their organizations. Dr. Hall also mentioned that STFM now provides a free web-based ‘Leading Change’ curriculum as another resource supporting this commitment.

Closely connected to faculty and workforce development is STFM’s support for reforms within graduate medical education (GME) funding, specifically its advocacy towards ensuring that any future growth is governed to produce the primary care workforce the country needs.

See HALL on page 30

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STUDENTS

ncafp.com/students

INTEREST & INITIATIVES

NCAFP’s Student Experiences Help Confirm My Decision

Medicine on a national scale. These experiences allowed me to connect with peers from other regions as we recognize and work toward a common goal.

In the end, I realized that my questioning and the resulting deliberation was actually a positive experience. It brought the reasons underlying my decision to enter

As all students must do, I placed my

into Family Medicine into sharper focus

By: Yoon Hie Kim

career goals first and realized, once again,

and ultimately made me more confident

MS4 - ECU Brody School of Medicine

that they would best be met through a

in my choice.

career in Family Medicine.

I

eyes to the excitement surrounding Family

During

These

my

period

of

goals and notions

reflection I relied heavily

of

my

future,

on my experiences with the

have always known that I wanted to

however,

had

NCAFP. I believe students’

pursue Family Medicine – that’s why

been

powerfully

exposure to the specialty

the end of my third year of medical

shaped

even

school was so unsettling. For the first

further

through

time in my medical school career, my

my

of

Family

Medicine

is

exceptional in this state.

We

experiences

are

provided

with

unwavering confidence was shaken during

with the NCAFP.

opportunities

my final rotation. These feelings forced me

Specifically,

beginning of our medical

to truly contemplate my decisions for the

allowed

first time in three-plus years.

learn

school

education

the to

me

to

about

the

experience all that Family

of

Medicine has to offer. The

“culture” Family

they

from

unique

Medicine,

Family

Medicine

one that is unique

culture I have been able

Previously, I had enjoyed knowing exactly

and

impressive.

to experience first-hand is

what I wanted to do and sympathized

The

externship

for my peers who struggled to find their

experience allowed me to appreciate the

throughout medical school. The presence

“calling” after every rotation (and some

workings of a private practice and ask

of the NCAFP at our schools throughout

may still be doing so!). I then found myself

questions about the trajectory and life of

the first few years is key when it comes to

in their midst, forced to take a hard look

a family physician.

The annual winter

introducing students to – and keeping their

at the branching paths that lay before

meetings served as a window into my

interest in – Family Medicine. This presence

me. I agonized over it for weeks before

future as a family physician in North

boosts student participation in programs

the decision resolved itself. In the end, it

Carolina and allowed me to feel increasingly

and conferences which in turn can provide

boiled down to a few factors: the mission

connected to a larger community while

the motivation and inspiration that many

of Family Medicine and its alignment

building friendships across the state.

students may be missing, particularly

what has kept me energized

during their first few years.

with my own career goals, my exposure to Family Medicine at Brody (FM Interest

Finally, the AAFP National Conference

Group, faculty and the clerkship), and my

for Family Medciine Residents & Medical

I look forward to joining Family Medicine’s

participation in the NCAFP Foundation’s

Students and the AAFP Family Medicine

spirited community, where the challenge

student interest programs.

Congressional Conference opened my

of “knowing it all” is a welcomed one.

18

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

NCAFP Foundation’s Summer Programs Popular with Medical Students The NCAFP Foundation helped twenty-eight rising 2nd-year medical students from North Carolina participate in Family Medicine learning experiences throughout this summer. Medical students participated in either the four-week clinical Family Medicine Externship Program or one of the two-week Rural Health Experiences that were delivered in eastern and western North Carolina. All students who applied for programs demonstrated the potential to excel in Family Medicine and offer very diverse academic, work and volunteer experiences. Some sights and scenes from the experiences appear at right.

NATIONAL Health is Primary Begins to Form Core Tactics Teams National Push Continues with Opening Keynote at 2015 National Conference Family Medicine for America’s Health’s (FMAHealth) Core Teams have identified their priority tactics for the year in the areas of Practice, Payment, Workforce Education and Development, Technology, Research, and Engagement. FMAHealth has begun to actively seek members who would like to get involved in these Tactic Teams. Each team has three specific roles that members may fill: project team members, advisory group members, and communicators.

carrying out certain tasks or they may be organizations that have resources and/or infrastructure to support those carrying out specific tasks.

Advisory Group Members are people who use their experience and/or expertise to consult to Tactic Teams. These could include people who lend a particular perspective that would be helpful, including some who are “skeptical friends” who can raise valid questions that challenge assumptions in a useful

Project Team Members can help Tactic Teams get work done. These are people who have the passion and interest in

See TACTICS on page 24

AAFP Weighs In on NIH’s Draft National Pain Strategy Academy Strongly Supports More Physician Education on Pain Treatment In response to the National Institute of Health’s (NIH) solicitation of comments on a draft National Pain Strategy developed by the Interagency Pain Research Coordinating Committee, the AAFP sent a letter offering its feedback in early spring.

The National Pain Strategy is a comprehensive, population healthoriented plan based on a 2011 report from the Institute of Medicine that offered recommendations “to increase the recognition of pain as a significant public health problem in the United States.”

In a May 20th letter to Linda Porter, Ph.D., program director for systems and cognitive neuroscience at NIH’s National Institute of Neurological Disorders and Stroke and a co-author of the draft document, the Academy expressed its support for the draft and its strong agreement that additional education and training is needed to help physicians better treat their patients’ pain.

“The AAFP agrees that provider education and instruction in the use

20

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

of multimodal pain management strategies, to include safe prescribing practices for opioid analgesics as one component of a comprehensive pain management plan, is needed and urges medical schools and Family Medicine residency programs to integrate into curricula and provide during training (this information),” said the letter, which was signed by AAFP Board Chair Reid Blackwelder, MD, of Kingsport, Tennessee.

In 2008, the Academy joined the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the Society of Teachers of Family Medicine in developing recommended curriculum guidelines to teach Family Medicine residents how to care for patients with chronic pain. Those guidelines were revised in 2011.

The letter also explained that the AAFP, along with other major professional physician organizations, continues to oppose any action that limits patients’ access to physician-prescribed

pharmaceuticals.

“The AAFP is committed to maintaining family physicians’ rights to treat their patients efficiently and effectively,” the letter said.

Furthermore, the letter also stated that the Academy is adamantly opposed to mandating CME as a condition for prescribing any type of medication.

The AAFP continues to work with the FDA and other government agencies to support education and physician self-regulation regarding the FDA’s risk evaluation mitigation strategy process, said the letter. “By collaborating with stakeholders and interprofessional groups to address the pain epidemic, the AAFP remains an active partner in processes surrounding physician selfregulation.”

The letter concluded by saying the AAFP plans to continue to collaborate with key organizations and government entities to improve the management of pain, as well as to combat drug addiction and opioid abuse.

Source: AAFP News, May 22, 2015 © AAFP

TEAMS

WORK

WHERE HEALTH IS PRIMARY. In primary care, teams of health professionals provide patients what they need when they need it in a coordinated setting.

Family doctors work closely with team members to keep their patients healthy.

Let’s make health primary in America.

Learn more at healthisprimary.org. #MakeHealthPrimary

RESIDENTS & NEW PHYSICIANS

ncafp.com/residents

By: Holly Stegall, MD Cabarrus Family Medicine

International Mission Trips are Rewarding Experiences for Residents “Hospital medicine in the third world is unparalleled—it will cause you to recognize the resilience of these people, the very essence of survival.”

W

hen NCAFP Resident Director Dr. Deanna Didiano first asked me to share a few words regarding my international medical mission experiences, I was overjoyed, as I do love sharing about my time spent overseas. However, as I began contemplating what to say, I found myself in a bit of a tug of war…how best to share my love for medical missions. I decided to invoke a challenge to change the world, one person at a time whether medical mission work abroad, throughout the USA, or in the great Tarheel State.

So why do I go? In Luke 5:31, scripture reads: “Jesus answered and said to them, ‘Those who are well have no need of a physician, but those who are sick.’” This may seem rather obvious to many of you, but when I sat down and truly considered this verse, I could not help but begin to see the reality of what we do each and every day of our lives. We are asked to share in some of the greatest moments and most difficult times in our patients’ lives.

We are asked to be a healer, a comforter, and most importantly, to share love with those who are in the utmost need.

So then, why not take this vision outside my comfort zone?

With this challenge, my husband Chris and I embarked on our first medical mission trip, alongside two of my medical school buddies, Dr. Tala Smith and Dr. Vontrelle Roundtree, during my fourth

22

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

year of medical school. We traveled to Nicaragua through Global Health Outreach, the medical missions arm of CMDA, at the urging of Dr. Dean Patton of the Department of Family Medicine at the Brody School of Medicine at East Carolina University.

This trip began to weave a love for missions into all of our lives. There is one moment forever etched in my mind from this first trip, a mother who brought her small infant who was dying of dehydration from a diarrheal illness. This experience brought two things to the forefront of my mind: one, this infant lay dying of something we would treat so easily with modern medicine, and two,

life is finite, here but for a moment.

When we returned from this trip, my husband and I recognized how much we

enjoyed international missions and wanted this to become a part of our lives. So with the start of my Family Medicine residency at Cabarrus Family Medicine in Concord, I decided to pursue an Area of Concentration (AOC) in Travel Medicine at the leading of Dr. Charles Rhodes of the Cabarrus faculty, in order to gain more experience.

My husband and I returned once again to Nicaragua, and as one might expect, several moments are again forever etched in my mind. On this particular trip, we were blessed with a small, outdated (by American standards, of course) ultrasound. The midwife and I were the only two female providers on this trip. As you may have guessed, we were inundated with gynecological problems and women with limited prenatal care. I will never forget the look on the faces of one particular young couple when seeing their baby-to-be for the first time…absolute awe!

Of course, this trip only cemented our desire to continue pursuing medical missions, and with that, we were given the opportunity to travel with Hearts United and two of our dearest friends, Chad and Jennifer Whitley, to Nebbi, Uganda, in the winter of 2014.

We worked in the local hospital alongside the hospital’s only physician to provide care for men, women, and children. Hospital medicine in the third world is unparalleled— it will cause you to recognize the resilience of these people, the very essence of survival. You see children battling malaria from constant mosquito exposure and typhoid so severe that it results in intestinal perforation. There are men and women, young and old alike, dying of AIDS every day at endemic rates.

Young women walk for hours seeking help because of failure of their labor to progress at home. Or the hospital’s only physician working tirelessly, night and day, to provide care. Yet, in the midst of this battle, a stoic, irrepressible spirit exists amongst the people.

They are grateful, never complaining, and thanking us for what we represent—love, compassion, and a desire to bring healing to those who are sick.

I hope that you will all consider participating in a medical mission trip to share what you have learned in residency with the world.

T U O D N A P ST L E H & D A LE

Engage in NCAFP Resident Leadership There’s no better way to gain real world leadership experience than by getting involved with the NCAFP. Interact with your peers, network with NC’s leading family physicians and help steer the direction of the specialty.

Elections for all resident offices will take place at the NCAFP’s upcoming Winter meeting in Asheville -- Dec. 3-6, 2015.

Available positions include Resident Director-Elect, (2) Resident Trustees on the NCAFP Foundation Board of Trustees, and (4) Resident Representative positions to the Academy’s councils.

Visit www.ncafp.com/resident-leaders for complete information. The deadline for self-nominations is Fri, Nov. 20, 2015.

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

23

TACTICS continued from p.20 way. In addition to playing an advisory role, you may also be asked to take part in surveys targeted to areas that are of interest to you.

Communicators will stay informed through periodic updates with two ends in mind.

First, you’ll be able to keep on the lookout for opportunities to get involved in more meaningful ways. Second, you’ll be able to let others in your network know what’s happening and get them involved in Family Medicine for America’s Health.

To join a Tactic Team, FMAHealth has created an online portal to help you make an informed decision about how best to get involved. The portal application asks you to provide information about yourself and indicate what role you would like to play, and on which Tactic Team. To express your interest, visit the following page: http://cfarsurveys.polldaddy.com/s/ fmahealth-engagement.

In other Health is Primary news, NCAFP Past President Dr. Karen Smith (2005) of Raeford, NC, was one of three physicians

who helped deliver the opening keynote session at the 2015 National Conference of Family Medicine Residents and Medical Students. The segment showcased three innovative Family Medicine practices from around the country, including Dr. Smith’s own solo rural practice in Raeford, NC. In her comments to approximately 400 medical students, Dr. Smith outlined how Family Medicine can be an fun, innovative, rewarding, and technology-centric career.

She encouraged students to follow their passion for the speciality by relating her own unique journey.

24

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

LEADERSHIP

DEVELOPMENT

Two NC Residents Named to the AAFP Foundation’s Emerging Leader Progam New effort will build and develop leadership skills

T

he AAFP Foundation’s new leadership development program -- The Family Medicine Emerging Leader Institute -- recently selected 30 scholars for the program’s inaugural year, two of which hail from North Carolina Family Medicine residency programs.

Dr. Catherine Coe (PGY-2) of the UNC Family Medicine Residency Program and Dr. John Bernot (PGY-3) of the Wake Forest Family Medicine Residency were selected from more than 100 applicants nationwide.

The Family Medicine Leads Emerging Leader Institute looked to identify Family Medicine residents and medical students who displayed strong leadership potential. In the next year, each participating scholar will complete an intensive 2-day leadership training seminar at AAFP headquarters in Leawood, KS, and be required to complete a project related to one of three areas: Policy and Public Health Leadership, Personal and Practice Leadership, or Philanthropic and Mission-Driven Leadership. The program formally kicked-off earlier this month at the AAFP National Conference of Family Medicine Residents and Medical Students.

Wake Forest’s John Bernot, MD, expressed a lot of excitement for being selected for the prestigious opportunity. Prior to medical school, Dr. Bernot worked in information technology, rising to hold an IT leadership role with the Maryland Hospital Association.

NC’s Emerging Resident Leaders: Resident physicians Catherine Coe, MD (UNC) and John Bernot, MD (WFU) pictured at the 2015 AAFP National Conference.

Dr. Catherine Coe of UNC is also excited to be participating and possesses a range of leadership experience as well. While in medical school at the University of Washington, Dr. Coe helped lead her Family Medicine Interest Group (FMIG) and also served as National FMIG Coordinator with the AAFP. Additionally, Dr. Coe continues to be an active resident leader at UNC, serving as an advisor to UNC’s undergraduate FMIG, and helping UNC Medical School to develop an enhanced three year medical school curriculum pipeline towards service in rural North Carolina.

Congratulations to these two residents.

Look for additional coverage on their experiences in the program in an upcoming edition.

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ncafp.com/practice-mgt

PRACTICE MANAGEMENT, NEWS & INSIGHTS

NC’s Anti-Underage Drinking Campaign Makes Progress, Identifies New Challenges in First Year Family Physicians seen as key partners in statewide effort In December 2014, the North Carolina Alcoholic Beverage Control (ABC) Commission launched “Talk It Out,” a statewide campaign designed to raise awareness about the dangers of underage drinking, and to give parents the tools they need to speak with their children openly, honestly, and often.

The NC Academy of Family Physicians has been one of our strongest allies since the launch of the initiative, and we are grateful for everything you do to help educate patients and families about underage drinking.

Together, we’ve made some real progress in the first year of the campaign.

The percentage of parents who believe that underage drinking is a serious problem rose significantly (from 37 to 44 percent), as did the percentage of parents who frequently speak about the dangers of alcohol with their children (from 33 to 43 percent).

But significant challenges remain. Young people in our state still consider underage drinking to be a bigger problem than their parents do (54 percent vs. 44 percent).

And many parents refuse to accept that it’s an issue that could impact their children. This year’s survey shows that while 87 percent of parents see underage drinking as a community problem, only 59 percent are concerned about their own children drinking, with only 16 percent describing themselves as “very concerned.”

We all want to believe our children and grandchildren would never do anything wrong. But, parents can’t be blinded by love. Instead, their love should motivate them into action. And, I am calling on North Carolinians to choose to act.

Earlier this summer, we launched our second year of the Talk It Out campaign, including a new round of television and radio ads urging parents to take advantage of everyday opportunities to speak with their children.

I encourage you to share our website and materials, including our onepager on Conversation Starters, with the families you serve.

26

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

UNDERAGE DRINKING CONVERSATION STARTERS Things to think about when talking about underage drinking.

Ask open-ended questions and try not to interject or interrupt too much. Truly listen to what your children have to say. It can help you to better understand their thoughts on drinking in general, rather than limiting the discussion to “Do you drink?” Maybe most important, it’s a great signal to them that you are there to listen, now and in the future, if or when there really is a problem.

Take advantage of all kinds of situations. Anytime there’s a commercial, a TV show, a real-life example of someone your kid knows, a drunk person in public, or any other opportunity to talk about underage drinking — take it.

Use age-appropriate messages. It’s never too early to talk to your kids about underage drinking — and there’s no stopping point, either. Just realize that different types of messages will be more effective depending on your children’s ages. (Just saying no is never enough.)

10-12 YEARS OLD

13-17 YEARS OLD

18-20 YEARS OLD

Younger kids — pre-teens and tweens — are typically more curious about alcohol, and this is a great time to have an honest conversation about what alcohol is and the dangers associated with it.

Once kids become teenagers, curiosity can transform into pushing boundaries: “Why can’t I?” They know what alcohol is, and now they need to know why they shouldn’t use it, even when many of their friends are.

By the time they get to college, underage drinking is unfortunately very present in their lives and culture. Focus on the implications their actions can have on things like future job opportunities.

Keep in mind that one size does not fit all in talking with your children about underage drinking.

The more you talk to your kids, and the more you really get to know them, the easier it will be to gauge what they need to hear.

TalkItOutNC.org

Thank you for your continued leadership on protecting the health and safety of our state’s children.

Jim Gardner, chairman of the N.C. ABC Commission, is co-chair of the Governor’s Substance Abuse and Underage Drinking Prevention and Treatment Task Force.

Health, Systems & Improvement

NC IOM Report Stresses Importance of Patient and Family Engagement to Reducing Costs, Improving Care Family Medicine plays important role

By: Jim Gardner NC ABC Commission

Things to say about underage drinking.

Take advantage of every opportunity to engage, listen and make your rules clear.

Relate it to what’s happening at school.

“Do you guys talk about alcohol at school?”

Praise their good judgment and reinforce all the positive things they do.

“Thanks for being a good friend to _____ – they need to see it’s just as cool not to drink. You’re a good role model, and I’m proud of you.”

“Have you ever seen someone from your school drunk?”

Tell a story from your own life, and acknowledge the consequences.

Ask about a party or event. Find out what they’re doing. Make sure they know expectations.

“Did I ever tell you about that time…”

“Haven’t I told you about my friend…”

“When I was a teen, some kids had fake ID’s. Have you ever seen that?”

Share the facts. show you care enough to have done your homework.

“I read that x in 10 kids your age are drinking. I know it might not be you, but it’s probably happening with your friends and with people you know.

Do you want to talk about it?”

“You’re going to your friend’s party this weekend? Let’s talk about what to watch out for.”

“Did you have fun at the party?

What did you guys do?”

Comment on a commercial or TV show.

“Do kids really drink like that these days?”

“Why do you think kids drink alcohol?”

“Did you know it only takes x amount of alcohol before you are too impaired to drive?”

Signal your willingness to talk, when there is a problem and when there isn’t.

“Do you have any friends who are in trouble?

Or maybe need some help? I’m interested in you and your friends’ health/safety and want you to be able to come to me.”

Talk about the latest local news. Use realworld examples to explain the dangers and consequences.

“Hey I heard about… What do you think about that?”

Faced with rising health care costs and suboptimal performance on health care measures, the North Carolina Institute of Medicine (NCIOM) brought together stakeholders from across the state to develop strategies to engage patients and families as partners in their health and health care. Research shows that engagement improves the quality and safety of health care, health outcomes, and reduces health care costs. Meaningful patient and family engagement requires that all stakeholders—patients, families, providers, health care organizations and systems, employers, insurers, and government—take steps Patient to increase patient and and Family family involvement in health Engagement: A Partnership care. The task force issued for Culture recommendations to serve as Change A Report of the a catalyst for stakeholders to NCIOM Task Force on Patient embrace patient and family and Family Engagement engagement to improve July 2015 health and health care systems in North Carolina.

North Carolina The recommendations are Institute of Medicine published in the task force report, “Patient and Family Engagement: A Partnership for Culture Change.”

In partnership with North Carolina Quality Center of the North Carolina Hospital Association, Community Care of North Carolina, North Carolina Medical Society, and Foundation for Nursing Excellence Funded by The Duke Endowment

“Did you hear about what happened to…?”

“My coworker’s son...”

“Are any of your friends pushing you to join them?”

TalkItOutNC.org

CONVERSATION STARTERS:

Family physicians wishing to integrate under-aged drinking prevention within their populations can access a range of resources at www.talkitoutnc.org, including this handy ‘Conversation Starters’ tipsheet.

The core of patient and family engagement lies in welcoming the patient and family as essential partners in care. “It is remarkable to see the difference in the way some patients respond to an invitation and expectation for partnership in care. Doing this well will require health system leadership and culture change,” said Adam Zolotor, MD, DrPH, president and CEO of the NCIOM. There are many organizations and health systems in North Carolina that are working to implement patient and family engagement strategies, including the North Carolina Quality Center, Community Care of North Carolina, and numerous other health systems, and insurers. The task force was convened in order to build upon current efforts and to develop recommendations on best practices and evidence-based strategies for increasing patient and family engagement. The task force recommendations include: • Incorporating patient and family engagement techniques into health professional training • Revising health care organization processes and policies to support patient and family engagement Continued on next page THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

27

• Encouraging more transparency around health care costs, quality, and safety • Ensuring patients and families have meaningful impact on the governance and operation of health care systems and organizations “Engaging patients and families in the governance structure of health care systems allows health care systems to harness the knowledge and expertise that individuals gain as patients to improve both the delivery and experience of care,” said Kimly Blanton, a patient family advisor for Vidant Health and co-chair of the task force. “We hope that stakeholders at all levels of health care in North Carolina will use these recommendations as inspiration to increase patient and family engagement. Both the people of North Carolina and our health care systems can benefit from the knowledge and insights that patients and families bring to the table.”

The NCIOM Task Force on Patient and Family Engagement was created in collaboration with the North Carolina Quality Center of the North Carolina Hospital Association, Community Care of North Carolina, the North Carolina Medical Society, and the Foundation for Nursing Excellence. The Task Force was funded by The Duke Endowment.

Other co-chairs of the Task Force included Melanie Bush, assistant director of policy and regulatory affairs with the Division of Medical Assistance in the North Carolina Department of Health and Human Services; and Dr. Warren Newton, director of the North Carolina Area Health Education Centers Program and professor and chair of the Department of Family Medicine at the University of North Carolina at Chapel Hill School of Medicine. The Task Force included 46 additional task force and steering committee members representing patients and family members, youth, caregivers, providers, insurers, health systems, community-based organizations, local health agencies, and several divisions within the North Carolina Department of Health and Human Services.

The full report is available online http://www. nciom.org/publications/?patient-and-familyengagement

SOURCE: NCIOM Press Release, July 8th, 2015

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THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

UNC Receives AHRQ Award to Advance Heart Health in NC Primary Care The University of North Carolina at Chapel Hill and a cooperative team of health care and quality improvement experts were recently awarded a $15M federal grant from the Agency for Healthcare Research and Quality (AHRQ) to help primary care practices use the latest evidence to improve the heart health of millions of Americans. UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project is one of seven grantees awarded as part of the AHRQ initiative, EvidenceNOW – Advancing Heart Health in Primary Care, which supports the broad U.S. Department of Health and Human Services (HHS) effort for Better Care, Smarter Spending, and Healthier People, and is aligned with the Departments’ Million Hearts® national initiative to prevent heart attacks and strokes.

“The goal of the EvidenceNOW initiative is to give primary care practices the support they need to help patients live healthier and longer,” said HHS Secretary Sylvia M. Burwell. “By targeting smaller practices, we have a unique opportunity to reduce cardiovascular risk factors for hundreds of thousands of patients, and learn what kind of support results in better patient outcomes.”

Heart disease is the leading cause of death for men and women in the United States. In North Carolina, the latest data show an annual cardiovascular death rate of 263 per 100,000, explaining almost one-third of deaths in the state, more than any other cause. To successfully prevent heart attacks it’s critical that health care professionals work with patients to adopt the ABCS of cardiovascular prevention: Aspirin use by high risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation. New evidence is continually evolving about how to best deliver the ABCS. The goal of this initiative is to ensure that primary care practices have the evidence they need and use it to help patients live healthier and longer.

As part of the EvidenceNOW-Advancing Heart Health in Primary Care, Heart Health Now! is composed of public and private partnerships and multidisciplinary teams of experts that will recruit and engage 250-300 small, independent primary care practices and provide quality improvement services typically not available to them because of their size. These services include onsite practice facilitation and coaching, expert consultation, shared learning collaboratives, and electronic health record support.

Heart Health Now! is based at the Cecil B. Sheps Center for Health Services Research in partnership with the NC Area Health Education Center (AHEC) Program’s Practice Support Services, the UNC School of Medicine, Community

Practice Briefs Care of North Carolina (CCNC) and its family of Informatics Services. AHEC and CCNC have already built a standard of success in these areas. To learn more, visit www.ahecqualitysource.com or www.communitycarenc.com

CMS Begins to Implement Medicare Payment Changes as Part of MACRA CMS recently released the first proposed update to the Medicare physician payment schedule since the repeal of the SGR earlier this year. CMS’s proposed rule includes updates to payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System, and updates to the Physician Value-Based Payment Modifier. It’s expected that the final rule will be published this fall.

While Heart Health Now! will conduct an internal evaluation, AHRQ also awarded a grant to the Oregon Health and Science University (OHSU) to conduct an independent national evaluation of the overall EvidenceNOW initiative. The team will study the impact of the EvidenceNOW interventions on practice improvement and the delivery of cardiovascular care.

In addition, the evaluation team will study which practice supports and quality improvement strategies are most effective in improving the implementation of new evidence.

UNC’s grant will run for three years and the evaluation grant for four years. Together, these grants represent one of the largest research investments to date by AHRQ. Funding for this initiative comes from the Patient-Centered Outcomes Research Trust Fund created by the Affordable Care Act and supports AHRQ’s mandate to disseminate and implement patientcentered outcomes research findings so that new findings are integrated into the delivery of health care.

For more information about AHRQ’s EvidenceNOW initiative, including details on each of the grantees and cooperatives, visit: http://www.ahrq.gov/evidencenow. html.

NC Optometric Society Updates Online Listing of Diabetic Eye Care Collaborative Participants Family physicians and Family Medicine practices now have a convenient way to locate and identify optometrists who participate in the statewide Diabetic Eye Care Collaborative (DECC): simply go to www.nceyes.org/decc-participants.

DECC participants are optometrists who have agreed to provide a dilated diabetic ophthalmic examination and submit the results to the patient’s primary care physician. All DECC participants abide by certain communication standards when a family physician/PCP refer a patient for a diabetic retinal eye exam. The listings provide complete name and contact information, including a web address if applicable.

Helpful Tips on Diagnosing Acute Pesticide Poisoning The North Carolina Pesticide Incident Surveillance Program, a program within the NC Division of Public Health, monitors the frequency of acute pesticide poisonings in the state and requires health providers to report confirmed or suspicious cases to them. Like many illnesses linked to environmental exposures, however, pesticide poisonings are commonly under diagnosed due in large part to barriers in seeking care and lack of recognition. So how do you properly diagnose and treat a pesticide poisoning? Taking an occupational and environmental history is the first step. It is not only extremely important for diagnostic and therapeutic reasons, but for workplace corrective action and prevention counseling. For more information on

For more information about Million Hearts, visit http://millionhearts.hhs. gov/index.html.

diagnosing pesticide poisonings, see www2.epa.gov/pesticide-worker-safety/recognition-andmanagement-pesticide-poisonings

North Carolina Tracking Above National Average on Some Key Adolescent Immunizations, According to CDC Survey North Carolina continues to outperform the national average on several adolescent immunizations, including Tdap, MenACWY, and HPV vaccinations according to the latest survey report from the CDC. According to the 2014 National Immunization Survey-Teen (NISTeen), CDC estimates that 92.3% percent of teens (aged 13-17) have received more than 1 does of Tdap (national avg is 87.6%) and HPV vaccinations (both male and female) are above national averages for all dose levels (1,2, and 3 doses). The survey’s results are based on provider-reported vaccination history among teens with adequate provider data.

THE NORTH CAROLINA FAMILY PHYSICIAN • Summer 2015

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HALL, continued from p. 16 “It’s critical to grow GME positions.

But we also must have a clear plan that reflects the needs of our communities,” Dr. Hall said in describing STFM’s work in the area. Dr. Hall explained that STFM was fully supportive of the AAFP’s 2014

whitepaper that outlined the need for comprehensive GME reform. To Dr. Hall, a big part of GME reform entails directing new or reconfigured funding towards the places that are producing the workforce that communities need and desire.

With these issues in mind -- workforce development, change management and GME funding -- Dr. Hall also explained that STFM’s strategic plan is largely built around achieving progress in these areas.

A big part of STFM’s anticipated work plan over the next year centers on the workforce and research aims of Family Medicine for America’s Health (FMAHealth) and especially to having STFM members intimately involved in the project.

Carolinas HealthCare’s Dr. Mary Hall was a panelist at the Health is Primary event in Raleigh this past April.

“Family Medicine for America’s Health is a project we all own,” said Dr. Hall. “We want our members to be fully engaged in helping achieve its goals.”

She went on to note that STFM is committed to ensuring that academic faculty have the skills needed to produce PCMH-competent physicians, but also those well-versed in embracing the Triple Aim. “In all of our work, we tightly link

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our education to clinical work and to the care of our patients.”

Outside of her STFM involvement, Dr. Hall is currently the Chief Academic Officer at Carolinas HealthCare in Charlotte. As Carolina’s Designated Institutional Officer, she is responsible for all educational programs including undergraduate and graduate medical education, continuing education, and programs in nursing, allied health, and the Center for Advanced Practice.

In addition to these responsibilities, Dr. Hall also serves as Associate Dean at the University of North Carolina, where, with Dr. Trisha White, Assistant Dean, she supervises student affairs, student recruitment and curriculum development for UNC School of Medicine’s Charlotte campus.

As Dr. Hall’s daily responsibilities have changed in recent years, they have given her more motivation to continue her involvement nationally in organizations like STFM. Dr. Hall says her STFM service keeps her closely connected to the important work of the specialty even if she’s seeing patients less often in the Family Medicine Center.

“My national work teaches and informs me and I bring it back here. I learn about the issues of concern for primary care nationally that I then work to apply that knowledge locally,” Hall noted. “It keeps me connected and engaged in a specialty I’m passionate about.”

It’s an exciting time of change in the specialty. One that holds a lot of promise. For academic family physicians, STFM continues to play a leading role in equipping and informing them on how best to navigate and thrive.

The Classifieds PHYISICIAN WANTED - Murdoch Developmental Center’s medical providers strive to enhance the well-being of individuals with intellectual and developmental disabilities. We offer low physician ratio, no fee-forservice billing and state benefits. Our medical providers perform annual physical examinations and quarterly medical reviews, refer to specialist as appropriate, and collaborate/participate on interdisciplinary medical and behavioral teams, work flow depends on the needs of our individuals. Hours are flexible, and primarily Monday to Friday from 8:00 AM to 5:00 PM. After hours coverage is telephonic with occasional on-site rounds on weekends and holidays.

For more information; please visit http://www.oshr.nc.gov/jobs/ Employment with the state of North Carolina provides malpractice insurance, health insurance, paid leave, retirement eligibility, longevity bonuses and CME session opportunities, etc. For details on state employment benefits, visit http:// www.oshr.nc.gov/Reward/benefits/leave.htm

PHYSICIANS NEEDED FOR OUTPATIENT EXAMS Tri-State Occupational Medicine, Inc. (TSOM) is looking for physicians to join their group to perform disability evaluations in their NC offices. Part-time opportunities. No treatment is recommended or performed. No insurance forms. No follow up.

No call, no weekends and no emergencies. Physicians working for us have various backgrounds and training. Training and all administrative needs including scheduling, transcription, assisting, and billing are provided. Must have a current NC medical license.

TSOM has an excellent reputation for providing Consultative Evaluations for numerous state disability offices.

Contact: Susan Gladys 866-929-8766 866-712-5202 (fax) susang@tsom.com.

North Carolina Academy of Family Physicians, Inc. 1303 Annapolis Drive Raleigh, North Carolina 27608

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