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THE NORTH CAROLINA

Volume 11 Issue 4 / Autumn 2015

quarterly news in north carolina family medicine

Dr. Maureen Murphy Named National Family Physician of the Year


ORDER YOURS TODAY AT

www.ncafp.com/fps-freakin-awesome


Inside 16

Success in Family Medicine Comes Full Circle

A Grand Tribute to a Godfather of Family Medicine in NC

6

Residents & new Physicians

Great Mentors Were Instrumental in My Educational Journey Kidney Transplant at ion Update

Kidney Transplantation Is the Best Treatm ent Option for Advanced CKD or ESRD When a patient has advanced CKD or ESRD & needs renal replacem ent therapy, treatm ent options included transplantation or dialysis. In general, transplantation will im prove the patient’s quality & quantity of life.

General Assembly Passes Landmark Medicaid Reform Overhaul

8

THE NORTH CAROLINA a

Practice

The num ber of patients listed for transplant far exceeds the num ber of patients transplanted

DEPARTMENTS

each year. As a consequence, waiting tim es for a deceased donor transplant have increased

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

24

Transplanting as the First Mode of Renal Replacem ent Is the Best dram atically improved if a patient can avoid dialysis or limit the tim e on dialysis. Because waiting times are long, early referral & listing, along with living donation, increase the chances of an early transplant.

US HD Units 2012 Data

Network 6

US

Prevalent ESRD Patients

38,712

408,711

All ESRD Pts

# Transplant Centers

10

244

Dialysis Pts

# HD Units

656

6,284

Transplant Rate

0.69

1

GA) are the lowest of all regions in the county

Waiting Tim es for Kidney Transplantation Are Long

12

10 year patient & t ransplant survival are Network 1

Referral & transplant rates in Network 6 (NC, SC,

Waiting Tim e > 1 transplant

President’s Message.......................... 4. NCAFP Foundation................................ 6 Policy & Advocacy................................ 8 Chapter Affairs.................................... 12 CME Meetings & Education................. 14 years).

PUBLISHED BY

STR = 1

Network 6

Kidney Transplantation and Failure in North Carolina

dram atically (average waiting tim e is about 4

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

Transplant Pts

Kidney wait list counts (in 1,000)

health policy & advocacy

Standardized US Transplant Raios ’07-‘10

Wa

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Tim

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st

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fi n ts

la sp

ti rst

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Median waiting tim es (years)

NCAfp foundation

4

chapter affairs

What’s Right with Primary Care and Family Medicine Today

Standardize Transplant Ratio

President’s message

Firefighting Method Very Applicable to Family Medicine

30

Anyone Can Refer a Patient for Transplant Evaluation While most referrals to a transplant center com e from a Nephrologist, anyone can refer. Any patient with an estimated GFR < 20mL/ min can be placed on the waiting list & accum ulate waiting tim e. Ask your patients with advanced CKD or ESRD if they have

National.............................................. considered kidney transplantation & if16 they have been seen at a transplant center. Membership....................................... 20 Residents & New FPs.......................... 24 Student Interest.................................. 28 Practice Management.......................... 30 Counts subsequent list

Year

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.


THE NORTH CAROLINA

PRESIDENT’S MESSAGE

TO

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

NCAFP MEMBERS

Firefighting Method is Very Applicable to Family Medicine “2-In, 2-Out” is about teamwork and trust

I

n recent years I have developed an inThus the notion of “2 in, 2 out.” I learned terest in firefighter health, particularly that there is a rule - which is both philosophitheir risk of cardiovascular disease and cal and federally-mandated - that requires sudden cardiac death. Starting first firefighters to pair up as they enter a fire, so with an assessment of the small local each can assist the other and make sure the fire department in my community, other exits safe and sound. (To be complete, we have expanded the project and are in the OHSA actually requires that firefighters enter midst of a state-wide survey to gather more a scene as a pair, and also that 2 others should data on exactly how firefighter health is be “outside”, with one of them having the assessed in the more than 1,000 departments responsibility of accounting for the 2 on the across North Carolina. We “inside.”) hope to identify “2 in, 2 out.” A best practices, and very simple commonusing evidencesense and effective Whether it’s a firefighter or based approaches, strategy.  advocate for It occurred to me a patient, having a partner at practical and as I learned about one’s side can be beneficial, beneficial stratethis “rule” that it often essential, at times lifegies, backed by had applicability to adequate funding.  the care of patients saving, to prevent problems and It has been in our practices. We actually obtain better results.  an honor and as family physicians also highly form very close educational to be and committed allowed inside the relationships with culture of the “firehouse.” The commitment, our patients. We literally and figuratively walk passion, courage, and attention to detail of with them and hold their hands as they try to these public servants is impressive.  avoid illness and when they deal with illness. But perhaps most impressive of all is the We stay by their side as they try to maneuver comraderie of firefighters. They spend many this complicated health care system. It’s what hours together, in anticipation and under we do. We believe in continuity. Relationships duress. Their families become each other’s over time, not in “Minute” portions.  families. They understand that their personal But a question about “patient noncomplisafety depends on the eyes and ears of each ance” at the “Health is Primary” event in other, of their comrades inside and outside that Raleigh this past February with TR Reid made burning structure, at that dangerous fire scene.  me realize there is another consideration to

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THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

this “2 in, 2 out” rule. In this era of quality outcomes, pay for performance, and accountability, aren’t noncompliant patients going to be more than a nuisance, but a real liability? Isn’t there a risk of patients being discharged from panels and practices who fail to comply and who prevent “goal attainment?” Not true you say. The statisticians and actuarials have “baked” noncompliance into the metrics. We are not expected to have “perfect” numbers. Patients are human. We all have our share. No worries.  Maybe so.  But it does worry me as we enter this new “pay for performance” era, how will we deal with patient behaviors which hurt not merely our “numbers” but our pocketbooks? Will we be quicker to part company with them, letting our “problem patients” become someone else’s “problem patients?” Will we be too impatient with the estimated 50% of patients with chronic diseases who fail to stay on their prescribed medications? Will we “cherry pick” our patients?  I hope not. I hope we never forget that patients are all human, prone to the very same habits, temptations, addictions, and laziness


2014-2015

NCAFP Board of Directors Executive Officers President President-Elect Vice President Secretary/Treasurer Board Chair Past President (w/voting privileges) Executive Vice President

that we as physicians are. We physicians are not particularly perfect patients either. Gasp. Now I’m all for personal responsibility and accountability. But life can get messy. Doing what we know is best for our health is not always easy.  I hope we will remain committed to the “2 in, 2 out” approach with our patients. That we will actually spend even more time and energy understanding the real whys of their noncompliance and imperfections, and assist them in a “we are in this together” kind of way. Even when it costs us time and money in the process. And that we do it for the right reasons.  Which, lastly, begs the question: Do each of us have a family physician? Someone we trust and can confide in? Someone who will walk with US on our own health journey? Someone who won’t be quick to discard us

Thomas R. White, MD Rhett L. Brown, MD Charles W. Rhodes, MD Tamieka M.L. Howell, MD William A. Dennis, MD Shannon B. Dowler, MD 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

when we don’t schedule our annual physical or overdue colonoscopy? Our own “2 in, 2 out” health care partner, preferably a family physician like us. In the longest running campaign in Ad Council history, Smokey the Bear issued this famous warning: “Remember. Only You Can Prevent Forest Fires.”  Actually Smokey, I disagree. It takes a team. Sometimes a village.  Whether it’s a firefighter or a patient, having a partner at one’s side can be beneficial, often essential, at times life-saving, to prevent problems and actually obtain better results.  “2 in, 2 out.” Together With our patients.  That’s what we as Family Physicians do.  And hopefully will continue to do.

At-Large Jason T. Cook, MD At-Large Jennifer L. Mullendore, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Cody A. Wingler, MD NC Family Medicine Departments Brian A. Kessler, DO (Campbell) 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 AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. ‘Chuck’ Rich, Jr., MD The NCAFP Family Medicine Councils Advocacy Council Robert L. Rich, Jr., MD, Chair Brian Kessler, DO, Vice-Chair CME Council

Alisa C. Nance, MD, Chair

Membership & Workforce Practice Management Council Public Relations & Marketing

5

5

Jessica Triche, MD, Chair Benjamin Simmons, MD, Vice-Chair Joseph Pye, MD, Chair Thomas Wroth, MD, Vice-Chair William A. Dennis, MD, Chair Brian Blank, MD, Vice-Chair


THE NORTH CAROLINA

FOUNDATION

Online at ncafp.com/foundation

THE 2015 FAMILY MEDICINE GALA A Grand Tribute to a

I

‘Godfather’

n late August, the NCAFP Foundation held its inaugural Family Medicine Gala in downtown Raleigh. The event brought together over 200 Academy members, supporters and friends of family medicine for an evening of fundraising, fellowship and laughs at the expense of a living legend in NC family medicine: Dr. James G. Jones of Hampstead, NC. Affectionately known by many as ‘the godfather,’ of family medicine in North Carolina, the evening

6

celebrated his remarkable career and the indelible mark he’s stamped onto the specialty. The Gala’s aim was to raise funds for the NCAFP Foundation’s medical student interest programs. These programs are critical to the Academy’s strategy of ensuring the continued vibrancy of family medicine and primary care in communities across North Carolina. All told, the Foundation is proud to report that the Gala was a great success and helped raise more than $50,000! This figure repre-

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

sents the largest ever one-night fundraising event in the chapter’s history and will help make our student programs even stronger. The highlight of the evening were the roasts and video tributes delivered to Dr. Jones. Speakers included NCAFP Past Presidents Drs. Allen Dobson and Shannon Dowler, along with NCAFP Vice President Dr. Charles Rhodes, Dr. Pam Silberman of UNC’s Gillings School of Public Health, and medical student Daniel Moses of the Jerry M. Wallace


CONTRIBUTE

TO THE FOUNDATION

ncafp.com/contribute

of Family Medicine in North Carolina School of Osteopathic Medicine, at Campbell University. In addition, several video tributes were shown, including ones from NCAFP Past Presidents Drs. Lin Church and Douglas Henley (current AAFP Executive Vice President), former NC governor Jim Hunt, and ECU’s Dr. Tom Irons. NC Spin’s Tom Campbell served as Master of Ceremonies.  If you were unable to attend but wish to contribute to the Foundation in honor of  Dr. Jones, go to www.ncafp.com/contribute.

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

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THE NORTH CAROLINA

HEALTH POLICY S T A T E

NCAFP Director of Government Relations & General Counsel

G O V E R N M E N T

General Assembly Passes Landmark Medicaid Reform Overhaul

HO

PATIENTS

PROVIDE

Provider-led Entities (PLE Care Organizations (MC primary administration v

Patients will select or be enrolled in Medicaid plans available in their region One statewide Preferred Drug List

All Medicaid providers w with PLEs/MCOs in their

Dual Eligibles carved-out initially

PLEs expected to be mo could operate statewide. operate statewide

T

he 2015 legislative session marked the end of the beginning of Medicaid reform. In capping nearly three years of debate, the North Carolina General Assembly formally approved sweeping changes to the state’s Medicaid program. The legislation, named Medicaid Transformation and Reorganization, provides a framework for the delivery of services to Medicaid recipients and instructs the Department of Health and Human Services to fill-in many of these details.

Overview The legislation will shift North Carolina’s Medicaid program from its current fee-for-service model to a managed care one, where “Prepaid Health Plans” will receive a fixed payment from the state for the delivery of Medicaid services to Medicaid recipients enrolled in their plan. The term “Prepaid Health Plan” includes both commercial plans and provider-led entities (PLEs). PLEs must be owned by one or more Medicaid provider and must also have a governing body composed of physicians, physician assistants, nurse practitioners, or psychologists. Both commercial plans and PLEs must hold a license issued by the Department of Insurance.

The Delivery of Healthcare Services Each Prepaid Health Plan will hold a contract with the state of North Carolina. These capitated contracts will be awarded through a “request for proposal” issued by the Division of Health Benefits, a new division that will be created within the NC Department of Health and Human Services. The new division will also set capitation rates that are actuarially sound and risk-adjusted. The contracts will also include a portion that is at risk for achieving quality and outcomes. More details

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By: Joanna Spruill, JD

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

about the number and nature of the contracts are below. There will be three statewide Prepaid Health Plans that may be either a commercial insurance plan or a PLE. There will be up to ten regional plans for only PLEs. Contracts will be awarded on staggered terms to avoid having to renew all contracts at the same time and ensure against gaps in coverage. Initial terms will be three to five years. All Prepaid Health Plans will be required to cover all Medicaid and NC Health Choice services, including physical health, prescription drugs, long-term services and supports. Behavioral health services for Medicaid recipients currently covered by LME/MCOs are not covered in the capitated contracts and will continue to be paid as they are currently for at least four years after capitated contracts begin.

Practices may contract w PLEs and MCOs

Six regional service areas designed by DHHS

Up to 3 MCOs will prov

Safety-net providers inclu

NORTH CAROL NEW MEDICAID NC DHHS to Develop and File Federal CMS Waiver

CMS waiver aproval mid-to-late 2

2015-2016

2017

Dental services will remain fee-for-service and are also not included in the capitated contracts. All Medicaid and Health Choice program aid categories will be covered by the Prepaid Health Plans, except for those recipients who are dually eligible for Medicare and Medicaid.

Timeline of Implementation Before North Carolina can make any changes to our Medicaid program, the changes must be approved by the Centers for Medicaid and Medicare Services (CMS) at the federal level. In order to make the changes required under this legislation, North Carolina is required to submit a waiver to the federal government. An outline of


Online at ncafp.com/advocate

OW REFORM WILL AFFECT

ERS

PAYMENT

Es) and Managed COs) will be new vehicles

will have to register r region

ostly regional, but . MCOs can only

Capitation rates to be actuarially determined based on patient population.

New Divsion of Medicaid Management within DHHS to run program

Full capitation to begin 18-months after official CMS approval of waiver.

General Assembly setting aside $225 M to cover startup and capitation costs

Initial Provider Protections: CCNC to remain in-place until full implementation Rate floor for primary care

with both

Commercial insurance laws will also apply to Medicaid Managed Care plans

s will be

PROGRAM

Medical Loss Ratio is 88% One statewide Preferred Drug List DHHS to launch ‘Innovations Center’ Annual expense rate increase mandated at 2% lower than national average.

vide coverage statewide

uded

LINA’S D

l anticipated 2017

Capitated contracts and initial enrollment begins

2018 -2019

this process and other deadlines imposed by the bill are as follows: March 1, 2016: NC Department of Health and Human Services (NCDHHS) must report back to the General Assembly regarding: their progress on the waiver, the timeframe for waiver submission, any other statutory changes needed, recommended performance measures, and their CCNC transition plan. May 1, 2016: NCDHHS to submit to the General Assembly a program design for the Transformation Innovations Center.

Let’s make NCAFP’s voice even

Current Division of Medical Assistance to sunset

2020

in Raleigh

Contribute

Today!

June 1, 2016: NCDHHS to submit the necessary waivers and state plan amendments to the federal government. July 1, 2016: NCDHHS to renegotiate its contract with North Carolina Community Care Networks (NCCCN), reduce the contract by 15% from its January 2015 contract, and include various performance measures within the contract. June 2017-December 2017*: Estimated CMS approval of the waiver. Continues on next page

FAMPAC Empowering Family Medicine

ncafp.com/fampac


January 1, 2017: Reporting requirements for the Division of Health Benefits kick in, requiring a detailed four-year forecast of enrollment growth, a report of any program changes to be made by DHHS, and the cost to maintain the current level of services. January 31, 2017: Dual Eligible Advisory Committee reports to the General Assembly on their strategy to include dual eligibles in capitated contracts. December 2018-June 2019*: Capitated contracts and initial enrollment begins. December 2019-June 2020*: Current Division of Medical Assistance eliminated. December 2022 - June 2023*: LME/MCO four-year carve out expires. *Dates are all contingent upon CMS approval of the waiver, which we have estimated as 12-18 months. It could take up to 24 months or longer.

Patient and Provider Protections NCAFP along with the NC Medical Society and other physician specialty groups, worked tirelessly during the final stages of negotiation on this bill to ensure that providers and patients were adequately protected. The legislation includes several key protections, such as: • Applying Chapter 58 of the Insurance laws. Chapter 58 currently governs commercial insurance plans and will apply to all Prepaid Health Plans and include protections such as: prompt claim payments (N.C.G.S. § 58-3-225), Managed care reporting and disclosure requirements (N.C.G.S. § 58-3-191), uniform claim forms (N.C.G.S. § 58-3-171), and uniform provider credentialing (N.C.G.S. § 58-3-230) to name a few.

• Requiring Prepaid Health Plans to include all essential providers within their geographical coverage. Essential providers are defined as FQHCs, Rural Health Centers, Free Clinics, and Local Health Departments. • Requiring at a minimum that Prepaid Health Plans must operate with an 88% medical loss ratio, until final federal regulations are promulgated. An 88% medical loss ratio would require the managed care organizations and PLEs to spend 88% of premium dollars on medical care (clinical services, quality improvement, etc). It is a way to ensure the plans are spending an appropriate amount of money on healthcare services and not overhead or administrative costs. • Requiring the use of one preferred drug list for all plans, which will be developed by the state.

Oversight and Regulation The bill envisions a new division within the Department of Health and Human Services, named the Division of Health Benefits, that will slowly replace the current Division of Medical Assistance. The new division is charged with implementing Medicaid transformation and administering and operating all functions, obligations, and duties associated with Medicaid and NC Health Choice programs. The Governor will appoint the Director of the Division of Health Benefits, subject to confirmation by the General Assembly. Two other bodies will also have an oversight and regulatory role. The Department of Insurance will regulate the Prepaid Health Plans since commercial managed care organizations and PLEs are required to hold a license issued by the Department of Insurance. Lawmakers also created a new oversight committee on Medicaid and NC Health Choice to examine budgeting, financing, and operational issues related to those programs.

• Requiring the Department of Health and Human Services to determine rate floors for primary care physicians, specialists, and pharmacy dispensing fees. • Requiring Prepaid Health Plans to maintain provider networks that meet access to care requirements and may not exclude providers except for quality reasons or refusal to accept network rates.

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Role of Community Care of North Carolina NCAFP has maintained throughout the reform process the necessity of building on our award-winning medical home model and advocated for preserving this system throughout the transition to capitation.

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

In the final version of reform, CCNC is preserved throughout the transition period, though DHHS is to renegotiate its current contract with NCCCN by July 2016. The legislature placed certain requirements for the renegotiated contract, including: (1) a reduction of 15% from January 2015 geared towards administration, including informatics; (2) facilitation of a smooth transition of features of the current primary care case management program to the care management models utilized by the Prepaid Health Plans; and (3) inclusion of performance measures.

Miscellaneous Provisions The legislation creates an Innovations Center charged with helping providers achieve the goals of better health, better care, and lower costs. It will support providers through technical assistance and learning collaboratives that foster peer-to-peer sharing of best practices. DHHS is to design a program that creates the Transformation Innovations Center within the Division of Health Benefits. Additionally, the legislation gives the DHHS broad authority to manage Medicaid and NC Health Choice programs within an authorized budget. The only authority retained by the General Assembly is the determination of eligibility categories.

Sustained Advocacy Now that a general framework has been agreed upon by both chambers of the General Assembly and the Governor, it is more important than ever for family physicians to remain engaged in the advocacy process. NCAFP will continue to work with the General Assembly and the Department of Health and Human Services to advocate on behalf of family physicians so that the details of reform can help minimize administrative burdens, ease the transition to the new system, move towards value-based care, and ensure quality care for your patients.


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Let’s make health primary in America. Learn more at healthisprimary.org. #MakeHealthPrimary THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

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THE NORTH CAROLINA

CHAPTER

What’s Right with Primary Care and Family Medicine Today By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

M

any times we get down about the negatives that are happening in medicine right now, especially with all the regulations and acronyms that are thrown at physicians today: PCMH, MU, PQRS, etc., etc. And it’s been even easier this year to sometimes get down, particularly with the fights in our own legislature about the future of the state’s Medicaid program. As a result, sometimes I think we need to step back and remind ourselves of those things that are going right in Family Medicine and primary care. Let’s examine just a few of them. In early October, Rep. David Rouzer (R-NC) and Rep. Joe Courtney (D-CT) announced the formation of the Congressional Primary Care Caucus to focus on the growing primary care needs across the country, particularly in rural and underserved areas. Our own Dr. Chuck Rich spoke at the announcement of the

12

caucus, highlighting the need for primary care in southeastern North Carolina. This is a great step forward to have a caucus within Congress to focus on the country’s primary care needs. Earlier this year, Congress repealed the Sustainable Growth Rate formula that led to the constant threat of major provider rate cuts for Medicare. While things certainly aren’t perfect with Medicare, the same legislation put in motion a new effort to base future Medicare rates more on value versus volume, which should be helpful to primary care. And the legislation specifically recognizes the Patient-Centered Medical Home as adding value to the healthcare system. Despite the Legislature’s decision to move toward a capitated Medicaid system in North Carolina, we were successful in ensuring a few key victories moving forward. Some of these included key provider protections, a single Preferred Drug List for all Medicaid plans in the state, and a glide path for Community Care of North Carolina to continue

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

to provide their care management services and other supports for primary care at least for the next few years. In addition, CCNC received an $18.6 million federal grant over the next four years to help small and independent practices transform to add greater value to the healthcare system. And also in October, the AAFP recognized the true spirit of working for the future of Family Medicine by naming our own Dr. Maureen Murphy as the 2016 national Family Physician of the Year for her work to mentor students, residents and young physicians. The Health is Primary campaign, which stopped in Raleigh in April, continues to move across the country highlighting many of the positive steps family physicians are taking to provide higher quality care at a lower cost to their patients. And finally, both AAFP and your state chapter continue to work with both public and private payers to bring more focus on the importance of primary care, working to


Online at ncafp.com/chapter

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enhance payment for family physicians and reduce the barriers associated with providing exceptional patient care. The fight over the importance of primary care is certainly not over, but there are some signs that the message of strong family medicine is beginning to be heard. It won’t happen overnight, and it will take persistence, but I believe that family medicine is going to ultimately be seen as foundational to our healthcare system. In fact, I think it’s an imperative. But we will continue to need your help to move your specialty forward. So I ask that you continue to be engaged with both the AAFP and the NCAFP. I ask that you continue to reach out to your legislators at both the state and federal level. And I ask that you continue to share your stories with us, both the stories of the good things you are doing and the obstacles you face. Without knowing about both, we cannot effectively move the family medicine agenda forward. And remember, your NCAFP staff is here to help you. I’m glad to come visit your practice and talk with you about any concerns you have. To set up a time for me to visit or even talk by phone, I can be reached most easily by e-mail at ggriggs@ncafp.com. I look forward to hearing from you as we work to give family physicians your rightful place in our nation’s healthcare system.

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THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

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THE NORTH CAROLINA

EDUCATION

By: Kathryn Atkinson NCAFP Meetings & Events Manager

Online at ncafp.com/cme

25+ AAFP PRESCRIBED

CREDITS

2015 NCAFP

winter FAMILY PHYSICIANS WEEKEND

DEC. 3-6, 2015

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

Asheville, NC

Leave The Tangled Strands of Lights at Home...

Kick Off Your Holidays in Asheville During The NCAFP Winter Family Physicians Weekend!

W

hile we haven’t decked the Academy’s halls or hung our stockings just yet, there are certainly no ‘bah-humbug’ attitudes around here. It’s almost time for the holidays and we are so excited for this December! So, whether you’ve been naughty or you’ve been nice, it’s time to get your holiday spirit in gear and make plans to attend the NCAFP Winter Family Physicians Weekend this December 3-6, 2015. Way more fun than untangling strands of lights, this annual event is the perfect kick-start to your holidays. Hosted each year in the beautiful Blue Ridge Mountains of Asheville, NC at the historic Omni Grove Park Inn, this conference brings together over 650 family physicians and other medical providers for a terrific weekend of fun, relaxation and great CME. Our Program Chair this year, Dr. Joseph Pye and our Program-Vice Chair, Dr. Nadine Skinner, have assembled an impressive line-up of topics seen by primary care physicians in practice today. With over 30 knowledgeable and expert guest speakers and 25+ AAFP Prescribed credits on tap, you

14

are sure to come away with pertinent and useful information to begin using in your practice right away. Evidence-based lectures on timely issues such as asthma, depression, cancer, weight loss, wilderness medicine, COPD, and immunizations are just a few of the topics slated for the meeting’s agenda. Our schedule of events also includes several terrific optional workshops and satellite programs all weekend long. Attendees will appreciate the chance to learn more on the topics of diabetes, osteopathic manipulations and procedures, wound care management, streamlined practice enhancements and more. Be sure to also participate in the SAMS Study Working Group on Hypertension and the non-CME satellite opportunities on restless leg syndrome, lowering drug costs, and chronic obesity. Celebrity guest speaker Dominique Wilkins will also be participating at this year’s event. This annual conference and its terrific location offer you a wonderful opportunity to earn useful CME while enjoying valuable quality time with friends and family. The hotel’s top-rated spa is a treat for anyone with its rock walls, tunnels, therapeutic waterfall, and mineral-based pools. Guests

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

will definitely enjoy relaxing in the hotel’s rustic grandeur while sipping hot chocolate by the cozy giant fireplaces in the Great Hall. Fascinating and award-winning gingerbread houses are on display and the beautifully decorated Christmas trees and holiday wreaths are simply stunning this time of year. The amazing skyline of Asheville and its afternoon sunsets are certain to delight all who pause to relax in comfy rocking chairs and admire the view. You and your guests can also explore Asheville’s top-rated breweries during the popular Asheville Micro-Brewery Tour. Or, get your foodie-fix and tour a few off-the-beaten-path shops with local culinary samples during the Asheville Epicurean Tour. The Omni Grove Park Inn and Asheville simply sparkle this time of year! Bring your friends and family because there is something for everyone to do, see, and enjoy! Please visit our conference website at www.ncafp.com/wfpw for additional schedule details and conference information. Or, contact Kathryn Atkinson, Manager of Meetings & Events, at 919-833-2110 (800-872-9482 NC Only) or via email at katkinson@ncafp.com


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THE NORTH CAROLINA

NATIONAL Awards & Recognition

Success in Family Medicine Comes

FULL CIRCLE Concord’s Dr. Maureen Murphy Named National Family Physician of the Year

N

ear the end of September, Dr. Maureen Murphy of Concord, NC, received the AAFP’s most prestigious award when she was named national Family Physician of the Year. The award is just the latest recognition of Dr. Murphy’s lifelong work as one of North Carolina’s leading family physicians, making her not only a state standout, but clearly a national one too! In many ways, Dr. Murphy is representative of the thousands of great North Carolina family physicians who blazed the trail before her. She was extraordinarily honored to have been selected. “The first thing I thought was: ‘How can I possibly compare to Dr. Seaborn Blair?’” explained Dr. Murphy, complete with a look of shock and amazement across her face, to be sure. Dr. J. Seaborn Blair, Jr., of Wallace, NC, was a highly respected rural family physician who received the award in 1988.  In her acceptance speech – in front of several thousand family physicians in Denver - Dr. Murphy recalled seeing Dr. Blair accept the award after being escorted down the aisle by his two family physician sons.  It was a vision that stuck

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THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

2016 AAFP Family Physician o

from AAFP Executive Vice Presiden


of The Year - North Carolinaâ&#x20AC;&#x2122;s Dr. Maureen Murphy accepts her award as the national Family Physician of the Year

nt Dr. Douglas Henley.


A Winding Journey in Family Medicine

with her all these years. In reflecting on her journey, Dr. Murphy attributes her success to the legions of family physicians and colleagues who have guided, mentored, and motivated her along the way. Physicians like Dr. Blair. This was the major message she shared when accepting the award. “I look out here today and see many of you whom I have worked with in some capacity — as students, as residents, as colleagues.  Others are not here physically but they are here, with me.  I see how my life as a doctor was made ever so much better, richer, and more complete by working with all of you,” Dr. Murphy explained.   “Thank you for making me a better doctor --- for asking me all those questions I had to look up.”

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THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

Dr. Murphy’s journey into medicine was anything but typical. She began her career as a television reporter in Joplin, Missouri, in the early 1970s, and later became a public relations professional in the Kansas City area.  It was in 1978, while working as a public relations specialist for the Society of Teachers of Family Medicine, that she discovered her life calling to become a family physician.  As she researched and wrote about the specialty of family medicine, she developed such a strong belief in its tenets that it motivated her to change careers.  She attended the University of Kansas School of Medicine determined to become a family physician.  Dr. Murphy graduated in 1985 with her medical degree and an award for Outstanding Student in Family Practice. A major portion of Dr. Murphy’s lasting legacy to family medicine centers on her gift as a talented teacher and mentor to medical students – the next generation of family physicians. Throughout three decades of practice, she has touched the lives of nearly 200 residents, and more than 1,000 medical students.  Dr. Murphy has also made significant leadership contributions to the NCAFP and the NCAFP Foundation, most notable of which have included establishing several key programs aimed at developing the leadership skills of medical students and residents. In practice, Dr. Murphy has been just as adept, practicing in Gastonia, rural Sparta, and Concord, NC. In each of these places she’s been a beloved physician and an inspiring family doctor and leader. Following her residency at Duke University Family Medicine Residency Program, Dr. Murphy became a clinical instructor at the East Carolina School of Medicine Family Practice Center in Greenville, where she oversaw patient care, as well as administrative duties overseeing nursing staff.  Most recently, her passion for teaching brought her to Cabarrus Family Medicine in Concord, North Carolina, where she continues mentoring the next generation of family physicians and providing care to patients of all ages.  Dr. Murphy remains very involved as a preceptor for medical schools, both in and outside North Carolina. And she shows no sign of letting up, either. In fact, as she closed her acceptance speech, she urged physicians to go the extra mile with medical students and residents. Everyone can play a part, according to Dr. Murphy, because FPs are “freakin’ awesome.”


2016 NCAFP

MID-SUMMER FAMILY MEDICINE DIGEST

2016 NCAFP

FAMILY PHYSICIANS WEEKEND

2016 Mid-Summer Family Medicine Digest Sunday, July 3rd - Friday, July 8th, 2016 Myrtle Beach, South Carolina www.ncafp.com/msfmd

2016 Winter Family Physicians Weekend Thursday, Dec. 1st - Sunday, Dec. 4th, 2016 Asheville, North Carolina www.ncafp.com/wfpw

Learn more at www.ncafp.com/education THE NORTH CAROLINA FAMILY PHYSICIAN â&#x20AC;¢ Autumn 2015

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THE NORTH CAROLINA

MEMBERSHIP

By: Peter Graber NCAFP Director of Communications

Physicians by Day...

Authors by Night

O

utside the rush of busy practice life, family physicians are known to pursue a wide range of hobbies and interests. Some chase subjects like gourmet cooking, some garden, and some are fitness fanatics. There's music, art and even collectibles. The skyâ&#x20AC;&#x2122;s the limit. A number of NCAFP family physicians are authors in their spare time, plying their skills with prose to educate, entertain and help others. The NCAFP caught up with member authors to help uncover what motivates them, discover how they got their start, and possibly to plant the seed with other members that authorship is both attainable and rewarding.

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C. Nicole Swiner, MD Durham Family Medicine Durham, NC Profile: Eight years in full spectrum Family Medicine (minus prenatal and hospital care) at Durham Family Medicine. Serves as an Adjunct Assistant Professor at University of North Carolina at Chapel Hill. Book Title: How to Avoid the Superwoman Complex About the Book: How to Avoid the Superwoman Complex is both a labor of necessity and of love for Dr. Swiner, as she started writing articles for the local newspaper shortly after finishing residency and starting her practice as a family doctor. She used writing

THE NORTH CAROLINA FAMILY PHYSICIAN â&#x20AC;˘ Autumn 2015

as both an outlet from her day-to-day experiences with her patients and also as a way to reach new patients. The writings soon developed common themes, such as the importance of preventive health and of self-awareness as a way to prevent illness. After 8 years, she dreamed of putting all of her common sense medical advice in book form, Thus, How to Avoid the Superwoman Complex was born. The superwoman (or superman) complex or syndrome is the false belief that one person can be all things to all people, perfectly. It can have devastating effects- emotionally, mentally and physically. She hopes this book will serve as a guide for recovering superwomen (and supermen) everywhere to avoid said negative effects, and to make it a little easier and less stressful to take care of one's self and family. What motivated you to write this book? I wrote this book for many reasons, but mostly because of the interest I had in the


Online at ncafp.com/members

topic myself as a new wife and mother with a full time job. To prevent physician burnout, I also needed to do something different to reach a broader audience and broaden my horizons a bit, after nearing a decade of practicing medicine and seeing patients day in and day out. As an FP, what benefits have you seen by your authorship to your practice of medicine? It helps me appear as more of an expert to women and those under tremendous amounts of stress. I'm able to establish much more rapport with other working wives and mothers as we all go through these transitions together. It's also easier for me because almost all of my most commonly covered discussion topics are in this book, so I can say now, "Hey, read chapter soand-so when you get home" and then we can spend time on more things during the visit. Any pointers/tips to potential family physician authors? Don't be afraid. Step out on faith and complete that book idea you've had for years. It's easier, and can be cheaper, than you think. Copies of Dr. Swiner's book can be purchased at www.docswiner.com, www.amazon.com, Barnesandnoble.com, and africanbookstore.net.

Darin Kennedy, MD, FAAFP Elizabeth Family Medicine at CMC Mercy Charlotte, NC Profile: A graduate of Wake Forest's Bowman Gray School of Medicine, Dr. Kennedy completed residency training in Virginia and went on to serve as a United States Army Physician for eight years. He returned to North Carolina in 2009. 

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Book Title: The Mussorgsky Riddle

Corporate Sponsor of the North Carolina Academy of Family Physicians About the Book: A paranormal thriller based on Mussorgsky's masterpiece, psychic Mira Tejedor possesses unique talents that enable her to find anything and anyone, but now she must find a comatose boy wandering lost inside the labyrinth of his own mind. Thirteen-year-old Continues on next page


Anthony Faircloth hasn't spoken a word in almost a month and with each passing day, his near catatonic state worsens. No doctor, test, or scan can tell Anthony's distraught mother what has happened to her already troubled son. In desperation, she turns to Mira for answers, hoping her unique abilities might succeed where science has failed. What motivated you to write this book? I am a huge fan of Pictures at an Exhibition, composed by Modest Mussorgsky, and wanted to write a novel of that famous classical music piece. How it ended up being a murder mystery is anybody's guess.

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FAMILY MEDICINE

Physician Career Opportunities 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. 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

As an FP, what benefits have you seen by your authorship to your practice of medicine? I feel having the creative outlet gives me a different perspective through which to see my patients. The writing lets me try on other voices and other mindsets as well, which I feel broadens my understanding of other people. Any pointers/tips to potential family physician authors? Make the time to write. Make it a priority. Books, short stories, and poems, unfortunately, don't write themselves. Most importantly, if you are passionate about any creative endeavor, make it happen. It will make you a better doctor. Copies of Dr. Kennedy's book are available at Amazon, and Barnes & Noble.com, and can also be ordered from your local bookstore even if it's not in stock.

A. Clark Gaither, MD, FAAFP Goldsboro Family Physicians Goldsboro, NC Profile: In practice for 23 years, graduate of ECU in 1989 and completed residency training at Pitt County Memorial Hospital in 1992. Dr. Gaither was honored by the NCAFP as the 2002 NC Family Physician of the Year. Book Title: Powerful Words About the Book: Powerful Words helps authors, speakers and podcast hosts discover precise, personal and powerful words to better connect with their audience on an emotional level and maximize the impact their particular message will have on the world. What motivated me to write this book? An incident, while hiking solo in La Gomera, Spain, caused me to have an epiphany. Reviewing the pivotal events of my life caused me to consider the profound emotional impact words can have on us when it comes to choice and change. Words and the emotional impact they convey determines if, then how strongly, we connect with others. It is our greatest source of personal power and where our greatest influence lies. As an FP, what benefits have you seen by your authorship to your practice of medicine? Although I wrote Powerful Words with the intention of helping others, the writing experience was of great personal benefit. It allowed me to stretch outside my comfort zone, heal old and new wounds and make myself vulnerable to help others deliver their unique messages to the world. This had practical benefits in all areas of my life, including medicine. Any pointers/tips to potential family physician authors? If you feel you have a book in you, START writing. If you wait until you feel like it you will never do it because you will never feel like it. Use the BIC method of writing- Butt In Chair. Dr. Gaither's book can be purchased via Amazon.

PHYSICIAN RECRUITER

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

EOE/AA

Please let us know if you have authored a book so that we can feature other authors in the future. We already know there are other books out there, including “A Practical Guide to Joint & Soft Tissue Injections” by Mooresville’s Dr. Jim McNabb, and also “Jackie” by Dr. Sam Newsome of King, NC.


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THE NORTH CAROLINA

RESIDENTS & NEW PHYSICIANS

By: Deanna Didiano, DO NCAFP Resident Director

Great Mentors Were Instrumental in My Educational Journey

A

t the end of this academic year, I will have completed my twelfth year of higher education. A great accomplishment that I am proud to have achieved. Despite extensive education, one of the most important things I have learned is that I could not have accomplished this journey without several great mentors. For me there are only a few characteristics that make a great mentor. They have to be supportive and encouraging, they challenge me to reach my goals, and most importantly they have to be respectful as a friend. Like most people, my parents were my first mentors and still are great role models today. However, as I grew to find special interests and a career in medicine, I also found fellow physicians who are just as passionate as I am in the power of caring and educating.

The Power of Mentors As I get ready to start my career, I am continually reminded that healthcare is a challenging and multifaceted profession and I gain a new appreciation for primary care physicians everyday. They devote their lives not only to the treatment, but more importantly, to the education of patients and the future doctors that train under their guidance. “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” Family Medicine physicians are the educators of the healthcare system. They teach patients how to navigate their complicated health issues while guiding medical students and residents on how to navigate a complicated patient.

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THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015


Online at

ncafp.com/residents

t u o p e t S d a e L &

The Resident-Physician Mentoring Program NCAFP residents and physician members can sign-up online to participate in the program. Enrollment is free and requires no set time committment. See www.ncafp.com/rpm for complete program details.

Engage in NCAFP Resident Leadership One such amazing family physician that I have the honor to call a mentor is Dr. Maureen Murphy. As many of you should know by now, the American Academy of Family Physicians (AAFP) awarded Dr. Murphy its 2016 Family Physician of the Year Award at its annual Family Medicine Experience conference this past month. A few things you might not know about Dr. Murphy is that her involvement in medical education goes further than her position as a faculty member at the Cabarrus Family Medicine Residency Program. Dr. Murphy has been a continual advocate for medical education throughout her years as a teacher, preceptor, and mentor. I have heard many stories from medical students, residents, and physicians across the state of North Carolina about the role she played in fostering their See Mentors on next page

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 • Autumn 2015

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MENTORS continued from p.25 passion for Family Medicine over her 20-plus year career. The time she takes working one-on-one with students and residents instills in them the full scope and role a family physician can play in the lives of their patients and in their community.

Advance Your Career

FASTER Mentors make a difference: (Left to Right) Dr. Maureen Murphy is pictured here with Drs. Holly Stegall and Deanna Didiano at the 2014 NCAFP Winter Family Physicians Weekend in Asheville.

There are very few people who have infused my life and my career the way Dr. Murphy has. She has challenged me to stay down to earth in my patient care; to speak persistently as an advocate for patients and family physicians; and to enjoy the colleagues I work with because they will support me. What she has taught me the most is to be a well-rounded physician, by enjoying work and life in balance. As a way to honor and foster the important role mentors play in the lives of young physicians (both residents and new physicians), the NCAFP will be launching a new mentoring program called the Residentâ&#x20AC;&#x201C;Physician Mentoring Program (RPM). The mission is to help Family Medicine residents connect with community physicians for both clinical and professional networking and to help accelerate their careers in the process. One of the goals of this program is to foster relationship building and interaction between residents and community physicians who may not be involved in resident education. This will help residents become great family doctors through clinical insight and relationships with experienced community family physicians. New family physicians are faced with a challenging climate as they enter the workforce. They are navigating an employment market with many job opportunities but are struggling to find the right work environment for them. The goals of the NCAFP Resident-Physician Mentoring Program are to provide residents a reliable resource that will connect them with great NCAFP physician members. Through this mentor relationship they can share their experience and input on practice models, different hospital systems, and the community where they live and work. Please consider joining the Resident-Physician Mentor Program and start a potential synergistic relationship today. NCAFP

Resident+ Physician Mentoring PROGRAM

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THE NORTH CAROLINA FAMILY PHYSICIAN â&#x20AC;˘ Autumn 2015

www.ncafp.com/rpm


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.


THE NORTH CAROLINA

STUDENTS

Online at ncafp.com/students

F A M I L Y

M E D I C I N E

O N

C A M P U S

Family Medicine Interest Groups at NC Medical Schools Busy Promoting Family Medicine

I

n different ways and in different places, North Carolina medical students across the state are sharing their interest and passion for family medicine. The state’s Family Medicine Interest Groups (FMIG) and their student leaders are using tried and true methods of the past and creative new ways to inform and excite medical students who recently arrived on campus (and still undecided upperclassmen) about family medicine.

Promoting Family Medicine at NC's Medical Schools In the few short months since being back in the classroom, most NC medical schools have had organizational fairs where they have shared information about their FMIG or club to prospective members. Most schools have also offered the "What is Family Medicine" talk, with faculty and/or residents offering their perspectives on the diverse opportunities within the specialty. Through these sessions alone, it’s estimated that hundreds of 1st-year students across North Carolina have been introduced to family medicine. ECU Brody FMIG leaders have been busy. In addition to their standard program offerings, they held a Joint Injection workshop early this school year that was sponsored

28

By: Tracie Hazelett NCAFP Family Medicine Interest Initiatives Manager

by one of North Carolina's family medicine residency programs. During October's Primary Care Week, the Brody FMIG participated in a community service activity at the Ronald McDonald House in Greenville where students prepared an evening meal for families. These families were very grateful for the support, conversation and the wonderful meal provided during what is certainly a difficult time in their lives. BSOM students also played a fun and interactive trivia game throughout Primary Care Week, quizzing students about random and important facts about family medicine at the beginning of each class. The students loved it! The Jerry M. Wallace School of Osteopathic Medicine at Campbell University’s Family Medicine Interest Group (CUFMIG) is starting its third year and continues to explode with both interest and activities. The FMIG works hard to raise funds for both their group and the school’s recently created student-run clinic. To help raise funds and promote student interest, CUFMIG planned their first Camels on the Run 5K early in this school year. They had a wonderful turnout, met their fundraising goal, and even secured a corporate sponsorship. This event helped garner great support for the Campbell University

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

Community Care Clinic, a clinic that helps the uninsured population of Harnett County receive the medical care they so desperately need. Duke University's FMIG student leaders have worked hard this year to reach their peers and their initial meetings have been well-attended and are demonstrating strong interest. In addition to their 'Welcome to FMIG' pizza night, Duke FMIG also offers a 'Lifestyles of a Family Physician' opportunity where students are invited into the home of a family physician for dinner. This allows for open and casual conversations about the realities of work/life balance away from the classroom. The dinners provide great opportunities to discuss how family physicians live comfortably and lets students ask any burning question they might have about life as a family physician. At the University of North Carolina School of Medicine in Chapel Hill in late summer, FMIG leaders, faculty and staff hosted a cookout for all interested students, FM faculty and even FM residents. Family Medicine interest at UNC is high and 70 (mostly MS-1s) attended the "What is FM" talk this year. Additionally, UNC FMIG partnered with the Carolina Ob/Gyn Interest Group and others


to offer a workshop about the basics of contraceptive counseling and selection. Family Medicine and Family Planning residents and faculty also led students through hands-on procedural demonstrations of various contraceptive methods. This workshop coincided with the second year students' Reproductive Medicine course, allowing students to apply their knowledge in an interactive setting. In Winston-Salem, the Wake Forest FMIG capitalized on Primary Care Week by partnering with their campus’s Health Policy Interest Group and invited NCAFP’s Executive Vice President Greg Griggs to speak on the state of healthcare reform in North Carolina and the US. The talk was especially timely for MS-2s since they were in a health policy class learning about HMOs, PPOs, the ACA, and Medicaid expansion, etc. The chance to hear real world applications enhanced student understanding of our healthcare system. Wake Forest’s FMIG also recently announced an exciting opportunity to partner with Delivering Equal Access to Care, Wake’s student-run clinic. They plan to offer a series of low-budget, healthy cooking classes this fall at a nearby YMCA, and will work with the Salem Pregnancy and Exchange Scan to fill classes with new mothers. This is only a sampling of the creative way FMIGs are providing outreach - on campus and in their communities - and helping grow student interest in family medicine and primary care as a career option. As of this writing, student membership in the AAFP/NCAFP has risen by over 100 students since classes resumed in August. This increase in membership and FMIG participation is another step towards increasing in the number of students that choose family medicine. We extend a ‘Special Thank You’ to the student and faculty advisors of these groups on campus for their hard work and dedication to reach their peers and their communities!

STUDENT BRIEFS Four Medical Students Awarded NCAFP Foundation Family Medicine Scholarships The NCAFP Foundation is pleased to announce that four medical students have been selected to receive a scholarship through the Foundation for the academic year of 2015-2016. Fourth-year medical students Katy Mayo, ECU; and Liza (Rathbun) Straub, UNC; have committed to family medicine and are currently applying to family medicine residency programs.  Also receiving awards are 3rd-year medical students Hallum Dickens, UNC; and Daniel Moses, Jerry M. Wallace School of Osteopathic Medicine at Campbell University.  The NCAFP congratulates these outstanding students and extends them best wishes as they continue their training. 

Family Medicine Interest Programs Available for First-Year Medical Students The NCAFP Foundation offers a variety of programs and clinical experience opportunities to 1st-Year medical students. These opportunities take place during the summer between your first and second year of medical school and range from two-four weeks in length. To learn more about these programs and the exciting specialty of Family Medicine, visit: www.ncafp.com/students The application deadline to apply for both is January 15, 2016. For questions or more information please contact Tracie Hazelett at 919-833-2110, ext. 120 or thazelett@ncafp.com. Continues on next page

Family Medicine Day Saturday, March 19, 2016 North Carolina

Doubletree by Hilton Raleigh Brownstone Raleigh, North Carolina

Build Skills! ncafp.com/fmd

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THE NORTH CAROLINA

Student Leadership Opportunities

patients preemptively, before dialysis is needed or after short period of time on dialysis. Kidney transplantation becomes less expensive than dialysis approximately two years after the transplant. Given that the average deceased donor transplant functions for 8 years and the average living donor kidney functions for 12 years, kidney transplantation offers a significant cost savings to our health care system compared to dialysis. Because a patient can expect to wait on the kidney transplant waiting list for about 4 years, early referral is critical to allow the patient to accumulate as much time as possible to avoid the need for dialysis. Furthermore, as a consequence of early referral, patients’ living donors can come forward, be evaluated and hopefully donate before dialysis is ever needed.

By: Matthew Ellis, M.D. and Stuart Knechtle, M.D. Duke Transplant Center matthew.ellis@dm.duke.edu stuart.knechtle@duke.edu

K

idney transplantation is known to be the best treatment option for patients with advanced chronic kidney disease (CKD) or end stage renal disease (ESRD), providing longer survival, better quality of life, lower hospitalization rates, and substantial cost savings (1-3). Nevertheless, many North Carolinians with CKD or ESRD are not referred for transplant evaluation; North Carolina has one of the lowest transplant rates (per dialysis patient population) in the United States (see adjacent figure). Furthermore, transplant outcomes are maximized by transplanting

Kidney Transplant at ion Update

Kidney Transplantation Is the Best Treatm ent Option for Advanced CKD or ESRD When a patient has advanced CKD or ESRD & needs renal replacem ent therapy, treatm ent options included transplantation or dialysis. In general, transplantation will im prove the patient’s quality & quantity of life.

Standardized US Transplant Raios ’07-‘10 STR = 1

dram atically improved if a patient can avoid dialysis or limit the tim e on dialysis. Because

Network 6

waiting times are long, early referral & listing, along with living donation, increase the chances of an early transplant.

US HD Units 2012 Data

Network 6

US

Transplant Pts

Prevalent ESRD Patients

38,712

408,711

All ESRD Pts

# Transplant Centers

10

244

Dialysis Pts

# HD Units

656

6,284

Transplant Rate

0.69

1

Referral & transplant rates in Network 6 (NC, SC, GA) are the lowest of all regions in the county

Waiting Tim es for Kidney Transplantation Are Long The num ber of patients listed for transplant far exceeds the num ber of patients transplanted each year. As a consequence, waiting tim es for a deceased donor transplant have increased dram atically (average waiting tim e is about 4 years).

Waiting Tim e > 1 transplant

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Transplanting as the First Mode of Renal Replacem ent Is the Best 10 year patient & t ransplant survival are

Network 1

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2015

Median waiting tim es (years)

The Board of Directors of the Pisacano Leadership Foundation, Inc. (PLF) announced their selections for the 2015 Pisacano Scholarships in early fall. The scholarships, valued up to $28,000 each, are awarded to students attending U.S. medical schools who demonstrate a strong commitment to the specialty of Family Medicine. Duke University School of Medicine’s Trevor Dickey (MS4), was one of six students selected for this prestigious award. He graduated from the University of Washington with a Bachelor of Science in Biochemistry. During his third year of independent study in the Duke curriculum, Trevor earned his Master of Public Health from the University of North Carolina, Gillings School of Global Public Health. Trevor was also one of a select group of students admitted to Duke’s inaugural class in the Primary Care Leadership Track. Through this program, he gained experience working with the underserved through programs such as LATCH (Local Access to Coordinated Healthcare), a case management program for the uninsured in Durham County.

Kidney Transplantation and Kidney Failure in North Carolina: Facts That Matter to Patients

Standardize Transplant Ratio

Duke Student Trevor Dickey Named 2015 Pisacano Scholar

PRACTICE

Kidney wait list counts (in 1,000)

Elections for new student leaders will take place during the Student Section Meeting on Saturday, December 5th 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, 2015. For more details please visit: www.ncafp.com/students/leaders. If you have questions please contact Tracie Hazelett at 919-833-2110, ext. 120, thazelett@ncafp.com.

Anyone Can Refer a Patient for Transplant Evaluation While most referrals to a transplant center com e from a Nephrologist, anyone can refer. Any patient with an estimated GFR < 20mL/ min can be placed on the waiting list & accum ulate waiting tim e. Ask your patients with advanced CKD or ESRD if they have considered kidney transplantation & if they have been seen at a transplant center.


ncafp.com/practice-mgt

North Carolina has five renal transplant programs and the performance of each of these programs is reported bi-annually by the Scientific Registry of Transplant Recipients (SRTR.org) database through the United Network for Organ Sharing (UNOS). Each program in our state has outcomes within expected ranges. Because the health of CKD and ESRD patients in North Carolina be dramatically improved, we encourage you to promote renal transplantation as the healthiest choice for patients with CKD or ESRD, to encourage early referral, and to promote living donation as the best option

for such patients. For more general and North Carolina specific information on kidney transplantation, see the figure below.

PHYSICIANS NEEDED FOR OUTPATIENT EXAMS

References: Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LYC, Held PJ , Port FK, N Engl J Med 1999; 341:1725-1730. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J. Am J Transplant 2011, 11: 2093-2109. 2014 Annual Data Report, United States Renal Data System. www.usrds.org/adr.htm

practice briefs Dental Varnish Payment Update: Codes Must be Billed in Specific Order In late summer, a revision to the billing process for Dental Varnish claims went into effect. Medicaid payment claims that include procedure codes D0145 (Oral evaluation for a patient under 3 years of age and counseling with primary caregiver) and D1206 (Topical application of fluoride varnish) must now be billed in a particular order for both to pay correctly. Procedure code D1206 must be billed on the detail line before D0145. NCTracks is designed to adjudicate one detail line at a time, beginning with the first detail line on the claim and proceeding through the last. NCTracks must verify that D1206 has been paid before D0145 can be paid for the same date of service. Ensuring that claims are billed with the procedure codes in this order will expedite processing and payment.

Promote Eat Smart, Move More’s Annual Holiday Challenge to Patients Weight gain during the holidays is common, with many Americans gaining between 1 to 5 pounds. The Holiday Challenge offers resources to help patients maintain their weight during the holiday season -- from Thanksgiving to New Year’s Eve. Throughout the 7-week program, participants receive weekly e-newsletters, daily tips, and healthy recipes. More than 12,500 people registered for last year’s program, with almost 2,400 going on to complete the program’s post-challenge survey. Let’s help raise these numbers! For complete information on the program and how your practice and its patients may participate, see https://esmmweighless.com/holiday-challenge-live.

The Classifieds Family Doctor needed at Lincoln Community Health Center Website: http://www.lincolnchc.org

Lincoln Community Health Center, a Federally Qualified Health Center serving 30,000+ patients at 10 different sites in Durham, NC. Our main site has been serving our community for over 40 years and offers pharmacy, lab, radiology, dental and behavioral health services.  Due to recent expansions, we would love to hire another Family Physician.  Spanish is a plus but not required. Contact Ms. Claretta Foye, COO and HR Director, Claretta.Foye@duke.edu.

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 Non-Profit Org. US Postage

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