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THE NORTH CAROLINA

Volume 12 Issue 1 / Winter 2016

quarterly news in north carolina family medicine

Family Physicians -

Providing Support, Guidance and Acceptance


VOTE YES ON THE BOND March 15th, 2016

This March 15th, voters will have the opportunity to support a $2 billion bond that builds a better North Carolina for today and tomorrow: • Invests in Healthcare, Science, & Higher Education

The Bond provides nearly $1 billion for our state’s university system, including funds for state-of-the-art science, healthcare, technology, engineering and math facilities. Five new health educational facilities are funded!

• Invests in Agriculture

Agriculture helped build North Carolina and it continues to be our largest economic driver at $76 billion dollars annually, employing over 16% of our state. The Bond makes a historic, $179 million investment to keep agribusiness and family farms growing.

• Invests in State Parks & NC Zoo

The bond provides $75 million to build new facilities in our state parks, new hiking trails and campgrounds, and provides funding to support environmental education. It also makes a significant investment into the NC Zoo.

• Invests in Water & Sewer The Bond provides $309 million to improve infrastructure services for municipal

and county governments, and to make improvements and updates to water/sewer facilities to assist with economic development and growth.

Learn more at www.voteyestoinvest.com


Inside 12

Rural Superstar: Dr. Karen L. Smith of Raeford

President’s message

Family Physicians - Providing Support, Guidance and Acceptance

health policy & advocacy

Triple Full Moon Casts Shadow on Open Seats: A 2016 Election Overview

Meetings & education

NCAFP Education Evolving to Meet Members’ Needs

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THE NORTH CAROLINA

Residents & new Physicians

Residents Elect New Leaders and Launch Career Mentoring Program

student interest & initiatives

Family Medicine & Family An STFM Blog Contest Entry

Practice Management

Federal Award Brings New Support to North Carolina Family Practices

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DEPARTMENTS President’s Message.......................... 4. Policy & Advocacy................................ 8 Chapter Affairs.................................... 12 CME Meetings & Education................. 18

Membership....................................... 20 Residents & New FPs.......................... 24 Student Interest.................................. 26 Practice Management.......................... 30

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.


THE NORTH CAROLINA

PRESIDENT’S MESSAGE

TO

By: Dr. Rhett L. Brown 2015-2016 NCAFP President

NCAFP MEMBERS

Family Physicians -

Providing Support, Guidance and Acceptance

W

ow! What an incredible honor to serve as the president of this amazing Academy. I am truly humbled by the opportunity to work with outstanding visionary leaders and with an organization that is tireless in its efforts to improve the lives of North Carolina residents and the Family Physicians who serve them.

Why a Family Physician? As far back as I can remember, I wanted to become a physician. Although my family was not a medical one per se, I'm convinced that in another time my mother would have been a physician. She was a true servant leader and healer and personified the special qualities of a Family Physician I wished to emulate.

When I was young, I asked Mom why she took our family to Since serving a Family Physician on the NCAFP instead of a PediatriBoard of Direc“I have always liked the way the cian or Internist. tors, as I have word ‘family’ sounds. It holds a Her response listened to the continues inspiring speeches of my special place in our culture, in our me and I carry her predecessors, a words with me into powerful theme development and growth as every exam room. has stuck with physicians, and for this Academy.” She said that a Famme: as Family ily Physician will Physicians, irre— Dr. Rhett L. Brown sit down and talk spective of where to you, wants to get we work, we to know you, know focus on family what's important to and embrace its you, and not spend the appointment looking true diversity through the individual patients at the chart and ordering tests. A Family we care for. Physician gets to know you as a person, not as a patient, she explained. I have always liked the way the word 'family' sounds. It holds a special place in After all my years of training and conferour culture, in our development and growth ences, I have never heard it said better. as physicians, and for this Academy. The Family physicians provide unconditional supconcept of family can embody the very best port, guidance and acceptance to everyone. of us and challenge us in countless ways. This is what makes us so powerful.

Embracing Patient & Family Diversity Over the years primary care has led the House of Medicine in embracing diversity in the patients and families we serve. We provide primary care to disenfranchised groups and diverse populations that need support, guidance and acceptance like all others. We know it's not always easy, especially when our patients are not like us. Diversity has always existed in families, with some types of diversity more readily accepted than others. Blended families have long been the norm, especially given the historical high rates of maternal death in childbirth, divorce/separation, or other factors. Some cultures have embraced adoption, while others have considered it taboo. Today, we find some families having two parents, while some just have one. But as Family Physicians, I believe many of us recognize the family unit as the basis of support, guidance and acceptance for each individual patient. In thinking of families and their power, I offer you a story about my Dad. While growing up in rural North Carolina in the 1970s and 1980s, individual diversity related Continues on page 6

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THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016


2015-2016

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

Rhett L. Brown, MD Charles W. Rhodes, MD Tamieka M.L. Howell, MD Alisa C. Nance, MD, RPh Thomas R. White, MD William A. Dennis, MD Gregory K. Griggs, MPA, CAE

District Directors District 1 - Mackenzie Smith, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Dimitrios “Taki” P. Hondros, MD District 6 - Cody A. Wingler, MD District 7 - Jennifer L. Mullendore, MD

THE PRESIDENTIAL OATH: Dr. Rhett Brown of Charlotte, NC, takes the presidential oath of office as directed by AAFP Board Member and NCAFP Past President Dr. Mott P. Blair, IV (‘03), during his installation last December.

At-Large Jason T. Cook, MD At-Large David R. Rinehart, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Jessica Triche, MD Medical School Representatives Chair Warren P. Newton, MD, MPH (UNC) Family Medicine Residency Directors Viviana Martinez-Bianchi, MD (Duke University FMR) Resident Director Margarette Shegog, MD, MPH (MAHEC-A) Resident Director-Elect Alyssa Shell, MD, PhD (MAHEC-A) Student Director Jeffrey Pennings (Campbell) Student Director-Elect Angie Maharaj (Campbell) Medical School Representatives & Alternates Chair (UNC) Warren P. Newton, MD, MPH Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (Campbell) Charlotte Paolini, DO 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 CME Council

Alisa C. Nance, MD, RPh, Chair David R. Rinehart, MD, Vice-Chair

Membership & Workforce Practice Management Council Public Relations & Marketing

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


to sexual orientation was rarely, if ever, discussed. References at school or on the media were either outright negative or at best pejorative in some way. For many others and myself, it wasn't hard to realize that it was best to hide and pretend these feelings did not exist. Although I never heard any negative stereotypes or words coming from my parents, I never wanted to disappoint “As with them.

the first sentence. "Who do you think you are? How dare you? What in the world are you thinking?," it read.

everything Family Physicians can, should, and must be to our patients and to the vast array of individuals and families we serve. For many LGBT individuals, unfortunately, But my initial fears quickly melted away. It their families do not provide this crucial turned out my Dad was upset and angry that support, guidance or acceptance. Although I hadn't felt I could confide in him first, that I many in this group have created 'families' of choice and have benefitted from the rapid societal changes over the last 25-years, many continue any other component of primary care, my to struggle. Transgender patients, for example, challenge to you as a Family Physician is to provide nonrepresent a constituency judgmental support, guidance, and acceptance to any and all in major need of care.

At age 28, after completing residency and opening my first patients, practice, I was still hiding this part of myself from my parents. I was afraid of being rejected. Then it happened. My parents found out and my first thought was, "Oh, God, what's Dad going to think?" I soon found out when I received a letter from him in a big, thick envelope (which had never happened before). I gulped before opening it.

especially in our underserved populations.” — Dr. Rhett L. Brown

had not trusted him. For him my orientation never mattered anyways. His love and acceptance was pure, complete and unquestioning. He offered his support, guidance and acceptance freely.

As I began to read it, my heart sank with

That letter from my Dad reminded me of

Up to 5-years ago I was admittedly blind to the medical needs of this community. Only at the urging of a colleague did I discover that by and large transgender patients were not receiving basic healthcare, were generally afraid to go the doctor for routine services like physicals and preventive care, and mostly were self-medicating from black market sources. The youth of this population face tremendous additional obstacles as well, including bullying from students and

THE 2015-2016 NCAFP PRESIDENT: Dr. Rhett L. Brown is pictured here with his partner, Mr. Carl Brinson, after his installation as chapter president.

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THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016


teachers, being rejected by their families and houses of worship, and altogether suffering from staggering rates of suicide, physical violence, and homicide.

for the support, guidance and acceptance of our patients and improving their lives through better health.

Throughout 2016, this Academy will work across five major areas to help fulfill In learning to serve this population, I our mission. These areas are government downloaded treatment algorithms and affairs; membership and workforce; practice attended education conferences. What I management; public relations and marketing; discovered is that transition therapy is not as mysterious as I anticipated, and is a larger need than I originally thought. In PRACTICE TEAM: accepting referrals (with Dr. Rhett Brown is all new patients seemingly smiles as he’s greeted every week), these patients by his practice partner, describe stories of being NCAFP Past President refused care by physicians Dr. Carson Rounds (‘06). or being ridiculed in medical offices. In serving them and providing a medical home, I really have internalized what my Mom and Dad have always taught: unconditional support, guidance and acceptance. I believe I am a much better physician because of it. I’m not asking you to suddenly become an expert in every area of care. For example, I’m not an expert in Parkinson’s disease, but I still serve as a medical home for Parkinson patients and work closely with others in the healthcare team to ensure these patients receive comprehensive care. As with any other component of primary care, my challenge to you as a Family Physician is to provide non-judgmental support, guidance, and acceptance to any and all patients, especially in our underserved populations. It will make you a better physician like it has for me. Remember: we are Family Physicians and this is the right thing to do.

The Year Ahead The mission of our Academy is to advance the specialty of Family Medicine in order to improve the health of patients, families and communities in our state. While this very straightforward statement hides the complexity of fulfilling this mission -- especially with the diversity of patient populations we serve -- everything the NCAFP does is ultimately

and in education. Here is what we intend to accomplish in each area: Government Affairs: The NCAFP will be the policy voice for all Family Physicians and their patients in North Carolina. We will be at the table, at the important meetings, attending legislative conferences, leading or fighting if needed to advance polices and laws that are in our patients best interests. We will provide guidance and support to our legislators and policy leaders. Membership and Workforce: The NCAFP will work to create a culture of engagement among member practicing physicians, students, and residents. The citizens of North Carolina depend on a strong workforce of Family Physicians and the Academy is

vested in strengthening and increasing this workforce. In addition, we will work with our state's medical schools, undergraduate colleges and universities to promote and sustain student interest in family medicine. Practice Management: NCAFP will support Family Physicians across the broad array of practice environments. The Academy wants its members to have thriving and sustainable practices in order to ensure the greatest access and improved health care for patients. Public Relations & Marketing: NCAFP will strive to educate patients, payers, health systems and others about the value of family medicine. As our health care system continues to adjust, Family Physicians will work to demonstrate how family medicine can be the foundation for effective and sustainable healthcare. Education: This Academy will continue to provide high-quality and innovative education. The NCAFP is dedicated to keeping its members the besteducated, trained and most capable providers of any specialty. Our patients are counting on us. That brings me full circle. Family. It's at the core of what we do. We look to our own families when we need support, guidance and acceptance, and we can also look to our Academy 'family' as well. But most importantly, we as Family Physicians can be there for our patients to provide support, guidance and acceptance on their lives journey. Thank you again and I look forward to serving you this year.

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THE NORTH CAROLINA

HEALTH POLICY S T A T E

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

G O V E R N M E N T

Triple Full Moon Casts Shadow on Open Seats An overview of North Carolina’s 2016 elections By: Joanna Spruill, JD NCAFP Director of Government Relations & General Counsel

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THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016


Online at ncafp.com/advocate

I

t's the triple full moon election. For the first time in eight years, North Carolina voters will elect three top offices: president, governor, and senator. With the national focus on North Carolina for the presidential ticket, voters can expect lots of national money, campaign commercials, and a national spotlight on the political environment in North Carolina.

President

North Carolina has remained a swing state since 2008, our last triple full moon election. Before 2008, the state had not voted for a Democratic presidential candidate since 1976, when our thirteen electoral votes went to Jimmy Carter. In 2008, North Carolina went blue for Barack Obama, but just barely. Obama won North Carolina by securing only 14,000 more votes than John McCain. In 2012, Mitt Romney won our now fifteen electoral votes in one of his narrowest victories. This year, North Carolina could matter even more. Lawmakers during the 2015 session moved the state's presidential primary from May to March 15th. This March date will put North Carolina's primary on the same date as Florida, Missouri, Illinois, and Ohio. With national candidates spending more time and money in North Carolina, their get-out-the-vote campaigns will affect who turns out to vote for the primary in March as well as the general election in November. Our local elections will undoubtedly be influenced by who is on the presidential ticket.

US Senate Incumbent Senator Richard Burr is up for election this year attempting to win his third term for US Senate. While

Democrats were slow and uncertain in rallying behind one nominee, four choices have emerged in the Democratic primary: Kevin Griffin, Ernest Reeves, Chris Rey, and Deborah Ross. Richard Burr will also face a primary, against Republicans Greg Brannon, Larry Holmquist, and Paul Wright. With Burr's strong name recognition, the Republican primary will probably unfold as just a formality, while the democratic one could be more interesting. There is also a third-party candidate, Libertarian Sean Haugh, who will be on the ballot in November as well. North Carolina is a key target for presidential nominees, and our Senate race will be influenced by who shows up to vote on Election Day. If 2014 is any indication, expect large sums of money to be spent on the Senate race. The 2014 US Senate race between incumbent Senator Kay Hagan and then, House Speaker Thom Tillis was one of the most expensive campaigns in the country. North Carolina saw more than $100 million spent on the race, and Thom Tillis narrowly defeated Kay Hagan.

Governor Republican Governor Pat McCrory seeks his second term as governor, but first must face a primary in March. Former state Representative Robert Brawley filed for the race, as well as Charles Moss. While Brawley and Moss face long odds against McCrory, their entrance to the race will likely create more annoyance for the Governor's re-election campaign, rather than a threat. Brawley is no stranger to inter-republican conflict, as he argued often with then-Speaker Thom Tillis, and was ultimately kicked out of the Republican caucus. In the Democratic primary, Roy Cooper faces Durham attorney Ken Spaulding. By all accounts, Continues on page 11 Continues on page 11

Let’s make NCAFP’s voice even in Raleigh

Contribute

Today!

FAMPAC Empowering Family Medicine

ncafp.com/fampac


DOTS CONNECTED WHERE HEALTH IS PRIMARY. A growing body of evidence shows that chronic medical conditions are best managed in a primary care setting. That’s because patients with access to coordinated, comprehensive care have better outcomes. Family doctors treat patients, not conditions. We want everyone to have a doctor who sees them as a whole person and provides them with quality, coordinated care.

Let’s make health primary in America. Learn more at healthisprimary.org. #MakeHealthPrimary THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

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political insiders expect McCrory and Cooper to face off for the general election in November. Like the US Senate race, a third-party libertarian, Lon Cecil, will also be on the ballot.

Legislative Oversight Committee on Health and Human Services and Joint Legislative Oversight Committee on Medicaid and NC Health Choice. He is running to keep his seat in 2016.

Bob Rucho (R-Mecklenburg), Fletcher Hartsell (R-Cabarrus, Union), and Stan Bingham (RDavidson, Montgomery). Senator Dan Soucek (R-Alleghany, Ashe, Avery, Caldwell, Watauga) is also not seeking re-election.

North Carolina General Assembly

Other Representatives who are not seeking re-election include: Paul Tine (U- Beaufort, Dare, Hyde, Washington) Rick Catlin (R-New Hanover) Leo Daughtry (R-Johnston) James Langdon (R-Johnston) Nathan Baskerville (D-Granville/Vance/Warren) Rayne Brown (R-Davidson) Jacqueline Schaffer (R-Mecklenburg) Chris Whitmire (R-Henderson/Polk/Translyvania) Roger West (R-Cherokee/Clay/Graham, Macon)

2016 Short Session

Because of the earlier March 15 primary, the filing period to run for office ended December 21, 2015 and campaigns at this point are well underway. This year marked an exodus of current state representatives and senators. Twenty-two of the 170 members seated at the start of the two-year legislative session have already resigned or announced they will not seek re-election.

North Carolina House of Representatives Within the House of Representatives, thirteen sitting members chose not to re-file and two announced they were resigning in late 2015. Representative Paul Stam (R-Wake), current Speaker Pro Tempore of the House, announced during one of the last floor sessions of the House in 2015 he would not be seeking re-election. Four members on the House Health Committee are not running for their seats: Tricia Cotham, (D- Mecklenburg); Dan Bishop (R-Mecklenburg), who is running for an open seat in the NC Senate; Ken Waddell (D- Bladen, Columbus, Robeson); and Brian Brown (R- Pitt). Rep. Brown resigned late last year and Greg Murphy, a urologist and currently the only physician in the legislature, was appointed to fill his seat. Representative Murphy has already been named to the Joint

Representative Bryan Holloway (R- Stokes, Rockingham) also resigned last year. Kyle Hall was appointed to fill Holloway's seat and is running to maintain it in 2016.

North Carolina Senate Seven members of the Senate are not seeking re-election in 2016, including two in powerful leadership positions: Rules Chairman, Senator Tom Apodaca (R- Buncombe, Henderson, Translyvania), and Finance Chairman, Bob Rucho (R-Mecklenburg). Senators Buck Newton (R- Johnston, Nash, Wilson) and Senator Josh Stein (D-Wake) are not running for their Senate seats, but if they survive the March primary, they will face each other in the general election for North Carolina's next Attorney General. Three members of the Senate standing Healthcare Committee are not seeking re-election, including Senators

With the primary moved to March 15th, legislators also moved the start of the 2016 ‘short session.’ The session will begin on April 25, 2016. As is always the case, lawmakers have stated the short session this year will be short and many hope to be back in their districts campaigning by late summer. If the past two years are any indication, however, it is anyone's guess how long the session will be. What remains to be seen is how retirements will affect policy issues in Raleigh. Will retiring members give one last push for policies they hold near to their hearts? Will their fellow members help them accomplish one last goal for their legislative term? Or, will members be focused on the November election and be eager to return home to their districts to meet voters and raise campaign money? Further complicating matters are the national elections, national money, and the spotlight on North Carolina.

Save the Date! NCAFP is hosting our first White Coat Wednesday of the short session on April 27, 2016. More information will be forthcoming, but for now, save the date and we hope to see you in Raleigh as the 2016 short session gets underway!

THIS SAVE E DAT

NCAFP

WHITE COAT WEDNESDAY

April 27, 2016 IN RALEIGH

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

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THE NORTH CAROLINA

CHAPTER AFFAIRS

Rural Superstar Raeford’s Dr. Karen L. Smith, FAAFP Named 2015 North Carolina Family Physician of the Year

By: Peter Graber NCAFP Director of Communications

I

n early December, Raeford, NC’s, Dr. Karen L. Smith, FAAFP, was named North Carolina’s 2015 Family Physician of the Year. The award recognized Dr. Smith for her tireless work as a compassionate and community-minded family physician whose constant work in driving meaningful connections has set her apart. Dr. Smith serves a rural community in the heart of the Sandhills region that’s been growing steadily over the last 25-years. The population of Hoke County where Smith

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resides has more the doubled since 1990, increasing to over 51,000 citizens. As its population has expanded, Hoke’s need for healthcare services has grown too. Back in the early 1990s before its most recent growth stretch, Hoke County ranked near the bottom of the state in several key health indicators. Around the same time, the county was also identified as a critical health shortage area and a top county of need. According to Hoke County Commission Chairman James Leach, the community began making positive strides when Dr. Smith

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

arrived in 1992. Dr. Smith’s compassionate care process really made a difference. “Being a poor county with so many of our citizens being afraid to talk about their issues, Dr. Smith has made her patients feel very comfortable,” said Leach. “That’s meant so much and has had a profound impact.” Leach explained that Hoke County continues to improve in its health outcomes largely because of stronger primary care and physicians like Dr. Smith. A major tool in Hoke County’s community health effort is its primary care clinic.


Online at ncafp.com/chapter

As the clinic’s Medical Director & Supervising Physician, Dr. Smith plays a key role in overseeing how care gets delivered to its diverse patient population. The clinic serves mostly Medicare and Medicaid beneficiaries, with a sizeable portion of both privately insured and uninsured. Hoke County Health Director Helen Edwards, MS, RD, LDN, praised Dr. Smith’s work and dedication to the clinic. She pointed out that Smith’s close proximity (her office is less than one mile away) has enabled the clinic’s mid-level staff to provide even better care to patients struggling with complex conditions. It’s been a huge win for the county. While the clinic provides much needed healthcare access, growing the number of providers serving Hoke’s communities is vital to its continued progress. To help move the needle, Dr. Smith and her practice recently embarked on a new strategy. She’s begun using her practice as a training ground for mid-level providers, providing an engaging, firsthand experience to the rural practice environment. Smith’s efforts have already begun to bear fruit, with at least one provider trained in her office already expressing interest in working with the Hoke County Health Department. Additionally, Dr. Smith continues to work hard developing interest in family medicine and primary care by hosting undergraduates from several surrounding colleges, including UNC Greensboro, NC Central University and East Carolina University. She also has participated in the NCAFP Foundation’s student interest programs when possible, most recently as a physician Continues on next page

COMMUNITY ENGAGEMENT: (Top to Bottom) Dr. Karen Smith with Hoke County officials (l to r): James Leach, County Commission Chair; Letitia Edens, County Manager; Helene Edwards, County Health Director; Ashley Rozier, CEO, Cape Fear Regional Bureau for Community Action; and Harry Southerland, County Commission Vice Chairman. Dr. Smith wih Hoke County Sheriff Hubert Peterkin. Dr. Smith with Tia Hart Community Recovery Program Founder and Director, Shirley Hart.

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ADVOCACY ON THE AIR: Dr. Smith is a trusted voice on Hoke’s hometown AM radio station, WFMA 1400. She’s pictured her with station owner and broadcaster, the William Hollingsworth family.

preceptor in the rural health program. “This area has a rich history in terms of medicine, but growing our provider base is extremely important,” said Dr. Smith.

Integrative, Culturally-Sensitive & High-Tech Rural Care An often unspoken challenge in rural health delivery is serving patients whose needs may include behavioral care or counseling with lifestyle issues that affect health. Dr. Smith delivers integrative and culturally-sensitive care to her patients, and promotes the same approach through her involvement with several community efforts. It’s all in support of her personal and practice motto: The Power of Touch: Spiritual, Physical, and Emotional. According to Dr. Smith, in the course of a day, she often serves patients who need a caring ‘touch’. This could be a simple hand on the shoulder, a heartfelt re-assurance, or uplifting words. Providing these connection

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to her patients -- and within her community -- is what drives her every day. “When you are all together with a physical, spiritual, and emotional touch, then we can get to where you are trying to go to.” Day to day, Dr. Smith serves patients in an independent practice she founded in Raeford in 2004. Smith invested heavily into the community by constructing a state-of the-art building in 2005. Her practice and facility established her as one of Hoke County’s most important health providers, and earned her a national reputation as a leading proponent of health technology in primary care. Today, Dr. Smith’s investments continue to pay dividends through improved quality, increased efficiency, streamlined patient communication, and more effective population health management. Outside her practice, Dr. Smith’s community work is just as progressive. She’s a tireless volunteer, leader and advocate with several community-based programs. This ex-

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

tends her reach and improves the lives of her neighbors. For example, Dr. Smith serves as the volunteer Medical Director for the Cape Fear Regional Bureau for Community Action (CFRBC). CFRBC’s Chief Executive Officer Ashley Rozier, II, noted that her commitment to serving a wide range of underserved and marginalized populations is what sets her apart. “Dr Smith is an amazing doctor who serves everyone -- even the folks struggling with issues that we don’t typically like to talk about in a rural community,” Rozier explained. “It’s somewhat rare in a rural community and that’s what makes the difference in closing the disparity gaps that exist. She has made Hoke County a far healthier and better place to live.” Mr. Rozier went on to credit Dr. Smith in playing an instrumental role in helping CFRBC receive the Norton Group Award by the North Carolina Public Health Association last fall. The award recognizes public health organizations making lasting impacts in their communities. It was a major win. Smith also contributes her time and talents to the Tia Hart Community Recovery Program, an organization seeking to close critical human service gaps in Hoke and Cumberland counties. The program helps people with substance abuse issues, provides food distribution to the area’s needy, and works with wayward youth delivering after school programs and guidance. Program founder Shirley Hart estimates the program touches more than four thousand annually. For Dr. Smith, programs like Tia Hart are critical -- even potentially as important as good medicine. “We can do all we want in a medical office, but programs like these -- providing food and shelter -- are what keep people alive.” Another unique way Dr. Smith contributes is by acting as a familiar and trusted voice on the community’s local AM radio station, WFMA 1400, owned by the William Hollingsworth family. Smith is keenly aware of the power of radio, especially in a rural community where many older citizens rely on it as a information source. “Seeing what I do in clinic, the question becomes how can we get out into the community and start talking about important health issues,” described Smith. “But it’s a little more than that.” She went on to describe that in last November’s elections, she worked with the station to encourage people to vote as a means to affect healthcare change was a big success. “If you’re complaining about your healthcare insurance going up or you don’t have any and are sick, you need to go and vote to affect the change.” All of Dr. Smith’s work towards improving


Hoke County has not gone unnoticed. Community leaders praise her involvement, vision and commitment to advancing the public good. “When you see a doctor who gets involved in the community outside her office, that’s what makes her really important,” explained Hoke County Sheriff Hubert Peterkin. Peterkin continued by saying, “she’s brought something big to a small community.” One family that has been under the care of Dr. Smith is the Carter Family of Raeford. Since relocating to the area from New Orleans after Hurricane Katrina, Dr. Smith and her practice team have opened their doors -- and hearts -- to the family. “I cannot say enough about Dr. Smith,” commented Stephanie Carter. Carter’s young son David struggles with a number of health challenges that require constant vigilance and mutual trust. Building this has took time and Dr. Smith has delivered flawlessly. “David is not like a patient to Dr. Smith, he’s more like a family member.” Carter when on to describe that no matter the time of day or night, Smith is there for them, and especially David. Many of Carter’s family members are now patients of Dr. Smith as well, and she noted that her entire staff go out of their way to make sure needs are met. “It’s always great service.”

Journey to Family Medicine Dr. Smith’s interest in medicine was seeded at a young age. Growing up in rural Maryland, her father was a researcher assigned to the National Institutes of Health in Bethesda, MD. This brought her into some of the most renowned and richest research facilities in the world, where science, technology and service was ever present. Her interest in medicine began to germinate shortly thereafter as Dr. Smith watched her mother fight a long illness that would eventually take her life. She vividly recalls the frequent home visits by Dr. Barrington B. Barnes, an internist-pulmonologist who cared for her mother. Dr. Barnes even sutured Dr. Smith’s chin one time when she fell. “I was always mesmerized by that. And his little black bag,” Smith recalled with a laugh. But those experiences really planted the seed. “It was like, ‘wow,’ I can help people. At their house!” Committed to serving people, Dr. Smith would go on to attend Duke University, graduating in 1984 with a Bachelor of Science in Biology. She later attended Hahnemann University School of Medicine, earning her medical degree in 1989, coming back to the state for rotations in the Sandhills region. After graduating from the Southern Regional

A HERITAGE OF SERVICE: Dr. Smith provides compassionate, whole-person care, through her independent practice in Raeford, NC. Her strong faith serves as the foundation for her commitment. Dr. Smith is pictured here with Ellen McNeill, Rev. John D. Fuller, and Rev. Mary Owens.

AHEC Family Medicine Residency Program in Fayetteville in 1992, Dr. Smith connected with the NC Medical Society Foundation’s Community Practitioner Program, settling into practice in Raeford. It’s been a journey she takes great pride and joy in. Outside of practice, Dr. Smith and her family are proud members of Mount Pisgah Missionary Baptist Church. Smith recalls that the congregation embraced her immediately and it felt like ‘home’ instantly. Since then, she and her family have shared many important life events at the church, including her Renewal of Marital Vows and christenings of her children. “For me, the church is home. If anything was going to happen in my life that made a difference, it was going to be here, in church,” notes Dr. Smith. Dr. Smith also recalled the significant influence her grandparents had on shaping her life and service philosophy. Her grandfather was a Baptist minister in the church she grew up in and her grandmother

was a direct descendant of the Muscogee tribe. Smith attributes much of the desire to help others as part of this upbringing, as well as the inborn tradition of service that’s been spread down through the generations in her family. As an active parishioner, Smith has been involved with and put her stamp on many church programs that have benefitted Raeford and the county. These include efforts like presenting to the Hoke County Civic League, and several health-related initiatives. Dr. Smith resides in Raeford and is married to Michael Hendricks. They are parents of four children: Marcus, Michaela, Marquise, and Mikara. “I am truly fortunate to be a change agent, a person dedicated and committed to making a difference in the lives of others. Anything which is done for the sake of another is an expression of love for all mankind to share.”

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

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EXECUTIVE’s DESK

One Easy Way to Make Your Voice Heard:

Vote (But Educate Yourself First) By: Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

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ne of your Academy’s key goals is to enhance the voice of family medicine so that your profession becomes the specialty of choice for both future physicians (medical students) and our state’s citizens. Isn’t it true, that every North Carolina citizen deserves a family physician and a medical home? But we can’t meet this goal alone. We need the help of every single member. You may ask, “What can I do?” Well one answer is simple. First and foremost, vote! Our primary elections are earlier than ever this year (Tuesday, March 15th). I truly believe that if we don’t vote, we can’t complain about our politicians or how our government works.

But this year, I would ask that you do just a bit more than simply vote. Find out what your local elected officials think about key issues impacting healthcare. Find out if your state Senator or State House member supports Medicaid expansion or what their opinion is about Medicaid reform. Find out how they feel about the importance of primary care and the foundation that family medicine can provide for our healthcare system. (For more background on this year’s election, see page 8). I would never presume to tell anyone how they should vote, but I do want you to be an educated voter. And I believe most local elected officials are willing to have those exact conversations. So go to an event that your local Legisla-

ture may be holding in your area. Or call your legislators up and ask to meet with them or even have them come by your practice. I believe most state legislators really do want to learn. Very few of our elected officials have any healthcare experience, so you could become their “go to” person on healthcare by just trying to get to know them a little bit better. There are many informal opportunities as well. For example, I know one state Senator who is planning weekly visits to area coffee shops to informally chat with constituents. So find out what kind of events your elected officials may be holding. Go to their campaign websites and sign up to receive e-mails from them. And check out the websites and

4.5 Prescribed Credits

VALUABLE VALUABLE VALUABLE ncafp.com/procedures


events from candidates of both parties, both incumbents and challengers. Once you’ve gotten to know their positions, you can then decide whether you want to do more. Do you want to provide them a campaign contribution directly? Do you want to donate to our Family Medicine Political Action Committee (FAMPAC) and then encourage us to consider donating to certain candidates? Do you want to actively campaign for a candidate? You may decide not to take the next steps, but I do urge you to be an educated voter. Research the candidates. Ask them questions at an event or meet with them if you can. And for goodness sake: vote! If you feel like you need any help or direction with any of these ideas, your Academy staff is always here to help. Joanna Spruill, JD, our Director of Government Relations and General Counsel, and I are glad to talk to you about becoming more politically involved. We’re glad to review the issues we’ve dealt with in the past few years. And we’re glad to give you tips on how to move forward. Just call or e-mail us. We’re always here to help. But most importantly, get to know the issues and vote on March 15th.

We also know the obesity crisis our state and nation faces, and the need for safe places for outdoor activities. As part of this bond referendum, the state is investing $100 million in upgrades to our state parks -- from new facilities, to trails, camping sites and more. We certainly want every patient to have opportunities for recreation and physical activity. However, the most important investment – at least in my opinion -- is in our university system and community colleges, funding capital improvements of $1.25 billion. Many of the planned projects have direct impact on healthcare education at some level. Let me give you just a few of the specifics. The bond package includes:

Voting For the Bond Referendum

The bond also includes many more projects in the science fields that directly impact undergraduate training in healthcare fields. Beyond our university system, there is $350 million set aside for new construction, repairs and renovations at community college campuses across the state. Many of these programs help train entry level healthcare workers from phlebotomist to medical assistants to two-year nursing students. Those are the key reasons that your NCAFP leadership looked at this bond package and wanted to support this investment in North Carolina. We believe these investments will have both long-term public health benefits and a significant impact on our pipeline of healthcare professionals at all levels. So come March 15th, we ask that you support this important bond package and encourage your friends and colleagues to do the same. The package has bi-partisan support from Republican and Democratic political leaders, as well as our university and business communities. If you would like more information, you can find it at www.voteyestoinvest.com.

This year, your NCAFP Executive Committee voted to endorse North Carolina’s bond referendum. You may ask why we would get involved in this issue. While it is somewhat unprecedented, it truly is fitting with the mission of the Academy: to advance the specialty of Family Medicine, in order to improve the health of patients, families and communities in our state. We believe funding for these bonds can help do just that: improve the health of patients, families and communities. Let me explain why. It’s been 15-years since our state last issued bonds through a citizen vote. Since that time, 2 million new residents have moved to North Carolina (a 25 percent increase, pushing our population to 10 million people). With that comes numerous infrastructure needs. No one debates that public water systems are one of the most important public health improvements in history. As you look at the increase in our lifespan over time, you can certainly see an improvement since governments began investing in public water and sewer. And that investment must continue. These bonds put $309 million into public water and sewer improvement.

• Funding for a new Medical Education Building at UNC-Chapel Hill • Funding for a new Health Sciences Building at Appalachian State • Funding for a new Nursing School at UNC Greensboro • Funding for a new Allied Health and Human Services Building at UNCWilmington • Funding for a new Life Sciences & Biotech Building at East Carolina

You belong on our team.

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 PHYSICIAN RECRUITER

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

EOE/AA


THE NORTH CAROLINA

EDUCATION

Online at ncafp.com/cme

NCAFP Education Offerings Evolving to Better Meet Member Needs By: Brent Hazelett, MPA, CAE NCAFP Vice President & Chief Operating Officer

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he NCAFP prides itself in continually offering high quality education to our members at an affordable price. Recently, we surveyed our members to get feedback on the education we provide, in an effort to best plan our evolution over the next few years. Thanks to your feedback, we now have information on the topics you want to hear more about. For instance, increased educational offerings in the areas of cardiovascular disease, behavioral health, diabetes, pharmacology, geriatrics, obesity and musculoskeletal issues were cited as the most important areas. NCAFP staff will be working with our volunteer leaders in education to provide more to our members on these topics. Conversely, topics such as critical care, alternative medicines, sports medicine, dermatology and cosmetic medicine, autoimmune disease and addiction diagnosis and treatment ranked low and thus will be offered less at our upcoming meetings. In addition to providing timely topics to our members, the Academy also ensures the best possible speakers are invited to present, the majority of which are physicians practicing in primary care. Over the past few years, the Academy has also experimented with alternative learning models. While the didactic lecture will almost assuredly always have a place in continuing medical education, more and more learners are demanding more engaging methods for learning. Recently, this has included smaller classrooms with group learning, hands-on topics with engaging sessions, and panel discussions with greater opportunity to have

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questions discussed on a case-by-case basis. These alternative learning models have been met with great interest and the Academy will continue to find ways to appeal to all types of learning preferences. In 2015, the NCAFP provided over 70 credits to our members. Additionally, we developed educational opportunities that were not only heard in our meetings, but placed in meetings all over the country. These six programs consisted of topics ranging from Asthma to Major Depression Disorder, and consisted of 20 lectures heard by nearly 6,000 family physicians across the country. This national exposure provides the Academy with excellent opportunities to work with partner organizations to provide high level education for family physicians in our state and beyond. Finally, as the prices we are charged by hotels continue to rise (you would be shocked by what they charge for a gallon of coffee or a soda), the Academy must endeavor to find ways to cut costs at our meetings to ensure our members can afford to attend. If you have attended a meeting recently, you have likely noticed the reduction in paper as just

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

one of these methods. Increased functionality of our mobile application, along with the use of other technologies, hopefully provide a meaningful experience for our members, while at the same time having less of an impact on the environment and costing the Academy less in resources. This is just one way we are continuing to search for ways to provide a better experience for our members. If you have suggestions on other ways to improve our education sessions, please contact us at bhazelett@ncafp.com. Thank you to everyone that attends and helps plan our great CME events. We hope to see you at an education offering in 2016.


PHYSICIANS NEEDED FOR OUTPATIENT EXAMS

55th Annual Post-Graduate Symposium Friday, May 20 - Sunday, May 22, 2016 The Ballantyne Hotel - Charlotte, NC NC Academy of Family Physicians & The Mecklenburg County Chapter of the Academy of Family Physicians

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2016 Mid-Summer Family Medicine Digest Sunday, July 3 - Thursday, July 7, 2016 Embassy Suites / Kingston Plantation, Myrtle Beach, SC

30+ AAFP Prescribed Credits

2016 Winter Family Physicians Weekend Thursday, December 1 - Sunday, December 4, 2016 Pre-conference workshops beginning the afternoon of Wednesday Nov. 30th. The Omni Grove Park Inn - Asheville, NC 25+ AAFP Prescribed Credits

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


THE NORTH CAROLINA

MEMBERSHIP

By: Tara Hinkle NCAFP Membership Coordinator

We Want to Hear From You! Send in Your Member News!

F

rom time to time, you may have wondered what happened to your long lost colleagues from residency days...or what might be going on with your colleagues just across town. We realize that many of you have professional and personal news you may wish to share with your extended NCAFP family. As a result, we have created a convenient online fillable form where you can share such information to be considered for inclusion in the new "Member News" section in future NC Family Physician magazine issues. Keep us in the loop with practice news, milestones, and anniversaries; awards/recognitions; appointments; publishing notes; births and adoptions; marriages, etc. We are excited to incorporate this new feature, and we hope to see many submissions from across the state! To access the form anytime, please visit www.ncafp.com/membership/submit-a-note. If you are unable to use the form, you may email your news to Tara Hinkle, NCAFP Membership Coordinator, at thinkle@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


Online at ncafp.com/members

2016 Membership Dues--

What to Do if You Missed The January 1st Payment Deadline Attention Active, Inactive, Supporting, and FirstTime Life Members: The 2016 payment deadline was January 1st, 2016. To check if you have paid already, please visit www.aafp.org/checkmydues. Members can make payments via that webpage, or complete other tasks, too, like printing invoices and setting-up installment and auto renewal plans. If an installment plan is chosen, dues are taken monthly through August, 2016. Please pay balance or set up an installment plan as soon as possible to maintain your membership. Multiple Ways to Pay Dues: • By AAFP Mobile App (Press My Account button). • By Phone: (800) 274-2237 between 9:00 a.m. 6:30 p.m. EST. • By Mail: Make checks payable to AAFP and mail to AAFP, P.O. Box 419662, Kansas City, MO 64141. • Online: www.aafp.org/checkmydues. Note: For office personnel making multiple payments, please use www.aafp.org/quickpay. For all sites, your seven-digit AAFP ID # serves as your username. For login issues or dues questions, please contact AAFP at (800) 274-2237.

2015 CME Re-Election--Reporting Deadline is March 31st, 2016 December 31, 2015 marked the end of the earning cycle for 2015 CME Re-Election candidates. To view your re-election cycle or update your transcript, please visit www.aafp.org/mycme. Your seven-digit AAFP ID # serves as your username. For 2015 candidates, please report your credits by March 31st to maintain your membership. The AAFP will notify the ABFM when you have met its recertification CME requirements. Questions? View FAQs at www.aafp.org/cme or call AAFP at (800) 274-2237 between 9:00 a.m. 6:30 p.m. EST.

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THE NORTH CAROLINA

Online at ncafp.com/foundation

FOUNDATION

Thank You to Our 2015 Family Medicine Gala Gold Sponsor, Friends and Patrons!

Friends

patrons

Blue Cross and Blue Shield of NC Brody School of Medicine at ECU, Dept. of Family Medicine Campbell University Jerry M. Wallace School of Osteopathic Medicine Maureen E. Murphy, MD Maxwell Tool Sales Medical Mutual of NC Novant Health Family Medicine Residency Program UNC Health Care and Department of Family Medicine Wake Forest School of Medicine Department of Family Medicine

Charles W. Rhodes, MD • David A. Rinehart, MD Frank W. Leak, MD • Holy Trinity Greek Orthodox Cathedral Foundation • J. Thomas Newton, MD • Janice Huff, MD and Darlyne Menscer, MD • L. Allen Dobson, MD • Levine Cancer Institute • New Hanover Regional Medical Center • North Carolina Medical Society • Novant Health Crown Point Family Physicians • Novant Health Midtown Family Medicine Rex UNC Health Care • The Family Health Centers Asheville, Arden & Hominy Valley, PA • Thomas Rhyne White, MD Vidant Medical Group • William A. Dennis, MD • Lin Church, MD

Save The Date for The 2016 Family Medicine Gala The NCAFP Foundation is excited to announce the date for its 2016 Family Medicine Gala:

in helping to ensure the future of Family Medicine in North Carolina through valuable, first-hand clinical experiences for North Carolina medical students and other programs that help students learn about and embrace family medicine.

Saturday, August 27th, 2016 at The Raleigh Convention Center This will be a fun and glamorous black tie (optional) event that will include food, spirits and an evening spent honoring and roasting North Carolina’s Dr. Maureen E. Murphy. The goal of the Family Medicine Gala is to help raise money for the NCAFP Foundation’s Family Medicine Interest Initiatives. The initiatives play vital roles

Honoring Dr. Maureen E. Murphy

NCAFP members wishing to support the event but who cannot attend inperson can still be a part of the Gala through financial support. To learn more about sponsorship options for this fantastic event, please contact the NCAFP Foundation’s Tracie Hazelett at thazelett@ ncafp.com or via telephone at (919) 833-2110.


Family medicine is in your hands. Now the AAFP is too. Download the AAFP’s mobile app and get enhanced access to AAFP services and benefits. AAFP.org

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THE NORTH CAROLINA

RESIDENTS

By: Margarette Shegog, MD, MPH NCAFP Resident Director

& NEW PHYSICIANS

Residents Elect New Leaders and Launch Exciting Career Mentoring Program

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he last year has been an exciting and notable one for North Carolina Family Medicine Residents. North Carolina residents advocated for patients in Raleigh, represented why “Health is Primary,” and educated ourselves and others. Our activities culminated at last December’s Winter Meeting in Asheville, where a total of 71 residents were present, increasing from 66 in 2014. A number of important resident developments took place at the Resident Section Meeting.

Resident-Physician Mentoring Program Foremost, the meeting formally introduced the Resident Physician Mentoring Program. Through this new program, residents can connect with community physicians for clinical, professional and personal networking. You can sign up at http://www.ncafp. com/rpm to start connecting with practicing family physicians from around the state. This project was initiated by residents in early 2015 and we are excited to have it available now. The meeting also featured presentations from our Resident Council Representatives. These representatives serve a key role in having residents ‘at the table’ within all of the NCAFP’s councils. In addition, we held elections for a slate of new representatives for the current year, and the following were elected: Will Mclean, MD (MAHEC-A) as representative to the Practice Management Council; Rebekah Hayden, MD (Cabarrus) as

24

representative on the Continuing Medical Education Council; Autumn Eglitis, MD (UNCChapel Hill) as representative on the Public Relations & Marketing Council; and Preyanka Makadia, DO (Duke) as representative on the Membership & Workforce Council. Additionally, Margarette J. Shegog, MD MPH, (MAHEC-A) ascended to the role of Resident Director and Alyssa M. Shell, MD, PhD., (MAHEC-A) was elected as Resident Director-Elect. Two new Resident Physician Trustees to the NCAFP Foundation Board of Trustees were also elected, including Amy Nayo, MD (UNC-Chapel Hill) and Stephen Carek, MD (CMC-Charlotte). Please congratulate these physicians on their elections to lead the residents of North Carolina. In other happenings, a presentation was given by Jerry Boylan of the North Carolina Office of Rural Health (ORH). Mr. Boylan described several excellent loan repayment opportunities for NC residents. Typically, ORH’s Medical Placement Services (MPS) will find opportunities in Health Professional Shortage Areas (HPSA) that match both your personal and professional needs. According to Boylan, Post-Graduate Year 2 is an excellent time to complete a short online interest form and make a connection with the MPS recruiter to review options on your own time. Please check out http://qa.dhhs.state.nc.us/ orhcc/ for more information. There was also lively discussions at the meeting and many topics brought up. Three topics were formalized and brought to the

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

2016 RESIDENT LEADERS: (L to R) Drs. Will McLean, Practice Management Council Representative; Autumn Eglitis, Public Relations & Marketing Council Representative; Stephen Carek, Resident Trustee; Margarette Shegog, Resident Director; Amy Nayo, Resident Trustee; and Alyssa Shell, Resident Director-Elect. Right: Jerry Boylan reviewed the key NC loan repayment programs available to graduating physicians.

attention of the NCAFP Board of Directors, including one action item that won approval. The item approved consists of naming a resident at each residency program to serve as that program’s advocacy ‘point person.’ Each named resident will help distribute advocacyrelated information and encourag participation in NCAFP’s advocacy-related events and activities. Look for additional information on this program in the weeks ahead. Residents also discussed physician burnout, expressing that it is of great concern even within residency, and that wellness training and education while in residency would be valued and should be explored where possible. There was also discussion about residents considering a rural rotation or electives and its overall costs. Identifying potential partnerships and funding sources may be helpful and help drive increased interest in rural service.


Online at

ncafp.com/residents

Resident Career

speed Finally, residents were touched and moved as new NCAFP President Dr. Rhett Brown “stripped down” and got back to basics as he spoke to accepting differences and the importance of transgender medicine during his inaugural address as NCAFP president. In closing, we would like to thank Dr. Deanna Didiano for her wonderful leadership and service for the last two years. December 2015 Winter conference was both the close and the start of another wonderful year for NCAFP Residents.

NCAFP

Resident+Physician Mentoring PROGRAM www.ncafp.com/rpm THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

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THE NORTH CAROLINA

STUDENTS

Online at ncafp.com/students

Family Medicine and Family By: Bridgid Wilson, PhD (MS-3) Brody School of Medicine at East Carolina University

What Family Medicine Means to Me Blog Compeition The Society of Teachers of Family Medicine (STFM) recently held a writing competition for students, residents, and fellows, with participants answering the question, ‘What Family Medicine Means to Me.” As this publication went to press, Brody School of Medicine’s Ms. Bridgid Wilson’s submission below was a top finalist. You can vote for Bridgid’s article by simply visiting www.ncafp.com/fm-me .

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ur first indication that my pregnancy may not be quite as smooth as we originally thought came around 6-weeks when I experienced some spotting. It was days before Christmas, and knowing that our ability to get care may be limited in the coming days,

my husband, a family medicine doctor, reached out to his colleague, Dr. Justin Edwards, in hopes we might get a quantitative hCG before the holiday. Not only did Dr. Edwards order the tests and let us know the results as soon as they were available, but he also offered the kindest

Family Medicine Day Saturday, March 19, 2016 North Carolina

Doubletree by Hilton Raleigh Brownstone Raleigh, North Carolina

Build Skills! 26

ncafp.com/fmd

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

support during a time that would have been otherwise unbearably nerve-wracking. We had a good Christmas because of Dr. Edwards. A few weeks later, just when I started to feel less anxious about my pregnancy following our first little scare, I began experiencing

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episodes of tachycardia. The episodes increased in length and frequency over time and quickly became refractory to vagal maneuvers. Not only did Dr. Edwards identify the diagnosis following a Holter Monitor Study, but he also presented me with the appropriate medical management options. Furthermore, he listened patiently as I routinely—and I’m talking at each visit “routinely”— agonized over taking pregnancy category C medications, and would gently remind me of the current literature suggesting that my medication would not harm the baby at this point in the pregnancy. Then at one of my appointments in the third trimester, I was measuring small. At the same appointment, Dr. Edwards performed an ultrasound and found that my amniotic fluid levels were on the very low side of normal, and it appeared my son was quite small. I had enough medical school under my belt at this point to be terrified, and I could also see the worry in my husband’s face. Dr. Edwards sat with my husband and me and enumerated the reasons this may be happening, and reassured us that my son still appeared to be healthy. In those moments that Dr. Edwards talked with us, our very scary news seemed more manageable. The weeks that followed were certainly filled with some anxiety and careful monitoring, but ultimately my son’s delivery was exactly as I had imagined and he is now a healthy, happy infant. I initially hesitated to write a response for the call for submissions of “What does family medicine mean to me?” for a couple of reasons. First, I tend to think “doctor as patient” stories are overdone, and I don’t think doctors should only be able to acknowledge the need to relate to patients after their own experience with illness. Second, I’m a fiercely private person and having my pregnancy saga on the Internet for anyone to read admittedly makes me a bit uncomfortable. Ultimately, I decided to submit a response, however, because this experience has truly strengthened and invigorated my passion for family medicine. Family medicine requires an academic rigor that is often underestimated but was expertly demonstrated by Dr. Edwards. While Dr. Edwards did have me consult with subspecialists with each complication to make sure his plan was sound, at no point did he shy away from caring for me or make me feel as though I was out of his scopeof-practice. From an academic perspective,

I find this to be tremendously exciting: in no other specialty does one have the opportunity to vacillate between the spectrum of generalist and subspecialist the way that a family physician does. Using just me as a patient, for example, Dr. Edwards was the primary source of management for routine prenatal care, routine postpartum care, as well as both cardiologic and obstetric complications. He also delivered my son, and will serve as my son’s primary pediatrician and care for any acute pediatric complaints. On a more personal level, it was remarkable to me just how comforting it was to have one physician that had the medical knowledge and capability to integrate all of my care. It should be noted that I got tremendous care from the subspecialists I saw, and by no means do I think that family medicine can replace the expertise of these other physicians; however, where I truly became confident about the decisions I was making regarding the complications of my pregnancy was in my visits with Dr. Edwards. He was the individual that offered guidance, counseling, and support when my husband and I—both in the medical field—looked him in the eye and asked, “What do we do?” Family medicine doctors are not just looking at a snapshot of the patient; rather, they are treating the whole individual and serve a vital role in bringing together the care received from multiple specialties and physicians. The impact that responsibility has on the patient cannot be understated, and my own “doctor as patient” experience helped me realize what a privilege it is to be a family medicine physician and serve as the individual that can help a patient piece it all together. So now when I think about what family medicine means to me, I find that I am enticed and motivated by the requirement to continually challenge yourself academically as you meet the needs of each patient through a dynamic process of delving into different subspecialties. I find that I am hopeful I can be as compassionate and effective as Dr. Edwards, who truly epitomizes what it means to practice full spectrum family medicine, in helping patients integrate their care. Most importantly, I hope that I can play my cards right as I progress through medical school so that I may have the privilege to call myself a family medicine doctor in the future.

THE NCAFP Student Scholarship IN FAMILY MEDICINE The NCAFP Foundation will offer scholarships up to $5,000 to medical students considering a career as a Family Physician. Current 2nd and 3rd year NC medical students are eligible to apply.

Application deadline is May 1st, 2016.

For complete details and an application please visit www.ncafp.com/scholarships


A D V E R TO R I A L

NORTH CAROLINA PHYSICIAN ASSISTANT UPDATE: IMPORTANT CHANGES TO AUTOMATIC MD LIABILITY By Jason Newton, Senior Vice President & Associate General Counsel, Medical Mutual

Prior to May 1, 2015, the North Carolina Medical Board’s Rules purported to make the Primary Supervising Physician (“PSP”) of record responsible for everything the Physician Assistant (“PA”) did (i.e., any negligence). This led plaintiff’s lawyers to exploit the Rules and argue that the PSP was automatically negligent whenever it could be proven that the PA was negligent—even if the PSP was not actively involved in the care at issue. If the PA had a separate/independent set of professional liability limits, the plaintiff’s lawyer’s goal was to put a second set of professional liability insurance limits in play to create “deeper pockets” that would apply to the claim/litigation. This tactic also had potential impact on the PSP’s reputation and obligations on reporting to the NC Medical Board and the National Practitioner Data Bank. Earlier this year, the Board struck language in the “definitions” portion of the rule that previously (1) made the PSP, by virtue of overseeing the PA, accept responsibility for the medical acts performed by the PA; and (2) made the PSP accept “full responsibility” for the PA’s medical activities and professional conduct at all times. The most relevant changes can be seen in the black-lined portions below: 21 NCAC 32S.0201 (8) “Supervising” “Supervise” or “Supervision” means the physician’s function of overseeing the activities of, and accepting the responsibility for, the medical services rendered acts performed by a physician assistant. 21 NCAC 32S.0201 (10)(a) “Primary Supervising Physician” is the physician who accepts full responsibility is accountable to the Board for the physician assistant’s medical activities and professional conduct at all times, whether the physician personally is providing supervision or the supervision is being provided by a Back-up Supervising Physician. The Board also struck a couple of portions of the regulations in their entirety: 21 NCAC 32S.0211 AGENCY Physician assistants are the agents of their supervising physicians in the performance of all medical practice related activities, including the ordering of diagnostic, therapeutic and other medical services. 21 NCAC 32S.0214 SUPERVISING PHYSICIAN A physician wishing to serve as a primary supervising physician must exercise supervision of the physician assistant in accordance with rules adopted by the Board. The physician shall retain professional responsibility for the care rendered by the physician assistant within the scope of the supervisory arrangement. These changes should eliminate a PSP’s automatic/vicarious liability for a PA’s alleged negligence in all civil cases filed after the May 1, 2015, effective date; however, it is important to note that the PSP is still accountable to the Board for a PA’s medical activities and professional conduct at all times, as referenced in 21 NCAC 32S.0201 (10)(a) above. These developments provide a moment to reflect on what the North Carolina Medical Board examines when it comes to their review of PAs. The Board’s site visit audit tool is publicly available at http://www.ncmedboard.org/images/uploads/other_pdfs/SITEVISI_PA_5_2013.pdf. For the time being, at least, Medical Mutual’s data tends to show that PAs are significantly less likely (than physicians) to be named as defendants in medical malpractice litigation, but that could change with increasing independence of PAs and with physician shortages. Therefore, it is as important as ever to ensure compliance with supervisory requirements. As always, any routine questions about PA supervision may be answered by reviewing Medical Mutual’s online Risk Management Resources including our Risk Management Handbooks. Additionally, our insureds are always welcome to call one of our risk consultants at 800.662.7917 on any related issues at any time!

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THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016


STUDENT BRIEFS

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S SIDENT INE RE ENTS MEDIC FAMILY EDICAL STUD 1 ST U AND M G U 2014 NATIONAL CONFERENCE ATTENDEES

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2016 AAFP National Conference Key Application Dates for Students & Residents Shin Jung

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RegisterCity TodayinAAFP.ORG/NC Travel to Kansas July (7/28-7/30) for great educational workshops, leadership forums and an opportunity to meet Residency Programs from North Carolina and all over the country at the 2016 AAFP National Conference of Family Medicine Residents & Medical Students. Please keep the following upcoming deadlines in mind as you plan your trip: NTL15010747 -2015 NC Ad Full Page.indd 1

2016 STUDENT LEADERS: (L to R) Franklin Niblock, Alyssa D’Addezio, Angie Maharaj, and Jeffrey Pennings.

Medical Student Members Elect New Leaders At last December’s NCAFP Winter Meeting, approximately 130 medical students were on hand to represent all five North Carolina medical schools. Students participated in educational sessions, business meetings and took advantage of several social and networking opportunities with other students, residents and physicians. A packed Student Section meeting discussed opportunities available to NC-based medical students, shared information about activities at their medical schools and elected new student leaders. Jeffrey Pennings (Campbell) became Student Director on the NCAFP Board of Directors; and Angie Maharaj (Campbell) was elected as Student Director-Elect. Others elected to represent and lead the Student Section were 2 Student Trustees on the NCAFP Foundation Board of Trustees: Alyssa D’Addezio (Brody); and Franklin Niblock (UNC). Congratulations, thank you for your service!

Academy Gearing Up to Deliver Student Summer Experiences The NCAFP Foundation will once again provide numerous opportunities and clinical experiences to rising 2nd year medical students this summer. There will be two Rural / Underserved health programs offered, one in Eastern NC and one in Western NC, as well as multiple 4-week clinical externships. Up to 26 rising 2nd year medical students will participate, with stipends to offset travel and related costs. If you are a physician or resident interested in hosting a medical student in your practice or at your home, please contact Tracie Hazelett at NCAFP Offices. Note: The application period for students to apply to these programs has passed.

AAFP’s Emerging Leaders Institute Deadline is March 1st The AAFP Foundation’s Family Medicine Leads Emerging Leader Institute is a year-long leadership development program focused on ensuring the future of the Family Medicine specialty by increasing the number of future family medicine leaders and providing training for this important role. The program selects a total of 30 participants through a competitive application process. Eligible participants include: family medicine residents in their first, second, or third year and medical students in their second, third, or fourth year when the program begins. The deadline for applications is March 1, 2016. Each selected participant receives a $1,000 scholarship to attend both the AAFP National Conference and the Family Medicine Leads Emerging Leader Institute. Scholarship funds are to be used for hotel and other travel costs associated with participation. For complete information and to apply, visit www.aafpfoundation.org

2/17/15 2:48 PM

• Conference Poster Presentation Application Deadline is April 1st, 2016 Medical students and family medicine residents are invited to share their innovative and effective educational programs and showcase unique community projects. To submit your presentation, visit www.aafp. org/events/national-conference/education/ posters.html1 • Travel Scholarships Application Deadline is May 1st, 2016 Travel scholarships are available through the AAFP to go to Kansas City. These help medical students and residents offset travel expenses to attend the conference, with several categories to choose from. For more details and to apply, visit: www.aafp.org/events/national-conference/ about/scholarships.html • National Leadership Positions Must Notify NCAFP by May 1st, 2016 Students and residents interested in pursuing national leadership positions with the AAFP or its affiliate and/or partner organizations, MUST notify the NCAFP of your intention to seek a position by 5/1/16. This deadline is for all elected and some appointed positions. Medical students should contact Tracie Hazelett for questions or more information.

THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016

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THE NORTH CAROLINA

PRACTICE

ncafp.com/practice-mgt

Federal Award Brings New Support for North Carolina Family Practices Empowering Practices for Success in a Value Based Healthcare Environment By: Tom Wroth MD, MPH President and Chief Medical Officer North Carolina Community Care Networks

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This initiative will additionally equip practices with state-of-the-art analytic and reporting tools, by connecting your EMR to CCNC’s Informatics Center. This includes access to patient registries for quality metrics that will impact revenue under value-based payment mechanisms. You will also get help with quality dashboards to support rapidcycle improvement initiatives, identification of patients who are most likely to benefit from targeted interventions, and insight into the costs and quality of care received by your patients elsewhere, to help you make informed referral decisions. They’ll even set you up to track patient satisfaction through surveys your patients complete on tablets while they are in your office.

hanges in reimbursement are coming and YOU ARE NOT ALONE. Community Care of North Carolina (CCNC) is here to help you prepare your practice for success under new payment models in Medicare, Medicaid, and the commercial sector. CCNC is one of 39 Practice Transformation Networks (PTNs) selected nationally to participate in the Transforming Clinical Practice Initiative (TCPI). The four-year award will fund technical assistance, tools, information, and network support for eligible North Carolina medical practices to improve quality of care, increase patients’ access to information, and spend health care dollars more wisely. The Community Care of NC Practice Transformation Network aims to engage and support 3000 clinicians across North and South Carolina in transforming their practices for success in a value-based healthcare environment. These clinicians will achieve sustained improvement in practice efficiency and quality of care, and demonstrate savings through reduction of unnecessary testing and avoidable hospital use.  Their patients will use more preventive services, engage in better management of chronic conditions, experience better health outcomes, and report greater satisfaction with care received.

A key benefit will be embedded “practice transformation coaches” who will help you improve your practice’s workflow and clinical efficiency. They’ll also analyze your patient panel, and help you enhance patient care through improved care coordination and more efficient collaboration with specialty providers. They will show you how to better engage your most complex patients and improve compliance with your medication and treatment recommendations.

The healthcare world is changing fast. CCNC and the PTN effort can help you and your practice thrive value-based reimbursement, leverage the power of informatics to improve outcomes and efficiencies, and help you deliver “whole person care.” For more information about how to participate in the program, contact: Lynne Taylor (ltaylor@n3cn.org) or go to http://ccnc.care/ptn.

The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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THE NORTH CAROLINA FAMILY PHYSICIAN • Winter 2016


HEALTH OF THE PUBLIC

Building Healthier Communities: YMCAs as Community Health Partners By: Sherée Thaxton Vodicka, MA, RDN, LDN Executive Director, NC Alliance of YMCAs

Family Medicine Plays Growing Role in Providing Medical Homes for I/DD Patients By: Karen Luken Medical Health Home for I/DD Populations Initiatives Manager

Last Fall, the NC Academy of Family Physicians participated in a Summit The YMCA is being recognized convened by the Medical Health Homes for by many in the health care arena People with Intellectual and Developmennow as a key partner for meeting tal Disabilities (I/DD) initiative. Particithe Triple Aim, and for three good pants were from across North Carolina and reasons. included health care professionals, LME First, is the Y’s reach. NationMCOs, disability providers, state agencies, per week, keeping them diabetes free. Eight wide, 80% of all households live within 5 families and individuals with I/DD. The NC Y Associations offer the program at 42 HEPA Standards Gaining Traction Statewide miles of a Y. Here in North Carolina, YMCA summit was part of on-going efforts to sites, with more scheduled to begin in 2016. programs and facilities reach one out of every advance whole person care for people with The program can be offered in any loca10 residents of the state, from the coast to the Intellectual and Developmental Disabilities tion – not just at a YMCA facility. The YMCA mountains. (I/DD). The initiative, funded by the NC of the Triangle Area offered the program in Second is the Y’s focus on building Council on Developmental Disabilities, is 2015 at Alliance Medical Ministry, a safetyhealthier communities to improve population awarded to Easter Seals UPC and The Arc net provider for uninsured adults in Wake health. of NC. County, paid for through generous charitable Just this year, the YMCA put its reputation This initiative has been working with donations. Mini-Grant Supports and advocacy might behind efforts to help stakeholders across NC to develop recomThe programs do struggle from lack of Walking and families find safe places to play by encouragmendations that ensure people receive the referrals, which is where family physicians Walkability in North ing the state’s lawmakers to pass a bill that right care in the right setting at the right come into play. In order for these programs to Carolina allows local school districts to open their time. The summit agenda included presenremain in place, a healthy system of referrals YUSA just announcedtations from four playgrounds to families after school hours. must be established. that all state alliances will The third is cost savings: the Y can deliver states: New on the horizon are evidence-based receive $4000 to services in community settings with trained programs for blood pressure management, lifestyle coaches at cost of delivery. promote the Surgeon• A Federallysmoking cessation and childhood obesity preAnd because nobody is turned away for inGeneral's Call to qualified vention. Adding these to the existing chronic Policies, Practices & Promises: Ensuring the Health of NC Kids Summit ability to pay, the Y is increasing accessibility Action to support walking Health Center disease prevention and treatment portfolio for low-income individuals and families. that serves as and walkability in North will help meet patient need for services at a On October 29th, 50 statewide stakeholders gathered in A healthy relationship between health care a patient-centered medical home for Carolina. As a grant low cost with great outcomes into the future. Durham to talk specifically about how to get the Healthy and the Y is nothing new. The fact is, Ys have individuals with I/DD and their families deliverable, the Alliance There are already numerous examples of Eating and Physical Activity (HEPA) Standards implemented in been partnering with physicians, hospitals in California; will be conducting a family physicians and other primary care proa more sustainable way in both the early care and education and health care systems for decades, offering • Aspring-time walking statewide trans-disciplinary evaluaviders working with their local YMCA, from setting as well as out-of-school-time settings for school-age rehabilitation services on their wellness floors tion and consultation services based at NCAFP’s own Dr. Tom White in Cherryville to promotion event, focused kids. Dr. Carolyn Dunn with Cooperative Extension shared a or in their pools, often staffed by hospital the University of New Mexico; general internist Dr. Ben Fischer in Raleigh. on advocating for "day in the life" of kids, reminding participants just how therapists. • Acommunities that are specialty clinic that provides interAs healthcare moves from fee-for-service to ubiquitous less healthy foods and sedentary lifestyles are to What’s new is that YMCA staff are trained disciplinary patient care, teaching, and value-based payment models and population safe and accessible for all our children and youth. The rest of the day was spent lifestyle coaches, supporting chronic disease research in Kentucky; and health, local partnerships to improve a developing a shared vision for how North Carolina could look people to walk or roll. prevention and treatment with evidence• AUpdates on this will be state developmental center that supcommunity’s health will grow in importance. if we could strengthen current child care regulations and based programs for cancer survivorship, falls ports the transition of individuals with Working with your local YMCA is just one forthcoming in future rules, and how a voluntary recognition program for HEPA prevention, arthritis management – and the I/DD from institutions to communityexample of these types of partnerships in editions of the Alliance Y is enjoying national recognition for Standards for after school might look. Attendees emerged their based health care in Mississippi. action. Voice. the day with a set of recommendations and an action plan for effectiveness and impact. To learn more about the YMCA’s Diabetes improving the HEPA landscape. The YMCA’s Diabetes Prevention Program, NCAFP’s Greg Griggs offered opening Prevention Program and other health and a year-long, CDC-recognized program, helps remarks and is a member of the initiative’s wellness initiatives, visit participants lose 5 to 7% of their body Advisory Consortium. www.NCYMCAAlliance.org. weight and increase exercise to 150 minutes

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