NC Family Physician - Spring 2019

Volume 15 Issue 2 • Spring 2019

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

BUILDING FM’S

WORKFORCE PIPELINE

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© Novant Health, Inc. 2018 10/18 • 1741

Inside

NCAFP

Spring 2019

2018 NCAFP Annual Report p.13

PRESIDENT’S MESSAGE

MEMBERSHIP & MEMBER SERVICES

4

22 Profiles in Mentorship:

Building FM’s Workforce Pipeline

Linville’s Dr. Charlie Baker

HEALTH POLICY & ADVOCACY

PROFESSIONAL DEVELOPMENT

8

24 Our Winston-Salem CME Dinner Program is Your Must-Do This June

At the Table to Eat, Not to Be on the Menu

CHAPTER AFFAIRS

10 We Can All Be a Mentor

28 Lessons Learned from a Straw Bale Garden

DEPARTMENTS

PUBLISHED BY

t 919.833.2110 •

PRACTICE MANAGEMENT

fax

919.833.1801 • ncafp.com

Managing Editor & Production Peter T. Graber, NCAFP Communications

President’s Message 4 Health Policy & Advocacy 8 Chapter Affairs 10 Membership 22

Professional Development 24 Residents & Students 26 Practice Management 28

Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to pgraber@ncafp.com.

PRESIDENT’S MESSAGE to Members

By Dr. Alisa Nance, RPh 2018–2019 NCAFP President

~ THE NCAFP COMMITTEES ~

Building FM’s Workforce Pipeline Well I must say, things are rolling for the NCAFP and health issues in our state. I hit the ground running as my Presidency began. The year, 2019, is especially unique for me—the 50th Birthday of Family Medicine and my 50th Birthday!!! I am thankful for Family Medicine and its impact on my life!

Throughout this year, I would like to focus each issue of the NCAFP magazine on an individual NCAFP committee. As you may know, the NCAFP strategic plan changed in 2018 and developed the following committees: 1) Workforce Pipeline, 2) Payer and System Advocacy, and 3) Member Satisfaction and Practice Environment. All committees have members who applied and were selected for their positions. Each committee has a chairperson, a new physician, a resident physician, a student, a past president, an executive board liaison, and at large members.

Workforce Pipeline Committee This issue I will focus on the Workforce Pipeline Committee. This committee has the following objectives: • Encourage systems, payers and others in North Carolina to incentivize teaching and mentoring.

• Develop opportunities for members to provide education to school-age children, college students and medical students about Family Medicine, with 4

an emphasis on underserved areas.

• Highlight existing family physician mentoring and teaching efforts.

• Provide opportunities for residents and younger physicians to learn about job opportunities in Family Medicine.

• Modify existing student programs based on evaluation data and workforce needs.

• Increase resident engagement.

Committee members include: Dr. Kelley Lawrence, Chair; Dr. Jay Patel, New Physician; Dr. Demetria

The North Carolina Family Physician

2018-2019

NCAFP Board of Directors Executive Officers President President-Elect Secretary/Treasurer Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh David R. Rinehart, MD Jessica Triche, MD Tamieka M.L. Howell, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios “Taki� P. Hondros, MD Jennifer Mullendore, MD Mackenzie Smith, MD Ying Vang, MD Slade A. Suchecki, DO Brian McCollough, MD Elizabeth B. Baltaro, MD Family Medicine Residency Directors Mark L. Higdon, MD (Novant FMR) Resident Director David S. Baker, MD (MAHEC-A) Resident Director-Elect Elizabeth Ferruzzi, MD (Novant) Student Director Cameron G. Smith (Campbell) Student Director-Elect Katelyn Turlington (WFSOM)

Medical School Representatives & Alternates

Rawlinson, Resident Physician; Mr. Geoffrey Houtz, Medical Student; Dr. Maureen Murphy, Past President; Dr. Liz Baltaro, NCAFP Board Liaison; Dr. Jessica Triche, NCAFP Executive Committee Liaison; and Dr. Janalynn Beste, Dr. Josh Carpenter, Dr. Catherine Coe, Dr. Viki Kaprielian, Dr. Susan Schmidt, Dr. Aregai Girmay, Members at Large.

Long-term goals of the Workforce Pipeline Committee are: to develop written toolkits for promoting Family Medicine to elementary and middle school students and a toolkit for community preceptors designed to enhance student clinical experience; address non-clinical aspects of Family Medicine, such as personal finance, choosing what brings you joy; and, to help preceptors understand ways to maximize skills of rotating students to improve their own efficiency instead of feeling hindered when teaching.

Continues on next page Spring 2019

5

Chair (ECU) Alternate (Campbell) Alternate (Duke) Alternate (UNC) Alternate (Wake)

Chelley K. Alexander, MD Nicholas Pennings, DO Anthony J. Viera, MD, MPH Cristen P. Page, MD Richard W. Lord, Jr., MD, MA

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

Michelle F. Jones, MD Karen L. Smith, MD, FAAFP Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607 www.ncafp.com

Committee Member Focus Working to promote our students and residents, the Academy has focused on pipeline initiatives. The NCAFP hosted the 12th Annual North Carolina Family Medicine Day on March 9th. Attendees, representing twelve medical schools and eight states, participated in skills workshops for various procedures encountered in full-scope Family Medicine practice and networked with residency program physicians. The day was co-sponsored by the North Carolina Fully Health IntegratedEducation Readiness for Service Centers (AHEC) Training (FIRST) is anProenhanced, threegram.

Family Medyear medical school curriculum linked icine Day 2019Family had Medicine to a North Carolina a record high attenResidency, followed by three years of dance of 115 medical service to North Carolina with ongoing students.

FIRST Program

- WORKFORCE PIPELINE -

Although there are many faculty and preceptors in our state who provide excellent, above and beyond work with students and residents of Family Medicine, Dr. Catherine Coe embodies the true nature and goals of the Workforce Pipeline Committee.

After completing her undergraduate and medical school training at the University of Washington, Dr. Coe completed her Family Medicine residency at UNC Chapel Hill in June 2017, serving as Chief Resident her last year. She then joined the UNC School of Medicine Department of Family Medicine as an Assistant Professor. Working through the mentorship and vision of Dr. Cristy Page, Executive Dean of the UNC School of Medicine, Dr. Coe helped develop the Fully Integrated Readiness of Service Training (FIRST) program and currently serves as its Director. Her academic interests include design, implementation, and evaluation of innovative curricula and pipeline initiatives for Family Medicine.

Our vision is to be the leading department of family medicine transforming care and growing leaders practice support. to improve health.

Match Day was March 15th, 2019, a record day for Family Medicine in America. Over 3,800 medical students and graduates matched into Family Medicine residency programs in 2019, the most in Family Medicine’s history as a specialty, and 313 more than in 2018. In North Carolina, 50% of students matching in Family Medicine will stay in North Carolina to train at North Carolina Family Medicine residency programs. Also, the state’s Family Medicine residencies filled all 120 intern slots. Congratulations to all students and residency programs!

Fully Int Readi Service T

FIRST.unc.edu

Some of your state chapter’s other activities around Class ofinclude: 2020 workforceFIRST pipeline

NCAFP members recently gave feedback to the Office of Rural Health on NC Loan Repayment, High The FIRST program consists of two parts: For more Needs information Service Bonus about Program, the J-1 Visa/Conrad Anenhanced accelerated (1) a three-year accelerated and the FIRST Program, FIRST Program 30 Program, and thecontact: State Loan Repayment Program. medical school curriculum tothree-year fast-track into a medica Catherine We Coe, hopeMD; ourDirector comments will help the Office of William Rural B. AycockNorth FamilyCarolina MedicineFamily BuildingMedicine residency, and Cristy Page, MD, MPH; Founding Director to serve the peopl continue to make improvements to how590 they Manning Drive(2) three years of service in North Carolina with Dawn Health Morriston, MPH; FIRST Coordinator work to assure underserved areas of North Carolina Campus Box 7595 ongoing support in practice. While the total curDawn_morriston@med.unc.edu have excellent physicians and care delivery.

Chapel Hill, NC 27514 ricular time is like other programs, FIRST has FIRST Faculty Leaders Phone: 984-974-4987 in teaching and advising: components intensified and condensed into The NCAFP is also bolstering the “America Needs E-mail: FIRST@unc.edu Tommy Koonce, MD, MPH three years. Since students of this program Yee Lam, MD, PhD Beat Steiner, MD, MPH 6

Catherine Coe, MD Assistant Professor, UNC Dept. of FM Director, FIRST Program

establish their patient panel in their outpatient clinic starting March of their first year of medical school, FIRST participants have enhanced oneon-one time with patients. In addition, if FIRST students stay in the program through residency at UNC, they have up to 6-years continuity with these same patients.

Interestingly, FIRST students participate in either the underserved training track or pursue an area of concentration in underserved care. During residency, FIRST graduates serve as mentors to the future classes of the FIRST program. Also, during the final year of medical school, FIRST students are matched with loan repayment programs linked to service in a rural or underserved setting.

tegrated iness for Training (FIRST)

Since the FIRST program’s inception in 2016, the inaugural class of two students graduated in 2018, and this year will mark the second class of two graduates; both of whom will complete their residencies at UNC. According to the Sheps Center data, 67% of medical students who completed medical school training and residency in North Carolina - stay in North Carolina!

The FIRST program’s longterm goals will be to continue the good work at UNC and expand into other residencies within the UNC system. The UNC School of Medicine will continue to work with the Office d and enhanced of Rural Health to establish connected resources, support, and programs to expand the number al school curriculum primaryCarolina care physicians seeking to serve rural le ofofNorth and underserved areas of North Carolina.

Thank you, Dr. Coe, for your vision and commitment to teaching medical students and helping them practice in North Carolina!

More Family Doctors: 25 x 2030 Collaborative.”

The collaborative developed the goal of having 25% of medical students enter Family Medicine by the year 2030. Leading this initiative is the “Family of Family Medicine,” who will meet to address broad issues facing the specialty. The “Family” is composed of eight organizations: 1) The AAFP 2) The AAFP Foundation 3) The American Board of Family Medicine 4) The American College of Osteopathic Family Physicians 5) The Association of Departments of Family Medicine 6) The Association of Family Medicine Residency Directors 7) The North American Primary Care Research Group, and 8) The Society of Teachers of Family Medicine.

I also applaud the valuable work of the NCAFP Foundation which contributes to the financial, educational, and professional needs of students and residents. The Foundation continues to support the Family Medicine Interest Groups (FMIGs) and participation on the NCAFP board of directors and the NCAFP Foundation board of trustees, and on each NCAFP committee through its student leadership development. Other student activities supported by the NCAFP Foundation include: student summer programs; the Student Leadership and Health Policy Elective; the NCAFP Foundation Loan/Scholarship Program; and financial assistance to offset the attendance cost at the NCAFP Annual Meeting.

The NCAFP Foundation also supports students to attend the AAFP National Conference and both students and residents by sponsoring the annual Research Poster Contest held at the NCAFP Annual Winter Family Physicians Weekend.

As you can see, the NCAFP has been actively promoting and supporting our future. Our pipeline is our FUTURE!

7

By Peter Graber NCAFP Communications Services

• Providing family physicians the needed resources in their office during the move to value, including the possibility of scribes, additional medical assistants, imbedded behavioral health services, etc.

~ Fighting for Family Medicine ~

• Advocating for a broad scope of practice for family physicians in our state, including OB, dermatological procedures, sports medicine and more.

POLICY & ADVOCACY

At the Table to Eat, Not to Be on the Menu

• Advocating for dedicated teaching time for community-based primary care physicians so that today’s medical students can have engaged and satisfied role models.

Stay tuned as the NCAFP continues to meet with additional health systems across the state.

NCAFP’s new strategic plan is designed to put Family Medicine at the table of key healthcare decisions in our state. And it’s beginning to happen.

Here are a few key ways Family Medicine has been at the table in recent months: Meeting with Healthcare System Leaders As you may remember from our 2018 Annual Meeting, we heard from a panel of key healthcare system executives. Since that time, we have had follow-up meetings with executives from two of those systems: Novant and Cone Health.

NCAFP leaders are holding these meetings to better understand how your Academy can work with integrated health systems in order to advocate for the resources family physicians need as our state transitions to value-based healthcare. Both initial meetings went well with follow-up plans in place for the future. Some of the key goals of these meetings include: • Increasing health system investment in Family Medicine.

8

Key Medicaid Reform Committees NCAFP continues to be involved in key areas of Medicaid Transformation. Most recently, NCAFP President-Elect Dr. David Rinehart was named to Medicaid’s Technical Advisory Group (TAG) for Advanced Medical Homes. The role of the TAG is to inform the state Department of Health and Human Services on key aspects of the design and evolution of the Advanced Medical Home program. The TAG held its first meeting on April 1st. Other NCAFP members serving on the TAG include Dr. Eugenie Komives, representing Duke University Health System, and Dr. Tommy Newton, in his role as a Medical Director for WellCare Health Plans.

Healthcare Transformation Discussions In February, NCAFP Past President Dr. Karen Smith and NCAFP EVP Greg Griggs both participated in a panel discussion at a day-long summit, entitled “Advancing Health Care Transformation in North

The North Carolina Family Physician

Carolina,” hosted by the Duke Margolis Center for Health Policy. The Margolis Center is directed by Mark B. McClellan, MD, PhD, a former head of both the Federal Drug Administration and the Centers for Medicare and Medicaid Services. Other speakers at the summit included Dr. Wesley Burks, CEO and Dean of UNC Health; Dr. Eugene Washington, President and CEO of Duke University Health System; Dr. Mandy Cohen, Secretary of the NC Department of Health and Human Services; Dr. Patrick Conway, President and CEO of Blue Cross and Blue Shield of North Carolina; Gary Salamido, Chief Operating Officer and Acting President of the North Carolina Chamber of Commerce; and Dr. Bill Roper, Interim President of the University of North Carolina system.

As a result of the summit, Dr. McClellan has tapped a small group of individuals to continue discussing how to move healthcare transformation forward in North Carolina. Griggs was named to that group and attended a small dinner with about 15 others in late March, including Dr. McClellan, Dr. Conway, Dr. Cohen, Terry Akin (CEO of Cone Health System), Dr. Thomas Owens (President of Duke University Hospitals), representatives of a few of the Medicaid managed care plans, and representatives of a few other healthcare associations, including the NC Pediatric Society, the NC Nurses Association and the NC Medical Society.

The group discussed possible ways for collaboration and concentrated on a few key themes: • Aligning quality metrics and payment models across health plans, including Medicaid and Commercial plans; • Identifying the most important social determinants of health to provide greater focus on health versus sick care; • Providing the right resources at the right point of care; • Better communication between healthcare providers and employers to move value-based healthcare forward with a common language.

The group will continue to meet with additional steps taken in between each meeting. Look for more information as this process moves forward.

Dialogue with BCBS NC NCAFP leaders and staff have continued to dialogue with the leadership at Blue Cross and Blue Shield of North Carolina as the organization has announced several major initiatives. Due to the ongoing collaboration, NCAFP EVP Greg Griggs had the chance to speak with BCBS NC President and CEO Dr. Patrick Conway on the night that his company announced a partnership with Cambia Health Solutions, with Conway becoming the President and CEO of both BCBS NC and Cambia, an Oregon-based company that offers health plans in four northwestern states.

During the conversation, Dr. Conway explained the benefits of their relationship with Cambia, including enhanced technology.

Griggs and Conway also discussed NCAFP concerns around Blue Cross’s decision to partner with three out-of-state organizations to open practices specifically for Medicare and Medicaid customers in North Carolina. Dr. Conway noted his company’s concerns that there may not be enough Medicaid capacity in certain areas of the state, and by partnering with these companies (Iora Primary Care, Cityblock Health and CareMore Health), they could provide better access to Medicaid recipients.

As previously reported, BCBS NC has also partnered with several of the state’s largest healthcare systems to share financial risk for patients. In addition, BCBS NC partnered with Aledade to provide additional assistance to independent practices including the opportunity for enhanced payment and quality incentives.

The NCAFP continues to monitor all these changes and provide feedback to our state’s largest insurance company. If you have questions or concerns about any of these initiatives, please contact NCAFP EVP Greg Griggs at ggriggs@ncafp.com.

Continues as ‘Advocacy’ on page 31 Spring 2019

9

CHAPTER AFFAIRS

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

We Can All Be a Mentor This quarter, we are highlighting one of our three core committees, our Workforce Pipeline Committee.

Elsewhere in this magazine, our President, Dr. Alisa Nance, highlights some of the activities of the committee and one of its committee members. There’s also an article in this issue about how Dr. Charlie Baker served as a mentor to our Workforce Pipeline Committee Chair, Dr. Kelley Lawrence.

Our focus on the efforts to build the Family Medicine workforce of tomorrow made me think of the larger subject of mentoring. But I was struggling with how to approach the subject. Then it hit me in the most unusual of ways.

evaluate a decision we made. It’s always easy to see the outcome after the fact. It would have been much easier to predict Auburn’s defeat of UNC in the NCAA Tournament if you already knew that Auburn would hit 17 three-pointers and at least two key Tar Heels had the flu. But it was harder to predict that at the beginning of the NCAA Tournament, without the benefit of hindsight.

In turn, foresight is defined as the act or power of foreseeing – basically, knowing in advance.

As I thought about mentoring in this context, it hit me that we all learn by not only our own successes and mistakes but also by the mistakes and successes of others.

My wife and I ordered takeout Chinese one Friday night, and the fortune in that night’s cookie said it all: “A mentor is someone whose hindsight can become your foresight.”

How many times have you told a colleague or even a medical student about a mistake you made as a key teaching moment – or even a success. In reality, we can all be a mentor by sharing our experiences both good and bad with others – helping someone else learn from our successes and failures.

In reality, many of our members are always helping other family physicians, residents and medical students. That’s mentoring. And that’s really one of the reasons a professional association exists: to bring people together, share ideas and mentor colleagues.

To me that really represents the spirit of Family Medicine. I see each and every one of you doing that almost every day. Family physicians are always helping their patients, their colleagues and the future members of the profession.

Let me take a bit to break down this fortune even more.

In the association world, we sometimes call it our own unique form of R&D, but we don’t just mean research and development. We sometimes say, “rip-off and duplicate.” Yes, we learn what has succeeded or sometimes even failed in another chapter or another association and try to apply it to our own activities.

First, Webster defines hindsight as the perception of the nature of an event after it has happened. We’ve all said hindsight is 20/20, when we can look back and 10

The North Carolina Family Physician

ing medical students. As we meet with healthcare system leaders around the state, we are advocating for dedicated time and/or compensation for employed physicians who teach. We want to make sure that today’s medical students have happy, enthusiastic and engaged preceptors to mentor the next generation of family physicians. That can only happen when everyone values the time needed to teach. In a feefor-service world, we believe teaching should have an RVU. But even as we move to value-based healthcare, we need to make sure our members have the time to teach as part of developing the workforce of the future. And in fact, it should be an investment our healthcare systems readily embrace.

In closing, I sometimes hear our members say that they aren’t mentors, but each of you are whether you teach students or not. So, as you move forward this month, I ask you to think about how you can share your hindsight to a younger physician, resident or medical student in order to give them the foresight to succeed.

As family physicians, you do that every day – learning from the good and bad and teaching others from your own experiences.

One of our strategic initiatives is designed to help make it easier for you to be a mentor through teach-

N A T I O N A L

A Mentor: someone whose hindsight can become another’s foresight. Doesn’t that say it all...

PS: My wife’s fortune that night said the following: “a leader is powerful to the degree that he/she empowers others.” Maybe that’s my next column.

F A M I L Y

M E D I C I N E

NCAFP Past President Dr. Karen Smith Announces Candidacy for the AAFP Board of Directors The NCAFP is proud to announce that Past President Dr. Karen L. Smith (2005) of Raeford, N.C., has formally announced her candidacy for the AAFP Board of Directors.

Dr. Smith will be one of five candidates vying for three positions at this year’s AAFP Congress of Delegates in late September.

Spring 2019

An article outlining Dr. Smith’s candidacy and her perspectives on the issues facing the specialty will be published in the summer edition of The North Carolina Family Physician. Members should receive this issue during the first week in August, 2019.

To learn more about Dr. Smith and to contribute to her effort, visit www.smithforboard.org.

11

A A F P

N E W S

&

D E V E L O P M E N T S

AAFP CEO Dr. Doug Henley to Retire in 2020 Dr. Doug Henley, the Chief Executive Officer of the AAFP, has announced that he will step down and retire from the AAFP effective August 1st, 2020, marking twenty years leading Family Medicine’s largest organization. A native of Hope Mills, NC, Dr. Henley served as President of the NCAFP from 1987 to 1989.

In a statement by the AAFP announcing the decision, AAFP Board Chair Dr. Michael Munger noted that Henley will remain at the helm until next August while a national search is conducted and a leadership transition is completed.

Dr. Munger also reflected on Henley’s leadership during the evolutionary healthcare jobs.ncafp.com changes that have taken place during his tenure.

“I think I speak for all who have worked alongside him when I say that he is as principled, dedicated, and passionate a leader as I’ve ever had the privilege

to know. When it comes to the issues that matter jobs.ncafp.com most to our members, he is quite possibly the most well-informed and well-read person I know,” noted Dr. Munger. “His command of health care policy and what it means to our members is humbling. His passion for the unique dignity of Family Medicine is unmatched. His absolute and unyielding commitment to doing what’s right is inspiring.”

Prior to leading the AAFP, Dr. Henley served on the AAFP Board of Directors from 1991-97, and as president from 1995 to 1996. He was the first practicing family physician to be named executive vice president and the first AAFP past-president and board chair to serve in that position.

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NCAFP

2018 Annual Report North Carolina Academy of Family Physicians

State of the Academy

A

s North Carolina’s leading advocate for Family Medicine, it gives me great pleasure to report that the NCAFP accomplished much in 2018 as we led the charge to equip family physicians, Family Medicine residents and medical students with the skills and resources to tackle the challenges of the fast-changing healthcare environment.

The following pages showcase our work and efforts throughout 2018. We shifted more energy into re-aligning our Academy’s governance structure for the future, but we also worked hard on several other fronts, including Medicaid, workforce development, and with insurance companies and health systems building relationships. Together, they represent NCAFP’s commitment to helping family physicians adapt to the changing needs of today’s practice environment and to securing a bright future for Family Medicine in North Carolina.

Much of NCAFP’s work was guided by feedback it received from a member needs assessment we conducted in early 2018. This assessment led to several strategic changes to NCAFP’s governance structure that included the redesign of its core committees, the streamlining of its board of directors, and a revamp of the board and committee nominations process. Three new member committees now help inform our board of directors— Payer & System Advocacy, Member Satisfaction & Practice Environment, and Workforce Pipeline. These committees also represent the major areas of focus for our Academy over the next few years.

Outside of chapter affairs, the NCAFP worked hard within North Carolina’s Medicaid program to help achieve two major victories that will pay big dividends for family physicians as the program moves to managed care. First, working alongside our state’s pediatricians, we successfully advocated for increased Medicaid rates for primary care beginning in 2019. This resulted in Medicaid E&M code rates increasing by almost 30%, as they will now match what Medicare pays for the same services. Second, we also worked with several key partners to establish a higher medical loss ratio for the state’s Medicaid Managed care plans that is estimated to keep nearly a billion dollars in healthcare.

Beyond payment and policy, NCAFP also made strides in growing Family Medicine’s voice within several public health issues, such as rogue internet pharmacies, adolescent immunizations and the opioid crisis. I am proud to report that the NCAFP is being increasingly referenced as a trusted healthcare information source from the media, state government and elected officials.

Please review the following pages. It was an honor and privilege to help lead our Academy in such a successful fight.

2017-2018 NCAFP LEADERSHIP Executive Officers President

Tamieka M.L. Howell, MD

President-Elect

Alisa C. Nance, MD, RPh

Vice President

NATIONAL & INTERNATIONAL FAMILY MEDICINE LEADERSHIP

David R. Rinehart, MD

Secretary/Treasurer

Warren P. Newton, MD

Jessica L. Triche, MD

Board Chair

President and CEO American Board of Family Medicine

Charles W. Rhodes, MD

Past President (w/voting privileges) Executive Vice President

Rhett L. Brown, MD Gregory K. Griggs, MPA, CAE Beat Steiner, MD

Directors District 1

Mackenzie Smith, MD

District 2

Gilbert Palmer, MD

District 3

Garett R. Franklin, MD

District 4

Shauna L. Guthrie, MD, MPH

District 5

Dimitrios “Taki” P. Hondros, MD

District 6

Ying Vang, MD

District 7

Jennifer L. Mullendore, MD

At-Large

Jason T. Cook, MD

At-Large

Elizabeth ‘Libby’ Baxley, MD Executive Vice President American Board of Family Medicine

Viviana Martinez-Bianchi, MD

Talia M. Aron, MD

IMG Physicians

Executive Committee WONCA - The World Organization of Family Doctors

Brian McCullough, MD

Minority Physicians

Jewell P. Carr, MD

Osteopathic Family Physicians

Slade A. Suchecki, DO

New Physicians

Elizabeth B. Baltaro, MD

FM Residency Directors Resident Director

2018-2019 President Society of Teachers of Family Medicine

Benjamin “Frankie” Simmons, MD

Mark L. Higdon, MD (Novant)

New Physician Member AAFP Board of Directors

Courtland Winborne, MD, MPH (Cabarrus)

Resident Director-Elect

David S. Baker, MD

Student Director

Allyson Mentock (BSOM)

Student Director-Elect

Cameron G. Smith Alexa Mieses, MD, MPH

Medical School Representatives Chair (ECU) Representative (Campbell)

Nicholas Pennings, DO

Representative (Duke)

J. Lloyd Michener, MD

Representative (UNC)

Cristen P. Page, MD

Representative (Wake)

Resident Member AAFP Board of Directors

Chelley Kaye Alexander, MD

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. Rich, Jr., MD

Karen L. Smith, MD AAFP Commission on Governmental Advocacy (Chair) Shannon Dowler, MD AAFP Commission on Health of the Public & Science Brittany Watson, MD (PGY-2) AAFP Commission on Health of the Public & Science Erin Clark AAFP FMIG Regional Coordinator - Southeast

Chapter Governance & Operations

MEMBER SATISFACTION & PRACTICE ENVIRONMENT

•

Completed Member Needs Assessment and Developed New Strategic Plan.

•

Refined Chapter Governance and Restructured Nomination Process for All Board and Committee Positions.

•

Introduced New Three-Pronged Committee Structure:

PAYER AND SYSTEM ADVOCACY

NCAFP BOARD OF DIRECTORS

WORKFORCE PIPELINE

1) Member Satisfaction and Practice Environment 2) Payer and System Advocacy 3) Workforce Pipeline

Regulatory Advocacy •

Successfully Fought to Increase Medical Loss Ratio for Medicaid Managed Care Plans from 85% - 88%. Estimated to Keep $1B in Healthcare in North Carollna.

•

Supported Better Integration of Non-High Need Behavioral Health In Medicaid Plans.

•

Significant Involvement in Payer Advocacy, Particularly within Medicaid and The State Health Plan.

•

Helped Stop Change that Would Have Taken $30-40M from Practices

by Eliminating Medical Home Fees to Practices Serving Medicaid Patients.

•

Supported AAFP Efforts on Capitol Hill on Importance of Primary Care.

NC Rep. David Rouzer Honored as a Primary Care Champion by AAFP.

Public Health Affairs •

Greater Involvement with Key State Healthcare Partners, Including The North Carolina Healthcare Association, State Health System Executives, and Employer Groups Such as the North Carolina Chamber, and the North Carolina Business Group on Health.

•

Conducted Integrated Communications Campaign on Adolescent Immunization Month, including Print, Social Media, Op-Ed, and Statewide Major Media.

• Produced Three Conferences, including the

Largest State-Based Family Medicine Meeting

in the US.

2018 Spring Symposium

Nichole L. Johnson, MD – Program Chair

71

TOTAL CREDIT

SO

ED ER FF

Accomplishments

Continuing Medical Education

8.00 AAFP Prescribed Credits

2018 Mid-Summer Family Medicine Digest

Lisa A. Cassidy-Vu, MD – Program Chair Slade A. Suchecki, DO – Program Vice-Chair 31.50 AAFP Prescribed Credits

2018 Winter Family Physicians Weekend

111 Registered CME Attendees

172 Registered CME Attendees | 27 Exhibitors

Jewell P. Carr, MD – Program Chair Shannon B. Dowler, MD – Program Vice-Chair 31.75 AAFP Prescribed Credits

817 Registered CME Attendees | 76 Exhibitors

• Secured over $1,053,000 in Educational Grant

Funds to Deliver Education to Family Physicians

and Learners in 14 Partner AAFP Chapters:

Alabama Arkansas Florida Georgia Indiana Louisiana Michigan

•

1,100 TOTAL ATTENDEES

Mississippi Oklahoma San Diego South Dakota Texas Virginia West Virginia

Began Presenting More Localized, Shorter Educational Symposia. Full Rollout Planned for 2019.

7,800 TOTAL LEARNERS

Membership & Member Services •

Top Performance Among Extra-Large AAFP Chapters:

#1 XL Chapter Active Retention (96.3%). #1 XL Chapter New Physician Retention (92.5%). #1 XL Chapter Market Share (88.4%). #2 XL Chapter Resident to Active Conversion (83%).

• Membership Growth Across All Major Categories

Total Membership: 4,194 (vs 4,112 in 2017).

SUPPORTING 10

INACTIVE 31

RESIDENT 342

LIFE 318

ACTIVE 2,509

STUDENT 978

OTHER 6

Chapter Awards & Recognitions

2018 NC Family Physician of the Year

Kenneth T. Yang, MD Clinton, North Carolina Dr. Yang is an outstanding example of a family physician who excels at patient care while serving his community and helping to advance his profession. An avid swimming and soccer coach, Dr. Yang has made siginificant contributions to his community’s youth sports programs. He has also worked hard to advance the specialty and contributed to helping build the next generation for family physicians who will serve Clinton, NC. Dr. Yang earned his medical degree at NY Medical College and completed residency training at Tufts University-Beverly Hospital Family Medicine Residency.

AAFP Residents & Students Recognitions

Jessica Lapinski, DO 2018 AAFP Excellence in GME Award Winner

Erin Clark First Osteopathic Medical Student Elected as FMIG National Coordinator for AAFP

2018 NCAFP Foundation Leadership L. Allen Dobson, Jr., MD, FAAFP

Vice-President

Shannon B. Dowler, MD, FAAFP

&

President Secretary-Treasurer

William A. Dennis, MD

Physician Trustee

Lisa A. Cassidy-Vu, MD

Physician Trustee

Cherrie C. Hart, MD

Physician Trustee

Eugenie M. Komives, MD, FAAFP

Physician Trustee

R. Aaron Lambert, MD, FAAFP

Physician Trustee

David E. Lee, MD

Physician Trustee

Amy E. Marietta, MD, MPH

Physician Trustee

Holly L. Stegall, MD

Academy President Academy President-Elect

Tamieka M.L. Howell, MD, FAAFP Alisa C. Nance, MD, FAAFP

Corporate Trustee

Steve Parker

Corporate Trustee

John R. Smith Jr., MD

Resident Trustee

Sarah E. Barker, DO

Resident Trustee

Megan C. Campbell, MD

Student Trustee

Courtney Brooks

Student Trustee

Olivia S. Johnson

Trustee Emeritus

Development Progress

The NCAFP Foundation promotes the specialty of Family Medicine to medical students in North Carolina. In 2018, experiences included early clinical exposure to rural Family Medicine, mentoring experiences, travel stipends to attend state and national conferences, a research poster contest, and support to Family Medicine Interest Groups for on-campus activities. Students can develop leadership skills by serving on one of the NCAFP’s two boards or three committees, or they can participate in a policy and leadership rotation with the NCAFP. The NCAFP Foundation’s financial investment is also made evident through the Foundation’s Family Medicine Scholarship program.

Maureen E. Murphy, MD, FAAFP

2018 by the Numbers •

$1,114,245.28, balance of the Medical Student Endowment effective 12/31/18.

•

$100,000 + in direct financial support provided for student and resident programs.

•

$34,846.00 raised for the Foundation via the Family Medicine Gala.

•

$45,393.00 raised through other individual and corporate contributions to the

Foundation or Medical Student Endowment.

•

979 medical student members at the end of 2018.

2018 Foundation Contributors NCAFP members and supporters of the Academy are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation. The following corporations and individuals contributed to the Foundation in 2018.

Thank you for your continued support.

C OR P OR AT E D ONOR S Accu Reference Medical Labs

DBA Qui Medical Innovations

Levine Cancer Institute

Aledade

Duke Population Health Management and the Duke Dept. of Community & Family Medicine

Mako Medical Laboratories

Family Medical Associates of Raleigh

Novant Health

FirstHealth of the Carolinas

UNC SOM, Dept. of Family Medicine

Giant Genie/Randolph Medical Pharmacy

Wake Forest Baptist Health

Hoke County Democratic Party

Wake Forest School of Medicine

Alliant Health Blue Cross and Blue Shield of North Carolina Brody SOM @ East Carolina University Campbell University Jerry M. Wallace School of Osteopathic Medicine Cape Fear Valley Health System

Medical Mutual

Holy Trinity Greek Orthodox Foundation of Charlotte, NC

I N DI V I DUA L D ONOR S Dr. Chelley Alexander Dr. Talia Aron Dr. Charles Atkinson Dr. Amanda Austin Dr. David Baker Dr. Elizabeth Baltaro Dr. Keli Beck Dr. Janalynn Beste Dr. Holly Biola Dr. Jessica Bitencourt Dr. Seaborn Blair Dr. Karolen Bowman Mr. Jason Bragg Ms. Courtney Brooks Dr. Don Brown Dr. Rhett Brown Dr. William Byars Mrs. Marianne Campbell Mr. Richard Campbell Mr. Tom Campbell Dr. Jewell Carr Dr. Lisa Cassidy-Vu Dr. Bryan Cheever Ms. Chris Collins Dr. Clayton Cooper Dr. Christopher Danford Dr. William Dennis Dr. Andrea DeSantis Dr. Deanna Didiano Dr. L. Allen Dobson

Dr. Shannon Dowler Dr. Kawanta Durham Dr. Howard Eisenson Dr. Elizabeth Ferruzzi Dr. Conrad Flick Dr. Vickie Fowler Dr. Garett Franklin Dr. Aregai Girmay Dr. Donald Goodman Mr. Gregory Griggs Dr. Wayne Hale Dr. David Hall Dr. Cherrie Hart Mr. Brent Hazelett Mr. David Henderson Dr. Mark Hester Dr. Melissa Hicks Dr. Mark Higdon Dr. Anne Hines Ms. Susan Hogeland Dr. Dimitrios Hondros Dr. Tamieka Howell Dr. Janice Huff Dr. Tochi Iroku-Malize Dr. Mishi Jackson Dr. Nichole Johnson Dr. Jason Jones Dr. Victoria Kaprielian Dr. William Kelly Dr. Eugenie Komives

Dr. R. Aaron Lambert Dr. Lars Larsen Dr. Sarita Lavani Dr. David Lee Dr. Richard Lord Dr. Shelly Lowery Dr. John Mangum Dr. Amy Marietta Mr. Chester Martin Dr. Viviana Martinez-Bianchi Mr. Scott Maxwell Dr. Alfred May Dr. Brian McCoullough Dr. J. Patrick McGee Dr. James McNabb Dr. Kathleen Meehan-de la Cruz Mr. Ken Melton Dr. Albert Meyer Dr. Kevin Mikus Dr. Jennifer Mullendore Dr. Lucy Muhirwa Dr. Maureen Murphy Dr. Alisa Nance Dr. John Newton Mr. Whit Newton Dr. Augustine Onwukwe Dr. Gib Palmer Mr. Steve Parker Dr. Nicholas Pennings Ms. Renda Powell

Ms. Karla Pratt Dr. Demetria Rawlinson Dr. Charles Rhodes Dr. Robert Rich Dr. David Rinehart Dr. Sarah Ringel Dr. J. Carson Rounds Dr. Elizabeth Saft Dr. George Saunders Dr. Charles Sawyer Dr. Susan Schmidt Dr. Frankie Simmons Dr. Nadine Skinner Mr. Alex Smingler Dr. Mackenzie Smith Mr. Phil Smith Dr. Barbara Stagg Dr. Erika Steinbacher Dr. Julian Taylor Dr. Netra Thakur Dr. Gregory Thompson Dr. Jessica Triche Mr. Robert Ward Dr. Thomas Ward Dr. Kaitlyn Watson Dr. Adam Wenzlik Dr. Thomas White Mr. James Wilson Ms. Judy Wood Dr. Christopher Zagar

- T H E 2 0 1 9 N C A F P F O U N DAT I O N R A F F L E -

Win One of

5

Fabulous Vacations in the US!

Become a Sonoma Valley Winemaker: Intimate Blending Seminar, Winery Tours & Tastings, Fairmont Sonoma Mission Inn & Spa 3-Night Stay with Airfare for two.

Classic Wrigley Field Rooftop Experience: Rooftop Bleachers

& Dining Package at Regular Season Chicago Cubs Game, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

Tennessee Whiskey Adventure: Jack Daniels and George Dickel Distillery Tours and Tastings, Lunch, Transportation, 3-Night Stay at Renaissance Nashville with Airfare for two.

New York Long Weekend: Choice of Broadway Show, Dinner, 3-Night Weekend Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

America’s Cup Yacht Sailing in San Diego: Sailing Experience on America’s Cup Yacht, 3-Night Stay in San Diego at Estancia La Jolla Hotel & Spa with Airfare for two.

THE NCAFP FOUNDATION’S EFFORTS TO SUPPORT STUDENT INTEREST INITIATIVES CONTINUES. YOU CAN SUPPORT THIS IMPORTANT WORK AND HAVE A CHANCE TO WIN YOUR CHOICE OF ONE OF FIVE FANTASTIC TRIPS! Information about the Foundation’s raffle can be found at www.ncafp.com/raffle. Make your purchase by Noon on Saturday, December 7th, 2019, and your name is automatically entered in the drawing. Each entry is $50.00.

Winner will be drawn that evening at the Presidential Gala in Asheville. Winners do not need to be present to win, so spread the word and support the cause!

Winners will be fully informed of options prior to making their selection. Full details about available trips can be found at www.ncafp.com/raffle.

Questions? Contact Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

$50

per entry

MEMBERSHIP & MEMBER SERVICES

~ PROFILES IN MENTORSHIP

~

Linville’s Dr. Charlie Baker Set to Complete 40-Years of Service as Community Physician, Mentor and FM Workforce Builder Before becoming a physician in 1973, Dr. Charlie Baker wanted to be a teacher, and that desire stuck throughout his career. He sat down to share his story about that with the NCAFP alongside one of his mentees and patient who ultimately became a physician and teacher herself.

“Charlie Baker defined Family Medicine for me growing up,” said Kelley Lawrence, MD, Associate Program Director at Novant Health Family Medicine Residency in Huntersville. “He did everything in our community. He took care of my parents, my friends and me. And he delivered my baby brother. He was the rock of support for my family.”

Growing up, when Lawrence became interested in a career as a health professional, she thought she would be a nurse since that’s what she saw women doing in healthcare. However, her dad encouraged her to be like Dr. Baker, and Baker agreed.

“I watched what he did and started asking lots of questions in middle school,” Lawrence said. “He set up a summer volunteer position for me in high school, teaching me to take blood pressures and use a stethoscope. When I decided to apply to medical school, he set up a summer

22

internship in the hospital for me while I was in college. He just opened a lot of doors for me and showed me what Family Medicine was about.”

As part of his m e n t o r s h i p, Baker took Lawrence on home visits, nursing home visits, asked her to be on call with him, and even allowed her to watch a delivery while still in college (the mother had invited Lawrence to be there alongside Baker as well).

Baker’s path to Family Medicine wasn’t a straight line either. He ultimately finished a pediatric residency, but before completing the residency program he had also done work in the Indian Health Service and in Inner City Pittsburgh.

“I did a lot of CME and cared for people of all ages, so I ended up taking the family practice boards and passed, being one of the last grandfathered individuals in 1979,” Baker said. “I’ve considered myself a family doctor ever since, including full scope pediatrics and obstetrics.”

His first medical student teaching began when he moved to Crossnore, NC (in

Avery County) from Pittsburgh, when students from Pittsburgh Children’s Hospital followed him down for rotations.

“That was the first pipeline,” Baker said.

“Then I got hooked-up with UNC and my practice has been a teaching practice for UNC medical students for 30 years.”

It was only natural for Lawrence to want to complete her Family Medicine rotations with Baker while in medical school at UNC. “I worked with him in high school, in college, for a few weeks in both the first and second year of medical school, and in my first rotation back after giving birth to my first child – completing my six-week Family Medicine rotation with Dr. Baker,” Dr. Lawrence said. “During the rotation, my baby came to the office every day at lunch. He helped me be a breastfeeding mom in the medical field, which I have tried to pass on to my residents.”

Fittingly, but unplanned, Dr. Baker would later deliver one of Dr. Lawrence’s children.

“When I graduated from residency in Massachusetts, I came down to visit my parents, and at 37 weeks, I went into labor at my parent’s house far away from where I was planning on delivering,” Lawrence said. “I called Dr. Baker and asked if he felt like delivering a baby that day; he delivered my baby 13 minutes after I got to the hospital.”

Dr. Baker is now moving on to the next phase of his career, serving as Assistant Director of the new MAHEC-Boone Family Medicine Residency Program, which will open in the summer of 2020.

“I am on the Board of Directors for the Appalachian Regional Hospital System,” Baker said. “They started brainstorming about a residency, and it turned out there was some funding available for family practice residencies in rural settings.”

Dr. Baker will retire from full-time practice this June, exactly 40 years to the day from when he started his NC practice in

The North Carolina Family Physician

DECADES OF SERVICE: (L) Dr. Baker

delivered John Vance (now a General Surgeon in Bristol, TN). His sister, Dr. Kelley Lawrence, is seen holding him.

rural Avery County. His teaching, however, will thankfully continue.

“This is a perfect way that I can continue be useful,” Baker said. “This fall, we will be interviewing students, and we’ve already had our ACGME site review and it went fabulously.”

So now, the relationship between Baker and Lawrence has come full circle.

“There was finally a moment where I felt like I could share some knowledge with him after all these years,” Lawrence said. “When he got involved in this residency, he called and asked me to come learn about our residency at Novant. I got to share some things about my experience in helping to build a residency with my teacher, the doc who taught me all about caring for families.”

While Baker is retiring from practice, don’t worry, his patients will remain in good hands.

Dr. Beth Cherveny, a graduating resident at the MAHEC-Asheville Family Medicine Residency and a former NCAFP-BCBS NC Family Medicine Scholar, will be joining the Baker Center for Primary Care in Linville, starting an entirely new cycle of mentoring and teaching.

Spring 2019

Medical Mutual is now Curi Helping physicians in medicine, business, and life.

Curious to know more? Visit curi.com

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

ADVERTISE! Reach many types of Family Medicine professionals in North Carolina.

Contact Peter Graber with the NCAFP at pgraber@ncafp.com 23

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP NCAFP Meetings & Conferences Manager

- UPCOMING EVENTS -

Our Winston-Salem CME Dinner Program is Your Calendar “Must-Do” This June

2019 Street Drugs: Do’s, Don’ts, and Dupes

A convenient, regional, after-office dinner and CME opportunity in a relax We know that providing exceptional care to patients is your priority. Because of that, we take pride in providing you with convenient CME opportunities that address the important and timely issues you and your colleagues are presented with each day. Our winning combination of requested topics, presented by expert speakers, is a standard that you can count on for all of our CME programs. This June, we’re adding a fun little twist to this combination by serving up a unique after-office hours dinner presentation. This one-of-akind educational opportunity to address street drugs in 2019, just happens to include foosball tables, bowling, and a delicious dinner. Yes, it almost sounds too good to be true, but it is happening. And, the NCAFP Meetings Department is simply delighted to bring this first-rate combination of education and fun to Winston-Salem.

Make your plans now to join us after your office hours on Thursday, June 13th, from 6:00 pm to 8:30 pm at the Kimpton Cardinal Hotel located in downtown Winston-Salem. You and your colleagues will not want to miss Dr. Paul Martin’s presentation, “2019 Street Drugs: Do’s, Don’ts, and Dupes.” This important CME presentation will address the current drugs of abuse in NC and will include monitoring methods

24

THURSDAY, JUNE 13, 2019 • 6:00 PM –

Kimpton Cardinal Hotel, Winston Salem

Presenter: J. Paul Martin, MD, FAAFP, DFA President, NC Society of Addiction Medi

Join Dr. Paul Martin for an important CME pres reviewing the current drugs of abuse in NC, mo methods you can use to detect aberrant dru and strategies to help avoid diversion o prescription medications.

$25 registration fee includes dinner and 1.5 AAFP Prescribed Credits

Register now at www.ncafp.com/winstonsa

All medical education topics offered by the NCAFP have been rev physician, and when possible and appropriate, presented by a While the NCAFP may receive pharmaceutical funding to help pro our events, they are allowed no influence on the content provide the information provided is always the NCAFP’s primary

The North Carolina Family Physician

s

e hours xed setting

– 8:30 PM

m, NC

ASAM icine

sentation onitoring ug use, of

r

you can use to detect aberrant drug use, and strategies to help avoid diversion of prescription medications. If you’ve ever attended an NCAFP CME event before, you’ve probably enjoyed a session or two led by Dr. Martin. A family physician and a Distinguished Fellow of the American Society of Addiction Medicine, Dr. Martin is the Medical Director of Neil Dobbins Detoxification and Crisis Stabilization Center. He is also a Community Faculty Member of the Mountain AHEC Family Practice Residency Program, a Medical Review Officer for federally regulated drug testing programs, and the current president of the NC Society of Addiction Medicine.

This out of the ordinary learning experience will be held in the Kimpton Cardinal Hotel’s world-famous Recreation Room. Plan to arrive a few minutes early (BTW: feel free to make your grand entrance via the indoor 2-story blue spiral slide – for real!) and enjoy

a friendly round or two of bowling and foosball with your colleagues before the program begins. Registration fees are just $25 per person and include a welcome reception, a brief NCAFP update, a delightful dinner prepared by the Kimpton chef, and 1.5 AAFP Prescribed Credits. It is important to note, credits earned by your participation will also count towards the state’s controlled substance CME requirement for physicians and other healthcare providers.

Be sure to add this CME “must-do” to your June calendar and feel free to invite a colleague or a staff member to join you for this critical update with take-home pearls you are sure to begin using right away. Registration and additional program details can be found at www.ncafp.com/winstonsalemcme. Contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at katkinson@ ncafp.com or via direct-dial at 919-214-9058 with questions. We look forward to seeing you there. Race you to the slide!

~ MAINTENANCE OF CERTIFICATION- FAMILY PHYSICIANS ~

alemcme

viewed by a family family physician. rovide education at ed. The integrity of y concern.

Spring 2019

First Looks: Navigating ABFM’s New Longitudinal Board Certification Option The ABFM recently launched a new pilot program for diplomates completing their formal re-certification: a ‘longitudinal’ option in lieu of the traditional one-day exam. This new option consists of diplomates being required to answer 25-questions every quarter for up to 4 years. For members not familiar with this new option, the AAFP

has a webpage dedicated to the pilot.

See www.aafp.org/cme/fmcla.html.

AAFP Board member Dr. Tochi Iroku-Malize, MPH, MBA, published an insightful overview of her experience so far in AAFP Leader Voices. Leader Voices can be found online at AAFP.org/leadervoices.

25

RESIDENTS & STUDENTS

By Tracie Hazelett NCAFP Medical Student & Residency Relations Manager

- STATE NEWS -

NC AHEC Selected for STFM Pilot Addressing Medical Student Training Needs The North Carolina Area Health Education Centers program was one of fifteen sites selected by the Society of Teachers of Family Medicine to participate in a national pilot project called “Building Better Clinical Training Experiences: A Learning Collaborative.”

The project will feature Family Medicine departments across the state collaborating on processes and resourc-

May 31st is Deadline for NCAFP Student and Resident Leadership Positions Excellent Opportunity and Experience If you are interested in serving in a Student or Resident leadership role with the NCAFP, please visit your respective student or resident leadership page on the NCAFP website: www.ncafp.com for more information and a list of current leaders. You can also contact Tracie Hazelett at the Academy’s office to inquire. Deadline for all board and committee appointments for the 2019-2020 term is May 31, 2019. This includes a letter of support from your program.

26

es to reduce the administrative burden associated with allowing students to complete clinical rotations at community practices. The goals of the two-year project are to ease the administrative burden on community-based faculty by standardizing documentation and the preparation of students, to engage community-based faculty, to encourage and reward teaching, and to enhance the quality of training at community sites.

“There is a critical shortage of clinical training sites for students,” noted STFM president Beat Steiner, MD, “and it’s important for students to learn how to take care of patients in community settings so they’ll be prepared for future clinical practice.”

More information about the pilot project is available online at https://stfm.org/bettertrainingexperiences.

- FAMILY MEDICINE RESEARCH -

October 1st is Deadline for NCAFP Foundation Research Poster Contest The NCAFP Foundation’s twenty-sixth annual Research Poster Presentation will be held at the Academy’s Winter Family Physicians Weekend Dec. 5 - 8, 2019.

The Foundation is interested in practice-based research, but poster presentations may address any topic relevant to Family Medicine. Work-in-progress may also be submitted. Posters will be judged for awards with winners announced at the Annual Meeting in December. Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by 11:59pm October 1st, 2019. For complete details, visit www.ncafp. com/residents/rpp/. Contact Tracie Hazelett if you have questions at thazelett@ncafp.com or 919-980-5357.

The North Carolina Family Physician

Discover first-rate CME that meets your needs

Mark your calendars now for NCAFP’s 2019 CME opportunities!

2019 NCAFP Dinner & CME A Unique & Fun Learning Experience 1.5 AAFP Prescribed Credits THURSDAY, JUNE 13, 2019 6:00 PM to 8:30 PM The Kimpton Cardinal Hotel Winston Salem, NC 2019 NCAFP Dinner & CME An After Office Hours Opportunity

We look forward to providing exceptional CME that fits your busy schedule.

1.5 AAFP Prescribed Credits THURSDAY, SEPT 12, 2019 6:00 PM to 8:30 PM Hops Supply Company Wilmington, NC 2019 NCAFP ½ Day A Saturday CME Event 4.0 AAFP Prescribed Credits

Presenting 40+ AAFP Prescribed Credits in 2019

SATURDAY, OCT 12, 2019 7:15 AM to 12:30 PM

CME | Camaraderie | Networking | Fun

The Hampton Inn @ Brier Creek Raleigh, NC

Highly-rated expert speakers

Requested timely topics

Convenient regional locations

After office hours opportunities

Live audience polling technology

Case-based studies & panel discussions

Interactive & hands-on learning

Innovative product theaters

User-friendly mobile conference app

Automatic credit reporting for AAFP members

2019 Annual Winter Family Physicians Weekend 25+ AAFP Prescribed Credits THURSDAY, DEC 5, 2019– SUNDAY, DEC 8, 2019 The Omni Grove Park Inn Asheville, NC

Have questions? Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at 919.214.9058 or at katkinson@ncafp.com.

All medical education topics offered by the NCAFP have been reviewed by a family physician, and when possible and appropriate, presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.



www.ncafp.com The North Carolina Family Physician

PRACTICE MANAGEMENT

- PRACTICE PERSPECTIVES -

Lessons Learned from a Straw Bale Garden Can I Change How I Practice Medicine?

By Thomas White, MD Owner/Founder Hometown Direct Care

Over the years, I have written a number of articles for our very own NC Family Physician Magazine, sharing lessons I have learned from my life experiences and observations.

These have ranged from kayak excursions, to hiking on the Appalachian Trail, and even an exceedingly difficult acknowledgment of the genius and example of the late Dean Smith (yes, UNC fans, I actually did that).

In the fall of 2013, I found myself at a crossroads professionally. I was an unhappy system-employed physician.

Was it me? Was it the system? A little of both? Time for me to retire and simply hike more? Time to convert to a UNC fan?

a new hobby - a rather clever method of gardening, called “straw bale gardening.” This too has taught me many new lessons. As the gardening season came to an end this past fall, I better appreciate those lessons, their relevance to the practice of medicine, and my path to DPC. Here goes:

Crazy as it seemed, I decided to resign from my employment and set up a new independent “direct primary care” (DPC) practice. I was told I was crazy, that it would never work in a little town with modest incomes like Cherryville.

Lesson #1: Keep it simple. Because you can.

Starting a straw bale garden is surprisingly simple. Find a small area (it can be in your back yard, on the patio, or the balcony of your high rise) which gets at least 6-8 hours of sunshine daily. Acquire 4-8 bales of straw sometime in the early spring, from your local nursery or from one of your local farmers. Note: you want to buy “straw” bales, not “hay” bales. You will need a water hose for watering, a trowel for planting, a knife or pair of scissors, and if you plan to grow tomatoes, some form of a trellis. Pretty simple. Now you are ready to start your garden.

I opened in March of 2015. The practice has grown, perhaps too quickly, but I am glad I made the decision. Many of my family medicine colleagues have visited my practice many secretly - and many more have called or emailed me.

Those who said I was crazy don’t say much now.

Admittedly, I have not done it all well or perfectly. My new amazing young partner (Dr. Josh Carpenter) and our super staff and I continue to tweak and tamper and try to do what we do better.

I do love learning, and this past spring I stumbled upon 28

Similarly, starting a DPC requires little. A small amount of space (500-1000 sq. ft.), or your car (if you want to just make house and office visits). Renting usually makes sense (or just work out of your home). One or two exam tables and a limited amount of equipment. Most DPC practices

The North Carolina Family Physician

start up on less than $10,000. Think Amazon, Craig’s List, Ebay for acquiring your supplies. One versatile staff person at first is sufficient; or maybe 1 full-time staff and someone part time. You will probably want an EHR (but that is actually optional). Excellent user-friendly, cloud-based systems are available free or at a very affordable fee. And you will need some sort of financial system which allows for bank or credit card drafts for the monthly or annual payments. Or you could just accept checks. (I do not recommend cash, even if the patient insists, and I am surprised how many who do insist!).

Lesson #2: Listen. To those who have been there before.

Before I started my garden, I read an entire book on the subject (yes, there is one!) and scoured the web for tips and ideas. I asked my local experienced farmers and gardeners for their advice. Most knew about the concept (“Oh yeah, old man Smith used grow taters in them bales!”) And I hung out at local feed and garden shops and asked a lot of questions. Tip: If an experienced farmer tells you how and when to plant and water their tomatoes, it pays to listen.

They know best.

To learn about DPC, I read and attended many lectures, including the AAFP DPC Summit. I called and visited doctors all over the country, paying close attention to what has worked, and what has not. Even when the advice seemed illogical (like “give them your cell phone number and be on call 24/7, they will rarely call you” or “offer house calls for no extra charge, you will not be abused”) I trusted their wisdom. Like the farmer who is willing to share his/her solution to “tomato end rot,” (a common and challenging affliction!) DPC doctors are among the most open, supportive, and collegial I have ever experienced in my career. The AAFP DPC “Member Interest Group”, the recently-formed DPC Alliance, and an active Facebook page dedicated to DPC are all excellent sources for advice and direction.

Lesson #3: Prep. Lay down the foundation. First.

Once you have put your bales out and arranged them the way you prefer, choose a planting date (again, listen to the experts!) and 2-3 weeks prior, you begin to “prep” the bales by covering the surface with a thin layer of fertilizer, apply water, and repeat the process every 3-4 days until it is time to plant. Which fertilizer to use can get rather complicated and a story for another day. There is no dirt to deal with in a straw bale garden; you just need the bale, a little fertilizer, and a small amount of topsoil just for planting. Prepare like the book and experts say, and you are soon ready to plant.

Remember, there will be no weeds in a straw bale garden to

Spring 2019

fight and contend with; another advantage of this method!

Likewise, I recommend starting a DPC small, and growing comfortably, learning and improving protocols and habits each step of the way. Signing-up a large number of patients before opening day is appealing, both to the pocketbook and the ego, but solid, careful, well-planned baby steps pay dividends later. The revenues will come. Keep it simple. Design your practice the way you want it to be and try to stay true to your dream. Be patient. There will be few weeds to get in your way.

Lesson #4: Goldilocks knew best. Just right matters.

I was told the major errors made by beginner gardeners are over-seeding and over-watering. I did both. I planted my tomato plants too close together. I placed too many zucchini and cucumber seeds too close together (Doesn’t more seeds mean more plants will sprout and thrive? No, it means too much competition and too much sun cover.). I watered according to the prep protocol faithfully but once I saw growth, I got too excited and concluded that watering more often would be appreciated by my new plant friends. I failed to realize that the beauty of the straw bales is that they absorb and hold so much water, unlike traditional gardens.

The old farmer who told me he only waters once a week, sometimes less, proved to be right.

A successful DPC practice is very dependent on getting it “just right” as well. Grow too fast, and you will not have the time to offer same day access and spend that extra time with patients. Grow too slowly, and you cannot meet payroll and overhead. Set your fees too high and you will likely attract a more complicated panel of patients, as I tended to do. Choose a high rent location, buy property with a large mortgage, furnish the office with too many frills, or have too many staff, and you will feel pressured to grow too quickly, or borrow more money (debt, by the way, is something I do not like). Starting out in a sparse, minimally furnished space, can create an uncomfortable or sterile environment.

Generally, it takes about $10K-20K for the initial investment, and with monthly fees at $50-100, and 1-2 staff, it takes 6-12 months (about 150 patients) to break even in a DPC practice. I started off with two staff members, perhaps a 0.5 FTE more than I needed, but both employees were long time co-workers of mine in my previous practice, and I would not have considered starting without both of them.

I found very affordable space to rent on Main Street, and I chose furnishings and equipment carefully (again, think affordable) and benefitted greatly from a wife and staff with good taste. A friend suggested I set out bowls of fresh apples. A nice touch, with multiple messages.

See “Lessons Learned” on p. 31 29

Screen, Test, and Refer Your Patients to Diabetesfreenc.com

By Casey Collins, MPH Diabetes Prevention Program Coordinator NC State University

National statistics show that likely one-third of your patients over age 18 have prediabetes. Even more alarming is that 9 out of 10 individuals are unaware of their risk1. When the national prevalence is applied to North Carolina adults, almost 2.6 million North Carolinians may have prediabetes. However, the onset of type 2 diabetes can be delayed or prevented with appropriate intervention, and this can greatly improve an individual’s quality of life and lower health care costs. According to the Centers for Disease Control and Prevention (CDC), without lifestyle changes, up to 30% of those with prediabetes will develop type 2 diabetes within 5 years.

Diabetes Free NC is a partnership between NC State University and the NC Division of Public Health with Blue Cross and Blue Shield of North Carolina to offer CDC-recognized diabetes prevention programs (DPPs) to all North Carolinians regardless of insurance status. DPPs

are research-based yearlong programs that focus on healthy eating and physical activity to help prevent or delay the onset of type 2 diabetes. Diabetes Free NC is made possible through $5 million in funding from Blue Cross NC. The project is supported by several statewide partners including the NC Academy of Family Physicians. The funding supports both online and onsite DPPs across the state by covering the program registration fee (avg. cost = $430). The goal of the project is to remove the barrier of cost to participate in a DPP for all North Carolinians.

To promote all available CDC-recognized DPPs and maximize their reach across the state, diabetesfreenc.com serves as a portal for qualifying adults interested in taking the first step toward their diabetes-free future. The website allows individuals to determine their risk of prediabetes as well as their readiness for the yearlong program. Free and low-cost DPPs are designated on the Find a Program page of the website. Onsite classes are offered in selected counties across the state. Online classes are available anywhere with internet access. Screen, test, and refer your patients to diabetesfreenc.com!

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2017. Atlanta, GA: U.S. Department of Health and Human Services; 2017.

HHS Announces New Value-Based Payment Initiative The US Department of Health & Human Services (HHS) recently announced a new series of five value-based payment models being offered as the centerpiece of a five-year, value-based payment pilot. The pilot aims to ‘transform primary care to deliver better value for patients throughout the healthcare system.’

Formally known as the Primary Cares Initiative, the program will feature five new payment models for serving Medicare beneficiaries. Two broad pathways are being offered: Primary Care First (for individual practice sites) and Direct Contracting (for population management organizations like ACOs, MCOs, CINs, etc.) Both pathways will provide performance-based payment adjustments to physicians who reduce hospital utilization and total cost of care, with each pathway designed to test whether financial risk and performance-based payments to primary care physicians and other clinicians will reduce total

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Medicare expenditures, maintain quality, and improve results. Each pathway will focus on individual primary care practice sites and will be tested for five years beginning in January 2020; a second round of applications is scheduled for participants starting in January 2021.

The AAFP is analyzing the details of the initiative and will be offering an executive summary to help guide family physicians looking to participate. Look for additional information in the weeks ahead.

The North Carolina Family Physician

ADVOCACY OTHERS WORKING WITH US

As the NCAFP has continued to gain clout, other organizations are coming to us to discuss issues before trying to take action at the NC General Assembly.

A prime example of this is a recent effort by the NC Community Pharmacists and the Retail Merchants Association to re-examine which immunizations pharmacists may be able to provide. You may remember that in 2013, we had a major legislative fight on how and when pharmacists could provide immunizations. As an organization, your leadership tried to balance the overall public health needs of the state while working to ensure that the medical home is not further fragmented.

In 2013, we ultimately came to an agreement that balanced those two elements.

This year, rather than taking a bill to the Legislature first, the other professional organizations came to

LESSONS LEARNED Lesson #5: Be an optimist. Things usually sprout.

I was told by some skeptics that a simple bale of straw, with no dirt to toss and turn, could surely not support a real garden. I was told this method sounded too simple to be true. I was told that it took much more land and space to have a successful garden. And lots of good luck.

The luck factor proved to be true. As I mentioned, it rained too much initially. Sometimes you cannot control the deer, squirrels, and raccoons.

But my crazy little garden project worked out. I actually grew and picked enough to eat tomato sandwiches, fry some green tomatoes, learn new okra

the NCAFP and the NC Pediatric Society to talk about the issue in advance. As a result, we were able to negotiate key items from our colleagues in both retail and community pharmacists without a legislative fight.

While we agreed to add Hepatitis A, HPV and Serogroup B Meningococcal to the list of immunizations certain pharmacists can provide to individuals over 18 (under a physician-supervised protocol,) we also got the pharmacists to agree to several key provisions, including: A work group (like was established in 2013) to further look at changes to any screening questions that a pharmacist must ask before providing an immunization.

A work group to develop educational materials about the processes required for immunizing pharmacists.

A commitment from both the NC Retail Merchants Association and the state’s Community Pharmacists to provide ongoing reminders to their

recipes, and enjoyed some basil. Some plantings failed miserably, for reasons still unclear, like my zucchini, parsnips, and beets. Next year, I will do better. I already have a game plan.

So too has my practice done well; far more in terms of personal satisfaction and patient relationships than financially. I have an income, and money in the business checking account. Our second location is now rapidly growing after a slow start, and that has certainly confirmed our expectation that a physician new to the community will build their DPC practice more slowly than a physician with a history in the community. Seeds take longer to sprout than seedlings with roots!

Our specialty of Family Medicine is at a crossroads. Will we thrive? Will we be replaced by others less trained and

members about these policies and procedures, including a requirement that they both enter the immunization into the NC Immunization Registry and report it to the individual’s primary care physician.

And an agreement that both these organizations will work with the medical community to tighten requirements for seeking a religious exemption to vaccinations in future legislation.

Because these organizations came to us in advance, we were able to have a more meaningful discussion on other areas to help increase immunizations, preserve the medical home and have an overall public health benefit. This new legislation is now pending in the NC General Assembly.

These represent just a few of the examples of how the NCAFP is at the table making sure you are having dinner and not part of the menu. Like they say in Hamilton, the musical, we want to make sure we’re in the room where it happens.

unprepared? Will we attract the numbers of students needed, or will we slowly shrink by attrition and retirement? I want to be optimistic. But I sincerely feel that DPC offers our best hope. It works. For patients and physicians. With growth and a few tweaks, we provide care to every patient in a DPC model. If it can work in Cherryville, it can work most anywhere.

Simpler, fewer weeds, lots of assistance: a proven approach.

So - I am an amateur gardener, and an experienced family physician, learning new lessons every day, and enjoying the fruits (or rather, veggies) of my labor.

Isn’t that what life should be about?

Is it time for you to plant some new seeds?

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