NC Family Physician - Autumn, 2020 by NCAFP

Volume 16 Issue 4 â&#x20AC;˘ Autumn 2020

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

2020 Virtual Winter Family Physicians Weekend Presenting your favorite engaging and informative annual conference experience with a safe and convenient virtual approach.

A Two-Day Cyber-Conference Friday, December 4, 2020 12:45 pm to 8:15 pm Saturday, December 5, 2020 7:45 am to 4:40 pm

Program Chair Victoria Kaprielian, MD Program Vice-Chair Jay Patel, MD Count on our trademark of timely lecture topics guaranteed to support your commitment to providing the best possible care to your patients. HCV Treatment Osteoarthritis & Low Back Pain Diabetic Kidney Disease Musculoskeletal Issues in Pediatrics Depression Firefighters & Cancer Risk

Chronic Heart Failure Migraines & Cluster Headaches HPV Related Cancers New E/M Coding Requirements Pediatric Asthma And many more

Obesity Management Reproductive Health Type 2 Diabetes Radon & Lung Cancer Infectious Disease

Registration Rates

AAFP / NCAFP Member Registration Rate only $250

Approximately 20+ CME Credits Up for Grabs

Attendees can anticipate earning approximately 20+ CME credits by participating in the pre-conference KSA Palliative Care workshop (Thurs. Dec. 3) and the general sessions.

Connect | Network | Engage

Topic specific and social opportunity chat rooms, virtual exhibit hall, mobile conference app, and more.

Convenient & Safe

If you have never attended the Winter Weekend because of travel concerns, budget restrictions, or scheduling conflicts, this is the perfect opportunity to join us for timely and engaging CME from the comfort and safety of your favorite location.

Online registration and full conference details available at www.ncafp.com/wfpw It is important to note, the CME sessions will only be available over the conference dates. The virtual sessions will not be recorded for later on-demand viewing. Contact Kathryn Atkinson, CMP, Manager of Meetings & Events, at 919.214.9058 or katkinson@ncafp.com with any questions.

Inside Autumn 2020

Medical Students Look to the Future of Medicine Through the Lens of COVID-19 P. 23

PRESIDENT’S MESSAGE

PROFESSIONAL DEVELOPMENT

Family Physicians: Healthcare’s most trusted source

ADVOCACY

RESIDENTS & NEW PHYSICIANS

NCAFP Helps Secure Significant Support Through Teamwork and Relationships

Two NC Residents Recognized with AAFP Award for Excellence in Graduate Medical Education

CHAPTER AFFAIRS

PRACTICE MANAGEMENT

10 Advocacy in So Many Different Ways

Statewide Campaign Aims to Reduce PreDiabetes in North Carolina

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Advocacy 6 Chapter Affairs 10 Professional Development 18 t 919.833.2110 •

fax

Residents & New Physicians 20 Medical Student Programs 22 Practice Management 24

919.833.1801 • ncafp.com

Managing Editor, Design & Production Peter T. Graber, NCAFP Communications

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. David Rinehart 2019–2020 NCAFP President

~ 2020 TODAY ~

Family Physicians: Healthcare’s Most Trusted Source We family physicians should be justifiably proud of the way we have stepped up to the challenges of COVID-19. We have drastically retooled our office procedures with telehealth and many other changes to meet this pandemic with innovation and expertise. We have guided our patients and our coworkers and staff in myriad ways in order to keep them safe and to keep healthcare moving forward. We are finding new ways to continue to provide chronic care, urgent care and preventive care day in and day out. But the pandemic has taken a heavy toll on our patients, both medically and financially. The stress has been especially onerous for our historically marginalized populations. There are swaths of great skepticism and mistrust regarding all aspects of this pandemic in our country and in our state. There are pandemic deniers, there is pandemic fatigue, and there is lack of trust in our political and even our medical leadership. THE OPPORTUNITY As I write this in mid-October, there is much hype, hope, and speculation about the prospects of a safe and effective vaccine for COVID-19. We are learning more each week about how to treat this disease, with our case fatality rates dropping significantly. New

Dr. Rinehart attended the University of Virginia and earned his BA in 1978 (Phi Beta Kappa) and his MD in 1982 (Alpha Omega Alpha). He completed his residency in Family Medicine at Charlotte Memorial Hospital in 1985 and was recognized as a national Mead Johnson Outstanding Resident. Dr. Rinehart has enjoyed 34 years of community-based Family Medicine practice with South Point Family Practice in Belmont, NC, 22 years as an independent group practice and 12 years as part of CaroMont Health. Dr. Rinehart lives in Belmont with his wife of 40 years and has three grown children and two grandchildren.

treatments and improved testing methods are close at hand. Patients will need a trusted source of guidance during these changing times. Family physicians will have many critical roles to play in the months ahead as these new prevention and treatment options arise. THE PATH TO TRUST How do we approach this problem of vaccine hesitancy and of pandemic fatigue and pandemic denial? Here are suggestions: • Be scientists. Science is an iterative process; it requires constant testing and frequent reevaluation as new data is gained. We learn, we analyze, and we follow the science. • Be transparent and humble. Let us be up front; we will not know how long immunity might last from a vaccine for a long time. We don’t know how long this pandemic will last. Admit that we don’t know about possible long-term side effects of treatments we might suggest or of the eventual course of the disease itself.

The North Carolina Family Physician

2019-2020

NCAFP Board of Directors

Executive Officers President

David R. Rinehart, MD

President-Elect

Jessica Triche, MD

Secretary/Treasurer

Dimitrios “Takie” P. Hondros, MD

Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Elizabeth B. Baltaro, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Brian McCollough, MD Mark McNeill, MD Ying Vang, MD

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director Elizabeth Ferruzzi, MD (Novant)

• Listen to patients. We must attend to and address their fears, doubts and concerns. Understanding patients in the context of their families, their work, and their communities is in our sweet spot. • Engage the team. Have your staff understand COVID-19, have them understand the pros and cons of the vaccines as they become available, have them talk with your patients and supply a coherent message. Speak with and educate community leaders, faith leaders, and other leaders in your community about the science. • Strive for equitable treatment. The historically marginalized communities have taken the brunt of the medical and financial distress during this pandemic. They deserve our proactive, best efforts to reduce and eliminate disparities in access to our care and particularly to access to vaccines. Step up to make a difference.

Resident Director-Elect Clayton Cooper, MD, MBA (Duke)

Student Director Katelyn Turlington (WFSOM)

Student Director-Elect Hannah Smith (ECU)

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

We have the amazing opportunity to help our patients continue to navigate this COVID-19 pandemic through both non-pharmacological intervention and, as the science allows, though vaccinations and therapeutics. We must all rise to the occasion and continue to provide trustworthy advice and trusted treatment to all of our patients. 2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

Fall 2020

www.ncafp.com

ADVOCACY By Peter Graber NCAFP Communication Services

~ ACADEMY IN ACTION ~

NCAFP Helps Secure Significant Support Through Teamwork and Relationships With family physicians and many parts of the healthcare system reeling as a result of the COVID-19 pandemic, the NCAFP has been working for Family Medicine at a fevered pitch since March. The immediate financial impacts of the crisis were recognized very early by Academy leaders, and with it, the NCAFP has leveraged its relationships across the healthcare spectrum to help the plight of family physicians, independent Family Medicine practices, and others. By drawing on the power of teamwork and collaboration, family physicians are now accessing several key supports to help their practices navigate the financial impact of the crisis. COVID Financial Support In early September, the NC Legislature approved allocating $25 million to the NC Medical Society Foundation for distribution to financially struggling independent medical practices in North Carolina as a result of COVID-19. This was a significant collaborative advocacy victory that featured key work by the the NC Medical Society, the NCAFP, the NC Pediatric Society, and several other specialty groups. Formally known as the Financial Recovery Program, (FRP) this effort is already under way. Physicians and

practices can use the FRP portal to apply now. Note: given that the appropriation making this program possible is part of the federal CARES Act, the funding cannot simply be given as â&#x20AC;&#x153;grantsâ&#x20AC;? to practices in need, but must be used to reimburse practices for COVID-19-related expenses incurred between March 1 and November 30, 2020. For complete information and to apply, visit www.ncafp.com/frp/info. The NCAFP also helped provide key perspectives to NCDHHS on two additional programs designed to help mitigate the financial stresses due to the pandemic. Reimbursement for COVID Services The NCDHHS introduced a program in early October that is now reimbursing primary care physicians who provide COVID-19 related primary care services to North Carolina residents without medical insurance. A payment of $150 per eligible encounter will be available to physicians and practice. $7.8M is available to support this program through Dec. 30, 2020, or until the funds are depleted, whichever occurs first. Reimbursement will be made on a first-come, first-served basis and claims will be reimbursed retroactively to Sept. 1, 2020. Physicians are encouraged to submit claims to the portal regularly rather than holding them until December due to the limited amount of funding available. Family Medicine patients are eligible if they are NC residents and have no health care coverage. Physicians are available if you operate in the state of North Carolina and are registered in NCTracks. You can find additional details www.ncafp.com/dhhs-reimburse. Medicaid Rate Increase Extended to Jan. 2021 The NCDHHS's Division of Health Benefits (NC Medicaid) is extending temporary rate increases related to COVID-19 through the end of the federal COVID-19 public health emergency, which goes through Jan. 21, 2021. Every Medicaid provider will continue to receive rates that are at least 5% greater than pre-COVID levels. Additionally, medical homes will continue to receive an enhanced per-member/per-month payment through January.

The North Carolina Family Physician

FAMPAC

Empowering Family Medicine

JOIN THE FIGHT FOR FAMILY MEDICINE IN RALEIGH Participating is easy -•

Get to know your elected officials and become their trusted healthcare advisor.

•

Contribute so we can support candidates that support Family Medicine.

•

Participate in NCAFP’s ongoing advocacy events and efforts.

To learn more about FAMPAC and donate, visit www.ncafp.com/fampac

PUBLIC HEALTH ADVO CACY

NCAFP Among 24 Organizations in Joint Statement on Importance of Flu Vaccine The NCAFP was among 24 organizations that issued a public statement in early October urging North Carolinians to get influenza vaccines to protect their health. “As North Carolina prepares for the coming flu season, organizations representing health care providers, hospitals, business owners, educators and senior citizens — as well as community stakeholders — have joined together to issue this statement to promote the importance of getting a flu shot during the COVID-19 global pandemic,” the statement begins. “This year, it is more important than ever to get a flu vaccination, considering the continued presence of the COVID-19 viral global pandemic that has already claimed more than 205,000 American lives. Widespread flu and COVID-19 at the same time could overwhelm our health care system, making it hard for people to get medical care they may need.”

While data from the Centers for Disease Control and Prevention (CDC) indicates that the percent of Americans getting flu vaccines has risen in recent years, many people still do not get vaccinated. During the 2018-19 flu season, CDC data shows just 45.3 percent of U.S. adults (ages 18 and older) and 62.6 percent of children (ages 6 months to 17 years) received the vaccine. The effort urges all North Carolinians to practice the following essential precautions to protect against the spread of flu, COVID-19, and other viruses: • Practice the 3 Ws.

o Wear a cloth mask over your nose and mouth when in public spaces.

o Wait 6 feet apart and avoid close contact with people outside your household.

The statement also highlighted that the Centers for Disease Control and Prevention (CDC) recommends vaccination against the flu for everyone 6 months and older with any licensed, age-appropriate flu vaccine.

o Wash hands frequently with soap and water and use an approved hand sanitizer with at least 60 percent ethyl alcohol content.

Millions of Americans get the flu each year. It is estimated that at least 39 million people became sick due to flu-related illness during the 2019-20 flu season, leading to more than 18 million medical visits, 410,000 hospitalizations, and at least 24,000 deaths. Vaccination has been shown to reduce the risk of flu-related illnesses, hospitalizations, and deaths.

• Contact your doctor if you are sick or have a fever, for advice on treatment and stay home until you have been cleared by your doctor.

• Cover coughs and sneezes with a tissue, then discard the tissue promptly.

In addition to the human cost, the economic impact of the flu amounts to billions of dollars annually in lost work time and productivity, and increased health care costs.

The North Carolina Family Physician

G U E ST C OM M E N TA RY

Five years of change in six months By Tom Campbell First Published October 9, 2020 -- Reprinted with Permission

f you long for January, when things were “normal,” you are not alone. We may not have liked everything then, but we at least knew how to navigate our lives. Since March, everything has turned upside down. Nick Patton Walsh, a CNN analyst, says we’ve seen five years of change in six months. There are some, especially politicians, who want to tell us that normal is just around the corner. They say, “just hang on for a few more months and things will return to the way they were.” They are fooling themselves and trying to fool you. There is growing understanding we won’t return to “before” for years, if ever. The Kenan Institute held a virtual forum in mid-September that reflected on changes titled “Seven Forces reshaping the Economy.” We want to list them, adding comments of our own. “By far the biggest impact of the pandemic has been where people go – to work, to play, to live,” the report begins. Businesses can meet using Zoom (or other apps) and don’t have to work from one location; neither is travel to meetings and conventions as essential. Many employees can work from home, forcing change in real estate markets, both as companies reduce rented office space and as workers choose where they want to live. No longer will folks hop a plane to Cabo, Snowshoe or Disney for leisure travel, instead choosing locations where they can

reasonably drive. The travel and hospitality industries face major change. Shopping habits have changed. Brick and mortar retailers have suffered and many are closing, as people shop online. Survivors will include a few mass-market chains and unique boutiques with specialized goods or personal services. Delivery services for food, groceries and merchandise are now a way of life. People are making fewer trips to the grocery but will likely end up spending more on food purchases. Many lower wage workers will be out of work. COVID-19 demonstrated that supply chains must be nimbler, more efficient, more resilient and closer to home. Companies will seek partnerships with regional warehousing and distribution facilities. Some will bring manufacturing inhouse or at least within this country. Manufacturing will be highly automated and computerized and will not require as many workers. Recent racial protests have prompted the business community to redouble diversity efforts, conduct more sensitivity training and to partner with minority owned businesses, not because they are forced to do so but because they recognize it is the right thing to do. They will re-emphasize participation within their communities and a renewed emphasis in doing business with local supplier networks. The pandemic demonstrated the need

For over 50 years Tom has observed and commented on North Carolina politics and public policy. He has owned and operated radio and television stations, performing every function from being a disc jockey to writing and delivering daily editorials. In 1998 he created and became executive producer and moderator of NC SPIN, a weekly half-hour program designed to ensure people get in-depth, civil and balanced discussion on North Carolina issues. Tom also writes a weekly column “My Spin” that is published in newspapers across the state and appears on the ncspin.com website.

for major school reform. This year’s disrupted education proved that educators must incorporate new technologies, both online and in-class. Education outcomes must improve; successful innovators will be rewarded in this era of school choice. Government revenue shortfalls will reverberate down to local school systems, increasing the urgency for education to improve quickly and for reliable and safe childcare parents need in order to earn livelihoods. Our healthcare systems are under extreme pressure. Many rural hospitals are barely surviving, too many communities have a shortage of doctors, and too many citizens have no government or private health insurance. See COVID on Back Cover

Fall 2020

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

~ FIGHTING FOR YOU ~

Advocacy in So Many Different Ways

• We focused on telemedicine, advocating for parity and flexibility to ensure you had the appropriate tools to care for your patients no matter what the circumstances. • We pushed for payment reforms. The pandemic has certainly shown the flaws in a fee-for-service system that focuses on procedures rather than prevention. The pandemic highlighted the systemic underfunding of primary care and public health. We have met with payers urging them to invest more in primary care, and some have reacted in a positive manner. Some have implemented special one-time payments or other types of relief, while others changed clinical coverage policies to make care just a bit easier.

In some ways, advocacy as your professional society is just a little bit like your work with patients every day, just in a different way. As family physicians, you react, pivot, handle multiple complicated patients and deal with different issues and health concerns, particularly in the days of a pandemic. Like Dr. Rinehart says in his article, you are the trusted source. That’s what we try to do as your professional organization as well. We react, pivot and handle multiple complicated policy issues and react as things change, particularly during COVID-19. We also try to be both your trusted source and the trusted source for policy makers. That trusted source, particularly in advocacy, has been more important than ever this year. We had to pivot, but we never forget our core values. We have a strategic plan to guide us, but we reacted quickly and nimbly to meet your needs. Here are just a few of the ways we advocated for you this year. • We distilled information from numerous sources, especially our state Department of Health and Human Services, determined what was the most important data for family physicians, and then disseminated it to you.

• We have highlighted the health disparities and inequities that exist in our healthcare system and beyond, trying to focus on our most vulnerable populations. It has certainly been a different year, but we have done what we always do – fight for you and for your patients. It’s not always easy, and it’s not always simple, but it is what we are supposed to do for our members. That is the bottom line.

like to compare advocacy, particularly at the federal or state level, to your most complicated chronic disease patient. You must build trust. You do not fix every problem the first time you see a patient (or a politician for that matter). It takes time, in many instances, a lot of time. You must be persistent. On occasion, it takes different members of the team or a different strategy. You usually don’t make headway yelling at a patient, although there may be the very rare time where that tactic works. Then, all of the sudden your diabetic patient decides they do want to make lifestyle changes, or your hypertensive patient finally decides to quit smoking. It is the same in advocacy and policy. It’s dirty. It’s See ‘Trusted’ on page 12

The North Carolina Family Physician

ADVERTORIAL

Physician Well-Being During the COVID-19 Crisis: Leadership in the Time of COVID-19 By Jason Horay, Manager of Health Strategy and Well-Being, Physician Well-Being During the COVID-19 Crisis: Leadership Curi in the Time of COVID-19 By Jason Horay, Manager of Health Strategy and Well-Being, Curi Physiciansthe andImportance their practices the country feelthe theCOVID-19 impact of COVID-19 every day, and the Understanding ofacross Well-Being During Pandemic decisions physician make nowthe in the face feel of the impactevery their day, future success. To Physicians and their leaders practices across country thepandemic impact ofwill COVID-19 and the By Jasondecisions Horay, Manager ofleaders Health Strategy Well-Being, be an effective leader for your practice times ofCuri crisis, it’s important to their have future a reliable toolbox physician make nowand induring the face of the pandemic will impact success. Toof habits and identified strengths to draw from. be an effective leadercharacter for your practice during times of crisis, it’s important to have a reliable toolbox of habits and identified character strengths to draw from. The COVID-19 pandemic has quickly become one of the most significant global events in any of our lifetimes, impactAs a leader, it’s important that you communicate across the organization clearly and frequently, explain ing virtually all individuals and industries around the world. Operating on the front lines of efforts to protect their your decisions, tie them back your organization’s mission, vision, and values. are fiveexplain As a leader, it’s and important that youto communicate across the organization clearly andHere frequently, communities, physicians and healthcare professionals have assumed tremendous responsibility while simultaneously recommendations healthcare Paul DeChant to mitigate workforce your decisions, andfrom tie them back toconsultant your organization’s mission, vision, and values.burnout Here areand fivehelp trying to adapt to the many new challenges this pandemic has introduced to the practice of medicine. navigate employees through an unsettling world: recommendations from healthcare consultant Paul DeChant to mitigate workforce burnout and help navigate employees through an unsettling world: As a result, many clinicians are experiencing greater levels of stress and anxiety than ever before. In fact, more • Be visible. Break out of committee meetings and conference rooms as much as possible to than three-quarters of practices (78%) in North Carolina report that clinical staff seem stressed since the onset of spend more timeout in clinical areas observing and communicating with This • Be visible. Break of committee meetingsthe andwork conference rooms as much asclinicians. possible to COVID-19, according to a recent survey conducted by Curi, The North Carolina Medical Group Managers Association face time can go a wayareas toward mitigating building trust. with clinicians. This spend more time inlong clinical observing thedoubt work and communicating (NCMGMA), and the North Carolina Medical Society (NCMS). Furthermore, only 2% of surveyed North Carolina practictimeresources. can go a long way toward mitigating doubt your and building trust. • face Provide Do everything you can to provide clinicians the staffing, equipment, and es reported that their physicians or APPs had sought help for COVID-related mental or emotional issues. More results suppliesresources. they need Do now and will need later. you work anticipate and follow • Provide everything you can to As provide your to clinicians theclinician staffing,needs equipment, and can be found at ncmgm.memberclicks.net/urgent-practice-data-survey. through with them, yourneed leadership shows. supplies they fulfilling need now and will later. As you work to anticipate clinician needs and follow with fulfilling them,atyour shows. • through Empower decision-making the leadership point of care. Rein in micromanaging. While at times you may On a national•scale, The Physicians Foundation recently found of U.S. physicians surveyed have experienced feel out ofdecision-making control, enforcing tight control can50% demoralize your clinicians and result in you bad may Empower at the point ofthat care. Rein in micromanaging. While at times inappropriate anger, tearfulness, or anxiety as a result of COVID-19’s effects on their practice or employment. Howevdecisions. the midsttight of chaos often more insight into problems than in leaders feel out of People control,inenforcing control canhave demoralize your clinicians and result bad do, er, only 13% of physicians sought medical attention foroften a mental-health a result of thethan pandemic’s and theyhave typically great solutions. Trust them.moreproblem as decisions. People inhave the midst of chaos have insight into problems leaders do, effects. The complete findings of the Foundation’s 2020 Physician Survey: Part 2 can be found on their website, they gratitude. typically have Trust • and Express Takegreat everysolutions. opportunity to them. thank your teams; anything from a quick physiciansfoundation.org. handwritten card to broad public acknowledgement can teams; do the anything trick. Your people are going way • Express gratitude. Take every opportunity to thank your from a quick above and beyond, and potentially their families’ to serve handwritten card torisking broad their publichealth acknowledgement can do the trick.health Your people aretheir going way patients. your gratitude will further establish and maintain their respect, loyalty, and At Curi, we believe investments should be made to improve healthcare organizational culture to generate an environabove andShowing beyond, risking their health and potentially their families’ health to serve their determination. patients. your gratitude will further establish andsigns maintain their respect, loyalty, and ment that promotes greaterShowing mental and physical well-being. We seek to identify of professional burnout within • determination. Anticipate shortand for long-term changes. that Pull end, backour from immediateDepartment crisis to look individual practices and develop a vision a path forward. To Riskthe Management willaround soon and begin identifying and assessing next steps. It’seffort not too early. Lookingcrisis tohow next week, next • a Anticipate short- and long-term changes. Pullinback from immediate totolook be introducing Provider Well-Being Assessment to our members an tothe better understand bestaround supmonth, and next yearand istools, smart can a It’s sense confidence and control. and begin identifying assessing nextinstill steps. notoftoo early. Looking to next week, next port them through specific interventions, andand resources. month, and next year is smart and can instill a sense of confidence and control. Another way to reinforce leadership andcan problem-solving abilities is tohealth: identify your character strengths. Here are some other resources that practice leaders use to support staff’s mental Character strengths are positive parts ofproblem-solving your personality abilities that impact you your think,character feel, andstrengths. behave, Another way to reinforce leadership and is to how identify and according to the VIA Institute on Character, scientists have identified 24 character strengths Character strengths are positive parts of your personality that impact how you think, feel, and behave, Ensure staff are aware of the National Suicide Prevention Lifeline. This service is available 24/7 across the U.S. Call that we and according to theinformation, VIA Institute onsuicidepreventionlifeline.org. Character, scientists have identified 24 character strengths thatto we all have theFor capacity to express. Knowing and applying your dominant character strengths is the key 800.273.TALK (8255). more visit youhave being your best self, which inKnowing turn canand reinforce your abilities to lead and problem solve. Visit all the capacity to express. applying your dominant character strengths is the key to viacharacter.org to take institute’s character strength survey and discover your unique character you being your best self, the which in turn can reinforce your abilities to lead and problem solve. Visit Tap into the Physicians Foundation’s Vital Signs initiative. This initiative seeks to empower physicians along with their strengths profile and lean on those strengths in crisis times. viacharacter.org to take the institute’s character strength survey and discover your unique character colleagues and loved ones to check in on one another’s well-being. You can access key resources at physiciansfounstrengths profile and Well-Being lean on those strengths in crisis times. dation.org/vitalsigns. Use Curi’s resources. Building comprehensive well-being strategies for your organiMuch rides on how well your organization comes this volatile environment. Workforces zation is a key foundation that can lead to better outcomes for out yourof practice and your staff. These resources can are be a challenged by exhaustion and waning morale, and they’re looking to you for leadership. Be ready Much rides on how well your organization comes out of this volatile environment. Workforces areto starting point for helping to drive a culture of wellness, marked by more effective lifestyle choices and organizational spendcuri.com/practice-services/well-being morebytime and effort your clinicians, communicating, resources, empowering challenged exhaustion andsupporting waning morale, andmore. they’re looking to youproviding for leadership. Be ready to strategies. Visit to learn decision making, thanks, andyour strategizing next steps. Discover your character strengths for spend more time expressing and effort supporting clinicians, communicating, providing resources, empowering decision making, expressing thanks, and strategizing next steps. Discover your character strengths for handling stress and developing relationships with those who matter most, including your employees. If you have questions about these thoughts or how we can support the well-being of your employees further, please While disruption anddeveloping uncertainty could breakwith an organization, they can be opportunities nimbly pivot handling stress and those who matter most, including yourto employees. contact me at jason.horay@curi.com or call relationships 800-662-7917. to a successful The strength effectiveness of your leadership could make all the While disruptionrecovery. and uncertainty could and break an organization, they can be opportunities to nimbly pivot difference. to a successful recovery. The strength and effectiveness of your leadership could make all the difference. If you have questions about these strategies or how we can support the well-being of your employees further, please contact me at jason.horay@curi.com. If you have questions about these strategies or how we can support the well-being of your employees further, please contact me at jason.horay@curi.com. © Copyright 2020 Curi © Copyright 2020 Curi

800-662-7917 | curi.com 800-662-7917 | curi.com

TRUSTED from page 10

morphing into whatever your community needs.

not a “Hail Mary” pass but is usually three yards and a cloud of dust. It takes different team members. You have to be persistent. Only on rare occasions can you yell at a politician. But one day, just when you think it’s not possible, suddenly that key piece of legislation passes, or that politician finally gets what you have been saying for years.

At NCAFP, we are proud to advocate on your behalf. You are crucial. You are the foundation of our healthcare system. You are superheroes. You are family physicians!

But as the musical Hamilton states, “You’ve got to be in the room where it happens.” Even amid a pandemic, your state’s family physicians have been in the room where it happens, even if it’s in a virtual room. Let me give you just a few examples. One NCAFP board member, Dr. Garett Franklin was tapped to serve on the state’s COVID-19 Testing Surge Workgroup. Your NCAFP President, Dr. David Rinehart, is a member of the NC Institute of Medicine’s COVID-19 Vaccine Advisory Committee that is providing assistance to the NC Department of Health and Human Services as they develop the state’s plan for distribution of a COVID-19 vaccine once a vaccine is available. Former NCAFP Board Member Dr. Viviana Martinez-Bianchi has been serving as special advisor to the NC Department of Health and Human Services focusing on the impact of COVID-19 on historically marginalized communities in our state, particularly the Latinx population. And of course, Past NCAFP President Dr. Shannon Dowler has been serving as Chief Medical Officer for North Carolina Medicaid for over a year but has had an especially pivotal role during the pandemic. These are just a few examples of how Family Medicine truly is in the room helping guide the state’s response to this pandemic. There are many, many more. But isn’t that your role, stepping up wherever you needed? As has been said many times before, family physicians truly are the pluripotent stem cells of healthcare,

AAFP Debates Policy Issues at Congress of Delegates The 2020 Special Session of the Congress of Delegates (COD) has come and gone, with the session being held virtually due to the COVID-19 pandemic. Given the nature of the session, only items of an exigent nature could be considered, but the COD still reviewed 28 resolutions and numerous board reports from the AAFP Commissions. These are just a sampling of the issues addressed by the Congress this year. One resolution called for the AAFP to develop a set of principles establishing appropriate ethical standards in primary care technologies, with the goal of applying these standards to companies selected to partner with the AAFP Innovation Lab. The resolution, which was ultimately approved, asked the AAFP to develop a Task Force to consider the following: • how to prevent the commodification of primary care through technology, • how to humanize technology within the scope of primary care, • how tech companies should work with primary care and • what the AAFP’s relationship to the tech industry should be. The adopted resolution calls for a report back to the 2021 COD on the principles the Task Force will develop.

The North Carolina Family Physician

Two separate resolutions dealt with various aspects of telehealth. The resolutions asked that AAFP:

• Review how the resolution aligns with the most recent national or chapter member needs assessment/surveys; and

• advocate with CMS and commercial health plans to make permanent the telehealth coverage and payment policies enacted during the current Public Health Emergency,

• Obtain support by two co-sponsoring chapters, in addition to the original sponsoring chapter.

• ensure site-of-service payment parity with established patient office visits of like duration, • provide payment parity for audio-only telehealth visits conducted in lieu of in-person visits, and • standardize eligible patient originating and distant sites of service to include home and work settings. The members of the reference committee agreed with a number of those who testified that the two resolutions could and should be combined, offering a substitute measure that encompasses the specific topics raised in both, while adding a resolved clause that the AAFP advocate to CMS and commercial insurers that primary care telehealth services “occur within the context of a comprehensive primary care relationship.”. The Congress included several controversial issues including Medical Aid in Dying. On Medical Aid in Dying, the delegates ultimately reaffirmed AAFP’s policy of engaged neutrality. On most of the other more controversial issues, delegates voted to reaffirm existing AAFP policy or called for more information from the AAFP Board or Commissions. The NC Chapter, in partnership with seven other chapters, introduced a resolution intended to improve operational efficiency by encouraging greater focus on members’ strategic priorities. The sponsoring chapters pointed out that more than 80 resolutions were submitted to the 2019 COD, but less than one-fourth of those addressed one of the top six priorities identified by family physicians in that year’s Member Satisfaction Survey. The resolution asked for Chapters to do the following before submitting a resolution: • Review existing AAFP policy and past action by the Congress prior to submission; • Provide information indicating how the resolution aligns with the AAFP’s strategic plan, as well as a chapter’s strategic plan, if applicable;

Those opposed testified that that the proposal was too restrictive and would limit the voices of members. The Congress ultimately voted down the resolution with the reference committee writing in its report that although it “appreciated the intent of the resolution to encourage collaboration and foster a more efficient and effective meeting,” it was concerned about the mandatory nature of some of the clauses, as well as a limit on proposed resolutions. During the Congress, AAFP delegates also elected new officers and board members. The Delegates elected Sterling Ransone, M.D., of Deltaville, VA, to be the Academy’s president-elect. Others elected or chosen by acclamation for the following positions are: • Speaker of the Congress — Alan Schwartzstein, M.D., of Oregon, Wis. • Vice Speaker — Russell Kohl, M.D., of Stilwell, Kan. • Directors — Jennifer Brull, M.D., of Plainville, Kan.; Mary Campagnolo, M.D., M.B.A., of Bordentown, N.J.; and Todd Shaffer, M.D., M.B.A., of Kansas City, Mo. • New physician Board member — Danielle Carter, M.D., of Jacksonville, Fla., • Resident Board member — Anna Askari, M.D., M.S.B.S., of Palm Desert, Calif. • Student Board member — Cynthia Ciccotelli, of Scranton, Pa. In addition, Ada Stewart, MD, of Columbia, SC, was installed as the new President of AAFP. During her installation speech, Dr. Stewart made the following comments: “It is said that the health care industry is recession-proof, but the primary care sector is decidedly not pandemic-proof,” said Stewart. “Even before the pandemic, primary care was in crisis. Let us not waste this crisis. For history has shown that it is only during times such as Continues on next page

Fall 2020

these that true reform can be achieved. More and more Americans have awakened to the tragic realities of our health care system: a system that costs too much; a system that neglects the poor, the disadvantaged and people of color; a system that is failing us during our hour of greatest need – the worst health care crisis in more than a century.” The following North Carolinians held official roles as part of the chapter’s delegation or other delegations during the Congress of Delegates: • Dr. Karen L. Smith served as NC delegate and participated on the Rules Committee. • Dr. Robert L. (Chuck) Rich served as a NC delegate and was a member of the Reference Committee on Health of the Public and Science. • Dr. Rich Lord served as NC Alternate Delegate and served as a member of the Reference Committee on Practice Enhancement. • Dr. Michelle Jones served as a NC Alternate Delegate and served on the Reference Committee on Organization and Finance. • Dr. Victoria Boggiano served as a Resident Delegate and also was on the Reference Committee on Organization and Finance. • Dr. Nichole Johnson served as an Alternate Delegate for special constituencies. • Dr. David Rinehart participated as our Chapter President. • Dr. Jessica Triche participated as our Chapter President-Elect. • Ms. Hannah Smith participated as the AAFP National FMIG Network Coordinator. For more information on the AAFP Congress of Delegates, visit the AAFP website at www.aafp.org.

-- NEW RESOURCES --

Toolkit Available for Presentations to School Children about Healthcare and Family Medicine As a family physician, have you ever been asked to make a presentation at your child's school or a school at all? The answer is probably yes. We want to make that easier for you -- to talk about both issues regarding healthcare but more importantly to encourage student interest in healthcare careers, particularly Family Medicine. NCAFP's Workforce Pipeline Committee has developed a toolkit to assist you in these presentations. You can download four PDF files, including an overview of making presentations, as well as age appropriate materials for presenting to three different groups: K-3, 4th to 7th grade, and 8th to 12th grade. If you would like to provide feedback about these materials, please e-mail NCAFP EVP Greg Griggs at ggriggs@ ncafp.com. A special thank you to Dr. Kathryn Timberlake, a physician in Greensboro, who organized this project as a leadership project while completing her residency. You can find the toolkits at www.ncafp.com/school-presentations

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Employers:

Family Physicians:

• PLACE your job in front of our highly qualified members • SEARCH our resume database of qualified candidates • MANAGE jobs and applicant activity right on our site • LIMIT applicants only to those who are qualified • FILL your jobs more quickly with great talent

• POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

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MEMBERSHIP

2021 Membership Renewal Gift Announced by AAFP Act by Dec. 31st and Save! Exciting news for Active members: Pay your 2021 membership dues before 12/31/20 and receive a renewal gift of 50% off one AAFP CME Livestream course of your choice (must be redeemed by or before 11:59 p.m. May 31, 2021). Active members who pay in full by the 12/31/20 deadline will receive a confirmation email within 24 hours with further details. The code is good for one use and cannot be combined with any other AAFP offer. The offer does not apply to other membership categories (Resident, Student,

NCAFP Past President Dr. Allen Dobson Presented with T. Reginald Harris Memorial Award Dr. Allen Dobson was named this year’s winner of the T. Reginal Harris, MD Memorial Award during the Annual Business Meeting of the NC Medical Society. Established by The Carolinas Center for Medical Excellence (CCME) in 1999, the Award is presented annually to a North Carolina physician for his or her outstanding achievements in health care, quality improvement and service to the medical community. In announcing the award, CCME noted that Dr. Dobson’s career focus has been access to quality health care for all North Carolinians. A graduate of NC State University and Wake Forest University’s Bowman Gray

Transitional, Life, International, Supporting, and Inactive), or any excluded courses. Details can be found at aafp.org/renewgift along with a video from Gary LeRoy, MD, FAAP, AAFP Immediate Past President. Access your invoice online anytime at www.aafp. org/quickpay. You may pay in full or enroll in installments for the entirety of 2021. Remember, with AAFP’s revamped website, your AAFP login username is now the email address on file in your member record and not your AAFP ID number. If you have any issues logging onto your account or would like to pay/set up installments over the phone, please call the AAFP at 1-800-274-2237 x0 (9:00 a.m. – 6:30 p.m.). If you have moved or are moving out of NC or your practice status has changed (fellowship, retired, interrupted practice), please contact the AAFP immediately at 1-800-274-2237 x0 so you can be transferred to the correct state chapter or moved to the correct membership category with the appropriate invoice amount reflected. Thank you again for everything you do for your patients and communities. We sincerely appreciate your membership!

School of Medicine, Dr. Dobson completed his residency in family medicine at East Carolina University. He founded Cabarrus Family Physicians in 1983, and helped start the Cabarrus Family Medicine Residency Program, which grew into a multi-site system serving thousands of patients in Cabarrus and neighboring counties. Dr. Dobson also launched Community Care of North Carolina (CCNC), a statewide infrastructure for Medicaid that made it possible for physicians to efficiently work together, test ideas, compare outcomes and share best practices.

The North Carolina Family Physician

NEWSMAKERS

A number of NCAFP family physicians have received media coverage over the past several months. Mooresville’s Dr. James McNabb NCAFP Member Dr. Jim McNabb was featured by AAFP in a story discussing his practice’s ongoing effort to confront the challenges of COVID-19. You may remember that Dr. McNabb’s son produced a video about a day in the life of a private practice showing how COVID-19 initially impacted the practice. You can read the complete AAFP story at www.ncafp.com/ mcnabb-aafp. Dr. McNabb was also featured in an article on the plight of primary care in the Washington Post that went online Tuesday, September 8. The article, titled “Diagnosis for small family doctors: Less money, greater hardship, and patients on video,” discusses the impact that COVID-19 has had on small Family Medicine practices, including less income, trouble finding PPE, enhanced cleaning procedures, and implementing telehealth. “I sink or swim depending on my revenue,” McNabb says in the article. “There is no salary.” The article features numerous pictures of McNabb’s practice and discusses Family Medicine offices in Virginia, California, and Texas. In addition, NCAFP EVP Greg Griggs is quoted discussing the problems with our current health care system, and closes with a quote from AAFP EVP & CEO Shawn Martin. Read the article at www.ncafp.com/mcnabb-wpo. Duke’s Dr. Viviana Martinez-Bianchi Dr. Martinez-Bianchi is featured in an article and video about efforts to support the LatinX community during

Fall 2020

COVID-19. At the peak of the pandemic, nearly half of positive Covid-19 cases in North Carolina were among Latinos, despite just being 9.6% of the population. In the absence of adequate state or federal support, a group of Latina doctors and activists has taken the community’s health into their own hands. You can find an article and video published as a partnership of Univision Digital and Enlace Latino NC at www.ncafp.com/vmb-enlace. Raeford’s Dr. Karen Smith NCAFP Past President Karen L. Smith, MD, is featured in a series of videos by the Physician’s Foundation entitled: America’s Health: Stories from Physicians on the Frontline. You can watch the video and learn more at www.ncafp.com/kls-tpf. The story is entitled: Health Disparities, Health Inequity is Real. Dr. Jane McCaleb Wins Bernstein Award Long-time NCAFP member Dr. Jane McCaleb was honored as the 2020 Jim Bernstein Community Health Career Achievement Award winner late last month by the Foundation for Health Leadership and Innovation. Congratulations to Dr. McCaleb for this impressive accomplishment and for all she has done for her patients throughout her career. A video of her acceptance remarks can be viewed at www.ncafp.com/mccaleb-jbch (begins at 22:20). UNC’s Dr. Alex Mieses-Malchuk UNC Family Physician Dr. Alexa Mieses-Malchuk was recently featured on WRAL urging patients not to skip vaccines this year. She shared her thoughts about the concerning trend in the decline of vaccination rates, as well as the importance of vaccines as a form of preventive care. She also served on two online panels for ABC-11 after the Gubernatorial and Presidential debates.

PROFESSIONAL DEVELOPMENT By Kathryn Atkinson, CMP Manager, NCAFP Meetings & Events

~ UPCOMING EVENTS ~

A Safe, Convenient, & Affordable Must-Do for Everyone Do you have the 2020 Virtual Winter Family Physician’s Weekend on your December calendar, but you haven’t registered yet because you are just not quite sure about your personal or professional schedule? That’s OK. We have you covered. Online registration will remain open throughout the virtual conference dates, which means you can register online at any time with no fee increases for late registration. While we highly encourage early registration so that you are on the list to receive timely and helpful conference reminders and updates in advance, we hope the extended registration opportunity makes attending the most anticipated annual CME event even easier for you. Speaking of making things easier. Have you ever missed out on this fantastic annual conference because of travel challenges or budget restrictions? Perhaps the new virtual format will better enable you to join us this year. We think the 2-day webcast with approximately 20+ live CME credits and the affordable member reg-

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istration rate of $250 make the 2020 Virtual Winter Family Physicians Weekend a safe, convenient, and affordable must-do for everyone, from wherever you are. Your NCAFP CME team remains committed to providing you with the same informative and inspiring conference experience you have come to know and love, even via this year’s virtual platform. And, in keeping with tradition, the Winter Weekend is jampacked with timely CME presented by top-notch speakers. Count on updates from the experts on infectious disease, HCV, osteoarthritis, diabetic kidney disease, depression, firefighters and cancer risk, chronic heart failure, migraines, HPV, pediatric asthma, obesity, reproductive health, lung cancer, coding, and many more. Complete with several fantastic networking opportunities, we guarantee this is still the one CME conference you will not want to miss. And, if you have never experienced our brand of engaging and fun CME, we warmly invite you to join us for this year’s exciting family tradition with a twist. If you haven’t saved the date to your calendar yet, the 2020 Virtual Winter Family Physicians Weekend is scheduled for Friday, December 4, and Saturday, December 5, 2020. Please visit the conference website for complete schedule information (including a pre-conference KSA opportunity), guest speakers, registration details, and more at www.ncafp.com/wfpw. It is important to note: because of the guidelines and costs for hosting enduring CME versus live CME, the virtual sessions will not be recorded for on-demand viewing. The CME sessions will only be available over the conference dates. On behalf of the NCAFP, thank you for your continued hard work and dedication to Family Medicine. We appreciate you, we are so thankful for you, and we cannot wait to see you again. Please contact Kathryn Atkinson, CMP, Manager of Meetings & Events, at katkinson@ncafp.com, with any questions you may have about this year’s Virtual Winter Family Physicians Weekend.

Fall 2020

RESIDENTS & NEW PHYSICIANS

Victoria Boggiano, MD, MPH RESIDENCY

Two NC Residents Recognized with AAFP Award for Excellence in Graduate Medical Education Third Recipient has NC Ties

Each year, the AAFP is proud to recognize a select number of outstanding Family Medicine residents with the AAFP Award for Excellence in Graduate Medical Education. Family doctors like these 16 winners have not chosen this life path for glory, but rather for the health and wellness of families and communities. Since 1952, this esteemed distinction also recognizes outstanding Family Medicine residents for leadership, civic involvement, exemplary patient care, and aptitude for and interest in Family Medicine. More than 900 residents have received this honor in the past—a number that grows proudly each year. Thanks to generous support by a grant from Novo Nordisk, winners are awarded a $1,000 scholarship and transportation and lodging for two nights to receive the honor in person at an exclusive breakfast at the AAFP Family Medicine Experience (FMX). The NCAFP is proud to announce that two North Carolina residents -- and a third with strong ties to our state -- have been selected to receive this honor.

University of North Carolina Family Medicine Residency Program, Chapel Hill, North Carolina MEDICAL SCHOOL

Stanford Medical School, Palo Alto, California Dr. Boggiano cites being elected as Chief Resident at University of North Carolina (UNC) Family Medicine for 2021-2022 as her greatest professional accomplishment to date. As part of UNC’s Academy of Educators, she is participating in “Residents as Teachers” training to become a better teacher and mentor to younger learners. Other professional interests include helping to increase availability of primary care to underserved populations through a grassroots organization called Primary Care Progress and seeking opportunities to be involved in research and translate that research in order to improve patients’ lives. In her personal life, she pursues her interest in political activism and enjoys traveling throughout the United States, especially visiting the East Coast to spend time with family members. She also enjoys international travel, and her experiences traveling and working in Vietnam have fostered an interest in global health. Dr. Boggiano’s career plans include remaining in academic Family Medicine, pursuing opportunities to be part of clinical research projects, and continuing her involvement with the AAFP. After she graduates from residency, she will be completing a chief residency year at UNC. She may pursue an OB-GYN fellowship in the future.

Clayton Cooper, MD RESIDENCY

Duke Family Medicine Residency, Durham, North Carolina MEDICAL SCHOOL

Penn State College of Medicine, Hershey, Pennsylvania

The North Carolina Family Physician

One of Dr. Cooper’s most important professional accomplishments is founding and co-directing a student-run free clinic during his third year of medical school. Since 2016, the clinic has served a rural, underserved community, and he is proud of how it has grown and evolved to meet patients’ needs with available resources. His involvement in community health also includes participation on the team that is rolling out NCCARE360 in Durham County and at Duke University. This statewide network is designed to link health care professionals with community-based organizations in order to address social and behavioral drivers of health. Dr. Cooper counts innovation in medical education and health policy and advocacy among his other professional interests. Away from work, he finds time for a variety of outdoor activities, including running, biking, swimming, skiing, and hiking. He also enjoys traveling and spending time with friends and family. Following residency, he will return home to Pennsylvania to practice outpatient medicine with Geisinger Health System. In addition, he plans to stay involved in

health policy and advocacy work as an active member of the Pennsylvania Academy of Family Physicians. A third honoree completed medical school at the UNC School of Medicine and was very involved in NCAFP, but is now a resident at the University of Colorado in Denver, Dr. Franklin Niblock. Dr. Niblock’s most important professional accomplishment to date is being a founding member and program evaluator for MedServe while in medical school. This not-for-profit service-year program was designed to expose recent college graduates to primary care medicine in rural and underserved NC. In addition to rural health, his professional interests include broad-scope Family Medicine and the integration of primary care and public health. Away from work, he is focused on balancing residency with being a new father to his baby girl, but also tries to find time to enjoy fly fishing and barbecue. Following residency, Dr. Niblock plans to practice full-spectrum, community-based Family Medicine in North Carolina.

A Family Medicine Community Podcast

www.ncafp.com/ncfmtoday

OCTOBER - A Leadership Journey

Dr. Shannon Dowler, Chief Medical Officer for North Carolina Medicaid, talks about her leadership journey, how COVID-19 impacted her role at Medicaid, and the key differences between activism and advocacy.

SEPTEMBER - Developing Future FM Leaders

Dr. Mary Hall, Senior Vice President of Medical Education and Chief Academic Officer at Atrium Health in Charlotte, discusses her leadership journey in Family Medicine both at Atrium and through the Society of Teachers of Family Medicine.

Fall 2020

AUGUST - Discovering Commonality

Dr. Tamieka Howell answers the question: what do Family Medicine, mentoring, social justice, boxing and advocacy have in common in this informative 13-minute discussion of her career and what she wants to impart to future family physician leaders.

JULY - On the Frontlines in a Pandemic

Dr. David A. Rinehart discusses what it has been like to be a frontline family physician during a pandemic and discusses how the NCAFP has pivoted to better serve its members during these unprecedented times.

STUDENT INTEREST & INITIATIVES By Peter Graber NCAFP Communications Services

Five Medical Students Awarded NCAFP Foundation Family Medicine Scholarships The NCAFP is pleased to announce that five medical students have been selected to receive the Family Medicine Scholarship offered by the NCAFP Foundation. Annually, the Foundation provides scholarships to North Carolina medical students considering careers as family physicians. Medical students in their 3rd or 4th year of medical school are eligible to apply. The awards received by students are financial scholarships, unless the recipient does not complete their Family Medicine residency training. In that circumstance, the awarded money is converted to a loan and is paid back to the Foundation with interest. This year, a majority of the recipients are fourth-year medical students who are currently interviewing at Family Medicine residency programs. Alongside a sincere interest in Family Medicine, these medical students exhibited a commitment to community and service, have demonstrated leaderships skills, as well as financial need. The NCAFP would also like to extend a special 'thank you' to the Foundation’s Scholarship Review Committee and acknowledge that all applicants were extremely deserving medical students with impressive experiences. It is understood that every medical student has financial need, so decisions were difficult. We are grateful for each student’s dedication to Family Medicine and anticipate North Carolina will be the recipient of these outstanding individuals’ commitment and healthcare services to our communities in the future.

Tony R. Li Campbell Class of 2021 Long-term care and meaningful relationships with patients are what initially drew me towards a career in medicine. I cherish the time speaking with patients, listening to their history, and empathizing with their stories. During my time in medical school, I took interest in the preventive side of medicine because it aligns with how I like to problem-solve. I strive to find the root cause of problems instead of constantly patching the surface. All these aspects that I enjoy has led me to Family Medicine.

Caitlin S. Porter Campbell Class of 2021 My biggest passion within Family Medicine is patient education. I love getting to sit down with a patient and empowering them with the knowledge surrounding their health so that they can take equal part in their care. This is one of the main reasons I love Family Medicine so much. I can help my patients navigate the world of healthcare and coordinate medications, doctor visits, and lifestyle changes- all things that they need to be successful in staying healthy.

Willa J. Chen UNC Class of 2022 As I went through my clinical rotations, I realized that Family Medicine was a perfect fit for me, as it encompassed my passions for women’s health and empowerment, and more. I have always enjoyed forming deep relationships with people, and my most fulfilling experiences during my rotations were getting to work with my Family Medicine patients repeatedly through our school’s longitudinal program.

Andres A. Lopez UNC Class of 2021 My goal is to return to Hendersonville, which shaped my youth, and practice full-spectrum care while focusing on effective, high-value care for the Latino community which is a cornerstone of my foundation. I want to dip my hands into everything, includSee ‘Scholarships' on Back Cover

The North Carolina Family Physician

Medical Students Look to the Future of Medicine Through the Lens of COVID-19 By Chloe Chabanon-Hicks, MBS, MS4 Kaiulani Houston, Ph.D., MS4 Carolei Bryan, MS3 Catherine Sotir, MD

As the pandemic approached our community, medical students reached out with a sincere desire to help. Their commitment and enthusiasm led to “on the fly” learning innovations. Student volunteers were tasked with performing virtual needs assessments and providing education for patients. The students adeptly accomplished this and, in addition, conducted virtual clinic visits under virtual physician supervision. As medical schools and residencies grapple with how and when to teach virtual skills, a more appropriate question may be how can we, as faculty attendings, learn the intricate skill set and possibilities of quality virtual visits from our medical students! Below is an account from medical students about how their desire to show up, help patients, and use creative problem-solving skills led to relevant and meaningful learning in the context of a national public health crisis.

Helping physicians in medicine, business, and life. Curious to know more? Visit curi.com

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

e felt lost. We all received an email in mid-March notifying us that further clinical rotations would be suspended due to the COVID-19 pandemic. Our minds were full of racing thoughts and questions about what the rest of our medical school careers would look like. Will we graduate on time? How will we maintain our clinical skills? How can we be involved in our community’s See ‘Students’ on page 25

Fall 2020

ADVERTISE! Reach many types of Family Medicine professionals in North Carolina. Contact Peter Graber with the NCAFP at pgraber@ncafp.com 23

PRACTICE MANAGEMENT By Brent Hazelett, MPA, CAE NCAFP Vice President & Chief Operating Officer

Statewide Campaign Aims to Reduce PreDiabetes in NC

It’s time to take on prediabetes. You’re ready. Make it real. The National Diabetes Prevention Program lifestyle change program is designed for your success. You’ll attend classes and work with a lifestyle coach to help you stay active, eat healthy and manage stress to achieve a diabetes-free future.

identifying patients at risk of developing type 2 diabetes and providing those patients with a treatment plan that includes referral to a CDC-recognized program. • Explore free or low-cost options • Take small steps toward big changes • Attend interactive, virtual classes

An estimated 2.7 million adults in North Carolina have prediabetes, a condition that puts them at risk for other medical complications and diseases including progression to type 2 diabetes. According the Centers for Disease Control and Prevention (CDC) only 15% of people with prediabetes are aware of their condition. This creates an opportunity for physicians and their clinical teams to address this rising population health problem.

There are a few simple steps that clinical practices can take to identify, educate, and refer their patients to a local or Ask program. your doctor virtual The EHR can be used to create a registry how you can prevent of patients with BMI of 25 and greater who also have lab type 2 diabetes. values in the prediabetes range. Once the patent’s prediabetes diagnosis is documented in the EHR and the patient is alerted to their prediabetes status, physicians can refer lifestyle change program through multiple convenience referral options.

The good news is that prediabetes is treatable and in many cases is reversible. The CDC’s National Diabetes Prevention Program (National DPP) lifestyle change program is an evidence-based intervention for adults with prediabetes that empowers patients to make healthy, sustainable choices. Success in preventing diabetes depends on physicians

DiabetesFreeNC is a state-wide initiative that aims to raise awareness for prediabetes and make it easier for physicians to refer eligible patients to a free or low-cost National DPP lifestyle change program. Learn more about the program and how to refer your patients at www.reverseprediabetesnc.org.

Medicaid Transformation

DHHS Introduces Two New Webinar Series on Medicaid Managed Care and Clinical Quality The North Carolina Department of Health and Human Services and North Carolina AHEC are offering two monthly evening webinar series to help prepare physicians, practice managers, and quality managers for Medicaid Managed Care scheduled to go live on July 1st, 2021.

Hosted by Chief Medical Officer of the NC Division of Health Benefits and NCAFP Past President Dr. Shannon Dowler, the two series will feature changing subtopics on Medicaid Managed Care on the first Thursday of each month and clinical quality on the third Thursday of each month. The first series kicked-off on October 1st with a high-level introduction to Medicaid Managed Care, and was followed by the second series that began on October 15th and reviewed pediatric immunization trends during COVID-19.

The North Carolina Family Physician

STUDENTS from page 23

care of their loved ones and community members.

health during this time of “social distancing”? How can we, as the future of medicine, help change the way that we care for patients even after the pandemic has subsided? How can we influence medical education to encourage innovation and adaptation into our curriculums going forward?

We acquired a different skill set through this experience – one that was not taught through the traditional classroom curriculum or observed during our hospital rotations. We learned to convey warmth, empathy, and active listening over a virtual visit while considering potential distractions for the patient and providers that could limit the mental bandwidth required to comprehend the essential elements of their visit. We were primed with these skills that we knew, as future physicians, would be a part of our everyday practice.

Several Zoom, WebEx, FaceTime meetings, emails, and text messages later, we found our niche during the pandemic. We helped patients set up and conduct virtual visits alongside resident and attending physicians to hear their questions, concerns, and needs during a time when it was even harder to gain access to resources. We broadened our clinical skills by conducting virtual physical examinations of the patients, as well as further developing our differential diagnoses and treatment plans. We were able to see patients in their homes, see their kids running in the background, hear their dogs barking, and many times were on standby while they patiently troubleshot technological complications. We were (virtually) there to celebrate their accomplishments. We were able to provide a method of care that overcame the barriers of transportation, cost of childcare, and job inflexibility. By giving patients face-to-face time in the comfort of their own homes, we helped empower patients to have roles in their healthcare, as well as the health-

To register for the series of Medicaid Managed Care and/or Clinical Quality webinars, visit www. ncafp.com/mmc-cq. To prepare for Medicaid Managed Care, Family Medicine practices should consider taking the following three steps: • Contract with any or all five Medicaid Managed care plans that will handle most Medicaid beneficiaries in North Carolina. If you previously signed a contract, review the terms of that contract since the implementation of Managed Care has been delayed.

Fall 2020

Fast-forwarding a few months later, our minds are still racing about how we can share our experiences to empower other medical schools to have a role in telemedicine and inspire the development of virtual opportunities that will improve the health of our patients and community (virtual health fairs, home blood pressure monitoring programs, support groups, nutrition and exercise programs for special populations such as diabetics or the elderly, just to name a few). As patients, physicians, and medical students, we do not know what the future holds, but we are being prepared with new previously unimagined ways to listen and respond.

C. Chabanon-Hicks, K. Houston, and C. Bryan are medical students at the University of North Carolina at Chapel Hill, Wilmington campus. C. Sotir, MD, is a faculty physician at the NHRMC Family Medicine Residency Program in Wilmington, NC, and Associate Clinical Professor affiliated with the Department of Family Medicine, University of NC at Chapel Hill.

• Consider how your practice is shifting to or preparing for value-based payment models because the state is asking all the plans to quickly move to value-based payment. • Make sure you are scheduling catch up visits for Medicaid beneficiaries who have not seen their primary care physician in a while, particularly because of COVID-19. If a beneficiary has not visited your practice in a long time, they may be assigned to a different practice once auto-assignment begins next Spring.

NC-PAL: A Pediatric and Perinatal Mental Health Infrastructure and Education Program The North Carolina Psychiatry Access Line (NC-PAL) is a telephonic mental health consultation program for providers of pediatric and perinatal care across North Carolina. Family physicians and other providers in their practice can call the NC-PAL line [919-681-2909] and speak to a child psychiatrist or perinatal psychiatrist on demand. NC-PAL began in 2017 in response to a recognition that access to mental health services in North Carolina, as in much of the United States, is a problem. Because of access challenges, primary care physicians have become both the front line, and often the only clinicians diagnosing and treating pediatric mental illness in their community. North Carolina Medicaid data has demonstrated that pediatricians, family physicians and other community health care providers prescribe the majority of psychotropic medications to children in our state. Surveys of these clinicians have identified a lack of training and subsequent discomfort in managing pediatric mental health care. In 2004, the Massachusetts Child Psychiatry Access Program (McPAP) attempted to address this challenge in their state. The program provided real-time professional telephone consultation to primary care physicians to discuss mental health needs, differential diagnoses, and treatment options of patients managed by community-based clinicians. Amazingly, the percentage of pediatricians and other primary care physicians who felt they could meet the psychiatric needs of their patients increased from just 8% at the start of McPAP to 63% after a few years enrolled.

locally by children’s community-based physicians and other providers. NC-PAL was built to provide this service to physicians and other clinicians across North Carolina. Through partnerships of the Duke Department of Psychiatry and Behavioral Sciences, the NC Council on Developmental Disabilities, NC Department of Health and Human Service, and the UNC School of Medicine, NC-PAL has already provided training and consultation to over 100 individuals across the state for hundreds of their patients, including perinatal women and children, about a range of conditions. Satisfaction with the program is high with 74% of participants reporting increased confidence in managing mental illness and a 100% satisfaction rate. The NC-PAL line is available Monday-Friday, 8 a.m. to 5 p.m., at 919-681-2909. For more information about NC-PAL, please contact: Chelsea Swanson, MPH (chelsea.swanson@ duke.edu) This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,670,000 with 20% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. NC Department of Health and Human Services • Division of Public Health • https://publichealth.nc.gov/ • NCDHHS is an equal opportunity employer and provider. • September 2020

Through support and education, McPAP was able to expand community access to pediatric mental health care across the state by augmenting the care provided 26

The North Carolina Family Physician

TOOLS & RESOURCES

Key Resources Available on 2021 E&M Coding Changes / Other Practice Management Issues The AAFP has issued several key resources regarding the upcoming changes in Evaluation & Management codes. The changes go into effect January 1, 2021, and AAFP's resources are designed to ensure accurate payment. With these resources, there's no need to search through coding manuals or pour over articles on how to efficiently adopt the new guidelines. The resources include: • • •

A Checklist for Solo and Independent Physicians A Checklist for Employed Physicians And a List of Questions to Ask Your Vendors, Particularly EHR Vendors.

It is critical for family physicians to familiarize themselves with these changes before they go into effect in 2021. In addition, AAFP has developed a Physician's Guide to Navigating a Bureaucracy, which provides practical skills for employed physicians to navigate their organization to help reduce inefficiencies. Each of these resources can be found on the NCAFP website at www.ncafp.com/practice-resources.

AAFP Releases New Telehealth Toolkit The AAFP has released a new telehealth toolkit to help guide members toward developing and implementing a virtual care strategy that works for their practices. The 54-page document, prepared in collaboration with the consultancy Manatt Health, provides an overview of the regulatory environment, a comprehensive review of telehealth services and payment, an outline of key considerations for Family Medicine practices seeking to make telehealth services sustainable, and a series of Family Medicine telehealth "scenarios.” According to the toolkit, prior to the COVID-19 pandemic, telehealth technology had been incrementally changing the practice of Family Medicine in the United States. In March 2020, only 13% of AAFP members had provided video or telephone visits to their patients. By May 2020, 94% of members were regularly doing so, aided by sweeping temporary policy changes that brought down many of the regulatory and reimbursement barriers that had inhibited the growth of telehealth for years. By late spring 2020, physicians across the country achieved years of progress in a matter of weeks. Download at www.ncafp.com/aafp-telehealth.

Fall 2020

COVID from page 9

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levels for many months as the economy adjusts. Changes are sometimes hard to accept and may be viewed negatively. But as New York Times writer Peter Baker said, “when tectonic plates of history move, move with them.” Some changes can bring good. The question is how can we be agents for positive change? Note: You can read the Kenan Institute report at: https://kenaninstitute.unc.edu/kenan-insight/seven-forces-reshaping-the-economy-amidand-beyond-covid-19/

www.ncafp.com

We see the results of these problems in the rates of those infected and dying from COVID. The need for expanded telemedicine is urgent. New funding models are needed that place emphasis on wellness instead of just treating sickness. Our healthcare providers spend too much time processing paper and not enough treating patients. New job opportunities in biopharmaceutical, R&D and teleservices will create job opportunities. For the economy to rebound, capital providers need new risk assessments for long-term investments. Workforce retraining is urgently needed to offset those losing jobs and businesses striving to meet the new demands. Our unemployment rate has dropped but won’t likely return to January

SCHOLARSHIPS from page 22 ing teaching residents, inpatient medicine, and

obstetrics. Furthermore, Family Medicine to me embodies community engagement. Ultimately, I hope to use my experiences in medicine and education, in addition to my personal history, in the area to continue to improve my community.

Katelyn D. Turlington Wake Forest Class of 2021 I am drawn to rural Family Medicine because of its longitudinal and relationship-centered approach to healthcare. Rural communities are frequently supported by strong ties among extended families; this unique demographic enables me to paint a comprehensive picture of a patient’s personal health in the context of his or her family’s health history. In no other environment can I treat a grandmother and her grandchild on a routine basis or offer such consistent continuity of care.

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