Volume 17 Issue 2 • Spring 2021
The North Carolina
Family Physician Quarterly News in North Carolina Family Medicine
Do You Know Your Patients' Dialect? P. 4
SAVE THESE DATES FOR TERRIFIC NCAFP CME IN 2021 One-Day Saturday CME Opportunity Saturday, Aug. 7, 2021
2021 Winter Family Physicians Weekend Thursday, Dec. 2 to Sunday, Dec. 5, 2021
Learn more at www.ncafp.com/continuing-education Planning is already underway for these two fantastic CME opportunities. We will keep you well-informed of the in-person and/or virtual plans for both opportunities. Contact Kathryn Atkinson, CMP, Manager of Meetings & Events at Katkinson@ncafp.com.
Inside Spring 2021
The 2020 NCAFP Annual Report P. 11
PRESIDENT’S MESSAGE
4
Do You Know Your Patients' Dialect?
RESIDENTS & NEW PHYSICIANS
22
Duke Family Medicine Residency Launches New Rural Training Track
CHAPTER AFFAIRS
STUDENT INTEREST & INITIATIVES
8
24
Refocusing on You — Like a Laser!
PRACTICE MANAGEMENT
NCAFP COMMITTEES
20
Medical Student Teams
Report: Member Satisfaction & Practice Environment - The Seasons of Family Medicine.
26
MAHEC Plays Leading Role in New AAFP Field Manual on Opioid Use Disorder
DEPARTMENTS
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President’s Message 4 Chapter Affairs 8 NCAFP Committees 20 t 919.833.2110 •
fax
919.833.1801 • ncafp.com
Managing Editor, Design & Production Peter T. Graber, NCAFP Communications
Residents & New Physicians 22 Student Interest 24 Practice Management 26
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. Jessica Triche 2020–2021 NCAFP President
Do You Know Your Patients' Dialect? Understanding dialect is important in the clinical setting
Patient 1 Me- “Hey..how have you been?” Patient-”Well, pretty good except for Mr Arthur paying me a visit.” Patient 2 Me-”How’s everything going?” Patient- “Well, ok except that Arthur hit me last week.”
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Dr. Triche attended UNC-Chapel Hill for undergraduate studies and attended medical school at the Brody School of Medicine at East Carolina University. She completed her residency training at Moses Cone Family Medicine in Greensboro, NC, where she served as Co-Chief Resident. Dr. Triche is married and has two sons and enjoys life on the water in Bath, NC. She is currently working at Vidant Family Medicine-Chocowinity located in Chocowinity, NC. She enjoys seeing a variety of patients as well as teaching medical students. She is a graduate of both Vidant's Physician Leadership Institute as well as the North Carolina Medical Society Foundation's Leadership College and completed their Health Care Leadership and Management (HCLM) Program in 2018. Dr. Triche is currently involved in several leadership roles within the Vidant system. She also serves on the Beaufort County Board of Health.
Wow, who the heck is this Arthur guy? Do I need to call Adult Protective Services?! Practicing my entire career in Eastern North Carolina, it didn’t take me very long to realize that Arthur was not some evil person preying on the elderly in the cold winter months.
The North Carolina Family Physician
2020-2021
NCAFP Board of Directors
Arthur was osteoarthritis-or arthritis, which really can attack the elderly during wintertime. No matter where we practice, we will encounter many phrases, sayings, and cultural practices unique to the area. It is very important to become familiar with these in order to relate to our patient population and build trust within the community. North Carolina is a diverse state with residents from many different nationalities and backgrounds. Across the state there are several different dialects and many accents. To clarify, an accent involves pronunciation differences. Dialect includes phrases, vocabulary, and idioms. When I first moved to North Carolina as a kid, I was confused when my teacher asked me to get the “bale”. I was trying to figure out why she was asking me to get a bale of hay in the middle of a school day. She said “bell”. I was definitely not used to the Southern accent yet! The first time I had the pleasure of caring for a Hoi Toider, I thought they were from another country. But, really, it was just Pamlico Sound dialect! There are at least 5 known regional dialects in North Carolina. I recommend becoming familiar with the dialects around where you live. It’s also probably worthwhile to learn the dialect where your in-laws live especially if you are playing the game Taboo. FYI- ”holler” is “hollow” in Appalachia dialect. I just learned this while preparing for this article. I spent 3 months trying to figure out why my mother-in-law was using words like ‘yell’ and ‘loud’ to describe the clue “hollow”! Understanding dialect is important in the clinical setting. During my first year of practice, my nurse wrote “piles” under chief complaint. Now, these were the days of paper charting so Epic didn’t give her the choices it does now. She handed me the chart and I asked her “piles of what??” I was then educated about the Eastern North Carolina term for hemorrhoids. Out of curiosity, while writing this article, I did learn there is an ICD-10 code for piles. It’s K64.9 for inquiring minds-go ahead and try it. I have since encountered piles numerous times, more often than I encounter hemorrhoids. I no longer have to clarify with the patient what they mean. Over the years I have learned about many more ailments that afflict the Eastern North Carolina population. Every few weeks or so, I have to lance a “risin”. For those that do not know, in Eastern North Carolina, a “risin” is an abscess or boil. To save us time, my nurse and I know to go ahead and prepare the room ahead of time for an I&D whenever we see that the reason for visit is “risin”, which improves our workflow. For the record, there is no ICD-10 code for “risin”. Another, non ICD-10 ailment is a “pone”. This is pronounced like “hone” but with a “p”. This is not nearly as common as a risin but is still found around the eastern part of the state. This a bit harder to describe, but involves a soft, raised area under the skin. It is not an abscess nor is it an area of
Executive Officers President
Jessica L. Triche, MD
President-Elect
Dimitrios “Takie” P. Hondros, MD
Secretary/Treasurer
Shauna Guthrie, MD, MPH
Immediate Past President Executive Vice President
David A. Rinehart, MD Gregory K. Griggs, MPA, CAE
At-Large Directors Talia M. Aron, MD Elizabeth B. Baltaro, MD Jewell P. Carr, MD Garett R. Franklin, MD Nicole Johnson, MD, MPH Brian McCollough, MD Mark McNeill, MD Ying Vang, MD
Academic Position Mark L. Higdon, DO (Novant FMR)
Resident Director Clayton Cooper, MD, MBA (Duke)
Resident Director-Elect Ryan Paulus, DO (UNC)
Student Director Hannah Smith (ECU)
Student Director-Elect Morgan Carnes (Wake Forest)
AAFP Delegates & Alternates AAFP Delegate
Karen L. Smith, MD
AAFP Delegate
Robert L. Rich, Jr., MD
AAFP Alternate
Richard W. Lord, Jr., MD, MA
AAFP Alternate
Tamieka Howell, MD
2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
Spring 2021
www.ncafp.com
swelling due to injury. It is not a lipoma. I honestly do not know what it is, but I have seen it. It is just a “pone” and only requires reassurance to the patient that it is nothing to worry about. Understanding local terms saves you time in the clinic. I no longer have to clarify what a “whelp” is. It is not what my brother says when the TarHeels lose as in “Whelp, there goes the season”. Whelps are really welts, or hives. Understanding local terminology is also helpful when documenting review of systems. It is much more efficient to go ahead and document phlegm when a patient says they are coughing up “cold”. Admittedly, it took me several attempts with patients to clarify what they meant when they only coughed up cold. I have now incorporated this term when asking some patients about upper respiratory symptoms. “Are you coughing up colored stuff, blood, or just cold”? Why am I even bothering to write about this? As I mentioned above, understanding local terms, phrases, and dialect may help with clinic efficiency. I think,
more importantly, patients realize that you are a true part of the community. They may feel more comfortable relating to you in their own terms knowing you understand them. This can lead to learning things about your patients that you may not have learned otherwise. Another reason I share this relates to my Winter speech about mentoring. It is important to teach our students and residents local dialect and culture. I will never forget trying to explain a “pone” to a first year medical student. He looked at me like I was crazy. He returned to rotate with me later in his medical school career and, one day, came running out of the room, laughing. “She has a pone!!” He could not believe it, but understood what the patient meant when she told him she had a pone. If students truly feel like they are part of a clinic and community, they are more likely to remain or return to the area to practice. We all need to do our parts to introduce them to the community. I look forward to hearing about other terms, phrases, and dialects from your clinic in the future.
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The North Carolina Family Physician
URGENT Now’s the Time to Help Your Patients Quit Tobacco and Improve Their Lung Health This Standard of Care can Triple Your Patients’ Quitting Success! 1) Medication: 12 weeks of EITHER Varenicline OR Combination Nicotine – Patch AND Gum OR Lozenge 2) Counseling: Refer to QuitlineNC.
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NC Department of Health and Human Services • Division of Public Health • Tobacco Prevention & Control Branch • www.tobaccopreventionandcontrol.ncdhhs.gov • NCDHHS is an equal opportunity employer and provider.
CHAPTER AFFAIRS By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President
~ FIGHTING FOR YOU ~
Refocusing on You – Like a Laser Fast-Tracked Member Needs Assessment Yields Insight In late December and early January, we asked you to complete an extensive Member Needs Assessment, following up on a survey we conducted three years ago. We had originally planned to wait one more year, but with so many changes attributed to COVID-19 over the last year, we moved our timeline forward a year. Over 420 of you answered the call and completed the online survey. Fortunately, those who completed the survey almost perfectly matched the demographic profile of our active members at large. While the results did not lead to any wholesale changes in our committee structure, it did lead to a significant tightening of our strategic plan to focus specifically on the most pressing needs you brought forth. For this issue of the magazine, I wanted to provide you a quick overview of what you said and what we are doing to try to address your needs. First, we asked a new question this year, how would you like to see $100 of your dues divided up and used by the NCAFP. Your top three answers were: 1) Reducing Administrative Burden, representing on average 30 percent of your dues 2) Increasing Payment, representing 22 percent 3) and CME Programming, representing 18 percent.
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Other key areas you identified included workforce pipeline and public health initiatives. The top market factors you felt would have the greatest impact on Family Medicine over the next three years included: • Adjusting to value-based payment – 74% of you ranked this as one of your top three concerns; • The ramifications of COVID – 52% ranked this as a top three-concern; and • Practice and Health System Consolidation – 46% of you noted this as a top-three concern. On the top causes of frustration in Family Medicine, you were also very clear:
The North Carolina Family Physician
• Administrative burden caused by payers ranked first with 69% of you ranking it in the top three; • The growing number of quality metrics ranked second at 63%; • And Electronic Health Records was third with 46% of members raking it as a top three concern.
S
o how is the NCAFP adjusted in these areas? First, we have adjusted the name of the Payer and System Advocacy Committee to simply, Advocacy Committee, and added government agencies to the list of groups where the NCAFP wants to strengthen our influence (now including health systems, government agencies and payers). We have also reduced our goals for this committee to four key areas: A) Decrease the administrative burdens faced by family physicians in their day-to-day practice lives; B) Work to ensure the value of Family Medicine is maximized; C) Empower and increase the number of family physicians serving in leadership roles; and D) Improve access to full-scope Family Medicine for the people of North Carolina. Our next step will be digging into the specifics of administrative burdens to look at which issues are the biggest pain points for our members (look for a follow up survey from the NCAFP on this in the near future). We want to look at what is taking your time, what is just causing frustrations and what are the issues we can best address on a state level. As we further examined the result of the Member Needs Assessment, we found that 58 percent of you were very or extremely satisfied with membership in the NCAFP and another 35 percent were somewhat satisfied. Fortunately, only 5 percent of you were not very satisfied, but we know we can work to do even
Spring 2021
better. Ninety-six percent of you said you were likely to retain your membership, with 83 percent being very or extremely likely. You also told us what you thought were the most important member benefits, and that broke out as follows: • 82 percent of you said that physician advocacy in state legislative and regulatory affairs were either highly desirable or absolutely critical • 73 percent said the same about patient advocacy in legislative affairs • 72 percent said advocacy efforts with large health systems were highly desirable or critical • 66 percent said private/payer advocacy was the same. On down the list included member services (59 percent), the Winter Family Physicians Weekend (57 percent), Single Day CME Programs (53 percent) and Virtual CME Meetings (52 percent). Our membership also valued us very highly for continuing education (57 percent), for practice management needs (64 percent) and for networking opportunities (74 percent). The only organization valued more highly was AAFP for continuing education and practice management, but NCAFP was the highest valued organization in terms of networking. As a result of this information, goals for our Member Satisfaction and Practice Environment Committee have also been adjusted. The three core goals now are: 1) Improve the practice environment by providing education on different practice styles and opportunities to enhance practice efficiencies/effectiveness. 2)
Increase networking opportunities and support for NCAFP members while providing quality education that impacts patient care and the practice of Family Medicine.
Continues on next page
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3) Help family physicians thrive (not simply survive) by promoting physician health and wellness and preventing burnout. Finally, around the Family Medicine workforce, you told us that the following three areas would likely have the most impact on the workforce over the next three years: - Maintaining work/life balance – a top-three concern for 69 percent of respondents; - Physicians leaving the profession due to increasing responsibilities unrelated to clinical care (62 %); and - Identifying, recruiting, and retaining family physicians in North Carolina (55 percent). You also told us that in general, many of you precept health professional students (medical students, residents, NP students and PA students) but very few of you who precept get dedicated time or reduced responsibilities to teach (only 25 percent of you do). As a result, we have also updated the core goals of our workforce pipeline committee to include: - Encourage systems, payers, and others in NC to incentivize precepting, teaching and mentoring. - Provide opportunities for medical students, residents, and new physicians to learn about job opportunities in Family Medicine. - And nurture medical student and resident engagement. Each of these three committees are now much more targeted than they had been in our last strategic plan, trying to address the most pressing concerns you have. In our strategic plan from three years ago we had 19 core goals spread across the three focus areas. This time we are much more targeted with 10 core goals across the three focus areas instead. We believe this will help make your board, committees, and staff much more efficient and agile in meeting our members’ most pressing needs. We were agile during 2020 and really focused on helping each of you deal with the impact of COVID. We think this revised strategic plan will help us continue that agility to best meet your needs going forward. 10
A Family Medicine Community Podcast
www.ncafp.com/ncfmtoday
APRIL - Diabetes Free Prevention Program In this episode of NCFM Today, Dr. Karen Smith, a former president of the NCAFP, talks about her involvement in Diabetes Free NC. Franklin Walker, Vice President of Rural Health Innovations for the NC Medical Society, talks about how physicians can get involved in Diabetes Free NC. Finally, we provide brief updates on efforts to advocate for dedicated teaching time and payment for our state's community preceptors and the role of family physicians in COVID-19 vaccine efforts, particularly combating vaccine hesitancy.
MARCH - Residents & Students in Family Medicine Ryan Paulus, DO, a second-year Family Medicine resident at UNC, discusses continuity of care in Family Medicine and the scope of Family Medicine, and why that drew him to this career. Hannah Smith, a fourth-year medical student at the Brody School of Medicine at East Carolina University, talks about why she chose Family Medicine and what sparked her love affair. Finally, a few brief updates on what's impacting Family Medicine this month.
FEBRUARY - Advanced Medical Homes for Medicaid Learn about the role of the Advanced Medical Home as North Carolina transitions its Medicaid Program to Managed Care. Carol Stanley, Medicaid Transformation Manager for the NC AHEC Practice Support Team, and Nicole Cannady, Practice Support Coordinator and Quality Improvement Coach for the Southeastern AHEC in Wilmington, discuss tools that NC AHEC has available to help primary care practices achieve Advanced Medical Home (AMH) Status, the differences between a Tier 2 and a Tier 3 AMH, and what Family Medicine should be doing now to prepare for Medicaid Managed Care in North Carolina.
The North Carolina Family Physician
2020 ANNUAL REPORT
The State of the Academy What a year! When 2020 began, little could any of us imagine the challenges that the first global pandemic in over 100 years would bring. But true to our mission and calling as family physicians, our organization and its members adapted quickly, making necessary but tough decisions for our patients, practices, and communities. 2020 began similarly to previous years, with our leaders continuing to advocate for Family Medicine by working to strengthen relationships across healthcare and advancing the interests of our members particularly around issues such as payment, administrative burdens, and the transition to value-based care. But as the pandemic tightened its grip on our communities, a different slate of issues arose, and I am proud to report that our Academy adapted quickly and effectively. By mid-March 2020, the Academy’s primary concern was getting the latest COVID information to our members in a timely basis. Academy staff immediately adjusted its communications workflows to become a near daily constant in members
email boxes. This kept our members informed of important onthe-ground changes with COVID, helped mobilize our overall advocacy response, allowed us to gather actionable data via member surveys and helped connect our member practices to the latest resources. We also educated and kept members informed through a long list of webinars that covered topics as wide ranging as telehealth to applying for financial assistance. Behind the scenes, Academy leaders also worked in close coordination with the NC Department of Health & Human Services, our state’s insurers, and the legislature to advocate for critically important financial relief, including telehealth payment parity, temporary Medicaid rate increases, and other adjustments to help independent practices and primary care during an unprecedented time. I am particularly proud of the key collaborations we conducted with organizations like the NC Pediatric Society, AHEC, the NC Psychiatric Association, Community Care of North Carolina, and the NC Medical Society. Alongside professional advocacy, the Academy also adjusted
2019-2020 NCAFP Leadership Academic Position
Executive Officers President President-Elect Secretary/Treasurer
Mark L. Higdon, DO (Novant FMR)
David A. Rinehart, MD Jessica L. Triche, MD
Resident Director
Dimitrios P. Hondros, MD
Immediate Past President
Alisa C. Nance, MD, RPh
Executive Vice President
Gregory K. Griggs, MPA, CAE
Elizabeth Ferruzzi, MD (Novant) Resident Director-Elect Clayton Cooper, MD, MBA (Duke)
At-Large Directors
Talia M. Aron, MD Student Director
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
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
its day-to-day operations and the methods used to deliver its core programming of educational events and conferences. Chapter leaders recognized early that in-person events would not be feasible in the short term, and quickly pivoted to providing them through an all-virtual format. Our chapter staff navigated this change exceptionally well, and I am proud to report that the NCAFP was one of the few AAFP chapters not to cancel or postpone an event due to COVID. Even with these challenges, our organization still pursued its strategic initiatives. Just prior to March’s shutdown we held our 13th annual Family Medicine Day that promotes our state’s exceptional Family Medicine residency programs. Additionally, Family Medicine continues to be well-represented within several of North Carolina’s most influential health policy organizations, including Community Care of NC, the NC Institute of Medicine, NC DHHS, and NC Medicaid. 2020 will be remembered forever. It was a year full of challenges and a time in which all of us had to sacrifice. Thank you for the trust you placed in me and the NCAFP during a most challenging time.
National & International Family Medicine Leadership Viviana Martinez-Bianchi, MD Executive Committee WONCA - The World Organization of Family Doctors Mott P. Blair, IV, MD Board of Directors American Board of Family Medicine Tamieka M.L. Howell, MD AAFP Commission on Membership & Member Services Thomas R. White, MD AAFP Commission on Quality and Practice Victoria Boggiano, MD Resident Delegate to the AAFP Congress of Delegates and Resident Member - AAFP Commission on Education Hannah Smith AAFP FMIG National Network Coordinator Erin Clark, MD, DO Student Member - AAFP Commission on Health of the Public & Science Clayton Cooper, MD, MBA Resident Member - AAFP Commission on Membership and Member Services
David A. Rinehart, MD 2019-2020 NCAFP President
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. He has been a preceptor for dozens of medical students and nurse practitioner students over the years. Dr. Rinehart has held several leadership and committee positions within CaroMont Health including past Chair of the Physician Leadership Council and immediate past Co-Administrative Physician Lead of the Primary Care Service Line. He is a past Board Chair of Presbyterian Samaritan Counseling Center in Charlotte and has participated in medical mission trips in Honduras and Ethiopia. He has served for the past 18 years as team physician for the local high school football team and has held several leadership positions in his church including Chair of the daycare facility. Dr. Rinehart lives in Belmont with his wife of 40 years and has three grown children and two grandchildren.
2020: A Year in Review –
Agility, Opportunity, Success When we left Asheville in December of 2019, neither the NCAFP Board nor staff would not have guessed that the next year plus would be totally upended by the novel coronavirus SARS-CoV2. We left Asheville with a sense of anticipation and excitement regarding what we could accomplish in 2020. While our goals and activities shifted greatly when our state basically shut down in mid-March of 2020, the NCAFP and all our members showed a sense or resiliency and agility that we may have never seen before. That ability to be agile led to great opportunities and many successes for Family Medicine in North Carolina. The results of two surveys around the impact of COVID-19 on your practice and opportunities your board identified at that time tell quite a story. Here are five opportunities NCAFP developed from those survey results and began to focus on in early May of last year. And we succeeded on every goal.
Opportunity 1: Encourage the state and other payers to provide financial support to primary care practices and ensure stability in telehealth policies. Outcome: Thanks to the advocacy of the NCAFP and others, the two largest payers in North Carolina (Medicaid and Blue Cross and Blue Shield of NC) stepped up with extra resources and changed numerous policies. Medicaid doubled the per-member, per-month payment that Medical Homes receive for caring for Medicaid beneficiaries. They also quickly changed many telehealth policies under the guidance of NC Medicaid Chief Medical Officer, and NCAFP past president, Dr. Shannon Dowler. Many of these policies have now been made permanent. Blue Cross NC also changed their telehealth policies and continue to pay at parity with in-person visits as this is written. In addition, thanks to extensive advocacy by the NCAFP and the NC Pediatric Society, Blue Cross NC implemented payments to “true up” the income of independent practices when comparing their commercial revenue with 2019. Opportunity 2: Work with the state to promote awareness on the importance of well-child and adolescent visits that include immunizations.
G Membership Profile NCAFP’s overall membership increased 2% from 2019.
Active................................ 2,574 Student............................. 1,024 Life..........................................354 Resident...............................364 Inactive................................... 37 Supporting........................... 10 Transitional..............................7
TOTAL.................................. 4,370
Outcome: This was also a significant collaborative win led by NCAFP and the NC Pediatric Society. The NC Department of Health and Human Services implemented the “Keeping Kids Well” program, providing direct assistance to practices who had care gaps among their Medicaid beneficiaries and promoting the need to keep children coming to their medical home for care. In addition, NCAFP and NC Peds partnered with Pfizer to create a statewide radio Public Service Announcement to promote well child visits and immunizations, with two versions – one in Spanish and one in English. The PSA aired over 300 times on more than 40 radio stations across the state. Opportunity 3: Advocate for the Legislature to provide direct funding to independent primary care practices.
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Outcome: Thanks to a fantastic partnership AVERAGE FINA RECOVERY FU and joint lobbying efforts of numerous other TO FM PRACT medical organizations including the NC Medical Society and the NC Pediatric Society, the NC General Assembly allocated $25 million to the NC Medical Society Foundation for distribution to independent practices. Over 640 independent medical practices, including 132 Family Medicine practices, received on average $38,000 of Financial Recovery Program funds each. Thanks to Franklin Walker
Our Membership Growing, Strong and Committed NCAFP Membership Performance Market share: 87.9% (AAFP 76.8%) Active member retention: 96.5% (AAFP 93.4%) Resident to Active conversion: 81.6% (AAFP 70.8%) New physician retention: 92.8% (AAFP 86.1%)
7.1%
1st Place for XL Chapters 1st Place for XL Chapters 1st Place for XL Chapters 2nd Place for XL Chapters
87.9%
Resident Member Growth
Marketshare
Outcome: NCAFP partnered with the NC Area Health Education Centers Program (NC AHEC), Community Care of North Carolina, the NC Pediatric Society, and the NC Psychiatric Association to produce 16 Navigating COVID-19 webinars in 2020. These Opportunity 4: Continue to educate practices included webinars on conducting teleabout how to acquire PPE and successfully navihealth and virtual visits, innovative gate the DHHS website. ways to do hybrid visits and more. OthNavigating er webinars in this series included how Outcome: NCAFP developed an entirely new COVID-19 Webinars to apply for Payroll Protection Program section of our website around COVID-19 inforloans from the federal government, and mation including a list of Personal Protective many other clinical tips about dealing Equipment vendors and provided inforwith both sick and well patients during an unprecedented mation about how to acquire PPE through the state pandemic. Department of Health and Human Services. Along with other like-minded organizations, we also advoWhen we first reviewed the joint survey results with the NC cated heavily for NC DHHS to provide PPE to indePediatric Society and developed this list of key opportunipendent primary care practices. We even partnered FINANCIAL RY FUNDS ties, we could not have guessed we would be successful in on a project led by Blue Cross NC and Freudenberg RACTICES addressing all five of these major focus areas, but we did. Non-wovens to purchase manufacturing equipment Thanks to collaboration and cooperation with numerous orand begin making N-95 masks in North Carolina. Figanizations in an unprecedented way, we were able to meet nally, we worked with AAFP to offer group discounted the pressing needs of our state’s family physicians. While pricing on PPE orders from a national non-profit organiza2020 was not the year we thought it would be, we were certion. tainly successful in meeting the most pressing needs of our members. Opportunity 5: Provide education on best practices regarding the need for in-person versus virtual visits. at the NC Medical Society Foundation for organizing this amazing effort to distribute the funds in a very short period and thanks to the NC General Assembly for appropriating these funds.
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Continuing Medical Education 2020 Virtual Spring Symposium – April Dimitrios “Taki” Hondros, MD – Program Chair 8.00 AAFP Prescribed Credits 215 CME Attendees 2020 Sports Medicine for the Active Patient – August Karl “Bert” Fields, MD – Program Chair 4.50 AAFP Prescribed Credits 184 CME Attendees 2020 Virtual Winter Family Physicians Weekend – December Victoria Kaprielian, MD – Program Chair Jay Patel, MD – Program Vice Chair 21 AAFP Prescribed Credits 462 CME Attendees
33+
861
MEETING ATTENDEES
AAFP CREDITS PRESENTED
2020 CME Grant Program Delivery Due to the ongoing concerns with the global COVID-19 pandemic and the continued restrictions regarding larger gatherings and travel, no approvals of new grant programs occurred in 2020. Most of the programs that were held in 2020 were originally planned as live meetings that had to be transitioned to virtual settings. Even with this limitation, NCAFP was still able to provide a total of approximately 9,000 attendee/learners from the chapter partners for our programs. 21 AAFP Chapters included programming funded by NCAFP grants during 2020: Alabama Alaska Florida Georgia Indiana Kentucky Louisiana
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CHAPTER PARTNERS
Maine Mississippi Missouri Montana New Jersey Ohio Oklahoma
Pennsylvania San Diego South Dakota Tennessee Texas Virginia West Virginia
9,000 LEARNERS REACHED
Chapter Awards & Recognitions Thomas White, MD Cherryville, North Carolina
2020 North Carolina Family Physician of the Year Affectionately known as a ‘hometown’ and ‘Main Street’ family physician, Dr. White currently practices at Hometown Direct Care in Cherryville, NC, a direct primary care practice he founded in 2015. Dr. White’s practice has had a tremendous impact on the health of the community and is a testament that although his practice setting and style have changed, Dr. White’s commitment has never wavered during his 32 years serving the people of Cherryville and the local community. Dr. White is
a graduate of Duke University, earning both his undergraduate and medical degrees. He completed his Family Medicine residency training at Charlotte Memorial Hospital and returned to Cherryville in 1988 and began community practice.
The NCAFP Foundation promotes the specialty of Family Medicine to medical students in North Carolina. Due to the COVID-19 pandemic, traditional student experiences were paused in 2020. However, student delegations from North Carolina attended state and national virtual conferences and participated in the Foundation's annual research poster presentation. The Foundation also continued to offer scholarships and other opportunities for medical students even with the constraints of the pandemic. Students are encouraged to develop leadership skills through active service on one of the NCAFP’s two Boards or three committees, or by participating in a policy and leadership rotation with the NCAFP. 2019-20 LEADERSHIP President Vice-President Secretary-Treasurer Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Academy President Academy President-Elect Corporate Trustee Corporate Trustee Corporate Trustee Resident Trustee Resident Trustee Student Trustee Student Trustee Trustee Emeritus
Shannon B. Dowler, MD, FAAFP William A. Dennis, MD Eugenie M. Komives, MD, FAAFP Lisa A. Cassidy-Vu, MD Christopher P. Danford, MD Cherrie C. Hart, MD R. Aaron Lambert, MD, FAAFP Amy E. Marietta, MD, MPH Susan A. Schmidt, MD Holly L. Stegall, MD David A. Rinehart, MD, FAAFP Jessica L. Triche, MD Rhett L. Brown, MD, FAAFP - Novant Health Steve Parker - Curi John R. Smith Jr., MD - BCBSNC Brian P. Grave, MD Ryan M. Paulus, MD Morgan O. Carnes Caitlin S. Porter Maureen E. Murphy, MD, FAAFP
2020 BY THE NUMBERS • • • • • •
$1,455,910.64 balance of the Medical Student Endowment, effective 12/31/20. 1,024 Medical Student Members at the end of 2020. >$40,000 in direct financial support provided for student and resident programs. $250,000 contributed by Blue Cross Blue Shield of North Carolina. $15,893 contributed by individuals to the Foundation. $10,000 contributed by corporate members to the Foundation.
2020 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 individuals contributed to the Foundation in 2020. Thank you for your continued support.
Talia Aron, MD Elizabeth Baltaro, MD Monica Barnes-Durity, MD Perry Bartelt, MD David Bate, MD Cathy Belk, MD Mary Bengtson, MD Holly Biola, MD Karolen Bowman, MD Jack Brunson, MD Donna Capps, MD Joshua Carpenter, MD Anh Causey, MD Wendy Coin, MD Clayton Cooper, MD Gary Crawford, MD Wiley Davis, MD William Dennis, MD Andrea DeSantis, DO Deanna Didiano, DO Morgan Ferruzzi, MD Conrad Flick, MD Deepak Gelot, MD Aregai Girmay, MD Anne Gonzalez, MD Paul Gordon, MD Greg Griggs, MPA, CAE Katherine Haga, DO Mary Hall, MD David Hall, MD Scott Harper, MD Michael Harris, MD Brent Hazelett, MPA, CAE Milton Hester, MD Melissa Hicks, MD
Tamieka Howell, MD Janice Huff, MD Mishi Jackson, MD Nichole Johnson, MD Jason Jones, MD Michelle Jones, MD Eugenie Komives, MD Krista Kozacki, MD Kelley Lawrence, MD, IBCLC Richard Lord, MD, MA Shelly Lowery, MD Brian McCollough, MD Robert McConville, MD James McGrath, MD Elizabeth McKeon, MD William McLean, MD Maureen Murphy, MD Alisa Nance, MD, RPh Tommy Newton, MD Carl Nordstrom, MD Deborah Norton, MD Daniel Olson, MD Lara Pons, MD Elizabeth Provost, MD Michael Reid, MD David Rinehart, MD Joseph Roberts, MD Mark Robinson, MD George Saunders, MD Charles Sawyer, MD Allen Shepard, DO Karen Smith, MD Jack Spies, DO Barbara Stagg, MD Ying Vang, MD
REGISTRATION IS NOW OPEN AT
WWW.NCAFP.COM/SUMMERCME With an estimated 6.00 AAFP Prescribed Credits, this is a summertime must-do for you and your colleagues. Clinical topics have been selected, and the convenient one-day schedule is designed to advance your knowledge and understanding of common patient issues that you see and treat every day. Planned sessions include:
• Adolescent depression • Lupus • Influenza • Hypertension • Diabetes
• Osteoporosis • Obesity management • Sports Medicine • Transgender Patient Care
Visit the conference website for complete schedule information and online registration
Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at katkinson@ncafp.com, with any questions you may have about this Spring 2021 fantastic summer CME opportunity.
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NCAFP COMMITTEES
Member Satisfaction and Practice Environment By: Brent Hazelett, MPA, CAE NCAFP Senior Vice President and COO
~ CAREER TRANSITIONS ~
The Seasons of Family Medicine Are you happy? Are you practicing the type of medicine you always dreamed of practicing? Are you positively influencing the lives of your patients? Or are you a cog in a massive machine that continually demands more of you? Are you struggling to juggle your professional and personal life? Do you feel trapped?
Recently, the NCAFP’s Member Satisfaction and Practice Environment Committee met and throughout the course of the meeting, several committee members discussed their recent career transitions. Several members noted how great it is that Family Medicine as a specialty is relatively unique because one can make multiple transitions throughout the course of one’s career. Thus, the idea of this article was born. What season are you in with your career, and is it time to make a change? If so, you are far from alone. After speaking with five North Carolina family physicians about their careers, and their recent and very diverse career transitions, there are several prominent themes and similarities to their journeys. Perhaps some of this will resonate with you. In a time when physician wellness is finally increasingly discussed, even without a pandemic that is overtaxing the healthcare system, the NCAFP wants our members to know that if your current season of family medicine is not 20
where you want to be, perhaps it is time for a change of season, and there are colleagues out there who can help. This is exactly what happened with Tom White, MD, who after attending an NCAFP Winter Meeting, realized it was time to make a change. According to Dr. White, “my lowest point professionally was when I came to the realization that I was no longer happy being a family physician; that my workload and task load was intolerable, that I had lost the time and enthusiasm for listening to the patient, and that my employer and I did not share my value that the patient should be the center and focus of what we call health care.” Dr. White returned home from that meeting and submitted his resignation and a year later, opened his own Direct Primary Care practice. As an increasing percentage of graduating Family Medicine residents sign their first employment with a large health system, we are also seeing some of those health system employees become frustrated. After 11 years with her first employer, Dr. Talia Aron did not know what change was next, but she knew it was time for something different. Frustrated with her repeatedly failed attempts to make changes from within, after self-reflection and feedback from her friends, she realized she was putting patients and charting before her personal life. “Being a mother, a wife, a friend and a physician should not be mutually exclusive, commented Dr. Aron. “If you are like me, hard-headed, it might take a few years to figure this out, and that’s okay. But when you do finally hit that wall, go for it. There will always be a need for good family physicians, and you WILL find another job.” Dr. Aron is taking a year to figure out what is next, and while she does that, is working full-time in telemedicine. Realizing work-life balance is completely out of whack
The North Carolina Family Physician
is a recurring theme for the physicians that have gone through career transformations. And while many family physicians find it hard to leave their current role, often due to a deep personal desire to not disappoint their patients or community, changing jobs is a perfectly normal part of almost everyone’s career, and these changes are often beneficial for both the physician and the patients. Another physician (whose name we were asked not to reveal in case the timing of the magazine was too close to the time of her transition) just six years out of residency, recently left a position she liked but realized was not a good fit for her family. “I had my third child in 2019, and within a few months of my return our health system suffered a major malware attack, followed quickly by COVID-19, then multiple providers ultimately leaving our practice. There were increasing demands on my time and I found myself stretched too thin, and in an unsustainable place for myself, my family, and my patients.” Thanks to the counsel of many people in her life, she elected to take the advice she often gives patients about preventive care and made a decision that was in her best personal interest. Dr. Vickie Fowler has made multiple career changes as she has entered different “seasons” of her life. According to her, some of them have been good and some have not. But perhaps her best lesson learned, and her appreciation for family medicine, was summarized with these words: “I appreciate that our specialty allows us to lovingly pack away some of our “hats” once we decide they no longer fit our personal or professional goals.” For most of Dr. Fowler’s career, she practiced full scope family medicine, with a large focus on delivering babies and newborn care. But those areas of focus often came at a personal cost, and she recently decided some things had to give. “My newest opportunity at Wake Med Primary Care has been chosen with my personal needs balanced with my professional needs, along with two very specific desires – no interstate commute and no non-compete in my contract.” Dr. Fowler continued “I am thrilled to feel in control of my destiny once
Spring 2021
again while also having the support of a large local healthcare organization with a focus on patient care and community.” Other bits of wisdom shared by these physicians: •
Trust your heart and trust your plan. Do not let others write your plan for you. And never forget why you chose to be a family physician. You are smart – probably a lot smarter than you think – and there are many smart people who have been through what you have been through, so lean on them.
•
Get help before you sign a contract that could very much impact your ability to leave or change jobs. Really do your homework, ask a lot of questions, be honest with yourself and thoroughly evaluate where you are in life and what you need that you currently are not getting.
•
Finally, the importance of sharing your thoughts with friends, colleagues, mentors, therapists, was underscored by everyone interviewed for this article. Talk to your friends in other parts of the state, talk with your colleagues at the NCAFP, talk with your friends and family and discuss openly with others.
As Dr. Takie Hondros put it “Don’t feel trapped; that you don’t have any choice. We all want to be happy in our lives as a family physician, but we can only accomplish that if we support each other no matter what arena of Family Medicine we work in.” Thankfully, there are a wide range of arenas available to you as a family physician. Perhaps it is time to investigate other options and change seasons. If the NCAFP can help you with this journey, please do not hesitate to reach out to a staff member. We want the best for our members; for you to be a happy, healthy, productive family physician.
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RESIDENTS & NEW PHYSICIANS By Peter Graber NCAFP Communications
N C ' S R E S I D E N C Y P RO G R A M S
Duke Family Medicine Residency to Launch New Rural Training Track With the healthcare needs of North Carolina’s rural communities growing by the year, Duke University’s Family Medicine Residency is proud to announce that it will formally launch a new rural training track later this year. The new track has been accredited by the ACGME Residency Review Committee and has recently MATCHed two new interns slated to begin this coming July. The track is a collaboration between Duke Primary Care Oxford and Maria Parham Health, a Duke LifePoint hospital, based in Henderson, North Carolina. NCAFP Past President Dr. Thomas Koinis (1997) will be serving as founding Residency Director for the new track. Dr. Koinis will be complemented by Drs. Eric Buenviaje and Alexa Namba who will be serving as Associate Program Directors and Medical Instructor, respectively. According to Koinis, the new option comes at a much-needed time. “Our rural areas in North Carolina and throughout the country are struggling with finding Family
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Medicine and other primary care physicians to serve their communities,” noted Koinis. “I am very excited to offer this rural environment as a place for residents to train and develop as family physicians, capable of caring for folks in underserved and under-resourced areas. One of my major goals will be to have residents learn and experience the joy and satisfaction of rural Family Medicine.” According to Koinis, the effort is a culmination of several years of work between Duke’s Department of Family Medicine & Community Health and Duke Primary Care. Dr. Koinis was quick to note that Duke’s Drs. John Anderson, Viviana Martinez-Bianchi, Anthony Viera and Greg Swain each played instrumental roles in developing and launching the track, as did the tremendous organizational and financial support of the Duke Health System. Interns of the new track will experience the same Year One curriculum as residents in Duke’s core Family Medicine Residency program. They will then serve the majority of their second and third years with continuity patients from Duke Primary Care Oxford and staff in-patient services at Maria Parham Health in Henderson. The track’s founding interns will be Drs. Rashmi Jyotsna Saincher of Saint George’s University in London, and Jessica Yeary Sanders from the University of Texas at Houston. Dr. Koinis noted that the timing of ACGME’s accreditation approval happened only days prior to the formal opening of the 2021 MATCH season. All in all, the program was able to draw from a strong applicant pool and couldn’t be more pleased with its founding interns.
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Spring 2021
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STUDENT INTEREST & INITIATIVES By: Hannah Smith NCAFP Student Director
Medical Student Teams Diversity drives impact We have all heard of the team-based approach to healthcare. However, what has meant the most to me throughout medical school was creating my own team that helps me reach my full potential and uncover novel interests. My team looks a little different than a healthcare team but consists of many different professionals that are working to impact the health outcomes of individuals in North Carolina.
Leadership Opportunities with the NCAFP and the AAFP June 4th, 2021 Application Deadline
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My Team The principles I see displayed within healthcare teams include frequent communication, honesty in struggles, and overlapping core goals. As I began medical school and connected with classmates, I looked for these qualities in my colleagues. Through them I was introduced to the NC Academy of Family Physicians. Throughout conferences and meetings, I made an effort to thank speakers and reach out to the individuals I met who made me feel inspired about my future. The best opportunities arose because of my close connection to the leaders at NCAFP and my desire to get more involved with North Carolina healthcare. When looking for summer opportunities, the NCAFP helped me connect with a physician who was practicing my dream job in rural western North Carolina. Dr. Sloss in Bat Cave, NC, kept my love of rural medicine alive. NCAFP also helped me
STATE LEVEL WITH THE NCAFP: Students and Residents interested in serving in a leadership role at the state level can visit the student or resident page on the NCAFP website for more information, or contact Brent Hazelett at the Academy’s office to inquire. Deadline to apply for all board and committee appointments for the 2021-2022 term is June 4th, 2021. For available positions and to meet the current student or resident leadership team, please visit www.ncafp.com. NATIONAL LEVEL WITH THE AAFP: Although the AAFP deadlines are not until July, many national leadership options require support from the NCAFP; June 4th is the Chapter’s deadline for students and residents to submit their application for review by the NCAFP Nominating Committee for all elected positions and some appointed positions. Involvement at the Chapter level (this can be a former state if you are resident that attended medical school elsewhere) is required to be considered for a national position. Please note: there are a few appointed positions with a deadline of Aug. 5th. Please refer to the NCAFP policy on AAFP Nominations at www.ncafp.com and the AAFP site for a complete list of available leadership positions: www.aafp.org/nc.
Please contact Brent Hazelett at bhazelett@ncafp.com for more information or if you have The North Carolina Family Physician questions on any of these opportunities.
connect with a public health family physician during a fourth-year elective. Dr. Guthrie in Henderson, NC, sparked my interest in public health and incarcerated medicine. Each new mentor showed me a different avenue within primary care and how they set up their own team along the way.
FAMPAC
Empowering Family Medicine
Alongside the NCAFP, I have also had repeated exposure to mentors working with the NC Medical Society. While attending my first NCMS conference, I noticed that many of the physicians I looked up to were present and involved in the programming. The NCMS helped me see the importance of advocacy and physician leadership in our local policy efforts and has helped me incorporate many physicians into my team as a medical student. Physicians who encourage me to share stories and participate in opportunities that enhance my understanding of health care. As I grow and my interests develop, the NCAFP continues to support me and connect me with leaders throughout North Carolina. As my last rotation of medical school, I participated in an Advocacy, Policy, and Leadership elective with the NCAFP. I had the opportunity to meet with healthcare organizations, insurance companies, senators and representatives in the General Assembly, and other key stakeholders who advocate for North Carolina healthcare. I gained valuable insight into the behind-the-scenes effort that comes with supporting family physicians, residents, and students. I feel beyond blessed that the NCAFP is a key part of my team. As medical students, these connections are critical to keeping us mindful and aware of why we began this journey in the first place. The other members of my team are See TEAM on Back Cover
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
PRACTICE MANAGEMENT By Peter Graber NCAFP Communications Services
MAHEC Plays Leading Role in New AAFP Field Manual on Opioid Use Disorder In late February, the AAFP formally published its first field manual on treating Opioid Use Disorder (OUD). Release of the manual was a culmination of several years of work that featured faculty from North Carolina’s Mountain Area Health Education Center program (MAHEC) playing a lead role. “This manual we hope will provide basic information and access to further reading and resources to increase physician comfort level in treating this disease,” explained Dr. Susan McDowell, a faculty physician and substance use educator with MAHEC’s Family Medicine Residency Program in Asheville. McDowell spends half her time in patient care and the other half in education and community outreach around substance use disorders, primarily OUD, and acted as the designated lead author of the manual. The manual’s release comes
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at a key time in the fight to reduce opioid abuse-related deaths. According to provisional data released late last year by the CDC, the total number of US drug overdose deaths increased 18.2% between June 2019 and May 2020, with the largest increase occurring at the start of the nation’s pandemic response from March 2020 to May 2020. Broadly, the manual is the first contemporary field guide designed to orient family physicians on treating OUD within their patient populations. The guide provides an overview of current best practices, reviews diagnostic criteria, and offers a convenient outline of the processes physicians and practices can use to implement OUD services. An excellent listing of resources is also provided for additional study.
MAHEC’s involvement originated from AFFP’s solicitation as they conceptualized the effort. MAHEC has built a national reputation as a leading expert in OUD clinical treatment, with faculty members presenting several didactic sessions at AAFP conferences, as well as presenting medicaTreating Opioid Use Disorder tion-assisted trainings as a Chronic Condition across North Carolina. They also provide techA Practice Manual for Family Physicians nical assistance to physicians, health agencies and community health centers. According to McDowell, MAHEC has trained more than 3,000 healthcare providers across the state over the last two years and more than 19,000 participants in its continuing education programs. This manual was developed and distributed using funds from an unrestricted grant through Indivior.
During development of the manual, McDowSee 'OUD' on back cover
The North Carolina Family Physician
RESOURCES
School Presentation Toolkit Available on Our Website As a family physician, you have likely been asked to deliver a presentation at your child's school or a school in your area. 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. Your Workforce Pipeline Committee has developed a toolkit to assist you in these presentations. You can download the toolkit on our website at www.ncafp.com/school-presentations. You will find four PDF files. The first is an overview of making school presentations and includes tips and a checklist. The next three files include age-appropriate materials for presenting to three different groups: K-3, 4th to 7th grade, and 8th to 12th grade. The materials in each age group are meant to be fun, engaging, and encourage active participation— from videos, games, flashcards, and activities to worksheets and interactive quizzes.
Helping physicians in medicine, business, and life. Curious to know more? Visit curi.com
CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS
We hope you find this toolkit useful and helpful. 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 these materials as part of a leadership project while completing her residency.
ADVERTISE! Reach many types of Family Medicine professionals in North Carolina. Contact Peter Graber with the NCAFP at pgraber@ncafp.com
Spring 2021
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TEAM, from p25 2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
Mentors and leaders introduce me to new networks, and each time I am so thankful for the connections that are made. Starting residency, I look forward to finding new teammates, bringing them with me to conferences along the way, and continuing to build my team. Together, we will serve North Carolina fearlessly.
www.ncafp.com
my support system. They include community members like my dance teacher, scuba diving instructor, and local plant nursery experts. Each student’s team will look different but keeping those core principles in mind when meeting inspirational individuals is key: communication, honesty, and overlapping goals. A Growing Team I have seen my team grow and change with each new networking opportunity.
OUD, from p26 ell described how she and other authors benefited from reviewing the work and research in the space and how they applied these learnings in building the manual. “The key thing we learned here at MAHEC by working on this manual is how much family physicians need a simplified, easy-to-read resource to get started. My hope is providers will read this manual and realize OUD is a treatable disease within the realm of family practice,” she noted.
fight the stigma and shame some patients with substance use disorders feel by letting patients know it is not who they are - they are not an addict just like someone is not an asthmatic, they are a person with an OUD or a person with asthma.” Members are encouraged to download the manual at www.ncafp.com/ oud-manual
For Dr. McDowell, treating OUD has been one of the most rewarding parts of her career thus far. While she feels it’s unfortunate that many barriers, misconceptions, and stigma exist around treatment for this community, it’s a population of people who desperately need medical care. The manual is a great way to get started.
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“I’m going to adopt one of my favorite advertising slogans and say, “Just Do It!”,” McDowell says. “Remember, OUD just like any other chronic illness that benefits from evidence-based treatment. We can