Volume 18 Issue 2 • Spring 2022
The North Carolina
Family Physician Quarterly News in North Carolina Family Medicine
PRECEPTING FAMILY MEDICINE'S FUTURE WORKFORCE P4
Complex Pain Project (Virtual) A collaborative project with the Governor’s Institute
Expanding Expertise of Primary Care Providers to Treat Complex Pain Through Training and Consultation
www.ncafp.com/complexpain
Flexible Learning Opportunities for Approximately 6 Prescribed Credits Part 1: Wed., June 15, 2022 6pm to 9pm Part 2: Wed., June 22, 2022 6pm to 9pm
Part 1: Sat., June 18, 2022 Part 2: Sat., June 18, 2022
9am to 12pm 1pm to 4pm
2022 Virtual Summer Symposium Program Chair: Thomas R. White, MD
Saturday, August 6, 2022 7:30 am – 3:00 pm
Pre-Conference KSA: Heart Disease Friday, August 5, 2022| 5:30 pm – 8:30 pm
www.ncafp.com/summercme
Approximately 14 Prescribed Credits Available
2022 Winter Family Physicians Weekend (In-Person) Omni Grove Park Inn, Asheville, NC
Program Chair: Deanna Didiano, DO Program Vice Chair: Tamieka Howell, MD
Thursday, December 1 – Sunday, December 4, 2022 Pre-Conference KSA: Hypertension Wednesday, November 30, 2022| 3:00 pm – 7:00 pm
www.ncafp.com/wfpw
Approximately 30+ Prescribed Credits Available
Inside Spring 2022
The 2021 NCAFP Annual Report P. 13
PRESIDENT’S MESSAGE
CHAPTER AFFAIRS
4
10
Making Your Mark with Family Medicine's Workforce
ADVOCACY
6
Making the Case for Family Medicine in the North Carolina Legislature
MEETINGS & CONFERENCES
8
Timely Hot Topics + A Cool Learning Opportunity = 2022 Virtual Summer Symposium
Viviana Martinez-Bianchi Named 2021 NC Family Physician of the Year
STUDENT INTEREST & INITIATIVES
24
Summer Immersion Experiences Returning this Season
PRACTICE MANAGEMENT
28
Efforts to Assist with Physicians Well-Being Now Law
DEPARTMENTS
PUBLISHED BY
President’s Message 4 Advocacy 6 Meetings & Conferences 8 Chapter Affairs 10 t 919.833.2110 •
fax
Membership 21 Student Interest 24 Residents & New Physicians 26 Practice Management 28
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. Dimitrios 'Takie' Hondros 2021–2022 NCAFP President
PRECEPTING
Making Your Mark with Family Medicine's Future Workforce As metrics with the pandemic continue to improve, I have recently started precepting medical students again. I didn’t realize how much I had missed teaching, but quickly after the first day, I was reminded how much happiness it brings to our patients, our staff, and myself.
PRECE
FAMILY MEDICINE'
Precepting students has always been an integral part of what has given me joy in Family Medicine. Teaching the next generation of hopeful family physicians always re-invigorates my love for mentoring. Now that I have transitioned to independent practice, for the first time, I also have more time to teach. This allows the student and preceptor to have more focused attention on the patient as they become part of the teaching experience. As a collaborative office, we have our medical students work closely with both APP and PharmD students as well. They integrate their knowledge, and we ask them to prepare a ‘mini grand’ rounds presentation each month. Our students also work with our other extenders like behavioralists and nutritionists as well. We make sure they experience full scope and collaborative primary care. Collaborative value-based care is the future, so early exposure for them is key.
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As my first student’s rotation ends, I am proud to say that she is committed to go into Family Medicine. Be a mentor. Be a teacher. Do it with joy and passion. It is one thing we can all do to help foster the next generation of family physicians. We need EVERYONE’s help!!! So please
The North Carolina Family Physician
2021-2022
NCAFP Board of Directors
Executive Officers President
Dimitrios “Takie” P. Hondros, MD
President-Elect
Shauna Guthrie, MD, MPH
Secretary/Treasurer
Garett R. Franklin, MD
Immediate Past President Executive Vice President
Jessica L. Triche, MD Gregory K. Griggs, MPA, CAE
At-Large Directors Joshua Carpenter, MD Jewell P. Carr, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Mark McNeill, MD Benjamin F. Simmons, MD Ying Vang, MD Courtland Winborne, MD
CEPTING
Academic Position Margaret Helton, MD (UNC)
NE'S FUTURE WORKFORCE
Resident Director Ryan Paulus, DO (UNC) Resident Director-Elect Matthew Drake, MD (ECU)
Student Director Morgan Carnes (Wake Forest) Student Director-Elect Morgan Beamon (ECU)
AAFP Delegates & Alternates AAFP Delegate
Richard W. Lord, Jr., MD, MA
AAFP Delegate
Robert L. Rich, Jr., MD
AAFP Alternate
Tamieka Howell, MD
AAFP Alternate
Thomas R. White, MD
reach out to our state’s medical schools and offer to serve as a preceptor. And also volunteer to serve as a preceptor for NCAFP’s summer rotations with medical students between their first and second year of school. You can make a difference. Volunteer.
2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
Spring 2022
www.ncafp.com
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ADVOCACY By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President
~ Working for You ~
Making the Case for Family Medicine in the NC Legislature In early April, I had the privilege to represent our state’s family physicians before the NC Joint Legislative Oversight Committee on Access and Coverage. The committee is examining the possibility of finally expanding Medicaid in North Carolina but added a few thorny issues to the discussion, including Certificate of Need laws, scope of practice for Advanced Practice Registered Nurses, and more. While I technically presented on a day dominated by Certificate of Need (CON) discussions, I focused on the benefits that Family Medicine brings to our state, economic realities that all family physicians face that are exacerbated in rural and underserved areas, and a few solutions that the NC General Assembly should consider. To open the presentation, I took the opportunity to remind the legislative committee what Family Medicine truly is: providing continuous and comprehensive health care for the individual and the family. I described Family Medicine as the specialty of breadth encompassing all ages, genders, organ systems and disease entities. I went on to outline the benefits of Family Medicine: lower cost, improved quality, and better outcomes. I noted that individuals with a primary care physician have lower death rates of cancer, heart disease and stroke, and 33 percent lower healthcare cost than adults without a family physician. Additionally, in North Carolina, family physicians are
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more geographically dispersed than any other healthcare profession. In other words, Family Medicine truly is the solution to what ails our healthcare system. Throughout the presentation, I discussed the maldistribution of physicians in North Carolina by geography and specialty, noting that not all specialties have shortages, and the state needs to invest more in producing the right specialties to practice in the right geographic regions, especially Family Medicine. Most importantly, I outlined some of the reasons that this maldistribution exists today. First, the rate of uninsured adults in a county and the mix of payers has a direct impact on the economic viability of practice in that county. For example, the ten counties with the lowest rate of uninsured adults have 50 percent more primary care providers per 10,000 residents than the ten counties with the highest rate of uninsured adults. While Medicaid expansion would do so many things to improve the health of the individuals who would receive health insurance, it also would help the economic viability of practicing in our rural and underserved areas. Thanks to NCAFP Medical Student Director Morgan Carnes, who will be graduating from the Wake Forest University School of Medicine about the time this article appears, for her efforts in correlating the uninsurance rate with the rate of primary care providers by county. Second, pay disparities matter. During the presentation, I pointed out that healthcare professionals in primary care earn over 50 percent less than their sub-specialty colleagues. Family physicians, general pediatricians, general surgeons, and psychiatrists are among the most needed specialties especially in rural North Carolina. It’s not surprising that they are also among the lowest paid specialties. Third, debt burden matters. In 1978, the average debt of a medical school graduate was $13,500 (or about $53,000 adjusted for inflation). Today, the average medical school graduate has well over $200,000 in student debt, a 400 percent increase. Finally, I highlighted other factors that impact special-
The North Carolina Family Physician
ty choice and particularly practice location choice, including: growing up in a rural area; early and frequent exposure to community practice, particularly in rural and underserved areas; and yes, financial incentives to practice in rural and underserved areas.
FAMPAC
Empowering Family Medicine
I wrapped up my presentation to the Joint Legislative Oversight Committee on Access and Coverage with a call for a sustained and comprehensive approach to overcoming healthcare professional shortages and distribution issues, offering solutions that the General Assembly should consider: • Expanding Medicaid to provide coverage for the uninsured and help overcome one economic obstacle to practice in our rural and underserved areas. • Greater overall investment in Family Medicine specifically and primary care in general. States that increase their investment in primary care ultimately have lower overall healthcare costs. • Tying class size increases for our state’s health professional schools to outcomes (placing physicians in needed specialties in areas of the state that have the highest need for physicians). • Funding for increased rural training sites to provide greater exposure to medical students earlier in their education. • A rural scholarship program to cover medical school tuition up front in See 'Making the Case' on back cover
Spring 2022
JOIN THE FIGHT FOR FAMILY MEDICINE 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
continues on Back Cover
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PROFESSIONAL DEVELOPMENT By: Kathryn Atkinson, CMP Manager of NCAFP Meetings & Events
~ Keeping You in the Know ~
Timely Hot Topics + A Cool Learning Opportunity = 2022 Virtual Summer Symposium Your NCAFP CME Team remains dedicated to delivering top-quality education in convenient and versatile formats. And now, back by popular demand, we are thrilled to offer the NCAFP’s 2nd Annual Virtual Summer Symposium on Saturday, August 6, 2022, from 7:30 am to 3:00 pm. Under the direction of Program Chair Dr. Thomas R. White, the convenient learning opportunity will provide attendees with approximately 6 Prescribed Credits by their participation. This lively interactive webcast means you can enjoy valuable education centered on the topics you see and treat most often – all from the comfort of your favorite air-conditioned location this August. In keeping with our trademark of timely hot topics presented by expert guest speakers, this summertime CME opportunity has something for everyone. The slate of highly requested clinical presentations includes hyperkalemia, Alzheimer’s, overactive bladder,
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type 2 diabetes, PrEP Update, foot disorders in older adults, and newborn care. There is even an optional pre-conference virtual KSA opportunity on heart disease on Friday, April 5, from 5:30 pm to 8:30 pm. KSA participants can expect to earn an additional 8 CME credits and 10 ABFM activity points. In addition to a forty-five-minute coding and billing update, the Summer Symposium will also include an important presentation from the NC Medical Board highlighting “after-Covid” changes and requirements surrounding telemedicine and virtual visits. Attendees can also count on live Q&A sessions and unique Meet the Expert Zoom Room opportunities throughout the day. The one-day program will also feature the NCAFP’s super-user-friendly events app designed to allow learners to easily claim CME credit, connect with colleagues, download slide presentations, review speaker bios, and much more. Plan to spend your day with us on Saturday, August 6, 2022, as you expand your clinical knowledge and stay up to date with practical and valuable information that you’re sure to begin using right away. Registration fees are $160 for members and $225 for non-members. You can review the complete schedule along with the guest speaker line-up and submit your online registration at www.ncafp.com/summercme. Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings and Events with any questions you may have. We look forward to learning with you in August!
The North Carolina Family Physician
UPCOMING THIS JUNE -
NCAFP Partners with The Governor’s Institute to Offer Important, Unique and Free Virtual Complex Pain CME Opportunity this June By: Kathryn Atkinson, CMP NCAFP Manager of Meetings & Events
This June, family physicians and their healthcare partners can participate in several complimentary virtual learning opportunities intended to expand a clinician’s expertise in treating complex pain through training and consultation. Several flexible 3-hour virtual learning sessions (divided into Parts I and II) will equip our members and other primary care providers with the knowledge, skills, and support needed to manage chronic pain in patients with comorbidities. The sessions are free, and participants can attend as much or as little as they would like for up to 6 CME credits total. Credits earned will also count towards the state’s controlled substance CME requirement for physicians and other healthcare providers. The courses are available after office hours on Wednesday, June 15 (Part I) & Wednesday, June 22 (Part II) and also on Saturday, June 18 (Parts I in the morning & II in the afternoon). Dr. Steve Prakken, retired Chief of Medical Pain Service at Duke Pain and current Chief of Avance Medical Pain Service, will facilitate the sessions. Learning objectives for the entire activity include: • Identify the main mechanisms of pain, pain expression in acute and chronic conditions, and pain management options. • Identify common psychiatric diagnoses that occur in chronic pain patients and explore treatment options. • Identify and better understand the physiological effects of potentially addictive substances and various treatment options. • Identify the complex pain in patients with multiple comorbidities and explore treatment options. The Governor’s Institute conducted important research illustrating why this valuable learning opportunity is so helpful and very necessary for North Carolina’s primary care physicians and their patients.
PROBLEM: The nexus of pain, addiction, and mental illness accounts for 20-35% of all healthcare expenses (https://pubmed.ncbi.nlm.nih.gov/26082321/). The pandemic has only exacerbated the overlapping crises of opioid addiction, inadequate access to psychiatric care, and the general unavailability of pain management. Opioid overdoses are now at an all-time high, and demand for mental health services has risen sharply. Pain management, particularly for patients with behavioral health comorbidities, is not available to many North Carolinians. OPIOID EPIDEMIC: Initial efforts to stem the tide of the escalating opioid epidemic revolved around efforts to reduce access to prescription opioids. These efforts included statewide training on recommended practices for chronic pain and safer opioid prescribing practices. As overdose numbers continued to increase, regulatory agencies and boards, and legislatures were activated. Regulatory boards adopted guidelines and mechanisms for identifying outlier prescribers and legislatures enacted laws putting restrictions on opioid prescribing. The medical community took note, and prescriptions decreased. Because of the oversight measures, many clinicians have opted to exit pain management completely and/or sharply reduce the numbers and dosages of opioid prescriptions. At least 25% of providers in North Carolina have subsequently stopped treating pain (NCMB Survey 2018). Already grossly underserved, the chronic pain population continues to expand as the population ages, further complicating pain management access. With sharply reduced access to pain management, patients are suffering, with observable consequences both in terms of See 'Governor's Institute' on back cover
Spring 2022
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CHAPTER AFFAIRS By: Peter Graber NCAFP Communications
CHAPTER AWARDS
Dr. Viviana Martinez-Bianchi Named NC Family Physician of the Year for 2021 Last December, during the NCAFP’s Winter Family Physicians Weekend, Duke University’s Dr. Viviana Martinez-Bianchi was named the 2021 North Carolina Family Physician of the Year. The award recognized Dr. Martinez-Bianchi’s wide range of academic teaching, clinical care, health policy leadership, as well as a lifelong commitment to serving and improving care to marginalized communities. Growing up in Argentina, Dr. Martinez-Bianchi, MD, would watch her father, Carlos, deliver care to those around him – his family, members of the community and many more in the hospital and surgical center where he worked. A vascular surgeon by training, she was inspired by his passion for people and his commitment to providing care for the underserved and marginalized. “I grew up in an environment with doctors,” noted Dr. Martinez-Bianchi. “My father, although a surgeon, I think he was the most family-doctor surgeon I’ve ever met! He would take his doctor bag with him in our cruising sailboat and fishermen who lived on the river’s edge would row out to our boat to consult with him. He would provide advice, cure wounds, bring medications from the city, check blood pressures, recommend stopping smoking. Sometimes we would bring someone back to the city for care at the hospital.” Martinez-Bianchi described a time when she was fourteen, specifically the 1978 Alma-Ata Declaration by the World Health Organization – a watershed moment that essentially declared health as a human right for the first time -- had a big influence on her parents, especially her father. “My father introduced me to the concept of the intersec-
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tion between clinical care and public health and suggested I should create my own path.” This led her to dream of her own goals. “I was taught to pay attention to the needs of the community,” she explained. “When I read about the declaration of Alma-Ata, I discovered I wanted a career that involved working in international policy. My international activities started with a summer program spent in Ireland learning English as a Second Language and living with a family in Dublin, and then going on to be a foreign exchange student in Mount Prospect, a suburb of Chicago, for my senior year of high school. In medical school, I learned I enjoyed primary care and wanted to help people of all ages.” At the time, Family Medicine was rising in the United States, and while not popular yet in South America, she knew she wanted to combine some aspects of public health and clinical care.
The North Carolina Family Physician
explained. “I thought, ‘I want to be like them,’ and a physician who’s seen it all.” That vision drove her to serve the next five years in Muscatine, Iowa. She subsequently transitioned and served a stint as a Family Medicine faculty member at the Quad Cities Genesis Family Medicine Residency Program in Davenport, IA, from 2002 to 2005. She went on to complete a faculty development fellowship at the University of Cincinnati. Seeking escape from the biting cold winters of the mid-West, she arrived in North Carolina in 2006, joining Duke University faculty. Martinez-Bianchi arrived at a time when the school had just decided to redesign its Family Medicine residency. While she immediately recognized the wealth of resources available at the institution, especially in its work within community, she also saw some gaps.
“Family Medicine is the vehicle that would allow me to have one foot on each side of public health and clinical care.” After completing medical school at Argentina’s National University of Rosario School of Medical Sciences, Martinez-Bianchi travelled to the United States in 1990 to complete her Family Medicine training. Her first two years were completed at Hinsdale Hospital in Illinois, but she married Greg Bianchi, a medical student in Chicago and they moved to Iowa for his training in urology, and she finished at the University of Iowa/Mercy where she served as the Chief Resident. After residency, she entered practice as a rural family doctor. “I always thought I would be an academic family physician, but the physicians I admired the most in academics were those who had served communities in rural spaces,” she
“What I saw was a disconnect between how residents were being trained and the community,” she explained. “My thought was that we could redesign the program to really put residents in the community, have them understand how to develop partnerships, and train them to engage communities, be leaders and partners.” Martinez-Bianchi helped play an important role in the program’s redesign, working closely with colleagues Drs. Lloyd Michener, Woody Warburton, Joyce Copeland, Viki Kaprielian, Brian Halstater, and others. Intertwined with her academic and clinical work has been a passion for policy making and contributing to the specialty through wide-ranging efforts in organized medicine. Dr. Martinez-Bianchi explained that both of her parents were involved in their societies, and she would often see their excitement after returning from conferences and meetings. “I’ve always thought I could contribute more and learn more through participating and giving back,” she noted, in explaining her drive. While in Iowa, Martinez-Bianchi become involved in the Continues on next page
Spring 2022
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Iowa AAFP chapter by representing the state at AAFP’s National Conference of Women, New Physicians and Minority Physicians, a precursor to today’s National Conference of Constituency Leaders. She came back from that initial conference enthralled. “I came back so energized! I had found colleagues with whom I could share concerns about health inequities in a safe space and learn with them how to make a difference…” she explained. The following year, Martinez-Bianchi would be elected as the Minority Alternate Delegate to the AAFP Congress. Alongside, she was also chosen to serve on the Iowa chapter’s board of directors. According to Martinez-Bianchi, both state and national involvement are great ways to contribute back. During the last decade, Martinez-Bianchi has focused much of her energy within the international Family Medicine community with the World Organization of Family Doctors, WONCA. She began to serve after being selected to represent WONCA at some select high-level meetings of the World Health Organization and the United Nations. Most recently, Martinez-Bianchi served two terms on the WONCA Executive Committee, and as liaison to the World Health Organization which she described as an incredible opportunity to learn and influence international policy. “I found myself in Kazakhstan representing family doctors at the Global Conference on Primary Health Care in October 2018, held by WHO and UNICEF celebrating the 40th anniversary of the Declaration of Alma-Ata. It was a powerful experience to have gone full circle from the message of the declaration of health as a human right that inspired me to become a doctor, to being there in person, influencing how the countries of the world would support primary health care.” Today, Dr. Martinez-Bianchi sees patients at Duke Family Medicine, does mother-baby care rounds at Duke Regional Hospital and works as Director of Health Equity for the Duke Department of Family Medicine and Community Health. Close to the clinical frontlines but also perched to see the wider public health aspect of the university’s work, it’s a vantage point that has allowed her to see how policy making can link up with efforts on the ground. “This is a key role of a family doctor,” noted Martinez-Bianchi, “because we can see how our communities are impacted by the decisions that are made.” She went on to describe that many emerging health issues are seen early in the clinic before they become ‘public health numbers.’ For example, her clinic diagnosed 53 cases of COVID at
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the very beginnings of the pandemic, and together with colleagues working in Siler City, she worked on education after she was alerted about the initial outbreak at a meat-packing facility in Alamance County in a largely Spanish-speaking population. Combining the two issues, she sprang into action almost immediately. Dr. Martinez Bianchi quickly saw the crucial need to communicate with North Carolina’s Spanish-speaking citizens. She played an instrumental role in establishing the Latinx Advocacy Team & Interdisciplinary Network for COVID-19, better known as LATIN-19. The group launched in March of 2020 to address inequities in the COVID-19 pandemic response within the Latino community, focusing on the health system in general and specifically communities in Central North Carolina and helping to address their vulnerabilities and strengths. She frequently contributed to DHHS’s daily news conferences, and her leadership efforts were immediately recognized by state health leaders. “At the peak of the pandemic, almost half of positive COVID-19 cases in North Carolina were among Latino residents, despite representing less than 10 percent of the population,” wrote former DHHS Secretary Dr. Mandy Cohen in a letter supporting her nomination. “Turning this trend around was not easy and would not have been possible without the leadership and partnership of LATIN-19.” Martinez-Bianchi described the challenges of translating policy making efforts into on-the-ground action. Working with state health leaders like Dr. Cohen, she actively participated in several pandemic news briefings, presenting in Spanish, and speaking directly to members of that community. “The community heard the messages and were paying attention,” Martinez-Bianchi explained. She was later offered to co-lead the historically marginalized testing team for the NC DHHS. “We collectively created not only messages that people could understand, but also culturally and economically aware places closer to their own neighborhoods for people to get tested for Covid, and later on to get vaccinated.” Dr. Martinez-Bianchi continues to apply the learnings of a skilled clinician to help train Duke residents both as clinicians and community leaders and is also just as involved at the intersection between public health and clinical care. “All of my past experiences I’m using now to help make a positive difference.”
The North Carolina Family Physician
2021 ANNUAL REPORT
2021 State of the Academy Will it ever end? I am sure many NCAFP members asked themselves this very question multiple times throughout 2021. As we slogged through the pandemic’s second full year, delivering quality health care challenged everyone, including our practices, our patients, and the communities we serve. Throughout these challenges, several silver linings emerged for our Academy and the specialty. We managed to sustain continued progress in several key areas, including advocacy by demonstrating our leadership on Family Medicine’s national stage, helping our state successfully transition to a new Medicaid
Jessica L. Triche, MD 2020-2021 NCAFP President
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
delivery model. And as a ‘family’ of physicians, we even managed to come together in Asheville for the first time since 2019. At the outset of 2021, Academy leaders committed themselves to not allowing the pandemic to hinder our advocacy. While we planned for a major shift to our state’s Medicaid program – the transition to managed care – we leveraged it as a growth opportunity. Our contributions over the past several years of planning helped make the roll-out relatively smooth, even in the face of
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. During her presidential service, Dr. Triche practiced 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 So-
2020-2021 NCAFP Leadership Executive Officers President President-Elect Secretary/Treasurer Immediate Past President Executive Vice President
Jessica L. Triche, MD Dimitrios P. Hondros, MD Shauna Guthrie, MD, MPH David A. Rinehart, MD Gregory K. Griggs, MPA, CAE
ciety Foundation's Leadership College and completed their Health Care Leadership and Management (HCLM) Program in 2018. Dr. Triche served in several leadership roles within the Vidant System in the past. She also serves on the Beaufort County Board of Health.
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
continued operational challenges of COVID. Our
Board of Directors in a ‘virtual’ campaign that repre-
Academy worked very closely with North Carolina's
sented another first for the specialty. Dr. Smith is the
DHHS to ensure unforeseen issues were addressed as
latest in what’s becoming a very long line of North
quickly as possible, and in doing so, helped strengthen
Carolinian family physicians who have been chosen for
our relationships with key state health leaders.
such a key national role.
Another area of progress was our continued success
Closer to home, the NCAFP succeeded in delivering
relative to payment advocacy and administrative burden
new services to members while also adapting for new
reduction. These two areas are extraordinarily important
and future challenges. For the first time, we introduced
and were identified in our 2020 Member Needs Assess-
a new Family Medicine podcast designed to help show-
ment as your leading issues. We didn’t let the pandemic
case the specialty’s contemporary topics in a digital
slow us down on either of these fronts and we helped
format popular today. We also played a role in helping
play an important role in ensuring that critical changes
launch a second one hosted by two outstanding mem-
made to help practices during the pandemic were not
bers, both former NC Family Physicians of the Year.
sunset too soon. We also continued to advocate with our state’s insurers and payers relative to reducing adminis-
2021 was a memorable year in so many ways for all
trative burdens, particularly around prior authorizations.
of us. For our specialty and our Academy, it was most remarkable to witness how we adapted, reacted and
Outside of advocacy, I am proud to report that on Family
lead in healthcare.
Medicine's national stage, our state continues to be looked to for leadership. We were successful in helping
Thank you for this opportunity.
to elect Dr. Karen Smith of Raeford, N.C., to the AAFP
Academic Position
National & International Family Medicine Leadership
Mark L. Higdon, DO (Novant FMR) Resident Director
Viviana Martinez-Bianchi, MD Executive Committee WONCA - The World Organization of Family Doctors
Clayton Cooper, MD, MBA (Duke) Resident Director-Elect
Mott P. Blair, IV, MD Board of Directors American Board of Family Medicine
Ryan Paulus, DO (UNC) Student Director
Tamieka M.L. Howell, MD AAFP Commission on Membership & Member Services
Hannah Smith (ECU)
Thomas R. White, MD AAFP Commission on Quality and Practice
Student Director-Elect Morgan Carnes (Wake Forest)
Hannah Smith AAFP FMIG National Network Coordinator 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 M.L. Howell, MD
Conrad L. Flick, MD Vice Chair AAFP Federal Political Action Committee (FamMedPAC)
Strategic Progress Payer and System Advocacy •
Succesfully advocated for family physicians relative to COVID Vaccination Priorization planning and roll-out.
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Conducted ongoing dialogue with state payers regarding the value of primary care, including input into value-based care model development, administrative burden reduction and workforce.
•
Advocated for preceptor tax credit, as well as for funding for a Multi-Disciplinary Teaching Hub.
•
Actively particpated in a White House Roundtable discussion on pediatric COVID vaccine distribution.
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Advocated for responsible extensions to the telehealth payment policies with payers.
Member Satisfaction and Practice Environment •
Gathered member feedback on administrative burdens.
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Collaborated with several other medical organizations in promoting pandemic practice support funding.
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Continued to co-sponsor a series of webinars on “Navigating COVID-19.”
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Sucessfully held virtual summer meeting and in-person Winter Family Physicians Forum.
Workforce Pipeline •
Ongoing financial support to the state's Family Medicine Interest Groups and residency programs.
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Presented a Community Preceptor workshop held at Annual Meeting.
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Continued successful medical student interest programs.
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Offered a virtual webinar on employment contracts.
2021 NCAFP Membership Summary Membership Profile
NCAFP Membership Performance
NCAFP’s overall 2021 membership by category:
Active member retention New physician retention 100% Resident Membership
Active................................ 2,584 Student.................................859 Life..........................................371 Resident...............................393 Inactive................................... 46 Supporting..............................8 Transitional..............................1 TOTAL.................................. 4,262
Chapter Awards & Recognitions Viviana Martinez-Bianchi, MD Durham, North Carolina
2021 North Carolina Family Physician of the Year Recognized for a wide range of academic teaching, clinical care, health policy leadership and a lifelong commitment to serving and improving care to marginalized communities, Dr. Viviana Martinez-Bianchi life's work in Family Medicine has centered around excellence in care, combined with a passion for mentoring, teaching and leading.
1st Place for XL Chapters 1st Place for XL Chapters
Continuing Medical Education
39+
2021 Virtual Summer Symposium (New!) Tamieka Howell, MD – Program Chair 6.00 AAFP Prescribed Credits 125 Registered CME Attendees
AAFP CREDITS PRESENTED
2021 Winter Family Physicians Weekend Jay Patel, MD – Program Chair Deanna Didiano, DO – Program Vice-Chair 33.75 AAFP Prescribed Credits 586 Registered CME Attendees 53 Exhibitor Displays
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MEETING ATTENDEES
The Numbers For 2021 • 39.75 AAFP Prescribed Credits • 711 Total NCAFP CME conference attendees during the year • Secured $360,000 in grant funding, allowing the NCAFP to educate an additional 1,950 learners across the country
$360,000 Grant Funding Secured
2021 Grants Program Due to the continued concerns with the global COVID-19 pandemic and the restrictions regarding larger gatherings and travel, we received only 3 new grant programs whose meetings will occur in 2021 and 2022. While many programs held in early 2021 were virtual programs, we began the transition back to live meetings with some state chapters in the second half of the year. Even with this limitation, NCAFP was still able to provide a total of approximately 1,950 attendee/learners from the chapter partners for our programs.
10 AAFP Chapters who held 2021 Meetings from grants programs that were secured in 2021: • • • • • • • • • •
Arkansas Georgia Iowa Louisiana Mississippi Ohio Pennsylvania South Dakota Texas Virginia
Total Grant Funds: $360,000 Grants received from: Biogen, Amgen, Seqirus
Total Attendee/Learners from the Chapter Partners: 1,950 (does not include NCAFP learners)
The NCAFP Foundation promotes the specialty of Family Medicine to medical students in North Carolina. As a result of the continued COVID pandemic, NCAFP Foundation student experiences were paused. Student delegations from North Carolina did attend state and national virtual conferences and participated in the Foundation's annual research poster presentation held during NCAFP's Winter meeting. The Foundation continued to offer scholarships and other opportunities for medical students. Students were also engaged 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.
2020-21 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
Shannon B. Dowler, MD, FAAFP William A. Dennis, MD Eugenie M. Komives, MD, FAAFP Lisa A. Cassidy-Vu, MD Christopher P. Danford, MD Michael J. Harris, MD R. Aaron Lambert, MD, FAAFP Amy E. Marietta, MD, MPH Susan A. Schmidt, MD Holly L. Stegall, MD Jessica L. Triche, MD Dimitrios Hondros, MD Rhett L. Brown, MD, FAAFP - Novant Health Jim Kay - Curi John R. Smith Jr., MD - BCBSNC Matthew Drake, MD Vanessa Crerar, MD Jordan Rawlings James B. Sanford
Trustee Emeritus
Maureen E. Murphy, MD, FAAFP
2021 BY THE NUMBERS
• $1,730,977 balance of the Medical Student Endowment, effective 12/31/21. • >$40,000 in direct financial support provided for student and resident programs. • $250,000 contributed by Blue Cross Blue Shield of North Carolina. • $60,000+ in total Member Contributions to the Medical Student Endowment. • $10,000 contributed by corporate members to the Foundation.
2021 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 2021. Thank you for your continued support.
Dr. Christina Anderson Mr. Chip Baggett Dr. Elizabeth Baltaro Dr. Elizabeth Baxley Dr. Mary Bengtson Dr. Holly Biola Dr. Regina Bray Brown Dr. Kristin Bresowar Dr. Rhett Brown Dr. John Campbell Ms. Morgan Carnes Dr. Joshua Carpenter Dr. Jewell Carr Dr. Lisa Cassidy-Vu Dr. Dawn Caviness Dr. Sandra Clark Dr. Clayton Cooper Dr. Valencia Covington Dr. Gary Crawford Dr. Vanessa Crerar Dr. Laddie Crisp Dr. Christopher Danford Dr. Wiley Davis Dr. William Dennis Dr. Andrea DeSantis Dr. Deanna Didiano Dr. Ashley Donahue Dr. Matthew Drake Dr. Amy E Marietta Dr. Ken Edel Dr. Fernando Escabi Mendez Dr. Walter Ezeigbo Dr. Mark Faruque Dr. Garett Franklin Dr. Joanne Fruth Dr. Deepak Gelot Dr. Anne Gonzalez Dr. Donald Goodman Mr. Greg Griggs
Dr. Shauna Guthrie Dr. David Hall Dr. Shawn Hamm Dr. Michael Harris Mr. Brent Hazelett Dr. William Hedrick Dr. Mark Hester Dr. Mark Higdon Dr. Dimitrios Hondros Dr. Tamieka Howell Dr. Laura Hubbard Dr. Latonja Ivery Dr. Nichole Johnson Dr. Ronald Johnson Dr. Michelle Jones Dr. Cynthia Jones Dr. William Kelly Dr. Eugenie Komives Dr. Jill Konkol Dr. Aaron Lambert Dr. Ronnie Laney Dr. Kelley Lawrence Dr. Richard Lord Dr. Shelly Lowery Dr. John Mangum Dr. V. Martinez-Bianchi Dr. Alfred May Dr. Brian McCollough Dr. John Patrick McGee Dr. Mark McNeill Dr. Paul Meyer Dr. Jennifer Mullendore Dr. Maureen Murphy Dr. John Newton Dr. Michelle Nicholson-Wilson Dr. Carl Nordstrom Dr. Stephen North Dr. Deborah Norton Dr. Bill Parker
Dr. Steve Parker Mr. Shawn Parker Dr. Pulak Patel Dr. Jay Patel Dr. Ryan Paulus Dr. Jeffrey Pennings Dr. Lara Pons Dr. Elizabeth Richards Dr. David Rinehart Dr. J. Carson Rounds Dr. John Rowe Mr. Bailey Sanford Dr. George Saunders Dr. Benjamin Simmons III Dr. Nadine Skinner Dr. Jessica Sloan Dr. Karen Smith Dr. Hannah Smith Dr. John Smith Dr. Richard Smits Dr. Neil Sparks Dr. Barbara Stagg Dr. Erika Steinbacher Dr. Christopher Street Dr. Paul Sykes Dr. Julian Taylor Dr. Netra Thakur Dr. Robert Toborg Dr. Jessica Triche Staton Dr. Ying Vang Dr. Eugene Wade Dr. Brittany Watson Dr. Patrick Williams Dr. Courtland Winborne Dr. Christopher Zagar
MEMBERSHIP & MEMBER SERVICES By: Tara Hinkle NCAFP Member Services Manager
Getting to Know AAFP's CME Policies If you are a new physician, AAFP’s CME Re-Election process might be new to you. If you have been a member for a while, a little refresher might help clarify some questions you may have. The information below can be found on AAFP’s website, but we condensed it in one place for you. So, what is re-election? As a condition of continued membership, active members are required to report at least 150 credits of approved CME every three calendar years. This period is called a re-election cycle and always ends 12/31 of your re-election year (e.g., by Dec. 31, 2022, for a re-election cycle that ends in 2022). For AAFP members in their first re-election cycle, the cycle is four calendar years: the year in which they become an active member, plus the next three full calendar years. To be eligible for re-election, members must earn the required CME credits within the re-election cycle. Once members have met the CME requirement, they are “re-elected” to AAFP membership. If re-election requirements are not met, membership is canceled. You can find your three-year re-election cycle at www.aafp.org/cme. What are the requirements for re-election? Active members must report at least 150 credits of approved CME every three calendar years (i.e., during their re-election cycle). The 150 credits must include at least 75 AAFP Prescribed credits. AAFP Prescribed credit is designated for activities that are designed primarily for physicians. Content is directly related to patient care, patient care delivery, or certain nonclinical topics. A family physician who is an AAFP active or life member must be directly involved in the planning of the activity to ensure the content is relevant to the specialty of Family Medicine. Examples of AAFP Prescribed credit include:
Spring 2022
• CME activities for which application has been made to the AAFP Commission on Continuing Professional Development (COCPD) that have been approved for AAFP Prescribed credit • Instruction of health professions learners in formal individual (e.g., preceptorships) or live educational formats • Most life support courses (e.g., ALSO, ACLS, ATLS, BLS, NALS, PALS) • American Family Physician and FPM journal quizzes • Most activities produced by the AAFP • Some point-of-care learning • Activities designated as Mainpro by the College of Family Physicians of Canada (CFPC) • Scholarly activities AAFP Prescribed credit is accepted by the American Medical Association (AMA) as equivalent to AMA Physician’s Recognition Award (PRA) Category 1 Credit™ toward the AMA PRA. In addition, the NC Medical Board will accept AAFP prescribed credits from members to meet CME requirements. If the activity is not considered Prescribed credit, it is recorded as AAFP Elective credit, which are activities not individually approved by the AAFP as AAFP Prescribed credit that have been designated as American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 CreditTM or have been approved by the American Osteopathic Association (AOA) are acceptable as AAFP Elective credit. Examples of Elective credit include: • Professional enrichment activities for which proof of completion is not required, (e.g., informal self-study activities, such as reading a medical journal); these activities may or may not be documentable • Activities approved for American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credit ™ Continues on next page
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• Activities approved for Association (AOA) credit
American
Osteopathic
Programs created without family physician input and designed for nonphysician health care professionals, if they have medical education content of interest to family physicians. Allowances: • Professional enrichment: limited to 25 AAFP Elective credits • Teaching health professions: limited to 60 AAFP Prescribed credits • Advanced training: limited to 25 AAFP Prescribed credits • ABFM or AOA One-Day certification: limited to 30 AAFP Prescribed credits • Scholarly activities: limited to 100 AAFP Prescribed credits (this includes credit for presentation/publication of a paper) Members in other AAFP membership categories are not required to report CME but may do so to maintain a centralized CME record. Reporting CME Your CME credits must be reported in the year in which they were earned. AAFP bylaws do not allow for an extension to earn CME credit, so it is important to keep track of your progress at www.aafp.org/cme. You will need to be logged in to your AAFP account at the top right of the page to access and update your CME transcript. AAFP members can view, edit, print, or email transcripts of all CME activities they have reported since 2002 on this site. You • • • •
may
also
update
your
transcript
via:
AAFP’s free mobile app Email: aafp@aafp.org Phone: 1-800-274-2237 (M-F 9 a.m. – 6:30 p.m.) Fax completed CME reporting form or certificate of participation to (913) 906-6075 • Mail to AAFP Member Resource Center, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
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At the conclusion of a live AAFP CME activity, a link will be provided to assist you in reporting your CME for that activity. To obtain credit for an AAFP self-study or online CME activity (including American Family Physician, Family Practice Management, and FP Essentials™) you must complete a post-test or quiz. CME credit is added to your transcript on the date the post-test or quiz is completed. AAFP members can print letters of participation for AAFP-produced CME activities. • Click the “CME Transcript” link. • Click “Print Letter” next to the activity for which you would like to obtain a letter of participation. If you have reported more than the required 150 credits but your status says you need more, this may be one of the reasons: • You have not reported enough credits to fulfill the minimum requirement of 75 AAFP Prescribed credits. • You have exceeded the maximum amount of credit allowed for certain activities during a three-year re-election cycle. • The 150 credits you have reported were not all earned during your re-election cycle. The AAFP reports out to other organizations, including the ABFM when you have met their CME requirements. By reporting your CME to the AAFP: • You fulfill a requirement of AAFP membership. • You maintain a centralized CME record. • You have 24-hour access to your CME transcript. • You can email a copy of your CME transcript to other organizations to which you belong. ABFM Self-Assessment Modules and FMCLA When you complete the self-assessment modules on the ABFM website, the CME credit will automatically be reported to the AAFP. If you prefer to self-report, go to Report CME via www. aafp.org/cme then follow these instructions:
The North Carolina Family Physician
ADVISORY CAPITAL
Click “Search Self-Study Activities.” Enter the date you completed the module. Enter a keyword from the title of the module. Enter American Board of Family Medicine as the provider. Click “Search Self-Study.” Select the appropriate module(s). Click “Report Selected Activities.” For participation in ABFM’s Family Medicine Certification Longitudinal Assessment (FMCLA), credit will be rewarded after successful completion. The FMCLA has been approved for 20 AAFP Prescribed credits. Where to Find CME
INSURANCE
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You can search a comprehensive list of all AAFP certified CME on AAFP’s website at www.aafp. org/cme. Board Review questions are also available! In addition, when you attend NCAFP meetings and conferences, we will automatically report your CME earned to the AAFP by using your completed evaluation. Check out our upcoming CME opportunities at www.ncafp.com/ continuing-education. Questions? If you have trouble logging in, if you think your CME record has an error, or if you need help with CME, please call the AAFP Member Resource Center at 1-800-274-2237 or email aafp@aafp. org. You may also access AAFP’s CME FAQs at www.aafp.org/cme/about.html. It is important to note that not all CME providers report your CME credit to the AAFP automatically, so it is essential that you check your record frequently and self-report any missing credits. Thank you for your continued membership, and we hope to see you at a CME event soon!
CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS
ADVERTISE! Reach many types of Family Medicine professionals in North Carolina. Contact Peter Graber with the NCAFP at pgraber@ncafp.com Spring 2022
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STUDENT INTEREST & INITIATIVES By: Perry Price NCAFP Manager of Workforce Initiatives
STUDENT UPDATE
Summer Immersion Experiences Returning This Season For the first time in two years, we are back to in-person Summer Immersion Experiences for Medical Students! Fourteen students between their first and second years of medical school will be participating in eye-opening experiences across the state that will guide them in their Family Medicine journeys. The MAHEC Hendersonville Residency program is generously opening their doors to nine students who will be spending two weeks in Western North Carolina. Their first week will be engaging in activities such as patient home visits, rural health and Family Medicine discussions, Wilderness Medicine sessions, hands on skills workshops, visits to a rural hospital, health department, FQHC, or other safety-net
clinics, and more. In the second week, they will be matched with a practicing family physician to spend a week in the life of a family doctor working in rural or other underserved areas. We are incredibly grateful to MAHEC Hendersonville for hosting! Five students will be participating in our 4-Week Clinical Externship Program which is designed to offer students a chance to work with a practicing community family physician to see first-hand the daily life and activity of a full time, community-based family doctor. Many thanks to the following physicians who are opening their practices and hosting our students this summer: Conrad Fick, MD, at Family Medical Associates of Raleigh; Michael Harris, MD, at Carolina Family Practice & Sports Medicine; Latonja Ivery, MD, at Novant Health Village Family Care; Ben Fischer, MD at Fischer Clinic, and Dimitrios Hondros, MD at Avance Care Matthews. Family Medicine is a field with innumerable rewards, the greatest being community. One of the most impactful things that you as a physician can do to give back to that community is serving as a preceptor to medical students who are pursuing their own career in the field. Preceptors help students translate theoretical learning to actual understanding of what clinical practice looks like and gain a further understanding of what their future can hold. Interested in learning more or serving as a Ppreceptor? Reach out to Perry Price, Manager of Workforce Initiatives, at perry@ ncafp.com.
AAFP National Conference Medical Students and Residents - are you interested in connecting with nearly 3,000 peers and exploring Family Medicine up close through 3 days of tailored Family Medicine workshops, networking opportunities, and an exhibit hall? Register to attend the 2022 AAFP National Conference in Kansas City, MO from July 28-30! From birth to end of life care, Family Medicine is the backbone of health. As the future of Family Medicine, you deserve access to innovative education, dynamic resources, and important professional connections. Register now at AAFP.org/NC! 24
The North Carolina Family Physician
Connecting Family Physician Job Seekers and Employers in North Carolina.
JOBS.NCAFP.COM
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ACCESS career resources, job searching tips and tools.
FILL your jobs more quickly with great talent. ADVERTISE your open positions in the exclusive Job Flash™ email sent directly to 2,000+ family physicians in North Carolina. CONTACT Jan Kielec at Jan.Kielec@communitybrands.com or (860) 935-8437 for package and recruitment options.
GAIN insights and detailed data within the family physician profession including salary, job outlook videos, education and more. REQUEST a free resume critique from an expert writer. CONTACT NCAFP Career Center’s Customer Service at clientserv@communitybrands.com or (727) 497-6565 for questions and concerns.
Visit jobs.ncafp.com to log in or create your account today! Spring 2022
25
RESIDENTS & NEW PHYSICIANS By: Perry Price NCAFP Manager of Workforce Initiatives
RESIDENT MATCH UPDATE
Near Record Number of NC Medical Students Enter Family Medicine A near record number of medical students from North Carolina’s five medical schools will enter Family Medicine residency programs later this summer. A total of 85 students matched into Family Medicine from our state’s medical schools, just shy of the record 92 that entered in 2018. In total, just over 13 percent of our state’s medical students chose Family Medicine as their career path in 2022. Of the 85 students going into Family Medicine, 37 (or just over 43 percent) are staying in state for residency training.
their graduating medical students match into Family Medicine respectively, with each school having over 57 percent of those students staying in state for training. NCAFP continues to track long-term match rates from our state’s medical schools, tracking the percent entering Family Medicine from each school, the actual number of students entering Family Medicine by school, the percent staying in state for Family Medicine and residency training, as well as the actual number staying in state for training (See Tables 1, 2 and 3). Research shows that students who attend both medical school and residency in the same state are extraordinarily likely to practice in that state. Nationally, Family Medicine residency programs offered 4,916 first-year positions in 2022, with a fill rate of over 90 percent. This year, 1,541 U.S. allopathic seniors matched into Family Medicine, and 1,494 U.S. osteopathic seniors matched into the specialty. The number of first-year Family Medicine residency positions in the United States has grown
Campbell University’s Jerry M. Wallace School of Osteopathic Medicine led the way with a record 43 graduates entering Family Medicine this year and 15 of those staying in state for residency training. The 43 students represent 29 percent of their 2022 graduates. ECU and UNC had 14 and 19 of 26
The North Carolina Family Physician
from 3,629 in 2018 to 4,916 in 2022, an increase of over 35 percent in five short years.
Spring 2022
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PRACTICE MANAGEMENT
By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff
Effort to Assist Physicians with Well-Being Now Law The Dr. Lorna Breen Health Care Provider Protection Act On March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Act (H.R. 1667/S.610) into law1. The law is named after Lorna Breen, M.D. who died by suicide in April of 2020 following an intense stretch treating COVID-19 patients at the onset of the pandemic. The Lorna Breen Act requires the Department of Health and Human Services to establish grant programs and conduct other activities intended to address the behavioral health and well-being of health care professionals. Even before the pandemic, the U.S. clinical workforce was experiencing a crisis of burnout. A study conducted in 2019 found that more than 300 physicians die by suicide each year, nearly one per day2. According to the CDC, physicians in the U.S. face higher incidence of suicide than almost any other profession. As noted in the study, despite working to improve the health of others, physicians often sacrifice their own well-being to do so. Furthermore, there are systemic barriers in place that discourage self-care and help-seeking behaviors among physicians.3 Physician suicide is a growing public health concern. The COVID-19 pandemic not only magnified this issue but exasperated it with painful clarity regarding the personal hardships physicians faced as they cared for patients, themselves, and their families resulting in a surge of physical and emotional harm tantamount to a second parallel crisis.
in mental health resources to help provide suicide and burnout prevention training in health professional training programs and increase awareness and education about suicide and mental health concerns among health care professionals. Specifically, the Act authorizes up to $135 million, over three years as funding for grants to promote mental health among the health professional workforce, as well as for an education and awareness campaign encouraging healthy work conditions and greater use of mental health and SUD services by health care providers. Those funds are to be used to provide sustained and predictable programming to support the behavioral health and well-being among health care providers through (i) the establishment of programs that offer behavioral health services for front-line health care workers, (ii) the authorization of studies and recommendations about strategies to address provider burnout and facilitate resiliency, and (iii) the creation of a public awareness campaign encouraging health care workers to seek assistance when needed. In addition, the Act directs the US DHHS Secretary, upon consultation with relevant stakeholders, to develop a national evidence based or evidence informed awareness initiative on best practices and recommen-
PHYSICIAN WELL-BEING RESOURCES American Academy of Family Physicians-Physician Well-being Resources
www.aafp.org/family-physician/practice-and-career/ managing-your-career/physician-well-being.html Additionally see Editorial on Preventing Physician Suicide
www.aafp.org/afp/2021/0401/p396.html Mental Health America- COVID-19 Mental Health Resources
www.mhanational.org/covid19
The Lorna Breen Act makes a long overdue investment
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The North Carolina Family Physician
dations for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to promote their mental health. The initiative shall (i) encourage health care professionals to seek support and care for their mental health or substance use concerns, to help such professionals identify risk factors associated with suicide and mental health conditions, and to help such professionals learn how best to respond to such risks, with the goal of preventing suicide, mental health conditions, and SUDs, and (ii) to address stigma associated with seeking mental health and SUD services. Finally , the Act directs the Secretary of HHS, in consultation with stakeholders, to conduct a review on improving health care professional mental health and the outcomes of programs authorized under the legislation that takes into account (i) the prevalence and severity of mental health conditions for health care professionals and factors that contribute to those conditions, (ii) barriers to seeking and accessing men-
tal health care for health care professionals, which may include consideration of stigma and licensing concerns, and actions taken by State licensing boards, schools for health professionals, health care professional training associations, hospital associations, or other organizations, as appropriate, to address such barriers, (iii) the impact of the COVID–19 public health emergency on the mental health of health care professionals and lessons learned for future public health emergencies, (iv) factors that promote mental health resiliency among health care professionals, including programs or strategies to strengthen mental health and resiliency among health care professionals and (v) the efficacy of health professional training programs that promote resiliency and improve mental health. Your NCAFP will continue to monitor the implementation of the act and provide updates as grants are awarded and programs are created. In addition, below is a short list of resources intended to help physicians manage their mental health and well-being during these challenging times.
1 “H.R. 1667-117th Congress: Dr. Lorna Breen Health Care Provider Protection Act.” www.GovTrack.us. 2 “Physician Suicide: A Call-to-Action.” Molly C. Kalmoe, Matthew B. Chapman, Jessica A. Gold, Andrea M. Giedinghagen Mo Med. 2019 May-Jun; 116(3): 211–216. 3 ibid
National Academy of Medicine - Clinician Well-being Strategies and Resources
https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-well-being-resources-during-covid-19 North Carolina Medical Board - Clinician Wellness- Resources and Links
https://www.ncmedboard.org/resources-information/professional-resources/special-topics/ clinician-wellness-resources-and-links Physician Support Line -
A support line that offers free confidential peer support for physicians and medical students via telehealth by volunteer psychiatrist. 7 days a week 8:00 AM-1:00AM ET www.physiciansupportline.com If you or someone you know is considering suicide, call Doctor Lifeline (1-888-409-0141), the National Suicide Prevention Lifeline (1-800-273-8255), text “HOME” to 741741 or visit https://suicidepreventionlifeline.org.
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ENCOUNTERS This visual art presentation by Duke Undergraduate Mr. Aaron Zhao aims to viscerally capture the state of medicine and health care in six rural North Carolina towns: Laurinburg, Bladenboro, Red Springs, Raeford, and Elizabethtown. Accompanied by photo captions generated from the interviews of rural physicians and patients, this collection of artistic-documentary photographs depicts the unforeseen triumphs and challenges of practicing 21st century rural medicine in North Carolina. Mr. Zhao completed this photo essay as an undergraduate capstone project. He hopes to enter medical school focusing on primary care in rural areas in the near future.
B
D
A
G
A) DISCOUNT DRUGS, AMERICA (2022): A self-portrait taken in-front of a prescription drugstore in Lumberton, NC. America has been plagued with opioid crisis; prescription drug abuse has skyrocketed; rural regions have it especially difficult. B) COMMUNITY DOCTOR (2021): Dr. Smith serves the town of Raeford and its surrounding community. Her dedication to serving her community motivates her to partake in community events, advocating for her patients like family. C) FUTURE (2022): A self-portrait taken in front of a Cape Fear Valley clinic at night. This journey served as my own exploration of rural medicine. Is this the right path for me? Could I envision myself working as a rural physician? D) CLINIC (2021): A rural doctor documents his notes following a patient visit in his small but homey clinic. E) BLOOD DRAW (2021): Patients in rural areas are disproportionately more likely to have chronic illness than urban areas. F) Patient Connection (2022): A patient rushed through the clinic door complaining about shortness of breath. Being from a rural area, the doctor knew the patient personally. A few minutes later, the asthma attack cleared, and a fist bump was earned. G) BORN AND RAISED (2022): Rural doctors
C
D
F
H
who grew up in the same community they practice in have a better understanding of their patient population, resulting in better patient care. Dr. Rich, born and raised in Garland, NC, works a mere few miles from his hometown. Medicine becomes heavily personalized. H) Graveyard (2021): Unfortunately, rural American towns typically have a lower life expectancy than its urban peers. With a health professional shortage in many rural areas, there remain patients who lack adequate access to medical care.
'Making the Case,'continued from p7
• And finally, a sustained effort around healthcare professional workforce led by the state’s AHEC Program. NCAFP will continue to be involved in the work of the Joint Legislative Committee on Access and Coverage as one of our key ongoing advocacy priorities, but that will be just part of our efforts. We must focus on solving the key issue, not putting a band-aid on systemic underfunding of primary care. It seems that every fix the Legislature or others bring up is just treating the symptoms, not solving the underlying problem. So, as we have previ-
'Governor's Institute,'continued from p9 suicide and overdose (largely due to more easily accessed and far more lethal synthetic opioids like fentanyl).
Moving to a system that allows you to truly take time with your patients so you can truly address their issues rather than spending time on your EHR. I believe the move to value can fix many of these issues, paying for results, valuing your time, and putting the physician-patient relationship at the center of healthcare once again. Have faith. I can’t guarantee we will be successful on every issue, but I do believe your voice – the voice of North Carolina’s family physicians – is being heard.
practitioners, as well as pain management specialists. This comorbid population is also the most challenging to the healthcare system, with some of the highest healthcare utilizers and total expenditures of at least 25% of all healthcare dollars. To date, little attention has been paid to this cohort. The bottom line is that with further restrictions on opioid prescribing, we can expect that more patients with higher acuity chronic pain, psychiatric comorbidity, and substance use disorders will not have access to care. Registration for the Complex Pain Project is open! To review course schedule times and to learn more about these free, unique virtual learning opportunities, please visit the conference site at www.ncafp.com/complexpain. Non-Profit Org. US Postage
PAID
This Governor’s Institute and NCAFP collaborative project is supported by the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services with funding from the SAMHSA Substance Abuse Prevention and Treatment Block Grant.
Pontiac, Illinois Permit No. 592
PAIN, MENTAL ILLNESS & ADDICTION: Comorbidities are common in the chronic pain population, and this added complexity contributes to the undertreatment of pain. It is known that Major Depression is seen in over 60% of chronic pain patients, along with high rates of anxiety/PTSD/TBI/ADHD. The goal of reducing exposure to opioids in pain management does not factor in the reality that death from suicide is five times greater than death from overdose in pain patients taking opioids (https://pubmed.ncbi.nlm.nih. gov/26082321/). Timely access to psychiatric care, in general, continues to be a challenge, and psychiatric access for pain patients is even more limited. This combination of chronic pain with psychiatric comorbidity is commonly seen as the most difficult patient population to treat and is clearly a challenge for front-line
• Increasing the investment in primary care not just in North Carolina, but throughout our country;
2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
• A tax credit for community preceptors who want to be role models for medical students, and/or other incentives for teaching.
• Reducing the administrative burden you face in practice each day;
www.ncafp.com
addition to the state’s loan repayment programs. A scholarship program reduces overall debt and reduces interest payments on that debt.
ously outlined in articles about our strategic plan, we will continue the fight to address the true issues: