NC Family Physician - Spring 2023 by NCAFP

Volume 19 Issue 2 • Spring 2023

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Anniversary 1947-2023

Celebration & Remembrance

2023 NCAFP CME Opportunities

Learn | Connect | Engage | Celebrate 2023 Virtual Summer Symposium Saturday, June 24, 2023 From your favorite location!

credits 2023 VirtualApproximately Summer6 CME Symposium

*Pre-Conference Saturday, June 24, KSA 2023on Friday, June 23, 2023 From your favorite location! Approximately 6 CME credits Networking Dinner *Pre-Conference KSA on Friday, June 23,with 2023

30-Minute Hot Topic Exchanges Chapel Hill, NC Tuesday, Sept. 19, 2023 UNC Family Medicine Center

1.75 CME credits Networking Dinner withApproximately 30-Minute Hot Topic Exchanges

Chapel Hill, NC 2023 Winter Family Physicians Weekend

Tuesday, Sept. 19, 202330 – Sunday, December 3, 2023 Thursday, November UNC Family Medicine Center Omni Grove Park Inn | Asheville, NC Approximately 1.75 CME credits Approximately 30+ CME credits

*Pre-Conference KSA on Wednesday, November 29, 2023

Celebrate your commitment to providing the best possible care to your patients with these fantastic learning opportunities in 2023! Visit us at www.ncafp.com/cme for information about these events, or contact Kathryn Atkinson, CMP, Director of CME & Events at Katkinson@ncafp.com for more details.

www.ncafp.com/cme

Inside Spring 2023

The 2022 NCAFP Annual Report PG. 18

PRESIDENT’S MESSAGE

MEMBERSHIP

4 Wa(i)ve(r) Goodbye! Treatment of Opioid

15 Dr. Catherine Coe Leads in NC And Nationally

ADVOCACY

PROFESSIONAL DEVELOPMENT

6 NCAFP Advocacy Efforts Are Paying Off

26 The Topics are Hot, and the Speakers are Family

CHAPTER AFFAIRS

PRACTICE MANAGEMENT

8 Celebration & Remembrance

32 What Would the Proposed Rule to Ban

Use Disorder as Part of Whole-Person Care

PUBLISHED BY

t 919.833.2110 • fax 919.833.1801 • ncafp.com Managing Editor, Design & Production Peter T. Graber, NCAFP Communications Assistant Editor Kevin LaTorre, NCAFP Communications

on the AAMC Board

Medicine Experts

Noncompete Clauses Mean for Physicians?

DEPARTMENTS President’s Message 4 Advocacy 6 Chapter Affairs 8 Membership 15 Professional Development 26

Residents & New Physicians 28 Student Interest & Initiatives 30 Practice Management 32 Contributions 34

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

PRESIDENT’S MESSAGE to NCAFP Members By Dr. Shauna Guthrie 2022–2023 NCAFP President

Wa(i)ve(r) Goodbye! Treatment of Opioid Use Disorder as Part of Whole-Person Care As a family physician, I (and most of you) pride myself on providing “whole person care,” having a “broad scope,” and “caring for the patient, not the disease.” We’re GREAT at that! We also fight fiercely to maintain our scope of practice — not just for ourselves but for other family physicians. However, we have a big blind spot in the treatment of opioid use disorder (OUD). Why did we let this disorder go without a second thought when it is so important to our patients, families, and the communities we care for and live in? I won’t bore you with the statistics — I don’t think anyone will say that OUD is not a serious problem, or that it is not KILLING our neighbors and our family members, or that fentanyl and stronger derivatives aren’t one of the worst things out there. Many of us (in my generation and earlier) will openly admit that we likely — unintentionally and regretfully — played a role in the development of this epidemic which has since spun out of control. Is this gnawing feeling that we may have anything to do with this why most of us avoid providing this care to our patients? I’ll admit, there are barriers to providing medication for opioid use disorder (MOUD) — THE evidence-based treatment for OUD. (By the way, I’m told MOUD is pronounced like the name “Maude.” I’m dubious, but I guess that’s better to say than “mowed” or “mood” or a word that rhymes with “proud”?) Methadone treatment has to be done in the setting of an inpatient program or opioid treatment program (OTP), which makes it highly regulated on a state and federal level. That doesn’t fit in with the traditional outpatient practice where most of us work. Meanwhile, only “waivered” providers could prescribe buprenorphine (I’m not forgetting naltrexone, it’s just not relevant to this article). The training process to obtain your DATA 2000

NCAFP President Dr. Shauna Guthrie

“X-Waiver” took about eight hours of (FREE) CME for a physician. This “barrier” is more of a small hurdle. So why am I — and many others who provide MOUD — excited that, as of Jan. 12, 2023, the DEA confirmed the Dec. 29,2022 legislation that eliminated the waiver? For me, it’s not the waiver PROCESS that’s the problem, it’s the fear and stigma the waiver causes. THAT is what removing the waiver will help with. Remember Accutane/Isotretinoin (some prescribe it, some never started)? To prescribe, we had to do special training, read the FDA Risk Evaluation and Mitigation Strategy (REMS), sign up for a registry, and promise to follow all the rules without question or room for error. This medication plagued our dreams with fears of birth defects and suicidal teens. Buprenorphine products for OUD (“Suboxone” or “Subutex,” among other brand names) do still have a REMS, but the specific training and licensing has been removed BECAUSE the risk versus benefit of treatment (especially in a world that includes fentanyl and carfentanyl) is SO LOW. This medication is not scary. The disease is scary — and we can do something about it. In 2018 the primary care team at Granville Vance Public Health started MOUD (then called medication assisted treatment — MAT) because of the need in the community. I have always worked to fill in gaps in the community, and this was a significant one. As part of my training I also opted to go through UNC’s Community Health and Mobilization Partnership program to learn how to treat Hepatitis C (it’s surprisingly easy, #recommend) for similar reasons. We were a little unsure what we were getting into, but it turned out caring for more parts of our existing patients and others in the community was intensely rewarding. As a health department, we thought we were masters of harm reduction (condoms, anyone?) but I always tell people the shape of my brain changed doing this

The North Carolina Family Physician

2022-2023

work through learning to better meet people where they are, make shared goals, and truly focus on safety. I’ll admit, one reason I felt it was important to start this treatment was to SHOW that it can be done, and I did! Now the next step is to get others to join.

NCAFP Board of Directors

Executive Officers President

Shauna Guthrie, MD, MPH

President-Elect

If you’re all set and absolutely not going to take up the mantle with me to start providing MOUD, that’s okay! We all have our areas of interest and skills (that’s one of the fun things about being a family physician), but if the reason you haven’t considered it is fear — let me tell you — that fear is quickly replaced with immense joy, job satisfaction, learning, patient appreciation, and (in our rural health department practice) a dramatic improvement in our no-show rate. I don’t often really feel like I saved someone’s life, but I will tell you: prescribing insulin is FAR more dangerous than prescribing buprenorphine AND you can reduce risk of overdose even if a patient does take opioids. It’s rare even when treating severe depression that you see such dramatic changes in health — both mental and physical. A harm reduction worker once said, “Back when I was using, I had no trouble finding hundreds of dollars a week for drugs. When I got sober I couldn’t get $5 for gas.” When someone goes from their body and brain making priority one obtaining substances to working their way up Maslow’s hierarchy, when a patient tells me how for the first time in over 10 years he was PRESENT for Christmas with his young children and wife, I’m amazed about how life-changing this can be for people. MOUD changes behavior, changes intention, and changes lives. So what now? Here are some resources to learn more. The only training requirement is eight hours of opioid use disorder/treatment training, and these are readily accessible. Even if you decide not to prescribe, you can serve as a resource for your patients. And remember, this training can be retrospective. If you already have eight hours of previous training related to treating OUD, you have met the requirement. If you have ever had your X-waiver, you have met the requirement. And even if you graduated from residency in the last five years, you’ve met the requirement. Here are some more resources: • Trainings: www.pcssnow.org • Mentoring: Find a mentor and/or join an ECHO group for MOUD (also on PCSS) • Read the REMS: https://btodrems.com/ • Read SAMHSA TIP 63: https://store.samhsa.gov/sites/default/files/ pep21-02-01-003.pdf • Check out this handy guide (that I may or may not have helped develop): https://populationhealth.duke.edu/sites/default/files/2022-09/Practi calGuidanceforImplementingOBOT.pdf

Garett R. Franklin, MD

Secretary/Treasurer

Mark McNeill, MD

Immediate Past President Executive Vice President

Dimitrios P. Hondros, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Lisa Cassidy-Vu, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Kelley Lawrence, MD, IBCLC, FABM Benjamin F. Simmons, MD Patrick Williams, MD Courtland Winborne, MD

Academic Position Margaret Helton, MD (UNC)

Resident Director Matthew Drake, MD (ECU) Resident Director-Elect Morgan Parker, DO (Novant Health) Student Director Morgan Beamon (ECU) Student Director-Elect Akhila Boyina (Wake Forest)

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

Oh, and to answer the most common question I get — bill like you would any old E/M visit. There is nothing special about this part of whole person care, except for the impact you will have on your patient, their family, and your community. 2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

Springr 2023

www.ncafp.com

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

NCAFP Advocacy Efforts Are Paying Off Sometimes it seems like it takes forever to see the fruits of our labor. Just as it takes time for the preventive work or chronic disease management you do with patients to show a benefit to their health, our advocacy work can be much the same. But thus far, 2023 appears to be the year that NCAFP advocacy is returning dividends. MEDICAID EXPANSION First and foremost, on March 27, Governor Roy Cooper signed House Bill 76 into law. The new law, which would be effective with adoption of the 2023-24 state budget, expands Medicaid eligibility and is expected to provide health care to over 600,000 people and bring billions of federal dollars to the state. During the bipartisan signing ceremony, Gov. Roy Cooper said, “This law, once implemented, will be the working families bill of the decade. Today is a historic step toward a healthier North Carolina.” Medicaid expansion had long been a legislative priority for the NCAFP. At times, it looked like an impossibility. In the early years of the coverage expansion fight, the tie to the Affordable Care Act seemed to be problematic, and then an uncertain Medicaid budget proved worrisome to many in the General Assembly. However, in the last two years, legislative leaders who once opposed the bill began to soften their stance as rural health care providers struggled. Beyond adding coverage to hundreds of thousands of our state’s citizens, the bill will add much-needed financial support to rural primary care and rural hospitals alike by reducing the number of uninsured patients in the neediest areas of the state. Medicaid expansion does have one last hurdle: it is tied to

adoption of the state budget. While the House has approved a draft budget, as of early May the Senate is now working on their version. Once the Senate budget is adopted, the two chambers will have to work out differences. The budget will then go to the Governor for his signature, his veto, or his adoption without a signature. WORKFORCE PIPELINE Another key priority for the NCAFP is increasing the family physician pipeline, particularly by providing incentives that encourage students to enter Family Medicine and practice in rural or underserved areas. Beyond those provisions related to implementing Medicaid expansion, the current House Budget includes a few key workforce priorities. First, the Health and Human Services budget includes $2 million for each of the next two years for an additional loan repayment program specifically for family physicians, pediatricians, and psychiatrists who work in rural and underserved areas, as well as another $23 million for the Office of Rural Health’s existing loan repayment programs for health care professionals (including primary care). The new program would provide payments of $25,000 per year for up to four years for at least 15 individual physicians each year. Any private practice setting located in a rural or underserved area of the state will be deemed automatically eligible under the proposed program. While we are pleased that this funding is currently in the budget, we will continue efforts to have the money available as up-front scholarships, rather than loan repayment. Second, the Education budget includes $1 million for NC AHEC to establish five rural community teaching sites for training medical students and NP or PA students in primary care. Each site would receive $150,000 per year to protect teaching time for physicians and other clinicians. The allocation also includes funding for a study of the existing community preceptor crisis, where AHEC will examine: the availability of community preceptors in NC and nearby states; the demand for those preceptors; and barriers that community-based outpatient clinicians face in teaching professional health care students. AHEC is directed to consult with various health care professional organizations (including the NCAFP) in this process. For some time, we have been advocating for a thorough examination of the need for community-based preceptors, as well as funding for dedicated clinical teaching sites. While the Senate budget is still under development at the time of writing, there are positive signs that the Senate

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version will strongly consider these priorities. For example, all three Senate Health Chairs (Sen. Jim Burgin, Sen. Kevin Corbin, and Sen. Joyce Krawiec) helped introduce Senate Bill 473, which would provide up to $100,000 per year for each year of medical school for medical students interested in primary care or psychiatry. This funding would be considered forgivable loans. For each year that a physician worked in rural primary care or psychiatry, up to $80,000 of loans would be forgiven under this program, meaning a medical student could be forgiven for up to $400,000 of loans for practicing in a rural area for five years. In addition, Senate Bill 310 mirrors language in the House Budget calling for a study of the impediments to the availability of community-based preceptors. While it does not include the funding for the rural clinical teaching sites, this bipartisan piece of legislation has 25 Senate sponsors. INVESTING IN PRIMARY CARE We are also excited about a bill that would establish a Primary Care Payment Reform Task Force (Senate Bill 595) sponsored by Sen. Ralph Hise, the Senate Deputy President Pro Tempore, and two of the Senate Health Committee Chairs, Sen. Jim Burgin and Sen. Joyce Krawiec. The bill would establish a task force within the NC Department of Health and Human Services to establish a definition of primary care; conduct an actuarial evaluation of the current health care spend on primary care services; determine the adequacy of the primary care delivery system in North Carolina; study the primary care payment landscape in other states, specifically considering states that have implemented a minimum primary care spend; identify data collection and measurement systems to inform the creation of a primary care investment target for health plans; evaluate the need for a permanent Primary Care Payment Reform Task Force; and submit a report with its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services. The Task Force would include the Deputy Secretary for Medicaid (or his designee), the Commissioner of Insurance (or his designee), the Administrator of the NC State Health Plan, the Director of the NC AHEC Program, the Director of the NC HIE, a physician representative selected by the NCAFP, an advanced practice registered nurse representative selected by the NC Nurses Association, and a representative of health plans selected by the NC Association of Health Plans.

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Given Sen. Hise’s role in the Senate, we anticipate that the legislative language may also be included in the Senate budget. When discussing the Task Force with members of the UNC-Asheville Health Policy Initiative, Sen. Hise has described primary care investment as one of the most important elements of improving the healthcare workforce in North Carolina. Stay tuned as the legislative process continues to move forward on this opportunity for primary care investment. ADMINISTRATIVE BURDEN AND PRIOR AUTHORIZATION REFORM Finally, outside of the legislature, the NCAFP has been meeting with major insurance companies in North Carolina to press for administrative burden reductions, including prior authorization reforms. During our efforts, UnitedHealthcare made a national announcement about reducing the number of prior authorizations they require by 20%. These reductions will begin in the third quarter of 2023 and continue through the rest of the year for most Commercial, Medicare Advantage, and Medicaid businesses. UnitedHealthcare will then implement a new national Gold Card Program early next year, which will eliminate prior authorization requirements for many individuals who meet eligibility requirements. Like the Q3 code reductions, the Gold Card program applies to most UnitedHealthcare members for commercial, Medicare Advantage, and Medicaid. The NCAFP and AAFP continue to push payers at both the state and national level to reduce the administrative burdens you face in your day-to-day practice, but this step by UnitedHealthcare is encouraging—our messages are finally getting through. We are also working with other stakeholders in North Carolina, including the NC Medical Society, to consider legislative remedies to this issue as well. NOTE: Just before our print deadline, a bill reforming prior authorization and utilization management — which NCAFP supports — passed the State House unanimously. Just like treating a patient with multiple chronic diseases, advocacy is never easy, and it usually takes time. However, just as building trust and continuity are important in your patient care, they’re also important in advocacy. We believe that relationship building and continuity of effort at the General Assembly, with our payor community, and with others is finally paying off. It hasn’t happened overnight, but the tide is slowly turning toward primary care.

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

Celebration and Remembrance On Sunday, April 9, the North Carolina Academy of Family Physicians reached a significant milestone: the 75th Anniversary of our charter as a chapter of what was then the American Academy of General Practice (AAGP). AAGP had been established in the Fall of 1947 and many chapters were chartered in the first six months of 1948. As we celebrate such a momentous milestone, it is also important that we remember our past, including the leaders who worked so hard to get the NCAFP where we are today. From the five individuals who signed the charter (Dr. John R. Bender, our first President; Dr. Roscoe D. McMillan; Dr. G. Grady Dixon; Dr. Vernon W. Taylor; and Dr. W.E. Selby) to our current President, Shauna Guthrie, MD, MPH. Without the volunteer leadership we have had over the last 75 years, NCAFP would not exist and certainly would not have the political clout we do today. So, as we celebrate this year, let’s also remember those who came before us. Unfortunately, we recently lost two of our past presidents — Dr. Hal Stuart (President in 1981-82) passed away on March 24, and Dr. Bob Gwyther (President in 200102) passed away on April 8, just the day before our 75th Anniversary. It seems especially appropriate to remember these two leaders as we look back over the last 75 years. These two family physicians served exactly 20 years apart but held much in common, particularly their love for their profession and for their professional society. The obituary for Dr. Stuart noted that “he served as Scientific Program Chairman, District Director, Vice-President, AAFP Delegate, and President of the North Carolina Academy of Family Physicians and was given the Family Physician of the Year award in 1998.” He was a true pioneer in establishing the specialty of Family Medicine, having opened

his practice in Elkin in 1960 while also continuing to make house calls and deliver approximately 4,500 babies. Dr. Stuart also had teaching appointments at both the Bowman Gray School of Medicine (Wake Forest) and the Duke University School of Medicine, particular- Dr. Martin "Hal" Stuart ly mentoring many Wake Forest residents. He was a pillar of his community. To highlight his impact, the nurses at Hugh Chatham Memorial Hospital established the Dr. Hal M. Stuart Award in 2006. The award is voted on by the nursing staff each year and awarded to a physician who most clearly exemplifies the values of commitment to service, excellence in patient care, and collaborative teamwork with nursing professionals. Dr. Stuart consistently exemplified all three. Dr. Robert (Bob) Gwyther took a bit of a different path but had a similar impact, as he served on the faculty of the UNC Department of Family Medicine for nearly 40 years, beginning in 1978. His obituary stated, “Bob was particularly honored to serve as President of the NC Academy of Family Physicians, to help bring The Healer’s Art and Finding Meaning in Medicine curricula to the UNC School of Medicine, to have a resident clinician award established in his name, to practice obstetrics for more than 30 years (longevity which allowed him to attend the births of two generations of some families), and to work with many families struggling with alcohol and other substance use disorders.” Dr. Gwyther was double board-certified in Family Medicine and addiction medicine and spoke widely on addiction treatment. But what he will probably be most remembered for is his mentorship of so many medical students at UNC, the way he imparted wisdom to generations of family physicians. These two presidents’ impact and careers cannot be summarized in just a few paragraphs. Both touched many lives and left legacies that will live on in those they taught and cared for. While having many differences, they had many similarities: they practiced Dr. Bob Gwyther full-scope Family Medicine, desired to mentor future physicians, and simply loved their profession. Drs. Stuart and Gwyther are just two of the many leaders whose shoulders we stand on today. There are many who have benefitted our state. There are those like Dr. James “Jim” G. Jones, the first Native American graduate of Wake

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Forest University, who went on to advocate for the Brody School of Medicine at East Carolina University and became the founding chair of Family Medicine there. There’s Dr. Bill Hedrick, who served patients in the same location in Raleigh for over 60 years (only moving into retirement this year, at the young age of 90). There’s Dr. Doug Henley, who cared for patients outside Fayetteville and also went on to run the American Academy of Family Physicians as the Executive Vice President and CEO for years. There’s Dr. Maureen Murphy, who provided care in Gastonia, Sparta, and

Concord during her career but also mentored hundreds of students and residents. There’s Dr. Karen Smith, who now serves on the boards of both the NC Medical Society and the American Academy of Family Physicians. And these leaders are only a very few of the giants who built Family Medicine in North Carolina. And now, there’s our current President, Dr. Shauna Guthrie, who proves you can truly work in almost any setting — even at the same time. She exemplifies the broad scope of Family Medicine and epitomizes the love of the profession that so many of our past leaders have shown. Just a few years ago, Dr. Guthrie started her own direct primary care practice, Sunflower DPC, in the small town of Henderson. Yet at the same time, she serves as both the Medical Director of her local health district (Granville-Vance Health District), and the Chief Medical Officer for the local hospital, Maria Parham Health. It’s amazing to watch her move seamlessly from the requirements of one of her roles to another, all the while putting her patients and community first. But that’s why Family Medicine is such a great specialty, unlike any other. It has the breadth that no other specialty can touch. It provides the ability to work in so many different roles. Those who become part of the specialty have hearts like no other physicians. All our past leaders exemplify just that, from 1948 to today. As we continue to remember our 75 years of history through 2023 (culminating in the ultimate celebration at our annual meeting in December), take a few minutes to remember our past and celebrate our future. Remember to thank the leaders who have led us to where we are today. And if you haven’t already done so, take a minute to walk through some of our history on our website at www.ncafp. com/timeline. It lists all our past presidents by decade, providing facts and figures from their year as president. It’s worth a look. Celebrating and remembering. things we should do every year.

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They’re

CHAPTER EVENTS

NCAFP Hosted Medical Residencies and Students at the Family Medicine Academic Summit and Family Medicine Day 2023 By Kevin LaTorre NCAFP Communications & Membership Manager

On Feb. 17 and 18, the North Carolina Academy of Family Physicians (NCAFP) hosted over 200 family physicians, residents, and medical students at the Sheraton Imperial RTP for two events: the 2023 Family Medicine Academic Summit – Point of Care Ultrasound: Beyond OB & MSK (Academic Summit) and the 2023 Family Medicine Day (FMD). Both events combined CME sessions and keynote lectures with the member reunions and socializing that anchor every NCAFP gathering. During the Academic Summit, academic faculty from Family Medicine residency programs and medical schools around the state taught and discussed best-practice applications of Point of Care Ultrasound (POCUS), shared curriculum guidance for training residents, and discussed what it really means to learn and teach in a collaborative. On Feb. 17, the afternoon started with comments from program co-chairs Dr. Adam Zolotor and Dr. Aaron Lambert. From there, the Academic Summit ranged through lectures, panel discussions, and breakout groups which shared one purpose: pooling the physicians’ knowledge of optimal POCUS uses in formal collaborative. During FMD, medical students from all five of our North Carolina medical schools joined together for a full day of hands-on clinical training, residency interview prep, and face-to-face conversation with our North Carolina Family Medicine residency programs. Many of the attendees were first- or second-year students experiencing these training courses and interacting with our residency programs for the first time, which made their attendance even more important. After all, attending NCAFP events makes medical students five times more likely to match into the specialty compared to those who don’t, according to our findings since 2016.

“A Meeting of Friends”: Members Enjoyed the Social Pulse at Both Events Throughout the weekend, attendees enjoyed the togetherness and camaraderie built into each NCAFP event. “The educational offerings are great,” Dr. Lambert said on Feb. 17, “but the best collaborative happens in unstructured so-

cial time. Tomorrow that means our breakout discussions, and tonight that means our social in the lobby.” The Friday social proved him correct, as members gathered to catch up with one another. Those breakout discussions Dr. Lambert mentioned were also as social as they were effective, when members traded jokes and recalled in-group treatment experiences as often as they gave one another practical advice. “It’s a very good day,” said NCAFP Director of CME and Events Kathryn Atkinson, “and the fellowship and camaraderie centered around timely education and meaningful conversations make it even better. This event is always so rewarding for everyone.” The attendees’ social excitement rolled through Saturday morning into the start of Family Medicine Day, when NCAFP Foundation President Dr. Maureen Murphy introduced keynote speaker Dr. Rhett Brown by saying, “It’s always a meeting of friends here.” During the FMD sessions, medical students socialized as intentionally as they learned during their training workshops. The all-day event gave them the chance to meet with their counterparts from other medical schools, which builds their sense of belonging to a larger medical community. “This is where we meet other medical students, especially from other medical schools,” said Hoon Kong, an MS2 from Brody School of Medicine. “It’s the kind of event that makes me think of us all being back here as residents or presenting here as faculty someday.” According to NCAFP Manager of Workforce Initiatives Perry Price, that connection is the point. She said, “It’s incredible to witness this huge group of medical students from all over learning more about the variety of paths available in Family Medicine while feeding off the energy and enthusiasm of their peers! There isn’t a comparable experience.” The schedule of FMD technically included only one opportunity for open-ended social gathering: the Residency Fair on Feb. 18. But that never stopped the attendees from congregating together during the 15-minute passing periods between sessions. Some took official group pictures in front of

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the NCAFP backdrop, while others chatted over refreshments. “I’ve been looking forward to being surrounded by this group of people interested in improving North Carolina’s health care,” said Ross Marnock, an MS3 at Campbell University School of Osteopathic Medicine. “And just having fun, also. Everyone wants to be here, we’re taking our time on a Saturday.”

Both events brought the wide-ranging education attendees will actually use. CME at the Academic Summit began only 10 minutes after the start of the conference, when Dr. Lambert and Dr. Zolotor presented, “What is a Collaborative and What Does ACGME Require?” There would be another two sessions on Friday and four more on Saturday morning, outlining best practices when it comes to building POCUS programs and implementing POCUS education in our residency programs. The presenters included Dr. Audy Whitman (ECU), Dr. Carina Brown (Cone Health), Dr. Ryan Paulus (UNC), and Dr. Puja Dalal (Novant Health Cornelius). Guest faculty offered in-depth presentations with key takeaways. For example, Dr. Dalal headlined the Saturday morning CME sessions with her presentations on POCUS Credentialing and POCUS Billing, where she explained how she became the Director of POCUS by seeking to provide “excellent medical care to all persons in a compassionate and thoughtful manner.” For the conference attendees to understand how they (and their learners) can earn credentials for regular ultrasound treatments, Dr. Dalal outlined the steps she’d learned for accrediting, certifying, and privileging family physicians to use POCUS in patient care and fielded audience questions. The three breakout discussions shared this same in-depth approach. There, attendees opened the conference’s topics for deeper discussion and proposed ideas to better coordinate POCUS training between their organizations. With residency programs at various stages of implementing training, opportunities for them to collaborate are vital for sharing useful input about on-the-ground implementation. Family Medicine Day, in turn, covered a full spectrum of topics that Family Physicians may come across in practice. Students participated in workshops like Skin Procedures, Wound Care, Suboxone Secrets, Endometrial Biopsies, and many others hosted by our residency programs. The Mock Interview workshop was especially helpful to attendees. “We don’t get a lot of that application training in our third year,” said UNC medical student Christina Frederick. “It’s all good. I was here last year, and it’s just as good today.”

Spring 2023

Several sessions included hands-on training to practice the procedures attendees were learning for the first time, like suturing, wilderness medicine with tourniquets, osteopathic approaches to headaches, and POCUS training. “After the workshops, I feel like I can do these procedures,” said firstyear UNC medical student Nicholas Wells. “They’re all five out of five for me.” Once the formal workshops and sessions ended on Saturday, the students’ education only continued with the Residency Fair. For over two hours, faculty and residents from 16 North Carolina residencies hosted booths where interested students could chat and learn more about their programs. The Fair gave a key two-way introduction in this social setting: residencies met their future applicants, and the medical students met their prospective destinations. We’d like to thank all the guests who joined us for the weekend of events, not only for your insights and expertise but also your good company. We hope that you’ll consider joining us again at a future NCAFP event — make sure to learn more about future opportunities online: https://www. ncafp.com/cme We’d also like to thank the residency programs who hosted workshops this year: • Atrium Health Carolinas Medical Center Family Medicine Residency • Atrium Health Cabarrus Family Medicine Residency • Cone Family Medicine Residency Program • Duke Family Medicine and Community Health Residency Program • ECU Family Medicine Residency Program • Harnett Health Family Medicine Residency Program • MAHEC-Asheville Family Medicine Residency Program • MAHEC-Boone Family Medicine Residency Program • MAHEC-Hendersonville Family Medicine Residency Program • Novant Health Family Medicine Residency Program Cornelius • Novant NHRMC Wilmington Family Medicine Residency Program • Sampson Regional Family Medicine Residency Program • UNC Family Medicine Residency Program • Wake Forest University Family Medicine Residency Program

The 2023 Academic Summit: Point of Care Ultrasound Beyond OB and MSK “It was wonderful to spend time with Family Medicine colleagues from around the state who share the same passion for teaching. The topic of this year’s conference was very well timed for our program. We at Harnett have POCUS exposure during didactics in a longitudinal basis, but we are just getting a more formal ultrasound elective off the ground, so it was very helpful to get insight from those more experienced.” — Regina Bray-Brown, MD Program Director Harnett Health Family Medicine Residency Dr. Ryan Paulus “The Summit provided opportunities to network with other Family Medicine educators across the state on the topic of POCUS. The lectures and breakout sessions led to great discussions and sharing of ideas. I connected with people during the Summit that I will now be collaborating with on POCUS. Thank you to the NCAFP for putting the summit together!” — Ryan Paulus, DO Assistant Professor Department of Family Medicine University of North Carolina School of Medicine

Dr. Adam Zolotor

The wilderness medicine workshop at Family Medicine Day

Family Medicine Day 2023 “I learned a lot and am excited to continue through my first year and beyond. I have a better idea of how to set myself up for success, which questions to ask, and which things to look for when starting to apply for residency.” — Arti Bhalani Campbell University School of Medicine Class of 2026

Campbell medical students from Family Medicine Day

The North Carolina Family Physician

“Family Medicine Day is a wonderful opportunity for medical students of all years and fields of interests to get exposure to Family Medicine. Specifically, students learn about the unique qualities of each Family Medicine program in North Carolina, are able to network with peers, future colleagues, and mentors, and practice procedures, such as POCUS, pelvic exams, OMT techniques, and more. I have attended the past two years and would recommend it highly to any medical student!” — Justin Chan Duke University School of Medicine Class of 2023 The suturing workshop at Family Medicine Day

The residency interview workshop at Family Medicine Day

The residency fair at Family Medicine Day

ANIMO SANO PSYCHIATRY AND CONNECTIVE HEALTH

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SUPPORTED BY

~ IN MEMORIUM ~

Our Long-Time NCAFP CME Director Marietta Saunders Passed Away Unexpectedly It is with great sadness that we report the passThe number of family physicians impacted ing of our long-time colleague and friend, Mrs. by Marietta’s service and commitment is imMarietta (Wheaton) Saunders. Marietta retired measurable. If you participated in any of the from the NCAFP in 2022 after over 25 years of NCAFP’s CME offerings over the last three service to the family physicians of North Carolidecades, you benefited from her work and na. She was a trusted and well-respected memdedication to Family Medicine. ber of the NCAFP team, serving as Director of CME for most of her tenure with the AcadeNCAFP EVP Greg Griggs reflected on his my. A tremendous asset, Marietta consistently years working with Marietta, stating, “Mariproduced the highest-quality education for our etta was a remarkable individual who put her members and helped make the NCAFP’s eduheart and soul into making our CME proMarietta Saunders cational meetings and events some of the most grams the most innovative in the country. Former NCAFP Director of CME sought-after CME conferences in the country. But more importantly, she was an exceptionMarietta passed away unexpectedly on Monday, al person. She truly cared for all those she Feb. 27, due to complications from a medical procedure worked with, including the numerous family physicians related to cancer. who chaired meetings and CME programs during her long tenure with the Academy. Marietta was born on Sept. 14, 1953, in Germany to the late James L. Wheaton, Sr. and Ola Zulean Wheaton. She We extend our heartfelt condolences and our deepest was raised in a military family and traveled to several states sympathies to her family, especially her husband, NCAFP and countries around the world. We most often experimember Dr. George Saunders. Marietta will truly be enced her professional career, but in her personal life Marmissed by all.” ietta found more than enough to enjoy: she had a love of music, especially gospel music. Her faith was strong, and Marietta is survived by Dr. Saunders and his 3 daughyou would often find her reading faith-based books. In her ters, Nzingha Saunders, Makare Saunders, and Keyanna spare time, she loved shopping and finding a good deal. Alexander of North Carolina. She is also survived by her brothers, James L. Wheaton Jr. (Bridgette) of Germany The NCAFP staff remembers her fondly and is eternally and David L. Wheaton Sr. (Jocelyn) of Georgia; her niecgrateful for her many contributions and remarkable dedies and nephews: Tina Corsey, Joy Francis, Sonja Brown, cation to the Academy. “Marietta took me under her wing Nicole Benschine, Natalie Rivera, Bruce Jennings Jr., at the Academy in 2006,” said NCAFP Events and CME David L. Wheaton Jr., Janice Wheaton, David Wheaton Director Kathryn Atkinson. “She taught me everything (deceased); her goddaughter, Robyn Pope; and a host of I know about medical education, hosting unforgettable other relatives. events, and so much more. She was just extraordinary at her job, and she is why I am at the NCAFP today. She opened so many doors for me over the years. Most of all, she was a fiercely loyal and caring friend. And my goodness, we always had so much fun together!” Atkinson continued. “I will forever be grateful for her kind mentorship, our very special friendship, and her big, beautiful heart. I will always miss her.”

The North Carolina Family Physician

MEMBERSHIP By Kevin LaTorre NCAFP Communications & Membership Manager

MEMBER PROFILES

Dr. Catherine Coe Leads in NC and Nationally on AAMC Board Dr. Catherine Coe will tell you that Family Medicine isn’t found only in the family physicians serving patients today. The specialty also appears in the medical students and residents who will support its practice tomorrow. That’s why she has devoted her career to preparing the next generation of Family Medicine. But who is Dr. Coe, who first excelled through precepting and residency and rose to her national position of influence?

Dr. Coe’s Secret Mission in Family Medicine

Dr. Coe says that involvement with the WAFP also helped her choose Family Medicine. “It was apparent that in every policy meeting, it was the family physicians who cared most about patients and were trying to make their patients’ lives better,” she says. “They weren’t self-involved. They had the patient at the center of what they did.” These physician examples led Dr. Coe to become a family physician herself, and they gave her a purpose: “Secretly, my lifelong mission is to make more family docs, because I love what we do and think there should be more of us.” In addition to her work at UNC’s Department of Family Medicine, Dr. Coe serves as the director of the Fully-Integrated Readiness for Service (FIRST) Program. This accelerated three-year medical school curriculum links to direct progression into a UNC-affiliated residency program, which is then followed by three years of service to the state of North Carolina. Dr. Coe also directs several medical education grants as a principal investigator and is the Co-Director of the Patient Centered Care Course, which introduces clinical medicine for first- and second-year medical students. All these roles speak to Dr. Coe’s commitment to workforce development that will improve undergraduate- and graduate-level medical education in all its forms.

Dr. Coe’s National Role at the AAMC

Dr. Catherine Coe More recently, she joined the AsShe is an assistant professor in the Desociation of American Medical Colleges (AAMC) partment of Family Medicine and the Assistant Dean Board of Directors as the first-ever junior faculty represenfor Clinical Curriculum at the UNC School of Medicine, tative. It suits the years of work she has already done in stubut her journey to the specialty began before medical school dent curricular development and leadership, and she serves at the University of Washington. “I was looking for opporas the Board’s only family physician. tunities to shadow physicians,” Dr. Coe says, “and it was hard to come by that opportunity.” Dr. Coe says she’s glad to be with the AAMC as it takes actions that’ll help medical students with wellness and the But then she found a preceptor program through the Washoverall cost of medicine. “That’s been something that’s really ington Academy of Family Physicians (WAFP). Through amazing to facilitate,” she says. “Being junior faculty, I’m that program, she met Dr. Jeanne Cawse-Lucas, the family more proximate to these specific issues than other memphysician who soon taught her about Family Medicine and bers of the board. It’s why I appreciate the real commitment still mentors her. “Shadowing her was when I fell in love they’ve made to navigating these issues.” with the specialty,” Dr. Coe says. “I was amazed by how she had such a breadth of knowledge and could so nimbly serve Specifically, Dr. Coe works with the AAMC to enable medone patient after another.” continues on next page

Spring 2023

ical students to move between the different parts of medicine. “We’re looking at ways we can harmonize the continuum of medical education,” she says. “That’s a big passion area of mine with the FIRST program. I hope we see more recommendations that minimize barriers for students transitioning from one part of medicine to another. That’s where we can make a broader impact.”

precepting options you can enter as a student or as a mentor. Just contact us at perry@ncafp.com! A version of this article appeared online in April 2023 as “Our April 2023 Monthly Member Spotlight: Dr. Catherine Coe.” If you’re a member providing unique service to your practice and community, please let us know at kevin@ncafp.com.

We’d like to thank Dr. Coe for her work on behalf of her patients and her students! And if you’re interested in her experience shadowing Dr. Cawse-Lucas, the NCAFP also has

“Make Systematic Impacts to Change Things”: Wisdom from the 2022 NCAFP Distinguished Physician of the Year, Dr. Shannon Dowler Second of Two Parts By Peter Graber, NCAFP Communications Dr. Shannon Dowler needed to move from the examination room and into the board room. It’s how and why she came into high-level leadership at NC Medicaid. If you recall, she’d spoken at length about her beginnings in Family Medicine, mentorship, and advice in the winter issue of The North Carolina Family Physician. Today, we complete her full interview and share her insights into her leadership as a physician executive and her role as a public servant.

opportunity to interact with. Family Medicine is in many ways like a fingerprint — we have all developed our careers uniquely to fit our strengths and gifts. Being able to interact with so many different professionals doing amazing things in different — yet very real — ways is humbling and inspiring.

NCAFP: As a physician executive, what’s been the most rewarding part of serving your patients and community? Dr. Dowler: When you move out of the exam room and into the board room, the world gets a lot bigger and, at times, scarier. With this comes the ability to make systematic impacts to change things at a much higher level and influence investments and resources to drive transformative change. NCAFP: How has your involvement and Dr. Shannon Dowler leadership within the NCAFP and other organized medicine groups helped make you a better executive?

NCAFP: Public service is a huge part of your community contributions. How has this work helped you grow as a family physician? Dr. Dowler: It is incredibly important to me to serve others. Whether it is in a homeless ministry, migrant outreach, through my church community, or making donations to support nonprofits, there are myriad ways we can impact the lives of others outside of our day jobs. Understanding the paths, and often pain, of others as they navigate poverty, injustice, or inequity challenges me to use my time and influence to the best of my ability to make life better for others.

Dr. Dowler: One of the highlights of working with the NCAFP and AAFP is the breadth of colleagues you have the

The North Carolina Family Physician

MEMBERS IN THE NEWS

Dr. James Jones (center)

East Carolina University Honors Former NCAFP President Dr. James Jones On Jan. 27, 2023, former NCAFP President Dr. James “Jim’ Jones received the honor of a professorship in his name at the East Carolina University (ECU) Brody School of Medicine. In addition, the chair’s suite at the Family Medicine Center at ECU was officially named in his honor. After his decades of pioneering service for Family Medicine and underserved patients in North Carolina, Dr. Jones was recognized by ECU Chancellor Philip Rogers and UNC – Pembroke Chancellor Robin G. Cummings., MD. He has been a pillar of ECU and our specialty since he began practicing in 1962. NCAFP members made sure everyone heard their support. Dr. Mott Blair called the award “an appropriate honor” for Dr. Jones and said on Twitter, “I am glad to have him as a mentor all these many years!” Former NCAFP and AAFP president Dr. Douglas Henley said on Twitter, “Great honor for a great man! Thank you for all you have done for the people of eastern NC and all you have done for the specialty of Family Medicine!” Greg Griggs, Executive Vice President of the NCAFP, attended the luncheon to honor Dr. Jones’s legacy and leadership. “The luncheon was great,” said Griggs, “and it was impressive to see two chancellors from separate universities honoring Dr. Jones. He was instrumental for the creation of the ECU Family Medicine Department, and he’s definitely the godfather of Family Medicine in North Carolina.” The NCAFP staff and leadership congratulate Dr. Jones on his impactful career in North Carolina. He has helped define and defend our specialty in the state and nation, and we’re glad to count him as a member and leader in our association.

Spring 2023

Duke Regional Hospital Named Dr. Devdutta Sangvai Its President in January In January, NCAFP member Devdutta Sangvai, MD, MBA, became president of Duke Regional Hospital in Durham. He has worked at Duke for over 20 years across a variety of leadership roles, including class instruction, clinical practice, and population health management. He said that Family Medicine prepared him for his new role: “The fact that we take care of patients from before they’re born to Dr. Devdutta Sangvai their end-of-life care gives you a sense of all the services you will encounter in a hospital.” But he also named the direct-to-patient realities of the specialty as formative: “Family Medicine also allows you to understand that you need to meet your patients where they’re at. That’s a phenomenon we certainly see in the direct patient care of Family Medicine, and it translates nicely to the administrative space as well.” And he made sure to mention that he’s still seeing patients as a physician, no matter his new responsibilities. In addition to exposing Dr. Sangvai to the clinical work and patient-first mentality, Family Medicine introduced him to other levels of Duke leadership long before he was president of Duke Regional. His work as a family physician and faculty member connected him to the county board which runs Duke Regional, on which Dr. Sangvai served for six years. “I learned a lot about the hospital by serving on the board,” he said. He explained that his years of work Duke Regional Hospital’s leadership made his transition to interim president (later permanent president) a welcome step. “There were a number of ways I’d been interacting with the hospital,” Dr. Sangvai says. “Combine that with the deep affinity I have for Durham and the great team at Duke Regional, and the opportunity just made sense.”

Former President Dr. Brian Forrest Co-Authored Health Equity Findings in Family Practice Management In March, former NCAFP president Dr. Brian Forrest appeared as a coauthor in “Case Studies in Innovative Commucontinues on page 24

2022 ANNUAL REPORT

2022 State of the Academy As we all came out of quarantine, the NCAFP was back in full swing fighting for family physicians and patients across the state of NC. Specifically, our advocacy efforts circled around efforts in the General Assembly and with North Carolina payors and health systems.

Dr. Dimitrios “Takie” Hondros Dr. Hondros completed his undergraduate studies at the University of North Carolina in Chapel Hill and attended medical school at the Wake Forest University School of Medicine. He completed residency training in Family Medicine at the former Carolinas Medical Center (now Atrium) Family Medicine Residency in Charlotte, NC, where he served as chief resident. For the past 16 years, he has practiced Family Medicine in Matthews, NC. In February 2021, he opened a new Family Medicine practice, Avance Care — Matthews. Dr. Hondros has been involved with the NCAFP since he began medical school, serving as student representative to the NCAFP board and also on other North Carolina state committees. He later served as a resident member of the NCAFP Foundation board and more recently served as an at-large physician member and Executive Committee member of the NCAFP Board. Dr. Hondros regularly precepts both medical students and physician assistant students.

Those efforts in 2022 included testimony from our staff and members before state committees, collaboration with our peer associations, lobbying our state’s payors to reduce providers’ administrative burden, increasing state investment in primary care, and other measurable steps. There was certainly a lot of work done this past year. But across all of it, there was diligence, persistence, success, and learning. Speaking of learning: our medical education boomed in 2022. Continuing medical education only enhances us as family physicians. Medicine and its best practice are changing daily, and the NCAFP was here to help provide a scientifically-sound platform to learn them. Our successful CME events expanded to include the first-ever Family Medicine Academic Summit, where 66 faculty from our medical schools and residency programs attended. Over 75 medical students then participated in the subsequent Family Medicine Day event, a day of hands-on didactics complete with a residency recruitment fair. We held the Virtual Summer Symposium for nearly 150 attendees, and we also partnered with the Governor’s Institute to offer a robust program on Complex Pain Management for 135 of our members. We had many things to feel thankful for this year. The state of our Academy continues to be strong. All these accomplishments wouldn’t have happened without our NCAFP staff, our NCAFP Executive Committee and Board of Directors, and the countless physicians, residents, and students who also participate in North Carolina and nationally through their volunteer leadership roles. I was centered by the two things I learned this year: don’t be afraid to stand up for your profession, and do what you can to help foster the next generation of family physicians. No matter the arena of health care where you practice, understand that we should be the ones who drive what helps Family Medicine thrive in this new value-based world.

Progress Toward NCAFP Strategic Goals in 2022

2021-2022 NCAFP Leadership Executive Officers President President-Elect Secretary-Treasurer Immediate Past President Executive Vice President At-Large Directors

Academic Position Resident Director Resident Director-Elect Student Director Student Director-Elect

Advocacy Dimitrios P. Hondros, MD Shauna Guthrie, MD, MPH Garett R. Franklin, MD Jessica L. Triche, MD Gregory K. Griggs, MPA, CAE Jewell P. Carr, MD Joshua Carpenter, MD Deanna Didiano, MD Nicole Johnson, MD Mark McNeill, MD Benjamin “Frankie” Simmons, MD Ying Vang, MD Courtland Winborne, MD Margaret Helton, MD Ryan Paulus, DO Matthew Drake, MD Morgan Carnes Morgan Beamon

• Provided testimony to Joint Legislative Oversight Committee on Access and Coverage on the importance of Family Medicine and the need to expand Medicaid • Successfully advocated to merge NC Health Choice into Medicaid in collaboration with the NC Pediatric Society • Successfully advocated to fix coding issues which had led some Family medicine practices go unpaid for counselling on the COVID-19 vaccine during certain visits • Re-engaged senior management meetings with both the NC Medical Society and NC Healthcare Association to increase collaboration coming out of COVID-19

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

Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD Tamieka M.L. Howell, MD Thomas R. White, MD

National Family Medicine Leadership Karen L. Smith, MD

AAFP Board of Directors

Mott P. Blair IV, MD

American Board of Family Medicine Board of Directors

Austin Witt, MD

Society of Teachers of Family Medicine Resident Board Member

Tamieka M.L. Howell, MD

AAFP Commission on Membership & Member Services

Thomas R. White, MD

AAFP Commission on Quality and Practice

Conrad L. Flick, MD

Chair, FamMedPAC, AAFP Political Action Committee

Dalia Brahmi, MD

AAFP Reproductive Health Project Advisory Group

Catherine Coe, MD

Junior Faculty Representative Association of American Medical Colleges Board of Directors

Member Satisfaction and Practice Environment • Conducted ongoing meetings with health plans and other organizations to address administrative simplification and prior authorizations • Began participating in the AAFP Primary Care Learning Community on Primary Care Investment • Participated in a coalition to advance the collaborative care model of integrating behavioral health into primary care in North Carolina Workforce Pipeline • Introduced legislation to provide scholarships to those medical students entering Family Medicine and those planning to practice in rural areas • Partnered with Community Care of NC and the Center for Community-Based Primary Care to deliver a series of presentations to residency programs about models of practice, employment contracts, and more • Participated in NC Institute of Medicine panel on the workforce needs of primary care 19

Continuing Medical Education

2022 NCAFP Membership Summary

58.75

Total AAFP Prescribed Credits

Our Members by Status 2022 Family Medicine Academic Summit Active

2,588

Student

814

Life

427

Resident

390

Inactive

Supporting

Transitional

Total

2022 Virtual Complex Pain Project A Collaborative Project with the NC Governor’s Institute 6 Live AAFP Prescribed Credits 133 CME Attendees

4,275

Chapter Awards & Recognitions

Our Member Retention Active Member Retention Rate

94.5%

New Physician Retention

90.3%

*AAFP 2022 Active Retention Rate: 92.3%

*AAFP 2022 NP Retention Rate: 85.1%

Program Co-Chairs: Victoria Boggiano, MD, MPH and Lisa Cassidy-Vu, MD 6 Live AAFP Prescribed Credits 66 CME Attendees

Shannon Dowler, MD, FAAFP, CPE Chief Medical Officer at NC Medicaid The 2022 Distinguished Family Physician Award Recognized for her years of North Carolina medical practice, health care leadership through state positions, and a lifelong commitment to caring for underserved communities, Dr. Shannon Dowler has built her career of service through tireless care and advocacy. She received the 2022 Distinguished Family Physician Award during the 2022 Winter Family Physicians Weekend.

Dr. Shannon Dowler and Dr. Dimitrios Hondros

1,052

The North Carolina Academy of Family Physicians Foundation Total CME Attendees

2022 Virtual Summer Symposium with Pre-Conference KSA Opportunity Program Chair: Thomas R. White, MD 14 Live AAFP Prescribed Credits 144 CME Attendees 2022 Winter Family Physicians Weekend with Pre-Conference KSA Opportunity Program Chair: Deanna Didiano, DO Program Vice Chair: Tamieka Howell, MD 32.75 Live AAFP Prescribed Credits 709 CME Attendees

North Carolina FAMPAC This Family Medicine PAC ensures that North Carolina family physicians have a persistent and trustworthy voice in the state legislature. By supporting NCAFP advocacy, FAMPAC impacts both health policy at the state level and the overall practice environments of our members. Tactically, this impact comes through political fundraising and campaigning. Pragmatic and nonpartisan results at the legislature begin well before its sessions start, and so the NC FAMPAC prepares the way of the most effective lawmakers. In 2022:

Candidates received direct NC FAMPAC support

96% 50+

of supported candidates were elected

Individuals donated at least once

Medical students are the future of Family Medicine in North Carolina. The NCAFP Foundation promotes interest in the specialty by working closely with each medical school’s Family Medicine Department on program delivery and funding to introduce students to the many benefits a career in Family Medicine provides. Through the Foundation’s interest programs, medical students can take advantage of opportunities to learn about the scope of Family Medicine, the lifestyle of a family physician, and the community of patients they serve through hands-on learning experiences. In 2022, the Foundation sponsored student attendance at several state and national conferences as well as the opportunity to present student and resident research during the Annual Research Poster Presentation at the NCAFP Winter Meeting. The Foundation awarded $15,000 in scholarships, and students were 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. Approximately 75 students participated in Family Medicine Day, gaining hands-on clinical skills from workshops hosted by 15 of our NC Family Medicine Residency Programs. Summer programs also resumed – 13 students participated in either the Western NC Rural Immersion Program or in a four-week externship and gained firsthand knowledge from Academy Members across the state. The Foundation also took steps to embark upon a multi-year Capital Campaign to grow the Medical Student Endowment in order to better sustain its activities. We look forward to sharing more information about how NCAFP members can get involved and contribute in the coming months! 2021-22 LEADERSHIP President Vice President Secretary/Treasurer Academy President Academy President-Elect Executive Vice President Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Corporate Trustee Corporate Trustee Resident Trustee Resident Trustee Student Trustee Student Trustee

Maureen E. Murphy, MD Eugenie M. Komives, MD Rhett L. Brown, MD Dimitrios Hondros, MD Shauna Guthrie, MD, MPH Greg Griggs, MPA, CAE Christopher P. Danford, MD Vickie A. Fowler, MD Michael J. Harris, MD Amy E. Marietta, MD, MPH Kyle Melvin, MD Susan A. Schmidt, MD Holly L. Stegall, MD Patrick S. Williams, MD Steven Parker John Smith, MD Carley N. Borrelli, MD Caitlin S. Porter, DO Keri Lanier Collette A. O’Connor 21

2022 NCAFP 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 2022. Thank you for your continued support.

Kira Alatar, MD

Mary Hall, MD

Steve North, MD, MPH

Daniel Allen, MD

Shawn Hamm, DO

Tambetta Ojong, MD

Christina Anderson, MD

William Handy, MD

Shawn Parker, JD, MPA

Hannah Anderson, DO

Revella Harmon, MD

Steve Parker

Phillip Austin, MD

Scott Harper, MD

Ryan Paulus, DO

David Baker, MD

William Hedrick, MD

Timothy Plaut, MD

William Belcher, MD

Lori Heim, MD

Tanya Pratt, MD

Mary Bengtson, MD

Mark Hester, MD

Joseph Pye, MD

Mary-Emma Beres, MD

Dimitrios Hondros, MD

Demetria Rawlinson, MD

Holly Biola, MD

Tamieka Howell, MD

Charles Rhodes, MD

Dalia Brahmi MD, MPH

Latonja Ivery, MD

Cecile Robes, DO

Regina Bray Brown, MD

William Johanson, MD

Carson Rounds, MD

David Brendle, DO

Nichole Johnson, MD

John Rowe, MD

Rhett Brown, MD

Jason Jones, MD

Raleigh Rumley, DO

Morgan Carnes, MD

Michelle Jones, MD

George Saunders, MD

Joshua Carpenter, MD

Michelle Keating, DO

Carl Shealy, MD

Jewell Carr, MD

Susan Keen, MD

Nadine Skinner, MD

Lisa Cassidy-Vu, MD

William Kelly, MD

Colin Smith, MD

Anh Causey, MD

Eugenie Komives, MD

Hannah Smith, MD

Dawn Caviness, MD

Krista Kozacki, MD

John Smith, MD

Stefani Connel, MD

Aaron Lambert, MD

Mackenzie Smith, MD

Gary Curran, MD

Jona Lamphier, DO

Neil Sparks, DO

Samuel Dail, MD

Kelley Lawrence, MD

Barbara Stagg, MD

Christopher Danford, MD

Katherine Lee, MD

Holly Stegall, MD

Wiley Davis, MD

Richard Lord, MD

Erika Steinbacher, MD

Andrea DeSantis, DO

Shelly Lowery, MD

Beat Steiner, MD

Deanna Didiano, DO

Donald Maharty, MD

Christopher Street, MD

Nancy Distefano, DO

John Mangum, MD

Paul Sykes, MD

Allen Dobson, MD

Steven Manning, MD

Netra Thakur, MD

Matthew Drake, MD

J. Paul Martin, MD

Rachel Thomas, MD

Kawanta Durham, MD

Alfred May, MD

James Thompson, MD

Ken Edel, MD

Brian McCollough, MD

Elizabeth Trout, MD

Fernando Escabi-Mendez, MD

Carolyn McCormick, MD

Ying Vang, MD

Allison Evanoff, MD

Mark McNeill, MD

Scott Vogler, MD

Conrad Flick, MD

Ken Melton

Eugene H. Wade, MD

Vickie Fowler, MD

Morton Meltzer, MD

Robin Wallace, MD

Joanne Fruth, MD

J. Lloyd Michener, MD

Adam Wenzlik, MD

Angelo Garbarino, MD

Benjamin Missick, MD

Robert Wergin, MD

Deepak Gelot, MD

George Moore, MD

Thomas White, MD

Anne Gonzalez, MD

Jennifer Mullendore, MD, MSPH

Gustav Wilde, MD

Donald Goodman, MD

Maureen Murphy, MD

Ashley Williams, MD

Shauna Guthrie, MD, MPH

Alisa Nance, MD

Patrick Williams, MD

Katherine Haga, DO

Sara Neal, MD

Kerry Willis, MD

David Hall, MD

J. Thomas Newton, MD

Courtland Winborne, MD

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Avoiding Patient Termination with an Effective Service Recovery Strategy

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(Please note, the following suggestions are not intended to address a hostile and threatening patient or family member.) For frustrated providers trying to cope with a problematic patient, implementing the discharge process is often the first solution that comes to mind. In reality, terminating a patient should be a last-resort solution. In these situations, there were likely preceding signs that things were not going well with the doctor-patient relationship. But what can be done to preserve the doctorpatient relationship, and, more importantly, to prevent this issue from happening at all? Service Recovery: The Key to Preserving Patients Customer service is not the same as service recovery. Good customer service typically means that the practice is meeting the minimal standards of patient expectations. However, service recovery can be thought of as an intentional investment in your practice’s mission and training, designed to yield elevated patient loyalty as the result of prompt, effective resolutions for patient complaints. Service recovery garners the opportunity to demonstrate to the patient how important they are to you and your practice. Building an effective service recovery program begins with a commitment to preserving the doctorpatient relationship, rather than believing patients are expendable. Buy-in from the physicians, establishment of standard operating procedures, staff training, and identification of service recovery talents within the practice are all components that will help create a successful service recovery program. When you hear those powerwalking moves of the frustrated provider coming your way, take a deep breath and listen intently. Then consider these potential contributing factors: • • • • • •

Is there a breakdown in communication? Has there been a failure in service recovery? If the issue is non-compliance with the prescribed medical treatment, why is the patient non-compliant? Are there social determinants of health (SDOH) that are contributing to the non-compliance, and can those barriers be conquered? Is there a health equity issue here between the care team and the patient? Is the patient’s behavior the problem? If so, is there another member of the family who you can appeal to? Have the problems, expected behavior, and potential consequences been effectively communicated to the patient? Clearly stating these concerns to the patient in a letter from the physician, prior to a termination letter, can often be effective to modify the undesirable behavior.

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800-662-7917 | curi.com

nity Engagement to Improve Health Equity in Cardiovascular Disease,” published in Family Practice Management. Dr. Forrest’s practice in Apex, NC, received a grant from the AAFP to improve health care disparities and equity in cardiovascular disease over the last two years, one clinic of three measured in the report. “I spoke at FMX about this topic and am now leading a national effort through peer-to-peer mentoring at primary care clinics,” Dr. Forrest said. The AAFP began the two-year project in March 2021 to address cardiovascular disparities in African American communities, especially focused on atrial fibrillation. Through clinic-community partnership models, family physicians and their teams at the three participating locations learned their communities’ needs from partners and fostered new ideas to reduce equity gaps in cardiovascular health. Based on the three instances of clinic-community partnerships, the study lists a few recommendations clinics can use to improve health equity: forming community partnerships to link your patients with health resources, offering health

NCAFP Member Dr. Blake Fagan Visited the White House to Celebrate Expanded Opioid Treatments By Kevin LaTorre NCAFP Communications and Membership Manager On Jan. 24, Blake Fagan, MD, attended the bipartisan “White House Removing Barriers to Treatment” event which celebrated the Mainstreaming Addiction Treatment (MAT) Act signed by President Biden in December 2022.

information through different media (paper packets, digital links, text messages, and more) to improve all patients’ access and understanding, leading clinics with goals that commit to building sustainable relationships with the community, and other steps based on the study’s findings.

President Biden Names Dr. Viviana Martinez-Bianchi to Federal Health Council In late March, the White House announced the members of President Biden’s Council on Sports, Nutrition, and Fitness. NCAFP member Viviana Martinez-Bianchi, MD, FAAFP, was named to the council for her work with North Carolina’s Latino community throughout COVID-19. If you remember, Dr. Martinez-Bianchi serves as Director of Health Equity at Duke’s

Dr. Fagan leads the office-based opioid treatment services at MAHEC family centers and received his invite on behalf of MAHEC, after his decade of working for rural patients in this crucial care. The MAHEC statement called his treatment “important work in addressing the nation’s opioid crisis” which “resulted in the invitation to the White House event.” The event also hosted leaders of the national response to the opioid crisis, including Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy, Anne Milgram, Administrator of the Drug Enforcement Administration, and Dr. Miriam Delphin-Rittmon, Assistant Secretary for Mental Health and Substance Use at the U.S. Dept. of Health and Human Services.

This new law expands access to the anti-opioid medication buprenorphine by removing the X-Waiver Program and other administrative steps required to prescribe it. Without these barriers, doctors can prescribe buprenorphine with only the standard controlled-substance license required for most other medicines. “The “At a time when our nation has exMAT Act makes it easier for patients with OpiDr. Blake Fagan and Dr. Rahul Gupta perienced 107,000 drug overdoses oid Use Disorder to receive lifesaving medicaand poisonings in just one year’s tion-assisted treatment from their healthcare time, this change could not have come sooner,” said Dr. providers,” said a Mountain Area Health Education CenGupta during the event, according to Fierce Healthcare. ter (MAHEC) representative in a statement.

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Dept. of Family Medicine and Community Health and in 2021 received the NCAFP Physician of the Year Award. “I am honored, humbled, and thankful for the opportunity to serve in this role,” she said. The Council on Sports, Nutrition, and Fitness exists to promote healthy, accessible eating and exercise for all Americans without regard for their resources or background, according to the White House’s statement. Its mission suits Dr. Martinez-Bianchi well, given her role as Director of Health Equity at Duke’s Dept. of Family Medicine and Community Health, her role as co-founder of the LATIN-19 group, and her experience as the Latinx Health advisor at the NC Dept. of Health and Human Services (NCDHHS) during the state’s pandemic response. Two others with strong North Carolina ties were also named to the Council: Salisbury-based Food Lion President Meg Ham and NBA star (and Davidson grad) Stephen Curry. Congrats to Dr. Martinez-Bianchi for this

Dr. S. Mark McNeill, Secretary-Treasurer at the NCAFP, commended Dr. Fagan and the work he’s done with MAHEC: “The event is to celebrate the bipartisan effort to remove bureaucratic barriers to prescribing buprenorphine,” he said. The January White House invite came from Dr. Fagan’s 25 years in Family Medicine. Dr. Fagan matched into the MAHEC Family Medicine residency in Asheville after medical school, where he’s been ever since. “I came here for the mission and the colleagues,” Dr. Fagan said. “We’re here to take care of everyone in western North Carolina, including the poor and marginalized, and then to train the next generation of learners to do the same thing. The reason I stayed on as faculty is that the people here really believe in that mission.” He became the chair of the center’s Family Medicine department in January 2022, where he oversees focused care for the underserved rural populations most at risk of opioid addiction. Dr. Fagan felt he had to begin his work prescribing buprenorphine to treat opioid addiction after losing a patient to an overdose in 2013. “I had delivered two of her kids,” he said. “That loss really changed my life as a physician.” He researched treatments for opioid addiction and soon learned

Spring 2023

prestigious appointment!

Dr. Christine Kistler Informed The Washington Post About Elder Care In early April, Dr. Christine Kistler, MD, MASc, spoke with reporter Marlene Cimons at The Washington Post to inform her article, “Why are falls so serious in older people?” “For the elderly, a fall is a life-changing and potentially life-ending event,” Dr. Kistler said in the piece. She explained that the older your body gets, the “more serious” a noninjury like a fall becomes, and she even adds that (however much we love them) pets can be “cute little trip hazards” for older pet owners. We love to see Dr. Kistler sharing her insights into wiser patient care with a wider public. Family physicians treat every stage of the patient’s life span, and Dr. Kistler showcased exactly that for The Washington Post!

about buprenorphine as a long-term treatment. Then, he brought his findings to his administration to propose that the center start prescribing it for opioid addiction treatment. “It took about two years,” Dr. Fagan said, “but we started writing it and training our residents for it. Now, opioid addiction treatment is part of our chronic disease management. All of our faculty and residents are trained for it.” MAHEC Asheville now treats about 500 patients using the medication, compared to only five when the treatments began. Dr. Fagan explained that the success wasn’t just numerical: “We’ve seen people get jobs, go back to college, graduate from college, and regain custody of their children from foster care because they’ve restabilized their lives on buprenorphine. We’ve seen great successes for our patients but also for their families. Frankly, I think these are big wins for society as well.” A version of this article appeared online in January 2023 as “NCAFP Member Dr. Blake Fagan Visits White House to Celebrate Expanded Opioid Treatments.”

PROFESSIONAL DEVELOPMENT By Kathryn Atkinson, CMP NCAFP Director of CME & Events

2023 VIRTUAL SUMMER SYMPOSIUM

The Topics are Hot, and the Speakers are Family Medicine Experts Your NCAFP is super excited to offer a cool and convenient summertime CME opportunity this June! Designed with flexibility in mind, the virtual webcast is sure to fit your busy schedule, allowing you to join in from anywhere. This year’s Virtual Summer Symposium, scheduled for Saturday, June 24, 2023, from 7:30 a.m. to 3:00 p.m., enables you to earn approximately six prescribed credits from wherever you are this summer. Program chair Dr. Jessica Triche and program vicechair Dr. Dawn Caviness have teamed up and developed a slate of important CME presentations filled with strategies for optimizing patient care. Count on updates on the latest guidelines for managing chronic conditions and the common issues you see and treat most often. The interactive schedule will include 30-, 45-, and 60-minute updates on timely relevant topics, including OUD/SUD, asthma, common MSK problems, pediatric autism, ASCVD prevention, hospice care, obesity, and dementia. There is also a critical session centered on selfcare for busy physicians that you will want to attend. And those interested in a Behavioral Health KSA can join in on Friday, June 23, 2023, for a pre-conference KSA that evening from 5:30 p.m. to 8:30 p.m. Plan to fulfill your ABFM requirements and pick up an extra eight CME credits by participating in the workshop.

The topics are hot, and the speakers are Family Medicine experts. This year’s guest faculty lineup includes a range of experts with unique knowledge and experience. You’ll learn from the best and gain valuable insights that will help you enhance your patient outcomes. Carefully chosen by your program chairs, each of the presenters listed below is ready to share their wealth of knowledge and experiences with you, making this webcast an absolute must-attend event. We’re sure you’ll recognize many of your mainstage favorites on deck for the program: Stephen Brunton, MD Maggie Clifton, DO Nathan Copeland, MD, MPH Kawanta Durham, MD Blake Fagan, MD Karl “Bert” Fields, MD, CAQSM, FAMSSM Jonathan Firnhaber, MD Cheryl Masters, PhD Erika Steinbacher, MD Thomas White, MD Jennifer Woodard, MD The interactive webcast will include live Q&A sessions with our guest faculty and “Meet the Expert” Zoom Room opportunities. At the end of each session, participants can connect one-on-one with the speakers to dive deeper into the topics and gain insight into specific questions. Plan to spend your day with us on Saturday, June 24, 2023, as you expand your clinical knowledge and stay up to date with practical and valuable information that you will begin using immediately. Registration fees are $160 for members, $75 for resident members, $60 for life members, $25 for medical student members, and $225 for non-members. Review the complete schedule, session learning objectives, and guest speaker bios, and submit your online registration at www.ncafp.com/summercme. Please contact Kathryn Atkinson, CMP, Director of CME and Events with any questions at Katkinson@ncafp.com. We look forward to learning with you in June!

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2023 WINTER FAMILY PHYSICIANS WEEKEND

Get Ready to Celebrate and Honor the Specialty of Family Medicine This December! By Kathryn Atkinson, CMP NCAFP Director of CME & Events

Make plans to be in Asheville from Nov. 30 through Dec. 3, 2023, when your NCAFP marks its 75th Anniversary! From start to finish, we will celebrate and honor the specialty of Family Medicine (and you!) during the 2023 Winter Family Physicians Weekend. Hosted at the Omni Grove Park Inn among its beautiful Blue Ridge Mountain setting, this highly anticipated conference will be rewarding and fun for everyone. The annual celebration of Family Medicine is the best opportunity to learn from experts in the field, network with peers, and earn valuable CME credits. Program chair Dr. Tamieka Howell and program vice-chair Dr. Thomas White will keep you engaged and connected all weekend with updates on timely clinical topics you see and treat most often. Expect to enjoy a wide range of sessions on new treatment options, patient care, physician wellbeing, and technology, all brought to

you by the best and brightest experts in primary care. We are certain that you will leave with new knowledge and many helpful resources you can begin using right away for your practice and patients. Don’t worry — it won’t be all work and no play! This annual conference also promises plenty of surprises (and lots of fun!) to commemorate our diamond jubilee. Don’t miss out on this opportunity to celebrate and learn with colleagues and friends. Watch your email and the conference page at www.ncafp.com/wfpw for more details and links for online registration opening this summer! We can’t wait to celebrate this milestone anniversary with you! Please contact Kathryn Atkinson, CMP, Director of CME & Events, at Katkinson@ncafp.com with any questions.

Watch your email and the conference page at www.ncafp.com/wfpw for more details and links for online registration opening this summer!

Spring 2023

RESIDENTS & NEW PHYSICIANS By Dr. Corinna Myers

LEADERSHIP & ADVOCACY

Want to Better Serve Your Patients? Build Your Legislative Relationships As family physicians, we advocate for our patients as the leader of the care team and coordinate the delivery of the treatment plan to provide quality care. We spend our days seeing patients, signing notes, completing administrative tasks, and answering portal messages. We are left with little time at the end of the day to do things outside the world of medicine, yet we find ourselves seeking a higher purpose and wanting to leave this world in a better place than how we found it. For me, that higher purpose has become advocating for my patients outside of the exam room and creating relationships with my local and state legislators who ultimately affect the way I am able to deliver care to my patients and my community. As a third-year resident at Cabarrus Family Medicine Residency Program, I was (graciously) allowed to create a twoweek elective to work with the NCAFP and our Executive Vice President, Greg Griggs. Through this elective, I came to better understand what the Academy does to promote Family Medicine and primary care. I was also afforded the opportunity to meet several key players in North Carolina health care and policy. Most notably, I met with Sen. Jim Burgin to discuss the importance of investing in Primary Care and supporting scholarships for healthcare professionals. I received invaluable advice from Rep. Kristin Baker and Rep. Tim Reeder, who are both physicians serving in the General Assembly. I also met legislators from my district, Sen. Rachel Hunt and Rep. Laura Budd, to discuss issues such as scope of practice and reproductive health. After these opportunities, I genuinely feel that my voice is valued for issues pertinent to Family Medicine.

Dr. Myers (center) with Rep. Kristin Baker and Rep. Tim Reeder

Dr. Myers with Rep. Jim Burgin

What You Can Do To my fellow NCAFP members: I encourage you to find the time in your busy schedules to be an advocate outside of the exam room, too. This can be as simple as showing up to the voting polls on Election Day. If you have patients who are frustrated by not being able to afford their medications, encourage them to write to their legislators. Politics has a significant effect on how we can provide care, and so we have an obligation to share our perspectives. If you have an interest in health care policy, my advice to you is to start building a relationship. Look up your local legislators using the North Carolina legislative website (www.ncleg.gov) and introduce yourself as their constituent. They want to get to know you and are very open to hearing from you. No matter your political affiliation,

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ADVISORY CAPITAL INSURANCE

Can understanding deliver outstanding? Our solutions are driven by a deep understanding of you. By actively listening and proactively creating tailored solutions, our advice is grounded in your priorities and elevated in your

Dr. Myers with Sen. Rachel Hunt

outcomes so you can do more and achieve more—in medicine, business, and life. Find valued advice at curi.com

Dr. Myers with Rep. Tim Reeder

you can always find common ground to build upon. As to what else you might tell them, I cannot express how valuable a simple thank-you is when they support something you are passionate about. If you are interested in finding ways to get involved, reach out to Greg directly (at ggriggs@ ncafp.com). I hope that you find advocacy as rewarding as I do.

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

ADVERTISE! Meet the whole office of Family Medicine professionals, all across North Carolina!

Spring 2023

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

STUDENT INTEREST & INITIATIVES

medical students in Summer 2023!

By Perry Price Workforce Initiatives Manager

The NCAFP 2023 Summer Programs Attendees Summer opportunities are an important opportunity to introduce medical students to Family Medicine, and we are very excited to have three different offerings for

Fourteen students from medical schools across North Carolina will be participating in either the Western NC Rural Health Immersion Experience, the Concord, NC Health Immersion Experience, or a 4-Week Externship, learning from some of NC’s best family physicians. These experiences are designed to give students a chance to better understand what a career in Family Medicine can be, all outside their academic settings! We are grateful to our partners at MAHEC Hendersonville Family Medicine Residency and Atrium Cabarrus Family Medicine Residency, as well as the many NCAFP member physicians who make these programs possible.

OUR SUMMER 2023 COHORT

Mark Bushhouse Campbell University School of Osteopathic Medicine

David Lehrburger Campbell University School of Osteopathic Medicine

Paul Scott Campbell University School of Osteopathic Medicine

Tsaiwei Cheng Brody School of Medicine

Morgan Maner Brody School of Medicine

Alexandra Sobisch Campbell University School of Osteopathic Medicine

Emma Fullett Campbell University School of Osteopathic Medicine

Shaitia Martin UNC School of Medicine

Ryan Taylor Campbell University School of Osteopathic Medicine

Zoe Greene Brody School of Medicine

David Murray Brody School of Medicine

Warren Wolfe Wake Forest University School of Medicine

Sara Jacob UNC School of Medicine

Kelsey Rich UNC School of Medicine

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FAMILY MEDICINE ON CAMPUS

Seeing My Value as a Medical Student: Completing the NCAFP Health Care Leadership and Policy Elective By Sheryl Fuehrer Medical Student at the UNC School of Medicine Class of 2023

It seems to be a common experience among my fellow medical students to feel awkward and out of place on a medical team. What doesn’t feel normal as a medical student is when your presence in a group setting piques everyone’s interest. This was the unexpected part of my experience standing with our state’s elected officials during my NCAFP health care leadership and policy elective.

WHAT IS THE NCAFP HEALTHCARE LEADERSHIP AND POLICY ELECTIVE? The NCAFP leadership and staff provide this elective for fourth-year medical students who are pursuing a career in Family Medicine. This is a monthlong experience which exposes students to organized medicine. If you’re like I was five months ago and unsure of what “organized medicine” really means, it refers to the result of physicians joining an organization to advocate for themselves and for their patients, alongside a network of passionate advocates who are not necessarily medically trained. These organizations include national societies like the American Academy of Family Physicians, the American Congress of Gynecologists and Obstetricians, and the American Academy of Pediatrics (AAP), but also local chapters like the North Carolina Medical Society and the NCAFP. While these societies provide timely information regarding current events in medicine and patient care education, they most notably represent the physician community during legislative sessions to ensure that physicians’ voices are heard before bills impacting patient care, scope of practice, and other medical concerns become laws. In this elective, students gain exposure to the work NCAFP is doing behind the scenes to support our state’s family physicians and their patients. These include exposure to various healthcare policy change initiatives underway in North Carolina and insight into legislative events that directly affect physicians.

WHO SHOULD TAKE THIS ELECTIVE?

of the major role politics plays in shaping health care for patients and providers alike. This experience level is acceptable, along with higher levels. However, a strong desire to glean the role physicians can play in healthcare policy and to understand those nuances is baseline. Other reasons to pursue this elective are to better understand the impact of healthcare policy issues on a state level and to better understand the process of making policy decisions. During this elective, NCAFP Executive Vice President Greg Griggs and other leaders help identify your clinical interests as they relate to policy. Specifically, the NCAFP coordinates one-to-one meetings and conversations with various community leaders and advocates, notably physicians who fill a leadership role in your area of interest. To capitalize on this opportunity, I would encourage the interested student to reflect on their advocacy interests beforehand. The more precisely you pinpoint topics important to you, the more prepared you will be in structuring your elective time, as well as engaging in conversations with the state’s advocates and elected officials, with whom you will likely be interacting with.

MY TAKEAWAYS I had a great time. You can consider me the newest, smiling member of the NCAFP fan-club. It was energizing to be surrounded by others who share my passion for primary care. My month exposed me to the multiple directions I can take as a future physician with respect to advocating for my patients, such as becoming an NCAFP board member, working for the state health department, or even running for office. I can now see the benefit and means of forming relationships with my county and state elected officials. Back to my comment about feeling valuable as a medical student: I did not anticipate the sheer interest, dare I say excitement, that elected officials demonstrated when in the presence of a medical student. That’s why I urge all medical students to use their position to voice their professional concerns because your voice matters to the legislators! And last but not least, vote!!

I pursued this elective because of my interest in healthcare policy. My interest consisted of essentially no real experience with health policy, and instead was a general awareness

Spring 2023

PRACTICE MANAGEMENT By Shawn Parker General Counsel and Chief of Staff

What Would the Proposed Rule to Ban Noncompete Clauses Mean for Physicians?

On Jan. 5, 2023, in response to President Biden’s “Executive Order on Promoting Competition in the American Economy,” the Federal Trade Commission (FTC) announced its proposed rule that — among other things — would prohibit the use of noncompete clauses in agreements by employers with their employees, independent contractors, or volunteers. The proposed “Noncompete Clause Rule” would not only prohibit an employer from entering into, or attempting to enter into, new noncompete agreements, but it also includes retrospective enforcement by prohibiting an employer from maintaining existing noncompete agreements. The proposed rule, if enacted, will impact countless physicians and their patients by protecting the physician-patient relationship regardless of where a physician practices. As the health care landscape has rapidly shifted towards an employed model, noncompete agreements are much more prevalent and restrictive, which can threaten to disrupt patient access, limit physicians’ ability to choose their employer, or practice in their chosen communities. For these reasons, the AAFP and NCAFP have historically opposed restrictive covenants in physician agreements and support the proposed rule with some suggested modifications. However, as included in our comments to the FTC, the current proposed rule would not apply to certain nonprofit organizations such as hospitals (which are major employers of physicians) and does not cover all restrictive covenants.

The FTC is tasked with protecting consumers from unfair and deceptive business practices and enforcing antitrust laws. The FTC’s authority (and limitations) to enact and enforce rules come from the Federal Trade Commission Act. While the FTC Act empowers the FTC “to prevent persons, partnerships, or corporations” from using unfair methods of competition (which, under the proposed rule, include noncompete clauses), it expressly excludes certain industries and businesses from its purview. Further, the FTC Act only applies to corporations “organized to carry on business for its own profit or that of its members.” Therefore, true nonprofit corporations are not subject to the FTC’s regulatory authority. That said, what constitutes a true nonprofit corporation for purposes of FTC regulation is somewhat unsettled. To date, the FTC has only confirmed that the exemption for nonprofits applies to the regulation, but it has not elaborated on how it may view the parameters of the exception. Secondarily, the new rule would not expressly prohibit all restrictive covenants but would rather limit the use of noncompete clauses. As the FTC noted in its summary of the rule, the definition of noncompete clause would generally not include other types of restrictive employment covenants — such as non-disclosure agreements (“NDAs”) and client or customer non-solicitation agreements — because these covenants generally do not prevent a worker from seeking or accepting employment with a person or operating a business after the conclusion of the worker’s employment with the employer. Many physician employment agreements include non-solicitation language that limits the physician from contacting or having additional communication with a patient who received treatment from the physician or any other physician at the practice. While non-solicitation language may not be covered by the rule, it would be exceedingly difficult for a physician to maintain continuity of care which could deter a physician from taking another job, certainly minimizing one of the benefits of the new rule. Additionally, a number of physician employment agreements include forfeitures/repayments of sign-on bonus, student loan reimbursements, and other recruitment incentives. These could also make changing

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jobs costly or otherwise problematic. The FTC will use a functional test to determine whether a contractual term is a “de facto” noncompete clause for circumstances like this, but unless it is expressly prohibited in the rule, resolution of these issues will be on a caseby-case basis and could require cumbersome litigation. Your NCAFP, in its written comment, encouraged the FTC to expand the definition of a “de facto” noncompete clause to expressly prohibit contractual terms that, by their nature, undermine the flexibility and mobility of the employee. The comment period for the proposed rule closed in April, and the FTC will now review the comments and may amend the rule before finalizing. The law will go into effect 180 days after the publication of the final rule. The rule will preempt any inconsistent state law, regulation, order, or interpretation, unless such law, regulation, order, or interpretation affords the worker greater protection. This is the first time that the FTC has promulgated a rule proscribing an unfair method of competition in many decades, and whether the FTC still has the authority to issue such rules is a matter of intense debate. We fully expect the final rule will be challenged in court regardless of its final form.

CONTRIBUTIONS By Clark Gaither, MD, FAAFP, MRO NCPHP Medical Director

PHYSICIAN WELLNESS

NCPHP: A Resource for North Carolina Physicians The North Carolina Professionals Health Program (NCPHP) has been continuously serving healthcare providers in North Carolina for nearly 35 years. Created in 1988 by the cooperative efforts of the North Carolina Medical Society and the North Carolina Medical Board (NCMB), NCPHP assists struggling physicians, physician assistants, and other medical providers with substance use disorders, mental health issues, job-related burnout, or communication issues. NCPHP has a dual mission — to assist in protecting the public while simultaneously assisting the provider with whatever issues they may be facing personally or before their respective medical boards. NCPHP believes that by assisting the physician we also protect the public. Healthy doctors make for healthy patients. Structurally, NCPHP is a 501(c)(3) nonprofit and operates independently from the Boards with which we work. Our program is open to MDs, DOs, PAs, pharmacists, registered pharmacy technicians, DVMs, and registered veterinary technicians in North Carolina. Generally, providers come to us in two ways: as an anonymous self-referral or as a direct referral from the NCMB, North Carolina Board of Pharmacy (NCBOP), or North Carolina Veterinary Medical Board (NCVMB). Many of our anonymous referrals come from employers, colleagues, family members, medical staff, attorneys, residency training programs, and others. Initially named the North Carolina Physicians Health Program, NCPHP began working with the NCVMB to help veterinarians and veterinary technicians in 2005. In 2016, NCPHP engaged with the North Carolina Board of Pharmacy (NCBOP) to assist pharmacists and pharmacy technicians, and as a result, we changed to the North Carolina Professionals Health Program. Since 1988, we have served over 5,000 34

healthcare providers from all across North Carolina. Almost every hospital, hospital system, or provider group in this state has had providers participate in our program. Traditionally, about half of NCPHP’s referrals come from hospitals, colleagues, medical practices, friends and family, or even the provider themselves. The rest come from the licensure boards. Self-referrals are well received and highly recommended, as preemptively seeking assistance demonstrates a willingness to address a potential issue before patient care is affected. If you are considering self-referral, you may want to complete a self-assessment questionnaire. Licensees of the NCMB can find more information about professional obligations pertaining to incompetence, impairment and unethical conduct, by referring to the NCMB’s position statement. In addition, NCMB licensees can check “NO” to the question pertaining to a past history of excessive use of alcohol or substance abuse, or treatment of substance use disorders and mental health issues “if you are working with NCPHP.” This “out” for non-disclosure was placed in the application because the NCMB did not wish the question to pose a barrier to providers seeking help. Any individual may contact NCPHP to voice such concerns and to make a referral. Anonymous referrals are accepted, and referrals to our program can be made without fear of repercussion. NCPHP also assists providers with professional job-related burnout (JRB). The hallmarks of which are emotional exhaustion, cynicism, and a lack of a sense of personal accomplishment. Health care worker burnout rates were very high and climbing prior to the pandemic. The pandemic only served to amplify these hallmarks and intensify the underlying drivers of burnout (work overload, lack of control, insufficient reward, breakdown of community, absence of fairness, and conflicting values). This was very problematic for providers. While the damage from stress is primarily physical, the damage from burnout is primarily emotional. When providers burn out, they will sometimes act out with alcohol/drugs, or develop a mental health issue such as chronic anxiety, major depression or, in the worst case, suicidality. For these reasons, NCPHP believes job-related burnout should be addressed with The North Carolina Family Physician

the same urgency and intensity as any other serious health related issue. NCPHP has a well-trained staff with over 130 years of combined recovery experience. We can relate to what providers go through when facing a substance use disorder or other health-related challenges. We offer compassionate, empathetic, confidential, individualized care to the providers we serve. Our track record of success speaks for itself. For participants who have substance use disorders and receive treatment with follow-up monitoring for additional support, the sobriety rate at five years is between 74% and 88%. This is almost an order of magnitude better than results from the general public. Even when relapses are included, the return-to-work rate for properly treated and supported providers exceeds 96% overall. Please visit our website, NCPHP.org, to read testimonials from some past participants. At NCPHP, we see lives transformed every week. The transformations we have the privilege to witness are nothing short of miraculous. Unshackled from their substance use or other troubling issues, providers get their lives back and often explode with energy, creativity, innovation, and a renewed since of purpose. We have helped save careers, licenses, marriages, jobs, reputations, and most

importantly, lives. This is why we do what we do. If you are a provider and you do not develop an issue with drugs, alcohol, other self-destructive behaviors, or a serious mental health issue, sooner or later you will encounter a colleague who has. Addiction rates amongst healthcare providers (12- 14%) are higher than in the general population by 1-2 %. It is important to know what your responsibility is when you encounter a provider who is struggling and may pose a risk to themselves or patients. It is the position of the AMA, the NCMB, and the state of North Carolina (codified in state statute) that you have a duty to report. We hope the first call you make, or the troubled provider makes, is to NCPHP. A large portion of NCPHP’s mandate is education. That is the purpose of this article. If your institution or group would like a more in-depth presentation of who we are, what we do, and how NCPHP can help you, just call our office (919-870-4480) and schedule a talk. We will answer your questions and provide additional information upon request. There is no charge for this service. We are here to help and serve the healthcare providers of North Carolina. We hope the providers we serve will turn to us for help first whenever help is needed.

Comprehensive care for eating disorders in North Carolina

Multidisciplinary treatment for children, adolescents, and adults of all genders All levels of care: inpatient, residential, PHP/IOP, and outpatient Individual, group, and family therapy Medical and psychiatric services Telehealth and in-person options available

For more information or to make a referral, call 855-875-5812 or visit veritascollaborative.com