NC Family Physician - Fall 2022

Volume 18 Issue 4 • Autumn 2022

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

MOMS in Family Medicine Navigating a Fulfilling Career and Family: Part 1 P26

2023 NCAFP CME Opportunities Learn | Connect | Engage | Celebrate Celebrate your commitment of providing the best possible care to your patients with these fantastic learning opportunities.

2023 Family Medicine Academic Summit

Friday, February 17 – Saturday, February 18, 2023 Sheraton Imperial Hotel Raleigh Durham Approximately 5 credits

Networking Dinner with 30‐Minute Hot Topic Exchanges Charlotte

Thursday, March 30, 2023 Atrium Health Carolinas Medical Center Family Medicine Residency Approximately 1.5 credits

2023 Virtual Summer Symposium

Saturday, June 24, 2023 From your favorite location!

Approximately 6 credits

Networking Dinner with 30‐Minute Hot Topic Exchanges Chapel Hill

Tuesday, September 19, 2023 UNC Family Medicine Center Approximately 1.5 credits

2023 Winter Family Physicians Weekend

Thursday, November 30 – Sunday, December 3, 2023 Omni Grove Park Inn | Asheville, NC Approximately 30 credits

Watch your email and www.ncafp.com/cme for more information coming soon!

Inside Autumn 2022

The NCAFP Goes to Washington...for the 2022 AAFP Congress of Delegates P. 10

PRESIDENT’S MESSAGE

PROFESSIONAL DEVELOPMENT

4

18

Rediscovering Our Passions and Reasons for Choosing Family Medicine

Several Terrific Learning & Networking Events Slated for 2023

ADVOCACY

MEMERSHIP & MEMBER SERVICES

6

24

Advocacy Work Beyond the Legislature

Dr. Viviana Martinez-Bianchi Honored by Foundation for Health Leadership & Innovation

CHAPTER AFFAIRS

PRACTICE MANAGEMENT

10

30

The NCAFP Goes to Washington...for the 2022 AAFP Congress of Delegates

NC DHHS Delays Tailored Plans Implementation

DEPARTMENTS

PUBLISHED BY

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

fax

Meetings & Conferences 18 Membership 24 Student Programs & Initiatives 27 Practice Management 30

919.833.1801 • ncafp.com

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

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

PRESIDENT’S MESSAGE to Members

By Dr. Dimitrios 'Takie' Hondros 2021–2022 NCAFP President

PERSPECTIVES

Rediscovering Our Passions and Reasons for Choosing Family Medicine Over the last year or so, I’ve had the opportunity to precept and mentor a Campbell University medical student, Sofia Gkoulgkountina. As I thought about what to write in my last quarterly column as President of the NCAFP, her words from a statement she wrote stood out. As a result, I want to share some of her thoughts and how they relate to me as well.

WHAT ARE YOU PASSIONATE ABOUT AS IT RELATES TO FAMILY MEDICINE? Here’s what Sofia said: “Family Medicine is the heart of medicine. What draws me to this profession is the unique opportunity of physicians practicing the full scope of medicine, incorporating expertise from all subspecialties, and using that vast knowledge to provide holistic, integrated care…. I want to maintain a broad knowledgebase of medical science, strive to expand the scope of my practice to better serve my community, and build meaningful relationships with patients across generations.”

4

wanted the breadth. We wanted to do a bit of everything. We wanted to be our community’s pluripotent stem cell, morphing into what our individual patients and their communities need. We want the long-term relationships with our patients, so we truly know them and their families.

More from Sofia: “In a healthcare system that is becoming increasingly segmented, it is easy to overlook the big picture, which is treating the whole person. My passion for medicine and my motivation for pursuing a career in healthcare, stems from the philosophy of holistic, patient-centered care. I am passionate about Family Medicine because it encompasses proficiency of the full scale of medicine and unites it with the art of connecting with patients across generations and being a vigorous source of support in the community.”

And my thoughts: Family Medicine truly is the solution to a healthcare system that has become overly complicated and truly fragmented. We are the ones who will help our patients navigate the complexity. But as we get back to the roots of family medicine, providing more services under one roof, we will help improve quality and lower costs at the same time.

HOW ARE YOU DECIDING WHICH SPECIALTY IS RIGHT FOR YOU? From Sofia: “My own family’s FM physician in Charlotte is my role model and inspiration for pursuing Family Medicine.

His dedication to the profession, vast medical knowledge, and commitment to our community helped me see the magic in Family Medicine. I hope to emulate his dedication to his patients and the community.

And my thoughts:

And my thoughts:

Isn’t that why we all entered Family Medicine. We

The importance of role models in our profession is so

The North Carolina Family Physician

2021-2022

NCAFP Board of Directors

Executive Officers President

Dimitrios “Takie” P. Hondros, MD

President-Elect

Shauna Guthrie, MD, MPH

Secretary/Treasurer

Garett R. Franklin, MD

Immediate Past President Executive Vice President

Jessica L. Triche, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Jewell P. Carr, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Mark McNeill, MD Benjamin F. Simmons, MD

important. We must mentor the next generation of students. Some of that mentoring can occur well before someone gets in or maybe even thinks about medical school. How we are relating to our patients, especially those patients who may have an interest in healthcare and/or scientific careers, matter.

Margaret Helton, MD (UNC)

MY REASON FOR FAMILY MEDICINE:

Resident Director

Ying Vang, MD Courtland Winborne, MD

Academic Position

Ryan Paulus, DO (UNC)

From Sofia:

Resident Director-Elect Matthew Drake, MD (ECU)

“I immigrated from Greece when I was 14. During my rotation with Dr. Dimitrios Hondros, I reconnected with the Greek community and strengthened my love for Family Medicine. My past experiences revealed a common denominator that fueled my passion for medicine: forming strong relationships, understanding each person’s unique needs, and serving the community with compassion. While working alongside my mentor and connecting with patients, I felt my past experiences align revealing my calling, Family Medicine. I want to center my practice around the holistic treatment of patients and serve my community. I want to connect with patients and their families over generations and empower them to take charge of their health.”

My Thoughts:

Student Director Morgan Carnes (Wake Forest) Student Director-Elect Morgan Beamon (ECU)

AAFP Delegates & Alternates AAFP Delegate

Richard W. Lord, Jr., MD, MA

AAFP Delegate

Robert L. Rich, Jr., MD

AAFP Alternate

Tamieka Howell, MD

AAFP Alternate

Thomas R. White, MD

Again, isn’t this why we all went into Family Medicine. At times, we let the administrivia get in the way of our passion. At times, we focus on the negatives, and not the positive that our work with our patients bring to us on a daily basis. Rest assured that the NCAFP is working to minimize the negatives, but never forget the positives. Those positives are what will resonate with the next generation of family physicians.

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

Autumn 2022

5

www.ncafp.com

ADVOCACY

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

~ REPRESENTING FAMILY MEDICINE ~

Advocacy Work Beyond the Legislature Occasionally, I like to update our members on some of our non-traditional advocacy work, that I think can pay dividends that are bigger than even legislative advocacy. So, for this article, I’m highlighting some of our efforts that don’t always receive the most attention.

Workforce When it comes to increasing the workforce pipeline, collaboration is the name of the game. Our biggest collaborator of late has been Community Care of North Carolina. For example, CCNC has partnered with our Foundation to provide medical students and residents greater exposure to various practice settings within primary care. Through that effort, we have jointly developed a curriculum for residency programs, which can also be utilized with medical students and new physicians. Some of the modules that have been jointly developed include: Models of Care, Employment Contracts, Practice Structure, and more. We have already presented these to a few of our state's residency programs and as part of this year’s Family Medicine Day. We are also working together to increase teaching and mentoring of medical students.

In November, I have the privilege to represent your profession on a primary care workforce panel at the NC Institute of Medicine. I’ll be discussing a few policy levers that should be utilized to increase family

6

physicians, and other primary care providers, in rural areas, including economic incentives. Beyond the NC IOM, we continue to participate in the activities of the NC Center on the Workforce for Health. This Center is a joint project of the NC AHEC Program, the NC IOM and the Foundation for Health Leadership and Innovation. The multi-stakeholder group is looking at future workforce needs to help make a healthier North Carolina and is meeting quarterly to develop solutions.

We also meet quarterly with the President/CEO & Vice President of Government Affairs of the NC Healthcare Association. One of our key areas of discussion has been on workforce needs but has also ventured into the scope of employed physicians and more.

Practice Environment/Payor Relations As Medicaid Managed Care moves into its second year, we still remain very engaged with the NC Department of Health and Human Services, particularly with Deputy Secretary for Medicaid David Richard and Medicaid CMO Dr. Shannon Dowler. We continue to provide feedback on implementation and have turned our attention to concerns about when tailored plans ultimately go live. Some of the concerns we offered fed into the decision to delay Tailored Plan implementation from December 1, 2022, to April 1, 2023.

Speaking of Medicaid plans, we continue to meet monthly with representatives of Healthy Blue, quarterly with AmeriHealth Caritas, and on a regular basis with WellCare and United. Because of our relationships with them, we were recently able to help one practice get paid for claims that were denied because they were not timely filed, but the filing problem was related to a cyberattack. We continue to pass feedback we hear from you on to the plans as we work to reduce your administrative burden.

In the last few months, we have been involved with a NC Medical Society Task Force looking to relieve administrative burden and other payor issues. Specifically, many groups are working together through the Task Force to develop ideas and policy levers to reduce prior authorizations, network issues with payors and more.

The North Carolina Family Physician

We are very pleased to work with the Medical Society through this Task Force to address some of these issues.

These aren’t easy issues to resolve, but the power of many can make a big difference.

Other

Collaborative Care Model Moving Forward Statewide Earlier this Fall, representatives of the NCAFP (including NCAFP President Dr. Dimitrios Hondros, Board Member Dr. Mark McNeill and NCAFP EVP Greg Griggs), gathered with colleagues from the NC Psychiatric Association and the NC Pediatric Society, as well as representatives of NC Medicaid, the NC AHEC Program, Community Care of NC, and others to celebrate the completion of a planning effort to move the Collaborative Care Model (CoCM) forward in NC. This evidence-based model helps provide behavioral health services in primary care practices by using a consulting psychiatrist, a behavioral health care manager, and a family physician to partner to provide care for patients with co-existing behavioral health issues or substance abuse using a population health model.

Some of the outcomes of the planning phrase include contracting to provide the AIMS Registry for smaller practices in North Carolina (Community Care of NC is lead in this effort), developing a model contract for primary care practices and consulting psychiatrists (NCAFP and NC Psychiatric Association led this effort), developing a list of psychiatrists willing to consult in this model, and developing practice support materials and education that will be provided by the NC AHEC Program.

NC AHEC has developed a CoCM Training Series that describes the principles of Collaborative Care, identifies the key concepts and care roles for effective implementation, explains the use of and evidence for measurement-based care, and discusses the contributing factors to successful implementation. The series of 10 modules will be issued on a monthly basis. Module 1 is entitled Collaborative Care Model (CoCM) Rationale and Evidence. In addition to these learning opportunities, NC AHEC will provide coaching support to practices that accept Medicaid.

For more information about practice support, email practicesupport@ncahec.net

We also remain involved in numerous other organizations. Member of your NCAFP staff or NCAFP physician leaders participate in numerous public health working groups such as the NC Immunization Coalition, the Justus-Warren Heart Disease and Stroke Prevention Task Force, the NC Colorectal Cancer Roundtable, the NC Cancer Control and Coordination and Advisory Committee, Medicaid Advanced Medical Home Technical Advisory Group, and many others.

We also continue to give feedback on many issues. Most recently, we commented on a NC Medical Board proposed Position Statement on Employed Licensees, noting concerns with restrictive covenants, negotiating with large employers, and more.

Finally, we are at many tables. Remember, if you aren’t at the table, you may be on the menu. The NCAFP works to be at as many tables impacting your professional environment as possible. Recently we attended an event celebrating the 75th Anniversary of the Kate B. Reynolds Charitable Trust and the Foundation for Health Leadership and Innovation’s Bernstein Dinner. In both instances, we were able to network with health care policy leaders from throughout the state. continues on Back Cover

Autumn 2022

7

PRACTICE ADVOCACY

Blue Cross NC Updates Guidance on Coding for Vaccine Counseling and Separate Vaccine Administration and Counseling Codes Outreach by NCAFP and NC Pediatric Society Creates Action Some claims for vaccine counseling codes have recently been denied and even recouped from Blue Cross and Blue Shield of North Carolina. However, after NCAFP and the NC Pediatric Society expressed concerns about this issue, Blue Cross NC issued updated guidance and are helping practices correct the issue. They have also ceased recouping any unpaid claims.

PRACTICE & ADMINISTRATIVE ADVOCACY

The claims that were not paid or attempted to be recouped were done so because of coding edits from the National Correct Coding Initiative (CCI). CCI was created to prevent unbundling and the incorrect or inaccurate billing of a combination of codes. These are also called CCI edits. CMS identifies individual services that are components of a more inclusive service using the CCI edits.

One example of a Correct Coding Initiative edit relates to the E/M codes 90460 and 99401.

• 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes • 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered.

CPT code 99401 is not specific to counseling for COVID vaccines and because counseling is inclusive with code 90460, it is designated a CCI edit by CMS. Therefore, without a modifier to

8

indicate a significant and separately identifiable service, such as modifier 25 to 99401, the CCI edit will link the counseling services as already built into the administration, per the code descriptor. Billing a claim with a COVID diagnosis would not affect the CCI edit since diagnosis codes are not part of CMS' procedure-to-procedure (PTP) CCI edit.

Counseling is included in any vaccine administration, per code definition. If counseling is provided for COVID or any other vaccine, outside of a vaccine that was actually administered, Blue Cross NC does consider that separate counseling reimbursable, but it must be appended with an appropriate modifier, such as 25 or 59, to indicate it is separate and distinct. You may review the Blue Cross NC reimbursement policy here. Blue Cross NC identified claims in which the two codes 99401 and 90460 were not billed with an appropriate modifier, and therefore were denied reimbursement.

Thanks to the joint advocacy of NCAFP and NCPeds, the company has ceased any further recovery efforts with this CCI edit denial and will be re-processing any claims for those providers who have submitted partial or full recovery payments. However, beginning August 24, 2022, the CCI edit for the code combination 90460/99401 will be effective.

Please confirm that you are coding and billing your claims to accurately reflect these services.

The North Carolina Family Physician

ADVISORY CAPITAL

Medicaid Publishes Results of Consumer and Provider Surveys NC Medicaid recently published results of two surveys. One measures patient experiences with their health care while the other describes findings from the baseline assessment (Year 1) of the provider experience and satisfaction with the traditional NC Medicaid Direct system.

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 outcomes so you can do more and achieve more—

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a patient experience survey that serves as a national standard for measuring and reporting respondents’ experiences with their health care. NC Medicaid administers the CAHPS surveys to adult and child Medicaid beneficiaries to understand the Medicaid beneficiary experience and inform improvements in care. The full report and a two-page summary are available. Some key results included:

in medicine, business, and life.

Find valued advice at curi.com

• Adults rated both their overall health and mental or emotional health slightly better in 2021 than in 2019. However, when asked about their child’s mental or emotional health, ratings were slightly lower in 2021 than in 2019.

• Over 34 percent of adults reported not using non-emergency health care in the previous six months, up from 21 percent in 2019. But almost 85 percent indicated they usually or always received care right away when needed in 2021, up slightly from 2019.

• Over 41 percent of respondents reported their child did not use non-emergency healthcare in the previous six months as compared to just under 28 percent in 2019, verifying that there were gaps in well child visits and services during the pandemic. But nearly 96 percent reported their child usually or always received care right away, up slightly from 2019.

• Slightly more than 34 percent of adults reported being offered a telehealth visit instead of an in continues on page 31

Autumn 2022

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

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

Contact Peter Graber with the NCAFP at pgraber@ncafp.com 9

CHAPTER AFFAIRS

By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff

MEMBERS IN ACTION

NCAFP Goes to Washington…for the AAFP 2022 Congress of Delegates After a two-year hiatus, your AAFP’s Congress of Delegates (COD) met in-person in Washington DC for an action-packed two- and half-day business meeting. This year’s COD considered a larger slate of topics than usual, with new 2022 resolutions and resolutions held over from the virtual 2021 COD. As a first timer, I was impressed with the efficiency and effectiveness of the body’s ability to work through such a breadth of important topics. True to the spirit of Family Medicine, your physician representatives were thoughtful, enthusiastic, and respectful in their debate of a diverse range of issues that impact patient access and improve a physician’s ability to deliver quality health care.

North Carolina was well-represented with an esteemed group of attendees including our two voting Delegates, Dr. Chuck Rich (who also chaired the Reference Committee on Health of the Public) and Dr. Rich Lord, and Alternates Delegates Dr. Tameika Howell (who also served on the Reference Committee on Practice Enhancement) and Dr. Tom White; representatives of our Board’s executive committee including President-Elect Dr. Shauna Guthrie and Greg K. Griggs EVP-CEO. Also attending as part of North Carolina's delegation were AAFP board member Dr. Karen Smith; Past AAFP Presidents Dr. Lori Heim, Dr. Jim

10

Jones, and former AAFP Executive Vice-President and an AAFP Past President Dr. Doug Henley; Dr. Conrad Flick, AAFP’s FamMedPac Chair; and active members Dr. Michele Jones, Dr. Viviana Martinez-Bianchi, Dr. Dalia Brahmi, and Dr. Shannon Dowler.

The COD serves as the Academy’s policy-making body.

It conducts its work through Reference Committees that consider business (resolutions) items referred to them for recommendation to the COD for further debate and action. Resolutions are primarily submitted through state chapters. The Reference Committees take testimony on the merits of the resolution and recom-

The North Carolina Family Physician

mend any action to the Congress of Delegates, to the COD to Adopt; Not Adopt; Adopt with Substitution (as amended by the Reference Committee); or refer to the AAFP Board of Directors.

regard to a proposed resolution.

This year there were four Reference Committees: (i) on Health of the Public and Science; (ii) on Advocacy; (iii) on Practice Enhancement; and (iv) on Cross Topical Issues which considered and made recommendations on approximately thirty-three resolutions and a host of Board reports. All AAFP members are welcome to participate in hearings of the reference committees or to submit written testimony in

Advocacy

A few noteworthy highlights of resolutions that were adopted this year include:

Administrative Burden: The COD referred a resolution to the Board to consider forming an Administrative Burden Task Force to address this high priority of the AAFP and a major issue for family physicians.

AAFP continues to work on the issue of administrative burden and will continue to work with chapters continues on next page

Autumn 2022

11

to best address this extraordinarily important issue.

Restrictive Covenants: The COD approved an amended substitute resolution that directed the AAFP to “strengthen its existing policy against restrictive covenants to include noncompete activities that interfere with the physician-patient relationship and patient access to care” and undertake federal advocacy through lawmakers and relevant federal entities “to eliminate noncompete clauses and noncompete activities for family physicians.” Testimony provided supported the notion that restrictive covenants hurt physicians and patients by hindering access, worsening physician shortages, and disrupting physicians’ well-being.

HIPAA Updates: Delegates adopted a measure urging the Academy to advocate for HIPAA changes to allow commonly available real-time audiovisual communication technology to be used for telehealth without the requirement of a Business Associates Agreement with the company that runs the platform.

Cross-Topical Issues Increasing POCUS CME Opportunities: Delegates adopted a measure that called for the Academy to support more CME on point-of-care ultrasound (POCUS) at AAFP-sponsored events. Supporters expressed appreciation for the numerous POCUS-related offerings already available at AAFP events like FMX and the National Conference of Family Medicine Residents and Medical Students. More such opportunities, they said, could increase the POCUS training workforce.

Global Health: The COD adopted a substitute resolution directing the AAFP to reinstate a dedicated annual Global Health Summit.

Health of the Public and Science Eat, Sleep, Console: The COD adopted a resolution to update the neonatal drug withdrawal section of the AAFP’s substance use disorders policy to “include patient-centered methods of managing neonatal abstinence syndrome such as the Eat, Sleep, Console approach” and offer education on that approach. continues on Back Cover

12

PERSPECTIVE

Looking Back. And Being Grateful

By Thomas R. White, MD Last month I had the opportunity to attend the American Academy of Family Physicians (AAFP) 2022 Congress of Delegates (COD) and The Family Medicine Experience, commonly referred to as FMX, in Washington DC. One evening I exited my hotel to go to dinner, and about a block away, I came upon a statue of Edmund Burke. Not knowing enough about him, I did my research. Burke was a famous member of the British Parliament, a highly respected philosopher and economist, and considered by many to be “The Father of Conservatism.” He actually was an advocate for the American Colonies, arguing in Parliament against unfair taxation. Thus, the statue, I presume.

Reading about Burke, I discovered the following quote: “People will not look forward to posterity, who never look backward to their ancestors.” That got me thinking about Family Medicine, how we got to where we are, and how important it is that we not forget those who went before us.

A little history. It was after the Second World War that American Medicine moved toward specialization. So-called “general practitioners” were looked down upon. Discrimination, especially in the hospital setting, was common.

In time, however, these generalists banded together and fought for their identity, their professional privileges, and their deserved respect in the house of medicine.

Thanks to the efforts of many, Family Medicine became recognized as a specialty in 1969. The American Board of Family Medicine was established in 1970, becoming the first specialty to require periodic re-certification. Originally the American Academy of General Practitioners, it was renamed the American Academy of Family Physicians in 1971. And today, the AAFP is the second largest specialty association in the country.

None of those accomplishments occurred without a fight, without opposition, without amazing leadership. I am reminded of those leaders of Family Medicine who went before us, helping to establish the specialty and organizing it

The North Carolina Family Physician

into what it is today. I will name just a few.

Dr. Gayle Stephens, a general practitioner in Wichita, Kansas, who later established one of the first Family Medicine residency programs at Wichita State University and then served as Chair of the Department of Family Practice at the University of Alabama School of Medicine in Birmingham. His essays on Family Medicine as a “counterculture” uprising were so inspirational to me as a medical student, as it was to many others. Dr Lewis Barnett, who practiced in Woodruff, South Carolina, and later served on the Family Medicine faculty at the Medical University of South Carolina in Charleston, and then as Chair at the University of Virginia in Charlottesville. My interview with Dr Barnett for a residency position at UVa in 1979 was an emotional, life changing experience. And our own Dr Jim Jones, who practiced in Jacksonville, North Carolina, and went on to develop and chair the Department of Family Medicine at East Carolina in Greenville. Still referred to as “The Godfather of Family Medicine” in North Carolina, Dr Jones has been an inspiration and role model for me, and a mentor for so many of you.

received the broad training we have enjoyed, the privilege to practice in the hospital – from delivering babies to caring for patients in the intensive care unit – and the respect we have as a specialty in the halls of Congress and in state legislatures across the country.

I am optimistic about Family Medicine going forward. We all know the virtues. We know that the generalist has been the backbone of medicine in this country. That the Family Medicine of today can best deliver what is needed now, and in the future: quality, cost-effectiveness, and relationship-based, patient-centric care.

Family Medicine is the specialty that can save our broken health care system. Of course, as a Direct Primary Care (DPC) physician and advocate, I believe that DPC is part of that solution. An option which our specialty should continue to embrace and support to ensure that better future.

For Family Medicine to be that specialty of the future, I strongly believe we need to remember our past, and those who had this vision. That gives us perspective.

It grounds us. It reminds us of our values and the reason we go to work every day. It inspires us to fight for what we believe. Our predecessors did just that. It’s in our blood. Our DNA.

There are many other such forerunners here in North Carolina. Too many to name them all. Dr George Wolff from Greensboro. Dr John Nance in Clinton. Drs Robert Shackelford and Hervy Kornegay of Mt Olive. Dr Ed Shahady, former Chair at UNC. The list goes on and on.

So here we are in 2022. A time for us to remember how we got here. A time for us as Family Physicians to understand that we are standing on second base, but we did not hit a double all by ourselves. A time for us to say thank you. A time for gratitude. A time to embrace our past, as we create a new future.

We owe them all our gratitude. Without them, it is almost certain that we Family Physicians of today would have never

Edmund Burke stands tall in DC to remind us!

Autumn 2022

13

Connecting Family Physician Job Seekers and Employers in North Carolina.

JOBS.NCAFP.COM

EMPLOY ERS:

Target Candidates with Ease

PROFESSIONALS:

Take Your Career to the Next Level

PLACE your job in front of our highly qualified members and job seekers.

POST your resume or anonymous career profile that leads employers to you.

SEARCH our resume database of qualified candidates.

SEARCH and apply to thousands of family physician jobs in North Carolina on the spot by using robust filters.

MANAGE jobs and applicant activity right on our site.

SET UP efficient job alerts to deliver the latest jobs right to your inbox.

LIMIT applicants only to those who are qualified.

ACCESS career resources, job searching tips and tools.

FILL your jobs more quickly with great talent.

ADVERTISE your open positions in the exclusive Job Flash™ email sent directly to 2,000+ family physicians in North Carolina.

CONTACT Jan Kielec at Jan.Kielec@communitybrands.com CONTACT Emily Morenzoni at or (860) 935-8437 for package and Emily.morenzoni@communitybrands.com recruitment or 860.544.6518 foroptions. package and

recruitment options.

Visit jobs.ncafp.com to log in or create your account today!

GAIN insights and detailed data within the family physician profession including salary, job outlook videos, education and more.

REQUEST a free resume critique from an expert writer.

CONTACT NCAFP Career Center’s Customer Service at clientserv@communitybrands.com or (727) 497-6565 for questions and concerns.

@ H E A D Q UA RT E R S

Academy Adds Finance and Operations Manager to Staff The NCAFP is excited to announce the addition of Jan Rainy to its headquarters team.

Jan joined the NCAFP staff on June 1, 2022, as Manager of Finance and Operations. She focuses on the NCAFP financial and accounting respon-

sibilities. Her years of experience in the accounting department of a manufacturing business and most recently managing the business office of a private school are invaluable to her role.

Jan graduated from NC State University with a degree in Business Management and Economics. She is married and has two grown children. In her free time, she likes spending time with her family, gardening and traveling.

OUTREACH EVENTS & EFFORTS

NCAFP Provides Advocacy Training to MAHEC-Asheville Residents The NCAFP team, along with NC AHEC Director Hugh Tilson, JD, presented a workshop on advocacy to residents at the MAHEC Family Medicine Residency Program in Asheville this past August.

NCAFP President Dr. Dimitrios (Takie) Hondros discussed the goals of the NCAFP and outlined a few of our activities. NCAFP EVP Greg Griggs, MPA, discussed NCAFP advocacy initiatives and how you can spend 15 minutes a week to make advocacy a habit.

Autumn 2022

NCAFP’s Manager of Workforce Initiatives Perry Price discussed utilizing social media and letters to the editors as key advocacy tools. And Hugh Tilson discussed the importance of getting to know and meeting with elected officials. The residents then broke into small groups to undertake hands on practice on both written and face-to-face advocacy.

During the visit, the group also met with MAHEC CEO Dr. William Hathaway, and AHEC Director Francisco Castelblanco, DNP, RN.

15

Sights & Scenes from Chapter Events

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

~ PROFESSIONAL DEVELOPMENT ~

Several Terrific Learning & Networking Events Slated for 2023

The NCAFP would like to thank the m the 2022 Winter Family Phys

Get ready to celebrate the specialty of Family Medicine all year long with the NCAFP! We have several fantastic learning opportunities slated for 2023, and we think you will really like what we have planned. Whether you enjoy in-person learning and networking, convenient virtual learning from anywhere, or both … We’ve got you covered!

2023 FAMILY MEDICINE ACADEMIC SUMMIT

The 2nd Annual Family Medicine Academic Summit, scheduled for February 17- 18, 2023, is a calendar highlight for all NC medical school departments of family medicine and NC family medicine residency programs. This two-day in-person conference will be held at the Sheraton Imperial Hotel Raleigh Durham Airport RTP. The “Working in Collaboratives – Meeting the New ACGME Guidelines” seminar is themed around Point of Care Ultrasound and will include terrific networking, regional collaboration, and CME credit. The Academic Summit will roll right into the NCAFP’s 16th Annual Family Medicine Day Conference on Saturday, February 18, 2023. A fun day of hands-on skills training led by family medicine residents, the highlight of this event is the Residency Recruiting Fair. Designed to introduce medical students to North Carolina’s diverse array of family medicine

18

This highly anticipated annual even without the support of these and their dedication to Fam

The North Carolina Family Physician

residency training programs, Family Medicine Day is always an NCAFP highlight for students, residents, and residency programs. Save the dates for now. Complete schedule information and online registration for both programs are coming soon.

2023 VIRTUAL SUMMER SYMPOSIUM

many terrific sponsors of sicians Weekend.

The 3rd Annual Virtual Summer Symposium is slated for Saturday, June 24, 2023. This fun and lively web-based learning opportunity will earn participants approximately six credits by their participation. Count on a fun day of convenient online learning from wherever you are that day!

Plan to take advantage of a pre-conference virtual KSA opportunity on Friday, June 23, 2023, and scoop up eight additional credits and 10 ABFM activity points. Watch your email for more information coming soon on this terrific summertime CME opportunity that you will not want to miss.

NETWORKING DINNERS WITH 30-MINUTE HOT TOPIC EXCHANGES

Before the pandemic, the NCAFP hosted several fun and highly attended regional dinner programs around the state. We are excited to bring similar networking and learning opportunities back to Charlotte and Chapel Hill next year. These fun, mid-week dinner programs with your colleagues and friends are the perfect after-office-hours opportunity to earn up to 1.5 CME credits. Attendees will enjoy three 30-minute hot topic updates with take-home pearls to begin using right away. The Charlotte meeting will be hosted at the Atrium Health Carolinas Medical Center Family Medicine Residency on Thursday, March 30, 2023.

The Chapel Hill meeting will be hosted at the UNC Family Medicine Center on Tuesday, September 19, 2023. You will see more details coming soon for both programs.

nt would not be possible fantastic sponsors mily Medicine.

Autumn 2022

Last but not least, there will be quite a celebration during the 2023 Winter Family Physicians Weekend! Make your plans now to be in Asheville next November 30 – December 3, 2023, when your NCAFP marks its 75th Anniversary! From start to finish, we intend to celebrate and honor the specialty of family medicine and all of you. Your program chair, Dr. Tamieka Howell, and your program vice-chair, Dr. Thomas White, will keep you engaged and connected all weekend long with updates on timely clinical topics you see and treat most often. Count on surprises and lots of fun sprinkled in to commemorate our diamond jubilee. We can’t wait to celebrate this milestone anniversary with you!

A brand-new year is right around the corner, and we hope to see you at that these terrific learning and networking opportunities. Watch your email and our website for more information coming soon.

19

CME RECAP:

The Recent Virtual Summer Symposium Was a Cool Learning Experience for Many By: Kathryn Atkinson, CMP Director of CME & Events

In early August, your NCAFP CME Team hosted a fun and lively web-based learning opportunity that proved to be a very cool learning experience for over 140 Family Physicians and their healthcare partners.

Attendees joined in for the second annual Virtual Summer Symposium from the comfort of their sofas, sunrooms, patios, and kayaks (yes, kayaks!) and enjoyed a fun day of learning and discovery. With a variety of 60-minute, 45-minute, and 30-minute learning sessions, the day served up 6 AAFP Prescribed Credits from start to finish. The convenient virtual sessions included clinical updates on hyperkalemia, Alzheimer’s, overactive bladder, diabetes, PrEP, foot & ankle treatments, and newborn care. An important coding and billing update and a telemedicine update from the NC Medical Board also rounded out the schedule.

Over 60 attendees also took advantage of a pre-conference KSA on Heart Disease for an additional eight CME credits. Here are a few of our favorite comments from the overall conference survey: “I continue to enjoy and appreciate these virtual CME opportunities!”

“Well done! Amount of break time appropriate. Lectures great. Speakers engaging.”

“Everything was excellent. I absolutely enjoyed spending my day learning with the NCAFP today.

Thank you for this opportunity” “Well-run conference, with great communication before, during, and after, and excellent platforms.

Thanks again!”

20

The NCAFP Meetings Department would also like to extend a big heartfelt thank you to program chair, Dr. Thomas R. White, and the many terrific guest faculty who shared their expertise and knowledge with our attendees. Lastly, please join us in thanking the Avance Care team for their kind sponsorship of the Symposium’s mobile app. We are excited to host this much-appreciated virtual learning program again next year. Mark your calendars now for the next Virtual Summer Symposium scheduled for Saturday, June 24, 2023. More details are coming soon!

Family Medicine Day February 18, 2023!

Medical Students should plan to be in Durham on February 18th for Family Medicine Day! Come and join us to get hands on training from 14 of our incredible NC Residency Programs, and learn more about the great variety of scope a career in Family Medicine can provide -- including a great lineup of hands-on workshops!

Mock Interviews Osteopathic Approach to Headaches POCUS Ultrasound Guided Injections Suturing Wound Care Wilderness Medicine Backboards and Braces Skin Procedures SPG Blocks Cervical Blocks LARC Emotional Resilience Amniotomies and Internal Fetal Monitoring

Visit www.ncafp.com/fmd

The North Carolina Family Physician

REGISTRATION OPENS IN DECEMBER FOR NCAFP'S 2023 SUMMER PROGRAMS FOR MEDICAL STUDENTS Once again, the NCAFP is excited to offer a variety of opportunities for students to immerse themselves in Family Medicine in a multitude of locations!

• 2-Week Family Medicine Immersion • 4-Week Externship NCAFP expects to offer two locations for our 2-week Immersion Program, as well as offering our 4-week Externship in locations across the state!

Contact Perry Price, Manager of Workforce Initiatives, with any questions at perry@ncafp.com

*If you are interested in hosting students in your practice during the summer for any length of time, please reach out to Perry at perry@ncafp.com!

MEMBERSHIP & MEMBER SERVICES

MEMBERS IN THE NEWS

Dr. Viviana Martinez-Bianchi Honored by Foundation for Health Leadership and Innovation The Foundation for Health Leadership and Innovation (FHLI) presented the winners of its annual awards on Oct. 6 during the organization’s Annual Bernstein Dinner at the Friday Center in Chapel Hill.

“I want to make sure that this recognition goes also to those who have worked tirelessly with LATIN-19, collectively joining in the effort to improve the health outcomes of the comunidad latina in North Carolina and the US,” said Dr. Martinez-Bianchi.

The 2022 FHLI Community Achievement Award recognizes individuals who have dedicated their careers to improving the health of communities, exemplifying the values lived by Jim Bernstein: everyone has a right to care; care should be delivered in a respectful, efficient, and effective manner; and health care belongs to the community it serves. The award recipient has had an impact, like Bernstein, at the community, state, and federal level and is deeply respected among their peers.

“These award winners represent innovation, empathy, and a deep dedication to improving health outcomes,” said David Reese, president and CEO of FHLI. “It’s an honor to recognize their decades of service in North Carolina.”

The 2022 FHLI Community Achievement Award was presented to Dr. Viviana Martinez- Bianchi, M.D., FAAFP, of the Department of Family Medicine at Duke Health. During the COVID-19 pandemic, she co-founded the Latinx Advocacy Team & Interdisciplinary Network for COVID-19, better known as LATIN-19.

“LATIN-19 is creating space for leaders across North Carolina to collaborate on innovative solutions to the unique barriers faced within the Latinx community,” said Reese. “This organization and Dr. Martinez-Bianchi’s leadership are testaments to the importance of diverse voices having a seat at the table to create more equitable health systems.”

22

munity or region.

The 2022 Jim Bernstein Community Health Career Achievement Award was be presented to Randy Jordan, outgoing CEO of the North Carolina Association of Free and Charitable Clinics. Jordan, who retired in 2022, is a longtime supporter and partner of FHLI. The Jim Bernstein Community Health Career Achievement Award recognizes individuals who are invested in improving the health of their com-

About Jim Bernstein The Bernstein Event honors the late Jim Bernstein, the founder and first president of the Foundation for Health Leadership & Innovation. Bernstein dedicated his life and work to improving health care in rural communities across North Carolina. An innovator and a motivator, he served as a role model for how to address some of rural health care’s most pressing challenges.

About FHLI Launched in 1982, under the leadership of James D. Bernstein, the Foundation for Health Leadership & Innovation develops innovative programs and establishes strong partnerships that advance affordable, sustainable, quality health services that improve the overall health of communities in North Carolina and beyond.

The North Carolina Family Physician

Past President Dr Shannon Dowler Promoted – Named One of Two Deputy CMOs for NC DHHS NC DHHS Secretary Kody Kinsley recently announced a reorganization and expanded roles for some of the Department’s medical leadership in order to better resource their cross-departmental work and support the Department’s three overarching priorities – Behavioral Health & Resilience, Strong & Inclusive Workforce, and Child & Family Wellbeing – and ensuring a foundation of health equity and whole person health is woven throughout the Department.

Dr. Shannon Dowler will serve as the NC DHHS Deputy CMO for Health Access, in addition to remaining the Chief Medical Officer for Medicaid. In this more expanded DHHS role, Dr. Dowler will work at the direction of Debra Farrington, Chief Health Equity Officer, in supporting the Health Equity Portfolio and Health Equity team as they provide departmental leadership to health equity. She will bring clinical and operational expertise to multiple health equity issues which align with Departmental priorities with a focus on embedding equity in payment models and in clinical frameworks and policy. She will continue her

strong leadership in the Medicaid program where she oversees the Clinical, Quality and Population Health teams. In this new role, Dr. Dowler, will continue to report directly to Deputy Secretary for Medicaid and will have matrix reporting to Dr. Elizabeth Tilson, NC DHHS CMO and State Health Director. She will begin to transition into this role immediately and will be fully effective 1/1/2023.

Dr. Carrie Brown will serve as the NC DHHS Deputy Chief Medical Officer and Chief Psychiatrist. In this role, Dr. Brown will continue and expand upon DHHS’s work in promoting integrated physical and behavioral healthcare, child and family well-being and behavioral public health. She will lead the department’s Behavioral Health and Resilience priority area initiatives. She will continue her partnership with key stakeholders for behavioral health, substance use disorder, intellectual and developmental disabilities, traumatic brain injuries, and provide medical leadership for the Division of Mental Health, Developmental Disabilities, and Substance Use Services. She will also continue to serve as the Chief Medical Officer for State Operated Health Facilities. As Deputy Chief Medical Officer and Chief Psychiatrist, Dr. Brown, will continue to report directly to the Deputy Secretary for Health and will have matrix reporting to Dr. Elizabeth Tilson, NC DHHS CMO and State Health Director.

2022 CME Re-Election Deadline is December 31st Members with a CME Re-election cycle ending 12/31/22 have until the end of this year to earn the 150 required credits for the three-year re-election cycle. The cancelation date for any unreported CME credits will be early March, so make plans now to report your hours before the holiday rush. Reporting by the 12/31/22 deadline will also remove you from any reminder notifications. You may report your credits any of the following ways: • Visit www.aafp.org/cme (your username is your email address on file with AAFP) • Call 1-800-274-2237 M-F 9:00 a.m. – 6:30 p.m.

• Fax to 913-906-6075 • Scan letters of participation on AAFP’s free mobile app • Mail submissions to: AAFP Member Service Center, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672 If you have retired, interrupted practice, or moved out of NC, please contact the AAFP immediately for a status transfer or chapter relocation. If you are a 2023 re-election candidate, remember that you may count teaching/precepting, Board certification exam, and medical staff/society meetings. And a bonus, the AAFP will inform the American Board of Family Medicine (ABFM) once you have met its CME requirement!

If you have any questions, please email aafp@aafp.org, call 1-800-274-2237, or visit CME FAQs at aafp.org/cme. The AAFP would also be happy to “walk through” your transcript with you to ensure all the credits you’ve earned are included.

Autumn 2022

23

NCAFP Dr. Rebecca Hayes Receives Golden Stethoscope Award from NC Medical Society The NC Medical Society recently honored four physicians with Golden Stethoscope Awards at its Gala Banquet held in conjunction with their LEAD Conference in mid-October. NCAFP Member Rebecca Hayes, MD, MBA-HM, was one of the four physicians honored. Dr. Hayes is Vice Chair of Clinical and Community Operations

Past President Dr. R.W. (Chip) Watkins Appointed to CLIA Workgroups NCAFP Past President Dr. R.W. (Chip) Watkins has been appointed to the Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver and Provider-performed Microscopy Procedures (PPMP) Workgroup. In this workgroup, Dr. Watkins will share his experiences and challenges observed in Certificate of Waiver and Certificate for PPM Procedures testing sites. This is part of his continuing work with CDC as a member of the CLIAC (Clinical Laboratory Improvement Advisory Committee). Dr. Watkins currently serves as CCNC Regional Medical Director.

Dr. Dev Sangvai Appointed Interim President of Duke Regional Hospital Family Physician Dr. Devdutta "Dev" Sangvai has been appointed interim president of Duke Regional Hospital. He begins this leadership role in

24

in the Department of Family Medicine and the Assistant Specialty Medical Director of the community clinics in the Emerging Care Model Division at Atrium Health. In her 15 years at Atrium, she has also served as medical director and core faculty at Elizabeth Family Medicine, and associate program director for the Cabarrus Family Medicine Residency Program.

mid-August. Dr. Sangvai has served on the Durham County Hospital Corporation Board of Trustees, which is the board for Duke Regional Hospital. At Duke, Dr. Sangvai is vice chair for strategy in the Department of Family Medicine and Community Health, as well as vice president for Population Health Management. He is also the executive director of Duke Connected Care, Duke's accountable care organization.

Dr. Art Apolinario Installed as NC Medical Society President Dr. Art Apolinario, a family physician and NCAFP member, was installed as the latest President of the NC Medical Society (NCMS) this past October during a gala as part of the NCMS LEAD Conference. Dr. Apolinario completed his medical degree at Tulane University and completed his Family Medicine Residency at Saint Vincent Health System in Erie, PA. He has practiced at Clinton Medical Clinic for well over 20 years. Congratulations to Dr. Apolinario, and the entire NC Medical Society team for a great LEAD Conference.

The North Carolina Family Physician

STUDENT PROGRAMS & INITIATIVES

FAMILY MEDICINE ON CAMPUS

Wake Forest Introduces Innovative Effort to Attract Students into FM Increasing the workforce pipeline into Family Medicine is a core tenant of the NCAFP Foundation, but how do we encourage those pre-dispositioned to Family Medicine to choose medical school, and then ensure those students do in fact find their home in Family Medicine? The answer is certainly multi-faceted, and the strategies numerous, but it’s especially exciting when a new endeavor is successful.

At Wake Forest University School of Medicine, Arleen Settles, Administrative Support, and Danielle Averitt, Clerkship Coordinator for Family Medicine, saw an opportunity for greater engagement with the medical students coming through their doors and took a chance on a new idea – and it’s working!

Each month as a new group of M3s begin their Family Medicine Outpatient Clinic they are invited to attend a Meet-and-Greet event held on-site and given a chance to mingle with their classmates and faculty in a casual setting.

The real draw however – the themes! From Alice in Wonderland to Grey’s Anatomy, the imaginative events serve as a unique way to disarm the students (and faculty!) and create a setting where all can socialize and build a foundation for budding relationships. By getting to know the students a bit more personally, the faculty and staff in the Family Medicine Department are better suited to pinpoint students who are interested in pursuing Family Medicine or those who they see potential in…something they might have missed before.

The students and faculty have great things to say too:

Autumn 2022

“Having grown up in the middle east, it is well known that barriers to communication are often removed when food is in a room - allowing us to see the human side of those we respect and recognize the innate needs we all have. Coupling that psycho-social thrombolytic with a room full of welcoming potential mentors was one of the pivotal components allowing me to see the field of Family Medicine as one that I could be welcomed into. Once barriers came down, it was much easier to feel comfortable asking questions, hear about opportunities available, and see our mutual ambitions.”

- Joshua Pontier, MD Candidate – Class of 2024 “There are so many avenues to explore in the field of Family Medicine! I came into this rotation with limited exposure to how broad this specialty is and how a physician can tailor their practice towards their personal and professional strengths and interests. The planned lunches and Meet and Greet event crafted by Danielle and Arleen allowed for these intentional opportunities to talk candidly with residents and attendings outside the clinic.

After the combination of clinical exposure and hearing from physicians in various stages of training discuss why they chose this specialty, what others were considered during medical school, and how they currently structure their workday, Family Medicine is now in my top choices of specialties. I am really excited to come to clinic every day and continue to learn more. “

- Megan Alsaeedi, MD Candidate – Class

of 2024 “Our departmental “Meet and Greet” activities have been a big hit. These unique, themed gatherings allow for a relaxed exchange between our staff, faculty and residents in family medicine with potential future family medicine physicians (i.e 3rd year clerkship students). Whether it was our clerkship director, Scott Harper, as Uncle Sam or our recent representation of “Dr. McDreamy” by our departmental chair, these gatherings bring lighthearted fun and a platform for the students to get more insight into what makes family medicine such an awesome specialty. Arleen and Danielle do a fantastic job of welcoming the students and encouraging dialogue beyond the standard didactic and clinical teaching. This has been a great addition to our curriculum.”

- Chris Miles, MD It’s easy to overlook these simple opportunities but bringing a bit of levity has opened the doors for building community and relationships within the Family Medicine Department at Wake Forest School of Medicine!

25

CAREers in FOCUS

MOMS in Family Medicine Navigating a Fulfilling Career and Family: Part 1

By Perry Price NCAFP Workforce Initiatives Manager

26

The North Carolina Family Physician

I

n 2020, roughly 42% of practicing Family Physicians were women -- up almost 8% from 2010. While the increase is promising and expected to continue (more than 50% of US medical students are women), it also clearly shows the need for employers and decision makers to formulate workplace policies and strategies that promote professional growth alongside parental responsibility for female physicians. Balancing practice and motherhood should be a celebrated feat, not a tolerated one. While parenthood is not unique to female physicians, there are unique burdens and pressures that regularly fall on mothers.

We interviewed a few of our members to get their perspectives on being Moms in Family Medicine, and to hear their stories about starting and raising families at different times and across a variety of practice settings. This edition of The North Carolina Family Physician features Part 1, an introduction of our interviewees and an acknowledgement of some of the policies that supported and challenged them. Make sure to read Part 2 in our February 2023 edition where our interviewees will share their strategies and advice, and the benefits of being a Mom in Family Medicine!

Share your story - At what stage of your career did you have children? What type of practice setting were you in? What stage of your career are you currently in?

Jessica Triche, MD: ​I had my first child, Kevin, during my 3rd year of residency. My program frontloaded call so this was planned. I was able to take extra call earlier in my training, so it balanced out with my classmates, and I did not feel bad. Currently, I have two kids and am practicing in an academic clinic.

Vickie Fowler, MD: As it so happened, my journey into motherhood began in the fall of 1999 just after I returned to my hometown of Ashe County, NC joining my own family physician to provide full spectrum rural Family Medicine. I found out I was pregnant Autumn 2022

halfway through my obstetrical fellowship, which was particularly challenging with the frequent call and long hours. I had three children in my 30s and I joke that I spent my entire 30s either pregnant or breastfeeding or BOTH! Currently I am mid-career with children ages 16 to 23 and I practice in Raleigh, NC in a hospital owned outpatient-only practice.

Kelley Lawrence, MD: I had my first child about a month after taking Step 1, so after my MS2 summer. My second child came at the beginning of PGY2 year of residency, my third child came after residency graduation (and after taking the Family Medicine boards), and my fourth child came as I left my first clinic to pursue the academic portion of my medical career. I am currently Associate Program Director of our Family Medicine Residency (have been with this organization for 7.5 years) and also the Assistant Dean for a regional campus of the UNC School of Medicine (in this role for 2 years).

Jackée Clement, MD: My husband and I decided to have a child during my second year of FM residency. It has been almost a year, so I am currently a third-year resident.

Liz Baltaro, MD: I was shocked to be pregnant with twins in my 2nd year of residency. They were born at the start of 3rd year. My 3rd child was born during my PGY7 year working as an employed family physician for a rural health system. I’m now entering PGY11 about a decade into my medical career-- mom of three, employed medical director and family physician.

What workplace policies have been in place that allowed you to succeed as a mother? Or policies in place that made it difficult?

JT: In residency, I took the minimum time off for maternity leave. I did not want to miss training and I did not want to crap on my classmates. I was not pressured by my program. When I had my 2nd kid, I made sure to take the full 12 weeks. Some of it was unpaid but I didn’t care. I actually got a paper check for “zero dollars”. My organization was supportive during my 27

full 12 weeks of maternity leave. I have not had any more kids since then. As for policies that have allowed me to succeed, not many. I have winged it! Most of the time everyone has been understanding of time off for kids related issues/sports, etc. My current practice manager is very supportive of me making it to kids sporting events or things like Math Team competition.

ers can be with parental leave and pumping breaks to adequately plan mentally and physically to be a physician mother.

JC: One of the reasons I chose the Novant Health Family Medicine Residency program is because they were finalizing a strong maternal health policy. In fact, I met my future mentor, Dr Kelley Lawrence, during my interview day VF: Practicing in my own practice there. During my in rural NC and providing full specI benefitted greatly from the interview with her, trum care in a critical access hosI asked if they had pital, I cannot really acknowledge support of other understanding maternity leave any formal workplace policies that physicians, who gave good advice for residents inexisted. What allowed me to sucand encouraged me to follow my terested in having ceed as a mother was the concept parental instincts and spend that children during that, “It takes a village to raise a training.

This was child” and my incredibly supportive early time with my children.” a risky question family and colleagues. There were to ask during an times when my male colleagues in — Kelley Lawrence, MD interview; howthe practice told me to not come ever, I knew it was important to me and my then into the office or the hospital on my day off when they fiancé. I didn’t want to go to a residency that would could see the demands of my job weighing on me. It look down on a medical school student for asking was more me learning to accept others help and being anyway. And fortunately, Dr. Lawrence was a womwilling to acknowledge the importance of that day off an with a plan. She was so open and passionate with my children. The ability to have a complete day about the policy she was working on. Essentially, we off during the week from the office (if not the hospital) get 3 months of parental leave. One month is fully was absolutely critical for my ability to be a Mom. Evdedicated to being with baby as a maternal health ery physician or APP had a day off from the office each elective. The other two months, we return gradually week. My greatest challenge was finding an opportunito patient care. And over those three months, we are ty and a location to pump breastmilk while working. expected to come up with a maternal health project, In spite of all odds against me in terms of my schedule such as a presentation on breastfeeding medicine, and work demands, I was able to breastfeed all three of that encompasses some of what we learned from my children successfully for years. our first-hand experience taking care of a newborn.

KL: While I don’t know of many policies that helped LB: I feel fortunate to work in the post-1993 era where me with my own pregnancies or breastfeeding efFMLA is in place, but believe that parental leave polforts, I benefitted greatly from the support of other icies could be better. I experienced unexpected pregunderstanding physicians, who gave good advice and nancy complications, and hospitalizations prior to encouraged me to follow my parental instincts and my premature delivery. It was physically demanding spend that early time with my children. Dr. Georgette to work while pregnant with twins, especially night Dent at the UNC SOM gave me the advice to take a shifts. My residency program was supportive, yet it year between MS2 and MS3 to pursue my “MOM” was painful to leave babies in the NICU, and to have degree and I regret not one moment of that time. In only 5 weeks at home with my twins once they were residency, I wish I had asked to see the parental leave discharged. If I had taken more time, I may have had policy during interviews. It is also important to know to repeat a year of residency. how supportive and flexible your supervisors/employ-

“

28

The North Carolina Family Physician

Policies which felt challenging included inability to train or work part-time, rotations/ hospital call/ evening meetings that prevented me from being with my children during their waking hours for over 2 full days in a row. I was required to work the same number of weekend/ call weeks per year when I took parental leave, making my time back at work even more challenging than usual.

What workplace policies would you advocate for?

Workplaces, especially healthcare workplaces, need to have policies in place that support and protect lactating mothers who are employees—not just those who are patients/clients of the healthcare facilities. The USBC is a great advocacy organization that gives guidance to workplaces who want to improve their lactation policies. Also, the North Carolina Breastfeeding Coalition gives guidance as to how to be a breastfeeding-friendly business or clinic (similar to how hospitals can work to become Baby Friendly).

JT: I would advocate for some sort of “childcare issue” time. Like CME... when your kids are sick or have snow days you can take a day and not be penalized.

Maybe work from home, virtually. Would need documentation of child illness or school closure. I am making this up...just thought of it with this question but would have been helpful during my career!

JC: I was happy with my experience. So I would advocate for polices that emulate that. So women need a minimum of 3 months just to recover from delivery, so policies should not stop shy of this time requirement. Obviously, men should be able to stay at home and provide support for their family as well. Not only should there be at least 3 months off, but it should be paid leave.

VF: Maternity leave for 12 weeks all fully paid if possible. A 30-minute break to pump breast milk as often as every 4 hours if needed in an appropriately private and comfortable location. Ability to return to work part time following the birth of a child for up to the first year. Not a policy but a culture that is supportive for pregnancy/motherhood, ex, ability to leave or decrease participation in the call schedule readily during parts of pregnancy or post-partum time as needed (without guilt.)

LB: Policies that promote flexibility in residency training and beyond-- allowing parents to feel supported to take more time off if needed, or work part-time or different hours (such as starting/ ending earlier in order to pick up kids). I would especially like to see these policies support both partners. I would advocate for subsidized child care, and on site daycares, and support in securing childcare. I would like to see all parents, and especially parents of multiples allowed longer parental leave.

KL: I believe that we as a profession (and as a nation) need to honor the important work of bearing and, when possible, naturally-feeding children. At the residency level, I have worked with colleagues to build and share on state and national levels our family learning plan—for residents building family, we couple 6 weeks off as now required by the ABFM with 6 additional weeks of at-home learning (there’s plenty of that with a new child and it can be practice-defining!) with a small amount of “transition-back” to residency time to give the new parent one session per week for a few weeks to practice some time away and troubleshoot rather than coming back all at once.

Autumn 2022

Be sure to read Part 2 of Moms in Family Medicine in our February 2023 edition, where our interviewees will give their advice for navigating these challenges, reveal who they look to for guidance, and share how being a mom has shaped them into the successful Family Physicians they are!

29

erate the Tailored Plans, more time to contract with additional practices to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.

PRACTICE MANAGEMENT MEDICAID

While the start of Tailored Plans will be delayed, specific new services will still go live Dec. 1, 2022. NCDHHS and LME/MCOs will support providers of Tailored Care Management to launch their services on Dec. 1.

Through Tailored Care Management, eligible beneficiaries will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the beneficiary’s whole-person health needs.

NC DHHS Delays Launch of Tailored Plans In late September, NC Medicaid announced the decision to delay implementation of Tailored Plans until April 1, 2023, in order to ensure beneficiaries can seamlessly receive care on day one. Tailored Plans, originally scheduled to launch Dec. 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care, and will also provide additional specialized services for individuals with significant behavioral health conditions, intellectual/developmental disabilities and traumatic brain injury.

Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health services and I/ DD and TBI supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today.

More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS.

The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will op-

igent in getting yearly mammograms for that reason.

There were two surgical biopsies for suspicious calcifications in the late 1990s. I think I always thought the other shoe would drop. It finally did.

BREAST CANCER

October Awareness

By Lib Campbell

October is National Breast Cancer Awareness Month. Katie Couric made the decision to lead a charge for awareness in revealing her journey with breast cancer that began last summer. Her story takes you through diagnosis, treatment and all the things that happen with a breast cancer diagnosis. If you remember, her husband died with cancer. She obviously felt it important to elevate awareness and concern for any of us who are at risk. I think it is important too, for I have also lived that journey over the last year.

They told me not to open the report that came on MyChart, but I couldn’t resist. Invasive Ductile Carcinoma.

I told my friend on the phone, “That sounds like cancer to me.” Why, yes it does. So shortly before Christmas, my journey into the world of cancer began. More testing. Planting radioactive seeds. Surgery in February. Radiation until May 5, 2022. Cinco de Mayo in the treatment room with glitter, leis and intermittent music was a celebration to remember.

On December 23 of 2021, I was on the phone with a young colleague. I had just had a routine mammogram. I expected a letter saying that I was good to go until next year. But I saw the film in the room. I saw the array of calcifications, and I knew something was different.

The experience of cancer and all that surrounds it is a roller coaster of emotion to begin with. Then the routine of driving to the UNC Rex Cancer Center became pretty normal. I liked the people there. The guys doing valet service, the women on the front desk. Sandy in the radiation treatment lobby always had flowers and a big smile.

Martha, Tim and the others in the treatment room were friendly and competent. I always felt at ease.

Like Katie Couric, I have dense breast tissue. My science self makes me wonder if this is because I did not breast feed my babies. My OBGYN for years used to call me “Lumpy Libby,” and he was right. I have been pretty dil-30

It’s funny how many people coming and going in the center were either former neighbors or former co-workers.

There is a real sisterhood among the patients who share the same routines of treatment. I found blessing in it all. The

North

Car-

'Medicaid Survey' continued from p9

good satisfaction with provider relations and the logistics of claims. Items with the lowest satisfaction prior to managed care go live were access to behavioral health and the process for managing grievances and appeals.

person visit, and 81 percent used it when offered.

The North Carolina Provider Experience Survey was developed and administered across all North Carolina primary care practices or their corporate parent to evaluate the influence of the North Carolina Medicaid Transformation on primary care and obstetrics/ gynecology (Ob/Gyn) practices that contract with NC Medicaid. This assessment also explored the experience of providers in early contracting with prepaid health plans (PHPs), as it overlapped with the launch of Standard Managed Care Plans on July 1, 2021. The baseline assessment will serve as a comparison against PHP performance in future years. The full report and a twopage summary are available. Some key findings include:

• When considering contracting with one of the managed care plans, respondents resoundingly prioritized claims and reimbursement, as well as access to specialists and behavioral health for patients.

• In rating satisfaction with the managed care plans prior to go-live with the transition, most respondents rated their interactions as good to excellent, but the survey was administered prior to implementation of managed care.

• When asked about the anticipation for the transition to managed care, most practices felt largely ambivalent to hopeful.

• Systems and practices were generally satisfied with North Carolina’s pre-existing Medicaid program (prior to managed care). Respondents conveyed excellent/

Both of my oncologists are women, helpful, always compassionate, and they are smart! Having excellent medical teams right across town is a blessing. Across North Carolina, there are good medical facilities offering cancer care. Breast cancer research is yielding more targeted, less invasive treatment options. Great strides are being made to prolong life and lessen side effects and unintended consequences of various treatments.

Shortly after my diagnosis, we were at Reynolds Coliseum for a women’s basketball game. It was Kay Yow Night. Survivors walked onto the court at halftime. Oneyear survivors. Two-year survivors on up to ten years and beyond survivors. They were raising awareness and money for the Kay Yow Cancer Research Foundation.

I leaned over to my friend and told her that I had survived for one week. I am still surviving, thriving. I will likely always be a little nervous at mammogram time.

But I will not miss a mammogram. I encourage you not to miss one either.

In North Carolina there are 6,000 women diagnosed with breast cancer every year. An average of 1,000 women will die every year from breast cancer. One in eight women has a risk for breast cancer. Some men have that risk too. Be aware.

Autumn

Very few people know about the journey I have had with2022

breast cancer. I wanted to hold it close and deal with it without gnashing of teeth and rehashing of story. Having lived this experience, my compassion for all who deal with cancer has increased. I know what it’s like now.

I give thanks for good insurance, the availability of good medical facilities, the blessing of competent and welltrained doctors and technicians. I also give great thanks for my friends who have gone through this. Their tips, like Jean’s Cream, their encouragement and advice were precious. And for those who don’t have insurance, county health services can help locate places for anybody to get a mammogram. I stand with Katie Couric, and all the many who have walked this path, in encouraging you to get a mammogram yearly. Early detection improves outcomes. Until this disease is eradicated, we all have a part to do in our own health watch.

If you are going through this now, you have my email. I will walk with you.

Lib Campbell is a retired Methodist Pastor, retreat leader and columnist who blogs at www.avirtualchurch. com. You may contact her at libcam05@gmail.com

'Advocacy Outside of Legislature,' continued from p7 2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

The bottom line: NCAFP is undertaking a breadth of activities to help our members today and in the future. Many solutions don’t come easy, but we continue to take one step at a time to address the issues most impacting your day-to-day practice, following our strategic plan to improve the Practice Environment, Advocate on your Behalf and increase the Workforce of tomorrow.

www.ncafp.com

And I would be remiss if I didn’t mention our involvement in an effort to move the Collaborative Care Model of integrating behavioral health into primary care forward in North Carolina. In late September, partners in the project (from the NC AHEC Program to CCNC to the Pediatric Society to the NCAFP) came together in Asheville just before the NC Psychiatric Association Annual Meeting to celebrate our process so far and continue to make plans to move the model forward. Look for more information on this effort in the sidebar on page 7.

'NCAFP Goes to Washington,' continued from p12 Postpartum care: The COD adopted a reaffirmation of AAFP’s existing policy advocating for dedicated support of postpartum care in the Family Medicine setting noting the crucial role family physicians play in caring for parents and families, especially in the first year after birth.

Practice Enhancement Prior Authorizations: The Reference Committee combined two resolutions seeking to rein in the administrative problems and reverse delays in patient care associated with prior authorizations and recommended the adoption of a measure that called for the AAFP to “advocate for the reduction of prior authorization requirements of health insurance companies through the creation of and adoption of standardized prior authorization criteria.”

After attending my first in-person meeting of the Congress of Delegates, I left with an enhanced appreciation of the many unique issues that affect our physician members and the specialty practice of Family Medicine, a better understanding of AAFP policy making process, and immense pride in our state Chapter and how well we are regarded and represented at a national level.

Non-Profit Org. US Postage

PAID

Pontiac, Illinois Permit No. 592

Stakeholder Metrics: Delegates adopted a measure that called for the Academy to collaborate with stakeholders to develop metrics that measure the physician’s experience with the health insurance company, similar to how CMS measures the patient experience with physicians and to report their performance on those metrics annually.

Impact of Retail Medicine: The COD referred a resolution to the AAFP Board of Directors seeking a way to evaluate the impact of retail medicine’s incursion into primary care.