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Physician-Driven Efforts Drawing Attention to Obesity Epidemic





The Skinny on Milk, Cheese and Yogurt 3-A-Day of Dairy Increases Weight Loss When Part of a Reduced-Calorie Diet Research continues to support the relationship between dairy foods and weight management. In a clinical trial, people on a reduced-calorie diet who consumed 3 servings of milk, cheese or yogurt each day lost significantly more weight and body fat than those who just cut calories while consuming little or no dairy.1 How It Works Cell culture and animal studies provide a strong potential framework to explain dairy’s weight loss effect, part of which has to do with the role that dietary calcium, and potentially dairy protein, may play in lipolysis and lipogenesis. Low-calcium diets have been shown to increase a key calcium-regulating hormone, which in turn increases intracellular calcium concentrations in human adipocytes and results in increased fat storage. Conversely, a high-calcium intake inhibits production of the hormone, thereby decreasing intracellular calcium and ultimately the fat content of fat cells. Moreover, studies in animals and humans show that dairy foods promote substantially greater loss of body weight and fat than calcium supplements.

Benefits Beyond Weight Loss The newly released Dietary Guidelines for Americans also acknowledges the important role of dairy products’ unique nutrient package.The guidelines recommend people consume 3 servings of fat-free or low-fat dairy foods every day as part of a healthy diet. It also recommends dairy products like lactose-free milk or yogurt first for individuals who are lactose intolerant.

Dairy Foods Accelerate Loss of Abdominal Fat1 Results after six-month study 0.0 Change in Waist Circumference (inches)

A Motivating Benefit: Losing Inches in the Waist Research also indicates that including 3 daily servings of dairy in a reduced-calorie diet may help patients lose more inches and burn more fat in the abdominal region.1 Visual results can help motivate patients to decrease a high waist circumference, a trait that indicates abdominal obesity and an increased risk for the metabolic syndrome, hypertension and cardiovascular disease.

-0.5 -1.0 -1.5

Low Calcium (400-500 mg daily)

-2.0 -2.5 -3.0

High Calcium (1200-1300 mg daily) High Dairy (1200-1300 mg daily)

-3.5 -4.0

Motivate patients with what they find important. Adults may lose more inches in the waist when including 3 servings of milk, cheese or yogurt each day as part of a reduced-calorie diet.

To learn more about the body of research supporting dairy’s role in weight loss and to download a free Healthy Weight Education Kit with patient education materials, visit nationaldairycouncil.org. Also encourage your patients to assess their diet at assessyourdiet.webmd.com. Zemel MB, et al. Dietary calcium and dairy products accelerate weight and fat loss during restriction in obese adults. Obesity Research. 2004; 12(4): 582-590.


© 2005 America’s Dairy Farmers. The 3-A-Day of Dairy logo is a mark owned by Dairy Management Inc. ®



3 servings of dairy a day in a reducedcalorie diet supports weight loss. 3aday.org


Ta b l e o f C o n t e n t s Vol 2 • No 1


Changes in Latitudes, Changes in Attitudes



Cultural Diversity in the Physician Office: It’s Time for CLAS!

12 Membership News CME News


Title to come??


Physician-Driven Efforts Drawing Attention to Obesity Epidemic

winter 2006 PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS The North Carolina Family Physician is published quarterly by the NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS P.O. Box 10278 Raleigh, NC 27605 919.833.2110 • fax 919.833.1801 www.ncafp.com 2006 NCAFP Board of Directors NCAFP Executive Officers President J. Carson Rounds, MD President-Elect Michelle F. Jones, MD Vice President Christopher S. Snyder, III, MD Secretary/Treasurer Elizabeth B. Gibbons, MD Board Chair Karen L. Smith, MD, FAAFP Executive Vice President Sue L. Makey, CAE Past President (w/voting privileges) Conrad L. Flick, MD The District Directors District 1 Donald Keith Clarke, MD District 2 Robert Lee Rich, Jr., MD District 3 Victoria S. Kaprielian, MD District 4 William A. Dennis, MD District 5 Sara O. Beyer, MD District 6 Thomas J. Zuber, MD District 7 Shannon B. Dowler, MD At Large R.W. Watkins, MD, MPH At Large Richard Lord, MD IMG Physicians Constituency Ofelia N. Melley, MD Minority Physicians Constituency Claudia E. Gonzalez, MD New Physicians Constituency Jessica J. Burkett, MD Resident Director Jennifer L. Mullendore, MD, (GAHEC) Resident Director-Elect Parker McConville, MD, (GAHEC) Student Director Oritsetsemaye Otubu, (UNC) Student Director-Elect Mary Jean Deason, (UNC) AAFP Delegates and Alternates AAFP Delegate L. Allen Dobson, MD AAFP Delegate Conrad L. Flick, MD AAFP Alternate Mott P. Blair, IV, MD AAFP Alternate George H. Moore, Jr., MD FP Department Chairs and Alternates Chair (WFU) Michael L. Coates, MD Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Valerie J. Gilchrist, MD Alternate (UNC) Warren P. Newton, MD, MPH NCAFP Council Chairs Child & Maternal Health Shannon B. Dowler, MD Governmental Affairs Advisory Robert Lee Rich, Jr., MD Health Promotion & Disease Prev. Mott P. Blair, IV, MD Mental Health Michelle F. Jones, MD Professional Services Brian Forrest, MD Health Disparities Karen L. Smith, MD NCAFP Editorial Committee Chair William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard Lord, MD David C. Luoma, MD

CREATED BY: Virginia Robertson, President vrobertson@pcipublishing.com Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION: Steve McPherson smcpherson@pcipublishing.com 501.221.9986 • 800.561.4686 edition


Foundation News

10 Title to come??

Retirement Plan Insights for Practice Administrators

14 Do You Know the Difference between Fluoride and Sealants? 15 North Carolina Match 2006 15 NC DHHS Secretary Carmen Hooker Odom Honored by Academy

NCAFP Strategic Plan Vision Statement The vision of the North Carolina Academy of Family Physicians is to be the leader in transforming healthcare in NC to achieve optimal health for all people of NC. Mission Statement The mission of the North Carolina Academy of Family Physicians is to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity. Strategic Objectives 1. Health Promotion & Disease Prevention (Health of the Public): Assume a leadership role in improving the health of North Carolina’s citizens by becoming proactive in health promotion, disease prevention, chronic disease management and collaborating in other public health strategies. 2.Advocacy: Shape healthcare policy through interactions with government, the public, business, and the healthcare industry. 3. Workforce: Ensure a workforce of Family Physicians which is sufficient to meet the needs of patients and communities in NC. 4. Education: Assure high-quality, innovative education for family physicians, residents, and medical students that embodies the art, science, and socioeconomics of family medicine. 5. Technology & Practice Enhancement: Strengthen members’ abilities to manage their practices, maintain satisfying careers, and balance personal and professional responsibilities. 6. Research: Develop and promote new medical knowledge and innovative practice strategies through information technology, primary care research and assessment of the practice environment. 7. Communications: Promote the unique role and value of family medicine, family physicians and the NCAFP to the public, business, government, the healthcare industry and NCAFP members.


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CHANGES IN LATITUDES, CHANGES IN ATTITUDES (with apologies and thanks to Jimmy Buffett) by Dr. J. Carson Rounds, NCAFP President It’s these changes in latitudes, changes in attitudes, nothing remains quite the same. With all of our running and all of our cunning, if we couldn’t laugh, we would all go insane. - Jimmy Buffett Toyota is projected to become the number one automaker in the world this year, sixty-one years after the end of World War II. This rise from the devastation of postwar Japan to domination of the automobile market is widely attributed to the Toyota Production System, an integration of W. Edwards Deming’s philosophy of quality and Kiichiro Toyoda’s philosophy of manufacturing. Deming’s philosophy of continuous quality improvement is reflected in Toyota’s philosophy of business, Kaizen. Kaizen, literally translated, means change (kai) to be good (zen). Key elements of this philosophy include quality effort, involvement of all employees, willingness to change, and communication. It emphasizes a continuous learning culture and an expanded role for employees. There is an opportunity for us to apply these principles to our practice of medicine. I have heard that a manager at Kaiser once said that “our doctors know what to do, they just don’t have the time to do it.” I believe that all of us strive everyday to deliver the highest quality care we can, given the system in which we work. It is clear that the system is not designed to allow us to maximize the care we deliver every day. An accumulating body of evidence demonstrates improvements in healthcare outcomes when systems are redesigned to maximize our ability to provide the best-known care for a given illness. The Future of Family Medicine report


outlines a vision of a world where appropriMedical Excellence, CCME, offers help for ately paid Family Physicians function in a those of you who are interested in adopting system designed to provide the best care at an EHR. Through the DOQ-IT program you the best time to the right person, for both can receive free help in evaluating and acute and chronic illnesses. The Institute implementing EHR in your practice. The for Healthcare Improvement envisions a Academy is sponsoring an EHR vendor future where all patients get what they need showcase on April 22 in Charlotte to assist when they need it. A utopian ideal? you as well. AHEC’s website includes the Perhaps, but the adoption of continuous Quality Source (www.ncahec.net/quality) quality improvement strategies and a serious where you will find a wealth of information look at the structure of how we deliver care about quality improvement activities in can certainly move us closer to that goal North Carolina, including links to the NC than where we are now. Frustrated physiCenter for Hospital Quality and Patient cians and frustrated patients could find satSafety, the Quality Council of North isfaction again in the transformation of a Carolina, and seminars on quality improvesystem that seems hell-bent on destroying ment. The North Carolina Medical any semblance of a rational way to provide Society’s Physician and Patient Resource for anyone’s health care needs. Center ( www.ncmedsoc.org/pages/prc/National and local resources are available prc.html) is another excellent resource. to help your practice become a Kaizen pracYour Academy is intimately involved in tice? Nationally, the AAFP Performance two other resources for quality improveImprovement Program has been piloted in ment: IPIP and CCNC. several states. A team of representatives Improving Performance in Practice, or from a practice – physician, nursing, and IPIP, is a three-year project of the national clinical team members – spend a I believe that all of us strive everyday to weekend learning how to lead the deliver the highest quality care we can, given organization through the system in which we work. It is clear that the quality improvethe system is not designed to allow us to ment process. maximize the care we deliver every day. Preparation before the meeting, follow up support after the meeting, and another weekend together specialty Boards of Family Medicine, round out the program. We hope to have the Pediatrics, and Internal Medicine in conprogram brought to NC early in the process junction with the national specialty sociof expansion from a pilot program. Many eties, including the AAFP. Colorado and tools are available on the AAFP website North Carolina were the states chosen for (www.aafp.org) for you to use if you want to the project. In North Carolina, under get started now. The Institute for Healthcare Warren Newton’s leadership, the NCAFP, Improvement website (www.ihi.org) is NC Pediatric Society, AHEC, the American another excellent resource online. College of Physicians, CCME (previously There are a number of resources here in MRNC), the Chronic Disease section of the North Carolina. The Carolinas Center for NC DPH, the Office of Rural Health, the

North Carolina Academy of Family Physicians

Community Care of North Carolina (CCNC) leadership, and recently NCMS leadership have all been meeting to develop this collaborative project. It will focus on developing collaborative improvement networks, webbased improvement modules, and collection of quality improvement data. The model under consideration will bring expertise to your office to assist you in your efforts at quality improvement and practice redesign. Local physician input and guidance are crucial to the design. The first phase of the project will enroll 16 practices, with plans to add another 50 practices in the second and third years of the project. It is hoped that what we learn in the project will be expandable and scaleable on a statewide level. Perhaps the best place to learn about continuous improvement in Medicine in North Carolina is the Community Care network. Under the leadership of former NCAFP President Dr.Allen Dobson, CCNC has grown into one of the most respected Medicaid programs in the country. Practices that participate in CCNC learn a great deal about continuous improvement; the Deming cycle, Plan Do Study Act, forms the basis for all CCNC does. Efforts to improve the quality-of-care in the network follow the steps of planning ahead and predicting results, doing an example with a small controlled change, studying the results, and acting to standardize or improve the process. The “employees,” the physicians and practices in the networks, are intimately involved in the process. In fact, the process ensures that the providers of the care are the ones who identify the need for change and then bring about the change. Results are communicated with colleagues who can adopt best practices rather than edicts being issued from a central office far removed from the actual delivery of care. If you see Medicaid patients but are not a member of CCNC, you owe to yourself, your practice, and your

patients to get involved. I believe the value of the learning and improvement in your practice would be sufficient for you to become a Medicaid provider through CCNC if you do not see any Medicaid patients now. You are not likely to find a better resource to help you transition your practice into the New Model practice described in the Future of Family Medicine report. While you are doing that, remember to take care of yourself. I keep hearing the words ‘overwhelmed’ and ‘frustrated’ to describe so many of us today. Yet, personal conversations with overwhelmed, frustrated family docs almost always reveal a profound and deep sense of caring, dignity, and satisfaction in the day-to-day interaction with patients. The environment we are working in now is toxic to us and to our patients. We need to reach out to each other, get together with each other, and talk about the things we like about medicine, the things that excite us, the things that fuel the passion lurking inside us. Ours is an awesome profession, a fearful profession, a grieving profession, a joyous profession, a hopeful profession, and a caring profession. We profoundly impact many lives everyday, and are in turn profoundly affected ourselves. I encourage all of you to visit www.findingmeaninginmedicine.org and explore the idea of forming a community of support during these stressful times. If we don’t laugh, we will go insane. My office team will tell you that I am eternally optimistic, even if I do get grumpy and sometimes enraged at the lengths I have to go to to do what is right for my patients. It is hard to imagine doing things differently than I have since I started this wonderful journey called Family Medicine. But my eternally-optimistic self knows that the cur-

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rent system cannot continue like it is. The American College of Physicians recently issued what is essentially their version of the FFM report. They noted the impending demise of general internal medicine if nothing changes. W. Edwards Deming said we don’t have to change; survival is an option. We can survive, thrive, and maybe even get back to position where we don’ t have to fight to do what is right. We will have the data we need to show that the care we deliver is the right thing to do. CCNC has a jump start on the process. If you are participating, thank you. If you are involved in redesign on your own, thank you but consider coming aboard anyway. If you are still trying to figure out what to do to survive and have a good personal quality of life, I encourage you to contact CCNC. We have a bright future if we can just hold on and come together. Let’s adopt Kaizen and produce the number one healthcare system in the world. Oh, yesterday’s over my shoulder so I can’t look back for too long. There’s just too much to see waiting in front of me, and I know that I just can’t go wrong. - Jimmy Buffett Changes in Latitudes, Changes in Attitudes


Cultural Diversity in the Physician Office: It’s Time for CLAS! Picture this: A Hispanic father brings his eighteen-year old daughter into the emergency room early Saturday morning. The daughter has overdosed on her antidepressant medication and the hospital staff suspects a suicide attempt. The father and daughter have limited English proficiency, which resulted in a misinterpretation of the medication dosing instructions. Once in English, means eleven in Spanish. How could this situation have been avoided? Patients with a variety of languages, customs, and beliefs utilize the healthcare delivery system every day. In North Carolina, the fastest growing population is Hispanic. Nearly half of America’s population will be from cultures other than non-Hispanic white within fifty years. To deliver culturally competent care and meet the needs of these patients, healthcare providers must gain new skills and understanding. Increased cultural awareness can improve patient satisfaction and compliance while preventing medical errors. The Carolinas Center for Medical Excellence (CCME), formerly Medical Review of North Carolina, is offering web-based cultural competency training designed to help primary care providers learn skills that enhance their communication with diverse patient populations. This training also orients healthcare providers to the national Cultural and Linguistically Appropriate Services (CLAS) standards and related requirements for physicians receiving federal funds. Basic care processes such as making a diagnosis, explaining care options and obtaining informed consent can be affected by cultural and language differences. Web-based CLAS training will enhance your evidence-based strategies to overcome these barriers.

(This still needs a headline) The new AAFP Commission on Continuing Professional Development met for the first time on January 19 - 22 in Phoenix, Arizona. The group had a very productive meeting, covering the scopes of the former Committees on Scientific Program and CME Accreditation. A major focus of the group is to move CME credit away from "seat time" in lectures to activities with greater variety and educational impact. Changes were also made to improve consistency between AAFP and AMA CME credits. Proposals from the Commission which were approved by the AAFP Board of Directors in March include: 1. Credit for manuscript review - members serving as peer reviewers for journals may claim up to 3 prescribed credits per manuscript, with a maximum of 15 credits per year. 2. Point of care learning -- members using approved point-ofcare learning providers may claim up to 0.5 credits per Internet search, with a maximum of 20 credits per year.


Do you have the tools you need to provide patient-centered care to your diverse patients? Would you like to know more about the needs, behaviors, communications systems, and values of the diverse patients you serve? Contact us for more information about CCME’s CLAS initiative. Visit www.mrnc.org/ncdisparities or contact project manager, Franzi Rokoske, 800-682-2650, ext. 2070, HYPERLINK "mailto:frokoske@ncqio.sdps.org" CLAS@ncqio.sdps.org.

By Victoria S. Kaprielian, MD

3. Test-item writing -- members writing exam questions for NBME, ABFM, or peer-reviewed, published, self-assessment activities may claim credit for these activities. 4. Relevant topics on physician health and well-being will be eligible for AAFP elective credit. Topics that include learning objectives about positive impact on patients and modeling healthful behavior as part of the treatment regimen will be eligible for Prescribed credit. 5. CME requirements will be simplified to establish all per election cycle (as contrasted to the current system where some requirements are annual, and others by election cycle). Plans for the 2006 Annual Scientific Assembly are proceeding well, and will include a rally on the National Mall to draw legislative attention to issues of importance to members and our patients.

North Carolina Academy of Family Physicians

Physician-Driven Efforts Drawing Attention to Obesity Epidemic The Academy's Adolescent Obesity Initiative has now entered a new phase with the project concentrating on counties that have family physician-cooperative extension service teams already in place. Funded by a grant from the N.C. Health and Wellness Trust Fund, the project established physician-agent teams in 15 counties across the state. The extension agents serve as a referral source for adolescent patients deemed obese or at risk by their family physician. The new phase of the effort is seeking to determine what are the key variables for success when establishing relationships with community referral sources. The current effort also hopes to better understand barriers to successful partnerships in order to establish outlines for overcoming such obstacles.

The goal is to teach the students skills so they are better equipped to make healthier choices when they are eating. Some of the recent county efforts have included celebrating Healthy Weight Week in New Hanover County and participation in a school-wide nutrition program in Nash County. In New Hanover County, Dr. Belinda McPherson's office celebrated Healthy Weight Week on January 19th. Dr. McPherson opened the event with a brief introduction and overview of the childhood obesity epidemic in North Carolina. Dianne Gatewood, the New Hanover County cooperative extension agent, followed with a cooking demonstration. After the demonstration, participants had their heights and weights measured and their BMI calculated. A computer set up with the Fast Food and Families CD was accessible for participants to interactively visit fast food restaurants and choose more healthier options than they might normally. Gatewood has plans for a series of weekly classes that will take place in Dr. McPherson’s office.

In Nash County, Dr. Nadine Skinner is participating with a school-wide program called Friends Unraveling Nutrition (FUN). FUN is a 12-week program for middle school and high school students who have been declared at-risk because they are overweight or obese. The program is voluntary, with a weekly session during school hours. The goal is to teach the students skills so they are better equipped to make healthier choices when they are eating. Dr. Skinner plans to speak with the parents of the adolescents at a session as a part of this effort. Her session will include a discussion of the health consequences of poor nutrition and inactivity in hopes to motivate both the parents and the adolescents. These counties are just two examples of unique physiciandriven efforts to bring community attention to the growing problem of adolescent obesity. The Adolescent Obesity Initiative project staff would like to thank the following physicians for their continued participation: Tamara Babbs, MD Mott P. Blair, IV, MD Jack Cahn, MD Bill Carr, MD William Dennis, MD Mary Digel, MD Shannon Dowler, MD Elizabeth Gibbons, MD Al Hawks, MD Peter Jacobi, MD Colin Jones, MD Belinda McPherson, MD Maureen Murphy, MD Tommy Newton, MD Karen L. Smith, MD Susan Snider, MD Chris Snyder, MD Nadine Skinner, MD

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FOUNDATION NEWS NCAFP Foundation Gearing Up for Silent Auction!! The tradition continues! The NCAFP Foundation is gearing up for its 2006 Silent Auction to be held during the Winter Family Physicians Weekend at The Grove Park Inn Resort & Spa in scenic Asheville, November 29 – December 3. Don’t be left out! Be a part of the fun by donating something special. Do you know of a hotel or charming bed & breakfast that you want to share with us? Or perhaps you have a special talent, such as woodworking, quilting, painting? Maybe you’ve got that “dark horse” tucked away in your attic that you’d like to donate? You might want to contact your college for sports memorabilia. All donated auction items are tax deductible, and the proceeds go towards the various NCAFP Foundation programs and projects. Be a part of the tradition! Look for more publicity on this year’s Silent Auction in the coming months. If you’re interested in how you can be a participant, contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com. Thank you!

THANK YOU FOR YOUR SUPPORT! The NCAFP Foundation extends a special “thank you” to all our members who made individual contributions in 2005. With programs designed to meet the needs of children, adults and seniors, we are fulfilling our mission of providing quality healthcare to the people of North Carolina. With projects designed specifically for medical students, we are showing them that the specialty of Family Medicine is a worthwhile choice. Please join your colleagues and make a contribution towards the future of Family Medicine. Make a contribution to the NCAFP Foundation! For more information on how you can make a donation to the NCAFP Foundation, contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or


mrosol@ncafp.com. You can also visit the NCAFP Foundation at www.ncafp.com. Thank you for your support!

HELP THE FUTURE OF FAMILY MEDICINE – JOIN THE NCAFP LEGACY LEAGUE! The North Carolina Academy of Family Physicians Legacy League is established to recognize those who make provisions through their estate for the North Carolina Academy of Family Physicians Foundation, Inc. By making such a planned gift, members of the Legacy League help ensure that the Foundation will have the financial resources to provide vital programs and services to future generations. The NCAFP Foundation relies primarily on annual financial support to implement its programs. We also encourage consideration of gifts that can endow one of our existing programs or endow a new program. The financial needs of the Foundation increase as the need for more programs arise, and the Foundation must keep pace by continually increasing its annual program funds. A planned gift can help the Foundation make a significant difference for the future of Family Medicine. Planned giving enables donors to create a living memorial that will continue their support, even after their lifetime. For information on how you can become a member of the Legacy League, please contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com.

FOUNDATION SCHOLARSHIP PROGRAM The NCAFP Foundation wants to help our North Carolina medical students! All NC medical students are eligible to apply for one of four scholarships in 2006.

Applications are due in the Foundation office by May 1, 2006. There is still time for you to apply for a scholarship. Applications are available through the four FMIG programs or you can download them on the NCAFP website (www.ncafp.com). For more information on student scholarships, or how you can make a donation to the Scholarship Program, please contact Peter Graber, Programs Coordinator, at (800) 872-9482 [NC only], (919) 833-2110, or HYPERLINK "mailto:cayscue@ncafp.com" pgraber@ncafp.com.

VISIT THE FOUNDATION ON THE WEB! Pay a visit to our web site at www.ncafp.com and discover more about the NCAFP Foundation. You’ll be able to read all about our programs and projects, and how you can get involved!

THE FOUNDATION VALUES ITS CORPORATE MEMBERS! The NCAFP Foundation’s Corporate Members are important to us! Their participation and support are crucial to what we do, and we are proud to include them as part of our Foundation family. Thank you to our 2005 Corporate Members – we couldn’t do it without you!!

MAKE A SPECIAL GIFT You can honor or memorialize a colleague, friend or family member with a gift to the NCAFP Foundation. By making a special designation, the Foundation will send a card to the family of the deceased, individual or organization being honored. The card will show your name as the donor, but not the amount of the contribution. To make your special, tax-deductible gift, contact Marlene Rosol, Development Coordinator, NCAFP Foundation, (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com. Thank you!

North Carolina Academy of Family Physicians


THANK YOU TO OUR 2005 CORPORATE MEMBERS! WE COULDN’T DO IT WITHOUT YOU! Grand Patrons First Citizens Bank, Raleigh, NC* NC Academy of Family Physicians, Raleigh, NC* Supporters ECR Pharmaceuticals, Richmond, VA** MAG Mutual Insurance Company, Atlanta, GA** MedCost, LLC, Winston-Salem, NC* Moses Cone Health System, Greensboro, NC* Misys Healthcare Systems, Raleigh, NC* Rudy L. & Joyce B. Snow, Pharmaceutical & Sales Marketing Consultants, Stanfield, NC* *Corporate Members – Unrestricted **Corporate Members – Restricted

To find out more, or to speak to an Army Reserve Health Care Recruiter, call 800-785-8867 or visit healthcare.goarmy.com/hct/51

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SHAP E \* M ERGEFOR MAT The North Carolina State Health Plan (SHP) is pleased to announce a new initiative called North Carolina HealthSmart, a program designed to help members stay healthy and to support physicians as they care for members with chronic medical conditions. One of NC HealthSmart’s goals is to encourage the 590,000 SHP members to partner more closely with their physicians when making informed health care decisions. What is HealthSmart? NC HealthSmart is a healthy living initiative that aims to: • Help the SHP members with chronic diseases or disease risk factors better manage their health • Empower healthy members to stay healthy • Offer integrated, cutting edge resources and programs to members at work, at home and through their health care provider How does HealthSmart assist physicians? NC HealthSmart embraces the Shared Decision Making® principle that the best clinical decisions are shared between physicians and their fully informed patients, utilizing the best available clinical evidence,


blended with patient’s values and preferences. NC HealthSmart will target diabetes, asthma, coronary artery disease, chronic heart failure and COPD. By offering SHP members “whole person” Health Coaching, members can gain insight about their conditions and support while following their physician’s treatment plan. By offering decision support, members can more fully understand their treatment options and have a fully informed dialog with their physicians when making certain treatment decisions. This results in more adherent, satisfied and educated patients with improved outcomes. In addition to working with members, the NC HealthSmart initiative will be offering support to physician practices. Clinicians, knowledgeable about NC HealthSmart, who have lived and worked in North Carolina, will be available to meet with physicians and their office staff to provide additional program information and a variety of practice aides. Please look for them soon. NC HealthSmart is a free, voluntary service for eligible* North Carolina State Health Plan members.

We invite you to communicate feedback or concerns, or to refer a member for Health Coaching by calling the NC HealthSmart Provider Support Line at 1-800-819-7075. *Members of the State Health Plan of North Carolina, including active employees, retirees, and enrolled dependents, are eligible for NC HealthSmart as long as they are not eligible for Medicare or COBRA. Shared Decision Making® is a trademark of the Foundation for Informed Decision Making. Used with permission. ©Health Dialog 2006.

North Carolina Academy of Family Physicians

Retirement Plan Insights for Practice Administrators introduced – The Mutual Fund Reform Act of 2004. The repeal of rule 12b-1 was contained within the bill but it did not pass. As an investor, you should know that once a broker sells a mutual fund with a 12b-1 fee, they continue to receive 12b-1 fees annually, as long as the fund is held. Over the years, this will have an impact on returns because you are charged the 12b-1 fee directly by the Mutual Fund Company. Make sure you include the 12b-1 fee in your comparisons of mutual funds – or better still, avoid mutual funds with 12b-1 fees, since there is no evidence to support the claim that funds with 12b-1 fees produce higher returns.

Practice Administrators have a myriad of subject matter areas where they need to be well versed. One area that is complex, ever changing, and holds perils of personal liability is the company retirement plan. Practice Administrators frequently act as plan administrator. As such, they have fiduciary obligations that involve due diligence in selecting advisors. They also must ensure that they select an advisor that is independent and competent in fulfilling the advisor role. Sometimes plan administrators rely too heavily on the advisor (or more often, broker) to provide full disclosure of the parties involved. This can lead to a breach of fiduciary obligations. This article will help the plan administrator (be it the Physician owner or Practice Administrator) become better informed on issues regarding disclosure of conflicts of interest. Recall that under ERISA, a plan sponsor and plan administrator must not only identify conflicts of interest, they must avoid them.

THINGS TO WATCH FOR HIDDEN FEES Do any of the plan mutual funds have 12b-1 fees? If so, it may serve as a conflict of interest with the advisor and reduce their ability to assume a fiduciary role. You should ask your advisor why you have funds with 12b-1 fees anyway. This is an ongoing fee paid by the Mutual Fund company to a brokerage for marketing the fund. When the 12b-1 fee was introduced by the Securities Exchange Commission (SEC) in 1980 it was supposed to help Mutual Fund Companies pay for advertising in order to grow their funds so that some economies of scale could lower the ongoing management costs. We have seen that many of the funds charging 12b-1 fees have grown considerably in size, but we frequently do not see a corresponding reduction in the size of the 12b-1 fee. Alternatively, witness the existence of thousands of no-load funds (with no 12b-1 fees either). Clearly 12b-1 fees are not necessary, and clearly they do nothing to help the consumer. For this reason, the SEC considered repealing 12b-1 fees in 2004. In parallel with this, a bill was

COMMISSIONS If any products inside the plan are mutual funds with class A, B or C, your participants are paying sales loads (commissions). Leaving aside for a minute that there is no evidence to conclude that mutual funds with loads perform better than no-loads, the presence of commissions helps to ensure the advisor does not take much (if any) of the fiduciary responsibility due to conflict of interest. You’re on your own here. SETTING YOURSELF UP TO PAY A HIGHER TAX RATE As practice administrator, you may have been hired because of great business breadth and depth, but you probably were not hired to be a tax expert. We are not suggesting you need to be either. We are, however, suggesting you be mindful of some basic tax implications to retirement plans, and more importantly, that you hire an advisor that educates the plan participants about the impact to their investment on poor tax planning. Here is a rudimentary fact that is frequently not taken into consideration. Federal personal income tax rates on long term capital gains, and on dividends, are only 15%. Yet, the same investments (those that are equity-based i.e., stocks and mutual funds holding stocks) held inside your company retirement plan will be taxed at personal income tax rates when withdrawn. Most Physicians are in the 33% federal personal income tax bracket or higher. Would they rather pay 33% or 15% in taxes? Some of you may be thinking that this argument does not hold water because the purpose of the retirement plan is to defer income tax to the future, when personal tax rates are assumed to be lower. Good point. Now consider this: if the Physician is planning on living comfortably in retirement, they are still going to be drawing enough from their retirement plan to pay more tax than 15% in taxes (hopefully, so will you). In addition, the current status of the nation’s fiscal situation (ballooning debt, aging population, plummeting national savings rate, lowest personal income tax structure in decades, pending social security & medicare solvency crises) mean there is considerable chance we will see higher marginal income tax rates in the future. We’re not saying you should not hold any equities in your retirement plan (read: deferred savings plan), but you need to be aware of the tax implications of your asset allocation decisions. Certainly your advisor needs to educate plan members about this and other facts.

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MEMBERSHIP NEWS Reelection News If you were last reelected in 2004, you have until the end of 2006 to report 150 hours of CME in order to maintain your Academy membership. Requirements include at least 75 AAFP prescribed credit hours, a minimum of 25 group learning activities, no more than 25 from enrichment activities, plus caps on other activities. Hours reported should be obtained between January 1, 2004 through December 31, 2006. For further details, review the AAFP CME Requirements for Members reprint 101 or visit www. ncafp.com or www.aafp.org. You can also call the AAFP at 800-274-2237 or the NCAFP at 919833-2110 or 800-872-9482.

Membership Tidbits Did you know that there are seven categories of AAFP membership? Each classification carries certain privileges, terms of membership, requirements and, of course, dues. Once an individual elects to join the organization, then he or she will be designated as a Student, Resident, Active, Supporting, International, Inactive or Life member. The NCAFP is permitted to have members in all categories except International. Remember – membership in the AAFP and state chapters is unified. Once you join the national organization (AAFP), you are required to belong to the state (constituent) chapter. We are pleased to report that the NCAFP has over 2,600 members!

KEEP US UPDATED! Members – please be sure to keep all of your contact info up to date! This includes your home and business address, phone, fax, and email address. To update, contact Marlene Rosol, NCAFP Membership Coordinator, at mrosol@ncafp.com, 919-833-2110 or 800-872-9482.

NCAFP 2006 CME CALENDAR Spring CME Lowdown Recap If you did not register for the Spring Family Physicians Weekend in Charleston, South Carolina, you missed out on a wonderful program with over 8 evidence-based lectures --double-CME credits! Registrants earned up to 30 prescribed credits during this short weekend getaway. On Saturday, lectures ended at 1:15 pm to allow registrants and families to explore Charleston with evening dine around options. The Cosmetic Procedures and Chronic Low Back Pain workshops were available at no charge to registrants, along with Insulin Therapy and Joint Injections workshops available at a nominal fee. Congratulations to Dr. Greg Pleasants for an outstanding program!

Tell Us What You Think of Our SAMs Study Halls? SAMs (Self-Assessment Modules) Study Halls are part of the NCAFP’s plan to assist members with completing the ABFP Maintenance of Certification program for family physicians. The objective of the study hall is to review the 60 objective questions divided into several competencies. Members are being encouraged to e-mail the Academy Meetings Department at HYPERLINK "mailto:mellis@ncafp.com" mellis@ncafp.com of your interest in continuing developing these seminars.

NEW TO THE CME Calendar MID-SUMMER FAMILY MEDICINE DIGEST- Plans are underway for a wonderful Fourth of July week-long Summertime Getaway for CME, July 2 – 8, 2006 at the Kingston Plantation – Embassy Suites, Myrtle Beach, SC. Participants can earn up to 36 prescribed credits (evidence-based credits for portions of the program are still pending). Dr. Sara Beyer has planned an outstanding program; please continue to check our website up-todate information, www.ncafp.com WINTER FAMILY PHYSICIANS WEEKEND- Grove Park Inn, November 30 – December 3, 2006. Dr. Kevin Burroughs, Program Chair for our Annual Meeting, has begun with the preliminary planning of this wonderful winter program. Don’t forget to make your reservations early at the Grove Park Inn; October 19, 2006 is the cut-off date.


North Carolina Academy of Family Physicians

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D o You Know the Difference bet w e e n Fluoride and Sealants?


he Centers for Disease Control state that fluoride and sealants are the most effective ways to prevent dental decay, but each is unique in the way it works. Dental sealants are thin, plastic coatings applied to the tops of the permanent back teeth (molars and premolars). They prevent bacteria from getting into the pits and grooves of these teeth and causing cavities. Sealants are permanent, although they should be checked regularly by a dental professional to make sure they remain in place. Children who have sealants placed between the ages of 5 and 15 will have the most benefit. Topical fluoride works differently from sealants by stopping or even reversing very continued from Page 11

PREFERRED FUNDS Ask your advisor if they or their company receive any remuneration in any form (trips to Maui, BMWs, Rolexes etc) from fund companies. There are brokerages that have charged mutual fund companies for the privilege of being called a preferred fund company. This status may lead to improved access to the sales force (brokers). Failure to disclose this- or any similar arrangement leads to a clear conflict of interest. TRADING COSTS When a plan participant sells mutual fund shares (redeems them back to the fund company), they do not directly incur a fee/cost for the trades that must be done to sell the stocks that make up the fund. Instead, the remaining fund holders pay for it. In this manner, any short-term trading of the fund hurts returns of the long term fund holders. For Mutual Funds with high turnover (a great deal of buying & selling), fund holders may see up to 1% of the value of the fund lost annually to trading costs. Trading costs are not disclosed in the fund prospectus so the investor has no ability to know in advance what will be lost to trading costs. You may, however, ask for the “Statement of Additional Information” (SAI). Sometimes the SAI will disclose trading costs for the 14

early tooth decay. It prevents the loss of important minerals from the tooth enamel, keeping the tooth hard. Topical fluoride must come into contact with the tooth enamel at regular intervals to be most effective. Children and adults of all ages benefit from fluoride, with the recommended type and amount determined by individual caries risk. You can play a part in preventing cavities in very young, high-risk children by providing oral screening, parent education, and fluoride varnish. Medicaid is reimbursing physicians to perform these procedures (up to a maximum of six times) for covered children under age three. Analysis has shown that children receiving 4, 5, or 6 procedures have significantly fewer dental fund in a previous year. Look for funds with trading costs as low as possible – ideally less than 0.4% of the fund’s value per year. This should be something your advisor analyzes and discusses with you. BROKER OR ADVISOR You must know whether the person(s) you are working with to provide the plan are brokers or advisors. Ask them to disclose their role in writing. Brokers will vehemently deny any fiduciary responsibility when among themselves, but some have been known to muddy the waters when it comes to a clear distinction of their role when they are in front of clients. The Financial Planning Association has brought suit against the SEC in allowing Merrill Lynch to continue to call their brokers advisors. An Advisor is an individual licensed to provide investment advice and representing a Registered Investment Advisor. Advisors have a legal obligation to act in the best interest of their client (1940 Investment Advisor Act). Brokers do not. OTHER SOURCES OF CONFLICT: ERISA states that you must have an advisor that is independent and validate the product providers (mutual funds companies) performance results. This means your advisor must not be in any way affiliated with the mutual fund companies represented in the plan- unless you hire a separate independent

treatment needs than children who do not receive the service. Training is available in your office at no charge by contacting Kelly Haupt, Into the Mouths of Babes Project Coordinator at 919-707-5485 or kelly.haupt@ncmail.net advisor. If the advisor recommends products that are proprietary, you need to understand the implications to your fiduciary role. We recommend avoiding proprietary products because they serve to lock-in the client by preventing them from transferring those assets elsewhere. Does this practice serve your participants well, or the brokerage? Plan sponsors and plan administrators must not accept services that are not offered to all participants- if the services are offered within the plan. A clear ERISA violation, but some brokers try to offer this as a selling feature. SUMMARY We have provided insight into areas that may become problematic for plan sponsors and administrators. Many of these areas are not disclosed very well and indeed should be. The securities industry is under fire from regulators (Spitzer et al) in part because of poor disclosure, and in part for failure to perform the role of fiduciary. It is our hope that the pressure to reform and provide improved transparency continue. Jeff Seymour is Managing Director of Triangle Wealth Management LLC. His practice works solely with Physicians and Dentists in personal financial planning, wealth management, asset protection, and procurement consulting. He may be reached from their website (www.doctorwealth.com ), or at 919 469 3600.

North Carolina Academy of Family Physicians

NORTH CAROLINA MATCH 2006 According to the AAFP, the 2006 Match placed 26 more candidates in family medicine residencies this year, giving the specialty a slight uptick in numbers for the third year in a row. The 2,318 applicants who matched into family medicine residencies filled 85 percent of available positions, a higher Match fill-rate than the specialty has had since 1998. When compared to last year (2005), the same number of U.S. medical school seniors -- 1,132 -- matched into family medicine residencies this year. US seniors filled 41.5 percent of the 2,727 available positions this year, a percentage that has stayed steady for four years. Within North Carolina, the Match results held steady as compared to 2005. The following table lists each state program and the results as reported at time of publishing. 2006 MATCH RESULTS BY PROGRAM Program Cabarrus Camp Lejeune Naval Hospital** Carolinas Medical Center – Charlotte Carolinas Medical Center – Rural Duke SRAHEC MAHEC – Asheville MAHEC – Hendersonville UNC Moses Cone ECU New Hanover WOMACK** WFU

# Offered via Match 8 12 8 2 6 4 9 3 8 7 10 4 10 10

# Filled via Match 4* 11 8 1 2 3 9 1 8 7 10 1 10 10

#Filled via Scramble 1 0 0 1 2 0 0 2 0 0 0 3 0 0

# Total Slots Filled 5 of 8 11 of 12 8 of 8 1 of 2 4 of 6 3 of 4 9 of 9 3 of 3 8 of 8 7 of 7 10 of 10 4 of 4 10 of 10 10 of 10

* 3 filled prematch candidates who did not want to participate in the Match, for a total of 5 of 8 slots filled. ** Do not participate in National Match Program.

N C D H H S Secret a r y C a r m e n H o o ke r O d o m H o n o r e d By A c ademy Each year, the NCAFP recognizes individuals whose work and efforts make significant impacts on improving healthcare. NC's Secretary of Health and Human Services Carmen Hooker Odom was honored by the NCAFP on April 8, 2006 at the Spring CME Lowdown in Charleston, SC and presented with an NCAFP Distinguished Service Award for her progressive leadership. Appointed by Governor Easley in 2001, Hooker Odom has been a strong supporter and advocate for enhancing primary care access to citizens in North Carolina. She's also been a visionary who's recognized that big risks bring big rewards. Early on Secretary Odom saw the power that coordination and

integration can have on managing complex disease. Today, our state has one of the most advanced care management networks in the country with Community Care. There's numerous other ways she's made an impact. All of them demonstrate a clear passion, a clear purpose and a clear understanding. Her progressive and inclusive leadership style has enabled her to take action and improve many critical areas, as well as to embrace innovative concepts.

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