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NCAFP Presid Presid Vice P Secreta Board Execut Past P The Dist Distric Distric Distric Distric Distric Distric Distric At Lar At Lar IMG P Minori New P FM D FM Re Reside Reside Studen Studen AAFP D AAFP AAFP AAFP AAFP FP Depa Chair ( Altern Altern Altern NCAFP Child & Govern Health Mental Profes Health NCAFP Chair

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Vol 3 • No 2

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

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Presidents Message

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Exchange Traded Funds (ETFs) Versus Mutual Funds

By Jeff Seymour CFP®

NCAFP Forms Partnerships to Advocate for Physician Needs

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Effectiveness of Tar Wars Youth Tobacco-Free School Education Program

Adolescent Obesity & Inactivity Project: 2006 YearIn-Review

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American Board of Family Medicine Sleep Medicine CAQ Approved by the ABMS

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2007 Match Results by Program

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2007 NCAFP Board of Directors NCAFP Executive Officers President Michelle F. Jones, MD President-Elect Christopher S. Snyder, III, MD Vice President Robert Lee Rich, Jr., MD Secretary/Treasurer Elizabeth B. Gibbons, MD Board Chair J. Carson Rounds, MD Executive Vice President Sue L. Makey, CAE Past President (w/voting privileges) Karen L. Smith, MD, FAAFP The District Directors District 1 Donald Keith Clarke, MD District 2 Christopher B. Isenhour, 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 Rafael G. Torres, MD Minority Physicians Constituency Suzanne E. Eaton Jones, MD New Physicians Constituency Jana C. Watts, MD FM Department Constituency Michael L. Coates, MD FM Residency Director Stephen Hulkower, MD Resident Director Parker McConville, MD, (GAHEC) Resident Director-Elect Tamieka Howell, MD, (GAHEC) Student Director Mary Jean Deason, (UNC) Student Director-Elect Carrie Hamby, (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 Karen L. Smith, 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: Greg Jones gjones@pcipublishing.com 501.221.9986 • 800.561.4686 edition

NCFP

Ta b l e o f C o n t e n t s

Winter 2007

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NCAFP Legislative Advocacy Activities in Full Swing ICARE Partnership to Sponsor Evening Meeting on May 10

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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Presidents Message Dr. Michelle F. Jones, 2006-07 NCAFP President

Soon after the NCAFP’s annual meeting, your leadership was invited to attend a forum of the North Carolina Institute of Medicine. The topic was Primary Care and Specialty Workforce. The Institute has been working on this issue for nearly one year and we were asked to review the recommendations and make comments.

The Institute has concluded that the growth in the supply of ‘providers’ (they include PAs, NPs and nurse midwives) has not kept up with the growth in the demand for medical care and services.

The conclusion is that the state has one of two options: 1) “restructure the healthcare delivery and finance system to create new and more efficient systems of care” or 2) “increase the provider supply”.

Many of you may remember a document released by our Academy some 12 or more years ago entitled ‘Who Will Care for Our People?’ It was a red flag to the legislators and academic community from family physicians in this state who realized that the population was increasing, growing more aged and sickly, and that fewer medical students were choosing primary care and family medicine as a career. Sadly, there was no response, but this was the age of managed care and we did see a small increase in family medicine match rates. Then, six years ago another red flag was sent from family physicians entitled, ‘Who Will Care for Our Communities?’ Since that time our population has doubled, became on average older, and we find significant mal-distributions of healthcare leaving many communities and peoples disparaged. Unfortunately, both of our calls went unheeded. It is no surprise to us that the Institute of Medicine has researched the issue and found that even if we begin training more primary care and family physicians today, there will still be a deficit in the providers of first-line care. Our answer: THERE ALREADY IS AND THERE HAVE BEEN too few family physicians to provide a medical home for all of the state’s citizens.

Present at the IOM meeting were academic leaders of our four medical schools. There was significant discussion about increasing class size in each of these institutions, but none stated an interest in training more family physicians (with the possible exception of ECU). For many years the legislature has required a reporting of the specialty selection of the senior classes of each school. However, this is a reporting of the match at graduation and does not take into account a student who matches in general internal medicine for a preliminary year only to go on to match in dermatology; or the general pediatrician who decides to sub-specialize in neurology.

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And there is no penalty to schools who graduate less than 50% in the primary care specialties.

The American Association of Medical Colleges and the American Medical Association have recommended a graduation rate of 50% primary care and 50% specialty care. This is not happening in our state and has contributed to the current shortage of primary care providers.

Also present with the academic leaders was James McDeavitt, MD, Senior Vice President of Education and Research at Carolinas Healthcare System in Charlotte. There has been talk of UNC collaborating with Charlotte to help train the increased numbers of medical students in the 3rd and 4th years of school. Our leadership asked the academic administrators if there would be requirements on admission or at the match for these students to go into primary care fields.

Their answer was that they had considered it and thought it would be best to allow students their choice of specialty.

The American Association of Medical Colleges and the American Medical Association have recommended a graduation rate of 50% primary care and 50% specialty care. This is not happening in our state and has contributed to the current shortage of primary care providers.

If past history is a predictor of the future, the plight of primary care in this state will only worsen and North Carolina citizens will have to pay more for a healthcare system in which they receive care that is fragmented and reactive, not preventative or comprehensive.

The IOM has been inclusive in its assessment of primary care providers and has included PAs, NPs and nurse midwives in its recommendation to increase the numbers of these individuals. The IOM calculates the physician extender as ½ the FTE of a physician since this is how they are calculated in the federal workforce programs.

(Some physician assistant- generated data calculates extenders in the range of ¾ a FTE physician).

We have found several problems with the IOM assumptions concerning physician extenders. 1) While they do contribute to the health care system, a physician extender is not trained in the breadth and depth of medicine and is not a replacement for a physician and should not be calculated as such. 2) From the IOM’s own research, there is a trend for extenders to seek higher paying specialty fields and not the lower paying primary care fields. Thus, these extenders will not replace primary care physicians. We believe that those schools which receive state support should also be held to the standard of graduating 50% in the primary care fields. 3) There is a recommendation for the NCAFP and others to change the practice environment to encourage the acceptance of certified nurse midwives into obstetrical practice. As Family Physicians trained in medical schools and in 3-year residencies, some have been driven out of the obstetrical practice of medicine by increasing malpractice premiums and by hospital credentials committees. Now we are being encouraged to change the practice environment so a physician extender can deliver our patients. My recommendation is a reinstitution of the ROCI funds by the legislature that allows family physicians to practice the obstetrical medicine they were trained to provide.

While the retention data is not clear for PAs, NPs, and nurse midwives, it is known that only one in four medical school graduates will go on to practice in North Carolina. The proposition to increase the numbers of students in medical schools is not without some merit but is an expensive proposition considering the state will need to train possibly 12 students (under the current structure) to graduate and retain one as a primary care physician seven years later. There are good data showing retention of residents trained in family medicine in North Carolina. If a resident trains in a rural tract program, that resident has an 80% chance of staying in that area of North Carolina and continuing to practice in the community. Not only will these physicians remain in the community but they are more likely to be in rural communities where they can help alleviate shortages and disparities. North Carolina has 3 rural tract programs presently, but these should be increased. There are some hurdles to overcome with residency positions being limited by federal Title VII funding, but it would seem that the state legislators could put its citizen’s tax money to good use by supporting the training and salaries of these physicians in training.

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Increase the numbers of students and residents trained in North Carolina if we must, but an overhaul of the healthcare system would seem timely. Community Care of North Carolina is a novel idea that has provided better patient care, and at the same time saved the state millions in Medicaid dollars. Patients get better care and money is saved. The basis of care is that every Medicaid patient has a primary care physician and the case workers help see that patients get to their physician appointments and also get the medicines they need. It has helped keep patients healthier and out of the hospital. Although not perfect, it promises a better way to spend Medicaid dollars. It is my dream that every citizen of North Carolina has a primary care physician who is paid for keeping patients healthy and preventing complications of diabetes, obesity and hypertension.

There are not enough primary care providers in North Carolina for every citizen to have a medical home, but there should be. If there was, the system would have no need to be overhauled.

There are family physicians in every district of every state legislator. Several years ago Dr. Conrad Flick enacted the ‘Key Contact Program’ so that every legislator had an identified member of the NCAFP who could relay information to that legislator. I am asking that he key contact program be fully implemented and that you contact your state representative and senator on these issues.

No recommendation of the IOM has been presented as a bill. The NCAFP is creating a white paper on workforce issues and will provide you with talking points for your conversations. Please call the NCAFP office for more information. As these issues arise, please contact your legislators and give them information about these and other tissues.

Encourage your patients to do the same. If we do not speak out, nothing will change for us or our patients.

Study Shows Effectiveness of Tar War s Youth Tobacco-Free School Education Progr am A study conducted by a Colorado team of family physicians has concluded that a school-based tobacco-free education program is effective in increasing students’ knowledge and understanding about the short-term consequences of tobacco use, including cost of tobacco uses, truth of tobacco advertising, and peer norms.

The study, conducted by a research team from the University of Colorado at Denver and Health Sciences Center Department of Family Medicine, presented findings that evaluated the effectiveness of the Tar Wars school education program in Colorado. The results of the study are published in the November/December 2006 issue of the Journal of the American Board of Family Medicine.

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The research team was headed by Jeffrey J. Cain, MD, Chief of Family Medicine at The Children’s Hospital in Denver.

As part of this effort, the AAFP will be bringing their “Ask and Act” Roadshow to the NCAFP Annual Meeting in December.

Dr. Cain recently presented the results of the research project to the Scientific Assembly of the American Academy of Family Physicians (AAFP) in Washington, D.C., where he was awarded first place for the “best research presentation overall.”

Tar Wars is a national program operated by AAFP that utilizes an interactive 45-minute session taught by volunteer family physicians and other health care professionals in fourth and fifth grade classrooms and focuses on the short-term image-based consequences of tobacco use.

“Ask and Act" encourages family physicians to ASK about the tobacco use habits of all of their patients, then to ACT on that information.

Research evaluated by the AAFP Tobacco Cessation Advisory Committee at the March 2005 Tobacco Cessation Summit indicated that 70 percent of physicians ask their patients about tobacco use, and about 40 percent take action to help those who use tobacco. Through the Ask and Act program, AAFP members have access to a variety of resources to help patients kick the habit. “Ask and Act” resources are available through the AAFP website at http://www.aafp.org/online/en/home/clinical/pu blichealth/tobacco/askandact.html.

In the study, Dr. Cain and his research team evaluated the effectiveness of the program in Colorado with both quantitative and qualitative measures.

Students participating in the quantitative evaluation were tested before and after a Tar Wars teaching session using a 14-question test covering shortterm and image-based consequences of tobacco use, cost of smoking, tobacco advertising, and social norms of tobacco use. Qualitative evaluation included guided telephone interviews and focus groups with students, teachers and presenters.

Quantitative evaluation showed statistically significant improvement in correct responses for the 14 questions measured. Three areas specifically recommended by the Centers for Disease Control (CDC) for youth tobacco prevention programs showed even greater change in correct responses, including the cost of smoking, truth of tobacco advertising, and peer norms of tobacco use.

Qualitative evaluation found that the overall message from the lesson was well received, a positive response to having a guest physician speaker, that new information was learned, and previously known tobacco information was reinforced by the novel teaching format.

The study also showed that Tar Wars meets the guidelines set by CDC as one component of effective comprehensive youth tobacco prevention.

For more information about the Tar Wars program in North Carolina, please contact Jenni Fisher at jfisher@ncafp.com or 919-833-2110.

NCAFP For ms Par tner ships to Advocate for Physician Needs The Academy continues to seek partnerships in order to better meet the needs of member physicians. One of the recent efforts centers on Tobacco Cessation.

To provide physicians the tools to help patients cease tobacco use, the NCAFP has developed partnerships on both the state and national level.

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The state Tobacco Prevention and Control Branch of the NC Department of Health and Human Services and the N.C. Health and Wellness Trust Fund hope NCAFP members will go one step further: Ask, Act and Refer.

The two state agencies are also partnering with NCAFP to help promote tobacco cessation through the N.C. Tobacco Use Quitline Fax Referral Program. The Quitline (1-800-QuitNow) is free and confidential. It is available from 8:00 a.m. to midnight, seven days a week and can accommodate patients who do not speak English. The state Tobacco Prevention and Control Branch will highlight local resources during a presentation to correspond with the Ask and Act Roadshow at the Academy’s Annual Meeting in December. In the meantime, additional information on how to refer your patients to the Quitline (1-800784-8669) is available on the web at: http://quitlinenc.com/faxreferral/default.htm.

Tobacco prevention has long been a major component of the NCAFP’s public health efforts. The NCAFP Foundation began work with the national Tar Wars® Program in 1999, during Dr. Edward Campbell’s term as President. Tar Wars® is a pro-health, tobaccofree education program and poster contest for fourth- and fifth-graders. For information on the program, please contact Jenni Fisher, MPH, NCAFP Tar Wars Coordinator at 919-833-2110 or jfisher@ncafp.com.

NCAFP FOUNDATION SILENT AUCTION PROMISES TO BE FUN!!

Mix, mingle and enjoy the camaraderie of your fellow Academy members at the NCAFP Foundation’s Silent Auction. Being held during the 2007 Winter Family Physicians Weekend, November 29 – December 2 at The Grove Park Inn in the breathtaking mountains of Asheville, North Carolina, this is your early invitation to get in on the fun! (Continued on page 11)

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North Carolina Academy of Family Physicians

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NCAFP Legislative Advocacy Activities in Full Swing With the start of the New Year, your Government Affairs Advisory Council is addressing many of the issues impacting the education and practice of family medicine in North Carolina. Our first two meetings of 2007 drew an average of more than 20 NCAFP members for the three-plus hour meetings. Some of the issues discussed include the following: (1)Medical education at Duke Univer sity and East Carolina Univer sity. Reports were presented from GAAC members who have met and continue to meet with representatives of the respective institutions in reference to family medicine within their medical schools. We continue to monitor the status of family medicine training at Duke University. We also continue to monitor the status of the new family medicine center at ECU as the proposal goes through the budgetary process and actual start of construction. As of this article, meetings continue between your Academy leadership and staff and the involved institutions.

(2) Flu vaccine distr ibution progr am. As most of you are probably aware, we have discussed for some time mechanisms for getting flu vaccines into the offices of our members in a more timely and orderly fashion. These discussions have also involved members of the N.C. Medical Society and as announced in late January, culminated with a signed contract between GSK, their distributor and N.C. Community Care Networks, Inc. If by chance you have not received info about the arrangement, go to the web site www.ncccninc.org. It is hoped that other manufacturers of vaccines will sign-on to this important program.

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cerns to BCBS. Additional information about this issue and the proposed expansion to the Universal Vaccination Program mentioned below are included elsewhere in this issue. See page 13.

(5)Univer sal Vaccination Progr am expansion. A proposal is currently being discussed by the state to expand the vaccines covered by the universal childhood vaccine program. As discussed at GAAC and after polling membership, the GAAC has recommended that the Executive Committee of the Academy lend cautious support to the proposal with the provision that expansion of the program not increase the administrative paperwork required of the individual member’s office. We will continue to monitor this provision as it develops.

(6)Legislative Advocacy effor ts. GAAC discussed var ious effor ts to increase our visibility in the legislature while it is in session. To date, several GAAC members were able to participate in the Legislative Heart Day on February 14 and Diabetes Day on March 27. Additional days in the Legislature for Academy members will be planned on an ongoing basis. During these days, staff members arrange opportunities for the visiting physician member to meet with their local Representative/Senator, as well as other important legislative contacts.

If you are interested in this process, please contact Academy staff to arrange your participation.

(7)Malpr actice issues. The Academy continues to work with the N.C. Medical Society and other medical groups to deal with the ongoing issue of medical malpractice, trying to attack the issue from every possible angle.

At present, we have joined the N.C. College (3)Cer tificate of Need process. At present, of Emergency Physicians in their discussion there is a $500,000 threshold which must be of EMTALA and liability protection for exceeded before the state requires a CON be emergency care as covered under EMTALA. submitted for review for imaging equipment. As (EMTALA is the Emergency Medical practices continue to expand their scope of Treatment and Active Labor Act, commonly operation with in-house CT scanners and other known to as the anti patient-dumping law.) technology, we are concerned about possible limitations that could be imposed by subjecting (8)Discussion of the N.C. Institute of such purchases to a CON review. After polling Medicine recommendations for healthcare members in attendance, GAAC has elected to workforce. GAAC discussed several of the continue to support and possibly expand that positions from an upcoming report by the threshold.

IOM about workforce recommendations for North Carolina in the future, including rec(4)BCBS Diagnostic Imaging update. BCBS ommendations for expanding existing medhas implemented a preauthorization program for ical schools and possibly opening a new various diagnostic imaging and other procemedical school in NC. The groups agreed dures ordered through your offices. GAAC that there are some good points in the promembers discussed the various impediments posed report but were concerned that the recthis has imposed on their own individual offices ommendations do little to address the need and have since polled Academy membership for more primary care physicians. To about their experience with this issue. We con- address our concerns, the Academy, under tinue to voice our con Dr. Michelle Jones’s leadership, have pre-

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develop a more formal report on the need for family physicians in our state.

(9)Other miscellaneous discussion items have included: (A) Committee leadership of the new Legislature.

(B) Support for the federal effort to drop the requirement for PAs/FNPs at Rural Health Centers.

(C) Proposed rules by the state Division of Medical Assistance for Telemedicine.

(D) Retail Health Clinics.

(E) Continued participation in the ICARE Partnership.

(F) Legislative issues from the Justus-Warren Heart Disease and Stroke Prevention Task Force, including smoking in public buildings and funding of county health promotion coordinators.

(G) Supervisory disclosure for mid-level providers.

(H) Promotion of the medical home concept.

This report summarizes the discussion items and our proposed action for the first GAAC meetings of 2007. We welcome your participation and comments and we also ask you to remember to contribute to the Academy’s political action committee or FAMPAC as we continue to support those candidates who are supportive of issues favorable to family medicine. If you have questions about any of these issues, please do not hesitate to contact me or the Academy staff.

With best regards, Robert L. Rich, Jr., MD NCAFP Vice President and Government Affairs Advisory Council Chair

NCAFP FOUNDATION SILENT AUCTION PROMISES TO BE FUN!! (Continued from page 5) Whether you donate an item to the auction, or engage in a “bidding war,” you’ll be helping to further the NCAFP Foundation’s mission of providing quality healthcare to the people of North Carolina.

If you’d like to donate an item to the Foundation’s 2007 Silent Auction, suggested items are electronics (DVD players, palm pilots, iPods), children’s toys, hand-crafted jewelry, Christmas decorations, silk plants, gift baskets, pottery, or a fashionable knitted scarf and hat.

These are just a sampling of items! All donated auction items are tax deductible, and the proceeds go towards the various NCAFP Foundation programs and projects.

Get in on the fun! 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) 8332110, (800) 872-9482 [NC only], or mrosol@ncafp.com. Thank you!

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ICARE Par tner ship to Sponsor Evening Meeting on May 10 The ICARE Partnership, a collaborative effort providing physical and behavioral health professionals a platform to explore new models to integrate patient care, will host a regional educational program in Greenville on Thursday, May 10.

The dinner program will include a presentation on Crisis Assessment and Management, and a panel discussion on the region’s available referral resources. The evening’s activities will also include an opportunity for primary care physicians to interact with mental health professionals from Pitt and the surrounding counties.

The May event is part of a series of regional programs that will be scheduled across the state. The May 10th program will take place at the Greenville Hilton with registration at 5:30, and the program beginning promptly at 6:00 p.m. Family physicians will be able to receive two hours of CME credit, and evidence-based credit is pending with the American Academy of Family Physicians, meaning that NCAFP members may be able to receive up to four hours of free CME by attending the program.

The ICARE Partnership currently consists of several related initiatives, including: provider training and technical assistance; four pilot projects across the state; and development of web-based resources related to integrated care. The web resources can be accessed by visiting www.icarenc.org.

The website already has resources on integrated care, tools for primary care physicians (such as the anxiety algorithm developed by the N.C. Academy of Family Physicians and the N.C. Psychiatric Association), and access to forums and a newsletter on integrated care.

“ If you are already co-locating mental health professionals in your office, we hope you will visit the ICARE website and let us know your experiences,” said Dr. Michelle Jones, NCAFP President and the Academy’s physician representative on the ICARE Advisory Group.

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“If you are interested in integrated care but

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have not taken the next steps, we hope the website will be a key tool for you as you move forward.”

Ultimately, the website will feature local referral resources on an Academy level, but that database remains under development.

The Academy is a key member of the ICARE Partnership with primary responsibility for “Provider Training and Technical Assistance.” The Training and Technical Assistance includes educational sessions at specialty society meetings, regional training such as the May event, and ultimately practice-based training programs.

Look for more details about the May meeting and other ICARE activities in the Academy’s e-newsletter, NCAFPNotes, and on the Academy’s website at www.ncafp.com.

Academy Ur ges BCBS to Pay Administr ative Fees to Refer r ing Physicians’ The Academy’s leadership is urging Blue Cross/Blue Shield of North Carolina to pay referring physicians an administrative fee when required to file pre-authorizations for Digital Imaging.

Despite the objections of several medical organizations, BCBS NC implemented a Digital Imaging Management Program in mid-February.

In a letter to the company last December, NCAFP President Michelle F. Jones, MD, said, “Family physicians across the state continue to be burdened by rising administrative costs. Rather than focusing on the care of our patients, we are continually asked to complete administrative tasks such as these pre-authorizations.”

“In addition, we believe the pre-authorization process could unduly delay necessary diagnostic tests and put our patients’ health in jeopardy,” Jones’ letter to the company continued. (4)

Once BCBS implemented the program, the Academy surveyed members across the state to determine the impact on their particular practice. One hundred and twenty physicians of the 271 who answered the survey had already sought preauthorization during the first two weeks of the implementation. Those physicians took an average of 21minutes to receive clearance for the digital tests for their patients. Based on the survey’s respondents, the authorization process took as little as two minutes to as much as more than 90 minutes.

Many members reported that their practice was not in the computerized pre-authorization system despite seeing BCBS patients for many years. Others experienced the need to talk to multiple personnel on the BCBS hotline or requests for excessive data from patient charts.

Academy leaders have already shared the results of the survey with BCBS of NC, stating that these requirements were unacceptable without appropriate payment for the administrative time and effort required due to the pre-authorization process.

The Academy will also continue to monitor the effects of this new program by asking for additional feedback by members.

NCAFP President Jones recently requested another face-to-face meeting with representatives of Blue Cross/Blue Shield. In addition, the Academy is developing a dialogue with the State Insurance Commissioner to report specific problems.

Healthcare providers can access “Guidance on Complaints Against Health Plans” and a “Provider Complaint Form” on the Department of Insurance website at www.ncdoi.com/Consumer/consumer_prov iders.asp.

If you have questions or would like additional information, please contact Greg Griggs, MPA, CAE, NCAFP Director of Professional Services, at (919) 833-2110 or ggriggs@ncafp.com.

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Amer ican Board of Family Medicine Sleep Medicine CAQ Approved by the ABMS The voice of family medicine has been heard loud-and-clear by the American Board of Medical Specialties (ABMS). On March 19, the ABMS approved the American Board of Family Medicine’s (ABFM) application to provide a Certificate of Added Qualifications (CAQ) in Sleep Medicine today at its Annual Meeting. ABFM Diplomates will be able to sit for the first Sleep Medicine examination in November of this year.

The Board of Directors of the ABFM made the decision at its Interim Meeting last October to seek approval from the ABMS for the ABFM’s co-sponsorship of a CAQ in Sleep Medicine along with the ABMS Boards of Internal Medicine (ABIM), Pediatrics, Psychiatry and Neurology, and Otolaryngology.

The ABFM has begun to work closely with ABIM, who will administer the exam. When the application process is finalized, details will be announced on the ABFM website, www.theabfm.org.

“In seeking approval for a Certificate of Added Qualifications in Sleep Medicine, the American Board of Family Medicine realized the essential need for more primary care physicians interested in the field of sleep medicine,” noted James C. Puffer, M.D., President and Chief Executive Officer of the ABFM. “The approval of this certificate today by the ABMS is an essential step in guaranteeing that sufficient numbers of family physicians are adequately trained to address the growing health epidemic of sleep-related disorders.”

Student Updates ATTENTION STUDENTS: NCAFP FOUNDATION Scholar ship Progr am Application Deadline is May 1, 2007

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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 2007.

Applications are due in the Foundation office

by May 1, 2007. 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) 872Annual FMIG Banquet Dates Announced Never short of being fun and even insightful, the annual FMIG Banquets at each medical school are a great way to learn about family medicine and keep in touch with old friends and colleagues. Last year, over one hundred fifty people attended the various events. The dates for the four banquets this year are as follows: UNC Chapel Hill – Monday, April 2, 2007 Wake Forest University – Thursday, April 12, 2007 East Carolina University – Tuesday, April 17, 2007 Duke University – Thursday, April 26, 2007

2007 Family Medicine Day Attr acting Students from Across Southeast Saturday, May 19, 2007 will be a day you don’t want to miss. Medical students from NC, SC, VA, TN, GA, and FL will be converging in Cary, NC to take advantage of four hours of clinical skills workshops and getting to know more about the family medicine residency training opportunities in the Tar Heel state. Space continues to fill. All medical students graduating in 2008 or 2009 are encouraged to attend. For complete information and online registration, please visit http://www.ncafp.com/fammed2007.

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ECU Student Member ship Dr ive Results in 28 Student Member ships Dr. Valerie Gilchrist, Chair of the Department of Family Medicine at the Brody School of Medicine at East Carolina University and the entire family medicine department, conducted a unique student membership drive that has resulted in 28 new student AAFP/NCAFP memberships at the school. Dr. Gilchrist challenged her faculty members to donate student memberships in the AAFP/NCAFP (only $25 for all four years) and pledged that for every two memberships contributed by her faculty, she would donate one herself. Her challenge was built upon a call-to-action the NCAFP

Foundation presented to all NCAFP members in December, 2006. Hats off to Dr. Gilchrist and the entire family medicine staff at ECU for a remarkable and successful effort!!

MEDICAL STUDENT ENDOWMENT FUND ON THE UPSWING! Thanks to our members, the Medical Student Endowment Fund is on the upswing! Using only the interest earned on the endowment’s funds, our goal is to grow the endowment to the point where the annual interest is large enough to support all of our student activities and programs. In 2006, due to the generosity of individual members and the NCAFP Board of Directors, we raised $8,599, bringing the fund’s total to $494,880.

As of December 31, 2006, the total interest on the fund is $6,985.98. At the 2005 Winter Family Physicians Weekend, Sue Makey issued a challenge to reach $500,000 for the Medical Student Endowment Fund prior to her retirement on December 31, 2007. Let’s help Sue reach her goal!

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Open

Coastal Carolina North Carolina Neuropsychiatry

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North Carolina Academy of Family Physicians

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2007 Match Results by Program Program

# Offered Via Match

# Filled Via Match

# Filled Via Scramble

# Total Slots Filled

Cabarrus Camp Lejeune Naval Hospital Carolinas Medical CenterCharlotte Carolinas Medical CenterRural

8

8*

0

8 of 8

18

6/5/4

0

15 of 18

8

8

0

8 of 8

2

1

1

2 of 2

1 Duke

0

0

0

N/A

7

2

5

7 of 7**

MAHEC-Asheville

9

9

0

9 of 9

MAHEC- Hendersonville

3

2

1

3 of 3

UNC

8

8

0

8 of 8

Moses Cone

8

8

0

8 of 8

ECU

82

8

0

10 of 10

New Hanover

4

4

0

4 of 4

WOMACK**

9

7

2

9 of 9

10

8

2

10 of 10

SR-AHEC

WFU

* 4 filled candidates outside of the Match, for a total of 4 of 8 slots filled. *** May increase number of positions offered by 1 on strength of candidates

** Do not participate in National Match Program.

1 Did not participate in the Match for 2007

2 Filled (2) slots outside the Match for a total of 10 slots filled.

House ad

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The North Carolina Academy of Family Physicians, Inc. P.O. Box 10278 Raleigh, NC 27605

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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