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The North Carolina Family Physician

Vol. 4 - No. 2

Second Quarter, 2008


Every Family Physician Needs to Raise Their Voice Details on Page 8

In This Edition A Season of Expectancy..........................................................................3 The 2007 NCAFP Annual Report................................................................9 Disparities Initiative Continues to Train on Cultural Competency..................... 27 Childhood Vision Care Program Releases New Screening Forms..................... 30


THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, NC 27605 919.833.2110 • fax 919.833.1801 The North Carolina Family Physician


2007-2008 NCAFP Board of Directors NCAFP Executive Officers President Christopher Snyder, III, MD President-Elect Robert Lee Rich, Jr., MD Vice President R.W. ‘Chip’ Watkins, MD, MPH, FAAFP Secretary/Treasurer Richard W. Lord, Jr., MD Board Chair Michelle F. Jones, MD Executive Vice President Gregory K. Griggs, MPA, CAE J. Carson Rounds, MD Past President (w/voting privileges) The District Directors District 1 Kevin Talton, 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 Brian R. Forrest, MD At Large Elizabeth B. Gibbons, 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 Warren P. Newton, MD, MPH FM Residency Director Janalynn F. Beste, MD Resident Director Tamieka Howell, MD (GAHEC) Resident Director-Elect Alicia C. Walters, MD (WFUBMC) Student Director Carrie Hamby (UNC) Student Director-Elect Lillianne M. Lewis (Duke)

TA B L E O F C O N T E N T S Features

A Season of Expectancy..................................................................................... 3 Every Family Physician Needs to Raise Their Voice.................................................... 8 The 2007 NCAFP Annual Report............................................................................ 9 A Family Physician Ready to Take The Lead - Part 2..................................................25 Disparities Initiative Continues to Train Physicians on Cultural Competency......................27 NC Early Childhood Vision Care Program Releases New Screening Forms........................30 Sections President’s Message...................................................... 3 Advocacy for Family Medicine.....................................................8 EVP’s Corner.................................................................. 4

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Mott P. Blair, IV, MD Conrad L. Flick, MD L. Allen Dobson, MD Karen L. Smith, MD

FP Department Chairs and Alternates Warren P. Newton, MD, MPH J. Lloyd Michener, MD Kenneth Steinweg, MD Michael L. Coates, MD

NCAFP Council Chairs Child & Maternal Health

Janalynn F. Beste, MD Jennifer Mullendore, MD Governmental Affairs Robert Lee Rich, Jr., MD Brian R. Forrest, MD Health Promotion & Disease Prev. Jessica Shore-Saxe, MD Mental Health Michelle F. Jones, MD Al Mooney, III, MD Professional Services Brian R. Forrest, MD Christopher B. Isenhour, MD Health Disparities Viviana Martinez-Bianchi, MD Continuing Medical Education Richard W. Lord, Jr., MD NCAFP Editorial Committee Chair

William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard W. Lord, Jr., MD David C. Luoma, MD


Peter T. Graber, MMC,CAE Director of Communications PUBLISHED BY

Virginia Robertson, President Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION

Katrice Summerlin ksummerlin@pcipublishing.com 501.221.9986 • 800.561.4686 Ed i t i o n 14

Health Initiatives Update.............................................................27

Chapter Briefs................................................................ 5 Residents & Residency...............................................................29 Meetings & Education.................................................... 6

AAFP Delegates and Alternates

Chair (UNC) Alternate (Duke) Alternate (ECU) Alternate (WFU)

Volume 4 Number 2

Family Medicine In Practice........................................................30

Student Activities........................................................... 7




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 family physicians 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.


A Season of Expectancy Chapter initiatives beginning to take root and gain ground In my inaugural address, I outlined three areas your Academy will cultivate. Before we can harvest the fruits of our labors, we must first prepare the ground and plant the seeds of success. Some initiatives have already taken root and are gaining ground. The transition to new leadership with Greg Griggs as Executive Vice President has occurred seamlessly and our momentum continues. The new “business as usual” required in this Web 2.0 era is the ability to conduct business quickly, maximizing the opportunities around us for the advancement of our mission while retaining the best of our heritage and values and preserving our assets. Your Academy has the nimbleness and flexibility to react to changing environments and proactively assert our programs and goals. At the Congress of Delegates of the American Academy of Family Physicians in Chicago last October, the seeds for Dr. Lori Heim’s campaign for President-Elect of the AAFP were sown and her campaign is growing at the proper speed and direction. She is cultivating her campaign carefully and strategically, adding just the right amount of energy and resources to gain momentum thru the Annual Leadership Forum in Kansas City, in May and into the peak season of activity before the Congress of Delegates session in San Diego this September. Her campaign committee is prepared to carry out her message and work on her behalf. We approach this season with hopeful expectancy for victory for her, for North Carolina and for the American Academy of Family Physicians. Payment reform through legislative action has a longer growing season. The ground is not as fertile and there is much competition for resources. The NC Institute of Medicine in 2007 issued “The new ‘business as usual’ required in this Web 2.0 era a report revealing alarming is the ability to conduct business quickly, maximizing trends in the healthcare the opportunities around us for the advancement of our workforce for primary care, mission while retaining the best of our heritage and values obstetrical care and general and preserving our assets.” surgery. The national average of physicians to population in - Christopher Snyder, III, MD 2005 was 18.5 to 100,000. Due to many factors, such as the aging of the population, the aging out of primary care workforce (and not being replenished), the increase of chronic disease and the influx of new people settling in North Carolina, that ratio is predicted to drop by 8% in 2020 and by 21% by 2030. This will particularly affect our rural areas. It is especially difficult to recruit new physicians into rural areas. The recommendation of the Institute of Medicine is to increase medical school class size. You may already be aware that both UNC and ECU are working to do just that. This strategy alone will have limited impact on the access to care for North Carolinians. For every student that graduates, less than half will stay in North Carolina. And, there is no lasting incentive in place to encourage a graduate to enter primary care and/or locate in a healthcare shortage area (loan repayment is, in reality, a short term incentive with hopes that those who take advantage of this incentive will have established enough roots to stay where they are). The most effective strategy to forestall the impending shortage of physicians is to increase the number of graduates choosing Family Medicine. Studies reveal that resident graduates are very likely to remain near where they train. As I write this article, the Match results have just been released. Collectively, all the North Carolina Family Medicine Residency Programs offered a total of 79 first year slots and filled 67 for an 85% fill rate (nationally, 2387/2636 for a 91% fill rate). On the surface that sounds encouraging but over the last several years, many programs have cut back the number of residents or closed. The good news for North Carolina (and the nation) is that communities with adequate numbers of primary care physicians report better healthcare outcomes, lower costs and increased patient satisfaction. Ensuring access to care in North Carolina will require an environment where Family Physicians can earn

Christopher Snyder, III, MD 2007-08 NCAFP President Dr. Snyder attended Hampden-Sydney College in Virginia for his undergraduate work and attended medical school at the Medical College of Virginia in Richmond. His internship and residency were completed at Fairfax Family Practice Center in Falls Church, Virginia. Dr. Snyder practiced Family Medicine in Leesburg, Virginia for 12 years before joining Mt. Pleasant Family Physicians in 1991. In 1998, Dr. Snyder became an Associate Director for Cabarrus Family Medicine Residency Program. He joined Lakeside Family Physicians, Novant/ Presbyterian Medical Group in 2006. His interests include medical education, prevention and professional well-being.

an attractive living so they can retain competent and caring staff, offer modern services and cover rising overhead, regardless of where the practice is located. Our only recourse is to leverage not only insurance companies but also employer groups to compensate our services commensurate with the value those services bring. This may best be accomplished through legislative action. Our strategy is to educate all our Legislators during the Short Session which begins in May, as to the value of Family Medicine and why it is the most effective means of caring for North Carolinians. We will work to cultivate legislation during the summer and fall and press those initiatives into the Long Session in 2009. Your Academy and its leadership are committed to carrying out this endeavor until we harvest the fruits of our labor.

WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC



WHY FAMILY MEDICINE? You Know, but How Do We Tell the World? Chapter is Developing Communications Tools for Enhanced Advocacy Better access! Better care! Better outcomes! Those three statements sum up family medicine. And in your practice each day, you don’t just know these facts, you live them. The question is simple: how do we let the world know: your patients, your payers, and our policy leaders? Gregory K. Griggs, MPA, CAE Executive Vice President

Both the national Academy and your state Chapter are beginning efforts to do just that. Last October, AAFP introduced a new brand for the Academy and family medicine. Using the slogan, “Strong Medicine for America,” AAFP developed a new logo and started advertising in leading publications around the country. The efforts target key business and policy leaders through publications such as the Wall Street Journal and Roll Call. But they also reach out to a broader audience by advertising in publications like USA Today. While we have not reached the level of “Got Milk,” family medicine has at least made a start. And we ARE asking the right question: What if every family had a doctor in it? That’s the exact question asked in a full-page advertisement in USA Today last Fall. Making sure the answer to that question is “Yes” is a key to our future. We must make sure every man, woman and child have a medical home: a medical home led by a family physician. In short, a family doctor in (or at least for) every family. At the state level, we are working to do our part. One of the first steps is the development of a fact sheet educating our state legislators about the importance of primary care. Thanks to the help of our government affairs team, we will take this message to the General Assembly beginning with the legislative short session this summer. We plan to give all 170 members of the General Assembly a set of “fast facts” on family medicine. So what are some of these facts? Fast

Call to Action: Contact your Congressional Delegation Now to Prevent Medicare Cuts! Your members of Congress will soon determine whether family physicians face a payment increase, freeze or cut. They need to hear from YOU now! See page 8 for further details.



• More family physicians mean increased access through board-certified specialists. • Family physicians mean early detection and in many instances prevention of chronic disease. • More family doctors mean increased life span, improved quality of life and better outcomes for North Carolina’s citizens. • Adding a family physician to a local community in North Carolina leads to nearly $1 million in economic impact. • More sub-specialists mean higher costs. More primary care specialists mean lower costs and better outcomes. • The equation is simple. We just have to deliver the message. We hope you will help deliver this message: on Capitol Hill, at the Legislature and to our nation’s employers. You may ask, what can I do to help? The answer is a lot! • Go to AAFP’s Speak Out and make sure your Congressional delegation acts to prevent the Medicare cut scheduled to go into effect July 1 (see article on page 8).




• Join us in visiting the N.C. General Assembly during the Short Session this summer. Look for specific dates and other information in an upcoming edition of NCAFPNotes. • Write your Legislator telling them the importance of family medicine and the new Family Medicine Center at East Carolina. • Travel to Cary this July to help further develop our strategic initiatives to insure alignment with the needs of our members. The Academy’s “Leadership Retreat” will focus on “Strategies for Success for the Future,” and will be held on Saturday, July 26, at the Embassy Suites in Cary. Visit our website at www.ncafp.com to learn more and register to attend. Our goal is simple: well-paid, happy family physicians delivering high quality care to our state’s citizens. I hope you will join us in the quest to make this happen. It will not be a sprint, but through effort and endurance, we will succeed. I look forward to the journey.

NOTE: For more information on AAFP’s new brand and the advertising effort undertaken at the national level, visit: http://www.aafp.org/online/en/home/aboutus/theaafp/torch.html


april - june 2008 | the North Carolina Family Physician


NCAFP Welcomes Two New Staff Members, Announces Additional Responsibilities for a Third

Print • CD-ROM • On-Line

The Academy recently added two new professionals to its headquarters staff. Mr. Brent Hazelett, MPA, will be serving as the chapter’s new Director of Finance and Administration. Mr. Hazelett spent the last nine years with the Motor and Equipment Manufacturers Association in RTP and most recently served as its Vice President of Operations. Brent obtained his Masters Degree in Public Administration from NC State and lives in Cary with his wife and two children. Also new to the staff is Mrs. Tara Hinkle. Tara will be working to assist with various membership and meetings functions. A native of Virginia, Mrs. Hinkle is a graduate of Virginia Tech and resides in Apex with her husband and daughter. Finally, Kathryn Atkinson, who previously worked part-time with the Academy, has increased her responsibilities beyond meetings and events planning and is now a full-time staff member. Kathryn will also be working with the NCAFP Foundation and assisting Executive Vice President Greg Griggs with Academy activities.

NCAFP’s Jenni Fisher, MPH, Named to National Tar Wars Advisory Panel See more Tar Wars news on p. 27

The AAFP Commission on Health of the Public has named the new slate of national Tar Wars Program Advisors and has appointed NCAFP’s Health Initiatives Ms.1 Jenni Fisher, MPH, as a member. This important /31/07 2:05 Manager PM Page 12-person panel serves as the key program advisory council for Tar Wars, the AAFP’s signature tobacco use prevention initiative. Ms. Fisher has been with the NCAFP since 2005 and oversees a number of NCAFP Foundation health programs, including North Carolina Tar Wars. Congratulations!

The Core Content Review of Family Medicine is a unique educational resource for family physicians who desire a comprehensive, practical, and affordable home-study program for preparing for a Board examination.

2008 Print Version Available Now!!!


Family Medicine Physicians

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Plenty of Online CME at NCAFP.com The NCAFP has produced four online educational programs this past year. Each of these programs is available online at no charge to NCAFP/AAFP members simply by visiting http:// www.ncafp.com/home/cme/online. Physicians can capture a total of eight prescribed credits in two convenient formats: three (3) interactive online programs (w/audio and slides) and one downloadable printed monograph. Here is a summary of what’s available right now — take advantage of these today: Promoting Adolescent Health Through Immunization - In this one hour program, Dr. J. Carson Rounds addresses adolescent health to help physicians implement the latest immunization recommendations. Features audio and slides. Free with simple registration. 1 Prescribed Credit. Childhood and Adolescent Obesity Advances - Dr. Mott P. Blair and Carolyn Dunn, PhD, review current trends in childhood obesity prevention and provide several evidence-based strategies for family physicians. 1.5 Prescribed Credits. Adolescent Immunization Advances: Preventing Meningococcal - Dr. J. Carson Rounds discusses how meningococcal disease is so difficult to diagnose because its signs and symptoms may be hard to distinguish from common viral illnesses. 2.0 Prescribed Credits. Osteoporosis: A Perspective for Family Physicians - 10 million people in the United States have osteoporosis. Millions more have low bone mass (called osteopenia), placing them at risk for osteoporosis and broken bones. Eighty percent of US citizens with osteoporosis are women. Dr. Richard Lord, MA, Program Chair, presents a complete discussion on this important topic in a downloadable monograph format. 4.0 Prescribed Credits.


8 2 0 0

er est m m u S Mid- icine Dig

Med - July 4, 2008 y l i m a F June 29

Myrtle Beach Here We Come! Don’t Miss The 2008 NCAFP Mid-Summer Family Medicine Digest - June 29 – July 4, 2008 Come and enjoy July Fourth while taking in quality evidence-based CME. The NCAFP 2008 Mid-Summer Family Medicine Digest (June 29-July 4, 2008) will feature a convenient schedule of half-day sessions that open up your afternoons for family fun and recreation. Program Chair Dr. Brian R. Forrest has planned an outstanding program full of variety that covers key issues facing most primary care physicians today. This is the second year that the Academy has delivered the meeting in this schedule and format.

and analyzing patient somatic symptoms, as well as managing the patient with depression from diagnosis through treatment. This activity is geared toward Maintenance of Certification and assisting members in tackling their Self Assessment Modules (SAMs), clinical simulations, and practice improvement projects.

Smoking Cessation – Participants will be able to identify patients that are thinking of quitting or are ready to quit smoking, outline an effective behavioral modification program The Mid-Summer Family Medicine for patients that includes strategies Digest will present over 26 prescribed to overcome high levels of nicotine educational credits. Evidence-based dependence and lifelong psychological credit is being sought for a number of dependence on smoking, describe lectures, and based on their approval, the steps (i.e. 5 A’s) or STAGES for will only increase the total number of intervention with tobacco users, credits available. Here are some great identify the local, state, and national topics currently scheduled: groups who can provide materials and support for smoking cessation Complete information is online Management of Alzheimer’s Disease at www.ncafp.com/msfmd efforts and utilize financial resources in a Primary Care Setting (AD) – available with proper coding of effective This program will utilize case study smoking cessation treatment. discussion to review the evidence supporting best practices in AD management. The goal will be Myrtle Beach couldn’t be a more fun, lively and to provide attendees with the factors that should be entertaining place to be on the Fourth of July! There’s considered in the management of the patient with AD so much to do, see and explore, that everyone in and improve patient outcomes. the family will have a story to tell. For complete conference information, go to the Academy website at Vaccines Update – This program will highlight http://www.ncafp.com/msfmd. recommendations for the use of newlylicensed vaccines, including meningococcal conjugate vaccines and tetanus-diptheria July 2008 December 2008 an acellular pertussis vaccine for adolescents. Anticipated FDA approval of certain 2008 NCAFP 2008 NCAFP vaccines will be discussed. Major Depressive Disorder – Is MDD over Diagnosed? What Every Primary Care Professional Needs to Know - This program will assist learners in diagnosing patients with depression, using screening questions

april - june 2008 | the North Carolina Family Physician


Leadership Retreat

Annual Meeting

July 26,2008

Dec. 4-7, 2008

Cary, NC


Asheville, NC



NCAFP’s 2nd Annual Family Medicine Day is May 17, 2008 Medical students from across North Carolina and the southeast will converge in Durham on May 17, 2008 for the NCAFP’s second annual Family Medicine Day. The event is being held at the Millennium Hotel in Durham and is being made possible by the generous support of the North Carolina AHEC Program. Family Medicine Day is designed to introduce rising 3rd- and 4th-year medical students to North Carolina’s diverse family medicine residency training programs. Attending students take advantage of four hours of clinical skills training and then participate in a full residency recruiting fair. The workshops are delivered by residency program faculty from North Carolina and cover topics such as suturing, shoulder and knee exams, radiology reviews and several others. Each student selects four workshops from eight options. Following the workshops, students attend a small residency fair where all NC family medicine residency programs will be exhibiting, as well as some select programs from outside of May 17, 2008 North Carolina. Sat. May 17,- Durham, 2008 NC

2008 family medicine day Learn and Discover

Millennium Hotel Last year, Family Medicine Day attracted students from as far away as Florida Durham, North Carolina and a number of students from surrounding states. This year, at the time of writing, out-of-state medical students registeredINFO: for the event has grown http:// www.ncafp.com/fmd2008 substantially. To learn more about family medicine day and to register, visit the Academy website at http://www.ncafp.com/2007fmd.

Externship Program Interest Grows Again - Interest in the NCAFP Foundation’s Family Medicine Externship Program has increased for the third straight year! A total of 13 applications for the program were received by the Foundation this year, up from 9 received last year. Family physicians interested in serving as preceptors should contact Peter Graber, MMC, CAE, at Academy offices at (919) 833-2110 or via email at pgraber@ncafp.com. May 5, 2008 is the Deadline for Scholarship Program Applications All medical students interested in applying for the NCAFP Foundation’s 2008-09 Scholarship/Loan Program must have their applications in by Monday, May 5, 2008. This program offers up to $2,000 per year for participating medical students. For complete information about the program, including a downloadable application and full terms and conditions, go online to http://www.ncafp.com/scholars. FMIGs Hold End-of-Year Banquets - Another memorable round of Family Medicine Interest Group (FMIG) banquets took place in April at North Carolina’s medical schools. These events are always a great way to meet, greet and inspire medical students and even to touch base with former colleagues. Photos from this year’s events can be seen online at the Academy’s website at http://www.ncafp.com/galleries. 2008 AAFP National Conference Begins July 30, 2008 - The AAFP National Conference of Family Medicine Residents and Medical Students will be held in Kansas City, MO, Wed., July 30, 2008 to Sat., August 2, 2008. There are a number of travel scholarships available to help pay students’ and residents’ travel expenses, including several from the AAFP. The NCAFP also offers stipends through each medical school FMIG. The deadline for AAFP applications is May 2, 2008. Contact your FMIG leader or advisor for applications, or call the NCAFP at (919) 833-2110 for additional information.

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Every Family Physician Needs To Raise Their Voices

Providing Mental Health Care in the Primary Care Setting: An Opportunity for Family Physicians

10% Medicare Cut Slated to Begin July 1 if Relief Fails

By Cherrie Crowder Hart

By Conrad L. Flick, MD

At the end of last year, Congress and the White House chose not to fix the Medicare physician payment formula again and instead passed a Band-Aid solution that barely altered the current payment by raising it 0.5 percent. Unfortunately, that increase will only last through July 1st. If no further action is taken before then, our payments from Medicare will be cut by more than 10 percent after July 1. Advocacy is the Academy’s #1 priority and we are working hard both on the state and national level to help with this and other important issues we face every day in our offices. However, we need the help of you, as physicians, and your patients, to contact your members of Congress and let them know how these cuts will affect your practices and the Medicare population’s access to care.     Here’s what you can do to take action right now. Visit http://www.aafp.org/medicarecut and use the tools and resources you will find on this site. Each action listed below can be taken by utilizing this link, and the Academy has worked to make this as easy as possible for you. •        Send an e-mail to your Senators and Representative asking them to act by July 1 to stop the Medicare payment cut. Use the AAFP’s Speak Out section or create your own e-mail, and encourage your partners, colleagues and patients to do the same. •         Print off a sample op-ed, sign it and send it to your local newspaper describing what this cut will do to your Medicare patients and your community. •         Print off a downloadable poster and hang it in your office. •         Send us your personal story: How are declining Medicare payments hurting your patients and your practice?  What have you had to do as a result of the payment decline?  Write to us at us at your state Chapter by e-mailing your Chapter Executive Greg Griggs at ggriggs@ncafp.com and send the story directly to the AAFP at ann@aafp.org. Continues on Back Cover

Cuts weighing heavily on physician practices According to a March 6, 2008 press release by the Medical Group Management Association (MGMA), nearly 24% of medical practices that responded to a recent survey by MGMA indicated that they have begun limiting or not accepting new Medicare patients as a result of the ‘financial uncertainty’ created by temporary adjustments to Medicare physician payments. Over one thousand physician practices responded to MGMA’s survey. Perhaps more telling is that approximately 46% of respondents said that they would have to stop accepting new Medicare patients or limit the number of Medicare patients their practices treat because of the expected payment reduction this summer.

PROLOGUE: Given the Academy’s role in the ICARE Partnership and the recent spotlight on mental health reform, now is an appropriate time to examine the delivery of mental health services in the context of primary care. During the month of February, Cherrie Crowder Hart, a fourth year student at the Brody School of Medicine at East Carolina University who will enter a family medicine residency program this summer, completed a leadership rotation, the NCAFP Leadership Fellows Program. During the time at the Academy, Hart focused on mental health delivery in the primary care setting. The following article is one of the outcomes from her work at the Academy.

Mental health care is a key component of primary care medical practices today, and will only continue to grow in importance. As a result, family physicians and other primary care providers have the opportunity to be leaders in the re-integration of mental and behavioral health with physical health. Primary care is already at the forefront of delivering mental health care with fifty percent of all U.S. mental health care delivered exclusively by primary care physicians. These same physicians prescribe two-thirds of all psychopharmacologic drugs in the U.S. The Future of Family Medicine Project notes that, “As health care becomes more complex and medical care becomes more interdependent, family physicians of the future… will have a special role in promoting better integration of medical and mental health services” (http://www.futurefamilymed.org/x26842.html). Family physicians are already uniquely trained to assess all facets of their patients’ health, including the psychosocial and behavioral pieces that many other specialists overlook. Most primary care providers already treat many mental health problems including depression, anxiety, ADHD, and substance abuse. They also make referrals to community resources, including social services, psychiatrists, and other specialists. Screening and preventative medicine are done best by primary care providers, and tools are available to broaden these screenings to mental health issues. Primary care has proven that it is a cost-effective mode of health care delivery, and patients experience improved compliance and outcomes. Several groups are working to ensure that primary care physicians will have the tools that they need to deliver appropriate, evidence-based, efficient mental health care to North Carolina patients and families. The ICARE Partnership, which stands for Integrated, Collaborative, Accessible, Respectful, and Evidence-based, is currently spearheading its Local Model Development Project for integrated care. These pilot programs are in four different communities in North Carolina, and encompass several different practice models. ICARE is also examining other models of integrated care, including mental health integration pilots being tested by Community Care of North Carolina, and programs in Western and Central areas of the State. The Area Health Education Centers and the Office of Rural Health, as well as the North Carolina Foundation for Advanced Health Programs, and the Continues on p. 26


april - june 2008 | the North Carolina Family Physician

2007 Annual Report N.C. Academy of Family Physicians, Inc. Raleigh, North Carolina

The State of The Academy It gives me great pleasure to report the significant accomplishments of the North Carolina Academy of Family Physicians in 2007. Not only have we pursued important advocacy initiatives both statewide and nationally, but we also have collaborated on key programs within North Carolina to ensure the success of family medicine for the future. Progress Through Advocacy Michelle F. Jones, MD 2007 NCAFP President

Dr. Jones is in her ninth year of private practice with Wilmington Health Associates, a multi-specialty group in Wilmington, NC. Dr. Jones completed her medical education at East Carolina University and her residency training at Duke University. She has been an active member of the NCAFP since medical school, serving as Student Director on the NCAFP Board in 1993. At the national level, Dr. Jones has been a member of the AAFP Committee on Quality and Scope of Practice and the Committee on Scientific Program. Her special interests include increasing reimbursement for family physicians, and improving student interest in family medicine.

The Academy made several important strides as we worked to strengthen family medicine’s influence and improve our practice environment. We were especially active in the NC legislature and provided significant input into a number of proposals. Through the efforts of our leadership, along with the Academy’s Sue Makey and its Governmental Affairs Consultant Peyton Maynard, the NCAFP helped craft legislation that sought to require private payers to conduct comprehensive impact studies on any new health policies they propose. Although this effort was not successful this session, it sent a clear message that Family Physicians will act vigilantly to ensure private industry supports the best healthcare interests of patients, families and physicians. Several other legislative initiatives are mentioned by topic below. Progress Through Programs The chapter also advocated for family medicine through a growing array of collaborative statewide health improvement initiatives. Our leaders focused significant energies working to improve the delivery of mental health care by participating in NC’s ICARE Partnership, a collaborative project uniting primary care and mental health care providers. Efforts like these, as well as policies such as the recently passed mental health parity legislation, are extremely vital steps in recognizing and valuing the mental health services Family Physicians provide. We were also integral to fostering improvements in health care quality. Several NC Family Physicians helped guide North Carolina’s Improving Performance in Practice (IPIP) Initiative. This project has built steady momentum over the last year, and as more physicians learn to apply its principles, we expect overall outcomes to steadily improve. I’m proud that the voice family medicine is playing a major role in this project. T h e

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Additionally, we continued to educate physicians on cultural competency and tackling the issue of health disparities. Progress Through A Shared Vision Complementing our advocacy and outreach activities, the NCAFP also made significant progress in positioning our association for the future, sustaining North Carolina’s diverse training programs, and helping to recruit the best and the brightest into our state for family medicine residency training. First, the retirement of our long-serving chapter executive Sue L. Makey, CAE, required that we make an extremely important staffing decision - possibly the most important one in decades. After conducting a nationwide candidate search, we were proud to name Gregory K. Griggs, MPA, CAE, as our new chapter executive. Greg is a seasoned professional who brings diverse leadership experience, an intimate understanding of family medicine and a savvy knowledge of our legislative process to the chapter. With a capable leader in place, NCAFP’s leadership and Board feel that the Academy is well positioned for continued success, both tactically and strategically. Another important achievement centered on sustaining our diverse network of family medicine residency training programs. In August, Duke University announced that its restructured family medicine residency had been formally accredited and that the school will begin recruiting new residents beginning in 2008. This announcement was a culmination of significant and intense lobbying by the Chapter and works to guarantee that one of our nation’s most prestigious universities will continue to train Family Physicians for the future.

R e p o r t

The NCAFP Board is comprised of family physicians from across the state. Directors and officers originate from each of seven (7) districts and represent a diverse set of professional and practice backgrounds.

Board of Directors


The Executive Officers

President President-Elect Vice President Secretary/Treasurer Board Chair Executive Vice President Past President (w/voting privileges)


Michelle F. Jones, MD Christopher Snyder, III, MD Robert Lee Rich, Jr., MD Elizabeth B. Gibbons, MD J. Carson Rounds, MD Sue L. Makey, CAE Karen L. Smith, MD

Christopher Snyder, III, MD Robert Lee Rich, Jr., MD R. W. ‘Chip’ Watkins, MD, MPH, FAAFP Richard W. Lord, Jr., MD Michelle F. Jones, MD Gregory K. Griggs, MPA, CAE J. Carson Rounds, MD

Donald Keith Clarke, MD Christopher B. Isenhour, MD Victoria S. Kaprielian, MD William A. Dennis, MD Sara O. Beyer, MD Thomas J. Zuber, MD Shannon B. Dowler, MD R.W. Watkins, MD, MPH Richard Lord, MD Rafael G. Torres, MD Suzanne E. Eaton Jones, MD Jana C. Watts, MD Michael L. Coates, MD Stephen Hulkower, MD Parker McConville, MD, (GAHEC) Tamieka Howell, MD, (GAHEC) Mindy Jean Deason, (UNC) Carrie Hamby, (UNC)

Kevin Talton, MD Christopher B. Isenhour, MD Victoria S. Kaprielian, MD William A. Dennis, MD Sara O. Beyer, MD Thomas J. Zuber, MD Shannon B. Dowler, MD Brian R. Forrest, MD Elizabeth B. Gibbons, MD Rafael G. Torres, MD Suzanne E. Eaton Jones, MD Jana C. Watts, MD Warren P. Newton, MD, MPH Janalynn F. Beste, MD Tamieka Howell, MD (GAHEC) Alicia C. Walters, MD (WFUBMC) Carrie Hamby (UNC) Lillianne M. Lewis (Duke)

L. Allen Dobson, MD Conrad L. Flick, MD Mott P. Blair, IV, MD Karen L. Smith, MD

Conrad L. Flick, MD Mott P. Blair, IV, MD L. Allen Dobson, MD Karen L. Smith, MD

Michael L. Coates, MD J. Lloyd Michener, MD Valerie J. Gilchrist, MD Warren P. Newton, MD, MPH

Warren P. Newton, MD, MPH J. Lloyd Michener, MD Kenneth Steinweg, MD Michael L. Coates, MD

The District Directors

District 1 District 2 District 3 District 4 District 5 District 6 District 7 At Large At Large IMG Physicians Constituency Minority Physicians Constituency New Physicians Constituency FM Department Constituency FM Residency Director Resident Director Resident Director-Elect Student Director Student Director-Elect AAFP Delegates and Alternates

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate FP Department Chairs and Alternates

Chair (UNC) Alternate (Duke) Alternate (ECU) Alternate (WFU) NCAFP Council Chairs

Child & Maternal Health Shannon B. Dowler, MD Janalynn F. Beste, MD Governmental Affairs Robert Lee Rich, Jr., MD Health Promotion & Disease Prevention Mott P. Blair, IV, MD Jessica Shore-Saxe, MD Mental Health Council Michelle F. Jones, MD Professional Services Brian Forrest, MD Health Disparities Karen L. Smith, MD Viviana Martinez-Bianchi, MD Continuing Medical Education Richard W. Lord, Jr., MD

Finally, through the generosity of the NC AHEC Program, the Academy also produced a residency recruitment fair that attracted medical students from as far away as Florida to learn about North Carolina’s residency training options. Recruiting the best to our training programs is growing ever more important, especially in the face of our workforce demands. Thank you NC AHEC! T h e

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Janalynn F. Beste, MD Jennifer Mullendore, MD Robert Lee Rich, Jr., MD Brian R. Forrest, MD Jessica Shore-Saxe, MD Michelle F. Jones, MD Al Mooney, III, MD Brian R. Forrest, MD Christopher B. Isenhour, MD Viviana Martinez-Bianchi, MD Richard W. Lord, Jr., MD

This has been a brief highlight of efforts by your Academy in 2007. These and other projects are explained in more detail in the remainder of this report. It has been a pleasure to serve as your president in 2007 and I look forward to the continued success of our Academy in the years to come.

A n n u a l

R e p o r t

Chapter Executive’s report 2007 truly served as a year of transition for the Academy. And now, for the first time in over three decades, Sue L. Makey, CAE, is no longer leading the charge. At the Academy’s Annual Meeting in December, we each paused to honor Sue’s 31 years of service. I personally had the honor and privilege to work with her at the Academy for two and a half years. Now, I have been given the responsibility to fill her shoes. A Year of Transition / A Year of Accomplishment

Gregory K. Griggs, MPA, CAE Executive Vice President

Mr. Griggs has been on staff with the NCAFP since 2005

I am truly honored to have been chosen as the new Executive Vice President of the Academy. Through the strength of over 2,600 members, the Academy is one of the most respected professional associations in our state, and in fact is the largest medical specialty society. I look forward to leading your organization for many years to come, building on the 60 years success of the organization.

American Society of Association

But enough about the past, because the true purpose of an Annual Report is to review the accomplishments of the past 12 months. And in the case of the N.C. Academy of Family Physicians, there were many. I’ll touch on just a few of these.

Executives (ASAE). He

Through the efforts of your leadership, Duke University restored its Family Medicine Residency Program with a new focus on leadership development. 2007 NCAFP President Michelle F. Jones, MD, served on a Blue Ribbon Commission to advise the University as it developed plans to renew its commitment to family medicine education.

The NCAFP took aggressive action against insurers who continue to implement new policies with undue burden falling on family physicians and other primary care providers. Sue and the Academy’s Government Affairs Advisory Consultant, G. Peyton Maynard, worked to directly address the negative impact of insurance-driven imaging pre-authorization programs. As a result, Rep. Bobby England introduced Fiscal Impact Legislation. The proposal would force insurers to conduct fiscal impact studies of policy changes impacting the health care community, including a plan to share savings with those who help implement the policies. While the bill failed to gain initial traction in the Legislature, the effort brought insurers to the table for a greater discussion of these issues.

The Academy also began taking steps to minimize the impact retail health clinics could have on the continuity of care provided by a medical home. These efforts will continue into 2008, as the NCAFP attempts to address both quality of care and public health issues that could arise as a result of the increasing number of retail clinics.

Another key initiative in 2007 centered on mental health care. Through the Academy’s involvement in the ICARE Partnership, Dr. Michelle Jones sought to insure family physicians across the state have the needed skills to care for patients with mental health problems, and at the same time, insure an appropriate referral network when psychiatrists or other mental health professionals are needed to address more complicated issues. The ICARE Partnership is also working to “integrate” mental health professionals into the primary care setting and truly reattach the head to the body. Part of the overall mental health effort resulted in passage of “mental health parity” legislation in the N.C. General Assembly.

The Academy also addressed medical manpower issues actively shaping and responding to a study by the N.C. Institute of Medicine. While the study called for more physicians and other health care providers, particularly in primary care, your leadership hoped the recommendations would go even further. Our Academy’s recommendations include steps to insure that as new physicians are trained, they are in specialty areas (such as family medicine) that will truly meet the healthcare needs of our state’s citizens.

and is a member of the

completed his undergraduate studies at UNC-Chapel Hill and his graduate training in association and non-profit management at North Carolina State University. He formerly served as CEO of the Henderson-Vance County Chamber of Commerce and as Executive Director of the Association Executives of North Carolina and the Filter Manufacturers Council. Married with two children, Greg is Past President of the Henderson Lions Club, a member of the Maria Parham Hospital Board of Directors, a current active member of First United Methodist Church in Henderson, and serves Kerr-Vance Academy on its Board of Directors.

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R e p o r t

Continuing Medical Education continued to be a cornerstone of success in 2007. The Academy’s three key meetings: the Spring Family Physicians Weekend, the MidSummer Family Medicine Digest and the Annual Winter Family Physicians Weekend, once again had outstanding attendance, with the Winter Meeting drawing 535 attendees.

Finally, the Academy introduced six resolutions at the AAFP Congress of Delegates and five at the N.C. Medical Society’s House of Delegates in order to impact policy across medical specialties in North Carolina and across the nation. And North Carolina family physicians continued to take active leadership roles at the national level with Dr. Mott P. Blair, IV, serving as national chair of the AAFP Commission on the Health of the Public.

These are just a few of the Academy’s accomplishments over the past 12 months. As the Academy enters a new era and celebrates 60 years of success in 2008, you can rest assured that your staff and leaders will continue to focus on addressing the needs of our state’s family physicians and your patients. I look forward to helping uphold the mission of your organization: to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity.

Chapter Staff 2007 - 2008

Kathryn Atkinson Meetings & Events Planner Board/Foundation Liaison

Marietta Ellis Director of CME Meetings

Carol Ervin

With best regards,

Gregory K. Griggs, MPA, CAE

Administrative Support

Jennifer Fisher, MPH Health Initiatives Manager

Peter T. Graber, MMC, CAE

Executive Actions Summary

Director of Communications

The NCAFP’s Board of Directors and Executive Committee officially met three times in 2007. These included meetings in the spring, late summer, and winter. Between these official meetings, numerous teleconferences took place among the Executive Officers throughout the year. The following summarizes significant motions and action items. • •

• •

Greg Griggs, MPA, CAE Executive Vice President

Ann Lefebvre, MSW, CPHQ NC Project Director - IPIP

Members of the Executive Committee participated in the Institute of Medicine’s Summit on the Primary and Specialty Workforce in North Carolina.

Brent Hazelett, MPA

Academy & Foundation Executive Committee approved signing of the IPIP (Improving Performance in Practice) Phase III project from the American Board of Medical Specialties.

Tracie Hazelett

Academy & Foundation Executive Committee formally approved written “guidelines” for our student activities.

Tara Hinkle

Approved draft legislation that would require health insurers to study the fiscal impact of policy changes on physicians required to implement those changes, including a plan to share in the cost savings generated by the changes. The proposed bill was a direct response to imaging pre-authorization policy changes implemented by insurers during the past year.

Entered into a collaborative agreement with the N.C. Pediatric Society on a minigrant to help teach primary care physicians communication skills for use in treating behavioral health issues.

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ICARE Provider Training Specialist

Membership Coordinator

Members of the Executive Committee once again met with Chancellor Steve Ballard, East Carolina University, regarding the new Family Medicine Center. In addition, members of the Executive Committee and staff met with the architectural design team and other University leaders.

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Director of Finance & Administration

R e p o r t

G. Peyton Maynard Government Affairs Consultant

Reviewed and unanimously approved a letter nominating Dr. Conrad Flick to serve as Chair of the AAFP Commission on Governmental Advocacy. Dr. Flick successfully received this prestigious appointment.

Approved support of the re-nomination of Al Oshabar, MD, to AMA Board.

Encouraged continuing promotion of the resources available on the ICARE website at www.icarenc.org.

Discussed a plan to better educate our elected officials about family medicine and specifically the payment disparities relevant to our specialty. Noted the Colorado Uniform Contracting Bill as an example of potential steps to take.

Approved a recommendation to have all light fixtures replaced in the Academy’s building at an approximate cost of $10,000.

Approved a proposal to replace the Academy’s existing computers that are approximately four years old at a cost of $20,000.

Approved plans to implement the new AAFP Membership Management software beginning in 2008 which will require an annual budget item of approximately $6,000.

Reported that Dr. Jones, Dr. Snyder and Greg Griggs met with Deputy State Health Director Steve Cline, DDS, and Marcus Plescia, MD, to discuss ongoing collaboration with the Division of Public Health.

Approved letter of support regarding ECU’s application for grant funding from the Golden Leaf Foundation and two internal funds to support construction of the new Family Medicine Center.

Approved up to $20,000 for exterior painting and interior repairs and updates for the Academy’s headquarters building to take place in 2008.

Approved recognizing each FMIG Director at the four medical schools in North Carolina with a certificate of appreciation and letter to Department Chair. In the future, this will be added to the Awards Program at the Annual Meeting.

Formally endorsed Dr. Lori Heim’s candidacy for AAFP President-Elect.

Upon recommendation of the Executive Transition Task Force and the Executive Committee, the Board unanimously approved hiring Greg Griggs as the next Executive Vice President of the Academy upon Sue Makey’s retirement.

Approved resolutions to the AAFP on: Certification of Care in the Medical Home; to Eliminate the Two-Year Medicare Opt-Out Period; to Encourage a Continued Emphasis on Health Care Disparities; to Encourage Endorsing the Fitness Renaissance Program; and to address Medical Manpower issues.

Approved resolutions to the NC Medical Society on: Collection of Accurate Race and Ethnicity Data at Hospital Discharge; regarding allowed charges for Copying Medical Records; addressing Medical Manpower; and regarding Appropriate Wheelchair Restraints in vehicles.

Approved a significant contribution from the Academy to the Foundation’s Medical Student Endowment Fund.

Honored longtime Chapter Executive Sue L. Makey, CAE, upon her retirement.

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Chapter Communications The Academy continued to develop its communications vehicles and outlets to provide family physicians with timely and useful content, in convenient, easy to use formats. A number of changes and improvements were carried out this year to take advantage of members’ increasing use of the Internet and to reduce time/costs associated with traditional print production and distribution. Throughout the year, the Academy communicated with members on average of twice a week, using either mail, fax or electronic means. NC Family Physician - Quarterly fullcolor member magazine of the NCAFP, the chapter continued to work with its preferred contract publisher, Innovative Publishing Incorporated. Design and production of the magazine was moved in-house in June of 2007. NCAFPNotes - The Academy continued to publish its bi-weekly electronic news update. Published 27 times and distributed to members through email and fax transmission. The 2006 Annual Report - The Report was completed in mid-April and made available for download from the Academy’s website. The NCAFP Website - A website redesign was completed and launched in early February. The revised and upgraded site integrated more content on family medicine and utlized a framework for additional tools through an expanded members-only area. Press Releases - The chapter released several press releases throughout 2007 regarding chapter news, elections of officers, and awards conferred.

A n n u a l

R e p o r t

Continuing Medical Education The chapter produced seven educational events in 2007, along with numerous grant-funded programs.  The number of evidence-based (EB) lectures increased this year, providing stronger practice recommendations to participants.  In 2007, fifty-five (55) of our prescribed credits conformed to AAFP criteria for EB continuing medical education.  The AAFP provides double credit for those learning programs.

The Academy acknowledges the support of the fol­lowing companies which have enabled us to carry out our programs.


Abbott Laboratories

CME Conference and Credit Summary 2007 Spring Family Physicians Weekend Dr. Sara Beyer, Program Chair Attendees: 142 Credits:  31.75 (13 Evidence-Based)

2007 Supporters

Charleston, SC


Candela Laser Corporation


2007 Mid-Summer Family Medicine Digest Dr. Karen Smith, Program Chair Attendees: 221 Credits:  50 (21.75 Evidence-Based)

Myrtle Beach, SC

2007 Leadership Retreat Dr. Michelle F. Jones, Program Chair Attendees: 37 Credits: 6

Cary, NC

Astra Zeneca • Boehringer Ingelheim Pharmaceuticals, Inc. • Eli Lilly GlaxoSmithKline • Merck • Pfizer Sanofi Aventis • Schering Plough Takeda Pharmaceuticals North America • Wyeth • Ellman International • New Jersey AFP


2007 Winter Family Physicians Weekend Dr. Kevin Burroughs, Program Chair Attendees: 537 Credits: 43  (16 Evidence-Based)

Asheville, NC

Adolescent Immunization – Meningococcal Dr. J. Carson Rounds, Program Chair Credit: 2 (1 Evidence-Based)

Online Program

Childhood and Adolescent Obesity Advances Dr. Mott Blair & Dr. Carolyn Dunn, Program Chairs Credit:  1.50 (.75 Evidence-Based)

Online Program

Osteoporosis: A Perspective for Family Physicians Dr. Richard Lord, Program Chair Credit: 4 (2 Evidence-Based)

Printed Monograph

Advanced Bionics Corporation MAG Mutual • New Jersey AFP Outcomes Management Educational Workshops, Inc. • Sanofi Aventis NC Division of Public Health Forest Pharmaceuticals • California AFP • The AAFP Michigan AFP • Ortho-McNeil Janssen Scientific Affairs • Daiichi Sankyo, Inc.

Online CME

On-line Monograph Fundraising and Revenue Activities

Fundraising activities continue to evolve for the association.  Continually more pharmaceutical companies have transitioned to online grant submission processes and the chapter continues to participate in grant-funded projects and leverage its existing partnerships. The Academy has also sought new sources of income by delivering educational materials in new ways, such as online and printed format through monographs.  These activities have helped to mitigate the continued shift in private funding.

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Governmental Affairs & Advocacy FAMPAC Summary FAMPAC raised a total of $7,683 from NCAFP member contributions in 2007. As of Dec. 31, 2007, NCAFP’s FAMPAC account totaled $17,447.05. The following summarizes member contributions and amounts. $500-999

Conrad Flick, MD Michelle F. Jones, MD Robert L. Rich, Jr., MD

Advocacy and government affairs continues to be a key focus area of the Chapter. In fact, for the first time ever, data from the 2006 Membership Survey of Academy members, showed advocacy ranking higher in importance than Continuing Medical Education. Listed below are just a few of the legislative issues addressed by the Government Affairs Advisory Council during 2007. •

House Bill 1590 – Fiscal Impact of Insurance Policy Changes: As a result of the administrative burdens placed on primary care physicians by changes in insurance plans such as pre-authorization requirements, the NCAFP successfully sought introduction of a bill that would require insurers to address the fiscal impact of such changes, including ways to share savings with those who face these new administrative burdens. While Rep. Bob England introduced the bill, it has not moved forward due to insurance company opposition. However, Rep. England has agreed to sit down with all parties involved to discuss the issue, and several other organizations have praised the Academy for bringing the issue to light.

Mental Health Parity (HB 973): Legislation establishing limited mental health parity passed both the state House and Senate. The bill provides limited parity and covers nine key mental health diagnoses. It does not cover some key pediatric issues, nor does it cover substance abuse.

Voluntary Arbitration (HB 1671): A bill passed the state House and Senate that proves an important first step for medical liability reform. The bill caps damages at $1 million and limits discovery when both parties agree to voluntary arbitration.

ECU Family Medicine Center: Rep. Marian McLawhorn introduced House Bill H1999 that would allocate funds for the ECU Family Medicine Center and require reporting of a comprehensive timeline for construction. While the bill did not move forward, UNC System President Erskine Bowles committed to reporting the status to the Legislature in a timely manner.

Supervisory Disclosure: The Academy, along with other medical organizations, continues to work on potential proposals that would require the disclosure of the supervising physician for mid-levels and other related issues.

Community Care of North Carolina: The Academy took several actions to stop a proposed Medicaid HMO that would have undermined Community Care of North Carolina (CCNC). Activities included a letter sent to Senator Tony Rand and a phone conversation between Sen. Rand and GAAC Chair Dr. Robert L. (Chuck) Rich, Jr.

$200-499 Holly Biola, MD, MPH Lisa Cash, MD Wayne A. Hale, MD Lori Heim, MD Christopher Isenhour, MD Champ Jones, MD Robert Kline, MD Kevin Mikus, MD R.W. (Chip) Watkins, MD

Up to $199

Evan Ballard, MD Timothy M. Beittel, MD Sara O. Beyer, MD Drew Bridges, MD William A. Dennis, MD Shannon Dowler, MD Suzanne Eaton Jones, MD, MPH Allen Richard Edwards, MD Brian R. Forrest, MD Elizabeth Gibbons, MD Valerie S. Gilchrist, MD Gregory K. Griggs, MPA, CAE Michael Gross, MD Robert Gwyther, MD James Hawkins, MD Victoria S. Kaprielian, MD Burton Kassel, MD Robert Kastner, MD John Kelly, MD Hervy Kornegay, MD Richard Lord, MD Sue L. Makey, CAE John Mangum, MD Anne McLaurin, MD Paul Meyer, MD George Horace Moore, MD Jennifer Mullendore, MD Maureen Murphy, MD Lisa Nelson, MD Alexander N. Newman, MD J. Thomas Newton, MD Nicole Ogg, MD David Rinehart, MD Mark Robinson, MD J. Carson Rounds, MD George Saunders, MD Christopher (Reb) Snyder, III, MD Jack C. Spies, DO Robert Talton, MD Elliott Vizel, MD Katherine Walker, MD Richard Walton, MD Melinda D. Wonsick, MD

These represent just a few of the issues addressed by your Government Affairs Advisory Council during the past year. In fact, the Council addressed more than 25 various issues during monthly meetings throughout the legislative session. For more information on any of the Academy’s advocacy efforts, contact Executive Vice President Greg Griggs, MPA, CAE.

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Chapter Awards & Honors 2 0 07 Fam i ly P h y s i c i a n o f T h e Y e a r

Dr. J. Thomas ‘Tommy’ Newton, Clinton, North Carolina - Newton has taken exceptional pride in becoming a trusted member of his patients’ families and his community. He combines a passion to give and lead with an almost insatiable desire to improve the common good in Clinton and Sampson County. Through his service to patients inside and outside of practice, Dr. Newton was recognized as the embodiment of a care giver in all aspects of his life. As a servant to his patients, his local city and his profession, he serves as a great example of an individual physician making huge impacts on a daily basis. In his community and within family medicine, his work has been tireless: volunteer team physician for Clinton High School athletics; developing an innovative program to fight obesity in the youth of his community; serving as president of the NCAFP; testifying before legislative committees and acting as Doctor of the Day at the North Carolina General Assembly on numerous occasions; serving as his county hospital’s Chief of Staff; precepting and mentoring medical students; and representing the state’s family physicians and other primary care doctors. Most recently Dr. Newton played a significant role in helping Clinton, NC achieve what only nine other US communities did in 2007: receive the coveted All American City Award by the National Civic League. One of the keys to Clinton capturing this honor was Newton’s successful physical activity program for school children known as Fitness Renaissance. Fitness Renaissance has been cited as being directly responsible for a 12% decrease in obesity levels from 2005 to 2006 for children ages K-5 at Clinton Elementary School. This program, including his involvement of a local civic group to partner with the school system, served as one of the cornerstones to his community’s All American City application.

J. Thomas Newton, MD

2007 L ife t ime S e r vice Awa r d

Sue L. Makey, CAE - recognized for her lifetime of service to the chapter and the first non-physician to be honored with the award since its creation by the NCAFP in 1999. Sue began her service to family medicine in 1976 and in the ensuing thirty-one years, shepherded NCAFP’s growth from approximately 700 members into North Carolina’s largest medical specialty association, comprised of over 2,600 members. Sue was also recognized for her instrumental work in growing the chapter’s charitable organization, the NCAFP Foundation. During her tenure she worked tirelessly to establish and build the very sizeable Student Activities Endowment Fund that supports student recruitment into the specialty and is expected to finance recruitment efforts into the foreseeable future. The Endowment has become a national model for other organizations

Sue L. Makey, CAE with twenty-six past NCAFP Presidents

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Dr. Drew Bridges - recognized for his integral role in developing and leading a growing statewide integration effort between primary care physicians and the mental health services community known as ICARE. Dr. Warren P. Newton, MPH - recognized for his efforts in helping to lead an influential statewide physician quality improvement initiative. The Improving Performance in Practice program is training individual practices on techniques and measures to improve their overall care quality.

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Drew Bridges, MD

R e p o r t

Warren Newton, MD

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2007 Membership Summary

Fourteen third-year family medicine residents were recognized as Outstanding Residents by their respective programs. P r o g r am R e s i d e n t

Cabarrus Family Medicine Residency Camp Lejeune Family Medicine Residency CMC-Charlotte Family Medicine Residency CMC-Union Family Medicine Residency Duke University Family Medicine Residency East Carolina University Family Medicine Residency MAHEC – Asheville Family Medicine Residency MAHEC – Hendersonville Family Medicine Residency Moses Cone Family Medicine Residency New Hanover Family Medicine Residency Southern Regional AHEC Family Medicine Residency UNC – Chapel Hill Family Medicine Residency Wake Forest University Family Medicine Residency WOMACK Family Medicine Residency

NCAFP membership saw a slight increase, with the largest gains in the Active Member category. At the end of 2007, the chapter ranks ninth in terms of the highest membership totals among AAFP chapters, which remains consistent with previous year-end standings. Final membership numbers for 2007 with a 2006 comparison are as follows December 31, 2007 December 31, 2006

Brent Messick, MD Rachel Thomas, MD Matthew Sproul, MD Jamie Wise, MD Mario Olmedo, MD Elizabeth Fry, MD Jennifer Hall, MD Mark Cornelius, MD Adlih Moreno-Coll, MD Gandhari Loomis, DO Quoc Tai Phan, MD Kenyon Railey, MD John Hyden, Jr., MD David Gordon, MD

Retention and Recruitment - The chapter continues to recruit viable members through direct correspondence. This includes contacting physicians who live in NC, but who have not yet joined the AAFP/NCAFP. Additionally, the chapter solicits members of the Uniformed Services living in NC to join our chapter as “Adjunct Affiliates”. This membership class gives them the opportunity to receive all mailings and CME notices, but not to participate as voting members.

Each medical school’s family medicine department recognizes family physicians who help advance the principles of the specialty by dedicating themselves to the teaching and mentoring of medical students.

M e d i c a l S c h o o l H o n o r e e

Sara O. Beyer, MD Ann Scott, MD Scott Visser, MD Chris Christakos, MD

AAFP Appointments & Leadership - The following members serve at the national level through appointments by the AAFP or elections by the AAFP Congress.

2007 R es ea r c h P o st e r C o n t est

Mott P. Blair IV, MD - Chair, Commission on Health of the Public; Observer, Reference Committee on Public Policy.

The chapter’s annual poster contest consisted of three presentations. As a result of such close competition in the student category, the NCAFP Foundation awarded two runners-up. R e s e a r c h Cat e g o r y R e s e a r c h e r

Physician Category Resident Category Student Category

Active: 2006 Supporting: 15 Inactive: 21 Life: 208 Students: 108 Residents: 242 Total: 2600

Resident Membership - For the third consecutive year, the chapter achieved 100% resident membership and was recognized for this accomplishment by the AAFP.

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Duke University School of Medicine Brody School of Medicine at East Carolina University University of North Carolina – Chapel Hill Wake Forest University School of Medicine

Active: 2064 Supporting: 15 Inactive: 24 Life: 202 Students: 112 Residents: 236 Total: 2653

Michael Toedt, MD, FAAFP Jeffrey Roberts, MD Lorene Temming (UNC)

Conrad L. Flick, MD - Member, Commission on Governmental Advocacy. Dr. Flick was elected as Chair for 2007-08. Lori J. Heim, MD - Member, AAFP Board of Directors; Board Liaison, Commission on Quality. Victoria S. Kaprielian, MD - Member, Commission on Continuing Professional Development. Viviana Martinez-Bianchi, MD - Member, Commission on Membership and Member Services.

In Memoriam The following members passed away in 2007.

Edward L. Boyette, MD 2004 Family Physician of The Year Walter N. Long, Jr., MD Robert F. Willis, MD

Warren P. Newton, MD, MPH - Ex-Officio ADFM, Commission on Education. Karen L. Smith, MD - Member, Commission on Membership and Member Services. Thomas F. Koinis, MD - Member, Commission on Science

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Financial Position Summary

C o n s o l i dat e d Stat e m e n t o f F i n a n c i a l P o s i t i o n

The following represents the year-end financial summary for the NCAFP Academy. Dec. 31, 2007

Dec. 31, 2006

Dec. 31, 2005




38,510 15,548 281,099

28,321 13,453 312,890

23,688 13,770 292,336




205,000 606,113 219,006 36,022

205,000 606,113 181,904 36,022

205,000 606,113 175,706 36,022
















Dec. 31, 2007

Dec. 31, 2006

Dec. 31, 2005

3,278 223,305

4,804 222,675

117,998 253,259

Total Current Liabilities




Long-term Liabilities: Deferred Compensation Accrued Leave

104,074 36,000

85,449 36,000

74,008 36,000







Net Assets: Undesignated Board Designated

1,930,307 71,528

1,839,976 59,203

1,718.286 59,203

Total Net Assets




Total Liabilities and Net Assets




Position� is only a part of the

Assets Current Assets: Cash and Cash Equivalents Accounts Receivable, net of Allowance for Doubtful Accounts of $500 in 2006, 2005 Prepaid Expenses Investments

complete financial statements

Total Current Assets

examined by Thomas, Judy

Property and Equipment: Land Building and Improvements Furniture and Equipment Vehicles

Note: “The Consolidated Statement of Financial

& Tucker, P.A., Certified Public Accountants. The complete Financial Statements are available to any member of the North Carolina Academy of Family Physicians, Inc. upon request at the Academy headquarters.

Less Accumulated Depreciation Net Property and Equipment Other Assets: Investment, Deferred Compensation Total Assets

Liabilities and Net Assets Current Liabilities: Accounts Payable Deferred Revenue

Total Long-term Liabilities Total Liabilities

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State of the NCAFP Foundation As President of the NCAFP Foundation Board of Trustees, it gives me great pleasure to provide you with this 2007 State of the Foundation report. Our volunteers and chapter staff worked hard this year to address numerous health care issues in North Carolina, expand the reach of our programs and make continued progress toward ensuring that family medicine’ future is well-funded. Highlights of the year are listed below. Thank you for the opportunity. Fundraising & Contributions Summary •

Maureen Murphy, MD Foundation President

Dr. Murphy graduated from the University of Kansas School of Medicine in 1985, then moved to North Carolina to do her

residency at Duke-Watts Family Medicine Residency program in 1988. Upon completion, she taught for two years in the Department of Family Medicine at ECU in Greenville. She then

Contributions Total Member Contributions


Includes Member Dues Designated to the Foundation / $10 per member

Medical Student Endowment Fund Silent Auction Academy Contribution to Medical Student Endowment Fund Corporate Contributions

$7,462.00 $6,297.00 $80,000.00 $10,500.00

(restricted & unrestricted)

Grant Projects (Revenue) HWTF Adolescent Obesity and Inactivity Project HWTF Health Disparities Initiative IPIP Project – Robert Wood Johnson Funding IPIP Project – NC Division of Public Health Funding ICARE Partnership AAFP Foundation Health Literacy Grant Governor’s Institute on Alcohol and Substance Abuse N.C. Pediatric Society – Mini Fellowship

$117,746.23 $93,799.45 $241,666.67 $43,879.37 $61,443.50 $8,000.00 $30,000.00 $6,100.00

relocated to Gastonia, where she was in private practice for

Note: Due to grant project fiscal years, in some instances, revenue is provided in one fiscal year for the NCAFP Foundation and utilized in one or more fiscal years. The grant revenue listed above reflects the revenue to the Foundation in calendar year 2007 based on year-end audited financial statements.

12 years. She now practices in Sparta at Alleghany Family Practice, working at a critical

Medical Student Endowment Fund - Our endowment made a significant achievement in 2007 by growing to $604,706.69. We will continue to be aggressive in building this fund to ensure medical student interest is well funded for generations.

access hospital. Dr. Murphy has served in several positions in the NCAFP, including President

The Annual Silent Auction - We once again held our signature wintertime fundraiser alongside the Annual Meeting in Asheville. The Silent Auction generated a total of $6,297.00.

in 2001.

Medical Student Activities Family Medicine Interest Groups - We continued to support all interest groups in 2007 with funding, as well as staff support when necessary. The Foundation was also able to support each FMIG with a total of $1,400.00 in funding. Family Medicine Externship - A total of eight students completed the program in 2007. This represented an increase of 400% compared with 2006. The Foundation was also able to secure a grant for this program in the amount of $1,250.00. NCAFP/F Student Scholarship/Loan Program - The program witnessed an upsurge in interest, fielding a total of eight applications. Four scholarships were awarded: Cherrie Crowder (ECU), Rhianna Kirkpatrick (UNC), Oritsetsemaye Otubu (UNC), and Lorene Temming (UNC). T h e

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Foundation Board of Trustees The NCAFP Foundation works to enhance healthcare delivered to the people of North Carolina through philanthropy, quality health programs and by promoting the specialty of family medicine.

2007 Foundation Corporate Members



Foundation Officers President Vice President Secretary/Treasurer Executive Vice President

Maureen E. Murphy, MD Margaret Gradison, MD Shannon B. Dowler, MD Sue L. Makey, CAE

Maureen E. Murphy, MD Mott P. Blair, IV, MD Shannon B. Dowler, MD Gregory K. Griggs, MPA, CAE

Physician Trustees

Mott P. Blair, IV, MD Shannon B. Dowler, MD E. Bruce Elliston, MD Margaret Gradison, MD Robert E. Gwyther, MD James G. Jones, MD Michelle F. Jones, MD Eugenie M. Komives, MD Ofelia N. Melley, MD Maureen E. Murphy, MD Christopher Snyder, III, MD

Mott P. Blair, IV, MD Shannon B. Dowler, MD E. Bruce Elliston, MD Robert E. Gwyther, MD James G. Jones, MD Eugenie M. Komives, MD Ofelia N. Melley, MD Maureen E. Murphy, MD Jennifer L. Mulliendore, MD Robert L. Rich, Jr., MD Christopher Snyder, III, MD

Corporate Trustees Judy Mann Misys Healthcare Systems Rudy L. Snow Stanfield Mini Mart

Rudy L. Snow Southeastern Biomedical Associates, Inc.

Kim Frazier First Citizens Bank

Ad Hoc Members

Kirsten E. Bekker, MD MAHEC FMRP

Andy Gilliland, MD Wake Forest FMRP

Victor M. Vargas, MD Cabarrus FMRP

Jason Perlman, MD Cabarrus FMRP

Cherrie Crowder ECU FM Program

Kyle Geissler ECU FM Program

Rhianna Kirkpatrick UNC FM Program

Miles Harmon UNC FM Program

Grand Patrons

NC Academy of Family Physicians, Inc., Raleigh, NC


ECR Pharmaceuticals

MAG Mutual Insurance Company, Atlanta, GA

MedCost, LLC, Winston-Salem, NC

Misys Healthcare Systems, Raleigh, NC

The Medical Mutual Group, Raleigh, NC

Rudy L. Snow, Stanfield Mini Mart, Stanfield, NC

It is the mission of the North Carolina Academy of Family Physicians

Foundation to enhance healthcare delivered to the people of North Carolina. T h e

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Resident Activities & Programs Family Medicine Day Residency Recruitment Fair - The Foundation produced a residency recruitment event in Cary, North Carolina that attracted forty-six medical students. The event was made possible through funding by the NC AHEC program. Resident Section Workshops & Meetings - Clinical skills development workshops were held during the Annual Meeting in Asheville. Resident section meetings also took place at both the NCAFP Spring Meeting and NCAFP Winter Meeting. Residency Training Promotions - A unified ‘mountains-to-the-coast’ theme was developed for the state’s family medicine residency programs exhibiting during the annual National Conference.

Health Improvement Initiatives Adolescent Obesity & Inactivity Project (AOI) - This project was finalized in December, 2007. Project staff concentrated on documenting key success factors and barriers, as well as translating existing materials into accessible digital formats to ensure that key information would self-sustain in the future. Two capstone projects included creating a “how-to” guide for physicians and revamping the initiative’s website. The guide was successfully completed and printed copies made available at the Academy office and online at the chapter’s website. Mott Blair, MD, and Carolyn Dunn, PhD, completed the recording for Child and Adolescent Obesity Advances, an online CME program that will be available for 2 years and provide 1.5 CME credits. The North Carolina Tar Wars Program - Ms. Emily Osborne of Sparta, NC was selected as the 2007 Tar Wars Poster Contest winner for her poster titled “Birds of a Feather.” The National Tar Wars Conference was held July 16-17 in Washington, DC, with the Academy represented by Ms. Osborne, her mother, and Jenni Fisher, MPH, NCAFP Health Initiatives Manager. The chapter was awarded a grant from the AAFP for the Ask and Act Chapter Road Show. Overall, Tar Wars was presented at eighteen elementary schools, reaching 1,630 fourth- and fifth-graders. Health Disparities Initiative- Throughout 2007, the project provided speakers at the Spring, Summer and Winter CME Meetings with topics ranging from language access to understanding the Latino population in North Carolina. Throughout the year Academy staff worked with the Carolinas Center for Medical Excellence to recruit and enroll more than 60 practices in the online training curriculum developed by the Office of Minority Health. Five pilot practices were selected for the practice-based initiative in Raeford, Burlington, Mebane and Siler City. Medical students from the UNC School of Medicine assessed each practice’s compliance with the CLAS standards and developed a plan to help close the gaps where standards are not being met. The medical students also created a community outreach plan for the practices to implement in the next two years. The ICARE Partnership -- A provider-led initiative, the ICARE Partnership, comprises three focus areas: (1) training, technical assistance and clinical consultation services for providers; (2) coordination of pilot programs to identify best practices; and (3) recommended process and policy changes to promote integrated care. The NCAFP Foundation continues to be responsible for implementing related educational training into medical specialty and other healthcare association meetings. In addition, the Academy is responsible for provider training and technical assistance at the practice level under the direction of Tracie Hazelett, ICARE Provider Training Specialist. Improving Performance in Practice (IPIP) – The overall goal of the IPIP Project is to improve the quality of care in the areas of asthma and diabetes by transforming how family physicians, internists, pediatricians and their care teams deliver primary care. The plan calls for working closely with North Carolina Community Care, the North Carolina AHEC Program, the N.C. Department of Health and Human Services and the N.C. Division of Public Health. Funding for the project to the NCAFP Foundation comes through a contract with the American Board of Medical Specialties from a grant provided by the Robert Wood Johnson Foundation, and through a contract with the N.C. Division of Public Health. Other Activities and Sub-Contracts: The Foundation continues to work with related organizations on issues of concern to Academy members. Most recently, the Foundation has worked with: the Governor’s Institute on Substance Abuse to provide training on screening and managing substance use issues in primary care; the N.C. Pediatric Society to provide primary care practices with training on communication skills relevant to the treatment and management of family behavioral health issues; and the AAFP Foundation on funding for a pilot Health literacy initiative. T h e

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Ms. Emily Osborne of Sparta, NC was selected as the 2007 NC Tar Wars Poster Contest winner. There were a total of eight posters submitted to the contest in 2007.

Consolidated Statement of Financial Position The following represents the year-end financial summary for the NCAFP Foundation.

2007 Assets

Current Assets Cash and Cash Equivalents Investments Accounts Receivable Notes Receivable - Current Total Current Assets



Temporarily restricted




Permanently restricted



429,110 236,272 552,683 8,068 66,379 9,492

1,218,065 754,935 8,068 13,284 66,379 68,912 9,492 5,077






Endowment Investments Cash and Cash Equivalents Investments 208,113

Total Endowment Investments 208,113

Property and Equipment Furniture and Equipment Less Accumulated Depreciation

Net Property and Equipment

78,403 (74,573) 3,830

78,403 78,403 (74,573) (69,712) 3,830


Notes Receivable 21,297 Total Assets $516,879 $236,272 $552,683 1,305,834 1,080,309

Liabilities & Net Assets Current Liabilities Accounts Payable







Total Liabilities

Net Assets

Total Liabilities and Net Assets




1,271,452 1,043,970




1,305,834 1,080,309

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Summary of Financial Position Note: “The Consolidated Statement of Financial Position� is only a part of the complete financial statements examined by Thomas, Judy & Tucker, P.A., Certified Public Accountants. The complete Financial Statements are available to any member of the North Carolina Academy of Family Physicians, Inc. upon request at the Academy headquarters.

2007 Foundation Contributions Members and supporters are encouraged to consider making gifts of ongoing significance or yearly, individual donations to the Foundation. Contributions help the Foundation fullfill its mission of improving the health care of all North Carolinians and establishes a lasting legacy in a donor’s name. The following individuals have contributed to the NCAFP Foundation in 2007.

Grand Patron - $1000+ Robert E. Gwyther, MD Drs. Michelle F. & James G. Jones in honor of Sue L. Makey, CAE Genie Komives, MD Sue L. Makey, CAE & Mr. Bob Makey Maureen E. Murphy, MD & Mr. Scott Maxwell R.W. Watkins, MD, MPH

Patron - $500 - $999 Sara O. Beyer, MD Dr. Ed & Mrs. Marianne Campbell Jane T. Carswell, MD Margaret Gradison, MD & Mr. Gary Tiller Wayne A. Hale, MD Thomas F. Koinis in honor of Sue L. Makey, CAE

Benefactor - $250 - $499 Lin and Linda Church in honor of Sue Makey Amy R. Csorba, MD William A. Dennis, MD Dr. & Mrs. Charles H. Duckett in memory of Julian F. Keith, MD E. Bruce Elliston, MD Conrad L. Flick, MD in honor of Sue Makey Valerie J. Gilchrist, MD Lori J. Heim, MD Dr. Hervy B.& Mrs. Deborah Kornegay in honor of Sue Makey Dr. & Mrs. Robert L. Rich, Jr. in honor of Sue Makey Mark D. Robinson, MD Rudy L. Snow in honor of Sue Makey Hal M. Stuart, MD Sharon Sweede, MD Robert G. Townsend, Jr., MD in memory of R.G. Townsend, Sr.

Dr. George & Mrs. Betty Wolff in honor of Sue Makey Thomas J. Zuber, MD

Sponsor - $100 - $249 Robin D. Adams, MD Robert E. Almquist, MD Michael C. Alston, MD in honor of Dr. Charles Sawyer Robert J. Andrews, MD Amanda C. Austin, MD Johnny W. Bagwell, MD Timothy M. Beittel, MD Holly Biola, MD Kirsten Nicole Ferebee Bray, MD in honor of Vallie & W. Donald Bray Jack Cahn, MD Josiah M. Carr II, MD Robert S. Cline, MD in honor of Sue Makey’s retirement Michael Coates, MD, MS Thomas L. Cronan, MD Kenneth L. Crutcher, MD L. Allen Dobson, MD in honor of Dr. James G. Jones and Sue Makey Shannon B. Dowler, MD in honor of Sue Makey James H. Early, MD Karl B. Fields, MD in honor of George Wolff, MD Brian R. Forrest, MD Roy J. Friedman, II, MD Cammie J. Fulp, MD Deepak R. Gelot, MD Stephanie M. Glenn, MD Gregory K. Griggs, MPA, CAE in honor of Sue Makey James Grayson Hall, MD Mary Nolan Hall, MD & David H. Hall, MD Irene M. Hamrick, MD James R. Hodges, MD Jeffrey Dale Hoffman, MD

Janice Elizabeth Huff, MD Ronald Samuel Intini, MD Christopher B. Isenhour, MD Nicola J. Jacobucci, MD Cynda Ann Johnson, MD, MBA Champ M. Jones, Jr., MD in honor of Sue L. Makey, CAE Victoria Kaprielian, MD & Mr. Jon Luis A. Paul Kitchin, MD in memory and honor of Dr. Bill Deskins, Class of ’62, Bowman Gray School of Medicine Dr. & Mrs. Frank Leak in honor of Michelle F. Jones, MD and in honor of Sue Makey Mary Elizabeth Lyon-Smith, MD Marjorie F. Matthews, MD A. Thomas May, III, MD Robert H. McConville, Jr., MD Deborah S. McRoberts, MD Darlyne Menscer, MD Susan E. Murphey, MD J. Thomas Newton, MD Warren P. Newton, MD George R. Parkerson, Jr., MD Rajal Patel, MD Edward T. Plyler, MD Charles W. Rhodes in honor of Dr. L. Allen Dobson Dr. David & Mrs. Lucille Rinehart Carlos M. Rish, MD in honor of healthcare to the people of NC Marlene & Phil Rosol in honor of Sue Makey J. Carson Rounds, MD & Amy Burgin in honor of Sue L. Makey, CAE Elizabeth L. Saft, DO George L. Saunders, III, MD Charles J. Sawyer, III, MD Stephen C. Seltzer, MD Philip D. Sloane, MD Ben D. Thomas, MD Rafael G. Torres, MD William “Bev” Tucker, MD Eugene H.P. Wade, MD Dr. Jana Watts & Mr. Terrence Greene Adam Wenzlik, MD

1303 Annapolis Drive Raleigh, NC 27608 P.O. Box 10278 Raleigh, NC 27605

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Telephone Fax In-State Toll Free Web Site


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Francis P. Wong, MD Thomas Hayes Woollen, Jr., MD

Donor - $99 or less William Evan Ballard, MD Janalynn F. Beste, MD C. Christopher Bremer, MD Francis E. Buckman, MD Erik S. Butler, DO Karol C. Cheek, MD Hazel Duncan-Guy, MD Suzanne Eaton Jones, MD Carol & Don Ervin in honor of Sue Makey Jennifer K. Fisher Jack Gerard Peter T. Graber Colin D. Jones, MD Tae J. Lee, MD Andre L. Lopez, MD Mary T. Mackenzie, MD Lloyd Michener, MD Seema C. Modi, MD Jennifer L. Mullendore, MD Augustine N. Onwukwe, MD Albert J. Osbahr, MD Dean Patton, MD David M. Ramsey, III, MD W. Richard Schmits, Jr., MD Curtis D. Schultz, MD Tom Shelburne, MD Karen L. Smith, MD Christopher Snyder, III, MD Kenneth K. Steinweg, MD Thomas R. Terrell, MD Rachel E. Thomas, MD Walter H. Wray, Jr., MD

Legacy League Planned Gifts to the Foundation

Gary O. Bean, MD C. Christopher Bremer, MD Maureen E. Murphy, MD Robert W. Patterson, MD

(919) 833-2110 (919) 833-1801 (800) 872-9482 http:// www.ncafp.com


o f

T w o


A Family Physician Ready To Take The Lead Dr. Lori Heim Campaigns for AAFP President-Elect AAFP Board Director and North Carolina resident Dr. Lori Heim of Vass recently announced her candidacy for AAFP President-Elect. To provide members insight into her leadership philosophy and her perspectives on the specialty and what’s needed at the national level, The North Carolina Family Physician asked her to share her thoughts on a number of key questions. The first portion of her thoughts appeared in the last edition (V.4, N1). What follows is the continuation of her thoughts. As a candidate, what do you think are your key strengths as a physician leader and as a representative of the specialty?

Attracting student interest is crucial to the specialty’s future.  What are your perspectives on this?

Payment reform is critical. If Family Physicians aren’t able I am tenacious. I have a well-developed sense of organization to keep their doors open then we can’t attract new docs. Loan forgiveness or payment is another especially for thoseproven support of our association and can beneficial change. Myelections training inpresent strategica tremendous Therecognize upcoming AAFP Board opportunity for option, the NCAFP. Your Dr. Lori Heim of Vass, NC that go into underserved areas. There are models that have planning allows me to assess situations, both locally and gives me confidence that you’ll consider this important call to action. nationally, to see how to align our mission. I can represent our been successful in other states that we can use on a national Academy to others and make our value case. I’ve the experience level once we have the political support. Dr.AAFP Heim has been aof member of As you are aware, Dr. Thomas Koinis, our current NCAFP Foundation President, is a candidate for the Board Directors. Development of mentoring programs from high school to give the perspective of the ‘doc in the trenches’ and from the AAFP since 1985. She served as offers the NCAFP an excellent to influence AAFP the national though medical schools to show policy studentsat what Family level, and to help direct our that, His of a candidacy medical director responsible for running a hospitalopportunity a delegate to the specialty at a very critical time. Should he be elected, Dr. Koinis willsatisfaction. be able toWe communicate views onAAFP’s topicsCongress like tort Physicians do and the also know fromour the region’s or clinic. that admission practices that encourage more diverse reform, medical malpractice insurance, the Futureresearch of Family Medicine Project, and our agrowing reimbursement crisis. If toelected, of Delegates from 2000 2004, he student population will increase thebeen. numbers who choose will be a powerful resource for our association as Drs. Jones and Henley have as well as on the Commission on How can the AAFP advance the concept on the Family Medicine.

‘medical home’?

Health Care Services and on the

Although the benefits are clear, election campaigns are both time-consuming and costly. I am personally asking for your financial Task Force of Linkages to Practice From the members’ point - assess and Major of the New Model are predicated support. Yourstand contribution willyour helppractice our chapter offsetportions campaign expenses – estimated this on year at over $15,000 – and allow us to then wage look toawhat might do toeffort improve. The AAFP Shebe hasheard held theby all payment reform. Please your thoughts this. veryyou competitive leading up towill balloting on October 2nd. share It will insure thatonDr. Koinis’s Improvement. message will continue to engage business leaders, as well as other allies within offices of president, vice president, AAFP delegates. His election will help us secure a strong voicehas onbeen the AAFP 2006. The Academy resolved Board that anythrough discussions on Your contribution and medicine, and patient advocacy groups to educate and advance newsletter editor and member of the involvement is vital.FamMedPac and our private and the patient-centered medical home or any new payment the medical home. Through board of directors of the Uniformed public advocacy efforts, we are reaching out to other allies to methodologies includes new funds. We cannot continue in status quo and as weform strive below to improve delivery of headquarters. care, make contribution, simply fax or mailthethe completed toour Academy The fax number is show To the value of your the medical home. Demonstration projects, Services Academy of Family thereenvelope. must be additional payments to Family Medicine. Our both (919) government and privately continue to show the reply 833-1801 or usefunded, the enclosed business Physicians. value of Family Medicine and the patient-centered approach. models include 3 sources of payment 1) traditional fee for Our job is to get this message out to the public, politicians and payment 2) a per member per month care coordination fee I always appreciate your continued commitment and look forward to success in October. Thanks! and 3) performance improvement bonus. businesses, large and small.


Contribute To Dr. Heim’s AAFP President-Elect Campaign

North Carolina has a unique opportunity to impact the direction of family medicine at the national level within leadership at the AAFP. By contributing to Dr. Lori Heim’s campaign for AAFP Dr.that Mott P. Blair, IVresources it needs to conduct one of the best President-Elect, you help ensure our state has the President presidential campaigns in the nation. To contribute, simply complete the form below and return with your contribution to Academy offices.

Mental Health - continued from p8 North Carolina Psychiatric Association (NCPA), as well as the North Carolina Academy of Family Physicians, The North Carolina Pediatric Society, are all working to find “what works” as the system for delivery of mental health care evolves. The specialty societies are also involved in developing tools to assist primary care providers with screening, algorithms for treatment, and support for referrals to other professionals. What does integrated care look like? Several models exist, one of which is called co-location. This model includes the placement in a primary care practice (PCP) of one or more mental health

professionals, such as clinical psychologists, licensed clinical social workers (LCSW’s), advanced nurse practitioners, or physician’s assistants, who are specially trained in mental health. These professionals can be directly hired by the practice, or they may be available on a rotating basis to a number of practices in a geographic area, and work for a local mental health agency or specialized provider. These providers can accept duties delegated by PCP physicians, including screening, referrals to higher-level psychiatric providers, counseling, and assistance with finding resources to manage the patient’s needs. In some instances, a psychiatrist is even co-located in a primary care practice.

Another option is to co-locate an independent mental health practice with an existing PCP, whether in the same office or “just down the hall.” This practice may be a single practitioner or a group of mental health providers, and the costs and reimbursement all go to the mental health practice. Phone consultation is another critical aspect of integration of care. Western Horizons (in the western end of the State) and Five County Mental Health Authority (north-central), both Local Management Entities charged with overseeing the delivery of mental health to their citizens, have implemented phone services that encompass such activities as referrals for patients (directly), crisis triage, and serving as a resource for local physicians to ask questions about behavioral health. Some concern exists about billing and reimbursement for additional services and/or extended visits. While coding and billing are notoriously complex, options do exist for both Medicaid and Medicare reimbursement for mental health diagnoses. And, contrary to one prevalent myth, one does not have to be a psychiatrist to utilize billing codes associated with a mental health diagnosis. Mental health professionals who are co-located or integrated may either bill “incident to” the physician visit, or may bill under their own provider number.

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

More equitable reimbursement is now beginning for private insurance. The North Carolina Mental Health Equity Bill was signed into law by Governor Easley, and goes into effect on July 1, 2008. This State bill aims to reduce the “carving out” of mental health and substance abuse treatment from health care plans, and requires mandatory health insurance coverage of several serious mental illnesses, including bipolar disorder, major depressive disorder, anorexia nervosa, bulimia, schizophrenia, paranoia, post-traumatic stress disorder, and obsessive-compulsive disorder. Furthermore, the bill requires a minimum benefit package for other mental illnesses, and forbids increased co-payments or deductibles for mental health diagnoses (http://www.ncmedicaljournal. com/sept-oct-03/ar090302.pdf ). A bill at the Federal level, which would supersede any state law that was less comprehensive, passed the Senate last September. This bill (S. 558) is currently in a U.S. House Subcommittee, and would apply to insurance plans for employers who have more than 50 employees. Mental health is already a large component of family medicine. We must continue to expand our knowledge of and comfort with the patient’s “whole picture,” and sharpen our skills in dealing with the real-life problems in our families and communities. We must be advocates for our patients in this area, as we are in so many other areas of health.

Health Initiatives UPdate

Health Disparities Initiative Continues to Train Physicians on Cultural Competency Dr. John Torontow creates innovative cultural learning activity that’s also a great team builder

NC Tar Wars Program Highlighted at UNC’s Community Service Day Two UNC Medical Students designed a poster and gave an excellent presentation on North Carolina’s Tar Wars Project during UNC School of Medicine’s Community Service Day in late February. Community Service Day showcases community service accomplishments by the school’s medical students. Yearly, a number of first- and second-year medical students at UNC volunteer to present Tar Wars in Chapel Hill and Carrboro elementary schools. Last year they reached over 450 fifth grade students! If you have interest in presenting Tar Wars to your local elementary school, please contact Jenni Fisher at 919833-2110 or jfisher@ncafp.com.

By Jenni Fisher, MPH, NCAFP Health Initiatives Manager

The Academy’s Health Disparities Initiative (HDI) is now into its second year. Throughout 2008 the project will continue to educate physicians through CME opportunities at the NCAFP meetings and through more intensive intervention at its five (5) pilot practice sites. The Academy staff is focusing efforts on consistent follow-up at the pilot practice sites and in assisting them with changes related to increasing their compliance with the Culturally and Linguistically Appropriate Services (CLAS) Standards. Last year, HDI lectures were held at both the NCAFP Mid-Summer Family Medicine Digest in July and the NCAFP Annual Meeting in November. Dr. Karen Smith spoke

at the Mid-Summer meeting on “Providing Patient-Centered Care through Cultural Proficiency,” and Dr. Rafael Torres brought another perspective by sharing his experiences with working in the Latino population in his presentation “Understanding HIV and Its Affect on Disparate Populations.” During December’s Annual Meeting, Dr. Aasama Jafri and Dr. Sunita Mutha from the California Academy presented on behalf of a health disparities project currently being implemented in California. They delivered a one-hour lecture, as well as a more intensive workshop to a smaller group of physicians titled “Addressing Language Access Issues in Your Practice.” Dr. John Torontow was an additional speaker

on the topic as well and presented an engaging session about his experiences in treating his Hispanic patients with diabetes and how awareness of their cultural beliefs can impact the care they receive. Ironically, Dr. Jafri, Dr. Mutha and other members of the California Academy were so impressed with Dr. Torontow’s talk, they felt his ideas matched perfectly with their efforts in California. Dr. Torontow will be presenting at the California Continues on back cover

One Hour = Healthier Kids

Present the tobacco-free message at a local school. In just one hour, you can give kids in your community the gift of longer, healthier lives.

How? Volunteer to be a Tar Wars presenter. The experience is rewarding!

Make a positive impact in your community.

Learn more at www.tarwars.org

Supported in part by a grant from the American Academy of Family Physicians Foundation. WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC


Dr. Brian Forrest - Program Chair

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r e m m u S igest d-

Miily Medicine 4D, 2008


y l u J 9 June 2

at Kingston Plantation Myrtle Beach, SC

Up to 28+ Credits!


Complete Spring Family Physicians meeting information and registration is online at http://www.ncafp.com/msfmd complete information on this meeting and to register, go to www.ncafp.com/msfmd


Health Initiatives Update

ICARE Project Entering New Phase with Practice-Based Trainings Mental Health Learning Modules Complement Academy’s Spring Meeting in Concord Statewide education and assistance is a primary focus areas of the ICARE Partnership’s mental health integration project. Particular attention is being placed on developing practice-based provider training opportunities that encourage capacity enhancement and relationship building. ICARE is preparing to begin this portion of its initiative in the coming months. Several topics are currently under consideration for practice-based trainings. These include the use of general screening tools; how to incorporate use of algorithms into the practice; information on various models of integrated care; how to begin the process of providing integrated care to patients; and, information on billing

Mental Health & Primary Care Integration

www.ncafp.com/icare and coding as it pertains to mental / behavioral health codes. If you have suggestions for training topics or would like to request assistance in an identified area, please contact Tracie Hazelett at 919-833-2110 or thazelett@ncafp.com. ICARE also held a regional training session in tandem with the NCAFP’s

Spring Family Physicians Weekend in Concord in late April. Titled ‘Alcohol Use and Abuse: Intervening Across the Continuum’, the seminar was delivered by UNC’s Dr. Robert Gwyther, MBA and Terrill Bravender, MD, MPH, and it assisted attendees in learning the importance of screening and recognition of substance abuse. Attendees also were presented with options for screening and assessment of patients, as well as understanding the basics of how to perform a brief intervention. Participants were also encouraged to share the changing nature of substance abuse treatment and the role of primary care physicians in an integrated treatment system.

Make a Special Gift

You can honor or memorialize a colleague, friend or family member with a gift to the NCAFP Foundation. With this 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 Kathryn Atkinson, NCAFP Foundation, (919) 833-2110, (800) 872-9482 [NC only], or katkinson@ncafp.com.

NCAFP/F’s Disparities Initiative Presents to Society of Teachers of Family Medicine Members from the NCAFP Foundation’s Health Disparities Initiative presented a lecture titled, ‘PC3 Redesigning Medical Offices Into Healing Environments: Using CLAS as the Model’, during the Society of Teachers of Family Medicine’s (STFM) 28th Annual Conference on Families and Health in New Orleans in early March. The aim of the presentation was to describe how a CLAS (Culturally and Linguistically Appropriate Services) Assessment can be carried out in the office setting and to present recommendations and findings from the four CLAS Assessments conducted in family medicine offices and community health clinics in the state. UNC medical students Kevin Sitko (M2) and Joshua Evans (M2) served as lead presenters, with UNC’s Pam Fraiser and NCAFP’s Jenni Fisher, MPH, sharing additional information and perspectives.

resident tracks

2008 A Good Match Year for Family Medicine Interest in family medicine among U.S. medical students jumped in 2008, and evidence of that growth came on March 20 when the National Resident Matching Program, or NRMP, announced the 2008 Match results. And according to at least one North Carolina residency program, the quality of applicants was just as impressive. “Overall, I was impressed with the quality of this year’s applicants. As a group they have all the character traits to be wonderful family docs,” noted Cabarrus’s Residency Director Dr. Mark Robinson. Dr. Robinson current serves as President of the Association of Family Medicine Residency Directors. According to the AAFP, the results show that 1,172 U.S. medical school graduates -- 65 more than in 2007 -- chose family medicine for their careers, and 2,404 of 2,654 family medicine residency positions were taken, for a fill rate of nearly 91 percent. North Carolina’s results were similar.



Cabarrus FMR Southern Regional AHEC FMR Duke University FMR Wake Forest University FMR UNC-Chapel Hill FMR East Carolina University FMR CMC-Charlotte FMR CMC-Union FMR Moses Cone FMR MAHEC-Hendersonville FMR New Hanover FMR MAHEC-Asheville FMR

8* 8 4 10 8 10 8 2 8 3 4** 9



6 4 4 7 8 10 8 0 8 3 1 9

1 4 0 3 0 0 0 2 0 0 3 0


8 8 4 10 8 10 8 2 8 3 4 9

* Contracted one position outside of match. ** Participated in the DO match, with one position placed.

WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC


family medicine IN practice

NC State Health Plan Will No Longer Offer Indemnity Plan After July 1, 2008

NC Early Childhood Vision Care Program Releases Revised Screening Forms Vision screening is now a key part of the Kindergarten Health Assessment. Revised forms are now available.

In 2006, Governor Easley signed into law the North Carolina Early Childhood Vision Care Program (ECVCP), requiring all children entering kindergarten to receive a vision screening. Kindergarten screenings must be conducted in accordance with standards adopted by the Commission on Early Childhood Vision Care. Children who fail a vision screening must receive a comprehensive eye examination. Funds are available for eligible children to receive a comprehensive eye examination

and prescribed glasses. Visit http://www.ncpublichealth. com/visioncare for more information about ECVCP screening and available financial assistance. VISION SCREENING STANDARDS To satisfy the requirements of the Early Childhood Vision Care Program, Kindergarten vision screenings must include an assessment of the following components:

1.  Signs and symptoms of eye disease 2.  Distance visual acuity for each eye 3.  Stereopsis The child is then referred for failure of any of these three components. KINDERGARTEN HEALTH ASSESSMENTS Vision screening is a required element of the kindergarten health assessment. A Kindergarten Continues on p. 31

According to a notice released by the NC State Health Plan, its indemnity plan will no longer be offered effective July 1, 2008. During the upcoming enrollment period, members will be given a choice of the three Preferred Provider Organization (PPO) plan options. Members who do not make a selection will be automatically enrolled in the PPO Standard Plan. Please note that providers will still be able to submit indemnity plan claims for up to the next 18 months. Members and providers will also continue to have access to Indemnity Plan Customer Service and appeal rights. Providers can direct all questions to (919) 881-2300.

Attention Physicians: Know Your New Immunization Requirements!! Physicians, are you aware of the newest immunization requirements for kindergarten, Continues on back cover


april - june 2008 | the North Carolina Family Physician

N C O r a l H e a lt h S e c t i o n

Vision Screening, cont. from p31

Health Assessment form completed by the family physician or pediatrician is mandated for all children entering kindergarten in North Carolina and is acceptable proof of vision screening. These screenings are not the responsibility of school nurses or other school staff or volunteers. Visit http://www.ncafp.com/home/ 2008kha or http://www. nchealthyschools.org/docs/home/ kha0809.pdf to access the revised 2008-09 Kindergarten Health Assessment form. FINANCIAL RESOURCES Funds are available for eligible children referred for suspected vision problems. The ECVC Program provides funding to cover vision examinations and glasses for children entering Kindergarten through grade 3. Children must be uninsured, not eligible for the VSP program, and their family income must be at or below 250% of the Federal Poverty Level. One pair of replacement glasses is available to children who have lost or broken glasses. The VSP Sight for Students Program provides free vision exams and glasses to uninsured school children who have a social security number and a family income at or below 200% of the Federal Poverty Level. Visit http://www.ncpublichealth. com/visioncare to access the VSP/ ECVC combined application form.   PREVENT BLINDNESS NORTH CAROLINA Focused on promoting a continuum of vision care, Prevent Blindness North Carolina touches the lives of thousands of people a year through vision screenings for preschoolers and adults, certified vision screening training, and public and professional education. For additional information on the following subjects, visit http://www.preventblindness.org/nc • Vision Screening Tools: Lang Stereotest II, Titmus Butterfly or Fly; LEA Symbols chart; HOTV chart • Vision Screening Instructions: A self-instructional module on vision screening for primary care offices; Early Childhood Vision Care Program Screening Guidelines; and instructions for Lang II stereopsis testing.

Water Fluoridation in Your Community is Important By Kelly Haupt

Lately and more frequently, citizens are questioning the importance of fluoridating their public water supplies. Citizens hear or read erroneous information, often found as opinions or ‘studies’ on the Internet, that labels community fluoridation as a health risk. Most of these so-called ‘expert’ opinions or studies are based on faulty, non-peer-reviewed research, antidotal occurrences, or just plain false facts. When citizens bring their concerns to the attention of city or town council members, local elected officials may not be familiar with the factual science behind fluoridation and the evidence-based proof of its benefits. They can be swayed by the sentiments and emotions of well-meaning, but ill-informed alarmists. As physicians practicing within the community, you are looked to as health care experts whose opinions will give balance and reason to the arguments against fluoridation. You know that community fluoridation reduces the incidence of dental disease. You can explain that the State Health Director of North Carolina, Dr. Leah Devlin, the Centers for Disease Control and Prevention, and each US Surgeon General since the 1950s all strongly support fluoridation. Moreover, every responsible national health advocacy organization supports fluoridation. The American Dental Association promotes its position on community fluoridation very well in its publication Fluoridation Facts. Tooth decay has been dramatically reduced over the years since community fluoridation began in the late 1940s. However, in North Carolina, 25% of fifth grade children have had tooth decay in their permanent teeth and 19% of children enter kindergarten with untreated decay in their primary teeth. After years of decline, the amount of tooth decay in primary teeth has leveled off, and has even increased in some groups of very young children. Only one in four children in NC visits a dental office regularly and there exists a measurable disparity in the dental health of certain ethnic populations. (NC Oral Health Section data) These are all reasons to continue the fluoridation of public water supplies. Please be aware when your elected officials are asked to reconsider fluoridation. Be ready to speak up for its importance to the dental health of your community.

REMINDER: The Dental Varnish Procedure Has New Time Interval Requirements That Enable Additional Screenings By Kelly Haupt, MPH, Into The Mouths of Babes Project Coordinator

In an effort to increase opportunities for young Medicaid children to have the six maximum dental varnish procedures, Medicaid has changed the time interval requirements. Children are now eligible for the procedure until they are 3 ½ years old (through 41 months) and the time interval between procedures is reduced from 90 to 60 days. This promotes flexibility for providing the procedure at well child visits scheduled at 90 day time intervals as well as at the 3 year well child visit. Effectiveness data show that children receiving 4, 5 or 6 oral screening




and fluoride varnish procedures have approximately 40% fewer dental treatment needs. At the present time most children receive the procedure only twice before their 3rd birthday. Thank you for your feedback on these barriers and to Medicaid for working to increase access to oral preventive care for enrolled children. ALL ‘Into the Mouths of Babes’

toolkit contents and the ‘Babes Brief ’ newsletter are now on the web! Visit http://www.oralhealth.ncdhhs.gov to access materials or their links. Scroll to the bottom of the page and you will see the ‘Into the Mouths of Babes’ link. It will take you to the general overview and the Oral Health Toolkit materials. If you are interested in becoming an IMB provider or would like more information about the program, check out the above web site or call Kelly Haupt, Project Coordinator, at 919707-5485 or email Kelly.Haupt@ ncmail.net

WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC


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Disparities- cont. from p27

Immunization Requirements - continued from p30

Academy of Family Physician’s 2008 Annual Scientific Assembly: Family Medicine’s Clinical Roadmap to the Future. His talk is titled “Ay Que Susto! Treating Diabetes in an Emerging Hispanic Population: How Culture Matters.” Another effort of Dr. Torontow’s is participating in the pilot practice portion of the Health Disparities Initiative. One activity he envisioned and created was to organize a staff luncheon to increase awareness of different cultures. All staff was required to attend the luncheon and to bring a dish and a story from either a place where they have traveled to or their home country. The stories served as a way to debunk myths about certain cultures and to increase knowledge of disparate population groups. The luncheon was very well received and Dr. Torontow thought it was even a great team building activity for the staff. He plans to continue this as an annual staff event. The Health Disparities Initiative is made possible from a grant through the N.C. Health and Wellness Trust Fund Commission. The Academy received the three-year grant in July 2006. If you would like more information, please contact Jenni Fisher at 919-833-2110 or jfisher@ ncafp.com.

sixth grade and college entry? The immunization rules were updated on January 1, 2008 and there are new requirements for school entry for tetanus/diphtheria/pertussis

Keep YOur member info Up-to-date 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 Tara Hinkle, NCAFP Membership Coordinator, at thinkle@ncafp.com, 919-833-2110, or 800-872-9482.

(Tdap) and mumps vaccinations. For more information, the NCAFP has made available for download a flyer produced by the NC Immunization Branch. The flyer

can be found online at the Academy website at http://www.ncafp.com/ home/node/387. Download it today.

Advocacy: Raise Your Voice - continued from p8 And what I feel may have the most impact: get your patients to lobby on our behalf! •         Print off a letter about this issue and hand it to your patients. Then encourage them to send it to their Senators and Representative, telling them not to shut the door on Medicare patients. •         And finally, print off a sample

petition for your patients to sign; then send it to your Senators and Representative. (These are also available at http://www.aafp.org/ medicarecut) This is one area in which the entire Academy, your fellow members and patients need your help. It will require the input of as many

The NCAFP Annual Meeting Dec. 4th - 7th, 2008

Grove Park Inn - Asheville, NC www.ncafp.com/wfpw

physicians and patients as possible to accomplish what we need - payment reform. We need your help to stop the Medicare physician payment cut. Thank you for taking time out of your busy day to act and spread the word to others. Encourage your partners and colleagues to do the same. It’s critical that we all work together to ensure a stable payment system.

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