Page 1

Winter 2009

See Details on Page 9 The North Carolina Family Physician

Vol. 5 - No. 4

Fourth Quarter, 2009


Dec. 3-6, 2009

The Grove Park Inn & Spa Asheville, North Carolina

2009 Presidential Odds and Ends Academy Accomplished Much This Year Despite Challenges See Page 4

Also in This Edition Family Medicine Achieves Victories in Contentious Legislative Session..................................5 CME: A Cornerstone of Your Academy..........................................................................6 Overview of Loan Repayment Programs...................................................................... 12 Suggestions for Selecting Information Technology for Your Practice................................. 14

Invest In The Future of Family Medicine N O R T H

FAMPAC is NCAFP’s voluntary political action committee (PAC) that provides North Carolina family physicians with an opportunity to have a strong voice in the N.C. General Assembly.


FAMPAC Why contribute?

 The NC Medicaid Program  Managed Care Issues  The Uninsured & Underinsured  Scope of Practice Issues

Why support your PAC? FAMPAC contributions go directly to support legislators whose business, legal, and medical philosophy are consistent with those of the NCAFP and family medicine. As a result, our specialty’s interests are more likely to receive greater attention among the many competing interests and proposals put forth for consideration.

 Liability Reform  Health Care Access  Family Medicine Education  Other Practice Concerns

Please complete the following information as required by law for political contributions:

Indicate Amount:

Today’s Date:

Name of Employer:

q $1,000.00 q $500.00 q $250.00 q $100.00

Your Profession:

Contribution Payment:

Voluntary contributions to FAMPAC are not limited to the suggested amounts and should be written on a PERSONAL CHECK. Funds from corporations cannot be used for contributions and expenditures in either federal or state elections. If you are a Professional Association (PA) physician and send your contribution on a PA check, such funds must be from a non-refundable drawing account established to permit draws against salary or profits and represent personal funds rather than funds of your PA. The NCAFP will not favor or disadvantage anyone based upon the amounts of, or failure to, make PAC contributions. Copies of FAMPAC reports are filed with the Federal Election Commission and are available for purchase from the Federal Election Commission in Washington, D.C. Voluntary political contributions are subject to the limitations of FEC regulations, Section 110.1, 110.2 and 110.5 (Federal regulations require this notice). Contributions to FAMPAC are not deductible as charitable contributions for Federal Income Tax Purposes. N.C. LAW REQUIRES POLITICAL COMMITTEES TO REPORT THE NAME, MAILING ADDRESS, JOB TITLE OR PROFESSION AND NAME OF EMPLOYER OR EMPLOYER’S SPECIFIC FIELD FOR EACH INDIVIDUAL WHOSE CONTRIBUTIONS AGGREGATE IS IN EXCESS OF $50 IN AN ELECTION CYCLE.

Payment Type:



q $50.00 q $25.00 (Residents) q $10.00 (Students) q Other: __________ q




Name on Card: Card Number:

Exp. Date:

Billing St. City



Invest In The Future of Family Medicine North Carolina Academy of Family Physicians N O R T H

FAMPAC is NCAFP’s voluntary political action committee (PAC) that provides North Carolina family physicians with an opportunity to have a strong voice in the N.C. General Assembly.


FAMPAC Why contribute?


 The NC Medicaid Program  Managed Care Issues  The Uninsured & Underinsured  Scope of Practice Issues

 Liability Reform  Health Care Access  Family Medicine Education  Other Practice Concerns


Why support your PAC? FAMPAC contributions go directly to support legislators whose business, legal, and medical philosophy are consistent with those of the NCAFP and family medicine. As a result, our specialty’s interests are more likely to receive greater attention among the many competing interests and proposals put forth for consideration.

March 26-28, 2010 Indicate Amount: Kingsmill Resort q $1,000.00 & Spa q $50.00 q $500.00 q $25.00 Williamsburg, VA $250.00 q q $10.00

Please complete the following information as required by law for political contributions: Today’s Date:

Name of Employer: Your Profession:


Voluntary contributions to FAMPAC are not limited to the suggested amounts and should be written on a PERSONAL CHECK. Funds from corporations cannot be used for contributions and expenditures in either federal or state elections. If you are a Professional Association (PA) physician and send your contribution on a PA check, such funds must be from a non-refundable drawing account established to permit draws against salary or profits and represent personal funds rather than funds of your PA. The NCAFP will not favor or disadvantage anyone based upon the amounts of, or failure to, make PAC contributions. Copies of FAMPAC reports are filed with the Federal Election Commission and are available for purchase from the Federal Election Commission in Washington, D.C. Voluntary political contributions are subject to the limitations of FEC regulations, Section 110.1, 110.2 and 110.5 (Federal regulations require this notice). Contributions to FAMPAC are not deductible as charitable contributions for Federal Income Tax Purposes. N.C. LAW REQUIRES POLITICAL COMMITTEES TO REPORT THE NAME, MAILING ADDRESS, JOB TITLE OR PROFESSION AND NAME OF EMPLOYER OR EMPLOYER’S SPECIFIC FIELD FOR EACH INDIVIDUAL WHOSE CONTRIBUTIONS AGGREGATE IS IN EXCESS OF $50 IN AN ELECTION CYCLE.

(Residents) (Students)

q Other: __________

q $100.00

Contribution Payment: Payment Type:







Name on Card: Card Number:

Exp. Date:

Billing St. City




THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, North Carolina 27605 919.833.2110 • fax 919.833.1801 http://www.ncafp.com

2008-2009 NCAFP Board of Directors NCAFP Executive Officers President Robert Lee Rich, Jr., MD President-Elect R.W. ‘Chip’ Watkins, MD, MPH, FAAFP Vice President Richard W. Lord, Jr., MD Secretary/Treasurer Shannon B. Dowler, MD Board Chair Christopher Snyder, III, MD Executive Vice President Gregory K. Griggs, MPA, CAE Past President (w/voting privileges) Michelle F. Jones, MD The District Directors District 1 R. Kevin Talton, MD District 2 Connie Brooks-Fernandez, MD District 3 Victoria S. Kaprielian, MD District 4 Tim J. McGrath, MD District 5 Sara O. Beyer, MD District 6 James W. McNabb, MD District 7 Thomas R. White, MD At Large Brian R. Forrest, MD At Large William A. Dennis, MD Minority Physicians Constituency Enrico G. 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 Alicia C. Walters, MD (WFUBMC) Resident Director-Elect Meshia Todd, MD (Duke) Student Director Lillianne M. Lewis (Duke) Student Director-Elect Kathryn Norfleet (UNC)

Volume 5

The North Carolina Family Physician

Number 4

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

2009 Presidential Odds and Ends ............................................................. 4 Family Medicine Achieves Victories in Contentious Legislative Session................ 5 CME: A Cornerstone of Your Academy........................................................ 6 Overview of Loan Repayment Programs.....................................................12 Suggestions for Selecting Information Technology for Your Practice................14 Sections

Policy & Advocacy...............................5

Health Initiatives.......................................... 10

Chapter Affairs..................................... 6

Residents & Students..................................12

Education & Development......................9

Family Medicine in Practice............................. 14

AAFP Delegates and Alternates 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 Chair (UNC) Alternate (Duke) Alternate (ECU) Alternate (WFU)

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

NCAFP Editorial Committee Chair NCAFP Council Chairs Advocacy Council Continuing Medical Education Council Health of the Public Council Practice Enhancement

William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard W. Lord, Jr., MD Brian Forrest, MD R. W. Watkins, MD Richard Lord, Jr, MD James McNabb, MD Jennifer Mullendore, MD Thomas R. White, MD William A. Dennis, MD Tim J. McGrath, MD


Peter T. Graber, MMC,CAE, Director of Communications FOR ADVERTISING INFORMATION

Peter Graber, pgraber@ncafp.com 919.833.2110 • 800.872.9482 Ed i t i o n 20

The NCAFP Strategic Plan Mission Statement: to advance the specialty of Family Medicine, in order to improve the health of patients, families, and communities in North Carolina. Vision Statement: Family physicians will be universally valued for their role in providing high quality care to the people of North Carolina. Core Beliefs: • We believe that Family Medicine is essential to the well-being of the health of North Carolina, and that Family Medicine is well-suited to improve the health of the residents of our state. • We believe in a healthcare system that is primary care driven. We believe there is an inherent value in a primary care medical home—providing quality, access and affordability. • We believe in a healthcare system that is fair, equitable and accessible. We believe in the elimination of health disparities and barriers to access to healthcare for North Carolina. • We believe in a comprehensive approach to patient care, and value the health and well being of patients, families and communities. • We value collaborative communication with all parties concerned with healthcare delivery, and advocate for a positive practice environment to nourish the specialty of family medicine. • We value the professional and personal well being of our members. Core Values: • Quality, evidence-based, timely education. • Professional excellence and integrity. • Fiscal responsibility, organization integrity and viability. • Creativity and flexibility. • Member-driven involvement in leadership and decision making. Additional details on the strategic plan are located at www.ncafp.com/home/academy/mission


Policy & Advocacy

Family Medicine –

The Most Highly Sought After Specialty Choice for Medical Students By Dr. Brian Forrest, MD Chair, NCAFP Advocacy Council Yes, you read it correctly. That is what our goal needs to be as practicing Family Physicians, preceptors, community advocates, faculty, and policy makers! The key to reducing health care costs lies with the coordination of primary care to optimize prevention of disease, wherever possible. Family Physicians are that key. We need to educate our communities about the value of having a doctor who knows you, your family, your health history, and your name. Too many people at emergency rooms give a blank stare when asked “Who is your doctor?” Many respond that they “usually just go to some urgent care when they are sick.” Some respond that they have a heart doctor, a kidney doctor, a stomach doctor, and a cancer doctor, but there are so many doctors that they cannot remember their names. They do not have an answer for the question that was really being asked - “Who is the physician that you and your family trust to address most of your health concerns and who you have taken advice from for years? Who is the one that makes sure you get your mammograms, your cholesterol checked, your PSA, and helps you to stay healthy, while also being the first one you go to when you do not feel well?” The answer to that question is your family doctor. The importance of our specialty cannot be questioned, but what about the rewards? The average medical school debt in the United States is six figures and is climbing annually. Medical students have (or will soon have) families, financial obligations such as mortgages, and generally little savings when they graduate. Students expect to have a minimal standard of living such as a place to live, something to drive to get to work, and the ability to afford family costs like daycare and college educations. See Family Medicine on Back Cover WWW.NCAFP.COM




Family Medicine Achieves Victories in Contentious State Legislative Session This year’s session of the General Assembly proved contentious with major cuts to the state’s budget. However, the House of Medicine proved successful in several areas due to the persistence of government affairs teams from the Academy, the NC Medical Society and several other specialty groups. A few of the victories for family medicine are outlined below: Health Plan Provider Contracts/ Transparency (Senate Bill 877) - This legislation, which was backed by the Academy, the N.C. Medical Society, the N.C. Medical Group Managers Association, and many other specialty groups, bans unilateral changes to fee schedules during the term of a contract, and requires the use of a provider-identified contact person to receive fee schedule and other contract amendments, among other things. While the ultimate legislation did not go as far as the Academy leadership had hoped, it is a major victory for medicine in terms of insurance contracting. Due Process/NC Medical Board Disciplinary Procedures (Senate Bill 958) - The N.C. Medical Society led an effort requiring the N. C. Medical Board’s disciplinary processes to be more transparent, requiring notice when an investigation is initiated and requiring the Board to communicate through the licensee’s counsel, as well as a number of other provisions. It also banned Board members from initiating an investigation on their own and from serving

as expert witnesses for the prosecution. In separate legislation (House Bill 703), the threshold for publishing medical malpractice settlements on the Medical Board’s website was increased from $25,000 to $75,000. The State Budget - Facing the largest financial shortfall in years, the state’s Medicaid program faced tremendous cuts, with provider rate cuts proposed in the double digit percentages. On September 29th, the N.C. Division of Medical Assistance released a new Medicaid provider rate structure with changes to be implemented October 1, as a result of the budget cuts implemented during this year’s Legislative session. Most rates are being reduced 9% to an average of 86.5% of Medicare. However, the Legislature had provided the Secretary of the Department of Health and Humans Services the ability to protect access to primary care. As a result, primary care E&M codes will remain unchanged from the current rate of 95% of Medicare. Codes protected include new patient office visits, established patient visits, hospital visit codes, nursing home visit codes, new patient comprehensive preventive medicine, smoking cessation, and brief intervention for alcohol and substance abuse. Thanks to the Academy’s Government Affairs Consultants - Peyton and Joel Maynard - for their superb efforts this year to work with others from the House of Medicine to minimize the negative impact of the state’s current economic condition.

North Carolina ACADEMY OF Family PhysicianS, INC

NCAFP President’s Message

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N O .


2009 Presidential Odds and Ends Academy Accomplished Much This Year Despite Challenges

As I prepare the final column for my presidential year, I had the opportunity to attend the North Carolina Obama visit to Raleigh to hear his town hall presentation about health care reform, as well as attend briefings by our national leaders regarding the same subject. In doing so, the Academy has made every effort to communicate our findings to the membership, and in turn, we have heard your comments both pro and con about the proposed reforms. Granted, there have been many concerns, both liberal and conservative, published in the various media about the process. This has also been reflected in communications that we have received from the membership. And in return, I would like to briefly reiterate the Academy’s position on health care reform as formulated by the leadership. Our primary message in discussions with our elected officials has been the importance of primary care, particularly Family Medicine, and the need to substantially improve the reimbursement our members receive for services. We have heard various speakers, including President Obama himself, emphasize how primary care must be the backbone of any significant health reform effort, and in return, we have reminded all who will listen that without substantial improvement to our reimbursement, within a few years, there will be no primary care physicians left. We have emphasized that our reimbursement must be raised to levels enjoyed by our procedural colleagues, otherwise there will be few, if any, medical school graduates choosing primary care specialties. In addition to the emphasis on improved physician reimbursement, we have also emphasized a need to expand and revitalize primary care physician training, both at the medical school and residency levels (see article from Dr. Brian Forrest on page 5). As we have worked to guide the discussions of medical school expansion in North Carolina, we have also utilized similar arguments in discussions with our national leaders in emphasizing the need to expand primary care training, particularly at the residency program level. That’s where we have had the best

success in producing primary care physicians that subsequently stay in the local area around their training site. We have also emphasized the importance of health care reform in leading to the obtainment of basic health care for all citizens, although we have NOT called for a single payer system. Instead, we have envisioned health care reform utilizing a mixture of public, private, employer-based and individual options. We have chosen not to involve ourselves in the discussions about the public option, choosing instead to emphasize the need for insurance reform, reductions in the amounts spent solely on administrative costs, and the need for a reduction in the amount of fraudulent care that we see occurring daily in our communities. Other areas of emphasis in the health care reform debate have included discussions about liability reform and the role of physician extenders in this process. Our emphasis regarding physician extenders is that they are part of the healthcare team, but not independent practitioners. We have also focused on the need to be prudent in spending for the reform process and the need to include some wording about individual responsibility. We acknowledge that in the process of discussing these and other concerns with our political leaders, that some will not act on our recommendations and enact reforms favorable to Family Medicine. We do hope that if our political leaders hear the message repeatedly from the Academy leadership, as well as the general membership, that they will be persuaded to take favorable action. The various health care reform bills have also included some discussion of the PatientCentered Medical Home (PCMH). My presidential focus has been on this topic and the need for implementing the medical home in our practices. While the health care reform bills have lauded the importance of PCMH and called for its adoption by our practices, none of the bills to my knowledge have included significant funds to help practices

October-december, 2009 | the North Carolina Family Physician

Robert L. Rich, Jr, MD NCAFP President transition to PCMH nor have they definitively called for a per-member/per-month (PMPM) reimbursement option to be included with the increases for E&M codes being discussed (although they do discuss pilots that include per member/per month fees). The Academy will continue to lobby for PMPM reimbursements, as well as other inducements, to encourage the adoption of the PCMH. The Academy does acknowledge that going to a PCMH status may be difficult for the small solo/partnership office to achieve. Recognizing this situation, we continue to lobby for increased E&M codes and rural health incentives, etc., in order to improve the status of our smallest offices. As your President, I outlined the additional goal of improved physician contracting both in terms of employment contracts and also contracts with insurance carriers. As I talk with our members from across the state, I continue to hear of examples of inadequate or poorly negotiated, hastily signed contracts. I continue to see examples of restrictive covenants that members inappropriately have accepted, restrictive benefit and salary packages that have been agreed to, and lengthy opt-in/out clauses accepted in the settings of negotiations with larger corporate entities. We all wish to be treated fairly in these situations and in general we are not out to take advantage of our prospective employer. However, I remain concerned that many of us, including myself, have negotiated away too much in the past See Odds-n-Ends on Back Cover WWW.NCAFP.COM





CME: A Cornerstone of Your Academy We don’t always write about it -- other than to promote a meeting -- but the fact is continuing medical education (CME) is central to what your Chapter does each year. In fact, it’s a cornerstone of the Academy.

Gregory K. Griggs, MPA, CAE Executive Vice President Mr. Griggs has been on staff with the NCAFP since 2005 and is a member of the American Society of Association Executives (ASAE). He 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 current active member of First United Methodist Church in Henderson, and serves the Boards of Directors of both Kerr-Vance Academy and Maria Parham Medical Center.

High quality CME is an imperative for every Family Physician: from the requirement to maintain your board certification to your state licensure requirements. Both of these organizations: the N.C. Medical Board and the American Board of Family Medicine require 150 hours of continuing medical education every three years. So where do you turn? We hope it’s to your state Academy. When developing a new strategic plan last year, CME remained high on the list of key areas of focus. In fact, it was one of the four key goals of the new strategic plan. The goal was simple: The NCAFP will provide high-quality, innovative, sustainable Continuing Medical Education to improve the care provided by Family Physicians. So how do we accomplish that goal? With a variety of continuing medical education opportunities to meet every family doctor’s needs. Most of you are probably familiar with our upcoming Annual Meeting (December 3-6 at The Grove Park Inn Resort & Spa in Asheville). This is likely the largest gathering of any medical specialty in the state, with over 500 attendees each of the past two years. The meeting always covers a variety of clinical topics, but this year also includes an emphasis on practice management and the Patient-Centered Medical Home, along with a variety of business meetings, workshops and other special events. While our Annual Meeting is extremely important, it is just one of a large number of CME offerings each year. Other live CME programs offered by the NCAFP this year included: • Our Spring Family Physicians Weekend, featured several programs utilizing team-based learning methods. The 2010 Meeting is scheduled for Williamsburg, Virginia, March 25-28. • Our Mid-Summer Family Medicine Digest combined a variety of clinical sessions along with procedures and practice management workshops. The 2010

October-december, 2009 | the North Carolina Family Physician

Meeting is scheduled for Myrtle Beach, SC the week of the Fourth of July (7/4 - 7/10). • A special procedures workshop in Cary focusing on joint injections and basic dermatological procedures sold out. Look for more of these in 2010. • A partnership with the AAFP to bring you a free “AAFP Live” program on Oct. 24, 2009 in Greensboro focusing on pain management and sleep disorders. And all of our live CME programs include audience response activities to better involve the learner in the education. But that’s not all. Your Director of CME, Marietta Ellis, continues to work to develop a variety of activities to provide the education when you need it, wherever you are. For example, some of the Chapter’s recent nontraditional CME offerings have included: • A monograph on osteoporosis. • A monograph on lipids developed from an innovative panel discussion held at the Academy’s Annual Meeting two years ago. • Online programs on Understanding and Addressing Health Disparities and What Every Family Physician Should Know About Cancer. And coming soon: an online program called Mastering Hands-On Procedures that is currently in production. We’re even working with The TCL Institute (a local CME company) to develop a primary care curriculum on GERD, titled CANVASS: Continuing Education Approaches to Instill Valuable Acid Suppression Strategies. The bottom line: each year we strive to bring you the best variety of high-quality CME whether it’s at a meeting, online or in printed form. That’s our commitment to you. It’s key to our mission. It’s our cornerstone. Don’t hesitate to let us know how we are doing. For more information about any of the Academy’s CME programs, visit www.ncafp. com and click on ‘CME Center.’


M em b ership

Q uestions


~ Chapter Briefs ~

A ns w ers

Construction Has Begun at East Carolina University’s Family Medicine Center

Answers to Common Membership Questions By Tara Hinkle, NCAFP Membership Coordinator

The NCAFP Membership Department would like to thank all members for maintaining their commitment to their professional community and to family medicine. We value your membership, participation, and interest in the AAFP/NCAFP, and we’re always here to answer any questions you may have. Many members have asked a series of common questions throughout the year, and hopefully the Q&A below will serve as a helpful resource. Q: Once I become a member, when and how do I pay my dues? A: The AAFP will mail an invoice to your preferred address in October for the upcoming year. To make a payment, you may call the AAFP at 1-800-2742237; pay online at www. aafp.org/myacademy; or mail payment to: American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. CMC Residents: The AAFP will mail an invoice to your preferred address. Please give your invoice to your Residency Coordinator so your Residency program may pay your dues. Your billing cycle is July – June.

Q: How do I view or update my CME record or determine my re-election cycle? A: You may do that anytime at the AAFP’s website at www.aafp.org/myacademy. Click on the CME Center tab, then click on CME Records (Members Only). There, you will be able to view your re-election cycle; view your transcript; report CME; print a reporting form; and find upcoming CME like announcements for NCAFP meetings and workshops (always a great way to earn credits!). Keep in mind that if you were last re-elected in 2006, you have until the end of 2009 to report 150 hours of CME in order to maintain your Academy membership. Hours reported should be obtained between January 1, 2007 through December 31, 2009. To report CME, call the AAFP at 800-274-8043; Fax to 913-906-6269; or report online as instructed above. Q: How do I view or update my contact information? A: Making sure we have your current phone and fax numbers, e-mail address and work/home addresses are extremely important, especially when information needs to get to you in a timely manner. You may always send contact information directly to Tara Hinkle, NCAFP Membership Coordinator, at thinkle@ncafp. com, or you may change it online at www.aafp. org/myacademy.

New Chapter Website to Launch The NCAFP will be launching a re-designed website in the coming weeks. The site is built with an updated version of an open source content management platform that enables staff and selected members to publish web content easily, without the need of technical knowledge. The enhanced site features several main areas that have existed on the Academy presence since 2005. Several new features have been added as well. The site enables registered members to post


comments on individual stories, share content with external colleagues and access information easier. The Chapter will introduce the new site in the coming weeks. Visit www.ncafp.com today.

After years of advocacy work by leaders at East Carolina University and the NCAFP, the reality of a new family medicine center at ECU can be seen firsthand. Recently, active construction activities for the Center have begun, the most visible of which include site preparation and foundation work. If all goes according to schedule in Greenville, it is anticipated that the building will be operational late next year. The Academy will be monitoring construction progress of the Center and will be posting photos as they become available at http://www. ncafp.com/home/gallery/ ecu_fmc. A few aerial shots showing the completed site work appear at left. Stay tuned for more.

NC Family Medicine Leaders Sharpen Their Media Skills at Annual Leadership Retreat The NCAFP held its annual leadership retreat in Raleigh in late July. Family physician leaders participated in a full day of media training led by Roger Friedensen of the Catevo Group, a Triangle-based advertising and communications agency. Two media professionals were on-hand to offer pointers and insights. NBC 17’s Julie Henry, and Van Denton, a reporter formerly with the Raleigh News & Observer, both spoke about key aspects of reporting and media coverage during a panel discussion. Taped mock interviews were also conducted, then analyzed and discussed. The day concluded with a meeting of the NCAFP Board of Directors.

North Carolina ACADEMY OF Family PhysicianS, INC



3:55:29 PM











Upcoming CME Events & Projects AAFP LIVE CME in Greensboro on Saturday, October 24, 2009

AAFP LIVE is coming to Greensboro, NC, on Saturday, Oct. 24th for a full day of free education. Two 4-hour sessions will be presented to attendees: one segment on Pain Management and one segment on Sleep Disorders. Attendance is free, but each session requires separate registration. For complete information on this conference and to register, visit http:// www.aafp.org/online/en/home/cme/aafpcourses/ conferences/aafplive/greensboro.html.

Annual Meeting in Asheville will Be Filled with Education and Fun


Workshop – Skin Biopsies & The 2009 Winter Family Joint Injections Procedures and Physicians Weekend 2009 an early evening dinner lecture, (Dec. 3-6, 2009) will have The Key to Their Hearts: The something for everyone. The Role of the Primary Caregiver conference will be packed FAMILY PHYSICIANS WEEKEND in the Management of Patients with educational activities Post-MI. including a diverse lineup of On Friday, December 4th, optional workshops and an the Patient-Centered Medical engaging general sessions. Dec. 3-6, 2009 Home Workshop and Advanced And just like previous years, The Grove Park Inn & Spa Asheville, North Carolina Cosmetic Procedures Workshop there will also be a whole host will be presented in late afternoon. of Academy business meetings Finally, on Saturday, December and a number of fun social 5th, Time to Talk Cardio will be offered. activities for the entire family. Three non-CME workshops are also being Below is a brief summary of the many conducted during the weekend. An Advance optional workshops being offered at the in Multimodal Analgesic Therapy (Thursday, meeting. Due to limited printing space, Dec. 4 at 12:45 pm), The Patient Journey: complete information on each workshop is Excellent in Diabetes Care (Saturday, Dec. 5 available by visiting www.ncafp.com/wfpw. at 7:30 am) and What Does The American Most workshops are free, but do require Recovery and Reinvestment Act Mean to registration. Providers and Their Practice (Saturday, Dec. Educational activities begin on Wednesday 5 at 4:45 pm). These are free to attend but afternoon, December 2, 2009, with the require registration. Neither provide CME Health Behavior SAM Working Group. This credit. workshop is for physicians who have entered Complementing the meeting’s educational the ABFM Maintenance of Certification agenda, the NCAFP will be conducting a cycle and need to complete the knowledge number of official business meetings. Each of assessment section for the MC-FP SAM the Chapter’s four family medicine councils requirement (Part ll). If you are registered will meet, as will the Boards of Directors of the to attend the entire Winter Meeting, the Academy and the NCAFP Foundation. registration fee for this course is $125. If you The meeting’s social events are always lively, are only attending this SAM Working Group fun and entertaining. As a follow-up to last and not the whole conference, the registration year’s anniversary, the NCAFP Foundation will fee is $155. Later on Wednesday evening, the be holding a special party on Friday, December ICARE Partnership will present a free dinner 4th called ‘Wine, Dine & Chocolate Divine’ lecture, titled Motivational Interviewing: A that will combine the NCAFP Foundation Primary Care Primer. Silent Auction with other fun activities. Plus Thursday, December 3rd offers a full-day of tours of the Biltmore Estate, golf, Biltmore Spa learning. At the conclusion of the conference’s packages and the President’s Gala on Saturday general sessions track, three workshops will be night will also be offered. presented. Successful Modern Contracting Complete information on all of these Strategies for Family Physicians by Smith activities is available at www.ncafp.com/wfpw. Anderson, Valuable Hands-On Procedures WWW.NCAFP.COM

Mastering Hands-On Procedures Online Another online CME project sponsored by the

NCAFP and supported by an educational grant from the Gebauer Company will be presented in the coming months. If you need an update to the joint injections and skin biopsies workshop, you will be able to participate in our online CME workshop via the web in the near future.

Making the Connection: Practical Strategies for the Clinical Management of GERD for Positive Patient Outcomes

Sponsored by the NCAFP and the TCL Institute, LLC, and supported by an educational grant from Takeda Pharmaceuticals North America, Inc, this project will include various CME opportunities available via teleconferences, online self-study, live meetings, e-cases, chart review assessments, and patient surveys. The program is expected to be available later this year and throughout 2010. If you are interested in any of these, please contact the Marietta Ellis, mellis@ncafp.com, telephone 919-833-2110, ext 109.

2010 Spring Family Physicians Weekend March 25 – 28th, in Williamsburg, VA.

Join us in historic Williamsburg, VA, for an educational and fun-filled weekend for the whole family. Dr. Sara O. Beyer has begun planning another great educational program. Some of the tentative topics include: Controlling Hypertension in the African American Patient, Safer Opioid Prescribing/Pain Management, Vitamin D, Diabetes Update, Patient Centered Medical Home, American Recovery and Reinvestment Act (Economic Stimulus) and many more topics. Look for a postcard in your mailboxes later this year.

North Carolina ACADEMY OF Family PhysicianS, INC


Phase II of Foundation Health Disparities Initiative Kicks into High Gear

ICARE Partnership Successful in Advancing Integrated Care

By Jenni Fisher, MPH, Health Initiatives Manager

The ICARE Partnership began its work in July, 2006 and this upcoming December will mark the end to the inital phase of the project. The core partners since its inception have been the NCAFP, the NC Psychiatric Association (NCPA), NC Pediatric Society (NCPS), Southern Regional Area Health Education Center (SR-AHEC) and the Foundation for Advanced Health Programs. In addition to these partners, the Partnership has been fortunate to have an Advisory Board membership that reflects broad support for the project from governmental agencies, primary care providers, psychiatric professionals, postgraduate, professional and consumer advocacy organizations (see the ICARE website for a list of Board members www.icarenc.org). Since 2006, with the support of the NC Office of Rural Health and Community Care and through funding from Astra Zeneca, the Duke Endowment, the Kate B. Reynolds Charitable Trust, and the NC Department of Health and Human Services, ICARE has strived to be a Center of Excellence for Integrated Care. This has been demonstrated through the following accomplishments: • Development and maintenance of a very successful website (www.icarenc.org). • Implementing many model programs. • Training over 7000 providers: held over 140 trainings for primary care providers and behavioral health specialists and delivered technical assistance to approximately 65 practices since 2006. ICARE’s phase I and II pilots involved 20 practices that have served over 6700 patients. • Becoming a central statewide clearinghouse for innovations in integrated care. • Establishing a national reputation for being a pioneer in integrated care. • and, identifying key policy and process issues which must be addressed for Governor Perdue’s objectives for integrated care to be realized in North Carolina.

The NCAFP Foundation has completed Phase I of the Health Disparities Initiative. During the 3 years of the grant (July 1, 2006 through June 30, 2009), the project reached 1,563 Family Physicians, medical students and residents through educational sessions. A total of 13 educational sessions were delivered during the grant period. This is a remarkable accomplishment and one that the NCAFP Foundation is seeking to build upon in the next phase of the effort which has already begun. In Phase II, which began on July 1, 2009, the NCAFP has partnered with the North Carolina Academy of Physician Assistants to provide resources to physician assistants in North Carolina. Dr. Karen Smith will be speaking at the NCAPA’s 24th Annual Winter Recertification Conference in Durham, North Carolina. Dr. Smith will discuss cultural proficiency; what it is and how to become proficient in serving minority populations. Also through the grant, the NCAFP has launched “Understanding and Addressing Healthcare Disparities” an online educational

O N L I gN E n ni ar e L e lin On


Understanding & Addressing

Healthcare Disparities An Online Educational Program Made Available By

program available from the NCAFP website at http://www.ncafp.com/healthcaredisparities. This free online module is presented by Dr. John Smith and is approved for 3 AAFP prescribed credits. The program is also approved by the NC Nurses Association for 1.5 nursing credits. If you would like more information about the NCAFP’s Health Disparities Initiative, please visit the website at www.ncafp.com/home/programs/ disparity.

NC Receives 10th Place at Tar Wars National Poster Contest Docs Needed to Spread the Anti-Tobacco Message This School Year NC’s Rebecca Robinson won a 10th place honorable mention in the National Tar Wars Poster Contest that was held in Washington this past July. While in Washington, Rebecca had the opportunity to meet with Senator Richard Burr. She also was interviewed by her local news channel in Spruce Pine, Channel 13, and had her poster displayed on a billboard in her hometown! (See photo at right) With the 2009-10 school year now in full swing, the AAFP and NCAFP are encouraging all Family Physicians, family medicine residents and medical students to consider becoming engaged in helping to spread the anti-tobacco message to 4th and 5th graders. Across the nation, the Tar Wars message is presented to approximately 400,000 students each year. This year, the Academy has updated the Tar Wars curriculum with the latest tobacco information. As in past years, the Chapter will provide support materials for the presentations and help coordinate the state Tar Wars Poster Contest. For additional information on getting involved, please contact Jenni Fisher, MPH, Health Initiatives Manager, at (919) 833-2110 or via email at jfisher@ncafp.com. 10

July - September 2009 | the North Carolina Family Physician

The Partnership is currently investigating opportunities for continuing the important work of this project in a new phase. Existing project resources will continue to be available via the ICARE website at www.icarenc.org. WWW.NCAFP.COM




Overview of Loan Repayment Programs Family medicine residents and new physicians have a number of programs they can access regarding medical student loan repayment. Below is an overview of several key programs that can be investigated by new family physicians. Each of these programs list specifics and application forms on their respective web pages. NC Medical Society Foundation’s Community Practitioner Program - The Community Practitioner Program provides financial assistance to family physicians (and other types of providers) in return for service in an underserved community. The Community Practitioner Program serves 153 rural, economically distressed and medically underserved communities in 87 counties. Eligibility requirements include practicing in a documented health manpower shortage area, medically underserved area or economically distressed area. The program has supported 370 health professionals in the state since 1989. To date, the program has provided $5.1M in loan repayment to Family Physicians. Visit http:// www.ncmsfoundation. org/pages/comm_pract_ prog/our_successes.html for complete information and an application. NC Office of Research, Demonstrations and Rural Health Development - The shortage of primary health care providers in North Carolina is severe, particularly in the state’s rural areas. In response to this shortage, the state has pioneered innovative approaches using incentives for placing health professionals in its underserved communities. Incentives include medical loan repayment (principal plus interest) and facilitation of the application process for the Federal Loan Repayment Program (National Health Service Corps.) Please visit http://www.ncruralhealth. org/services.html for complete information.


National Health Service Corps - The National Health Service Corps Loan Repayment Program provides $50,000 (or the outstanding balance of qualifying student loans if it is less than $50,000), tax free, to primary care medical, dental and mental health clinicians in exchange for two years of service at an approved site in a Health Professional Shortage Area. Upon completion of the service commitment, clinicians may be eligible to apply for additional support for extended service. Information on this program is available at http://nhsc.hrsa.gov/ loanrepayment or via the NC Office of Research, Demonstrations and Rural Health Development at http://www.ncruralhealth. org/services.html. Public Service Loan Forgiveness Program This is a brand new federal program established in late 2008 for federal student loan borrowers who work in certain kinds of jobs and in certain settings. It will forgive remaining federal student loan debt after 10 years of eligible employment and qualifying loan payments. Please refer to http://www.ibrinfo. org/what.vp.html#pslf for complete information on this new program. Each of these programs are outlined on the NCAFP website, with links to the specific web pages. Residents and new Family Physicians are encouraged to visit http://www.ncafp.com/ residents_and_students/scholarships.

October-december, 2009 | the North Carolina Family Physician


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NC Active at National Conference of Family Medicine Residents & Students August’s National Conference in Kansas City was a busy one for North Carolina. All public and university-based residency programs were represented and the Chapter’s Resident and Student Delegates, Dr. Meshia Todd and Lillianne Lewis, were active in their respective Congresses. The Chapter co-hosted an event that showcased the state’s residency programs. In the Resident Congress, a resolution that was co-authored by NC’s Megan Adamson, MD, titled ‘Increasing U.S. Medical School Graduates Entering Family Medicine Residencies’ was officially adopted. In the Student Congress, a resolution by NCAFP’s Lillianne Lewis led the Congress to re-affirm AAFP’s current policy on its ‘Health Care for All’ position. Finally, the ECU Family Medicine Interest Group was recognized with a Programof-Excellence Award and received Special Consideration in the FMIG Categorical Awards for it retention of M3 and M4 Members. Wake Forest Family Medicine Interest Group Highlighted by AAFP’s E-Student Update The AAFP showcased the work of Wake Forest University’s Family Medicine Interest Group in its summer e-newsletter targeted at medical students. Wake’s current FMIG President, Ms. Lexi Nifong, (M2) was quoted throughout the article as she outlined the club’s activities last year. It is expected that the group will present an equally impressive array of activities for this academic year as well. Kudos to Wake FMIG! New Resource Available to Educate Medical Students on the Medical Home The AAFP announced the availability of a new educational resource aimed at helping to educate medical students on the Patient-Centered Medical Home model of care. The resource highlights Community Care of North Carolina (CCNC) and other PCMH efforts. The resource is a product of a collaborative project between the Academy’s Division of Medical Education and the Society of Teachers of Family Medicine (STFM) and is entirely web-based. Visit http://fmignet. aafp.org for more information and to download.


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Suggestions for Selecting Information Technology to Support Your Practice By Margie Satinsky, MBA, President, Satinsky Consulting, LLC Selecting information technology to support your practice is a formidable challenge. Several years ago, four Philadelphia family physicians compared their transition from paper to electronic health records to flying an airplane without a pilot! You can avoid their negative experience by paying careful attention to your decision and implementation processes. Here are some suggestions. 1. Start with your practice, not the technology. Clarify your mission and goals before investing in expensive technology. A small practice with one location has different needs from a large practice with multiple sites and aggressive growth plans. Agree on your future direction and let the technology support your efforts. 2. Be honest about your technology readiness and receptivity. In most practices, physicians’ attitudes toward technology vary greatly. Some love it, and others hope they will retire before they have to make changes in the way in which they currently practice. Structure your software selection, staff training, and implementation to accommodate everyone’s needs. 3. Assess your current workflow and fix problems before you automate. If you assume that automating specific aspects of your practice operations will correct current problems in your workflow, think again. For example, transitioning from paper to electronic health records won’t fix human resource problems or poor financial management. If you automate malfunctioning processes, you’ll compound the problems. Fix what doesn’t work before you automate. 4. Plan and implement a total information technology strategy rather than focusing on a single application. The most important IT applications are your practice management system (PMS), electronic health records (EHR), e-prescribe, your Website, and the way in which these four applications relate to each other. The components are not always discrete, so consider all the applications together rather than on a piecemeal basis. For example, look for a vendor 14

that offers both PMS and EHR applications that are built off the same operating platform so you won’t have to worry about building and maintaining an interface between the two applications. Similarly, if you select an EHR that offers an e-prescribe feature either as an option or part of the total package, prescription information will automatically link to your EHR. If you want a patient portal, you can either build it through your Website or as part of your EHR. You get the picture – everything’s intertwined. 5. Do your homework before inviting vendors to make a presentation to your practice. Take time to research the big picture about the applications in which you are interested before talking with specific vendors. Give each vendor comprehensive background information on your practice and a standard list of questions. If everybody gives you the same information, you’ll have an easier time comparing the responses. Look carefully at the provisions of American Recovery and Reinvestment Act (ARRA). Although the details are not all clear, your purchase and use of an EHR may make you eligible for incentive funds available through the Medicare or Medicaid programs. To qualify for stimulus money, you’ll not only need to have your EHR in place, you must also meet requirements for interoperability and reporting on quality measures. 6. Select a vendor that is appropriate for your practice. Consider vendors that offer applications for your specialty at a price you can afford. Independent organizations like the AC Group or KLAS regularly test and rank the vendors according to specific criteria. The American Academy of Family Physicians (www.aafp.org) has a comprehensive Web site that includes input from existing physicians who are willing to share their experiences, both good and bad. 7. Manage the selection and implementation processes carefully. Identify a lead physician and a multi-disciplinary task force within your practice to manage both your vendor selection and implementation. A physician champion is

October-december, 2009 | the North Carolina Family Physician

essential. Seek external expertise when you need it. If you ask a member of your administrative staff to take on additional responsibilities related to IT, temporarily delegate some of his/her functions to another employee so there’s time to do the job right. Remember that IT is a tool, not a solution. People, not computers, will make the experience of selecting new technology a positive or a negative one for your practice. Good luck! Margie Satinsky, MBA, is President of Satinsky Consulting, LLC in Durham, NC. She can be reached at Margie@satinskyconsulting.com or (919) 383-5998).





Federal Standards Committee on IT Approves ‘Meaningful Use’ Standards

How to Get Paid for Administering H1N1 Vaccine When it Arrives NC DHHS released information in September regarding Medicaid payment for practices participating in H1H1 vaccine administration efforts. NC DHHS plans to reimburse for the H1N1 administration in accordance with the current immunization administration rates for other vaccines. For Medicare, CMS wants physicians to bill for the vaccine using the new ‘HCPCS G9141’ code; payment will be the same as for administration of the seasonal flu. Other major carriers like Cigna, Aetna, United and others are requesting physicians utilize existing CPT codes for the administration, with specific codes for the vaccine itself. It is important to indicate the amount of $.01, as some payment clearinghouses will reject no-charge items. For BCBS, physicians and practices are being directed to contact their local plan representative. As more payment information on H1N1 payment is available, the NCAFP will make this information available.

NC Medical Board Set to Expand Licensee Information Pages The NC Medical Board is expanding the licensee information pages published on its website to include new, optional information that each physician can update. Notices on this expansion were sent in September and implementation is expected in December, 2009. Expanded information on each licensee will include practice web addresses, lists of professional memberships, scholarly works and achievements, honors and awards, more information on residency training and Board certification(s), and expanded information on how each physician practices (EHR utilization, insurances, office hours, focus areas). Physicians will also be able to comment on prejudicial information where appropriate. See www.ncmedboard.org for more information.


In mid-July, the federal health information technology (HIT) Standards Committee approved a set of quality measures and standards that providers could use to demonstrate ‘meaningful use’ of electronic health records (EHRs). The panel endorsed a matrix of 27 quality measures and 12 standards that build on each other. Physicians and practices who demonstrate meaningful EHR use will qualify for Medicaid and Medicare incentive payments as part of the federal economic stimulus package. The standards call for providers to use HIT tools for continuity-of-care documents, discharge summaries; inpatient and outpatient prescriptions; laboratory results and other structured health data. A good analysis and discussion of this development by Chapel Hill’s Dr. David Kibbe can be found online at http://www.thehealthcareblog.com/the_health_care_blog/2009/08/finally-areasonable-plan-for-certification-of-ehr-technologies.html.

New Vaccine Storage Requirements for Universal Childhood Vaccine Providers

Family physicians and practice professionals that participate in NC’s Universal Childhood Vaccine Distribution Program (UCVDP) are advised that all dorm-style refrigerators commonly used for permanent storage of vaccines are to be phased-out of provider offices by Dec. 31, 2009. A dormstyle refrigerator is considered a unit with one door and one that utilizes a combination refrigerator/ freezer. The new UCVDP requirements can be found in the ‘Vaccine Storage Equipment’ section of the UCVDP Minimum Required Vaccine Ordering, Handling, and Storage Procedures’ (updated January, 2009). The new requirements are designed to ensure that vaccines are properly stored and managed. Practices that have questions about the new guidelines are being directed to contact the UCVDP Help Desk at (877) 873-6247.

NC Medicaid Set to Implement Web-Based Eligibility Verification Tool

The N.C. Medicaid Program began implementing the North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool last month. This tool allows providers to access electronic recipient eligibility via the North Carolina Electronic Claims Submission (NCECS) Webtool at https://webclaims.ncmedicaid.com/ncecs/ and to immediately verify recipient information such as current eligibility, Medicaid benefit category, Medicare participation, CCNC/ CA (Carolina ACCESS) participation and other insurance information. Providers who currently have an NCECSWeb logon ID and password can utilize this same logon information to access recipient eligibility verification. For additional information on verifying recipient eligibility refer to the Basic Medicaid Billing Guide on DMA’s website at http://www.ncdhhs.gov/dma/basicmed/. Source: NC Medicaid Alert, 08/20/2009

High Tech Imaging for Medicaid Patients Now Requires Pre-Authorization

As of dates of service beginning 11/01/09, certain radiologic procedures for Medicaid patients will require prior authorization from Med Solutions. Med Solutions will begin to accept requests for prior authorization on 10/19/09 via their website, phone, or by fax. Physicians and practices are being encouraged to familiarize themselves with MedSolutions by visiting the MedSolutions website at http://www.medsolutionsonline.com/. Among the many online tools and services available, providers may also register for prior authorization services and view MedSolutions’ imaging guidelines.

New Web Tool Helps Physicians Qualify for PQRI Bonus Dollars

The AAFP is offering members discounted access to a new tool designed to help them earn extra dollars through CMS’s 2009 Physician Quality Reporting Initiatives (PQRI). The ‘PQRI Wizard’ enables participating physicians to track individual patients and correctly report all necessary quality data to CMS. PQRI bonus payments generally range between $600 - $2,000 and depend on each physician’s Medicare population. A good rule of thumb for physicians seeking to estimate their potential PQRI bonus is to multiply their 2008 Medicare revenue by 2%. The new tool also helps physicians who are starting late with PQRI to catch-up by working back through a limited number of charts. The cost to AAFP members is $199. Visit https://aafp.pqriwizard.com/default.aspx for more information and to sign up.

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Odds-n-Ends, continued from p4 in our contracts. I remind you that in almost all situations, our prospective employers have had your physician contract reviewed in detail by a team of contract attorneys, as this is just good business practice in these economic times. To improve the status of member contracting, I have sought legal firms sensitive to the needs of our members to develop a legal contracting service that I would feel comfortable using for myself and our membership. In addition to being sensitive to the particular needs of Family Physicians, I have also sought out firms that had extensive experience in the area of physician contracting, that had a proven track record in successful contract negotiation, that were knowledgeable of

current and future developments of the contract process, and that were free of conflicts-of-interest in this process. Utilizing the advice of our Academy leadership, recommendations from the N.C. Medical Society and other entities, I would like to announce that we have developed an initial relationship with the Raleigh firm of Smith Anderson, et. al., to help assist members in this area. The leaders of that firm clearly have expressed an understanding of the goals of Family Physicians in contracting and will actually present a workshop on this subject at this year’s Annual Meeting in Asheville. Please look for these and other developments from this association in the future.

In closing this final article as your president, I wish to thank you, the membership, for your support in the process. It has been a year of challenges for the Academy and as we have worked to tackle these challenges, it has amazed me how quickly this Presidential year has gone by. I look forward to the leadership that will be provided by our rising leadership team and I hope to encourage our younger members to step forward and become involved in this process as well. Last, I wish to ask for your support for our PAC and Foundation with your contribution dollars as the challenges which are to come may prove to be greater than anything that we have faced in our previous sixty years of existence. Thank you.

Family Medicine, continued from p5 Unfortunately, medical students have been led to believe that they cannot manage this if they become Family Physicians. Although it can be a struggle financially for some primary care physicians, it is important that we develop a family medicine culture which shows medical students that they can in fact thrive financially and they can expect to be valued by their patients, community, and the medical profession as an esteemed health care provider that is at the heart of quality medicine. However, we also have to be active to shape policy that makes our profession the “cream of the crop.” As policymakers, we have to ensure that we make Family Physician payment adequate, the lifestyle appealing and the bureaucracy minimal for those entering our profession.

With medical school expansion on the horizon and the possibility of many new residency positions, we need to insist that extra slots be reserved for primary care, especially family medicine. If more medical students graduate and pursue careers in Cardiothoracic Surgery, we will not have helped our workforce shortage and the answer to the question: “Who is your Doctor?” will remain an elusive one for many patients. The NC Academy of Family Physicians is strongly advocating financial incentives for medical schools that have students who stay in primary care and that any increase in residency positions needs to maintain a significant balance of primary care positions. With any health care reform, resources have to be targeted to the right area to get results. Family medicine has to be at the center of that bull’s eye.


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NCAFP Foundation Annual Poster Presentation Submission Deadline is Oct. 30th, 2009 The North Carolina Academy of Family Physicians Foundation is currently seeking submissions for its Sixteenth Annual Research Poster Presentation being held Dec. 3-6, 2009 in Asheville. The Poster Presentation is part of the Academy’s Winter Family Physicians Weekend. Practice-based presentations are being encouraged this year, but posters may also address any topic relevant to family medicine. Judging categories include physicians, family medicine residents and medical students. For complete guidelines and instructions on submitting entries, please download this year’s application at: http:// www.ncafp.com/2009rpp

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