Page 1


Volume 9 Issue 1 / Winter 2013

quarterly news in north carolina family medicine

2013 NCAFP President Dr. Shannon Dowler —

On Mentors & Mentoring See page 4

See page 4 Winter 2013 • The NC Family Physician


2012-2013 NCAFP Board of Directors Executive Officers President Shannon B. Dowler, MD President-Elect William A. Dennis, MD Vice President Thomas R. White, MD Secretary/Treasurer Rhett L. Brown, MD Board Chair Brian R. Forrest, MD Past President (w/voting privileges) Richard Lord, Jr., MD Executive Vice President Gregory K. Griggs, MPA, CAE District Directors District 1 - Jessica Triche, MD District 2 - Matthew M. Williams, MD District 3 - Scott E. Konopka, MD District 4 - Tamieka Howell, MD District 5 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Holly Biola, MD At-Large Charles W. Rhodes, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD New Physicians Jennifer L. Mullendore, MD NC Family Medicine Departments Michael L. Coates, MD Family Medicine Residency Directors William A. Hensel, MD

2013 Spring Family Physicians Weekend April 4-7, 2013 The Sheraton Hotel

at Four Seasons Greensboro, NC

Resident Director Mo Shahsahebi, MD (Duke) Resident Director-Elect Aaron George, DO (Duke) Student Director Katy Kirk (ECU) Student Director-Elect Julie Barrett (ECU)

FM Department Chairs & Alternates Chair (WFU) Alternate (Duke) Alternate (ECU) Alternate (UNC)

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

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Mott P. Blair, IV, MD Karen L. Smith, MD, FAAFP L. Allen Dobson, Jr., MD Michelle F. Jones, MD

The NCAFP Family Medicine Councils Advocacy Council

Robert L. Rich, Jr., MD, Chair William A. Dennis, MD, Vice Chair

CME Council Health of the Public Council

See p.14

Practice Enhancement Council

Thomas R. White, MD, Chair Charles W. Rhodes, MD, Chair Rhett L. Brown, MD, Chair www.ncafp.com/ncfp

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.

2013 NCAFP President Dr. Shannon Dowler—

Vision Statement: Family physicians will be universally valued for their role in providing high quality care to the people of North Carolina.

On Mentors & Mentoring See page 4

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, organizational integrity and viability. Creativity and flexibility. Member-driven involvement in leadership and decision making.

Additional details on the NCAFP strategic plan are located at www.ncafp.com/academy/mission




On Mentors & Mentoring.............................................................................................. 4

PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. R al ei gh, Nor th Ca r olina 27605 919.833.2110 • fa x 919.833.1801 http://www.nc a fp.c om M AN AG IN G EDITOR & PRODUCTION P eter T. G raber, MMC , CAE, Dir e c tor of Communic a tions

Lessons Learned in a Kayak........................................................................................... 8 Change Comes to the Capital..................................................................................... 12 2013 Spring Meeting - April 4-7 in Greensboro, NC................................................... 14 The UNC Family Medicine Residency: Adaptability in Full Scope .............................. 17

President’s Message............................................... 4 Policy & Advocacy................................................................ 12 . Leader Perspective..................................................... 8 Executive’s Message................................................. 10

Meetings & Education......................................................... 14 Residents & New Physicians.............................................16 Student Interest.................................................................... 19


On Mentors & Mentoring By Shannon B. Dowler, MD 2012-2013 NCAFP President

About Dr. Dowler

Dr. Dowler graduated from

Dr. Shannon Dowler of

The Brody School of Medicine

Asheville was installed as

at East Carolina University

the 64th President of the

in 1999 and completed her

NCAFP on December 1st, 2012.

residency training in family

Below are the remarks she

medicine at the MAHEC

shared with members during

Family Medicine Residency

her inaugural address.

Program in Asheville. She is a Fellow of the American Academy of Family Physicians and has served on the NCAFP Board of Directors since 2003. She currently serves as Chief Medical Officer for Blue Ridge Community Health Services in Hendersonville. In addition to her clinical service, Dr. Dowler serves as a trustee on the Western North Carolina Medical Society Foundation.

4 Winter 2013 • The NC Family Physician

I want to take this opportunity to tell you about myself, because, frankly, you’re a pretty captive audience and I tend a little towards narcissism. It’s not unreasonable for you to have a slight sense of who you have chosen to help lead your Academy over the next year through what will almost certainly be unprecedented times of change, challenge, and innovation in healthcare. Born and raised in NC, I did not travel far to graduate from ASU. I left the mountains to head down east where I spent four very hot years in medical school at East Carolina, now The Brody School of Medicine. Eager to make my way back to the hills, I did my residency here in Asheville and have never left this area. I have spent all 10-years since finishing residency working for non-profits and it turns out that perhaps I am just “one of those people.” I am now and have been for several years the Chief Medical Officer at a community health center in these lovely mountains where I care for a population of uninsured and underinsured, including a large population of migrant farmworkers with a phenomenal group of colleagues in an integrated medical home. When I turn on my ipod it is likely I will hear Eminem, Black Eyed Peas or Donna the Buffalo but it’s almost certain you will never hear country music or Rush. (There is a notable exception to a few Dixie Chic tunes, I confess).

When not in the practice of medicine it is likely you will find me kayaking, playing tennis, cooking, hiking, reading or possibly writing (I harbor a secret hope to be an author one day but it turns out that requires a degree of discipline that evades me). My guilty pleasures include dark chocolate, fine bourbon, hard ciders, and unfortunately, diet Coke. You will never find me seeking out asparagus, dentists or conflict. I have an aversion to failure and my most irrational fear in life is cockroaches. I remain puzzled about why people smoke, how computers actually work and the meaning of this life. I am somewhat strangely obsessed with stamping out STDs, taking care of a population of patients most aptly described as train-wrecks, and figuring out how to connect with millennial learners. Because we are now a society devoted to multitasking and sensory stimulation, I thought I was going to try to set a new presidential record and see if I could speak for two minutes without anyone in the room checking their smart phones, texting or playing angry birds. Judging from the first few rows of tables that I can see I have already failed. In full disclosure, I confess that I have historically been one of those manic texters who couldn’t tolerate a speech for long, so don’t feel judged. In our Academy, you spend several years (or in www.ncafp.com/ncfp

Presidential Pinning - Jared Dowler, husband of NCAFP President Dr. Shannon Dowler, places the Academy presidential lapel pin during inauguration ceremonies in Asheville. Dr. Dowler became the chapter’s 64th president.

my case close to a decade) sitting on the board and executive committee before your time comes to give the “big speech”. I have invested a lot of mental equity pondering what topic would most engage this exceptional group of peers. Greg told me right out of the gate that I absolutely could not give an STD talk, which was clearly my first choice, and I think we have all possibly had enough politics in the past few months to last us a decade. In the same way that you shouldn’t try out a new recipe on guests, you probably shouldn’t give a speech on a topic that you are not expert in, but I found myself drawn again and again to the idea of the importance of mentoring and the critical importance of mentoring for the future of our specialty. Over the past several months I have cornered many of your colleagues, some who are in this room today, ranging from medical students to experienced family docs and have gathered their opinions on the topic of mentoring. Over the next ten minutes I would like to share with you some of their thoughts and some of my personal experiences. My hope is that by the end of this time together

you will leave with a renewed charge to seek out opportunities to mentor others, to be mentored, or to express some gratitude to a mentor in your life. My first real mentor as an adult learner came in college and was a vibrant and accomplished woman named Joni Petschaeur. I first got to know Joni while I was a tutor for biology and chemistry students. Joni ran the learning assistance program on the campus of ASU and convinced me to become a supplemental instructor, teaching a group of 20-30 students when I had never taught a soul before in my life. She imparted this tremendous sense of self-confidence. I remember she invited Jared and I to her home to dine with her and Peter, chair of the History Department at the time. To this day, more than twenty years later, I clearly remember watching her cook risotto and drinking my first glass of Gewurtztraminer (let’s face it, Boone’s Farm was more my speed) and feeling like an emerging adult for the first time in my life. Joni convinced me to run for elected office with Gamma Beta Phi, the academic and service honor society that she advised and by

the time I graduated I had served as the president, a leadership role I would have never in a million year imagined taking on without her prompting, encouragement and enthusiasm. Did Joni know at that time that she would be such a powerful mentor to that inexperienced, often anxious, undergraduate student? Did I even know at the time what an impacting presence she was having on my life and professional development? This issue of mentoring is a complex one. Sometimes mentoring is an intentional, planned act and sometimes it can be spontaneous and almost ordained in its creation. Regardless of the origin, these relationships are powerful and often enduring and I believe for our specialty of Family Medicine critical to the future. I was lucky to have several physician mentors early on in my residency training; however, as a medical student perhaps I was too self-involved and frenetic to see much beyond myself but my first medical mentor was an accidental mentor who I happened across on an elective rotation in rural family medicine in Jefferson, NC. Continues on next page Winter 2013 • The NC Family Physician


Leigh Bradley lived the passion and energy of a family doctor. She did it all -- ER work, inpatient, delivered babies, outpatient clinic -- and she did it with humor and a brand of humility that was transfiguring to me as a young doctor. When I worked with her, I saw a future that could have been my own. In residency I had several academic mentors, but Suzanne Landis stands out. She was the first doctor to model the critical importance of chasing down a passion for social justice. Dr. Landis taught me the finer arts of getting your way (something near and dear to my heart) in her remarkable ability to bring consensus to the program she founded called, Project Access. But she also emphatically believed and preached quality

(L to R) The Dowlers: Jared, Shannon, Eli, Jacob, Jennifer and Drake

improvement well before it was in vogue and reeled me in to attending and even co-presenting at transformative IHI and STFM meetings. As a faculty, mentoring was a part of what she did and she did it well. Leigh and Suzanne were two very different doctors, practicing medicine in different places in different ways, but still incredibly powerful influences on me as an emerging physician trying to find my way. One of the great ironies in mentoring is often the fact that you don’t always know that moment when a mentor enters your life. For most of us there is definitely a moment when we are able to recognize that they have become that person. I asked my colleagues how they knew when they had found a mentor. Perhaps the most longstanding and impacting mentor for me has been Dr. Maureen Murphy. Sadly, she could not be with us thie weekend. She just decided to have her knee replaced at what is perhaps the culmination of my career, thereby missing the opportunity to support me on this very important day. But, I’m cool. It’s good. As a medical student attending this meeting in the mid 1990s, Maureen took me under her wing. She encouraged me to run for office of Resident Director so I could “hang out” on the board with her. I watched her lead as one of the only women in a largely male leadership with her unique flair of self-deprecating humor. I watched her advocate for and be pivotal in the development of the student interest endowment for the Foundation, now sitting on over 900,000 dollars in funding for the sole purpose of supporting students find the path to Family Medicine. This planted the seed for what has now grown into the Family Medicine Interest & Scholars Program. Maureen and Scott would take Jared and I out to dinner at every Winter Meeting at The Grovewood Café. Big deal, you’re thinking. But, as a very poor young couple often living on mac and

6 Winter 2013 • The NC Family Physician

cheese, this was like a window into a world we rarely got to see. Being treated so honorably by someone as important and accomplished as Maureen was monumental. Not to say we didn’t give anything back, of course. I mean, we brought all the ingredients for the apple martinis we mixed table-side for Sue Makey’s retirement dinner! Perhaps what stood out the most to me and continues to impress me, is the genuine joy she seemed to get out of mentoring. Graceful leaders, enthusiastic teachers, role models, cheer leaders…mentors come in all shapes and sizes. As our specialty continues to be in demand and more and more primary care doctors are needed across the state and country, an intentional effort at mentoring will undoubtedly pay itself forward. The time you spend today to guide a student, to offer a home-cooked meal or a fancy dinner out, to listen to the trials and tribulations and offer your words of wisdom from your life experience, the time you spend today could very well be time spent on the next president of the Academy…the next dean of a medical school…the next family doc that sets up shop in a rural area desperate for their care and compassion. With the diversity of ways we practice medicine as family doctors, each of us has the perspective and experience to be that guide for someone early on their path. Lastly, I would add that our need for mentors does not really go away, does it? As I have developed as a physician I have continued to rely on mentors like Susan Mims, who helped me learn how to navigate bureaucracy by modeling grace in leadership. As I explore the world of physician executives, I rely on the knowledge and experience of those who have walked the path before me. Whether it is guidance from Marc Westle on how to negotiate my next contract and to stand up for my worth, or management wisdom on how to coach and develop a physician team from Jennifer Henderson, I continue to rely on and seek out mentors. While I have told many people I was absolutely not going to rap during this speech, I never said I would not rhyme. In closing, In this presidential year ahead I will endeavor to make you proud To lead but be also be led Whether standing or part of the crowd. The good news I’m here to impart Your executive committee is geared We will lead with a good heart I’m sure the membership has nothing to fear. Long suffering Dr. Forrest can relax While Dr. Dennis and I share a stiff drink Dr. Brown will watch our backs poor Dr. White doesn’t know what to think. Greg and Brent may need a big raise I really hope the staff don’t all quit But, hey, what’s a year? A few days? Even they can put up with my… wit. Brace yourself for millennial brains Who text faster than the eye can see Where technology is deeply ingrained Just for playing everyone gets a trophy. They are smart and savvy and quick Finding answers with frightening speed Short term, the answer may not stick, But they are geared to love and to lead. Our academy must take on the charge To get the best and brightest of docs The challenge no doubt it is large But the truth is, our membership rocks So thanks for your vote and your trust Please take to heart my words here today Mentoring’s a choice, but also a must, For our learners we must pave the way.

To see the video of Dr. Dowler’s speech, visit www.ncafp.com/2012-inaugural-address




OCT 1, 2014

2014 COMPLIANCE DEADLINE FOR ICD-10 The ICD-10 transition is coming October 1, 2014. The ICD-10 transition will change every part of how you provide care, from software upgrades, to patient registration and referrals, to clinical documentation, and billing. Work with your software vendor, clearinghouse, and billing service now to ensure you are ready when the time comes. ICD-10 is closer than it seems. CMS can help. Visit the CMS website at www.cms.gov/ICD10 for resources to get your practice ready.

Official CMS Industry Resources for the ICD-10 Transition



Lessons Learned in a Kayak By Thomas White, MD NCAFP Vice President

At a recent professional training program in Florida for association volunteer leaders and executives, some of the leadership of the NCAFP– President Shannon Dowler, President-Elect William Dennis, our Executive Vice President Greg Griggs and me - arrived looking for some time in the sun and physical activity before the "real work" began. We discussed a number of options, before deciding that we would rent kayaks and spend some time in the ocean. While we were really intending to unwind and just have some fun, reflection tells us that we learned some valuable lessons from this experience. I thought I would share them with you here. 1. Sometimes you just have to get in the water. Before our kayak excursion, there were mixed feelings and different levels of enthusiasm among the group. Ultimately, everyone agreed to proceed. Within minutes our feet were wet, and even the most reluctant among us gained confidence and began to appreciate the experience. The same could be said for us as Board members and physician leaders. We all have different interests and wishes, and varying factors pulling us in other directions. Initially we may balk and hesitate at committing, but when we eventually do and join the group (in this instance getting involved in the NCAFP), good things can begin to happen.  2. Have a map. Before we set sail, we received some brief instructions and were told where we should paddle, and that we would find a calm cove to explore just down the beach around a point.  As an Academy, often we wonder where we should be going, and even more so, what we might find as we explore new territory. Should we even go here, or there? While there will always be surprises and unknowns, we have a Mission Statement and a Strategic Plan. We discussed over the weekend the need to reexamine them, and make sure they are still relevant and complete. We decided to proceed with a member survey, to give us guidance and direction. We have to have a map. 

8 Winter 2013 • The NC Family Physician

3. Stay balanced. We quickly learned that kayaks are lightweight, at times wobbly little vessels, and staying balanced in the craft was first priority. Tipping over was relatively easy.  Our Academy has many initiatives and priorities, from CME to Advocacy to Practice Enhancement to the Health of the Public. Occasionally - due to pressing issues, or board interest, or other developments - some of these tend to take precedence over others, diverting time and resources. Of course, this is not all bad and often necessary. Along our journey though, we should always be aware of our balance, making sure we are always paying enough attention to all of our values and members' needs.  4. Keep paddling. Kayaking can be tiring. And sometimes you have to stop and rest, and appreciate the beauty of nature. But to get to the destination (and to get back to the hotel !!!) you simply have to keep paddling. Our members and our patients are depending on us to do just that. Board service is rewarding but takes time and energy away from practices and family. Let's not forget to thank each other. 

5. Hit the waves head-on.   As a group we quickly recalled from experience and first hand that those waves coming in - generated by bigger and much more powerful boats - were treacherous, and could easily tip over a small kayak. Turning the kayak into the waves at a 90 degree angle proved to be the best strategy. Facing the waves turned out to be safer than facing the other direction, so that one could see what was actually coming. Aligning the kayak parallel to the waves was actually the most risky, allowing the kayak to rock back and forth in a less stable fashion and potentially tip. Our Academy faces many waves and obstacles. Many of them are created by entities much bigger than us. Turning sideways and going with flow is tempting at times, and sometimes the right strategy, but perhaps we need to remind ourselves that dealing with issues head-on may often be best. We've got to stay afloat. We have work to do.  6. The wind makes you stronger.   Going out in our kayaks, the wind was at our backs, and the paddling seemed easy. We kayaked into a quiet cove, where the water was relatively still, and the exploring was fun and easy. Returning to the hotel, the wind was against us, and the effort required was a bit more. We were a little tired after our


excursion. We had gotten the exercise we wanted. The next morning, a comment or two was made about sore arms and backs. But we all agreed the trip was worth it. As we deal with unpleasant and difficult issues, even disagreements among ourselves, we will benefit from the process and be stronger as an Academy. 7. We all have different skill sets.   Some of us had spent time in a kayak; some of us had not.  Some of us were faster; others were slower but very consistent. Some of us were more observant of nature's wonders; others pushed ahead with a destination more in mind. Like our Academy staff and our Board, we need to recognize those strengths and special skills and make sure we tap into all of them. We are very fortunate to have the talent we have among us.  8. We are better together. As we started out in our kayaks, it was soon obvious that some of us would be faster than others. That was fine - it was not a race or a contest. But without even discussing it, we functioned like a group should. When one member struggled a bit, another dropped back to keep them company. When someone got ahead of the pack, they looked back periodically to make sure the others were OK.  Our Academy is diverse, and individuals are and will be at different places both personally and professionally. Knowing where each other are, and being a team, makes the whole better. 

9. "Kayak" can be spelled forward and backward. "Kayak" is a palindrome.  Like radar, racecar, and civic, the word reads the same going in either direction.  We talked over the weekend about the responsibility of Board service and that at times, each of might be in a situation where we hold differing views on an issue than the majority or in contradiction to the Academy's official position. We discussed the importance of speaking with one voice with clarity and conviction. That goes for the most experienced board member to the newest addition. While conflict can be good and healthy, outside the board room, we need to represent the Academy and our members with a unified voice.  10. It is about the journey, but also results.   We embarked on our kayak outing because we knew we needed to unwind and get some Vitamin D before the "real work" began. It turns out, as described above, some "real work' was accomplished as we learned more about each other and bonded as friends. The "journey" taught us much. But as beneficial as the outing was - and as enjoyable as board service and attending meetings can be - we have to produce results. Our tasks are to educate physicians, help transform their practices, promote health and better management of disease, and help craft legislation in the best interest of our members and our patients. At the end of the day, the results we achieve are most important, and make the journey even more worthwhile. 


2013 Mid-Summer

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The Tortoise and The Hare:

Slow and Steady Will Carry the Day By Gregory K. Griggs, MPA, CAE Executive Vice President

It’s always easy to want a quick fix. In fact, many times we’ve looked for that rapid return on investment and seen our bubbles burst. Sometimes we simply need to remember those stories from our childhood: in this instance the story of the tortoise and the hare. The hare wanted quick rewards and always seemed to get distracted by the new bright and shiny object (could this be the latest test or newest procedure). In turn, the tortoise was slow and steady always focused on the ultimate prize (quality/effective, low cost healthcare led by primary care physicians). We all know the outcome: the tortoise ultimately prevailed. And I think that is exactly where we are heading. I recently began to relate this story from our collective childhoods to the current status of primary care. We would like a quick fix to an upside down system that values procedures over prevention, diagnostic tests over listening to your patients. You, as family physicians, have long deserved to get the accolades/the spoils of victory, but yet are still under-valued and underpaid compared to your specialist colleagues. But I believe times are changing. A few years ago, one of your Academy presidents wrote that he believed the “worm was turning” to primary care. And I think he is right. Maybe not quick enough, but it is turning. We are nearing that tipping point. But now, more than ever we cannot get distracted by those bright and shiny objects or the desire for a quick return. We must remain focused on providing effective prevention, better chronic disease management and lower costs: patient-centered care. That doesn’t mean doing things just like they have always been done in the past. It means we must focus on better population management. We must provide better access. And we must use our healthcare teams differently than in the past. But our state is much better positioned than most, and our physicians have led the way in obtaining national quality recognition. But don’t become discouraged if the awards are not as quick to come as they should be. Because I truly believe they are coming.

key components of redesigned primary care. What do they mean by redesigned primary care? It’s simple: The Patient-Centered Medical Home. And what is one of the leading states for PCMH recognition? North Carolina, of course. • As another example, Blue Cross and Blue Shield of North Carolina highlighted several networks of primary care offices, including Key Physicians in the Triangle, when announcing a new lower cost health insurance plan. BCBSNC cited the smaller, more streamlined network of high-quality/low cost providers as a key method of helping consumers control insurance costs without sacrificing benefits. And while BCBSNC is able to offer this coverage at about 15 percent less compared to similar plans, they are also providing higher payment for the participating primary care practices, focusing on practices that have received PCMH recognition. What does it mean: insurance consumers win and primary care practices win.

We must remain focused on providing effective prevention, better chronic disease management and lower costs: patient-centered care. That doesn’t mean doing things just like they have always been done in the past. It means we must focus on better population management. We must provide better access. And we must use our healthcare teams differently than in the past.

Let me give you just a few examples: • Recently, CMS held an online educational session entitled: Redesigned Primary Care - An Essential Foundation for Accountable Care Organizations. Let me reiterate, they called primary care essential! CMS went on to say that effective primary care was “crucial” for the future of healthcare, but highlighted

10 Winter 2013 • The NC Family Physician

• Finally, Cornerstone Healthcare in the Triad is being touted nationally as a group of physicians, with a foundation based on primary care, working together to improve quality and lower costs. Cornerstone is involved in both public sector (Medicare) and private sector accountable care organizations.

The bottom line: don’t be discouraged because the system isn’t moving to primary care as quickly as we all know it should. For in the end, I truly believe – just like the tortoise and the hare – the slow and steady will rule the day. Keep working to transform your practice. Keep working to add value by improving quality (among entire populations). Keep working to provide better access. Then your day of victory will certainly come.

Help, questions, feedback or perspectives to ggriggs@ncafp.com


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P o lic y & A dv o cac y


or the first time in more than a century, Republicans hold majorities in both the State House and State Senate and also control the Governor’s mansion. The makeup of our state legislature is also ‘new’, with approximately 60% of General Assembly members having served one term or less. Coupled with these leadership changes is a looming legislative calendar. Some extraordinarily important issues will be decided in 2013, including whether our state maintains a physician-driven Medicaid system through Community Care of North Carolina or turns to outside managed care. Other issues that likely will be addressed includes tax reform, scope of practice, whether our state expands Medicaid, the nature of NC’s participation in the Health Benefits Exchange, and implementing the Medicaid Primary Care rate increase (to bring parity with Medicare rates). All told, 2013 may be one of the most important times for Family Medicine in decades but also could bring challenging times for the Academy’s advocacy efforts. The state legislature formally began its bi-annual ‘long session’ on January 30th. It’s expected to be a hectic term just like it was in 2011. The healthcare arena and Medicaid are both seeing a lot of action. Each presents significant advocacy challenges for the Academy. North Carolina Medicaid

Medicaid is already a key focus this session primarily because of health care reform implementation, but also due to the size of its budget. Over the last few sessions there has been suggestions that the Legislature will consider thirdparty management for the roughly $12B program or other tools to better control costs. Formally known as Medicaid Managed Care Organizations (MCO), MCOs tout capitation as a means to reduced Medicaid spending. The legislature will also be considering whether or not to expand Medicaid as part of the Accountable Care Act (ACA), and will need to decide the nature of North Carolina’s participation in the ACA-mandated Health Benefits exchange. At press time, the state Senate

12 Winter 2013 • The NC Family Physician

passed legislation not to expand Medicaid in NC and to opt out of a state Health Benefits Exchange. Senate Bill 4 now moves to the House. MCOs are in place in a number of states. Shifting North Carolina’s Medicaid program to this type of arrangement would lead to very significant changes for providers and patients. Even though North Carolina currently operates one of the country’s most cost-effective and qualitydriven approaches to Medicaid management -- thanks in large part to Community Care of North Carolina-- the capitation-centric approach to Medicaid cost containment has garnered more attention from legislative policy makers in Raleigh. And as an alternative to an outside MCO, some

legislative leaders would like to see the healthcare community have more “skin in the game” in controlling Medicaid spending. Outside MCOs would prospectively have the authority to independently set Medicaid provider rates, establish policy regarding utilization (procedure authorization, medicines, etc), and also make decisions on the availability of non-mandated services (dental, home health, mental health, etc.). According to a survey report last year from The Kaiser Commission on Medicaid and the Uninsured, almost all states with MCOs carve out at least one acute care benefit, with dental care and outpatient behavioral health services the most common, See ADVOCACY on back cover


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Sheraton Greensboro Hotel at Four Seasons

Spring Meeting Coming to Greensboro Convenient Learning Schedule & Optional Sessions Offer Unique Opportunity

The Academy is headed to the beautiful Sheraton Greensboro Hotel at Four Seasons in Greensboro, NC for the 2013 Spring Family Physicians Weekend. The conference will begin late Thursday afternoon on April 4th with an optional SAMs Study Working Group and an optional Coding Workshop. Core general session lectures take place on Friday, April 5th and Saturday, April 6th. The conference will adjourn on Sunday, April 7th with an NCAFP Board of Directors Breakfast Meeting and a second optional SAMs Study Working Group. Be sure to mark your calendars and do not miss out on this fantastic opportunity to gain insightful and useful knowledge. The scientific learning program is being led by Program Chairs, James W. McNabb, MD and Nadine B. Skinner, MD and will present many outstanding lectures. Talks on diabetes, fibromyalgia, rhinitis, COPD and a number of requested topics are tentatively scheduled. Be sure to visit www.ncafp.com/sfpw for a listing of topics, speakers and to register on line. The early bird cut-off date for conference registration is Monday, March 4th. In addition to the learning schedule, the Academy will also be holding its Annual Leadership Development Forum in conjunction with this event. Join us Saturday afternoon for an in-depth look at media training. As primary care continues to be a popular topic in today’s media, this is a

14 Winter 2013 • The NC Family Physician

fantastic opportunity to learn more about and the “do’s and Tell Family Medicine’s Story don’ts” while in front of the Media Training Workshop camera or during an interview. Saturday, April 6, 2013 Greensboro is a great place 2:30 pm - 5:30 pm to visit in the springtime! The city offers a great selection The Academy will be presenting a You will hear how to of more than 100 different fantastic media training workshop, respond to quesattractions and there’s plenty Telling The Family Physician Story tions, wear the right to the News Media & Patients in clothing, create to do and to discover. With conjunction with the conference. sound bites and a thriving and historic As primary care continues to be even use social medowntown that offers a range a popular topic in today’s media, dia to share your story. The conversational of shops, restaurants, and this is a fantastic opportunity to tips you practice may also help you share learn more about and the “do’s and information with your patients, including local attractions, Greensboro don’ts” while in front of the camera helping to make your patient an advocate is an ideal place for a weekend or during an interview. Learn the for family medicine and the medical home. getaway with the whole family. basics of remaining calm, comThe session will feature a didactic presentaposed and confident when speaking tion, case studies, video analysis and role In addition, this is the perfect to a reporter. This session will go plays. Our presenter is an award-winning setting to mix and mingle over what to expect in both a routine speaker and health beat reporter. with your colleagues in Family and an aggressive news interview. Medicine. And sports fans, we have you covered. Be prepared to cheer on your favorite team Family Physicians Weekend to benefit from this during the Final Four on Saturday night as we host a discounted rate. The cut-off date for reservations in private event within the hotel with large screen TVs, our block is Monday, March 4, 2013. light fare and beverages. The promotional brochure arrived in your You may make your hotel reservations now mailbox in late January. If you have questions or by calling the Sheraton at 800-242-6556 and need assistance in advance, please contact the requesting the NCAFP’s discounted room rate Meetings Department at 919-833-2110/800-872of $128 per night plus tax. When calling, please 9482 (NC Only) or via email at meetings@ncafp. indicate that you are attending the NCAFP/Spring com. www.ncafp.com/ncfp

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R e s i d e n t

P e r s p e c t i v e


FPs Will Need New Skills to Excel in Tomorrow’s Complex Health Care System How is your residency program meeting the training challenge? By Mo Shahsahebi MD, MBA, NCAFP Resident Director Aaron George, DO, NCAFP Resident Director-Elect


mericans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. Yet, health care and systems innovation drives forward with technologic advancement, team and leadership modeling, along with a host of other skills and competencies. Family physicians must be proactive and prepared leaders who are ready to step into this changing health care environment and both initiate and adapt to change.  Residencies across North Carolina, as well as across the country, are undergoing curricular and cultural shifts to meet these needs.   The goal for the future of Family Medicine will be to maintain the classic and recognized historical image of the family physician in concert with the  goals and responsibilities of the adaptive health care world of tomorrow.  In essence, while we will always be able to carry our traditional black handbags, we must constantly search for opportunity to fill them with new skills and tools.  In this way, we can best unite patient expectations with quality care.   New "tools" in the next generation handbag include population health management, flexible usage of technology, advocacy, teamwork and communication.  Programs from around North Carolina have already begun to develop specific aims to address areas such as (1) community engagement; (2) Adaptable integration of technology; (3) Awareness and involvement in active advocacy; (4) Responding to change; and (5) Team dynamics. Today’s residents need new skills to excel in tomorrow’s health care system. As we transform from a reactive system designed for acute care to

16 Winter 2013 • The NC Family Physician

a proactive one capable of managing complex chronic disease, graduate medical education must find ways to teach emerging competencies that may not be fully mastered by even the most experienced clinicians. The next generation of family physicians must not only provide outstanding patient care at the bedside, but also be capable of simultaneously managing entire populations through more than direct interaction. This marriage of micro and macro, the ability to see and navigate patient care on a larger context, will be crucial in containing runaway costs while maximizing patient outcomes. A paradigmatic shift is at hand: the medical world has recently been presented with progress and innovation through abrupt disruption of the modern model.  The P4 project, TransforMed's residency program re-design pilot designed to test and compare different approaches in adapting residency training, and the Future of Family Medicine initiative both demonstrate that Family Medicine residencies are ripe for the same sort of innovative disruption.  Along these lines, MedPAC has laid out recommendations in their June 2010 report to Congress to modify GME payment schemes to create incentive toward just this sort of health care development at the residency level.1 There is some indication that MedPAC will go even further in more specific terms for these recommendations in their coming reports.  Each and every one of our patients now carries a device that contains more information with the stroke of a few keys, than all the textbooks we read in training.  We are no longer purveyors of information, but rather intuitive and experienced interpreters for our patients. This change empowers us into the role of patient facilitator. We no longer need reside in a world of regurgitation, but rather we can be an intuitive examiner that arrives on the scene to decipher information and make recommendations. The modern physician is called to provide

twenty-first century health care upon the foundation of twentieth-century training. Today's physician trainees enter a world of teamwork and collaboration in health care delivery. The growing demand for primary care coupled with our aging population mean that physicians can no longer care for their patients within their silos. To meet the needs of tomorrow, we must serve as leaders of multidisciplinary teams and continue to decentralize certain responsibilities. We have seen the positive impact of this team based model within patient-centered medical homes across the state, but we are still only scratching the surface of what is possible. Further, we must continue to engage trainees in systems development and quality improvement. We should also look to continue to find ways to balance service with education in the longitudinal structure of residency programs. These goals will continue to streamline and advance the process of developing a successful and productive family physician in modern health care. The kind of family doctor that is best for his patients, his community, and his profession. But these changes cannot happen within medical education alone. There are countless family physicians in their early to mid-careers that should develop new skills to adapt to the needs of tomorrow. We cannot afford to wait for an entirely new cohort of physicians. To truly transform Family Medicine, we must bring opportunities to all physicians interested in adding these skills to their black handbag. What is your residency program, community clinic or practice doing to meet these challenges? What tools are you working to add to your black handbag? Collaboration and the open sharing of new ideas, accomplishments and failures are crucial to our efforts to collectively advance family medicine. Please send us your thoughts and share your views at residentdirector@ncafp.com.

1. MedPAC Report to Congress, Aligning Incentives in Medicare. June, 2010. Pages 103-125


Our Residencies: UNC Chapel Hill Family Medicine Residency

The UNC Chapel Hill Family Medicine Residency-

Adaptability in Full Scope Full scope Family Medicine training has never been as vibrant or as diverse as it is today in Chapel Hill. The UNC Department of Family Medicine’s residency training program is using a broad spectrum of training locations and continuity experiences to develop family physicians who are adaptable and skilled for most any practice environment. With an expanded emphasis on rural underserved care, maternal and child health, and increased flexibility with residents’ elective training, the program is stronger than ever. Broad Spectrum of Training Environments

The UNC Family Medicine Residency is a 1010-10 program, with two residents from each class now serving in a new underserved track. UNC offers resident physicians a training opportunity that blends experiences within a busy academic medical center, a large community hospital, several community clinics, and a rural health center catering to the underserved. Residents get exposure to a diverse mix of patients that represent different ethnic and socioeconomic backgrounds and present with a wide range of health issues. It all makes for a training experience where UNC residents must learn to adapt to their environment and to the needs of the individual patient. “We want our graduates to be as adaptable as possible,” noted Dr. Cristen Page, Residency

Program Director. “It’s all so that they can go into their communities and fill the need. That requires a full-scope emphasis in inpatient, outpatient, maternal child health and procedures.” UNC’s residents get a majority of their inpatient training on the Family Medicine Inpatient Service run by the department at UNC Hospital, the school’s flagship state-of-the-art tertiary care center. They also get exposure to a large community hospital in Raleigh (WakeMed), and even a tiny rural hospital in Chatham County. For continuity training and outpatient care, UNC residents provide patient care in the department’s Family Medicine Center, a Level III Patient-Centered Medical Home that serves approximately 55,000 patients annually. They also have a number of special outpatient rotations, including a rural rotation at Chatham Hospital (where Family Physicians staff the Emergency Department and Inpatient Service), procedural rotations, and another four months of in- and out-of-town electives to develop individual skills. Outpatient services at the Family Medicine Center are structured around four clinical teams to which residents are individually assigned. Residents play an integral role in helping to direct their care teams as they access a full complement of resources on the patient’s behalf. These include lab and x-ray services, nutritionist support, social workers, care managers and pharmacy. Third year residents develop outpatient leaderships skills, working closely with a faculty member as Clinical Team

Leaders. Other support services such as financial counseling, nicotine dependence programming, acupuncture, and even physical therapy are also available to promote comprehensiveness and improve outcomes. Expanding Rural Care Training

In October of last year, UNC formally announced the expansion of its program with a new rural underserved track. Although UNC has had a long history of training residents in rural and underserved care, its new track is allowing it to focus more resources on a critical area of need for North Carolina and attract more interest in its program. “Our new track at Prospect Hill really demonstrates our program’s and our department’s commitment to vulnerable populations,” commented Dr. Page. “For students who want to work with a mainly Spanish-speaking population in a rural and community health center setting, it’s a fantastic option. We’ve had a tremendous amount of interest.” All UNC Family Medicine residents receive training in rural/underserved care through their inpatient and continuity experiences. Going forward, two residents from each class will be selected for the new track. Both will complete a majority of their continuity training at the Prospect Continues on next page Winter 2013 • The NC Family Physician


Tracking Continuity - UNC Residency Program Director Dr. Cristen Page highlights how the program tracks patient continuity per each resident.

Hill Community Health Center, an FQHC located about 30-minutes from Chapel Hill. Prospect Hill operates in a newly-renovated 4,000-square-foot facility and serves a largely Latino and Spanish-speaking population. Residents get to experience working in a clinicallydemanding and multidisciplinary rural setting that’s also home to many regional community health programs. Prospect Hill is also an important regional site for prenatal care for underserved and minority patients. Living The PCMH Model

Like most Family Medicine residencies today, training residents to embrace the Patient-Centered Medical Home model is a major focus of the program. For UNC, PCMH is embedded within every aspect of its curriculum, so residents get longitudinal exposure as they progress. “Our philosophy for teaching PCMH is to focus on clinical innovation and have residents really live PCMH. Our residents learn a tremendous amount about the pillars of PCMH by living it and doing it every day,” explained Dr. Page. A significant part of UNC’s PCMH effort is the program’s heavy emphasis on tracking its patients’ experience with physician/patient continuity. Because the patient-physician relationship is so vital in PCMH, the program closely measures the percentages of patients who see their personal physician at the time of their visit. “We put a lot of emphasis on the personal relationships because that’s how a resident learns and grows as a clinician,” noted Dr. Page. UNC averages in the 70% range, an excellent percentage when compared to other programs nationwide that track the metric. Another hallmark of patient-centeredness is team-based clinical care. Team care is so embedded and ever present within the program’s clinical operations, it’s almost invisible. In the inpatient setting, residents conduct multi-disciplinary

18 Winter 2013 • The NC Family Physician

rounds each day that bring them together with other subspecialist physicians and allied health staff. During their outpatient experiences, they also routinely interact with ancillary providers such as care managers, outpatient pharmacists, social workers and the clinical nursing staff. The ‘team approach’ is learned by doing and continual repetition, according to Dr. Page. Quality improvement is another key aspect of PCMH and UNC approaches this by getting residents involved. For instance, 2nd- and 3rd-year residents each complete a 6-week rotation where they investigate and work to uncover the reasons behind an identified trouble area. As an active participant, they become familiar with the language and processes around quality improvement. During the 3rd year, the entire graduating class works together to complete a QI project. These projects have helped UNC achieve dramatic improvements in patient care, including registry implementation, systems for screening patients with chronic disease for depression, and improvements in diabetes care. “These QI projects allow the residents to integrate improvements right into our systems and clinic processes, so they’re sustained after they graduate. Their projects have helped us achieve PCMH recognition and have improved the care of our patients. For the past three years our residents have been invited to STFM to present their work nationally, which helps them join the national dialogue and learn from other programs as well.” Fostering Adaptability

Adaptability is perhaps the most important clinical trait for a family physician. To foster and ignite this requires extensive ongoing education, but also the freedom for a physician to pursue their own areas of interest. UNC devotes weekly structured learning time using small group and seminar style techniques of teaching that cover topics ranging from cardiovascular health to preventive care.

It also offers residents the option to utilize a portion of their electives to develop an ‘area of concentration’ (AOC) tailored to their interests. UNC offers AOC’s in healthcare leadership, sports medicine, geriatrics, care of the underserved, and procedures. Additional AOC’s are available to residents depending on interest, and can be developed to help residents pursue almost any clinical or teaching passion. UNC graduates today are working in a wide range of practice environments, from traditional outpatient community practices to working with the underserved, or to those who pursue additional fellowships and go on to academic careers. Dr. Page did note that 40% of UNC graduates in the last couple of years do obstetrics, with a much higher percentage providing prenatal care. But it all cases, graduates are well-prepared. “Our primary emphasis is on creating excellent, full-scope family doctors who are prepared to meet the needs of their communities and provide leadership in health care reform. Continuing to train our residents in a wide variety of settings and including the child and maternal health piece, is vital to helping residents be as good as they can be, wherever they ultimately practice.”

Hendersonville FM Residency Partnering to Create Teaching Health Center The MAHEC Hendersonville Family Medicine Residency program will be expanding its program through a new consortium consisting of MAHEC, Blue Ridge Community Health Services and Pardee Hospital. The collaboration will create western North Carolina’s first teaching health center and enable the program to expand by one training slot through 2016. The program’s expansion is being made possible through grant dollars available to MAHEC by the Accountable Care Act’s “Teaching Health Center” program. Coinciding with the expansion, the program is also shifting its longitudinal ambulatory training to two clinical sites operated by Blue Ridge, a federally qualified health center, thus establishing the first teaching health center in the region.




UPCOMING DATES March 31st - National-Level Elections & Appointments Notification Deadline

FM Scholar Patrick Williams of ECU Receives Dr. Lynn Hughes Scholarship In honor of Dr. Lynn Hughes, the Cabarrus Family Medicine Residency Program decided to start an annual scholarship for the Cabarrus Family Medicine mission trip to San Juan De La Maguana, Dominican. Dr. Hughes practiced otorhinolaryngology in Concord, NC, for over 40 years. Dr. Hughes had an ongoing relationship with the Clinica Christiana in San Juan de la Maguana, which is in a medically underserved area of the Dominican Republic, close to the border of Haiti. Dr. Hughes performed thousands of ENT surgeries over the 20 plus years that he made mission trips to the Dominican Republic. Dr. Hughes has also been a lifelong advocate of Family Medicine, and was a strong voice in establishing both the Department of Family Medicine at CMC – NorthEast, as well as an advocate for the Cabarrus Family Medicine Residency Program.

Start thinking about this now. Many positions require Chapter Support. All candidate information is provided to the NCAFP Executive Committee for review.  This committee makes the decision on whether or not to support individual candidates.  Please note, the process of review is the same for all national positions whether you are a student, resident or physician.

April 6th – Student Section Discussion in Greensboro Apply at http://www.ncafp.com/scholarships

In honor of Dr. Hughes, the Cabarrus Family Medicine Residency Program has established a scholarship program, whereby two students from the ECU/Brody School of Medicine will be awarded $500 each to participate in the annual CFMRP mission trip to San Juan de la Maguana.  This year, the recipient of the 2012 Lynn Hughes Scholarship was Patrick Williams. Patrick is a native of Hickory and a 4th-year medical student at ECU. His is a Family Medicine Scholar in the program’s inaugural class and will be MATCHing into Family Medicine later this Spring. Congratulations!

May 1st - AAFP National Conference Scholarship Deadline 200 available/up to $500 each. See www.aafp.org

May 6th - NCAFP Scholarship Application Deadline Apply at http://www.ncafp.com/scholarships

May 18th – 2013 Family Medicine Day Register at http://www.ncafp.com/2013fmd

Family Medicine Charlotte Metro Area


Outstanding outpatient family medicine opportunities available in communities located minutes from Charlotte, one of the fastest growing cities in the country. These are employed opportunities and will offer competitive compensation packages including two year salary guarantee, productivity bonus potential, generous benefits and relocation expenses. CaroMont Medical Group operates under the guidance of a physician-led Governance Committee allowing for an active partnership with the Medical Staff. Over 300 active medical staff representing all major medical specialties at Gaston Memorial Hospital, a modern and progressive 435-bed hospital which provides comprehensive care to patient base of over 300,000. These lovely communities have easy access to the beautiful North Carolina Mountains and some of the most popular beaches on the East coast. Just minutes from an international airport and two large lakes, communities offer unlimited cultural and recreational amenities. A superb quality of life exists here with many charming neighborhoods and stellar public and private schools. If interested in being considered for this opportunity, please send CV to: Celia G. Billings Manager, Physician Recruitment CaroMont Health 2240 Remount Road Gastonia, NC, 28054 T: 704-834-2153 | F: 704-834-4615 Email: billingc@caromonthealth.org

Gaston Memorial Hospital | CaroMont Medical Group | CaroMont Specialty Surgery | CLiC | Gaston Hospice | Courtland

Winter 2013 • The NC Family Physician


ADVOCACY continued from p. 12 with pharmacy (completely or partially) also being popular. As an alternative to this approach, some thought has been to have CCNC begin assuming some level of risk relevant to the Medicaid program. The Academy expects to work closely with the its allies across medicine to educate legislators why North Carolina’s current Medicaid care management approach remains the state’s best course, and to continue to work with CCNC to improve quality and lower costs. In terms of Medicaid expansion, the ACA stipulates that the federal government will pay for 100% of the cost of Medicaid expansion for the first three years. However, federal support gradually decreases to 90% in 2020, with states responsible for paying the difference. According to a report published last year by the NC Institute of Medicine, NC DMA has estimated that the combined total cost of expansion through state fiscal year 2019 to be just over $830M or anywhere between approximately $70M and $220M in additional Medicaid spending each year.1 These figures, however, don’t include any ‘offsets’ or savings that expansion is expected to create in areas such as reduced ER utilization, reductions in uncompensated care, savings generated with the mental health/developmental disabilities and substance abuse systems, and medically needy expenditures. It all makes savings and expenditures difficult if not impossible to quantify and leaders within the General Assembly are cautious. Most site concerns about the federal government leaving states holding the bag by sharply reducing the federal share of Medicaid as Congress deals with their own fiscal

issues. Some Legislative leaders fear that the state could end up holding 50 percent or more of the burden of any expansion. In addition to Medicaid expansion, the legislature must also determine what course of action it will take on the Health Benefits Exchange (HBE). The ACA provides flexibility on what level a state can be involved in the development of exchanges. A state can create their own exchange or partner with the federal government. For states electing not to establish their own HBE or partner on one, the federal government will create one for them. But similar to Medicaid expansion, financial impacts of the decision are weighing heavily. New Leadership at DHHS and Medicaid

Outside the walls of the legislature, North Carolina’s Department of Health & Human Services and the state’s Medicaid program have both undergone leadership changes. New Governor Pat McCrory announced in mid-December the selection of Dr. Aldona Wos as new Secretary of the Department of Health and Human Services. Wos (pronounced vosh) is a Greensboro-based Internist who was the United States Ambassador to Estonia from 2004 until early December, 2006. She practiced medicine for 18-years including stints in private practice, clinical care, corporate medicine, teaching and consulting. Prior to coming to North Carolina, Wos worked in New York City where she was heavily involved in fighting HIV/AIDs. While Wos does not have specific experience overseeing a department with the scale and scope of DHHS,

NC FAMPAC FORERUNNER Now more than ever, NC’s family medicine community must support and educate legislators on both sides of the aisle. FAMPAC Family Medicine Forerunners help make this happen. As a Family Medicine Forerunner, your contribution of $100 each quarter (just over a dollar a day) to NCAFP’s Political Action Committee (FAMPAC) helps family medicine keep its voice heard and our issues recognized in the NC legislature.

McCrory cited Wos’ independence as a key driver in his decision to offer her the position. Secretary Wos announced her first major appointment in early January with the selection of Carol Steckel, as the department’s new director of the Division of Medical Assistance. Prior to her appointment, Steckel most recently served as the director of the Center for Health Care Innovation at the Louisiana Department of Health and Hospitals. She was also formerly Commissioner of the Alabama Medicaid Agency and National Chair of the Medicaid Directors Association. According to a press release from the department, Steckel led the design and implementation of a realignment of information technology services for the Department of Health and Hospital while in Louisiana. She holds a Master’s Degree in Public Health from the University of Alabama. Beyond the Medicaid Director, Dr. Wos has also announced plans to replace the Director of the Office of Rural Health and Community Care and has named a new IT Manager to her executive level team. Issues Framework

The Academy’s governmental affairs team is keenly aware of these changes and has created a policy framework to guide its efforts this session. In short, your Academy will work to advance physician-directed and primary care-centric healthcare delivery as the basis for overall health quality improvement and cost management. Several inter-related efforts on issues such as NC Medicaid, supporting Community Care of NC, the roles of primary care in Accountable Care, scope of practice, and health workforce development each feed back into this framework. Additionally, your Academy will support public health initiatives related to the core tenets of Family Medicine. Throughout this session, the Academy expects to call upon members to connect with their respective state Senate and House members to communicate our positions. This year more than ever, Family Medicine’s voice must be strong, clear and unified. Please consider participating if called upon to act. Advocating in this way only takes a short amount of time, but is known to pay big dividends as policy is being considered and acted upon. Another way to participate is with you checkbook. The Academy’s Family Medicine Political Action Committee (FAMPAC) is North Carolina’s only PAC dedicated specifically to the issues important to our specialty. Funds generated through member contributions help us to financially support legislators who show leadership on issues important to primary care and Family Medicine. Giving is easy, simply visit www.ncafp.com/fampac.

www.ncafp.com/forerunner 1. Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina: Draft Final Report Pending U.S. Supreme Court Decision, Chapter 3, Medicaid, p.64, http://www. nciom.org/wp-content/uploads/2012/05/Ch.3-Medicaid.pdf

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