Summer 2014 by California Academy of Family Physicians

California

FAMILY PHYSICIAN VOL. 65 NO.3 Summer 2014

Dr. Carla Kakutani named 2014 Family Physician of the Year!

CAFP HONORS FOUR FAMILY MEDICINE LEADERS

PHYSICIANS PROMOTING JUSTICE HEALTH CARE

EMBRACING GENERATIONAL DIFFERENCES CREATES A POSITIVE WORK ENVIRONMENT

THE FACE OF FAMILY MEDICINE IS CHANGING

GENERATIONS IN THE WORKFORCE: EMBRACING DIFFERENCES TO GROW THE FUTURE OF FAMILY MEDICINE

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California Family Physician Summer 2014

$250 AAFP Savings!

Loews Coronado Bay Resort San Diego, California September 17–20, 2014

Transforming “disease” care to “health” care. Join many of the leading names in preventive, nutritional medicine who will be presenting as part of the 2014 International Plant-Based Nutrition Healthcare Conference. Learn ¿ rst hand from the experts about the ef¿ cacy of plant-based nutrition and its ability to prevent, suspend and often even reverse the chronic, degenerative diseases that are pervasive in our patient populations.

Who should attend? Physicians representing each and every practice specialty area, nurses and allied health practitioners—those who are dedicated to empowering patients and clients with the ultimate prescription. Earn valuable Continuing Medical Education credits (CMEs) —this Live activity has been reviewed and accepted for up to 20 Prescribed Credit(s) by the American Academy of Family Physicians. Visit pbnhc.com, watch videos of last year’s attendees and faculty members, and register to be part of a medical education event that many have said is “life changing”—for themselves, for their families and for their medical practices and patients.

Faculty pictured above, left to T. right: Colin Campbell, PhD; Thomas M. Campbell, MD; Brian Clement, PhD, NMD, LN; Caldwell Esselstyn, Jr., MD; Michael Greger, MD; Micaela Karlsen, PhD Candidate; Michael Klaper, MD; William Li, MD; Doug Lisle, PhD; James Loomis, Jr., MD; Terry Mason, MD, FACS; John McDougall, MD; Dean Ornish, MD; Michele Simon, JD, MPH; Scott Stoll, MD and Phil Tuso, MD, FACP

It’s exciting when you treat causation of disease: It’s prompt, powerful and persistent. The power of this option needs to be clearly communicated to patients. — Caldwell Esselst yn, Jr., M D, Conference Facult y and Author, Prevent and Reverse Heart Disease

$250 Savings

for AAFP Members!

Use discount code AAFP250CA when registering at pbnhc.com. California Family Physician Summer 2014 3

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Workforce Development Manager anarayanan@familydocs.org

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California FAMILY PHYSICIAN Quarterly publication of the California Academy of Family Physicians

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California Family Physician Summer 2014

10 CAFP Honors Four Family Medicine Leaders

Shelly Rodrigues, CAE, FACEHP

13 Hello-Goodbye for AAFP National Converence of Special Constituencies 17 Physicians Promoting Justice through Health Care

Sophia Henry Bryce Spitze and Brenda Campos-Spitze

19 Embracing Generational Differences Creates a Positive Work Environment

Carol Havens, MD

20 Generational Differences in the Workforce: Reflections from a Gen-X’er

P.T. Koenig, MD

26 Work Life Balance: Prioritizing Pebbles in a Glass Jar

Editorial

Wise Family Doctors Are Good Farmers

Presidents Message

The Unexpected Consequences of the Primary Care Shortage

PCMH Corner

PCMH Post-JAMA: No Post-Mortem

Michelle Quiogue, MD

Nathan Hitzeman, MD Del Morris, MD Leah Newkirk

12 Membership

Member Survey Results Reveal Opportunities for Growth and Development Emma Lundberg

14 Political Pulse

CAFP Priority Legislation Reflects Family Medicine’s Priorities

16 Public Health

Children, Diseases, Vaccinations and Parental Peer Pressure

30 Executive Vice

The Face of Family Medicine Is Changing

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Ashby Wolfe, MD, MPP, MPH Steve Heilig, MPH Susan Hogeland, CAE

For the upcoming CME calendar go to www.familydocs.org California Family Physician Summer ϮϬϭϰ 5

EDITORIAL

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Wise Family Doctors Are Good Farmers

dŚŝƐ ŝƐƐƵĞ ŝƐ ĂďŽƵƚ ŐĞŶĞƌĂƚŝŽŶĂů ĚŝĨĨĞƌĞŶĐĞƐ ǁŝƚŚŝŶ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͘ tŚĂƚ ŝƐ ƐƚƌŝŬŝŶŐ ĂƌĞ ƚŚĞ ƐŝŵŝůĂƌŝƚŝĞƐ͘ tĞ ƉƵƚ ƉĂƚŝĞŶƚƐ ĨŝƌƐƚ ĂŶĚ ƌĞĂĚŝůǇ ŵĞĞƚ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ĂŚĞĂĚ ŽĨ ƚŚĞ ĐŚĂŶŐŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ůĂŶĚƐĐĂƉĞ͘ &ĂŵŝůǇ ĚŽĐƐ ĚŽ ŶŽƚ ďĂĐŬ ĚŽǁŶ ĨƌŽŵ Ă ĐŚĂůůĞŶŐĞ͘ /Ŷ ŵĂŶǇ ǁĂǇƐ͕ ƚŚĞ ĨĂŵŝůǇ ĚŽĐ ŝƐ ůŝŬĞ ƚŚĞ ƐŵĂůůͲƐĐĂůĞ ĨĂƌŵĞƌ͘ dƌƵƐƚĞĚ͕ ƚŝŵĞͲŚŽŶŽƌĞĚ ĂŶĚ ĐŽŵŵƵŶŝƚǇ ĞŵďĞĚĚĞĚ͘ tĞ ĐƵůƚŝǀĂƚĞ͕ ŶƵƌƚƵƌĞ ĂŶĚ ƌŽůů ƵƉ ƚŚŽƐĞ ƐŚŝƌƚ ƐůĞĞǀĞƐ ƚŽ ĚŽ ƚŚĞ ũŽď Ăƚ ŚĂŶĚ͘ DǇ ĨĂŵŝůǇ ĂŶĚ / ƌĞĐĞŶƚůǇ ĞŶũŽǇĞĚ Ă ͞ĨĂƌŵ ƐƚĂǇ͟ ǁĞĞŬĞŶĚ ŝŶ Ă ƋƵĂŝŶƚ ƐĞƚƚŝŶŐ ŝŶ ^ŽŶŽŵĂ͘ tĞ ŵŝůŬĞĚ ĐŽǁƐ͕ ĨĞĚ ĐŚŝĐŬĞŶƐ͕ ĐŽůůĞĐƚĞĚ ĞŐŐƐ ĂŶĚ ŚĞůƉĞĚ ƉůĂŶƚ Ă ŐĂƌĚĞŶ͘ DǇ ĚĂƵŐŚƚĞƌƐ ůĞĂƌŶĞĚ ƚŽ ƉƌŽĐĞƐƐ ǁŽŽů ĨƌŽŵ ƚŚĞ ƐŚĞĞƉ͘ tĞ ƐůĞƉƚ ŝŶ Ă ĐŽŶǀĞƌƚĞĚ ďĂƌŶ ĂŶĚ ƐƚĂǇĞĚ ƐŽŵĞǁŚĂƚ ǁĂƌŵ ǁŝƚŚ Ă ǁŽŽĚ ďƵƌŶŝŶŐ ƐƚŽǀĞ͘ tĞ ĂǁŽŬĞ ďƌŝŐŚƚ ĂŶĚ ĞĂƌůǇ ƚŽ ƚŚĞ ƐŽƵŶĚ ŽĨ ůůŝŽƚƚ͕ Ă ƚĂŝůůĞƐƐ ƌŽŽƐƚĞƌ͘

ƉĂƚŝĞŶƚͲƉŚǇƐŝĐŝĂŶ ŝŶƚĞƌĂĐƚŝŽŶ ĂŶĚ ƚŚĞ ĚĞůŝǀĞƌǇ ŽĨ ƚŚĞ ŵĂũŽƌŝƚǇ ŽĨ ŽƵƌ ƉĂƚŝĞŶƚƐ͛ ĐĂƌĞ͘ EĞǁĨĂŶŐůĞĚ ŚŽƌŵŽŶĞƐ͕ ƉĞƐƚŝĐŝĚĞƐ͕ ĂŶƚŝďŝŽƚŝĐƐ͕ ŐĞŶĞƚŝĐĂůůǇ ŵŽĚŝĨŝĞĚ ŽƌŐĂŶŝƐŵƐ ʹ Ăůů ƐĞĞŵ ŽƐƚĞŶƐŝďůǇ ŐŽŽĚ Ăƚ ĨĂĐĞ ǀĂůƵĞ ĂŶĚ ŵĂǇ ŽĨĨĞƌ ƐŚŽƌƚ ƚĞƌŵ ǇŝĞůĚƐ͘ Ƶƚ ǁĞ͛ǀĞ ƐĞĞŶ ĞŶŽƵŐŚ ŚǇƉĞĚ ͞ĂĚǀĂŶĐĞƐ͟ ƚƵƌŶ ŝŶƚŽ ƋƵĂĐŬĞƌǇ ŽǀĞƌ ƚŚĞ ǇĞĂƌƐ͘ dŚĞ ǁŝƐĞ ĨĂŵŝůǇ ĚŽĐƚŽƌ͕ ůŝŬĞ ƚŚĞ ŐŽŽĚ ĨĂƌŵĞƌ͕ ǁŝůů ůŝƐƚĞŶ ĂŶĚ ŽďƐĞƌǀĞ ďĞĨŽƌĞ ũƵŵƉŝŶŐ ƚŽ ƌŽƚĞ ƚƌĞĂƚŵĞŶƚ Žƌ ƚĞƐƚŝŶŐ͘ tĞ ĂƌĞ ĐŽŶƐĐŝŽƵƐ ŽĨ ƚŚĞ ĨŝŶŝƚĞ ƌĞƐŽƵƌĐĞƐ ŽĨ ŚĞĂůƚŚĐĂƌĞ ĂŶĚ ƉƌĞĨĞƌ ƚŽ ƵƐĞ ĐŽƐƚͲĞĨĨĞĐƚŝǀĞ ŵĞĚŝĐŝŶĞƐ ĂŶĚ ƐĐƌĞĞŶŝŶŐƐ ĂŶĚ ƚƌĞĂƚŵĞŶƚƐ ƚŚĂƚ ĂƌĞ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƚŽ ŝŵƉƌŽǀĞ ŽƵƌ ƉĂƚŝĞŶƚƐ͛ ůŝǀĞƐ͘ tĞ ƚƌĞĂƚ ǁŚŽůĞ ƉĂƚŝĞŶƚƐ͗ ŶŽƚ ũƵƐƚ ƚŚĞŝƌ ŚĞŵŽŐůŽďŝŶ͕ ƚŚĞŝƌ ƚƵŵŽƌ ůŽĂĚ Žƌ ƚŚĞŝƌ ĐŽƌŽŶĂƌǇ ĐĂůĐŝƵŵ ƐĐŽƌĞ͘

ȱ ȱ ȱ ȱ ȱę ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȭ ě ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȭ ȱ ȱ ȱ ȱ Ȃȱ ǯ

tĞ ƌĞĐŽŐŶŝǌĞ ƚŚĞ ŝŶƐŝĚŝŽƵƐ ŚĂƌŵƐ ŽĨ ƚŽŽ ŵƵĐŚ ŵĞĚŝĐŝŶĞ͗ ƉŽůǇƉŚĂƌŵĂĐǇ͕ ŵĞĚŝĐĂů ƌĂĚŝĂƚŝŽŶ͕ ƚŚĞ ǁŽƌƌŝĞƐ ĂƌŝƐŝŶŐ ĨƌŽŵ ĞǆĐĞƐƐŝǀĞ ƚĞƐƚŝŶŐ ĂŶĚ ƚƌĂŶƐŝƚŝŽŶƐ ŽĨ ĐĂƌĞ͘ ;/ŶƚĞƌĞƐƚŝŶŐůǇ͕ Ăůů ƚŚĞ ĐŚŝĐŬĞŶƐ ŽĨ ŽƵƌ ŚŽƐƚ ĨĂŵŝůǇ ǁĞƌĞ ďĞŚĞĂĚĞĚ ďǇ ƌĂĐĐŽŽŶƐ ŽŶĞ ǁĞĞŬ͘ dŚĞǇ ǁĞƌĞ ĂǁĂǇ ĂŶĚ ŚĂĚ ƌĞŶƚĞƌƐ ǁĂƚĐŚ ƚŚĞŝƌ ĨĂƌŵ͕ ĂŶĚ ƚŚĞǇ ůĞĨƚ ƚŚĞ ĐŽŽƉ ŽƉĞŶ ŽŶĞ ĞǀĞŶŝŶŐ͘Ϳ

tŚĂƚ ƐƚƌƵĐŬ ŵĞ ĂďŽƵƚ ƚŚĞ ĨĂŵŝůǇ ǁĞ ƐƚĂǇĞĚ ǁŝƚŚ ǁĂƐ ŚŽǁ ŵƵĐŚ ƚŚĞǇ ǀĂůƵĞĚ ƚŚĞŝƌ ůĂŶĚ ĂŶĚ ƚŚĞŝƌ ĂŶŝŵĂůƐ͘ dŚĞ ĂŶŝŵĂůƐ ǁĞƌĞ ƉĂƌƚ ŽĨ ƚŚĞ ĨĂŵŝůǇ͘ dŚĞǇ Ăůů ŚĂĚ ŶĂŵĞƐ ĂŶĚ ƉĞƌƐŽŶĂůŝƚŝĞƐ͘ dŚĞŝƌ ŶĞĞĚƐ ǁĞƌĞ ĂƚƚĞŶĚĞĚ ƚŽ͘ ^ƵƌĞ͕ ŽƵƌ ŚŽƐƚƐ ǁĞƌĞ ŶŽƚ ƚŚĞ ĨĂƌŵĞƌƐ ŽĨ ǇĞƐƚĞƌǇĞĂƌ͘ dŚĞǇ ŚĂĚ ƚŚĞ ĂŵĞŶŝƚŝĞƐ ŽĨ ŵŽĚĞƌŶ ĚĂǇ ůŝĨĞ ʹ ĞůĞĐƚƌŝĐŝƚǇ͕ Ă ŵŝĐƌŽǁĂǀĞ͕ ǁĂƐŚŝŶŐ ŵĂĐŚŝŶĞ͕ ĐĂƌƐ͕ ĐĞůů ƉŚŽŶĞƐ ĂŶĚ ƚƌĂĐƚŽƌƐ͘ tŚŽ ŝŶ ƚŚĞŝƌ ƌŝŐŚƚ ŵŝŶĚ ǁŽƵůĚ ǁĂŶƚ ƚŽ ŐŽ ďĂĐŬ ƚŽ ǁĂƐŚďŽĂƌĚƐ ĂŶĚ ŚŽƌƐĞ ĚƌĂǁŶ ƉůŽǁƐ͊ Ƶƚ ǁŚĂƚ ŚĂĚ ŶŽƚ ĐŚĂŶŐĞĚ ǁĂƐ ƚŚĞŝƌ ĐŽŶŶĞĐƚŝŽŶ ǁŝƚŚ ƚŚĞ ĨĂƌŵ͕ ƚŚĞŝƌ ĚĞǀŽƚŝŽŶ ƚŽ ƚŚĞŝƌ ĚƵƚŝĞƐ ĂŶĚ ƚŚĞŝƌ ƌĞƐƉĞĐƚ ĨŽƌ ůŝĨĞ ŽĨ Ăůů ĨŽƌŵƐ͘

>ĂƐƚůǇ͕ ǁĞ ĂƌĞ ŶŽƚ ĂĨƌĂŝĚ ƚŽ ŐĞƚ ĚŝƌƚǇ͘ tĞ ŐƌĂď ƚŚĂƚ ŚĂŶĚĨƵů ŽĨ ƉƌŽǀĞƌďŝĂů Ěŝƌƚ ĂŶĚ ƐŝĨƚ ŝƚ ƚŚƌŽƵŐŚ ŽƵƌ ĨŝŶŐĞƌƐ͘ tĞ ƚĂŬĞ ŽĨĨ ŽƵƌ ĚŝĂďĞƚŝĐ ƉĂƚŝĞŶƚƐ͛ ƐŚŽĞƐ ůĂƚĞ ŝŶ ƚŚĞ ĂĨƚĞƌŶŽŽŶ ĂŶĚ ĐŚĞĐŬ ƚŚĞŝƌ ƐƚŝŶŬǇ ĨĞĞƚ͘ tĞ ůŽŽŬ ŝŶ ŶĞƚŚĞƌ ƌĞŐŝŽŶƐ ŽĨ ƚŚŽƐĞ ǁŝƚŚŽƵƚ ƚŚĞ ďĞƐƚ ŚǇŐŝĞŶĞ͘ tĞ ĚƌĂŝŶ ƉƵƐ͘ tĞ ŐĞƚ ĐŽƵŐŚĞĚ ŽŶ ĂŶĚ ĐůĂǁĞĚ Ăƚ ďǇ ƉƌŽƚĞƐƚŝŶŐ͕ ƐŶŽƚƚǇͲŶŽƐĞĚ ŬŝĚƐ ĨŝŐŚƚŝŶŐ ĂŶ ĞĂƌ ĞǆĂŵ Žƌ Ă ƐŚŽƚ͘

dŚĂƚ ŝƐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ ^ƵƌĞ ǁĞ ŚĂǀĞ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ ĂŶĚ /ŶƚĞƌŶĞƚ͕ ǀĂƌŝŽƵƐ ŶĞǁ ŐĂĚŐĞƚƐ ĂŶĚ ĂŶ ĞǀĞƌ ŐƌŽǁŝŶŐ ĂƌƌĂǇ ŽĨ ƐƵďƐƉĞĐŝĂůŝƐƚƐ ƚŽ ƚĞŶĚ ƚŽ ƚŚĞ ŵĂŶǇ ŝƐƐƵĞƐ ƚŚĂƚ ĂƌŝƐĞ͘ Ƶƚ ŽƵƌ ĐŽƌĞ ũŽď ŝƐ Ɛƚŝůů ƚŚĞ ĐŽŶƚŝŶƵŝƚǇ ŽĨ ƚŚĞ

^Ž ĨƌŽŵ ǁŚĂƚĞǀĞƌ ŐĞŶĞƌĂƚŝŽŶ ǇŽƵ ĂƌĞ͕ ďĞ ƉƌŽƵĚ ŽĨ ǁŚĂƚ ǇŽƵ ĚŽ͕ ŬĞĞƉ ǁŽƌŬŝŶŐ ŚĂƌĚ͕ ĂŶĚ ƌĞƐƉĞĐƚ ƚŚĞ ďĂůĂŶĐĞ ŽĨ ůŝĨĞ ĂƌŽƵŶĚ ǇŽƵ͘ 'Ž ƚŽ ďĞĚ Ăƚ ŶŝŐŚƚ ;ŚŽƉĞĨƵůůǇ ŶŽƚ ƚŽŽ ůĂƚĞ͊Ϳ ŬŶŽǁŝŶŐ ǇŽƵƌ ĐĂƌĞ ŝƐ ǀĂůƵĞĚ ĂŶĚ ŝƐ ǀĂůƵĂďůĞ ƚŽ ƚŚĞ ǁŽƌůĚ͘

California Family Physician Summer 2014

Nearly 100 years ago, Nobel Prize-winning scientist August Krogh and his wife Marie embarked on a journey to revolutionize diabetes care, driven by her needs as a diabetes patient. Today, Novo Nordisk still takes a deeply human approach to everything we do. As a world leader in diabetes care, we are in a position of great responsibility. We must continue to combine drug discovery and technology to turn science into treatment. We must prioritize research, education, and partnership around the world to make diabetes a global priority. We must conduct our business responsibly in every way. And most importantly, we can never lose sight of the patientcentric approach that has driven our vision of innovation since our inception.

Together, we can defeat diabetes in our lifetime. For more about us, visit novonordisk-us.com

ÂŠ2011 Novo Nordisk 141928 June 2011

California Family Physician Summer 2014 7

PRESIDENT’S MESSAGE

ȱ ǰȱ

The Unexpected Consequences of the Primary Care Shortage ĂůŝĨŽƌŶŝĂ ǁĂƐ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ƐƵĐĐĞƐƐĨƵů ƐƚĂƚĞƐ ƚŚŝƐ ǇĞĂƌ ŝŶ ŐĞƚƚŝŶŐ ƉĞŽƉůĞ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ͕ ŵĂŬŝŶŐ ŚĞĂĚǁĂǇ ƚŽǁĂƌĚ ĂĐŚŝĞǀŝŶŐ ŽŶĞ ŽĨ ƚŚĞ ŵĂũŽƌ ŐŽĂůƐ ŝŶ ƚŚĞ ĨĨŽƌĚĂďůĞ ĂƌĞ Đƚ͗ ƚŽ ĚĞĐƌĞĂƐĞ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƵŶŝŶƐƵƌĞĚ ŵĞƌŝĐĂŶƐ͘

ŐŽŝŶŐ ƚŽ ƚŚĞ ĚŽĐƚŽƌ͘ tŝƚŚŽƵƚ ĞǀĂůƵĂƚŝŽŶ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ŽĨ ĂƉƉƌŽƉƌŝĂƚĞ ĐĂƐĞƐ ǁŝƚŚ ĂŶƚŝǀŝƌĂůƐ ƐŽŵĞ ǁŽƵůĚ ŚĂǀĞ ĚĞǀĞůŽƉĞĚ ĐŽŵƉůŝĐĂƚŝŽŶƐ ƐƵĐŚ ĂƐ ƐŝŶƵƐŝƚŝƐ Žƌ ƉŶĞƵŵŽŶŝĂ͘ dŚĞǇ ƌĞĐĞŝǀĞĚ ĂƉƉƌŽƉƌŝĂƚĞ ĐĂƌĞ͕ ďƵƚ ŝŶ ƚŚĞ ǁƌŽŶŐ ƉůĂĐĞ͘

EĞǀĞƌƚŚĞůĞƐƐ͕ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ƉƌŝŵĂƌǇ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ĐĂŶ ŚĂǀĞ ƚƌŽƵďůĞƐŽŵĞ ĂŶĚ ƵŶĞǆƉĞĐƚĞĚ ĐŽŶƐĞƋƵĞŶĐĞƐ͘

KƚŚĞƌ ƐƵƌƉƌŝƐĞƐ ĂŶĚ ƵŶŝŶƚĞŶĚĞĚ ĐŽŶƐĞƋƵĞŶĐĞƐ ůŝŬĞůǇ ĂǁĂŝƚ ĂƐ ŽƵƌ ƐǇƐƚĞŵ ŐŽĞƐ ƚŚƌŽƵŐŚ ŶĞĞĚĞĚ ƌĞĨŽƌŵ͘

KŶ :ĂŶƵĂƌǇ ϭϯ͕ ϮϬϭϰ ^ƚĂŶŝƐůĂƵƐ ŽƵŶƚǇ ĂƉƉƌŽĂĐŚĞĚ Ă ƉƵďůŝĐ ƐĂĨĞƚǇ ĐƌŝƐŝƐ͘ dŚĞ ŵĞƌŐĞŶĐǇ DĞĚŝĐĂů ^ĞƌǀŝĐĞƐ ŐĞŶĐǇ ƵƚǇ KĨĨŝĐĞƌ ƌĞƉŽƌƚĞĚ ĂŵďƵůĂŶĐĞ ĚĞůĂǇƐ Ăƚ ŽŶĞ ŽĨ ƚŚĞ DŽĚĞƐƚŽ ŚŽƐƉŝƚĂůƐ͘ ^ĞǀĞŶ ĂŵďƵůĂŶĐĞƐ ǁĞƌĞ ĚĞůĂǇĞĚ Ăƚ ƚŚĂƚ ŚŽƐƉŝƚĂů͕ ĨŽƵƌ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ĂŶ ŚŽƵƌͲĂŶĚͲĂͲŚĂůĨ͘ dŚĞ ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚ ; Ϳ ƌĞƉŽƌƚĞĚ ƚŚĂƚ ƚŚĞƌĞ ǁĞƌĞ ϴϰ ƉĂƚŝĞŶƚƐ ŝŶ ŝƚƐ ůŽďďǇ ĂŶĚ ĨŝǀĞ /ŶƚĞŶƐŝǀĞ ĂƌĞ hŶŝƚ ;/ hͿ ƉĂƚŝĞŶƚƐ ǁĂŝƚŝŶŐ ĨŽƌ ĂĚŵŝƐƐŝŽŶ͘ dŚĞ ƐĞǀĞŶ ĂŵďƵůĂŶĐĞ ƉĂƚŝĞŶƚƐ ǁĞƌĞ Ɛƚŝůů ŽŶ ƚŚĞ ĂŵďƵůĂŶĐĞ ŐƵƌŶĞǇƐ ǁĂŝƚŝŶŐ ĨŽƌ Ă ďĞĚ ĂƐƐŝŐŶŵĞŶƚ͘ EŽ ŵŽƌĞ ͕ / h Žƌ dĞůĞ ďĞĚƐ ǁĞƌĞ ĂǀĂŝůĂďůĞ͘ ƉŽůů ŽĨ ŽƚŚĞƌ ŚŽƐƉŝƚĂůƐ ŝŶ ^ƚĂŶŝƐůĂƵƐ ŽƵŶƚǇ ƐŚŽǁĞĚ ƚŚĞǇ ǁĞƌĞ ĂƉƉƌŽĂĐŚŝŶŐ ĐƌŝƚŝĐĂů ůĞǀĞůƐ͕ ƚŽŽ͘

/ ǁŽƌŬ ŝŶ Ă ƐĂĨĞƚǇ ŶĞƚ ĐůŝŶŝĐ ĂŶĚ ŚĂǀĞ ĨĞůƚ ƚŚĞ ŝŵƉĂĐƚ ŽĨ ƚŚĞ ŵĂŶǇ ŶĞǁůǇͲĞůŝŐŝďůĞ DĞĚŝͲ Ăů ƉĂƌƚŝĐŝƉĂŶƚƐ͘ / ŚĂǀĞ ƐĞĞŶ ŵĂŶǇ ŶĞǁ ƉĂƚŝĞŶƚƐ ǁŚŽ ŚĂǀĞ ŶĞǀĞƌ ŚĂĚ ƌŽƵƚŝŶĞ ŚĞĂůƚŚ ƐĐƌĞĞŶŝŶŐ ĂŶĚ ƉƌĞǀĞŶƚŝǀĞ ĐĂƌĞ͘ DĂŶǇ ŚĂǀĞ ŵƵůƚŝƉůĞ ĐŚƌŽŶŝĐ ŵĞĚŝĐĂů ƉƌŽďůĞŵƐ ƐƵĐŚ ĂƐ ĚŝĂďĞƚĞƐ͕ ŚǇƉĞƌƚĞŶƐŝŽŶ͕ ĚǇƐůŝƉŝĚĞŵŝĂ͕ ĂƐƚŚŵĂ ĂŶĚ KW ͕ ĂƐ ǁĞůů ĂƐ ĚĞƉƌĞƐƐŝŽŶ͘ hŶƚŝů ŶŽǁ͕ Ă ŵĂũŽƌŝƚǇ ŚĂǀĞ ŽŶůǇ ƌĞĐĞŝǀĞĚ ĐĂƌĞ ĚƵƌŝŶŐ ĞƉŝƐŽĚĞƐ ŽĨ ĐƌŝƐŝƐ͘ dŚĞǇ ŶŽǁ ŚĂǀĞ ĂĐĐĞƐƐ ƚŽ ƚĞƐƚƐ ƚŽ ĞƐƚĂďůŝƐŚ ƚŚĞŝƌ ĚŝƐĞĂƐĞ ƐƚĂƚƵƐ͕ ďĞŐŝŶ ŵĞĚŝĐĂů ƌĞŐŝŵĞŶƐ ƚŽ ĐŽŶƚƌŽů ĂŶĚ ŝŵƉƌŽǀĞ ƚŚĞŝƌ ĨƵŶĐƚŝŽŶ ĂŶĚ ƌĞĐĞŝǀĞ ĨŽůůŽǁͲƵƉ ǀŝƐŝƚƐ ƚŽ ŵŽŶŝƚŽƌ ƚŚĞ ƌĞƐƵůƚƐ͘

ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ¢ ȱ ȱ ȱ ȱ ǯ

ƚ ƚŚĂƚ ƚŝŵĞ͕ ǌĞƌŽ ĂŵďƵůĂŶĐĞƐ ǁĞƌĞ ĂǀĂŝůĂďůĞ ĨŽƌ DŽĚĞƐƚŽ ĂŶĚ dƵƌůŽĐŬ͘ &ŝƌĞ ƚƌƵĐŬ ƌĞƐƉŽŶƐĞƐ ƚŽ ĞŵĞƌŐĞŶĐǇ ŵĞĚŝĐĂů ĐĂůůƐ ǁĞƌĞ ŚĞůĚ Ăƚ ƚŚŽƐĞ ƐŝƚĞƐ͕ ǁĂŝƚŝŶŐ ĨŽƌ ĂŵďƵůĂŶĐĞ ƚƌĂŶƐƉŽƌƚ ƚŽ ĂƌƌŝǀĞ͘ ZƵƌĂů ĂŵďƵůĂŶĐĞ ƉƌŽǀŝĚĞƌƐ ĨƌŽŵ WĂƚƚĞƌƐŽŶ͕ ,ƵŐŚƐŽŶ͕ KĂŬĚĂůĞ ĂŶĚ ƐĐĂůŽŶ ǁĞƌĞ ĐĂůůĞĚ ŝŶ ƚŽ ĐŽǀĞƌ DŽĚĞƐƚŽ ĂŶĚ dƵƌůŽĐŬ͘ >ĂƚĞƌ͕ Ă ƌĞǀŝĞǁ ŽĨ ƚŚĞ ƐŝƚƵĂƚŝŽŶ ǁĂƐ ƉĞƌĨŽƌŵĞĚ͘ dŚŝƐ ĐƌŝƐŝƐ ŽĐĐƵƌƌĞĚ ĚƵƌŝŶŐ ƚŚĞ ƉĞĂŬ ŽĨ ƚŚĞ ŝŶĨůƵĞŶǌĂ ĞƉŝĚĞŵŝĐ͘ dŚĞ Ɛ ǁĞƌĞ ƐĞĞŝŶŐ Ă ŚŝŐŚ ǀŽůƵŵĞ ŽĨ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ŝŶĨůƵĞŶǌĂ ƐǇŵƉƚŽŵƐ͘ dŚĞ ǀĂƐƚ ŵĂũŽƌŝƚǇ ĚŝĚ ŶŽƚ ŶĞĞĚ ͲůĞǀĞů ĐĂƌĞ͘ DĂŶǇ ŚĂĚ ũƵƐƚ ƌĞĐĞŝǀĞĚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ďƵƚ ŚĂĚ ŶŽƚ ĐŽŶŶĞĐƚĞĚ ǁŝƚŚ Ă ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶ͘ tŝƚŚŽƵƚ ŝŶƐƵƌĂŶĐĞ͕ ŵĂŶǇ͕ ŝĨ ŶŽƚ ŵŽƐƚ͕ ůŝŬĞůǇ ǁŽƵůĚ ŚĂǀĞ ǁĂŝƚĞĚ ŝƚ ŽƵƚ ǁŝƚŚŽƵƚ

California Family Physician Summer 2014

WƌŝŵĂƌǇ ĐĂƌĞ ŚĂƐ ďĞĞŶ ƌĞĐŽŐŶŝǌĞĚ ĂƐ ƚŚĞ ĨŽƵŶĚĂƚŝŽŶ ŽĨ ĂŶ ŝŵƉƌŽǀĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ͕ ĂŶĚ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ĐĂƉĂĐŝƚǇ ŝƐ Ă ƐĞƌŝŽƵƐ ƉƌŽďůĞŵ͘ &ŝǆŝŶŐ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ĚŝƐƉĂƌŝƚǇ ǁŝůů ŶŽƚ ŚĂƉƉĞŶ ŽǀĞƌŶŝŐŚƚ͘ dŚĞ &W ŝƐ ǁŽƌŬŝŶŐ ŽŶ ŵĂŶǇ ĨƌŽŶƚƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚŝƐ ŝƐƐƵĞ͘ dŚĞ WĂƚŝĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ŵŽĚĞů ĐĂŶ ŝŶĐƌĞĂƐĞ ĐĂƉĂĐŝƚǇ͕ ĂŶĚ ƚŚĞ &W ŚĂƐ Ă ŶƵŵďĞƌ ŽĨ ƌĞƐŽƵƌĐĞƐ ĂǀĂŝůĂďůĞ ƚŽ ŚĞůƉ ƉƌĂĐƚŝĐĞƐ ƚƌĂŶƐŝƚŝŽŶ͕ ŝŶĐůƵĚŝŶŐ Ă ŶĞǁ W D, hŶŝǀĞƌƐŝƚǇ ǁĞď ƉĂŐĞ͘ ůƐŽ͕ ƚŚĞ &W ŝƐ ǁŽƌŬŝŶŐ ŽŶ ůĞŐŝƐůĂƚŝŽŶ ƚŽ ŝŶĐƌĞĂƐĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ ƐůŽƚƐ ƚŚƌŽƵŐŚ ĨƵŶĚŝŶŐ ďǇ ƚŚĞ ƐƚĂƚĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƚŝŽŶ͘ DĂŶǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĐĂŶ͛ƚ ƐƵƌǀŝǀĞ ĞĐŽŶŽŵŝĐĂůůǇ ŽŶ ƚŚĞ ůŽǁ DĞĚŝͲ Ăů ƌĂƚĞ ŽĨ ƉĂǇŵĞŶƚ͕ ĂŶĚ ƚŚĞ &W ŝƐ ǁŽƌŬŝŶŐ ƚŽ ƌĞŵŽǀĞ ƚŚĞ ϭϬ ƉĞƌĐĞŶƚ ƉĂǇŵĞŶƚ ĐƵƚ ŝŶ ƚŚĂƚ ƉƌŽŐƌĂŵ ĂŶĚ ƚŽ ĞǆƚĞŶĚ DĞĚŝͲ ĂůͲDĞĚŝĐĂƌĞ ƉĂƌŝƚǇ ďĞǇŽŶĚ ϮϬϭϰ͘ EŽ ƐŝŶŐůĞ ĂŶƐǁĞƌ ĞǆŝƐƚƐ ƚŽ ŵĞĞƚ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ŽĨ ŝŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ŵĂĚĞ ƉŽƐƐŝďůĞ ƚŚƌŽƵŐŚ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ͘ /ƚ ǁŝůů ƌĞƋƵŝƌĞ Ă ĐŽŶĐĞƌƚĞĚ ĞĨĨŽƌƚ ŽŶ ŵĂŶǇ ĨƌŽŶƚƐ ʹ ĂŶĚ ƚŚĂƚ ŝƐ &W͛Ɛ ƉůĂŶ͘

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ȱȱȱȱȱȱȱȱȱȱ ȱ

ȱȱȱȱȱȱȱ

PCMH CORNER

PCMH Post-JAMA: No Post-Mortem

KŶ &ĞďƌƵĂƌǇ Ϯϲ͕ ƚŚĞ :ŽƵƌŶĂů ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ DĞĚŝĐĂů ƐƐŽĐŝĂƚŝŽŶ ;: D Ϳ ƉƵďůŝƐŚĞĚ ƚŚĞ ƌĞƐƵůƚƐ ŽĨ Ă ƉŝůŽƚ ƐƚƵĚǇ ŽĨ WĂƚŝĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞƐ ;W D,ƐͿ ƚŚĂƚ ŐĞŶĞƌĂƚĞĚ ĐŽŶƐŝĚĞƌĂďůĞ ĂƚƚĞŶƚŝŽŶ ŝŶ ǀĂƌŝŽƵƐ ŵĞĚŝĂ ŽƵƚůĞƚƐ͘ dŚĞ ŐŽĂů ŽĨ ƚŚĞ ƐƚƵĚǇ ǁĂƐ ƚŽ ŵĞĂƐƵƌĞ ĂƐƐŽĐŝĂƟŽŶƐ ďĞƚǁĞĞŶ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ Ă ŵƵůƟͲƉĂǇĞƌ W D, ƉŝůŽƚ ĐŽŶĚƵĐƚĞĚ ŝŶ WĞŶŶƐǇůǀĂŶŝĂ ďĞƚǁĞĞŶ ϮϬϬϴ ĂŶĚ ϮϬϭϭ ĂŶĚ ĐŚĂŶŐĞƐ ŝŶ ƚŚĞ ƋƵĂůŝƚǇ͕ ƵƟůŝǌĂƟŽŶ ĂŶĚ ĐŽƐƚƐ ŽĨ ĐĂƌĞ͘ dŚĞ ƐƚƵĚǇ ĨŽƵŶĚ ŶŽ ĐŽƐƚ ƌĞĚƵĐƟŽŶ ĂŶĚ ŽŶůǇ ŵŽĚĞƐƚ ŝŵƉƌŽǀĞŵĞŶƚ ŝŶ ƋƵĂůŝƚǇ ŽĨ ĐĂƌĞ͘ dŚĞ ƐƚƵĚǇ ŝƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ĂĚĚŝƟŽŶ ƚŽ Ă ůĂƌŐĞƌ ďŽĚǇ ŽĨ ƌĞƐĞĂƌĐŚ ŽŶ W D,͕ ĂŶĚ ŝƚ ŝƐ ĞƐƐĞŶƟĂů ƚŽ ƐĞĞ ŝƚ ŝŶ ƚŚĂƚ ĐŽŶƚĞǆƚ͘ ĂůĂŶĐĞ ƚŚĞ : D ƐƚƵĚǇ ĂŐĂŝŶƐƚ͕ ĨŽƌ ĞǆĂŵƉůĞ͕ ƚǁŽ ŽƚŚĞƌ ƌĞƉŽƌƚƐ ƉƵďůŝƐŚĞĚ ĂƌŽƵŶĚ ƚŚĞ ƐĂŵĞ ƟŵĞ͗ ƚŚĞ DŝŶŶĞƐŽƚĂ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ͛Ɛ :ĂŶƵĂƌǇ ƌĞƉŽƌƚ ŽŶ ŝƚƐ ƐƵĐĐĞƐƐ ǁŝƚŚ ƚŚĞ ŵŽĚĞů Žƌ ƚŚĞ WĂƟĞŶƚͲ ĞŶƚĞƌĞĚ WƌŝŵĂƌǇ ĂƌĞ ŽůůĂďŽƌĂƟǀĞ͛Ɛ :ĂŶƵĂƌǇ ƌĞƉŽƌƚ ƚŚĂƚ ĂŶĂůǇǌĞƐ ϮϬ W D, ƐƚƵĚŝĞƐ ;ϭϯ ƉĞĞƌͲƌĞǀŝĞǁĞĚ ĂŶĚ ƐĞǀĞŶ ŝŶĚƵƐƚƌǇ ƐƚƵĚŝĞƐͿ ƌĞůĞĂƐĞĚ ŝŶ ϮϬϭϮ ĂŶĚ ϮϬϭϯ͘ ŽƚŚ ĚĞƐĐƌŝďĞ ŽǀĞƌĂůů ĐŽƐƚ ƌĞĚƵĐƟŽŶƐ͕ ĚĞĐƌĞĂƐĞƐ ŝŶ ĞŵĞƌŐĞŶĐǇ ƌŽŽŵ ǀŝƐŝƚƐ ĂŶĚ ĨĞǁĞƌ ŚŽƐƉŝƚĂů ĂĚŵŝƐƐŝŽŶƐ͘ ŽƚŚ ĚĞƐĐƌŝďĞ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ŽƚŚĞƌ ĂƌĞĂƐ͕ ŝŶĐůƵĚŝŶŐ ŝŵƉƌŽǀĞĚ ƉŽƉƵůĂƟŽŶ ŚĞĂůƚŚ͕ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĂŶĚ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ͘ W D, ƉƌŽũĞĐƚƐ ĐŽŵĞ ŝŶ Ă ǁŝĚĞ ǀĂƌŝĞƚǇ͖ ƚŚŝƐ ŝƐ ƵŶĂǀŽŝĚĂďůĞ ʹ ĂŶĚ ŐŽŽĚ͊ dŚĞ ŽůĚ ĂĚĂŐĞ ƚŚĂƚ ͞ŚĞĂůƚŚ ĐĂƌĞ ŝƐ ůŽĐĂů͟ ƌŝŶŐƐ ƚƌƵĞ ĂƐ ƐŝŐŶŝĮĐĂŶƚ ĚŝǀĞƌƐŝƚǇ ŝŶ ƚŚĞ ĚĞůŝǀĞƌǇ ĂŶĚ ƉĂǇŵĞŶƚ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ĐŽŶƟŶƵĞƐ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ͘ dŚĞ W D, ŵŽĚĞů ŶĞĞĚƐ ƚŽ ǁŽƌŬ ĨŽƌ Ă ƌĂŶŐĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌĂĐƟĐĞƐ ŝŶ ǀĂƌŝĂďůĞ ƐǇƐƚĞŵƐ ƉĂŝĚ ĚŝīĞƌĞŶƚůǇ ďǇ ƉƵďůŝĐ ĂŶĚ ƉƌŝǀĂƚĞ ƉĂǇĞƌƐ͘ tĞ ĂƌĞ Ăƚ Ă ƉŽŝŶƚ ŝŶ ƚŚĞ ĞǀŽůƵƟŽŶ ŽĨ ƚŚĞ W D, ŵŽĚĞů͕ ŚŽǁĞǀĞƌ͕ Ăƚ ǁŚŝĐŚ ŝƚ ǁŽƵůĚ ďĞ ƵƐĞĨƵů ƚŽ ŚŽŵĞ ŝŶ ŽŶ ǁŚĂƚ ƉƌĞĐŝƐĞůǇ ŝŶ Ă W D, ƚƌĂŶƐĨŽƌŵĂƟŽŶ ůĞĂĚƐ ƚŽ ƚŚĞ ƋƵŝĐŬĞƐƚ ĂŶĚ ŐƌĞĂƚĞƐƚ ŝŵƉƌŽǀĞŵĞŶƚ͘ &W ƐƚĂī ŝƐ ƌĞŐƵůĂƌůǇ ĂƐŬĞĚ ͞ǁŚĂƚ ĂƌĞ ƚŚĞ ĮƌƐƚ Žƌ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ĐŚĂŶŐĞƐ ŵǇ ƉƌĂĐƟĐĞ ƐŚŽƵůĚ ŵĂŬĞ ĂƐ / ŵŽǀĞ ƚŽǁĂƌĚ W D,͟ ďǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ŵĞŵďĞƌƐ ĞǇĞŝŶŐ ƚŚĞ ĞǆƉĞŶƐĞ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ƌĞƋƵŝƌĞĚ ďǇ ƚƌĂŶƐĨŽƌŵĂƟŽŶ͘ ƵƌƌĞŶƚ ƌĞƐĞĂƌĐŚ ĚŽĞƐ ŶŽƚ ŐŝǀĞ ƵƐ Ă ƉƌĞĐŝƐĞ ĂŶƐǁĞƌ͕ ďƵƚ͕ ǁŝƚŚ ƚŚĞ ŝŶƐŝŐŚƚ ŽĨ ƌĞĐĞŶƚ ƌĞƐĞĂƌĐŚ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ : D ƐƚƵĚǇ͕ ǁĞ ĂƌĞ ŐĞƫŶŐ ĐůŽƐĞƌ͘ dŚŝƐ ŝƐ ǁŚĂƚ ƚŚĞ ĂƵƚŚŽƌƐ ĂŶĚ ĨƵŶĚĞƌƐ ŽĨ ƚŚĞ : D ƐƚƵĚǇ ǁĂŶƚ ƌĞĂĚĞƌƐ ƚŽ ƚĂŬĞ ĂǁĂǇ ĨƌŽŵ ŝƚ͘ dŚĞ ŽŵŵŽŶǁĞĂůƚŚ &ƵŶĚ͕ ǁŚŝĐŚ ŚĞůƉĞĚ ĨƵŶĚ ƚŚĞ ƐƚƵĚǇ͕ ĚĞĨĞŶĚĞĚ ƚŚĞ W D, ĂŌĞƌ ƉƵďůŝĐĂƟŽŶ ŽĨ ƚŚĞ ĂƌƟĐůĞ͕ ŶŽƟŶŐ ƐŽŵĞ ŽĨ ƚŚĞ ůŝŵŝƚĂƟŽŶƐ ŽĨ ƚŚĞ WĞŶŶƐǇůǀĂŶŝĂ ƉƌŽũĞĐƚ ĂŶĚ ƐƵŐŐĞƐƟŶŐ ƚŚŝƐ ƐŚŽƵůĚ ĚŝƌĞĐƚ ĨƵƚƵƌĞ W D, ƉƌŽũĞĐƚƐ͘ DĂƌŬ &ƌŝĞĚďĞƌŐ͕ D ͕ ƚŚĞ ĐŽƌƌĞƐƉŽŶĚŝŶŐ ĂƵƚŚŽƌ ŽĨ ƚŚĞ : D ĂƌƟĐůĞ͕ ƐĂŝĚ ŝŶ ĂŶ ŝŶƚĞƌǀŝĞǁ ǁŝƚŚ &W EĞǁƐ ƚŚĂƚ ƉŚǇƐŝĐŝĂŶƐ ƐŚŽƵůĚ ŶŽƚ ͞ĂƩĂĐŚ ƚŽŽ ŵƵĐŚ ŝŵƉŽƌƚĂŶĐĞ ƚŽ ĂŶǇ ƐƚƵĚǇ͟ ĂŶĚ ƚŚĂƚ ŵŽƌĞ ƌĞƐĞĂƌĐŚ ŽŶ ƚŚĞ W D, ŝƐ ŶĞĞĚĞĚ͘ ͞/ƚ͛Ɛ ǀĞƌǇ ŚĂƌĚ ƚŽ ŵĂŬĞ ĞǀĞŶ Ă ŐĞŶĞƌĂů ƐƚĂƚĞŵĞŶƚ

ĂďŽƵƚ ƚŚĞ ƌĞƐƵůƚƐ ŽĨ ĚŝīĞƌĞŶƚ ƐƚƵĚŝĞƐ ƵŶůĞƐƐ ǇŽƵ ĮƌƐƚ ĚĞĮŶĞ ƚŚĞ ŵĞĚŝĐĂů ŚŽŵĞ͕͟ ƐĂŝĚ ƌ͘ &ƌŝĞĚďĞƌŐ͘ ͞^ŽŵĞƟŵĞƐ ƉĞŽƉůĞ ƚŚŝŶŬ ƚŚĞǇ͛ƌĞ ƚĂůŬŝŶŐ ĂďŽƵƚ ƚŚĞ ƐĂŵĞ ƚŚŝŶŐ ǁŚĞŶ͕ ŝŶ ĨĂĐƚ͕ ƚŚĞǇ͛ƌĞ ƵƐŝŶŐ ƚŚĞ ƚĞƌŵ ͚ŵĞĚŝĐĂů ŚŽŵĞ͛ ŝŶ Ă ǀĞƌǇ ŐĞŶĞƌĂů ǁĂǇ͘͟ tŚĂƚ ŚĂƉƉĞŶĞĚ ŝŶ ƚŚĞ : D ƐƚƵĚǇ͍ ZĞƐĞĂƌĐŚĞƌƐ ĨŽůůŽǁĞĚ ϯϮ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌĂĐƟĐĞƐ ŽǀĞƌ ƚŚƌĞĞ ǇĞĂƌƐ ĂƐ ƚŚĞǇ ƌĞĐĞŝǀĞĚ EĂƟŽŶĂů ŽŵŵŝƩĞĞ ĨŽƌ YƵĂůŝƚǇ ƐƐƵƌĂŶĐĞ ;E Y Ϳ W D, ƌĞĐŽŐŶŝƟŽŶ͘ dŚĞ ƉƌĂĐƟĐĞƐ ƌĞĐĞŝǀĞĚ ƐŝŐŶŝĮĐĂŶƚ ƐƵƉƉŽƌƚ ŝŶĐůƵĚŝŶŐ ƉĂǇ ĨŽƌ ĂĐŚŝĞǀŝŶŐ E Y ƌĞĐŽŐŶŝƟŽŶ͕ Ă ƌĞĂŬƚŚƌŽƵŐŚ ^ĞƌŝĞƐ ŽůůĂďŽƌĂƟǀĞ͕ ĐŽĂĐŚĞƐ ĨƌŽŵ /ŵƉƌŽǀŝŶŐ WĞƌĨŽƌŵĂŶĐĞ ŝŶ WƌĂĐƟĐĞ ĂŶĚ ƵƐĞ ŽĨ Ă ĚŝƐĞĂƐĞ ƌĞŐŝƐƚƌǇ͘ tŚĂƚ ǁĂƐ ŵŝƐƐŝŶŐ ĨƌŽŵ ƚŚĞ : D ƐƚƵĚǇ͍ dŚĞ ƉƌĂĐƟĐĞƐ ŝŶǀŽůǀĞĚ ǁĞƌĞ ŐŝǀĞŶ ŝŶĐĞŶƟǀĞƐ ƚŽ ĞĂƌŶ W D, ƌĞĐŽŐŶŝƟŽŶ ďƵƚ ŶŽƚ ƚŽ ƌĞĚƵĐĞ ĐŽƐƚƐ͘ dŚĞ ƉƌŽũĞĐƚ ĚŝĚ ŶŽƚ ƚĂƌŐĞƚ ŚŝŐŚͲĐŽƐƚ ƉĂƟĞŶƚƐ ǁŝƚŚ ŵƵůƟƉůĞ ĐŽŵŽƌďŝĚŝƟĞƐ͘ EŽ ĞīŽƌƚ ǁĂƐ ŵĂĚĞ ƚŽ ŝŶĐƌĞĂƐĞ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ƚŚƌŽƵŐŚ ĞǀĞŶŝŶŐ ŚŽƵƌƐ Žƌ ǁĞĞŬĞŶĚ ĐĂƌĞ͘^ŽŵĞ ĐŽŶƐƚƌƵĐƟǀĞ ƚĂŬĞͲĂǁĂǇƐ ĨŽƌ ĨƵƚƵƌĞ ƌĞƐĞĂƌĐŚ ĂŶĚ ƉƌŽũĞĐƚƐ ĂƌĞ͗ ͻ

E Y ƌĞĐŽŐŶŝƟŽŶ ĂƐ Ă W D, ĚŽĞƐ ŶŽƚ ĂƐƐƵƌĞ ƋƵĂůŝƚǇ ŝŵƉƌŽǀĞŵĞŶƚ ĂŶĚ ĐŽƐƚ ƌĞĚƵĐƟŽŶ͘ Ɛ ƚŚĞ : D ĂƵƚŚŽƌƐ ŶŽƚĞ͕ ĨŽĐƵƐŝŶŐ ŽŶ E Y ĂĐĐƌĞĚŝƚĂƟŽŶ ĐĂŶ ďĞ Ă ĚŝƐƚƌĂĐƟŽŶ ĂŶĚ ĞŶĐŽƵƌĂŐĞ Ă ͞ĐŚĞĐŬůŝƐƚ ŵĞŶƚĂůŝƚǇ͘͟ DŽƌĞ ĨƵŶĚĂŵĞŶƚĂů ĐŚĂŶŐĞ ŝŶ ƚŚĞ ƉƌĂĐƟĐĞ ŝƐ ŶĞĐĞƐƐĂƌǇ͘ &ŝŶĂŶĐŝĂů ŝŶĐĞŶƟǀĞƐ ƐŚŽƵůĚ ďĞ ƟĞĚ ƚŽ ĐŽŶĐƌĞƚĞ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ƉĂƟĞŶƚ ĐĂƌĞ ĂŶĚ ŽƵƚĐŽŵĞƐ͕ ĂƐ ǁĞůů ĂƐ ĐŽƐƚͲƐĂǀŝŶŐƐ͘ dŚĞ ĮŶĂŶĐŝĂů ŝŶĐĞŶƟǀĞƐ ŝŶ ƚŚĞ : D ƉƌŽũĞĐƚ ǁĞƌĞ ƉĞƌŚĂƉƐ ĨŽĐƵƐĞĚ ŽŶ ƚŚĞ ǁƌŽŶŐ ĞŶĚƉŽŝŶƚ͗ E Y ƌĞĐŽŐŶŝƟŽŶ͘ /ƚ ŵĂŬĞƐ ƐĞŶƐĞ ƚŚĂƚ W D, ƉƌŽũĞĐƚƐ ƐŚŽƵůĚ ƉƌŝŽƌŝƟǌĞ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ͛Ɛ ďŝŐŐĞƐƚ ƵƐĞƌƐ ŽĨ ĐĂƌĞ͘ ͞,ŝŐŚͲƌŝƐŬ͟ ƉĂƟĞŶƚƐ ǁŝƚŚ ĐŚƌŽŶŝĐ ŝůůŶĞƐƐĞƐ ƐŚŽƵůĚ ďĞ Ă ĨŽĐƵƐ ŽĨ ƚŚĞ W D, ƚŽ ŝŵƉƌŽǀĞ ŽƵƚĐŽŵĞƐ ĂŶĚ ƌĞĚƵĐĞ ƵƟůŝǌĂƟŽŶ ĂŶĚ ĐŽƐƚƐ͘ &ƵƌƚŚĞƌ ƌĞƐĞĂƌĐŚ ƐŚŽƵůĚ ŝĚĞŶƟĨǇ ǁŚĂƚ ĂƐƉĞĐƚƐ ŽĨ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ĐŽůůĂďŽƌĂƟǀĞ ĂŶĚ ĐŽĂĐŚŝŶŐ ůĞĂĚ ƚŽ ĨƵŶĚĂŵĞŶƚĂů ƉƌĂĐƟĐĞ ĐŚĂŶŐĞ͘ W D, ƉƌŽũĞĐƚƐ ĨƌĞƋƵĞŶƚůǇ ƵƐĞ ďŽƚŚ͕ ďƵƚ ƚŚĞƌĞ ŝƐ ŐƌĞĂƚ ǀĂƌŝĞƚǇ͘ dĞĐŚŶŝĐĂů ĂƐƐŝƐƚĂŶĐĞ ĐĂŶ ďĞ Ă ŐƌĞĂƚ ďĞŶĞĮƚ͖ ǁĞ ŵƵƐƚ ŝĚĞŶƟĨǇ ǁŚǇ ŝƚ ƐŽŵĞƟŵĞƐ ǁŽƌŬƐ ĂŶĚ ƐŽŵĞƟŵĞƐ ĚŽĞƐ ŶŽƚ͘ ĨŽĐƵƐ ŽŶ ŝŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ ŵĂǇ ďĞ ŝŵƉŽƌƚĂŶƚ ƚŽ ƐŽŵĞ ŐŽĂůƐ ŽĨ W D,͗ ƌĞĚƵĐĞĚ ƵŶŶĞĐĞƐƐĂƌǇ ĞŵĞƌŐĞŶĐǇ ƌŽŽŵ ǀŝƐŝƚƐ ĂŶĚ ŚŽƐƉŝƚĂůŝǌĂƟŽŶƐ͘

dŚĞ : D ƐƚƵĚǇ ŝƐ ƟŵĞůǇ ĂŶĚ ďĞŶĞĮĐŝĂů͗ ŝƚ ĐĂŶ ŚĞůƉ ƵƐ ůĞĂƌŶ ŚŽǁ ƚŽ ďĞƩĞƌ ŝŵƉůĞŵĞŶƚ ƚŚŝƐ ĞǀŽůǀŝŶŐ ŵŽĚĞů͘ /ƚ ƐŚŽƵůĚ ŶŽƚ ůĞĂĚ ƵƐ ƚŽ ĂďĂŶĚŽŶ ŝƚ͘

California Family Physician Summer 2014 9

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CAFP Honors Four Family Medicine Leaders ĂĐŚ ǇĞĂƌ ƚŚĞ ĐĂĚĞŵǇ ĂŶĚ &ŽƵŶĚĂƟŽŶ ŚŽŶŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƌĞƉƌĞƐĞŶƚ ƚŚĞ ǀĞƌǇ ďĞƐƚ ŽĨ ƚŚĞ ƐƉĞĐŝĂůƚǇ͘ &W ƉƌĞƐĞŶƚĞĚ ĨŽƵƌ ĂǁĂƌĚƐ Ăƚ ƚŚŝƐ ǇĞĂƌ͛Ɛ ĐĞůĞďƌĂƟŽŶ ĚŝŶŶĞƌ ŽŶ DĂǇ ϴ͘ ŽŶŐƌĂƚƵůĂƟŽŶƐ ĂŶĚ ƚŚĂŶŬ ǇŽƵ ƚŽ ƚŚĞƐĞ ŝŶĐƌĞĚŝďůĞ ůĞĂĚĞƌƐ͊ 2014 Family Physician of the Year &W ƉƌĞƐĞŶƚƐ ƚŚŝƐ ƉƌĞƐƟŐŝŽƵƐ ĂǁĂƌĚ ƚŽ ĂŶ ŝŶĚŝǀŝĚƵĂů ǁŚŽ ŐŽĞƐ ĂďŽǀĞ ĂŶĚ ďĞǇŽŶĚ ŝŶ ƐĞƌǀŝĐĞ ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƚǇ͘ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ D ŚĂƐ ďĞĞŶ ŝŶ ƉƌĂĐƟĐĞ ŝŶ Ă ƐŵĂůů ƌƵƌĂů ĐŽŵŵƵŶŝƚǇ ŝŶ ŶŽƌƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ ĨŽƌ Ϯϱ ǇĞĂƌƐ͘ ^ŚĞ ĮŶŝƐŚĞĚ ŚĞƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ ŝŶ ϭϵϴϵ͕ ĂŶĚ ƐŚŽƌƚůǇ ƚŚĞƌĞĂŌĞƌ͕ ŽŶ ƚŚĞ ƌĞĐŽŵŵĞŶĚĂƟŽŶ ŽĨ ŚĞƌ ŵĞŶƚŽƌ :ŽƐĞƉŚ ^ĐŚĞƌŐĞƌ͕ D ͕ ƐŚĞ ŵŽǀĞĚ ůŽĐŬ͕ ƐƚŽĐŬ ĂŶĚ ďĂƌƌĞů ƚŽ tŝŶƚĞƌƐ͕ Ă ƚŽǁŶ ŽĨ ϲ͕ϲϬϬ͕ ŝŶ ŶŽƌƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ͘ ƌ͘ <ĂŬƵƚĂŶŝ ũŽŝŶĞĚ Ă ƐŵĂůů ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉƌĂĐƟĐĞ ŝŶ ƚŚĞ ĐŽŵŵƵŶŝƚǇ͕ ďƌŝŶŐŝŶŐ ǁŝƚŚ ŚĞƌ Ă ĨƵůů ƐĐŽƉĞ ŽĨ ƐĞƌǀŝĐĞƐ͕ ĨƌŽŵ ŽďƐƚĞƚƌŝĐƐͲ ŐǇŶĞĐŽůŽŐǇ ƚŽ ŵĞŶƚĂů ŚĞĂůƚŚ͘ ƌ͘ <ĂŬƵƚĂŶŝ ďĞŐĂŶ ŚĞƌ ŝŶǀŽůǀĞŵĞŶƚ ǁŝƚŚ &W ŝŶ ϭϵϴϵ͕ ĂƐ Ă ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌ ĞůĞĐƚĞĚ ƚŽ &W͛Ɛ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ͘ ^ŚĞ ŚĂƐ ƌŝƐĞŶ ƚŚƌŽƵŐŚ ƚŚĞ ƌĂŶŬƐ ƚŽ ƐĞƌǀĞ Ăƚ &W WƌĞƐŝĚĞŶƚ͕ ĐŚĂŝƌ ŽĨ ŽƵƌ ĞůĞŐĂƟŽŶƐ ƚŽ ďŽƚŚ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ ĂŶĚ ŵĞƌŝĐĂŶ ĐĂĚĞŵǇ ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ĂŶĚ ƐĞƌǀĞƐ ĂƐ Ă ŬĞǇ ĐŽŶƚĂĐƚ͕ ƐƉŽŬĞƐƉĞƌƐŽŶ͕ ĐŚĞĞƌůĞĂĚĞƌ ĂŶĚ ĞǀĞŶ ͞ďƵƌƌ ŝŶ ƚŚĞ ƐŝĚĞ͟ ŽĨ ƚŚŽƐĞ ǁŚŽ ŶĞĞĚ ƚŽ ŚĞĂƌ ŽƵƌ ƐƚŽƌǇ͘ Ǉ ŶĂƚƵƌĞ Ă ƋƵŝĞƚ͕ ŝŶƚƌŽǀĞƌƚĞĚ ŝŶĚŝǀŝĚƵĂů͕ ƐŚĞ ĚĂŝůǇ ƉƵƚƐ ŽŶ ƚŚĞ ĐĂƉ ŽĨ Ă ĐŚĂŵƉŝŽŶ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ǁŝƚŚ Ă ŐůŽǀĞĚ ĮƐƚ ŵĂŬŝŶŐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͛Ɛ ĐĂƐĞ ďĞĨŽƌĞ ůĞŐŝƐůĂƚŽƌƐ͕ ƉŽůŝĐǇ ŵĂŬĞƌƐ͕ ƉĂǇĞƌƐ͕ ĂĐĂĚĞŵŝĐ ĐƌŝƟĐƐ͕ ƌĞƉŽƌƚĞƌƐ ĂŶĚ ŽƚŚĞƌƐ ŝŶ Ă ŵĂŶŶĞƌ ƚŚĂƚ ŝƐ ŚŝŐŚůǇ ĐƌĞĚŝďůĞ ĂŶĚ ĐŽŵƉĞůůŝŶŐ͘ dŚĂƚ ŐůŽǀĞĚ ĮƐƚ ďĞĐŽŵĞƐ Ă ŐĞŶƚůĞ ŚĂŶĚ ǁŚĞŶ ĚĞĂůŝŶŐ ǁŝƚŚ ƉĂƟĞŶƚƐ ĂŶĚ ƚŚĞŝƌ ĨĂŵŝůŝĞƐ͕ ŚĞƌ ŽǁŶ ĨĂŵŝůǇ ĂŶĚ ŚĞƌ ĂĚŽƉƚĞĚ &W ĨĂŵŝůǇ͘ &W ŝƐ ŚŽŶŽƌĞĚ ƚŽ ŶĂŵĞ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ D ĂƐ ƚŚĞ ϮϬϭϰ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ͊ 2014 arbara ,arris Award for EducaƟonal Eǆcellence dŚĞ &W &ŽƵŶĚĂƟŽŶ ƉƌĞƐĞŶƚĞĚ >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW, ǁŝƚŚ ƚŚĞ ĂƌďĂƌĂ ,ĂƌƌŝƐ ǁĂƌĚ ĨŽƌ ĚƵĐĂƟŽŶĂů ǆĐĞůůĞŶĐĞ͘ ƌ͘ ^ŝŵŽŶ ƉůĂǇƐ Ă ǀŝƚĂů ƌŽůĞ ŝŶ ĞĚƵĐĂƟŶŐ ĂŶĚ ŵĞŶƚŽƌŝŶŐ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ũƵŶŝŽƌ ĨĂĐƵůƚǇ͘ ƌ͘ ^ŝŵŽŶ ŝƐ ŝŶƐƉŝƌĂƟŽŶĂů͘ ^ŚĞ ĞīĞĐƟǀĞůǇ ƉƌŽŵŽƚĞƐ͕ ŝŶƐƉŝƌĞƐ ĂŶĚ ĞĚƵĐĂƚĞƐ ůĞĂƌŶĞƌƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶƐ ŽŶ ƚŚĞ ďƌĞĂĚƚŚ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ ŝƐ ƉƌŽƵĚ ƚŽ ŚŽŶŽƌ >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW, ĂƐ ƚŚĞ ϮϬϭϰ ĚƵĐĂƚŽƌ ŽĨ ƚŚĞ zĞĂƌ͊ 10

California Family Physician Summer 2014

>ĞŌ ƚŽ ƌŝŐŚƚ͗ dŽŵ ĞŶƚ͕ D ͕ >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW,͕ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ D ͕ ĂŶĚ ĂŶŝĞů WŝŽ͕ D ͕ D

2014 Preceptor of the Year dŚĞ ϮϬϭϯ WƌĞĐĞƉƚŽƌ ŽĨ ƚŚĞ zĞĂƌ ĂǁĂƌĚ ŐŽĞƐ ƚŽ dŽŵ ĞŶƚ͕ D ͘ ƌ͘ ĞŶƚ ǁĂƐ ƐĞůĞĐƚĞĚ ďĂƐĞĚ ŽŶ ŚŝƐ ŵĂŶǇ ǇĞĂƌƐ ŽĨ ĞŶŐĂŐĞŵĞŶƚ ǁŝƚŚ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ͖ ŚĞ ŝƐ Ă ůĞĂĚĞƌ ŝŶ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂŶ ĞǆĐĞůůĞŶƚ ĐůŝŶŝĐŝĂŶ ĂŶĚ Ă ƐƵƉĞƌď ƚĞĂĐŚĞƌ͘ ƌ͘ ĞŶƚ ŝƐ Ă &W WĂƐƚ WƌĞƐŝĚĞŶƚ͕ ŚĂƐ ƐĞƌǀĞĚ ŽŶ ƚŚĞ &W ĂŶĚ &W ŽŵŵŝƩĞĞƐ ŽŶ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ĂŶĚ ĐŚĂŝƌĞĚ ƚŚĞ &W ŽŵŵŝƩĞĞ ŝŶ ϮϬϬϲ͘ ,Ğ ŝƐ Ă ĨŽƵŶĚŝŶŐ ŵĞŶƚŽƌ ŝŶ ƚŚĞ &W D >ĞĂĚĞƌƐ /ŶƐƟƚƵƚĞ ĂŶĚ ŚĂƐ ŵĞŶƚŽƌĞĚ ŵĂŶǇ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ƚŚƌŽƵŐŚŽƵƚ ŚŝƐ ĐĂƌĞĞƌ͘ ,Ğ ŝƐ ĂůƐŽ ƐĞƌǀŝŶŐ ĂƐ ĨŽƵŶĚŝŶŐ ĨĂĐƵůƚǇ ĨŽƌ ƚŚĞ ŵĞŶƚŽƌƐ͛ ǁŽƌŬƐŚŽƉƐ͕ ŚĞůƉŝŶŐ ƉƌĞƉĂƌĞ ƚŚĞ ŶĞǁ ŵĞŶƚŽƌƐ ǁŚŽ ǁŝůů ƐĞƌǀĞ ƚŚĞ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ^ĐŚŽůĂƌƐ ƉƌŽŐƌĂŵ͘ &W &ŽƵŶĚĂƟŽŶ ŝƐ ƉƌŽƵĚ ƚŽ ƌĞĐŽŐŶŝǌĞ dŽŵ ĞŶƚ͛Ɛ ŵŽƌĞ ƚŚĂŶ ƚǁŽ ĚĞĐĂĚĞƐ ŽĨ ĞǆĐĞůůĞŶĐĞ ĂƐ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ƉƌĞĐĞƉƚŽƌ ĂŶĚ ŵĞŶƚŽƌ͘ ŽŶŐƌĂƚƵůĂƟŽŶƐ ƚŽ ƌ͘ ĞŶƚ͊ 2014 Resident of the Year dŚĞ &W &ŽƵŶĚĂƟŽŶ ŝƐ ƉůĞĂƐĞĚ ƚŽ ƌĞĐŽŐŶŝǌĞ ĂŶŝĞů WŝŽ͕ D ͕ D ͕ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ >ŽƐ ŶŐĞůĞƐ W'zͲϮ͕ ĂƐ ƚŚĞ ϮϬϭϰ ZĞƐŝĚĞŶƚ ŽĨ ƚŚĞ zĞĂƌ͘ KǀĞƌ ƚŚĞ ƉĂƐƚ ǇĞĂƌ͕ ƌ͘ WŝŽ ŚĂƐ ĞǆŚŝďŝƚĞĚ ŝŶƐƉŝƌŝŶŐ ůĞĂĚĞƌƐŚŝƉ ƋƵĂůŝƟĞƐ ŝŶĐůƵĚŝŶŐ ƐĞƌǀŝĐĞ ĂƐ ŽͲ ŚĂŝƌ ŽĨ &W͛Ɛ ZĞƐŝĚĞŶƚ ŽƵŶĐŝů͘ ,Ğ ŚĂƐ ĂůƐŽ ďĞĞŶ ŝŶƐƚƌƵŵĞŶƚĂů ŝŶ ůĂƵŶĐŚŝŶŐ ƚŚĞ ͞ ƵŝůĚŝŶŐ ƌŝĚŐĞƐ͟ ĐĂŵƉĂŝŐŶ͕ ǁŚŝĐŚ ƐĞĞŬƐ ƚŽ ŝŶĐƌĞĂƐĞ ĐŽůůĂďŽƌĂƟŽŶ ďĞƚǁĞĞŶ &W ůŽĐĂů ĐŽƵŶƚǇ ĐŚĂƉƚĞƌƐ͕ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂŶĚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ͘ DŽƐƚ ƌĞĐĞŶƚůǇ͕ ƌ͘ WŝŽ ŚĞůƉĞĚ ŽƌŐĂŶŝǌĞ Ă ƉƌŽĐĞĚƵƌĂů ǁŽƌŬƐŚŽƉ ĨŽƌ >ŽƐ ŶŐĞůĞƐͲĂƌĞĂ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϲϬ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ĨĂĐƵůƚǇ ĨƌŽŵ Ɛŝǆ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ŝŶ ĂƩĞŶĚĂŶĐĞ͘ ŽŶŐƌĂƚƵůĂƟŽŶƐ ƚŽ ĂŶŝĞů WŝŽ͕ D ͕ D ϮϬϭϰ &W &ŽƵŶĚĂƟŽŶ ZĞƐŝĚĞŶƚ ŽĨ ƚŚĞ zĞĂƌ͊

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ICD-10

STAY ON THE ROAD TO 10 STEPS TO HELP YOU TRANSITION The ICD-10 transition will affect every part of your practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. CMS can help you prepare. Visit the CMS website at www.cms.gov/ICD10 and ﬁnd out how to: •

Make a Plan—Look at the codes you use, develop a budget, and prepare your staff

•

Train Your Staff—Find options and resources to help your staff get ready for the transition

•

Update Your Processes—Review your policies, procedures, forms, and templates

•

Talk to Your Vendors and Payers—Talk to your software vendors, clearinghouses, and billing services

•

Test Your Systems and Processes—Test within your practice and with your vendors and payers

Now is the time to get ready. www.cms.gov/ICD10

Official CMS Industry Resources for the ICD-10 Transition

www.cms.gov/ICD10

California Family Physician Summer 2014 11

MEMBERSHIP

Member Survey Results Reveal Opportunities for Growth and Development

tĞ ŚĂǀĞ ƐƚĂƌƚĞĚ ĐŽŵƉŝůŝŶŐ ĚĂƚĂ ĨƌŽŵ ƚŚĞ ϮϬϭϰ &W DĞŵďĞƌ ^ƵƌǀĞǇ ĂŶĚ ǁŝůů ƉĞƌŝŽĚŝĐĂůůǇ ƉƵďůŝƐŚ ŽƵƌ ĨŝŶĚŝŶŐƐ ŝŶ ƚŚĞ ĐĂĚĞŵǇ ŝŶ ĐƚŝŽŶ ĞŵĂŝů ŶĞǁƐůĞƚƚĞƌ͕ ƐŚĂƌŝŶŐ ƚŚĞ ƉƌŽŐƌĞƐƐ ǁĞ ŵĂŬĞ ŝŶ ĂĚĚƌĞƐƐŝŶŐ ǇŽƵƌ ĨĞĞĚďĂĐŬ͘ tĞ ĂƌĞ ŚĂƉƉǇ ƚŽ ƌĞƉŽƌƚ ƚŚĂƚ ǁĞ ƌĞĐĞŝǀĞĚ ƚŚĞ ŚŝŐŚĞƐƚ ůĞǀĞů ŽĨ ƉĂƌƟĐŝƉĂƟŽŶ ƚŽ ĚĂƚĞ ŽŶ ŽƵƌ ŵĞŵďĞƌ ƐƵƌǀĞǇ͕ ǁŝƚŚ ŶĞĂƌůǇ ϴϬϬ ƌĞƐƉŽŶƐĞƐ͘ dŽ ƚŚŽƐĞ ŽĨ ǇŽƵ ǁŚŽ ƉĂƌƟĐŝƉĂƚĞĚ͕ ƚŚĂŶŬ ǇŽƵ͘ KƵƌ ďŝĂŶŶƵĂů ŵĞŵďĞƌ ƐƵƌǀĞǇ ŝƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ƚŽŽů ƵƐĞĚ ƚŽ ĂƐƐĞƐƐ ŵĞŵďĞƌ ŶĞĞĚƐ ĂŶĚ ŝŶƚĞƌĞƐƚ ĨŽƌ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ͕ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐǇ͕ ŶĞƚǁŽƌŬŝŶŐ͕ ƉƌĂĐƟĐĞ ŵĂŶĂŐĞŵĞŶƚ ƌĞƐŽƵƌĐĞƐ ĂŶĚ ŽƚŚĞƌ ŵĞŵďĞƌ ƉƌŽŐƌĂŵƐ ĂŶĚ ƐĞƌǀŝĐĞƐ͘ /ŶĨŽƌŵĂƟŽŶ ŐĂŝŶĞĚ ďǇ ĂŶĂůǇǌŝŶŐ ƚƌĞŶĚƐ ĨƌŽŵ ƚŚĞ ϮϬϭϰ ƐƵƌǀĞǇ ĂŶĚ ĐŽŵƉĂƌŝŶŐ ĚŝīĞƌĞŶĐĞƐ ĂŶĚ ƐŝŵŝůĂƌŝƟĞƐ ŝŶ ŬĞǇ ŵĞŵďĞƌ ƐĞŐŵĞŶƚƐ ǁŝůů ŐƵŝĚĞ &W͛Ɛ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ŝŶ ƚŚĞ ǇĞĂƌ ĂŚĞĂĚ͘

ĞǆĐŚĂŶŐŝŶŐ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ŬĞǇ ŝƐƐƵĞƐ ŽĨ ŝŵƉŽƌƚĂŶĐĞ ƚŽ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝƐ ƚŚĞŝƌ ƚŽƉ ƌĞĂƐŽŶ ĨŽƌ ŵĞŵďĞƌƐŚŝƉ͘ dŚĞ ŝŶƚĞƌĞƐƚƐ ŽĨ ƚŚĞƐĞ ŬĞǇ ŵĞŵďĞƌ ƐĞŐŵĞŶƚƐ ǁŝůů ƉůĂǇ ĂŶ ŝŵƉŽƌƚĂŶƚ ƉĂƌƚ ŝŶ &W͛Ɛ ĨƵƚƵƌĞ ƉůĂŶŶŝŶŐ ĂŶĚ ĚŝƌĞĐƟŽŶ͘ Topics of Interest ZĞƐƉŽŶĚĞŶƚƐ͛ ŝŶƚĞƌĞƐƚ ŝŶ ĐŽŵŵƵŶŝĐĂƟŽŶ ƚŽƉŝĐƐ ĂůŝŐŶƐ ǁŝƚŚ ƚŚĞ ƚŽƉͲǀĂůƵĞĚ &W ŵĞŵďĞƌƐŚŝƉ ďĞŶĞĮƚƐ͘ DŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ƉŚǇƐŝĐŝĂŶ ƌĞƐƉŽŶĚĞŶƚƐ ƌĞƉŽƌƚ ƚŚĂƚ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ; D Ϳ ƉƌŽŐƌĂŵƐ ĂƌĞ ƚŚĞŝƌ ŵŽƐƚ ǀĂůƵĞĚ ŵĞŵďĞƌ ďĞŶĞĮƚ͕ ǁŝƚŚ ĂĚǀŽĐĂĐǇ ĂŶĚ ƌĞƉƌĞƐĞŶƚĂƟŽŶ ƚŽ &W ĨŽůůŽǁŝŶŐ͘ dŚĞ ƐƵƌǀĞǇ ĨŽƵŶĚ ƚŚĂƚ D ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ;ϳϯ ƉĞƌĐĞŶƚͿ ĂŶĚ ĞŵĞƌŐŝŶŐ ŝƐƐƵĞƐ ŝŶ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ;ϳϬ ƉĞƌĐĞŶƚͿ ŶŽǁ ƌĂŶŬ ƐŝŐŶŝĮĐĂŶƚůǇ ŚŝŐŚĞƌ ƚŚĂŶ &W͛Ɛ ŝŶǀŽůǀĞŵĞŶƚ ŝŶ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐǇ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ ;ϱϰ ƉĞƌĐĞŶƚͿ͕ ĐŽŵƉĂƌĞĚ ƚŽ ϮϬϬϵ ǁŚĞŶ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐǇ ǁĂƐ ƚŚĞ ƚŽƉͲƌĂŶŬĞĚ ƚŽƉŝĐ ŽĨ ŝŶƚĞƌĞƐƚ͘

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Reasons for Membership ŝŐŚƚǇͲƚǁŽ ƉĞƌĐĞŶƚ ŽĨ ƌĞƐƉŽŶĚĞŶƚƐ ƌĞƉŽƌƚĞĚ ƚŚĂƚ ƚŚĞǇ ǁĞƌĞ ƐĂƟƐĮĞĚ ǁŝƚŚ ƚŚĞ ďĞŶĞĮƚƐ͕ ƉƌŽŐƌĂŵƐ ĂŶĚ ĂĐƟǀŝƟĞƐ ƉƌŽǀŝĚĞĚ ďǇ ƚŚĞ &W͕ ƐŚŽǁŝŶŐ Ă ƐůŝŐŚƚ ĚĞĐůŝŶĞ ŝŶ ƐĂƟƐĨĂĐƟŽŶ ĨƌŽŵ ϮϬϭϮ ;ϴϰ ƉĞƌĐĞŶƚͿ͘ dŚĞ ƐƵƌǀĞǇ ƐŚŽǁĞĚ ƚŚĂƚ ůŽǇĂůƚǇ ƚŽ ƚŚĞ ƐƉĞĐŝĂůƚǇ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĐŽŶƟŶƵĞƐ ƚŽ ďĞ ƚŚĞ ƉƌŝŵĂƌǇ ƌĞĂƐŽŶ ĨŽƌ &W ŵĞŵďĞƌƐŚŝƉ͕ ǁŝƚŚ ϴϬ͘ϲ ƉĞƌĐĞŶƚ ŽĨ ŵĞŵďĞƌƐ ƐĞůĞĐƟŶŐ ƚŚŝƐ ĂƐ ƚŚĞŝƌ ƚŽƉ ƌĞĂƐŽŶ͘ dŚĞ ƐĞĐŽŶĚ ĂŶĚ ƚŚŝƌĚ ŵŽƐƚ ĨƌĞƋƵĞŶƚůǇ ƐĞůĞĐƚĞĚ ƌĞĂƐŽŶƐ ĨŽƌ ŵĞŵďĞƌƐŚŝƉ ǁĞƌĞ ĂĚǀŽĐĂĐǇ ;ϳϵ͘ϴ ƉĞƌĐĞŶƚͿ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ƋƵĂůŝƚǇ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ;ϳϮ͘ϱ ƉĞƌĐĞŶƚͿ͘ tŽŵĞŶ͕ ŚŽǁĞǀĞƌ͕ ǁŚŽ ĂĐĐŽƵŶƚ ĨŽƌ ŶĞĂƌůǇ ŚĂůĨ ŽĨ &W ŵĞŵďĞƌƐ͕ ŝŶĚŝĐĂƚĞ ƚŚĂƚ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ĂƌĞ ƚŚĞŝƌ ƉƌŝŵĂƌǇ ƌĞĂƐŽŶ ĨŽƌ ŵĞŵďĞƌƐŚŝƉ͕ ǇĞƚ ŽŶůǇ ϲϳ ƉĞƌĐĞŶƚ ŽĨ ǁŽŵĞŶ ĂƌĞ ƐĂƟƐĮĞĚ ǁŝƚŚ ƚŚĞŝƌ ŵĞŵďĞƌƐŚŝƉ͘ &ƵƌƚŚĞƌ͕ ǇŽƵŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ Žƌ ƉŚǇƐŝĐŝĂŶƐ ƵŶĚĞƌ ϰϬ ǇĞĂƌƐ ŽĨ ĂŐĞ ǁŚŽ ŵĂŬĞ ƵƉ Ϯϴ ƉĞƌĐĞŶƚ ŽĨ &W͛Ɛ ĐƟǀĞ ŵĞŵďĞƌƐŚŝƉ͕ ƐƚĂƚĞ ƚŚĂƚ

California Family Physician Summer 2014

Practice Challenges ŽŶĐĞƌŶ ĂďŽƵƚ ƉƌĂĐƟĐĞ ĮŶĂŶĐĞ ŝƐƐƵĞƐ ŚĂƐ ƌŝƐĞŶ ŽŶ ĂǀĞƌĂŐĞ ďǇ ϮϬ ƉĞƌĐĞŶƚ ƐŝŶĐĞ ϮϬϭϮ͕ ǁŚĞŶ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ǁĂƐ ƚŚĞ ƚŽƉͲĐŝƚĞĚ ĐŽŶĐĞƌŶ ĂŵŽŶŐ ƉŚǇƐŝĐŝĂŶ ŵĞŵďĞƌƐ͘ dŚĞ ƐƵƌǀĞǇ ĨŽƵŶĚ ƚŚĂƚ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ƌĞƐƉŽŶĚĞŶƚƐ ĂƌĞ ĐŽŶĐĞƌŶĞĚ ĂďŽƵƚ ƉƌĂĐƟĐĞ ŽǀĞƌŚĞĂĚ ĂŶĚ ŵĂŶĂŐŝŶŐ ƌŝƐŝŶŐ ŽƉĞƌĂƟŽŶ ĐŽƐƚƐ ĂŶĚ ϲϵ ƉĞƌĐĞŶƚ ŽĨ ƌĞƐƉŽŶĚĞŶƚƐ ĂƌĞ ĐŽŶĐĞƌŶĞĚ ĂďŽƵƚ ĐŽĚŝŶŐ͕ ďŝůůŝŶŐ ĂŶĚ ƉĂǇŵĞŶƚ ƉƌŽďůĞŵƐ͘ ůĞĐƚƌŽŶŝĐ ,ĞĂůƚŚ ZĞĐŽƌĚƐ ; ,ZͿ ƵƐĞ ŚĂƐ ŝŶĐƌĞĂƐĞĚ ďǇ ϮϬ ƉĞƌĐĞŶƚ ƐŝŶĐĞ ϮϬϭϮ͘ KĨ ƚŚĞ ƌĞƐƉŽŶĚĞŶƚƐ ǁŚŽ ŚĂǀĞ ŝŵƉůĞŵĞŶƚĞĚ ,Z͕ ϳϵ ƉĞƌĐĞŶƚ ŝŶĚŝĐĂƚĞĚ ƚŚĂƚ ĂĐŚŝĞǀŝŶŐ ŵĞĂŶŝŶŐĨƵů ƵƐĞ ŝƐ ƚŚĞŝƌ ƚŽƉ ƉƌĂĐƟĐĞ ĐŚĂůůĞŶŐĞ͘ dŚĞƐĞ ĮŶĂŶĐŝĂů ĂŶĚ ƚĞĐŚŶŽůŽŐŝĐĂů ƉƌĂĐƟĐĞ ĐŚĂůůĞŶŐĞƐ ǁŝůů ĚŝƌĞĐƚ ĨƵƚƵƌĞ ƉůĂŶŶŝŶŐ ĨŽƌ &W͕ ǁŚŝĐŚ ĂŝŵƐ ƚŽ ŽīĞƌ ŵŽƌĞ ƉƌĂĐƟĐĂů͕ ĚĂƚĂͲĚƌŝǀĞŶ ƉƌĂĐƟĐĞ ŵĂŶĂŐĞŵĞŶƚ ƌĞƐŽƵƌĐĞƐ ĨŽƌ ďŽƚŚ ƐŵĂůůͲ ĂŶĚ ůĂƌŐĞͲƐĐĂůĞ ƉƌĂĐƟĐĞƐ͘ tĞ ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƐŚĂƌŝŶŐ ŵŽƌĞ ŽƵƚĐŽŵĞƐ ĨƌŽŵ ƚŚŝƐ ǇĞĂƌ͛Ɛ ƌĞƐĞĂƌĐŚ͘ dŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƌĞƐƵůƚƐ ĨƌŽŵ ƚŚĞ ϮϬϭϰ ůů DĞŵďĞƌ ^ƵƌǀĞǇ͕ ƉůĞĂƐĞ ĐŽŶƚĂĐƚ &W͛Ɛ DĞŵďĞƌƐŚŝƉ ĞƉĂƌƚŵĞŶƚ Ăƚ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ͘

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Hello-Goodbye for AAFP National Conference of Special Constituencies

ƵƌŝŶŐ ƚŚĞ ϮϬϭϰ &W EĂƚŝŽŶĂů ŽŶĨĞƌĞŶĐĞ ŽĨ ^ƉĞĐŝĂů ŽŶƐƚŝƚƵĞŶĐŝĞƐ ;E ^ Ϳ ŝŶ <ĂŶƐĂƐ ŝƚǇ͕ DK͕ ŚĞůĚ DĂǇ ϭͲϯ͕ ĂůŝĨŽƌŶŝĂ ĂĐĂĚĞŵǇ ƌĞƉƌĞƐĞŶƚĂƚŝǀĞƐ ĨƌŽŵ Ăůů ĂĐƌŽƐƐ ƚŚĞ ƐƚĂƚĞ ƌĞƉƌĞƐĞŶƚĞĚ ĨŝǀĞ ƐƉĞĐŝĂů ĐŽŶƐƚŝƚƵĞŶĐŝĞƐ ʹ ǁŽŵĞŶ͕ ŵŝŶŽƌŝƚŝĞƐ͕ ŶĞǁ ƉŚǇƐŝĐŝĂŶƐ ;ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ŚĂǀĞ ďĞĞŶ ŽƵƚ ŽĨ ƌĞƐŝĚĞŶĐǇ ŽŶĞ ƚŽ ƐĞǀĞŶ ǇĞĂƌƐͿ͕ ŝŶƚĞƌŶĂƚŝŽŶĂů ŵĞĚŝĐĂů ŐƌĂĚƵĂƚĞƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƐĞůĨͲŝĚĞŶƚŝĨǇ ĂƐ ŐĂǇ͕ ůĞƐďŝĂŶ͕ ďŝƐĞǆƵĂů Žƌ ƚƌĂŶƐŐĞŶĚĞƌ ;'> dͿ Žƌ ǁŚŽ ƐƵƉƉŽƌƚ '> d ŝƐƐƵĞƐ͘ dŚĞ ĐŽŶĨĞƌĞŶĐĞ ŝƐ Ă ƵŶŝƋƵĞ ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ ŵĞŵďĞƌƐ ŽĨ ƚŚĞƐĞ ƵŶĚĞƌƌĞƉƌĞƐĞŶƚĞĚ ĐŽŶƐƚŝƚƵĞŶĐŝĞƐ ƚŽ ǀŽŝĐĞ ƚŚĞŝƌ ŝŶĚŝǀŝĚƵĂů ĂŶĚ ŐƌŽƵƉ ƉĞƌƐƉĞĐƚŝǀĞƐ͘ dŚĞ ĂůŝĨŽƌŶŝĂ ĚĞůĞŐĂƚŝŽŶ ƚŽ ƚŚĞ ϮϬϭϰ E ^ ƐƚĞƉƉĞĚ ƵƉ ƚŽ ƚŚĞ ƉŽůŝĐǇͲŵĂŬŝŶŐ ƉůĂƚĞ͕ ĐŽͲĂƵƚŚŽƌŝŶŐ ĂŶĚ ƐƵďŵŝƚƚŝŶŐ ϭϮ ƌĞƐŽůƵƚŝŽŶƐ ĂŶĚ ƚĞƐƚŝĨǇŝŶŐ ŽŶ ŵĂŶǇ ŵŽƌĞ ǁŝƚŚ ŐƌĞĂƚ ƐŬŝůů͘ E ^ ĚĞůĞŐĂƚĞƐ ĂĚŽƉƚĞĚ Ă ƌĞƐŽůƵƚŝŽŶ ĐŽͲĂƵƚŚŽƌĞĚ ďǇ EĞǁ WŚǇƐŝĐŝĂŶ ůƚĞƌŶĂƚĞ ĞůĞŐĂƚĞ ƌƚŚƵƌ KŚĂŶŶĞƐƐŝĂŶ͕ D ;>ŽƐ ŶŐĞůĞƐͿ ƚŚĂƚ ĂƐŬƐ ƚŚĞ &W ƚŽ ƐƵƉƉŽƌƚ ƉƌŽŐƌĂŵƐ ĂůůŽǁŝŶŐ ĨŝƌƐƚͲƌĞƐƉŽŶĚĞƌƐ ƚŽ ĂĚŵŝŶŝƐƚĞƌ ŶĂůŽǆŽŶĞ ŝŶ ĞŵĞƌŐĞŶĐǇ ƐŝƚƵĂƚŝŽŶƐ͕ ƉĂƌƚŝĐƵůĂƌůǇ ĂƐ ϭϳ ƐƚĂƚĞƐ ŚĂǀĞ ĂůƌĞĂĚǇ ƉĂƐƐĞĚ ůĞŐŝƐůĂƚŝŽŶ ĞǆƉĂŶĚŝŶŐ ŶĂůŽǆŽŶĞ ĂĐĐĞƐƐ͘ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ D ;KĂŬůĂŶĚͿ ĐŽͲĂƵƚŚŽƌĞĚ Ă ŵĞĂƐƵƌĞ ĂĚŽƉƚĞĚ ďǇ E ^ ĐĂůůŝŶŐ ĨŽƌ ĞǆƉĂŶĚĞĚ ƚƌĂŶƐŐĞŶĚĞƌ ĞĚƵĐĂƚŝŽŶ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ ^ŝŵŝůĂƌůǇ͕ ĚĞůĞŐĂƚĞƐ ĂĚŽƉƚĞĚ Ă ƌĞƐŽůƵƚŝŽŶ ƚŚĂƚ ĂƐŬĞĚ ƚŚĞ &W͕ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ƚŚĞ ŵĞƌŝĐĂŶ ŽĂƌĚ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͕ ƚŽ ƉƌŽŵŽƚĞ ƚŚĞ ĚĞǀĞůŽƉŵĞŶƚ ŽĨ Ă ƐĞůĨͲĂƐƐĞƐƐŵĞŶƚ ŵŽĚƵůĞ ŽŶ ĐĂƌĞ ĨŽƌ '> d ƉĂƚŝĞŶƚƐ ĂƐ ƉĂƌƚ ŽĨ ŵĂŝŶƚĞŶĂŶĐĞ ŽĨ ĐĞƌƚŝĨŝĐĂƚŝŽŶ͘ ƵƌŝŶŐ ƚŚĞ E ^ dŽǁŶ ,Ăůů ŵĞĞƚŝŶŐ͕ &W WƌĞƐŝĚĞŶƚ ZĞŝĚ ůĂĐŬǁĞůĚĞƌ͕ D ĂŶŶŽƵŶĐĞĚ ƚŚĂƚ ƚŚĞ ŶŶƵĂů >ĞĂĚĞƌƐŚŝƉ &ŽƌƵŵ ; >&Ϳ ĂŶĚ E ^ ǁŝůů ďĞ ƌĞŶĂŵĞĚ ƚŚĞ &W >ĞĂĚĞƌƐŚŝƉ ŽŶĨĞƌĞŶĐĞ ĨŽƌ ƵƌƌĞŶƚ ĂŶĚ ƐƉŝƌŝŶŐ >ĞĂĚĞƌƐ͘ dŚĞ ϮϬϭϱ ĐŽŶĨĞƌĞŶĐĞ ǁŝůů ŚĂǀĞ ƚǁŽ ƚƌĂĐŬƐ͗ ƚŚĞ ŶŶƵĂů >ĞĂĚĞƌƐŚŝƉ &ŽƌƵŵ ĂŶĚ ƚŚĞ EĂƚŝŽŶĂů ŽŶĨĞƌĞŶĐĞ ŽĨ ŽŶƐƚŝƚƵĞŶĐǇ >ĞĂĚĞƌƐ͘ dŚĞ ĐŚĂŶŐĞ ǁĂƐ ďƌŽƵŐŚƚ ĂďŽƵƚ ƚŽ ŚĞůƉ ƚŚĞ ĐĂĚĞŵǇ ƉƌŽƉĞƌůǇ ĂĚĚƌĞƐƐ ƚŚĞ ŶĞĞĚƐ ŽĨ ĞŵĞƌŐŝŶŐ ŵĞŵďĞƌ ŐƌŽƵƉƐ ĂŶĚ ĐƌĞĂƚĞ Ă

&W͛Ɛ >& ĂŶĚ E ^ >ĞĂĚĞƌƐ

ĨŽƌƵŵ ĨŽƌ ƚŚĞŝƌ ŝƐƐƵĞƐ ƚŽ ďĞ ŚĞĂƌĚ͘ tŚĂƚ ŝŶƐƉŝƌĞƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ĐĂƌǀĞ ƚŚƌĞĞ ĚĂǇƐ ŽƵƚ ŽĨ ƚŚĞŝƌ ďƵƐǇ ƐĐŚĞĚƵůĞƐ ĂŶĚ ƚƌĞŬ ŚĂůĨǁĂǇ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ ĨŽƌ ƚŚĞ ĐŚĂůůĞŶŐŝŶŐ ǁŽƌŬ ŽĨ ƉŽůŝĐǇŵĂŬŝŶŐ͍ ͞E ^ ǁĂƐ ĂŶ ĂŵĂǌŝŶŐ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ƐŚĂƌƉĞŶ ŵǇ ĂĚǀŽĐĂĐǇ ƐŬŝůůƐ͕ ƐƉĞĂŬ ƵƉ ĨŽƌ ĐŚĂŶŐĞ Ăƚ ƚŚĞ ŶĂƚŝŽŶĂů ůĞǀĞů͕ ĂŶĚ ŶĞƚǁŽƌŬ ǁŝƚŚ ƉƌŽǀŝĚĞƌƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ͘ / ŚŽƉĞ ƚŽ ƌĞƚƵƌŶ ĨŽƌ ŵĂŶǇ ǇĞĂƌƐ ƚŽ ĐŽŵĞ͊͟ ʹ ^ĂƌĂŚ DĐEĞŝů͕ D ͕ DĂƌƚŝŶĞǌ͕ ͞E ^ ƉƌŽǀŝĚĞĚ Ă ƉůĂƚĨŽƌŵ ƚŽ ĚŝƐĐƵƐƐ ŝĚĞĂƐ͕ ĨŽƌŵĂůŝǌĞ ƌĞƐŽůƵƚŝŽŶƐ ĂŶĚ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ƉŽůŝĐǇŵĂŬŝŶŐ ƉƌŽĐĞƐƐ͕ ǁŚŝĐŚ ǁŝůů ŚĞůƉ ŵĞ ƚŽ ďĞĐŽŵĞ Ă ŵŽƌĞ ĞĨĨĞĐƚŝǀĞ ĂĚǀŽĐĂƚĞ ĂŶĚ ůĞĂĚĞƌ͘ dŚŝƐ ǁĂƐ Ă ƌĞǁĂƌĚŝŶŐ ĞǆƉĞƌŝĞŶĐĞ͕ ĂŶĚ /͛ŵ ŐůĂĚ ƚŚĂƚ / ǁĂƐ ĂďůĞ ƚŽ ďĞ ƉĂƌƚ ŽĨ ƚŚĞ &W ĚĞůĞŐĂƚŝŽŶ ƚŽ E ^ ͘ / ǁŽƵůĚ ĚĞĨŝŶŝƚĞůǇ ƌĞƚƵƌŶ ĂŐĂŝŶ ŝŶ ƚŚĞ ĨƵƚƵƌĞ͘͟ ʹ dŽŶǇ dƌƵŽŶŐ͕ D ͕ ^ĂŶƚĂ ůĂƌĂ͕ /ŶƚĞƌĞƐƚĞĚ ŝŶ ŐĞƚƚŝŶŐ ŝŶǀŽůǀĞĚ͍ ŽŶƚĂĐƚ ^ŽƉŚŝĂ ,ĞŶƌǇ Ăƚ ƐŚĞŶƌǇΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ͘

California Family Physician Summer 2014 13

¢ȱ ǰȱ ǰȱ ǰȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

POLITICAL PULSE

CAFP Priority Legislation Reflects Family Medicine’s Priorities

/Ŷ ƚŚŝƐ ǇĞĂƌ ŽĨ ŐƌĞĂƚ ŚĞĂůƚŚ ĐĂƌĞ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ͕ &W͛Ɛ ŶƵŵďĞƌ ŽŶĞ ƉƌŝŽƌŝƚǇ ŝƐ ƚŽ ĞŶƐƵƌĞ ƉĂƚŝĞŶƚƐ ŚĂǀĞ ĂĐĐĞƐƐ ƚŽ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŶĞĞĚĞĚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͘ DŝůůŝŽ ŝ ŶƐ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ ŚĂǀĞ ŶĞǁůǇ ĂĐƋƵŝƌĞĚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ͕ ĂŶĚ ǁĞ ŵƵƐƚ ĞŶƐƵƌĞ ƚŚĞƌĞ ĂƌĞ ĞŶŽƵŐŚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ƐĞĞ ƚŚĞŵ͘ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ůĞŐŝƐůĂƟŽŶ ĂŶĚ ƐƵƉƉŽƌƚĞĚ ďŝůůƐ ǁŽƵůĚ ĚŽ ũƵƐƚ ƚŚĂƚ͘ &W ŝƐ ƐƉŽŶƐŽƌŝŶŐ Ϯϰϱϴ ; ŽŶŝůůĂͿ͕ ǁŚŝĐŚ ŚĞůƉƐ ĂůůĞǀŝĂƚĞ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ƉƌŽďůĞŵƐ ďǇ ŵĂŬŝŶŐ Ă ΨϮϱ ŵŝůůŝŽŶ ƐƚĂƚĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ŝŶĐƌĞĂƐŝŶŐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƌĞƐŝĚĞŶĐǇ ƚƌĂŝŶŝŶŐ ƐůŽƚƐ ŝŶ ŐĞŽŐƌĂƉŚŝĐ ĂƌĞĂƐ ŽĨ ŶĞĞĚ͘ &W ŝƐ ĂůƐŽ ĐŽͲƐƉŽŶƐŽƌŝŶŐ ƚǁŽ DĞĚŝͲ Ăů ƉĂǇŵĞŶƚ ďŝůůƐ͗ ϭϴϬϱ ;^ŬŝŶŶĞƌͿ ǁŝůů ƌĞǀĞƌƐĞ ƚŚĞ ϭϬ ƉĞƌĐĞŶƚ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌ ƉĂǇŵĞŶƚ ĐƵƚ ŝŵƉůĞŵĞŶƚĞĚ ůĂƚĞ ůĂƐƚ ǇĞĂƌ ĂŶĚ ϭϳϱϵ ;WĂŶͿ ǁŝůů ĞǆƚĞŶĚ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ ƉƌŽǀŝƐŝŽŶ ƚŚĂƚ ŝŶĐƌĞĂƐĞƐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶ DĞĚŝͲ Ăů ƉĂǇŵĞŶƚ ƚŽ DĞĚŝĐĂƌĞ ůĞǀĞůƐ ĂŶĚ ŝƐ ƐĞƚ ƚŽ ĞǆƉŝƌĞ Ăƚ ƚŚĞ ĞŶĚ ŽĨ ϮϬϭϰ͘ ϭϳϱϵ ĂůƐŽ ǁŝůů ĐƌĞĂƚĞ ĂŶ ĂŶŶƵĂů ŝŶĚĞƉĞŶĚĞŶƚ ĂƐƐĞƐƐŵĞŶƚ ŽĨ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌ ƉĂǇŵĞŶƚ ƌĂƚĞƐ ĂŶĚ ƚŚĞŝƌ ŝŵƉĂĐƚ ŽŶ ĂĐĐĞƐƐ ĂŶĚ ƋƵĂůŝƚǇ ŽĨ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ DĞĚŝͲ Ăů ƉƌŽŐƌĂŵ͘

ŝŶĚŝǀŝ ŝŶĚŝ ǀŝĚƵ ǀŝ ĚƵĂů ĚƵ ĂůƐ Ăů Ɛ ƚŽ ƚŽ ƉƵƌ ƵƌĐŚ ĐŚĂƐ ĐŚ ĂƐĞ ĂƐ Ğ ĐŽ ĐŽǀĞƌĂ ƌĂŐĞ ŐĞ ƚŚƌ ŚƌŽƵ ŽƵŐŚ ŽƵ ŐŚ ŽǀǀĞƌ ĞƌĞĚ ĞĚ Ě Ăů ĂůŝĨŽƌ ů Ž Ŷŝ Ŷ Ă Ă ǁŚŽ ǁŽƵůĚ Žƚ ŽƚŚĞ ŚĞƌǁ ŚĞ ƌǁŝƐ ŝƐĞĞ ŚĂ ŚĂǀĞĞ ďĞĞ ĞĞŶ Ŷ Ğů ĞůŝŐ ŝŐŝď ŝďůĞ ůĞ ƚŽ Ž ďƵ ďƵǇǇ ŝŝŶƐƵ ŝŶ ƵƌĂĂŶĐ ŶĐĞ Ğ ďƵƚ ĨŽƌ ƚŚ ƚŚĞŝŝƌ ŝŝŵŵŝŝŐƌĂƟ ƟŽŶ ƐƚĂƚƵƐ͖ ĂŶĚ Ϯϱϭϰ ;WĂŶͿ͕ ǁŚŝĐŚ ŐŝǀĞƐ Ă ƚĂǆ ĐƌĞĚŝƚ ƚŽ ŚĞůƉ ƉĂǇ ƚŚĞ ƐƚƵĚĞŶƚ ůŽĂŶƐ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĐŚŽŽƐĞ ƚŽ ǁŽƌŬ ŝŶ ƌƵƌĂů ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂů ƐŚŽƌƚĂŐĞ ĂƌĞĂƐ͘ &W ŝƐ ĂůƐŽ ĮŐŚƟŶŐ ƚŽ ƉƌŽƚĞĐƚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĐƵƌƌĞŶƚůǇ ƚŚƌĞĂƚĞŶĞĚ ďǇ ƚƌŝĂů ůĂǁǇĞƌƐ͛ ĂƩĞŵƉƚƐ ƚŽ ŝŶĐƌĞĂƐĞ ƚŚĞŝƌ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ƉĂǇŽƵƚƐ͘ ĂƌůŝĞƌ ƚŚŝƐ ǇĞĂƌ͕ ƚŚĞ ƚƌŝĂů ĂƩŽƌŶĞǇƐ ƐƵďŵŝƩĞĚ ĂŶ ŝŶŝƟĂƟǀĞ ĨŽƌ ƚŚĞ EŽǀĞŵďĞƌ ϮϬϭϰ ďĂůůŽƚ ĂŝŵĞĚ Ăƚ ĚŝƐŵĂŶƚůŝŶŐ ƚŚĞ ůĂŶĚŵĂƌŬ DĞĚŝĐĂů /ŶũƵƌǇ ŽŵƉĞŶƐĂƟŽŶ ZĞĨŽƌŵ Đƚ ;D/ Z Ϳ͘ D/ Z ŝƐ ĂůŝĨŽƌŶŝĂ͛Ɛ ƉƌŽĨĞƐƐŝŽŶĂů ůŝĂďŝůŝƚǇ ůĂǁ ƚŚĂƚ ŚĂƐ ĞŶƐƵƌĞĚ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ Ăůů ĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ ĂŶĚ ŵĞĚŝĐĂů ĐĂƌĞ ƚŽ ǁŚŝĐŚ ƚŚĞǇ ĂƌĞ ĞŶƟƚůĞĚ͕ ďƵƚ ůŝŵŝƚƐ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ ;ƉĂŝŶ ĂŶĚ ƐƵīĞƌŝŶŐ ĂǁĂƌĚƐͿ ƚŽ ΨϮϱϬ͕ϬϬϬ ĂŶĚ ĐĂƉƐ ĂǁĂƌĚƐ ƚŽ ƚƌŝĂů ĂƩŽƌŶĞǇƐ ŽŶ Ă ƐůŝĚŝŶŐ ƐĐĂůĞ ďĂƐŝƐ͘ D/ Z ĞŶƐƵƌĞƐ ƉĂƟĞŶƚ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ďǇ ůŝŵŝƟŶŐ ŐƌŽǁƚŚ ŝŶ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ƉƌĞŵŝƵŵƐ ĂŶĚ ĚŝƐĐŽƵƌĂŐŝŶŐ ĨƌŝǀŽůŽƵƐ ůĂǁƐƵŝƚƐ ĂŐĂŝŶƐƚ ƉŚǇƐŝĐŝĂŶƐ͘ dŚĞ ďĂůůŽƚ ŵĞĂƐƵƌĞ ǁŝůů ƌĂŝƐĞ ƚŚĞ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ ĐĂƉ ƚŽ Ăƚ ůĞĂƐƚ Ψϭ ŵŝůůŝŽŶ ĂŶĚ ƌĞƋƵŝƌĞ ĚƌƵŐ ƚĞƐƟŶŐ ŽĨ ƉŚǇƐŝĐŝĂŶƐ͘ &W ŚĂƐ ŝƐƐƵĞĚ Ă ďƵůůĞƟŶ ĂďŽƵƚ D/ Z ƚŽ Ăůů ŽĨ ŝƚƐ ŵĞŵďĞƌƐ͕ ĐƌĞĂƚĞĚ Ă ƐƉĞĐŝĂů ƐĞĐƟŽŶ ŽĨ ŽƵƌ ǁĞďƐŝƚĞ ĚĞĚŝĐĂƚĞĚ ƚŽ ĐŽŵďĂƫŶŐ ƚŚŝƐ ŝŶŝƟĂƟǀĞ ĂŶĚ ŵĂĚĞ Ă ΨϮϬ͕ϬϬϬ ĐŽŶƚƌŝďƵƟŽŶ ƚŽ ƚŚĞ ĐĂŵƉĂŝŐŶ ŽƉƉŽƐŝŶŐ ƚŚĞ ŵĞĂƐƵƌĞ͘ &ŝŶĚ ŽƵƚ ŚŽǁ ǇŽƵ ĐĂŶ ŐĞƚ ŝŶǀŽůǀĞĚ ďǇ ŐŽŝŶŐ ƚŽ ŚƚƚƉ͗ͬͬǁǁǁ͘ƐƚŽƉŚŝŐŚĞƌŚĞĂůƚŚĐĂƌĞĐŽƐƚƐ͘ĐŽŵ͘

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/Ŷ ĂĚĚŝƟŽŶ ƚŽ ŽƵƌ ƐƉŽŶƐŽƌĞĚ ďŝůůƐ͕ &W ŝƐ ůĞŶĚŝŶŐ ŝƚƐ ĨƵůů ƐƵƉƉŽƌƚ ƚŽ ϭϳϳϭ ;s͘ D͘ WĠƌĞǌͿ͕ ǁŚŝĐŚ ƌĞƋƵŝƌĞƐ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĐŽŵƉĂŶŝĞƐ ƚŽ ƉĂǇ ĐŽŶƚƌĂĐƚĞĚ ƉŚǇƐŝĐŝĂŶƐ ĨŽƌ ƚĞůĞŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ͕ ŝŶĐůƵĚŝŶŐ ƚĞůĞƉŚŽŶĞ Žƌ ŽƚŚĞƌ ĞůĞĐƚƌŽŶŝĐ ƉĂƟĞŶƚ ŵĂŶĂŐĞŵĞŶƚ͖ ϭϱϳϵ ;^ƚŽŶĞͿ͕ ǁŚŝĐŚ ĂůůŽǁƐ ĞůŝŐŝďůĞ ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ ǁŚŽ ĚŽ ŶŽƚ ŚĂǀĞ ĂŶǇ ŽƚŚĞƌ ĐŚŝůĚƌĞŶ ƚŽ ĂĐĐĞƐƐ ĂůtKZ<Ɛ ďĞŶĞĮƚƐ ƵƉŽŶ ƉƌĞŐŶĂŶĐǇ ǀĞƌŝĮĐĂƟŽŶ͖ ϮϯϮϱ ;:͘ ͘ WĠƌĞǌͿ͕ ǁŚŝĐŚ ĐƌĞĂƚĞƐ ƚŚĞ WĂƟĞŶƚͲ ĞŶƚĞƌĞĚ ŽŵŵƵŶŝĐĂƟŽŶ ƉƌŽŐƌĂŵ ; ŽŵŵƵŶŝ ĂůͿ ƚŽ ƉƌŽǀŝĚĞ ŵĞĚŝĐĂů ŝŶƚĞƌƉƌĞƚĂƟŽŶ ƐĞƌǀŝĐĞƐ ƚŽ DĞĚŝͲ Ăů ďĞŶĞĮĐŝĂƌŝĞƐ ǁŚŽ ĂƌĞ ůŝŵŝƚĞĚ ŶŐůŝƐŚ ƉƌŽĮĐŝĞŶƚ͖ ^ ϭϬϬϱ ;>ĂƌĂͿ͕ ǁŚŝĐŚ ǁŽƵůĚ ĂůůŽǁ

California Family Physician Summer 2014

WůĞĂƐĞ ĂůƐŽ ƐŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞǇ ŽŶƚĂĐƚ ĂŶĚ ƐƚĂǇ ƚƵŶĞĚ ĨŽƌ &W ĂĚǀŽĐĂĐǇ ĂůĞƌƚƐ ƐŽ ǇŽƵ ĐĂŶ ĨŝŶĚ ŽƵƚ ŚŽǁ ƚŽ ƐƵƉƉŽƌƚ Ăůů ƚŚĞƐĞ ŝŵƉŽƌƚĂŶƚ ĞĨĨŽƌƚƐ͊ Dr. Wolfe is Chair, CAFP Legislative Affairs Committee

PHYSICIAN â&#x20AC;&#x201C; FAMILY MEDICINE Vista Community Clinic located in North San Diego County Seeking: Full-time, part-time and per diem Family Medicine Physicians. Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in family medicine. Bilingual English/Spanish preferred. Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702

MED7 has been providing urgent care services in the Greater Sacramento area since 1987 Urgent care clinics are located in Roseville, Carmichael, Folsom & North Sacramento. Board CertiďŹ ed or Board Eligible in family practice or emergency medicine. All shifts 9am to 9pm. Full time is 13 shifts per month. We offer our full time physicians the following: full malpractice coverage, medical & dental coverage at no cost for the physician & any dependents, disability policy & we have a simple IRA you can contribute to with 3% matching. Part time is 6 to 8 shifts per month. There is no call. There is no tail coverage that needs to be purchased should you leave our employment. We have a single policy that continues on after you leave. If something were to arise here after you left our employment, you would be covered. For more information about MED7 and our clinics please visit our website: www.med7.com We offer an attractive compensation package. Contact Merl Oâ&#x20AC;&#x2122;Brien,MD, at: (916) 483-5400, ext.111; or email CV to: sherry@med7atwork.com.

UCSF FRESNO FAMILY MEDICINE FACULTY POSITION THE UCSF Fresno Medical Education Program and the Central California Faculty Medical Group (CCFMG) are recruiting for a physician to join the teaching faculty. The successful applicant should be board certified in Family Medicine and be licensed or eligible to practice in California. This position provides an opportunity for teaching, clinical research, and community practice. Proficiency in OB optional. Administrative/leadership opportunities are available. A competitive salary is offered. The program is based in Fresno, California, where residents enjoy a high standard of living combined with a low cost of living. The result is a quality of life uniquely Californian, yet surprisingly affordable. Limitless recreational opportunities and spectacular scenery is all accessible in a community with abundant affordable housing. While there is much to see and do in Fresno, the city is ideally located for fast, convenient getaways to the majestic Sierra (just 90 minutes away) as well as the scenic Central Coast, just two and one-half hours away. Fresno is the only major city in the country with close proximity to three national parks, including renowned Yosemite National Park.

Interested applicants should apply online at https://aprecruit.ucsf.edu/apply/JPF00026 Visit our websites: www.fresno.ucsf.edu

www.communitymedical.org

â&#x20AC;&#x153;UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for underrepresented minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women.â&#x20AC;?

FAMILY PRACTICE PHYSICIAN

(100% Ambulatory) County Hospital in San Francisco Bay Area

BC/BE Family Physician sought by integrated public hospital & clinic system with Family Medicine Residency Program in Contra Costa County, San Francisco Bay Area. s ./ NIGHT OR WEEKEND CALL .O %MERGENCY $EPARTMENT CALL s 7E HAVE A HIGHLY REGARDED &AMILY 0RACTICE 2ESIDENCY 0ROGRAM AND MANY OF OUR STAFF PHYSICIANS ARE INVOLVED IN RESIDENT TEACHING s /UR &AMILY -EDICINE PHYSICIANS LOVE WORKING TOGETHER AND ARE PASSIONATE ABOUT PROVIDING EXCEPTIONAL PATIENT CARE

For Advertising CONTACT

Michelle Gilbert mgilbert@pcipublishing.com

1-800-561-4686

ext. 120

s .EW HOSPITAL CLINIC FACILITIES SERVE THE NEEDS OF ETHNICALLY AND CULTURALLY DIVERSE POPULATIONS WITH A FASCINATING VARIETY OF CLINICAL PROBLEMS s ,OCATED MILES EAST OF 3AN &RANCISCO WITH EXCELLENT WEATHER AND CLOSE TO OUTSTANDING CULTURAL RECREATIONAL AND NATURAL ATTRACTIONS /NE HOUR TO THE .APA 6ALLEY WINE COUNTRY OR BEACH AND Â&#x17E; HOURS TO SKIING s #OMPENSATION PACKAGE INCLUDES MALPRACTICE GENEROUS VACATION SICK LEAVE HEALTH DISABILITY INSURANCE PAID #-% DEFINED BENEFIT PENSION MUCH MORE s 0OSITIONS AVAILABLE IMMEDIATELY For more information, please contact Jose Yasul, MD, at : jose.yasul@hsd.cccounty.us %/% California Family Physician Summer 2014 15

PUBLIC HEALTH

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Children, Diseases, Vaccinations and Parental Peer Pressure sĂĐĐŝŶĂƚŝŽŶ ŝƐ ŽŶĞ ŽĨ ŚŝƐƚŽƌǇ͛Ɛ ŵŽƐƚ ƐŝŐŶŝĨŝĐĂŶƚ ŚĞĂůƚŚ ĂĚǀĂŶĐĞƐ͘ Ƶƚ ĂůŝĨŽƌŶŝĂ ŚĂƐ ŚĂĚ ŽƵƚďƌĞĂŬƐ ŽĨ ŵĞĂƐůĞƐ ĂŶĚ ƉĞƌƚƵƐƐŝƐ ŝŶ ƚŚĞ ƉĂƐƚ ǇĞĂƌ͘ ĂůŝĨŽƌŶŝĂ ĂůƐŽ ŚĂƐ Ă ƌŝƐŝŶŐ ŶƵŵďĞƌ ŽĨ ĐŚŝůĚƌĞŶ ŶŽƚ ǀĂĐĐŝŶĂƚĞĚ ĨŽƌ ƐƵĐŚ ĚŝƐĞĂƐĞƐ͘ hŶƐƵƌƉƌŝƐŝŶŐůǇ͕ ĞǆƉĞƌƚƐ ƐĂǇ ƚŚĞƐĞ ƚƌĞŶĚƐ ĂƌĞ ůŝŶŬĞĚ͕ ĂŶĚ ƐƵĐŚ ƚƌĞŶĚƐ ĂƌĞ ǁŽƌƐĞŶŝŶŐ͘ ^ŽŵĞ ĐŚŝůĚƌĞŶ ĂƌĞ ŶŽƚ ǀĂĐĐŝŶĂƚĞĚ ďĞĐĂƵƐĞ ƚŚĞŝƌ ƉĂƌĞŶƚƐ ŵŝŐŚƚ ŶŽƚ ďĞ ĂďůĞ ƚŽ ĂīŽƌĚ ƚŚĞ ǀĂĐĐŝŶĞ͕ ǁŚŝĐŚ ƚŽŽ ŽŌĞŶ ŚĂƐ ďĞĞŶ ƉŽŽƌůǇ ƌĞŝŵďƵƌƐĞĚ Žƌ ŶŽƚ ĐŽǀĞƌĞĚ ďǇ ŝŶƐƵƌĂŶĐĞ Ăƚ Ăůů͘ ^ŽŵĞ ŵŝŐŚƚ ŶŽƚ ŚĂǀĞ ĞĂƐǇ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ͘ ^ŽŵĞ ĨĞĞů ŝƚ ŝƐ ĂŐĂŝŶƐƚ ƚŚĞŝƌ ƌĞůŝŐŝŽŶͶ ƚŚĞ ƌĞĂƐŽŶ ĨŽƌ ĂŶ ĂǀĂŝůĂďůĞ ĞǆĞŵƉƟŽŶ ƚŽ ǀĂĐĐŝŶĂƟŽŶƐ ƌĞƋƵŝƌĞĚ ƚŽ ĞŶƚĞƌ ƐĐŚŽŽůŝŶŐ͘ ƌĞĐĞŶƚ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ ; D ͿͲƐƉŽŶƐŽƌĞĚ ĂŶĚ ^ĂŶ &ƌĂŶĐŝƐĐŽ DĞĚŝĐĂů ^ŽĐŝĞƚǇͲƐƵƉƉŽƌƚĞĚ ƐƚĂƚĞ ůĂǁ ƌĞƋƵŝƌĞƐ ƚŚĂƚ ƉĂƌĞŶƚƐ ďĞ ƚŽůĚ ĂďŽƵƚ ǀĂĐĐŝŶĞƐ ďǇ Ă ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂů ďĞĨŽƌĞ ƚŚĞǇ ŵĂŬĞ ƚŚĞ ĚĞĐŝƐŝŽŶ ǁŚĞƚŚĞƌ Žƌ ŶŽƚ ƚŽ ŚĂǀĞ ƚŚĞŝƌ ŬŝĚ ǀĂĐĐŝŶĂƚĞĚ͘ Ƶƚ ƚŚĞ ƉƌŝŵĂƌǇ ĨĂĐƚŽƌ ŝŶ ƚŚĞ ŵŽƌĞ ƌĞĐĞŶƚ ŝŶĐƌĞĂƐĞ ŝŶ ƉĂƌĞŶƚƐ͛ ŶŽƚ ŚĂǀŝŶŐ ƚŚĞŝƌ ĐŚŝůĚƌĞŶ ǀĂĐĐŝŶĂƚĞĚ ƐĞĞŵƐ ƚŽ ďĞ ĨĞĂƌ ĂďŽƵƚ ƌŝƐŬƐ ŽĨ ǀĂĐĐŝŶĞƐ͕ ĞƐƉĞĐŝĂůůǇ ĂďŽƵƚ ĂŶ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ ŽĨ ĂƵƟƐŵ͘ tŚŝůĞ ƚŚĂƚ ĂŶĚ ŽƚŚĞƌ ĨĞĂƌƐ ŚĂǀĞ ďĞĞŶ ĚŝƐĐƌĞĚŝƚĞĚ ŝŶ ƚŚĞ ƐĐŝĞŶƟĮĐ ǁŽƌůĚ͕ ŵŝƐŝŶĨŽƌŵĂƟŽŶ ƐƟůů ƐƉƌĞĂĚƐ ǁŝĚĞůǇ ǀŝĂ ƚŚĞ /ŶƚĞƌŶĞƚ ĂŶĚ ŝŶ ƐŽĐŝĂů ƐĞƫŶŐƐ͘ ŵŽŶŐ ĚŝĞͲŚĂƌĚ͕ ĂŶƟͲǀĂĐĐŝŶĞ ĂĐƟǀŝƐƚƐ͕ ŶŽ ĂŵŽƵŶƚ ŽĨ ĞǀŝĚĞŶĐĞ ƐƵĸĐĞƐ ƚŽ ĐŚĂŶŐĞ ƚŚĞŝƌ ŵŝŶĚƐ ĂŶĚ ĂĐƟŽŶƐ͘ ůŽŶŐ ĂŶĚ ǁĞůůͲĚŽĐƵŵĞŶƚĞĚ ŚŝƐƚŽƌǇ ŽĨ ĂŶƟͲǀĂĐĐŝŶĞ ƐĞŶƟŵĞŶƚ ŐŽĞƐ ďĂĐŬ ŽǀĞƌ Ă ĐĞŶƚƵƌǇ͕ ǁŝƚŚ ĐŽŶƐƉŝƌĂĐǇ ƚŚĞŽƌŝĞƐ ĂŶĚ ŵŝƐƚƌƵƐƚƐ Ă ĐŽŵŵŽŶ ƚŚĞŵĞ͘ /Ŷ ŽƵƌ ƟŵĞ͕ ƚŚŽƐĞ ƉƌŽǀŝĚŝŶŐ ǀĂĐĐŝŶĞƐ ĂƌĞ ĞǀĞŶ ďĞŝŶŐ ŵƵƌĚĞƌĞĚ ŝŶ ƐŽŵĞ ŶĂƟŽŶƐ͘ ,ĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ŚĂǀĞ ƐƚƌƵŐŐůĞĚ ƚŽ ĚĞǀĞůŽƉ ĞīĞĐƟǀĞ͕ ĐŽŶǀŝŶĐŝŶŐ ŵĞƐƐĂŐĞƐ ƚŽ ĐŽƵŶƚĞƌ ĂŶƟͲǀĂĐĐŝŶĞ ƐĞŶƟŵĞŶƚ͘ DƵĐŚ ŽĨ ƚŚĞ ŵŝƐƚƌƵƐƚ ĂŶĚ ŵŝƐŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ǀĂĐĐŝŶĞƐ ŝƐ ƐƉƌĞĂĚ ĂŵŽŶŐ ƉĂƌĞŶƚƐ ĂŶĚ͕ ŝŶƚĞƌĞƐƟŶŐůǇ ĞŶŽƵŐŚ͕ ďŽƚŚ ƚŚĞ ŵŽƐƚ ĂŶĚ ůĞĂƐƚ ĂŋƵĞŶƚ ĨĂŵŝůŝĞƐ ĂƌĞ ŽŌĞŶ ŵŽƐƚ ƉƌŽŶĞ ƚŽ ĂŶƟͲǀĂĐĐŝŶĞ ƉƌŽƉĂŐĂŶĚĂ͘ WĂƌĞŶƚĂů ƉĞĞƌ ƉƌĞƐƐƵƌĞ ŝƐ ƉŽǁĞƌĨƵů͘ tŚĞŶ ŚĞĂĚ ůŝĐĞ ĂƌĞ ĨŽƵŶĚ ŝŶ Ă ƐĐŚŽŽů͕ ĂůĞƌƚƐ ƚŽ ƉĂƌĞŶƚƐ ĐĂŶ ďĞ ĂŶ ĞīĞĐƟǀĞ ƚŽŽů ŝŶ ďĂƩůŝŶŐ ƚŚĞ ƉƌŽďůĞŵ͘ &Žƌ ƚŚŝƐ ŵŽƌĞ ƐĞƌŝŽƵƐ ŝƐƐƵĞ͕ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ĐŽƵůĚ ĚŽ ŵŽƌĞ ƚŽ ŚĂƌŶĞƐƐ ƚŚĂƚ ƉŽǁĞƌ ŝŶ ĨĂǀŽƌ ŽĨ ǀĂĐĐŝŶĞƐ͘ dŚĞ ůĂƌŐĞ ŵĂũŽƌŝƚǇ ŽĨ ƉĂƌĞŶƚƐ ƐƟůů ĚŽĞƐ ƚƌƵƐƚ ƚŚĞŝƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ĚŽĞƐ ǀĂĐĐŝŶĂƚĞ ƚŚĞŝƌ ĐŚŝůĚƌĞŶ͘ EŽƚ ĞŶŽƵŐŚ ŬŶŽǁ ƚŚĂƚ ƚŚĞ ĚĞĐŝƐŝŽŶ ďǇ Ă ŵŝŶŽƌŝƚǇ ŽĨ ƉĂƌĞŶƚƐ ŶŽƚ ƚŽ ǀĂĐĐŝŶĂƚĞ ĐĂŶ ƉƵƚ Ăůů ĐŚŝůĚƌĞŶ Ăƚ ƌŝƐŬ ʹ ĞƐƉĞĐŝĂůůǇ ǁŚĞŶ ƚŚĞ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ĐŚŝůĚƌĞŶ ǀĂĐĐŝŶĂƚĞĚ ĨĂůůƐ ďĞŶĞĂƚŚ ƚŚĂƚ ŶĞĞĚĞĚ ĨŽƌ ǁŚĂƚ ŝƐ ĐĂůůĞĚ ͞ŚĞƌĚ ŝŵŵƵŶŝƚǇ͘͟ dŚƵƐ͕ ƚŚŝƐ ŵŽĚĞƐƚ ƉƌŽƉŽƐĂů͗ ƚ ĂŶǇ ƐĐŚŽŽů ǁŚĞƌĞ ƵŶǀĂĐĐŝŶĂƚĞĚ ĐŚŝůĚƌĞŶ ĂƌĞ ĞŶƌŽůůĞĚ͕ ƉĂƌĞŶƚƐ ĐŽƵůĚ ďĞ ǁĂƌŶĞĚ ĂŶĚ ƵƌŐĞĚ ƚŽ ƚĂŬĞ ĂĐƟŽŶ ďǇ ĞŶĐŽƵƌĂŐŝŶŐ ƚŚĞ ƉĂƌĞŶƚƐ ŽĨ ƵŶǀĂĐĐŝŶĂƚĞĚ ĐŚŝůĚƌĞŶ ƚŽ ŚĞĞĚ ďŽƚŚ ƐĐŝĞŶĐĞ ĂŶĚ ƉƵďůŝĐ ƌĞƐƉŽŶƐŝďŝůŝƚǇ ĂŶĚ ŚĂǀĞ ƚŚĞŵ ǀĂĐĐŝŶĂƚĞĚ͘ ƉŽƐƚĞƌ ƐƵĐŚ ĂƐ ƚŚĂƚ ďĞůŽǁ ĐŽƵůĚ ďĞ ƉŽƐƚĞĚ Ăƚ ƐĐŚŽŽůƐ ĂŶĚ ƉĂƌĞŶƚͬƚĞĂĐŚĞƌ ŵĞĞƟŶŐƐ ĂŶĚ ŵĂŝůĞĚ ƚŽ ƉĂƌĞŶƚƐ͘ /ƚ ũƵƐƚ ŵŝŐŚƚ ŚĞůƉ͘ ŶĚ ĞǀĞŶ ŝĨ ƚŚŝƐ ŵŝŐŚƚ ďĞ ĐŽŶƐƚƌƵĞĚ ďǇ ƐŽŵĞ ĂƐ ͞ƉƵďůŝĐ ƐŚĂŵŝŶŐ͕͟ ŝƐŶ͛ƚ ƚŚĂƚ ƐŽŵĞƟŵĞƐ ũƵƐƟĮĞĚ ǁŚĞŶ ďĞŚĂǀŝŽƌ ĐĂŶ ũƵƐƟĮĂďůǇ ďĞ ĐĂůůĞĚ ƐŚĂŵĞĨƵů͍ 16

California Family Physician Summer 2014

Three important facts 1.

The number of unvaccinated children is increasing, even though for decades vaccines have been shown to lower disease among children. In many areas, some of the decline in vaccination is due to parental choice.

Declining rates of vaccination increase outbreaks of communicable diseases, resulting in more sick and even dying children than before. This is a more serious problem than alerts about head lice parents receive and respond to.

Vaccines do not cause diseases, including autism or other such conditions. Family physicians love their own children too —and have them vaccinated.

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DĞĂƐůĞƐ ŽƵŶƚ ZĞĂĐŚĞƐ ϰϵ ŝŶ ĂůŝĨŽƌŶŝĂ ĂůŝĨŽƌŶŝĂ ĞƉƚ͘ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͕ ϯͬϮϴͬϮϬϭϰ ŚƩƉ͗ͬͬǁǁǁ͘ĐĚƉŚ͘ĐĂ͘ŐŽǀͬWĂŐĞƐͬEZϭϰͲϬϯϱ͘ĂƐƉǆ sĂĐĐŝŶĂƟŽŶ ǆĞŵƉƟŽŶƐ ŵŽŶŐ ĂůŝĨ͘ <ŝŶĚĞƌŐĂƌƚŶĞƌƐ hƉ ϭϲй ĂůŝĨŽƌŶŝĂ ,ĞĂůƚŚĐĂƌĞ &ŽƵŶĚĂƟŽŶ͕ ϯͬϯϭͬϮϬϭϰ ŚƩƉ͗ͬͬǁǁǁ͘ĐĂůŝĨŽƌŶŝĂŚĞĂůƚŚůŝŶĞ͘ŽƌŐͬ ĂƌƟĐůĞƐͬϮϬϭϰͬϯͬϯϭͬǀĂĐĐŝŶĂƟŽŶͲĞǆĞŵƉƟŽŶƐͲĂŵŽŶŐͲĐĂůŝĨͲŬŝŶĚĞƌŐĂƌƚŶĞƌƐͲĂƌĞͲ ƵƉͲϭϲ sĂĐĐŝŶĞ ƌĞĨƵƐĂů ƟĞĚ ƚŽ ƉĞƌƚƵƐƐŝƐ ŽƵƚďƌĞĂŬ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͕ ϭϬͬϬϮͬϭϯ ŚƩƉ͗ͬͬǁǁǁ͘ĐŵĂŶĞƚ͘ŽƌŐͬŶĞǁƐͬĚĞƚĂŝů͍ͬĂƌƟĐůĞсǀĂĐĐŝŶĞͲƌĞĨƵƐĂůͲ ƟĞĚƚŽͲƉĞƌƚƵƐƐŝƐͲŽƵƚďƌĞĂŬ īĞĐƟǀĞ DĞƐƐĂŐĞƐ ŝŶ sĂĐĐŝŶĞ WƌŽŵŽƟŽŶ͗ ZĂŶĚŽŵŝǌĞĚ dƌŝĂů EǇŚĂŶ͕ Ğƚ Ăů͕ WĞĚŝĂƚƌŝĐƐ ϮϬϭϰ ŚƩƉ͗ͬͬƉĞĚŝĂƚƌŝĐƐ͘ĂĂƉƉƵďůŝĐĂƟŽŶƐ͘ŽƌŐͬĐŽŶƚĞŶƚͬ ĞĂƌůǇͬϮϬϭϰͬϬϮͬϮϱͬƉĞĚƐ͘ϮϬϭϯͲϮϯϲϱ͘ĂďƐƚƌĂĐƚ WƵďůŝĐ ƐŚĂŵŝŶŐ ĨŽƌ ƚŚĞ ƐĂŬĞ ŽĨ ƉƵďůŝĐ ŚĞĂůƚŚ ^ĂŶ &ƌĂŶĐŝƐĐŽ ŚƌŽŶŝĐůĞ ĞĚŝƚŽƌŝĂů͕ ϯͬϯϭͬϭϰ ŚƩƉ͗ͬͬǁǁǁ͘ƐĨŐĂƚĞ͘ĐŽŵͬĚĞĨĂƵůƚͬĂƌƟĐůĞͬWƵďůŝĐͲƐŚĂŵŝŶŐͲ ĨŽƌͲƚŚĞͲƐĂŬĞͲŽĨͲƉƵďůŝĐͲŚĞĂůƚŚͲϱϯϲϱϮϮϬ͘ƉŚƉ hŶĚĞƌ ŶĞǁ ůĂǁ͕ ƐĐŚŽŽů ŶƵƌƐĞƐ Ăŝŵ ƚŽ ƐƚŽƉ ƌŝƐĞ ŝŶ ǀĂĐĐŝŶĂƟŽŶ ŽƉƚͲŽƵƚƐ Ě^ŽƵƌĐĞ͕ Ɖƌŝů ϲ͕ ϮϬϭϰ ŚƩƉ͗ͬͬĞĚƐŽƵƌĐĞ͘ŽƌŐͬϮϬϭϰͬƵŶĚĞƌͲŶĞǁͲůĂǁͲƐĐŚŽŽůͲŶƵƌƐĞƐͲĂŝŵͲƚŽͲƐƚŽƉͲƌŝƐĞͲŝŶͲ ǀĂĐĐŝŶĂƟŽŶͲŽƉƚͲŽƵƚƐͬϲϬϬϰϰη͘hϬYŶYDĨǆƚyǌ

Steve Heilig is a public health advocate and medical ethicist with the San Francisco Medical Society and other healthcare organizations, and is co-editor of the Cambridge Quarterly of Healthcare Ethics. A version of this piece appeared in the San Francisco Chronicle.

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Physicians Promoting Justice through Health Care In some ways, we could not have led more dissimilar lives before we met in Davis. Brenda grew up the child of El Salvadoran immigrants in the high desert of California. Becoming a doctor was her dream even as a young girl, and she easily decided to study biology and Chicano/LaƟno studies in college in order to prepare for her journey. Bryce, on the other hand, grew up beneath the towering pines of the Sierra Nevada and resolved at a young age to become neither a physician nor a lawyer like his parents. Instead, he studied Spanish and internaƟonal relaƟons with a minor in LaƟn and soaked up as much of the world around him as he could before he was forced to grow up. Where our stories collide is in injusƟce.

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ ǯ &ƌŽŵ ZŽƐĂŵŽŶĚ ƚŽ tĞƐƚ ^ĂĐƌĂŵĞŶƚŽ͕ ƚŽ EŽƌƚŚ WŚŝůĂĚĞůƉŚŝĂ͕ WĞƌƵ ĂŶĚ ŽƐƚĂ ZŝĐĂ͕ ƚŚĞ ƉůŝŐŚƚ ŽĨ ƚŚĞ ŵĂƌŐŝŶĂůŝǌĞĚ ƌĞƐŽŶĂƚĞĚ ǁŝƚŚ ƵƐ͘ tĞ ǁŝƚŶĞƐƐĞĚ Ă ƐǇƐƚĞŵ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉŽŽƌ ĚŝƐƉƌŽƉŽƌƟŽŶĂƚĞůǇ ďĞĂƌ ƚŚĞ ďƵƌĚĞŶ ŽĨ ƐƵīĞƌŝŶŐ ĂŶĚ ǁĞ ǁĂŶƚĞĚ ƚŽ ƉĂƌƚŶĞƌ ǁŝƚŚ ĐŽŵŵƵŶŝƟĞƐ ĂƐ ƚŚĞǇ ƐŽƵŐŚƚ ƚŽ ďƌĞĂŬ ƚŚĞ ĐŚĂŝŶƐ ŽĨ ĞǆƉůŽŝƚĂƟŽŶ ƚŚĂƚ ƐŚĂĐŬůĞ ƚŚĞŝƌ ůŝǀĞƐ͘ DĞĚŝĐŝŶĞ ƉƌŽǀŝĚĞĚ ƚŚĞ ƉĞƌĨĞĐƚ ƚŽŽů ĨŽƌ ƚŚŝƐ͘ <ŶŽǁŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ƚŽ ďĞ ĂŶ ĂƌĚƵŽƵƐ ĞŶĚĞĂǀŽƌ͕ ǁĞ ƐĞĂƌĐŚĞĚ ĨŽƌ ĂŶ ĞŶǀŝƌŽŶŵĞŶƚ ǁŚĞƌĞ ŽƵƌ ƉĂƐƐŝŽŶ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ ǁŽƵůĚ ďĞ ǁĞůĐŽŵĞĚ ĂŶĚ͕ ŝŶĚĞĞĚ͕ ŶƵƌƚƵƌĞĚ͘ ŌĞƌ ŝŶƚĞƌǀŝĞǁŝŶŐ Ăƚ ƚŚĞ WƌŽŐƌĂŵ ŝŶ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ĨŽƌ ƚŚĞ >ĂƟŶŽ ŽŵŵƵŶŝƚǇ Ăƚ h /ƌǀŝŶĞ ;WZ/D Ͳ> Ϳ͕ ǁĞ ŬŶĞǁ ǁĞ ŚĂĚ ĨŽƵŶĚ ŽƵƌ ŚŽŵĞ͘ WZ/D Ͳ> ƚƌĂŝŶƐ ƌŽƵŐŚůǇ ƚĞŶ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĞĂĐŚ ǇĞĂƌ ƚŽ ďĞĐŽŵĞ ůĞĂĚĞƌƐ

ĨŽƌ ĂůŝĨŽƌŶŝĂ͛Ɛ ƵŶĚĞƌƐĞƌǀĞĚ >ĂƟŶŽ ƉŽƉƵůĂƟŽŶ͘ ŽŶĐƵƌƌĞŶƚ ǁŝƚŚ ŽƵƌ ŵĞĚŝĐĂů ĐŽƵƌƐĞǁŽƌŬ͕ ǁĞ ƐƚƵĚŝĞĚ ĂŶƚŚƌŽƉŽůŽŐǇ ĂŶĚ ŚŝĐĂŶŽͬ>ĂƟŶŽ ƐƚƵĚŝĞƐ ƚŽ ůĂǇĞƌ Ă ŚŝƐƚŽƌŝĐĂů ƉĞƌƐƉĞĐƟǀĞ ŽŶƚŽ ŽƵƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ƚŚĞ ƐƚƌƵŐŐůĞƐ ƚŚĂƚ >ĂƟŶŽƐ ĨĂĐĞ͕ ƉĂƌƟĐƵůĂƌůǇ ǁŝƚŚ ƌĞŐĂƌĚ ƚŽ ƚŚĞŝƌ ŚĞĂůƚŚ͘ ĚĚŝƟŽŶĂůůǇ͕ ǁĞ ďŽƚŚ ƐƚƵĚŝĞĚ ƉƵďůŝĐ ŚĞĂůƚŚ Ăƚ :ŽŚŶƐ ,ŽƉŬŝŶƐ͕ ǁŚĞƌĞ ƌĞŶĚĂ ĐŽŶĐĞŶƚƌĂƚĞĚ ŽŶ ĨŽŽĚ ƉŽůŝĐǇ ĂŶĚ ƌǇĐĞ ĨŽĐƵƐĞĚ ŽŶ ŐĞŶĞƌĂů ŚĞĂůƚŚ ƉŽůŝĐǇ͘ tĞ ĚŝĚ ƚŚŝƐ ǁŝƚŚ ƚŚĞ ĨƵůů ƐƵƉƉŽƌƚ ŽĨ ŽƵƌ ĐŽůůĞĂŐƵĞƐ ŝŶ WZ/D Ͳ> ͕ ǁŚŽ ǁĞƌĞ ƚŚĞŵƐĞůǀĞƐ ƐĐĂƩĞƌĞĚ ĂĐƌŽƐƐ ƚŚĞ ŶĂƟŽŶ ůĞĂƌŶŝŶŐ ŶĞǁ ƐŬŝůůƐ ƚŽ ďƌŝŶŐ ďĂĐŬ ƚŽ ĮŐŚƚ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ Ɛ ǁĞ ĞŶƚĞƌ ƌĞƐŝĚĞŶĐǇ͕ ǁĞ ĐŚŽƐĞ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ďĞĐĂƵƐĞ ŝƚ ŚĂƐ ůŽŶŐ ďĞĞŶ ƉĂƌƚ ŽĨ ƚŚĞ ŵŽǀĞŵĞŶƚ ƚŽ ŝŵƉƌŽǀĞ ŚĞĂůƚŚ ŽŶ ďŽƚŚ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ĂŶĚ ƉŽƉƵůĂƟŽŶ ůĞǀĞůƐ͘ tĞ ƐĞĞŬ ƚŽ ĚĞǀĞůŽƉ ƚŚĞ ďƌŽĂĚ ƐĞƚ ŽĨ ĐůŝŶŝĐĂů ƐŬŝůůƐ ǁĞ ǁŝůů ŶĞĞĚ ƚŽ ĂĐƚ ĂƐ ƚŚĞ ƉƌŝŵĂƌǇ ƌĞƐŽƵƌĐĞ ĨŽƌ ƉĂƟĞŶƚƐ ǁŚŽ ƚƌĂĚŝƟŽŶĂůůǇ ŚĂǀĞ ďĞĞŶ ĚŝƐĞŶĨƌĂŶĐŚŝƐĞĚ ĨƌŽŵ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ͘ tĞ ƐĞĞŬ ƚƌĂŝŶŝŶŐ ƚŚĂƚ ŝƐ ƌŝŐŽƌŽƵƐ ĂŶĚ ĞǀŝĚĞŶĐĞĚͲďĂƐĞĚ͕ ĂŶĚ ǁŝůů ƉƌŽǀŝĚĞ ƵƐ ǁŝƚŚ ƚŚĞ ĚĞƉƚŚ ŽĨ ŬŶŽǁůĞĚŐĞ ŶĞĐĞƐƐĂƌǇ ƚŽ ĞīĞĐƟǀĞůǇ ŵĂŶĂŐĞ ƉĂƟĞŶƚƐ ǁŝƚŚ ĚŝǀĞƌƐĞ ƉĂƚŚŽůŽŐǇ ĐŽŵŝŶŐ ĨƌŽŵ Ă ǁŝĚĞ ƌĂŶŐĞ ŽĨ ƐŽĐŝĂů ĐŝƌĐƵŵƐƚĂŶĐĞƐ͘ &ƵƌƚŚĞƌŵŽƌĞ͕ ďĞĐĂƵƐĞ ƐŽ ŵĂŶǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ůĂďŽƌ Ăƚ ƚŚĞ ǀĂŶŐƵĂƌĚ ŽĨ ƉĂƟĞŶƚ ĂĚǀŽĐĂĐǇ͕ ǁĞ ǁŝůů ƚƌĂŝŶ ŝŶ ĂŶ ĞŶǀŝƌŽŶŵĞŶƚ ƚŚĂƚ ĨŽƐƚĞƌƐ ƚŚŝƐ ƋƵĂůŝƚǇ ŝŶ ŝƚƐ ƌĞƐŝĚĞŶƚƐ͕ ƐŽ ǁĞ ĐĂŶ ĐŽŶƟŶƵĞ ƚŽ ƐŚĂƉĞ ŽƵƌ ĨƵƚƵƌĞƐ ĂƐ ƉŚǇƐŝĐŝĂŶ ĂĐƟǀŝƐƚƐ͘ Ǉ ŽƵƌ ŵĞĂƐƵƌĞ͕ ƚŚŝƐ ŝƐ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ͕ ŝŶĚĞĞĚ͕ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶ ĂƐ Ă ǁŚŽůĞ͗ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƉƌŽŵŽƚĞ ũƵƐƟĐĞ ƚŚƌŽƵŐŚ ŚĞĂůƚŚĐĂƌĞ͘ /Ŷ ŽƵƌ ŽĸĐĞƐ ǁĞ ƐĞĞ ƚŚĞ ĚŝƌĞĐƚ ĞīĞĐƚƐ ŽĨ ƵŶƐĂĨĞ ŶĞŝŐŚďŽƌŚŽŽĚƐ͕ ƚŚĞ ŝůůƵƐŝŽŶ ŽĨ ĐŚŽŝĐĞ ŝŶ ƚŚĞ ƐƵƉĞƌŵĂƌŬĞƚ͕ ƵŶŶĞĐĞƐƐĂƌǇ ǁĂƐƚĞ ŝŶ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ŵĂƌŬĞƚ ĂŶĚ ƚŚĞ ƐǇƐƚĞŵĂƟĐ ĞǆĐůƵƐŝŽŶ ŽĨ ĐĞƌƚĂŝŶ ƉŽƉƵůĂƟŽŶƐ ĨƌŽŵ ƚŚĞ ĐŽŵŵŽŶ ŐŽŽĚ͘ >Ğƚ ŝƚ ďĞ ŽƵƌ ƉƌŝǀŝůĞŐĞ ƚŽ ďĞĂƌ ǁŝƚŶĞƐƐ ƚŽ ƚŚĞƐĞ ŝŶũƵƐƟĐĞƐ ĂŶĚ ƚŽ ƐŚĂƉĞ Ă ŚĞĂůƚŚŝĞƌ ǁŽƌůĚ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ͘ Bryce Spitze and Brenda Campos-Spitze are graduating medical students in the Program in Medical Education for the Latino Community (PRIME-LC) at the University of California, Irvine and completed their Masters in Public Health at the Johns Hopkins Bloomberg School of Public Health. Bryce plans to use his voice as a physician to advocate to bring Single Payer to California, while Brenda plans to develop pipeline programs to make the medical workforce more representative of the diverse population it serves. You can contact them at brycespitze@gmail.com and brenda.r.campos@gmail.com.

California Family Physician Summer 2014 17

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David Geffen School of Medicine University of California, Los Angeles (UCLA)

CO-CHAIRS Brian Mandell, MD, PhD The Cleveland Clinic, Ohio

Professor Iain McInnes, FRCP, PhD, FRSE University of Glasgow, Scotland, UK

FACULTY Marcy B. Bolster, MD Harvard Medical School Daniel J. Clauw, MD University of Michigan Sherine E. Gabriel, MD, MSc Mayo Clinic Kenneth B. Gordon, MD Northwestern University Dinesh Khanna, MD, MSc University of Michigan Susan Manzi, MD West Penn Allegheny Health Center Eric L. Matteson, MD, MPH Mayo Clinic James R. Oâ&#x20AC;&#x2122;Dell, MD University of Nebraska Medical Center Ewa Olech, MD University of Nevada Charles L. Raison, MD University of Arizona Ruth Ann Vleugels, MD, MPH Harvard Medical School TUITION

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4 %"/( .*&! Arthritis: Current Treatment 4 "w Strategies and Molecules Large and Small 4 * (*, &!&.&"- ,diovascular and Depression 4 ain Management 4 /+/- & $)*-&- )! Treatment 4 -*,& -&- (+ . )! Treatment 4 -*,& .& Arthritis: Patient Outcomes 4 A-Associated Vasculitis 4 -."*+*,osis 4 '",oderma and Pulmonary Hypertension 4 *))" .&ve Tissue Diseases: Derm/Rheum Crossover 4 Polymyalgia Rheumatica and other Geriatric Challenges ACCREDITATION STATEMENT Physicians: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Rutgers, The State University of New Jersey and Global Academy for Education. Rutgers, The State University of New Jersey is accredited by the ACCME to provide continuing medical education for physicians. Rutgers, The State University of New Jersey designates this live activity for a maximum of 15.5 AMA PRA Category 1 Creditsâ&#x201E;˘. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurses: Rutgers, The State University of New Jersey, Center for Continuing and Outreach Education is an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission On Accreditation. Provider Number P173-12/12-15. This activity is awarded 15.5 contact hours. (60 minute CH) AAFP Credit: This Live activity, 7th Perspectives in Rheumatic Diseases presented by Family Practice News, Rheumatology News & Internal Medicine News, with a beginning date of 09/12/2014, has been reviewed and is acceptable for up to 15.50 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Pharmacy Credit: In support of improving patient care, Creative Educational Concepts, Inc. (CEC) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team. Pharmacy: These application-based activities are approved for 15.50 contact hours (1.55 CEUs) of continuing pharmacy education credit (UANs 0245-9999-14-007 to 010-L01-P).

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Embracing Generational Differences Creates a Positive Work Environment tŚĞŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ŽƚŚĞƌƐ ŝŶ ĚŝĨĨĞƌĞŶƚ ĂŐĞ ŐƌŽƵƉƐ͕ ŚĂǀĞ ǇŽƵ ĞǀĞƌ ĨŽƵŶĚ ǇŽƵƌƐĞůĨ ƚŚŝŶŬŝŶŐ͕ ͞/ ũƵƐƚ ĚŽŶ͛ƚ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞŵ͕͟ Žƌ ͞tŚǇ ĚŽŶ͛ƚ ƚŚĞǇ ǁŽƌŬͬĂĐƚͬƚĂůŬͬƚŚŝŶŬ ŵŽƌĞ ůŝŬĞ / ĚŝĚͬĚŽ͍͟ /ƚ͛Ɛ Ă ĐŽŵŵŽŶ ƚŚĞŵĞ ǁŚĞŶ ǁŽƌŬŝŶŐ ĂĐƌŽƐƐ ŐĞŶĞƌĂƚŝŽŶƐ͕ ĂŶĚ ƚŚĞ ƚƌƵƚŚ ŝƐ ƚŚĂƚ ƚŚĞƌĞ ĂƌĞ ĚŝĨĨĞƌĞŶĐĞƐ͘ ůƚŚŽƵŐŚ ƚŚĞƐĞ ŐĞŶĞƌĂƚŝŽŶĂů ĐŽŵƉůĂŝŶƚƐ ŐŽ ĂƐ ĨĂƌ ďĂĐŬ ĂƐ ƌĞĐŽƌĚĞĚ ŚŝƐƚŽƌǇ͕ ƌĞƐĞĂƌĐŚ ŝƐ ŶŽǁ ĂǀĂŝůĂďůĞ ŽŶ ŚŽǁ ĚŝĨĨĞƌĞŶƚ ŐĞŶĞƌĂƚŝŽŶƐ ǁŽƌŬ͕ ƚŚŝŶŬ͕ ůĞĂƌŶ ĂŶĚ ďĞŚĂǀĞ͘

ƐĞůĨͲƌĞůŝĂŶƚ͕ ƌĞƐŽƵƌĐĞĨƵů͕ ƐĞůĨͲĐŽŶƚĂŝŶĞĚ ĂŶĚ ĞŶƚƌĞƉƌĞŶĞƵƌŝĂů͘ dŚĞǇ ĂƌĞ ƵƐĞĚ ƚŽ ĮŐƵƌŝŶŐ ŽƵƚ ŚŽǁ ƚŽ ĚŽ ƚŚŝŶŐƐ ƚŚĞŵƐĞůǀĞƐ ŽŶĐĞ ƚŚĞǇ ŬŶŽǁ ǁŚĂƚ ƚŚĞ ŐŽĂů ŝƐ͘ tŚĞŶ ƚŚĞǇ ĂƌĞ ƚŽůĚ ƚŽ ĚŽ ƐŽŵĞƚŚŝŶŐ ĂŶĚ ĂƐŬ ǁŚǇ͕ ŝƚ ŝƐ ŶŽƚ ďĞĐĂƵƐĞ ƚŚĞǇ ƋƵĞƐƟŽŶ ƚŚĞ ƉĞƌƐŽŶ͕ ďƵƚ ďĞĐĂƵƐĞ ƚŚĞǇ ƚƌƵůǇ ǁĂŶƚ ƚŽ ŬŶŽǁ ǁŚǇ͘ /ƚ͛Ɛ ŶŽƚ ƉĞƌƐŽŶĂů͘

dŚĞƐĞ ĚŝīĞƌĞŶĐĞƐ ĚŽ ŶŽƚ ƌĞŇĞĐƚ ƌŝŐŚƚ ǀƐ͘ ǁƌŽŶŐ Žƌ ŐŽŽĚ ǀƐ͘ ďĂĚ͘ dŚĞǇ ũƵƐƚ ƌĞŇĞĐƚ Ă ĚŝīĞƌĞŶƚ ĂƉƉƌŽĂĐŚ ƚŽ ůŝĨĞ͕ ůĞĂƌŶŝŶŐ ĂŶĚ ǁŽƌŬ ĂŶĚ Ă ĚŝīĞƌĞŶƚ ĚĞĮŶŝƟŽŶ ŽĨ ĐŽŵŵŝƚŵĞŶƚ͘ dŽ Ă ĂďǇ ŽŽŵĞƌ͕ ĐŽŵŵŝƚŵĞŶƚ ŵĂǇ ŵĞĂŶ ďĞŝŶŐ ĂǀĂŝůĂďůĞ ƚŽ ŽƵƌ ǁŽƌŬ Ϯϰͬϳ͕ ĂŶĚ ǁĞ ŽŌĞŶ ĨĞĞů ǁĞ ŚĂǀĞ ƚŽ ŵĂŬĞ Ă ĐŚŽŝĐĞ ďĞƚǁĞĞŶ ǁŽƌŬ ĂŶĚ ͞ůŝĨĞ͟ Žƌ ŶŽŶͲǁŽƌŬ͘ /ƚ͛Ɛ ĂŶ Ăůů Žƌ ŶŽƚŚŝŶŐ ŵŝŶĚ ƐĞƚ͘ &Žƌ ƚŚĞ 'ĞŶĞƌĂƟŽŶ y Žƌ ŵŝůůĞŶŶŝĂů͕ ŝƚ͛Ɛ ŶŽƚ Ă ŽŶĞ Žƌ ƚŚĞ ŽƚŚĞƌ ĐŚŽŝĐĞ͖ ŝƚ͛Ɛ Ă ďŽƚŚ͕ ďƵƚ ĚŽŶĞ ĚŝīĞƌĞŶƚůǇ͘ dŚĞǇ ĂƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂŶĚ ƚŚĞŝƌ ǁŽƌŬ͕ ĂŶĚ ƚŚĞǇ ĂƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ƚŚĞŝƌ ĨĂŵŝůŝĞƐ ĂŶĚ ŽƚŚĞƌ ŝŶƚĞƌĞƐƚƐ͘ 'ĞŶĞƌĂƟŽŶĂů ƚƌĂŝƚƐ ĂƌĞ ĨŽƌŵĞĚ ďǇ ĞĂƌůǇ ĞǆƉĞƌŝĞŶĐĞƐ ŝŶ ĐŚŝůĚŚŽŽĚ ĂŶĚ ĞĂƌůǇ ƚĞĞŶƐ͘ ĞƌƚĂŝŶůǇ ŶŽƚ ĞǀĞƌǇŽŶĞ ŝŶ ĂŶǇ ŐĞŶĞƌĂƟŽŶ ǁŝůů ŚĂǀĞ Ăůů ƚŚĞ ĐŚĂƌĂĐƚĞƌŝƐƟĐƐ ŽĨ ƚŚĂƚ ŐĞŶĞƌĂƟŽŶ͕ ŶŽƌ ǁŝůů ƚŚŽƐĞ ĐŚĂƌĂĐƚĞƌŝƐƟĐƐ ďĞ ĨŽƵŶĚ ŽŶůǇ ŝŶ ĐĞƌƚĂŝŶ ŐĞŶĞƌĂƟŽŶƐ͘ dŚĞƌĞ ĂƌĞ ŐƌŽƵƉƐ ĨŽƌ ǁŚŽŵ ƚŚĞ ŐĞŶĞƌĂƟŽŶĂů ƚƌĂŝƚƐ ŽŌĞŶ ĚŽŶ͛ƚ ĂĐĐƵƌĂƚĞůǇ ĚĞƐĐƌŝďĞ ƚŚĞŵ͕ ŝŶĐůƵĚŝŶŐ ĮƌƐƚͲďŽƌŶ ĐŚŝůĚƌĞŶ Žƌ ŝŵŵŝŐƌĂŶƚƐ͘ &Žƌ ƚŚĞ ďĂďǇ ďŽŽŵĞƌƐ͕ ƚŚĞŝƌ ĨŽƌŵĂƟǀĞ ĞǀĞŶƚƐ ŝŶĐůƵĚĞ ƚŚĞ Đŝǀŝů ƌŝŐŚƚƐ ŵŽǀĞŵĞŶƚ͕ ƚŚĞ sŝĞƚŶĂŵ tĂƌ͕ ƉƌŽƚĞƐƚ ŵĂƌĐŚĞƐ ĂŶĚ ŐĞŶĞƌĂů ĞĐŽŶŽŵŝĐ ƉƌŽƐƉĞƌŝƚǇ͘ DŽƐƚ ŐƌĞǁ ƵƉ ǁŝƚŚ ŝŶƚĂĐƚ ƚƌĂĚŝƟŽŶĂů ĨĂŵŝůŝĞƐ ǁŝƚŚ ƐƚĂǇͲĂƚͲ ŚŽŵĞ ŵŽƚŚĞƌƐ ĂŶĚ ŚĂƌĚͲǁŽƌŬŝŶŐ ;ĂŶĚ ŽŌĞŶ ĂďƐĞŶƚͿ ĨĂƚŚĞƌƐ͘ tŽŵĞŶ ŐƌĞǁ ƵƉ ďĞůŝĞǀŝŶŐ ƚŚĞǇ ŚĂĚ ĐŚŽŝĐĞƐͶƚŽ ǁŽƌŬ͕ ƚŽ ŚĂǀĞ Ă ĐĂƌĞĞƌ͕ ŶŽƚ ƚŽ ďĞ ĚĞĮŶĞĚ ďǇ ŚƵƐďĂŶĚ ĂŶĚ ĐŚŝůĚƌĞŶͶĂŶĚ ƚŚĞǇ ůĂƚĞƌ ũŽŝŶĞĚ ƚŚĞ ǁŽƌŬ ĨŽƌĐĞ ŝŶ ƌĞĐŽƌĚ ŶƵŵďĞƌƐ͘ tĞ ƌĂƌĞůǇ ŐŽƚ ƚŽ ƐĞĞ ĂĚƵůƚƐ ĂĐƚƵĂůůǇ ŵŽĚĞůŝŶŐ ŚŽǁ ƚŽ ŚĂǀĞ Ă ĐĂƌĞĞƌ ĂŶĚ ǇĞƚ ĂůƐŽ ďĞ ĂŶ ŝŶǀŽůǀĞĚ ƉĂƌĞŶƚ͕ ŚŽǁĞǀĞƌ͕ ĂŶĚ ǁĞ ƐƚƌƵŐŐůĞĚ ƚŽ ƐĞĞ ŝƚ ĂƐ ĂŶǇƚŚŝŶŐ ŽƚŚĞƌ ƚŚĂŶ ĂŶ ĞŝƚŚĞƌͬŽƌ͘ tĞ ŐƌĞǁ ƵƉ ŽƉƟŵŝƐƟĐ ƚŚĂƚ ǁĞ ŚĂĚ ĐŚŽŝĐĞƐ ĂŶĚ ĮŶĂŶĐŝĂů ƐĞĐƵƌŝƚǇ ĂŶĚ ĐŽƵůĚ ďĞ ĐŽŵƉĞƟƟǀĞ͕ ďĞĐĂƵƐĞ ǁĞ ǁĞƌĞ ƌĞǁĂƌĚĞĚ ĨŽƌ ƐƵĐĐĞƐƐ͘ tĞ ďĞůŝĞǀĞ ŝŶ ŚŝĞƌĂƌĐŚǇ͕ ͞ƉĂǇŝŶŐ ŽƵƌ ĚƵĞƐ͕͟ ĂŶĚ ůŽǇĂůƚǇ ƚŽ ŽƵƌ ŽƌŐĂŶŝǌĂƟŽŶƐ͘ ŶĚ ǁŚĞŶ ŽƵƌ ĂƩĞŶĚŝŶŐƐ ƚŽůĚ ƵƐ ƚŽ ĚŽ ƐŽŵĞƚŚŝŶŐ͕ ǁĞ ĚŝĚ ŝƚ ǁŝƚŚŽƵƚ ƋƵĞƐƟŽŶ͘ 'ĞŶĞƌĂƟŽŶ y͛ĞƌƐ ŐƌĞǁ ƵƉ ŝŶ Ă ƟŵĞ ǁŚĞŶ ĞǀĞƌǇ ŝŶƐƟƚƵƟŽŶ ƚŚĂƚ ƐĂŝĚ ͞ƚƌƵƐƚ ƵƐ͟ ƉƌŽǀĞĚ ƚŽ ďĞ ƵŶƚƌƵƐƚǁŽƌƚŚǇͶƐĐŚŽŽůƐ͕ ĐŚƵƌĐŚĞƐ͕ ŐŽǀĞƌŶŵĞŶƚ͕ ĞǀĞŶ ĨĂŵŝůŝĞƐ Ăůů ĨĂŝůĞĚ ƚŚĞŵ͘ ŝǀŽƌĐĞ ĂŶĚ ĚƵĂů ĐĂƌĞĞƌ ĨĂŵŝůŝĞƐ ůĞĚ ƚŽ ͞ůĂƚĐŚ ŬĞǇ ŬŝĚƐ͟ ǁŚŽ ǁĞƌĞ ůĞŌ ŽŶ ƚŚĞŝƌ ŽǁŶ Žƌ ǁŝƚŚ ƚĞůĞǀŝƐŝŽŶ ĂƐ Ă ďĂďǇƐŝƩĞƌ͘ WĞƌƐŽŶĂů ĐŽŵƉƵƚĞƌƐ ďĞĐĂŵĞ ƚŚĞŝƌ ĨƌŝĞŶĚƐ͕ ĂŶĚ ĞĐŽŶŽŵŝĐ ƉƌŽƐƉĞĐƚƐ ǁĞƌĞ ŵŽƌĞ ůŝŵŝƚĞĚ͘ dŚĞŝƌ ůŽǇĂůƚǇ ŝƐ ŶŽƚ ƚŽ ĂŶ ŽƌŐĂŶŝǌĂƟŽŶ ďƵƚ ƚŽ Ă ƉĞƌƐŽŶ ǁŚŽ ŚĂƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ŚĞ Žƌ ƐŚĞ ŝƐ ǁŝůůŝŶŐ ƚŽ ƉĂƌƚŶĞƌ ĨŽƌ ƐƵĐĐĞƐƐ͘ dŚŝƐ ŐĞŶĞƌĂƟŽŶ ŚĂƐ ďĞĞŶ ĚĞƐĐƌŝďĞĚ ĂƐ ƚŚĞ ŵŽƐƚ ĐǇŶŝĐĂů ĂŶĚ ƉĞƐƐŝŵŝƐƟĐ ŝŶ ŚŝƐƚŽƌǇ͕ ĂŶĚ ŝƐ ŝƚ ĂŶǇ ǁŽŶĚĞƌ͍ dŚĞǇ ĂůƐŽ ŐƌĞǁ ƵƉ

ϮϬϭϰ ŶŶƵĂů ^ĐŝĞŶƟĮĐ ƐƐĞŵďůǇ ƩĞŶĚĞĞƐ

dŚĞ ŵŝůůĞŶŶŝĂů ŐĞŶĞƌĂƟŽŶ ĞǆƉĞƌŝĞŶĐĞĚ ǁŝĚĞƐƉƌĞĂĚ ǀŝŽůĞŶĐĞ ĂŶĚ ƚĞƌƌŽƌŝƐŵ͕ ĂůŽŶŐ ǁŝƚŚ ƚŚĞ ƚĞĐŚŶŽůŽŐǇ ďŽŽŵ͕ ǁŚŝĐŚ ůĞĚ ƚŽ ŵƵůƟĐƵůƚƵƌĂůŝƐŵ ĂŶĚ Ă ŵŽƌĞ ŐůŽďĂů ŽƵƚůŽŽŬ͘ dŚĞŝƌ ƉĂƌĞŶƚƐ ǁĞƌĞ ƚŚĞ ͞ŚĞůŝĐŽƉƚĞƌ ƉĂƌĞŶƚƐ͟ ǁŚŽ ĨĞůƚ Ă ŶĞĞĚ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞŝƌ ĐŚŝůĚƌĞŶ ĨƌŽŵ ƌĞĂů ĚĂŶŐĞƌƐ ĂƐ ǁĞůů ĂƐ ƚŚĞ ͞ĚĂŶŐĞƌ͟ ŽĨ ƉŽŽƌ ƐĞůĨͲĞƐƚĞĞŵ͘ DŝůůĞŶŶŝĂůƐ ƌĞĐĞŝǀĞĚ ƚƌŽƉŚŝĞƐ ĨŽƌ ƉĂƌƟĐŝƉĂƟŽŶ͕ ǁĞƌĞ Ăůů ƚŽůĚ ƚŚĞǇ ǁĞƌĞ ƐƉĞĐŝĂů ĂŶĚ ŚĂĚ ƚŚĞŝƌ ůŝǀĞƐ ĐŽŵƉůĞƚĞůǇ ĮůůĞĚ ǁŝƚŚ ƉůĂǇ ĚĂƚĞƐ ĂŶĚ ƐƚƌƵĐƚƵƌĞĚ ĂĐƟǀŝƟĞƐ͘ dŚĞǇ ƌĂƌĞůǇ ŚĂĚ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ ƐƉŽŶƚĂŶĞŽƵƐ ƉůĂǇ Žƌ ďĞŝŶŐ ĂůŽŶĞ͘ dŚĞǇ ĂƌĞ ĐŽůůĂďŽƌĂƟǀĞ͕ ŽƉƟŵŝƐƟĐ͕ ĂůƚƌƵŝƐƟĐ ĂŶĚ ŝĚĞĂůŝƐƟĐ͕ ĂůƚŚŽƵŐŚ ƚŚĞǇ ŵĂǇ ďĞ ůĞƐƐ ŝŶƚƌŽƐƉĞĐƟǀĞ Žƌ ƐƉŽŶƚĂŶĞŽƵƐ͘ dŚĞǇ ǁĂŶƚ ďŽƚŚ ƚŚĞŝƌ ǁŽƌŬ ĂŶĚ ƚŚĞŝƌ ŽƵƚƐŝĚĞ ƉƵƌƐƵŝƚƐ ƚŽ ďĞ ŵĞĂŶŝŶŐĨƵů͘ dŚĞǇ ĚŽŶ͛ƚ ďĞůŝĞǀĞ ŝŶ ŚŝĞƌĂƌĐŚǇ ;ƌĞŵĞŵďĞƌ͕ ƚŚĞǇ ĂƌĞ ƐƉĞĐŝĂů͊Ϳ͕ ƐŽ ĨĞĞů ƚŚĞǇ ĐĂŶ ĂƉƉƌŽĂĐŚ ƚŚĞ ĐŚŝĞĨ ŽĨ ƐƚĂī Žƌ ĚĞĂŶ ĂƐ ĞĂƐŝůǇ ĂƐ ƚŚĞŝƌ ŝŵŵĞĚŝĂƚĞ ƐƵƉĞƌǀŝƐŽƌ͘ dŚĞǇ ůŝŬĞ ƚŽ ǁŽƌŬ ŝŶ ŐƌŽƵƉƐ͕ ƐŽůǀŝŶŐ ƌĞĂů ƉƌŽďůĞŵƐ͕ ĂŶĚ ŚĂǀĞ ŶŽ ƟŵĞ ĨŽƌ ůŽŶŐ ůĞĐƚƵƌĞƐ ƚŚĂƚ ŝŶĐůƵĚĞ ǁŚĂƚ ƚŚĞ ĨĂĐƵůƚǇ ŚĂƐ ůĞĂƌŶĞĚ ŝŶ ƚŚĞŝƌ ĐĂƌĞĞƌƐ͘ dŚĞǇ ǁĂŶƚ ƚŽ ďĞŶĞĮƚ ĨƌŽŵ ƚŚĞ ǁŝƐĚŽŵ ŽĨ ĨĂĐƵůƚǇ ĂďŽƵƚ ŚŽǁ ƚŽ ĂƉƉůǇ ƚŚĞ ŝŶĨŽƌŵĂƟŽŶ ǁŚŝĐŚ ƚŚĞǇ ĐĂŶ ĞĂƐŝůǇ ĂĐĐĞƐƐ ƚŚƌŽƵŐŚ ƚĞĐŚŶŽůŽŐǇ͘ ŝīĞƌĞŶĐĞƐ ďĞƚǁĞĞŶ ŐĞŶĞƌĂƟŽŶƐ ĐĂŶ ĐĞƌƚĂŝŶůǇ ůĞĂĚ ƚŽ ĐŚĂůůĞŶŐŝŶŐ ǁŽƌŬ ĞǆƉĞĐƚĂƟŽŶƐ͕ ůĞĂƌŶŝŶŐ ĞŶǀŝƌŽŶŵĞŶƚƐ ĂŶĚ ƉĞƌƐŽŶĂů ŝŶƚĞƌĂĐƟŽŶƐ͘ ZĞĐŽŐŶŝǌŝŶŐ ƚŚĞƐĞ ĚŝīĞƌĞŶĐĞƐ ŝƐ ƚŚĞ ĮƌƐƚ ƐƚĞƉ ƚŽ ĐƌĞĂƟŶŐ Ă ďĞƩĞƌ ǁŽƌŬŝŶŐ ĂŶĚ ůĞĂƌŶŝŶŐ ĞŶǀŝƌŽŶŵĞŶƚ ĂŶĚ ƵƐŝŶŐ ƚŚĞ ďĞƐƚ ŽĨ Ăůů ŐĞŶĞƌĂƟŽŶƐ͘ Carol Havens, MD is a CAFP past president and chair of the Committee on Continuing Professional Development. California Family Physician Summer 2014 19

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extraordinary outcomes When you're part of Dignity Health Medical Foundation you'll be able to do more than just care for your patients. You’ll have the opportunity to develop and participate in health, education and wellness programs that will help improve the lives of people throughout your community…and beyond. If you want to achieve extraordinary outcomes, join us today.

Generational Differences in the Workforce: Reflections from a Gen-X’er dŚĞƌĞ ƐĞĞŵƐ ƚŽ ďĞ Ă ůŽƚ ŽĨ ďƵǌǌ ĂďŽƵƚ ͞ŐĞŶĞƌĂƚŝŽŶĂů͟ ĚŝĨĨĞƌĞŶĐĞƐ ŝŶ ŵĞĚŝĐŝŶĞ͘ dŚĞ ƉĂƚĞƌŶĂůŝƐƚŝĐ ĂƉƉƌŽĂĐŚ ǀĞƌƐƵƐ ƐŚĂƌĞĚ ĚĞĐŝƐŝŽŶ ŵĂŬŝŶŐ͘ zŽƵŶŐ ƚǇƉŝƐƚƐ ǀĞƌƐƵƐ ŽůĚĞƌ ŬĞǇďŽĂƌĚ ƉĞĐŬĞƌƐ͘ /Ŷ ŵǇ ŽƌŐĂŶŝǌĂƟŽŶ͕ / ƐĞƌǀĞ ŝŶ Ă ŵŽƟǀĂƟŽŶĂů ƌŽůĞ͕ ƚƌǇŝŶŐ ƚŽ ŝŵƉƌŽǀĞ ŽƵƌ ƉĂƟĞŶƚƐ͛ ĞǆƉĞƌŝĞŶĐĞ ŽĨ ŽƵƌ ŵĞĚŝĐĂů ĐĂƌĞ͘ KŶ Ă ĐĞƌƚĂŝŶ ůĞǀĞů͕ ŐŝǀŝŶŐ ĂĚǀŝĐĞ ƐĞĞŵƐ ĞĂƐǇ͘ / ƚƌĞĂƚ ƉĂƟĞŶƚƐ ƚŚĞ ǁĂǇ Ă ĨĂŵŝůǇ ŵĞŵďĞƌ Žƌ / ǁŽƵůĚ ǁĂŶƚ ƚŽ ďĞ ƚƌĞĂƚĞĚ͘ Ƶƚ ǁŚĞŶ ŽŶĞ ŐĞƚƐ ŝŶƚŽ ĚĞƚĂŝůƐ͕ ǁĞ ĚŽĐƚŽƌƐ ĂƌĞ ĂŶ ŽƌŶĞƌǇ ďƵŶĐŚ ǁŝƚŚ ǀĂƌŝŽƵƐ ŚĂďŝƚƐ ĂŶĚ ǁĂǇƐ ŽĨ ĚŽŝŶŐ ƚŚŝŶŐƐ͘

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Our locations offer access to outstanding schools, exciting recreational opportunities and a wide variety of cultural events. Our physicians utilize leading edge technology, including EMR, and enjoy a collegial and supportive environment. We also offer a competitive compensation & benefits package which includes bonus potential and a very desirable retirement plan. health.org &OR MORE INFORMATION PLEASE CONTACT

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California Family Physician Summer 2014

/ ƐƵƉƉŽƐĞ ƚŚĂƚ ŵǇ 'ĞŶ y ƐĞůĨ ĨĂůůƐ ŝŶ ƚŚĞ ŵŝĚĚůĞ ŽĨ ƚŚĞ ŐĞŶĞƌĂƟŽŶƐ͘ / ŚĂǀĞ ďĞĞŶ ŽƵƚ ŽĨ ƌĞƐŝĚĞŶĐǇ ĨŽƌ ϭϯ ǇĞĂƌƐ ʹ ǁŚŝĐŚ ůŽŽŬƐ Ă ůŝƩůĞ ǁĞŝƌĚ ƚŽ ŵĞ ĂƐ / ƚǇƉĞ ŝƚ͘ / Ăŵ ŶŽ ůŽŶŐĞƌ ĂƐŬĞĚ ďǇ ŵǇ ƉĂƟĞŶƚƐ͕ ͞ ƌĞ ǇŽƵ ƐƵƌĞ ǇŽƵ͛ƌĞ ŽůĚ ĞŶŽƵŐŚ ƚŽ ďĞ Ă ĚŽĐƚŽƌ͍͟ / ŚĂǀĞ ĂĐƋƵŝƌĞĚ ŶŝĐĞ ƉĂƚĐŚĞƐ ŽĨ ĚŝƐƟŶŐƵŝƐŚĞĚ ŐƌĂǇ ŚĂŝƌ Ăƚ ƚŚĞ ƚĞŵƉůĞƐ ʹ ƉĂƚĐŚĞƐ ǁŚŝĐŚ ĂƌĞ ƐƉƌĞĂĚŝŶŐ ĂůĂƌŵŝŶŐůǇ͘ ŶĚ ǇĞƐ͕ / ŚĂǀĞ ƐĞĞŶ ŵĞĚŝĐŝŶĞ ĞǀŽůǀĞ ĚƵƌŝŶŐ ƚŚŽƐĞ ϭϯ ǇĞĂƌƐ͘ / ƐƚĂƌƚĞĚ ǁŝƚŚ Ă ŚǇďƌŝĚ ĐŚĂƌƚ ŝŶ ŵǇ ĮƌƐƚ ǇĞĂƌƐ ʹ ǁĞ ŚĂĚ ĐŽŵƉƵƚĞƌƐ ǁŝƚŚ ĂŶ ĞĂƌůǇ ǀĞƌƐŝŽŶ ŽĨ W/ ͕ ďƵƚ ĂůƐŽ ƉĂƉĞƌ ĐŚĂƌƚƐ͕ ǁŚŝĐŚ / ĚŽ ŶŽƚ ŵŝƐƐ͘ dŚĞ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ͕ ǁĞ Ăůů ŶĞĞĚ ƚŽ ĂĚŵŝƚ͕ ŝƐ ŚŝŐŚĞƌ ƋƵĂůŝƚǇ ĐŚĂƌƟŶŐ ƚŚĂŶ ƚŚĞ ƉĂƉĞƌ ĐŚĂƌƚ͘ dŚŽƐĞ ĂŶŶŽǇŝŶŐ ƌĞŵŝŶĚĞƌƐ ĂŶĚ ,ĞĂůƚŚ ĂƌĞ DĂŝŶƚĞŶĂŶĐĞ ŇĂŐƐ ĂŶĚ ĂůůĞƌŐǇ ŝŶƚĞƌĂĐƟŽŶ ƉŽƉƵƉƐ ĂƌĞ ďĞƩĞƌ ƚŚĂŶ ũƵƐƚ ƌĞůǇŝŶŐ ŽŶ ŽƵƌ ŽǀĞƌƚĂǆĞĚ͕ ƌƵƐŚĞĚ ďƌĂŝŶƐ ͲͲ ƉŽǁĞƌĨƵů ďƌĂŝŶƐ ƚŚŽƵŐŚ ƚŚĞǇ ŵĂǇ ďĞ͘

tŚŝůĞ ŵĂŶǇ ĚŽĐƐ ƉƵƐŚ ďĂĐŬ ĂŐĂŝŶƐƚ ƚŚŝƐ ƟĚĞ͕ / ŚĂǀĞ ĞŵďƌĂĐĞĚ ŝƚ͘ / Ăŵ ƚŚĞ >ĞĂĚ ůŝŶŝĐŝĂŶ ŽŵŵƵŶŝĐĂƟŽŶ ŽĂĐŚ ĨŽƌ ŵǇ ŵĞĚŝĐĂů ŐƌŽƵƉ͘ dŚŝƐ ǁŽƌŬ ŚĂƐ ĐŚĂŶŐĞĚ ŵǇ ƉĞƌƐƉĞĐƟǀĞ ĐŽŵƉůĞƚĞůǇ ĂŶĚ ƚƌĂŶƐĨŽƌŵĞĚ ŵǇ ƉƌĂĐƟĐĞ ŽĨ ŵĞĚŝĐŝŶĞ͘ / ĨŽĐƵƐ ůĞƐƐ ŽŶ ƚŚĞ ŶĞŐĂƟǀĞƐ ŽĨ ŵǇ ĚĂǇ ĂŶĚ ŵŽƌĞ ŽŶ ƚŚĞ ƉŽƐŝƟǀĞƐ ĂŶĚ ŵĂŬŝŶŐ ƚŚŝŶŐƐ ďĞƩĞƌ ĨŽƌ ŵǇ ƉĂƟĞŶƚƐ ĂŶĚ ŚĞůƉŝŶŐ ŵǇ ĐŽůůĞĂŐƵĞƐ ƚŽ ĚŽ ƚŚĞ ƐĂŵĞ͘ ;DĂŶǇ ŽĨ ŵǇ ͞ŽůĚĞƌ͟ ĐŽůůĞĂŐƵĞƐ ŵĂǇ ƐŶŝĐŬĞƌ Ăƚ ƚŚŝƐ ͞ĚŝƐĐŽǀĞƌǇ͟ ʹ ƌĞĂůůǇ Ă Z ͲĚŝƐĐŽǀĞƌǇ ʹ ŽĨ ƚŚĞ ĐĞŶƚƌĂů ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƉĂƟĞŶƚƐ ŝŶ ŽƵƌ ŵĞĚŝĐĂů ƉƌĂĐƟĐĞ͘Ϳ Ƶƚ / ƚŚŝŶŬ ĨŽƌ ŵĞ ƚŚĞ ďŝŐŐĞƐƚ ĐŚĂŶŐĞƐ ŝŶ ŵǇ ŵĞĚŝĐĂů ƉƌĂĐƚŝĐĞ ĂƌĞ EKd ƌĞůĂƚĞĚ ƚŽ ƚŚĞ ͞ďŝŐ͟ ĐŚĂŶŐĞƐ ʹĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ͕ ƉĂƚŝĞŶƚ ƐĂƚŝƐĨĂĐƚŝŽŶ͕ ƚŚĞ ĨĨŽƌĚĂďůĞ ĂƌĞ Đƚ͕ ĞƚĐ͘ dŚĞǇ ĂƌĞ ƚŚŝŶŐƐ ƚŚĂƚ ŚĂǀĞ ĐŚĂŶŐĞĚ ŝŶ ŵĞ͘ / Ăŵ ŶŽƚ ƚŚĞ ƐĂŵĞ ĐŽŶĮĚĞŶƚͲďŽƌĚĞƌŝŶŐͲŽŶͲĐŽĐŬǇ ǇŽƵŶŐ ŚŽƚƐŚŽƚ ƚŚĂƚ / ǁĂƐ ǁŚĞŶ / ƐƚĂƌƚĞĚ͘ DǇ ŵŝƐƐƚĞƉƐ ĂŶĚ ŵŝƐƚĂŬĞƐ ŚĂǀĞ ďƌŽƵŐŚƚ ŵĞ Ă ŶĞĞĚĞĚ ƐĞƌǀŝŶŐ ŽĨ ŚƵŵďůĞ ƉŝĞ͘ DǇ ŽǁŶ ĨĂŝůƵƌĞƐ ĂƐ Ă ƉŚǇƐŝĐŝĂŶ ĂŶĚ Ă ƉĞƌƐŽŶ ŚĂǀĞ ŵĂĚĞ ŵĞ ŵŽƌĞ ĞŵƉĂƚŚĞƟĐ ĂŶĚ ƐǇŵƉĂƚŚĞƟĐ ƚŽ ŵǇ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞŝƌ ƐƚƌƵŐŐůĞƐ͘ ^ŝŶĐĞ ĮŶŝƐŚŝŶŐ ƌĞƐŝĚĞŶĐǇ͕ / ŚĂǀĞ ďĞĐŽŵĞ Ă ĨĂƚŚĞƌ͕ Ă ŚŽŵĞŽǁŶĞƌ͕ Ă ŵŽƌĞ ĨƌĞƋƵĞŶƚ ;͊Ϳ ƉĂƟĞŶƚ ʹ / Ăŵ ƚǇƉŝŶŐ ƚŚŝƐ ŝŶ ƚŚĞ ĞǇĞ ĚŽĐƚŽƌ͛Ɛ ŽĸĐĞ ĂƐ / ĂĚŵŝƚ ƚŚĂƚ ŵǇ ƐƋƵŝŶƟŶŐ ĂŶĚ ͞ŵĂŶĂŐĞŵĞŶƚ ďǇ ĚĞŶŝĂů͟ ĂƌĞ ŶŽ ůŽŶŐĞƌ ĐƵƫŶŐ ŝƚ ĂƐ / ƐƚƌƵŐŐůĞ ƚŽ ƌĞĂĚ ƌŽĂĚ ƐŝŐŶƐ ĂŶĚ ƉŝĐŬ ŽƵƚ ŵǇ ƐŽŶƐ ŽŶ ƚŚĞ ƐŽĐĐĞƌ ĮĞůĚ͘

ŶŽƚŚĞƌ ĐŚĂŶŐĞ / ŚĂǀĞ ŶŽƟĐĞĚ ŝƐ ĂŶ ŝŶĐƌĞĂƐĞĚ ĂǁĂƌĞŶĞƐƐ ŽĨ ǁĞůůŶĞƐƐ ĂŶĚ ƐĞƫŶŐ ůŝŵŝƚƐ ĨŽƌ ŽƵƌƐĞůǀĞƐ ʹ / ŬŶŽǁ ƌĞůĂƟǀĞůǇ ĨĞǁ ĐŽůůĞĂŐƵĞƐ ŵǇ ĂŐĞ ǁŚŽ ĂƌĞ ĨƵůůͲƟŵĞ͕ Ă ƚƌĞŶĚ ƚŚĂƚ ƉƌŽďĂďůǇ ĂŐŐƌĂǀĂƚĞƐ ĂĚŵŝŶŝƐƚƌĂƚŽƌƐ ĂŶĚ ƐŽŵĞ ŽĨ ŵǇ ͞ŽůĚĞƌ ŐĞŶĞƌĂƟŽŶ͟ ĐŽůůĞĂŐƵĞƐ͘

/ ŐƵĞƐƐ ƚŚĞƌĞ ŝƐ ƌĞĂůůǇ ŶŽƚŚŝŶŐ ŶĞǁ ŚĞƌĞ ʹ ǁĞ Ăůů ŐƌŽǁ ŽůĚĞƌ͕ ƐƚŽƉ ďĞŝŶŐ ƚŚĞ ŶĞǁ ĚŽĐƚŽƌ ŽŶ ƚŚĞ ďůŽĐŬ ĂŶĚ ĮŐƵƌĞ ƚŚŝŶŐƐ ŽƵƚ ŝŶ ǁĂǇƐ ƚŚĂƚ ƚŚĞǇ ĚŽŶ͛ƚ ƚĞĂĐŚ ǇŽƵ ŝŶ ƌĞƐŝĚĞŶĐǇ͘ /ƚ͛Ɛ ĐŽŵĨŽƌƟŶŐ ƚŽ ŵĞ ƚŽ ƌĞĐŽŐŶŝǌĞ ƚŚĂƚ ƚŚŝƐ͕ Ăƚ ůĞĂƐƚ͕ ǁŝůů ŶŽƚ ĐŚĂŶŐĞ͕ ĚĞƐƉŝƚĞ ŽƚŚĞƌ ƚĞĐƚŽŶŝĐ ƐŚŝŌƐ ŝŶ ŵĞĚŝĐŝŶĞ͘

KŶ ƚŚĞ ƉĂƟĞŶƚ ƐŝĚĞ͕ ǁĞ ƐĞĞ ĂŶ ŝŶĐƌĞĂƐĞĚ ĨŽĐƵƐ ŽŶ ŚŽǁ ƉĂƟĞŶƚƐ ĞǆƉĞƌŝĞŶĐĞ ŽƵƌ ĐĂƌĞ͘ dŚŝƐ ŝƐ ŵĂŶŝĨĞƐƚĞĚ ŝŶ ŵƵůƟƉůĞ ǁĂǇƐ͗ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ ĚĂƚĂ͕ ĨŽůůŽǁͲƵƉ ĐĂůůƐ͕ ƐƵƌǀĞǇƐ͘

P.T. Koenig, MD is a family physician in Dixon, and also serves as the Lead Clinician Communication Coach for Sutter Medical Group.

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California Family Physician Summer 2014 21

A change with powerful, long-lasting beneﬁts

Reductions up to -1.1%a

Weight loss up to 5.5 lba,b

Low rate of hypoglycemiac

1.8 mg dose when used alone for 52 weeks. Victoza® is not indicated for the management of obesity. Weight change was a secondary end point in clinical trials. In the 8 clinical trials of at least 26 weeks’ duration, hypoglycemia requiring the assistance of another person for treatment occurred in 11 Victoza®-treated patients.

b c

A 52-week, double-blind, double-dummy, active-controlled, parallel-group, multicenter study. Patients with type 2 diabetes (N=745) were randomized to receive once-daily Victoza® 1.2 mg (n=251), Victoza® 1.8 mg (n=246), or glimepiride 8 mg (n=248). The primary outcome was change in A1C after 52 weeks.

The change begins at VictozaPro.com. Indications and Usage

Victoza® (liraglutide [rDNA origin] injection) is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza® only to patients for whom the potential benefits are considered to outweigh the potential risk. Victoza® is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise. Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been observed in patients treated with Victoza®. Victoza® has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using Victoza®. Other antidiabetic therapies should be considered in patients with a history of pancreatitis. Victoza® is not a substitute for insulin. Victoza® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. Victoza® has not been studied in combination with prandial insulin.

Important Safety Information

Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be ruled out by clinical or nonclinical studies. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Based on the ﬁndings in rodents, monitoring with serum calcitonin or thyroid ultrasound was performed during clinical trials, but this may have increased the number of unnecessary thyroid surgeries. It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate human risk of thyroid C-cell tumors. Patients should be counseled regarding the risk and symptoms of thyroid tumors. Do not use in patients with a prior serious hypersensitivity reaction to Victoza® or to any of the product components. Postmarketing reports, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. Discontinue promptly if pancreatitis is suspected. Do not restart if Victoza® is a registered trademark of Novo Nordisk A/S. © 2013 Novo Nordisk All rights reserved.

California Family Physician Summer 2014

pancreatitis is confirmed. Consider other antidiabetic therapies in patients with a history of pancreatitis. When Victoza® is used with an insulin secretagogue (e.g. a sulfonylurea) or insulin serious hypoglycemia can occur. Consider lowering the dose of the insulin secretagogue or insulin to reduce the risk of hypoglycemia. Renal impairment has been reported postmarketing, usually in association with nausea, vomiting, diarrhea, or dehydration which may sometimes require hemodialysis. Use caution when initiating or escalating doses of Victoza® in patients with renal impairment. Serious hypersensitivity reactions (e.g. anaphylaxis and angioedema) have been reported during postmarketing use of Victoza®. If symptoms of hypersensitivity reactions occur, patients must stop taking Victoza® and seek medical advice promptly. There have been no studies establishing conclusive evidence of macrovascular risk reduction with Victoza® or any other antidiabetic drug. The most common adverse reactions, reported in ≥5% of patients treated with Victoza® and more commonly than in patients treated with placebo, are headache, nausea, diarrhea, dyspepsia, constipation and anti-liraglutide antibody formation. Immunogenicity-related events, including urticaria, were more common among Victoza®-treated patients (0.8%) than among comparator-treated patients (0.4%) in clinical trials. Victoza® has not been studied in type 2 diabetes patients below 18 years of age and is not recommended for use in pediatric patients. There is limited data in patients with renal or hepatic impairment. In a 52-week monotherapy study (n=745) with a 52-week extension, the adverse reactions reported in ≥ 5% of patients treated with Victoza® 1.8 mg, Victoza® 1.2 mg, or glimepiride were constipation (11.8%, 8.4%, and 4.8%), diarrhea (19.5%, 17.5%, and 9.3%), flatulence (5.3%, 1.6%, and 2.0%), nausea (30.5%, 28.7%, and 8.5%), vomiting (10.2%, 13.1%, and 4.0%), fatigue (5.3%, 3.2%, and 3.6%), bronchitis (3.7%, 6.0%, and 4.4%), influenza (11.0%, 9.2%, and 8.5%), nasopharyngitis (6.5%, 9.2%, and 7.3%), sinusitis (7.3%, 8.4%, and 7.3%), upper respiratory tract infection (13.4%, 14.3%, and 8.9%), urinary tract infection (6.1%, 10.4%, and 5.2%), arthralgia (2.4%, 4.4%, and 6.0%), back pain (7.3%, 7.2%, and 6.9%), pain in extremity (6.1%, 3.6%, and 3.2%), dizziness (7.7%, 5.2%, and 5.2%), headache (7.3%, 11.2%, and 9.3%), depression (5.7%, 3.2%, and 2.0%), cough (5.7%, 2.0%, and 4.4%), and hypertension (4.5%, 5.6%, and 6.9%). Please see brief summary of Prescribing Information on adjacent page.

1013-00018302-1

November 2013

Victoza® (liraglutide [rDNA origin] injection) Rx Only BRIEF SUMMARY. Please consult package insert for full prescribing information. WARNING: RISK OF THYROID C-CELL TUMORS: Liraglutide causes dose-dependent and treatmentduration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be ruled out by clinical or nonclinical studies. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Based on the findings in rodents, monitoring with serum calcitonin or thyroid ultrasound was performed during clinical trials, but this may have increased the number of unnecessary thyroid surgeries. It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate human risk of thyroid C-cell tumors. Patients should be counseled regarding the risk and symptoms of thyroid tumors [see Contraindications and Warnings and Precautions]. INDICATIONS AND USAGE: Victoza® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Important Limitations of Use: Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza® only to patients for whom the potential benefits are considered to outweigh the potential risk. Victoza® is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise. Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been observed in patients treated with Victoza®. Victoza® has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using Victoza®. Other antidiabetic therapies should be considered in patients with a history of pancreatitis. Victoza® is not a substitute for insulin. Victoza® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. The concurrent use of Victoza® and prandial insulin has not been studied. CONTRAINDICATIONS: Do not use in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use in patients with a prior serious hypersensitivity reaction to Victoza® or to any of the product components. WARNINGS AND PRECAUTIONS: Risk of Thyroid C-cell Tumors: Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors (adenomas and/or carcinomas) at clinically relevant exposures in both genders of rats and mice. Malignant thyroid C-cell carcinomas were detected in rats and mice. A statistically significant increase in cancer was observed in rats receiving liraglutide at 8-times clinical exposure compared to controls. It is unknown whether Victoza® will cause thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors could not be determined by clinical or nonclinical studies. In the clinical trials, there have been 6 reported cases of thyroid C-cell hyperplasia among Victoza®-treated patients and 2 cases in comparator-treated patients (1.3 vs. 1.0 cases per 1000 patient-years). One comparator-treated patient with MTC had pre-treatment serum calcitonin concentrations >1000 ng/L suggesting pre-existing disease. All of these cases were diagnosed after thyroidectomy, which was prompted by abnormal results on routine, protocol-specified measurements of serum calcitonin. Five of the six Victoza®-treated patients had elevated calcitonin concentrations at baseline and throughout the trial. One Victoza® and one non-Victoza®-treated patient developed elevated calcitonin concentrations while on treatment. Calcitonin, a biological marker of MTC, was measured throughout the clinical development program. The serum calcitonin assay used in the Victoza® clinical trials had a lower limit of quantification (LLOQ) of 0.7 ng/L and the upper limit of the reference range was 5.0 ng/L for women and 8.4 ng/L for men. At Weeks 26 and 52 in the clinical trials, adjusted mean serum calcitonin concentrations were higher in Victoza®-treated patients compared to placebo-treated patients but not compared to patients receiving active comparator. At these timepoints, the adjusted mean serum calcitonin values (~1.0 ng/L) were just above the LLOQ with between-group differences in adjusted mean serum calcitonin values of approximately 0.1 ng/L or less. Among patients with pre-treatment serum calcitonin below the upper limit of the reference range, shifts to above the upper limit of the reference range which persisted in subsequent measurements occurred most frequently among patients treated with Victoza® 1.8 mg/day. In trials with on-treatment serum calcitonin measurements out to 5-6 months, 1.9% of patients treated with Victoza® 1.8 mg/day developed new and persistent calcitonin elevations above the upper limit of the reference range compared to 0.8-1.1% of patients treated with control medication or the 0.6 and 1.2 mg doses of Victoza®. In trials with on-treatment serum calcitonin measurements out to 12 months, 1.3% of patients treated with Victoza® 1.8 mg/day had new and persistent elevations of calcitonin from below or within the reference range to above the upper limit of the reference range, compared to 0.6%, 0% and 1.0% of patients treated with Victoza® 1.2 mg, placebo and active control, respectively. Otherwise, Victoza® did not produce consistent dose-dependent or time-dependent increases in serum calcitonin. Patients with MTC usually have calcitonin values >50 ng/L. In Victoza® clinical trials, among patients with pre-treatment serum calcitonin <50 ng/L, one Victoza®-treated patient and no comparator-treated patients developed serum calcitonin >50 ng/L. The Victoza®-treated patient who developed serum calcitonin >50 ng/L had an elevated pre-treatment serum calcitonin of 10.7 ng/L that increased to 30.7 ng/L at Week 12 and 53.5 ng/L at the end of the 6-month trial. Follow-up serum calcitonin was 22.3 ng/L more than 2.5 years after the last dose of Victoza®. The largest increase in serum calcitonin in a comparator-treated patient was seen with glimepiride in a patient whose serum calcitonin increased from 19.3 ng/L at baseline to 44.8 ng/L at Week 65 and 38.1 ng/L at Week 104. Among patients who began with serum calcitonin <20 ng/L, calcitonin elevations to >20 ng/L occurred in 0.7% of Victoza®-treated patients, 0.3% of placebo-treated patients, and 0.5% of active-comparator-treated patients, with an incidence of 1.1% among patients treated with 1.8 mg/day of Victoza®. The clinical significance of these findings is unknown. Counsel patients regarding the risk for MTC and the symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea or persistent hoarseness). It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate the potential risk of MTC, and such monitoring may increase the risk of unnecessary procedures, due to low test specificity for serum calcitonin and a high background incidence of thyroid disease. Patients with thyroid nodules noted on physical examination or neck imaging obtained for other reasons should be referred to an endocrinologist for further evaluation. Although routine monitoring of serum calcitonin is of uncertain value in patients treated with Victoza®, if serum calcitonin is measured and found to be elevated, the patient should be referred to an endocrinologist for further evaluation. Pancreatitis: Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with Victoza®. After initiation of Victoza®, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting). If pancreatitis is suspected, Victoza® should promptly be discontinued and appropriate management should be initiated. If pancreatitis is confirmed, Victoza® should not be restarted. Consider antidiabetic therapies other than Victoza® in patients with a history of pancreatitis. In clinical trials of Victoza®, there have been 13 cases of pancreatitis among Victoza®-treated patients and 1 case in a comparator (glimepiride) treated patient (2.7 vs. 0.5 cases per 1000 patient-years). Nine of the 13 cases with Victoza® were reported as acute pancreatitis and four were reported as chronic pancreatitis. In one case in a Victoza®-treated patient, pancreatitis, with necrosis, was observed and led to death; however clinical causal-

ity could not be established. Some patients had other risk factors for pancreatitis, such as a history of cholelithiasis or alcohol abuse. Use with Medications Known to Cause Hypoglycemia: Patients receiving Victoza® in combination with an insulin secretagogue (e.g., sulfonylurea) or insulin may have an increased risk of hypoglycemia. The risk of hypoglycemia may be lowered by a reduction in the dose of sulfonylurea (or other concomitantly administered insulin secretagogues) or insulin Renal Impairment: Victoza® has not been found to be directly nephrotoxic in animal studies or clinical trials. There have been postmarketing reports of acute renal failure and worsening of chronic renal failure, which may sometimes require hemodialysis in Victoza®-treated patients. Some of these events were reported in patients without known underlying renal disease. A majority of the reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Some of the reported events occurred in patients receiving one or more medications known to affect renal function or hydration status. Altered renal function has been reversed in many of the reported cases with supportive treatment and discontinuation of potentially causative agents, including Victoza®. Use caution when initiating or escalating doses of Victoza® in patients with renal impairment. Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (e.g., anaphylactic reactions and angioedema) in patients treated with Victoza®. If a hypersensitivity reaction occurs, the patient should discontinue Victoza® and other suspect medications and promptly seek medical advice. Angioedema has also been reported with other GLP-1 receptor agonists. Use caution in a patient with a history of angioedema with another GLP-1 receptor agonist because it is unknown whether such patients will be predisposed to angioedema with Victoza®. Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Victoza® or any other antidiabetic drug. ADVERSE REACTIONS: Clinical Trials Experience: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety of Victoza® has been evaluated in 8 clinical trials: A double-blind 52-week monotherapy trial compared Victoza® 1.2 mg daily, Victoza® 1.8 mg daily, and glimepiride 8 mg daily; A double-blind 26 week add-on to metformin trial compared Victoza® 0.6 mg once-daily, Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, placebo, and glimepiride 4 mg once-daily; A double-blind 26 week add-on to glimepiride trial compared Victoza® 0.6 mg daily, Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, placebo, and rosiglitazone 4 mg once-daily; A 26 week add-on to metformin + glimepiride trial, compared double-blind Victoza® 1.8 mg once-daily, double-blind placebo, and open-label insulin glargine once-daily; A doubleblind 26-week add-on to metformin + rosiglitazone trial compared Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily and placebo; An open-label 26-week add-on to metformin and/or sulfonylurea trial compared Victoza® 1.8 mg once-daily and exenatide 10 mcg twice-daily; An open-label 26-week add-on to metformin trial compared Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, and sitagliptin 100 mg once-daily; An open-label 26-week trial compared insulin detemir as add-on to Victoza® 1.8 mg + metformin to continued treatment with Victoza® + metformin alone. Withdrawals: The incidence of withdrawal due to adverse events was 7.8% for Victoza®-treated patients and 3.4% for comparator-treated patients in the five double-blind controlled trials of 26 weeks duration or longer. This difference was driven by withdrawals due to gastrointestinal adverse reactions, which occurred in 5.0% of Victoza®-treated patients and 0.5% of comparator-treated patients. In these five trials, the most common adverse reactions leading to withdrawal for Victoza®-treated patients were nausea (2.8% versus 0% for comparator) and vomiting (1.5% versus 0.1% for comparator). Withdrawal due to gastrointestinal adverse events mainly occurred during the first 2-3 months of the trials. Common adverse reactions: Tables 1, 2, 3 and 4 summarize common adverse reactions (hypoglycemia is discussed separately) reported in seven of the eight controlled trials of 26 weeks duration or longer. Most of these adverse reactions were gastrointestinal in nature. In the five double-blind clinical trials of 26 weeks duration or longer, gastrointestinal adverse reactions were reported in 41% of Victoza®-treated patients and were dose-related. Gastrointestinal adverse reactions occurred in 17% of comparator-treated patients. Common adverse reactions that occurred at a higher incidence among Victoza®-treated patients included nausea, vomiting, diarrhea, dyspepsia and constipation. In the five double-blind and three open-label clinical trials of 26 weeks duration or longer, the percentage of patients who reported nausea declined over time. In the five double-blind trials approximately 13% of Victoza®-treated patients and 2% of comparator-treated patients reported nausea during the first 2 weeks of treatment. In the 26-week open-label trial comparing Victoza® to exenatide, both in combination with metformin and/or sulfonylurea, gastrointestinal adverse reactions were reported at a similar incidence in the Victoza® and exenatide treatment groups (Table 3). In the 26-week open-label trial comparing Victoza® 1.2 mg, Victoza® 1.8 mg and sitagliptin 100 mg, all in combination with metformin, gastrointestinal adverse reactions were reported at a higher incidence with Victoza® than sitagliptin (Table 4). In the remaining 26-week trial, all patients received Victoza® 1.8 mg + metformin during a 12-week run-in period. During the run-in period, 167 patients (17% of enrolled total) withdrew from the trial: 76 (46% of withdrawals) of these patients doing so because of gastrointestinal adverse reactions and 15 (9% of withdrawals) doing so due to other adverse events. Only those patients who completed the run-in period with inadequate glycemic control were randomized to 26 weeks of add-on therapy with insulin detemir or continued, unchanged treatment with Victoza® 1.8 mg + metformin. During this randomized 26-week period, diarrhea was the only adverse reaction reported in ≥5% of patients treated with Victoza® 1.8 mg + metformin + insulin detemir (11.7%) and greater than in patients treated with Victoza® 1.8 mg and metformin alone (6.9%). Table 1: Adverse reactions reported in ≥5% of Victoza®-treated patients in a 52-week monotherapy trial All Victoza® N = 497 Glimepiride N = 248 (%) (%) Adverse Reaction Nausea 28.4 8.5 Diarrhea 17.1 8.9 Vomiting 10.9 3.6 Constipation 9.9 4.8 Headache 9.1 9.3 Table 2: Adverse reactions reported in ≥5% of Victoza®-treated patients and occurring more frequently with Victoza® compared to placebo: 26-week combination therapy trials Add-on to Metformin Trial All Victoza® + Metformin Placebo + Metformin Glimepiride + Metformin N = 724 N = 121 N = 242 (%) (%) (%) Adverse Reaction Nausea 15.2 4.1 3.3 Diarrhea 10.9 4.1 3.7 Headache 9.0 6.6 9.5 Vomiting 6.5 0.8 0.4 Add-on to Glimepiride Trial All Victoza® + Placebo + Glimepiride Rosiglitazone + Glimepiride N = 695 N = 114 Glimepiride N = 231 (%) (%) (%) Adverse Reaction Nausea 7.5 1.8 2.6 Diarrhea 7.2 1.8 2.2 California Family Physician Summer 2014 23

Constipation Dyspepsia

5.3 0.9 1.7 5.2 0.9 2.6 Add-on to Metformin + Glimepiride Victoza® 1.8 + Metformin Placebo + Metformin + Glargine + Metformin + + Glimepiride N = 230 Glimepiride N = 114 Glimepiride N = 232 (%) (%) (%) Adverse Reaction Nausea 13.9 3.5 1.3 Diarrhea 10.0 5.3 1.3 Headache 9.6 7.9 5.6 Dyspepsia 6.5 0.9 1.7 Vomiting 6.5 3.5 0.4 Add-on to Metformin + Rosiglitazone ® Placebo + Metformin + Rosiglitazone All Victoza + Metformin + Rosiglitazone N = 355 N = 175 (%) (%) Adverse Reaction Nausea 34.6 8.6 Diarrhea 14.1 6.3 Vomiting 12.4 2.9 Headache 8.2 4.6 Constipation 5.1 1.1 Table 3: Adverse Reactions reported in ≥5% of Victoza®-treated patients in a 26-Week Open-Label Trial versus Exenatide Victoza® 1.8 mg once daily + Exenatide 10 mcg twice daily + metformin and/or sulfonylurea metformin and/or sulfonylurea N = 235 N = 232 (%) (%) Adverse Reaction Nausea 25.5 28.0 Diarrhea 12.3 12.1 Headache 8.9 10.3 Dyspepsia 8.9 4.7 Vomiting 6.0 9.9 Constipation 5.1 2.6 Table 4: Adverse Reactions in ≥5% of Victoza®-treated patients in a 26-Week Open-Label Trial versus Sitagliptin All Victoza® + metformin Sitagliptin 100 mg/day + N = 439 metformin N = 219 (%) (%) Adverse Reaction Nausea 23.9 4.6 Headache 10.3 10.0 Diarrhea 9.3 4.6 Vomiting 8.7 4.1 Immunogenicity: Consistent with the potentially immunogenic properties of protein and peptide pharmaceuticals, patients treated with Victoza® may develop anti-liraglutide antibodies. Approximately 50-70% of Victoza®-treated patients in the five double-blind clinical trials of 26 weeks duration or longer were tested for the presence of anti-liraglutide antibodies at the end of treatment. Low titers (concentrations not requiring dilution of serum) of anti-liraglutide antibodies were detected in 8.6% of these Victoza®-treated patients. Sampling was not performed uniformly across all patients in the clinical trials, and this may have resulted in an underestimate of the actual percentage of patients who developed antibodies. Cross-reacting antiliraglutide antibodies to native glucagon-like peptide-1 (GLP-1) occurred in 6.9% of the Victoza®-treated patients in the double-blind 52-week monotherapy trial and in 4.8% of the Victoza®-treated patients in the double-blind 26-week add-on combination therapy trials. These cross-reacting antibodies were not tested for neutralizing effect against native GLP-1, and thus the potential for clinically significant neutralization of native GLP-1 was not assessed. Antibodies that had a neutralizing effect on liraglutide in an in vitro assay occurred in 2.3% of the Victoza®-treated patients in the double-blind 52-week monotherapy trial and in 1.0% of the Victoza®-treated patients in the double-blind 26-week add-on combination therapy trials. Among Victoza®-treated patients who developed anti-liraglutide antibodies, the most common category of adverse events was that of infections, which occurred among 40% of these patients compared to 36%, 34% and 35% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. The specific infections which occurred with greater frequency among Victoza®-treated antibody-positive patients were primarily nonserious upper respiratory tract infections, which occurred among 11% of Victoza®-treated antibody-positive patients; and among 7%, 7% and 5% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. Among Victoza®-treated antibody-negative patients, the most common category of adverse events was that of gastrointestinal events, which occurred in 43%, 18% and 19% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. Antibody formation was not associated with reduced efficacy of Victoza® when comparing mean HbA1c of all antibody-positive and all antibody-negative patients. However, the 3 patients with the highest titers of anti-liraglutide antibodies had no reduction in HbA1c with Victoza® treatment. In the five double-blind clinical trials of Victoza®, events from a composite of adverse events potentially related to immunogenicity (e.g. urticaria, angioedema) occurred among 0.8% of Victoza®-treated patients and among 0.4% of comparator-treated patients. Urticaria accounted for approximately one-half of the events in this composite for Victoza®-treated patients. Patients who developed anti-liraglutide antibodies were not more likely to develop events from the immunogenicity events composite than were patients who did not develop anti-liraglutide antibodies. Injection site reactions: Injection site reactions (e.g., injection site rash, erythema) were reported in approximately 2% of Victoza®-treated patients in the five double-blind clinical trials of at least 26 weeks duration. Less than 0.2% of Victoza®-treated patients discontinued due to injection site reactions. Papillary thyroid carcinoma: In clinical trials of Victoza®, there were 7 reported cases of papillary thyroid carcinoma in patients treated with Victoza® and 1 case in a comparator-treated patient (1.5 vs. 0.5 cases per 1000 patient-years). Most of these papillary thyroid carcinomas were <1 cm in greatest diameter and were diagnosed in surgical pathology specimens after thyroidectomy prompted by findings on protocol-specified screening with serum calcitonin or thyroid ultrasound. Hypoglycemia: In the eight clinical trials of at least 26 weeks duration, hypoglycemia requiring the assistance of another person for treatment occurred in 11 Victoza®-treated patients (2.3 cases per 1000 patient-years) and in two exenatidetreated patients. Of these 11 Victoza®-treated patients, six patients were concomitantly using metformin and a sulfonylurea, one was concomitantly using a sulfonylurea, two were concomitantly using metformin (blood glucose values were 65 and 94 mg/dL) and two were using Victoza® as monotherapy (one of these patients was undergoing an intravenous glucose tolerance test and the other was receiving insulin as treatment during a hospital stay). For these two patients on Victoza® monotherapy, the insulin treatment was the likely explanation for the hypoglycemia. In the 26-week open-label trial comparing Victoza® to sitagliptin,

California Family Physician Summer 2014

the incidence of hypoglycemic events defined as symptoms accompanied by a fingerstick glucose <56 mg/ dL was comparable among the treatment groups (approximately 5%). Table 5: Incidence (%) and Rate (episodes/patient year) of Hypoglycemia in the 52-Week Monotherapy Trial and in the 26-Week Combination Therapy Trials Victoza® Treatment Active Comparator Placebo Comparator Monotherapy Victoza® (N = 497) Glimepiride (N = 248) None Patient not able to 0 0 — self−treat Patient able to self−treat 9.7 (0.24) 25.0 (1.66) — Not classified 1.2 (0.03) 2.4 (0.04) — Glimepiride + Placebo + Metformin Add-on to Metformin Victoza® + Metformin (N = 724) Metformin (N = 121) (N = 242) Patient not able to 0.1 (0.001) 0 0 self−treat Patient able to self−treat 3.6 (0.05) 22.3 (0.87) 2.5 (0.06) Continued Victoza® None Insulin detemir + Add-on to Victoza® + Metformin Victoza® + Metformin + Metformin alone (N = 163) (N = 158*) Patient not able to 0 0 — self−treat Patient able to self−treat 9.2 (0.29) 1.3 (0.03) — Add-on to Victoza® + Glimepiride Rosiglitazone + Placebo + Glimepiride (N = 695) Glimepiride (N = 231) (N = 114) Glimepiride Patient not able to 0.1 (0.003) 0 0 self−treat Patient able to self−treat 7.5 (0.38) 4.3 (0.12) 2.6 (0.17) Not classified 0.9 (0.05) 0.9 (0.02) 0 Placebo + Metformin Add-on to Metformin Victoza® + Metformin None + Rosiglitazone + Rosiglitazone + Rosiglitazone (N = 175) (N = 355) Patient not able to 0 — 0 self−treat Patient able to self−treat 7.9 (0.49) — 4.6 (0.15) Not classified 0.6 (0.01) — 1.1 (0.03) Placebo + Metformin Insulin glargine Add-on to Metformin Victoza® + Metformin + Glimepiride + Metformin + + Glimepiride + Glimepiride (N = 114) Glimepiride (N = 232) (N = 230) Patient not able to 2.2 (0.06) 0 0 self−treat Patient able to self−treat 27.4 (1.16) 28.9 (1.29) 16.7 (0.95) Not classified 0 1.7 (0.04) 0 *One patient is an outlier and was excluded due to 25 hypoglycemic episodes that the patient was able to self-treat. This patient had a history of frequent hypoglycemia prior to the study. In a pooled analysis of clinical trials, the incidence rate (per 1,000 patient-years) for malignant neoplasms (based on investigator-reported events, medical history, pathology reports, and surgical reports from both blinded and open-label study periods) was 10.9 for Victoza®, 6.3 for placebo, and 7.2 for active comparator. After excluding papillary thyroid carcinoma events [see Adverse Reactions], no particular cancer cell type predominated. Seven malignant neoplasm events were reported beyond 1 year of exposure to study medication, six events among Victoza®-treated patients (4 colon, 1 prostate and 1 nasopharyngeal), no events with placebo and one event with active comparator (colon). Causality has not been established. Laboratory Tests: In the five clinical trials of at least 26 weeks duration, mildly elevated serum bilirubin concentrations (elevations to no more than twice the upper limit of the reference range) occurred in 4.0% of Victoza®treated patients, 2.1% of placebo-treated patients and 3.5% of active-comparator-treated patients. This finding was not accompanied by abnormalities in other liver tests. The significance of this isolated finding is unknown. Vital signs: Victoza® did not have adverse effects on blood pressure. Mean increases from baseline in heart rate of 2 to 3 beats per minute have been observed with Victoza® compared to placebo. The long-term clinical effects of the increase in pulse rate have not been established. Post-Marketing Experience: The following additional adverse reactions have been reported during post-approval use of Victoza®. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure: Dehydration resulting from nausea, vomiting and diarrhea; Increased serum creatinine, acute renal failure or worsening of chronic renal failure, sometimes requiring hemodialysis; Angioedema and anaphylactic reactions; Allergic reactions: rash and pruritus; Acute pancreatitis, hemorrhagic and necrotizing pancreatitis sometimes resulting in death. OVERDOSAGE: Overdoses have been reported in clinical trials and post-marketing use of Victoza®. Effects have included severe nausea and severe vomiting. In the event of overdosage, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. More detailed information is available upon request. For information about Victoza® contact: Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ 08536, 1−877-484-2869 Date of Issue: April 16, 2013 Version: 6 Manufactured by: Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark Victoza® is covered by US Patent Nos. 6,268,343, 6,458,924, 7,235,627, 8,114,833 and other patents pending. Victoza® Pen is covered by US Patent Nos. 6,004,297, RE 43,834, RE 41,956 and other patents pending. © 2010-2013 Novo Nordisk 0513-00015681-1 5/2013

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Work Life Balance: Prioritizing Pebbles in a Glass Jar ZĞĂůŝŐŶŵĞŶƚ ĂŶĚ ƌĞũƵǀĞŶĂƟŽŶ ĚŽ ŶŽƚ ĐŽŵŵŽŶůǇ ĚĞƐĐƌŝďĞ ƚŚĞ ŝŵƉĂĐƚ ŽĨ Ă ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĐŽŶĨĞƌĞŶĐĞ͘ zĞƚ ƚŚĞƐĞ ĂƌĞ ƚǁŽ ǁŽƌĚƐ ƚŚĂƚ ŬĞĞƉ ƌĞƚƵƌŶŝŶŐ ƚŽ ŵĞ ĂƐ / ƌĞŇĞĐƚ ŽŶ ƚŚĞ ǁĞĞŬĞŶĚ ƐƉĞŶƚ Ăƚ ƚŚŝƐ ǇĞĂƌ͛Ɛ ŶŶƵĂů ^ĐŝĞŶƟĮĐ ƐƐĞŵďůǇ ŝŶ /ŶĚŝĂŶ tĞůůƐ͘ &ƌŽŵ ŵǇ ǀĞƌǇ ĮƌƐƚ ĐĂĚĞŵǇ ŵĞĞƟŶŐ ŝŶ <ĂŶƐĂƐ ŝƚǇ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ƚŽ ƚŚŝƐ ŵŽƐƚ ƌĞĐĞŶƚ &W ŵĞĞƟŶŐ͕ / ŚĂǀĞ ĨŽƵŶĚ ƚŚĞƐĞ ĐŽŶĨĞƌĞŶĐĞƐ ƉƌŽǀŝĚĞ ĐŽƵŶƚůĞƐƐ ĞǆĂŵƉůĞƐ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ůŝǀŝŶŐ ĨƵůů͕ ĐŽŵƉůĞƚĞ ůŝǀĞƐ͕ ƉƌŝŵĞ ĞǆĂŵƉůĞƐ Ğ ůŝǀĞƐ͕ ƉƌŝŵĞ ĞǆĂŵƉůĞƐ ŽĨ ǁŽƌŬͲůŝĨĞ ďĂůĂŶĐĞĞ͘ ůǁĂǇƐ Ăƚ ƚŚĞ ĨŽƌĞĨĨƌŽŶƚ ŽĨ ĂĚƵůƚ ĞĚƵĐĂƟŽŶ ĂŶĚ ŝŶŶŽǀĂƟŽŶ ĨŽƌ ƐŚĂƌŝŶŐ ŝĚĞĂƐ͕ &W ůĞĂĚĞƌƐƐ ŝŶ ĐŽŶƟŶƵŝŶŐ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ĐŚĂŵƉŝŽŶĞĚ ĂŶ ĞǆƉĞƌŝŵĞŶƚĂů ĨŽƌŵĂƚ ƐŝŵŝůĂƌ ƚŽ ͞d dĂůŬƐ͟ ƚŚŝƐ ǇĞĂƌ͘ /ƚ ǁĂƐ Ă ƉƌŝǀŝůĞŐĞ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ĂůŽŶŐ ǁŝƚŚ ĮǀĞ ŽƚŚĞƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĂĚĚƌĞƐƐĞĚ ǀĂƌŝĞĚ ƚŽƉŝĐƐ ĨƌŽŵ ĂƐƚŚŵĂ ƚŽ ƚƌĂŶƐŐĞŶĚĞƌ ƉĂƟĞŶ Ŷƚ ĐĂƌĞ͘ tŝƚŚŽƵƚ ƐůŝĚĞĞƐ ƚŽ ƌĞůǇ ŽŶ ƚŽ ƚƌĂŶƐŵ ŵŝƚ ƐƚĂƟƐƟĐƐ͕ ŵǇ ƚĂůŬ Ž ŽŶ ǁŽƌŬͲ ůŝĨĞ ďĂůĂŶĐĞ ƌĞůŝĞĚ Ž ŽŶ ƚŚĞ ƐƵďũĞĐƟǀĞ ĨĂĐƚƐ ŽĨ ŵǇ ůŝĨĞ ĂŶĚ Ă ĨƌĞƐŚŵĂŶ ƉŚǇƐŝĐƐ Ě Ă ĨƌĞƐŚŵĂŶ ƉŚǇƐŝĐƐ ůĞƐƐŽŶ͘ / ůĞĂƌŶĞĚ ƚŚŝƐ ůĞƐƐŽŶ ĂƐ / ƐĂƚ ŝŶ ĂŶ ŝŶƚƌŽĚƵĐƚŽƌǇ ƉŚǇƐŝĐƐ ĐŽƵƌƐĞ ŝŶ ĐŽůůĞŐĞ͘ /ƚ ŝƐ Ă ƐŝŵƉůĞ ĐŽŶĐĞƉƚ ƚŽ ŝůůƵƐƚƌĂƚĞ ƵƐŝŶŐ Ă ŐůĂƐƐ ũĂƌ͕ ƌŽĐŬƐ ŽĨ ǀĂƌŝŽƵƐ ƐŝǌĞƐ ĂŶĚ ƐĂŶĚ͘ ^ƚĂƌƚ ďǇ ƉŽƵƌŝŶŐ ƐĂŶĚ ŝŶƚŽ ƚŚĞ ũĂƌ͕ ĂŶĚ ŵŽƐƚ ŽĨ ƚŚĞ ƐƚŽŶĞƐ ǁŝůů ŶŽƚ Įƚ͘ Ƶƚ ŝĨ ǇŽƵ ƐƚĂƌƚ ǁŝƚŚ ƚŚĞ ůĂƌŐĞƐƚ ƐƚŽŶĞƐ͕ ĨŽůůŽǁĞĚ ďǇ ƚŚĞ ƐŵĂůůĞƌ ƌŽĐŬƐ ĂŶĚ ƉĞďďůĞƐ ĂŶĚ ůĞĂǀĞ ƚŚĞ ƐĂŶĚ ĨŽƌ ůĂƐƚ͕ ĞǀĞƌǇƚŚŝŶŐ ĮƚƐ͘ dŚŝƐ ůĞƐƐŽŶ ŝŶ ƉƌŝŽƌŝƟǌĂƟŽŶ ŚĂƐ ƉƵůůĞĚ ŵĞ ďĂĐŬ ŝŶƚŽ ŵǇ 26

California Family Physician Summer 2014

Žƌďŝƚ ǁŚĞŶĞǀĞƌ / ĨĞĞů ŵǇ ůŝĨĞ ŝƐ ƐƉŝƌĂůŝŶŐ ŽƵƚ ŽĨ ĐŽŶƚƌŽů͘ dŚĞ ũĂƌ ƌĞƉƌĞƐĞŶƚƐ ƚŚĞ ĮŶŝƚĞ ůŝĨĞƟŵĞ ĂůůŽƩĞĚ ƚŽ ĞĂĐŚ ŽĨ ƵƐ͕ ǁŚŝůĞ ƚŚĞ ƌŽĐŬ ĐŽůůĞĐƟŽŶ ƌĞƉƌĞƐĞŶƚƐ Ăůů ŽĨ ƚŚĞ ĐŚŽŝĐĞƐ ǁĞ ŵĂŬĞ ƚŽ ƐƉĞŶĚ ƚŚĂƚ ƟŵĞ͘ / ƚŚŝŶŬ ŽĨ ŵǇ ƉĞƌƐŽŶĂů ǀĂůƵĞƐ ĂŶĚ ƚŚĞ ĞƐƐĞŶƟĂů ĞůĞŵĞŶƚƐ ŽĨ ŵĞ ĂƐ ƚŚĞ ůĂƌŐĞƐƚ ƌŽĐŬƐ͘ dŚĞƐĞ ƐĞƌǀĞ ĂƐ Ă ĨŽƵŶĚĂƟŽŶ ĨŽƌ ĐŚŽŽƐŝŶŐ ǁŚŝĐŚ ĂĐƟǀŝƟĞƐ ƐŚŽƵůĚ ŽĐĐƵƉǇ ŵǇ ƟŵĞ ĂƐ ǁĞůů ĂƐ ƉƌŽǀŝĚĞ Ă ĨƌĂŵĞǁŽƌŬ ĨŽƌ ƌĞƐŽůǀŝŶŐ ĂƐ ƉƌŽǀŝĚĞ Ă ĨƌĂŵĞǁŽƌŬ ĨŽ ĐŽŶŇŝĐƚƐ͘ ,Žǁ ǁŽƵůĚ ŝƚ ĨĞĞĞů ƚŽ ƌŝĚ ǇŽƵƌ ĐŽůůĞĐƟŽŶ ŽĨ ĂĐƟǀŝƟĞƐ ƚŚĂĂƚ ĐĂƵƐĞ ƉĂŝŶ Žƌ ĂƌĞ ŶŽƚ ĂůŝŐŶĞĚ ǁŝƚŚ ƉĞƌƐŽŶĂů ǀĂůƵĞƐ͍ / ĮŶĚ ƚŚĂƚ ŝĨ / ĐĂŶ ƐƉ ƉĞŶĚ Ă ƐŝŐŶŝĮĐĂŶƚ ĂŵŽ ŽƵŶƚ ŽĨ ĞŶĞƌŐǇ ŽŶ ĂĐƟǀŝƟĞƐ ƚŚĂƚ ƌĞƐŽ ŽŶĂƚĞ ǁŝƚŚ ŵǇ ƐĞŶƐĞ ŽĨ ƉƵƌƉŽƐĞ͕ / ŐĞĞƚ ƐŽŵĞ ŽĨ ƚŚĂƚ ĞŶĞĞƌŐǇ ďĂĐŬ͘ ƋƵĂůůǇ ŝŵƉ ƉŽƌƚĂŶƚ͕ / ƐŝŐŶĞĚ ĂŶ ĞŶĞƌŐǇ ͞ĐĂƉ ĂŶĚ ƚƌƌĂĚĞ͟ ĂŐƌĞĞŵĞŶƚ ǁŝƚŚ ŵǇƐĞůĨ͘ / ĚŽ ǁ ŶŽƚ ĂĚĚ Ă ŶĞǁ Ŷ ĐŽ ŽŵŵŝƩĞĞ Žƌ ƉƌŽũĞĐĐƚ ƵŶůĞƐƐ / ƐƚĞƉ Žī ĂŶ ŽůĚ ĚĞƌ ŽŶĞ͘ /Ĩ / ĐĂŶ͛ƚ ƐƚŽƉ ĂĂŶǇ ŽĨ ŵǇ ĐƵƌƌĞŶƚ ĐŽŵŵ ŵŝƚŵĞŶƚƐ͕ ƚŚĞŶ / ƐĂĂǇ Ǉ ŶŽ ƚŽ ƚŚĞ ŶĞǁ ŽŶĞ͘ ĞĐŝĚŝŶŐ ƚƚŽ ƚĂŬĞ Žƌ ƉĂƐƐ ŽŶ ƉƌŽũĞĐƚƐ ĂīĞĞĐƚƐ ŽƵƌ ĨĂŵŝůŝĞƐ͘ /Ŷ ƚŚĞ ŝŵŵŽƌƚĂů ǁ ǁŽƌĚƐ ŽĨ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ ϮϬϭϰ &ĂŵŝůǇ WŚǇǇƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ͕ ͞ ůǁĂǇƐ ĐŽƉǇ ǇŽƵƌ ƐƉŽƵƐĞ ǁŚĞŶ zĞĂƌ ͞ ůǁĂǇƐ ĐŽƉǇ ǇŽƵƌ Ɛ ǇŽƵ ƐĂǇ ŶŽ͘͟ / ŚĂǀĞ ƚŚĞ ŝŶĐƌĞĚŝďůĞ ĨŽƌƚƵŶĞ ŽĨ ŚĂǀŝŶŐ Ă ƐƉŽƵƐĞ ǁŚŽ ƉƵƐŚĞƐ ŵĞ ƚŽ ĚŽ ŵŽƌĞ͕ ǁŚŽ ďĞůŝĞǀĞƐ ŝŶ ŵǇ ĚƌĞĂŵƐ ĞǀĞŶ ďĞĨŽƌĞ / ĚŽ͘ tŚĞŶ ǁĞ ĚĞĐŝĚĞĚ ŽŶ Ă ƌĞůĂƟǀĞůǇ ƚƌĂĚŝƟŽŶĂů ŵŽĚĞů͕ ǁĞ ǁĞƌĞ ƐƵƌƉƌŝƐĞĚ ƚŽ ůĞĂƌŶ ƚŚŝƐ ǁĂƐ ŶĂƟŽŶĂů ŶĞǁƐ͘ >ŝŬĞ ƐŽ ŵĂŶǇ ƉŚǇƐŝĐŝĂŶƐ ďĞĨŽƌĞ ŵĞ͕ / ǁŽƌŬ ĨƵůů ƟŵĞ ǁŚŝůĞ ŵǇ ƐƉŽƵƐĞ ĐĂƌĞƐ ĨŽƌ ŽƵƌ ĨĂŵŝůǇ ĨƵůů ƟŵĞ͘ ĞĐĂƵƐĞ ƚŚĞƌĞ ǁĞƌĞ ĨĞǁ ĚĂĚƐ ůŝŬĞ Śŝŵ ŝŶ ŽƵƌ ůŽĐĂů ĐŽŵŵƵŶŝƚǇ

ĂůŵŽƐƚ ϭϬ ǇĞĂƌƐ ĂŐŽ ǁŚĞŶ ǁĞ ƐƚĂƌƚĞĚ ƚŚŝƐ ĂƌƌĂŶŐĞŵĞŶƚ͕ ŚĞ ƐƚĂƌƚĞĚ Ă ďůŽŐ͘ dŚŝƐ ďůŽŐ ůĞĚ ƚŽ ŝŶƚĞƌǀŝĞǁƐ ĂďŽƵƚ ďĞŝŶŐ Ă ƐƚĂǇͲĂƚͲ ŚŽŵĞ ĚĂĚ ŽŶ EĂƟŽŶĂů WƵďůŝĐ ZĂĚŝŽ ;EWZͿ͕ dŝŵĞ DĂŐĂǌŝŶĞ ĂŶĚ dŚĞ dŽĚĂǇ ^ŚŽǁ͘ tŚŝůĞ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƐƚĂǇͲĂƚͲŚŽŵĞ ĚĂĚƐ ŚĂƐ ĚŽƵďůĞĚ ŝŶ ƚŚĞ ƉĂƐƚ ĮǀĞ ǇĞĂƌƐ͕ ƚŚŝƐ ĚŝǀŝƐŝŽŶ ŽĨ ůĂďŽƌ ƐƟůů ĂƩƌĂĐƚƐ ĐŽŶƚƌŽǀĞƌƐǇ͘ &Žƌ ŵĂŝŶƐƚƌĞĂŵ ŵĞĚŝĂ͕ ŐĞŶĚĞƌ ƌŽůĞƐ ĂƌĞ ƐƟůů ŵĞĂƐƵƌĞĚ ďǇ ƐƚĂŶĚĂƌĚƐ ƐĞƚ Ă ŐĞŶĞƌĂƟŽŶ ĂŐŽ͘ /Ŷ ŵǇ ĞǆƉĞƌŝĞŶĐĞ͕ ƚŚŽƐĞ ŽĨ ƵƐ ǁŚŽ ďĞĐĂŵĞ ĂĚƵůƚƐ ĂŌĞƌ ƚŚĞ ŝǀŝů ZŝŐŚƚƐ DŽǀĞŵĞŶƚ ĂŶĚ tŽŵĞŶ͛Ɛ >ŝď DŽǀĞŵĞŶƚ ŚĂǀĞ ŶŽ ƉĞƌƐŽŶĂů ƌĞĨĞƌĞŶĐĞ ĨŽƌ ͞ĂƉƉƌŽƉƌŝĂƚĞ ŐĞŶĚĞƌ ƌŽůĞƐ͕͟ ƐŽ ƚŚĞ ŵĞĚŝĂ ĐŽŶƚƌŽǀĞƌƐǇ ƐĞĞŵƐ ĂƌďŝƚƌĂƌǇ ĂŶĚ ĂƌĐŚĂŝĐ͘ DǇ ŚƵƐďĂŶĚ ĂŶĚ / ǁĞƌĞ ŶŽƚ ƚƌǇŝŶŐ ƚŽ ƌĞĚĞĮŶĞ ŐĞŶĚĞƌ ƌŽůĞƐ͘ dŚŽƐĞ ƐƚĞƌĞŽƚǇƉĞƐ ǁĞƌĞ ďƌŽŬĞŶ ďǇ ƚŚĞ ŐĞŶĞƌĂƟŽŶ ƚŚĂƚ ƌĂŝƐĞĚ ƵƐ͘ tĞ ǁĞƌĞ ũƵƐƚ ƚƌǇŝŶŐ ƚŽ ĮŶĚ ǁŽƌŬͲůŝĨĞ ďĂůĂŶĐĞ͘ dŚŝƐ ŝƐ ŚŽǁ ǁĞ ƐŚĂƌĞ ƚŚĞ ůŽĂĚ ŽĨ ŽƵƌ ůŝƩůĞ ƌŽĐŬ ĐŽůůĞĐƟŽŶ ŝŶ ŽƵƌ ĨĂŵŝůǇ͛Ɛ ŐůĂƐƐ ũĂƌ͘ dŚĞ ƌŝƉƉůĞ ĞīĞĐƚƐ ŽĨ ƉŚǇƐŝĐŝĂŶ ďƵƌŶͲŽƵƚ ĂƌĞ ĞǆƉĂŶƐŝǀĞ͘ dŽŽ ŽŌĞŶ ŝƚ ŝƐ ĞĂƐǇ ƚŽ ŵŝƐƚĂŬĞ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ Őƌŝƚ ĂŶĚ ƐĂŶĚ ĂŶĚ ƚŽ ƵŶĚĞƌĞƐƟŵĂƚĞ ƚŚĞ ǀĂůƵĞ ŽĨ ƚŚĞ ůĂƌŐĞƐƚ ƐƚŽŶĞƐ ŝŶ ƚŚĞ ĐŽůůĞĐƟŽŶ͘ dŚĂƚ ĨĞĞůŝŶŐ ŽĨ ĮŶĚŝŶŐ ǇŽƵƌ ũĂƌ ĮůůĞĚ ƚŽ ĐĂƉĂĐŝƚǇ ǁŚŝůĞ ǇŽƵƌ ǀĂůƵĂďůĞ ƐƚŽŶĞƐ ĂƌĞ ůĞŌ ŽƵƚ͕ ƚŚĂƚ ĨĞĞůŝŶŐ ŝƐ ƉĂƌƚ ŽĨ ďƵƌŶͲŽƵƚ͘ Ɛ ĐƵƌƌĞŶƚ &W ƉƌĞƐŝĚĞŶƚ Ğů DŽƌƌŝƐ ǁĂƌŶĞĚ Ăƚ ƚŚŝƐ ǇĞĂƌ͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ͕ ďƵƌŶĞĚ ŽƵƚ ƉŚǇƐŝĐŝĂŶƐ ĚŽ ŶŽƚ ƐƚŽƉ ƐĞĞŝŶŐ ƉĂƟĞŶƚƐ͕ ƚŚĞǇ ũƵƐƚ ĐŽŶƟŶƵĞ ƚŚĞŝƌ ǁŽƌŬ ǁŝƚŚŽƵƚ ũŽǇ͘ / ƚƌǇ ƚŽ ďĂůĂŶĐĞ ƚŚĞ ĚĂŝůǇ ŐƌŝŶĚ ǁŝƚŚ ƐƚŽƌŝĞƐ ŽĨ ŚƵŵĂŶ ĐŽŶŶĞĐƟŽŶ͘ Ɛ &W WƌĞƐŝĚĞŶƚͲ ĞůĞĐƚ :ĂǇ >ĞĞ ĐŚĂŵƉŝŽŶĞĚ ŝŶ ŚŝƐ d ƚĂůŬ͕ ǁĞ ǁŽƵůĚ ŝŶƐƉŝƌĞ Ă ƌĞǀŽůƵƟŽŶ ŝĨ ĞĂĐŚ ŽĨ ƵƐ ƐŚĂƌĞĚ ŽƵƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŽƌŝŐŝŶ ƐƚŽƌŝĞƐ ĂŶĚ ƚŚĞ ƐƚŽƌŝĞƐ ŽĨ ŚƵŵĂŶ ĐŽŶŶĞĐƟŽŶ ǁŝƚŚ ŽƵƌ ĨĂŵŝůŝĞƐ͕ ŽƵƌ ƉĞĞƌƐ ĂŶĚ ƐƚƵĚĞŶƚƐ͘ Michelle Quiogue, MD is CAFP’s Vice Speaker. She graduated from Brown University, KP LAMC Residency. She is a mother of two daughters and has been married to her husband for 16 years.

For Advertising CONTACT

Michelle Gilbert

mgilbert@pcipublishing.com

1-800-561-4686 ext. 120

California Family Physician Summer 2014 27

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KNOWLEDGE BASED

and Evidence Driven. This is the sort of care clients expect when they come to La Clinica. It is also the type of career you can expect. As a premier provider of primary care services, we strive to attract and retain a balanced, engaged and competent workforce to promote our culture of providing matchless patient experiences. To this end, we recognize the value our physicians bring and as a result, we work hard to support and advance their personal and professional endeavors. If you might be interested in exploring career opportunities, we are currently seeking Family Medicine doctors. Please visit www.laclinica.org for openings.

La Clinica de La Raza has outpatient practice opportunities for Family Physicians at our Vallejo & Oakland sites. A practice with La Clinica affords you: ΄ A starting salary of $161,395 ΄ Work/Life Balance with a strong focus on wellness/self-care/ﬂexible schedules ΄ Generous vacation and educational leave beneﬁts

La Clinica operates as a safety net community clinic serving over 90,000 patients annually and has been recognized for its innovation and unparalleled quality in underserved care in the San Francisco Bay Area. A thriving multidisciplinary practice model paired with a newly implemented electronic health record system connects our comprehensive network of 30 medical, dental and school based sites.

΄ ΄

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Great geographic location with a high quality of life, rich diversity and fantastic climate Camaraderie with inspired colleagues dedicated to building healthy communities Multidisciplinary care team: psychologists, Integrated Behavioral Health Clinicians, health educators Federal and State Loan Repayment program options Career Advancement options Federal Malpractice Insurance Coverage Eligibility for 50% reimbursement of CA & DEA licenses

Learn more at www.laclinica.org or please contact Yassin Janneh, Sr. Recruiting Consultant at 510 535 2942 or yjanneh@laclinica.org 28

California Family Physician Summer 2014

physician’s office, a malfunctioning thermostat ruined $51,000 in refrigerated vaccine. Make sure you’re covered.

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California Family Physician Summer 2014 29

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EXECUTIVE VICE PRESIDENT’S FORUM

Generational Differences — Change is Afoot &Žƌ ǀĞƌǇ ŐŽŽĚ ƌĞĂƐŽŶƐ͕ ƚŚĞ ƚŚĞŵĞ ŽĨ ƚŚŝƐ ŝƐƐƵĞ ŽĨ ĂůŝĨŽƌŶŝĂ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶ ĂĚĚƌĞƐƐĞƐ ŐĞŶĞƌĂƚŝŽŶĂů ĚŝĨĨĞƌĞŶĐĞƐ͘ / ƐĂǇ ĨŽƌ ŐŽŽĚ ƌĞĂƐŽŶƐ ďĞĐĂƵƐĞ͕ ƚŽ ƉĂƌĂƉŚƌĂƐĞ ^ŚĞƌůŽĐŬ ,ŽůŵĞƐ͕ ĐŚĂŶŐĞ ŝƐ ĂĨŽŽƚ͙ tŚĞŶ / ũŽŝŶĞĚ &W ŝŶ ϭϵϵϭ ;ǇĞƐ͕ ϭϵϵϭͿ͕ / ǁĂƐ ϰϮ ĂŶĚ ƚŚĞ ĞĚŝƚŽƌ ŽĨ ƚŚŝƐ ŵĂŐĂǌŝŶĞ ǁĂƐ ĂŶ ĞƐƚĞĞŵĞĚ ŵĞŵďĞƌ͕ ZĂŶƐŽŵ ͞ ƵĐŬ͟ dƵƌŶĞƌ͕ D ͕ ĂŐĞ ϲϱ͕ ǁŚŽ ŚĂĚ ŚĞůĚ ƚŚĞ ƉŽƐŝƟŽŶ ĨŽƌ ϭϬ ǇĞĂƌƐ͘ ƚ ŽƵƌ ϮϬϭϰ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ŝŶ DĂƌĐŚ͕ ǁĞ ĞůĞĐƚĞĚ Ă ŶĞǁ ĞĚŝƚŽƌ͕ EĂƚĞ ,ŝƚǌĞŵĂŶ͕ D ͕ ƚŽ ƌĞƉůĂĐĞ DŝĐŚĞůůĞ YƵŝŽŐƵĞ͕ D ͕ ǁŚŽ ŵŽǀĞĚ ƵƉ ƚŽ ƚŚĞ ŽĸĐĞ ŽĨ sŝĐĞ ^ƉĞĂŬĞƌ͘ EĂƚĞ ŵĂǇ ďĞ ŽůĚĞƌ ƚŚĂŶ ŚĞ ůŽŽŬƐ͕ ďƵƚ /͛Ě ƐĂǇ ŚĞ͛Ɛ ĚĞĮŶŝƚĞůǇ EKd ǇĞƚ ϰϮ͕ ǁŚŝůĞ / ũƵƐƚ ƚƵƌŶĞĚ ϲϱ͘ tŚĂƚ͛Ɛ ŵŽƌĞ͕ DŝĐŚĞůůĞ ŚĂĚ ŚĞůĚ ƚŚĞ ĞĚŝƚŽƌ ƉŽƐŝƟŽŶ ĨŽƌ ũƵƐƚ ƚŚƌĞĞ ǇĞĂƌƐ ďĞĨŽƌĞ ƐŚĞ ǁĂƐ ĞůĞĐƚĞĚ ĂƐ sŝĐĞ ^ƉĞĂŬĞƌ͘ dĂůŬ ĂďŽƵƚ ƚƵƌŶĂďŽƵƚ͊ 'ĞŶĞƌĂƟŽŶĂů ĚŝīĞƌĞŶĐĞƐ ŚĂƐ ďĞĞŶ Ă ĨƌĞƋƵĞŶƚ ƚŽƉŝĐ Ăƚ ŵǇ ŽǁŶ ƉƌŽĨĞƐƐŝŽŶĂů ĂƐƐŽĐŝĂƟŽŶ ŵĞĞƟŶŐƐ ĨŽƌ ŵĂŶǇ ǇĞĂƌƐ͕ ĂŶĚ ŝƚ ǁĂƐ Ă ƚŽƉŝĐ Ăƚ ďŽƚŚ ƚŚĞ ƌĞĐĞŶƚ ŵĞƌŝĐĂŶ ĐĂĚĞŵǇ ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ŶŶƵĂů >ĞĂĚĞƌƐŚŝƉ &ŽƌƵŵ ; >&Ϳ ŝŶ <ĂŶƐĂƐ ŝƚǇ ĂŶĚ Ăƚ ŽƵƌ ŽǁŶ ŶŶƵĂů ^ĐŝĞŶƟĮĐ ƐƐĞŵďůǇ ; ^ Ϳ ŝŶ /ŶĚŝĂŶ tĞůůƐ ŝŶ DĂǇ͕ Ă ƐĞƐƐŝŽŶ ĂďůǇ ƉƌĞƐĞŶƚĞĚ͕ ĂƐ ĂůǁĂǇƐ͕ ďǇ ĂƌŽů ,ĂǀĞŶƐ͕ D ͘ tŚǇ ŝƐ ŝƚ ĂŶ ŝŵƉŽƌƚĂŶƚ ƚŽƉŝĐ͍ &ŝƌƐƚ͕ ŝƚ ĂīĞĐƚƐ ǇŽƵ͕ ƚŚĞ ŵĞŵďĞƌ ĂŶĚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ďŽƚŚ ŽŶ ƚŚĞ ůĞǀĞů ŽĨ ĚĞĂůŝŶŐ ĂŶĚ ĐŽŵŵƵŶŝĐĂƟŶŐ ǁŝƚŚ ǇŽƵƌ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ĨĞůůŽǁ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ǁŝƚŚ ǇŽƵƌ ƉĂƟĞŶƚƐ͘ ^ĞĐŽŶĚ͕ ŝƚ ĂīĞĐƚƐ ǇŽƵƌ ĐĂĚĞŵǇ ĂŶĚ ŚŽǁ ŝƚ ƐĞĞŬƐ ƚŽ ƌĞƚĂŝŶ ĐƵƌƌĞŶƚ ŵĞŵďĞƌƐ ĂŶĚ ĂƩƌĂĐƚ ĂŶĚ ŬĞĞƉ ŶĞǁ ŽŶĞƐ͕ ĞƐƉĞĐŝĂůůǇ ƚŚŽƐĞ ŝŶ ǇŽƵŶŐĞƌ ŐĞŶĞƌĂƟŽŶƐ ǁŚŽ ŝŶĐƌĞĂƐŝŶŐůǇ ĂƌĞ ŵŽƌĞ ĨĞŵĂůĞ ĂŶĚ ͞ĞŵƉůŽǇĞĚ͟ ;ƚĞĐŚŶŝĐĂůůǇ͕ ǇŽƵ ĐĂŶ͛ƚ ďĞ ͞ĞŵƉůŽǇĞĚ͟ ĂƐ Ă ƉŚǇƐŝĐŝĂŶ ŝŶ ĂůŝĨŽƌŶŝĂ ďĞĐĂƵƐĞ ŽĨ ƚŚĞ ďĂƌ ŽŶ ƚŚĞ ĐŽƌƉŽƌĂƚĞ ƉƌĂĐƟĐĞ ŽĨ ŵĞĚŝĐŝŶĞ ʹ ďƵƚ ŝŶĐƌĞĂƐŝŶŐ ŶƵŵďĞƌƐ ŽĨ ǇŽƵŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ŶŽƚ ƌƵŶŶŝŶŐ ƚŚĞŝƌ ŽǁŶ ƉƌĂĐƟĐĞƐͿ͘ /Ŷ ǇŽƵƌ ƉƌĂĐƟĐĞ ʹ ǁŚĂƚĞǀĞƌ ƚŚĞ ƐĞƫŶŐ ʹ ǇŽƵ ƵŶĚŽƵďƚĞĚůǇ ĂƌĞ ǁŽƌŬŝŶŐ ǁŝƚŚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ƐƉĞĐŝĂůŝƐƚƐ ŝŶ ĚŝīĞƌĞŶƚ ĂŐĞ ŐƌŽƵƉƐ͘ /ƚ͛Ɛ ŐŽŽĚ ƚŽ ŬŶŽǁ ǁŚĂƚ ŵŽƟǀĂƚĞƐ ƚŚĞƐĞ ŝŶĚŝǀŝĚƵĂůƐ͕ ĂƐ ǁĞůů ĂƐ ǁŚĂƚ ƚƵƌŶƐ ƚŚĞŵ Žī ƚŽ ǇŽƵƌ ŵĂŶĂŐĞŵĞŶƚ Žƌ ĐŽůůĂďŽƌĂƟǀĞ ƐƚǇůĞ͕ ƐŽ ǇŽƵ ĐĂŶ ŵĂǆŝŵŝǌĞ ƚŚŽƐĞ ƌĞůĂƟŽŶƐŚŝƉƐ ƚŽ ĞŶƐƵƌĞ ǇŽƵƌ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ƚŚĞ ďĞƐƚ ĐĂƌĞ ƉŽƐƐŝďůĞ͘ dŚĞ ƐĂŵĞ ŝƐ ƚƌƵĞ ŽĨ ƚŚĞ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ĂŶĚ ŽƚŚĞƌ ŶŽŶͲƉŚǇƐŝĐŝĂŶ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂů ƐƚĂī ŵĞŵďĞƌƐ ǁŝƚŚ ǁŚŽŵ ǇŽƵ ǁŽƌŬ ʹ ƚƌĞĂƟŶŐ ĞǀĞƌǇŽŶĞ ĂƐ ŝĨ ƚŚĞǇ ǁĞƌĞ Ă ĂďǇ ŽŽŵĞƌ Žƌ 'ĞŶ y͛Ğƌ ŵĂǇ ŶŽƚ ŚĂǀĞ ƚŚĞ ĚĞƐŝƌĞĚ ƌĞƐƵůƚ͕ ďĂƐĞĚ ŽŶ Ă ůŽƚ ŽĨ ƐƚƵĚŝĞƐ͘ zŽƵƌ ŝŶƚĞƌĂĐƟŽŶƐ ǁŝƚŚ ƉĂƟĞŶƚƐ ĨĂůů ƵŶĚĞƌ ƚŚĞ ƐĂŵĞ ŶŽƟŽŶ ʹ Ă DŝůůĞŶŶŝĂů ƉĂƟĞŶƚ ůŝŬĞůǇ ǁŝůů ŶŽƚ ƌĞƐƉŽŶĚ ƚŽ ĂŶ ͞/͛ŵ ƚŚĞ ĚŽĐƚŽƌ͕ ĂŶĚ / ŬŶŽǁ ďĞƐƚ͟ ĂƉƉƌŽĂĐŚ͕ ďƵƚ ǁŝůů ĂĐƟǀĞůǇ ĞŶŐĂŐĞ 30

California Family Physician tŝŶƚĞƌ ϮϬϭϰ

ŝĨ ŐŝǀĞŶ ƚŚĞ ƌĞĂƐŽŶ ĨŽƌ ǇŽƵƌ ƌĞĐŽŵŵĞŶĚĂƟŽŶ ĂŶĚ ĂůůŽǁĞĚ ƚŽ ǁŽƌŬ ǁŝƚŚ ǇŽƵ ŽŶ ĂŶ ĂĐƟŽŶ ƉůĂŶ͘ &ƌŽŵ ĂŶ ĐĂĚĞŵǇ ƉĞƌƐƉĞĐƟǀĞ͕ / ĂůƐŽ ůĞĂƌŶĞĚ Ă ůŽƚ ĨƌŽŵ ƚŚĞ >& ƐĞƐƐŝŽŶ ŽŶ EĞǁ WŚǇƐŝĐŝĂŶƐ͘ &Žƌ ĞǆĂŵƉůĞ͕ ϯϴ ƉĞƌĐĞŶƚ ŽĨ &W ŵĞŵďĞƌƐ ĂƌĞ ŶŽǁ ĨĞŵĂůĞ ǁŝƚŚ ƐŽŵĞ ƵŶŝƋƵĞ ŶĞĞĚƐ ŽĨ ƚŚĞŝƌ ŽǁŶ͕ ƐƵĐŚ ĂƐ ƚŚĞ ĚĞƐŝƌĞ ĨŽƌ ĐŚŝůĚ ĐĂƌĞ Ăƚ ŵĞĞƟŶŐƐ͘ EĞǁ WŚǇƐŝĐŝĂŶƐ ŐĞŶĞƌĂůůǇ ƉůĂĐĞ ůĞƐƐ ĞŵƉŚĂƐŝƐ ŽŶ ĂĚǀŽĐĂĐǇ ďǇ ƚŚĞŝƌ ĂĐĂĚĞŵŝĞƐ͕ ŝŶĐůƵĚŝŶŐ ůŝĂďŝůŝƚǇ ƌĞĨŽƌŵ͕ ĂŶĚ ŵŽƌĞ ŽŶ ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ŝƐƐƵĞƐ͘ EĞǁ WŚǇƐŝĐŝĂŶƐ ĚŽŶ͛ƚ ƐĞĞ ƐĞŶŝŽƌŝƚǇ ĂƐ Ă ƋƵĂůŝĮĞƌ ĨŽƌ ŵŽǀŝŶŐ ƵƉ ŝŶ ĂŶǇ ŽƌŐĂŶŝǌĂƟŽŶ ʹ ƚŚĞǇ ǁĂŶƚ ƚŚĞ EĞǁ WŚǇƐŝĐŝĂŶ ǀŽŝĐĞ ŚĞĂƌĚ ;ŚĂƉƉŝůǇ͕ &W ŚĂƐ Ă ƐůŽƩĞĚ ƐĞĂƚ ŽŶ ŽƵƌ ŽĂƌĚ ĨŽƌ Ă EĞǁ WŚǇƐŝĐŝĂŶ͕ ĐƵƌƌĞŶƚůǇ >ŝƐĂ tĂƌĚ ŽĨ ^ĂŶƚĂ ZŽƐĂͿ͘ dŚĞǇ ǁĂŶƚ ƚŽ ďĞ ĂƐŬĞĚ ƚŚĞŝƌ ŽƉŝŶŝŽŶ͕ ĂŶĚ ŶĞŐĂƟǀĞ ĐŽŵŵĞŶƚƐ ĨƌŽŵ ͞ƐĞŶŝŽƌ͟ ďŽĂƌĚ ŵĞŵďĞƌƐ ĐĂŶ ƐŚƵƚ ƐŽŵĞ ŽĨ ƚŚĞŵ ĚŽǁŶ ĨŽƌ ǇĞĂƌƐ͕ ĂĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ >& ƉĂŶĞůŝƐƚƐ͘ ƵƐŝŶĞƐƐ ĂƐ ƵƐƵĂů ƐŚŽƵůĚ ďĞ ĂǀŽŝĚĞĚ ďǇ ƚŚĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ƚŚĞǇ ũŽŝŶ ʹ ƚŚĞǇ͛ƌĞ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ďŽƚŚ ŝŶĐƵďĂƚŽƌ ĂŶĚ ƌĞŐƵůĂƌ ƐĞƌǀŝĐĞƐ͘ dŚĞŝƌ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ŵĞĞƟŶŐƐ ĐĂŶ ďĞ ŝŶŇƵĞŶĐĞĚ ďǇ ŚŽǁ ƚŚĞ ŵĞĞƟŶŐƐ ĂƌĞ ƐƚƌƵĐƚƵƌĞĚ͗ ĐĂŶ ƚŚĞǇ ĚƌŝǀĞ ŝŶ ĞĂƌůǇ ŝŶ ƚŚĞ ŵŽƌŶŝŶŐ ĂŶĚ ŐĞƚ ŚŽŵĞ ďǇ ĞǀĞŶŝŶŐ ƚŽ ďĞ ǁŝƚŚ ƚŚĞŝƌ ŬŝĚƐ͍ ĂŶ ƚŚĞŝƌ ŬŝĚƐ ĐŽŵĞ ƚŽ ƚŚĞ ŵĞĞƟŶŐ͍ tĞ ǁĞƌĞ ƚŽůĚ ƚŚĞǇ ĂƌĞ Ă ǀĞƌǇ ƐŽĐŝĂů ŐĞŶĞƌĂƟŽŶ ʹ ƚŚĞǇ ůŽǀĞ ƚŽ ŶĞƚǁŽƌŬ ǁŝƚŚ ŽƚŚĞƌƐ ĂŶĚ ĚŽŶ͛ƚ ĂůǁĂǇƐ ŶĞĞĚ Ă ŵĞĞƟŶŐ ƚŽ ĚŽ ƚŚĂƚ ʹ ĂƐǇŶĐŚƌŽŶŽƵƐ ͞ŵĞĞƟŶŐƐ͟ ĐĂŶ ďĞ ĮŶĞ ǁŝƚŚ ƚŚĞŵ͘ KĨ ĨƵƌƚŚĞƌ ŝŶƚĞƌĞƐƚ ƚŽ &W ĂŶĚ ŝŶ ŵĂŶǇ ŝŶƐƚĂŶĐĞƐ͕ ƚŽ ǇŽƵ͕ Ăƚ ŚĞƌ ƐĞƐƐŝŽŶ ŽŶ ŐĞŶĞƌĂƟŽŶĂů ĚŝīĞƌĞŶĐĞƐ Ăƚ ƚŚĞ ^ ͕ ƌ͘ ,ĂǀĞŶƐ ŶŽƚĞĚ ƚŚĂƚ 'ĞŶ y ŵĞŵďĞƌƐ ĂƌĞ ŝŶĚĞƉĞŶĚĞŶƚ ůĞĂƌŶĞƌƐ ǁŚŽ ƉƌĞĨĞƌ ƚŽ ůĞĂƌŶ ŽŶ ƚŚĞ ũŽď͖ ƚŚĞǇ ĂƌĞ ŽƵƚĐŽŵĞͲŽƌŝĞŶƚĞĚ ĂŶĚ ǁĂŶƚ ĐŚŽŝĐĞƐ ĂŶĚ ǁĂŶƚ ƚŽ ŬŶŽǁ ͞ǁŚǇ͘͟ DŝůůĞŶŶŝĂůƐ͕ ŽŶ ƚŚĞ ŽƚŚĞƌ ŚĂŶĚ͕ ƉƌĞĨĞƌ ƚĞĂŵͲďĂƐĞĚ ĞĚƵĐĂƟŽŶ ĂŶĚ ŚĂǀĞ Ă ůŽǁ ƚŽůĞƌĂŶĐĞ ĨŽƌ ďŽƌĞĚŽŵ͖ ƚŚĞǇ ǁĂŶƚ ƚŽ ŬŶŽǁ ͞ǁŚǇ͕͟ ĂŶĚ ĚĞƐŝƌĞ ĞĚƵĐĂƟŽŶ ƚŚĂƚ ŚŝƚƐ ŬĞǇ ƉŽŝŶƚƐ ĂŶĚ ƚĞĂĐŚĞƐ ŚŽǁ ƚŽ ĂŶĂůǇǌĞ ĂŶĚ ƐŽůǀĞ ƌĞĂů ƉƌŽďůĞŵƐ͘ DĞĂŶƟŵĞ͕ ǁĞ ĂďǇ ŽŽŵĞƌƐ ƌĞŵĂŝŶ ĚĞƉĞŶĚĞŶƚ ŽŶ ĞĚƵĐĂƚŽƌƐ͕ ǁŝƚŚ ůĞĐƚƵƌĞ ĨŽƌŵĂƚ͕ ĂŶĚ ƉƌŽĐĞƐƐͲ ŽƌŝĞŶƚĞĚ ĐŽŶƚĞŶƚ͖ ǁĞ ǁĂŶƚ ƉůĂŶŶĞĚ͕ ƐĐƌŝƉƚĞĚ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ǁĞ ĚŽŶ͛ƚ ƌĞĂůůǇ ǁĂŶƚ ƚŽ ͞ƌŽůĞ ƉůĂǇ͘͟ KŶĞ ŽŶůǇ ŚĂĚ ƚŽ Ɛŝƚ Ăƚ ƚŚĞ ^ ĂŶĚ ǁĂƚĐŚ ƚŚĞ dǁĞĞƚƐ ĂŶĚ &ĂĐĞďŽŽŬ ƉŽƐƟŶŐƐ ŇǇŝŶŐ ĂďŽƵƚ ŶĞĂƌůǇ ĞǀĞƌǇ ƉƌĞƐĞŶƚĂƟŽŶ ʹ ƚŚĞ ƚĞǆƚƐ͕ ƚŚĞ ĞŵĂŝůƐ͕ ĂŶĚ͕ ƚŽŽ͕ ƚŚĞ ĐĂŵĂƌĂĚĞƌŝĞ ʹ ƚŽ ŬŶŽǁ ƚŚĂƚ ĂŶ ĞŶƟƌĞůǇ ĚŝīĞƌĞŶƚ ŐĂŵĞ ŝƐ ĂĨŽŽƚ͘ ^Ž͕ ǇŽƵ ĐĂŶ ƐĞĞ͕ ŬŶŽǁŝŶŐ ŚŽǁ ƚŽ ǁŽƌŬ ŵŽƐƚ ĞīĞĐƟǀĞůǇ ǁŝƚŚ ĚŝīĞƌĞŶƚ ŐĞŶĞƌĂƟŽŶƐ ĐĂŶ ŚĂǀĞ Ă ďŝŐ ŝŵƉĂĐƚ ŽŶ ǇŽƵƌ ƐƵĐĐĞƐƐ ĂŶĚ ŽŶ &W͛Ɛ ƐƵĐĐĞƐƐ͘ tĞ͛ƌĞ ƚĂŬŝŶŐ ŶŽƚĞ ĂŶĚ ŚŽƉĞ ǇŽƵ ĂƌĞ͕ ƚŽŽ͘

MULTIPLE FEDERAL PRISON VACANCIES Immediate Openings for Clinical Director, Staff Physician and Psychiatrist Join the Leader in Correctional Health Care

California Family Physician SĆ?Ć&#x2030;Ć&#x152;Ĺ?ĹśĹ? ĎŽĎŹĎĎŻ 311

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437

“ We listen to policyholders. We provide solid advice and offer real-time solutions to real-time problems.”

Loss Prevention Senior Representative Kathy Kenady

Service and Value MIEC takes pride in both. For almost 40 years now, MIEC has been steadfast in our protection of California physicians. With conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services, we’ve partnered with policyholders to keep premiums low. Added value: Q No profit motive and low overhead Q $17.5 million in dividends* distributed in 2014 For more information or to apply: Q www.miec.com Q Call 800.227.4527 Q Email questions to underwriting@miec.com * (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

Average Dividend as % of Premiums Past five Years

40% 35% 30% 25% 20% 15% 10% 5% 0%

MIEC 6250 Claremont Avenue, Oakland, California 94618 s 800-227-4527 s www.miec.com 32

California Family Physician Summer 2014

38.6%

6.66% MIEC

Med Mal Industry

MIEC Owned by the policyholders we protect.