Spring 2021 by California Academy of Family Physicians

VOL . 72 NO. 2 Sp ri n g 2 02 1

1520 Pacific Avenue • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board

Staff

President David Bazzo, MD, FAAFP

Lisa Folberg, MPP Chief Executive Officer lfolberg@familydocs.org

Immediate Past President Walter Mills, MD, MMM, FAAFP President-elect Shannon Connolly, MD, FAAFP Speaker Lauren Simon, MD, MPH, FAAFP Vice-Speaker Raul Ayala, MD, MHCM Secretary/Treasurer Alex McDonald, MD, FAAFP Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeffrey S. Luther, MD, FAAFP Lee Ralph, MD AAFP Alternates Jay W. Lee, MD, MPH, FAAFP Michelle Quiogue, MD, FAAFP CMA Delegation Raul Ayala, MD Kimberly Buss, MD, MPH Jay W. Lee, MD, MPH Felix Nunez, MD, MPH Kevin Rossi, MD

Morgan Cleveland Manager, Operations|Governance and FP-PAC mcleveland@familydocs.org Jerri Davis, CHCP Vice President, Professional Development, CME/CPD jdavis@familydocs.org Adam Francis Director, Government Affairs afrancis@familydocs.org Arlanna Henry Manager, Educational Programs ahenry@familydocs.org Josh Lunsford Director, Membership and Marketing jlunsford@familydocs.org Catrina Reyes, Esq. Vice President, Policy and Advocacy creyes@familydocs.org Jonathan Rudolph Manager, Finance jrudolph@familydocs.org

Looking for a job? Go to www.fpjobsonline.com Questions? Call 888-884-8242 and a HEALTHeCAREERS representative will help you.

Brent Sugimoto, MD, Editor Josh Lunsford, Managing Editor

The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year. Call 415-345-8667 to subscribe.

California Family Physician Spring 2021

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EDITION 38

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features The Voice of Family Medicine 13 In the News - Abraham is a Prominent Voice for South Los Angeles Communities 24 A Physician’s Voice in Politics: Interview with Dr. Akilah Weber 26 Resident Voice Rises to National Leadership: Spotlight on Anna Askari, MD, MSBS 28 Words Have Power: Your Voice in Social Media

Kim Yu, MD, FAAFP

departments 6 Editorial

Our Experiences Fuel Our Voices

Brent Sugimoto, MD, MPH

8 President’s Message

Looking Back on the Past Year

12 Political Pulse

Once More Unto the Breach, Dear Friends!

Carla Kakutani, MD

14 Legislative Update

CAFP Brings Value-Based Payment Models to Forefront

Catrina Reyes, Esq.

16 CAFP Foundation

CAFP Foundation Welcomes New Executive Director

Pamela Mann, MPH

18 CAFP Foundation

CAFP Foundation 2020 Annual Report

29 CEO Message

Find Your Voice in What Drives You

David Bazzo, MD, FAAFP

Lisa Folberg, MPP

For upcoming CME activities visit familydocs.org/cme California Family Physician Spring 2021

Brent K. Sugimoto,, MD, MPH, AAHIVS, FAAFP

editorial

Our Experiences Fuel Our Voices I remember my maternal grandmother describing it plainly, in a matter-of-fact way, as if describing the horrible traffic on the way home from work. They found out they were being interned. In a matter of weeks, they were evacuated to live in the horse stables of the Santa Anita Racetrack until they could be relocated to the permanent camp in Manzanar. She said the family was lucky because they had White neighbors who were willing to store their belongings while they were in prison: most Japanese-Americans had only the allowed two suitcases to pack up their world and had to sell the rest of their possessions for pennies on the dollar. My mom’s dad, newly admitted to Stanford University for medical school, had to forever relinquish his dream of becoming a physician. On my father’s side, his grandfather—ineligible to ever become a U.S. citizen because he was a Japanese national—had to give up his strawberry farm (according to family lore, he grew strawberries the size of one’s fist) on what is now prime real estate: Palos Verdes. The imprint of Franklin Delano Roosevelt’s Executive Order 9066 on my family and community—which ordered the World War II internment of Japanese-Americans— was to me a lesson in how the world worked. It taught me how powerful and frightening a force discrimination could be for upending lives, and about the experience of powerlessness. It taught me that success or failure often lay outside of one’s own control.

and TED Talk speaker Simon Sinek would call this my WHY. The question of our WHY is an important one. It motivates self to action and forms the resonance of our own voice, which with its authenticity, is the force that moves others to our vision. The story behind my own WHY is unique, but I have learned that the shape of that WHY is not so unfamiliar from the many family physicians that I admire. It a large reason why I am so proud to be a family physician: in our position of privilege and, yes, power, we so often use our voice in the service of others. This issue is dedicated to the Voice of Family Medicine. Here you will read the stories of some pretty amazing leaders, from family physicians to CAFP CEO Ms. Lisa Folberg. Each found their voice to become leaders and advocates in our specialty, in their respective organizations, in social media, in government, and in their communities. For each of these leaders you will read about, each has a story for what drives them to speak out and lead. Although their stories may be unique, they also have a common thread: they learned how their voices could make things better.

I also consider it a gift.

I would wager that most of us became family physicians because we identified something that we wanted to make better. Committing to change something is itself a form of leadership. As professionals who are committed to changing the conditions of another’s life, we are often looked to as leaders, whether we feel that way or not.

Without it I don’t think I would ever be as attuned to right from wrong, to fair from unjust. It has left in my soul a groove, the borders of which delimit a satisfactory and comfortable and compulsory path where meaningful work means helping others find those two freedoms of the four, ironically, articulated by Roosevelt himself: freedom from want and freedom from fear. Ethnographer

However, when we find our voice and use it, we amplify the power of our own vision by helping others see the world the way we do. Each and every one of you, with your voice, has the potential to lead. To paraphrase Margaret Mead, never doubt that a small group of thoughtful, committed family physicians can change the world.

California Family Physician Spring 2021

p r e s i d e n t ’s m e s s a g e

David E.J. Bazzo, MD, FAAFP

Looking Back on the Past Year My dear colleagues, COVID-19 has been a defining moment for my presidency, for us as family physicians and for the entire human race. It is hard to believe that it has been over one year since COVID hit the United States and the roller coaster ride began. The early days of the pandemic were stressful and scary times. Unfortunately, many of our fears were founded and we have seen great death and devastation from this terrible pandemic. A year later, we have vaccines and a reinforced commitment toward tackling the COVID pandemic. We can finally see a little light at the end of the tunnel. The theme for this month’s issue is “The Voice of Family Medicine.” I cannot begin to tell you how proud I am of the voices we have heard from our family physician colleagues throughout the state this last year. We were at the forefront, caring for patients, comforting them, and providing important information. Your CAFP immediately got to work getting our members evidence-based information we could share with patients, as well as breaking policy and political news. CAFP worked to ensure the voice of family medicine rang out. When it looked like a vaccine was going to be available, we made sure family physicians were at the table working on delivery mechanisms and getting vaccines into the arms of our patients and colleagues. The past year has taken a toll on our psyche. As family doctors, we do have a built-in resiliency that is amazing; however, that is not enough. CAFP has been there to help in alleviating our stress by providing continued connection, communications, and conduits for building community. The COVID pandemic has highlighted health disparities. At CAFP we have been talking about this issue for many years. Unfortunately, COVID-19 disparities as well as stark examples of systemic racism heightened the nation’s awareness that inequities are still pervasive. I have been proud of CAFP for working on making CAFP equitable, diverse, and inclusive. For those of you that attended the CAFP virtual Clinical Forum this year, you were treated to excellent discourse, dialogue and education on recognizing and addressing disparities.

California Family Physician Spring 2021

In this edition, you will hear from some of the “Voices of Family Medicine.” People that have advocated for us, taught us, and pushed for the benefit of our patients, colleagues and staff alike. I am sure that you, too, will read with pride and recognize that we are all heroes. Family physicians have stepped up like no other specialty during this time and I am so proud to call each one of you “my dear colleagues”. All your voices, both individually and collectively, are the voices of Family Medicine. You speak loudly and clearly and speak truth in putting your patients first. Know that CAFP will carry your voices forward and continue to advocate for policy that will bring benefit to Californians. I will no doubt reflect on these last 12 months for many years to come. I began thinking of my CAFP “president year” from my first days on the board. Having always been a relationship-based person, I had thoughts that I would get out to visit many chapters throughout the state and looked forward to meeting many new colleagues. I regret that I was not able to do that this year but obviously, there were other pressing matters. One good thing that came out of the pandemic is finding ways to make those connections virtually. While not fully replacing that in-person connection, it really did become the next best thing, and allowed for perhaps more frequent interactions that didn’t require traveling great distances but offered more efficient utilization of time. Like a true family physician, I tried to find the positive in what has been a tragic situation. I look forward to the day that I can see all of you face-toface, reconnect, and finally look at COVID in the rearview mirror. Until then, it has been my honor serving as your President and I look forward to great things coming next year when Dr. Shannon Connolly assumes the CAFP Presidency. We will be having our CAFP strategic planning meeting in November and setting the three-year plan for our great organization into the future. We have a wonderful Board of Directors representing you and I encourage everyone to get to know them, get involved and make your “Voices of Family Medicine” heard.

California Family Physician Spring 2021

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

Once More Unto the Breach, Dear Friends! As chair of CAFP’s Legislative Affairs Committee (LAC), I know firsthand how important it is that family physicians be involved in the legislative process. Each year, the LAC has no bigger responsibility than to prioritize roughly 50 bills for CAFP action out of the thousands of bills the State Legislature will consider. From bills we oppose or try to amend, to bills we work tirelessly to pass, each one will have a large impact on your practice, your patients or both. The LAC will meet at the end of March to select those bills and make position recommendations to the CAFP Board. The LAC uses CAFP policy to guide those positions, and its strategic plan to guide its prioritization. Here are just a few of the hundreds of bills the LAC will review and consider recommending a Support or Oppose position: • AB 864 (Low) would move the Controlled Substance Utilization Review and Evaluation System (CURES) database out from under the Department of Justice and into the Department of Public Health. CAFP for years has called for this change as the database should be used as a clinical tool to improve care, not as a prosecutorial weapon against health care professionals. • SB 428 (Hurtado) would require health plans and insurers to provide coverage and payment for adverse childhood experience (ACE) screenings. CAFP has been a strong supporter of efforts to screen and treat patients affected by ACEs in the Medi-Cal program, including through our education efforts . • AB 97 (Nazarian) would prohibit health plans and insurers from imposing a deductible on an insulin prescription drug. Insulin cost is a big reason the average annual per-patient spending on treatment for type 1 diabetes increased from $12,467 in 2012 to $18,494 in 2016. During that time, the price of insulin doubled, according to the Health Care Cost Institute. The price of one insulin product, Lantus, saw a 49 percent price increase in 2014 alone even though it had been on the market for decades. Another

California Family Physician Spring 2021

•

insulin brand, NovoLog, increased in list price by 353 percent from 2001 to 2016. SB 48 (Limón) would require all general internists and family physicians to complete at least four hours of mandatory continuing education on the special care needs of patients with dementia. As part of a family physician’s residency training, they must complete, at a minimum, 100 hours or 125 encounters with geriatric patients across a continuum of sites. Evidence does not show that family physicians are providing inadequate care and that four additional hours of continuing medical education in this area will improve health outcomes. SB 316 (Eggman) would allow federally qualified health centers and rural health clinics to bill for a patient who has two visits in the same day at a single location, if after the first visit the patient suffers illness or injury requiring additional diagnosis or treatment, or if the patient has a medical visit and a mental health visit or dental visit. This measure could greatly improve efficiency and access to care. SB 742 (Pan) would make it unlawful, except upon private property, for a person to engage in physical obstruction, intimidation, or picketing within 300 feet of a vaccination site during vaccination services. The site includes, but is not limited to, a hospital, physician’s office, clinic, or any retail space or pop-up location made available for largescale vaccination services. This issue has garnered significant attention as the large-scale effort to administer the COVID-19 vaccines has generated disruptive activity by vaccination opponents.

If you would like to get more involved in the legislative process, I encourage to attend CAFP’s All Member Advocacy Meeting , which will be held virtually this year on May 15-16, 2021. References 1. https://www.familydocs.org/aces/ 2. https://www.familydocs.org/events/amam/

IN THE NEWS Spring 2021 Abraham is a Prominent Voice for South Los Angeles Communities Jerry Abraham, MD, MPH and Kedren Community Health Center in South L.A., which serves the most underserved population of brown and black communities, have been diligently working to get the COVID-19 vaccine to as many members of these communities as possible. The current assistant secretary-treasurer of the CAFP Los Angeles chapter has appeared in dozens of news stories and became a model of success for effectively undertaking the vaccine administration in South Los Angeles, administrating about 2,000 doses per day. Dr. Abraham is striving to help change those numbers, by facilitating registration and breaking other barriers of entry, such as a lack of a vehicle, cell phone, internet, or email. During the day patients are registered on-site and vaccinated, in a positive environment inspired by music and dance. Los Angeles’ most underserved communities are being taken care of, one dose at a time in the fight against the pandemic. Dr. Abraham has shown how that doesn’t need to be complicated.

California Family Physician Spring 2021

legislative update

Catrina Reyes, Esq. Vice President of Advocacy and Policy

CAFP Brings Value-Based Payment Models to Forefront As family physicians know, there is consistent and growing evidence that investing in primary care promotes health equity, improves patient outcomes and experience, increases the supply of primary care providers, and reduces health care spending. Despite this strong evidence, however, primary care has been chronically underfunded. As such, one of CAFP’s priorities is to advocate for greater investment in primary care. Investing in primary care can take two complementary forms - increasing the percentage of medical spending dedicated to primary care and shifting primary care practice from fee-forservice payments to value-based payment models. They are complementary, because the transition from fee-for-service payments to value-based payment models for primary care practices will likely lead to a greater percentage of medical spending dedicated to primary care. Similarly, increasing the percentage of medical spending dedicated to primary care can be done by shifting primary care practices from fee-for-service payments to value-based payment models. CAFP’s sponsored bill, Senate Bill 402 introduced by State Senator Melissa Hurtado (D-Sanger), focuses on the shift from fee-forservice to value-based payment models. The bill creates a collaborative of health care payers and purchasers, primary care providers, and health care consumer representatives to establish multi-payer payment reform pilots in areas hardest hit by COVID-19, particularly in regions where the impact has been greatest among minority and marginalized communities. The goal of the pilots is to

California Family Physician Spring 2021

transition small, primarily fee-for-service primary care physician practices into value-based payment models by aligning health plan contracts around uniform payment methods and quality measures. While fee-for-service payments promote volume over value, the value-based payment model is a concept by which payers and purchasers of health care (government, employers, health plans and insurers, and consumers) hold physicians and other health care providers accountable for both the quality and cost of care through shared financial risk and tying incentives to certain quality measures and outcomes. The overarching goal of the value-based payment model is to incent care redesign and process improvement so that the care that is delivered is patient-centered, accessible, coordinated, comprehensive, longitudinal, planned, and high-value. The results of which are improved population health management and health outcomes, health equity and reduced disparities in care, and lower health care expenditures.

There are varying models and combinations of value-based payments that fall within a spectrum based on the amount of risk a physician practice would be assuming (see ValueBased Payment Risk Spectrum figure). AAFP’s Advanced Primary Care Alternative Payment Model (APC-APM) includes variations of and components from this spectrum. The APC-APM includes a payment structure for participating primary care practices consisting of a combination of four mechanisms: • A prospective, risk-adjusted, primary care global payment for direct patient care, • Fee-for-service limited to services not included in the primary care global fee, • A prospective, risk-adjusted, population-based payment, and • Performance-based incentive payments that hold physicians appropriately accountable for quality and costs. As mentioned above, some value-based payments are dependent on meeting specified quality measures and outcomes. Quality measures vary among different models and payers; however, CAFP has long advocated for alignment of quality measures and reporting among payers to reduce the administrative burden on physician practices. The AAFP APC-APM proposes practices be evaluated based on reporting six measures, including one outcome measure and patient experience measures. These measures will come from the core measure sets developed by the multistakeholder Core Quality Measures Collaborative, and all but one of the core measures are also measures under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Merit-based Incentive Payment System (MIPS). This ensures harmonization and the avoidance of competing quality measures among payers. As CAFP advocates for payment reform to transition the current predominant payment scheme of fee-for-service payments to value-based payment models, CAFP will need the voice and expertise of our members. You know how health care works because you live it every day. Your expertise is critical when lawmakers make policy decisions on health care issues. So, voice your opinion. Tell your story. If you are interested in getting involved in CAFP advocacy efforts, contact Catrina Reyes at creyes@familydocs.org.

California Family Physician Spring 2021

cafp foundation

CAFP Foundation Welcomes New Executive Director Pamela Mann has joined the CAFP Foundation as Executive Director. She oversees the organization's philanthropic programs that aim to build a strong family medicine pipeline and workforce in California. Prior to this role, Pamela supported the Foundation's student and resident programs, including pathways opportunities into family medicine. Pamela comes to CAFP Foundation with more than a decade of experience in nonprofit management — previously working on public health programs for a national government association, directing complex global health projects in Africa and India, coordinating university clinical trials research,

California Family Physician Spring 2021

and conducting disease control activities for state/county health departments. She has experience across multiple public health disciplines, including education, epidemiology and surveillance, maternalchild health, and infectious diseases. Pamela holds a Bachelor of Health Sciences degree from James Madison University and a Master of Public Health degree in International Health & Development from Tulane University. She completed a fellowship in Epidemiology at the Florida Department of Health in Miami-Dade County. Outside of work, Pamela is a wine enthusiast and a great lover of music, people, stories, and riding her bicycle.

California Family Physician Spring 2021

cafp foundation 2020 annual report

Letter from the President I am happy to share the CAFP Foundation’s 2020 accomplishments. Despite the challenges that came with 2020, the CAFP Foundation renewed our commitment to nurture medical students and residents in their family medicine journey. In keeping with our mission to support compassionate and comprehensive primary health care for the people of California, we have used your contributions to bring dynamic programs to life. I am proud of the CAFP Foundation’s work to support opportunities for medical students and residents as they develop leadership and advocacy skills. Projects include

the Susan Hogeland Health Policy Fellowship providing students and residents with advanced legislative advocacy and mentorship experiences and the CAFP Primary Care Residency Collaborative preparing resident physicians to address the opioid crisis. This year we collaborated with the California Residency Network to implement a very successful Chief Resident workshop. As we face a crisis in health care access, it is important to develop our future health care leaders. Thank you for your support of the CAFP Foundation and our mutual goal of providing access to quality health care for all people of California. Be well, Marianne McKennett, MD President, CAFP Foundation

Mission Through philanthropy, the California Academy of Family Physicians Foundation nurtures each generation of family physicians to ensure the future of family medicine and celebrate the joy of our specialty!

Scholarly Activity: Empowering students and residents to conduct and present clinical and educational research allows them to meet critical academic requirements through the Student Research Grant Program and the Resident Poster Contest.

About the Foundation CAFP-Foundation is an educational 501(c)(3) dedicated to advancing the specialty of family medicine in California. Serving as the philanthropic arm of the California Academy of Family Physicians – the largest primary care medical society in California and the only organization solely committed to advocating for family medicine interests – the Foundation supports academic projects and scholarly activities for medical students and family medicine residents throughout the state.

Education: Training the next generation of healthcare leaders ensures a capable and diverse workforce and is accomplished through activities including Procedures Workshops, the Family Medicine Summit, and the Primary Care Residency Collaborative.

The Work of the Foundation Scholarships: Investing in family medicine’s future means providing opportunities for students and residents to attend seminal family medicine events including the American Academy of Family Physicians National Conference. Funding: Building a strong primary care workforce is possible when we support leaders dedicated to transforming their communities through mentorship programs and organized networks, including Future Faces of Family Medicine, Emerging Health Advocates and Family Medicine Interest Groups.

California Family Physician Spring 2021

Our Programs CAFP represents more than 3,000 student and resident members and serves as a resource hub for 14 medical schools and 70 family medicine residency programs. We are excited to highlight our 2020 initiatives that have supported medical students and residents in their journey to become family physician leaders. California Primary Care Residency Program Collaborative • 30 Family Medicine, Internal Medicine, OB-GYN programs spend a year in a learning collaborative and work on their own OUD-SUD projects • Interdisciplinary Expert Advisory Panel, $50,000 grants • Live and webinar learning • Maintenance of Certification Part IV Performance • Improvement module for all CA residencies • Four Regional MAT workshops

cafp foundation 2020 annual report • •

Web portal Supported by a grant from the State Department of Health Care Services

Family Medicine Interest Groups Through funding and technical assistance, CAFP-F builds a strong network of Family Medicine Interest Groups (FMIGs) across the state and supports activities that promote student interest in family medicine.

Scholarships and Fellowships CAFP-F invests in opportunities that promote intensive learning, mentoring and networking to help medical students and family medicine residents become more effective leaders. In 2020, the Foundation issued more than 40 awards for scholarships, fellowships and scholarly activities. continued on next page >

In 2020, CAFP-F funded FMIGs at all 14 allopathic and osteopathic programs and supported more than 15 initiatives. Pipeline Programs CAFP-F supports the education and career development of high school students interested in primary care through two pipeline programs: Future Faces of Family Medicine (FFFM) - Santa Rosa, CA FFFM recruits high school students to participate in a five-month career development and primary care training program. With goals of targeting minorities and first-generation college students, FFFM excites underrepresented youth about careers in primary care through mentorship with FM residents and faculty, engaging curriculum and hands-on activities. Emerging Health Advocates (EHA) Moreno Valley, CA EHA is a school-based community initiative that develops high school students as agents of healthy change. Resident physicians introduce concepts of health advocacy and upstream approaches to healthcare. Despite the shift from in-person activities, the depth and quality of the student work remains inspiring! As they considered the impact of the pandemic on health disparities in their communities, the students focused specifically on addressing health equity within their projects. The latest class will present their work to the community at a virtual health fair, with an expected participation of more than 250 students. California Family Physician Spring 2021

cafp foundation 2020 annual report < continued from last page

NCRS Scholarships provide students and residents the opportunity to attend the AAFP National Conference for Family Medicine Residents and Students. 17 The Susan Hogeland Health Policy Fellowship provides students and residents with advanced legislative advocacy and mentorship experiences. The Resident Poster Contest promotes scholarly activity for family medicine residents to present their research at the Clinical Forum, a statewide conference for family physicians. NCRS Scholars Kelton Mock, MS4, UCI School of Medicine - “NCRS allowed me to experience a vast amount of resources that made an impact on my future trajectory in family medicine and directly answered long-standing questions about the transition from residency into practice.” Russyan Mark Mabeza, MS3, David Geffen School of Medicine at UCLA - “I have been yearning to “find my people" and build the foundations for my impact in this specialty. I feel that and so much more after this conference.”

California Family Physician Spring 2021

Cierra Virtue, MS4, UC San Diego - “It has been a difficult and unprecedented year so far and this conference was an experience full of positivity and hope. I knew family medicine was the path for me quite early on in medical school, but this conference reemphasized the reasoning behind my choice.” Susan Hogeland Health Policy Fellows The Susan Hogeland Health Policy Fellowship identifies and supports promising medical students and family medicine residents committed to family medicine advocacy. In 2020, we welcomed three additional fellows. Student and Resident Council The CAFP Student and Resident Council is the official student-resident voice of the Academy. By bringing students and residents together, the Council promotes the exchange of ideas, builds leadership skills, pursues transformational advocacy and enriches CA’s primary care workforce with a strong family medicine pipeline. Through meetings, workshops and social events, the Council not only advances FM interests, but also has fun celebrating the joy of our specialty. The 2020 Council was 30 members strong.

cafp foundation 2020 annual report Resident Poster Contest CAFP-F supported 19 residents at the 2020 Virtual Resident Poster Contest. The poster competition promotes scholarly activity by family medicine residents and provides an opportunity for residents to present their research with a network of family physicians. Family Medicine Summit The 2020 Summit for medical students and family medicine residents was reimagined to include virtual webinars and an online directory of California Family Medicine Residency Programs. Procedures Workshop Now in its seventh year, this half-day event brought together undergraduates, medical students, resident physicians, and family medicine faculty from Southern California. With goals of teaching office-based procedures within family medicine practice, the Procedural Workshop provides a forum for developing professional skills and building connections between trainees and family physicians. The high volunteer faculty-to-

student ratio makes this workshop so incredibly special for students being introduced to primary care and family medicine. Board of Trustees Angie Zhang, MS4 Anna Askari, MD, PGY3 Anthony "Fatch" Chong, MD Christina Spandler, PGY2 Irina de Fischer, MD Lauren Simon, MD Lee Ounanian, MD Marianne McKennett, MD Stephen Brunton, MD Ronald Labuguen, MD Thomas Bent, MD Wendy Lee, PhD Staff Lisa Folberg, Chief Executive Officer Shelly Rodrigues, Deputy Executive Vice President Pamela Mann, Manager of Foundation Programs

California Family Physician Spring 2021

cafp foundation 2020 annual report

Dr. Mariah Hansen

Future Faces of Family Medicine Program Breaks Barriers As you can probably imagine, it has been a challenging year in so many ways, particularly around providing safe, engaging pathways programming for the youth in our community. We have remained committed to pivoting programming in creative ways to maintain our values, goals, and connection with youth in our community. When the COVID-19 pandemic hit our community, we had to suspend in-person activities for all our programs. This required us to rework all our curriculums and rethink mentorship and ways to inspire our BIPOC youth into healthcare career pathways. We quickly transitioned our high school youth programming to an all-virtual format and are so proud of our scholars for persevering and successfully completing our program. We were honored to host a Zoom graduation of more than 100 scholars, mentors, and family members. Following the program’s end, we wanted to reinforce our commitment to our scholars and continue to offer them opportunities for further mentorship in health care careers. We were inspired to create a new pathways program called Dr.EAM Ambassadors for our most recent Future Faces of Family Medicine (FFFM) graduates. Eight of our scholars opted to sign on as Dr.EAM Ambassadors to receive mentorship from our resident physicians, leadership development, community engagement/outreach, and further exposure to healthcare careers. With this program, we also continue to offer our resident physician valuable training in developing mentorship skills, foster teaching skills, advocating for diversity in primary care, and promoting family medicine careers. To date, we have supported 103 scholars through our pathway program over the past 8 years. We are proud to share that our 2020 FFFM alumni survey showed that 53 per cent of our alumni are currently pre-med students with hopes of going to medical school. One hundred per cent of all alumni noted that the FFFM program was instrumental in helping them choose their current career path and found the program meaningful. “Being a part of FFFM has made me feel empowered by providing a small, but powerful avenue to break barriers for minority students who aspire to be part of the healthcare force." - Dr. Karla Panameño, MD R3

California Family Physician Spring 2021

“Future Faces of Family Medicine gives me the support to feel like I can make it in such a competitive field. I have the mentors, resources, and support to believe that I can achieve anything.” - Sirena Nordstrom Miranda, FFFM Alumni and current Dr.EAM Ambassador Dr.EAM (Doctors Educating, Advocating, & Mentoring) Pathways, founded and facilitated by Sutter Santa Rosa Family Medicine Residency, is a comprehensive, longitudinal health care pipeline program designed to address educational disparities and enhance career opportunities in Sonoma County youth. The program prioritizes recruitment and enrollment of minority youth underrepresented in medicine (URM), who reside primarily in the Roseland area of Santa Rosa.

A Physician’s Voice in Politics An Interview with Dr. Akilah Weber Below is an edited excerpt from our interview with Dr. Akilah Weber (March 8, 2021), who is running in the special election for California Assembly District 79 (Southeastern San Diego area). As of April 9, 2021, Dr. Weber held onto a majority of votes in the special election.

Q: What inspired you to become a physician? I’ve always loved science. My parents also showed me the importance of always being of service and trying to make your community better. The practice of medicine is in that space where science and service merge. Going into medicine, I could have my science, but I could also make lives and communities better by improving health. I chose to go into obstetrics and gynecology because I really wanted to focus on impacting the lives of girls and women. You can change a lot, when you focus on improving the lives and health care of women.

Q: How do you feel like being a physician will affect your perspective as a lawmaker? We need more doctors in politics because the way we think is different. As physicians we have to be creative, think outside the box, be data driven and also consider the uniqueness of every person and situation. And that is what is needed in Sacramento, it’s needed on a local level, and it’s needed in Washington. Lawmakers often do the same thing over and over, and that is why we don’t get any results. In medicine, we cannot do the same thing over and over again, because everybody is different, and every situation is different. So, we must be creative. Photos courtesy of Dr. Weber's Campaign. 24

California Family Physician Spring 2021

Q: How will you approach issues like social justice, housing and other issues outside the traditional health care lens? We in health care understand that there is so much more to creating healthy individuals and families that happens outside of clinical practice. This includes access to quality health care, closing the educational achievement gap, ensuring no community is a food desert, and economic security. We understand because we have been talking about this in the health care community for a very long time, the Social Determinants of Health. We understand the impact of systemic racism, bias and microaggressions on one’s body. We see in the realm of obstetrics that black women are 3-5 times more likely to die or have some kind of negative outcome during childbirth regardless of their socioeconomic status. We are now seeing that the cardiovascular aspect of COVID-19 is disproportionately impacting women and especially black women.

Dr. Weber, her husband, Dennis and their boys, Kadir and Jalil.

Q: Apart from health care, what are your priorities when you get to Sacramento? I will also be focusing on closing the academic achievement gap. There is a huge gap between ethnic groups and certain socioeconomic groups. That gap has just widened because of COVID-19 and we need to make sure we close it because we are dealing with the health and the future of California’s kids. And the economy is extremely important to me, especially making sure that we are helping out small businesses. They are the lifeline of the city. They make each city unique and keep each city going.

Q: You are a physician, mom of two young children, wife, and elected official. How do you find balance? I learned the importance of self-care and balance after my first son was born. I would wake up in the morning get myself and him ready, drop him off and go to work. I’d pick him up and be focused on him until he would go to sleep. And then as soon as he would go to sleep, I’d finish my charts and then go to sleep. There was no me-time. It was starting to impact my health. I have apps that help me do meditation and yoga. I bought an elliptical because I couldn’t go to the gym anymore during COVID-19. I am not a morning person, but I must do that before the boys get up. It is so important and helps to start my day.

Q: What is your advice to a physician who is thinking about running for office? Do it! We need more physicians, we need more people in health care making policy, and not just at a statewide level, but at a local level as well. I would tell them that the political process influences everything that you do every day. I would love health care policy and advocacy to be part of the medical school curriculum to get people engaged early on. Then it wouldn’t be such a surprise to see a physician jump into this arena. California Family Physician Spring 2021

the voice of family medicine

Resident Voice Rises to National Leadership Below is an edited excerpt from our interview with Anna Askari, MD, MSBS. Dr. Askari is a PGY-3 at Eisenhower Health in Rancho Mirage, CA. Dr. Askari was born and raised in Columbus, Ohio (at the same hospital where she trained). She graduated from Ohio State University with a Bachelor of Arts in political science and minor in Spanish. She continued at OSU eventually graduating with a medical degree. She is the current resident member of AAFP Board of Directors and ex-officio resident director of CAFP Board of Directors. She also serves as a current CAFP Susan Hogeland, CAE Health Policy Fellow, and serves as a faculty member on the Expert Advisory Panel for the CAFP Family Medicine Initiative for TraumaInformed Care (CAFP ACEs-FIT).

1. When did you decide you wanted to step forward to take a leadership role? Was there a singular event, series of events, or did you always have leadership in mind? It all started when I was elected mayor of my third-grade class. I would say that I naturally gravitate towards a leadership role in any group setting. I was never shy in sharing my opinion and fighting for what I felt was the right thing to do. I also enjoyed helping others find their voice and was comfortable representing their voice when allowed. A singular event that I can think of was when I decided to go for the role of president of my medical school's Family Medicine Interest Group (FMIG). That is what really started my path in leadership with organized medicine.

2. What do you remember from those early conversations and processes to apply to these roles? And what was your support structure like? The process to apply was always easy, and I was lucky to find wonderful mentors along my way. Those early conversations always involved encouragement and advice to “just go for it.” I really do believe that certain people come into your life for a reason, and my life has been proof of that for myself. I am grateful for all that I have learned 26

California Family Physician Spring 2021

from my mentors, and I would not be as confident as I was in getting involved in leadership and advocacy without their support.

3. What does it mean to you to have a voice in local, state, and national conversations? As a family physician, we have access to evidence and amazing stories from our experience regarding what works to improve the health outcomes of our patients, which include infants, children, adults, pregnant women, the elderly… entire families within our community. To have a voice in local, state, and national conversations is how we take care of our patients outside of the exam room. It is vital to what makes us unique as family physicians and valuable members of our communities. It is not only an honor, but a great responsibility to provide a voice and serve as a liaison between our patients and their elected officials who create policies that affect their lives.

4. In terms of raising your voice as a resident, what advice would you give a medical student or resident who is thinking about taking on a leadership role? My biggest advice is to show up! I did not have any experience when I first attended an FMIG meeting at my medical school. They were looking for a new president, and I decided to just go for it. As the new president of our FMIG, I was approached by my original state academy, the Ohio Academy of Family Physicians (OAFP). That is where my leadership journey began.

5. Similarly, what advice would you give to a medical student or resident who does not want to be in a leadership position? I would let them know that there are many ways to be involved and make a tremendous contribution behind the scenes that does not involve being in a leadership position. I would encourage them to get involved in the way that makes them happiest and most valuable. This does not solely mean

signing up or running for a leadership position. Contact the CAFP or your local chapter and see how you can get involved.

6. What obstacles have you faced while in your roles? How did you overcome them? I would say spreading myself too thin. I have been involved in leadership and advocacy on a state and national level since I was a medical student and have had to continue to juggle that while being a family medicine resident. I have had to practice discipline and stay organized (I would not survive without my written agenda/planner that I carry with me everywhere!). I have had a lot of support from everyone in my life to refocus and reprioritize what needs to happen first. I have been working hard at saying no. It has been very freeing, but I also find myself unable to stay still. I basically do this to myself by signing up for so many things. At the end of the day though, I love what I get to do as a family doctor and advocate for my patients.

7. What is a particular accomplishment you have seen from your work since taking on the leadership positions? The fact that I have been able to network so well because of being in these positions. I believe it is the reason why I was able to get a wonderful first job out of residency (early in the process) due to the connections that I have made over the years with the work that I have done. I feel that it equally helped me stand out as an applicant for residency.

8. If you could go back to Anna the medical student and tell her one thing, what would that be? You are 100 percent a family physician like you always knew you were since undergrad. I would tell her that the huge risk that I would eventually take to go to California for residency will 100 percent be worth it!

California Family Physician Spring 2021

the voice of family medicine

Kim Yu, MD, FAAFP

Words Have Power: Your Voice in Social Media I vividly remember sitting in a cold conference room years ago, surrounded by FM revolutionaries and colleagues from around the country, listening to Dr. Reid Blackwelder from Tennessee. His words have stayed with me. As he spoke of advocacy and the role of Family Medicine to be at the table, he tasked us to use our voices for our patients and our specialty. American author Jay Baer once said, “Content is fire, and social media is gasoline.” It is true. Social media has become a tool to help amplify our collective voices. From raising money post-Hurricane Maria for family physicians to buy generators in Puerto Rico, to providing supplies and a portable ultrasound to physicians in the Bahamas post-Hurricane Dorian, to being involved in the #ThisIsOurShot (TIOS) campaign to build COVID-19 vaccine trust - through it all, I have seen the importance of connecting and engaging with friends, family, colleagues, and communities utilizing social media. I dare say that for some, especially during these COVID times, social media has allowed us to connect with each other in so many ways. We’ve connected through different Facebook groups, like Physicians Moms in Family Medicine, a group started over three years ago and now over 3,100 women family physicians strong, to tweetchats or even newer platforms like TikTok or Clubhouse. Together, we are learning new ways of reaching out to each other and to our patients. Social media has helped make our world feel smaller and more connected despite quarantines and lockdowns. It has allowed us to speak in so many ways and to extended audiences. Recently, I have given webinars for work on value-based care, and soon will be speaking by invitation of the World Health Organization on Implicit Bias and Health Equity, and then will be presenting to another AAFP state chapter on the East Coast about COVID and primary care. This is the new normal.

California Family Physician Spring 2021

Perhaps your practice is getting more engaged with your community through different channels. I am inspired by family physicians like Alex McDonald, MD, who was on an AMA YouTube video training health care heroes about the COVID vaccine campaign . Perhaps you have read news articles or viewed videos about Jerry Abraham, MD, who is doing tremendous work. He is immunizing patients and health care workers at Kedren Community Health Center in South Los Angeles, testifying in front of a Senate committee hearing to shed light on vaccine inequity and the need for more resources by giving a ground-level perspective. It has been exciting to see grassroots advocacy take flight around the TIOS campaign, especially since low vaccine trust is currently the single greatest barrier in reaching herd immunity. A recent survey by NPR showed that 85% of patients trust their physicians. It is imperative that we take time to educate about vaccinations in a relevant, helpful, and informative way. So, what can we do to elevate and amplify the message about COVID vaccinations? Share on social media, in your practices, in your communities, and with your friends, families and co-workers why they should get vaccinated. Answer questions and concerns. Host town halls or virtual events. Share your stories. Reach out to your health departments and your legislators and ask for more vaccines to be sent to primary care practices so family physicians can do what we do best: immunize patients patients who overwhelmingly trust us. May we together stay strong, keep advocating, keep speaking up, and using those words, whether spoken, written, or shared via social media, to combat myths, misinformation, and disinformation, to reclaim the narrative on vaccinations and public health. Thank you for all that you are doing during these trying COVID times. Together, we can. #InspireCreateLead.

ceo message

Lisa Folberg, MPP

Find Your Voice in What Drives You Your CAFP staff members arrived from different paths, but we are all here to help amplify the voice of family medicine. My path to CAFP was born of an interest in policy and advocacy. My interest in health policy began when I volunteered on the SF AIDS Foundation hotline in the early 1990s. I was intrigued that social mores and values were expressed through the clinical and policy response to a deadly virus. It was an eye opener for me to see how the way we structured health care and the way we funded it was guided as much by politics and prejudice as it was by experience and expertise. Eventually, my interest in health policy and systems took me to graduate school and then to the California Legislative Analyst’s Office (LAO). The LAO prides itself on providing non-partisan, well-researched, and emotional-less advice to the legislature.

Eventually I did end up lobbying for CMA and I learned that there are a lot of different ways to be an effective advocate. I learned how much advocacy happens outside of the formal legislative process and came to appreciate even more the power of knowledge and lived experience with an issue as I watched how effective physician advocates could be.

I became interested in health advocacy when I realized that good policy was not enough. I knew that making policy recommendations based on fiscal prudency without considering what was the “right” thing to do would not be sustainable for me. I also saw good policy become roadkill on the political highway, and knew I wanted to be in the place where politics and policy met.

I had the pleasure of interviewing Dr. Akilah Weber about her journey to run for the state legislature and about the important role physicians play in advocacy. Running for office is not the only way to engage in political advocacy. I encourage you to join the All Member Advocacy Meeting on May 15-16. Unlike most years, AMAM will be a virtual event this year. While we will miss walking over to the Capitol together and seeing a sea of white coats, we have found virtual legislative visits can be highly effective. On Saturday, May 15, we will focus on CAFP’s policy making process, through resolutions and electing leadership. On Sunday, May 16, we will focus on advocacy, providing attendees with training on how to be an effective advocate, and providing updates on important and timely advocacy topics, including CAFP’s sponsored bill to change payment structures to create a more equitable and accessible health care system. CAFP and your local chapters will then set up virtual legislative visits the following week.

Around that time, I had been recruited to join the lobbying team at the California Medical Association (CMA). I never saw myself as a lobbyist. Lobbying was a bad word, and lobbyists were less popular than pharmaceutical reps. But I was still struggling with how to be able to be a professional advocate in a meaningful way for the things in which I believed. To understand more about what a lobbyist did I shadowed someone. I followed her for a few days as she roamed the halls of the capitol and met with legislators.

While I hope you will join us at our virtual AMAM, as family physicians, you do not need to come to the capital to make change. There are myriad ways to interact with policymaking at the local, statewide, and national levels. This past year, I was so proud to see our members kneeling in their white coats to shine light on racial injustice, giving media interviews about the deleterious health effects for immigrant children separated from their families, and challenging health systems to ensure access to reproductive health services.

I saw lobbyists drinking and swearing with legislators, sharing personal stories, and being incredibly strategic. Coming from an office like the LAO, where we could not wear capri pants because they were too informal for a legislative setting, I was horrified and fascinated. These methods were not what I had learned in policy school.

I think about the work that all of you do every day to be great advocates and I am inspired. Dr. Andrea Espinosa is a one of our dedicated physician members who is serving on the Board of Registered Nursing NP Advisory committee to help implement AB 890, which expands NP authority. I think of Dr. Jeff Luther, a CAFP member who is the voice continued on next page > California Family Physician Spring 2021

< continued from previous page

of family medicine on the Governor’s community immunization task force. Dr. Jasmeet Bains is working to figure out how to address California’s physician workforce shortage as chair of the Song Brown Commission. Dr. Alexis Smith created a video to help teach young children about the existence and acceptance of LGBTQ people. Dr. Alex McDonald helped start the #ThisIsOurShot campaign. It has been and continues to be an incredibly challenging time for many family physicians and I know many of you are struggling to manage your professional and personal responsibilities. There is fatigue of the frustration at the dearth of information about vaccine distribution, and fatigue in battling the plentiful supply of misinformation. The fatigue of standing up for science when it is under attack. Now is the time we need the voice of family physicians more than ever. As family physicians, your voice isn’t just important, it is essential. If we work together, we can turn the family physician voice from a whisper to a bellow for the changes that are important to family physicians and their patients. Please make a commitment that you will make your voice heard in at least one new way this year. It may be writing a support letter for CAFP’s sponsored bill or calling a legislator’s office on one of CAFP’s high-priority bills. It may be attending a local chapter meeting and helping to craft a resolution to be heard at next year’s AMAM. Or maybe this is the year you attend AMAM. Maybe you post on CAFP’s online forum SPARK or even just take the time to send me your thoughts. I always appreciate hearing from members and would love to know what you think about practice, policy advocacy or even what it means to be a family physician in 2021. 30

California Family Physician Spring 2021

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The Becoming ACEs Aware in California Training is a free, two-hour training to learn about Adverse Childhood Experiences (ACEs), toxic stress, screening, risk assessment, and evidence-based care to effectively intervene on toxic stress. You may receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits upon completion. The training is available to any provider, but it is particularly geared towards primary care clinicians who serve Medi-Cal (California's Medicaid program) beneficiaries. Beginning July l, 2020, Medi-Cal providers must attest to completing a certified core ACE training on the DHCS website to continue receiving payment for ACE screenings. Visit training.acesaware.org.

CAFP's Family Medicine Initiative on Trauma-Informed Care (FIT) workshop consists of two sessions, two weeks apart, designed to introduce clinicians to the concepts of toxic stress and Adverse Childhood Experiences (ACEs) as they relate to trauma-informed care. In session l, participants will learn about the relationship between toxic stress and chronic disease, how to screen for ACEs, and meet in small groups to discuss trauma-informed care. In session 2, the focus will shift to best practices, practical strategies to use when responding to ACEs in their patients, as well as regional/ state resources to use with patients.

Learners who attend both sessions can earn up to 6 AAFP Prescribed Credits. CALIFORNIA ACADEMY OF

FAMILY PHYSICIANS

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CAF P's e-publication "We are More than Our Numbers" released. The publication discusses ACEs and trauma-informed care, the landscape in California, and the risks for special populations. California Surgeon General Nadine Burke-Harris, MD provides the introduction. The e-publication is a complementary tool to the ACES FIT project and is sponsored for 7.25 AAF P Prescribed credits. Read at www.familydocs.org/aces.

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

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Spring 2021

Articles inside

Political Pulse: Once More Unto the Breach, Dear Friends!

Looking Back on the Past Year

Our Experiences Fuel Our Voices