Fall 2021 by California Academy of Family Physicians

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CONNECT WITH US:

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 President Shannon Connolly, MD, FAAFP Immediate Past President David Bazzo, MD, FAAFP President-elect Lauren Simon, MD, MPH, FAAFP Speaker Raul Ayala, MD, MHCM Vice-Speaker Alex McDonald, MD, FAAFP Secretary/Treasurer Anthony "Fatch" Chong, MD Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jay Won Lee, MD, MPH, FAAFP Lee Ralph, MD AAFP Alternates Michelle Quiogue, MD Lisa Ward, MD, MPH, FAAFP CMA Delegates Kimberly Buss, MD Felix Nunez, MD Sumana Reddy, MD, FAAFP Kevin Rossi, MD, FAAFP

Staff Lisa Folberg, MPP Chief Executive Officer lfolberg@familydocs.org Morgan Cleveland Manager, Operations|Governance and FP-PAC mcleveland@familydocs.org Jerri Davis, CHCP Vice President, Professional Development, CME/CPD jdavis@familydocs.org Pamela Mann, MPH Executive Director, CAFP Foundation pmann@familydocs.org Anita Charles Program Assistant acharles@familydocs.org Josh Lunsford Director, Membership and Marketing jlunsford@familydocs.org Christine Lauryn Manager, Member Communications clauryn@familydocs.org Catrina Reyes, Esq. Vice President, Policy and Advocacy creyes@familydocs.org Jonathan Rudolph Manager, Finance jrudolph@familydocs.org

CMA Alternate Delegates Raul Ayala, MD, MCMH Noemi Doohan, MD, PhD Adia Scrubb, MD, MPP David Tran, MD

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 Fall 2021

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The Fall 2021 issue of California Family Physician has been reviewed and accepted by the American Academy of Family Physicians for three Prescribed CME credits. Complete the quiz on page 28 to claim credit!

features SUBSTANCE USE DISORDER 14 Contingency Management Could Have Saved My Son 16 Approach the Intersection of Substance Use Disorder and ACEs 18 Fighting Against Two Standards of Care 20 Improving Services to Patients Experiencing Addiction

Irene Filimonoff-Haney Adia Scrubb, MD, MPP Eri Solomon Jerri Davis

22 COVID-19 Vaccine Uptake and Hesitancy Q&A with Alex McDonald, MD, FAAFP, CAQSM, Kim Yu, MD, FAAFP, and Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP 24 Trust Me, I’m a Family Physician

Jay W. Lee, MD, MPH, FAAFP

departments 6 Editorial

Embracing the Change that Seasons Bring

Brent Sugimoto, MD, MPH, FAAFP

8 President’s Message

EveryBODY for CAFP

11 Political Pulse

California Invests in Health Care

Carla Kakutani, MD

12 Legislative Update

The Journey of a Sponsored Bill

Catrina Reyes, Esq.

30 CEO Message

CAFP Moves to Sacramento

Shannon Connolly, MD

Lisa Folberg, MPP

Your Online Resource for Continuing Medical Education. Visit education.familydocs.org!

editorial

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

Embracing the Change that Seasons Bring As I write this, it is just now officially fall. Here in the Bay Area, it is a lovely time. At the bookends of the day, fog descends to cap the hills of the East Bay in velvety, diaphanous grey. The air is crisp, and the autumnal sunlight has a sideways brilliance that provides a new perspective on familiar surroundings. Lately, I am always appreciative when I can have a new perspective. The change of the seasons offers a new way to see things, and that, amidst the doomscrolling that is the news these days, is a gift.

“

In perennially sunny California, we look to signs in fall for the texture of our winter: wet or dry? One-minute navy showers (if you are familiar with navy showers, then either you’ve had a naval career or you’re truly a Californian!) or luxuriating in enveloping liquid warmth and head clearing steam? Flush with abandon or continue contemplating when yellow is yellow enough? We know with winter’s arrival, there will be change, but in California, trust no one who claims to predict our winter weather. Nothing is certain. The future is unwritten.

At the most recent COD, all five candidates who ran for the AAFP Board of Directors were women. Our candidates for president were a Black woman and international medical graduate, and a Black gay man from the military. These are historic events for family medicine, and were the culmination of many years of assiduous, concerted work to shape the leadership of our specialty. You can be proud that California family physicians have been part of this movement at all levels of organized medicine.

Uncertainty leaves the possibility for change, and if things can change, they can be better.

At this year’s AAFP Congress of Delegates (COD), departing board chair Dr. Gary LeRoy exhorted us to embrace change as a force to “push, pull, and drag our specialty to the future.” Californian family physicians have long made this advice their praxis and have helped to move the AAFP forward on many issues vital to our patients and practices, such as medical aid in dying, race-based medicine, reproductive health, and immigrant health.

California Family Physician Fall 2021

“

I do not know how the fall will turn this year, and in the context of the past one and half years of pandemic, I’ve come to realize that this uncertainty fills me with optimistic anticipation. Uncertainty leaves the possibility for change, and if things can change, they can be better. The future will not be free of challenges, but neither is it predestined. The future is our opportunity, if we choose to engage it.

To propel this progress further, I am excited that former CAFP president, Dr. Jay Lee has announced his campaign for the Board of Directors at the AAFP COD in the fall of 2022.

Jay is one of the family physicians who helped ignite and cultivate this movement of family medicine leaders. If you have ever chanted or tweeted for the #FMRevolution, then you know the work of Jay, its progenitor. He encouraged me and many others to seek leadership and convinced us of the worth of our perspectives in medicine. Jay has given me many lessons on leading from one’s own values, which for him include a commitment to patients, a commitment to service and a commitment to equity, along with the conviction of family medicine’s central role in creating a more just world for our patients. I encourage you to check out Jay’s campaign at the website FMRising.com (launching soon) and through social media with the hashtag #FMRising. I think you will be inspired by Jay’s vision for what our specialty can be. This is the last issue of California Family Physician for the year, which means that 2022 is already right around the corner. I hope you find your own reasons for optimism with the changing of the seasons. Best wishes these next couple of months, and we will see what the new year brings!

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p r e s i d e n t ’s m e s s a g e

Shannon Connolly, MD, CAFP President

EveryBODY for CAFP I remember presenting a patient to one of my attendings when I was a med student. I listed out her medical problems, which ranged from diabetes to hypertension, and explained my rationale for selecting each medication. The final problem I listed was obesity, and my treatment plan involved an exercise program and consultation with a dietician.

“

“I’m gonna stop you right there,” my attending said. “Don’t waste your time. People who are fat don’t want to change.” Discrimination against people with larger bodies is widely acceptable in our culture. We see it in popular media, as evidenced by the trope of the “fat villain” (think of Ursula from The Little Mermaid). Thin people are perceived as more disciplined, competent, and morally superior, and this has implications for job hiring, advancement, and even salaries. Perhaps most concerning, weight stigma continues in healthcare, and medical professionals discriminate against people who have excess weight frequently. These patients are more likely to be viewed as noncompliant, lazy, unintelligent, or as my attending would have me believe, “a lost cause.”

shows an error reading because it is not able to measure a weight over 500 lbs. You are brought into an exam room, and the MA has to leave the room to get a “thigh cuff” because the large BP cuff does not fit your arm. You’re given a gown to change into, but you soon discover that it is too small and leaves your breasts exposed. Things only get worse when the physician arrives to do your pap smear. The leg rests do not support your thighs. The speculum is the wrong size and the doctor struggles to do your pap. The clinical team has to “troubleshoot” at every step because there are no existing processes in place to ensure a patient-centered experience.

Family doctors can transform our clinical spaces into places of healing, comfort, and health promotion for people of all body types by changing the very culture of care delivery.

“

Imagine you are a patient arriving at your doctor’s office for a routine pap smear, and upon entering the waiting room, you discover that all the seats have armrests that make it impossible for you to fit in them, so you must stand. A medical assistant calls you to the back and then attempts to weigh you on a scale in the hallway….except the scale

Now imagine that you are also a person who has experienced childhood sexual trauma (because childhood sexual trauma is twice as common in people with obesity), you are a person of color, you have a long history of struggling with body image, and you have a mental health condition that requires that you take a medication that causes weight gain. This scenario is a nightmare. It is also the daily experience of many people living with obesity. Recently, my organization launched an initiative we call the EveryBODY Project to try to address this. We are educating our staff, examining our policies and procedures, creating physical spaces that accommodate people of all body sizes and types, and ensuring that we have the medical equipment and knowledge to take care of our patients in ways that are affirming and do not cause shame. I’m inviting

continued on page 10 8

California Family Physician Fall 2021

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continued from page 8

you to join me in this work! Family doctors can transform our clinical spaces into places of healing, comfort, and health promotion for people of all body types by changing the very culture of care delivery. There are many opportunities to do things better. We can train our medical assistants on how and when to take a patient’s weight, and how to respond when a patient expresses discomfort at getting weighed. We can learn how to frame conversations about healthy nutrition and physical activity in ways that are confidence-promoting and harness each individual’s personal strengths. We can educate ourselves about the causes of obesity, which are often rooted in social, educational, economic, political, and environmental factors. We can explain to our staff that people who have experienced and continue to experience high levels of toxic stress are more prone to obesity than those who do not. This is perhaps why there is such a strong correlation between trauma and obesity. In my organization we also learned that we needed to systematically evaluate our physical spaces and equipment to ensure that we could accommodate any body. We realized that we needed different furniture in the waiting rooms,

scales that could weigh people of any weight, gowns that fit a diversity of body types, different ways of measuring blood pressures, and different equipment for gynecological exams. We also needed to educate our staff on anticipating the needs of people with diverse body types and automatically adjust to accommodate them in a way that does not call attention to their bodies. Perhaps most importantly, we learned that almost every day we identify a new way in which our processes and spaces are not working for our patients, and each of these “aha moments” teaches us to that we must continue to do this work because we have not yet achieved our goal. The work of the EveryBODY project makes my heart full because it is one way that we can push back against body shaming narrative that is so prevalent in our society. I believe family doctors can lead this cultural shift. We can be more compassionate in health care. We can do better by our patients and promote healthy habits in ways that empower and do not cause shame. We can change our culture to be kinder, more compassionate, and more inclusive.

UCSF Fresno Family Medicine UCSF Fresno and CCFMG are recruiting physicians to join our teaching faculty. We have core and clinical tracks in both inpatient and outpatient settings. Our positions provide an opportunity for teaching, clinical research, and community practice. Each physician holds a faculty appointment from University of California, San Francisco at UCSF Fresno.

Located in the heart of California, Fresno County has a diversity of natural beauty and recreational opportunities. Fresno County is close to three national parks and other wilderness areas. From the cultural diversity displayed in museums, restaurants, and festivals, to recreational opportunities in the region’s numerous lakes, rivers, foothills and mountains – Fresno County has it all. Stephanie Delgado, Physician Recruiter 559.443.2689 Stephanie.Delgado@ccfmg.org UniversityMDs.com 10

California Family Physician Fall 2021

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political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

California Invests in Health Care We’ve reached the end of the legislative session, which means Governor Newsom has signed into law the 2021-22 State Budget, setting spending levels for the next fiscal year. The new Budget includes major investments in health care, including: •

$50 million augmentation for the Song-Brown Primary Care Physician Training program to fund new primary care residency programs.

•

$8 million to fund workforce programs that fund geriatricians or providers serving older adults in underserved areas.

•

Expanding Medi-Cal coverage to undocumented adults aged 50 and older beginning May 1, 2022.

•

Funding for the California Advancing and Innovating Medi-Cal (CalAIM) Initiative, which includes population health management services that would centralize administrative and clinical data from the Department of Health Care Services, health plans, and providers. Access to this information would allow all parties to better identify and stratify member risks and inform quality and value delivery across the continuum of care.

•

Extending Medi-Cal eligibility from 60 days to 12 months for postpartum individuals, effective April 1, 2022, for up to five years.

•

Extending telehealth flexibilities allowed during the federal public health emergency, including payment parity for audio-only modalities through December 2022 and coverage of remote patient monitoring.

•

Eliminating suspensions for Proposition 56 supplemental payment increases.

•

$300 million ongoing for investments in public health infrastructure.

•

$1.08 billion for COVID-19 response costs. These funds will support testing and laboratory operations, vaccination, medical surge capacity, contact tracing management, and other state operations needs.

Budget trailer bills are also passed along with the budget. Budget trailer bills include the detailed policy of how programs that received funds through the budget will operate. One of the trailer bills already signed by the Governor includes the transition of the Office of Statewide Health Planning and Development (OSHPD) to the Department of Healthcare Access and Information (HCAI). OSHPD’s growing portfolio made it time for the office to become a department. The change includes the creation of the California Health Workforce Education and Training Council to provide guidance on statewide health workforce education and training needs related to primary care, nursing, and oral, behavioral, and allied health. This new Council will replace the California Healthcare Workforce Policy Commission, which governed the Song-Brown program. The change also includes a new California Health Workforce Research Data Center that will serve as the state’s central hub of health workforce data with new statutory authority to collect additional workforce data. CAFP will continue to work with the new department during the transition to ensure investments in the primary care workforce remains a priority. Unfortunately, CAFP’s sponsored bill, Senate Bill 402 authored by Senator Hurtado, did not make it through the legislative process as it was placed on the Suspense File in the Assembly Appropriations Committee and did not make it out of the Committee. SB 402 would have created 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 wherein the impact has been greatest among minority and marginalized communities. The goal of the pilots was to transition small fee-for-services primary care physician practices into alternative payment models by aligning health plan contracts around uniform payment and quality measures.

California Family Physician Fall 2021

legislative update

Catrina Reyes, Esq.

Vice President of Advocacy and Policy

The Journey of a Sponsored Bill All legislation starts off as an idea. Factors that CAFP staff, the Legislative Affairs Committee, and the Board of Directors take into account when considering an idea include, amongst others, whether the bill idea advances CAFP’s strategic plan, has a primary care or family physician focus, solves a current problem, is feasible, avoids unintended consequences, and has potential allies and minimal adversaries. Senate Bill 402, CAFP’s sponsored bill this year, met all of these factors. SB 402 would have established multi-payer payment reform pilots in areas hardest hit by COVID-19 with the goal of transitioning primary care physician practices from fee-for-service payments to alternative payment models. After CAFP decides on a bill idea, CAFP staff draft bill language and a fact sheet to “shop” to members of the Legislature to persuade them to author the bill. If the author is a Senator, the bill is introduced at the Senate Desk; if an Assemblymember, at the Assembly Desk, where it is assigned a number and read for the first time. Senator Melissa Hurtado was the author for CAFP’s sponsored bill this year thanks to requests from her constituents and CAFP members, Jasmeet Bains, MD, and Raul Ayala, MD. After the bill is read for the first time, it goes to the Senate or Assembly Rules Committee, where it is assigned to a policy committee. CAFP sponsored bills are typically assigned to the Health Committee. Bills are not heard 12

California Family Physician Fall 2021

in policy committee until 30 days after they have been introduced and in print. Prior to a sponsored bill being heard in Committee, CAFP meets with other organizations that could be potential allies as well as members of the Health Committee to garner their support. SB 402 had broad-based support from organizations including the American Academy of Pediatrics (California), American College of Obstetricians and Gynecologists District IX, American Diabetes Association, California Chronic Care Coalition, California Medical Association, California Pan - Ethnic Health Network, California State Council of Service Employees International Union (SEIU California), CaliforniaHealth+ Advocates, Center for Collaborative Solutions, Children's Defense FundCalifornia, Community Health Councils, Latino Coalition for A Healthy California, Primary Care Development Corporation, and Purchaser Business Group on Health.

During the Committee hearing, the bill author presents the bill and time is allocated for witnesses in support of and in opposition to the bill. CAFP member, Sumana Reddy, MD, and CAFP Vice President of Advocacy and Policy, Catrina Reyes, testified in support of SB 402. There were no witnesses in opposition. SB 402 passed out of the Senate Health Committee with a unanimous vote. If the bill has a fiscal impact or a state cost, it will be heard in either the Senate or Assembly Appropriations Committee. The Senate Appropriations Committee placed SB 402 on the Suspense File, because it was assumed to cost the State $3 million to implement. The Appropriations Committee sends any bill with an annual cost of more than $150,000 to the Suspense File. Suspense File bills are then considered at one hearing after the state budget has been prepared and the Committee has a better sense of available revenue. No testimony is

presented – author or witness – at the Suspense File hearing. If a bill does not make it off the Suspense File, it does not continue through the legislative process. Fortunately, after strong grassroots advocacy from CAFP members during CAFP's Advocacy Week, SB 402 made it off the Suspense File and passed out of Senate Appropriations Committee. After the bill passes the Appropriations Committee, it is read for the second time on the Floor. Third Reading is the last stage that a bill goes through in the house of origin before it passes to the second house to go through the committee process all over again. On Third Reading, the author presents the bill for passage by the entire house. Most bills require a majority vote (it must pass by 21 votes in the Senate and 41 votes in the Assembly), while urgency measures and appropriation bills require a two-thirds vote (27 in the Senate, 54 in the Assembly). SB 402 passed the Senate Floor on the Consent Calendar as it had no opposition. Bills may be placed upon the Consent Calendar if they are reported to the Floor with that recommendation, received no “no” votes in committee, and have had no opposition. SB 402 also passed out of the Assembly Health Committee on the Consent Calendar. The bill, however, was again placed on the Suspense File in the Assembly Appropriations Committee and this time did not make it out of the Committee. The bill made it far through the legislative process though, which means we were able to educate many legislators on the importance of investing in primary care and to lay the foundation for future efforts. If a bill passes the Legislature, it goes to the Governor to sign, approve without signing, or veto. If the Governor vetoes the bill, a two-thirds vote in each house is needed to override the veto. The Governor's Office releases veto messages which explain the veto. If the bill is

signed or approved without a signature, it typically goes into effect January 1st of the following year. Throughout the Legislative process, from finding a bill author to getting SB 402 off of the Senate Appropriations Suspense

File, it was because of strong advocacy efforts from CAFP members that moved the bill forward. Never doubt the strength of your voices in promoting important issues that impact family physicians and your patients.

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By Irene Filimonoff-Haney Shatterproof Ambassador in California

Contingency Management Could Have Saved My Son In July of 2000, I wrote this to my son on the back of a photo of the two of us: “My sunshine, I’ve been blessed with having you. You are my soulmate. The happiest times of my life were shared with you. You have been my friend and support through hard times. And through you I found myself. Love life. Don’t be scared. Remember, ‘That shall also pass.’ God bless you, my love. Mom”

California Family Physician Fall 2021

I lost him, my only son and the father of my 3-year-old grandson, to fentanyl poisoning on November 9, 2020. He suffered on and off from stimulant use disorder, anxiety, and depression for 23 years. Last fall when he relapsed and was looking for treatment, most of the providers required cash only — up to $38,000 per month — and one treatment program told him that his private insurance

would only cover three days. It would have been a joke, if it didn’t result in tragedy. I’ve since learned that contingency management is the most effective treatment protocol for stimulant use disorder, but my son never received it. It was never offered. Contingency management incentivizes patients through tangible rewards, which has been shown to significantly improve retention in treatment and abstinence. There is a current bill that just passed in the California legislature, SB 110, which would allow for the inclusion of contingency management within substance use disorder services under the state’s Medicaid program. I will be urging the Governor to enact SB 110 swiftly so that this treatment protocol can be offered to patients and save lives. Unfortunately, stimulant-involved deaths are escalating. In 2020, California had a 45% statewide increase in fatal overdose deaths. My son became a statistic, one of 93,000 sons, daughters, fathers, mothers, sisters, brothers, friends. Besides the loss of the 93,000 lives, no one is talking about the families that are left behind and the generation we are losing. Nothing can return my soulmate to me. And my grandson will never see his beloved daddy again. So, this is what I live for: the hope that my grandson’s generation will not be cast away like his father’s generation was, and that the antiquated stigma surrounding

addiction will cease to exist. My hope is that my efforts may save another mother from the unimaginable loss of a child and that we will see more treatment options, like contingency management, which help people thrive in recovery. I am one of the countless mothers that would like to see SB 110 signed into law,

so that this evidence-based therapy can be utilized by treatment providers and help increase those entering treatment, ultimately saving lives. Shatterproof is a national nonprofit organization dedicated to reversing the addiction crisis in the United States. Shatterproof harnesses the models of

business, the rigor of science and the power of a national movement to create change and save lives through three pillars of work: revolutionizing the addiction treatment system, breaking down addiction-related stigmas and supporting and empowering our communities. To learn more visit www. Shatterproof.org

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California Family Physician Fall 2021

Adia Scrubb, MD, MPP

Approach the Intersection of Substance Use Disorder and ACEs When I met Robert, he was very motivated to stop his alcohol use. He was in his mid 50s and already had a long history of brief periods of sobriety with multiple relapses. He was tired of the relapses and really wanted my help to find something that would work for him. Robert was a little bit of a challenge, however, in that he had already gone to AA meetings, residential recovery programs, and had even taken disulfiram. But things were starting to take a toll on his liver and he was willing do any of those things again if it would somehow help him this time. About 50% of individuals experiencing substance use disorder have a co-occurring mental illness. Since he had been currently sober for a about 6 months, we decided to start working on what turned out to be moderate depression. Once he was connected to a community therapist and started on medications, he felt some improvement and was optimistic. He came in at regular intervals to update me on his progress and sobriety. With each conversation that we had, I realized that he was eager to understand why nothing had really worked in the past for his sobriety. I learned that he was unemployed, had a marriage that ended in divorce, and had a strained relationship with his daughter that he really wanted to repair. He was very hard on himself as he blamed himself for the relationships that fell apart. I remember asking Robert what his trigger to drink alcohol was, and he said, “being alone”. Isolation allowed him to ruminate about his personal failures and he would turn to drinking alcohol. His self-esteem was higher when he was around other people or working. I thought about why being alone, even for short periods of time, would send Robert into a spiral. He shared with me that his parents separated when he was young, and he didn’t have much of a relationship with his father. His father died before he could reconcile with him. He had a relationship with his mother, but she wasn’t entirely emotionally available. He thought that perhaps that had an influence on really wanting relationships to work and then feeling guilty when they failed. Robert expressed to me that his heavy drinking worsened after his own divorce. I now understood that 16

California Family Physician Fall 2021

Robert possibly had at least one Adverse Childhood Experience in connection to his alcohol use. Adverse Childhood Experiences (ACEs) has a very strong association with substance use disorder through the alteration of the hypothalamic pituitary adrenal (HPA) axis in an environment of toxic stress. This impacts brain development and can lead to maladaptive behaviors. Chronic stress has been associated with increased vulnerability to substance use and is a significant risk factors for relapse. Childhood parental divorce and emotional neglect are ACEs that can lead to substance use disorder and depression. Once I understood how important his relationships were, I wondered if Robert had taken steps to repair his connections or if there was a way to help him build new ones. I encouraged him to try additional group therapy and reconnect with his daughter with the hopes that working on these relationships could help prevent a relapse. After a few months, he was happy that things were going well after reconnecting with her. He also liked the group therapy session and attended when he could. My heart sank when I got a note from the ED for a head laceration after Robert fell while intoxicated. The note was followed by a message from Robert stating that he would be checking himself into residential rehab program for a month. During his stay he focused on the relationship with his father that he never had the chance to repair. In an office visit after his program was completed, he seemed to reach a point of closure about their relationship, and he felt ready to move forward. At my last visit with Robert, he was one year sober, working part time, and very happy that he understood himself better. Given the strong association with SUDs and mental illness, a trauma informed approach can help with establishing the rapport needed to encourage a patient through treatment. Considering and/or screening for a history of ACEs can not only add perspective about a patient and their difficulty with treatment, but it can sometimes be the key to helping a patient move forward in their treatment progress.

We Too Believe... Healthcare is a Fundamental Human Right! Join our team! Visit our Careers page at srhealth.org

phone: 707.303.3600 ext. 2587 TULARE COUNTY HEALTH & HUMAN SERVICES AGENCY

MEANING. SATISFACTION. IMPACT.

If you’re searching for a profession with meaning, that gives you job satisfaction and where you can make an impact on others’ lives, consider Tulare County Health and Human Services Agency(HHSA). We are actively recruiting for multiple vacancies for Physicians, Nurse Practitioners, and Physician Assistants to work in our Health Care Centers and adult Mental Health Clinics. These offer a progressive and innovative working environment and provide comprehensive health care in the community. Our employees are driven by the desire to help people, and they take pride in providing assistance to others to cope with the challenges of life and finding a solution.

Visit our website at http://tularecounty.ca.gov/hrd to obtain more information regarding the various career opportunities Tulare County HHSA has to oﬀer! California Family Physician Fall 2021

Eri Solomon Shatterproof Ambassador

Fighting Against Two Standards of Care

California Family Physician Fall 2021

with substance use disorders deserve comprehensive, compassionate, and standard of care medical treatment throughout our lifespan, without prejudice, discrimination, or shame.

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Together, I know that we will be able to build a healthcare system where everyone, including individuals with substance use disorders, has access to the comprehensive, compassionate, and standard of care medical treatment we all deserve.

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Hello! My name is Eri Solomon from Jamaica Plain, MA. I am a community organizing professional working to advance equitable economic justice policies and initiatives in the state of Massachusetts. However, I am sharing my story with you today because I am also a person in long-term recovery from a substance use disorder, as well as the child of a parent grappling with active addiction. Consequently, from my father’s fear of openly discussing his crack cocaine use with his healthcare providers as he ages to disparaging comments spoken directly to me in the clinic about people with substance use disorders, stigma in our healthcare system is intimately personal, intergenerational, and alive for me. I present my story as someone diagnosed with both a substance use disorder and a rare, connective tissue condition – hypermobile Ehlers Danlos Syndrome or “hEDS”. This perspective is meaningful because, while mine might be a rare disease, the experience of facing illness and injury is universal to all of us, including those of us with substance use disorders: both for reasons related to our addiction and for reasons entirely separate. Improving patient experiences for people with substance use disorders and our families must therefore systematically encompass all of these healthcare encounters, from primary care to pulmonology to psychiatry. People

Unfortunately, we remain far from actualizing this equitable vision, as stigma still occupies a deeply rooted and systemic presence in healthcare. Because of this, I carry with me a profound fear that I will be denied standard of care medical treatment because of provider stigma. I can imagine entering an emergency department in severe danger from complications of my Ehlers Danlos Syndrome and being sent home without assessment or treatment on accusations of drug seeking and hypochondria. I can imagine being

denied effective pain management while recovering from a procedure, abandoned in debilitating pain because a provider is unwilling or unprepared to offer necessary opioid treatment to someone with an opioid use disorder. I can imagine providers dismissing or doubting the validity of my recovery because of my use of Medication for Addiction Treatment (MAT) to support that recovery. And I can imagine these nightmares because they are not hypotheticals for those of us who are facing addiction. Rather, they reflect our lived experiences: collectively, our stories comprising patterns of symptom dismissal, treatment denial, and uncontrolled pain. Ultimately, substance use disorders can affect anyone and, consequently, they do impact every area of medicine and every aspect of the healthcare system. I meet regularly with eleven specialists, from neurology to cardiology to primary care. Together, they provide the comprehensive care that makes my healthy, active, and meaningful life possible. And this demonstrates that any physician could find themselves treating patients who happen to be experiencing addiction and those patients deserve to receive nondiscriminatory, compassionate, and standard of care medical treatment from every single provider they receive care from. I know that when I have faced stigma from any one of my treating professionals, my wellbeing,

• Physician • Allied Health Provider (FNP, PA, etc.) • RN

Top of the line benefits including; employer-paid health and life insurance and, generous contribution to 403B, 3 weeks paid vacation, 8 days paid sick leave, 10 paid holidays and 2 paid personal days, up to 5 paid CE days, relocation assistance, employee incentive bonuses, etc. All positions are Monday-Friday, 8am-5pm!

An opportunity you can’t pass up. Ione is our newest medical facility and is conveniently located in the middle of the charming foothills, with activities for the whole family. Less than an hour to Sacramento, two hours to Lake Tahoe and ski resorts, minutes from beautiful downtown Sutter Creek, thriving wine country, lakes, golfing, and a multitude of other activities.

Apply online at www.macthealth.org

Now Hiring! MACT Medical Ione, CA my health, and even my life have been inevitably imperiled because of it. For example, it took six years from the appointment in which I began searching for answers to a lifetime of debilitating symptoms before providers accurately diagnosed and offered treatment for my hypermobile Ehlers Danlos Syndrome, even as I awoke each morning in devastating unexplained and unaddressed pain. While this was partially because hEDS is a rare syndrome unfamiliar to many physicians, addiction and mental health stigma absolutely fueled the dismissive attitudes, remarks, and decisions I faced from providers. I am fortunate to now have excellent care, but those years without proper intervention left me with preventable and disabling physical harm that is now irreversible. Consequently, the most impactful and concrete action step each of you can take to improve both experiences and outcomes for patients with substance use disorders is simply to insist that we receive the same standard of care as those without them, a dignity regularly denied to us because of stigma in healthcare. The standard of care should be the standard of care for everyone: we must accept nothing less. Moving forward, while actualizing this ideal will require a multi-pronged approach that addresses stigma on the structural, cultural, and individual level, from within the framework of your own positions and initiatives each of you now have the powerful opportunity and responsibility to act as advocates amongst your peers for patients with substance use disorders; demonstrating what comprehensive, compassionate, and standard of care medical treatment for individuals with addiction ought to look like, with a commitment to dignity at its foundation. I invite you today to commit to engaging in this necessary and impactful education and advocacy work. Together, I know that we will be able to build a healthcare system where everyone, including individuals with substance use disorders, has access to the comprehensive, compassionate, and standard of care medical treatment we all deserve. Eri Solomon is one of the many Ambassadors sharing their story for Shatterproof.org.

Charles R. Drew University of Medicine and Science

invites applications for the position of: Director of Behavioral Sciences

This position is responsible for the development and delivery of the residency behavioral medicine curriculum in alignment with ACGME Requirements for the Family Medicine Residency Program.

Essential Duties: • Facilitate behavioral science curriculum development and teaching for the FM residency Program

• Counsel residents • Supervise Family Medicine residents in competently addressing issues of depression, addiction and other common mental health conditions seen in primary care • Respect resident work hours, paying close attention to signs of Fatigue and Sleep Deprivation in individuals • Develop and maintain a regular and viable presence within the family medicine practice, establishing positive and collaborative relationships with the nursing staff to assure efficient operation of the behavioral sciences program. • Collaborate with the development of a residency Wellness program • Take responsibility for resident successful performance on the behavioral health sections of the in-training exams. • Be a positive role model for professionalism and collaborative behavioral health integration. • Observe and evaluate a minimum of two FMP patient encounters per resident annually • Evaluate Family Medicine residents, using competency based/milestone evaluations and via direct observation and other relevant evaluation methods. • Coordinate relevant behavioral health curriculum and didactics. • Attend faculty meetings, serve on relevant committees, and participate in administrative decision making. • Participate regularly in and present scheduled didactics • Demonstrate a commitment to scholarly work, both self-directed and with residents

Applicant Requirements:

• Doctoral degree (PhD or PsyD) in clinical or counseling psychology, family therapy, or social work from an accredited program required. • Completion of a clinical internship/residency appropriate for the field of study (such as an internship/residency in clinical and/or counseling psychology/social work.) • Psychologist license or license eligible in the state of California.

For more information contact: Stephanie Brown, GME Program Administrator, stephaniebrown@cdrewu.edu Applications may be filed online at: https://jobs.cdrewu.edu/postings/4313 California Family Physician Fall 2021

By Jerri Davis CHCP Vice President of Education and Professional Development

Improving Services to Patients Experiencing Addiction We all know the pandemic has made the drug overdose epidemic even worse, especially in areas like San Francisco where by May 2020, three times as many people lost their lives due to drug overdose than from COVID-19. As California has seen rising rates of social inequities, homelessness, mental illness, and despair, the state also has seen an increase in opioid abuse, addiction, and overdose deaths, especially among those most marginalized in our society. This spring, powerful synthetic opioids such as fentanyl caused California’s 12-month all-drug overdose death rate to spike nearly 27%, significantly faster than the national average. And it is not just opioids. An alarming increase in deaths involving the stimulant drugs methamphetamine and cocaine make it clear we face a complex and ever-evolving addiction and overdose crisis characterized by shifting use and availability of different substances and use of multiple drugs (and drug classes) together. CAFP leads effort to improve services to patients experiencing Addiction in California CAFP and CAFP Foundation received a grant from the CA Dept of Healthcare Services in October 2019 to convene our second California Residency Program Collaborative (CRPC) to improve education, outreach, and treatment for patients with substance use

California Family Physician Fall 2021

California continues to lack the resources needed to treat the nearly 686,900 people suffering from opioid addiction. disorder disease, including stimulant and opioid use disorder, with a focus on increasing capacity for effective Medication Assisted Treatment (MAT) implementation. CRPC is designed using the Institute for Healthcare Improvement’s Breakthrough Series Collaborative model. This means the grantees will work individually on their own projects and collaboratively as a learning unit. The model encourages sharing of ideas, wins, barriers, strategies, tools, and resources. The project also supports extensive practice/program

“While I was hesitant to start providing MAT, I realized my patients would be worse off had I done nothing. Once I started treating them, I quickly realized that my patients receiving MAT were the most grateful patients I ever had walk in my clinic. There are few experiences more rewarding than making a real difference in a patient's life.” – California MAT Provider

transformation support, including quality improvement (QI) education, coaching, resources, and tools to help implement change. The overall transformation process provides a structure for awardees as they work through implementation of their projects. The collaborative framework of the overall project promotes sharing among residencies even as specific implementation and challenges vary. CAFP worked with other primary care specialty organizations to convene an Expert Advisory Panel that includes physicians specializing in Family Medicine, Emergency Medicine, Internal Medicine, and Pediatrics to help with the program. This panel had the difficult task of choosing the final 16 residency programs selected for awards. There were 34 applicants, and the final grantees include Family Medicine, Emergency Medicine, Pediatrics, Ob-Gyn, and Psychiatry Residencies. They were notified this spring and selected for their innovative local projects aimed at improving care for patients with opioid and substance use disorders, including stimulants. In addition to their projects that range from adding or expanding street medicine outreach, increasing harm reduction efforts, and forging productive collaborations with community partners to developing inpatient MAT consult services, most of the grantees continue to encourage as many providers in their programs as possible to get training and education to begin offering MAT, especially

now that HHS has issued new practice guidelines removing the 8 hour X-waiver training requirement to treat patients with buprenorphine [https://bit.ly/xwaiverruling]. This guideline change was announced days after a report showing that fatal overdoses have skyrocketed to record highs during the COVID-19 pandemic.

The medical evidence is clear: access to medication-assisted treatment (MAT), including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder. CAFP has worked with expert faculty to offer a wide variety of education that is available to everyone through CAFP’s education portal Homeroom [education. familydocs.org] and we encourage you to take a look. Accredited CME sessions range from 20-minute activities on addiction as a brain disease and screening tips for SUD to longer activities on communication strategies around SUD, Pregnancy and SUD, Telehealth for SUD and Evidence for Treating Stimulant Use Disorder, to name a few. In addition, we are fortunate in California to have access to so many terrific resources that support efforts to improve services to patients with SUD like the CA MAT Expansion Project [www.californiamat.org] consisting of a variety of programs – including the CA Substance Use Line (844-326-2626) offering free, expert, confidential 24/7 teleconsultation for substance use evaluation and management. Another terrific resource is CABridge.org providing a wide variety of practical tools, training, and support to increase the number of clinicians providing addiction treatment. Finally, links to the tools and resources being offered to the Collaborative are available on the CRPC website [ https://www.familydocs.org/crpc/ ] including AAFP’s EveryONE project and more.

We hope you are inspired by these residents and faculty that have taken on these projects to improve and expand the services they provide individuals suffering with substance use disorder. In addition to a lack of providers offering addiction treatment, stigma has been identified as a barrier preventing broader access to life-saving medications for Substance Use Disorder (SUD). Because clinicians are typically the first points of contact for a person with an SUD, health professionals can reduce the potential for stigma and negative bias by learning the terms to avoid and use. The National Institute on Drug Abuse (NIDA) offers “Words Matter,” a handout with tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction.

HOMEROOM ACTIVITIES: • Screening and Identifying Opioid Use and Substance Use Disorder • Medication Assisted Treatment (MAT) and its Utility to Treating OUD • Pregnancy and Women's SUD • Communication Matters: Motivational Interviewing and Substance Use Disorders • Medication Assisted Treatments (MAT) for Opiates, But What About Stimulants? • Telehealth for Substance Use • Is Addiction a Brain Disease? • The Role of Abstinence in OUD Treatment • Opioid and Substance Use Disorders in Special Populations: Youth and Young Adult Athletes • Treating SUD - Linking with Community Services • Incorporating MAT into Practice - A Community Conversation

Visit Homeroom online at education.familydocs.org

Discover your perfect practice. What are you searching for? More time with family? Growth opportunities? A change of scenery? It’s out there, and we can help you find it.

Explore hundreds of jobs at info.psdconnect.org/cfp California Family Physician Fall 2021

COVID-19 Vaccine Uptake and Hesitancy Q&A People with substance use disorder (SUD) are at increased risk for adverse effects of COVID-19, but getting vaccinated can prevent severe illness, hospitalizations, and death from COVID-19. However, people with SUD may face unique barriers to getting vaccinated. For example, it can be difficult for providers to contact and reach people who use drugs, who may not have a usual place of medical care. Like many others, people with addiction may have vaccine hesitancy—often spurred by misinformation and distrust of the health care system. Past experiences of stigmatizing interactions with healthcare may contribute to these feelings and perceptions. To bring you strategies to meet these challenges head-on, we talked with three providers working to expand access to vaccination among people with SUD and in under-resourced communities. The Q&A below was compiled from these interviews.

Meet the Providers Alex McDonald, MD, FAAFP, CAQSM Family and Sports Medicine Physician Southern California Permanente Medical Group Dr. Alex McDonald is a co-founder of the This Is Our Shot campaign, focused on motivating people to get vaccinated by spreading factual information about the vaccines to dispel myths and rumors. Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP Critical Care and Infectious Diseases Pharmacist Assistant Professor of Pharmacy Practice School of Pharmacy at Loma Linda University of Loma Linda Dr. Jacinda Abdul-Mutakabbir (Dr. Jam) has worked to expand vaccine access to minority and under-resourced communities—through working with faith leaders, setting up pop-up vaccine clinics, and developing “strike teams” to go door-to-door to share information about the vaccines and offer vaccination. Kim Yu, MD, FAAFP Regional Medical Director for Aledade Inc. President Elect for the Orange County Chapter of the California Academy of Family Physicians Dr. Kim Yu has been working to expand access to COVID-19 vaccines by developing strategies to identify and reach out to those who have not been vaccinated, reduce barriers to access, and normalize the conversation about the vaccines with patients. She is also a member of the executive leadership team for the This Is Our Shot campaign.

Expanding Access to COVID-19 Vaccinations Among People with SUD—A Q & A with Providers Q: How can I help improve access to vaccines for people with SUD? Meet them where they’re at. Reach people with SUD directly in their communities instead of expecting that they come to you—visit homeless and other shelters, barber shops, or attend Narcotics and Alcohol Anonymous meetings. Share information about the vaccines and offer it, if possible. Consider using paper forms to sign people up for the vaccine, 22

California Family Physician Fall 2021

which may help expand access to people who lack access to the internet, computers, or smart phones. Dr. Jacinda Abdul-Mutakabbir shared that her organization has developed strike teams that go door-to-door in minority communities and homeless shelters to talk to people about the vaccine and provide vaccinations.

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Normalize vaccination. Discuss the vaccines with patients regularly. Ask for permission to share your story about getting vaccinated (and stories of your staff, family, friends, and other patients) to let them know that you are confident in its safety and effectiveness. Make vaccines readily available. Increasing how often the vaccine is provided at your practice can help expand access to care—simply by being available at any time for patients to get vaccinated. Partner with community-trusted sources. Connecting with community leaders can help get the word out, often in a way that resonates with the community. Sharing talking points grounded in science can help provide a solid foundation for conversations on this topic. “We partnered with faith leaders to establish pop-up vaccine clinics in minority communities, providing access to and information about the vaccines. We also hosted faith summits to deliver and clarify information about COVID-19 vaccines in a culturally sensitive way. We talked about the burden of COVID-19; vaccine hesitancy; mutations of the virus; the pharmacology of the vaccines (e.g., how they work, what they do); and the meaning of clinical studies.” – Jacinda Abdul-Mutakabbir

Q: How can I address vaccine hesitancy among people with SUD? • Start from a place of caring. With consideration of the historical mistrust between people with SUD and the health care system, ask patients to share their story to get to know them first. Once you establish a foundation of trust, ask them to talk about why they may be hesitant to get vaccinated, giving them space to discuss why they believe any misinformation they share. • Talk about the benefits of vaccination. Discuss how vaccination can allow people to maintain their health and the health of those around them, and to return to normal activities from before the pandemic (e.g., family gatherings, restaurants, weddings and parties, feeling safe at work). • Be clear and transparent. Be transparent about risk factors and side effects; it is important not to minimize them. When discussing the science behind the vaccines, use simple and clear language and try to make the conversation enjoyable and/or relatable. If a patient asks whether they can continue to use substances, share information about side effects and discuss how people in their demographic group were accounted for in the clinical studies and what that means for them. • Clarify misconceptions. Common misconceptions include concerns about safety (e.g., causes infertility), that it was created too fast, and that

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there is a microchip tracker in the vaccine. To clarify misconceptions and assuage concerns, ask patients to explain why they think those things. Listen to their reply and ask them if you can share your understanding of the vaccine, how it works, how it was developed (e.g., no safety steps skipped), and its safety. Focus on shared decision making. It is the patient’s decision to get vaccinated, and using shared decision making processes can help you support them in their decision. Myth Buster Myth: The COVID-19 vaccine was created too quickly, and it’s probably not safe. Truth: [Coronavirus vaccines] have been in development since the original SARS outbreak in 2003, so the spike protein has been well-studied; the last mile was able to be pushed through because the regulatory burdens were reduced, and all safety steps were done concurrently.” – Dr. Alex McDonald

Q: What else can I do to help with vaccine uptake among people with SUD? • Get additional resources. Visit the Centers for Disease Control and Prevention (CDC) to read about common myths about the COVID-19 vaccines and get accurate information and facts to help stop them from circulating. The CDC also offers communications resources—including toolkits, graphics, factsheets and other tools—to help you talk about and share information about the vaccines with patients in a positive, proactive, and productive way. • Consider conducting personal outreach to patients. Reach out to patients who have not received the COVID-19 vaccines via phone, email, and or text messaging with information and access to vaccination. Sharing information and messaging that encourages vaccination through patient portals, websites, social media, along with flyers and posters in practices can also raise awareness and motivate patients to get vaccinated. • Bring in students. When it comes to going into communities to reach under-resourced populations, include young people and students when possible. The innovative community health work that is being implemented to increase vaccine uptake can be applied and translated to improve health outcomes for other public health needs. “Include students in these activities, because COVID is not going to go away, but there are other diseases that impact minority groups and the work with COVID can translate to work in these fields. Students bring longevity and give them the tools to continue to create equity across health care.” – Jacinda Abdul-Mutakabbir California Family Physician Fall 2021

Jay W. Lee, MD, MPH, FAAFP

Trust Me, I’m a Family Physician Family physicians are highly trained leaders. We lead by building trust. If trust is a formula, the trust equation is [credibility + reliability + intimacy] over [self-orientation]. Credibility has to do with the words we speak. Reliability has to do with actions. Intimacy refers to the safety or security we feel when entrusting someone with something. Self-orientation refers to the degree to which a person’s focus is on themself versus others. As you can see, by consistently allowing for a sacred place in the exam room for our patients, we become their trusted family physician by becoming the physicians we

California Family Physician Fall 2021

wrote about in our personal statements. This type of giving of ourselves has its positives but it also has its negatives. Consider the moral injury we have all suffered as a result of the COVID-19 pandemic, for example. Apply the trust equation to those who have questioned the science, our expertise, our training, our motivations for becoming physicians, and even, our caring. How has this made you feel? Personally, I’ve experienced a mix of denial, isolation, anger, and depression. In other words, I’m just short of bargaining and acceptance to have fully experienced the Kübler-Ross five

stages of grief. Yes, I am grieving because of COVID-19, and no, I will not accept that our trust has been toppled. In the movie, Inception, the concept of a dream within a dream is explored. Characters use totems to determine if they are in a dream or in reality. The main protagonist, Dominick Cobb, uses a spinning top, for instance. If the spinning top continues to spin, this indicates he is still within a dream. However, if the spinning top falls, this means he is in reality. Unusual times call for unusual methods. I think we all need a totem to ensure we are experiencing reality, not a dream. That totem is each other. Yes, the pandemic has weighed heavily on each of us. Yes, we have not been able to gather and see each other. Yes, we have become increasingly isolated. But being vulnerable is being strong and we need each other more than we ever have. Connectedness is powerful and we need it (we deserve it) more than ever so lean into your reality and reach for your totems. As Dr. Vivek Murthy writes so elegantly, “at the center of our loneliness is our innate desire to connect. We have evolved to participate in community, to forge lasting bonds with others, to help one another, and to share life experiences. We are, simply, better together.” You have permission. Connect with your med school and residency classmates. Connect with your colleagues. Share your feelings. Share your frustrations. Share your successes. Check in with someone to validate the reality you are experiencing. Share your hope. Be able to trust again because we are indeed entrusted to do the right thing. Our patients need us. Our nation needs us. We must not allow ourselves to be toppled by mistrust.

Physician Fellowship Opportunities in the Pharmaceutical Industry The Rutgers Institute for Pharmaceutical Industry Fellowships is the largest and most experienced provider of Doctor of Pharmacy (Pharm.D.) Fellowships in the Industry.

Elica Health Centers is Seeking: Physicians, Physician Assistants, Nurse Practitioner, LCSW and Dentist

Full-Time, Part-Time Positions Available Contact us:

The Institute is currently seeking physicians for new and exciting Fellowship opportunities beginning July 1, 2022 with several Pharmaceutical Companies located in the NJ/NY/PA and CA areas. Industry Physician Fellowships to date are designed as 1 year in length with adjunct faculty appointments at the Ernest Mario School of Pharmacy at Rutgers University. We are seeking physicians with completed Residencies in Internal Medicine, Family Practice, or Pediatrics for select positions; clinical practice experience is preferred for some Fellowship positions. We are also seeking physicians with completed Fellowships in Hematology, Oncology, Rheumatology/Immunology, Cardiology, or Infectious Disease for select positions. Interested candidates should visit pharmafellows.rutgers.edu/physicians for more information and to apply with a letter of intent, curriculum vitae, and 3 letters of recommendation. Recruitment for the July 2022 program will begin September 1, 2021. Candidates will be considered on a rolling basis. The application process for 2022 Industry Physician Fellows will be closed once the positions are filled.

Visit our web site at

www.elicahealth.org Or send resumes to

cpineda@elicahealth.org

Bilingual Primary Care Physician We seek a Primary Care Physician to join a team that is deeply committed to helping our employees and families lead healthier lives for our Central Valley Health & Wellness programs, in Lost Hills, CA. We Offer: • A patient-first approach, working towards increasing access for medically underserved, delivering free and top-notch quality of care. • Brand new state-of-the-art clinics • Support of a committed and collaborative interdisciplinary healthcare team • Manageable patient volume, with around 15 patients/day, 100% outpatient care, and NO obligations to be on medical call off-hours. • Monthly car allowance, relocation assistance, sign-on bonus, continuing medical education, and 100% of California accreditation fees paid. • A top-quality health coverage plan also includes a state-of-the-art onsite gym and a subsidized cafeteria serving fresh, healthy food. • Competitive benefits package including Medical (including 24/7 online access to a physician), Vision, Dental, and 401k with match eligibility. • Work-life balance - Paid holidays, vacation, personal, and sick time. • Monday – Friday work schedule with no nights, weekends or on call

For more information contact: Shelley Radford at Shelley.Radford@wonderful.com

California Family Physician Fall 2021

MD/DO Medical Director Needed for a Rural FQHC (Federally Qualified Health Center)

Join us to provide health care services in a Federally Qualified Health Center (FQHC) located in California’s beautiful western sierras. Shingletown is a small town located along California State Route 44 in the mountains just below Mount Lassen. We are also known as “The Gateway to Lassen”. Work as an integral part of our provider staff by participating in our medical/behavioral health team, QA/QI and additional staff teams. Will also perform supervision of PA/NP staff.

Benefits:

• Regionally competitive salary, health benefits and voluntary retirement plan • Employment bonus and moving allowance • Proposed schedule will consist of three 10-hour days (8:30am -7:00pm with half hour lunch) • Paid bereavement and jury duty leave, holidays, sick/vacation time • CME reimbursement • Company provided malpractice insurance for all providers • No after hour call required If you are interested in additional information or are the right candidate for this position please contact Denise Highfill, Chief Operations Officer at:

dhighfill@shingletownmedcenter.org or

530-474-3390

https://shingletownmedcenter.org/

PRIMARY CARE PHYSICIANS San Francisco Bay Area

Contra Costa Health Services is seeking full-time BC/BE FM, Peds or IM Primary Care Physicians. Our health centers across Contra Costa County are integrated with specialty care services and the public hospital. We are looking for providers from diverse backgrounds and lived experiences who share our vision of providing equitable and quality health care to all members of our Contra Costa community. Desired applicants would work with a motivated practitioner group to provide innovative community medicine that empowers patients by fostering an environment of belonging and well-being. We offer: • Modern facilities serving the needs of ethnically and culturally diverse populations • Opportunity to be involved in resident teaching with our nationally recognized Family Medicine Residency Program • Comprehensive compensation package • 4 hours of paid administrative time a week for full-time providers and No Call • Favorable HPSA score for national and state loan repayment programs • EPIC medical record system

For more information, please contact: Recruit@cchealth.org

2021 CAFP Fall Magazine: California Family Physicians (SUD/OUD) This Enduring Material activity, 2021 Fall California Family Physician Magazine, Fall 2021 has been reviewed and is acceptable for up to 3 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins October 20, 2021. Term of approval is for one year from this date. AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1. Clinicians should claim only the credit commensurate with the extent of their participation in the activity. To claim your credits, please complete and return this quiz and evaluation to CAFP, cafp@familydocs.org or fax 415-345-8668. You may also complete this online: https://bit.ly/cfpfall2021 As an Accreditation Council for Continuing Medical Education-accredited provider, CAFP is required by the ACCME Standards of Commercial Support, to identify, manage or resolve any conflict of interest for any individual who may have influence over educational content provided by the CAFP. Our conflict-of-interest policy is inclusive of all the elements of the ACCME definition of a commercial interest. Our policy requires us to collect disclosure forms from any individual who may have an influence on any educational content. Our goal in identifying, managing and resolving interest is to ensure that all education content and curriculum, presentations and products are free of commercial bias and promotion. The CCPD reviews all COI forms and employs a process to ensure the quality of our educational program. We also engage our learners through the evaluation process to monitor for bias/promotion and effectiveness of the activities.

NAME

AFFILIATION

RESPONSIBILITY

DISCLOSURE

Brent Sugimoto, MD, MPH

Decoded Health

Editor, Planner and Author

Nothing to Declare

Shannon Connolly, MD

Natividad FMRP

Author

Nothing to Declare

Eri Solomon

Shatterproof

Author

Nothing to Declare

Author

Nothing to Declare

Managing Editor, Planner

Nothing to Declare

Jay Lee, MD, MPH Josh Lunsford

CAFP

Learning Objectives After reading the articles in this issue, learners should be able to:

• Consider ACEs screening with SUD patients; • Apply strategies to combat stigma; and • Explain importance of transforming clinical spaces to improve patient care.

California Family Physician Fall 2021

Quiz: Please check the correct answer/s. 1. How many individuals in the US experiencing substance use disorder (SUD) also have a co-occurring mental illness? ( ) 10 percent ( ) 50 percent ( ) 80 percent National Alliance on Mental Health (NAMI) https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders

2. According to Eri Solomon, what is the most impactful and concrete action step one can take to improve both experiences and outcomes for patients with substance use disorders (SUD)? ( ) Spend more time with patients experiencing SUD. ( ) Receive the same standard of care afforded patients not experiencing SUD. ( ) Use motivational interviewing with patients experiencing SUD.

3. Dr. Connolly described several steps clinicians can take to improve patient care. Which of the following did she discuss in her article? Check all that apply. ( ) Designing physical spaces to accommodate all body types. ( ) Providing staff training on how and when to take a patient's weight. ( ) Educating ourselves about the causes of obesity. ( ) Having confidence-promoting conversations about healthy nutrition and physical activity with patients. ( ) Use the term “physical activity” instead of “exercise.” 4. Do you plan to make any changes based on the education you received? ( ) Yes ( ) No 5. If yes, what changes do you plan to make? [ ] Consider screening more for Adverse Childhood Experiences (ACEs) [ ] Seek additional information about Trauma Informed Care [ ] Incorporate strategies to reduce stigma [ ] Review opportunities to improve physical space and equipment [ ] Check out CAFP's ACEs-TIC Website with resources - www.familydocs.org/ACES [ ] Other - Write In: _________________________________________________ 6. What is your level of commitment to making the changes stated above? ( ) Committed ( ) Somewhat committed ( ) Not very committed 7. Please let CAFP know what educational programming you would like to see offered. _______________________________________________________________________________________________________ Please complete these demographic questions so we can process your CME credits. We will not share this information. Name: ___________________________________________________________________________________________________ Address: _________________________________________________________________________________________________ City/Start/Zip: __________________________________________________________ Email: ____________________________ To claim your credits, please complete and return this quiz and evaluation to CAFP, cafp@familydocs.org or fax 415.345.8668. You may also complete this online: https://bit.ly/cfpfall2021 California Family Physician Fall 2021

ceo message

Lisa Folberg, MPP

CAFP Moves to Sacramento The impact of COVID-19 on our personal lives, work and collective psyche will be fodder for PhD research and articles in the Harvard Business Review for years to come. Many of us have discovered new things about ourselves, our organizations and the world around us. As an organization we at CAFP have realized that we can work remotely but need to come together sometimes to maximize our creative teamwork. Much of the work we do as your CAFP staff is not place-based, meaning we need to be anywhere (and everywhere) our members are, but no place specifically. CAFP has almost 11,000 members from the Northern border with Oregon south to the Mexican border, from the Pacific Ocean to Nevada and Arizona on our Eastern borders. The exception to this is our work in advocacy and policy. This work is largely done in Sacramento and post-COVID restrictions will continue to have an important in-person aspect. This, coupled with lower housing and commercial property prices, resulted in the CAFP Board unanimously deciding to move the organization from San Francisco to Sacramento. This move is not just a physical move, it symbolizes a continued commitment to position CAFP as a thought leader in California. Being in Sacramento will help to ensure that we are able to attend legislative hearings, stakeholder meetings and better develop Sacramento-based relationships.

California Family Physician Fall 2021

I am very excited to report that CAFP has secured a purchase agreement for a new building in Sacramento. After some building improvements, it will be a wonderful new home for CAFP. Many of the CAFP staff will be working semiremotely, so we no longer need multiple private offices. Instead, we need large gathering places and smaller conference rooms. Our new building offers just that. We will have a conference room that will be perfect for hosting Board and committee meetings, educational sessions and community events. We hope to be able to host you at the 2022 AMAM in Sacramento on March 12-13, and Lobby day on March 14. Change is challenging, and that is the point. Change challenges us to keep growing and evaluating best practices. The timing couldn’t be better. In November 2021, your CAFP Board will meet in person for the first time in two years to develop a new three-year strategic plan. As a result of the CAFP Board’s hard work, staff input and a wonderful strategic planner, we are well positioned to develop a strategic plan that builds on the history and strengths of family medicine adapted for some new realities and objectives. Together we will ensure that the strategic objectives for the CAFP move the family medicine revolution forward toward a primary-care based health care system. Visit us online at familydocs.org to find out more and to get involved.

Family Medicine Physician Job Opening Position Summary:

UCI Family Medicine, a Department of the University of California-Irvine School of Medicine, is committed to upholding the highest professional and institutional standards. We thrive by promoting optimal health for patients, staff, trainees, and faculty. UCI Family Medicine provides clinical services for patients of all ages in a variety of settings as follows: Family Health Centers (federally qualified health centers or FQHC’s) in Santa Ana and Anaheim; Gottschalk Plaza; Senior Health Center; skilled nursing facilities; inpatient services and obstetric deliveries at the UCI Douglas Hospital in Orange. UCI Family Medicine provides education across a variety of programs including undergraduates; medical students; family medicine residents; fellows in geriatrics and sports medicine; and outreach to the community. We are seeking a qualified individual who is an excellent clinician with a strong commitment to clinical leadership, quality improvement and teambased patient care. The incumbent in collaboration with the Executive Medical Director (EMD) of the Federally Qualified Health Center (FQHC), will direct, coordinate, and implement the QI Program for the Federally Qualified Health Center and function as the Anaheim Site Medical Director. The incumbent will collect, manage, and analyze FQHC quality data and prepare quality reports for review. Incumbent will have practical knowledge and skills in Continuous Quality Improvement, including analysis and interpretation of data using computer based disease registries or similar data collection systems is essential. The incumbent reports directly to the EMD and to the Department Chair.

Essential Job Functions:

• Provides clinical expertise and leadership while assisting in the development, monitoring, and presentation of internal quality measures and initiatives. Disseminates QI performance to clinical staff team on a regular basis. Adheres to all UCI FQHC Policies and Procedures. • Leads and participates in Quality, and ad hoc meetings as directed by the EMD. Assists with coordination of monthly QI Meetings. Communicates FQHC initiatives to department members to ensure adequate understanding. Assists department medical directors to prepare QI reports and statistics. • Provides leadership by focusing teams and organization units on visions and distinctive strategies that result in excellent short and long-term performance. This includes coordinating, tracking, and reporting of clinical outcomes. Assist with annual UDS and HRSA reports and ensures timely completion of corrective action plans related to quality. • Reviews incident reports from the Safety and Quality Information System (SQIS) as well as patient grievances and conducts follow up investigations as warranted. • Collaborates with the FQHC Executive Medical Director in the investigation of clinical events including sentinel events, sentinel event near misses, and significant adverse events; leads and/or participates in the development of root cause analyses. • Oversee all aspects of patient care services at FHC Anaheim with the site Practice Manager to assure that the medical care provided is of highest quality and standards and consistent with all accreditation and licensure requirements. • Provide leadership, oversight, and supervision of all physicians and allied health care providers working at the site. • Serve as the medical liaison with outside referring physicians to facilitate inter-institutional transfers.

Requirements:

• Family physician; board-certified, full-scope ambulatory health care services including care of children, adults and the elderly. • Experienced in providing and/or oversight of pre-natal care. • Demonstrated experience in quality improvement to improve patient outcomes • Leadership skills; ability to motivate, inspire, communicate with faculty, residents, staff, and peers to maintain a professional, team-based approach in the care of patients. • Proficiency in Spanish

Compensation Range:

Commensurate with Experience

Link to Apply:

https://careersucirvine.ttcportals.com/jobs/7529484-staff-physician Note: Applicant may be eligible to apply for loan repayment.

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

Presorted Standard U.S. POSTAGE PAID

Fayetteville, AR Permit No. 986

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Fall 2021

Articles inside

CEO Message CAFP Moves to Sacramento Lisa Folberg, MPP

President’s Message EveryBODY for CAFP Shannon Connolly, MD

COVID-19 Vaccine Uptake and Hesitancy Q&A with Alex McDonald, MD, FAAFP, CAQSM Kim Yu, MD, FAAFP, and Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP

Improving Services to Patients Experiencing Addiction Jerri Davis

Political Pulse California Invests in Health Care Carla Kakutani, MD

Contingency Management Could Have Saved My Son Irene Filimonoff-Haney

Legislative Update The Journey of a Sponsored Bill Catrina Reyes, Esq

Editorial Embracing the Change that Seasons Bring Brent Sugimoto, MD, MPH, FAAFP

Approach the Intersection of Substance Use Disorder and ACEs Adia Scrubb, MD, MPP