VOL . 72 NO. 3 Su mme r 2 02 1
STAY ONE STEP AHEAD IN YOUR PRACTICE Request CAP’s Free Guide for Staying Up to Date on Today’s Critical Practice Management Issues.
Download Your Free Guide Now CAPphysicians.com/SUCCESS2
In One Step Ahead: An Essential Guide for Running a Successful Independent Medical Practice, you will ÀQG HDV\ WR IROORZ UHFRPPHQGDWLRQV IRU ɵ 2SWLPL]LQJ \RXU SUDFWLFH ZRUNÁRZ LQ WKH DJH RI COVID-19 and beyond
CAP is a physician-led organization offering secure medical malpractice protection to California physicians for more than 40 years.
ɵ Managing an effective and compliant telemedicine program
To see how much you can save on your medical malpractice coverage, get an easy, no-obligation quote at
ɵ Avoiding risks of patient consent and documentation-related liabilities
CAPphysicians.com/MYMEDMAL2
ɵ And more!
800-356-5672 MD @ CAPphysicians.com
Get Your FREE Guide Today: CAPphysicians.com/SUCCESS2
Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section RI WKH &DOLIRUQLD ,QVXUDQFH &RGH 0HPEHUV SD\ WD[ GHGXFWLEOH DVVHVVPHQWV EDVHG RQ ULVN FODVVLÀFDWLRQV IRU WKH DPRXQW QHFHVVDU\ WR SD\ FODLPV DQG DGPLQLVWUDWLYH FRVWV No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement.
Introducing business checking that’s a real team player »Óâ ÞàÓÛ×ãÛ ÐÓÜÓù âá âÖÏâ ù â âÖÓ ãÜ×ßãÓ ÜÓÓÒá ÝÔ âÖÓ ÖÓÏÚâÖÑÏàÓ Ðãá×ÜÓáá ÃÞâ×Û×èÓ ¶ãá×ÜÓáá ·ÖÓÑÙ×ÜÕSM,1 Ýø Óàá çÝã ÛÝàÓ áãÞÞÝàâ ÛÝàÓ ÑÝÜâàÝÚ ÏÜÒ ÛÝàÓ ÏÑÑÓáá »Óâ áÓÏÛÚÓáá ÐÓÜÓù âá âÝÝÚá ÏÜÒ áãÞÞÝàâ âÖÏâ ÖÓÚÞá çÝã ÔÝÑãá ÝÜ åÖÏâ ÛÏââÓàá • • •
· ÝÛÐ×ÜÓ âÖÓ ÔÓÏâãàÓá ÏÜÒ ÐÓÜÓù âá ÝÔ Ï áÛÏÚÚ Ðãá×ÜÓáá ÑÖÓÑÙ×ÜÕ ÏÑÑÝãÜâ å×âÖ ÝÞâ×ÝÜÏÚ âàÓÏáãàç ÛÏÜÏÕÓÛÓÜâ áÓàä×ÑÓá 2 µÑÑÓáá àÓÚÏâ×ÝÜáÖ×Þ ÐÓÜÓù âá âÖÏâ ÖÓÚÞ çÝã ÔÝÑãá ÝÜ çÝãà Ðãá×ÜÓáá áãÑÑÓáá ÇâàÓÏÛÚ×ÜÓ çÝãà ÞÏçÏÐÚÓá àÓÑÓ×äÏÐÚÓá ÏÜÒ àÓÞÝàâ×ÜÕ
ÀÓâ á âÏÚÙ ÏÐÝãâ åÖÏâ Ýãà ÞàÓÛ×ãÛ ÐÓÜÓù âá ÑÏÜ ÒÝ ÔÝà çÝã »×äÓ ãá Ï ÑÏÚÚ Ããà ¶ãá×ÜÓáá ¶ÏÜÙ×ÜÕ µÒä×áÝàç ÇÞÓÑ×ÏÚ×áâá ÏàÓ àÓÏÒç âÝ ÖÓÚÞ ÏÜáåÓà çÝãà ßãÓáâ×ÝÜá Ïâ 1-844-807-5060 ÝÞâ×ÝÜ ` Go online ºÝà ÞàÝÒãÑâ ×ÜÔÝàÛÏâ×ÝÜ ä×á×â ååå åÓÚÚáÔÏàÕÝ ÑÝÛ*ÝÞâ×Û×èÓÐãá×ÜÓááÑÖÓÑÙ×ÜÕ
Ýà áÑÏÜ âÖ×á ÅÆ ÑÝÒÓ
_ ÁÝÜâÖÚç ÛÏ×ÜâÓÜÏÜÑÓ ÔÓÓ ×á rec µÜ ÓÏàÜ×ÜÕá ÏÚÚÝåÏÜÑÓ ×á ãáÓÒ âÝ Ýø áÓâ ÓÚ×Õ×ÐÚÓ ÔÓÓá ÇÓÓ âÖÓ ¶ãá×ÜÓáá µÑÑÝãÜâ ºÓÓ ÏÜÒ ½ÜÔÝàÛÏâ×ÝÜ ÇÑÖÓÒãÚÓ ÏäÏ×ÚÏÐÚÓ Ïâ åÓÚÚáÔÏàÕÝ ÑÝÛ*Ðãá×ÜÓááÒÓÞÝá×âÒ×áÑÚÝáãàÓá ÔÝà ÛÝàÓ ÒÓâÏ×Úá #ÍÝãà ÓÏàÜ×ÜÕá ÏÚÚÝåÏÜÑÓ ×á ÑÏÚÑãÚÏâÓÒ Ðç ÏÞÞÚç×ÜÕ âÖÓ ÓÏàÜ×ÜÕá ÑàÓÒ×â àÏâÓ âÝ âÖÓ ×ÜäÓáâÏÐÚÓ ÐÏÚÏÜÑÓ ÏäÏ×ÚÏÐÚÓ ÔÝà áÓàä×ÑÓá ×Ü çÝãà ÏÑÑÝãÜâ #ÈÖÓ ÓÏàÜ×ÜÕá ÑàÓÒ×â àÏâÓ ×á Ï äÏà×ÏÐÚÓ àÏâÓ âÖÏâ âÖÓ ¶ÏÜÙ ÑÏÜ ÑÖÏÜÕÓ Ïâ ÏÜç â×ÛÓ ÈÖÓ àÏâÓ ÏÞÞÓÏàá ÝÜ your client analysis statement. #½Ü ÏÜç áâÏâÓÛÓÜâ ÞÓà×ÝÒ åÖÓàÓ çÝãà ÔÓÓá ÓæÑÓÓÒ çÝãà ÓÏàÜ×ÜÕá ÏÚÚÝåÏÜÑÓ çÝãà ÏÑÑÝãÜâ å×ÚÚ ÐÓ ÒÓÐ×âÓÒ (Ýà çÝã å×ÚÚ ÐÓ ×ÜäÝ×ÑÓÒ) ÔÝà âÖÓ Ò×ø ÓàÓÜÑÓ ` µäÏ×ÚÏÐÚÓ å×âÖ×Ü Ï Ð×ÚÚ×ÜÕ àÓÚÏâ×ÝÜáÖ×Þ ¹ÜàÝÚÚÛÓÜâ àÓßã×àÓÒ ÏÜÒ ÏÒÒ×â×ÝÜÏÚ ÔÓÓá ÛÏç ÏÞÞÚç ·ÝÜâÏÑâ Ï ÐÏÜÙÓà ÔÝà Ï ÑÝÛÞÚÓâÓ ÒÓáÑà×Þâ×ÝÜ ÝÔ áÓàä×ÑÓá ÔÓÓá ÏÜÒ ÓÜàÝÚÚÛÓÜâ ×ÜáâàãÑâ×ÝÜá \ `^`_ ËÓÚÚá ºÏàÕÝ ¶ÏÜÙ Â µ µÚÚ à×ÕÖâá àÓáÓàäÓÒ ÁÓÛÐÓà º¸½·
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.
4
California Family Physician Summer 2021
pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com 800.561.4686 ext 103 For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com
EDITION 39
Su mme r 2 0 2 1
features DIVERSITY, EQUITY AND INCLUSION 18 Focus on the Journey, Not the Destination 20 A Personal Look at Systemic Racism
Danielle Jones, MPH, PhD Clarissa Kripke, MD, FAAFP
22 An Interview with your new President, Shannon Connolly, MD 25 It’s Time to Challenge Race-Based Medicine
Monica Hahn, MD, MPH, MS, AAHIVS
departments 6 Editorial
Health Disparities on Autopilot
Brent Sugimoto, MD, MPH, FAAFP
12 President’s Message
Connolly Brings Commitment to DEI as CAFP President
14 Political Pulse
Coming Out of the Dark!
Carla Kakutani, MD
16 Legislative Update
CAFP Looks Back on 2021 All Member Advocacy Meeting
Catrina Reyes, Esq.
28 CAFP Foundation
CAFP Foundation Awards 2021 Honorees
Pamela Mann, MPH
30 CEO Message
You Are CAFP
Shannon Connolly, MD
Lisa Folberg, MPP
Your Online Resource for Continuing Medical Education. Visit education.familydocs.org! California Family Physician Summer 2021
5
editorial
Brent K. Sugimoto,, MD, MPH, AAHIVS, FAAFP
Health Disparities on Auto-Pilot Many of our family physician colleagues have dedicated themselves to the work of rooting out the systemic, institutional, cultural and individual racism that perpetuate inequities in the practice of medicine. In this issue of California Family Physician, we proudly highlight the gumption and the indefatigable advocacy of family physicians who make our profession better through their work in diversity, equity and inclusion (DEI). Work in DEI is critical because institutional racism in medicine is pervasive. Institutional racism can also be pernicious, its presence difficult to root out because the connection between the protocols and procedures of our health care institutions and the racist assumptions that underlie them can be opaque. This lack of transparency exists in health technology as well. The proliferation in artificial intelligence of machine learning (ML) algorithms is posed to transform medicine with the ability of ML to automate tasks or analyze complex health data. However, we humans cannot see how ML “thinks” nor can ML (yet) explain its thinking to us. Consequently, physicians using ML must trust these algorithms are arriving at the right answers for their patients, free of bias. Should we trust that our computer is not racist? I ask that with a bit of tongue in cheek, but as chief medical officer of a digital health startup, I grapple with how to prevent bias that can affect patient care. True, computers can do no more than execute their programming, but if we consider systemic racism as a form of racism designed to create and maintain racial inequality, then, yes, ML algorithms can be racist. Humans program computers and we are increasingly learning how humans introduce bias into algorithms that can disadvantage or even harm patients based on factors that include race. The disturbing reality is that lack of awareness or indifference to building bias-free systems has a high risk of being biased by default. Algorithm developers that do not have a vested interest in being circumspect about what they build very well may build discriminatory technology. Why is this the case? We must remember that, for the most part, this technology relies on our current healthcare system for its development; in particular, ML algorithms are dependent on
6
California Family Physician Summer 2021
large quantities of healthcare data to create their complex data models. We also know that our healthcare data reflects human bias because data collection and organization are a human endeavor. First, when certain groups are not included in the dataset, then the algorithms cannot create an accurate data model for those groups. Groups that suffer disproportionately from health disparities tend to be underrepresented in the data. Remember, it was only in 1993 that the NIH Revitalization Act of 1993 made it a requirement for any government-funded health research to include women and minorities in clinical trials. Social science has even created an acronym for the people likely to be more richly captured in data: Western, educated, industrialized, rich, and democratic (i.e., WEIRD). As an illustration of the magnitude of this problem, Kaushal et al. (2020) reported in JAMA that California, New York and Massachusetts were overwhelmingly overrepresented in health datasets used to train ML, present in over 70 percent of cases, with little representation from the remaining 47 states. Second, because racism is embedded in our institutions and our delivery of healthcare, that racism will also be reflected in the data that ML algorithms are trained on. Consider an algorithm, which determined access to high-risk health care management programs for 200 million people, was denying Black patients in favor of healthier White patients. Obermeyer et al. (2019) reported in Science that because the algorithm learned to use higher health care spending as a proxy for poor health, and because richer White patients could more easily access care, Black patients in poorer health were rated as being healthier because their poorer health care access meant they spent fewer health care dollars. Biased data create biased algorithms. This is one reason why work like that of family physician colleague Dr. Monica Hahn—who successfully advocated Zuckerberg San Francisco General Hospital to stop using race in reporting glomerular filtration rate calculations—is critical for an equitable technological future. Finally, like medicine, the health technology industry suffers from a lack of underrepresented minorities. The Pew Research Center found in 2018 that Black and Latinx Americans each made up only seven percent of the workforce in computer related continued on page 8
Primary Care: FM Opportunities
At the end of the day, this is where you want to be. Join the Banner Health Team, in an outdoor paradise where the beautiful Sierra Nevada and Cascade mountains meet the desert of the Great Basin in Susanville, California – where you’ll have the time to connect with your patients, your practice, your family and the great outdoors! We offer dedication to work/life balance unmatched in our industry. Meaning you get to spend more time doing what you love. That’s HEALTH CARE made easier, LIFE made better! • $240K Salary Guarantee • $100K Sign-On Bonus • $100K Educational Loan Repayment • Eligible for $50K from California Health Planning • Eligible for Public Service Loan Forgiveness • Eligible for HRSA Educational Loan Repayment • Retention Bonus • Focus on Patient and Provider Well-Being • Top of Market Compensation and Benefits
Join our Provider Talent Network! Register using our job portal: PracticeWithUs.BannerHealth.com Or, email CV to: doctors@bannerhealth.com For information call Martha Gonzales 602.747.4328 Banner Health is an EEO/AA - M/W/D/V Employer.
California Family Physician Summer 2021
7
fields. Thus, health technology companies wanting to increase their workforce diversity have a pipeline problem. Indeed, Tech Crunch in its 2019 survey found that the workforce of technology companies was overwhelmingly White and Asian. With a more diverse group of computer engineers and data scientists, more patient groups are represented in the development of this technology. For example, data scientists from a minority background may seek datasets with better racial representation for training their algorithms. More diverse talent likely would help ensure the needs of all patients were served by technology. The use of AI/ML is quickly gaining traction in health care, but it is still in its infancy. We are on the cusp of an explosion of its use in our profession, which may augment the quality of our work lives while also improving the quality-of-care patients receive. However, this technology has the potential to widen the gap of health disparities at a scale that is hard to fathom. Bias at the provider level occurs only one patient encounter at a time. A single biased provider can impact only the patients within their care. ML algorithms, deployed digitally, have the potential to make their effects felt at scale, for millions of patients at a time across every single health system in the country that uses them. The fear of such technology exponentially increasing disparities has a term that has been coined to describe it: digital redlining, a reference to the racist practice of redlining, or the denial of services (especially financial) based on racially segregated neighborhoods. We family physicians have an opportunity to be leaders in this frontier. Advocacy at multiple levels is key: • The American Academy of Family Physicians Congress of Delegates in 2020 passed a resolution requiring the academy to create a set of principles establishing appropriate ethical standards in primary care technologies. We can ask our professional associations like the AAFP, California Medical Association and American Medical Association to do even more with their advocacy. • Secure nominations of family physicians for key advisory committees within agencies regulating this technology like the Health Information Technology Advisory Committee (HITAC) or the Food & Drug Administration. • As constituents we can lobby our representatives to help protect the patients we serve through regulation of health technology. • We also have a very powerful position as physicians, who as end users of this technology, are the group technology companies woo to purchase their product. Family physicians can serve as thought leaders in their respective health systems, where you can help your place of work be an informed customer, discerning and demanding of the technology companies who depend on you to stay in business. Finally, research has shown that physicians—just as we typically accept without question the mathematical results of our calculators—are likely to accept as true whatever output they receive from a computer algorithm. However, now that you know 8
California Family Physician Summer 2021
“
Our patients may depend on us, their family physician, as the only person with the expertise who will say when the computer is wrong.
“
continued from page 6
these algorithms are not infallible, we can choose to keep our antennae raised when using this technology on the front lines. Maybe you see a suspicious pattern amongst a group of patients. Perhaps your patient is denied a vital service like being placed on the kidney transplant list because the computer calculated their kidney function with the formula for African Americans. Our patients may depend on us, their family physician, as the only person with the expertise who will say when the computer is wrong. INTERESTED IN LEARNING MORE ABOUT HOW ARTIFICIAL INTELLIGENCE CAN INCREASE INEQUALITY? Although these books cover the impact of technology on inequality more broadly, their insight is applicable to health technology and the potential impacts on our patients. They are both great reading. Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy by Cathy O’Neil. From the publisher: We live in the age of the algorithm. Increasingly, the decisions that affect our lives—where we go to school, whether we can get a job or a loan, how much we pay for health insurance—are being made not by humans, but by machines. In theory, this should lead to greater fairness: Everyone is judged according to the same rules. But as mathematician and data scientist Cathy O’Neil reveals, the mathematical models being used today are unregulated and uncontestable, even when they’re wrong. Most troubling, they reinforce discrimination—propping up the lucky, punishing the downtrodden, and undermining our democracy in the process. Welcome to the dark side of Big Data. Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor by Virginia Eubanks From the publisher: In Automating Inequality, Virginia Eubanks systematically investigates the impacts of data mining, policy algorithms, and predictive risk models on poor and working-class people in America. The book is full of heart-wrenching and eye-opening stories, from a woman in Indiana whose benefits are literally cut off as she lays dying to a family in Pennsylvania in daily fear of losing their daughter because they fit a certain statistical profile.
NEW FROM CDC
HIV Nexus is a new comprehensive website from the Centers for Disease Control and Prevention that provides the latest scientific evidence, guidelines, and resources on: • Screening for HIV. • Preventing new HIV infections by prescribing PrEP and PEP. • Providing treatment to people with HIV to help improve health outcomes and stop HIV transmission.
To access CDC tools for your practice and patients, visit:
www.cdc.gov/HIVNexus
FACIAL INJURIES
SHOULDER INJURIES, CONTRAST IMAGING, ARTHROGRAMS
TRAUMATIC BRAIN INJURY, DIFFUSION TENSOR IMAGING, CONCUSSION
ALAR LIGAMENT DAMAGE (WHIPLASH)
SPINAL CORD INJURIES
FRACTURES AND BROKEN BONES
INTERNAL INJURIES
SPINE INJURIES
WRIST AND HAND INJURIES INCLUDING WRIST WHIPLASH
If there’s an injury caused by an accident, our experts can diagnose it. Learn more at ExpertMRI.com or call 877.MRI.8888
SOFT TISSUE INJURIES
KNEE INJURIES
FOOT AND ANKLE INJURIES Locations throughout California
10
California Family Fam mily il Physician Phys Physi Ph y cia ian Summer Sum umme mer err 20 2021 21
Quality imaging… is only the beginning! Deep MSK and traumatic brain injury radiology expertise The full range of MRI equipment (open, upright, high field)
Fast scheduling and results reporting (robust 24/7 portal)
More than 20 locations throughout California
Learn more at ExpertMRI.com or call 877.MRI.8888
p r e s i d e n t ’s m e s s a g e
Shannon Connolly, MD
Connolly Brings Commitment to DEI as CAFP President Excerpted from President’s speech delivered during the 2021 All Member Advocacy Meeting It has almost become a trope to say that this last year has been extraordinary. For me, responding to the needs of my patients during the COVID-19 pandemic has certainly been the greatest challenge thus far in my career, as I’m sure it has been for many of you. But out of 2020, came some amazing things--even more amazing than the Tiger King, and our newfound sourdough bread baking skills. This year, family physicians demonstrated that we are the very best of what medicine has to offer. It takes operational brilliance to launch a telehealth program overnight or to build a fully functioning emergency department in a parking lot. It takes bravery to oversee a SNF while a deadly virus runs rampant. It takes an uncommon amount of stick-to-it-iveness to figure out what on earth is happening with a third-party administrator so you can just get vaccines into people's arms. It takes tremendous emotional resilience to sit at the bedside of a dying patient in the wee hours of the morning when others are sleeping because you know that if you don’t sit there, that person will die alone. It takes a lot a Band-Aids over the bridge of your nose to protect it from the bruising and abrasions that happen from wearing PPE for 16-, 18-, or 24-hour shifts. You all gave everything in the service of your patients this year. I am deeply humbled that you have entrusted me with the role of President of the CAFP. The people within this organization have sustained me throughout my career, in times where I have succeeded, in times when I have experienced empathy fatigue and started feeling angry towards my patients for the very circumstances that led them to my care, and in times when I swore that whatever administrator I was trying to convince had some personal vendetta against me, and wasn’t just an imperfect person trying to do her best in an perversely incentivized, imperfect system. As your president, I will do my best to represent you and the field of family medicine well. As I think about our future, I must acknowledge that we are in the midst of a national reckoning about racism. What we do will define how we are judged by future generations. We are at a point where change is possible if we are brave enough to take it on as the work of family medicine. A ship in the harbor is safe, but that is not what ships were built to do. Family doctors were built for adventures. We were built to 12
California Family Physician Summer 2021
navigate difficult journeys that others would not attempt. Family doctors have always uplifted the voices of those who have been overlooked and provided the services that people need to maintain their dignity. Family doctors work in prisons and jails, in immigration detention facilities, in substance use disorder treatment centers, in regional centers, abortion clinics, hospices, in gender affirming care clinics, on street outreach teams, in violence prevention programs, and so many other places. We are intuitively drawn to the places that have the most injustice because that’s where we know our work begins. But if we are going to truly make a difference, it is insufficient to simply agree that inequity is bad. The difference between being effective and ineffective in moving the needle is application of rigorous methodology to the work that we do. We must collect data and measure the effects of our efforts with patient-oriented outcomes. As scientists, we must measure what we treasure. We all know the statistics about Black maternal mortality. We know that COVID-19 has disproportionately affected people who are indigenous and Latinx. We know that the largest mental health institution in the world is the LA County jail because our society chooses to incarcerate people rather than acknowledge that they are unwell. We know that there are unaccompanied minors— toddlers, currently held in a convention center in Long Beach because our government doesn’t quite know what to do with them. This knowledge is our call to action. We must center this work, we must name it as our work, and we must define our success by how well we do this work. This fall, your board of directors will develop the strategic plan for the next few years. As always, our strategic plan will encompass all the areas that are important to our profession-- like payment reform, workforce development, medical education, and legislative advocacy. My commitment to you is that as we do this work, we will look through the lens of diversity, equity, and inclusion. When we are done, our strategic plan will reflect not only the future direction of the profession of family medicine, but also that the CAFP is a national thought leader in advancing health equity. While this year was extraordinary in what family medicine achieved, I believe our best work is yet to come. As we emerge from this pandemic, I look forward to doing this work together, as only family doctors can do.
Questions about substance use evaluation and management? Call the California Substance Use Line ([SHUW FRQ¿GHQWLDO WHOH FRQVXOWDWLRQ IRU VXEVWDQFH XVH HYDOXDWLRQ DQG PDQDJHPHQW LQFOXGLQJ PHGLFDWLRQV IRU VXEVWDQFH XVH GLVRUGHU WUHDWPHQW Available free to any clinician in California Call (844) 326-2626 :H DUH UHDG\ WR VXSSRUW \RX DQG \RXU SDWLHQWV
California Family Physician Summer 2021
13
Carla Kakutani, MD
political pulse
Chair, CAFP Legislative Affairs Committee
Coming Out of the Dark! As our state and nation are on the brink of reopening and rebounding from the COVID-19 pandemic, we are all taking stock of the past year, the challenges we faced as physicians (and, at times, patients), and the opportunities and optimism we see for the future. This same assessment is happening at the legislative level. At this time last year, CAFP was fighting (successfully) against the Governor’s May Revise budget proposal to cut almost all funding ($33 million) for the Song-Brown Primary Care Physician Training Program, a state-run program that provides tens of millions of dollars annually to primary care physician residency programs in underserved areas serving underserved populations. Now, CAFP is on the verge of securing not only $33 million in ongoing funding, but an additional $50 million over six years to create and sustain NEW primary care residency programs in underserved areas. At this time last year, CAFP was having difficulty convincing the Governor and his administration to take executive action to create financial security for small primary care physician practices hit hard by COVID-19. This year, our sponsored bill, SB 402 (Hurtado), has no opposition and hasn’t received a single ‘No’ vote as it moves from the Senate to the Assembly. The bill would create a primary care payment reform collaborative that would establish multipayer payment reform pilots to help small primary care practices in areas hit hardest by COVID to move away from fee-forservice to a payment model that truly supports primary care delivery. At this time last year, legislators were preparing a State Budget under the assumption that the California’s tax revenue would be several billion dollars short of early projections due to the COVID-19 pandemic. This year, California is preparing to fully replenish its Rainy Day Fund, pay down debt, and make significant investments in our long-neglected public health care infrastructure.
14
California Family Physician Summer 2021
Finally, in my last Political Pulse article, I let you know about several bills on which the CAFP Legislative Affairs Committee would likely act. Here is an update on CAFP’s action surrounding a few of those bills: • SB 428 (Hurtado) would require health plans and insurers to provide coverage and payment for adverse childhood experience (ACE) screenings. This CAFPsupported bill is still alive and headed to the Assembly. • AB 97 (Nazarian) would prohibit health plans and insurers from imposing a deductible on an insulin prescription drug. This CAFP-supported bill is still alive and headed to the Senate. • SB 48 (Limón) would have required 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. We informed legislators that family physician residency training already includes significant training in geriatric care, and worked with the author and sponsors of the bill to remove our opposition. The author and sponsors agreed to an amendment that removed the mandatory CME requirement, and instead allowed physicians already required to complete CME on the care of older patients to have courses on “the special care needs of patients with dementia” also satisfy the requirement. • SB 316 (Eggman) would allow federally qualified health centers and rural health clinics to be paid for a patient who has two visits in the same day at a single location if the patient has a medical visit and a mental health visit or dental visit. This CAFP-supported bill is still alive and headed to the Assembly. If you’d like to be involved in family medicine advocacy, I encourage you to visits CAFP’s Get Involved webpage: www.familydocs.org/advocacy/get-involved.
CME Courses in Florida Presented by
Johns Hopkins All Children’s Hospital Florida Family Physician registration discount: Save 5% with code: FFPHYSICIAN
21st Annual
3rd Annual
Current Concepts in Sleep
Pediatric Brain Symposium
August 27-28, 2021
November 4-7, 2021
The Ritz-Carlton, Sarasota, Florida or Join the Internet Live Conference or
The Westin, Sarasota, Florida
Hosted by:
Clinical Updates in Pediatrics Saturday Conference Series: October 2020 – May 2022
Visit HopkinsAllChildrens.org/CME Register for these conferences. View more upcoming courses. Earn CME online.
California Family Physician Summer 2021
15
legislative update
Catrina Reyes, Esq. Vice President of Advocacy and Policy
CAFP Looks Back on 2021 All Member Advocacy Meeting In mid-May, nearly 200 family physicians, residents, and medical students from across the state met virtually for CAFP’s All Member Advocacy Meeting (AMAM). AMAM gives members the opportunity to bring policy issues of urgent concern to the Academy for its consideration. This year, attendees provided testimony on 25 resolutions submitted to the Board of Directors for consideration. Also, during AMAM, the Academy’s leaders for the coming year were elected and celebrated for the efforts and achievements of those who worked to advance issues important to family physicians. Jerry Abraham, MD, was awarded the Hero of Family Medicine award for his relentless advocacy for patients, colleagues, and the family medicine specialty. State Senator Melissa Hurtado was named CAFP’s 2021 Champion of Family Medicine for her work in expanding access to care. Particularly, her work in authoring CAFP’s sponsored bill, Senate Bill 402, which seeks to transform the way primary care is paid for and delivered in areas hardest hit by COVID-19. AMAM develops successive waves of family physicians trained and dedicated to being the most effective advocates possible for their patients and specialty – whether in their own communities, in Sacramento, or even Washington, D.C. Through advocacy training and education on priority issues, AMAM ensures our family physician advocates are conversant and comfortable with the key issues confronting family medicine and health care. This year, CAFP’s sponsored bill SB 402, focuses on the shift from fee-for-service to value-based payment models, the education and discussion at AMAM centered around primary care payment reform. Ashby Wolfe, MD, Co-Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS) for the Western States and the Pacific Territories, presented on CMS primary care practice transformation models, including Primary Care First. Lance Lang, MD, a long-time CAFP member and former Chief Medical Officer for Covered California, presented on primary care initiatives in California. Finally, Farzad Mostashari, MD, CEO of Aledade, discussed how primary care physicians can transform their practices to transition to value-based payment models. After the presentations, attendees shared barriers to
16
California Family Physician Summer 2021
transitioning to value-based payments. The Family Physicians Political Action Committee (FP-PAC) received huge support for a virtual meeting, which will allow for early action in the upcoming election. FP-PAC is the only political action committee in California that has the sole mission of promoting family physicians and family medicine. At the end of AMAM, FP-PAC contributors attended a virtual donor reception with legislative guests State Senator Melissa Hurtado and State Assembly Member Dr. Joaquin Arambula. The week following AMAM, members advocated for their patients and specialty during CAFP’s Lobby Week. CAFP family physician advocates asked legislators to support CAFP’s sponsored bill, SB 402, and to urge the Senate Appropriations Committee to pass it out of the Committee, because SB 402 would reduce costs, improve patient outcomes and experience, improve access to care, and reduce administrative burdens. After a week of advocacy by CAFP members, SB 402 made it off the Senate Appropriations Committee Suspense File with unanimous bipartisan support. CAFP family physicians also advocated for the continued support of the Song-Brown Health Care Workforce Training Program, when the Office of Statewide Health Planning and Development transitions to the Department of Health Care Access and Information. CAFP members asked that the rigorous criteria for evaluating workforce programs remains in statute, and that the new California Health Workforce Education and Training Council that will oversee the programs has appropriate primary care representation. Finally, CAFP family physician advocates expressed support for the one-time $50 million augmentation to the Song-Brown Primary Care Physician Training Program, for new primary care residency programs. The 2022 All Member Advocacy Meeting is scheduled for March 12-14, 2022. Save the date! If you are interested in getting involved in CAFP advocacy efforts, contact Catrina Reyes at creyes@familydocs.org.
California Family Physician Summer 2021
17
Danielle Jones, MPH, PhD
Focus on the Journey, Not the Destination With the launch of its Center for Diversity and Health Equity (CDHE) in 2017, the American Academy of Family Physicians (AAFP) established an infrastructure by which it could centralize and operationalize its strategic priority to be a leader on issues of diversity and health equity as they impact family physicians, their patients, and the communities in which they serve. At that launch was family physician and former president of the American Public Health Association (APHA) Dr. Camara Jones, who urged the AAFP and attendees of the National Conference of Constituency Leaders (NCCL) in a call to action to address racism as a public health threat. Her guidance to us then was to first name it, identify how it operates and organize to dismantle it. Unbeknownst to us all at that time, we would soon have to do just that. Fortunately, the members and leaders of the AAFP were well prepared. With the CDHE in place, it did not take long to implement a process by which progressive policies could be developed and leveraged in the creation of education and training resources to facilitate a transformation in practice and a culture that values diversity and health equity. In rapid succession, the Congress of Delegates (COD) approved policy on Implicit Bias (2018), Institutionalized Racism (2019), required anti-racism and implicit bias training for officeholders and commission members and mandated that the AAFP take an active stance and speak out against racism (2019 Resolution 606). With this fierce momentum, the AAFP kicked off 2020 with the launch of its Implicit Bias Training Guide, a membersonly resource created to position family physicians as the lead subject matter experts in their organizations capable of delivering evidence-informed training. In addition, twelve chapters, including California received funding support from the CDHE to develop their own training event not just for their members but also other members of the practice team in coordination with other state primary care organizations. Yet, we and the world would soon be challenged with the twin pandemics of both COVID-19 and racism, the threat Dr. Camara Jones had warned us about just four short years before. “As a health care organization, the AAFP considers racism a public health crisis. The elimination of health disparities will not be achieved without first acknowledging racism’s contribution
to health and social inequalities.” These were the words of our then president and current board chair Dr. Gary Leroy, and in my opinion, marked a turning point for the AAFP. We could no longer ignore that to truly meet our aim of eliminating health disparities and advancing health equity, we had to prioritize racial equity first, starting with ourselves. So, at the direction of our executive leadership, an internal cross-functional staff team was formed to provide direct insight and guidance on immediate and long-term actions the organization could take to advance racial equity for staff, members, and other external stakeholders. This team was ambitious, providing nearly 50 recommendations on everything from who the AAFP does business with to the types of imagery we use around our building and at events. While many of the recommendations were implemented immediately, such as the addition of a new floating holiday for staff to observe the cultural holiday of their choice, others would take much more time and planning, which led us to working with an external consultant to advice the organization on further actions to becoming a more multicultural and anti-racist organization. “Family Medicine was born at a time of great social awareness and with great expectations of making radical changes in society.”1 It is no wonder that family physicians feel compelled at this moment to be the leaders of social change where they live, work and play. As you do so, the Academy is here to support you with policies, education, and tools you can leverage in your own organizations.
Danielle Jones currently directs the American Academy of Family Physicians' Center for Diversity and Health Equity (CDHE). In this role, she guides the strategic priorities of the AAFP’s Board of Directors towards a leadership role in addressing issues of diversity, equity, and inclusion across the family medicine specialty. These priorities include diversifying the workforce, establishing health in all policies, developing medical education, and implementing practice tools that advance equity. Jones earned her doctoral degree from the University of Kansas School of Medicine in Health Policy and Management where her research on unconscious bias has led to the development of evidence-based curriculum and training for faculty.
1. Gutierrez, C. and P. Scheid. The history of family medicine and its impact in US health care delivery. in Primary Care Symposium. 2002. 18
California Family Physician Summer 2021
–R. Shawn Martin, AAFP EVP
“
“
This movement demands that our organization approach issues of social determinants, health disparities, social inequality and racism not merely as subjects of scholarly debate but as calls to action. The patients and communities served by family physicians compel us to act, to lead and to build a better more inclusive and equitable health care system and country.
RESOURCES FOR GROWTH EveryONE Project Toolkit https://www.aafp.org/family-physician/ patient-care/the-everyone-project/toolkit.html Implicit Bias Training https://www.aafp.org/news/practice-
PES Invites you to Join our CME Cruise & Travel Seminars Captivating Caribbean Cruise on Crystal Symposia on Primary & Palliative Care 12-Night Luxury Cruise, Roundtrip Miami January 5 – 17, 2022
professional-issues/20200115implicitbias.html Physician Advocate https://www.aafp.org/dam/AAFP/ PROFE
Neighborhood Navigator https://www.aafp.org/family-physician/ patient-care/the-everyone-project/ neighborhood-navigator/neighborhoodnavigator-training.html Leadership Development Tool https://www.aafp.org/dam/AAFP/ documents/patient_care/health_equity/ cafm19-leadership-tool.pdf Customizable PowerPoint Presentations (Members-only) on topics like: An Overview of Implicit Bias; Science and Health Effects of Implicit Bias; Mitigating Implicit Bias in Clinical Practice; Creating a
• Experience planning healthcare programs since 1980 • 12 – 20 CME credits on each trip • Personalized service from first contact through to on-site travel • Travel with colleagues and like-minded individuals • Access to in-country medical and healthcare facilities • CME lecture seminars by PES Distinguished Speakers • Volunteer speaking opportunities • Possible tax-deductible benefits • New destinations every year • Family and friends welcome!
See more exciting trips at www.PEStravel.com!
CR
S
M
CE
hops19-physician-guide-sdoh.pdf
Why Travel with PES?
a division of Global Tracks, Inc.
IN
E/
documents/patient_care/everyone_project/
1980
AR
Since
CM
physican-advocate.pdf
https://www.aafp.org/dam/AAFP/
CIETY
documents/patient_care/everyone_project/
Guide to Social Needs Screening Tool
SO
SS
L EDUCATIO NA N IO
UI
SE & RAVEL T
SE
Yachting the Seychelles Islands on Crystal Hot Topics in Medical & Public Health Issues 7-Night Island-Hopping Tropical Cruise February 13 – 20, 2022 & March 19 – 26, 2023 West Coast Culinary Cruise on Windstar Medical Health and Well–Being Updates 10 Nights from San Diego to Vancouver May 10 – 20, 2022 Eastern Seaboard Cruise on Crystal Medical Symposium Confronting Healthcare Needs 14 Nights from Québec City to Miami October 21 – November 4, 2022 Grand Arabian Gulf Cruise on Crystal Exploring Medicine & Middle Eastern Healthcare 17 Nights from Athens to Abu Dhabi November 29 – December 16, 2022 Dreams of Tahiti Cruise on Windstar Treatment Considerations in Isolated Communities 7-Night Yacht Cruise with Included Air & Hotel January 18 – 26, 2023
Safe and Inclusive Learning Environment https://www.aafp.org/family-physician/ patient-care/the-everyone-project/toolkit/ implicit-bias.html)
info@PEStravel.com
Call Toll Free 877-737-7005
www.PEStravel.com
California Family Physician Summer 2021
19
Clarissa C. Kripke MD, FAAFP
A Personal Look at Systemic Racism The word systemic means "of or related to a system, especially when affecting the entirety of a thing" or, "relating to or noting a policy, practice, or set of beliefs that has been established normative or customary throughout a political, social or economic system.” My grandfather was a physician and Chief of Commissioned Officers in the U.S. Public Health system, working his way up from the 1930's onward. He worked for racial justice in his own way. His family received death threats when he developed the field of contact tracing in an effort to stop the syphilis epidemic. Many people were not happy to be traced. He was targeted when he developed our system of inspections for restaurants and had to shut down many establishments. He also took on great personal risk when rooting out corruption after World War II by taking down schemes to fake chest x-rays for tuberculosis clearances for emigration. My grandfather was horrified when he was ordered to set up medical services for Japanese internment camps, and he took great personal risks to help the people in his care. He told of a time when he had my grandmother stay at the camp so there would be a person in the bed at head count. He took a Japanese woman to his home to deliver her baby because a complex delivery was anticipated. He shot the lock off a supply train headed to the troops and stole the medicine for the camp in an attempt to save a Japanese child. He helped people of all races and genders. Yet in his letters, my grandfather describes how he accepted segregation. He reflected later that it was just how things were done, and, at the time, he didn't question it. It was established, normative, and customary throughout our political, social and economic system. Segregation in hospitals and healthcare produced unequal health outcomes, and the fallout of systemic racism is still impacting Black and brown families today. I am proud of my grandfather and the good work he did in his career. My work as a family physician providing care to people with developmental disabilities is a continuation of his work caring for people that others sometimes wouldn’t.
20
California Family Physician Summer 2021
My grandfather was not a bad person. Acknowledging the systemic racism of the past and that continues today in medicine does not mean all doctors are or were bad. It does not negate the good we do and have done in the past. It does not define the entire practice of medicine or what it means to be a family physician. Systemic racism is not just about the actions of individuals, it is about systems. And while we, as individuals cannot fix the system on our own, we as individuals must not stop working towards healing the world in which we were born and work. Fairness is about equality (treating everyone the same) and it is also about equity (providing more resources or different resources to some to achieve equal outcomes). In medicine, we have made progress towards equality (e.g. we mostly don't have segregated hospitals anymore), but because of the historical disadvantages and traumas that some people have experienced, we need to focus on equity too. There is a balance. Both approaches have a place and a time. There has been a lot of rhetoric, ad hominem attacks, and distortions of the issues. Racism in health care isn't (mostly) about bad people. It is about bad systems that don't produce equal health outcomes. We cannot fix our broken systems by blaming or pointing fingers at others. To address the problems with our system, and to address the reasons why Black and brown families continue to have unequal outcomes and access to care, we must acknowledge the systemic racism that is woven through the history of health care. Clarissa C. Kripke MD, FAAFP is a family physician who practices in San Francisco. This article is a lightly edited version of a response Dr. Kripke offered to a colleague in an exchange about racism in medicine on CAFP’s member-only on-line Forum SPARK.
SUPPORTING
LAC Medical Inc. Family Medicine Physician Job inBakersfield, CA
SINCE 1993 Located in beautiful Bakersfield, CA, LAC Medical Inc. is a
private practice with 3 Primary Care Providers, in San Joaquin Valley. Bakersfield is a great location, with easy travel to the beach or the mountains. We also have very competitive schools and affordable housing. Patient encounters average 25 – 35. 40 Patient contact hours per week. Call frequency: Approximately 1 in 10 – weekend call, weekdays shared amongst providers. This is for 1FTE. Fully Integrated Electronic Medical Record (eClinical).
Comprehensive benefits package: • 4 weeks off and CME allowance • Malpractice Insurance • Income details:$175,000 - $205,000 DOE • Potential Ownership of Practice MD/DO Please contact Dr. Cousins at Lcousin99@aol.com LAC Medical Inc.
9508 Stockdale Hwy., Suite 120 Bakersfield, CA 93311 (661) 735-1710 • Fax (661) 888-4841
TARGETED ADVERTSING
MEDICAL PROFESSIONAL FOR THE
Advertise HERE Contact Michelle Gilbert at 501-725-3561 mgilbert@pcipublishing.com California Family Physician Summer 2021
21
An Interview with your new President
Shannon Connolly, MD
Q: Why family medicine for you? Who were the role models who inspired you to go into family medicine? I took a very circuitous route to becoming a family doctor. After college I worked as a medical assistant and later a clinic supervisor in an abortion clinic that had been the site of a shooting where several people had been injured and killed, years before I arrived. Many of my coworkers had survived that event and continued to work in that clinic because they believed so strongly in reproductive justice and the importance of the work that they did. I was very inspired by the commitment that they had to the community. Over time, one of the family doctors there became a mentor and encouraged me to go to medical school because he could see that I loved working with patients as much as I loved the science of medicine. At the time it seemed like a crazy idea because I thought I had already found my career. Nonetheless, he convinced me to take the plunge and go back to school. As a second-year med student, I was fairly sure that I would go into family medicine because it seemed to be a field that was grounded in social justice. I wanted to be the kind of doctor that thought not only about how to fix people who were sick, but also about why people got sick and what role our society played in creating those conditions. I also loved sexual and reproductive health care and thought that family medicine would allow me to combine all these interests. I planned to do a rotation with a family doctor named George Tiller who had a family planning clinic in Kansas, so I could see what that might look like in practice. However, that rotation never came to pass. Shortly before I was going to start, Dr Tiller was murdered by an antiabortion extremist while he attended church. I was devastated. I think that that event tipped me into family medicine because I wanted to honor Dr Tiller by following his example.
Q: What piqued your interest in becoming active with your county and state AFP chapters? When I was a med student, one of my faculty members invited me along to go to what was then called the National Conference of Special Constituencies (NCSC), now called the National Conference of Constituency Leaders (NCCL) at the AAFP. I was just a med student and, on that trip, I met some family medicine “greats” —Jay Lee, Michelle Quiogue, Shelly Rodrigues, and Susan Hogeland. They were so warm and welcoming and encouraging that I just knew I had found “my people.” From there, I went to every CAFP event I could. 22
California Family Physician Summer 2021
Q: Is now the best time ever to be a family physician, in your estimation? Now is both the best and most important time to be a family physician! We have so much good work to do, and I believe right now we are in a moment in time where change is more possible than it ever has been before. The pandemic has incontrovertibly changed the way our society thinks about medicine and public health. The Black Lives Matter movement has the kind of momentum we have not seen since the Civil Rights era. The house of medicine is examining how it has reified historical injustices and people are finally paying attention. It is the perfect constellation of events. We must seize this opportunity and use it for the good of our patients. I cannot imagine a more important or rewarding job right now than that of the family physician.
Q: What are the most important challenges confronting CAFP? Well, we have a few! As an organization that exists to support family doctors and their patients, our challenges are the challenges of our members. We have a perversely incentivized health care system where doctors are undervalued and frequently treated as interchangeable commodities, rather than
A PHYSICIAN DRIVEN
California Medical Group
healers. The cost of medical education has reached a level that is unsustainable, and yet residencies are underfunded. The pandemic has demonstrated that decades of underinvestment in public health has caused the system to fail when it was needed most. We are fighting a culture war of misinformation and distrust in science alongside a national reckoning about racism. I am just getting started! There is no shortage of challenges to work on.
AUTONOMY
Q: What has been the best part of being an officer in CAFP so far? Easily the opportunity to get to know so many other family physicians. I am always amazed by all the different ways in which family doctors show up and make a difference in their communities. Getting to know other doctors and the work they are doing inspires me to be more aspirational in the work that I do.
Q: How do you maintain what former President Jay Lee calls “the joy” of family medicine? It is easy to find joy in family medicine when I am doing the work of family medicine. My patients are my joy—I love them, I love the honor of being able to participate in and witness their lives, I love their stories and their struggles. They are so generous and kind to me. A patient of mine with a rapidly progressive neurological condition recently presented me with a scarf that she had knitted for me. It was the last knitting project that she was able to complete continued on next page
QUALITY The healthcare professionals of Community Medical Providers have joined their LIFESTYLE practices to help minimize the business of healthcare and give the providers more opportunity to practice the art of caring for Central California families.
JoinOurCMPTeam.com California Family Physician Summer 2021
23
continued from previous page
before she lost all her fine motor coordination, and she chose to give this precious thing to me. How can I not be humbled by that? Connections with other humans like that are restorative. I think the key is being able to focus on the work of family medicine. There are so many competing time sinks in our lives—a lot of which are created by a health care system that is not designed to prioritize actual health care. Maintaining my joy is often about fiercely protecting my ability to spend time taking care of patients.
Q: How do you maintain work-life balance? I like to think of the rule of thirds. A third of my energy is for work, a third of my energy is for family and friends, and a third of energy of is for the community. I try to stick to that, with varying degrees of success! I find that I am happiest when I am busiest, and I try to stay busy with things that add value to my life or the world. Sometimes I don’t get to the laundry, but I’m ok with that!
Q: What do you see as the best ways CAFP can help its members maintain the joy? I believe the antidote to burnout in medicine is advocacy, and the CAFP creates easy pathways for getting involved with advocacy. It sounds counterintuitive to say that if you are having trouble finding your joy, you need to do more, but I would argue that whatever is burning you out will feel even worse if you’re not doing anything to change it. Through advocacy, you can fix
When the beauty of the Ozarks is combined with the culture, innovation and opportunities of Baxter Regional Medical Center, Mountain Home truly is the perfect place to live and play. Physician opportunities await! For more information about joining the Baxter Regional family, visit www.workwhereyouvacation.com.
M O U N TA I N H O M E, A R K A N SA S
(870) 508 -1010 | www.baxterregional.org physicianrecruitment@baxterregional.org 24
California Family Physician Summer 2021
the problems that are your pain points, and make a difference on a system, not just an individual level. There is nothing more empowering and rewarding than seeing change happening because of the work you have done.
Q: Where will family medicine be in 10 years and what role will CAFP have played in it? I believe that the CAFP has the potential to be a national thought leader for the field of family medicine, and my vision is that in ten years, the CAFP will be known as the change agent that made family medicine synonymous with health equity.
Q: What is your message to the next generation of family physicians – what will sustain them? Find your North Star early and keep your eye on it! Then remember that part of the job of a family physician is being an advocate for your patients and community. The walls of your clinics and hospitals do not represent the boundaries of your work. Your work can and should extend far beyond and believing that will keep you motivated to continue fighting for what is right.
Q: Finally, what is one fun thing that CAFP members should know about you? I love animals—big animals, small animals, furry, scaly, feathered, I love them all. If I had not become a doctor, I would have become a vet. I am always happy to meet your pets!
Monica Hahn, MD, MPH, MS, AAHIVS, CAFP’s 2021 Educator of the Year
It’s Time to Challenge Race-Based Medicine As you may be aware, a national movement to challenge structural racism in medicine is gaining momentum. At my home institution, SF General Hospital, race-based eGFR reporting was eliminated in 2019. In 2020, following a successful petition effort, we were able to abolish racebased eGFR reporting at affiliated UCSF laboratories and medical centers. Many other institutions have since followed suit. Today I’d like to answer some of the many questions my colleagues and I have received from physicians all over the country about pushing for systems change at their own institutions by sharing some invaluable resources. First and foremost, I’m proud to share a valuable resource: the Institute for Healing and Justice in Medicine (IHJM): https://www.instituteforhealingandjustice.org/,
Institute for Healing and Justice in Medicine fosters a space for vibrant dialogue and debate, consciousnessraising, and movement building, seeking to sharpen our collective analysis and develop methods to critique structures of power in medicine through community scholarship and solidarity.
an advocacy epicenter and dialogue space centered on uplifting social justice and community activism in medicine and public health. UCSF student co-founders of the IHJM published a 50-page report, “ Towards the Abolition of Biological Race in Medicine Transforming Clinical Education, Research, and Practice”, documenting history of the various manifestations of structural racism in healthcare lurking in our commonplace clinical algorithms and calculators. The IHJM was launched in May of 2020 in response to the growing attention to the many flawed uses of race-based medicine that were coming to light, and was elevated by the publication of this report. I am proud to be a co-founder of IHJM with these health justice colleagues and advocates. IHJM’s mission centers around publishing and uplifting perspectives (narratives, experiences, research, and other works) related to healing, social justice, and community activism in Western medicine and public health. IHJM fosters a space for vibrant dialogue and debate, consciousnessraising, and movement building, seeking to sharpen our collective analysis and develop methods to critique structures of power in medicine through community scholarship and solidarity. Through IHJM’s movement building efforts, we have held multiple teach-ins and conference speaking events, we have launched several national petitions to abolish race-based eGFR, we have created a crowd-sourced eGFR advocacy toolkit to help catalyze institutions across the nation to eliminate race-correction from eGFR. IHJM is currently hosting multiple interdisciplinary national working groups that are aimed at dismantling structural racism in medicine. Our national working groups have now expanded to include eGFR, ASCVD, PFTs, and reproductive health. Over 300 people have signed up to participate in our working groups, and we are always accepting more members to join. We are also in the process of building a Health Justice Library and Repository. We aim to bridge, share, and amplify continued on next page California Family Physician Summer 2021
25
continued from previous page
all existing work and activism related to social justice and community activism in medicine and public health. This includes advocacy by community and members and students including but not limited to syllabi, Op-Eds, theses, and more. We also aim to host regular regional gatherings with leaders to facilitate connection and community. We definitely encourage you to check it out on our website, and reach out to us if you have your own resources to share with our community.
“
I see CAFP and AAFP as organizations that are really positioning family physician advocates at the forefront as leaders in advancing racial equity in family medicine...
“
CAFP passed a resolution last spring to reject the use of flawed notions of race-based medicine and shortly after, AAFP’s congress of delegates upheld a policy officially opposing the use of race as a proxy for biology or genetics (July 2020 AAFP policy: https://www.aafp.org/about/policies/all/ racebased-medicine.html) It has been very encouraging to see the progress that has been made challenging structural racism in medicine over the past few years. I see CAFP and AAFP as organizations that are really positioning family physician advocates at the forefront as leaders in advancing racial equity in family medicine and I’m proud to be one of many family physicians championing this cause.
RESOURCES So many additional resources are available to learn more about this important topic. Below are some I recommend. PRESENTATIONS: AAFP CME panel on understanding racism in healthcare: Racism in Healthcare: Understanding https://www.aafp.org/cme/all/ online/racism-in-healthcare-understanding.html CAFP Clinical Forum health equity track sessions (links to these activities in Homeroom are listed in this Campus News) National AIDS Education & Training Center on the role of structural racism in health inequities in COVID and HIV: New Pandemic, Old Inequities: Impacts of COVID-19 and HIV on Marginalized Populations - https://aidsetc.org/resource/newpandemic-old-inequities-impacts-covid-19-and-hiv-marginalizedpopulations PUBLICATIONS: • Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms - https://www.nejm.org/doi/ full/10.1056/NEJMms2004740 • On Racism: A New Standard For Publishing On Racial Health Inequities - https://www.healthaffairs.org/do/10.1377/ hblog20200630.939347/full/ • How Structural Racism Works — Racist Policies as a Root Cause of US Racial Health Inequities | NEJM - https://www.nejm.org/ doi/10.1056/NEJMms2025396 • Levels of racism: a theoretic framework and a gardener's tale https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.8.1212 • Precision in GFR Reporting | American Society of Nephrology https://cjasn.asnjournals.org/content/15/8/1201
26
California Family Physician Summer 2021
PRIMARY CARE PHYSICIANS San Francisco Bay Area
TARGETED ADVERTSING
MEDICAL PROFESSIONAL FOR THE
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
Family, Internal, and Gastroenterologist Physicians Come join Yampa Valley Medical Associates, a multispecialty primary care practice in beautiful Steamboat Springs, Colorado!
Advertise HERE Contact Michelle Gilbert at 501-725-3561 mgilbert@pcipublishing.com
YVMA provides inpatient and outpatient care for newborns, children, adults, including endoscopic procedures and local skilled nursing facilities. Our clinic offers on-site ultrasound, point-of-care lab testing, an integrated behavioral health provider, a clinical pharmacist, and a diabetes care manager. We are part of the Comprehensive Primary Care Plus advance payment model and UCHealth Coordinated Care Colorado. A wonderful medical home close to world-class skiing, mountain biking, hiking, and more!
www.yvma.com Call or email today for more information:
970-879-3327 or jobs@yvma.com
cafp foundation
Pamela Mann, MPH
CAFP Foundation Awards 2021 Honorees Monica Hahn, MD, MPH, MS, AAHIVS Barbara Harris Award for Excellence in Education Dr. Hahn is an Associate Professor of Family and Community Medicine at the University of California, San Francisco (UCSF). She is widely recognized for her commitment to ending race-based medicine and for developing a new generation of medical students and residents who are equipped to achieve health equity and justice. She is leading efforts at UCSF to ground medical education in critical race theory and to recruit, educate and mentor under-represented minority students to become physician leaders. She holds multiple leadership positions that span clinical practice, medical education, and mentorship. Both the CAFP and AAFP acknowledge Dr. Hahn’s work in advancing diversity, equity, and inclusion efforts in the field of family medicine. Congratulations, Dr. Hahn, our 2021 Barbara Harris Award winner!
28
California Family Physician Summer 2021
Emmeline Ha, MD 2021 Family Medicine Resident of the Year Dr. Ha completed her third-year as resident at Stanford University, and recently honored as the 2021 Family Medicine Resident of the Year. Dr. Ha is an enthusiastic leader in both her residency program and in the Academy. Since 2017, she has served as a member of the CAFP Resident Council, a statewide group that works to promote and advocate for student and resident interests. As a leader, Emmeline collaborates with other council members to help CAFP address resolutions and to develop Academy policy and position statements. In the past, Emmeline has served as the resident delegate to the Congress of Delegates during AAFP’s National Conference. She is dedicated to representing family medicine interests among her peers and is committed to serving at the national level. Congratulations, Dr. Ha!
2021 Family Physician of the Year Jay W. Lee, MD, MPH, FAAFP The California Academy of Family Physicians presents this prestigious award to an individual who exhibits the finest qualities of family physicians, and who goes above and beyond in service to patients and community. This year, CAFP is proud to honor Dr. Jay Lee as our 2021 Family Physician of the Year. Dr. Lee is chief medical officer for the “Share Our Selves Community Health Center” in Costa Mesa. His mobile unit cares for homeless and other marginalized communities around Orange County, and his food pantry assists the more than 1 in 4 who are hungry in Southern California. This year he has been a tireless advocate for fair and equitable COVID-19 vaccine access for his community health center by meeting with local public health leaders, legislators, and health plans. And if that didn’t work, you would find him literally driving to public health departments and
other sites picking up whatever vaccine he could find for the low-income patients his clinic serves. Many of you know Dr. Lee for his extensive leadership at the national, state, and local levels. He is an influential voice at AAFP in his role as CAFP Alternate delegate. This year he has taken on additional responsibilities in AAFP committee service. As an AAFP Media Ambassador he has worked with media outlets to among other things, increase flu vaccination rates and highlight the dangers of E-Cigarettes. Dr. Lee epitomizes the best of family medicine. He has been a source of inspiration for future family physicians, peers, patients, and his community and has empowered many to be champions for family medicine. Congratulations, Dr. Lee, and thank you for your commitment to family medicine and the health of all Californians!
California Family Physician Summer 2021
29
ceo message
Lisa Folberg, MPP
YOU Are CAFP At a recent CAFP-Foundation Board meeting, we were asked to create a story about our lives in six words. My six-word story was “scaling challenges reaching summit of hope.” It feels like we collectively have climbed a mountain of challenges this last year and are at the Summit getting ready for the thrill of descending. We still have huge challenges ahead, but my hope is that the worst of a worldwide pandemic is behind us. Seeing our members step up to meet the challenges of the last year was a reminder of how proud I am to work for family physicians. You stepped up not only for your patients and communities, but for the CAFP. At the virtual All Member Advocacy Meeting (AMAM) held in May 2021, we welcomed a new slate of organizational leaders. It has been a professional highlight working with our now Past-President Dr. David Bazzo. Dr. Bazzo was an outstanding leadership partner who offered support, guidance and collaboration, and, as importantly, joy. I could not think of a better partner to lead the organization through a challenging and sometimes sorrowful year. Saying goodbye to Dr. Bazzo as President is tempered by the excitement that I have in welcoming CAFP’s new President Dr. Shannon Connolly. Dr. Connolly’s experience in executive management, commitment to public health and social justice, and strategic thinking is well timed as your CAFP Board develops the CAFP strategic plan for 2022 through 2024. At its core, CAFP is an organization of volunteers. Your CAFP officers, board members, committee members and key contacts are the foundation of the success of the organization. Given the essential role of CAFP’s family physician leaders in setting the
direction of the organization, I wanted to use this column to explain more about CAFP leadership roles and recap recent Board decisions. CAFP is largely governed by a 23-member Board of Directors, 10 of whom are elected by 10 geographic districts. Others are elected by the delegates of the AMAM. Student/resident members of the Board are elected by the student resident council. The Board receives advice and guidance from CAFP Committees and staff. The CAFP Board typically meets quarterly, and this last year met more frequently. The Board is responsible for overseeing the fiscal health of the organization, voting on new policy, and setting strategic direction. In a typical Board meeting, your Board is expected to do a lot. The April 2021 Board meeting was no exception. The CAFP Board has been engaging in a variety of activities in preparation for the development of the CAFP strategic plan in November of this year. At the April 2021 Board meeting CAFP Board members helped to identify priority areas for family physicians and CAFP. Members and chapter leaders were also asked to identify organizational priorities through a survey sent out to all members through our Academy in Action e-newsletter. Other highlights from the April Board meeting include reviewing and approving the financials, which show CAFP in a strong financial position. The Board heard from VP of advocacy and policy, Catrina Reyes and approved CAFP legislative bill positions. We heard from the Foundation president, Dr. Marianne McKennett about Foundation activities and welcomed the new CAFP-Foundation Executive Director, Pamela Mann. We also said goodbye to several Board members, including Drs. Walter Mills, Jeff Luther and Shani Muhammad. Also at the April 2021 Board meeting, the CAFP Board made the important decision to move the organization to Sacramento. Largely given CAFP’ emphasis on advocacy and policy the Board felt it would be strategic to move the organization closer to the Capitol. Most staff will continue to work at least part-time remotely. There are many ways to get involved with CAFP and local chapter governance. Please visit us online at www.familydocs.org for more information about committees or leadership positions, please visit us at cafp@familydocs.org.
30
California Family Physician Summer 2021
Leading the future of health care A FEW REASONS TO CONSIDER A PRACTICE WITH TPMG: • Work-life balance focused practice, including flexible schedules and unmatched practice support.
Adult & Family Medicine Physician Opportunities Northern & Central California The Permanente Medical Group, Inc. (TPMG - Kaiser Permanente Northern California) is one of the largest medical groups in the nation with over 9,000 physicians, 22 medical centers, numerous clinics throughout Northern and Central California, and a 75-year tradition of providing quality medical care. We currently have openings for BC/BE Family Medicine or Internal Medicine Physicians to join us throughout Northern & Central California, including: • Fairfield • Central Valley • Oakhurst/Fresno
• Santa Rosa • South Sacramento • Sacramento
FORGIVABLE LOAN PROGRAM $125,000 - $275,000 (based on location and experience) To learn more and to apply, please visit: https://tpmg.permanente.org. FAMILY MEDICINE: Contact Aileen Ludlow at Aileen.M.Ludlow@kp.org or 510-625-5934.
• We can focus on providing excellent patient care without managing overhead and billing. • We demonstrate our commitment to a culture of equity, inclusion, and diversity by hiring physician that reflect and celebrate the diversity of people and cultures. We practice in an environment with patients at the center and deliver culturally responsive and compassionate care to our member populations. • Multi-specialty collaboration with a mission-driven integrated health care delivery model. • An outstanding electronic medical record system that allows flexibility in patient management. • We have a very rich and comprehensive Physician Health & Wellness Program. • We are Physician-led and develop our own leaders. • Professional development opportunities in teaching, research, mentorship, physician leadership, and community service.
EXTRAORDINARY BENEFITS: • Competitive compensation and benefits package, including medical and dental • Moving allowance and home loan assistance - up to $200,000 (approval required) • Malpractice and tail insurance • Paid holidays, sick leave, education leave
INTERNAL MEDICINE (Outpatient): Contact Bianca Canales at Bianca.Canales@kp.org or 510-625-5935.
We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor
• Shareholder track • Three retirement plans, including pension
CONNECT WITH US:
CALIFORNIA ACADEMY OF FAMILY PHYSICIANS 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627
Presorted Standard U.S. POSTAGE PAID
Fayetteville, AR Permit No. 986
Have your medical malpractice rates gone up? If so, you may want to consider your options before routinely renewing your current policy. MIEC is a physician owned and governed company, whose mission is to provide its policyholders with the best possible care at the lowest sustainable price. Because we have no external shareholders, we return the proceeds of better than expected operating results in the form of dividends. Over the last 44 years we have put more than $442 million back into the pockets of our policyholders.
Get a quote today.
miec.com | 800.227.4527
Insurance by physicians, for physicians.™
