Winter 2023-2024

816

(415)

cafp@familydocs.org

Officers and Board Staff

President

Raul Ayala, MD, MHCM

Immediate Past President

Lauren Simon, MD, MPH, FAAFP

President-elect

Alex McDonald, MD, FAAFP

Speaker

Anthony "Fatch" Chong, MD

Vice-Speaker

Kim Yu, MD, FAAFP

Secretary/Treasurer

Brent Sugimoto, MD, MPH, FAAFP

Chief Executive Officer

Lisa Folberg, MPP

Foundation President

Ron Labuguen, MD, FAAFP

AAFP Delegates

Lee Ralph, MD

Lisa Ward, MD, MPH, FAAFP

AAFP Alternates

Shannon Connolly, MD, FAAFP

Michelle Quiogue, MD

CMA Delegates

Kimberly Buss, MD

Felix Nunez, MD

Sumana Reddy, MD, FAAFP

Kevin Rossi, MD, FAAFP

CMA Alternate Delegates

Raul Ayala, MD, MCMH

Noemi Doohan, MD, PhD

Adia Scrubb, MD, MPP

David Tran, MD

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

Karen Alvarado Advocacy Assistant kalvarado@familydocs.org

Anita Charles Manager, Educational Programs acharles@familydocs.org

Morgan Cleveland Manager, Operations & Governance mcleveland@familydocs.org

Jerri Davis, CHCP Vice President, Professional Development, CME/CPD jdavis@familydocs.org

Laurie Isenberg, MILS, CHCP Director, Education and Professional Development lisenberg@familydocs.org

Christine Lauryn Manager, Member Communications clauryn@familydocs.org

Josh Lunsford

Vice President, Membership & Communications jlunsford@familydocs.org

Pamela Mann, MPH Executive Director, CAFP Foundation pmann@familydocs.org

Jonathan Rudolph Manager, Finance jrudolph@familydocs.org

Tiyesha Watts Legislative & Policy Advocate trwatts@familydocs.org

Brent Sugimoto, MD, Editor

Scott

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.

Resolve to Prioritize Your Wellness in 2024

Raul Ayala, MD, MHCM CAFP President

The end-of-year holidays are always a culmination of celebrating, gathering with family and friends, and a time to reflect on all our accomplishments throughout the year. As we begin 2024, the new year is a chance for a new beginning we can all look forward to entering.

As physicians, we have long workdays at clinic or hospital. Equally important when we leave our workplace, we have our responsibilities and roles outside of work to manage undoubtedly. We counsel our patients on their wellness, however, at times we forget and likely do not prioritize our own well-being as we should, and there are occasions where we need the doctor, too.

As we look back on 2023 and reflect on the many blessings we enjoyed, we must be intentional in our planning for 2024. During this new year, schedule that vacation with those closest to you, start that hobby, eat nutritious foods, start that exercise program, and most importantly, set some alone time, that “me” time to reflect and rejuvenate. While planning the year and renewing ideas for what is ahead, let us remember that we must give ourselves that same love that we share with others in our lives. In 2024, prioritize the mind, body, and soul.

Ending the HIV Epidemic Starts With Routine HIV Screening.

The Centers for Disease Control and Prevention (CDC) recommends that everyone between the ages of 13 and 64 get tested for HIV at least once and that those with ongoing risk be screened at least annually. Yet 1 out of every 8 people in the United States are unaware of their HIV status.

You can play a critical role in ending the HIV epidemic by offering HIV screening to all your patients. Routine HIV screening helps to:

• Reduce HIV transmission by empowering your patients to know their status.

• Improve your patients’ health outcomes by linking them to prevention or care services.

• Eliminate stigma associated with HIV testing by making it the standard of care.

Access new CDC resources on integrating routine HIV screening into your practice at: cdc.gov/ScreenForHIV.

Our Fight Continues!

Tiyesha Watts CAFP, Legislative and Policy Advocate

On September 14, the California State Legislature adjourned the first year of its 2023-2024 two-year session, sending over 1,046 bills to Governor Gavin Newsom for signature or veto. The legislature will reconvene on January 3. During the interim, legislators, stakeholders, and other organizations will reassess their legislative priorities and begin to plan for what bills they will introduce for next year's legislative session. Additionally, the Governor will present the proposed state budget to the legislature on January 10, 2024, detailing the proposed State spending plan for the fiscal year beginning July 1, 2024. The legislature will have until June 15, 2024, to pass the final budget. Within those five

months, stakeholders and organizations can advocate for their budget priorities to be incorporated into the final budget.

As we prepare for the 2024 legislative session, our Key Contacts programs will relaunch to amplify the voice of Family Physicians in our advocacy efforts. Members will have the opportunity to opt into becoming a key contact in the new year. Our key contacts will be the leading voice representing Family Physicians across our state. The goal is to engage members in CAFP's advocacy initiatives and amplify the voice of Family Physicians across various decisionmaking spaces. Please consider joining our new program in the new year for an exclusive insight into events and opportunities to

raise the profile of family medicine and issues impacting family physicians, practice settings, and patients.

Additionally, Our All Member Advocacy Meeting (AMAM) will be held on April 13-14, with Lobby Day on April 15, at the Sheraton Grand Hotel in Sacramento. AMAM provides an opportunity for members to make changes in health care policy! At the AMAM, family physicians will hear from policy and political experts, get hands-on experience advocating for issues important to family medicine, network with advocacy-oriented colleagues, and meet with legislators! From improving public health to increasing primary care payment, learn how YOU can be the change you want to see in healthcare policy.

AMAM 2024 will focus on utilizing a team-based approach to advance health equity. Primary care is a natural integration point among clinical care, public health, behavioral health, and community-based services. Team-based care is a model continued on page 10

Join a team that’s been helping to redefine what it means to be a community clinic for 50 years.

Vista Community Clinic has outstanding opportunities for Full-Time and Part-Time Family Physicians. Join a team of dedicated, motivated and enthusiastic team players who make a difference in the community.

Vista Community Clinic is a federally qualified, not-for-profit healthcare clinic with state-of-the-art clinics. We provide healthcare throughout the Southern California regions of North San Diego, Orange and Riverside Counties.

Our compensation and benefits program includes: Competitive compensation, sign-on bonus, relocation bonus, health, dental, vision, company-paid life, longterm disability, flexible spending accounts , 403(b) retirement plan, malpractice coverage, CME allowance and no oncall hours. We are a NHSC loan repayment eligible organization.

Salary (full-time): $239,000 – $260,000/year

For more information visit www.vcc.org or email hr@vcc.org EEO/AA/M/F/Vet/Disabled

50 years

The California Prostate Cancer Coalition, founded in 1997 as a 501(c)(3) not-for-profit organization, is dedicated to saving men’s lives!!!

www.prostatecalif.org

https://naspcc.org/docs/informed-decision-making-laminate2023.pdf

www.naspcc.org

continued from page 8

of care delivery that can aid in reducing physicians' administrative burdens while improving patients' health outcomes through multidisciplinary care teams. This year's AMAM will offer many of the sessions you've come to know and love, such as how to talk to your legislator. In addition to exciting new sessions, you won't want to miss, such as an insider’s view of campaigns and elections.

OPPORTUNITIES

Join Adventist Health

Learn more about a primary care career at Adventist Health

At Adventist Health, we are dedicated to transforming the health experience of the more than 80 communities we serve. Our focus is the whole person — mind, body and spirit. As a faith-based health system founded on Seventh-day Adventist heritage and values, we know you want more purpose in your work. We will ensure you find it.

Adventist Health is 24 hospitals, 400 clinics and 4,500 providers throughout the West Coast and Hawaii.

Why Choose Adventist Health

• Opportunities in locations to suit any lifestyle

• Starting bonus up to $60,000

• Residency/Fellowship stipend

• Additional bonus and incentive structures

• Qualified Public Service Loan Forgiveness (PSLF) Employer

• Leadership and academic opportunities available

• Large network of primary care and specialty providers

Family Docs Podcast Launches Second Season

CAFP has launched the second season of the Family Docs Podcast. CAFP began the podcast in 2023 with a series on Medication for Opioid Use Disorder (MOUD). The second season launched with Data Exchange for Family Physicians. In this episode, Dr. Sumana Reddy spoke with attorney Andrea Frey (Hooper Lundy & Bookman) about what family physicians need to know about Data Exchange, the Data Exchange Framework, and the Data Sharing Agreement.

In the second episode, Rural Family Medicine & OB Deserts, we heard from Drs. Mooneyham, DiPaolo, and Hagge as they discussed Rural Family Medicine and reflect on Dr. Mooneyham’s article in the California Family Physician magazine (Fall 2023) on OB Deserts.

We are currently working on more episodes and are seeking proposals from CAFP members for potential episodes. If you haven’t listened to the podcast, find it in your favorite podcast platform or visit familydocs.org/app to listen. If you have an idea for an episode, let us know by emailing podcast@familydocs.org. The Family Docs Podcast is hosted by Rob Assibey, MD.

The first podcast series “Treating Addiction in Primary Care” includes four episodes:

Episode 1: The Time for Treating Substance Use Disorder Is Now includes Raul Ayala, MD as he interviews Arianna Campbell, PA-C.

Episode 2: Break the Stigma, Save a Life includes Shoaib Khan, MD, AAHIVS as he interviews Sky Lee, MD, AAHIVS and MK Orsulak, MD, MPH, AAHIVS.

Episode 3: Prescribing Medication for Opioid Use Disorder has Tipu Khan, MD, FAAFP, FASAM interviewing Rebecca Trotzky-Sirr, MD.

Episode 4: Addiction Medicine is Family Medicine! includes Carol Havens, MD as she interviews Mario San Bartolome, MD, MBA, MRO, FASAM

The series was supported by the National Institute on Drug Abuse (NIDA) and the California Department of Health Care Services (DHCS).

Download, listen, share, and review the Family Docs Podcast. Visit www.familydocs.org/podcast!

POCUS: A Pluripotent Tool for a Pluripotent Specialty

Mena Ramos, MD

What if I told you there was a technology that could drastically reduce time to diagnosis, lower healthcare system costs while generating value during patient visits, engage patients more deeply with their care, improve health equity and help family doctors find their work more meaningful and satisfying?

What if I told you this technology already exists, but we aren’t doing enough to lower barriers and facilitate widespread use in Family Medicine?

Enter Point of Care Ultrasound (POCUS) — ultrasounds performed by clinicians during patient encounters to answer focused clinical questions. POCUS has already taken obstetrics by storm, and improved flow in Emergency Departments worldwide. With the new ACGME guidelines released in July 2023 requiring POCUS in Family Medicine residency training (1), POCUS is poised to have an

Top 7 Primary Care POCUS Application

even more transformative impact in the world of Family Medicine.

Many family doctors — including myself — chose our specialty because we value the importance of meeting our patients where they are at, want to involve patients deeply in their care, and understand the importance of continuity relationships. Yet we are faced with a fragmented healthcare system and — along with our patients — witness the financial costs and emotional tolls of disjointed care:

The patient who we sent to the Emergency Department because we were worried about a Deep Venous Thrombosis, but who didn’t go because they were worried about copays.

The patient who suffered through our ineffective attempts to treat heartburn while waiting weeks to get the ultrasound diagnosis of gallstones.

Clinical Questions Answered by and Reasons for Visits (7) Impact of POCUS on Patient Care

1. Hypertension Cardiac Left Ventricular Hypertrophy? Congestive Heart Failure?

2. URI Lung Is there pneumonia?

Is there pulmonary edema?

Oropharynx Is there a peritonsillar abscess?

3. Depression/Anxiety General

Increased patient satisfaction, trust, and engagement when POCUS performed(4)

4. Back Pain Renal Is there hydronephrosis suggesting an obstructing kidney stone?

5. Routine Health Maintenance Abdominal Aortic Aneurysm Is there an Abdominal Aortic Aneurysm?

6. Arthritis (Not Back) Musculoskeletal Is there a rotator cuff tear?

Is there carpal tunnel syndrome?

Rheumatological Is there a joint effusion?

Is there gout?

Ultrasound Guided Joint Injections More accurate joint injections (8)

7. Dermatitis Skin Soft Tissue Is there Cellulitis vs. Abscess?

The uninsured patient who was so excited when we helped them quit smoking, but who couldn’t afford an Abdominal Aortic Aneurysm screening out of pocket and ended up in the ED with a rupture.

The pregnant patient who comes to her first prenatal visit with bleeding, wondering if her baby is ok.

POCUS gives family doctors the capacity to change these patients’ stories, and so many more. When we can make diagnoses in the moment, we save our patients time and money, deepen their trust and engagement, and make our own work vastly more meaningful. POCUS decreases costs from unnecessary additional testing saving patients thousands per visit in a community Emergency Department (2). It improves patient care and decreases length of stay through faster and more accurate diagnoses of common presentations such as shortness of breath(3). Moreover, POCUS can add financial value to patient visits if billed as a procedure, and also helps to facilitate in-office procedures like injections. It increases patient satisfaction, trust, engagement, and perceived quality of care (4). It reduces burnout by actually making our work more meaningful (5) And because it has the most impact for patients who face the greatest barriers to accessing care, POCUS improves health equity (6). For Family Medicine doctors practicing in inpatient, emergency, and peripartum settings, POCUS also has myriad applications in these arenas. In short, POCUS allows family doctors — no matter their practice setting — to be the most effective clinicians they can be.

Like any new technology, POCUS faces barriers to adoption. Despite the many benefits, fewer than 10 percent of primary

care physicians have POCUS integrated into workflows (9). Common barriers include lack of access to and protected time for longitudinal training, and access to machines (10). Health systems need to facilitate training opportunities and machine access, as well as creating clinician schedules and billing strategies that promote integration of POCUS into patient visits.

Fortunately, thanks to POCUS champions at all levels, change is already starting to occur. As a family medicine doctor working in a safety net hospital, I’ve seen countless patients’ faces light up as I hand the probe to them and say “show me where it hurts”, and seen how this simple act changes the course of their care. And as the founder and educational director of Global Ultrasound Institute (GUSI), I’ve seen countless clinicians’ faces light up as they see how this lifesaving technology will transform their medical practice.

As family physicians, we have already committed to being the first stop for our patients' needs. We are already a procedureoriented hands-on specialty and were among the first physicians to use ultrasound at the point of care in the 1990’s (11). POCUS has the potential to help Family Medicine physicians reclaim the essence of our specialty, while transforming our care. I hope you’ll join me in working towards a future where all Family Medicine physicians have POCUS at their fingertips.

Dr. Ramos is a Family Physician, Co-Founder of Global Ultrasound Institute (GUSI), a leader in point of care ultrasound education and training worldwide. www.globalultrasoundinstitute.com. She is a global advocate for the use of POCUS among frontline healthcare providers. The team at GUSI develops scalable POCUS solutions for health systems through longitudinal mentorship, a web-based learning platform and app, cloud based quality assurance, machine learning tools, and in person training. Dr. Ramos completed her FM residency at the Contra Costa Family Medicine Residency Program, co-authored the 2016 AAFP National POCUS Guidelines, and is an Assistant Professor at the UCSF Department of Family and Community Medicine.

Sources:

1. https://www.aafp.org/dam/AAFP/ documents/medical_education_ residency/program_directors/ Reprint290D_POCUS.pdf

2. https://onlinelibrary.wiley.com/doi/ abs/10.1002/jum.14910

3. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC10017566/#:~:text=Time%20 to%20diagnosis%20

4. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC8214303/

5. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC8918294

6. https://www.jabfm.org/content/ jabfp/34/4/853.full.pdf

7. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6234945/

8. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3324992/

9. https://www.jabfm.org/content/34/4/859

10. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC9508689/

11. https://pubmed.ncbi.nlm.nih. gov/7810467/

Health Sciences Clinical Professor Series - Family Medicine

JOB LOCATION:

Job location: FQHC Santa Ana and Anaheim

2 POSITIONS AVAILABLE:

The UC Irvine Department of Family Medicine anticipates openings for full-time faculty positions in the Department of Family Medicine, School of Medicine, at the University of California, Irvine. We are seeking qualified individuals who are excellent clinicians with a strong commitment to medical education. Language proficiency in Vietnamese is a plus. The positions will be offered in the Health Sciences Clinical Professor Series at the Assistant Professor, Associate Professor, or Professor level, and will serve as core faculty in the Resident Program. One position will have a primary care practice at FQHC Santa Ana (JPF08560) and one will have a primary care practice at FQHC Anaheim (JPF08787).

REQUIREMENTS:

Candidates must have MD or DO degrees and have current or applied for California Medical License. Candidates should be board-certified in Family Medicine.

TO APPLY:

Please log onto UC Irvine’s RECRUIT located at

https://recruit.ap.uci.edu/JPF08560

https://recruit.ap.uci.edu/JPF08787

Transforming Patient Care @ POP!: ACEs and TIROH for Everyone

Adia Scrubb, MD, MPP

At our very first Family Medicine POP! CAFP gathered family physicians together to explore how Adverse Childhood Experiences (ACEs) and Trauma-Informed, Resilience-Oriented Health Care (TIROH) can radically improve the way we serve our patients.

Toxic stress, ACEs, and TIROH are about recognizing the profound impact of prolonged stress on health outcomes. CAFP’s strategic directive to “help members practice through a traumainformed lens,” is an effort to help family physicians understand how to better serve their patients. CAFP is working hard to help members become better informed in this area. Please visit familydocs.org/ACEs for resources to consult.

When using a TIROH approach, Substance Abuse & Mental Health Services Administration (SAMHSA) suggests that we shift the focus. Instead of asking, "What's wrong with this person?" we are encouraged to ask, "What happened to this person?" Key TIROH principles to incorporate in practice include:

• Safety

• Trustworthiness & Transparency

• Voice, Choice & Empowerment

• Collaboration & Mutuality

• Strengths-based Resilience

• Peer Support & Mutual Self Help

• Cultural, Historical, & Gender Humility

Drs. Adia Scrubb, Elizabeth Shaw and Erika Roshanravan guide a TIROH exercise at 2023 Family Medicine POP.

These principles empower physicians to approach patient care with the understanding that everyone may have experienced some level of trauma in their life - a concept we know as universal precautions.

All family physicians can utilize practical tips for integrating trauma-informed care into clinical settings. The POP sessions explored this through conversation, exercises, and role play. We considered (and you can too!) refining physical exam methods, new approaches to telehealth, providing parenting tips, screening for resilience and much more. These recommendations empower us to create a safe and supportive environment for our patients. Even the waiting room can be a place of healing when designed with TIROH in mind.

At Family Medicine POP, we were treated to some practical examples of what embedding ACEs and TIROH in practice could look like from family physicians in FQHC clinical settings. Dr. Erika Roshanravan, MD, FAAFP, of CommuniCare Health Centers, emphasized the importance of identifying TIROH champions and leadership in clinics, nurturing a collective culture, and fostering a sense of community among peers and staff — because it takes a village to create a trauma-informed clinic.

Dr. Elizabeth Shaw, MD of Marin Community Clinics shared her insights on launching TIROH with a universal precautions approach and incorporating resilience screening. She shared the

need to inform providers and patients about the reasons behind the ACEs screening, along with training for providers and staff to make sure that all were informed and on board. Measuring the impact and ensuring the sustainability of screening were also at the heart of her clinic's implementation.

CAFP is receiving support from the UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN) to share important information and resources to equip family physicians and help them practice through a trauma informed lens. ACEs Aware is also offering support directly to California providers by way of a Clinical Implementation Pilot Program. Follow the QR code to learn more.

We invite you to join CAFP on this transformative journey as we incorporate ACEs, toxic stress and TIROH into everyday family medicine practice. Every interaction with a patient has the potential to heal and empower. By adopting these principles and techniques, we can make a lasting impact on the well-being of our patients, their families, and our community.

Dr. Mikah

Owen, MD, MPH, MBA

Co-Principal Investigator, UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN)

“I thoroughly enjoyed seeing the energy and commitment to TIROH at the POP conference. The UCAAN team sincerely valued the opportunity to hear from attendees about ways we can improve our resources and tools to be more useful for family medicine physicians. We are excited to continue growing our partnership with CAFP."

RESOURCES

CAFP ACEs Aware Webpage: https://familydocs.org/ACEs

ACEs Aware Training: https://training.acesaware.org/aa/

Validated screening tools: https://acesaware.org/learn-about-screening/

Stress Busters patient education materials: https://www.acesaware.org/managestress/

Drs. Elizabeth Shaw and Erika Roshanravan share TIROH strategies at 2023 Family Medicine POP.

Drs. Elizabeth Shaw, Adia Scrubb and Erika Roshanravan on the main stage at 2023 Family Medicine POP.

Pathways to Diversity in Family Medicine Are Not Long Enough

Brent K. Sugimoto, MD, MPH, FAAFP

Like many of our Family Medicine colleagues, I am currently in the thick of recruitment season for our next class of residents for our small but (IMHO) mighty training program, a teaching health center in the Richmond, California. Planted in an area dubbed Iron Triangle—so called because it is bounded by three geometrically positioned railroad tracks—we care for an underserved community with a foreboding name that is perhaps a tad dramatic.

We strive to be a place that our patients are proud to have as part of the community, which is primarily made up of persons of color. While research has shown that patient-physician race and ethnicity concordance improve patient outcomes and satisfaction, we believe that our patients deserve to have Family Physicians who share a similar lived experience with the community. That is why our program’s mission is to train Family Physicians whose communities have traditionally been underrepresented in medicine (URM).

CAFP’s own Justice through Equity, Diversity & Inclusion Committee (JEDI) has found recruitment efforts have made headway in decreasing URM disparities. Latinx and Black communities now make up 17 percent and six percent respectively of Family Medicine residents in California, compared to the representation of Black (39 percent) and Latinx (five percent) communities in the general population.

Progress, however, is threatened by the vexing fact that URM residents drop out of residency at higher rates than those who are not URM. According to the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book, 134 Family Medicine residents (~three percent) did not graduate in 2020-21. While I could not find data on dropout rates by race for Family Medicine residents, other specialties have published disturbing patterns with respect to URM residents.

For example, in their article in JAMA (2023), Haruno et al. found that unintended resident attrition (i.e., withdrawal, dismissal and transfers) was higher for surgical residents who were URM (RR, 1.92; 95% CI, 1.75-2.11; P < .001), especially among Black residents (RR, 2.59; 95% CI, 2.31-2.90; P < .001). Balumuka et al. (2023) similarly found that URM residents were more likely to drop out. The reasons for this differential are not understood. Most literature I could find on the dynamics driving dropout end at medical school. Inquiry further into the career pathway that includes graduate medical education is lacking.

I do wonder how the disparities in our primary and secondary education systems—more likely to be experienced by groups that are URM—contribute to the struggles of residents. For example, I have noticed that residents in my program with URM backgrounds are more likely to struggle with passing USMLE and COMLEX exams, which is a barrier to licensure and graduation. It may mean that these residents must train to become Family Physicians while simultaneously and unfairly learning to compensate for disparities in their earlier education. We must also consider that ongoing systemic bias—including in residency programs—may also contribute to URM resident struggles, whether it be confirmation bias leading to unfavorable evaluations, stereotype threat contributing to barriers to performance, or programs being unwilling or unable to accommodate challenges—like financial or housing disruptions— that may be more likely in those who come from less privileged backgrounds.

Any of these added burdens could explain why more residents from URM communities struggle or fail in residency. Alternatively, the explanations may well be off the mark. The point is, without research, any supposition is simply handwaving.

Nevertheless, the need for research is real. We need to understand whether the same differential in dropout rates exists amongst Family Medicine residents, and if so, we must investigate the dynamics driving that disparity so we can appropriately direct resources to fix it.

I suspect that similar inequities do exist in our specialty as in the surgical specialties. It would mean we must advocate for additional investments to help some of our residents succeed. Song Brown is an example of funding critical for primary care training to those with URM backgrounds, and we would need more funding like it. Resources directed towards the recruitment of a more diverse workforce will be meaningless if we do not simultaneously invest in the success of all residents.

References

Plastic and Reconstructive Surgery - Global Open 11(2S):p 13, February 2023. | DOI: 10.1097/01.GOX.0000921628.97443.38

Haruno et al. JAMA Surg. 2023;158(4):368-376. doi:10.1001/ jamasurg.2022.7640

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.

To learn more, please contact: Recruit@cchealth.org

We offer:

• Flexible full- and part-time schedules available

• 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

CAFP Looks Back at 2023 Advocacy Efforts

Jeff Luther, MD, FAAFP Chair, Legislative Affairs Committee

The 2023 legislative session concluded on September 14. Governor Newsom had until October 14 to act on the approximately 1,050 bills sent to him. Of those bills, the Governor signed 890 bills and vetoed 156 bills. His 15 percent veto rate was similar to the 2022 legislative session. Most bills go into effect on January 1 of next year; urgent measures take effect immediately after they are signed or allowed to become law without signature.

CAFP advocates for family physicians and their patients in several areas, including through legislation, regulations, administrative action, ballot propositions and legal measures. CAFP will continue to advocate on issues within CAFP's legislative priorities:

1. Advancing payment reform and system transformation, including transforming current payment models; reducing system complexity and administrative burden, including not legislating the practice of medicine; and creating new care models that promote better health outcomes, health equity, and access to care.

2. Promoting the growth of the primary care physician workforce, including guiding financial and policy changes in medical education that support primary care, and creating a more diverse workforce.

3. Defining and raising the profile of family medicine, including conducting public education and awareness, leadership development, and supporting full spectrum family physicians.

4. Supporting physician wellness, including alleviating burnout and supporting efforts that promote physician mental and emotional health.

5. Promoting Justice, Equity, Diversity, and Inclusion (JEDI), including advocating for policy changes that improve health equity and advancing a more diverse family medicine workforce.

CAFP supported 79 bills during the 2023 legislative session, and 32 were signed into law. Additionally, the 2023 budget contains significant wins for primary care, GME, and physician workforce. See further details below:

Legislative Advocacy

CAFP-Sponsored Bill AB 85

The Governor vetoed CAFP-sponsored bill AB 85(Weber) on October 7, despite the support of 30+ patient advocacy, health care and community-based organizations. AB 85 would have expanded access to social determinants of health screenings and resources by requiring health plans and insurers to provide coverage for SDOH screenings and to provide adequate access to community health workers, promotores, peer support specialists and social workers. The Governor cited unwarranted concern about duplication with other efforts and the lack of a uniform tool for screening in his veto message.

Postgraduate Training License (PTL) Fix

On September 13, Governor Newsom signed SB 143 (Committee on Budget and Fiscal Review), which immediately extends the expiration date of postgraduate training licenses (PTL) that expire after June 1, 2023, and before December 31, 2023, to March 31, 2024. No action is necessary for the extension to take place. The board will automatically change their expiration dates and notify affected licensees via email. SB 143 also makes the following changes:

• Provides residents who completed the board-approved postgraduate training required for licensure out-of-state and are enrolled in a California ACGME-accredited program more time to obtain a Physician's and Surgeon's (P&S) license under the Business and Professions Code (BPC) section 2065(g).

• Under the new law, these applicants have 180 days from the date they begin their training program to obtain a P&S license (under the prior law, they had 90 days from their enrollment date).

• States that residents must obtain a PTL within 180 days from beginning a California board-approved postgraduate training program rather than from the date of enrollment, as required under BPC section 2064.5(a).

The Medical Board of California sunset review bill SB 815 (Roth) also makes additional changes to physician licensing requirements. SB 815 was signed into law on September 30 by the Governor and made the following changes to the PTL:

• Postgraduate Training License (PTL): All newly issued PTLs will be valid for 36 months, and any PTL in an active status as of January 1, 2024, will be extended, if necessary, so that it is valid for 36 months.

• Physician's and Surgeon's License: Removed the requirement that board-approved postgraduate training include four months of general medicine.

• Physician Fee Increases: Increase in the initial license and biennial renewal fees for a physician's and surgeon's certificates. The current fee is $863, but effective January 1, 2024, the fee will increase to $1,151, and then to $1,255, effective January 1, 2027

Budget Advocacy

The California legislature passed the 2023 -2024 health budget trailer bill, which renews the State's Managed Care Organization (MCO) tax and provides the largest Medi-Cal rate increase in California history. Starting in 2024 Medi-Cal provider rates will increase to at least 87.5 percent of Medicare for primary care, maternity care, and non-specialty mental health services. Starting in 2025 an additional annual appropriation of $1.38 billion will be directed to primary care providers in the Medi-Cal program.

The health budget trailer bill includes other investments in health care, including, beginning in 2024, an additional $75 million to be allocated annually to increase residency slots for primary and specialty care and expand the number of residency programs in California. Beginning in 2025, $150 million annually will be allocated to grow the healthcare workforce. At least $500 million will be directed to family-

planning related services in both Medi-Cal and FPACT and abortion services.

Regulatory Advocacy

The Office of Health Care Affordability (OHCA) Investment and Payment Workgroup is tasked with providing input to OHCA on the development of primary care, alternative payment model (APM), and behavioral health definitions, data collection processes, and benchmarks. This year the CAFP participated in several workgroups and provided feedback on OHCA draft alternative payment model (APM) standard and implementation guidelines to promote equitable, highquality, and cost-efficient care. CAFP feedback included emphasizing the need for greater investments in primary care, reducing administrative burdens, and the need for multidisciplinary care teams to assess and address patients medical, behavioral, and social needs. To view CAFP’s comment letter visit https:// cafponcloud.egnyte.com/dl/rCX3vzGR7g.

A look to the future

The 2024 legislative session will reconvene on January 3. CAFP will have the chance to raise the profile of family medicine and advocate for issues that are important to family physicians, their practices, and their patients. Aside from legislation, 2024 is also an election year. There are numerous candidates running for Assembly and Senate seats in the California legislature.

New legislators provide opportunities for CAFP to educate members on the comprehensive training that family physicians receive and the populations they serve.

Additionally, as mentioned, the MCO tax was renewed in the 2023 budget. The caveat to the Managed Care Organization Provider (MCO) tax being renewed is that it is subject to federal approval, and if approved, which is predicted, it is set to expire at the end of 2026. In 2024 California voters will see a ballot initiative that would, among other things, make the MCO tax permanent. CAFP's advocacy also includes taking positions on ballot initiatives, such as we saw last year supporting Proposition 1 to enshrine the right to abortion access in the California Constitution. CAFP has not yet taken a position on the 2024 MCO Tax ballot initiative but will likely announce a position early in 2024. Next year will be an exciting one in the legislature, and we can't wait to see CAFP in action in 2024!

SB 143 - https://leginfo.legislature. ca.gov/faces/billNavClient.xhtml?bill_ id=202320240SB143

SB 815 - https://leginfo.legislature. ca.gov/faces/billTextClient.xhtml?bill_ id=202320240SB815

https://cafponcloud.egnyte.com/dl/ kYq1xKoPo0

SPARK Moves to CAFP 365

CAFP Members-Only Community Moves from SPARK to CAFP 365!

CAFP is putting connection in your hands with the CAFP 365 mobile app! As a CAFP member, you have access to the members-only content within CAFP 365, including the Member Topics area where you can discuss matters important to you as a family physician – just like you did with SPARK.

CAFP 365 is your connection to an incredible resource – more than 11,000 of your colleagues who share your challenges and successes as a family physician. CAFP 365 gives you the opportunity to seek advice, exchange resources and build relationships with fellow California physicians.

CAFP 365 also gives you a direct connection to CAFP resources, including

CAFP Events, Homeroom for 24/7 access to CME, the CAFP Career Center, FM Residency Program directory, the Family Docs Podcast, and more.

We know that CAFP members value networking and educational opportunities. To build on that value, we are excited to provide this platform for member communication where you connect, engage, and collaborate in real time.

The CAFP 365 app is designed for you, a CAFP member, to have resources and connections at your fingertips. You can access the CAFP 365 app on your mobile device, tablet, or computer. Visit familydocs.org/app for more information and to access CAFP 365.

Now Hiring Family Doctors

Introduce Yourself

To login to CAFP 365, visit the link, click on Member, click "Reset Password" if it is your first time. You will use your email associated with your CAFP or AAFP account.

Visit Member Topics in the app to introduce yourself to your fellow family docs!

Include:

- Your Name

- Your city/community/local chapter

- Why you are a current or future family physician!

environment that encourages professional and personal development We are at the forefront of models to invest in primary care, providing our physicians with autonomy and practice stability

For anyone who introduces themselves (including name, city/community, and why they're a current or future family physician), your name will be entered to win a host of prizes, including discounts to upcoming events (AMAM and POP!), free items from the Family Docs store, and more!

Questions? Reach out to us at cafp@familydocs.org.

CONTINUING MEDICAL EDUCATION

VIRTUAL

2024 PROPER PRESCRIBING

Various times available. Earn one AOA Category 1-A credit approved by the Oklahoma State Board of Osteopathic Examiners.

During each one hour livestream session we will explore the history of opioid use and the need for responsible prescribing.

VIRTUAL

EMERGENCY MEDICINE REVIEW

Monday, June 3, 2024, 8:00 amThursday, June 27, 2024, 11:59 pm. Earn 20.00 hours, AOA Category 1-A credits.

The goal of the 2024 Emergincy Medicine Review is to provide emergency physicians with the latest in evidence-based medicine practices.

VIRTUAL ENDURING CREDITS & PACKAGES

IN-PERSON OSU-CHS

AIRWAY SIMULATION

Friday, April 19, 2024, 1:00 pm - 5:30 pm. Earn 4.25 hours, one AOA Category 1-A credit, American Academy of Family Physicians Elective Credit(s). Hands-on training on difficult airway situations and learning troubleshooting techniques.

A wide variety of specialties offered starting at $25 a credit. Category 1-A & 1-B credits. Visit okla.st/cme-credits to see Enduring Credits and Package options.

Visit osu.cloud-cme.com for more information and to register.

Primary Care: FM Opportunities

Come for the Opportunities. Stay for the Lifestyle.

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 Network! Register using our job portal: PracticeWithUs.BannerHealth.com

Or, email CV: primarycaredocs@bannerhealth.com

For information call Martha Gonzales 602.747.4328

Banner Health is an EEO/AA - M/W/D/V Employer

HPSA score: 17

CAFP’s annual All Member Advocacy Meeting (AMAM) is your chance to make change in health care policy! At the AMAM, you will hear from policy and political experts, get hands-on experience advocating for issues important to family medicine, network with advocacy-oriented colleagues, and meet with your legislators! From improving public health to increasing primary care payment, learn how YOU can be the change you want to see in the health care policy world.

AMAM 2024 will focus on utilizing a team-based approach to advance health equity. Primary care is a natural point of integration among clinical care, public health, behavioral health, and community-based services. Teambased care is a model of care delivery that can aid in reducing physicians’ administrative burdens while improving patients’ health outcomes through multidisciplinary care teams. This year’s AMAM will offer many of the sessions you’ve come to know and love, such as how to talk to your legislator. AMAM will also offer exciting new sessions you won’t want to miss including an insider’s view of campaigns and elections.

Scholarships and financial assistance is available. Visit familydocs.org/amam for information and registration!

CME will be offered at AMAM. As we develop the sessions and schedule, please check online for more information on the available credits.

The 2024 All Member Advocacy Meeting will held at the Sheraton Grand Sacramento (1230 J Street, Sacramento) on Saturday and Sunday, April 13-14, 2024 with Lobby Day on Monday, April 15, 2024. Special rates available for a limited time. Visit familydocs.org/amam to book your stay!

What’s Up, Doc?

UMC in Las Vegas is now hiring providers for our expansive network of Primary Care and Quick Care clinics. Join Nevada’s most sophisticated health care system and enjoy our vibrant community, warm weather, and nearly 300 days of sunshine each year!

• Competitive Salary

• Sign-On Bonus

• Relocation Available!

Key Contact Program Reignites in 2024

Karen Alvarado Advocacy Assistant

Are you ready to amplify your advocacy efforts and play a crucial role in shaping the future of family medicine in California? The California Academy of Family Physicians (CAFP) warmly invites you to join our NEW Key Contact Program—a unique opportunity for you to become a vital voice representing Family Physicians across the state. This is more than just a membership; it's a chance to make a real impact.

The previous Key Contact program created a pathway to provide advocacy-focused communication to those members who opted in to receive the weekly Legislative Update. Some of those members were asked

to testify at hearings, meet with legislators, or provide the valuable insight into the work you do. However, many of those key contacts were never engaged or brought to the table. Because of the importance of CAFP’s advocacy efforts, we now distribute the Legislative Update to all members, whether they are Key Contacts or not. And most importantly, we want all Key Contacts to be engaged. So, we are reigniting our Key Contacts program in 2024.

Unlike the previous Key Contact program, our new program is designed to offer you an even more enriching experience, with exclusive opportunities, specialized trainings,

and insider insights, including:

• Expanded Learning Opportunities: Sharpen your advocacy skills, gain insights into new legislative developments, and stay at the forefront of policies affecting family physicians.

• Exclusive Events: Be the first to access our quarterly events from our brand-new Sacramento headquarters, providing you with insider information and networking opportunities.

• Impactful Advocacy: Your voice matters. Renewing as a Key Contact allows you to continue being a leading advocate, representing Family Physicians in decision-making spaces.

As a Key Contact, your contributions are critical to the efforts. We ask that you:

• Respond promptly to action alerts: Via VoterVoice/SpeakOut.

• Attend our annual All Member Advocacy Meeting and Lobby Day.

• Actively participate in exclusive Key Contacts trainings and insight events.

• Make an annual contribution to the FP-PAC to ensure Family Physicians have a seat at the table with key decision makers.

• Be a leading voice in statewide advocacy: Including testifying in Legislative Hearings, applying/serving in advisory groups, and learning how to be a better advocate in your organizations.

Sign Up Today! Visit www.familydocs.org/ keycontact for more information.

If you are currently a key contact, even if you recently signed up to become a Key Contact you will need to renew your role by completing the form linked on the Key Contact Program page. If you have any questions, please do not hesitate to contact CAFP’s Advocacy Assistant, Karen Alvarado at kalvarado@familydocs.org.

A leader and innovator in the future of health care

Adult and Family Medicine Physician Opportunities

Northern & Central California - Ask us about our enhanced compensation!

The Permanente Medical Group, Inc. (TPMG) has a longstanding reputation for progress and quality service that not only o ers you the stability you need for a fulfilling career, but also the freedom to explore innovative ideas. We invite you to join our over 9,500 physicians at one of our 22 medical centers or numerous clinics throughout Northern and Central California and become part of our 75-year tradition.

Adult and Family Medicine

Virtual Care Physician (aka

Virtualogist) - Exciting openings for remote work!

Seeking physicians who are BC/BE by an American Specialty Board to provide virtual care in a variety of ways that may include, but not limited to, scheduled and unscheduled video visits, telephone visits, e-visits, chat, and secure messages. Positions can be fully virtual/remote. Applicants must reside in and be licensed to practice in California. Applicants may also be required to receive licenses in multiple other states.

Ideal candidates:

• Must be flexible with the duration of work shifts and 24/7 availability, including weekdays, weekends, and holidays.

• Must be willing to work shifts in flexible increments (i.e. 1-10 hour units).

A FEW REASONS TO PRACTICE WITH TPMG:

• Work-life balance focused practice, including flexible schedules and unmatched practice support.

• We can focus on providing excellent patient care without managing overhead and billing. No RVUs.

• PSLF eligible employer

• We demonstrate our commitment to a culture of equity, inclusion, and diversity by hiring physicians that reflect and celebrate the diversity of people and cultures.

• Amazing benefits package, including comprehensive medical and dental, moving allowance and home loan assistance (up to $250,000 - approval required), and more!

ASK US ABOUT OUR FORGIVABLE LOAN PROGRAM!

For more information about our career opportunities and wage ranges, please visit: northerncalifornia.permanente.org

FAMILY MEDICINE: Contact Bianca Canales at: Bianca.Canales@kp.org or 510-421-2183

INTERNAL MEDICINE: Contact Michael Truong at: Michael.V.Truong@kp.org or 510-625-5917

CONNECT WITH US:

We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor.

As a reciprocal exchange, MIEC is entirely owned by the policyholders we protect. Our mission to protect physicians and the practice of medicine has guided us over the past 47 years. Our Patient Safety and Risk Management team continues to provide policyholders timely resources and expert advice to improve patient safety and reduce risk. To learn more about the benefits of being an MIEC policyholder, or to apply, visit miec.com or call 800.227.4527