Fall 2019 by California Academy of Family Physicians

VO L . 70 N O. 4 Fa l l 201 9

IN THIS ISSUE

CHANGE AND TRANSITION

ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ ĂůŝĨŽƌŶŝĂ ϵϰϭϬϵ • ǁǁǁ͘ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ WŚŽŶĞ ;ϰϭϱͿ ϯϰϱͲϴϲϲϳ • &Ăǆ ;ϰϭϱͿ ϯϰϱͲϴϲϲϴ • ͲŵĂŝů͗ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ

Officers and Board President tĂůƚĞƌ DŝůůƐ͕ D ͕ DDD Immediate Past President >ŝƐĂ D͘ tĂƌĚ͕ D ͕ D^ĐW,͕ D^ President-elect ĂǀŝĚ ĂǌǌŽ͕ D Speaker ^ŚĂŶŶŽŶ ŽŶŶŽůůǇ͕ D Vice-Speaker >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW, Secretary/Treasurer ZĂƵů ǇĂůĂ͕ D Chief Executive Officer >ŝƐĂ &ŽůďĞƌŐ͕ DWW Foundation President DĂƌŝĂŶŶĞ DĐ<ĞŶŶĞƚƚ͕ D AAFP Delegates :ĞĨĨ >ƵƚŚĞƌ͕ D ĂƌŽů ,ĂǀĞŶƐ͕ D AAFP Alternates :ĂǇ t͘ >ĞĞ͕ D ͕ DW, >ĞĞ ZĂůƉŚ͕ D CMA Delegation ZĂƵů ǇĂůĂ͕ D <ŝŵďĞƌůǇ ƵƐƐ͕ D ͕ DW, :ĂǇ t͘ >ĞĞ͕ D ͕ DW, &Ğůŝǆ EƵŶĞǌ͕ D ͕ DW, <ĞǀŝŶ ZŽƐƐŝ͕ D

Staff >ŝƐĂ &ŽůďĞƌŐ͕ DWW

Chief Executive Officer lfolberg@familydocs.org

ŽŶƌĂĚ ŵĞŶƚĂ

Director, Health Policy and Strategic Engagement camenta@familydocs.org

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

Manager, Operations|Governance and FP-PAC mcleveland@familydocs.org

:Ğƌƌŝ ĂǀŝƐ͕ , W

Director, CME/CPD jdavis@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

ƌůĂŶŶĂ ,ĞŶƌǇ

Administrative Assistant ahenry@familydocs.org

:ŽƐŚ >ƵŶƐĨŽƌĚ

Director, Membership and Marketing jlunsford@familydocs.org

^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͕ ͕ & ,W Deputy Executive Vice President srodrigues@familydocs.org

:ŽŶĂƚŚĂŶ ZƵĚŽůƉŚ

Looking for a job? 'Ž ƚŽ ǁǁǁ͘ĨƉũŽďƐŽŶůŝŶĞ͘ĐŽŵ YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ ǇŽƵ͘

Manager, Finance jrudolph@familydocs.org

Brent Sugimoto, MD, Editor Shelly Rodrigues, CAE, 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.

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California Family Physician Fall 2019

California

Fall 2019

FAMILY PHYSICIAN stro n g

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C a l i f o r nia

On the cover clockwise: ϮϬϭϵ DĞĚŝĐĂů ^ƚƵĚĞŶƚ ĂŶĚ &D ZĞƐŝĚĞŶƚ ^Ƶŵŵŝƚ ĚƌĞǁ Ă ƌĞĐŽƌĚͲďƌĞĂŬŝŶŐ ĐƌŽǁĚ ŝŶ September. :ĂǇ >ĞĞ͕ MD, MPH led the lunch session on sKd ϮϬϮϬ͖͊ ŵŽƌĞ ƚŚĂŶ ϯϬ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ ZĞƐŝĚĞŶĐǇ EĞƚǁŽƌŬ ŵĞƚ ƚŽ ĚŝƐĐƵƐƐ Ă ǀĂƌŝĞƚǇ ŽĨ ŝƐƐƵĞƐ͕ ĂŶĚ Student+Resident Council Co-Chairs ĂŶ EŝĐŚŽůƐ, ŶĚƌĞĂ ĂŶƵĞůŽƐ DŽƚĂ, ůŝǌĂďĞƚŚ ^ŽƉŚǇ, MD and ZŽď ƐƐŝďĞǇ, MD ǁĞůĐŽŵĞĚ ƚŚĞ ĂƩĞŶĚĞĞƐ͘

features 14 Honoring the Passing of a Gentle Giant 16 Change and Transition … Aren’t They the Same Thing? 18 Hep C Treatment as Primary Care: Alameda Health Consortium Experience

Marshall Kubota, MD Shelly B. Rodrigues, CAE, FACEHP Jan Diamond, MD, MPH

22 Attending Life: Embracing the Unknown 26 Contemplating Retirement

Julie Çelebi, MD Carol S. Havens, MD, FAAFP

departments 6

Editorial

Embracing Change Makes Family Medicine Stronger

President’s Message

Transitioning from Burn Out to Wellness: Stories of the Real FM Revolution

10 Political Pulse

Brent Sugimoto, MD, MPH Walt Mills, MD

The Final Countdown Begins

Carla Kakutani, MD

The Year Passed So Quickly

Lisa Folberg, MPP

12 In The News 30 CEO Message

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Physician Fall 2019

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Embracing Change Makes Family Medicine Stronger The Merriam-Webster Dictionary defines career as “a ƉƌŽĨĞƐƐŝŽŶ ĨŽƌ ǁŚŝĐŚ ŽŶĞ ƚƌĂŝŶƐ ĂŶĚ ǁŚŝĐŚ ŝƐ ƵŶĚĞƌƚĂŬĞŶ as a permanent calling.” Something in that definition feels overly constraining and perhaps not an accurate reflection of ǁŚĂƚ ŵĂŶǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĐĂƌĞĞƌƐ ĂƌĞ͘ dŚĂƚ ĚĞĨŝŶŝƚŝŽŶ ŚĂƐ Ă connotation of stasis. Family medicine is anything but static. Family medicine is dynamic.

transition out of active practice into retirement. Dr. Jan ŝĂŵŽŶĚ ƐŚŽǁƐ ƚŚĂƚ ƌĞƚŝƌĞŵĞŶƚ ŝƐ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ ŝŵƉĂĐƚ as she discusses an innovative program she leads for her ĐŽŵŵƵŶŝƚǇ͘ /Ŷ Ă ďŝƚƚĞƌƐǁĞĞƚ ĞǆĂŵƉůĞ ŽĨ ƚŚĞ ŝŶƚĞƌĐŽŶŶĞĐƚŝŽŶ of our transitions, Dr. Marshall Kubota reflects posthumously ŽŶ ƚŚĞ ŝŶĚĞůŝďůĞ ŵĂƌŬ ƌ͘ :ŽŚŶ ĞƌǀŝŶ ŵĂĚĞ ŽŶ family medicine.

Family physicians by nature constantly adapt to the needs /ƚ ǁĂƐ ŶŽƚ ƵŶƚŝů ƚŚĞ ϭϵƚŚ ĐĞŶƚƵƌǇ ƚŚĂƚ ƚŚĞ ǁŽƌĚ ͞ĐĂƌĞĞƌ͟ ĐĂŵĞ ŽĨ ŽƵƌ ƉĂƚŝĞŶƚƐ͕ ĐŽŵŵƵŶŝƚŝĞƐ ĂŶĚ ƚŝŵĞƐ͕ ĨŝŐƵƌŝŶŐ ŽƵƚ ŚŽǁ ƚŽ ŝŶƚŽ ƚŚĞ ƵƐĞ ĨĂŵŝůŝĂƌ ƚŽ ƵƐ ƚŽĚĂǇ͘ /ƚ ŝƐ ďĞůŝĞǀĞĚ ƚŚĞ ǁŽƌĚ get it done. This requires, ĚĞƌŝǀĞĚ ĨƌŽŵ ƚŚĞ >ĂƚŝŶ ǁŽƌĚ at minimum, a modicum carrus, and Classics buffs of improvisation and, at ǁŝůů ƌĞĐŽŐŶŝǌĞ ƚŚŝƐ ĂƐ ƚŚĞ Family physicians by times, a shift in identity. ǁŽƌĚ ĨŽƌ ǁĂŐŽŶ Žƌ ĐĂƌƚ͘ dŚĞ Our training is essential to ǁŽƌĚ ͞ĐĂƌĞĞƌ͟ ĐůĞĂƌůǇ ǁĞŶƚ nature constantly adapt ŽƵƌ ƐŬŝůůƐĞƚ͕ ǇĞƚ ǁĞ ĚŽ ŶŽƚ through some transitions of to the needs of our ƚŚŝŶŬ ŽĨ ŽƵƌƐĞůǀĞƐ ĂƐ ƚŚĞ ŝƚƐ ŽǁŶ͘ /Ŷ ŵĞĚŝĞǀĂů ƚŝŵĞƐ͕ patients, communities sum total of our training. carrus became carriere in The circumstances of our Middle French and referred and times, figuring out ƉĂƚŝĞŶƚƐ ĂůǁĂǇƐ ƐŚŝĨƚ ĂŶĚ to the short bursts of full how to get it done. morph—family doctors must ƐƉĞĞĚ ƌŝĚŝŶŐ ŬŶŝŐŚƚƐ ŚĂĚ do the same to meet our ƚŽ ƉĞƌĨŽƌŵ ǁŚŝůĞ ũŽƵƐƚŝŶŐ͘ patients’ needs. dŚĞ ϭϲƚŚ ĐĞŶƚƵƌǇ ŶŐůŝƐŚ ĐŽƌƌƵƉƚĞĚ ƚŚĞ ǁŽƌĚ ƚŽ career, the term for the high-speed This issue of California Family Physician explores transitions ƌŝĚŝŶŐ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĐŽƵƌƐĞƐ ƚŚĞ ŬŶŝŐŚƚƐ ƌŽĚĞ͘ Ǉ ƚŚĞ ŵŝĚͲϭϳƚŚ and examples of change throughout the career of a family century, career, defined as road or racecourse, continued to physician. From medical student to resident, from resident connote going fast, a meaning lost today. ƚŽ ĂƚƚĞŶĚŝŶŐ͕ ĨƌŽŵ ĂƚƚĞŶĚŝŶŐ ƚŽ ĞŵĞƌŝƚƵƐ ƉŚǇƐŝĐŝĂŶ͕ ǁĞ all navigate transition through those phases and any time / ǁŽƵůĚ ĂƌŐƵĞ ƚŚĂƚ ƚŚĞ ͞ŐŽ ĨĂƐƚ͟ ŵĞĂŶŝŶŐ ŝƐ ŵŽƌĞ ă ƉƌŽƉŽƐ ƚŽ ďĞƚǁĞĞŶ͘ ^ŽŵĞƚŝŵĞƐ ǁĞ ĂĐĐĞƉƚ ĐŚĂŶŐĞ͕ ĂŶĚ ƐŽŵĞƚŝŵĞƐ ǁĞ ŵǇ ŽǁŶ ůŝǀĞĚ ĞǆƉĞƌŝĞŶĐĞ ĂŶĚ ƉƌŽďĂďůǇ ƚŽ ƚŚĂƚ ŽĨ ŵĂŶǇ ĨĂŵŝůǇ are thrust into changing currents (e.g., economic forces, ƉŚǇƐŝĐŝĂŶƐ ĂƐ ǁĞůů͗ ĨƵůůͲƐƉĞĞĚ ďƵƌƐƚƐ ƚŚƌŽƵŐŚ ŵĂŶǇ ƚƌĂŶƐŝƚŝŽŶƐ regulatory shifts). Each passage traversed leaves us a in our careers as life flies by. The practice of medicine must different doctor on the other side. ŬĞĞƉ ƵƉ ǁŝƚŚ ƚŚĞ ƉĂĐĞ ŽĨ ĐŚĂŶŐĞ ŝŶ ůŝĨĞ͕ ĂŶĚ ƐŽ ǁĞ ĂĚĂƉƚ ŝŶ order to meet the needs of our patients and our communities. The contributors to this issue reflect on the meaning of those transitions, both in practice and after, through life and dŚĞ KǆĨŽƌĚ ŶŐůŝƐŚ ŝĐƚŝŽŶĂƌǇ ŚĂƐ Ă ƐůŝŐŚƚůǇ ĚŝĨĨĞƌĞŶƚ ƚĂŬĞ ƚŚĂŶ beyond. Deputy Executive Vice President Shelly Rodrigues Merriam-Webster on career ƚŚĂƚ ƌĞƐŽŶĂƚĞƐ ǁŝƚŚ ŵĞ ŵŽƌĞ͗ ͞ Ŷ gives insight and tips into navigating life’s transitions and ŽĐĐƵƉĂƚŝŽŶ ƵŶĚĞƌƚĂŬĞŶ ĨŽƌ Ă ƐŝŐŶŝĨŝĐĂŶƚ ƉĞƌŝŽĚ ŽĨ Ă ƉĞƌƐŽŶ͛Ɛ ƚĞĂĐŚĞƐ ƵƐ ǁŚǇ ŝƚ ŝƐ ĐƌƵĐŝĂů ƚŽ ĚŝĨĨĞƌĞŶƚŝĂƚĞ ƚƌĂŶƐŝƚŝŽŶ ĂŶĚ ůŝĨĞ ĂŶĚ ǁŝƚŚ ŽƉƉŽƌƚƵŶŝƚŝĞƐ ĨŽƌ ƉƌŽŐƌĞƐƐ͘͟ Ɛ ƌ͘ ĞůĞďŝ ŵĂǇ ĐŚĂŶŐĞ͘ ƌ͘ :ƵůŝĞ ĞůĞďŝ ƐŚŽǁƐ ƵƉ ǁŝƚŚ Ă ƐĞŶƐĞ ŽĨ ĂĚǀĞŶƚƵƌĞ ĂƌŐƵĞ͕ ĞŶĚůĞƐƐ ŶĂǀŝŐĂƚŝŽŶ ŽĨ ƚƌĂŶƐŝƚŝŽŶƐ ŝƐ ƐŝŵƉůǇ Ă ǁĂǇ ŽĨ ůŝĨĞ͕ ĂŶĚ ŽƉƚŝŵŝƐŵ ĨŽƌ ƚŚĞ ŵĂŶǇ ƚƌĂŶƐŝƚŝŽŶƐ ƐŚĞ ŬŶŽǁƐ ǁŝůů ĐŽŵĞ ďĞĐĂƵƐĞ ƚŚĂƚ ŝƐ ŚŽǁ ǁĞ ĂĐŚŝĞǀĞ ƉƌŽŐƌĞƐƐ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ throughout her career. Dr. Carol Havens anticipates the ĂŶĚ ŝƐŶ͛ƚ ƉƌŽŐƌĞƐƐ Ă ƉĂƚŚ ƚŽ ĨŝŶĚŝŶŐ ũŽǇ ŝŶ ǁŚĂƚ ǁĞ ĚŽ͍

California Family Physician Fall 2019

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Walt Mills, MD

Transitioning from Burn Out to Wellness: Stories of the Real FM Revolution /͛ǀĞ ďĞĞŶ ǀŝƐŝƟŶŐ ŵĂŶǇ ŽĨ ŽƵƌ ϯϬн &W ůŽĐĂů ĐŚĂƉƚĞƌƐ͘ ƵƌŝŶŐ these visits, I have been so inspired by the personal stories ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ;&WƐͿ ǁŚŽ ŚĂǀĞ ƌŝƐĞŶ ƚŽ ĐŚĂůůĞŶŐĞƐ ĂŶĚ ƐƵĐĐĞƐƐĨƵůůǇ ƚƌĂŶƐŝƟŽŶĞĚ ƚŚĞŝƌ ǁŽƌŬ ůŝĨĞ ƚŽ ďĞ ŚĂƉƉǇ ĂŶĚ ĨƵůĮůůĞĚ͘

In my travels, students and residents have come up to me declaring ƚŚĞǇ ĂƌĞ ƐŽ ŚĂƉƉǇ ƚŚĞǇ ĮŶĂůůǇ ͞ĨŽƵŶĚ ƚŚĞŝƌ ĐŽŵŵƵŶŝƚǇ͟ ŝŶ ĨĂŵŝůǇ medicine, a feeling that has persisted for me since I made that same discovery four decades ago.

dŚĞƐĞ ƐƚŽƌŝĞƐ ŽŌĞŶ ƌĞůĂƚĞ ƚŽ ƚŚĞ ƋƵĞƐƟŽŶ / ŚĂǀĞ ďĞĞŶ ĂƐŬŝŶŐ ƐŝŶĐĞ ŵǇ ŝŶƐƚĂůůĂƟŽŶ ĂƐ ƉƌĞƐŝĚĞŶƚ ŝŶ DĂƌĐŚ͗ ͞,Žǁ ĐĂŶ ŽƵƌ &D ZĞǀŽůƵƟŽŶ ŐƌŽǁ ŽƵƌ ŚĂƉƉŝŶĞƐƐ Ăƚ ǁŽƌŬ͍͟ ŶĂƟŽŶĂů ƐƵƌǀĞǇ ŝŶ ϮϬϭϴ ĂƐŬĞĚ ƉŚǇƐŝĐŝĂŶƐ͕ ͞,Žǁ ŚĂƉƉǇ ĂƌĞ ǇŽƵ Ăƚ ǁŽƌŬ͍͟ KŶůǇ Ϯϴ ƉĞƌĐĞŶƚ ŽĨ &WƐ ĂŶƐǁĞƌĞĚ ĂĸƌŵĂƟǀĞůǇ͘ ,ĞƌĞ ŝŶ ĂůŝĨŽƌŶŝĂ͕ / ŚĂǀĞ ĨŽƵŶĚ ƐŽŵĞ ďƌŝŐŚƚ ƐƉŽƚƐ͕ ƐƚŽƌŝĞƐ ĨƌŽŵ ĚŽĐƐ ǁŚŽŵ / ŵĞƚ ǁŚŽ ƐĂǇ͕ ͞zĞƐ͕ /͛ŵ ǀĞƌǇ ŚĂƉƉǇ ŝŶ ŵǇ ǁŽƌŬ͘͟

dŚĞ EĞǁ ^ĐŝĞŶĐĞ ŽĨ dƌĂŶƐŝƟŽŶŝŶŐ ĨƌŽŵ ƵƌŶŽƵƚ ƵůƚƵƌĞ ƚŽ tĞůůŶĞƐƐ

ǀĞƌǇ ƐƚŽƌǇ ŚĂƐ ƵůƟŵĂƚĞůǇ ďĞĞŶ ĂďŽƵƚ ĂĚĚƌĞƐƐŝŶŐ ĂĚǀĞƌƐĞ ĐŝƌĐƵŵƐƚĂŶĐĞƐ ǁŝƚŚ Ă ƐƵĐĐĞƐƐĨƵů ƚƌĂŶƐŝƟŽŶ ƚŽ ƐŽŵĞƚŚŝŶŐ ďĞƩĞƌ͕ ƐŽŵĞƚŚŝŶŐ ƚŚĂƚ ǁŽƌŬƐ ƚŽ ƌĞĂůŝŐŶ ǁŽƌŬ ǁŝƚŚ ƉƵƌƉŽƐĞ͕ ƚŽ ƌĞƐƚŽƌĞ ŵĞĂŶŝŶŐ ĂŶĚ ďĂůĂŶĐĞ͘ ^ŽŵĞ ƚƌĂŶƐŝƟŽŶƐ ĂƌĞ ĞŶƟƌĞůǇ ŝŶƚĞƌŶĂů͕ ŽƚŚĞƌƐ ŝŶǀŽůǀĞ ĚĞĞƉ ĐŚĂŶŐĞ ŝŶ ůŽĐĂƟŽŶ ĂŶĚ ƚǇƉĞ ŽĨ ǁŽƌŬ͘ DŽƐƚ success stories involve the themes deep personal insight and ƚƌĂŶƐĨŽƌŵĂƟŽŶ͘ ^ŽŵĞ ŽĨ ƚŚĞ ŵŽƐƚ ƉŽǁĞƌĨƵů ƚŚĞŵĞƐ ŚĂǀĞ ďĞĞŶ ƚƌĂŶƐŝƟŽŶŝŶŐ ĨƌŽŵ ƉĞƌĨĞĐƟŽŶŝƐŵ ƚŽ ĞǆĐĞůůĞŶĐĞ͖ ǁŽƌŬĂŚŽůŝƐŵ ƚŽ ŽŶĞ͛Ɛ ƚƌƵĞ ůŝĨĞ͛Ɛ ǁŽƌŬ͖ ĐŽŵƉĞƟƚŽƌ ƚŽ ĐŽůůĂďŽƌĂƚŽƌ͖ ŵĂŬŝŶŐ ŝƚ ƚŚŽƵŐŚ ƚŚĞ ĚĂŝůǇ ŐƌŝŶĚ ƚŽ ůŝǀŝŶŐ ĞĂĐŚ ĚĂǇ ďǇ ůŽǀŝŶŐ ǁŚĂƚ ǇŽƵ ĚŽ͖ ƌĞĨƌĂŵŝŶŐ ĚŝƐƚƌĞƐƐ ƚŽ ĞƵƐƚƌĞƐƐ͖ ƐĐĂƌĐŝƚǇ ƚŽ ĂďƵŶĚĂŶĐĞ ĂŶĚ ǀŝĐƟŵ ƚŽ ǀŝĐƚŽƌ͘

ŽƵƌĂŐĞ ƚŽ DĂŬĞ ƚŚĞ ZŝŐŚƚ dƌĂŶƐŝƟŽŶ KŶĞ &W ƌĞůĂƚĞĚ ŚŽǁ ŚĞ ŚĂĚ ďĞĞŶ ƚŚĞ ŚŝĞĨ DĞĚŝĐĂů KĸĐĞƌ ĨŽƌ Ă ůĂƌŐĞ ŶĞƚǁŽƌŬ͕ ůŽǀĞĚ ƚŚĞ ũŽď ĨŽƌ ϭϱ ǇĞĂƌƐ ƵŶƟů ƚŚĞ ŚŝĞĨ ǆĞĐƵƟǀĞ KĸĐĞƌ ; KͿ ƌĞƟƌĞĚ͕ ŚĞ ƚŚĞŶ ͞ďƵƌŶĞĚ ŽƵƚ͟ ƚƌǇŝŶŐ ƚŽ ĂĐĐŽŵŵŽĚĂƚĞ ƚŚĞ ŶĞǁ K͘ ŽƵƌĂŐĞŽƵƐůǇ͕ ƚŚŝƐ &W ĚŝƐƌĞŐĂƌĚĞĚ Ăůů ĨƌŝĞŶĚƐ͛ ĂŶĚ ĨĂŵŝůǇ͛Ɛ ĂĚǀŝĐĞ ĂŶĚ ƐƚĂƌƚĞĚ Ă ŶĞǁ ƉƌĂĐƟĐĞ͘ EŽǁ͕ Ă ĨĞǁ ƐŚŽƌƚ ǇĞĂƌƐ ůĂƚĞƌ͕ ƚŚŝƐ ĚŽĐƚŽƌ ŚĂƐ Ă ƚŚƌŝǀŝŶŐ ƉƌĂĐƟĐĞ ǁŝƚŚ ƚǁŽ ŐŽŽĚ &W ĨƌŝĞŶĚƐ ĂŶĚ ƐƉĞĂŬƐ ŽƉĞŶůǇ ĂďŽƵƚ ůŽǀŝŶŐ ƚŚĞ ǁŽƌŬ ĂŐĂŝŶ͘ dŚŝƐ ŚĞƌŽŝĐ ĞǆĂŵƉůĞ ŽĨ ŶŽƚ ƐĞƩůŝŶŐ ĨŽƌ ůĞƐƐ ƚŚĂŶ ŚĂƉƉŝŶĞƐƐ ǁĂƐ ƚƌƵůǇ ŝŶƐƉŝƌŝŶŐ͘ ŶŽƚŚĞƌ &W ƚŽůĚ ŵĞ ĂďŽƵƚ ƵƐŝŶŐ ϮϬ ƉĞƌĐĞŶƚ ŽĨ ƟŵĞ ŽƵƚƐŝĚĞ ŽĨ ŚĞƌ ŐƌŽƵƉ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ƚŽ ůĞĂĚ Ă ŶĞǁ tĞůůŶĞƐƐ ĞŶƚĞƌ͘ ^ŚĞ ƐĂŝĚ͕ ͞/ ĐĂŶ͛ƚ ŝŵĂŐŝŶĞ ďĞŝŶŐ ŚĂƉƉŝĞƌ ǁŝƚŚ ŵǇ ǁŽƌŬ͘͟ ŶŽƚŚĞƌ ŚĂƐ ďůĞŶĚĞĚ ŚĞƌ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŝŶ Ă ƌƵƌĂů ŚĞĂůƚŚ ĐĞŶƚĞƌ ǁŝƚŚ ĂŶ ŝŶŶŽǀĂƟǀĞ ƚĞůĞŚĞĂůƚŚ ƉƌĂĐƟĐĞ͘ ŶŽƚŚĞƌ ŝƐ ďƵŝůĚŝŶŐ ŚĞƌ ŝƌĞĐƚ WĂƟĞŶƚ ĂƌĞ ƉƌĂĐƟĐĞ ĂŶĚ ůŽǀŝŶŐ ĞǀĞƌǇ ĚĂǇ ŽĨ ŝƚ͘ ŶŽƚŚĞƌ ŝƐ ŐĞƫŶŐ ŚŝƐ DĂƐƚĞƌƐ ŝŶ ,ĞĂůƚŚĐĂƌĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ƚŽ ĚŽ Ă ďĞƩĞƌ ũŽď Ăƚ ƐĞƌǀŝŶŐ ŚŝƐ ĐŽŵŵƵŶŝƚǇ ĂŶĚ ĮŶĚŝŶŐ Ă ŐƌĞĂƚĞƌ ƐĞŶƐĞ ŽĨ ƉƵƌƉŽƐĞ ƵƐŝŶŐ ŶĞǁ ƐŬŝůůƐ͘ 8

California Family Physician Fall 2019

As I’ve listened and learned from our members, I’ve started to ĂƉƉƌĞĐŝĂƚĞ ƚŚĞ ǁŝƐĚŽŵ ŽĨ ͞ďƵƌŶŽƵƚ ŝĐŽŶ͟ ŚƌŝƐƟŶĂ DĂƐůĂĐŚ͕ WŚ ͕ ǁŚŽŵ / ŚĂĚ ƚŚĞ ƉůĞĂƐƵƌĞ ŽĨ ŐĞƫŶŐ ƚŽ ŬŶŽǁ ůĂƐƚ ǇĞĂƌ ǁŚĞŶ ǁĞ ĚŝĚ Ă ƐĞƌŝĞƐ ŽĨ ǁŽƌŬƐŚŽƉƐ ƚŽŐĞƚŚĞƌ ŽŶ ďƵƌŶŽƵƚ͘ ƌ Maslach, the creator of the famed Maslach’s Burnout Inventory, ĞŵƉŚĂƐŝǌĞƐ ƚŚĞ ƚŚƌĞĞ ŵĞƚƌŝĐƐ ŽĨ ďƵƌŶŽƵƚ ; ŵŽƟŽŶĂů ǆŚĂƵƐƟŽŶ͕ ĞƉĞƌƐŽŶĂůŝǌĂƟŽŶ͕ WĞƌƐŽŶĂů ĐĐŽŵƉůŝƐŚŵĞŶƚͿ ĂŶĚ ƚŚĞŝƌ ŝŵƉŽƌƚĂŶĐĞ ĂƐ ƌŝƐŬ ĨĂĐƚŽƌƐ ĨŽƌ ƉŽƚĞŶƟĂů ďƵƌŶŽƵƚ͘ ƌ DĂƐůĂĐŚ ŝĚĞŶƟĮĞĚ ͞Ɛŝǆ ĚƌŝǀĞƌƐ ŽĨ ďƵƌŶŽƵƚ͗ ǁŽƌŬůŽĂĚ͕ ĐŽŶƚƌŽů͕ ƌĞǁĂƌĚ͕ ĐŽŵŵƵŶŝƚǇ͕ ĨĂŝƌŶĞƐƐ ĂŶĚ ǀĂůƵĞƐ͘͟ ǀŝĚĞŶĐĞ ƐƵƉƉŽƌƚƐ ƚŚĞ ƉŽƐŝƟǀĞ ŝŵƉĂĐƚƐ ŽĨ ƚŚŝƐ ƐǇƐƚĞŵĂƟĐ ĂƉƉƌŽĂĐŚ͘ / ƌĞĐŽŵŵĞŶĚ ĐŚĞĐŬŝŶŐ ŽƵƚ ͞ ĂŶŝƐŚŝŶŐ ƵƌŶŽƵƚ͗ ^ŝǆ ^ƚƌĂƚĞŐŝĞƐ ĨŽƌ /ŵƉƌŽǀŝŶŐ zŽƵƌ ZĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ tŽƌŬ͟ ďǇ DŝĐŚĂĞů >ĞŝƚĞƌ ĂŶĚ ŚƌŝƐƟŶĂ DĂƐůĂĐŚ͘ dŚĞ &W ŚĂƐ ĂĐĐĞůĞƌĂƚĞĚ ŝƚƐ ĞīŽƌƚƐ ƚŽ ďƌŝŶŐ ƐƵĐŚ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ resources to members by launching the “Physician Health First” ƉƌŽŐƌĂŵ͘ / ŚŽƉĞ ǇŽƵ ǁŝůů ĐŽŶƐŝĚĞƌ ǀŝƐŝƟŶŐ ĂŶĚ ĐŽŵƉůĞƟŶŐ ƚŚĞ ƐĞůĨͲ ĞǀĂůƵĂƟŽŶ ĂŶĚ ĂĐƟŽŶ ƉůĂŶ Ăƚ͗ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬŵĞŵďĞƌƐŚŝƉͬ ďĞŶĞĮƚƐͬƉŚǇƐŝĐŝĂŶͲŚĞĂůƚŚͲĮƌƐƚ͘Śƚŵů͘

tŚĂƚ͛Ɛ EĞǆƚ͍ DǇ ǀŝƐŝƚƐ ƚŽ &W ĐŚĂƉƚĞƌƐ ŝŶƋƵŝƌŝŶŐ ĂďŽƵƚ ŵĞŵďĞƌƐ͛ ũŽǇ ŝŶ ǁŽƌŬ have served as an informal “needs assessment.” We’re learning ŚŽǁ &W ĐĂŶ ƐĞƌǀĞ ǇŽƵ ďǇ ƉƌŽŵŽƟŶŐ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƚŽŽůƐ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ŽƵƌ ŵĞŵďĞƌƐ ŶĞĞĚ ĂŶĚ ǁĂŶƚ͘ dŚĞ &W ƐƚĂī ĂŶĚ / ďĞůŝĞǀĞ ͞ƚƌĂŶƐŝƟŽŶŝŶŐ ƚŽ ǁĞůůŶĞƐƐ͟ ŝƐ Ă ĮƫŶŐ ŵŽĚĞů ĂůŝŐŶĞĚ ǁŝƚŚ ŽƵƌ ŵŝƐƐŝŽŶ ƚŽ ͞ĞŶŐĂŐĞ͕ ĞĚƵĐĂƚĞ ĂŶĚ ĞŵƉŽǁĞƌ ĐƵƌƌĞŶƚ ĂŶĚ ĨƵƚƵƌĞ FPs to improve the health of all Californians.” If our members ĂƌĞŶ͛ƚ ͞ǁĞůů͟ Ăůů ƚŚŝƐ ĨĂůůƐ ĂƉĂƌƚ͊

>ĞĂĚĞƌƐŚŝƉ͕ DŽĚĞůŝŶŐ ƚŚĞ tĂǇ

Last year’s CAFP President, Dr. Lisa Ward, inspired us by describing ŚŽǁ ƐŚĞ ƵƐĞĚ ƚŚĞ &W WŚǇƐŝĐŝĂŶ ,ĞĂůƚŚ &ŝƌƐƚ ƚŽŽůƐ ƚŽ ŐƵŝĚĞ ŚĞƌ ŽǁŶ ĂĐƟŽŶ ƉůĂŶŶŝŶŐ ƚŽ ŝŵƉƌŽǀĞ ǁĞůůͲďĞŝŶŐ ĂŶĚ ĂǀŽŝĚ ďƵƌŶŽƵƚ͘ / ŚĂǀĞ ĚŽŶĞ ŝƚ ƚŚƌĞĞ ƟŵĞƐ͊ KƵƌ ƌĞƐŝĚĞŶĐǇ ĨĂĐƵůƚǇ ĂŶĚ ƌĞƐŝĚĞŶƚƐ Ăƚ ^ĂůŝŶĂƐ ĂƌĞ ƵƐŝŶŐ ŝƚ͘ KƵƌ &W ŽĂƌĚ ƉůĂŶƐ ƚŽ ĚŝƐĐƵƐƐ ƚŚĞŝƌ ŽǁŶ

LAC Medical Inc. Family Medicine Physician Job inBakersfield, CA 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.

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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).

Tw o r o a d s d i v e r g e d in a wood, and I—

— Robert Frost

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I took the one less t r a v e l e d b y, And that has made all the difference.

Comprehensive benefits package: • 4 weeks off and CME allowance, • Malpractice Insurance, • Income details:$175,000 - $205,000 DOE.

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 Toll Free (661) 656-7245

ĞǆƉĞƌŝĞŶĐĞ ǁŝƚŚ ƚŚĞ ƚŽŽůƐ Ăƚ ŽƵƌ EŽǀĞŵďĞƌ ďŽĂƌĚ ŵĞĞƟŶŐ͘

tĞůůŶĞƐƐ͗ dŚĞ ZŽĂĚ >ĞƐƐ dƌĂǀĞůĞĚ dƌĂŶƐŝƟŽŶƐ ŝŵƉůǇ ŵĂŬŝŶŐ ĐŚŽŝĐĞƐ ĚƵƌŝŶŐ ƟŵĞƐ ŽĨ ĐŚĂŶŐĞ͘ DĂǇ ǇŽƵƌ ŽǁŶ ƌŽĂĚ ĂƐ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ǁŝƚŚ Ăůů ŝƚƐ ŝŶĞǀŝƚĂďůĞ ĐƵƌǀĞƐ ĂŶĚ ƚƌĂŶƐŝƟŽŶƐ͕ ďĞ ƚŚĞ ƌŽĂĚ ƚŚĂƚ ŵĂŬĞƐ Ăůů ƚŚĞ ĚŝīĞƌĞŶĐĞ ƚŽ ǇŽƵ ͙ ĂŶĚ ǁŚĞŶ ǇŽƵ ƌĞĂůŝǌĞ ǇŽƵƌ ƌŽĂĚ ŝƐ ƚŚĞ right one, remember to share your story … ǇŽƵ ŵŝŐŚƚ ŚĞůƉ ĂŶŽƚŚĞƌ &W ĂůŽŶŐ ƚŚĞŝƌ ǁĂǇ͊ ZĞĨĞƌĞŶĐĞƐ͗ ϭ͘ ĂŶŝƐŚŝŶŐ ƵƌŶŽƵƚ͗ ^ŝǆ ^ƚƌĂƚĞŐŝĞƐ ĨŽƌ /ŵƉƌŽǀŝŶŐ zŽƵƌ ZĞůĂƚŝŽŶƐŚŝƉ ǁŝƚŚ tŽƌŬ by Michael Leiter and Christina Maslach, ƉƵďůŝƐŚĞĚ ďǇ tŝůĞǇ͗ :ŽƐƐĞǇͲ ĂƐƐ͘ Ϯ͘ WƌĞǀĞŶƚŝŶŐ WŚǇƐŝĐŝĂŶ ƵƌŶŽƵƚ͗ ƵƌŝŶŐ ƚŚĞ Chaos and Returning Joy to the Practice ŽĨ DĞĚŝĐŝŶĞ͕ ,ĂŶĚďŽŽŬ ĨŽƌ WŚǇƐŝĐŝĂŶƐ and Health Care Leaders, by Paul DeChant, MD, MBA, and Diane Shannon, D ͕ DW,͘ ŚƚƚƉ͗ͬͬǁǁǁ͘ƉĂƵůĚĞĐŚĂŶƚŵĚ͘ ĐŽŵͬƉƌĞǀĞŶƚŝŶŐͲƉŚǇƐŝĐŝĂŶͲďƵƌŶŽƵƚͬ ƌƚŝĐůĞƐ͗ ^ŚĂŶĂĨĞůƚ͕ d͘ ͕͘ Θ EŽƐĞǁŽƌƚŚǇ͕ :͘ ,͘ ;ϮϬϭϲͿ͘ 3. ǆĞĐƵƚŝǀĞ ůĞĂĚĞƌƐŚŝƉ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ǁĞůůͲ ďĞŝŶŐ͗ EŝŶĞ ŽƌŐĂŶŝǌĂƚŝŽŶĂů ƐƚƌĂƚĞŐŝĞƐ to promote engagement and reduce ďƵƌŶŽƵƚ͘ DĂǇŽ ůŝŶŝĐ WƌŽĐĞĞĚŝŶŐƐ͕ ϵϮ;ϭͿ͕ ϭϮϵͲϭϰϲ͘ ^ǁĞŶƐĞŶ͕ ^͘ :͕͘ Θ ^ŚĂŶĂĨĞůƚ͕ d͘ ;ϮϬϭϳͿ͘ ϰ͘ Ŷ ŽƌŐĂŶŝǌĂƚŝŽŶĂů ĨƌĂŵĞǁŽƌŬ ƚŽ ƌĞĚƵĐĞ ƉƌŽĨĞƐƐŝŽŶĂů ďƵƌŶŽƵƚ ĂŶĚ ďƌŝŶŐ ďĂĐŬ ũŽǇ in practice. The Joint Commission Journal ŽŶ YƵĂůŝƚǇ ĂŶĚ WĂƚŝĞŶƚ ^ĂĨĞƚǇ͕ ϰϯ;ϲͿ͕ ϯϬϴͲ ϯϭϯ͘ California Family Physician Fall 2019

political pulse

Carla Kakutani, MD &KDLU &$)3 /HJLVODWLYH $σDLUV &RPPLWWHH

The Final Countdown Begins Ɛ / ǁƌŝƚĞ ƚŚŝƐ͕ ŶƵŵĞƌŽƵƐ &WͲƐƵƉƉŽƌƚĞĚ ďŝůůƐ ĂǁĂŝƚ 'ŽǀĞƌŶŽƌ 'ĂǀŝŶ EĞǁƐŽŵ͛Ɛ ƐŝŐŶĂƚƵƌĞ Žƌ ǀĞƚŽ͘ ,Ğ ŚĂƐ ƵŶƚŝů KĐƚŽďĞƌ ϭϯƚŚ ƚŽ ŵĂŬĞ ŚŝƐ ĚĞĐŝƐŝŽŶƐ͘ >ƵĐŬŝůǇ͕ ŚĞ ŚĂƐ ĂůƌĞĂĚǇ ƐŝŐŶĞĚ ƚǁŽ ďŝůůƐ &W ŝƐ ŚĂƉƉǇ ƚŽ ƐĞĞ ďĞĐŽŵĞ ůĂǁ͘ dŚĞƐĞ ƚǁŽ ĂŵĞŶĚ ĂŶĚ ŝŵƉƌŽǀĞ ƌĞĐĞŶƚ ůĂǁƐ ƚŚĂƚ ǁŽƵůĚ ƉůĂĐĞ ƐŝŐŶŝĨŝĐĂŶƚ ďƵƌĚĞŶ ŽŶ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͗ ϭϰϵ ʹ ĨƚĞƌ ƐŝŐŶŝĨŝĐĂŶƚ ƉƵƐŚďĂĐŬ ďǇ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ĐŽŵŵƵŶŝƚǇ͕ ŝŶĐůƵĚŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ŽƌŐĂŶŝǌĞĚ action using CAFP’s members-only message board (SPARK), ϭϰϵ ; ŽŽƉĞƌͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ƚŽ ĚĞůĂǇ Ă ƉƌŽǀŝƐŝŽŶ ŝŶ Ă ƌĞĐĞŶƚůǇ ƉĂƐƐĞĚ ůĂǁ ; ϭϳϱϯͿ͘ ϭϳϱϯ ǁŽƵůĚ ĨŽƌĐĞ physicians to replace all of their prescription pads and require all prescription forms for controlled substances to ŝŶĐůƵĚĞ Ă ƵŶŝƋƵĞůǇ ƐĞƌŝĂůŝǌĞĚ ŶƵŵďĞƌ͕ ďƵƚ ŝƚ ĚŝĚ ŶŽƚ ŝŶĐůƵĚĞ Ă ƚƌĂŶƐŝƚŝŽŶ ƉĞƌŝŽĚ ƚŽ ĂůůŽǁ ƚŝŵĞ ĨŽƌ ƉƌĞƐĐƌŝďĞƌƐ ƚŽ ŽƌĚĞƌ ŶĞǁ ƉƌĞƐĐƌŝƉƚŝŽŶ ƉĂĚƐ͘ dŚŝƐ ŵĞĂŶƚ ŽůĚ ƉƌĞƐĐƌŝƉƚŝŽŶ ĨŽƌŵƐ ǁĞƌĞ ŶŽƚ ǀĂůŝĚ ŽŶ :ĂŶƵĂƌǇ ϭ͕ ǁŚŝĐŚ ƌĞƐƵůƚĞĚ ŝŶ ĚŝĨĨŝĐƵůƚŝĞƐ ĨŽƌ ƉĂƚŝĞŶƚƐ trying to get prescriptions filled for controlled substances. ϭϰϵ ĂůůŽǁƐ ĨŽƌ Ă ƚƌĂŶƐŝƚŝŽŶ ƉĞƌŝŽĚ͕ ƵŶƚŝů :ĂŶƵĂƌǇ ϭ͕ ϮϬϮϭ͕ ďĞĨŽƌĞ ƚŚĞ ŶĞǁ ƌĞƋƵŝƌĞŵĞŶƚ ďĞŐŝŶƐ͕ ŵĂŬŝŶŐ ĐƵƌƌĞŶƚ ƉĂĚƐ valid until then. ϳϭϰ ʹ ŶŽƚŚĞƌ ďŝůů ƚŽ ŝŵƉƌŽǀĞ ƉƌĞǀŝŽƵƐ ůĂǁ͕ ϳϭϰ ĐƌĞĂƚĞƐ ĐůĂƌŝƚǇ ĂĨƚĞƌ ƚŚĞ ƉĂƐƐĂŐĞ ŽĨ ϮϳϲϬ͕ Ă ůĂǁ ƌĞƋƵŝƌŝŶŐ ƉƌĞƐĐƌŝďĞƌƐ ƚŽ ŽĨĨĞƌ Ă ƉƌĞƐĐƌŝƉƚŝŽŶ ĨŽƌ ŶĂůŽǆŽŶĞ ;ǁŚĞŶ ĐĞƌƚĂŝŶ ĐŽŶĚŝƚŝŽŶƐ ĂƌĞ ƉƌĞƐĞŶƚͿ ĂƐ ǁĞůů ĂƐ ƉƌŽǀŝĚĞ ŶĂůŽǆŽŶĞ ĞĚƵĐĂƚŝŽŶ ƚŽ ƚŚĞ ƉĂƚŝĞŶƚ ŽŶ Ă ƌĞƉĞĂƚĞĚ ďĂƐŝƐ͘ dŚŝƐ E t ůĂǁ ĐůĂƌŝĨŝĞƐ ǁŚĞŶ ŶĂůŽǆŽŶĞ ŵƵƐƚ ďĞ ŽĨĨĞƌĞĚ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ĂŶ ŽƉŝŽŝĚ Žƌ ďĞŶǌŽĚŝĂǌĞƉŝŶĞ͕ ŝŶĐůƵĚŝŶŐ ĞǆĞŵƉƚŝŽŶ ǁŚĞŶ ƚŚŽƐĞ ĚƌƵŐƐ ĂƌĞ ƚŽ ďĞ ĂĚŵŝŶŝƐƚĞƌĞĚ ƚŽ Ă ƉĂƚŝĞŶƚ ǁŚŝůĞ ŝŶ ĞŝƚŚĞƌ ĂŶ ŝŶƉĂƚŝĞŶƚ or outpatient setting, or for a terminally ill patient. It also exempts the education if the patient declines the education Žƌ ŚĂƐ ƌĞĐĞŝǀĞĚ ƚŚĞ ĞĚƵĐĂƚŝŽŶ ǁŝƚŚŝŶ ƚŚĞ ƉĂƐƚ Ϯϰ ŵŽŶƚŚƐ͘ &W ƐƵƉƉŽƌƚĞĚ ďŝůůƐ͕ ǇĞƚ ƚŽ ďĞ ƐŝŐŶĞĚ ŝŶĐůƵĚĞ͗ • ϭϲϮϮ ʹ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů ĨŝǆĞƐ ŽƵƚĚĂƚĞĚ ůĂǁƐ ƚŽ reflect the true value and diversity of care that family physicians can provide. • ϱϮϴ – Reduces several administrative burdens required of physicians in operating the CURES database. • ϳϰϰ – Requires a health plan to pay for a diagnosis, consultation or treatment delivered through 10

California Family Physician Fall 2019

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telehealth services on the same basis as in-person diagnosis, consultation or treatment. ϭϲϲϵ ʹ ZĞƋƵŝƌĞƐ ĂŵŵƵŶŝƚŝŽŶ ƐĂůĞƐ Ăƚ ŐƵŶ ƐŚŽǁƐ ĂŶĚ ĞǀĞŶƚƐ ŝŶ ĂůŝĨŽƌŶŝĂ ďĞ ƌĞŐƵůĂƚĞĚ ǁŝƚŚ ƚŚĞ ƐĂŵĞ rigor as firearms. ϭϳϭϴͬ^ ϴ ʹ DĂŬĞƐ ŝƚ ĂŶ ŝŶĨƌĂĐƚŝŽŶ ĨŽƌ Ă ƉĞƌƐŽŶ ƚŽ ƐŵŽŬĞ ŽŶ Ă ƐƚĂƚĞ ĐŽĂƐƚĂů ďĞĂĐŚ Žƌ ŝŶ Ă ƐƚĂƚĞ ƉĂƌŬ͘ ^ ϲϲ ʹ ƵƚŚŽƌŝǌĞƐ &ĞĚĞƌĂůůǇ YƵĂůŝĨŝĞĚ ,ĞĂůƚŚ ĞŶƚĞƌƐ ĂŶĚ ZƵƌĂů ,ĞĂůƚŚ ůŝŶŝĐƐ ƚŽ ďŝůů DĞĚŝͲ Ăů ĨŽƌ ƚǁŽ ǀŝƐŝƚƐ if a patient is provided mental health services on the same day as other medical services. ^ Ϯϳϲ – Creates methods for the State to monitor medical exceptions to childhood vaccinations to ensure no physician is unduly offering such exemptions outside of the standard of care.

Want to help in our advocacy efforts for these and other ƉŝĞĐĞƐ ŽĨ ůĞŐŝƐůĂƚŝŽŶ͍ ^ŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞǇ ŽŶƚĂĐƚ ďǇ emailing our Director of Government Relations, Adam Francis, at afrancis@familydocs.org.

tĞ ǁĞƌĞ ƚŚƌŝůůĞĚ ƚŽ ƐĞĞ &WͲƐƵƉƉŽƌƚĞĚ ^ Ϯϳϲ ;WĂŶͿ ƐŝŐŶĞĚ ŝŶƚŽ ůĂǁ ďǇ ƚŚĞ 'ŽǀĞƌŶŽƌ͘ dŚĞ ďŝůů ĐƌĂĐŬƐ ĚŽǁŶ ŽŶ ƵŶƐĐƌƵƉƵůŽƵƐ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƐĞůů ŵĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ ƚŽ childhood vaccines. The bill faced rabid opposition from ƚŚĞ ĂŶƚŝͲǀĂǆǆĞƌ ĐŽŵŵƵŶŝƚǇ͕ ĂƐ ǁĞůů ĂƐ ŵĂŶǇ ůĞŐŝƐůĂƚŝǀĞ ŽďƐƚĂĐůĞƐ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ 'ŽǀĞƌŶŽƌ ǁŚŽ ƐŽƵŐŚƚ ůĂƐƚ ŵŝŶƵƚĞ ĐŚĂŶŐĞƐ ƚŽ ƚŚĞ ďŝůů͘ dŚŽƐĞ ĐŚĂŶŐĞƐ ǁĞƌĞ ĞŶĂĐƚĞĚ ƚŚƌŽƵŐŚ Ă ĐŽŵƉĂŶŝŽŶ ďŝůů͕ ^ ϳϭϰ ;WĂŶͿ͕ ǁŚŝĐŚ ŵĂŬĞƐ ƐĞǀĞƌĂů ŬĞǇ ĐŚĂŶŐĞƐ ƚŽ ŚŽǁ ƚŚĞ ĞǆĞŵƉƚŝŽŶ ƉƌŽĐĞƐƐ ǁŝůů ǁŽƌŬ͗ • A child issued a medical exemption prior to January ϭ͕ ϮϬϮϬ ǁŝůů ďĞ ĂůůŽǁĞĚ ĐŽŶƚŝŶƵĞĚ ĞŶƌŽůůŵĞŶƚ ƵŶƚŝů ƚŚĞ ŶĞǆƚ ŐƌĂĚĞ ƐƉĂŶ ;Ğ͘Ő͕͘ ďŝƌƚŚ ƚŽ ƉƌĞƐĐŚŽŽů͖ ŬŝŶĚĞƌŐĂƌƚĞŶ ƚŽ ϲƚŚ ŐƌĂĚĞ͖ ϳƚŚ ƚŽ ϭϮƚŚ ŐƌĂĚĞͿ͘ • WŚǇƐŝĐŝĂŶƐ ǁŚŽ ƐƵďŵŝƚ ĨƌĂƵĚƵůĞŶƚ ŵĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ ǁŝůů ŶŽƚ ďĞ Ăƚ ƌŝƐŬ ĨŽƌ ƉĞƌũƵƌǇ ĐŚĂƌŐĞƐ͘ • dŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ ǁŝůů ŶŽƚ ƚƌĂĐŬ fraudulent medical exemptions unless they are ƐƵďŵŝƚƚĞĚ ĂĨƚĞƌ :ĂŶƵĂƌǇ ϭ͕ ϮϬϮϬ͕ ĂŶĚ ŶŽ ĂĐƚŝŽŶ ǁŝůů ďĞ ƚĂŬĞŶ ƚŽ ƌĞǀŽŬĞ ƉƌĞͲϮϬϮϬ ŵĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ unless the physician is currently on probation for ĂĐƚŝŽŶ ƌĞůĂƚŝŶŐ ƚŽ ŝŵŵƵŶŝǌĂƚŝŽŶ ƐƚĂŶĚĂƌĚƐ ŽĨ ĐĂƌĞ͘

11th World Congress on

ACSM’s 67th Annual Meeting

World Congress on

The Basic Science of Exercise in Regenerative Medicine

May 26-30, 2020 0 San Francisco, California USA

Charleston, South Carolina Charleston Marriott Charleston, South Carolina

Attend this interactive conference to learn new perspectives in the musculoskeletal, primary care and emergency medicine aspects of sports medicine. www.acsm.org/sme

Join more than 6,000 industry professionals from om around the world at this conference where you’lll ll find sessions covering every aspect of sports medicine, exercise science and physical activity. tyy. www.acsmannualmeeting.org

California Family Physician Fall 2019

IN THE NEWS Fall 2019

&W͛Ɛ ŽǁŶ ^ŚĂŶŶŽŶ ŽŶŶŽůůǇ is Ă ďŝůůďŽĂƌĚ͊ WůĂŶŶĞĚ WĂƌĞŶƚŚŽŽĚ and Melody Women’s Health have teamed up to promote experts in ŚĞĂůƚŚ ĐĂƌĞ͘ dŚĞ ďŝůůďŽĂƌĚƐ ǁŝůů ďĞ ƐĞĞŶ ŝŶ ĂŶĚ ĂƌŽƵŶĚ ƚŚĞ > ͬKƌĂŶŐĞ county area. Congrats Shannon, our ŽǁŶ &DZŽĐŬƐƚĂƌ͊

ŽŶĨĞƌĞŶĐĞ ŽĨ ŽŶƐƟƚƵĞŶƚ >ĞĂĚĞƌƐ ;E >Ϳ ŵĞĞƟŶŐ ƚŽ ƌĞƉƌĞƐĞŶƚ ŶĞǁ ƉŚǇƐŝĐŝĂŶƐ͘ ƌĞŶƚ ǁŝůů ƐĞƌǀĞ Ă ŽŶĞͲǇĞĂƌ ƚĞƌŵ͘ ŽŶŐƌĂƚƐ ƌĞŶƚ͕ ĂŶĚ ƚŚĂŶŬƐ ƚŽ ƌĞŶƚ͛Ɛ ŚƵƐďĂŶĚ DŝĐŚĂĞů ĂŶĚ ĚĂƵŐŚƚĞƌƐ ZĞŶ ĂŶĚ DĂƌŝ ĨŽƌ ƐŚĂƌŝŶŐ Śŝŵ ǁŝƚŚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŶĂƟŽŶǁŝĚĞ͘

ĂůŝĨŽƌŶŝĂ ǁĂƐ ǁĞůů ƌĞƉƌĞƐĞŶƚĞĚ Ăƚ the recent American Academy of Family Physicians Congress ŽĨ ĞůĞŐĂƚĞƐ ; K Ϳ ŵĞĞƟŶŐ ŝŶ

CAFP past president and FP-PAC president :ĂǇ >ĞĞ͕ D ͕ DW, ƐƉŽŬĞ ƌĞĐĞŶƚůǇ ŽŶ <d> ŵŽƌŶŝŶŐ ŶĞǁƐ ĂďŽƵƚ ƚŚĞ ǀĂƉŝŶŐ ĨĂĚ͘ ͞dŚĞƌĞ͛Ɛ Ă ĨĂůƐĞ ƉĞƌĐĞƉƟŽŶ ƚŚĂƚ ǀĂƉŝŶŐ ŝƐ Ă ƐĂĨĞ ĂůƚĞƌŶĂƟǀĞ ƚŽ ŽƚŚĞƌ ĨŽƌŵƐ ŽĨ ƐŵŽŬŝŶŐ͘ DŽƐƚ ĞͲĐŝŐĂƌĞƩĞ ĐĂƌƚƌŝĚŐĞƐ ŚĂǀĞ ŶŝĐŽƟŶĞ͕ ǁŚŝĐŚ ŝƐ ĂŶ ĂĚĚŝĐƟǀĞ ĂŶĚ ŚĂƌŵĨƵů ĐŚĞŵŝĐĂů͕ ĞƐƉĞĐŝĂůůǇ ǁŚŝůĞ ƚŚĞ ďƌĂŝŶ ŝƐ ƐƟůů ĚĞǀĞůŽƉŝŶŐ͘ EŝĐŽƟŶĞ ĐĂŶ ŚĂǀĞ Ă ŶĞŐĂƟǀĞ ŝŵƉĂĐƚ ŽŶ ƚŚĞ ŶĞƌǀŽƵƐ ƐǇƐƚĞŵ ĂŶĚ ďƌĂŝŶ͕ ůĞĂĚŝŶŐ ƚŽ ƉƌŽďůĞŵƐ ǁŝƚŚ ďůŽŽĚ ƉƌĞƐƐƵƌĞ͕ ďƌĞĂƚŚŝŶŐ͕ ŚĞĂƌƚ ƌĂƚĞ͕ ĂƐ ǁĞůů ĂƐ ĐŚĂŶŐĞƐ ŝŶ ŵĞŶƚĂů ĂŶĚ ĞŵŽƟŽŶĂů ǁĞůůͲďĞŝŶŐ͘͟ Philadelphia. Delegates and Alternates Drs. :Ğī >ƵƚŚĞƌ and ĂƌŽů ,ĂǀĞŶƐ, :ĂǇ >ĞĞ and >ĞĞ ZĂůƉŚ ǁĞƌĞ ũŽŝŶĞĚ ďǇ &W WƌĞƐŝĚĞŶƚ tĂůƚ DŝůůƐ͕ WƌĞƐŝĚĞŶƚ ůĞĐƚ ĂǀĞ ĂǌǌŽ͕ /ŵŵĞĚŝĂƚĞ WĂƐƚ WƌĞƐŝĚĞŶƚ >ŝƐĂ tĂƌĚ͕ sŝĐĞ ^ƉĞĂŬĞƌ >ĂƵƌĞŶ ^ŝŵŽŶ͕ K >ŝƐĂ &ŽůďĞƌŐ ĂŶĚ ĞƉƵƚǇ sW ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͘ DĂŶǇ &W ƌĞƐŽůƵƟŽŶƐ ǁĞƌĞ ĂĚŽƉƚĞĚ Žƌ ĂĚŽƉƚĞĚ ǁŝƚŚ ĂŵĞŶĚŵĞŶƚƐ ʹ ĞĂƌŶŝŶŐ ƵƐ Ă ǁŝŶŶŝŶŐ ĞǆƉĞƌŝĞŶĐĞ Ăƚ ƚŚĞ K ͘ KƚŚĞƌ &WĞƌƐ ŝŶ ĂƩĞŶĚĂŶĐĞ ƌĞƉƌĞƐĞŶƟŶŐ ĐŽŶƐƟƚƵĞŶĐŝĞƐ ǁŝƚŚŝŶ ƚŚĞ ŽŶŐƌĞƐƐ ŝŶĐůƵĚĞĚ ƌŝŬĂ ZŽƐŚĂŶƌĂǀĂŶ͕ ůĞǆ DƌŽƐǌĐǌǇŬͲDĐ ŽŶĂůĚ͕ DŽŝƌĂ ZĂƐŚŝĚ͕ ƌĞƐŝĚĞŶƚ ŶŶĂ ƐŬĂƌŝ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ :ƵůŝĂ tĂŶŐ͘ DĂŶǇ ŽƚŚĞƌ ĂůŝĨŽƌŶŝĂŶƐ ĂƩĞŶĚĞĚ ƚŚĞ K ĂŶĚ &Dy ĂƐ ǁĞůů͘ dŚĂŶŬƐ ƚŽ ƚŚĞŵ ĨŽƌ ƚŚĞŝƌ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ƚŚĞ &D ZĞǀŽůƵƟŽŶ͘ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ D ͕ DW,, Editor of ƚŚŝƐ ŵĂŐĂǌŝŶĞ͕ ŝƐ ŶŽǁ Ă ŵĞŵďĞƌ ŽĨ ƚŚĞ American Academy of Family Physicians ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ͘ ƌĞŶƚ ǁĂƐ ŝŶƐƚĂůůĞĚ at the September Congress of Delegates ĂƐ ƚŚĞ EĞǁ WŚǇƐŝĐŝĂŶ ĚŝƌĞĐƚŽƌ͘ ,Ğ ǁĂƐ ĞůĞĐƚĞĚ ŝŶ Ɖƌŝů Ăƚ ƚŚĞ EĂƟŽŶĂů 12

California Family Physician Fall 2019

Finally, your &W &ŽƵŶĚĂƟŽŶ ŽĂƌĚ ŽĨ dƌƵƐƚĞĞƐ met in September, the day before the Family Medicine Summit, in a strategic planning ƐĞƐƐŝŽŶ͘ dŚĞ ŽĂƌĚ ĚŝĚ ŝƚƐ ŚŽŵĞǁŽƌŬ ĂŶĚ ĐĂŵĞ ƉƌĞƉĂƌĞĚ ƚŽ ƚĂůŬ ĂďŽƵƚ ƐƚƌĞŶŐƚŚƐ͕ ǁĞĂŬŶĞƐƐĞƐ͕ ŽƉƉŽƌƚƵŶŝƟĞƐ ĂŶĚ ƚŚƌĞĂƚƐ͘ /ƚ ǁŝŶŶŽǁĞĚ ŶƵŵĞƌŽƵƐ ŝĚĞĂƐ ĚŽǁŶ ĨŽƵƌ ŐŽĂůƐ ĨŽƌ ƚŚĞ ŶĞǆƚ three years, determined three ϮϬϮϬ ŽďũĞĐƟǀĞƐ ĨŽƌ ĞĂĐŚ ŐŽĂů ĂŶĚ ǁƌŽƚĞͲĂƉƉƌŽǀĞĚ Ă ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ͊ EŽƚ ďĂĚ ĨŽƌ Ă ĚĂǇ͛Ɛ ǁŽƌŬ͘ DĂŶǇ ƚŚĂŶŬƐ ƚŽ &W &ŽƵŶĚĂƟŽŶ WƌĞƐŝĚĞŶƚ DĂƌŝĂŶŶĞ DĐ<ĞŶŶĞƩ͕ Secretary-Treasurer Irina deFischer, and Trustees Tom Bent, Lauren Simon, Ron Labuguen, Lee Ounanaian, student members Andrea ĂŶƵĞůŽƐ DŽƚĂ ĂŶĚ ĂĐ EŝĐŚŽůƐ͕ ǆĞĐƵƟǀĞ ŝƌĞĐƚŽƌ ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ ĂŶĚ &W W >ŝƐĂ &ŽůďĞƌŐ ĨŽƌ ƚŚŝƐ ǁŽƌŬ͘ dƌƵƐƚĞĞƐ ŶƚŚŽŶǇ ŚŽŶŐ͕ ^ƚĞƉŚĞŶ ƌƵŶƚŽŶ ĂŶĚ ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌƐ ZŽď ƐƐŝďĞǇ ĂŶĚ ůŝǌĂďĞƚŚ ^ŽƉŚǇ ǁĞƌĞ ŶŽƚ ĂďůĞ ƚŽ ĂƩĞŶĚ͕ ďƵƚ ƚŚĞǇ͛ůů ŚĞůƉ ƵƐ ĐĂƌƌǇ ŽƵƚ ƚŚĞ ǁŽƌŬ ŝŶ ϮϬϮϬ͊

Tr a n s i t i o n s a n d C h a n g e

Marshall Kubota, MD

Honoring the Passing of a Gentle Giant This past August, family medicine and the CAFP ůŽƐƚ Ă ĨƌŝĞŶĚ͘ ƌ͘ :ŽŚŶ ĞƌǀŝŶ ƉĂƐƐĞĚ ĂǁĂǇ peacefully at his home in Sebastopol surrounded by family and close friends. / ƚŚŝŶŬ :ŽŚŶ ĐŽƵůĚ ďĞ ƐĂŝĚ ƚŽ ŚĂǀĞ ďĞĞŶ ŽŶĞ ŽĨ the young guns of family practice in its infancy as Ă ƐƉĞĐŝĂůƚǇ͘ :ŽŚŶ ǁĂƐ ŚŝŐŚůŝŐŚƚĞĚ ŝŶ ƚŚĞ &W͛Ɛ ͞,ŽŶŽƌ zŽƵƌ WĂƐƚ͕ WƌĞƉĂƌĞ ĨŽƌ zŽƵƌ &ƵƚƵƌĞ͗ ϱϬ ǇĞĂƌƐ ŽĨ ĂůŝĨŽƌŶŝĂ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͟ ďŽŽŬ͕ ƉƵďůŝƐŚĞĚ ŝŶ ϭϵϵϴ͘ /Ŷ ƚŚĞ ŝŶƚĞƌǀŝĞǁ ĨŽƌ ƚŚĂƚ ďŽŽŬ͕ :ŽŚŶ ƐĂŝĚ͕ ͞ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƐŚŽƵůĚ ďĞ trained to perform many procedures … vasectomy, colposcopy, endoscopy” … thus ensuring continuity and comprehensive care. John graduated from the St. Louis School of DĞĚŝĐŝŶĞ ŝŶ ϭϵϲϳ͘ ,Ğ ŝŶƚĞƌŶĞĚ Ăƚ >ŽƐ ŶŐĞůĞƐ ŽƵŶƚǇ ,ŽƐƉŝƚĂů͕ ǁŚĞƌĞ ŚĞ ŵĞƚ WĂƚ͕ ŚŝƐ ǁŝĨĞ ŽĨ ŵŽƌĞ ƚŚĂŶ ϱϬ ǇĞĂƌƐ͘ :ŽŚŶ ĐŽŵƉůĞƚĞĚ ŚŝƐ 'ĞŶĞƌĂů Practice Residency at Community Hospital of ^ŽŶŽŵĂ ŽƵŶƚǇ ŝŶ ϭϵϳϬ ǁŚĞƌĞ ŚŝƐ ůĞĂĚĞƌƐŚŝƉ ƋƵĂůŝƚŝĞƐ ǁĞƌĞ ƉƌŽǀĞŶ ĂƐ ŚŝĞĨ ZĞƐŝĚĞŶƚ͘ ,Ğ ũŽŝŶĞĚ ƚŚĞ EĂǀǇ ŝŶ :ƵůǇ ϭϵϳϬ ĂŶĚ ǁĂƐ ƐƚĂƚŝŽŶĞĚ Ăƚ ƚŚĞ EĂǀĂů ,ŽƐƉŝƚĂů ŝŶ :ĂĐŬƐŽŶǀŝůůĞ͕ &ůŽƌŝĚĂ͘ KŶĐĞ more, leadership shone in establishing the first ĨĂŵŝůǇ ƉƌĂĐƚŝĐĞ ƌĞƐŝĚĞŶĐǇ ŝŶ ƚŚĞ EĂǀǇ͕ ǁŚĞƌĞ ŚĞ served as the residency director. John used to tell the story, having been trained in vasectomy, that ŚĞ ƐŚŽǁĞĚ ƵƉ Ăƚ ƚŚĞ ǀĂƐĞĐƚŽŵǇ ĐůŝŶŝĐ ƐƚĂĨĨĞĚ ďǇ Ă Navy urologist. Seeing John perform a vasectomy ƚŚĞ ƵƌŽůŽŐŝƐƚ ŶĞǀĞƌ ĐĂŵĞ ďĂĐŬ͘ :ŽŚŶ ƉĞƌĨŽƌŵĞĚ ŚƵŶĚƌĞĚƐ ŽĨ ǀĂƐĞĐƚŽŵŝĞƐ͕ ůŝŬĞůǇ ƐĂǀŝŶŐ ƚŚĞ Defense Department many thousands of dollars. Everyone trained by John in doing vasectomies ǁĂƐ ĂƐƚŽƵŶĚĞĚ Ăƚ ƚŚĞ ƐƉĞĞĚ ǁŝƚŚ ǁŚŝĐŚ ŚĞ ĐŽƵůĚ eliminate gene pools.

California Family Physician Fall 2019

,Ğ ĂŶĚ WĂƚ ƌĞƚƵƌŶĞĚ ƚŽ ^ĂŶƚĂ ZŽƐĂ ŝŶ ϭϵϳϮ͕ ŚĞůƉŝŶŐ ƚŽ establish that early family practice residency program there … its splendid reputation carries to this day. He served ĂƐ ƚŚĞ ĂƐƐŽĐŝĂƚĞ ĚŝƌĞĐƚŽƌ ĨŽƌ ŵĂŶǇ ǇĞĂƌƐ͕ Ăůů ǁŚŝůĞ ŚĂǀŝŶŐ ĂŶ ĂĐƚŝǀĞ ĐůŝŶŝĐĂů ƉƌĂĐƚŝĐĞ͘ :ŽŚŶ ǁĂƐ Ă &ĞůůŽǁ Ăƚ ƚŚĞ h ^& ĞƉĂƌƚŵĞŶƚ ŽĨ &ĂŵŝůǇ ĂŶĚ ŽŵŵƵŶŝƚǇ DĞĚŝĐŝŶĞ ĂŶĚ ǁĂƐ ůĂƚĞƌ ĂƉƉŽŝŶƚĞĚ Ă ĐůŝŶŝĐĂů ƉƌŽĨĞƐƐŽƌ͘ ,Ğ ǁĂƐ ĐŽůůĞĂŐƵĞ ĂŶĚ ĨƌŝĞŶĚƐ ǁŝƚŚ ƉŝŽŶĞĞƌƐ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂǀŝĚ tĞƌĚĞŐĞƌ͕ :ŽŚŶ 'ĞǇŵĂŶ͕ :ŽŚŶ ůŽƐƐŽŵ͕ :ĂĐŬ ZŽĚŶŝĐŬ͕ &ƌĂŶŬ ŽƌŶĨĞƐƚ ĂŶĚ ŵĂŶǇ ŽƚŚĞƌƐ͘ :ŽŚŶ ǁĂƐ Ă ŬĞǇ ƉĂƌƚŝĐŝƉĂŶƚ ŝŶ ƚŚĞ establishment of the Nurse Practitioner Program at Sonoma State University, bringing nurse practitioners and students into the Residency Family Practice Center. :ŽŚŶ ǁĂƐ Ă ĨĂŵŝůŝĂƌ ĨĂĐĞ Ăƚ ƚŚĞ &W ĂŶŶƵĂů ŵĞĞƚŝŶŐƐ ǁŚĞƌĞ ŚĞ ƚĂƵŐŚƚ ĂŶĚ ĞŶĐŽƵƌĂŐĞĚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ expand their scope of practice to include many of the ƉƌŽĐĞĚƵƌĞƐ ƚŚĂƚ ĂƌĞ ƉĂƌƚ ŽĨ ƚŚĞ ƐŬŝůů ƐĞƚ ŝŶƚĞŐƌĂů ƚŽ ŽƵƌ ƉƌĂĐƚŝĐĞ ŽĨ ŵĞĚŝĐŝŶĞ͘ ,Ğ ǁĂƐ ŚŽŶŽƌĞĚ ǁŝƚŚ ƚŚĞ &W

&ŽƵŶĚĂƚŝŽŶ͛Ɛ ϭϵϵϳ ĂƌďĂƌĂ ,ĂƌƌŝƐ ǁĂƌĚ ĨŽƌ ǆĐĞůůĞŶĐĞ in Education. “Every residency program needs a faculty ŵĞŵďĞƌ ůŝŬĞ :ŽŚŶ͕͟ ƐĂŝĚ ƌ͘ WĂƵůĞƚƚĞ ĚĂŵƐ͕ &W WƌĞƐŝĚĞŶƚ͕ ͞ƚŽ ƚĞĂĐŚ ƌĞƐŝĚĞŶƚƐ ƉƌŽĐĞĚƵƌĞƐ ƚŚĞǇ ǁŝůů ƵƐĞ ŝŶ ƚŚĞŝƌ ƉƌĂĐƚŝĐĞƐ͘ ,Ğ ƐĞƚƐ ŚŝŐŚ ƐƚĂŶĚĂƌĚƐ ĨŽƌ ŚŝƐ ŽǁŶ ƉĞƌĨŽƌŵĂŶĐĞ͕ ĂƐ ǁĞůů ĂƐ ƚŚĂƚ ŽĨ ƚŚĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŝƐ Ă ǀĞƌǇ thorough and persistent teacher.” ,Ğ ǁĂƐ ŝŶ ƚŚĂƚ ƌĂƌŝĨŝĞĚ Ăŝƌ ŽĨ ƉŚǇƐŝĐŝĂŶƐ͕ ƚŚŽƐĞ ǁŚŽ ǁĞƌĞ ƐŽ ǁĞůů ƌĞĂĚ ĂƐ ƚŽ ĞŶŐĞŶĚĞƌ ĚŝƐďĞůŝĞĨ͕ ǇĞƚ ŚĞ ĂƉƉůŝĞĚ ŚŝƐ ŬŶŽǁůĞĚŐĞ ĂŶĚ ƐŬŝůůƐ ƚŽ ƚŚĞ ƉĂƚŝĞŶƚƐ ĨŽƌ ǁŚŽŵ ŚĞ ĐĂƌĞĚ and to those of us fortunate enough to be his students and ĐŽůůĞĂŐƵĞƐ͘ dŚŝƐ ǁĂƐ ŐĞŶĞƌŽƵƐůǇ ŵŝǆĞĚ ǁŝƚŚ ƚŚĞ Ƶƌů /ǀĞƐ ůŽŽŬ ĂŶĚ ŵŝƌƚŚ ĂŶĚ ƚŚĞ ƌĂǌŽƌ ƐŚĂƌƉ ǁŝƚ ƚŚĂƚ ǁĂƐ ůĞŐĞŶĚ͘ Family medicine continues to lead health care, building ƵƉŽŶ ƚŚĞ ƐƚƌŽŶŐ ĨƌĂŵĞǁŽƌŬ ŽĨ ƚŚŽƐĞ ĨŽƵŶĚĞƌƐ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚǇ͘ ^ŽŵĞǁŚĞƌĞ Ăƚ ƚŚĞ ďĂƐĞ ĨŽƵŶĚĂƚŝŽŶ ŝƐ Ă ĐŽƌŶĞƌƐƚŽŶĞ ǁŝƚŚ :ŽŚŶ ĞƌǀŝŶ ĞƚĐŚĞĚ ƵƉŽŶ ŝƚ͘

California Family Physician Fall 2019

Tr a n s i t i o n s a n d C h a n g e

Shelly B. Rodrigues, CAE, FACEHP CAFP Deputy Executive Vice President

Change and Transition … Aren’t They the Same Thing?

ĐĐŽƌĚŝŶŐ ƚŽ ŵǇ ŶĞǁ ŚĂŶĚďŽŽŬ ŽŶ ŵĂŶĂŐŝŶŐ ƚƌĂŶƐŝƚŝŽŶϭ ΀ĂŶĚ ďŽǇ͕ ĚŽ / ǁŝƐŚ / ŚĂĚ ƌĞĂĚ ƚŚŝƐ ŝŶ :ĂŶƵĂƌǇ ϮϬϭϴ ŝŶƐƚĞĂĚ ŽĨ ĞĐĞŵďĞƌ ϮϬϭϴ͊΁ ĐŚĂŶŐĞ ŝƐ ƐŝƚƵĂƚŝŽŶĂů ʹ ŝƚ͛Ɛ ƚŚĞ ŵŽǀĞ ƚŽ Ă ŶĞǁ ŚŽŵĞ͕ ƚŚĞ ŝŶƐƚĂůůĂƚŝŽŶ ŽĨ W/ ͕ Ă ŶĞǁ ũŽď͕ ĐĂƌĞĞƌ ƌĞƚŝƌĞŵĞŶƚ Žƌ ĞǀĞŶ ĂŶ ĂƐƐŽĐŝĂƚŝŽŶ͛Ɛ ƌĞŽƌŐĂŶŝǌĂƚŝŽŶ͘ dƌĂŶƐŝƚŝŽŶ is psychological – William Bridges, author of Managing Transition, Making the Most of Change, describes transition ĂƐ Ă ƚŚƌĞĞͲƉŚĂƐĞ ƉƌŽĐĞƐƐ ǁĞ ŵƵƐƚ ŐŽ ƚŚƌŽƵŐŚ ƚŽ ŐĞƚ ƚŽ Ă ƉŽŝŶƚ ǁŚĞŶ ĐŚĂŶŐĞ ĐĂŶ ŚĂƉƉĞŶ͘ dŚĞ ƚŚƌĞĞ ƉŚĂƐĞƐ ŵĂŬĞ ƐĞŶƐĞ͕ ƌĞĂůůǇ͕ ǁŚĞŶ ǇŽƵ ƐƚƵĚǇ ƚŚĞŵ͗ ŶĚŝŶŐͲ>ŽƐŝŶŐͲ>ĞƚƚŝŶŐ 'Ž͖ dŚĞ EĞƵƚƌĂů ŽŶĞ͖ ĂŶĚ dŚĞ EĞǁ Beginning. dŚĞ ĨŝƌƐƚ ƉŚĂƐĞ ŝƐ ŶĚŝŶŐ͕ >ŽƐŝŶŐ ĂŶĚ >ĞƚƚŝŶŐ 'Ž͘ dŚŝŶŬ ďĂĐŬ to leaving your childhood home and the bedroom you’ve had ƚŽ ǇŽƵƌƐĞůĨ ĨŽƌ ϭϴ ǇĞĂƌƐ͖ ŶŽǁ ǇŽƵ͛ƌĞ ŵŽǀŝŶŐ ƚŽ ĐŽůůĞŐĞ ĂŶĚ ŝŶƚŽ ƚŚĞ ŶĞǁ ĚŽƌŵ ƌŽŽŵ ǇŽƵ͛ůů ƐŚĂƌĞ ǁŝƚŚ Ă ƌŽŽŵŵĂƚĞ͘ zŽƵ ŵƵƐƚ ŐŽ ƚŚƌŽƵŐŚ Ă ƉĞƌŝŽĚ ŽĨ ĞŶĚŝŶŐ ͙ ƌĞĐŽŐŶŝǌŝŶŐ ƚŚĂƚ ǇŽƵ ǁŝůů ŶŽ ůŽŶŐĞƌ ůŝǀĞ ƵŶĚĞƌ ǇŽƵƌ ĨŽůŬƐ͛ ƌŽŽĨ͕ ǁŝƚŚ ƚŚĞŝƌ ƉƌŽƚĞĐƚŝŽŶ͕ support, and for many of us, their full refrigerator and laundry ƌŽŽŵ͊ /ƚ ŝƐ ƚŝŵĞ ƚŽ ƐĂǇ ŐŽŽĚͲďǇĞ ƚŽ ǇŽƵƌ ĐƵƌƌĞŶƚ ůŝǀŝŶŐ

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Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everybody gets busy on the proof.

California Family Physician Fall 2019

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– John K. Gilbraith, American Economist

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Every exit is an entry somewhere else. – Tom Stoppard, British Dramatist

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ŚĂŶŐĞ ĂŶĚ ƚƌĂŶƐŝƚŝŽŶ ĂƌĞ ŝŶĞǆƚƌŝĐĂďůǇ ůŝŶŬĞĚ͖ ŽŶĞ ĚŽĞƐ ŶŽƚ ŚĂƉƉĞŶ ǁŝƚŚŽƵƚ ƚŚĞ ŽƚŚĞƌ͘ dŚĂƚ ƐĂŝĚ͕ ĂĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ literature on change and transition management, they are not ƚŚĞ ƐĂŵĞ͘ ŶĚ͕ ŝƚ ŝƐŶ͛ƚ ƚŚĞ ĐŚĂŶŐĞƐ ǁĞ ŵĂŬĞ ƚŚĂƚ ĚŽ ƵƐ ŝŶ͕ ďƵƚ ƚŚĞ ƚƌĂŶƐŝƚŝŽŶƐ ǁĞ ŵŝƐŵĂŶĂŐĞ ƚŚĂƚ ůĞĂĚ ƚŽ ĨĂŝůƵƌĞ͘ Ɛ Ă ĐƌĞĂƚƵƌĞ ǁŚŽ ůŽǀĞƐ ĐŚĂŶŐĞ͕ ĚŝǀĞƐ ŝŶƚŽ ŶĞǁ ŽƉƉŽƌƚƵŶŝƚŝĞƐ ĂŶĚ easily jettisons the old, I never really thought much about the difference, or the transition, in the past.

ĂƌƌĂŶŐĞŵĞŶƚ͘ ŶĚ ǁŚŝůĞ ƚŚĞ ƚƌĂŶƐŝƚŝŽŶ ƉŚĂƐĞƐ ŽǀĞƌůĂƉ͕ ƵŶƚŝů you’ve managed through this phase, you can’t really move on to the next. dŚĞ ŶĞǆƚ ƉŚĂƐĞ ŝƐ dŚĞ EĞƵƚƌĂů ŽŶĞ͘ dŚŝƐ ŝŶͲďĞƚǁĞĞŶ ƉĞƌŝŽĚ ŝƐ ƚŚĞ ƚŝŵĞ ƌĞƋƵŝƌĞĚ ƚŽ ŝŵĂŐŝŶĞ ƚŚĞ ŶĞǁ ƉŚĂƐĞ ŽĨ ůŝĨĞ͕ ƚŚĞ ŶĞǁ ĚŽƌŵ ƌŽŽŵ͕ ƚŚĞ ŶĞǁ ĨƌŝĞŶĚƐ͕ ƚŚĞ ĞŶĐŽƌĞ ĐĂƌĞĞƌ͕ ƚŚĞ ŶĞǁ ůĞĂĚĞƌƐŚŝƉ͘ ƌ͘ ƌŝĚŐĞƐ ĐĂůůƐ ƚŚŝƐ ƉŚĂƐĞ Ă ƚŝŵĞ ŽĨ ĐƌŝƚŝĐĂů psychological realignment, and unsurprisingly, it is the phase most people give short shrift. We’re so good at dumping ŽŶĞ ƚŚŝŶŐ ĂŶĚ ŐƌĂďďŝŶŐ ĂŶŽƚŚĞƌ ƚŚĂƚ ǁĞ ĨŽƌŐĞƚ ƚŽ ƉůĂŶ ƚŚĞ ƚƌĂŶƐŝƚŝŽŶ͘ ^Ž ďĂĐŬ ƚŽ ŽƵƌ ĚŽƌŵ ƌŽŽŵ ĐĂƐĞ͕ ƚŚŝƐ ŵŝŐŚƚ ďĞ ƚŚĞ ƚŝŵĞ ǇŽƵ ƐƚĂƌƚ ƚŚŝŶŬŝŶŐ ĂďŽƵƚ ǁŚĂƚ ƚŽ ƚĂŬĞ͕ ǁŚĂƚ ƚŽ ůĞĂǀĞ ďĞŚŝŶĚ͖ ǇŽƵ ŵŝŐŚƚ ǁƌŝƚĞ ĂŶ ĞŵĂŝů ƚŽ Žƌ ĨĂĐĞƚŝŵĞ ǁŝƚŚ ǇŽƵƌ ĂƐƐŝŐŶĞĚ ƌŽŽŵŵĂƚĞ Žƌ ĐŚĞĐŬ ŽƵƚ ƚŚĞ ĚŽƌŵ͛Ɛ ůŽĐĂƚŝŽŶ ŝŶ relation to the student center. It’s the time for giving up the past and considering the possibilities ahead.

Finally, once you’ve passed through the Neutral Zone, you ĞŶƚĞƌ dŚĞ EĞǁ ĞŐŝŶŶŝŶŐ͘ dŚŝƐ ƉŚĂƐĞ ĐĂŶ ďĞ ďŽƚŚ ĞǆŚŝůĂƌĂƚŝŶŐ ĂŶĚ ƚĞƌƌŝĨǇŝŶŐ͘ zŽƵ ŚĂǀĞ ƚŚĞ ĐŚĂŶĐĞ ƚŽ ƌĞŝŶǀĞŶƚ Žƌ ƉƌĞƐĞŶƚ Ă ŶĞǁ ƉĞƌƐŽŶĂ͕ ŶĞǁ ŽƌŐĂŶŝǌĂƚŝŽŶ͕ ŶĞǁ ƐƚƌĂƚĞŐǇ Žƌ ƚĞĐŚŶŽůŽŐǇ͘ zŽƵ ŵĂǇ ĂůƐŽ ŶĞĞĚ ƚŽ ĐŽŶƋƵĞƌ ǁŚĂƚ ƐŽŵĞ ĐĂůů ͞dŚĞ /ŵƉŽƐƚĞƌ ^ǇŶĚƌŽŵĞ͕͟ ĐŽŶǀŝŶĐŝŶŐ ǇŽƵƌƐĞůĨ ǇŽƵ ĂƌĞ ƌĞĂĚǇ ĨŽƌ ƚŚŝƐ ͞ŶĞǁ ͙ Ĩŝůů ŝŶ ƚŚĞ ďůĂŶŬ͘͟ ƚ ƐĐŚŽŽů͕ ǇŽƵ ƌĞŐŝƐƚĞƌ ĨŽƌ ĐůĂƐƐĞƐ͕ ŵĞĞƚ ƚŚĞ students on your floor, maybe go through sorority rush, learn the shortest route from one building to another, figure out ǁŚĞƌĞ ƚŽ ƉĂƌŬ͕ ĂŶĚ ŝŶ ƐŽŵĞ ĐĂƐĞƐ ΀ŝŶĐůƵĚŝŶŐ ŵŝŶĞ΁ ďƵǇ ƐƚƵĚĞŶƚ ƚŝĐŬĞƚƐ ƚŽ ŚŽŵĞ ĨŽŽƚďĂůů ŐĂŵĞƐ͊ ^Ž͕ ǁŚǇ ƚŚĞ ĐŽůůĞŐĞ ĐĂƐĞ ǇŽƵ ŵŝŐŚƚ ĂƐŬ ʹ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŚĂǀĞ ďŝŐŐĞƌ͕ ŵŽƌĞ ĚŝĨĨŝĐƵůƚ͕ ŵŽƌĞ ŝŵƉŽƌƚĂŶƚ͕ ĐŚĂŶŐĞƐ ƚŽ ŵĂŬĞ͘ tĞ ŚĂǀĞ ƚŽ ĚĞĐŝĚĞ ŽŶ Ă ŶĞǁ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ͕ ĂŶĚ ƉůĂŶ ŝƚƐ ŝŶƐƚĂůůĂƚŝŽŶͲŝŵƉůĞŵĞŶƚĂƚŝŽŶ͖ ǁĞ ĂƌĞ ŐƌĂĚƵĂƚŝŶŐ from medical school and selecting our residency program (and ĨƵƚƵƌĞͿ͖ ǁĞ͛ǀĞ ůĞĨƚ ƚŚĞ ƐĂĨĞ ǁŽƌůĚ ŽĨ ŽƵƌ ĨŝƌƐƚ ũŽď ĂŶĚ ŚĂǀĞ

^ĞǀĞƌĂů ŝŵƉŽƌƚĂŶƚ ŝƐƐƵĞƐ ĂƌŝƐĞ ǁŚĞŶ ĚŝĨĨĞƌĞŶĐĞƐ ďĞƚǁĞĞŶ ĐŚĂŶŐĞ ĂŶĚ ƚƌĂŶƐŝƚŝŽŶ ĂƌĞ ŽǀĞƌůŽŽŬĞĚ͖ ǁŚĞŶ ƚƌĂŶƐŝƚŝŽŶ ŝƐ ŵŝƐƚĂŬĞŶ ĨŽƌ ƵŶĨŝŶŝƐŚĞĚ ĐŚĂŶŐĞ Žƌ ǁŚĞŶ ƚŚĞ ƚĞƌŵƐ ĂƌĞ ƵƐĞĚ interchangeably, the chances for failure increase dramatically. With “change” ǁĞ ĨŽĐƵƐ ŽŶ ƚŚĞ ŽƵƚĐŽŵĞ ŽĨ ƚŚĞ ĂĐƚŝŽŶ ʹ ůĞĂƌŶŝŶŐ ǇŽƵƌ ǁĂǇ ĂƌŽƵŶĚ ĐĂŵƉƵƐ͘ ^ĂŵĞ ƚŚŝŶŐ ǁŝƚŚ ŝŵƉůĞŵĞŶƚŝŶŐ Ă ŶĞǁ ,Z ʹ ǁĞ ƚŚŝŶŬ ŽĨ ƚŚĞ ŶĞǁ ŵĞĂŶƐ ŽĨ capturing patient encounters and the boxes of paper files to be shredded. tŝƚŚ ƚƌĂŶƐŝƚŝŽŶ ǁĞ ĐĂŶ͛ƚ ĨŽĐƵƐ ŽŶ ƚŚĞ outcome but on the ending that must be completed to leave the “old” behind. If ǁĞ ĚŽŶ͛ƚ ƚĂŬĞ ƚŝŵĞ ƚŽ ĐŽŶƐŝĚĞƌ ůĞĂǀŝŶŐ ŚŽŵĞ͕ ƉĂĐŬŝŶŐ ŽƵƌ ƌŽŽŵƐ͕ ƚĂŬŝŶŐ ĚŽǁŶ ƚŚĞ ƉŽƐƚĞƌƐ͕ ǁĞ ĐĂŶ͛ƚ ƉŽƐƐŝďůǇ ŵĂŬĞ ǁĂǇ ĨŽƌ ŽƵƌ ŶĞǁ ŚŽŵĞ ĂŶĚ ůŝĨĞ͘ Ɛ ƌ͘ ƌŝĚŐĞƐ ǁƌŝƚĞƐ͕ ͞KƌŐĂŶŝǌĂƚŝŽŶƐ ΀ĂŶĚ ƉĞŽƉůĞ΁ ŽǀĞƌůŽŽŬ ƚŚĞ ůĞƚƚŝŶŐͲŐŽ ƉƌŽĐĞƐƐ ĐŽŵƉůĞƚĞůǇ͕ ŚŽǁĞǀĞƌ͕ ĂŶĚ ĚŽ nothing about the feelings of loss that ŝƚ ŐĞŶĞƌĂƚĞƐ͘ ŶĚ ŝŶ ŽǀĞƌůŽŽŬŝŶŐ ƚŚŽƐĞ effects, they nearly guarantee that the ƚƌĂŶƐŝƚŝŽŶ ǁŝůů ďĞ ŵŝƐŵĂŶĂŐĞĚ͘͟

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The past is to be respected and acknowledged, but not worshiped; it is our future in which we will find our greatness. – Pierre Trudeau, former Canadian Prime Minister

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ƐƚĂƌƚĞĚ Ă ĚŝƌĞĐƚ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌĂĐƚŝĐĞ͖ ǁĞ͛ǀĞ ĚĞĐŝĚĞĚ ƚŽ ƌĞƚŝƌĞ͖ ǁĞ͛ƌĞ ŵŽǀŝŶŐ ƚŽ Ă ŶĞǁ ƐƚĂƚĞ Žƌ ǁĞ͛ƌĞ ƐƚĂƌƚŝŶŐ Ă ĨĂŵŝůǇ͊ Huge changes all, and each requires the same three phases of transition.

As you read the articles in this issue, ƚŚŝŶŬ ĂďŽƵƚ ƚŚĞ ƚŚƌĞĞ ƉŚĂƐĞƐ͘ ŚĂŶŐĞ ŽŶůǇ ǁŽƌŬƐ ǁŚĞŶ ŝƚ ŝƐ ĂĐĐŽŵƉĂŶŝĞĚ ďǇ transition. W^͗ /Ĩ ǇŽƵ ĂƌĞ ŝŶ ĐŚĂŶŐĞͲƚƌĂŶƐŝƚŝŽŶ ŵŽĚĞ͕ / ŚŝŐŚůǇ ƌĞĐŽŵŵĞŶĚ ƚŚĞ ďŽŽŬ͘ /ƚ ŝŶĐůƵĚĞƐ ĐĂƐĞ ƐƚƵĚŝĞƐ͕ ĐŚĞĐŬůŝƐƚƐ ĨŽƌ processes and guidance tools for teams ĂŶĚ ŽƌŐĂŶŝǌĂƚŝŽŶƐ͘ tŝƐŚ /͛Ě ŐŽƚƚĞŶ a royalty for as many times as I’ve recommended it. ZĞĨĞƌĞŶĐĞ͗ ϭ͘ DĂŶĂŐŝŶŐ dƌĂŶƐŝƚŝŽŶƐͲDĂŬŝŶŐ ƚŚĞ DŽƐƚ of Change, William Bridges, PhD and ^ƵƐĂŶ ƌŝĚŐĞƐ͕ ϮϬϭϲ͘ California Family Physician Fall 2019

Tr a n s i t i o n s a n d C h a n g e

Jan Diamond, MD, MPH

Hep C Treatment as Primary Care: Alameda Health Consortium Experience Dr. Jan Diamond, MD, MPH, is a family physician who has experienced many transitions throughout her career. Dr. Diamond practiced for 26 years at Contra Costa Health Services, where she continuously adapted her practice and skills to meet the needs of the community, including training the system’s family medicine residents, providing HIV care in a pre-HAART era, specializing in geriatric medicine, attending on the inpatient services, and becoming one of the county’s expert hepatologists. Dr. Diamond retired from Contra Costa Health Services in 2013. Even though the breadth of her career had been expansive, after retirement from Contra Costa Health Services, when Dr. Diamond saw an opportunity in 2015 to better meet the needs of the community, she again took a leadership role in an innovative program that demonstrated the centrality of primary care in the health of communities. Here Dr. Diamond reflects on that experience. — Editor The treatment of chronic Hepatitis C (HCV) infection ŝƐ ƐƚƌĂŝŐŚƚĨŽƌǁĂƌĚ͕ ǁŝƚŚ ĐůĞĂƌ ŐƵŝĚĞůŝŶĞƐ ĂŶĚ ŶŽŶͲƚŽǆŝĐ medications. Why is it still so often considered the domain ŽĨ ƐƉĞĐŝĂůŝƐƚƐ͍ ƵƌƌĞŶƚ ƚƌĞĂƚŵĞŶƚ ŚĂƐ ĐƵƌĞ ƌĂƚĞƐ ĞǆĐĞĞĚŝŶŐ ϵϱ ƉĞƌĐĞŶƚ ǁŝƚŚ ϴ ƚŽϭϮ ǁĞĞŬƐ ŽĨ ƚƌĞĂƚŵĞŶƚͶŵƵĐŚ ŵŽƌĞ ƐƚƌĂŝŐŚƚĨŽƌǁĂƌĚ ƚŚĂŶ ƐŽ ŵƵĐŚ ŽĨ ǁŚĂƚ ǁĞ ĚŽ ŝŶ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ ŶĚ ƚŚĞ ĐŽƐƚ ŚĂƐ ĐŽŵĞ ǁĂǇ ĚŽǁŶ͗ ŵŽƐƚ , s ƚƌĞĂƚŵĞŶƚƐ ŶŽǁ ĐŽƐƚ ĂƉƉƌŽǆŝŵĂƚĞůǇ ΨϮϬ͕ϬϬϬ ĨŽƌ Ă ůŝĨĞƚŝŵĞ ĐƵƌĞ͘ WĂƚŝĞŶƚƐ ďĞŶĞĨŝƚ ǁŚĞŶ ƚŚĞŝƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ŝŶǀŽůǀĞĚ ŝŶ this lifesaving treatment. ^ŝŶĐĞ ϮϬϭϲ͕ ůĂŵĞĚĂ ŽƵŶƚǇ ŚĂƐ ƚŝĞĚ ĨƵŶĚŝŶŐ ĨŽƌ ŝƚƐ ĞŝŐŚƚ FQHC Community Health Clinics to specific goals that encompass HCV screening and treatment. To meet those goals the Alameda Health Consortium—a regional association of community health centers in Alameda County—has ĚĞǀĞůŽƉĞĚ Ă ƉƌŽŐƌĂŵ ƚŽ ĚĞǀĞůŽƉ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ŶĞĐĞƐƐĂƌǇ ƚŽ ƚĂĐŬůĞ ĐŚƌŽŶŝĐ , s ƚƌĞĂƚŵĞŶƚ͘ tĞ ŽĨĨĞƌ ŚĂůĨͲĚĂǇ ǁŽƌŬƐŚŽƉƐ ŽŶ , s ƚƌĞĂƚŵĞŶƚ ĨŽƌ ŝŶƚĞƌĞƐƚĞĚ ƉƌŽǀŝĚĞƌƐ͕ ǁŝƚŚ individual provider support through email, text, phone calls, ŽĨƚĞŶ ŶĞĞĚĞĚ ŽŶůǇ Ăƚ ƚƌĞĂƚŵĞŶƚ ŝŶŝƚŝĂƚŝŽŶ Žƌ ǁŝƚŚ ƵŶƵƐƵĂů ĐĂƐĞƐ͘ ^ŝŶĐĞ ǁĞ ƐƚĂƌƚĞĚ ŽƵƌ ƉƌŽŐƌĂŵ͕ ǁĞ͛ǀĞ ĞǆƉĂŶĚĞĚ ĨƌŽŵ ƚǁŽ ƚŽ ϲϮ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ĂĐƚŝǀĞůǇ ƚƌĞĂƚŝŶŐ HCV infection.

California Family Physician Fall 2019

^Ž ŽĨƚĞŶ ǁĞ ŚĞĂƌ ƚŚĂƚ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ǁŝůů ďĞ ƌĞƐŝƐƚĂŶƚ ƚŽ ƉƌŽǀŝĚŝŶŐ ƚŚŝƐ ĐĂƌĞ͗ ͞dŚĞǇ ĚŽŶ͛ƚ ǁĂŶƚ ƚŽ ƚƌĞĂƚ ,ĞƉ ͙ ƚŚĞǇ͛ƌĞ ƚŽŽ ďƵƐǇ ǁŝƚŚ ƚŚĞ ďĂƐŝĐ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ͕͟ or “they don’t have time.” We’ve found, on the contrary, ƚŚĂƚ ƚƌĞĂƚŝŶŐ Ă ƉĂƚŝĞŶƚ͛Ɛ , s ĐĂŶ ďĞ ƌĞǁĂƌĚŝŶŐ ĨŽƌ ďŽƚŚ ƚŚĞ patient and the physician and care team. In primary care, ǁĞ ƐŽ ƐĞůĚŽŵ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚǇ ŽĨ ĚĞĨŝŶŝƚŝǀĞůǇ ĐƵƌŝŶŐ Ă ƉĂƚŝĞŶƚ ĂƐ ǁĞ ĚŽ ǁŝƚŚ ĐŚƌŽŶŝĐ , sͶĂŶĚ ĂĐƚƵĂůůǇ ƋƵŝƚĞ ĞĂƐŝůǇ͘ WĂƚŝĞŶƚƐ ĂƌĞ ƐŽ ŐƌĂƚĞĨƵů͊

Ɛ ŽŶĞ ŽĨ ŽƵƌ ƚƌĞĂƚŝŶŐ , s ƉŚǇƐŝĐŝĂŶƐ ĞůŽƋƵĞŶƚůǇ ƐƚĂƚĞĚ͗ “I’ve found that engaging patients for their hepatitis C ĐĂƌĞ ŝƐ Ă ŐĂƚĞǁĂǇ ŝŶƚŽ ĞŶŐĂŐŝŶŐ ƚŚĞŵ ŝŶƚŽ ƉƌŝŵĂƌǇ ĐĂƌĞ ͙ By establishing a relationship over a short period of time ǁŝƚŚ Ă ĐŽŶĐƌĞƚĞ ŝŵƉĂĐƚ͕ ƚƌƵƐƚ ĚĞǀĞůŽƉƐ ĂŶĚ ƉĂƚŝĞŶƚƐ ĂƌĞ ƚŚĞŶ ŵŽƌĞ ůŝŬĞůǇ ƚŽ ĐŽŶƚŝŶƵĞ ƐĞĞŝŶŐ ƵƐ ĨŽƌ ƉƌŝŵĂƌǇ ĐĂƌĞ͕ improving their overall health…” – Kim Nguyen MD

ŵŽƌĞ ĞĨĨŝĐŝĞŶƚ ŝŶ ƐŽ ŵĂŶǇ ǁĂǇƐ ǁŚĞŶ ƚŚĞƌĞ ŝƐ ƐŽ ŽĨƚĞŶ poor specialty access, geographically or financially for the most vulnerable.

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We’ve found, on the contrary, that treating a patient’s HCV can be rewarding for both the patient and the physician and care team.

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We did a survey on the efficacy and satisfaction of the W WƐ ǁĞ ƚƌĂŝŶĞĚ ƚŽ ƚƌĞĂƚ , s͗ ϴϱ ƉĞƌĐĞŶƚ ƐƚĂƚĞĚ ƚŚĂƚ Ă ǀŝƐŝƚ ĨŽƌ , s ƚƌĞĂƚŵĞŶƚ ǁĂƐ ŵŽƌĞ ƐĂƚŝƐĨǇŝŶŐ͕ ĂŶĚ ŶŽ ŵŽƌĞ time consuming than a routine primary care visit. The ŵĂũŽƌŝƚǇ ƐĂŝĚ ƚŚĂƚ ŐĞŶĞƌĂů ƉƌŝŵĂƌǇ ĐĂƌĞ ǀŝƐŝƚƐ ǁĞƌĞ ŵŽƌĞ frustrating than visits for HCV. One hundred percent of the ƌĞƐƉŽŶĚĞŶƚƐ ƐƚĂƚĞĚ ƚŚĞǇ ǁŽƵůĚ ĐŽŶƚŝŶƵĞ ƚŽ ƚƌĞĂƚ , s ĂŶĚ ϵϲ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞŝƌ ƉĂƚŝĞŶƚƐ ǁĞƌĞ ĐƵƌĞĚ͘ dŚĞƐĞ ƉŚǇƐŝĐŝĂŶƐ also found that the strengthened patient partnership developed from treatment of HCV also facilitated the delivery of primary care.

Ɛ ǁĞ ƚƌǇ ƚŽ ŵĂŬĞ ŚĞĂĚǁĂǇ ƚŽǁĂƌĚ ƚŚĞ ĞůŝŵŝŶĂƚŝŽŶ ŽĨ , s͕ ƚƌĞĂƚŵĞŶƚ ďǇ ƉƌŝŵĂƌǇ ĐĂƌĞ ŝƐ Ă ĐƌƵĐŝĂů ĞůĞŵĞŶƚ͖ ŝƚ ŝƐ ĐůĞĂƌůǇ

A place to call home. Our not-for-profit clinic network is looking for top-quality health care professionals who are truly committed to the core values and mission of the Community Health Center movement. Established in 1978, CHC now operates more than thirty state-licensed health centers on California’s Central Coast. Spanning 120 miles of prime coastline, our service area is an ideal place to live, raise a family, and thrive. We support 150,000 unduplicated patients, 450,000 annual encounters, 900+ employees and and a $120M annual budget. Priority one is caring for our patients and providers, so CHC commits itself to operating a nimble, diverse and sustainable agency that’s here to stay.

CHC is an Equal Opportunity Employer. We strongly support a smoke and drug free environment.

To apply, contact: Madisyn Masatani at mmasatani@chccc.org or 1(805)346-3975

Community Health Centers of the Central Coast, Inc. (CHC) A complete list of career opportunities at: communityhealthcenters.org/careers California Family Physician Fall 2019

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California Family Physician Fall 2019

Tr a n s i t i o n s a n d C h a n g e

Julie Çelebi, MD

Attending Life: Embracing the Unknown We become so accustomed to transitions in medical school. dŚĞ ŵŝŶƵƚĞ ǇŽƵ ŐĞƚ ŝŶƚŽ ǇŽƵƌ ĨůŽǁ ǁĂŬŝŶŐ ƵƉ Ăƚ ϰ͗ϬϬ D to pre-round and prep for the day’s surgical cases, you ĨŝŶĚ ǇŽƵƌƐĞůĨ ƐŚƵƚƚůĞĚ ŽŶ ƚŽ ƚŚĞ ŶĞǆƚ ƌŽƚĂƚŝŽŶ͘ zŽƵ ůŽƐĞ ƚŚĞ ƐĐƌƵďƐ ĂŶĚ ĚŽŶ Ă ǁŚŝƚĞ ĐŽĂƚ ĨŽƌ ƌŽƵŶĚƐ ǁŝƚŚ ƚŚĞ DĞĚŝĐŝŶĞ ƚĞĂŵ͕ ƐƚĂďŝůŝǌŝŶŐ ĂĐƵƚĞůǇ ŝůů ƉĂƚŝĞŶƚƐ ĨŽƌ ĚŝƐĐŚĂƌŐĞ ŽŶĞ ďǇ one. This dance is both fun and exciting. And the ebb and ĨůŽǁ ĐŽŶƚŝŶƵĞƐ ŝŶƚŽ ƌĞƐŝĚĞŶĐǇ͕ ǁŚĞƌĞ ĂƐ a family physician in ƚƌĂŝŶŝŶŐ͕ ƚŚŝƐ ĞĂƐĞ ǁŝƚŚ the breadth of our practice just becomes a comfortable constant. Literally in the course ŽĨ Ă ĐĂůů ŶŝŐŚƚ͕ ǁĞ ŵŝŐŚƚ pronounce a patient and deliver a baby. tŽŵď ƚŽ ƚŽŵď͕ ƌŝŐŚƚ͍ /ƚ ŝƐ Ă ǁŝůĚ ƌŝĚĞ ƚŚĂƚ ŶŽ one else understands, ďƵƚ ǁĞ ůŽǀĞ ƚŚŝƐ ůŝĨĞ͘

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If I’ve learned anything in my short tenure as an attending, it’s the fact that we are constantly navigating transitions in life, but especially on the family medicine journey, a journey that can take you on many paths. The only certainty is indeed the uncertainty of what we may be faced with on any given day in clinical care.

That first job out of training is the learning curve of a lifetime – because the learning doesn’t stop and oftentimes

'ĞƚƚŝŶŐ ĐŽŵĨŽƌƚĂďůĞ ǁŝƚŚ ƚŚĂƚ ĨĞĞůŝŶŐ ŽĨ ĨƌĞĞ ĨĂůů ǁĂƐ Ă highly defining aspect of my transition into attending life. Not only did I have to convince myself that I could handle the responsibility of patient care, but I had to suddenly be ƚŚĞ ͞ǁŝƐĞ͟ ŽŶĞ ǁŝƚŚ ŵǇ ƌĞƐŝĚĞŶƚƐ͊ KŚ͕ imposter syndrome is a beast. Compounding the stress of simultaneously balancing clinical care, ƚĞĂĐŚŝŶŐ͕ ŵǇ ŽǁŶ learning, I became ƉƌĞŐŶĂŶƚ ǁŝƚŚ ŵǇ ƐĞĐŽŶĚ ĐŚŝůĚ ǁŝƚŚŝŶ months of moving to Ă ŶĞǁ ĐŝƚǇ͕ ǁŝƚŚ Ă ŶĞǁ job and all the selfĚŽƵďƚ ŝŶ ƚŚĞ ǁŽƌůĚ͘ ,Žǁ ǁĂƐ / ŐŽŝŶŐ ƚŽ ƌŝĚĞ ƚŚŝƐ ǁĂǀĞ͍ dŚĞ ĨŝƌƐƚ couple of years out of residency are already such a rollercoaster, ďƵƚ ǁĂƐ ƚŚŝƐ ƚŽŽ ŵƵĐŚ change, too much ƵŶĐĞƌƚĂŝŶƚǇ͍

California Family Physician Fall 2019

“

And then residency graduation happens, you find yourself feeling suddenly ƋƵŝƚĞ ĂůŽŶĞ ǁŝƚŚ ƚŚĞ responsibility of being the one stop shop, the home base for patients ǁŚŽ ƚƌƵƐƚ ǇŽƵ ŝŵƉůŝĐŝƚůǇ ǁŝƚŚ ƚŚĞŝƌ ůŝǀĞƐ͘ EŽ ƉƌĞƐƐƵƌĞ͕ ƌŝŐŚƚ͍

you don’t have the same safety net you had in training. zŽƵ ĐĂŶ͛ƚ ƐŽ ĞĂƐŝůǇ ďŽƵŶĐĞ ǇŽƵƌ ŝĚĞĂƐ ŽĨĨ ƐŽŵĞŽŶĞ ŵŽƌĞ experienced.

I feel fortunate that my first job out of residency has ƉƌŽǀĞŶ ƚŽ ďĞ Ă ƐƵƉƉŽƌƚŝǀĞ ĞŶǀŝƌŽŶŵĞŶƚ ǁŚĞƌĞ / ĨĞĞů ĞŶĐŽƵƌĂŐĞĚ ĂůŽŶŐ ŵǇ ŵŽƚŚĞƌŝŶŐ ũŽƵƌŶĞǇ ǁŚŝůĞ ŵĂŝŶƚĂŝŶŝŶŐ

a commitment to my patients as a full-spectrum family ĚŽĐ͘ / ŚĂǀĞ ĨĞůƚ ƐĂĨĞ ƚĂůŬŝŶŐ ƚŚƌŽƵŐŚ ƚŽƵŐŚ ĐĂƐĞƐ͕ commiserating on the difficulty of balancing myriad ƌĞƐƉŽŶƐŝďŝůŝƚŝĞƐ ŝŶ ĂĐĂĚĞŵŝĐƐ͕ ĂŶĚ ũƵƐƚ ĂůůŽǁŝŶŐ ŵǇƐĞůĨ ƚŽ ďĞ Ă ůŝƚƚůĞ ǀƵůŶĞƌĂďůĞ ďĞĐĂƵƐĞ ƚŚĂƚ͛Ɛ ǁŚĞƌĞ ƚŚĞ ƌĞĂů connection happens. It’s getting ĐŽĨĨĞĞ ǁŝƚŚ Ă ĨĞůůŽǁ ĚŽĐƚŽƌ ŵŽŵ ǁŚŽ ŶŽƌŵĂůŝǌĞƐ ƚŚĞ ĨĂĐƚ ƚŚĂƚ ǁŽƌŬ ĂŶĚ ŚŽŵĞ ůŝĨĞ ǁŝůů ŽĨƚĞŶ ďĞ Ăƚ ŽĚĚƐ ǁŝƚŚ ŽŶĞ ĂŶŽƚŚĞƌ͘ /ƚ͛Ɛ ĐŽŵƉĂƌŝŶŐ ŶŽƚĞƐ ǁŝƚŚ ĂŶŽƚŚĞƌ ĞĂƌůǇ ĐĂƌĞĞƌ attending, sharing strategies and ůŝĨƚŝŶŐ ĞĂĐŚ ŽƚŚĞƌ ƵƉ ĂƐ ǁĞ ĨŝŶĚ ŽƵƌ ǁĂǇ͘ /ƚ͛Ɛ ůĞĂŶŝŶŐ ŽŶ ŵǇ ǁŝƐĞƌ͕ ŵŽƌĞ experienced colleagues to give me ƉĞƌƐƉĞĐƚŝǀĞ ǁŚĞŶ / ĨĞĞů ĞƐƉĞĐŝĂůůǇ challenged in patient care. Four ǇĞĂƌƐ ŽƵƚ ŽĨ ƌĞƐŝĚĞŶĐǇ͕ / ĨĞĞů ůŝŬĞ / am finally getting to a secure spot in terms of my clinical confidence, ŝŵƉƌŽǀĞĚ ĨůŽǁ ĂŶĚ ĞĨĨŝĐŝĞŶĐǇ͕ ĂŶĚ ĨĂŵŝůŝĂƌŝƚǇ ǁŝƚŚ ŵǇ ƉĂƚŝĞŶƚ ƉĂŶĞůͲͲ and finally have more head space ĂŐĂŝŶ ƚŽ ůŽŽŬ ĂƌŽƵŶĚ ĂŶĚ ĐŽŶŶĞĐƚ ŵŽƌĞ ǁŝƚŚ ŽƚŚĞƌƐ͘ /ƚ ŵĂĚĞ ŵĞ ǁŽŶĚĞƌ ŚŽǁ / ĐĂŶ ĚŽ Ă ďĞƚƚĞƌ ũŽď ƚŽ ĞŶŐĂŐĞ ŽƚŚĞƌƐ Ăƚ ŵǇ ǁŽƌŬƉůĂĐĞ ǁŚŽ ŵŝŐŚƚ ĨĞĞů ůŝŬĞ ƚŚĞǇ ĂƌĞ ĨůŽƵŶĚĞƌŝŶŐ as I had been.

ĂŶĚ ĐĂŶ͛ƚ ŬŶŽǁ ŝƚ Ăůů͕ ĂŶĚ ŝƚ ŝƐ ďŽƚŚ ǁŝƐĞ ĂŶĚ ŵĂƚƵƌĞ ƚŽ ŬŶŽǁ ǁŚĞŶ ƚŽ ĂƐŬ ĨŽƌ ŚĞůƉ͘ dŚĞƐĞ ĨŝƌƐƚ ĨŽƵƌ ǇĞĂƌƐ ĂƐ ĂŶ ĂƚƚĞŶĚŝŶŐ ŚĂǀĞ ďĞĞŶ Ă ǁŚŝƌůǁŝŶĚ ĂŶĚ ĐŚŽĐŬͲĨƵůů ŽĨ ůŝĨĞ ůĞƐƐŽŶƐ͕ ďƵƚ ŝƚ͛Ɛ ŽŶůǇ ƚŚĞ ďĞŐŝŶŶŝŶŐ ʹ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ƚŚĞ ŶĞǆƚ ĐŚĂƉƚĞƌ͊

If I’ve learned anything in my short tenure as an attending, it’s ƚŚĞ ĨĂĐƚ ƚŚĂƚ ǁĞ ĂƌĞ ĐŽŶƐƚĂŶƚůǇ navigating transitions in life, but especially on the family medicine ũŽƵƌŶĞǇ͕ Ă ũŽƵƌŶĞǇ ƚŚĂƚ ĐĂŶ ƚĂŬĞ you on many paths. The only certainty is indeed the uncertainty ŽĨ ǁŚĂƚ ǁĞ ŵĂǇ ďĞ ĨĂĐĞĚ ǁŝƚŚ on any given day in clinical care. ^ĞůĨͲĚŽƵďƚ ǁŝůů ďĞ ƉƌĞƐĞŶƚ ;ĂŶĚ ƚŽ Ă ĐĞƌƚĂŝŶ ĞǆƚĞŶƚ͕ ĐĂŶ ŬĞĞƉ ƵƐ ŚƵŵďůĞ ĂŶĚ ŚŽŶĞƐƚͿ͕ ďƵƚ ǁĞ ĂůƐŽ need to trust our clinical intuition ĂŶĚ ƚŚĞ ĨŽƵŶĚĂƚŝŽŶ ǁĞ͛ǀĞ ůĂŝĚ ƚŽ ďĞĐŽŵĞ ƌŽĐŬ ƐƚĂƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ In family medicine and primary ĐĂƌĞ͕ ǁĞ ĂůǁĂǇƐ ƐƚƌŝǀĞ ƚŽ ŬŶŽǁ ŵŽƌĞ͕ ďƵƚ ǁĞ ĂůƐŽ ŚĂǀĞ ƚŽ ďĞ ŽŬĂǇ ǁŝƚŚ ƚŚĞ ĨĂĐƚ ƚŚĂƚ ǁĞ ĂƌĞ ŚƵŵĂŶ

California Family Physician Fall 2019

Integrating Primary and Behavioral Health Care Through the Lens of Prevention

To Improve Population Level Outcomes

Conference Speakers

R ch Ri chaarrd F. F. Catal aattaallano, ano, an o, Jr.r.,, Ph Ph.D. .DD.

Johhnnnett Jo neett tta DDaavi tta viss JJooyycce, e, M.AA.

PPrrof rooffeessssoor,r, PhD, hDD, Un Univveerrssiityy of Wash Waasshhingt ingt in gton on, an on, and nd th the the co-ffou co ound nddeerr of tthhhee SSooci occiiaall Dev evel elop opm meentt Res esea earrcch GGrrou rou oup

DDire Di ire recttor or of Ce Cenntter er for or Suubbst s an anccee Abbus Abus use Pr Prev e en entit oonn (CCSSAP) AP) AP

Unleashing the Power of Prevention in Communities: A Role for Primary Care

Integrating Across Systems: Multi-Sector Partnerships in Prevention

Earl Ea rly BBiirdd reggis rly istr trat trat ation ioon fe fee ((eend nds on on Octob ctobber ct er 15, 201 0119) 9): $5 9) $5255 – inc nclu lude d s th the he foll foolllllow ow winngg:: accceesss to thr to hree ree ee day ays ys of o con onfe fere erenc reenc nce ce pprrog ogra gramm ram ra mm min ing, ng, g fooood od func fuunc ncttiion o s an a d ccoonfer nnffer erren ence en ce maatter eria iaalss. ials

You Should Attend This Conference if You Are a: • PPhhys ysiicciiaan or or hoosspiita tal,l, clilini niic or or tre reat atm meent entt cennte ter er pprroggra ram m di direect ctor tor or,, cl clin inic iciaan an a d st staff ff worrkkiing ng in beha beehhaavi vioral orral al heeaalt alt lth caaree or pprrim imarry ca c re re • Pr Preevven venti ennti tioonnis nisst •M Meennttal healt ealt ea lth care ccaare re profe roofe fess ssiona ioona nal • Ps Psyc syc y ho h logi loogi g st st inc ncluudi ding ng clilini lini n caal aannd ccoom mm mun unit ity annd othe otthheer reelate laate t d aarreas eaas • Su Substa bsta bs tanc nncce mi misuusee tre misu reat atm atme at meentt sppeeciiaallis lis i t or o a spe peci c aallis ist st inn are reas eas a succh aass HIVV, et e c. c. • He H al altthh caarre poolilicy cyma makeer at at thee fed ederraall, sttaatte oorr loc ocaall lev evel evel e • Ed Educat ucat uc a orr in coomm mmon or hi high gherr edu duca caati t onn foc ocuussinng on on pub ubliic heeallth th • So Soci c al worrke ci ker,r, sch c oo ool ol coun cooun unse seelo lor or or nur u se • Re Rese seearrcchher her e /e /eva valu l attor o foccus u in ingg on iss ssuuees inn int n eg egra ratteed heeal ra alth th care th arre • Su Suic iccidde pr p eevveenntiionn spe peci eci c al alis ist • La L w Ennfo forrccem men e t Continuing Education Units available for this conference for MDs, DOs, LPCs, nurses, public health professionals and social workers will be available. This conference is transformative, timely, and fills an educational nationwide gap.

Conference Mission As nat As atio iona io nal leeadder nal ers in in thhee pre reveenttioon fie field, ldd, we w aree com ommi mmi m tt t eedd to im mpr proovvvin ing in bbeehaavi v orral al anndd pri rima maaryy heeaalt l h oouutccom om mes es by iinnte es nteegr graattin ing th thes eesse wi witthh the he scie sc ienc ie n e an and pr p aaccti ticee of pprrev even enti tioonn acros crros oss pu pubbllicc, aannd co comm mm mun u it ityy se secttor orss. s.

Join the National Conversation in New Orleans November 13-15, 2019 Conference Webpage: https://preventionandhealthcare.ou.edu/

California Family Physician Fall 2019

Tr a n s i t i o n s a n d C h a n g e

Carol S. Havens, MD, FAAFP

Contemplating Retirement /͛ǀĞ ŽŌĞŶ ŚĞĂƌĚ ƚŚĂƚ ƚŚĞ ƚŚƌĞĞ ƚƌĂŶƐŝƟŽŶƐ ŝŶ Ă ƉŚǇƐŝĐŝĂŶ͛Ɛ ůŝĨĞ ĂƌĞ ŐĞƫŶŐ ŝŶ͕ ŐĞƫŶŐ ĐŽŵĨŽƌƚĂďůĞ ĂŶĚ ŐĞƫŶŐ ŽƵƚ͘ /͛ǀĞ ĚŽŶĞ ƚŚĞ ĮƌƐƚ ƚǁŽ ĂŶĚ Ăŵ ŶŽǁ approaching the third. From Ă ĚŝƐƚĂŶĐĞ͕ / ĂůǁĂǇƐ ƚŚŽƵŐŚƚ ƚŚĞ ŐĞƫŶŐ ŽƵƚ ǁŽƵůĚ ďĞ ƚŚĞ ĞĂƐŝĞƐƚ͘ EŽǁ ƚŚĂƚ ŝƚ͛Ɛ ƵƉ ĐůŽƐĞ ĂŶĚ ƉĞƌƐŽŶĂů͕ / Ăŵ ĮŶĚŝŶŐ / Ăŵ having some regrets, more joy, ĂŶĚ ĨƌĂŶŬůǇ͕ Ă ĨĞǁ ĨĞĂƌƐ͘

“

Ƶƚ ƚŚĞ ďŝŐŐĞƐƚ ƋƵĞƐƟŽŶ ĨŽƌ ŵĞ ŚĂƐ ďĞĞŶ͕ ĂŌĞƌ ďĞŝŶŐ Ă ƉŚǇƐŝĐŝĂŶ ĨŽƌ ϰϬ ǇĞĂƌƐ͕ ŽŶĐĞ / ƌĞƟƌĞ͕ ǁŚŽ Ăŵ /͍ tŝůů / ƐƟůů ďĞ Ă work team? I’ve had to ĐŽŶƚƌŝďƵƟŶŐ ŵĞŵďĞƌ ŽĨ ƐŽĐŝĞƚǇ Žƌ ũƵƐƚ ĨĂĚĞ ŝŶƚŽ ŝƌƌĞůĞǀĂŶĐǇ͍ zĞƐ͕ accept that my team’s future / ŬŶŽǁ / ǁŝůů ƐƟůů ďĞ Ă ƉŚǇƐŝĐŝĂŶ͘ isn’t in my control anymore. ZĞƟƌĞŵĞŶƚ ĚŽĞƐŶ͛ƚ ĐĂŶĐĞů ŵǇ medical school diploma, but I I will do what I can to make ƚŚŝŶŬ ǇŽƵ ŬŶŽǁ ǁŚĂƚ / ŵĞĂŶ͘ / ŚĂǀĞ ŶĞǀĞƌ ƌĞĂůůǇ ƚƌŝĞĚ ƚŽ ŝĚĞŶƟĨǇ the transition smooth, but myself primarily as a physician. ĞŝŶŐ Ă ƉŚǇƐŝĐŝĂŶ ŝƐ ŶŽƚ ƚŚĞ ĮƌƐƚ it’s not really up to me to ĂŶ / ĮŶĂŶĐŝĂůůǇ ĂīŽƌĚ ƚŽ ƌĞƟƌĞ͍ ƚŚŝŶŐ / ŵĞŶƟŽŶ ǁŚĞŶ / ŵĞĞƚ ĐĐŽƌĚŝŶŐ ƚŽ ŽƵƌ ĮŶĂŶĐŝĂů ƐŽŵĞŽŶĞ ŶĞǁ͕ ďƵƚ ŝƚ ŝƐ Ă ďŝŐ ƉĂƌƚ arrange the future (drat!). planner, yes. ŽĨ ŵǇ ŝĚĞŶƟƚǇ͘ / ŚĂǀĞ ĨŽƵŶĚ ƚŚĂƚ ŵǇ ĨƌŝĞŶĚƐ ĂŶĚ ĨĂŵŝůǇ ƐƟůů ĂƐŬ ,Žǁ ǁŝůů / Įůů ŵǇ ĚĂǇƐ͍ ^ŽŵĞ my medical opinion, and I have ŝĚĞĂƐ͕ ďƵƚ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ƚƌǇŝŶŐ ƚŚŝŶŐƐ ŽƵƚ͘ DŽƌĞ ƵŬƵůĞůĞ͕ ďĞĞŶ ĂƐŬĞĚ ƚŽ ĐŽŵĞ ĂůŽŶŐ ƚŽ ŵĞĚŝĐĂů ĂƉƉŽŝŶƚŵĞŶƚƐ ďĞĐĂƵƐĞ ŵŽƌĞ ĨĂŵŝůǇ ƟŵĞ͕ ƚƌĂǀĞů͕ ŐĞƚ ŽƵƚ ƚŚĞ ǀŽƚĞ ĞīŽƌƚƐ͕ ĐŽŶƟŶƵŝŶŐ ĞǀĞŶ ƚŚŽƵŐŚ / ĚŽŶ͛ƚ ŬŶŽǁ ƚŚĞ ĂŶƐǁĞƌƐ͕ Ăƚ ůĞĂƐƚ / ŬŶŽǁ ƚŚĞ ƚŽ ƚĞĂĐŚ ͙ / ŚĂǀĞ ƐŽŵĞ ĐŽůůĞĂŐƵĞƐ ǁŚŽ ŶĞǀĞƌ ŚĂĚ Ă ĐŽŶĐĞƌŶ ƋƵĞƐƟŽŶƐ ƚŽ ĂƐŬ͘ ƉƌŝŽƌ ƚŽ ƌĞƟƌĞŵĞŶƚ͕ ŶŽƌ ĂŶǇ ƌĞŐƌĞƚƐ ĂŌĞƌ ;ĞǆĐĞƉƚ ŵĂǇďĞ ŶŽƚ ĚŽŝŶŐ ŝƚ ƐŽŽŶĞƌͿ͘ Ƶƚ / ŚĂǀĞ ĂůƐŽ ǁƌŝƩĞŶ ŵĂŶǇ ůĞƩĞƌƐ ŽĨ &Žƌ ƐŽŵĞŽŶĞ ǁŝƚŚ ŚŝŐŚ ĐŽŶƚƌŽů ŶĞĞĚƐ ŝƚ ŝƐ ƐĐĂƌǇ ƚŽ ŶŽƚ ŚĂǀĞ ƌĞĨĞƌĞŶĐĞ ĨŽƌ ĐŽůůĞĂŐƵĞƐ ǁŚŽ ƌĞƟƌĞĚ ƚŚĞŶ ǁĞŶƚ ďĂĐŬ ƚŽ ǁŽƌŬ ŵǇ ŶĞǆƚ ĚĂǇ͕ ǁĞĞŬ͕ ŵŽŶƚŚ͕ ǇĞĂƌ͕ ŵǇ ŶĞǆƚ ĂƉƉŽŝŶƚŵĞŶƚ͕ ŵǇ ;ƵƐƵĂůůǇ ƉĂƌƚ ƟŵĞͿ Ăƚ Ă ĐŽŵŵƵŶŝƚǇ ĐůŝŶŝĐ Žƌ ƚŚĞ s Žƌ ƐŽŵĞ next conference scheduled. I am used to deadlines (though I ŽƚŚĞƌ ŽƉƟŽŶ͘ / ŚŽƉĞ ƚŚĞǇ ĂƌĞŶ͛ƚ ĚŽŝŶŐ ŝƚ ĨŽƌ ƚŚĞ ŝŶĐŽŵĞ͕ ĚŽŶ͛ƚ ĂůǁĂǇƐ ŵĞĞƚ ƚŚĞŵͿ͕ ƚĂƐŬƐ͕ ŐŽĂůƐ͕ ͞ƚŽ ĚŽ͟ ůŝƐƚƐ ĂŶĚ ďƵƐǇ ďƵƚ ƌĂƚŚĞƌ ďĞĐĂƵƐĞ ƚŚĞǇ ƐƟůů ĞŶũŽǇ ƚŚĞ ǁŽƌŬ ĂŶĚ ƐƟůů ǁĂŶƚ ƚŽ ĚĂǇƐ ŝŶƚĞƌƐƉĞƌƐĞĚ ǁŝƚŚ ĚĂǇƐ ŽĨ ĐŽŵƉůĞƚĞ ƉĂŶŝĐ͘ tŚĂƚ ǁŝůů ƚŚĞ contribute. Others have found their next “career” in nonĨƵƚƵƌĞ ďĞ͍ /͛ŵ ĂůƐŽ ƵƐĞĚ ƚŽ ŚĂǀŝŶŐ ŐƌĞĂƚ ƚĞĐŚ ƐƵƉƉŽƌƚ͕ ŶŽƚ medical endeavors. One is a docent at our local art museum. ŚĂǀŝŶŐ ƚŚĂƚ ǁŝůů ďĞ ŵǇ ƐŽƵƌĐĞ ŽĨ ƉĂŶŝĐ͊ ŶŽƚŚĞƌ ůĞĂĚƐ ǁĂůŬŝŶŐ ƚŽƵƌƐ ŝŶ ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ ĂŶĚ ĂŶŽƚŚĞƌ ƚĞĂĐŚĞƐ ůŝƚĞƌĂĐǇ ƚŽ ĂĚƵůƚƐ͘ ůů ŚĂǀĞ ĨŽƵŶĚ Ă ǁĂǇ ƚŽ ĐŽŶƟŶƵĞ ƚŽ ^Ž͕ / ǁĞŶƚ ƚŽ ƚŚŽƐĞ / ƚƌƵƐƚ͕ ǁŚŽ ŚĂǀĞ ďĞĞŶ ƚŚƌŽƵŐŚ ƚŚŝƐ ĂůƌĞĂĚǇ ďĞ Ă ƉƌŽĚƵĐƟǀĞ ŵĞŵďĞƌ ŽĨ ƐŽĐŝĞƚǇ ĂŶĚ ƉƌŽǀŝĚĞ ƐĞƌǀŝĐĞ͘ ĂŶĚͬŽƌ ůŽǀĞ ŵĞ͕ĂŶĚ ƚŚŝƐ ŝƐ ǁŚĂƚ ƚŚĞǇ ƐĂŝĚ͗

What will happen to my

California Family Physician Fall 2019

“

ĂŶ ŵǇ ǁŝĨĞ ƐƚĂŶĚ ƚŽ ŚĂǀĞ ŵĞ ŚŽŵĞ Ϯϰͬϳ͍ ĐĐŽƌĚŝŶŐ ƚŽ ŚĞƌ͕ ƐŚĞ ŝƐ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ŝƚ͕ ďƵƚ ĐŚĞĐŬ ďĂĐŬ ǁŝƚŚ ŚĞƌ ŶĞǆƚ ǇĞĂƌ͘ tŚĂƚ ǁŝůů ŚĂƉƉĞŶ ƚŽ ŵǇ ǁŽƌŬ ƚĞĂŵ͍ /͛ǀĞ ŚĂĚ ƚŽ ĂĐĐĞƉƚ ƚŚĂƚ ŵǇ ƚĞĂŵ͛Ɛ ĨƵƚƵƌĞ ŝƐŶ͛ƚ ŝŶ ŵǇ ĐŽŶƚƌŽů ĂŶǇŵŽƌĞ͘ / ǁŝůů ĚŽ ǁŚĂƚ / ĐĂŶ ƚŽ ŵĂŬĞ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ƐŵŽŽƚŚ͕ ďƵƚ ŝƚƐ ŶŽƚ ƌĞĂůůǇ ƵƉ ƚŽ ŵĞ ƚŽ ĂƌƌĂŶŐĞ ƚŚĞ ĨƵƚƵƌĞ ;ĚƌĂƚ͊Ϳ͘

zŽƵ ǁŝůů ƐƟůů ďĞ Ă ĐŽŶƚƌŝďƵƟŶŐ ŵĞŵďĞƌ ŽĨ ƐŽĐŝĞƚǇ ƐŽŵĞŚŽǁ ĂŶĚ ǇŽƵ ǁŝůů ĮŶĚ ŽƵƚ ŚŽǁ͘

You don’t have to have a fully developed plan. Give ǇŽƵƌƐĞůĨ ƐŽŵĞ ƟŵĞ ĂŶĚ ƐƉĂĐĞ ƚŽ ĮŶĚ ǇŽƵƌ ŶĞǆƚ ƉĂƐƐŝŽŶ͘ Which is actually how I have always described my

career, I came to a fork in the road and I took it. ɸ

Life is short, have fun.

And from my wonderfully wise wife, “You have not been primarily Ă ƉĂƟĞŶƚ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶ ĨŽƌ ƐĞǀĞƌĂů years, you have always been primarily a physician educator and ǇŽƵ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĚŽ ƚŚĂƚ͘͟

KŶĞ ƚŚŝŶŐ / ŬŶŽǁ ŝƐ ƚŚĂƚ ƚŚĞ &W ǁŝůů ƐƟůů ďĞ Ă ƉĂƌƚ ŽĨ ŵǇ ůŝĨĞ ƐŽ ĚŽŶ͛ƚ ĞǀĞŶ ƚŚŝŶŬ ǇŽƵ͛ǀĞ ƐĞĞŶ ƚŚĞ ĞŶĚ ŽĨ ŵĞ ǇĞƚ͊ ŶĚ ƚŚĂƚ͛Ɛ ŽŶĞ ŽĨ ƚŚĞ ƚŚŝŶŐƐ / Ăŵ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ

ƚŽ͕ ƐƉĞŶĚŝŶŐ ŵŽƌĞ ƟŵĞ ǁŝƚŚ ƚŚŝŶŐƐ ĂŶĚ people I really enjoy and not having to do ƚŚŽƐĞ ƉĂƌƚƐ ŽĨ ŵǇ ũŽď ƚŚĂƚ / ĚŝĚŶ͛ƚ ůŝŬĞ ĂƐ much. I have been so blessed to have had ƚŚĞ ŽƉƉŽƌƚƵŶŝƟĞƐ / ŚĂǀĞ ĂŶĚ ƚŽ ŚĂǀĞ ƚŚĞ career I have. I am forever grateful for all ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ǁĂůŬĞĚ ƚŚŝƐ ƉĂƚŚ ǁŝƚŚ ŵĞͲ ͲŵǇ ĐŽůůĞĂŐƵĞƐ͕ ŵǇ ƉĂƟĞŶƚƐ͕ ŵǇ ĨĂŵŝůǇ͘ / Ăŵ Ă ůƵĐŬǇ ǁŽŵĂŶ͕ ĂŶĚ ŶŽ ŵĂƩĞƌ ǁŚĂƚ ŵǇ ĨƵƚƵƌĞ ŚŽůĚƐ͕ / ƚŚŝŶŬ ƚŚĂƚ͛Ɛ ƚŚĞ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ƚŚŝŶŐ ĨŽƌ ŵĞ ƚŽ ƚĂŬĞ ǁŝƚŚ me into the future.

Save the Date

May 15-17, 2020

THE ANNUAL CALIFORNIA

FAMILY MEDICINE CLINICAL FORUM PRESENTED BY THE CALIFORNIA ACADEMY OF FAMILY PHYSICIANS

Join hundreds of your fellow family physicians for two and a half days of CME and networking. The California Academy of Family Physicians invites you to join us for the 2020 California Family Medicine Clinical Forum on May 15-17, 2020 in Long Beach, CA.

WITH KEYNOTE SPEAKERS T. R. REID author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

DR. PAUL GRUNDY contributor to the newly-released book Trusted Healer Other opportunities during the forum include: the CAFP Foundation’s 5k FundRun, optional pre- and post-conference workshops, as well as various activities throughout the event.

Questions and registration: www.familydocs.org! Photo provided by the Long Beach Convention and Visitors Bureau

California Family Physician Fall 2019

Join Our Team in the

Heart of Sonoma Wine Country Healdsburg District Hospital is seeking a full-time Primary Care Physician with a background in Family Practice or Internal Medicine. This position would be located at our Healdsburg Physician Group Clinic on the hospitalâ&#x20AC;&#x2122;s campus located in the heart of Sonoma Wine Country. About an hour north of the Golden Gate Bridge, beautiful Healdsburg, California offers wonderful wineries, world-class dining, redwood forests and gorgeous countryside. Healdsburg District Hospital connects and delivers personalized high quality, accessible local healthcare services, and advocates for the health and wellness of the communities in the District. Healdsburg Physician Group is a distinctive primary care group delivering the highest-quality care and service available, and offers providers gratifying and sustainable careers. As an outpatient department of a Critical Access Hospital and independent of large healthcare institutions, our clinic is open Monday â&#x20AC;&#x201C; Friday, hours 9am â&#x20AC;&#x201C; 5pm.

In addition, we offer benefits designed to aid your health and wellness including: â&#x20AC;˘ Comprehensive Medical, Dental and Vision plans â&#x20AC;˘ Robust voluntary insurance plan options â&#x20AC;˘ Retirement Savings Program with Employer match â&#x20AC;˘ Paid Time Off (PTO) starting at over 30 days per year â&#x20AC;˘ Relocation assistance â&#x20AC;˘ Malpractice Insurance coverage â&#x20AC;˘ 5 days of Continuing Medical Education (CME) and $5,000 CME reimbursement; â&#x20AC;˘ Hospital sponsored loan repayment program and eligibility for additional loan programs Our ideal physician will have: â&#x20AC;˘ Excellent clinical and communication skills, bilingual ability a plus â&#x20AC;˘ An interest in using technology to deliver high quality, primary care â&#x20AC;˘ The desire to be an integral part of a rapidly growing team of clinicians dedicated to changing health care delivery â&#x20AC;˘ BC/BE in Family or Internal Medicine â&#x20AC;˘ California Medical license

Contact: Heather Balitzkat (707) 431-6492 Email: hbalitzkat@nschd.org www.healdsburgdistricthospital.org

-PPLJOH GPS #BMBODF 'JOE JU XJUI #BZ$BSF .FEJDBM (SPVQ

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California Family Physician Fall 2019

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California Family Physician Fall 2019

ceo message

Lisa Folberg, MPP

The Year Passed So Quickly KŶ ^ĞƉƚĞŵďĞƌ ϭϳ͕ / ĐĞůĞďƌĂƚĞĚ ŵǇ ĮƌƐƚ ĂŶŶŝǀĞƌƐĂƌǇ Ăƚ &W͘ ^ŽŵĞ ĚĂǇƐ / ĨĞĞů ůŝŬĞ / ŚĂǀĞ ďĞĞŶ ŚĞƌĞ ĨŽƌĞǀĞƌ͕ ĂŶĚ ŽƚŚĞƌ ĚĂǇƐ / ĨĞĞů ůŝŬĞ / just arrived. I love anniversaries and (other people’s) birthdays. They provide a ƌĞĂƐŽŶ ƚŽ ƌĞŇĞĐƚ ŽŶ ƚŚĞ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ ĂŶĚ ĐŚĂůůĞŶŐĞƐ ǇŽƵ ĚŽŶ͛ƚ ŶŽƟĐĞ ǁŚĞŶ ǇŽƵ ĂƌĞ ŝŶ ƚŚĞ ŵŝĚĚůĞ ŽĨ ƚŚĞŵ͘ / Ăŵ ƌĞĂůůǇ ƉƌŽƵĚ ŽĨ ƚŚĞ ǁŽƌŬ ƚŚĞ &W ƚĞĂŵ ŚĂƐ ĚŽŶĞ ƚŚŝƐ ůĂƐƚ ǇĞĂƌ͘ tĞ͛ǀĞ ŵĂĚĞ ƐŽ ŵĂŶǇ ďŝŐ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ͗ ŚĞůƉŝŶŐ ƚŽ ĞǆƉĂŶĚ ĨƵŶĚŝŶŐ ĨŽƌ ĨĂŵŝůǇ medicine residency programs and loan repayment, securing a ŵƵůƟŵŝůůŝŽŶ ŐƌĂŶƚ ƚŽ ŚĞůƉ ƌĞƐŝĚĞŶĐŝĞƐ ŝŵƉƌŽǀĞ ĞĚƵĐĂƟŽŶ͕ ŽƵƚƌĞĂĐŚ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ĨŽƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ƐƵďƐƚĂŶĐĞ ƵƐĞ ĚŝƐŽƌĚĞƌ ĚŝƐĞĂƐĞ and expanding local CAFP ĐŚĂƉƚĞƌ ĂĐƟǀŝƚǇ͘

“

I have learned so much this past year. I have learned about my ŶĞǁ ĐŝƚǇ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ &W ĂŶĚ ŵǇƐĞůĨ͘ /Ŷ ƐŽŵĞ ǁĂǇƐ / Ăŵ California Family Physician Fall 2019

dƌĂŶƐŝƟŽŶ ŝƐ ƚŚĞ ƐƉĂĐĞ ďĞƚǁĞĞŶ ǁŚĂƚ ǁĂƐ ĂŶĚ ǁŚĂƚ ǁŝůů ďĞ͘ ZĞŐĂƌĚůĞƐƐ ŽĨ ǁŚĂƚ ŚĂƉƉĞŶƐ ŝŶ ƚŚĞ ŶĞǆƚ ƉƌĞƐŝĚĞŶƟĂů ĞůĞĐƟŽŶ͕ ĐŚĂŶŐĞƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ŝŶ ϮϬϮϬ ǁŝůů ƌĞƋƵŝƌĞ ƵƐ ƚŽ ǁĂůŬ ƚŚƌŽƵŐŚ ƚŚĂƚ ƐƉĂĐĞ͘ EĂǀŝŐĂƟŶŐ ƚŚŽƐĞ ĐŽƌƌŝĚŽƌƐ ŽĨ ƚƌĂŶƐŝƟŽŶ can bring challenge and opportunity. Through media, ůĞŐŝƐůĂƟǀĞ ĂŶĚ ƌĞŐƵůĂƚŽƌǇ ĂĚǀŽĐĂĐǇ ŽƉƉŽƌƚƵŶŝƟĞƐ ǁŝůů ĂƌŝƐĞ ƚŽ ŵĂŬĞ ƐƵƌĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ůĞĂĚŝŶŐ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂƌŽƵŶĚ ŚĞĂůƚŚ ƐǇƐƚĞŵ ĐŚĂŶŐĞ͕ ƉĂǇŵĞŶƚ ĂŶĚ ǁŽƌŬĨŽƌĐĞ͘ dŚƌŽƵŐŚ ĂĚǀŽĐĂĐǇ ĂŶĚ ĐŽĂůŝƟŽŶ ďƵŝůĚŝŶŐ͕ ŽƉƉŽƌƚƵŶŝƟĞƐ ǁŝůů ďĞ ƉƌĞƐĞŶƚĞĚ ƚŽ ƉƌŽŵŽƚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂŶĚ ǁŝƚŚ it, family medicine training. Through CAFP’s professional and ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ͕ ǁĞ ǁŝůů ŚĂǀĞ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ƉƌŽǀŝĚĞ ĞĚƵĐĂƟŽŶ ĂŶĚ ůĞĂƌŶŝŶŐ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ŽƵƌ ŵĞŵďĞƌƐ͘ tŚĂƚĞǀĞƌ ƚŚĞ ƚƌĂŶƐŝƟŽŶƐ ǇŽƵ ŵĂǇ ĨĂĐĞ ŝŶ ϮϬϮϬ͕ ǇŽƵƌ ĐĂĚĞŵǇ ĐĂŶ ŚĞůƉ ǇŽƵ͕ ǁŚĞƚŚĞƌ ƚŚĂƚ ŝƐ ŶĂǀŝŐĂƟŶŐ ƚŚĞ ƚƌĂŶƐŝƟŽŶƐ ŽĨ ǇŽƵƌ ƉƌŽĨĞƐƐŝŽŶĂů ůŝǀĞƐ Žƌ ďĞŝŶŐ Ă ŶĞƚǁŽƌŬ ƚŽ ƉĂĚ ƚŚĞ ƌŽƵŐŚ ĐŽƌŶĞƌƐ ŽĨ ƉĞƌƐŽŶĂů ƚƌĂŶƐŝƟŽŶ͘

Being CAFP’s CEO is a dream job for me, and I love helping to lead this organization. Susan Hogeland left big shoes to ﬁll.

Being CAFP’s CEO is a dream job for me, and I love helping to ůĞĂĚ ƚŚŝƐ ŽƌŐĂŶŝǌĂƟŽŶ͘ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ůĞŌ ďŝŐ ƐŚŽĞƐ ƚŽ Įůů͘ ^ŚĞ ƐĞƌǀĞĚ ƚŚŝƐ ŽƌŐĂŶŝǌĂƟŽŶ ǁĞůů ĨŽƌ Ϯϳ ǇĞĂƌƐ͘ / ŬŶĞǁ ƚŚĂƚ ĨŽůůŽǁŝŶŐ Ă ďĞůŽǀĞĚ ƐƚĂī ůĞĂĚĞƌ ǁŚŽ ƌĂŝƐĞĚ ŵĂŶǇ ŽĨ &W͛Ɛ ƉŚǇƐŝĐŝĂŶ ůĞĂĚĞƌƐ ĨƌŽŵ ĂĚǀŽĐĂĐǇ ƉƵƉƐ ƚŽ ŽƌŐĂŶŝǌĂƟŽŶĂů ƉŽǁĞƌŚŽƵƐĞƐ ǁŽƵůĚ ŚĂǀĞ ĐŚĂůůĞŶŐĞƐ͘ DǇ ƚƌĂŶƐŝƟŽŶ ǁĂƐ ĞĂƐĞĚ ďǇ ĐŽŵŝŶŐ ŝŶƚŽ Ă ŚŝŐŚůǇ ĨƵŶĐƟŽŶŝŶŐ ŽƌŐĂŶŝǌĂƟŽŶ ǁŝƚŚ ŐƌĞĂƚ ƐƚĂī ĂŶĚ ĞŶŐĂŐĞĚ ůĞĂĚĞƌƐŚŝƉ͘ Ƶƚ ĞǀĞŶ ŐƌĞĂƚ ŽƌŐĂŶŝǌĂƟŽŶƐ ŚĂǀĞ ƚŽ ďĞ ǁŝůůŝŶŐ ƚŽ ĐŚĂŶŐĞ ĂŶĚ ƚƌĂŶƐŝƟŽŶ ĂƐ ƉĂƌƚ ŽĨ ƚŚĂƚ ĐŚĂŶŐĞ͕ ĂŶĚ ĞǀĞŶ ƚŚĞ ďĞƐƚ ƚƌĂŶƐŝƟŽŶƐ ĂƌĞ ŶĞǀĞƌ ĞĂƐǇ͘ dƌĂŶƐŝƟŽŶƐ ĂƌĞ ĐŚĂůůĞŶŐŝŶŐ ŝŶ ƉĂƌƚ ďĞĐĂƵƐĞ ǇŽƵ ĚŽ ŶŽƚ have the past or the future to hide behind and you can’t shroud ǇŽƵƌƐĞůĨ ŝŶ ƚŚĞ ƉĂƩĞƌŶƐ ŽĨ ƚŚĞ ĨĂŵŝůŝĂƌ͘

dƌĂŶƐŝƟŽŶƐ ůŝŬĞ ŵŽǀŝŶŐ͕ ƐƚĂƌƟŶŐ Ă ŶĞǁ ũŽď͕ ďĞŐŝŶŶŝŶŐ ƌĞƐŝĚĞŶĐǇ Žƌ ƌĞƟƌŝŶŐ ĨƌŽŵ ƉƌĂĐƟĐĞ ŽŌĞŶ ĨŽƌĐĞ ǇŽƵ ƚŽ ďĞ ŵŽƌĞ ĂǁĂƌĞ ŽĨ ƚŚĞ ǁŽƌůĚ ĂƌŽƵŶĚ ǇŽƵ ĂŶĚ ŽĨ ǇŽƵƌ ŽǁŶ ƉĂƩĞƌŶƐ͘ ,ŽůĚŝŶŐ ŽŶƚŽ ƚŚĞ ƐĂŵĞ ƚŚŝŶŐƐ ŝŶ Ă ǁŽƌůĚ ƚŚĂƚ ŶĞǀĞƌ ƌĞĂůůǇ ƐƚŽƉƐ ĐŚĂŶŐŝŶŐ ĐĂŶ ďĞ ĚĞďŝůŝƚĂƟŶŐ ĨŽƌ ƉĞŽƉůĞ ĂŶĚ ŽƌŐĂŶŝǌĂƟŽŶƐ͘ EŽƚ ďĞŝŶŐ ĂďůĞ Žƌ ǁŝůůŝŶŐ ƚŽ ƚƌĂŶƐŝƟŽŶ ĂŌĞƌ ĐŚĂŶŐĞ ĐĂŶ ďĞ ĞǀĞŶ ǁŽƌƐĞ͘

“

I am also very proud of the less ŶŽƟĐĞĂďůĞ ƚŚŝŶŐƐ &W ŐĞƚƐ ĚŽŶĞ ĨŽƌ ŵĞŵďĞƌƐ ĞǀĞƌǇ ĚĂǇ͗ ŚĞůƉŝŶŐ ŽƵƌ ŵĞŵďĞƌƐ ǁŝƚŚ ƋƵĞƐƟŽŶƐ ĂďŽƵƚ ƚŚĞŝƌ D ͕ managing all of the details that go into great conferences and ĐŽŶŶĞĐƟŶŐ ŽƵƌ ŵĞŵďĞƌƐ ǁŝƚŚ ƉƌĂĐƟĐĞ ƌĞƐŽƵƌĐĞƐ͘ dŚĞ ǁŽƌŬ ǇŽƵƌ &W ƐƚĂī ĂŶĚ ƉŚǇƐŝĐŝĂŶ leaders do every day to ĞŵƉŽǁĞƌ͕ ĞĚƵĐĂƚĞ ĂŶĚ ĐŽŶŶĞĐƚ family physicians is tremendous.

ƌĞƐŝƐƚĂŶƚ ƚŽ ĐŚĂŶŐĞ͘ / ŶĞǀĞƌ ƵƉĚĂƚĞ ŵǇ ŽƉĞƌĂƟŶŐ ƐǇƐƚĞŵ ƵŶůĞƐƐ / ŚĂǀĞ ƚŽ͖ / ƐƟůů ŐŽ ŝŶƚŽ ƚŚĞ ďĂŶŬ ƚŽ ĚĞƉŽƐŝƚ ĐŚĞĐŬƐ͘ /Ŷ ĐŽůůĞŐĞ / ĂƚĞ the exact same thing almost every morning for a year. I have also ůĞĂƌŶĞĚ ƚŽ ĂƉƉƌĞĐŝĂƚĞ ĐŚĂŶŐĞ ĂŶĚ ƚŚĞ ŝŶĞǀŝƚĂďůĞ ƚƌĂŶƐŝƟŽŶ ƚŚĂƚ ĐŽŵĞƐ ǁŝƚŚ ŝƚ͘

/ Ăŵ ĞǆĐŝƚĞĚ ƚŽ ƐƚĂƌƚ ŵǇ ƐĞĐŽŶĚ ǇĞĂƌ ĂƐ &W͛Ɛ K͘ /͛ůů ŚĂǀĞ ĨĞǁĞƌ ĮƌƐƚƐ͕ ďƵƚ ŵĂŶǇ ƚƌĂŶƐŝƟŽŶƐ͘ / Ăŵ ƌĞĂĚǇ ƚŽ ƌŽůů ƵƉ ŵǇ ƐůĞĞǀĞƐ ĂŶĚ ŐĞƚ ƚŽ ǁŽƌŬ ŽŶ ĐŽŶƟŶƵŝŶŐ ƚŽ ďƵŝůĚ ĂŶ ŽƌŐĂŶŝǌĂƟŽŶ ƚŚĂƚ ƌĞƐƉŽŶĚƐ ƚŽ ĂŶĚ ůĞĂĚƐ ŝŶ Ă ĐŚĂŶŐŝŶŐ ǁŽƌůĚ͘ tĞ ĂƌĞ Ăƚ Ă ƉŝǀŽƚĂů ƟŵĞ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ͕ Ă ƟŵĞ ǁŚĞŶ ǁĞ ŵĂǇ ůŽŽŬ ďĂĐŬ ĂŶĚ ƐĂǇ ƚŚĂƚ ŝƐ ŚŽǁ ŚĞĂůƚŚ ĐĂƌĞ ǁĂƐ͘ &ĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƐŚŽƵůĚ ďĞ Ăƚ ƚŚĞ ŚĞĂƌƚ ŽĨ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ƚŽ ŚŽǁ ŚĞĂůƚŚ ĐĂƌĞ ǁŝůů ďĞ͘ dŚĞ ,ĞĂƌƚ ŽĨ ƚŚĞ ZĞǀŽůƵƟŽŶ͘

Shape the future of health care and beneﬁt from our:

Joy and meaning in medicine One AFM - The Best Adult and Family Medicine Department in the Nation

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70 years of personalized, mission-driven care

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At The Permanente Medical Group, Inc. (TPMG), we seek new solutions to solve medical problems by taking a complete and innovative approach to the entirety of health, from prevention to cure.

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We believe that physicians should be equipped and enabled to fulfill their purpose: to truly make a difference in people’s lives by practicing the highest quality medicine that is focused and collaborative. And, when you join our Adult and Family Medicine Department, you will find fulfillment in practicing medicine as it was originally intended - with compassion and respect - regardless of where you choose to practice throughout our region. Family Medicine Opportunities: Contact Aileen Ludlow at: Aileen.M.Ludlow@kp.org I (510) 625-5934

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Internal Medicine Opportunities: Contact Bianca Davis at: Bianca.X.Davis@kp.org I (510) 625-5935 Permanente Medicine is a patient-centered, quality-driven approach to care practiced exclusively at Kaiser Permanente.

http://physiciancareers-ncal.kp.org

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No RVUs

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Malpractice insurance coverage

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Physician wellness programs

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Unparalleled beneﬁts package

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