contents
4
physcian call to action
5
important drug update: AbilifyÂŽ
10
wcms thanks project access practices and physicians for the donated care provided in 2013!
6 welcome new wcms members 7 a collaborative community approach to high risk & high need patients 20 was oedipus mad?
8
ncms amplifies doctors’ voices
WAKE COUNTY PHYSICIAN | 1
contributors
WCPM
July 2014
Publisher Wake County Medical Society Editor Paul Harrison Wake County Medical Society Officers and Executive Council
2014 President | Patty Pearce MD Secretary | Robert Munt, MD Treasurer | Robert Munt, MD President Elect | Andrew Wu, MD Past President | Dick McKay, MD Founding Editor | Assad Meymandi, MD, PhD, DLFAPA
Council Terry Brenneman, MD Members Maggie Burkhead, MD Warner L. Hall, MD Ken Holt, MD M. Dixon McKay, MD Assad Meymandi, MD, PhD, DLFAPA Robert Munt, MD Patricia Pearce, MD Derek Schroder, MD Michael Thomas, MD Brad Wasserman, MD Andrew Wu, MD
WCMS Barb Savage Alliance Karen Albright Co-Presidents
Wake County Medical Society 2500 Blue Ridge Road, Suite 330 Raleigh, NC 27607 Phone: 919.792.3644 Fax: 919.510.9162 dearp@wakedocs.org www.wakedocs.org
“The Wake County Physician Magazine is an instrument of the Wake County Medical Society; however, the views expressed are not necessarily the opinion of the Editorial Board or the Society.� 2 | JULY 2014
L. Jarrett Barnhill, MD
is a professor of Psychiatry at the UNC School of Medicine and the director of the Developmental Neuropharmacology Clinic within the Department of Psychiatry. He is a Distinguished Fellow in the American Psychiatric Association and Fellow in the American Academy of Child and Adolescent Psychiatry.
Valerie Brooks, PharmD, BCPP Network Clinicial Pharmacist
is a clinical pharmacist employed with Community Care of Wake and Johnston Counties. Her responsibilities include medication management for high risk Medicaid recipients with a concentration in integrated behavioral health medicine.
Robin Reed, MD, MPH, CCWJC Network Psychiatrist
is the Network Psychiatrist for Community Care of Wake and Johnston Counties. Dr. Reed is also the Director of Integrated Care for the UNC Center for Excellence in Community Mental Health. She practices in primary care, behavioral health, and hospital-based settings and primarily works with individuals with chronic and severe mental
Robert W. Seligson, MBA, MA Executive Vice President and CEO, North Carolina Medical Society
as Executive Vice President and CEO, of NCMS, the largest and oldest professional association in the state with over 12,000 members, Mr. Seligson directs a variety of advocacy efforts designed to serve the physician community in North Carolina.
Elizabeth Cuervo Tilson, MD, MPH
graduated John Hopkins University School of Medicine and is Board Certified in Preventive and Pediatrics. She currently provides primary care in the Wake County Human Service Child Health Clinic and is the Medical Director of Community Care of Wake/Johnston Counties.
Additional contributors include:
Jamie Philyaw, MSW, CCWJC Behavioral Health Program Manager Pam Carpenter | Project Access Deborah Earp | Membership Manager, WCMS
Wake County Physician Magazine (WCPM) is a publication for and by the members of the Wake County Medical Society. WCPM is a quarterly publication and is digitately published January, July, April, and October. All submissions including ads, bio’s, photo’s and camera ready art work for the WCPM should be directed to: Tina Frost Graphic Editor WCPM tina@tinafrost.com 919.671.3963 Photographs or illustrations: Submit as high resolution 5” x 7” or 8” x 10” glossy prints or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3” unless the artwork is for the cover. Please include names of individuals or subject matter for each image submitted.
Dear WCMS Executive Council Members, Please note the following Executive Council meeting dates for 2014. Dates: Sept. 9, 2014 Nov. 11, 2014 Time:
All meetings will take place at 6pm
Where: 2500 Blue Ridge Rd. #330 | Raleigh NC 27607 A light dinner will be served at each meeting. On behalf of Susan Davis, Executive Director of Community Health Foundation and myself, we look forward to working with you throughout 2014. Thank you, Paul Harrison Executive Director Wake County Medical Society
Contributing author bio’s and photo requirements: Submit a recent 3” x 5” or 5” x 7” black and white or color photo (snapshots are suitable) along with your submission for publication or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3”. All photos will be returned to the author. Include a brief bio along with your practice name, specialty, special honors or any positions on boards, etc. Please limit the length of your bio to 3 or 4 lines. Ad Rates and Specifications: Full Page $800 1/2 Page $400 1/4 Page $200
WAKE COUNTY PHYSICIAN | 3
An invitation to all Wake County Physicians and Physician’s Assistants
Below is a letter written by Patricia Pearce, MD, 2014 WCMS President, distributed during May, 2014.
Dear Wake County Physicians and Physician’s Assistants, The Wake County Medical Society Executive Council (board) invites you to join its Legislative Affairs Committee. The function of the Committee will be to advocate on behalf of Wake County physicians and physician’s associates with local, Wake county representatives, of the NC Legislature. Examples of current legislative issues include: 1. 2. 3. 4.
Medicaid reform and Medicaid ACO development Defense against physician scope of practice encroachment Defense of 2011 medical liability reform legislation Improving NC Medical Board relationships relative to legislative issues of mutual concern
Specifically, the role of the WCMS Legislative Committee will be to establish relationships with the 13 members of the Wake County NC Legislative Delegation, so that committee members will be able to effectively reach out to these representatives when an important message or position about pending legislation needs to be delivered. Please consider participating in the WCMS Legislative Committee, regardless of your WCMS membership status. We need your voice, especially as care providers in the NC County that is actually home to the NC Legislature. Please contact Paul Harrison, WCMS Executive Director at pharrison@wakedocs.org to participate in this advocacy role. Thank you, Patricia Pearce, MD, 2014 WCMS President
4 | JULY 2014
Important Drug Update: Abilify® By Valerie Brooks, Pharm.D., BCPP & Dr. Robin Reed MD, MPH, CCWJC Network Psychiatrist Aripiprazole (Abilify®), a second generation antipsychotic agent, was approved at the end of 2002 for the treatment of schizophrenia. Since that time, its indications have been expanded to include the treatment of bipolar disorder, adjunctive treatment in major depression, and the treatment of irritability in pediatric (greater than 6 years of age) patients with autism. It was hoped that second generation antipsychotics would cause fewer or less severe extrapyramidal side effects (ex., dystonia, akathisia, or tardive dyskinesia) while providing better treatment of the symptoms of psychosis. Aripiprazole is noteworthy as an “atypical” antipsychotic agent since its mechanism of action is considered to be unique. Aripiprazole works at dopamine and serotonin receptors like other antipsychotic agents. However, it is hypothesized to
act as a dopamine/serotonin antagonist where there is too much dopamine/serotonin and a dopamine/serotonin agonist where there is too little. The pharmacological activity of aripiprazole is mainly due to the aripiprazole itself and, to a lesser extent, relies on its metabolite, dehydroaripiprazole. The cytochrome P450 system, namely the CYP3A4 and 2D6 isoenzymes, is responsible for metabolism of aripiprazole. The half-life of aripiprazole is approximately 75 hours where that of dehydroaripiprazole is 94 hours. In patients considered poor metabolizers of CYP2D6, the half-life of both aripiprazole and its metabolite will be even longer. Due to its long half-life, aripiprazole has the advantage of once daily dosing. The cytochrome P450 system also plays a role in drug interactions involving
aripiprazole. Agents that either induce or inhibit CYP3A4 or 2D6 can affect aripiprazole concentrations in the body. Medications that inhibit CYP2D6 (e.g. paroxetine or fluoxetine) or CYP3A4 (e.g. ketoconazole or protease inhibitors) will increase aripiprazole plasma concentrations while CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifabutin) will decrease aripiprazole exposure. As is expected, dose adjustment of aripiprazole is required when it is given concomitantly with agents that affect these enzyme systems. Common side effects (at least 10% in adult participants in clinical trials) include headache, dizziness, insomnia, constipation, restlessness, akathisia, anxiety, nausea, and vomiting. In the pediatric population, extrapyramidal side effects, headache, fatigue, [continued on page 18]
WAKE COUNTY PHYSICIAN | 5
Derek P. Watson, MD Practice: Orthopedic Specialists of North Carolina Speciality: Physical Medicine & Rehabilitation
Jeevan B. Ramakrishnan, MD Practice: Raleigh Capitol Ear, Nose, and Throat Speciality: Otolaryngology
Priyanka Arora, MD Practice: Raleigh Children & Adolescent Medicine, PC Speciality: Pediatrics
6 | JULY 2014
of the statewide program, Community Care of North Carolina (CCNC), and seeks to improve access to, continuity, quality, and coordination of care for Medicaid, Health Choice, select Medicare and other populations. To achieve these goals, CCWJC works closely with primary care medical homes and their patients, provides data and analytics to guide population health activities, links major segments of the local health care systems (hospitals, public health, primary care providers, pharmacies, specialists, behavioral health providers, social services, community resources, etc.) and provides multi-disciplinary care management for high risk patients that includes nurses, social workers, pharmacists, physicians, a dietician, and a chaplain. Currently, there are 160 primary care medical homes and 115,542 patients in Wake and Johnston counties as part of the CCWJC network. CCC, established in 2006, is a national leader demonstrating how competitive health systems can work together to By Robin Reed, MD, MPH, CCWJC Network Psychiatrist improve health outcomes and lower the costs of care Jamie Philyaw, MSW, CCWJC Behavioral Health Program Manager for the low-income uninsured Elizabeth Cuervo Tilson, MD, MPH, CCWJC Medical Director community in Wake County. Partner organizations he Wake County Medical Society-Community include WakeMed Health and Hospitals, Health Foundation (WCMS-CHF) was Duke Raleigh Hospital, Rex Healthcare, Wake established as a 501(c)3 in 2000. Our vision: a County Human Services, and Wake County’s healthy, productive, empowered, and engaged safety-net health clinics. CCC allows partner community. Our mission: to improve health organizations to provide medical care to the outcomes and decrease health care costs for uninsured in a coordinated fashion, while the populations we serve by increasing access facilitating ongoing communication, assessment to high quality and coordinated health care. of community health needs, identification of The two main service programs administered priorities, and initiation of working partnerships through the WCMS-CHF are Community Care among providers. The CCC program provides multidisciplinary care management for uninsured of Wake and Johnston Counties (CCWJC) and individuals with chronic health conditions, the Capital Care Collaborative (CCC). CCWJC, established in 2003, is one of the 14 local networks mental health & substance abuse conditions,
A Collaborative Community Approach to High Risk and High Need Patients — Community Care of Wake and Johnston Counties, the Capital Care Collaborative, and the Wake County Advanced Practice Paramedics program
T
[continued on page 16]
WAKE COUNTY PHYSICIAN | 7
many thousands of our North Carolina residents while curtailing costs. Let’s hope they grasp this opportunity.” Now more than ever it is important for doctors to be heard and the NCMS is committed to ensuring that the medical community’s perspective is loud and clear for policymakers. The event with the Governor is just one among many ways the NCMS ensures that physicians’ views are recognized. Physicians in Wake County have an even greater chance to get involved because of By Robert W. Seligson, CEO, North Carolina Medical Society their close proximity to the General Assembly. octors from across the state turned out The NCMS stands ready to assist you in getting in record numbers – many from Wake more involved in the legislative process and County -- to speak to legislators about hope you will take advantage of the resources how to improve Medicaid. The event, White we have available to help you become better Coat Wednesday, sponsored by the North advocates for your profession. Carolina Medical Society (NCMS) began with White Coat Wednesday, the NCMS’ grassroots the Secretary of the NC Department of Health and Human Services, Aldona Wos, MD, speaking lobbying initiative that occurs every Wednesday when the legislature in is session, doesn’t always to the group at the NCMS Center for Leadership include meetings with the Governor or full-blown in Medicine in downtown Raleigh before the press conferences, but it does provide a longdoctors headed over to the Legislative Building. standing and continuing opportunity for doctors At noon, many of them met with Governor Pat in North Carolina. Seeing a flood of white coats McCrory at the Executive Mansion and then walking through the hallways of the General participated in a press conference on the steps Assembly sends a powerful message to legislators of the residence. that doctors are involved and vocal and are not The press conference, which came about afraid to express their views to those who are largely due to the behind-the-scenes efforts charged with making the policies and laws that of the NCMS, began with remarks from Dev affect their practice. Sangvai, MD, President of the NCMS and a Oftentimes, lawmakers are woefully unfamiliar family physician in Durham. with many of the challenges and rewards of “We will continue our work for meaningful and medical practice outside of encounters with their positive change that focuses on a homegrown own doctor. Any one-on-one conversation is a accountable-care approach rather than valuable opportunity to educate them. bringing in an outside corporation that would Since most doctors are busy practicing restrict health care for our citizens,” he told medicine rather than keeping tabs on the the media. “Our General Assembly has the latest happenings at the legislature, White opportunity to create genuine improvement for
NCMS Amplifies Doctors’ Voices
D
8 | JULY 2014
McCrory and Secretary Wos meeting with doctors in the Executive Mansion before the White Coat Wednesday meeting/press conference Coat Wednesdays begin at the NCMS Center for Leadership in Medicine with a breakfast briefing by NCMS Government Affairs staff on the hot issues of the day and what legislators want to know more about. Armed with talking points and helpful tips on how to approach legislators, the group takes the short three-block walk over to the Legislative Building and begins their visits with their representatives and senators. If you’re not already an NCMS member, you are missing out on learning how to get your message across to policymakers and many other money-saving and practice improvement resources NCMS offers. Please visit our website www. ncmedsoc.org
to learn more. The NCMS Assistant Director for Legislative and Political Action, Will Barnett (wbarnett@ ncmedsoc.org or 919-833-3836 x130) is the person to contact if you’d like to be part of White Coat Wednesday when the new Legislative Session resumes in winter 2015. §
Dr. Sangvai speaking at the White Coat Wednesday meeting/press conference
American Anesthesiology of NC Ajinder Chhabra, MD Al Melvin, MD Amanda Crow, MD Amanda Froment, MD Andrew Lutz, MD Asra Ali, MD Benjamin Antonio, MD Bruce Janson, MD Brendon Howes, MD Bryan Max, MD Carrie Gill-Murdoch, MD Charles Nicholson, MD Christa Gray, MD Clarence Huggins, MD Daniel Amitie, MD Deborah Pellegrini (Quint), MD Deitra Williams-Toone, MD Donald Edmondson, MD Earl Crumpler, Jr. Edgar Garrabrant, III, MD 10 | JULY 2014
Edward Bratzke, MD Elee Stewart, MD Erhan Atasoy, MD Eric Mason, MD Francis “Fran” Abdou, MD Francis “Greg” Brusino, MD Gerald Maccioli, MD Hsiupei Chen, MD Jack Lam, MD Jafar Shick, MD James Collawn, MD James Cummings, II, MD Jeremy Reading, MD John McDowell, MD Jonathan Blank, MD Justin Hauser, MD Karen Meyers, MD Kassell Sykes, Jr., MD Keith Kittelberger, MD Kimberly Greenwald, MD Manu Gupta, MD
Matthew Atkins, MD Melanie Lutz, MD Michael Hauser, MD Michael Lish, MD Michael Neville, MD Nathan Christie, MD Nevin Shrimanker, MD Nicole Scouras, MD Paul Woodard, MD Ralph Ramos, MD Randy Efrid, MD Reed VanMatre, MD Robert Alphin, MD Robert Marshall, III, MD Robert “Paul” Rieker, Jr., MD Robert Seymour, III, MD Robert Treadway, Jr., MD Ronald Gore, MD Russell Ford, MD Scott Garrison, MD Scott Tyrey, MD
Shawn Kruse, MD Shehzad Choudry, MD Sherman Lee, MD Stephen Rogers, MD Steven Sherman, MD Susan Steele, MD Thomas Buchheit, MD Thomas Monaco, MD Timothy Gruebel, MD Vincent Hoellerich, MD Walter Daniel, MD Wendell Zee, MD Whitney Scott, MD William Bolding, MD William Corkey, MD William Crocker, MD Andrus & Associates Dermatology, PA Rebekah M. Oyler, MD Associated Urologists of North Carolina Mark Jalkut, MD Timothy P. Bukowski, MD Steven Shaban, MD Brian Bennett, MD Scott Baker, MD Marc Benevides, MD Daniel Khera McRackan, MD Joseph Neighbors, MD Atlantic Pain Consultants Martin Harrell, MD AUNC Cary Urology PA Kevin Khoudary, MD Kevin Perry, MD Frank Tortora, MD William Kizer, MD Bariatric Specialists of NC Kevin Khoudary, MD Kevin Perry, MD Frank Tortora, MD William Kizer, MD Elizabeth Campbell, MD John Reilly, MD Margaret Deutsch, MD Mark Yoffe, MD Neeraj Agrawal, MD P.J. Singh, MD Roy Cromartie, MD Scott Sailer, MD
Stephen Tremont, MD Virgil Rose, MD William Berry, MD John F. Reilly, MD Scott D. Meredith, MD Monica B. Jones, MD Cancer Centers of North Carolina Alan Kritz, MD Charles F. Eisenbeis, MD PhD Elizabeth Campbell, MD John Reilly, MD Margaret Deutsch, MD Mark Yoffe, MD Neeraj Agrawal, MD P.J. Singh, MD Roy Cromartie, MD Scott Sailer, MD Stephen Tremont, MD Virgil Rose, MD William Berry, MD John F. Reilly, MD Scott D. Meredith, MD Monica B. Jones, MD Capital Area Ob-Gyn Associates, PA Christin N. Richardson, MD George M. Tosky, MD Katherine E. Barrett, MD Michael F. Buckley, MD Paige L. Gausmann, MD Capital Nephrology Associates, PA Daniel W. Koenig, MD Frederick S. Jones, MD James E. Godwin, MD Jeffrey G. Hoggard, MD Kevin M. Lee, MD Michael I. Oliverio, MD Prabhakar N. Vaidya, MD Capital Neurology & Headache Center David H. Cook, MD Capitol Ear Nose & Throat, PA David A. Clark, MD H. Craig Price, MD Jeevan Ramakrishnan, MD Mark S. Brown, MD
R. Glen Medders, MD Stanley Wilkins, MD Steven H. Dennis, MD Capitol Raleigh ENT H. Clifton Patterson, MD Kevin M. Doyle, MD Laura Devereux Brown, MD Mark W. Clarkson, MD Matthew J. Gerber, MD Stephen E. Boyce, MD Steven J. McMahon, MD William F. Durland, Jr., MD Caroling Cardiology - WMFP William Parsons, MD James Nutt, MD Carolina Endocrine, P.A. Michael J. Thomas, MD, PhD Khushbu Chandarana, MD Courtney Koppenal, PA-C Ellie Andres, PA-C Cary Dermatology Catherine Hren, MD Heidi Mangelsdorf, MD Cary Ob-Gyn Michael Anthony, MD Sharon Stephenson, MD Centre Ob-Gyn Ann Collins, MD Erika Clark, MD Jerome Gardner, MD Randolph Scott, MD Robert Littleton, MD Tanneisha Barlow, MD Creedmoor Centre Endocrinology Julia Warren-Ulanch, MD Dermatology Skin Cancer Center Eric D. Challgren, MD Gregory J. Wilmoth, MD Laura D. Briley, MD Margaret B. Boyse, MD W. Stacy Miller, MD Tracey S. Cloninger, PA-C
[continued on page 12]
WAKE COUNTY PHYSICIAN | 11
Digestive Healthcare Murtaza K. Parekh, MD Colm O’Loughlin, MD Karen Saville, FNP Kenneth R. Kohagen, MD M. Dixon McKay, MD Ruth Mokeba, MD Naveen V. Narahari, MD Rig S. Patel, MD
Duke Thoracic Surgery David White, MD Katie Gillis, PA-C
Duke Cardiology of Raleigh Lawrence Liao, MD Radha Kachhy, MD James Peterson, MD Mark Leithe, MD Stephen Robinson, MD
Friendship Medical Center Annette Troy, MD
Duke Cancer Center of Raleigh Michael Spiritos, MD Sharon Taylor, MD Yuri Fesko, MD
Joyner Ophthalmology Walton Joyner, MD
Duke Eye Center of Raleigh Christopher Boehlke, MD Eric Postel, MD Grace Prakalapakorn, MD Jason Liss, MD Leon Herndon, MD Paul Hahn, MD Duke Gastroenterology of Raleigh Aaron Woofter, MD Jane Onken, MD Jesse Liu, MD Michael Feiler, MD Rebecca Burbridge, MD Duke Neurology of Raleigh Paul Peterson, MD Duke Otolaryngology of Raleigh Seth Cohen, MD Duke Radiology of Raleigh Alan Rosen, MD Marc Finkel, MD Morgan Camp, MD Robert Vogler, MD Tedric Boyse, MD Vernon W. Pugh, III, MD
12 | JULY 2014
ENT & Audiology Associates Douglas K. Holmes, MD Eye Specialists of Carolina Demetrius Dornic, MD
Fuquay Chiropractic & Wellness Cente, PLLC Jill M. Miehe Currin, DC
Kamm, McKenzie, Harden, Smith, Bass Ashley N. Rush, MD Brian Bass, MD Crystal Privette, MD Cynthia Saacks, MD Joel M. Berstien, MD Lauren M. Wheeler, MD Michael D. Smith, MD Paul B. Harden, Jr., MD Sheppard McKenzie, III, MD Mann ENT Charles H. Mann, MD Jared E. Spector, MD Richard M. Jones, MD Mental Health Providers Cynthia Dowdy, PhD E. Janice Morgan, LCSW Gayle Gonzalez-Johnson, LCSW John O Donoghue LMFT Lou Murray, Substance Abuse Counseling Margaret J. Dorfman, MD Mid Carolina Obstetrics & Gynecology, PC Amy O. Groff, MD Eloise Watson, MD Leon F. Woodruff, MD Myra Lynn Teasley, MD Ruth Wind, MD Sarah Maddison, MD
North Raleigh Psychiatry Jeffrey Snow, MD John Olarte, MD Brady Lamm Orthopaedic Foot & Ankle Sarah E. Dewitt, MD Piedmont Foot & Ankle Clinic, PA Jason E Nolan, DPM Richard J. Hauser, DPM Robert J. Lenfestey, DPM Raleigh Endocrine Associates Elizabeth M. Holt, MD Raleigh Endoscopy Center Raleigh Infectious Diseases Christopher Ingram, MD Edwin Brown, MD Henry Radziewicz, MD Henry T. Radziewicz, MD John Engemann, MD Nisha Manickam, MD Paul Becherer, MD Ravi Padmanabhan, MD Debra Kosko, FNP Diane Tilley, FNP Drew Bullington, ANP Laurie Hogan, ANP Raleigh Neurology Associates, PA A. Thomas Perkins, MD David Konanc, MD Eric Kirch, PA-C Gregory Bertics, MD Karen Riley, NP Katharine Kovacs, PA-C Keith Hull, MD Kelly Pate, NP Kenneth Carnes, MD Michael Bowman, MD Patricia Naslund, MD Pavan Yerramsetty, MD Rhonda Gabr, MD S. Mitchell Freedman, MD Scott Binford, PA-C Susan Glenn, MD Theresa Behil, NP Wanda Cecil, NP William Ferrell, MD
Raleigh Neurosurgical Clinic Robin Koeleveld, MD Raleigh Ophthalmology & Surgical Eye Associates Timothy Jordan, MD Raleigh Orthopaedic Clinic Bradley K. Vaughn, MD Cara B. Siegel, MD Carroll D. Kratzer, MD Daniel J. Albright, MD David W. Boone, MD Dwayne E. Patterson, MD G. Hadley Callaway, MD Harrison Gray Tuttle, MD Jeffrey K. Kobs, MD John B. Chiavetta, MD Joseph U. Barker, MD Keith P. Mankin, MD Kevin Logel, MD Leonard D. Nelson, Jr., MD Lyman S.W. Smith, MD Mark R. Mikles, MD Matthew T. Boes, MD Neil C. Vining, MD Robert T. Wyker, MD Scott M. Wein, MD Wallace F. Andrew, MD William M. Isbell, MD
Kirk D. Peterson, MD Laura O. Thomas, MD Mark H. Knelson, MD Michael C. Hollingshead, MD Neil A. Ramquist, MD Satish Mathan, MD Steven R. Carter, MD Svati Singla Long, MD Todd J. Roth, MD Tracey E. O’Connell, MD W. Kent Davis, MD Rex Heart & Vascular George Adams, MD James G. Jollis, MD, FACC Sameh K. Mobarek, M.D., F.A.C.C. Deepak Pasi, MD, F.R.C.P., F.A.C.C., F.S.C.A.I., F.A.A.C. Mohit Pasi, MD, F.A.C.C., F.S.C.A.I. Bruce Usher Jr., MD, F.A.C.C. Ben Walker, MD James Zidar, MD F.A.C.C, F.S.C.A.I.
Rex Hematology Oncology Associates Marie Carr, PA Ashley Bragg, PA Clare Bremer, PA Denise Pescaro, NP Jeremiah Boles, MD Nirav Dhruva, MD Maha Elkordy, MD Erin Adcock, PA Jeffrey Crane, MD JoEllen Speca, MD Lola Olajide, MD Susan Moore, MD Beverly Neely, NP Robert Wehbie, MD Rex Pathology Associates F. Catrina Reading, MD John D. Benson, MD John P. Sorge, MD Keith V. Nance, MD Preeti P. Parekh, MD Keith Volmar, MD Timothy R. Carter, MD Vincent C. Smith, MD
Raleigh Pathology Labs Raleigh Plastic Surgery Glenn Lyle, MD Rhett High, MD Raleigh Radiology Andrew B. Weber, MD Andrew G. Moran, MD Cynthia S. Payne, MD Donald G. Detweiler, MD Gintaras E. Degesys, MD Gregory A. Bortoff, MD Gregory C. Hinn, MD Jason R. Harris, MD Jeffrey Browne, MD Jennifer S. Van Vickle, MD Jerry L. Watson, MD John G. Alley, Jr., MD Joshua B. Mitchell, MD Juilia K. Taber, MD
[continued on page 14]
WAKE COUNTY PHYSICIAN | 13
Rex Surgical Specialists Dustin M. Bermudez, MD Tricia A. Burns, P.A.-C. Woodward Cannon, MD, F.A.C.S. Richard A. Chiulli, M , F.A.C.S. Joel B. Dragelin, M , F.A.C.S. David B. Eddleman, MD , F.A.C.S. Kirk B. Faust, M , F.A.C.S. Rachel Goble, D.O. Thomas W. Maddox, MD, F.A.C.S. Peter M. Milano, MD, F.A.C.S. Peter C. Ng, MD, F.A.C.S. Paul B. Park, MD Yale D. Podnos, MD, F.A.C.S. David C. Powell, MD, F.A.C.S., R.P.V.I. Lindsey S. Sharp, MD David, A. Smith, MD Jerry A. Stirman, MD, F.A.C.S. Matthew J. Strouch MD Daniel R. Vig, MD, F.A.C.S. Seth M. Weinreb, MD, F.A.C.S. Rex/UNC Radiation Oncology Catherine Lee, MD Charles W. Scarantino
14 | JULY 2014
Justin Wu, MD Lawrence Marks, MD Leroy Hoffman, MD Robert Ornitz, MD Roger F. Anderson, MD Richard D. Adelman, MD Richard D. Adelman, MD Donna Griffith Kathleen Janus, FNP Southern Eye Associates Jerome Magolan, MD Philip Martin, MD Taylor Retinal Center Jeffrey Taylor, MD J. Carey Pate, MD Nitin Gupta, MD The Raleigh Eye Center Alice Lin, MD Holly P. Johnson, MD James W. Kiley, MD R. Jeffrey Board, MD
Triangle Radiation Oncology Triangle Orthopaedic Associates, PA Brett J. Gilbert, MD David B. Musante, MD Elliot Kopp, MD (rheum) Eugenia F. Zimmerman, MD Joseph B. Wilson, MD Kurt J. Ehlert, MD Mark A. Burt, MD Paul J. Kemer, MD Perico N. Arcedo, DO Shepherd F. Rosenblum, MD Tony Ning, MD (rheum) William D. Hage, MD William P. Silver, MD Wake Endoscopy Center Chris Schwarz, MD Michael Battaglino, MD Monica Manzi, PA-C Neeraj Sachdeva, MD Ronald Schwarz, MD Subhash Gumber, MD Tracy Jones, PA-C Wake Gatroenterology Bulent Ender, MD Wake Nephrology Associates, PA Karn Gupta, MD Mark Rothman, MD Michael Casey, MD Michael Monahan, MD Phillip Timmons, MD Sammy Moghazi, MD Samsher Sonawane, MD Sejan Patel, MD William Fan, MD Wake Opthalmology Associates Robert Stone, Jr., MD Christopher Rusinek, MD Wake Radiology Consultants, PA Wake Radiology Diagnostic Imaging, Inc. Wake Radiology Oncology Services Alan B. Fein, MD Andrew C. Wu, MD Brent Townsend, MD Bryan M. Peters, MD Carmello Gullotto, MD Carroll C. Overton, MD Catherine Lerner, MD
Charles V. Pope, MD Claire M. Poyet, MD Danielle L. Wellman, MD David Ling, MD David Schulz, MD Dennis M. O’Donnell, MD Duncan Rougier-Chapman, MD Eithne T. Burke, MD Elizabeth A. Rush, MD G. Glenn Coates MS, MD Holly J. Burge, MD Imre Gaal, Jr., MD J. Mark Spargo, MD Jared B. Bowns, MD John Matzko, MD John Sierra, MD Joseph B. Cornett, MD Joseph W. Melamed, MD Karen A. Coates, MD Kerry E. Chandler, MD Laura Meyer, MD Louis F. Poscillico, MD Lyndon K. Jordan, III, MD Margaret R. Douglas, MD Mark Marchand, MD Martin Rans Douglas, MD Michael D. Kwong, MD Michael L. Ross, MD Nikunj P. Wasudev, MD Paul A. Haugan, MD Peter L. Leuchtmann, MD Phillip C. Pretter, MD Phillip R. Saba, MD R. David Mintz, MD Randy D. Secrist, MD Richard E. Bird, MD Richard J. Max, MD Robert E. Schaaf, MD Russell C. Wilson, MD Sendhil K. Cheran, MD Steven R. Mills, MD Susan L. Kennedy, MD Thomas L. Presson, Jr., MD William G. Way, Jr., MD William James Vanarthos, MD William T. Djang, MD Williams, Benavides, Marston & Kaminski, MD, PA Randall Williams, MD
WAKE COUNTY PHYSICIAN | 15
[A Collaborative Community Approach continue...]
homelessness, and chronic pain and works to connect patients to primary care and behavioral health services as well as reduce emergency department visits and hospital admissions. Through the program Project Access, CCC also links uninsured patients with donated specialty and diagnostic care. Advanced Practice Paramedic (APP) programs have been a viable concept in North Carolina and in several areas of the country. The Wake County APP program has been in existence since 2009 and has been a leader in the state in this model of care. Similar models have been developed or are being developed in New Hanover, McDowell, Guilford, Durham, Cumberland, and Johnston Counties. APPs have an enhanced level of training beyond that of basic paramedics. In Wake County, APPs attend an in-house education program consisting of more than 200 didactic hours, 128 clinical hours, and on-going clinical education. Due to their advanced training, APPs can provide a range of services to patients with a variety of physical and behavioral health conditions. APPs have the ability to address a patient’s needs in their home or, if appropriate, can transport them to the most appropriate level and consistent site of care. APPs can respond to emergencies when needed (cardiac arrest, multiple patient incidents, etc.) and can perform minor medical procedures, laboratory services, and immunizations. In addition, APPs can complete injury risk assessments and referrals, home safety assessments, falls prevention and assessment, and social evaluations. They can provide assistance in hospital discharge follow16 | JULY 2014
up, chronic disease care, medication compliance and administration. They can facilitate hospice coordination and prevent revocation and EMS utilization for terminal patients. In addition, they can perform mental health assessments including medical clearance to prevent unnecessary ED use, incorporate Crisis Intervention Teams as needed, administer naloxone, and redirect care for people with mental health or substance abuse crises to facilities other than emergency departments. Currently, the Wake County EMS System uses 14 specially trained APPS and 2 APP supervisors who supplement the critical care response and serve as in-field resources to direct and coordinate the most appropriate care to patients. Up to 5 APP response units operate at the busiest times of the day. There is a growing recognition that patientcentered care needs a whole-person orientation and patients, particularly those with the most complex health conditions and high health care service utilization, may have a wide range of physical health, behavioral health, socio-economic needs. Gaps in coordination of services for complex patients can lead to high-risk situations and poor health outcomes, but can be lessened by strengthening the collaboration between community-based health care professionals. The collaboration between the multi-disciplinary care management teams of CCWJC and CCC and the Wake County APPs is an example of this type of collaboration. The care management teams of CCWJC and CCC utilize data
and analytics to identify and prioritize the target population, serve the holistic, educational, and self-care needs of the patient and families, and make links to and coordinate needed medical care and community services. The APPs deliver rapid in-home, hands-on assessment and care and can respond to after-hours and urgent needs. Further, the APPs are able to intervene and immediate address unforeseen gaps in post-discharge plans that are identified by care managers. For example, the APPs have been able to address glucometer malfunctions or gaps in medication availability RB is a 13 year old boy who had very poorly controlled insulindependent diabetes. In one year, the child was hospitalized 4 times for extended periods and had utilized the emergency room 6 times for uncontrolled diabetes and diabetic ketoacidosis. The child had been discharged from several physician practices due to non compliance and would go extended lengths of time without seeing a physician or using his insulin. The CCWJC care manager and pharmacist provided home and school visits for in-depth educational sessions, referrals to many community resources, and extensive follow up and communication with the patient, family, primary care provider, specialist, and all organizations involved in the patient’s care. The APPs completed home visits to monitor and assist with glucose checks and insulin doses and to reinforce the importance of disease management and control with the child and family. The patient became well linked with a primary care provider and specialist, had improved compliance with medications, improved health outcomes, decreased hospital admissions and emergency department use, and improved psychosocial status.
that occurred after-hours and during holiday times. A specific area of focus has been patients with behavioral health, substance misuse and abuse, and chronic pain issues often with multiple emergency department (ED) visits and hospitalizations. The teams meet on a regular basis with local ED representatives to develop a plan of care on shared patients. These collaborative meetings include identifying high risk patients, assessing barriers to appropriate care, and solidifying a comprehensive approach to patient care management. These meetings also allow for bi-directional referrals, planning of joint home visits, and the development of a standardized care plan on patients with frequent ED and EMS utilization and those that are at a high risk for unintentional overdose. This collaborative effort was derived from the basic tenets of Project Lazarus, a community and state-wide response to addressing chronic pain management and the epidemic of prescription pain medication use, overuse, and unintentional deaths. As part of this collaboration, a data sharing arrangement has been developed between the agencies to improve patient care, assure quality, and reduce costs. The data sharing agreement has allowed the APPs access to the CCNC Informatics Center which contains patient level data on utilization history, medication history, laboratory data, primary care and specialist providers. Through this shared data system, outreach and interventions with patients is documented and shared between the CCWJC/CCC care managers and the APPs. In addition, complex patients, common to each program,
have detailed care plans that include elements such as appropriate interventions for chronic conditions, flags for high risk physical health or behavioral health conditions, high cost health care utilization patterns, and a “destination plan” that designates one medical facility within Wake County where the patient will be transported, if transported by EMS. A consistent Emergency Department destination is a way to increase continuity of care, knowledge of the patient’s past treatments and medications, and patient safety. We are building on our success and have begun work on a collaborative approach to transitional care for Congestive Heart Failure (CHF) patients. CCWJC CHF Care Managers identify patients’ needs based on both acuity and hospital readmission risk. For those who need a high level of immediate, in-home, hands-on service, an APP referral is made. The APPs can meet the patient at the hospital, complete a home visit the day of discharge to review discharge instructions, complete a medication reconciliation, check vitals, and provide necessary disease education. This timely follow up serves as a bridge to service and allows for seamless transition in patient management with a joint follow up home visit between the APP and a CCWJC Care Manager. The CCWJC Care Manager can then do ongoing comprehensive care management with the patient. Recent work with a patient illustrates this new element of our collaboration. CW is a medically fragile patient with CHF and a history of multiple hospital readmissions. Through work with the patient, the CCWJC care manager
learned that the patient was experiencing episodes of confusion in the evening, which was contributing to her medication non-adherence and threatening her overall patient safety. The Wake APPs were contacted to provide enhanced in-home assessment and support. An initial home visit was made and details of the visit were communicated back to CCWJC through our shared documentation system. The next day, as a plan of care was being jointly developed, a call was dispatched through EMS requesting a response to this patient’s residence. The same APP was able to respond to the call and assist with the transport. Although it was determined that the patient’s condition did warrant a hospital admission, the increased knowledge the APP had about this patient’s health history helped to inform hospital personnel and influenced the course of treatment and subsequent disposition planning for this patient. As a result of this collaboration, a robust discharge plan was formulated that involved multiple agencies, including the APPs, the Primary Care Provider, CCWJC, and Home Health. This collaboration has been instrumental in assuring accurate information is being communicated across all the agencies involved and a comprehensive patient plan of care is being utilized by all of the patient’s care providers. Our collaboration on this patient and others continues to evolve and enhance as we draw upon the strengths and expertise from both organizations with the overall goal of improving patient care and outcomes, decreasing ED and hospital utilization, and decreasing health care costs. §
WAKE COUNTY PHYSICIAN | 17
[Important Drug Update continued]
increase appetite with expected weight gain, insomnia, nasopharyngitis, somnolence, nausea and vomiting occurred in at least 10% of trial participants. Providers should consider several important risks associated with aripiprazole. Despite its tolerability, aripiprazole is not without risks. Currently, it shares a black box warning with other antipsychotic agents as well as antidepressant agents. Additionally, it is associated with an increased risk of obesity, dyslipidemia, and hyperglycemia. Both first and second generation antipsychotic agents are associated with a small, but increased risk of death in elderly patients with dementia. The risk of dying while taking an antipsychotic agent is 1.6-1.7 times higher than it is while taking a placebo. Most of this mortality data is derived from studies of second generation antipsychotic agents. In a 2007 follow-up study by Gill and associates, first generation antipsychotic agents were associated with an increased risk for death in older dementia patients when compared to second-generation antipsychotic agents. Most deaths were linked to cardiovascular or infectious causes. An increased risk of cerebrovascular accidents in the elderly has been described. At the other end of the spectrum, aripiprazole, as an adjunctive treatment for depression, must carry the black box warning for antidepressant agents. The warning indicates that there may be an increase in the risk of suicidal thoughts and behaviors in children, adolescents, and young adults (18-24 years of age). There continues to be growing attention toward the effects of this warning on the treatment and management of depression in youth. A decrease in suicidality in patients over 65 years of age has been shown and was included as part of the black box warning. Compared to other second generation antipsychotic agents, like clozapine and olanzapine, aripiprazole is associated with fewer metabolic side effects (obesity, dyslipidemia, and hyperglycemia). Metabolic syndrome can be defined as a group of risk factors that occur together and can increase the risk of 18 | JULY 2014
cardiovascular disease, stroke, and diabetes. Metabolic syndrome is associated with increased morbidity and mortality so monitoring for any of
Risk Factors for Metabolic Syndrome in US Adults (3 out of 5 risk factors)
Risk Factor Increased waist circumference Increased triglycerides Decreased HDL Increased blood pressure Increased fasting glucose
Defining Level Men>40 inches Women>35 inches ≥ 150 mg/dL Men < 40 mg/dL Women <50 mg/dL ≥ 130/85 mm Hg ≥ 110 mg/dL*
100mg/dL by the American Diabetes Association
its known risk factors is necessary. At baseline, clinicians should make it a point to record relevant patient and family history, weight, BMI, waist circumference, and blood pressure. Fasting plasma glucose and a lipid profile should be obtained as close to baseline as possible. If any conditions are identified, treatment can be instituted. While the patient remains on aripiprazole, follow-up monitoring should be performed. The patient’s weight/BMI can be assessed at each office visit. Labs for blood glucose and lipids can be repeated annually or more frequently if clinically indicated.
Abilify® was the 14th most prescribed drug of 2013 with 8,964,479 prescriptions. It was number one for sales, with revenue approaching $6.4 billion dollars. There are currently no generic products available for Abilify®. Abilify® is scheduled to go off patent sometime in 2015. When comparing costs, Abilify® (regular release tablets) is the most expensive drug to NC Medicaid. Abilify® cost totaled $65 million or
5.3% of all drug costs in SFY 2013. The 2mg, 5mg, 10mg, and 15mg tablets cost the same at $26.77 per tablet. The cost per tablet of the 20mg and 30mg products are $37.85 . Abilify® is typically dosed once daily, but has been used on a twice daily basis. When given twice daily, the cost of Abilify® doubles.
Cost of Abilify® with twice daily dosing versus once daily dosing
Regimen A Total Daily Prescription Dose 10 mg 5mg po BID 15 mg 5mg po QAM and 10mg QHS 15 mg One 5mg table QAM and two 5mg tablets QHS 20 mg 10mg po BID 30 mg 15mg po BID
Regimen B
Cost per Month
Prescription
Cost per Month
$1,606 $1,606
10mg po Qday 15mg po Qday
$803 $803
$2,409
15mg po Qday
$803
$1,606 $1,606
20mg po Qday 30mg po Qday
$1,136 $1,136
Given the length of the half-life and drug cost, once daily dosing is preferrable. If it is necessary to have a patient take Abilify® twice daily, a higher strength tablet can be cut in half. Conclusions Aripiprazole is a drug with unique pharmacological activity that is used for several psychiatric disorders. Providers should consider several safety concerns such as extrapyramidal symptoms, metabolic effects, and costs when prescribing aripiprazole or when working with a patient who is prescribed aripiprazole by another provider. References
Aripiprazole indications and pharmacology. Online. factsandcomparisons.com. Accessed June 20, 2014. Croxtall JD. Aripiprazole: a review of its use in the management of schizophrenia in adults. CNS Drugs. 2012 Feb 1; 26(2): 155-83. Gill SS, Bronskill SE, Normand ST, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007; 146: 775-786. Khanna P, Suo T, Komossa K, et al. Aripiprazole versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2014 Jan 2; 1: CD006569. doi:
10.1002/14651858.CD006569.pub5. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. http://www.fda.gov/NewsEvents/Newsroom/ PressAnnouncements/2007/ucm108905.htm. Accessed June 21 2014. McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schiz Res. 2005. 80: 19– 32. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004; 27: 596– 601. National Institutes of Health. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel 3). Bethesda, MD: National Institutes of Health. 2001.
Top 100 selling drugs of 2013. http://www. medscape.com/viewarticle/820011. Accessed June 21, 2014. WAKE COUNTY PHYSICIAN | 19
Was Oedipus Mad? By L. Jarrett Barnhill, MD
I
n Greek drama, Oedipus has moments in which he is Sophocles’ most pitiable hero-protagonist. He seems to be suffering for events that he could not control. The deeper message for Greek audiences involved the down side of trying to escape one’s fate. For Oedipus his attempt to escape a prophecy puts him on a collision course with tragedy. The tragic backstory begins with a prophecy to King Laius of Thebes that his infant son will kill him. The king strikes pre-emptively by wounding Oedipus and exposing him on a mountain side. As in many hero myths, Oedipus survives, is rescued and eventually adopted by the king and queen of Corinth. As a young man, a stranger casually reveals that he is not the son of Polybus, King of Corinth. Confused Oedipus consults the Oracle to learn “who he is”. Unfortunately the Oracle provides him a symmetrical prophecy: he will kill his father and marry is mother. Horrified and confused, Oedipus flees Corinth. On the way to Thebes he confronts an old man at a place where 3 roads meet. A battle of wills develops over who will yield. The two impetuous, arrogant men fight and Oedipus kills the old man without any knowledge of his identity. Unfortunately, his victim was his biological father Laius. Still “blind” to this reality Oedipus proceeds to Thebes where he confronts the Sphinx, solves her riddle, marries the recently widowed queen and fathers 4 children. The play begins in the middle as his happily-ever-after scenario collapses amid a terrible
plague. There is a second riddle for Oedipus- what is the source of this calamity. Stumped, Oedipus sets in motion his own downfall. He consults the Oracle who delivers an ambiguous message: the murderer of Laius is living in Thebes and contaminating the city. The perpetrator must be destroyed to end the plague. Still uncertain he sends for the blind seer, Tiresias. Once in Thebes, Tiresias is cajoled, threatened and slandered by Oedipus to reveal what he knows. After intense crossexamination Tiresias provides a stabbing truth: Oedipus is the source of the contamination. Of course, Oedipus still sees himself as the son of Polybus, king of Corinth; his wife is the widow of Laius, not his own mother; and his children are his, not his half- siblings. He spends most of the play trying to solve a third riddle- his identity. Answering this riddle leads to chaos, drives Oedipus to blind himself and flee the Furies. Sophocles assigns Oedipus several irreconcilable conflictsa sure cause of madness in early Greek dramas. His attempts to avoid fate is perhaps analogous to modern day attempts to deny his genes and engage in high risk behaviors (bio-psychosocial risk factors). The first Oracle presented Oedipus with another inescapable and unresolvable conflict- if he stays in Corinth he will be a murderer; if he runs, he denies his duty to his adoptive family (he unaware of this) and polis. He flees Corinth but unknowingly fulfills the prophecy by killing his biological father, the king of Thebes. His third challenge
involves the limits of reason and reliance upon rhetorical skills (Sophist) to solve the riddle of the plague. As his presumed identity crumbles reason proves inadequate. Apollo gives way to the passions of Dionysius (madness and loss of self) and with it, the veneer of civilization. His sense of self as an individual is swept away by events. Intent is not relevant in this courtroom. Something else is on trial. Like the blind Tiresias, the blinded Oedipus can now see what he could not. The unconscious expression of this tragedy/myth is foundational to psychoanalysis. Freud borrowed the title character and used his tragedy to create his model of psychosexual development and a theory of neurosis. Freud re-interpreted Oedipus’ metaphorical blindness as castration. The metaphor may go deeper. In our psychologically obsessed literature we understand that his lack of insight (blindness in spite of vision) as both a cause and a later consequence of the unconscious. Blinding himself is a horrifying selfpunishment but Freud adds another layer. Leaving this conflict unresolved and banished to the unconscious is a source of future suffering. Through psychoanalysis can he gain insight or free up our psychological vision. The differences between hiding from one’s fate and Freud’s theories of neuroses are culture-bound phenomena. Significant differences in motivation, cause, effect and consequences separate Freud from Sophocles. To Freud blindness is both punishment and the result of unresolved
conflict leads to neurosis. For Sophocles it is a metaphor for a painful metamorphosis and new vision that allows one to go on with living. It is interesting to compare Oedipus with Freud. Freud was a Viennese neurologist who developed theories of infantile sexuality to explain neuroses. Yet his theories and techniques were not accepted with open arms by the deeply Catholic Viennese. His explanation of hysteria (his sphinx in the riddle of the unconscious) challenged existing beliefs and taboos and the backlash became his plague. He murdered traditional views of reason and self-control as a dominant force in human behavior (father/ Apollonian) and married a psychological model based on the repressed unconscious (mother/Dionysian). His social conflict led to a symbolic, professional castration. But his new vision and ideas (like Oedipus’ blindness) changed western intellectual history. In short, Freud might fit in well as a modern Sophoclean hero. So was Oedipus mad or did his struggle to escape fate and act of blinding himself mark the turning point between the senses, reason and the intelligible? Was Oedipus and by extension Sophocles a precursor to man escaping Plato’s metaphorical cave only to be blinded by his vision of a different reality. If so Freud and Oedipus were kindred spirits. In our next play, identity, blindness and madness take on cosmic proportions. We explore Shakespeare’s, King Lear. §
WAKE COUNTY PHYSICIAN | 21
The Wake County Medical Society (WCMS) is a 501 (c) 6 nonprofit organization that serves the licensed physicians and physician assistants of Wake County. Chartered in 1903 by the North Carolina Medical Society.
CURRENT PROGRAMS Project Access - A physician-led volunteer medical specialty service program for the poor, uninsured men, women, and children of Wake County. Community Care of Wake and Johnston Counties CCWJC has created private and public partnerships to improve performance with disease management initiatives such as asthma and diabetes for ACCESS Medicaid recipients. CapitalCare Collaborative - The CCC program is a membership of safety net providers working corroboratively to develop initiatives to improve the health of the regionâ&#x20AC;&#x2122;s medically underserved such as asthma and diabetes for Medicaid and Medicare recipients.
Become a Member of Wake County Medical Society and help support the indigent care and community service programs of the Society. WHY JOIN
BENEFITS OF MEMBERSHIP
Membership in the Wake County Medical Society is one of the most important and effective ways for physicians, collectively, to be part of the solution to our many health care challenges. A strong, vibrant Society will always have the ear of legislators because they respect the fact that doctors are uniquely qualified to help form health policies that work as intended. Itâ&#x20AC;&#x2122;s heartening to know the vast majority of Wake County physicians, more than 700 to date, have chosen to become members of the Wake County Medical Society.
HOW TO JOIN To become a member of the Wake County Medical Society contact Deborah Earp, Membership Manager at dearp@ wakedocs.org or by phone at 919.792.3644 A portion of your dues supports to the volunteer and service programs of WCMS. Membership is also available for PAâ&#x20AC;&#x2122;s. There is even an opportunity for your spouse to get involved by joining the Wake County Medical Society Alliance.
WCMS MISSION To serve and represent the interests of our physicians; to promote the health of all people in Wake County; and to uphold the highest ethical practice of medicine.
Service Programs - The spirit of volunteerism is strong in Wake County. Hundreds of local physicians volunteer to help our indigent. The Society coordinates several programs that allow low income individuals access to volunteer doctors and to special case management services for children with diabetes, sickle cell anemia or asthma. Publications - Members receive the peerreviewed The Wake County Physician Magazine four times a year, and we keep you informed regularly via pertinent emails. The magazine focuses on local health care issues in Wake County, the Wake County Medical Society and the WCMS Alliance, a companion organization composed of physician spouses and significant others. Socializing with your physician colleagues - Many physicians feel too busy to do anything except work long hours caring for patients. But, the WCMS provides an opportunity for physicians to nourish relationships through social interaction with one another at our dinner meetings featuring prominent speakers and at other events. Finally, joining the WCMS is plain and simple the right thing to do - Physicians and the community benefit from our membership and our leadership in local affairs.
JOIN TODAY!
Are you interested in becoming a Wake County Medical Society member? Simply visit our website at www.wakedocs.org and complete the online application or contact us by phone at 919.792.3644.
A portion of your dues joining the Wake County contributes to the volunteer Medical Society Alliance. and service programs of WCMS. Membership is also available for PAâ&#x20AC;&#x2122;s. There is even an opportunity for your spouse to get involved by
JOIN TODAY!