Spring 2019 by California Academy of Family Physicians

VO L . 70 N O. 2 S p r i n g 201 9

A FAMILY PHYSICIAN FOR ALL SEASONS An Interview With Your New President Walt Mills, MD, MBA

in this issue: THE INTERSECTION OF HOUSING AND HEALTH

NOT ALL HEROES WEAR CAPESâ&#x20AC;¦ SOME WEAR DOCTORSâ&#x20AC;&#x2122; COATS Your priority is protecting your patients. Our priority is protecting you. )RU PRUH WKDQ \HDUV WKH &RRSHUDWLYH RI $PHULFDQ 3K\VLFLDQV ,QF &$3 KDV SURYLGHG RXU SK\VLFLDQ PHPEHUV ZLWK VXSHULRU PHGLFDO PDOSUDFWLFH FRYHUDJH 2XU PLVVLRQ LV WR KHOS LQGHSHQGHQW &DOLIRUQLD SK\VLFLDQV GHOLYHU WKH EHVW FDUH SRVVLEOH ZKLOH UHDOL]LQJ SHUVRQDO DQG SURIHVVLRQDO VXFFHVV Sarah E. Pacini, JD &KLHI ([HFXWLYH 2IÃ&#x20AC;FHU

&$3 PHPEHUV DOVR UHFHLYH SURDFWLYH ULVN PDQDJHPHQW VHUYLFHV LQ KRXVH OHJDO DQG FODLPV VXSSRUW SUDFWLFH PDQDJHPHQW UHVRXUFHV DQG VR PXFK PRUH )LQG RXW ZKDW PDNHV &$3 GLIIHUHQW

CAPphysicians.com 800-252-7706

0HGLFDO SURIHVVLRQDO OLDELOLW\ FRYHUDJH LV SURYLGHG WR &$3 PHPEHUV E\ WKH 0XWXDO 3URWHFWLRQ 7UXVW 037 DQ XQLQFRUSRUDWHG LQWHULQGHPQLW\ DUUDQJHPHQW RUJDQL]HG XQGHU 6HFWLRQ RI WKH &DOLIRUQLD ,QVXUDQFH &RGH

ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board President tĂůƚĞƌ DŝůůƐ͕ D ͕ D Immediate Past President Lisa M. Ward, MD, MScPH, MS President-elect ĂǀŝĚ ĂǌǌŽ͕ D Speaker Shannon Connolly, MD Vice-Speaker Lauren Simon, MD, MPH Secretary/Treasurer ZĂƵů ǇĂůĂ͕ D Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD ĂƌŽů ,ĂǀĞŶƐ͕ D AAFP Alternates Jay W. Lee, MD, MPH Lee Ralph, MD CMA Delegation ƐŚďǇ tŽůĨĞ͕ D ͕ DW ͕ DW, ; ŚĂŝƌͿ Mark Dressner, MD Sumana Reddy, MD <ĞǀŝŶ ZŽƐƐŝ͕ D Lauren Simon, MD, MPH &Ğůŝǆ EƵŶĞǌ͕ D ͕ DW,

Staff Lisa Folberg, MPP

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

ůŝǌĂďĞƚŚ >ƵŬƌŝĐŚ

Manager, Communications and Social Media elukrich@familydocs.org

Josh Lunsford

Director, Membership and Marketing jlunsford@familydocs.org

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

Looking for a job? Go to www.fpjobsonline.com YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ ǇŽƵ͘

Jonathan Rudolph

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.

pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com EDITION 30

California Family Physician Spring 2019

California

Spring 2019

FAMILY PHYSICIAN st ron g

me d i ci ne

f o r

C al i f o r nia

zŽƵƌ ϮϬϭϵͲϮϬϮϬ ŽĸĐĞƌƐ͘

features 14 An Interview With Your New President, Walt Mills, MD, MBA 17 Making a Difference for Patients and Family Physicians at AMAM!

Adam Francis

19 CAFP Honors Five Outstanding Members 22 Five Years and Counting: A Look at CAFP’s Landmark PCMH Pilot 26 CAFP Foundation Talking about Immigration Policy Issues: What Is “ICE”?

Conrad Amenta Shelly B. Rodrigues, CAE

28 Exploring the Intersection of Health Care and Housing

Sheryl Recinos, MD

departments 6

Editorial

Making Government See The Big Picture in Health

President’s Message

Homelessness is a First Step to Health

10 Political Pulse

Brent Sugimoto, MD Lisa M. Ward, MD, MScPH, MS

Retaking the “Family” In Family Medicine

Carla Kakutani, MD

12 In The News 30 CEO Message

Make It Work

Lisa Folberg, MPP

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

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Making Government See The Big Picture in Health You have probably seen them on your commute: the tents. ^ŽŵĞƟŵĞƐ ŽŶĞ Žƌ ƚǁŽ ƉŽƉƐ ŽĨ ĐŚĞĞƌǇ ǇĞůůŽǁ Žƌ ŽƌĂŶŐĞ ƐƉƌŝŶŐ ƵƉ ŽŶ ƚŚĞ ƌŽĂĚƐŝĚĞ͕ ƐŝĚĞǁĂůŬƐ Žƌ ƉƵďůŝĐ ŐƌĞĞŶ ƐƉĂĐĞ ŝŶ ǇŽƵƌ ƚŽǁŶ͘ Where I live, villages of tents pack the underpasses, and since even this prime real estate is in short supply, I see tents planted in the ůĂŶĚƐĐĂƉĞĚ ŐŽƌĞƐ ďĞƚǁĞĞŶ ƐĞǀĞƌĂů ůĂŶĞƐ ŽĨ ŚŝŐŚͲƐƉĞĞĚ ĨƌĞĞǁĂǇ ŽŶ either side, islands of humanity in the most precarious places. It is Ă ŵĂŶŝĨĞƐƚĂƟŽŶ ŽĨ Ă ŐƌĞĂƚ ƉƵďůŝĐ ƉŽůŝĐǇ ĨĂŝůƵƌĞ ƌĞŶĚĞƌĞĚ ŝŶ ďƌŝŐŚƚůǇ ĐŽůŽƌĞĚ ŶǇůŽŶ ƚŚĂƚ ƐŚŽƵůĚ ďĞ ƐŚŽĐŬŝŶŐ͕ ǇĞƚ ƐŽŵĞŚŽǁ ŚĂƐ ƐƚĂƌƚĞĚ ƚŽ feel like one of the symbols of Californian life. Most visibly urban, but increasingly rural, homelessness is a profound public health issue in our state. Consider this: Californians ĂĐĐŽƵŶƚ ĨŽƌ ĂďŽƵƚ ŽŶĞͲĞŝŐŚƚŚ ŽĨ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ͛ ƉŽƉƵůĂƟŽŶ͕ BUT, one in four homeless individuals come from our state — ŚŽŵĞůĞƐƐŶĞƐƐ ǁĂůŬƐ ŝŶƚŽ ŽƵƌ ĐůŝŶŝĐƐ ĞĂĐŚ ĂŶĚ ĞǀĞƌǇ ĚĂǇ͘ Homelessness comes in many forms. I once cared for a pregnant, single mother and her young daughter. The daughter, giggly and ĂůǁĂǇƐ ŶĞĂƚůǇ ĚƌĞƐƐĞĚ ĂŶĚ ŝŶ ƉŝŐƚĂŝůƐ͕ ǁĂƐ ŚĞĂůƚŚǇ͘ dŚĞ ŵŽƚŚĞƌ ŚĂĚ ƐĞǀĞƌĞ ŝƌŽŶ ĚĞĮĐŝĞŶĐǇ ĂŶĞŵŝĂ͘ &ŽŽĚ ĨŽƌ ŚĞƌ ĚĂƵŐŚƚĞƌ ǁĂƐ ŶŽŶͲ ŶĞŐŽƟĂďůĞ͕ ƐŽ ƐŚĞ ǁĂƐ ůĞŌ ƚŽ ĐŚŽŽƐĞ ĂŵŽŶŐ ŶŽƵƌŝƐŚŝŶŐ ŚĞƌ ƉƌĞŐŶĂŶƚ ƐĞůĨ͕ ŬĞĞƉŝŶŐ ƵƉ ŽŶ ƌĞŶƚ Ăƚ ŚĞƌ ƌĞƐŝĚĞŶƟĂů ŵŽƚĞů Žƌ ĐŽƵĐŚͲƐƵƌĮŶŐ ǁŝƚŚ ƌĞůĂƟǀĞƐ͘ Considering that inadequate health care contributes only 10 percent to the risk of premature death and genes only 30 percent, our ďŝŐŐĞƐƚ ŝŵƉĂĐƚ ĐŽŵĞƐ ĨƌŽŵ ĂĚĚƌĞƐƐŝŶŐ ƚŚĞ ƌĞƐƚ ;^ĐŚƌŽĞĚĞƌ͕ ϮϬϬϳͿ͘ Indeed, the American Academy of Family Physicians considers understanding the social determinants of health a core competency ďĞĐĂƵƐĞ ǁŝƚŚŽƵƚ ŝƚ͕ ͞ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ƉĂƟĞŶƚƐ ĂůŝŬĞ ǁŝůů ďĞ ŝŵƉĞĚĞĚ ďǇ ƐƵďŽƉƟŵĂů ŽƵƚĐŽŵĞƐ͘͟ DǇ ƉĂƟĞŶƚ ƚŽŽŬ Ă ŚĞĂůƚŚǇ ďĂďǇ ďŽǇ from the hospital to her own ŚŽŵĞ ƚŚĂŶŬƐ ƚŽ ĐůŝŶŝĐ ƐƚĂī ǁŚŽ ŐŽƚ her referred to resources in our county. Her pregnancy had a good outcome because my health system could address an issue ͞ƵŶƌĞůĂƚĞĚ͟ ƚŽ ŚĞĂůƚŚ͘ ůƐŽ ͞ƵŶƌĞůĂƚĞĚ͟ ƚŽ ŵǇ ƉĂƟĞŶƚ͛Ɛ ŚĞĂůƚŚ ǁĞƌĞ ƉŽůŝĐŝĞƐ ƚŚĂƚ ůĞĚ ƚŽ Ă ĐŽŶƐƚƌĂŝŶĞĚ ŚŽƵƐŝŶŐ ƐƵƉƉůǇ ĂŶĚ Ă ůĂĐŬ ŽĨ ĂīŽƌĚĂďůĞ ĚĂǇĐĂƌĞ ƚŚĂƚ ůŝŵŝƚĞĚ ŚĞƌ ŝŶĐŽŵĞ ƉŽƚĞŶƟĂů ĂƐ Ă ƐŝŶŐůĞ ƉĂƌĞŶƚ͘ KƵƌ ƉĂƟĞŶƚƐ͛ ŚĞĂůƚŚ ŝƐ ƌĞŐƵůĂƌůǇ ĚŝĐƚĂƚĞĚ ďǇ ƉŽůŝĐŝĞƐ ƐĞĞŵŝŶŐůǇ ƵŶƌĞůĂƚĞĚ ƚŽ ǁĞůůͲďĞŝŶŐ͕ ǁŚĞƚŚĞƌ ŝƚ ďĞ ŚŽƵƐŝŶŐ ƐƵƉƉůǇ͕ ĞĚƵĐĂƟŽŶ ƌĞƐŽƵƌĐĞ ĚĞĐŝƐŝŽŶƐ͕ ĚĞƚĞƌŵŝŶŝŶŐ ǁŚĞƌĞ Ă ďƵƐ ůŝŶĞ ƐŚŽƵůĚ ƌƵŶ Žƌ 6

California Family Physician Spring 2019

ǌŽŶŝŶŐ ŶĞŝŐŚďŽƌŚŽŽĚƐ ƚŽ ĞŶĐŽƵƌĂŐĞ Ă ƉŚǇƐŝĐĂůůǇ ĂĐƟǀĞ ĐŽŵŵƵŶŝƚǇ͘ ,ĞĂůƚŚ ŝŶƚĞƌĂĐƚƐ ǁŝƚŚ ĞǀĞƌǇ ĨĂĐĞƚ ŽĨ ŚƵŵĂŶ ůŝĨĞ͕ ĂŶĚ ƚŚƵƐ ŚĞĂůƚŚǇ ƉŽůŝĐǇ ƌĞƋƵŝƌĞƐ ĂŶ ŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌǇ ĂƉƉƌŽĂĐŚ ŬŶŽǁŶ ĂƐ ŚĞĂůƚŚ ŝŶ Ăůů ƉŽůŝĐŝĞƐ ;,ŝ WͿ͘ ,ŝ W ŝƐ Ă ƐƚƌĂƚĞŐǇ ƚŽ ŝŶƚĞŐƌĂƚĞ ĐŽŶƐŝĚĞƌĂƟŽŶ ŽĨ ŚŽǁ ĂŶǇ ƉŽůŝĐǇ ǁŽƵůĚ ĂīĞĐƚ ŚĞĂůƚŚ ĞƋƵŝƚǇ ĂŶĚ ƚŚĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ͕ ĞŵďĞĚĚŝŶŐ ƐƵĐŚ ĐŽŶƐŝĚĞƌĂƟŽŶƐ ŝŶƚŽ ƚŚĞ ĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐ processes in every area of policy making. /Ŷ ĂůŝĨŽƌŶŝĂ͕ ,ŝ W ǁĂƐ ŝŶƐƟƚƵƚĞĚ ǁŚĞŶ ǆĞĐƵƟǀĞ KƌĚĞƌ ^ͲϬϰͲϭϬ ŝŶ ϮϬϭϬ ĨŽƵŶĚĞĚ ƚŚĞ ,ĞĂůƚŚ ŝŶ ůů WŽůŝĐŝĞƐ dĂƐŬĨŽƌĐĞ͕ Ă ƉĂƌƚŶĞƌƐŚŝƉ of the California Department of Public Health, the Public Health /ŶƐƟƚƵƚĞ ĂŶĚ ƚŚĞ ^ƚƌĂƚĞŐŝĐ 'ƌŽǁƚŚ ŽƵŶĐŝů͘ dŚŝƐ ƚĂƐŬĨŽƌĐĞ ďƌŽƵŐŚƚ ƚŽŐĞƚŚĞƌ ϮϮ ĚĞƉĂƌƚŵĞŶƚƐ͕ ĂŐĞŶĐŝĞƐ͕ ĂŶĚ ŽĸĐĞƐ ĨƌŽŵ ĂĐƌŽƐƐ ^ƚĂƚĞ 'ŽǀĞƌŶŵĞŶƚ ƚŽ ŝŶĐŽƌƉŽƌĂƚĞ ŚĞĂůƚŚ͕ ĞƋƵŝƚǇ ĂŶĚ ƐƵƐƚĂŝŶĂďŝůŝƚǇ ĐŽŶƐŝĚĞƌĂƟŽŶƐ ŝŶƚŽ ĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐ ĂĐƌŽƐƐ ƐĞĐƚŽƌƐ ĂŶĚ ƉŽůŝĐǇ ĂƌĞĂƐ͘ ,ŽǁĞǀĞƌ͕ ĂƐ ƚŚŝƐ ƉƌŽŐƌĞƐƐŝǀĞ ĂƉƉƌŽĂĐŚ ƚŽ ƉŽůŝĐǇŵĂŬŝŶŐ ŝƐ ŶŽƚ ĐŽĚŝĮĞĚ ŝŶ ůĂǁ͕ ƚŚĞ ƉĞƌŵĂŶĞŶĐĞ ŽĨ ƚŚŝƐ ƐƚƌĂƚĞŐǇ ŝŶ ŽƵƌ ƐƚĂƚĞ ŝƐ not assured. Assemblymember Richard Bloom* sought to make ƚŚŝƐ ƚĂƐŬĨŽƌĐĞ ƉĞƌŵĂŶĞŶƚ ŝŶ ƚŚĞ ϮϬϭϴ ƐĞƐƐŝŽŶ ƚŚƌŽƵŐŚ Ϯϰϯϰ͘ hŶĨŽƌƚƵŶĂƚĞůǇ͕ ƚŚŝƐ ďŝůů ĚŝĞĚ ŝŶ ĐŽŵŵŝƩĞĞ ŝŶ ƚŚĞ ^ĞŶĂƚĞ͘ dŽ ƐĞĞ ƚŚĞ ƌĞǀŝǀĂů ŽĨ ƚŚŝƐ ďŝůů ǁŽƵůĚ ĨĂĐŝůŝƚĂƚĞ ƚŚĞ ǁŽƌŬ ǁĞ ĚŽ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ / ŚŽƉĞ ƚŽ ƐĞĞ ŝƚ ĂƐ Ă ůĞŐŝƐůĂƟǀĞ ƉƌŝŽƌŝƚǇ ŝŶ ƚŚŝƐ Žƌ ĨƵƚƵƌĞ sessions of our Legislature. Imagine government being required ƚŽ ƚŚŝŶŬ ĂďŽƵƚ ƚŚĞ ŚĞĂůƚŚ ŝŵƉůŝĐĂƟŽŶƐ ĨŽƌ ĞǀĞƌǇ ƉŽůŝĐǇ ŝƚ ŵĂŬĞƐ͘ /ŵĂŐŝŶĞ ŐŽǀĞƌŶŵĞŶƚ ĐŽŵƉƌĞŚĞŶĚŝŶŐ ƚŚĂƚ ĂŶǇ ƉŽůŝĐǇ ŝŵƉĂĐƟŶŐ ƚŚĞ ĚĞĐŝƐŝŽŶƐ͕ ƐĂĨĞƚǇ͕ ĞŶǀŝƌŽŶŵĞŶƚ͕ ĞĚƵĐĂƟŽŶĂů ŽƉƉŽƌƚƵŶŝƟĞƐ ĂŶĚ ĮŶĂŶĐŝĂů ƐĞĐƵƌŝƚǇ ŽĨ ŝƚƐ ĐŽŶƐƟƚƵĞŶƚƐ ĂīĞĐƚƐ ƚŚĞŝƌ ǀĞƌǇ ŚĞĂůƚŚ͘ /ŵĂŐŝŶĞ ŐŽǀĞƌŶŵĞŶƚ ĂĐƟŶŐ Ă ůŝƩůĞ ŵŽƌĞ ůŝŬĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ References 1.

Ϯ͘

Social Determinants of Health Policy. American Academy of &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬƐŽĐŝĂůͲ ĚĞƚĞƌŵŝŶĂŶƚƐ͘Śƚŵů͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘ ^ĐŚƌŽĞĚĞƌ͕ ^ ͘ tĞ ĂŶ Ž ĞƩĞƌ Ͷ /ŵƉƌŽǀŝŶŐ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ WĞŽƉůĞ͘ E ŶŐů : DĞĚ ϮϬϬϳ͖ ϯϱϳ͗ϭϮϮϭͲϭϮϮϴ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ ŶĞũŵ͘ŽƌŐͬĚŽŝͬĨƵůůͬϭϬ͘ϭϬϱϲͬE :DƐĂϬϳϯϯϱϬ͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘ ϮϬϭϴ , Z͗ WĂƌƚ ϭ Ͳ W/d ƐƟŵĂƚĞƐ ŽĨ ,ŽŵĞůĞƐƐŶĞƐƐ ŝŶ ƚŚĞ h͘^͘ DĂƌĐŚ ϮϬϭϴ͘ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ŽƵƐŝŶŐ Θ hƌďĂŶ ĞǀĞůŽƉŵĞŶƚ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ ŚƵĚĞǆĐŚĂŶŐĞ͘ŝŶĨŽͬƌĞƐŽƵƌĐĞͬϱϳϴϯͬϮϬϭϴͲĂŚĂƌͲƉĂƌƚͲϭͲƉŝƚͲĞƐƟŵĂƚĞƐͲŽĨͲ ŚŽŵĞůĞƐƐŶĞƐƐͲŝŶͲƚŚĞͲƵƐͬ͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘

* Assemblymember Bloom is the brother of CAFP member Stuart Bloom.

p r e s i d e n t ’s m e s s a g e

Lisa Ward, MD, MsPH, MS, FAAFP Chief Medical Officer Santa Rosa Community Health

Homefulness is a First Step to Health When a firestorm burned through Santa Rosa in Sonoma County in October 2017, more than 5,000 homes were destroyed – about 10 percent of its housing stock. At the time of the fires, the vacancy rate stood at 1 percent for homes and at 3.5 percent for rentals.1 By all measures, the pre-fire housing market was already tight. The fires made a bad situation nearly impossible. So, where would our community members go?

“

health and housing needs. While the results have not been formally released, public health staff have conceded that this household, in-person survey represents a skewed sample. The survey likely missed homeless people who don’t have houses to survey and underrepresents people working and not at home during the day. Nonetheless, the results are startling. The rate of depression and anxiety among those surveyed doubled to 37 percent; one in four with a preexisting respiratory illness reported their chronic respiratory conditions had worsened; 44 percent reported trauma related to disruption in their household, separation from family, destruction of their home, or firerelated injury. Yet more than 50 percent of those surveyed reported periods of time without access to their primary care provider and to their regular pharmacy.

Whether one is homeless because of a fire, the result of poverty, the chaos of living with severe mental illness or due to limitations from chronic medical disease, being homeless makes matters worse.

A year after the fires, the Sonoma County Department of Health completed a needs assessment of health, mental

California Family Physician Spring 2019

“

A different kind of homelessness struck Santa Rosa that fall. When our Vista Family Health Center burned, about 25,000 patients found themselves medically homeless. They lost their primary care medical home and their known family physician. Since the fires, our Federally Qualified Health Center has lost about 6 percent – more than 4,500 – of its patients. Most patients who left are among the uninsured and those insured with Medi-Cal. They represent those least able to afford rising rents and mortgages, and least likely to have the savings needed to move to a new home in the aftermath of the fires. We have had too many good-bye visits with longtime patients who have found homes in nearby towns and far-away towns where housing is more affordable. Other patients have simply disappeared.

Now this may be stating the obvious, but I will do it anyway: “Studies have shown that being homeless is detrimental to one’s health.”2 What may be less obvious is that “selected housing interventions for low-income people have been found to improve health care outcomes and to reduce health care costs.”2 This is evidence-based medicine. Of all the social determinants of health, the reduction in homelessness is the most powerful influence on improved health outcomes and reduced health costs.

Many promising interventions include public-private partnerships, bond measures, increased investment in shelters and transitional housing, and even direct ĞǆƉĞŶĚŝƚƵƌĞƐ ďǇ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ĞŶƚŝƚŝĞƐ͘ Non-profit organizations and philanthropic groups have funded Housing First initiatives or permanent transitional housing for the chronically homeless. Many Housing First initiatives connect individuals and families to permanent ŚŽƵƐŝŶŐ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŽƚŚĞƌǁŝƐĞ ĞǆĐůƵĚŝŶŐ ĐŽŶĚŝƚŝŽŶƐ ƐƵĐŚ ĂƐ substance use, mental illness or service requirements. ^ŽŵĞ ŚŽƉĞĨƵů ĞǆĂŵƉůĞƐ ŝŶĐůƵĚĞ Ă ^ĂŶ &ƌĂŶĐŝƐĐŽ ďƵƐŝŶĞƐƐ ƚĂǆ ŵĞĂƐƵƌĞ ƚŚĂƚ ƉĂƐƐĞĚ ŝŶ EŽǀĞŵďĞƌ ϮϬϭϴ͘ dŚĞ ŵĞĂƐƵƌĞ is estimated to raise $300 million for increased shelter beds and mental health services for homeless people. In Oregon, ǁŚĞŶ ƚŚĞ ŚĞĂůƚŚ ƐǇƐƚĞŵ ŝŶǀĞƐƚĞĚ ŝŶ ŚŽƵƐŝŶŐ ƐƵƉƉŽƌƚ ĨŽƌ ŶĞĂƌůǇ ϭϬ͕ϬϬϬ ƉĞŽƉůĞ ǁŝƚŚ ƵŶƐƚĂďůĞ ŚŽƵƐŝŶŐ͕ ƚŚĞ ƉƌŽǀŝƐŝŽŶ ŽĨ ĂĨĨŽƌĚĂďůĞ ŚŽƵƐŝŶŐ ĚĞĐƌĞĂƐĞĚ DĞĚŝĐĂŝĚ ĞǆƉĞŶĚŝƚƵƌĞƐ ďǇ ϭϮ ƉĞƌĐĞŶƚ͘ ƚ ƚŚĞ ƐĂŵĞ ƚŝŵĞ͕ ŽƵƚƉĂƚŝĞŶƚ ƉƌŝŵĂƌǇ ĐĂƌĞ ƵƐĞ ŝŶĐƌĞĂƐĞĚ ďǇ ϮϬ ƉĞƌĐĞŶƚ ĂŶĚ ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚ ƵƐĞ ĚĞĐůŝŶĞĚ ďǇ ϭϴй ĨŽƌ ƚŚĞ ŶĞǁůǇ ŚŽƵƐĞĚ͘3 DǇ ŽǁŶ ƌĞŐŝŽŶĂů DĞĚŝͲ Ăů ŝŶƐƵƌĞƌ ŝŶǀĞƐƚĞĚ ŵŽƌĞ ƚŚĂŶ Ψϰ ŵŝůůŝŽŶ ĚŝƌĞĐƚůǇ ŝŶ

ŚŽƵƐŝŶŐ ĂƐ Ă ƉŝůŽƚ ƉƌŽũĞĐƚ ŝŶ ϮϬϭϴ ƚŽ ƉƌŽǀŝĚĞ ŚŽƵƐŝŶŐ ĨŽƌ fragile patients after hospitalization. Whether one is homeless because of a fire, the result of ƉŽǀĞƌƚǇ͕ ƚŚĞ ĐŚĂŽƐ ŽĨ ůŝǀŝŶŐ ǁŝƚŚ ƐĞǀĞƌĞ ŵĞŶƚĂů ŝůůŶĞƐƐ or due to limitations from chronic medical disease, ďĞŝŶŐ ŚŽŵĞůĞƐƐ ŵĂŬĞƐ ŵĂƚƚĞƌƐ ǁŽƌƐĞ͘ /Ŷ ƉĂƌƚ͕ ŵĞĚŝĐĂů homelessness disrupts access to a trusted primary care physician, access to medications and use of mental health services accessed through one’s primary care medical home. HomeFULness is the path to health for the 130,000 ĂůŝĨŽƌŶŝĂŶƐ ǁŚŽ ůŝǀĞ ŽŶ ƚŚĞ ƐƚƌĞĞƚƐ ĞĂĐŚ ĚĂǇ͘ dŚĞ ĐŽƐƚƐ ŽĨ ĨƵŶĚŝŶŐ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ĨŽƌ ŚŽƵƐŝŶŐ ĂƌĞ ƐƵďƐƚĂŶƚŝĂů͖ ƚŚĞ payoffs are priceless. References: 1.

ĐĐĞƐƐĞĚ ϯͬϭϱͬϮϬϭϵ͘ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ŚƵĚƵƐĞƌ͘ŐŽǀͬƉŽƌƚĂůͬ ƉƵďůŝĐĂƚŝŽŶƐͬƉĚĨͬ ^ĂŶƚĂZŽƐĂ ͲĐŽŵƉͲϭϳ͘ƉĚĨ͘ Ϯ͘ ͞,ŽŵĞůĞƐƐŶĞƐƐ ĂŶĚ ,ĞĂůƚŚ ĂƌĞ͗ tŚĂƚ ŝƐ ďĞŝŶŐ ĨƵŶĚĞĚ͍͟ ,ĞĂůƚŚ ĨĨĂŝƌƐ͘ &ĞďƌƵĂƌǇ ϮϬϭϵ ;ϯϴ͗ϮͿ ƉĂŐĞ ϯϮϰ͘ 3. ͞,ŽƵƐŝŶŐ ĂŶĚ ,ĞĂůƚŚ͗ Ŷ KǀĞƌǀŝĞǁ ŽĨ dŚĞ >ŝƚĞƌĂƚƵƌĞ͕ ͞ ,ĞĂůƚŚ ĨĨĂŝƌƐ ,ĞĂůƚŚ WŽůŝĐǇ ƌŝĞĨ͕ :ƵŶĞ ϳ͕ ϮϬϭϴ͘

California Family Physician Spring 2019

Carla Kakutani, MD

political pulse

Chair, CAFP Legislative Affairs Committee

Retaking the “Family” In Family Medicine Ǉ ŶŽǁ / ŚŽƉĞ ŵĂŶǇ ŽĨ ǇŽƵ ŚĂǀĞ ŚĞĂƌĚ ĂďŽƵƚ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů ĨŽƌ ƚŚŝƐ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ ǁŚŝĐŚ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĂŶĚ ŵŝƐŝŶĨŽƌŵĞĚ ƌĞƐƚƌŝĐƟŽŶƐ ŽŶ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ƐƵƉƉŽƌƟŶŐ ƵƐ ŝŶ ƉƌĂĐƟĐŝŶŐ ƚŚĞ ĨƵůů ƐƉĞĐƚƌƵŵ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂƐ ǁĞ ǁĞƌĞ Ăůů ƚƌĂŝŶĞĚ ƚŽ ƉƌŽǀŝĚĞ͘ Ɛ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ŽƵƌ ĞǆƚĞŶƐŝǀĞ ĂŶĚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ƚƌĂŝŶŝŶŐ enables us to provide high quality primary care to EVERY member ŽĨ ƚŚĞ ĨĂŵŝůǇ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŐĞŶĚĞƌ͕ ĂŐĞ Žƌ ĂīĞĐƚĞĚ ŽƌŐĂŶ ƐǇƐƚĞŵ͕ ĨƌŽŵ ďŝƌƚŚ ƚŽ ĞŶĚͲŽĨͲůŝĨĞ͘ KǀĞƌ ƟŵĞ͕ ƌĞŐƵůĂƚŽƌƐ͕ ůĞŐŝƐůĂƚŽƌƐ͕ ŚĞĂůƚŚ ƐǇƐƚĞŵƐ ĂŶĚ ŽƚŚĞƌƐ ŚĂǀĞ ƌĞƐƚƌŝĐƚĞĚ ĂŶĚ ƵŶĚĞƌƵƐĞĚ ;ƵŶĚĞƌǀĂůƵĞĚͿ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ dŚŝƐ ůŝŵŝƚƐ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ͕ ƌĞƐƚƌŝĐƚƐ ƉĂƟĞŶƚ ĐŚŽŝĐĞ ĂŶĚ ĚŝƐƌƵƉƚƐ ĐŽŶƟŶƵŝƚǇ ĨŽƌ ŝŶĚŝǀŝĚƵĂůƐ ĂŶĚ ĨĂŵŝůŝĞƐ͘ ϭϲϮϮ ĂŵĞŶĚƐ ƐƚĂƚƵƚŽƌǇ ůĂŶŐƵĂŐĞ ƚŽ ŵŽƌĞ ĂĐĐƵƌĂƚĞůǇ ƌĞŇĞĐƚ ƚŚĞ ƚƌĂŝŶŝŶŐ ĂŶĚ ĞǆƉĞƌƟƐĞ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ (see infographic below)

California Family Physician Spring 2019

Family physicians are more likely to be located in communitybased practices, including rural and underserved areas, compared to all other specialties. The breadth and depth ŽĨ ŽƵƌ ƚƌĂŝŶŝŶŐ ĂůůŽǁƐ ƵƐ ƚŽ ĂĚĂƉƚ ŽƵƌ ƉƌĂĐƚŝĐĞƐ ƚŽ ŵĞĞƚ ƚŚĞ specific medical needs of our community. With the skills ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ĨĂŵŝůǇ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ encourages continuity of care, reducing health care costs and improves outcomes. Our advocacy docket for this year also includes: • Making PERMANENT the $33 million investment in the ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌǇ ĂƌĞ WŚǇƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ ;ǁŝƚŚŽƵƚ ĂĐƚŝŽŶ͕ ƚŚĞ ĨƵŶĚŝŶŐ ǁŝůů ĞŶĚ ŝŶ ϮϬϮϬͿ͘ • ŶƐƵƌŝŶŐ ƚŚĞ ŵŽƌĞ ƚŚĂŶ Ψϭ ďŝůůŝŽŶ ŝŶ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ;ƚŽďĂĐĐŽ ƚĂǆͿ ĂŶĚ ĨĞĚĞƌĂů ŵĂƚĐŚŝŶŐ ĨƵŶĚƐ ŐŽĞƐ ƚŽǁĂƌĚ improving access to care for vulnerable populations

• • • •

through Medi-Cal provider payment increases. Improving private payer financial support for primary care. Stabilizing and improving California’s health insurance coverage. Banning flavored tobacco so cigarette companies no longer target children. Reducing the consumption of ƐƵŐĂƌͲƐǁĞĞƚĞŶĞĚ ďĞǀĞƌĂŐĞƐ͕ ǁŚŝĐŚ ŚĂǀĞ ďĞĞŶ ƐƚƌŽŶŐůǇ ůŝŶŬĞĚ to an increase in obesity.

/Ĩ ǇŽƵ ǁŽƵůĚ ůŝŬĞ ƚŽ ũŽŝŶ ƵƐ ŝŶ ĂŶǇ ŽĨ ƚŚĞƐĞ efforts, please consider signing up to be a CAFP Key Contact or email CAFP’s ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƚŝŽŶƐ͕ ĚĂŵ &ƌĂŶĐŝƐ ;ĂĨƌĂŶĐŝƐΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͿ͘

California Family Physician Spring 2019

IN THE NEWS Spring 2019 &W ǁĂƐ ŵĞŶƚŝŽŶĞĚ ŝŶ Ă March 6, 2019 New Yorker article by Sue Halpren for its role as a co-plaintiff in a case against the Food and Drug Administration led by the American Civil Liberties Union. The CAFP Board of Directors approved ƚŚĞ &W ƌŽůĞ͕ ĂŶĚ ƚǁŽ &W ŵĞŵďĞƌƐ ŚĂǀĞ ĂĚĚĞĚ ƚŚĞŝƌ ŶĂŵĞƐ ƚŽ ƚŚĞ ĐĂƐĞ͘ /Ŷ ϮϬϭϳ͕ ƚŚĞ ŵĞƌŝĐĂŶ ŝǀŝů >ŝďĞƌƚŝĞƐ hŶŝŽŶ ƐƵĞĚ ƚŚĞ &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƚŝŽŶ ;& Ϳ ŽǀĞƌ the Mifepristone REMS on behalf of the California Academy ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ͖ ƚŚĞ ^ŽĐŝĞƚǇ ŽĨ &ĂŵŝůǇ WůĂŶŶŝŶŐ͖ WŚĂƌŵĂĐŝƐƚƐ͛ WůĂŶŶŝŶŐ ^ĞƌǀŝĐĞƐ͕ /ŶĐ͘ ĂŶĚ ƌ͘ 'ƌĂŚĂŵ ŚĞůŝƵƐ͕ ƚŚĞ ĐŚŝĞĨ ŽĨ ƐƚĂĨĨ Ăƚ <ĂƵĂŝ sĞƚĞƌĂŶƐ DĞŵŽƌŝĂů ,ŽƐƉŝƚĂů͕ ǁŚŽ ŝƐ ƚŚĞ ŶĂŵĞĚ ƉůĂŝŶƚŝĨĨ͘ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ŶĞǁǇŽƌŬĞƌ͘ĐŽŵͬƐĐŝĞŶĐĞͬ ĞůĞŵĞŶƚƐͬƚŚĞͲĐŚĂůůĞŶŐĞƐͲŽĨͲŝŶŶŽǀĂƚŝŶŐͲĂĐĐĞƐƐͲƚŽͲĂďŽƌƚŝŽŶ͘

Welcome to Josh Lunsford, CAFP’s New Director of Membership and Marketing Josh comes to us from the Oklahoma Center for Non-Profits ĂŶĚ ŚĂƐ ŐƌĞĂƚ ĞǆƉĞƌŝĞŶĐĞ ŝŶ membership marketing, recruitment and retention strategies and communications. He jumped right into the fire, attending the Family Medicine Clinical Forum in March, a ŵĞƌĞ ǁĞĞŬ ŝŶƚŽ ŚŝƐ ƌŽůĞ͘

CAFP is Sending a Full Delegation to the AAFP’s National Conference for Constituent Leaders Ɖƌŝů ϮϰͲϮϳ͘ >ĞĚ ďǇ ƐĞŶŝŽƌ ŵĞŵďĞƌ͕ >' d ĞůĞŐĂƚĞ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ ŽƵƌ ĐƌĞǁ ǁŝůů ďĞ ĚĞĂůŝŶŐ ǁŝƚŚ Ă ŵǇƌŝĂĚ ŽĨ ŝƐƐƵĞƐ͕ from reproductive rights and education to addressing ŝŵŵŝŐƌĂƚŝŽŶ ŝƐƐƵĞƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ǁĞůůŶĞƐƐ͘ KƵƌ ĚĞůĞŐĂƚŝŽŶ includes: Shani Muhammad, MD and Laura Murphy, DO, tŽŵĞŶ͛Ɛ ĐĂƵĐƵƐ͕ ƌĞŶƚ ĂŶĚ DŝĐŚĞůůĞ YƵŝŽŐƵĞ͕ D ͕ >' d ĐĂƵĐƵƐ͖ WŽͲzŝŶ ^ĂŵƵĞů ,ƵĂŶŐ ĂŶĚ :ŽƌŐĞ 'ĂůĚĂŵĞǌ͕ DŝŶŽƌŝƚǇ ĐĂƵĐƵƐ͖ DĂƌŐĂƌĞƚĞ ǌŝŶǁĂ͕ D ĂŶĚ ƌŝŬĂ ZŽƐŚĂŶƌĂǀĂŶ͕ /D' ĐĂƵĐƵƐ͖ ĂŶĚ ůĞǆ DĐ ŽŶĂůĚ ĂŶĚ ^ƵŵĞĚŚ DĂŶŬĂƌ͕ EĞǁ WŚǇƐŝĐŝĂŶƐ͘ ƌƐ͘ YƵŝŽŐƵĞ ĂŶĚ :ĂǇ >ĞĞ ǁŝůů ĂůƐŽ ďĞ ƐƉĞĂŬŝŶŐ Ăƚ the meeting. Shelly Rodrigues, CAE, staffs the delegation. CAFP’s president Walt Mills, President-elect David

California Family Physician Spring 2019

ĂǌǌŽ ĂŶĚ K >ŝƐĂ &ŽůďĞƌŐ͕ DWW͕ ǁŝůů ĂƚƚĞŶĚ ƚŚĞ ŶŶƵĂů Chapter Leaders Forum at the same time. Thanks to each for their service.

CAFP Heads to Kyoto, Japan &W ŚĂƐ ďĞĞŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ƚŚĞ tŽƌůĚ KƌŐĂŶŝǌĂƚŝŽŶ ŽĨ &ĂŵŝůǇ ŽĐƚŽƌƐ ;tKE Ϳ ĨŽƌ ƚŚĞ ƉĂƐƚ ĨŝǀĞ ǇĞĂƌƐ ŽŶ Ă ǀĂƌŝĞƚǇ of educational needs assessments and activities. The latest, ͞/ŵƉƌŽǀŝŶŐ KƵƌ ĂƌĞ ŽĨ WĂƚŝĞŶƚƐ ǁŝƚŚ ĞƉƌĞƐƐŝŽŶ ĂŶĚ ŶǆŝĞƚǇ͕͟ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ŝƐƐƵĞƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŝŶ ƚŚĞ ƐŝĂ WĂĐŝĨŝĐ ƌĞŐŝŽŶ ĂŶĚ :ĂƉĂŶ ĨĂĐĞ ǁŝƚŚ ƚŚĞŝƌ ƉĂƚŝĞŶƚƐ͘ :ĂǇ >ĞĞ͕ MD, MPH, CAFP past president is a member of the master faculty for this initiative and chairs the train-the-trainer ǁŽƌŬƐŚŽƉƐ ĨŽƌ ŽƵƌ ĐŽŵŵƵŶŝƚǇ ĨĂĐƵůƚǇ͘ dŚĞ ĨŝƌƐƚ ǁŽƌŬƐŚŽƉ͕ Ă ƉŝůŽƚ ǁŝƚŚ ĞŝŐŚƚ W ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ǁĂƐ ŚĞůĚ ůĂƐƚ KĐƚŽďĞƌ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ƚŚĞ tKE ^ĞŽƵů ŵĞĞƚŝŶŐ͘ dŚĞ ŶĞǆƚ ƐĞƚ ŽĨ ǁŽƌŬƐŚŽƉƐ͕ ŝŶ DĂǇ͕ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ƚŚĞ tKE ͕ <ǇŽƚŽ ŵĞĞƚŝŶŐ͕ ŝŶĐůƵĚĞƐ ƚǁŽ ŚĂůĨͲĚĂǇ ǁŽƌŬƐŚŽƉƐ ĨŽƌ ϭϰ W ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ Ă ŵŝƌƌŽƌĞĚ ƚǁŽ ĨŽƌ Japanese physicians. Other members of the master faculty ŝŶĐůƵĚĞ ŚƌŝƐ ŽǁƌŝĐŬ͕ >ŝǀĞƌƉŽŽů͕ h<͖ ZǇƵŬŝ <ĂƐƐĂŝ͕ :ĂƉĂŶ͖ :ŝůůŝĂŶ ĞŶƐŽŶ͕ ƵƐƚƌĂůŝĂ͖ ŝŶĚǇ >Ăŵ͕ ,ŽŶŐ <ŽŶŐ͖ ĂŶĚ ^ŚĞůůǇ Rodrigues, CAAFP staff. The community faculty members ǁŝůů ƚŚĞŶ ƚĂŬĞ ƚŚĞŝƌ ůĞĂƌŶŝŶŐƐ ƚŽ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ caregivers in their region.

Division of General Internal Medicine University of California San Francisco School of Medicine

2019 Essentials CME Summer Courses Essentials of Womenâ&#x20AC;&#x2122;s Health

An Integrated Approach to Primary Care and Office Gynecology

June 30 - July 5, 2019 Westin Hapuna Beach Resort Mauna Kea, Big Island, Hawaii

Essentials of Primary Care A Core Curriculum for Ambulatory Practice

August 4 - 9, 2019 Resort at Squaw Creek North Lake Tahoe, California

For more information, visit: www.cme.ucsf.edu

A Family Physician for All Seasons An Interview with Your New President,

Walt Mills, MD, MBA Why family medicine for you? / ĚŝŝƐĐ ƐĐŽǀ ŽǀĞƌ ǀĞƌƌĞĚ ĨĂŵ ŵŝůůǇ ŵĞĚŝĐŝŶĞ ŝŶ ϭϵϳϱ ĂƐ ĂĂ ĨŝƌƐƚͲǇĞ ǇĞĂƌ Ă ŵĞĚ ĞĚŝĐ ŝĐĂů Ă ƐƚƵĚ ƵĚ ĚĞŶ ĞŶƚƚ Ăƚ Ăƚ h ^ĂŶ Ŷ ŝĞŐŽ͘ / ƌĞĐĂůů ŵǇ ĞǆĐŝƚƚĞŵĞŶƚ ƚŚĂ ŚĂƚƚ ƚŚ ƚŚĞƌĞ ǁĂƐƐ ĂĐ Ɛ ĂĐƚƵ ƚƚƵ ƵĂĂůůůǇǇ ĂŶ ĂůůŽƉĂƚŚŝĐ ƐƉĞĐŝĂůƚǇ ƚŚĂƚ ǁ ǁĂƐ ͞ŚŽůŝƐƚŝĐ͕͟ ŽŶĞ ƚŚĂƚƚ ĂƉƉ ƉƉƌĞĐŝ ĞĐŝĂƚ ĂĂƚƚĞĚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĐĂƌŝŶŐ ĨŽƌ ƚŚĞ ǁŚŽůĞ ƉĞƌƌƐŽ ƌƐŽŶ͕ ŵŝŶĚ ŵŝŶĚ ŵŝ ŶĚͲď ŶĚͲď ďŽĚǇ ĂŶĚ ƐƉŝƌŝƚ͘ dŚŝƐ ǁĂƐ ƚŚĞ ŶĂ Ŷ ƚƵƌĂů ŽƵƚĨůŽǁ ĨƌƌŽŵ Žŵ ŵǇ ƉƌĞŵ ĞŵĞĚ ĞĚ ĞǆƉ ƉĞƌ Ğ ŝĞŶĐĞƐ Ăƚ EŽƚƌĞ ĂŵĞ͕͕ ǁŚ ǁŚĞƌ ĞƌĞ / ďĞŐĂŶ ƚƌĂŶ ƚƌ ĂŶ ŶƐĐ ƐĐĞŶ Ğ ĚĞŶƚĂů ŵĞĞĚŝƚĂƚŝŽ ŝŽŶ͕ Ŷ ǁŚŝĐŚ ůĞĚ ŵĞ ƚŽ ƐƚƵĚǇ ĚǇ ƚŚĞ ŚĞ ƐĐŝĞŶĐĞ of the min i d-body dy-s -spi p rit con nnection. While I loved bio iolo logy and science, I elected to mi sc mino nor in n theology. So, family med dic i ine has ĂůǁĂǇƐ ďĞĞŶ ĨƵŶĚĂŵĞŶ ŶƚĂ ƚ ů ďĞĐĐĂƵƐĞ ǁĞ ĂƌĞ ƚŚĞ ŵŽƐƚ ŐƌƌŽƵ ŽƵŶ ŶĚĞĚ Ě ƐƉĞĐŝĂůƚǇ ŝŶ ƚŚĞ ͞ďŝŽƉƐǇĐŚ ŚŽƐ ŽƐŽĐŝĂů ŵŽĚĞů͘͟ Who were the role models who inspired you to go into family medicine? DǇ ĨĂĂƚŚĞƌ ǁĂƐ ŵǇ ĞĂƌůŝĞƐƚ ƌŽůĞ ŵŽĚĞů͘ ,Ğ ǁĂƐ Ă ŐĞŶĞƌĂů ŝŶƚĞƌƌŶŝƐƚ ŝŶ ^ƵŶŶǇǀĂůĞ͘ / ƌĞĐĂůů ŵĂŬŝŶŐ ŚŽƐƉŝƚĂů ƌŽƵŶĚƐ ǁŝ ǁŝƚŚ ƚŚ Śŝŵ and d being struck by the sense that being a personal ph physician ǁĂƐƐ ƐƵĐŚ Ă ŶŽďůĞ ǁĂǇ ƚŽ ƐĞƌǀĞ ŽƚŚĞƌƐ͘ tŚŝůĞ / ͞ŬŶ ŬŶĞĞǁ͟ ďǇ ĞůĞŵ ŵĞŶƚĂƌǇ ƐĐŚŽŽů / ǁĂŶƚĞĚ ƚŽ ďĞ Ă ƉŚǇƐŝĐŝ Đ ĂŶ ĂŶ͕͕ Ăƚ ƚŝŵ ŝŵĞƐ ĞƐ ŝŶ ĞĂƌůǇ adolles e cence I thought I should become a prrie iest. Ironicalllly,, it ǁĂƐ &Ă &ĂƚŚĞƌ 'ůĂƐƐ͕ Ă ŵĞŶƚŽƌ ǁŚĞ ŚĞŶ Ŷ / ǁĂ ǁĂƐ Ă ƚĞĞĞŶ ĞŶĂŐĞƌ͕ ǁŚŽ ƚŽ ƚŽůĚ ŵĞ ŚĞ ƚŚ ƚ ŽƵŐŚƚ ŵǇ ĐĂůůŝŶŐ ŶŐ ǁĂƐ ĂĐƚƵĂůůǇ ŵĞĞĚŝ ĚŝĐŝ Đ ŶĞ͘ / ƐĞĞ ƚŚŽ ŚŽƐƐĞ elem emen ents t of sacred calling ng at times as a fam amiily physiciaan st stilll. tŚĂƚ ƉŝƋƵĞĚ ǇŽƵƌ ŝŶƚĞƌĞƐƚ ŝŶ ďĞĐŽŵŝŶŐ ĂĐƚŝǀĞ ǁŝƚŚ ǇŽƵƌ ĐŽƵŶƚǇ ĂŶĚ ƐƚĂƚĞ &W ĐŚĂƉƚĞƌƐ͍ / ĐŽŶŶĞĐƚĞĚ Ě ǁŝ ǁŝƚŚ ƚŚ ƚŚĞ ^ĂŶ ŝĞĞŐŽ ŐŽ ŚĂƉƚĞƌ ǁŚĞ ŚĞŶ Ŷ / ǁĂƐ ŝŶ ŵĞĚŝĐĂů school at UCSD SD. They hosted a dinner for med dic ical students … ǁŝƚŚ ĚĂŶĐŝŶŐ͘ // ǁĂƐ ƐŽ ŚĂƉƉǇ ƉǇ ƚŽ Ž ďĞ ď ĂŵŽŶŐƐƚ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƐĞĞŵĞĚ ƚŽ ͞ŐĞƚƚ ŝƚ͕͟ / ŬŶĞǁ ƚŚĞ Ś Ŷ ƚŚ ƚŚĂƚ ƚŚŝƐ ǁĂƐ ͞ŵǇ ƚƌŝďĞ͕͟ ͞ŵǇ ĨĂŵŝůǇ͘͟ >ĂƚĞƌ Ğƌ͕ ŝŶ ŝŶ ^ĂŶƚĂ ZŽƐƐĂ ǁŚĞŶ / ǁĂƐ K ŽĨ WƌŝŵĂƌǇ ĂƌĞ ƐƐŽĐŝĂƚĞƐ ŽĨ ƚŚ ƚŚĞĞ ZĞĚǁŽŽ ŽĚ ŵƉŝƌĞ͕ Ă ŵƵ ŵƵůƚ ůƚŝƐƉĞĐŝĂůƚǇ ƚǇ ŐƌŽ ƌŽƵƉ Ƶ Ž Ĩ ŵŽƐƚůǇ ŐƌĞĂƚ &WƐ WƐ ;ĂďŽƵƚ ϯ ϯϬ ŽĨ ƵƐ ƵƐ ŽƵƚ Ƶ ŽĨ ϳϬͿ͕ / ǁĂƐ ďůĞĞƐƐ ƐƐĞĚ Ğ ƚŽ ƉƌĂĐƚŝĐĞ ǁŝƚŚ Ž Ž 'ƌĞĂǀĞƐ ; &W &W W WƌĞ ƌĞƐŝ ƐŝĚĞ ĚĞŶƚ Ŷ ŝŶ ϮϬϬϲͿ ĂŶĚ DĂƌǇ Ŷƚ ƌ &ƌĂŶŬ ; &W W Wƌ WƌĞƐ Ğ ŝĚĞŶƚ ŝŶ ϭϵϵϮ Ϯ ĂŶ Ă Ě &W & WƌĞ ƌĞƐŝ Ɛ ĚĞ Ě Ŷƚ ŝŶ ϮϬϬϮ ϬϮͿ͕ Ϳ͕ ǁŚŽ Ž ďŽƚŚ Ś ĞŶĐ ŶĐŽƵƌĂŐĞĚ ŵǇ ŵǇ ĐĂĂĚĞ ĚĞŵ ŵǇ ĞŶŐ ŵǇ ŶŐĂŐ ĂŐĞŵ ĂŐ ĞŵĞŶ Ğŵ ĞŶƚ͘ Ŷƚ͘ / ŚĂ ŚĂǀǀĞ ĞŶũŽǇĞĚ Ă ƉƌŽ ƌŽŐƌĞƐƐŝǀĞĞ ŝŶǀŽůǀĞ ŽůǀĞŵĞ ŵĞŶƚ Ŷƚ ǁŝƚƚŚ &W &W ƚŚĞ Ś ƉĂƐ ĂƐƚ ƚ 15 years as my oth ther profess sssio ionaal re resp spon onsi sibi bililiiti ties es per ermitt t ed ed. DǇ ƚĞƌŵ ĂƐ ĂƐ ^ŽŶŽŵĂĂ ĐŚĂƉ ƉƚĞĞƌ ƌ Ɖƌ Ɖ ĞƐ ĞƐŝĚ ŝ ĞŶ ŝĚ ĞŶƚ͕ ƚ͕ ϮϬϬ ϬϬϲͲ ϲͲϮϬ ϮϬ ϬϭϮ ϭϮ ƚĂƵŐ ϭϮ͕ ƚĂ Ƶ Śƚ ŵĞ Ă ůŽƚ Žƚ͘ ƵƌƌŝŶ ŝŶŐŐ ƚŚ ƚŚĂƚ Ăƚ ƚŝŵ ŝŵĞ͕ Ğ͕ ǁĞ Őƌ ŐƌƌĞǁ ŽƵƌ ƌĞů Ğ Ăƚ ĂƚŝŽ ŝŽŶƐ ŶƐŚ ŶƐ ŚŝƉ ǁŝ Śŝ ǁŝƚŚ thee Santaa Ro Rosa s Faam mililyy Me Medi d ci cine nee Res esid iden ency cy,, es esta taabl blis ishe hed da ĐŚĂƉƚĞ ĐŚ ƚĞĞƌ ďŽ ďŽĂƌ ĂƌĚ Ě ŽĨ ŽĨ Ěŝƌ ŝƌĞĐ ĞĐƚŽ ĞĐ ƚŽƌƐ ƚŽ ƌƐ͕͕ Ă ĨŽ ĨŽƌŵ ƌŵĂů Ăů ďƵĚ ƵĚŐĞ ŐĞƚ ƚ ǁŝ ƚ ǁŝƚŚ ƚŚ ĚƵĞ ƵĞƐ͕ Ɛ͕ ĂŶĚ en nha hanc han nced our u mem embe ber ed educ ucat atio ion n an and d ad advo voca caacy pro rogr g am gr ms. s. I 14

California Family Physician Spring 2019

ůĞĂƌŶĞĚ Ă ůŽƚ Ăď ĂďŽƵƚ ŽƚŚĞƌ ĐŚĂƉƚĞƌƐ͕ ŵĞ ŵĞƌŐ ƌŐŝŶŐŐ ŝŶ ϮϬϭϭ ǁŝƚŚ ƚŚĞ Marin chapter to become the North h Ba Bayy Ch C apter, thanks in part to the lead adership of the then CAFP P Di Dist s rict Director, Iriinaa ĚĞ&ŝƐĐŚĞƌ ĂŶ ŶĚ WĂ WĂŶŶĂ >ŽƐƐǇ ǁŚŽ ƌĞŵĂŝŶƐ ƚŚ ƚŚĞ Ğ EŽ E ƌƚŚ ĂǇ Ś ŚĂƉ ĂƉƚĞ ƚ ƌ president, (my bias, but I believe … onee of our most dyn nam a ic ƐƚĂƚĞ ĐŚĂƉƚĞƌƐ͘Ϳ /Ɛ ŶŽǁ ƚŚĞ ďĞƐƚ ƚŝŵĞ ĞǀĞƌ ƚŽ ďĞ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ŝŶ ǇŽƵƌ estimation? 'ƌĞĂƚ ƋƵĞƐƚŝŽŶ ŽŶ͘͘ /ƚ /ƚ͛Ɛ ͛ Ă ŚĂƌĚ ƚŝŝŵĞĞ ĨŽƌ Žƌ ŵĂŶǇ͕ ǁŝƚŚ ŚŝŝŐŚ ŐŚĞƌ ƌĂƚĞƐ ŽĨ ďƵƌŶŽƵƚ ĂŶĚ ŚƵ ŚƵŐĞ ŐĞ ŵĞĚ ĞĚŝĐĂůů ƐĐŚ ĐŚŽŽů ĚĞďƚ͘ / ƚŚŝŶŬ ŝĨ ǁĞ ŐĞƚ ƚŽ ƚŚĞ system issues th that at obs bstr truc uctt many FPs from haaving sustainable jo oy in practice, truly this could be the best ti tim me to be a family

physiciaan. p n I do bel eliieve ve that for some, it is a good tiime, and tha h t th t e future could be evven betttteer. Fami mily ly physicians continue ƚŽ ďĞ ƚŚĞĞ ŵŽ ŵŽƐƚƚ ƐŽƵ ŽƵŐŚ Ő ƚͲ ƚͲĂĨƚĞƌ ƐƉĞĐŝĂůƚǇ͖ comp mpenssati tion o and ben e ef efits continue to ƌŝƐĞ ĨĂƐ Ă ƚĞĞƌ ƚŚ ƚŚĂŶ ĂŶ ŵŽƐ ŽƐƚƚ Žƚ Ž ŚĞ ŚĞƌ ƌ ƐƉĞĐŝĂůƚŝĞƐ͖ ƚĞĐŚŶŽ Ŷ ůŽŐǇ ŐǇ͕ ǁŚ ǁ ŝůŝůĞ ŽĨ ǁŚ ŽĨƚƚĞŶ Ŷ ĐŽŵƉůĂŝŶĞĚ abou ut, t actua uallllyy pr prom omis ises to make family mediccine more effective and interesting than eve v r. As an AA AFP Ressid iden ency Consultant, I also o get to vissit man any programs around th thee ĐŽƵŶƚƌǇ͘ ^Ğ ^ĞĞŝ ĞŝŶŐ ŶŐ ƚŚĞ ƚƌĞŵĞŶĚŽƵƐ Őƌ ŐƌŽǁ ŽǁƚŚ ƚŚ ŽĨ ƌĞƐŝĚĞŶ Ğ Đŝ ĐŝĞƐ Ğ ͕ ǁŚŝĐŚ ŚĂƐ ŐŽŶĞ ĨƌŽŵ ŵ ϰϬ ϰϬϬ Ϭ ƚŽ ϲϮϬ ŝŶ ƚŚ ƚŚĞĞ ƉĂ ƉĂƐƚƚ ĚĞĐĂĚĞ ŐŝǀĞƐ ŵĞ ŵĞ ŐƌĞĂƚ o timism op m. What are the most important challenges ĐŽŶĨƌŽŶƚŝŶŐ &W͍ Stayin ing relevant. Adapting to the changes in meembers’ diverse needs. What rural physic icians need in their first years of practicee is differ erent from a UC faculty, a senior med edic ical al director, large medical group or one in di dire rect patient care practice. What has been the best part of being an ŽĨĨŝĐĞƌ ŝŶ &W ƐŽ ĨĂƌ͍ Comradery, co ontinuous education in the dialogu uess our board has about the ƐƚĂƚĞ ŽĨ ĂĨĨ ĨĨĂŝƌƐ ĂŶĚ ůĞĂƌŶŝŶŐ ŚŽǁ ƚŽ ŵŽƌĞ Ğ skillfful ully ly advocate for health equityy an and d tĂůƚ͕ ĂŶĚ ŚŝƐ ǁŝĨĞ ůŝǌĂďĞƚŚ͕ ĂƌĞ ƐŶŽǁƐŚŽĞŝŶŐ ĨĂŶƐ͘ ƐŽĐŝ ƐŽ ĐŝĂĂů ũƵƐƚŝĐĞ͘ dŚĞ ůĂƚƚĞƌ ŚĂƐ ƐŚ ƐŚŽǁ ŽǁŶ Ŷ ŵĞĞ ƚŚĂƚ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ƉƌŝǀŝůĞŐĞ ǁĞ ŚĂ ŚĂǀĞ as physicians can be uniquelly ef e fective infl f uenc ncingg health How do you maintain what former President Jay Lee calls care policy that directly affe fect cts the qualit i y of the care our “the joy” of family medicine? patients receive. Th hat at’s eassy. I ra rarrely do anything that I don’t love doingg. t ĞŶ tŚ ĞŶ ǇŽƵ Ƶ ĨŝŶ ŝŶĚ Ě ͞ǁ ǁŽƌ ŽƌŬ͟ ǇŽƵ ůŽǀĞ ǇŽƵ ŶĞǀĞƌ ͞ǁŽƌŬ͟ ĂŶŽ ŽƚŚĞƌ How do you balance your family life … two grown kids, and da dayy of you ourr life fee — I’m m there. I get to teach residents and a new grandbaby on the way, a full-time practice, teaching me medi dica call st studen ents ts eve very ry day, see patients, do geriatric ic ĂŶĚ ǇŽƵƌ ǀŽůƵŶƚĞĞƌ ǁŽƌŬ ǁŝƚŚ &W͍ cons co nsul u ta tati tion o s, and mor ore. e. I’m trulyy bl bles e sed. In ad addi d ti tion on,, I ,ŽŶĞƐƚůǇ͕ /͛ŵ ŶŽƚ Ă Ă ŐŽ ŐŽŽĚ ŽĚ ĞǆĂŵƉůĞ͙ ďƵƚ / ĐŽŶƐƚĂŶƚůǇ ƐƚƌŝǀĞ Ğ ŵ Ěŝ ŵĞ ĚŝƚĂ ƚĂƚĞ ƚĞ ĨŽƌ ŽŶĞ ƚŽ ƚǁŽ ŚŽ Ś ƵƌƐ ĞĂĐŚ ĚĂǇǇ ĂŶĚ ĞǆĞ ǆ ƌĐĐŝƐ ŝƐĞ ŵŽ ŵŽƐƚƚ ĨŽƌ ŝƚ͘ / ŚĂǀĞ ƚĂƵŐŐŚƚ Ă ĨĂĐƵůƚǇ ĚĞǀĞůŽƉŵĞŶƚ ǁŽƌ ŽƌŬƐŚŽ ŽƉ͕ Ě ǇƐ ĚĂ ǇƐ͕ Ɖƌ ƉƌĂĐĐƚŝ ƚŝĐŝ ĐŝŶŐ ŶŐ Ă ƉƌĞƚƚǇ ŚĞ ŚĞĂůƚŚǇ ůŝĨĞƐƚǇůĞ ĂƐƐ ǁĞů Ğůůů ĂƐ ďĞŝŶŐ ͞&ŝŶĚŝŶŐŐ ĂůĂŶĐĞĞ ŝŶ Ă DĞĚŝĐĂů >ŝĨĞ͕͟ ͕͟ ŝŶƐ ŶƐƉŝ ƉŝƌĞ Ɖŝ ƌĞĚ Ě ďǇ Ă ŶŽǁ Žǁ mind mi ndfful of the afo forrement re tio ioned ball juggl g in ng pr prioriti t es. deceased e dea ear friend, Lee Lipsen e thal en thal (high ghly ly recom omme mend nd >ĞĞ͛Ɛ ďŽŽŬƐ ͞& ͞&ŝŶ ŝŶĚŝŶŐ ĂůĂŶĐĞĞ ŝŶ Ă DĞ DĞĚŝ Ě ĐĂů >ŝ >ŝĨĞ Ĩ ͟ ĂŶĚ ͞ ŶũŽǇ tŚĂƚ ĚŽ ǇŽƵ ƐĞĞ ĂƐ ƚŚĞ ďĞƐƚ ǁĂǇƐ &W ĐĂŶ ŚĞůƉ ŝƚƐ ǀĞƌǇ ^Ă ^ĂŶĚ ŶĚǁŝ ǁŝĐŚ͟Ϳ͘ tĞ ŵĞŶ ĞŶƚŝ ƚŝŝŽŶ Ž Ă ĨĂŵŽƵƐ ƋƵŽƚĞ͕ Ğ͕ ͞zŽ zŽƵ zŽ Ƶ ǁŝ ǁŝůů members maintain the joy? ƐŽŽŶ ƵŶĚ ŶĚĞƌ Ğ ƐƚĂŶĚ ƚŚĂƚƚ ǁŽƌ ŽƌŬŬ ŝƐ ŝƐ Ă ƌƵďďĞĞƌ ďĂ ďĂůůůůůů͘ /Ĩ ǇŽƵ ǇŽƵ Ěƌ ĚƌŽƉ ŽƉ Ɖ ŝƚ͕ ŝƚ ƚ CAFP is alreadyy do doin i g a lot. The March Cllin nic i al For o um had ǁŝůů ďŽƵ ŽƵŶĐĞ ďĂĐŬ͘ Ƶƚƚ ƚŚĞ Ś ŽƚŚĞƌ ĨŽƵƌ ďĂ ďĂůůůůƐƐ ʹ ĨĂ ďĂ Ĩ ŵŝ ŵŝůǇ ůǇ͕͕ ŚĞ ŚĞĂů ĂůƚŚ͕ ů ƐĞǀĞƌĂů ƐĞƐƐƐŝŽ ŝŽŶƐ ĂĚĚƌĞƐƐŝŶŐ ǁĞůůŶĞƐƐ ĂŶĚ ǁĞ͛ Ğ͛ůůů ĐŽŶƚŝŶƵĞ ƚŽ friend nds and spirit – aree mad de of glass. Iff you u dro rop p on onee of of ǁŽƌŬ ǁŝƚŚ ƚŚ ƚŚĞĞ &W ;ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬŵ ͬŵĞŵ ĞŵďĞƌƐŚŝƉͬ ƚŚĞƐĞ͕ ƚŚĞ ŚĞǇ Ǉ ǁŝůů ďĞ ŝƌƌĞǀŽĐĂ ĐĂďů ďůǇǇ ƐĐƵĨĨĨĞ ďů Ĩ Ě͕ Ě ŵĂĂƌƌŬĞ ŬĞĚ͕ Ě͕ ŶŝĐ ŝĐŬĞ ŬĞĚ͕ Ě͕͕ ďĞŶĞĨŝƚƐͬƉ ͬƉŚǇ Ś ƐŝĐŝĂŶͲŚĞĂůƚŚͲĨŝƌƐƚ͘ŚƚŵůͿ ƚŽ ĞŶŚ ŚĂŶĐĞ ĐĞ ƐƵƉƉŽƌƚ ĚĂŵĂŐĞĚ Ě Žƌ Žƌ ĞǀĞŶ ƐŚĂƚƚĞĞƌĞ ƌĞĚ͘ Ě͘ dŚ dŚĞǇ ǁŝůůů ŶĞĞǀĞ ǀĞƌƌ ďĞ ƚŚĞ ƐĂŵ ŵĞ͘ of our mem embe bers. Myy in inco comi ming president add d ress in You must st und nderstand that and strivee fo for ba bala lanc ncee in you o r M rch focused Ma d on our three-yyea earr st s rategic pl plan an – practice ůŝĨĞ͘͟ tran tr a sformation, payment reform an an nd pipelinee as they relate

California Family Physician Spring 2019

to addressing the need to improv ove jo joyy in practice. In the h end, this fourth aim of the Quadru uple Aim mayy be the he most important purpose for our Academy. Where will family medicine be in 10 years and what role will &W ŚĂǀĞ ƉůĂǇĞĚ ŝŶ ŝƚ͍ /Ĩ ŵǇ ĐĂƌ ĐĂŶ ŶŽǁ ĚƌŝǀĞ ŝƚ ŝƚƐƐĞůĨ͕ ĞǀĞŶ ďĞ ƐƵŵŵŽŶĞĚ ŽŶ ŵǇ ŝWŚŽŶĞ ĂƉƉ͕ ƚŚĞŶ / ĐĂŶ͛ƚ ͛ƚ ŝŵĂŐŝŶĞ ŚŽǁ ĨƵŶ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůǇ medici c ne leveraged by the augmentation age could be! I imag im agin inee handheld po oint of care ultrasound at the bedside, ǀŝĚĞŽͬĨĂĐĞĞƚŝŵĞ ƚŝŵĞ ǀŝƐŝƚƐ ǀŝƐŝƚƐƐ ƚŽ ƚŽ ƉĂƚŝĞŶƚƐ ƉĂƚŝĞŶƚƐ͛ ŚŽŵ ŚŽŵĞƐ ŽŵĞƐ ĞƐ͕͕ ŝŶƚĞ ĞƐ ŝ ƚĞ ŝŶ ƚĞƌĂ ĞƌĂĐƚŝǀĞ ƌ ĐƚŝǀĞ ƐĞƐƐŝŽŶƐ ƐĞƐƐŝŽŶƐ ǁŝƚŚ ƉĂƚŝĞŶƚƚƐ ƵƐŝŶŐ ĂĂƌƚŝĨŝĐŝĂů ŝŶƚĞůůŝŝŐĞ ŐĞŶ ŶĐĞ͕ ĂĚǀ Ě ĂŶ Ă ĐĞĚ Ě ŐĞ ŐĞŶŽ Ŷ ŵŝĐƐ͘ Ɛ ŝŶĨŽƌŵĂƚŝŽŶ ŽŶ ŝŶƚĞŐŐƌĂ ƌ ƚŝŽŶ ŵĂƚƵƌĞƐ ĞƐ ŝƚ ǁŝůů ďĞ ĂŵĂǌŝŶŐŐ ǁŚ ǁ Ăƚ FPs have at theeir fingger ertips, like ke point of care evidencee-ba b sed guidelines at th he bedssid idee orr ele lect c ronic records that aree as ƐĞĂŵůĞƐƐ ĂŶĚ ĞĨĨ Ĩ ŽƌƚůĞƐƐƐ Ğǆ ĞǆƚĞ ƚĞŶƐ Ŷ ŝŽŶƐ ŽĨ ŽƵƌƐĞůǀĞƐ ĂƐ ŵĂŶ ŶǇ ŽĨ ƚŚĞ ƐŵĂƌƚƉŚŽŶĞ ĂƉƉ ƉƐ ƚŚĂƚ ǁĞ ŶŽǁ ƚĂŬĞ ĨŽƌ ŐƌĂŶƚĞĚ͘

^ŽŶͲŝŶͲůĂǁ DĂǆ͕ ĚĂƵŐŚƚĞƌ sŝĐƚŽƌŝĂ͕ ůŝǌĂďĞƚŚ͕ ƐŽŶ ŚƌŝƐ ĂŶĚ tĂůƚ͕ ŽŶ Ă ŚŝŬĞ ďƌĞĂŬ͘

/ ƐĞĞ &W ƉůĂǇŝŶŐŐ ƚŚĞ ƌŽůĞ ŝƚ ĂůǁĂǇƐ ŚĂƐ͕ ƉƌŽǀŝĚŝŶŐ ŵĞŵďĞ ďĞƌƐ ƌƐ ǁŝƚŚ ƐƚĂƚĞͲŽĨͲƚŚĞͲĂƌ Ă ƚ Ɖƌ ƉƌŽĨ ŽĨĞƐ Ğ ƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ƚŽ ďĞƚƚĞƌƌ Ğ ďƌĂĐĞ ƚŚĞ ĨƵƚƵƌĞ͕ ĂĚǀŽĐĂ Ğŵ ĐĂƚŝŶŐ ǁŝƚŚ ŽƵƌ ůĂǁŵĂŬĞƌƐ ƚŽ ĞŶƐ ŶƐƵƌĞ th hat technology and innovati tions affecting FPs supports ts our u ŵĞĞŵď ŵ ĞƌƐ ĂŶĚ ĐůŽƐĞůǇ ĞŶŐĂŐŝ Ő ŶŐ ŶŐ ǁŝƚŚ ŵĞ ŵĞŵďĞƌƐ ƚŽ ŝŶǀĞŶ Ŷƚ ƚŚ ƚŚĞ best st possible future of family ly mediccin i e imaginable.

I want members to know I would treasure them reaching out to me and telling me how I can serve them, personally, as president.

&W ŽĂƌĚ ŚĂŝƌ DŝŬĞ DƵŶŐĞƌ͕ D ͕ ƐǁŽƌĞ tĂůƚ ŝŶƚŽ ŽĸĐĞ͘

What’s your message to the next generation of FPs – what will sustain them? /Ĩ ǇŽƵƌ ĐĂůůŝŶŐ ŝƐ ŝ ƚŽ ďĞ Ă ĨĂŵ Ă ŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ƚŚĞ ĨƵƚƵƌĞ ǁŝůů ďĞ bright. Learn and nd practic icee resiliency, learn and use performance i provementt sc im s ieence to ree engineer the systems that impair ǇŽ ŽƵƌ Ăďŝ ď ůŝŝƚǇ ƚŽ ƐƵƐƚĂŝŶ ũŽǇ Ǉ ŝŶ ƉƌĂĐƚŝĐĞ ĂŶĚ ƌĞĂĚ ƚŚĞ ďŽŽŬ ͞'ƌŝƚ͟ ďǇ ŶŐĞůĂ ƵĐŬǁŽƌƚŚ͊ &ŝŶĂůůǇ͕ ǁŚĂƚ ŽŶĞ ƚŚŝŶŐ ƐŚŽƵůĚ &W ŵĞŵďĞƌƐ ŬŶŽǁ ĂďŽƵƚ ǇŽƵ͍ / ǁĂŶƚ ŵĞŵ ŵďĞ ďĞƌƐ ƌƐ ƚŽ ŬŶ ŬŶŽǁ Ž / ǁŽƵ Ž ůĚ ƚƌĞĂƐƵƌĞ ƚŚĞŵ ƌĞĂĐŚŝŶŐ ŽƵ Ƶƚ ƚ ƚŽ ŵĞĞ ĂŶĚ ƚĞ ƚĞůůůůŝŶ ŝŶŐŐ ŵĞ ŚŽǁ ǁ / ĐĂŶ ƐĞƌǀĞ ƚŚĞŵ͕ ƉĞƌƐŽŶĂĂůůůůǇ͕ Ǉ͕ ĂĂƐƐ ƉƌĞĞƐŝ ƐŝĚ ĚĞŶƚƚ͘ ƉŚŽ ŚŽŶĞ ŶĞ ĐĂů Ă ů ;ĐĞĞůů ϳϬϳͲϰϵϰͲϬϬϳϬͿ͕ ƚĞǆƚ͕ ĞŵĂ ŵĂŝůŝů ;ŵ ŵŝůŝůůƐ ůƐǁΛ ǁΛŶĂĂƚŝ ƚŝǀŝ ǀŝĚĂ Ě Ě͘ĐŽ ŽŵͿ ĂŶǇƚŝ ƚŝŵĞ ŵ ŽĨ ƚŚĞ ĚĂǇͬŶŝŐŚƚͬǁĞĞŬ ĞŬĞŶĚ ŝƐ ǁĞůĐĐŽŵ ŵĞĚ ĞĚ͕ Ăď ĂďŽƵ Ž ƚ E Ezz ĐŽŶĐĞƌƌŶ Ŷ ƚŚĂƚ / ĐĂŶ ŚĞůƉ ƚĂĐŬůĞ͘

tĂůƚ͕ ďŽƚŚĞƌͲŝŶͲůĂǁ ^ƚĞǀĞ ĂŶĚ ƐŽŶ ŚƌŝƐ ƚĂĐŬůĞ ƚŚĞ ǁĂǀĞƐ͘ 16

California Family Physician Spring 2019

/ ŐĞƚ ĞŶĞƌŐŐŝǌǌĞĚ Ě ǁŽƌŬŬŝŶ ŝŶŐŐ ǁŝ ǁ ƚŚ ŽƚŚ ƚŚĞƌ Ğ &WƐ͘ /͛Ě ůŝŬĞ ƚŽ ďĞ Ăƚ ŵĞŵ ĞŵďĞƌ ĐŚĂƉƚĞƌ ŵĞ ŵ Ğƚ ŵĞ Ğ ŝŶ ŶŐƐ ŐƐ͕ ǀŝƐŝŝƚ ŽĨ ŽĨĨŝ Ĩ ĐĞƐ͕ Žƌ ƌ ĐŽŵĞ ǁŚĞƌĞǀĞƌ ŝƚ͛Ɛ ƵƐĞĨƵ ĨƵů͘ ů͘ /͛Ě ůŝŬĞĞ ƚŽ ƉĞ ƉĞƌƐŽŶ ŽŶĂĂůůǇ ŬŶŽǁ ǁ ŚŽǁ ƚŽ Ž ƐƵƉƉŽƌƚ ŽƵƌ ĞŶƚŝƌĞ ĂůŝĨŽ ŽƌŶ ƌŶŝĂ ŝĂ ĨĂŵŝůǇ ŽĨ ĨĂ ĨĂĂŵŝ ŵ ůǇ ƉŚǇǇƐŝ Ɛ Đŝ ĐŝĂŶ ĂŶ ƉƌĂĐƚŝĐĞĞƐ ʹ ƌƵƌĂů͕ ƐƵďƵƌďĂŶͬƵƌďĂŶ͕ safety nett, acad adem e ic,, di direect patien nt care or solo to large group p.

Adam Francis CAFP Director of Government Relations

Making a Difference for Patients and Family Physicians at AMAM! /Ŷ ĞĂƌůǇ DĂƌĐŚ͕ ŶĞĂƌůǇ ϮϬϬ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů students from across the state converged on the State Capitol for &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ; D DͿ ĂŶĚ &ĂŵŝůǇ DĞĚŝĐŝŶĞ Lobby Day. Our goal: to discuss important topics in health care ĂŶĚ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚƐ͘ dŚĞ D D ŐŝǀĞƐ ĂƩĞŶĚĞĞƐ ƚŚĞ ƚŽŽůƐ ƚŚĞǇ ŶĞĞĚ ƚŽ ďĞĐŽŵĞ ƚŚĞ ůĞĂĚĞƌƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ ĂŶĚ ĞīĞĐƟǀĞ ĂĚǀŽĐĂƚĞƐ ĨŽƌ ƚŚĞŵƐĞůǀĞƐ ĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ dŚĞ &W ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ĂůƐŽ ŚĞĂƌĚ ƚĞƐƟŵŽŶǇ ĨŽƌ ĂŶĚ ĂŐĂŝŶƐƚ ƐĞǀĞƌĂů ƌĞƐŽůƵƟŽŶƐ ŽŶ ǁŚŝĐŚ ƚŚĞ ŽĂƌĚ ǁŝůů ĐŽŶƐŝĚĞƌ ĂĐƟŽŶ͘ dŚŝƐ ǇĞĂƌ͕ ĂƩĞŶĚĞĞƐ ĚƵŐ ŝŶƚŽ ŵĞĂƚǇ ƉŽůŝĐǇ ŝƐƐƵĞƐ͕ ƐƵĐŚ ĂƐ ŝŵŵŝŐƌĂƟŽŶ ĂŶĚ ĂĚǀŽĐĂĐǇ ĨŽƌ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐ͖ ƌĞůĂƟŽŶƐ ǁŝƚŚ ŚĞĂůƚŚ ƉůĂŶƐ͕ ƉŚĂƌŵĂĐĞƵƟĐĂů ĐŽŵƉĂŶŝĞƐ ĂŶĚ ŚŽƐƉŝƚĂůƐ͖ ĂŶĚ ƚŚĞ ďĞƐƚ ǁĂǇƐ ƚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ ǁŚŝĐŚ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŵŝƐŝŶĨŽƌŵĞĚ ĂŶĚ ŽƵƚĚĂƚĞĚ ƐĞĐƟŽŶƐ ŽĨ ůĂǁ ƚŚĂƚ ŝŵƉƌŽƉĞƌůǇ ĐŽŶƐƚƌĂŝŶ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ ƩĞŶĚĞĞƐ ĂůƐŽ ƌĞĐĞŝǀĞĚ ƚƌĂŝŶŝŶŐƐ ŝŶ ĐƌĂŌŝŶŐ Ă ŵĞƐƐĂŐĞ ĨƌŽŵ Ă ƉŚǇƐŝĐŝĂŶ͛Ɛ ƉŽŝŶƚ ŽĨ ǀŝĞǁ͕ ŚŽǁ ƚŽ ŵĞĞƚ ǁŝƚŚ Ă ůĞŐŝƐůĂƚŽƌ ĂŶĚ ŚŽǁ ƚŽ ŝŶƚĞƌĂĐƚ ĂŶĚ ĂĚǀŽĐĂƚĞ ǁŝƚŚ ŵĞŵďĞƌƐ ŽĨ ĚŝīĞƌĞŶƚ ŐĞŶĞƌĂƟŽŶƐ͘ dŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ǁĂƐ ĂůƐŽ Ă ĐŚĂŶĐĞ ƚŽ ĂĐŬŶŽǁůĞĚŐĞ ƚŚĞ ĞīŽƌƚƐ ĂŶĚ ĂĐŚŝĞǀĞŵĞŶƚƐ ŽĨ ƚŚŽƐĞ ǁŚŽ ŵĂĚĞ Ă ƚƌĞŵĞŶĚŽƵƐ ĚŝīĞƌĞŶĐĞ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŽǀĞƌ ƚŚĞ ƉĂƐƚ ǇĞĂƌ͘ :ĂƐŵĞĞƚ ĂŝŶƐ͕ D ;ůĞŌͿ ǁŽŶ ƚŚĞ ,ĞƌŽ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ĂǁĂƌĚ ĨŽƌ ŚĞƌ ŽƵƚƐƚĂŶĚŝŶŐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂĚǀŽĐĂĐǇ ĞīŽƌƚƐ Ăƚ ƚŚĞ ůŽĐĂů͕ ƐƚĂƚĞ͕ ŶĂƟŽŶĂů ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂů ůĞǀĞů͘ ;^ĞĞ ƚŚĞ ĂƌƟĐůĞ ŽŶ ŽƵƌ ĂǁĂƌĚƐ ǁŝŶŶĞƌƐ ŽŶ ƉĂŐĞ ϮϬ͘Ϳ ƐƐĞŵďůǇŵĞŵďĞƌ WŚŝů dŝŶŐ ; ʹ ^ĂŶ &ƌĂŶĐŝƐĐŽͿ ƌĞĐĞŝǀĞĚ ƚŚĞ ŚĂŵƉŝŽŶ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ǁĂƌĚ ĨŽƌ ƚŚĞ ǁŽƌŬ ŚĞ ŚĂƐ ĚŽŶĞ ŽŶ ƚŚĞ ƐƐĞŵďůǇ ƵĚŐĞƚ ŽŵŵŝƩĞĞ͕ ƐƉĞĐŝĮĐĂůůǇ ŝŶ ƐƵƉƉŽƌƚ ŽĨ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌǇ ĂƌĞ WŚǇƐŝĐŝĂŶƐ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͘

dŚĞ ǁĞĞŬĞŶĚ ǁĂƐ ĂďŽƵƚ ŵŽƌĞ ƚŚĂŶ ũƵƐƚ ůĞĂƌŶŝŶŐ͘ ƩĞŶĚĞĞƐ ƌĂǀĞĚ ĂďŽƵƚ ƚŚĞ ǁŽƌŬ ƚŚĞ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ ;&WͲW Ϳ ǁĂƐ ĚŽŝŶŐ ƚŽ ŚĞůƉ ĞůĞĐƚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĐŚĂŵƉŝŽŶ ůĞŐŝƐůĂƚŽƌƐ ŝŶ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĞŶƐƵƌĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĂĐĐĞƐƐ ƚŽ ůĞŐŝƐůĂƟǀĞ ůĞĂĚĞƌƐ͘ &WͲW ŝƐ ƚŚĞ ŽŶůǇ ƉŽůŝƟĐĂů ĂĐƟŽŶ ĐŽŵŵŝƩĞĞ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŚĂƚ ŵĂŬĞƐ ĚŝƌĞĐƚ ĐŽŶƚƌŝďƵƟŽŶƐ ƚŽ ƉƌŽͲĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ƉƌŽͲƉĂƟĞŶƚ ƐƚĂƚĞ ůĞŐŝƐůĂƟǀĞ ĐĂŶĚŝĚĂƚĞƐ ĂŶĚ ƐĞůĞĐƚ ƐƚĂƚĞǁŝĚĞ ŽĸĐĞƐ͘ D D ĂƩĞŶĚĞĞƐ ƌĂŝƐĞĚ ŵŽƌĞ ŵŽŶĞǇ ĨŽƌ &WͲW ƚŚŝƐ ǇĞĂƌ ƚŚĂŶ Ăƚ ĂŶǇ ŽƚŚĞƌ ƉƌĞǀŝŽƵƐ &W ŵĞĞƟŶŐ ŝŶ ŝƚƐ ĞǆŝƐƚĞŶĐĞ͊ &WͲW ĐŽŶƚƌŝďƵƚŽƌƐ ĂůƐŽ ĂƩĞŶĚĞĚ Ă ƐƉĞĐŝĂů ŽŶŽƌ ZĞĐŽŐŶŝƟŽŶ ^ŽĐŝĂů ǀĞŶƚ ǁŝƚŚ ŶĞǁ ĂůŝĨŽƌŶŝĂ /ŶƐƵƌĂŶĐĞ Commissioner Ricardo Lara. If you have not yet contributed to FP-PAC ŝŶ ϮϬϭϵ͕ ƉůĞĂƐĞ ŐŽ ƚŽ ŽƵƌ ĚŽŶĂƟŽŶ ƉĂŐĞ ;ŚƩƉƐ͗ͬͬĨĂŵŝůǇĚŽĐƐ͘ƐĞĐƵƌĞ͘ ĨŽƌĐĞ͘ĐŽŵͬƉĂĐͬ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĐĂŶ ĐŽŶƟŶƵĞ ŽƵƌ important electoral advocacy.

DŽŶĚĂǇ ǁĂƐ &ĂŵŝůǇ DĞĚŝĐŝŶĞ >ŽďďǇ ĂǇ͘ EĞĂƌůǇ ϭϬϬ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŵĞƚ ŝŶ ŵŽƌĞ ƚŚĂŶ dtKͲd,/Z ^ ŽĨ Ăůů ůĞŐŝƐůĂƚŽƌƐ͛ ŽĸĐĞƐ ƚŽ ƐƵƉƉŽƌƚ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ůĞŐŝƐůĂƟŽŶ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĐŽŶƐƚƌĂŝŶƚƐ ŽŶ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ zŽƵ ĐĂŶ ƌĞĂĚ ŵƵĐŚ ŵŽƌĞ ĂďŽƵƚ ϭϲϮϮ ŝŶ ĂƌůĂ <ĂŬƵƚĂŶŝ͛Ɛ WŽůŝƟĐĂů WƵůƐĞ ŽŶ ƉĂŐĞ ϭϬ͘ /ƚ ǁĂƐ ĂŶ ŝŶƐƉŝƌŝŶŐ ĂŶĚ ĞǆĐŝƟŶŐ ǁĞĞŬĞŶĚ͊ tĞ ŝŶǀŝƚĞ ĂŶǇ ĂŶĚ Ăůů &W ŵĞŵďĞƌƐ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ĂĚǀĂŶĐŝŶŐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚ ƉƌŽƚĞĐƟŽŶƐ ƚŽ ũŽŝŶ ƵƐ Ăƚ ŶĞǆƚ ǇĞĂƌ͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ĂŶĚ &ĂŵŝůǇ DĞĚŝĐŝŶĞ >ŽďďǇ ĂǇ͕ ƚĂŬŝŶŐ ƉůĂĐĞ DĂƌĐŚ ϭϯͲϭϱ͕ ϮϬϮϬ Ăƚ ƚŚĞ ^ŚĞƌĂƚŽŶ 'ƌĂŶĚ Hotel in Sacramento. WŚŽƚŽ ĐĂƉƟŽŶƐ WƌĞǀŝŽƵƐ ƉĂŐĞ͗ &W ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ůĞĂĚĞƌƐ ŐĂƚŚĞƌ ŝŶ ^ĂĐƌĂŵĞŶƚŽ͖͘ DŽƌĞ ƚŚĂŶ ϵϬ &WĞƌƐ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ >ŽďďǇ ĂǇ͖͘ ƐƐĞŵďůǇ ŵĞŵďĞƌ WŚŝů dŝŶŐ ǁĂƐ ŶĂŵĞĚ ƚŚĞ ϮϬϭϵ ŚĂŵƉŝŽŶ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͖͘ &WĞƌƐ ǀŝƐŝƚĞĚ ůĞŐŝƐůĂƟǀĞ ŽĸĐĞƐ͕ ŚĞĂƌĚ ĨƌŽŵ /ŶƐƵƌĂŶĐĞ ŽŵŵŝƐƐŝŽŶƐ ZŝĐĂƌĚŽ >ĂƌĂ ĂŶĚ ŐĂƚŚĞƌĞĚ ĨŽƌ ƚŚĞ ƚƌĂĚŝƟŽŶĂů ĂůŝĨŽƌŶŝĂ ďĞĂƌ ƉŚŽƚŽ͖͘ &W /ŵŵĞĚŝĂƚĞ WĂƐƚ WƌĞƐŝĚĞŶƚ >ŝƐĂ tĂƌĚ͕ ƐƐĞŵďůǇ ŵĞŵďĞƌ :ŝŵ tŽŽĚ͕ ĂŶĚ K >ŝƐĂ &ŽůďĞŐ ŵĞƚ in Sacramento.

California Family Physician Spring 2019

CAFP Honors Five Outstanding Members

Lee Ralph, MD

2019 Family Physician of the Year The California Academy of Family Physicians proudly ƉƌĞƐĞŶƚƐ ƚŚĞ ϮϬϭϵ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ ǁĂƌĚ ƚŽ >ĞĞ ZĂůƉŚ͕ D ͘ dŚŝƐ ƉƌĞƐƚŝŐŝŽƵƐ ĂǁĂƌĚ ŐŽĞƐ ƚŽ ĂŶ ŝŶĚŝǀŝĚƵĂů ǁŚŽ ĞǆŚŝďŝƚƐ ƚŚĞ ĨŝŶĞƐƚ ƋƵĂůŝƚŝĞƐ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ǁŚŽ ŐŽĞƐ ĂďŽǀĞ ĂŶĚ ďĞǇŽŶĚ ŝŶ ƐĞƌǀŝĐĞ ƚŽ ƉĂƚŝĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƚǇ͘ DŽƐƚ ŽĨ ǇŽƵ ŬŶŽǁ >ĞĞ ĂƐ Ă ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ŽĨ ƚŚŝƐ ĐĂĚĞŵǇ͘ WĞƌŚĂƉƐ ǇŽƵ ŬŶŽǁ Śŝŵ ĂƐ Ă ĨĂĐƵůƚǇ ŵĞŵďĞƌ ĨŽƌ CAFP educational events and a member of CAFP’s Committee ŽŶ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ DĂǇďĞ ǇŽƵ͛ǀĞ ǁŽƌŬĞĚ ǁŝƚŚ him in San Diego at the local chapter level, or in practice at UCSF and San Diego Sports Medicine. All those interactions ǁŝƚŚ >ĞĞ ĂƌĞ ƋƵŝƚĞ ǁŽŶĚĞƌĨƵů͕ ĂŶĚ ƚŚĞǇ ĂƌĞ ƉĂƌƚ ŽĨ ƚŚĞ ƌĞĂƐŽŶ ǁĞ ƐĞůĞĐƚĞĚ Śŝŵ ƚŚŝƐ ǇĞĂƌ͘ Ƶƚ͕ >ĞĞ ǁĂƐ ĂůƐŽ ƐĞůĞĐƚĞĚ because he possesses all of the qualities of an incredible family physician … He is bright, kind, compassionate, an ĞǆĐĞůůĞŶƚ ƚĞĂĐŚĞƌ ĂŶĚ ĂďůĞ ƚŽ ĂƚƚĞŶĚ͕ ǁŝƚŚ ŐƌĞĂƚ ĚŝůŝŐĞŶĐĞ͕ ƚŽ ŚŝƐ ƉĂƚŝĞŶƚƐ͛ ĂŶĚ ĐŽůůĞĂŐƵĞƐ͛ ŶĞĞĚƐ͘ ,Ğ ŝƐ ĂůƐŽ Ă ǁŽŶĚĞƌĨƵů father, husband and philanthropist. From a business ƐƚĂŶĚƉŽŝŶƚ͕ >ĞĞ ŚĂƐ ďĞĞŶ Ă ƉŚǇƐŝĐŝĂŶ ĂŶĚ ƉĂƌƚŶĞƌ ǁŝƚŚ ^ĂŶ ŝĞŐŽ ^ƉŽƌƚƐ DĞĚŝĐŝŶĞ ƐŝŶĐĞ ϭϵϵϳ͕ Ă ƚŚƌŝǀŝŶŐ ƉƌĂĐƚŝĐĞ and one of the first of its kind in our community. He has engendered the confidence and admiration of many in his profession and in doing so has been designated a leader at

Ăůů ůĞǀĞůƐ͘ >ĞĞ ŚĂƐ ĚŽŶĞ Ăůů ŽĨ ƚŚŝƐ ǁŚŝůĞ ŵĂŝŶƚĂŝŶŝŶŐ Ă ŚĞĂůƚŚǇ ůŝĨĞ ǁŽƌŬ ďĂůĂŶĐĞ͘ ,Ğ ĐŽŶƐŝƐƚĞŶƚůǇ ƐŚŽǁƐ Ă ǁŝůůŝŶŐŶĞƐƐ ƚŽ volunteer at every opportunity that presents itself in order ƚŽ ĨƵƌƚŚĞƌ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶ ĂŶĚ ĞŶŚĂŶĐĞ ƚŚĞ ǁĞůĨĂƌĞ ŽĨ ŚŝƐ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ƉĂƚŝĞŶƚƐ͘ ,Ğ ƌĞƉƌĞƐĞŶƚƐ Ăůů ƚŚŝƐ ŝƐ ƌŝŐŚƚ ǁŝƚŚ our specialty.

ZŽď ƐƐŝďĞǇ͕ D ĂŶĚ Romero Santiago, MD, MPH

2019 Family Medicine Residents of the Year Robert Assibey, MD, second-year resident at San Joaquin 'ĞŶĞƌĂů ,ŽƐƉŝƚĂů͕ ŝƐ ĂŶ ĞŶƚŚƵƐŝĂƐƚŝĐ ůĞĂĚĞƌ ŝŶ ďŽƚŚ ŚŝƐ residency program and in the Academy. He currently serves as Co-chair of CAFP’s Resident Council, and as Co-chair leader, Rob represents California as a delegate to local and ŶĂƚŝŽŶǁŝĚĞ ĐŽŶĨĞƌĞŶĐĞƐ ĂŶĚ ĞǀĞŶƚƐ͘ ,Ğ ŝƐ Ă ǀŽƚŝŶŐ ŵĞŵďĞƌ on the Academy Board of Directors and Foundation Board of dƌƵƐƚĞĞƐ͘ ZŽď ƚŽŽŬ ĨŝƌƐƚ ƉůĂĐĞ ŝŶ ƚŚĞ ϮϬϭϴ &W &ŽƵŶĚĂƚŝŽŶ ZĞƐŝĚĞŶƚ WŽƐƚ ŽŵƉĞƚŝƚŝŽŶ ĂŶĚ ǇŽƵ ƐĂǁ Śŝŵ ůĂƐƚ ĞǀĞŶŝŶŐ ƉƌĞƐĞŶƚ ŚŝƐ ϮϬϭϵ ƉŽƐƚĞƌ͊ KŶ Ă ƉĞƌƐŽŶĂů ůĞǀĞů͕ ZŽď ŝƐ ĐƵƌŝŽƵƐ and full of personality. He is quick to volunteer his time ĂŶĚ ƚŽ ŚĞůƉ ǁŚĞŶ ĞǆƚƌĂ ŚĂŶĚƐ ĂƌĞ ŶĞĞĚĞĚ͘ tŚĞŶ ZŽď ŝƐ ŶŽƚ encouraging his peers to get involved in CAFP, he is teaching &W ŽĂƌĚ ŵĞŵďĞƌƐ ŚŽǁ ƚŽ ĚŽ ƚŚĞ ͞ĨůŽƐƐ͟ ĂŶĚ ƉƌĞƉĂƌŝŶŐ his haiku presentations. California Family Physician Spring 2019

Romero Santiago, MD, a second-year resident at the University of California Davis Family and Community Medicine Program, ĐƵƌƌĞŶƚůǇ ƐĞƌǀĞƐ ŽŶ ƚŚĞ &W ZĞƐŝĚĞŶƚ ŽƵŶĐŝů͕ Ă ƐƚĂƚĞǁŝĚĞ ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌ ŐƌŽƵƉ ƚŚĂƚ ǁŽƌŬƐ ƚŽ ƉƌŽŵŽƚĞ ĂŶĚ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝŶƚĞƌĞƐƚƐ͘ ƵƌŝŶŐ ŚŝƐ ƚǁŽͲǇĞĂƌ ƚĞŶƵƌĞ ŽŶ ƚŚĞ ĐŽƵŶĐŝů͕ ŚĞ ŚĂƐ ĐŽͲĂƵƚŚŽƌĞĚ ƚǁŽ ƌĞƐŽůƵƚŝŽŶƐ ƚŚĂƚ ŚĂǀĞ ďĞĞŶ presented at the All Member Advocacy Meeting and passed by the CAFP Board of Directors. He is also a member of CAFP’s ŽŵŵŝƚƚĞĞ ŽŶ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ͕ ǁŚŝĐŚ ĂĚĚƌĞƐƐĞƐ ƚŚĞ ůĂƚĞƐƚ and most pressing public health concerns. As a leader, Romero ǁŽƌŬƐ ǁŝƚŚ ĐŽŵŵŝƚƚĞĞ ĂŶĚ ĐŽƵŶĐŝů ŵĞŵďĞƌƐ ƚŽ ŚĞůƉ &W address resolutions and develop Academy policy statements or position papers. Romero is committed to staying abreast of issues affecting family medicine and his patients, honing his advocacy and clinical skills, and posting positive messages about family medicine and CAFP on social media.

Kristine Brownell, MD

2019 Barbara Harris Award for Educational Excellence /ƚ ŝƐ ŽƵƌ ŚŽŶŽƌ ƚŽ ƉƌĞƐĞŶƚ ƚŚŝƐ ĂǁĂƌĚ ƚŽ <ƌƐŝƚŝŶĞ͕ ĂŶĚ ĨĞůůŽǁƐ ^ĂŶ ŝĞŐŽ ƌĞƐŝĚĞŶĐǇ faculty member. Kristine has all of the qualities of a great educator. She is an ŽƵƚƐƚĂŶĚŝŶŐ ĐůŝŶŝĐĂů ƚĞĂĐŚĞƌ͘ ^ŚĞ ǁŽƌŬƐ ǁŝƚŚ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ ŝŶ ŶƵŵĞƌŽƵƐ settings. She does scholarly projects and teaches her physician colleagues. She is a community leader, social justice zealot, ĂŶĚ ĂĐƚŝǀŝƐƚ͘ <ƌŝƐƚŝŶĞ͛Ɛ ǁŽƌŬ ƚŽ ƚĂĐŬůĞ ŽŶ social justice and health inequities and her program to assist patients in a very busy, diverse setting raise the bar for us all. Her specialized training including Masters of Public Health, Underserved DĞĚŝĐŝŶĞ &ĞůůŽǁƐŚŝƉ͕ ĂŶĚ ƐĞƌǀŝĐĞ ŝŶ ƚŚĞ WĞĂĐĞ ŽƌƉƐ͕ ŚĂƐ ŐŝǀĞŶ ŚĞƌ ĞǆƉĞƌƚŝƐĞ ŝŶ treating the very diverse San Diego patient population. On a typical clinic day she ĐĂŶ ďĞ ƐĞĞŶ ĨůŝƚƚŝŶŐ ŝŶƚŽ ŽŶĞ ƌŽŽŵ ǁŝƚŚ Ă ^ŽŵĂůŝ ƐƉĞĂŬŝŶŐ ƉƌĞŶĂƚĂů ƉĂƚŝĞŶƚ ǁŚŽ ŚĂƐ ƵŶĚĞƌŐŽŶĞ &' ;ĨĞŵĂůĞ ŐĞŶŝƚĂů ĐƵƚƚŝŶŐͿ͕ ŝŶƚŽ ƚŚĞ ŶĞǆƚ ǁŚĞƌĞ ƐŚĞ ŝƐ ƚƌĞĂƚŝŶŐ ƚŚĞ children and parents in a recently arrived ƵƌŵĞƐĞ ƌĞĨƵŐĞĞ ĨĂŵŝůǇ͕ ĂŶĚ ŝŶƚŽ ƚŚĞ ŶĞǆƚ ǁŚĞƌĞ Ă ǁĞůů ĞƐƚĂďůŝƐŚĞĚ ƵŶĚŽĐƵŵĞŶƚĞĚ ƉĂƚŝĞŶƚ ĨƌŽŵ DĞǆŝĐŽ ŚĂƐ ďƌŽƵŐŚƚ ŚĞƌ ŚŽŵĞ made caramels as a token of appreciation. ƌ͘ ƌŽǁŶĞůů ŝŶĨĞĐƚŝŽƵƐůǇ ƐŚĂƌĞƐ ŚĞƌ 20

California Family Physician Spring 2019

ũŽǇ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ŵĞĚŝĐŝŶĞ ǁŝƚŚ ŚĞƌ ƌĞƐŝĚĞŶƚƐ͘ ^ŚĞ ŝƐ ǁŝĚĞůǇ ƌĞĐŽŐŶŝǌĞĚ Ă ƉƌĞŵŝĞƌ ƉƌĞĐĞƉƚŽƌ ŝŶ ĂĚĚƌĞƐƐŝŶŐ ƐŽĐŝĂů determinants of health, accessing community resources, and ŬĞĞƉŝŶŐ ĚŝĨĨĞƌĞŶƚŝĂůƐ ďƌŽĂĚ ƐŽ ǁĞ ĚŽŶ͛ƚ ŵŝƐƐ ƌĂƌĞ ĚŝĂŐŶŽƐĞƐ such as malaria. <ƌŝƐƚŝŶĞ ŚĂƐ Ă ůŽŶŐ ůŝƐƚ ŽĨ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ͕ ďƵƚ ǁŚĂƚ ƐĞƚƐ ŚĞƌ apart is her amazing skill, passion and enthusiasm as a teacher.

Jasmeet Bains, MD

CAFP Hero of Family Medicine Dr. Jasmeet Bains has taken family medicine advocacy ƚŽ Ă ǁŚŽůĞ ŶĞǁ ůĞǀĞů͘ tŚĞƚŚĞƌ ŝƚ ďĞ ǁŝƚŚ ĞŵŽĐƌĂƚƐ Žƌ Republicans, in Washington DC or the State Capitol, Dr. Bains ƐƉĞĂŬƐ ƚƌƵƚŚ ƚŽ ƉŽǁĞƌ͘ /Ŷ ƚŚĞ ůĂƐƚ ǇĞĂƌ ĂůŽŶĞ͕ ƐŚĞ ŚĂƐ ďƌŽƵŐŚƚ ƚŚĞ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞǀŽůƵƚŝŽŶ ƚŽ ŵĞĞƚŝŶŐƐ ǁŝƚŚ ƚŚĞŶͲ 'ŽǀĞƌŶŽƌ ƌŽǁŶ͕ ŶŽǁͲ'ŽǀĞƌŶŽƌ EĞǁƐŽŵ͕ ĂŶĚ ƚŚĞŶͲDĂũŽƌŝƚǇ >ĞĂĚĞƌ <ĞǀŝŶ DĐ ĂƌƚŚǇ͘ /Ŷ ĂĚĚŝƚŝŽŶ ƚŽ ŚĞƌ ŵĞĞƚŝŶŐƐ ǁŝƚŚ ŚŝŐŚͲ ƉŽǁĞƌĞĚ ŽĨĨŝĐŝĂůƐ͕ ƌ͘ ĂŝŶƐ ƐŝƚƐ ŽŶ ƚŚĞ ĂůŝĨŽƌŶŝĂ ,ĞĂůƚŚĐĂƌĞ tŽƌŬĨŽƌĐĞ WŽůŝĐǇ ŽŵŵŝƐƐŝŽŶ͕ ǁŚŝĐŚ ŽǀĞƌƐĞĞƐ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ Healthcare Workforce Training Program that disburses grants

to primary care residency programs. In that role, Dr. Bains helps to direct funding to residency programs that recruit underrepresented minorities, ƚƌĂŝŶ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌǇ ĐĂƌĞ͕ ĂŶĚ ǁŚŽ ƐĞƌǀĞ ƵŶĚĞƌƐĞƌǀĞĚ populations and regions. Her advocacy for the underserved does not stop Ăƚ ŚĞƌ ƉŽůŝƚŝĐĂů ǁŽƌŬ͕ ƐŚĞ ůŝǀĞƐ ŝƚ every day delivering care at the Omni Family Health Clinic in Taft, a severely underserved area of the San Joaquin Valley. Dr. Bains has consistently ĚĞŵŽŶƐƚƌĂƚĞĚ ŚŽǁ ƉŽǁĞƌĨƵů ĂŶĚ influential an engaged family physician can be at the local, state, national, and even international level, embarking on medical missions to India and Honduras. She is member of the CAFP ϮϬϭϵͲϮϬϮϬ ZĞĂĚǇ ƚŽ >ĞĂĚ͗ ƵŝůĚŝŶŐ Women Family Physician Leaders class, ĂŶĚ ǁĞ ŚĂǀĞ ŶŽ ĚŽƵďƚ ƐŚĞ ǁŝůů ůĞĂĚ family medicine to great things.

We are looking for Family Medicine • Internal Medicine • Urgent Care Physicians

Set off for a partnership track in Southern California Come and join a well established, multi-specialty medical group of 250+ providers, first established in 1945 with continued growth.

Why Beaver Medical Group? Many people entrust their most valued possession — their good health — into the hands of our outstanding, committed physicians at Beaver Medical Group. We would like to extend a personal invitation to you to participate in a unique opportunity to combine professional excellence and camaraderie by joining us. You will love our competitive compensation plan, generous benefit package, vacation time, partnership track after 2 years, professional business account • Sign on bonus • medical insurance for family with Beaver HMO option • Relocation • Life insurance & disability insurance

BMGRecruiting@epiclp.com 909.335.4189

California Family Physician Spring 2019

Conrad Amenta CAFP Director of Health Policy

Five Years and Counting: A Look at CAFP’s Landmark PCMH Pilot Ă ϮϬϭϰ ƌĞƉŽƌƚ ƚŝƚůĞĚ ͞WĂƚŝĞŶƚͲ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ͗ >ŽŽŬŝŶŐ ĨŽƌ ǁĂǇƐ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ ďĞŶĞĨŝĐŝĂƌŝĞƐ ŽŵŵƵŶŝƚǇ DĞĚŝĐĂů WƌŽǀŝĚĞƌƐ͛ ^ƵĐĐĞƐƐ͘͟ ĂŶĚ ĂĚĚƌĞƐƐ ƚŚĞ ĞƐĐĂůĂƚŝŶŐ ĐŽƐƚƐ ŽĨ ĐĂƌĞ͕ ŝŶ ůĂƚĞ ϮϬϭϬ ƚŚĞ • dŚĞ ŶƵŵďĞƌ ŽĨ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ĚŝĂďĞƚĞƐ ǁŚŽƐĞ ďůŽŽĚ ƐĞůĨͲŝŶƐƵƌĞĚ &ƌĞƐŶŽ hŶŝĨŝĞĚ ^ĐŚŽŽů ŝƐƚƌŝĐƚͬ:ŽŝŶƚ ,ĞĂůƚŚ ƐƵŐĂƌ ůĞǀĞůƐ ǁĞƌĞ ĐŽŶĨŝƌŵĞĚ ĂƐ ĐŽŶƚƌŽůůĞĚ ŝŶĐƌĞĂƐĞĚ Management Board joined the California Academy of by 50 percent. Family Physicians in supporting a local Patient Centered ŵŽŶŐ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ĚŝĂďĞƚĞƐ ĂŶĚ ǁŝƚŚ ĐŽƌŽŶĂƌǇ • DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ŝŶŝƚŝĂƚŝǀĞ͘ dŚĞ ďĞŶĞĨŝƚƐ ŽĨ ƚŚĞ W D,͕ artery disease, blood pressure control and LDL as described by accrediting bodies such as the National control increased significantly. Committee for Quality Assurance, include increasing • ƌĞĂƐƚ ĐĂŶĐĞƌ ƐĐƌĞĞŶŝŶŐ ĂŶĚ ďŽĚǇ ŵĂƐƐ ŝŶĚĞǆ patient and staff satisfaction, better management of counseling increased across the entire patient ĐŚƌŽŶŝĐ ĐŽŶĚŝƚŝŽŶƐ͕ ƌĞĚƵĐŝŶŐ ĨƌĂŐŵĞŶƚĂƚŝŽŶ͕ ĂůŝŐŶŵĞŶƚ ǁŝƚŚ population. ƉĂǇĞƌƐ ĂŶĚ ƐƚĂƚĞͬĨĞĚĞƌĂů ŝŶŝƚŝĂƚŝǀĞƐ ĂŶĚ ůŽǁĞƌŝŶŐ ŚĞĂůƚŚ • Medication adherence increased. care costs. • Patient satisfaction increased. • Emergency department visits and inpatient /Ŷ :ƵůǇ ϮϬϭϮ͕ ĂĨƚĞƌ ϭϴ ŵŽŶƚŚƐ ŽĨ ƉƌĞƉĂƌĂƚŝŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ͕ admissions decreased. a primary care medical group – Community Medical WƌŽǀŝĚĞƌƐ ; DWͿ ʹ ůĂƵŶĐŚĞĚ ƚŚĞ ŝŶŝƚŝĂƚŝǀĞ͘ dŚĞ ƉƌŽũĞĐƚ DĞĂŶǁŚŝůĞ͕ ƚŽƚĂů ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ ĚĞĐƌĞĂƐĞĚ ďǇ ŶŝŶĞ ĐŽǀĞƌĞĚ ĂƉƉƌŽǆŝŵĂƚĞůǇ Ϯ͕ϱϬϬ ƉĂƚŝĞŶƚƐ ĐŽŵƉƌŝƐŝŶŐ ϭϬ percent, or almost a million dollars. Costs among high-risk ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŝƐƚƌŝĐƚ͛Ɛ Ϯϱ͕ϬϬϬ ďĞŶĞĨŝĐŝĂƌŝĞƐ͘ dŚĞ ƌĞƐƵůƚƐ ŵĞŵďĞƌƐ ĚĞĐƌĞĂƐĞĚ ďǇ ĂůŵŽƐƚ ϭϲ ƉĞƌĐĞŶƚ͘ ŽŶĞ ǇĞĂƌ ůĂƚĞƌ ǁĞƌĞ ƌĞŵĂƌŬĂďůĞ͘ dŚĞǇ ǁĞƌĞ ĐĂƉƚƵƌĞĚ ŝŶ

Quality and Patient Satisfaction Outcomes/All Cohorts This information is a sample of the 19 metrics captured during Periods 12 nad 13 of the project. Metric

P 12: 7/1/17-12/31/17

P13: 1/1/18-6/0/18

Goal

P4P%

Patients at Goal

Patients in Group

& at Goal

Patients at Goal

Patients in Group

% at Goal

P13-P12

Diabetes: HBA1c Poor Control (>9%)

644

636

10%

<25%

100%

Diabetes: LDL. Control (LDL <100)

431

644

67%

422

636

66%

-1%

50%

61%

100%

IVD: LDL Control (LDL <100)

247

376

66%

247

368

67%

88%

-24%

Population: BMI Counseling

2097

2265

93%

2029

2103

96%

60%

38%

100%

California Family Physician Spring 2019

The Fresno pilot has formed the backbone of CAFP’s The PCMH has evolved from an evidence-based concept advocacy for PCMH, providing tangible evidence of the to a tried-and-true, accredited method to improve benefits of investing in PCMH-accredited practices. quality and contain costs. That the CMP PCMH continues Five years after the release of its final report, the CMP to thrive, to the benefit of patients in Fresno, is a PCMH is still going strong. An update on the project testament to that fact. ĨƌŽŵ ĞĐĞŵďĞƌ ϮϬϭϴ ŝŶĚŝĐĂƚĞƐ ƚŚĂƚ the pilot is still performing across ϭϵ ƋƵĂůŝƚǇ ĂŶĚ ƉĂƚŝĞŶƚ ƐĂƚŝƐĨĂĐƚŝŽŶ indicators, including screening targets, documentation and control of the diabetes patient populations’ ƐǇŵƉƚŽŵƐ͕ ĂĐŚŝĞǀŝŶŐ ϴϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞƐĞ ƚĂƌŐĞƚƐ͘ dŚĞƌĞ ǁĂƐ ĂůƐŽ ĂŶ increase in the number of physicians using secure electronic patient messaging systems to communicate ǁŝƚŚ ƚŚĞŝƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ĂŶ ŝŶĐƌĞĂƐĞ in the number of ‘E-Visits’ conducted via a secure patient portal. The PCMH continues to represent a proactive method for furthering high-value, team-based care for AVAILABLE PROVIDER ƉĂƚŝĞŶƚ ƉŽƉƵůĂƚŝŽŶƐ ƚŚĂƚ ƉƌĞƐĞŶƚ ǁŝƚŚ OPPORTUNITIES IN FAMILY MEDICINE ŵƵůƚŝƉůĞ͕ ĐŽŵƉůĞǆ ĐŽŵŽƌďŝĚŝƚŝĞƐ͘

JOIN OUR TEAM • Salary based on experience

dŚĞ ĨƵůůͲƚŚƌŽĂƚĞĚ ƐƵƉƉŽƌƚ ǁĞ ŚĂǀĞ ŚŽƉĞĚ ǁŽƵůĚ ĞŵĞƌŐĞ ĨŽƌ W D,͕ including true, risk-adjusted, valuebased payment, has not emerged as of ϮϬϭϵ͘ WĂƌƚ ŽĨ ƚŚŝƐ ŝƐ ĚƵĞ ƚŽ ĂŶ ĞƌŽƐŝŽŶ of support for implementation of the Affordable Care Act by the federal government and, in part, is due to a lack of understanding among health plans of the value of the PCMH. Undaunted, CAFP continues to share ƚŚĞ ŽǀĞƌǁŚĞůŵŝŶŐ ĂŶĚ ĐŽŵƉĞůůŝŶŐ evidence of the effectiveness of the PCMH. Numerous research reports have emerged detailing the unprecedented shortage of primary care physicians California is facing. As a result, health plans and legislators ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůǇ ǁŝůůŝŶŐ ƚŽ ĐŽŶƐŝĚĞƌ increased investments in primary ĐĂƌĞ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ W D,͕ ƚŚĂƚ ǁŽƵůĚ ĂůůŽǁ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ƉƌĂĐƚŝĐĞ Ăƚ the top of their license and emphasize high-value care.

• Sign on bonus and relocation assistance • 5 days of CME, $3,000 CME reimbursement and 10 paid holidays • Bonuses based on quality and productivity • Cap Exempt and Offering Visa Sponsorship • National Health Service Corps Scholar and Loan Repayment eligible • Many sites close to Yosemite National Park, San Francsico Bay Area and Monterey • 37 sites located throughout California’s Central Valley and growing each year

TO DISCUSS CURRENT OPPORTUNITIES, CONTACT: Joshua Skunca Director of Medical Staff Services jskunca@gvhc.org Ofﬁce: 209.384.6489 | Cell: 209.291.9750

WWW.GVHC.ORG California Family Physician Spring 2019

Leading the future of health care. WE OFFER The Permanente Medical Group, Inc. (TPMG) is one of the largest medical groups in the nation with over 9,000 physicians, 22 medical centers, numerous clinics throughout Northern and Central California and a 70 year tradition of providing quality medical care.

• FAMILY MEDICINE RESIDENCY Faculty Inpatient Service Lead - Sacramento, California This is an exciting opportunity for a Family Medicine Physician to be the Faculty Lead for the Family Medicine Inpatient Service for the new Kaiser Permanente Sacramento Valley Family Medicine Residency Program. We invite you to join a forward-thinking educational team, develop a patientcentered curriculum, and work in the country's most collaborative and innovative medical group.

• ADULT & FAMILY MEDICINE PHYSICIAN OPPORTUNITIES Openings available throughout Northern & Central California

FORGIVABLE LOAN PROGRAM $150,000-$300,000 (based on location) FAMILY MEDICINE OPPORTUNITIES: Contact Aileen Ludlow at: Aileen.M.Ludlow@kp.org | (510) 625-5934 INTERNAL MEDICINE OPPORTUNITIES: Contact Bianca Davis at: Bianca.X.Davis@kp.org | (510) 625-5935

• Physician-led organization–career growth and leadership opportunities • Multi-specialty collaboration and integration • Technology driven innovation • Mission-driven, patient-centered care and one of the largest progressive medical groups in the nation!

EXTRAORDINARY BENEFITS • Shareholder track • Three retirement plans, including pension • Moving allowance • Comprehensive medical and dental • Home loan assistance - up to $200,000 • Malpractice and tail insurance (approval required)

• Reimbursement of new CA medical license fees • Paid holidays, sick leave, education leave (with generous stipend)

CONNECT WITH US:

http://physiciancareers-ncal.kp.org We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor.

CAFP Foundation Talking about Immigration Policy Issues: What Is “ICE”? /Ŷ ƚŚŝƐ͕ ƚŚĞ ƚŚŝƌĚ ŝŶ ƚŚĞ ,ĞĂůƚŚǇ ,ĂƌďŽƌƐ ƐĞƌŝĞƐ͕ ǁĞ ĚŝƐĐƵƐƐ / ĂŶĚ ǇŽƵƌ ƌŽůĞƐ͕ ƌĞƐƉŽŶƐŝďŝůŝƚŝĞƐ ĂŶĚ ƌŝŐŚƚƐ ǁŚĞŶ / ĐŽŵĞƐ ƚŽ ǇŽƵƌ ŽĨĨŝĐĞ͕ ĐůŝŶŝĐ Žƌ ŚŽƐƉŝƚĂů͘ tŽƌŬŝŶŐ ŝŶ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ the Alameda Contra Costa Medical Association, San Francisco Marin Medical Society, American Academy of PediatricsCalifornia, Osteopathic Physicians and Surgeons of California and Sonoma County Medical Society, your Foundation offers ĂŶ ŽƉĞŶŝŶŐ ƐĂůǀŽ͕ ƐŽ ƚŽ ƐƉĞĂŬ͕ ĂŶ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ĂǁĂƌĞŶĞƐƐ ĐĂŵƉĂŝŐŶ ƚŽ ůĂǇ ƚŚĞ ŐƌŽƵŶĚǁŽƌŬ ĨŽƌ ĨƵƚƵƌĞ ƉŽůŝƚŝĐĂů͕ ĂĚǀŽĐĂĐǇ and educational efforts aimed at protecting the health of California’s most vulnerable populations, especially children. Our thanks to the California Healthcare Foundation for a grant to support the Healthy Harbors project. ICE stands for Immigration and Customs Enforcement. ICE is Ă ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĂŐĞŶĐǇ ŽĨ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ ƚĂƐŬĞĚ ǁŝƚŚ ĞŶĨŽƌĐŝŶŐ ŝŵŵŝŐƌĂƚŝŽŶ ůĂǁƐ ĂŶĚ ŝŶǀĞƐƚŝŐĂƚŝŶŐ ĐƌŝŵŝŶĂů ĂŶĚ terrorist activities of foreign nationals residing in the United ^ƚĂƚĞƐ͘ / ŚĂƐ ƚǁŽ ƉƌŝŵĂƌǇ ĐŽŵƉŽŶĞŶƚƐ͗ ,ŽŵĞůĂŶĚ ^ĞĐƵƌŝƚǇ /ŶǀĞƐƚŝŐĂƚŝŽŶƐ ;,^/Ϳ ĂŶĚ ŶĨŽƌĐĞŵĞŶƚ ĂŶĚ ZĞŵŽǀĂů KƉĞƌĂƚŝŽŶƐ ; ZKͿ͘ What are “ICE raids”? A raid is an enforcement tactic ICE uses to confront immigrants ǁŚŽ ŚĂǀĞ ĂŶ ŽƵƚƐƚĂŶĚŝŶŐ ĚĞƉŽƌƚĂƚŝŽŶ ŽƌĚĞƌ͘ ĚĚŝƚŝŽŶĂůůǇ͕ ŝƚ ŝƐ ƵƐĞĚ ƚŽ ĨŝŶĚ ŽƚŚĞƌ ŝŵŵŝŐƌĂŶƚƐ ǁŚŽ ŵĂǇ ďĞ ŝŶ ƚŚĞ ĐŽƵŶƚƌǇ illegally. What are ICE officials empowered to do during a raid? / ĂŐĞŶƚƐ ĚŽ ŶŽƚ ŚĂǀĞ ƚŚĞ ƌĂŶŬ ŽĨ ͞ƐƉĞĐŝĂů ĂŐĞŶƚ͟Ͷ ǁŚĂƚ͛Ɛ ŬŶŽǁŶ ŝŶ ĨĞĚĞƌĂů ŐƵŝĚĞůŝŶĞƐ ĂƐ ϭϴϭϭ ƐƚĂƚƵƐ ͶǁŚŝĐŚ ƐĞƚƐ ŽĨĨŝĐĞƌƐ ŽŶ ƚŚĞ ƐĂŵĞ ůĞǀĞů ĂƐ & / ĂŐĞŶƚƐ ĂŶĚ ĂůůŽǁƐ ƚŚĞŵ ƚŽ ĞǆĞĐƵƚĞ Ă ƐĞĂƌĐŚ ǁĂƌƌĂŶƚ͘ dŚĞǇ ƉŽƐƐĞƐƐ ĂŶ ϭϴϬϭ ĐůĂƐƐŝĨŝĐĂƚŝŽŶ͕ Ă ƉŽƐŝƚŝŽŶ ƚǇƉŝĐĂůůǇ ŚĂǀŝŶŐ ůŝŵŝƚĞĚ ƉŽǁĞƌƐ͘ / ĂŐĞŶƚƐ ŵĂǇ ďĞ ŝŶ ƉŽƐƐĞƐƐŝŽŶ ŽĨ Ă ǁĂƌƌĂŶƚ ƚŚĂƚ ƉĞƌŵŝƚƐ ƚŚĞŵ ƚŽ ĞŶƚĞƌ Ă ŚŽŵĞ Žƌ ĨĂĐŝůŝƚǇ͘ /Ĩ ƚŚĞǇ ĚŽ ŶŽƚ ŚĂǀĞ Ă ǁĂƌƌĂŶƚ͕ ƚŚĞǇ ŵƵƐƚ ŽďƚĂŝŶ ĐŽŶƐĞŶƚ ƚŽ ĞŶƚĞƌ͘ / ĂŐĞŶƚƐ ŚĂǀĞ ďĞĞŶ ŬŶŽǁŶ to resort to intimidation tactics – the element of surprise, ĚĞŵĂŶĚŝŶŐ ĞŶƚƌǇ ĂŶĚ ƉŽƐƐŝďůǇ ĚƌĂǁŝŶŐ ƚŚĞŝƌ ǁĞĂƉŽŶƐ ʹ ŝŶ ŽƌĚĞƌ ƚŽ ŝŵƉůǇ ƚŚĂƚ ĐŽŶƐĞŶƚ ŵƵƐƚ ďĞ ŐŝǀĞŶ͕ ďƵƚ ƚŚĞǇ ĂƌĞ ŶŽƚ ĂůůŽǁĞĚ ƚŽ ĞŶƚĞƌ ǁŝƚŚŽƵƚ ĐŽŶƐĞŶƚ͘ Agents aren’t limited to arresting their initial targets. Based on information provided by people in the raided homes or ĨĂĐŝůŝƚŝĞƐ͕ ĂŐĞŶƚƐ ĐĂŶ ŵĂŬĞ ĂĚĚŝƚŝŽŶĂů ĂƌƌĞƐƚƐ͘ WĞŽƉůĞ ǁŚŽ admit to being in the country illegally are taken into custody ĂůŽŶŐ ǁŝƚŚ ŽƚŚĞƌƐ͘

California Family Physician Spring 2019

,Žǁ ŚĂǀĞ / ƌĂŝĚƐ ĐŚĂŶŐĞĚ͍ Until recently, ICE has abided by a policy intended to give ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ Ă ƐĞŶƐĞ ŽĨ ƐĂĨĞƚǇ ŝŶ ͞ƐĞŶƐŝƚŝǀĞ ůŽĐĂƚŝŽŶƐ͕͟ ŝŶĐůƵĚŝŶŐ ƐĐŚŽŽůƐ͕ ƉůĂĐĞƐ ŽĨ ǁŽƌƐŚŝƉ ĂŶĚ ŚŽƐƉŝƚĂůƐ͘ Anecdotal evidence suggests that ICE has been operating more often in the vicinity of sensitive locations to conduct raids. ,Žǁ ĚŽĞƐ ƚŚĞ ƉŽƚĞŶƚŝĂů ĨŽƌ ĂŶ / ƌĂŝĚ ĂĨĨĞĐƚ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͍ The primary effect of the threat of an ICE raid on a health care facility is a reticence among patients to seek medical care. Three steps should be taken by family physicians: ϭ͘ WƌĞƉĂƌĞ ǇŽƵƌ ƚĞĂŵ͕ ƉƌĂĐƚŝĐĞ ĂŶĚͬŽƌ ĨĂĐŝůŝƚǇ ƚŽ ƌĞƐƉŽŶĚ ƚŽ Ă ƌĂŝĚͬ/ ŝŶƚĞƌǀĞŶƚŝŽŶ Ϯ͘ /ŶĨŽƌŵ ǇŽƵƌ ƉĂƚŝĞŶƚƐ ĂďŽƵƚ ƚŚĞŝƌ ƌŝŐŚƚƐ ϯ͘ 'ĂƚŚĞƌ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ ĂŶ / ƌĂŝĚ ƚŚĂƚ ŚĂƐ ĂůƌĞĂĚǇ occurred

How family physicians should prepare for or respond to an ICE raid ƐƚĂďůŝƐŚ Ă ǁƌŝƩĞŶ ƉŽůŝĐǇ ŝĚĞŶƟĨǇŝŶŐ ĂƌĞĂƐ ŽĨ ƚŚĞ ĐůŝŶŝĐ ĂƐ ƉƌŝǀĂƚĞ ĂŶĚ ŶŽƚ ŽƉĞŶ ƚŽ ƚŚĞ ŐĞŶĞƌĂů ƉƵďůŝĐ͘ &Žƌ ĞǆĂŵƉůĞ͕ ĞǆĂŵŝŶŝŶŐ ƌŽŽŵƐ͕ ŽĸĐĞƐ ĂŶĚ ƌĞĐŽƌĚƐ ĂƌĞĂƐ͘ ůƚĞƌŶĂƟǀĞůǇ͕ ƚŚĞ ǁĂŝƟŶŐ ƌŽŽŵ ŵĂǇ ďĞ ŽƉĞŶ ŽŶůǇ ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ƉĞƌƐŽŶƐ ĂĐĐŽŵƉĂŶǇŝŶŐ ƚŚĞŵ͕ ǁŚŝůĞ ƚŚĞ ƉƵďůŝĐ ŵƵƐƚ ƌĞŵĂŝŶ ŝŶ ĂƌĞĂƐ ŽƵƚƐŝĚĞ ƚŚĞ building. ĞƐŝŐŶĂƚĞ Ă ƐƉĞĐŝĮĐ ƉĞƌƐŽŶ Žƌ ƉĞƌƐŽŶƐ ƌĞƐƉŽŶƐŝďůĞ ĨŽƌ ŚĂŶĚůŝŶŐ ĐŽŶƚĂĐƚƐ ǁŝƚŚ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ŽĸĐŝĂůƐ͘ dƌĂŝŶ Ăůů ŽƚŚĞƌ ƐƚĂī ƚŽ ŝŶĨŽƌŵ ŝŵŵŝŐƌĂƟŽŶ Žƌ ŽƚŚĞƌ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ŽĸĐŝĂůƐ ƚŚĂƚ ŽŶůǇ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ŝŶĚŝǀŝĚƵĂůƐ ĂƌĞ ĂƵƚŚŽƌŝǌĞĚ ƚŽ ƌĞǀŝĞǁ Ă ǁĂƌƌĂŶƚ Žƌ ƚŽ ĐŽŶƐĞŶƚ ƚŽ ƚŚĞŝƌ ĞŶƚƌǇ ŝŶƚŽ ƉƌŝǀĂƚĞ ĂƌĞĂƐ͘ /Ĩ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ĂƐŬ ƉĞƌŵŝƐƐŝŽŶ Žƌ ĂƩĞŵƉƚ ƚŽ ĞŶƚĞƌ Ă ƉƌŝǀĂƚĞ ĂƌĞĂ͕ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ƉĞƌƐŽŶ ƐŚŽƵůĚ ƐƚĂƚĞ ĞǆƉůŝĐŝƚůǇ ƚŚĂƚ ŚĞͬƐŚĞ ĚŽĞƐ ŶŽƚ ĐŽŶƐĞŶƚ ƚŽ entry without a warrant. /Ĩ ƚŚĞ ĂŐĞŶƚƐ ŝŶĚŝĐĂƚĞ ƚŚĂƚ ƚŚĞǇ ǁŝůů ŐĞƚ Ă ǁĂƌƌĂŶƚ͕ ĐŽŶƚĂĐƚ Ă ůĂǁǇĞƌ ĂŶĚ ƚƌǇ ƚŽ ŚĂǀĞ ƚŚĂƚ ƉĞƌƐŽŶ ƉƌĞƐĞŶƚ ĨŽƌ ƚŚĞ ƐĞĂƌĐŚ͘ tŚĞŶ ƉƌĞƐĞŶƚĞĚ ǁŝƚŚ Ă ǁĂƌƌĂŶƚ͕ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĐŽŶƚĂĐƚ;ƐͿ ƐŚŽƵůĚ ƌĞǀŝĞǁ ƚŚĞ ǁĂƌƌĂŶƚ ĨŽƌ ǀĂůŝĚŝƚǇ͘ ǁĂƌƌĂŶƚ ŝƐ ŶŽƚ ǀĂůŝĚ ƵŶůĞƐƐ ŝƚ ŝƐ ƐŝŐŶĞĚ ďǇ Ă ũƵĚŐĞ ĂŶĚ ƐƚĂƚĞƐ ƚŚĞ ĂĚĚƌĞƐƐ ŽĨ ƚŚĞ ƐƉĞĐŝĮĐ ƉƌĞŵŝƐŝƐ ƚŽ ďĞ ƐĞĂƌĐŚĞĚ͘ /Ĩ ƚŚĞ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ŚĂǀĞ Ă ǀĂůŝĚ ǁĂƌƌĂŶƚ͕ ƚŚĞǇ ĐĂŶ ĞŶƚĞƌ ƚŚĞ ƉƌŝǀĂƚĞ ĂƌĞĂƐ ĂŶĚ ƋƵĞƐƟŽŶ ĂŶǇŽŶĞ ƉƌĞƐĞŶƚ͘ ZĞŵŝŶĚ Ăůů ƉĂƟĞŶƚƐ ĂŶĚ ŽƚŚĞƌ ƉĞƌƐŽŶƐ ƉƌĞƐĞŶƚ ƚŚĂƚ ƚŚĞǇ ŚĂǀĞ ƚŚĞ ƌŝŐŚƚ ŶŽƚ ƚŽ ĂŶƐǁĞƌ ĂŶǇ ƋƵĞƐƟŽŶƐ͘ WƌŽǀŝĚĞ ƉŽƐƚĞƌƐ͕ ͞<ŶŽǁ zŽƵƌ ZŝŐŚƚƐ͟ ĐĂƌĚƐ ĂŶĚ ĞĚƵĐĂƟŽŶĂů ŵĂƚĞƌŝĂůƐ ĂĚǀŝƐŝŶŐ ƉĂƟĞŶƚƐ ƚŚĂƚ ƚŚĞǇ ŚĂǀĞ ƚŚĞ ƌŝŐŚƚ ƚŽ ƌĞĨƵƐĞ ƚŽ ĂŶƐǁĞƌ ƋƵĞƐƟŽŶƐ ĨƌŽŵ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ĂŶĚ ƚŽ ĂƐŬ ƚŚĂƚ Ă ůĂǁǇĞƌ ďĞ ƉƌĞƐĞŶƚ ŝĨ ƚŚĞǇ ĂƌĞ ƋƵĞƐƟŽŶĞĚ͘ ĚǀŝƐĞ ƉĂƟĞŶƚƐ ŶĞǀĞƌ ƚŽ ƌƵŶ ĨƌŽŵ ŝŵŵŝŐƌĂƟŽŶ ŽĸĐŝĂůƐ͕ ĂƐ ƚŚŝƐ ĐĂŶ ĐĂƵƐĞ ƚŚĞŵ ƚŽ ďĞ ĂƌƌĞƐƚĞĚ͘ ,ĂǀĞ ƉĂƟĞŶƚƐ Įůů ŽƵƚ Ă ĐĂƌĞŐŝǀĞƌ ĂƵƚŚŽƌŝǌĂƟŽŶ ĂĸĚĂǀŝƚ ĨŽƌ ŵŝŶŽƌ ĐŚŝůĚƌĞŶ͘ dŚŝƐ ǁŝůů ĂůůŽǁ ĂŶŽƚŚĞƌ ƌĞůĂƟǀĞ ƚŽ ƚĂŬĞ Ă ĐŚŝůĚ ƚŽ ĂŶ ĂƉƉŽŝŶƚŵĞŶƚ ŝĨ ƚŚĞ ƉĂƌĞŶƚƐ ĂƌĞ ƵŶĂǀĂŝůĂďůĞ ƚŽ ĚŽ ƐŽ ƚŚĞŵƐĞůǀĞƐ͘ ZĞĂĐŚ ŽƵƚ ƚŽ ŝŵŵŝŐƌĂŶƚ ƌŝŐŚƚƐ ŐƌŽƵƉƐ͕ ůŝŬĞ ƚŚĞ ĂůŝĨŽƌŶŝĂ /ŵŵŝŐƌĂŶƚ WŽůŝĐǇ ĞŶƚĞƌ͕ ƚŽ ŚĞůƉ ĐƌĞĂƚĞ ƚƌĂŝŶŝŶŐƐ ĨŽƌ ǇŽƵƌ ƐƚĂī ĂŶĚ ƉĂƟĞŶƚƐ͘ ,ĂǀĞ ƐƚĂī ƌŽůĞͲƉůĂǇ ƚŚĞŝƌ ƌĞƐƉŽŶƐĞƐ ƚŽ ĂŶ ŝŵŵŝŐƌĂƟŽŶ ƌĂŝĚ ŽŶ ƚŚĞ ĐůŝŶŝĐ͕ ƐŽ ƚŚĞǇ ĂƌĞ ƉƌĞƉĂƌĞĚ ƚŽ ƌĞƐƉŽŶĚ ĐŽŶĮĚĞŶƚůǇ ŝŶ Ă ƐƚƌĞƐƐĨƵů ƐŝƚƵĂƟŽŶ͘ ƐƚĂďůŝƐŚ Ă ƌĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ ĂŶ ŝŵŵŝŐƌĂƟŽŶ ĂƩŽƌŶĞǇ ǁŚĞŶ ƉŽƐƐŝďůĞ Žƌ Ă ůĂǁǇĞƌ͕ ƐƵĐŚ ĂƐ Ă ďŽĂƌĚ ŵĞŵďĞƌ ǁŚŽ ŝƐ ĂŶ ĂƩŽƌŶĞǇ͕ ǁŚŽ ĐĂŶ ďĞ ĂǀĂŝůĂďůĞ ŝĨ an agent comes into the clinic. KďƚĂŝŶ ĐŽŶƚĂĐƚ ŝŶĨŽƌŵĂƟŽŶ ;Ğ͘Ő͕͘ ƉŚŽŶĞ ŶƵŵďĞƌƐͿ ĨŽƌ ĨŽƌĞŝŐŶ ĐŽŶƐƵůĂƚĞƐ ŝŶ ǇŽƵƌ ĂƌĞĂ ĂŶĚ ƚŚĞ ƉŚŽŶĞ ŶƵŵďĞƌ ŽĨ ƚŚĞ ůŽĐĂů / ĚĞƚĞŶƟŽŶ ĐĞŶƚĞƌ ƚŽ ŚĞůƉ ƚŚĞ ĨĂŵŝůŝĞƐ ŽĨ ƉĂƟĞŶƚƐ ǁŚŽ ŵĂǇ ďĞ ĚĞƚĂŝŶĞĚ ŚƩƉƐ͗ͬͬǁǁǁ͘ŝĐĞ͘ŐŽǀͬĚĞƚĞŶƟŽŶͲĨĂĐŝůŝƟĞƐ͘

/ŶĨŽƌŵ ƉĂƟĞŶƚƐ ŽĨ ƚŚĞŝƌ ƌŝŐŚƚƐ ƐŽ ƚŚĞǇ ŬŶŽǁ ƚŚĞǇ ƐŚŽƵůĚ͗ ZĞŵĂŝŶ ƐŝůĞŶƚ Žƌ ƚĞůů ƚŚĞ / ĂŐĞŶƚ ƚŚĂƚ ƚŚĞǇ ǁĂŶƚ ƚŽ ƌĞŵĂŝŶ ƐŝůĞŶƚ͘ ƐŬ ƚŽ ƐƉĞĂŬ ǁŝƚŚ Ă ůĂǁǇĞƌ͘ NOT carry false documents. ĂƌƌǇ Ă ͞ŬŶŽǁ ǇŽƵƌ ƌŝŐŚƚƐ ĐĂƌĚ͟ &ŝŶĚ ŽƵƚ ƚŚĞ ŶĂŵĞ ĂŶĚ ƉŚŽŶĞ ŶƵŵďĞƌ ŽĨ Ă ƌĞůŝĂďůĞ ŝŵŵŝŐƌĂƟŽŶ ĂƩŽƌŶĞǇ ĂŶĚ ŬĞĞƉ ƚŚĂƚ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ƚŚĞŵ Ăƚ Ăůů ƟŵĞƐ͘ <ŶŽǁ ƚŚĞŝƌ ͞ĂůŝĞŶ ƌĞŐŝƐƚƌĂƟŽŶ ŶƵŵďĞƌ͟ ;͞ ͟ ŶƵŵďĞƌͿ ŝĨ ƚŚĞǇ ŚĂǀĞ ŽŶĞ ĂŶĚ ǁƌŝƚĞ ŝƚ ĚŽǁŶ ƐŽŵĞ ƉůĂĐĞ Ăƚ ŚŽŵĞ ǁŚĞƌĞ ƚŚĞŝƌ ĨĂŵŝůǇ ŵĞŵďĞƌƐ ŬŶŽǁ ǁŚĞƌĞ ƚŽ ĮŶĚ ŝƚ͘

/Ĩ ĂŶ / ƌĂŝĚ ŚĂƐ ŽĐĐƵƌƌĞĚ͕ ŐĂƚŚĞƌ ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƌĂŝĚ͕ ŝŶĐůƵĚŝŶŐ͗ ŽŶĮƌŵŝŶŐ ǁŚĞƚŚĞƌ ƚŚĞ ƌĂŝĚ;ƐͿ ŽĐĐƵƌƌĞĚ͗ Ă͘ tŚĞƚŚĞƌ ƚŚĞ ƌĂŝĚ ǁĂƐ ĐĞŶƚĞƌĞĚ ŽŶ Ă ǁŽƌŬƉůĂĐĞ;ƐͿ ĂŶĚ ǁŚŝĐŚ ůŽĐĂƟŽŶƐ͖ ď͘ ƉƉƌŽǆŝŵĂƚĞ ŶƵŵďĞƌ ŽĨ ƉĞƌƐŽŶƐ ĂƉƉƌĞŚĞŶĚĞĚ͖ Đ͘ /ĚĞŶƟƟĞƐ ŽĨ ƉĞƌƐŽŶƐ ĂƉƉƌĞŚĞŶĚĞĚ͖ Ě͘ >ŽĐĂƟŽŶ ŽĨ ƚŚĞ ŝŶŝƟĂů ĚĞƚĞŶƟŽŶ ;ĨƌĞƋƵĞŶƚůǇ Ă ůŽĐĂů ĨĂĐŝůŝƚǇ ŝƐ ƵƐĞĚ ĨŽƌ ƚĞŵƉŽƌĂƌǇ ŚŽůĚŝŶŐ ĂŶĚ ƉƌŽĐĞƐƐŝŶŐͿ͘ dŚĞ ŶĂŵĞƐ ĂŶĚ ďĂĚŐĞ ŶƵŵďĞƌƐ ŽĨ / ĂŐĞŶƚƐ͖ ŶǇ ĂŶĚ Ăůů ĂĐƟŽŶƐ ƚĂŬĞŶ ďǇ / ĂŐĞŶƚƐ ƚŚĂƚ ŵĂǇ ďĞ ƵŶůĂǁĨƵů͖ tŚĞƚŚĞƌ / ŝƐ ƐĐƌĞĞŶŝŶŐ ƉĞƌƐŽŶƐ ĨŽƌ ŚƵŵĂŶŝƚĂƌŝĂŶ ƌĞůĞĂƐĞƐ ;ƐŝŶŐůĞ ƉĂƌĞŶƚƐͬĐĂƌĞŐŝǀĞƌƐ͕ ƉĞŽƉůĞ ǁŝƚŚ ŚĞĂůƚŚ ŝƐƐƵĞƐ͕ ĞƚĐ͘Ϳ͖ tŚĞƚŚĞƌ / ŚĂƐ ĐƌĞĂƚĞĚ ĂŶ ϴϬϬη ĨŽƌ ĨĂŵŝůǇ ŵĞŵďĞƌƐ ƚŽ ůĞĂƌŶ ŝĨ ƚŚĞŝƌ ƌĞůĂƟǀĞƐ ŚĂǀĞ ďĞĞŶ ĂƉƉƌĞŚĞŶĚĞĚ ĂŶĚ ǁŚĞƌĞ ƚŚĞǇ ĂƌĞ ĚĞƚĂŝŶĞĚ͖ ĂŶĚ What arrangements are being made for minor children and other involvement by state social services agencies.

Ŷ ĞǆƚĞŶƐŝǀĞ ůŝƐƚ ŽĨ ƌĞƐŽƵƌĐĞƐ ŽŶ / ĂŶĚ ŽƚŚĞƌ ŝŵŵŝŐƌĂƟŽŶ ŝƐƐƵĞƐ ĐĂŶ ďĞ ĨŽƵŶĚ ŽŶ ƚŚĞ ,ĞĂůƚŚǇ ,ĂƌďŽƌƐ page on www.familydocs.org. California Family Physician Spring 2019

Sheryl Recinos, MD

Exploring the Intersection of Health Care and Housing We have not seen a better time to discuss the social ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ĂŶĚ ŚŽǁ ƚŚĞǇ ĂĨĨĞĐƚ ŚĞĂůƚŚ ŝŶ ŽƵƌ ĐŽŵŵƵŶŝƚǇ͘ WĂƚŝĞŶƚƐ ǁŝƚŚ ŝŶĂĚĞƋƵĂƚĞ Žƌ ŝŶƐĞĐƵƌĞ ŚŽƵƐŝŶŐ ĞǆƉĞƌŝĞŶĐĞ ŚŝŐŚĞƌ ůĞǀĞůƐ ŽĨ ƐƚƌĞƐƐ ĂŶĚ ŝŶĐƌĞĂƐĞĚ ŝŶĐŝĚĞŶĐĞ ŽĨ pulmonary and cardiovascular diseases. Additionally, patients ǁŚŽ ůŝǀĞ ŝŶ ĐƌŽǁĚĞĚ ŚŽƵƐŝŶŐ Žƌ ůĂĐŬ ŚŽƵƐŝŶŐ ĂƌĞ Ăƚ ŚŝŐŚĞƌ ƌŝƐŬ of infectious diseases. Homelessness is a serious concern as it greatly impacts patients’ morbidity and mortality. In California, ƉĂƚŝĞŶƚƐ ǁŚŽ ĂƌĞ ĐŚƌŽŶŝĐĂůůǇ ŚŽŵĞůĞƐƐ ŚĂǀĞ Ă ƐŝŐŶŝĨŝĐĂŶƚůǇ ƌĞĚƵĐĞĚ ůŝĨĞ ĞǆƉĞĐƚĂŶĐǇ ĐŽŵƉĂƌĞĚ ƚŽ ƚŚĞ ŵĂŝŶƐƚƌĞĂŵ ƉŽƉƵůĂƚŝŽŶ͘ tŚĞƌĞĂƐ ƚŚĞ h^ ůŝĨĞ ĞǆƉĞĐƚĂŶĐǇ ƌĂŶŐĞƐ ĨƌŽŵ ϳϲ ƚŽ ϴϭ ǇĞĂƌƐ ŽĨ ĂŐĞ͕ ŚŽŵĞůĞƐƐ ƉĂƚŝĞŶƚƐ ĐĂŶ ĞǆƉĞĐƚ ŽŶůǇ ƚŽ ƐƵƌǀŝǀĞ ĂŶǇǁŚĞƌĞ ďĞƚǁĞĞŶ ϰϮ ƚŽ ϱϮͲǇĞĂƌƐͲŽůĚ͘ As housing costs rise and previously housed people are ƉƵƐŚĞĚ ŽŶƚŽ ƚŚĞ ƐƚƌĞĞƚƐ͕ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉĞŽƉůĞ ĞǆƉĞƌŝĞŶĐŝŶŐ homelessness continues to climb in California and across the ŶĂƚŝŽŶ͘ dŚĞ ŐƌŽǁƚŚ ŽĨ ƚĞŶƚ ĐŝƚŝĞƐ ĂĐƌŽƐƐ ĂůŝĨŽƌŶŝĂ ŵĂǇ ƉƌŽǀĞ ƚŽ ďĞ ĂŶ ĞǇĞƐŽƌĞ ĨŽƌ ŵĂŶǇ͕ ďƵƚ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ǁĞ ƐŚŽƵůĚ see this as an opportunity. Our communities are greatly affected, and our impoverished populations are at risk. Many ĨĂŵŝůŝĞƐ ĂƌĞ ǁŝƚŚŝŶ ŽŶĞ ƉĂǇĐŚĞĐŬ ŽĨ ůŽƐŝŶŐ ƚŚĞŝƌ ŚŽƵƐŝŶŐ͘ dŚĞƐĞ ĂƌĞ ƚŚĞ ƐĂŵĞ ĨĂŵŝůŝĞƐ ǁŚŽ ƐƚƌƵŐŐůĞ ƚŽ ƉƵƌĐŚĂƐĞ ŶƵƚƌŝƚŝŽƵƐ ĨŽŽĚ ĂŶĚ ƉĂǇ ƚŚĞŝƌ ƉƌĞƐĐƌŝƉƚŝŽŶ ĐŽͲƉĂǇƐ͘ ͞,ƵŵĂŶ ĚŝŐŶŝƚǇ ŝƐ ŶŽƚ ƵŶŝƋƵĞ ƚŽ ƚŚŽƐĞ ǁŝƚŚ ƌŽŽĨƐ ŽǀĞƌ ƚŚĞŝƌ ŚĞĂĚƐ͕͟ ƐƚĂƚĞƐ ƉƵůŵŽŶĂƌǇ and critical care specialist Tabassum Nafsi, MD. Unfortunately, medical conditions can be both a cause of ŚŽŵĞůĞƐƐŶĞƐƐ͕ ĂƐ ǁĞůů ĂƐ ĂŶ ŽƵƚĐŽŵĞ ŽĨ ůŝǀŝŶŐ ŽŶ ƚŚĞ ƐƚƌĞĞƚƐ͘ In fact, 50 percent of all bankruptcies are caused by health care ĞǆƉĞŶƐĞƐ͘ /Ĩ ƚŚŽƐĞ ƉĂƚŝĞŶƚƐ ŚĂǀĞ ŶŽ ƐĂĨĞƚǇ ŶĞƚ͕ ƚŚĞǇ ĂƌĞ Ăƚ ƌŝƐŬ of losing their housing and finding themselves alongside many of our chronically homeless patients. Chronic health conditions such as substance abuse, mental health disorders, pulmonary disorders, infectious diseases such ĂƐ ƚƵďĞƌĐƵůŽƐŝƐ͕ ŚĞƉĂƚŝƚŝƐ͕ ,/sͬ / ^ ĂŶĚ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƚƚĞĚ infections are found in homeless youth. Homeless adults ƐƵĨĨĞƌ ĨƌŽŵ Ăůů ŽĨ ƚŚĞƐĞ ŝůůŶĞƐƐĞƐ͕ ĂƐ ǁĞůů ĂƐ ƚŚĞ ůŽŶŐ ƚĞƌŵ effects of poorly treated heart disease, liver disease, kidney disease and lung disease. 'ĂƐƚƌŽĞŶƚĞƌŽůŽŐŝƐƚ ƌŝƐƚŝŶĂ DĂƌŝŶ͕ D ͕ ƌĞůĂƚĞƐ Ă ƐƚŽƌǇ ŽĨ ƚĂĐŬůŝŶŐ ďĂƌƌŝĞƌƐ ƚŽ ĐĂƌĞ ĨŽƌ Ă ƉĂƚŝĞŶƚ ƐƚƌƵŐŐůŝŶŐ ǁŝƚŚ ďŽƚŚ schizophrenia and homelessness. While undergoing treatment 28

California Family Physician Spring 2019

^ŚĞƌǇů ĂŶĚ ŚĞƌ ŚƵƐďĂŶĚ ǇƌŽŶ ZĞĐŝŶŽƐ͕ ƐĞƌǀŝŶŐ Ă ŵĞĂů ƚŚĞǇ ƉƌĞƉĂƌĞĚ ĨŽƌ homeless youth at My Friend’s Place in Hollywood.

ĨŽƌ ,ĞƉĂƚŝƚŝƐ ͕ ŚĞƌ ƉĂƚŝĞŶƚ ƐƚƌƵŐŐůĞĚ ǁŝƚŚ ƉĂǇŝŶŐ ĨŽƌ ŚŝƐ ŵĞĚŝĐŝŶĞ ĂŶĚ ŬĞĞƉŝŶŐ ƚƌĂĐŬ ŽĨ ǁŚĞƌĞ ƚŚĞ ŵĞĚŝĐŝŶĞƐ ǁĞƌĞ ůŽĐĂƚĞĚ͘ ƌ͘ DĂƌŝŶ ĂŶĚ ŚĞƌ ƐƚĂĨĨ ƐĞƚ ƵƉ ǁĞĞŬůǇ ŵĞĞƚŝŶŐƐ ǁŝƚŚ him so he could take his treatment at her clinic. He received Ă ŵĞĂů Ăƚ ĞĂĐŚ ŵĞĞƚŝŶŐ͕ ǁŚŝĐŚ ŚĞůƉĞĚ ŐĞƚ Śŝŵ ŝŶƚŽ ƚŚĞ ĐůŝŶŝĐ͘ Ɛ Ă ƌĞƐƵůƚ͕ ŚŝƐ ,ĞƉĂƚŝƚŝƐ ǁĂƐ ĐƵƌĞĚ͘ ƌ͘ DĂƌŝŶ ƌĞƉŽƌƚƐ ƚŚĂƚ͕ ͞/ĚĞŶƚŝĨǇŝŶŐ ŝƐƐƵĞƐ ƚŽ ŚĞůƉ ŚŽŵĞůĞƐƐ ƉĂƚŝĞŶƚƐ ŚĂǀĞ ŝŵƉƌŽǀĞĚ ĂĐĐĞƐƐ ŝƐ ǀŝƚĂů͘͟

Homeless patients encounter health care in a variety of ƐĞƚƚŝŶŐƐ͖ ŽĨƚĞŶ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐǇ ƌŽŽŵ͕ ĂůƚŚŽƵŐŚ ŽƚŚĞƌƐ ƐĞĞŬ ĐĂƌĞ ŝŶ ĐŽŵŵƵŶŝƚǇ ĐůŝŶŝĐƐ ĂŶĚ ĨƌŽŵ ƉƌŽŐƌĂŵƐ ŐĞĂƌĞĚ ƚŽǁĂƌĚƐ ƚƌĞĂƚŝŶŐ ƉĂƚŝĞŶƚƐ ǁŚĞƌĞ ƚŚĞǇ ůŝǀĞ͘ EƵŵĞƌŽƵƐ ĨƌĞĞ ĐůŝŶŝĐƐ ĂŶĚ ŵŽďŝůĞ ŚĞĂůƚŚ ĐůŝŶŝĐƐ ƌĞĂĐŚ ŽƵƚ ƚŽ ƉĞŽƉůĞ ǁŚŽ ĂƌĞ ƐĐĂƚƚĞƌĞĚ amongst the city’s streets and offer specialized care for this disadvantaged population. On the frontlines of the crisis are primary ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ƐƵĐŚ ĂƐ &W ϮϬϭϵ ,ĞƌŽ of Family Medicine, Jasmeet Bains, MD. tŚĞŶ ƐŚĞ ďĞŐĂŶ ǁŽƌŬŝŶŐ ŝŶ Ă &ĞĚĞƌĂůůǇͲ YƵĂůŝĨŝĞĚ ,ĞĂůƚŚ ĞŶƚĞƌ ;&Y, Ϳ ĐůŝŶŝĐ ŝŶ dĂĨƚ͕ ĂůŝĨŽƌŶŝĂ͕ ƐŚĞ ǁĂƐ ĂƐƚŽƵŶĚĞĚ ďǇ the lack of support services for her local homeless population. As a result, she began volunteering at a local homeless ƐŚĞůƚĞƌ͕ ͞ ĞĐĂƵƐĞ ŝƚ ŚĞůƉĞĚ ŵĞ ĐŚĞĐŬ up on my patients and at the same time understand my patients by observing their ďĞŚĂǀŝŽƌƐ ŽƵƚƐŝĚĞ ŽĨ ĐůŝŶŝĐ͘͟ While a smaller percentage of homeless individuals die as a direct result of ůŝǀŝŶŐ ŝŶ ĞǆƚƌĞŵĞ ĐŽŶĚŝƚŝŽŶƐ ;ĨƌŽƐƚďŝƚĞ͕ ŚǇƉŽƚŚĞƌŵŝĂ͕ ŝŵŵĞƌƐŝŽŶ ĨŽŽƚͿ͕ ƉĂƚŝĞŶƚƐ ǁŚŽ ŚĂǀĞ ĞǆƉĞƌŝĞŶĐĞĚ ĂŶĚ ƐƵƌǀŝǀĞĚ ĨƌŽŵ ĂŶǇ ŽĨ ƚŚĞƐĞ ĞǆƉŽƐƵƌĞƐ ĂƌĞ ĞŝŐŚƚ ƚŝŵĞƐ more likely to die from any cause. These patients could be easily identified and ƉƌŽǀŝĚĞĚ ǁŝƚŚ ŝŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĂƐ Ă preventative measure. The numbers are staggering. As family ƉŚǇƐŝĐŝĂŶƐ͕ ǁĞ ĂƌĞ ƚŚĞ ůĞĂĚĞƌƐ ǁŚŽ ĂƌĞ uniquely suited to step up and take a stand for housing and health care. We can reach out to local government officials, develop patient care plans for our homeless ƉŽƉƵůĂƚŝŽŶƐ ĂŶĚ ǀŽůƵŶƚĞĞƌ ǁŝƚŚŝŶ ƚŚĞ community. We can participate in clothing and food drives, community health fairs, ĂŶĚ ǁŽƌŬ ĂůŽŶŐƐŝĚĞ ůŽĐĂů ŽƌŐĂŶŝǌĂƚŝŽŶƐ ƚŚĂƚ ĂƌĞ ĞǆƉĞƌƚƐ ŝŶ ŵĞĞƚŝŶŐ ƚŚĞ ŶĞĞĚƐ ŽĨ ƚŚŝƐ ĞǆƉĂŶĚŝŶŐ ƉŽƉƵůĂƚŝŽŶ͘ tĞ ĂƌĞ ƵŶŝƋƵĞůǇ suited to identify needs and find remedies at the local, state and federal level. These are our patients, this is our community, ĂŶĚ ǁĞ ĐĂŶ ĚŽ ŵƵĐŚ ďĞƚƚĞƌ ƚŚĂŶ Ă ůŝĨĞ ĞǆƉĞĐƚĂŶĐǇ ŽĨ ϰϮ ƚŽ ϱϮͲǇĞĂƌƐͲŽůĚ͘

^ŚĞƌǇů ZĞĐŝŶŽƐ͕ D ͕ ŝƐ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ǁŽƌŬŝŶŐ ĂƐ Ă Hospitalist in Los Angeles County. She recently released her memoir entitled Hindsight: Coming of Age on the Streets of Hollywood͕ ŝŶ ǁŚŝĐŚ ƐŚĞ ƐŚĂƌĞƐ ŚĞƌ ĞǆƉĞƌŝĞŶĐĞƐ ĂƐ Ă formerly homeless teenager.

BECOME AN INTEGRAL PART OF AN EXCITING YOUNG RESIDENCY PROGRAM! Become an integral part of an exciting young residency program that began in 2013. We have full 10 year ACGME accreditation. Eisenhower Health in Rancho Mirage, California seeks to hire a MD faculty member to serve as part of our residency program. You will have outpatient care responsibilities and may choose to have inpatient care responsibilities. You will precept FM residents in the Center for Family Medicine. Faculty have protected time for curriculum management, resident advising, and scholarly work. Board certification in Family Medicine (ABMS or AOA) is required. Academic appointment will be confirmed from the USC Keck School of Medicine or Western University of Health Sciences. Rank will depend upon experience and qualifications.

Eisenhower Health seeks candidates whose experience, teaching, research and community service have prepared them to contribute to our commitment to serving the Coachella Valley. Eisenhower is an EO/M employer. Qualified applicants, including recent residency graduates, are encouraged to apply. Candidates should submit a digital CV and statement of interest to Scott Nass, MD, MPA, Program Director at SNass@eisenhowerhealth.org with . cc: Tamara Dunn at TDunn@eisenhowerhealth.org. For questions, please contact Michelle Harding at mharding@eisenhowerhealth.org or 760-773-4504.

www.eisenhowerhealth.org California Family Physician Spring 2019

ceo message

Lisa Folberg, MPP

Make It Work I had the pleasure of helping plan, implement and then attend ŵǇ ĨŝƌƐƚ &W ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƚŝŶŐ ; D DͿ ŝŶ ^ĂĐƌĂŵĞŶƚŽ ŝŶ DĂƌĐŚ͘ / ǁŝůů ĂĚŵŝƚ ƚŚĂƚ Ă ĨĞǁ ĚĂǇƐ ďĞĨŽƌĞ ǁĞ ŚĞĂĚĞĚ ƚŽ ^ĂĐƌĂŵĞŶƚŽ͕ / ǁĂƐŶ͛ƚ ƐƵƌĞ ǁĞ ǁĞƌĞ ŐŽŝŶŐ ƚŽ ŵĂŬĞ ŝƚ Ăůů ŚĂƉƉĞŶ͘ dŚƌŽƵŐŚ ŝƚ Ăůů / ǁŽƌŬĞĚ ǁŝƚŚ ŽƵƌ ƉŚǇƐŝĐŝĂŶ ůĞĂĚĞƌƐ ǁŚŽ ŶĞǀĞƌ ƐĞĞŵĞĚ ŶĞƌǀŽƵƐ Žƌ ƉĂŶŝĐŬĞĚ ĂďŽƵƚ ĞǀĞƌǇƚŚŝŶŐ ĐŽŵŝŶŐ ƚŽŐĞƚŚĞƌ͘ KŶĞ ŽĨ ǇŽƵƌ ŽĂƌĚ ŵĞŵďĞƌƐ ĞǆƉůĂŝŶĞĚ ƚŚĂƚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝƐ Ă ƐĞƌŝĞƐ ŽĨ ŵĂŬĞ ŝƚ ǁŽƌŬ ŵŽŵĞŶƚƐ͘ ,Ğ ĂĚĚĞĚ ƚŚĂƚ ĂƐ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ǇŽƵ ŽĨƚĞŶ ĚŽŶ͛ƚ ŬŶŽǁ ǁŚĂƚ ƚŽ ĞǆƉĞĐƚ ǁŚĞŶ Ă ƉĂƚŝĞŶƚ ǁĂůŬƐ ƚŚƌŽƵŐŚ ƚŚĞ ĚŽŽƌ͘ EŽƚ ŽŶůǇ ĚŝĚ ƚŚĞ D D ǁŽƌŬ͕ ŝƚ ǁĂƐ ĨĂŶƚĂƐƚŝĐ͘ /ƚ ǁĂƐ ǁŽŶĚĞƌĨƵů to see so many people attending AMAM for the first time, and a ĚĞůŝŐŚƚ ƚŽ ƚĂůŬ ƚŽ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ŚĂǀĞ ĂƚƚĞŶĚĞĚ D D ƐŝŶĐĞ ŝƚƐ inception seven years ago.

share the plans they have put in place to keep ICE out of clinics and a brave member in tears as she shared for the first time in public that she is an abortion provider. I heard moms and dads ƚĂůŬŝŶŐ ĂďŽƵƚ ƚŚĞ ƐƚƌƵŐŐůĞƐ ŽĨ ďĂůĂŶĐŝŶŐ ǁŽƌŬ ĂŶĚ ƉĂƌĞŶƚŚŽŽĚ ĂŶĚ ŚŽǁ ŵƵĐŚ ƚŚĞǇ ŵŝƐƐ ƚŚĞŝƌ ŬŝĚƐ ŽŶ ǁĞĞŬĞŶĚƐ ůŝŬĞ ƚŚŝƐ͘ ǀĞŶ ǁŝƚŚ ƚŚĞƐĞ ĐŚĂůůĞŶŐĞƐ͕ ƐŽŵĞŚŽǁ ǇŽƵ ŵĂŬĞ ŝƚ ǁŽƌŬ͘ dŚĞ ĐŽŵŵŝƚŵĞŶƚ ƚŽ &W ĂŶĚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ǁĂƐ ĞǀŝĚĞŶƚ throughout the AMAM. The Family Physician Political Action ŽŵŵŝƚƚĞĞ ;&WͲW Ϳ ƌĂŝƐĞĚ ŵŽƌĞ ŵŽŶĞǇ ƚŚĂŶ ŝŶ ĂŶǇ ƉƌĞǀŝŽƵƐ ǇĞĂƌ͘ dŚĂŶŬ ǇŽƵ ƚŽ ĞĂĐŚ ŽĨ ǇŽƵ ǁŚŽ ŚĂƐ ŵĂĚĞ Ă ĚŽŶĂƚŝŽŶ ƚŽ &WͲ W ͘ tŝƚŚ ǇŽƵƌ ŚĞůƉ͕ ĂŶ ĞǆƉĂŶĚĞĚ &WͲW ǁŝůů ĂůůŽǁ ƵƐ ƚŽ ŚĂǀĞ an even bigger voice in State legislative issues.

/ƚ ǁĂƐ ƉŽǁĞƌĨƵů ƚŽ ƐĞĞ Ă ƐĞĂ ŽĨ ǁŚŝƚĞ ĐŽĂƚƐ Ăƚ ƚŚĞ ĂƉŝƚŽů ŽŶ Monday after AMAM for the CAFP Day at the Capitol. CAFP D D ǁĂƐ Ă ǁŽŶĚĞƌĨƵů ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ ŵĞ ƚŽ ŐĞƚ ƚŽ ŬŶŽǁ ŵŽƌĞ ŵĞŵďĞƌƐ ƚĂůŬĞĚ ǁŝƚŚ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĞŝƌ ƐƚĂĨĨƐ ĂďŽƵƚ &W͛Ɛ CAFP members and learn more about your practices. I spoke ƐƉŽŶƐŽƌĞĚ ďŝůů ϭϲϮϮ͕ ĂƵƚŚŽƌĞĚ ďǇ ƐƐĞŵďůǇ DĞŵďĞƌ tĞŶĚǇ ǁŝƚŚ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶƐ ĐŽŶƚĞŵƉůĂƚŝŶŐ ƌĞƚŝƌĞŵĞŶƚ͘ / ŵĞƚ Carillo. Your CAFP staff and contractors do a fantastic job ǁŝƚŚ WĞƌŵĂŶĞŶƚĞ ĂŶĚ ĐůŝŶŝĐ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ƚŚŽƐĞ ĚŽŝŶŐ ĚŝƌĞĐƚ advocating on your behalf, but no one can tell your stories primary care. ƚŚĞ ǁĂǇ ǇŽƵ ĐĂŶ͘ EŽ ŽŶĞ ĐĂŶ ƚĂůŬ ǁŝƚŚ ƚŚĞ ƐĂŵĞ ĂƵƚŚŽƌŝƚǇ ĂŶĚ ƉĂƐƐŝŽŶ ĂƐ ǇŽƵ ĂďŽƵƚ ǇŽƵƌ ĞǆƉĞƌŝĞŶĐĞ ǁŝƚŚ ƉĂƚŝĞŶƚƐ͕ ǁŚǇ / ǁĂƐ ĂůƐŽ ĂŵĂǌĞĚ Ăƚ ƚŚĞ ĚŝǀĞƌƐŝƚǇ ŽĨ ƉĞƌƐŽŶĂů ŝŶƚĞƌĞƐƚ ĂŶĚ ǇŽƵ ĐŚŽƐĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ǁŚǇ ŝƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ƉƌŽƚĞĐƚ ƚĂůĞŶƚƐ ŝŶ ƚŚĞ ƌŽŽŵ͘ / ŐŽƚ ƚŽ ŬŶŽǁ ƌ͘ ^ŚĞƌǇů ZĞĐŝŶŽƐ͕ ǁŚŽ a family physician’s ability to practice full spectrum family ǁƌŽƚĞ Ă ďŽŽŬ ĂďŽƵƚ ŚĞƌ ĞǆƉĞƌŝĞŶĐĞ ĂƐ Ă ŚŽŵĞůĞƐƐ ǇŽƵƚŚ ĂŶĚ medicine. ƌ͘ DŽĂǌǌĂŵ ĂǁũĂ ǁŚŽ ĚŽĞƐ ͞ƐƉŽŬĞŶ ǁŽƌĚ͟ ĂƐ Ă ǁĂǇ ƚŽ ƐƚĂǇ connected to his roots. California is facing a number of challenges, from natural disasters and the shortage of affordable housing to primary dŚĞ ĚŝǀĞƌƐŝƚǇ ŽĨ ƉƌŽĨĞƐƐŝŽŶĂů ĂŶĚ ƉĞƌƐŽŶĂů ĞǆƉĞƌŝĞŶĐĞ ĂŶĚ care physician shortages and rising health care costs. Family perspectives made for rich and interesting discussions. Part of physicians are continually challenged to meet mounting the focus of the AMAM is discussing and providing testimony administrative burdens. Many of you face student debt and on resolutions for CAFP action or policy change – these ƌĞƐƚƌŝĐƚŝŽŶƐ ŽŶ ŚŽǁ ǇŽƵ ĂƌĞ ĂďůĞ ƚŽ ĐĂƌĞ ĨŽƌ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ resolutions have been submitted by CAFP members for Board ǀĞŶ ǁŝƚŚ ƚŚĞƐĞ ĐŚĂůůĞŶŐĞƐ͕ ǇŽƵ ƉƌŽǀŝĚĞ ŚŝŐŚ ƋƵĂůŝƚǇ ĐĂƌĞ ƚŚĂƚ consideration. Eleven resolutions included challenging issues, benefits your patients and the health care system. Evidence ĨƌŽŵ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ĂŶĚ ƌĞƐŝĚĞŶƚ ǁĞůůŶĞƐƐ ƐŚŽǁƐ ƚŚĂƚ ĂĐĐĞƐƐ ƚŽ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƚŽ ƌĞƉƌŽĚƵĐƚŝǀĞ ŚĞĂůƚŚ ĂŶĚ ĂŝĚͲŝŶͲĚǇŝŶŐ͘ KƵƌ ŵĞŵďĞƌƐ ǁĞƌĞ providers helps people live longer, healthier lives. In fact, a respectful and thoughtful in their comments. Not afraid to &ĞďƌƵĂƌǇ ϮϬϭϵ ƐƚƵĚǇ ŝŶ ƚŚĞ EĞǁ ŶŐůĂŶĚ :ŽƵƌŶĂů ŽĨ DĞĚŝĐŝŶĞ speak their minds, but gentle in their delivery. ƐŚŽǁĞĚ ƚŚĂƚ ĂƌĞĂƐ ǁŝƚŚ ŵŽƌĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ŚĂǀĞ ůŽŶŐĞƌ ůŝĨĞ ĞǆƉĞĐƚĂŶĐǇ͘ ^Ž͕ ĂƐ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ĚĞĐŝƐŝŽŶ ŵĂŬĞƌƐ͕ ^ŝƚƚŝŶŐ ŽŶ ƚŚĞ ĚĂŝƐ / ŚĂĚ ƚŽ ĨŝŐŚƚ ďĂĐŬ ŵǇ ŽǁŶ ĞŵŽƚŝŽŶƐ ĂƐ / ǁĂƐ ǇŽƵ ǁŝůů ĂƉƉƌĞĐŝĂƚĞ ƚŚĂƚ ƐĐŝĞŶƚŝĨŝĐ ƌĞƐĞĂƌĐŚ ƐƵƉƉŽƌƚƐ ǁŚĂƚ / ƐĂǁ ƌĞŵŝŶĚĞĚ ŽĨ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚĞ ǁŽƌŬ ƚŚĂƚ ǇŽƵ ĚŽ at AMAM and CAFP Lobby Day, family physicians’ amazing ability for your patients across California. Listening to CAFP members to Make It Work. 30

California Family Physician Spring 2019

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

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437