Summer 2020 by California Academy of Family Physicians

VOL . 7 1 NO. 3 Su mme r 2 0 2 0

An Interview with Your New President,

David E.J. Bazzo, MD, FAAFP, CAQSM in this issue LEARNING, CONNECTING AND CELEBRATING IN A POST COVID-19 WORLD REFLECTIONS OF AN EARLY CAREER PHYSICIAN REFLECTIONS ON RESIDENCY DURING HEADWINDS OF PANDEMICS

California Family Physician Summer 2020

1520 Pacific Avenue • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board

Staff

President David Bazzo, MD, FAAFP

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

Immediate Past President Walter Mills, MD, MMM, FAAFP President-elect Shannon Connolly, MD, FAAFP Speaker Lauren Simon, MD, MPH, FAAFP Vice-Speaker Raul Ayala, MD, MHCM Secretary/Treasurer Alex McDonald, MD, FAAFP Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD Carol Havens, MD AAFP Alternates Jay W. Lee, MD, MPH Lee Ralph, MD CMA Delegation Raul Ayala, MD Kimberly Buss, MD, MPH Jay W. Lee, MD, MPH Felix Nunez, MD, MPH Kevin Rossi, MD

Morgan Cleveland Manager, Operations|Governance and FP-PAC mcleveland@familydocs.org Jerri Davis, CHCP Director, CME/CPD jdavis@familydocs.org Adam Francis Director, Government Affairs afrancis@familydocs.org Melissa Grindstaff Manager, Member Engagement mgrindstaff@familydocs.org Arlanna Henry Manager, Educational Programs ahenry@familydocs.org Josh Lunsford Director, Membership and Marketing jlunsford@familydocs.org Shelly Rodrigues, CAE, FACEHP Deputy Executive Vice President srodrigues@familydocs.org Jonathan Rudolph Manager, Finance jrudolph@familydocs.org

Looking for a job? Go to www.fpjobsonline.com Questions? Call 888-884-8242 and a HEALTHeCAREERS representative will help you.

Brent Sugimoto, MD, Editor Josh Lunsford, Managing Editor Shelly Rodrigues, CAE, Consulting 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.

California Family Physician Summer 2020

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EDITION 35

Summe r 2 02 0

Front cover photo provided by David Poller Photography

features 16 An Interview with Your New President, David E.J. Bazzo, MD, FAAFP, CAQSM 20 Reflections of an Early Career Physician

Alex McDonald, MD, FAAFP, Adia Scrubb, MD, MPH, Rossan Chen, MD, Rob Assibey, MD, and Jasmeet Kaur Bains, MD

24 Reflections on Residency During Headwinds of Pandemics 26 CAFP and CAFP Foundation Announce the 2020 Award Winners

Jeremy Fish, MD, Program Director, John Muir Health Family Medicine Residency Shelly Rodrigues, CAE, FAAMSE, Deputy EVP

departments 6 Editorial

New Physicians are Vital for Our Future

Brent Sugimoto, MD, MPH

8 Presidentâ&#x20AC;&#x2122;s Message

CAFP is Listening

10 Political Pulse

Family Physicians Stand Up to COVID-19 and Its Effects

12 Continuing Education

Learning, Connecting and Celebrating in a Post COVID-19 World

14 Advocacy Update

The Journey to Reform Primary Care Payment

30 CEO Message

Under Our Umbrella

David Bazzo, MD, FAAFP Carla Kakutani, MD Jerri Davis, CHCP Adam Francis Lisa Folberg, MPP

For upcoming CME activities visit familydocs.org/cme California Family Physician Summer 2020

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

New Physicians are Vital for Our Future Congratulations to the Class of 2020, both to those who have just embarked on their journey through residency and to those who have pushed through that long tunnel to the light as independently practicing family physicians. Members of your Academy, the California Academy of Family Physicians, are thrilled and proud that we can count you as a family doctor. You may hear yourself referred to as a “New Physician.” In the Academy (https://www.aafp.org/about/policies/all/newphysician.html), it is defined as a family physician “[…] who completed residency or extended training immediately following residency seven years ago or less.” Seven years ago, I myself puzzled at why I was labeled with this term, wondering if it was some sort of pejorative, like newbie or n00b.

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confronted with the need to adapt tends to inspire the impulse for innovation. And this impulse is the gift that avails one of opportunities that the less nimble are slower to seize. I am loathe to mention COVID-19 in everything I write these days—just another indication of how the pandemic has rewritten my, your, everyone’s lives. But amidst the exhausting—and sometimes heartbreaking—work you do to protect your patients and your community, I would like you to keep this in mind: the pandemic has exposed all the ways our health system does not work. You are still determining what works in practice and so you are not at all invested in the status quo. In my humble opinion, new family physicians are best positioned to lead our way to change.

This issue of C ali fornia Famil y Consider the following. It turns out that as new According to the American Phy sician will re f lec t on what it physicians concentrate on Board of Family Medicine means to be new in prac tice , as establishing themselves Graduate Survey Report of 2016 well as present thoughts abou t in practice, they tend to Family Medicine Residency navigating this formative time. be underrepresented Graduates (https://www. in physician leadership. theabfm.org/sites/default/files/ Early practice physicians PDF/NationalOnly_Report2019. were given the moniker pdf), although 88, 85 and 62 of “New Physician” to ensure the Academy met their practice percent felt well-trained in maternity care, newborn hospital needs and that they were provided leadership opportunities care and ICU care, respectively, only 27, 24, and 21 percent, were for representation in family medicine. I, myself, benefited from currently practicing in those settings. Lack of opportunity was this designation when I was elected to the American Academy one of the largest reasons recent graduates were not applying of Family Physicians (AAFP) Board of Directors as the New their training skills. Physician Director. “New Physician” is an important designation ensuring every segment of the Academy is supported in its Yet, during the coronavirus pandemic, family physicians have practice of medicine. been called on to provide surge capacity in exactly those roles they have even recently been denied (https://www.aafp.org/ This designation has another important function. It makes news/blogs/inthetrenches/entry/20200428itt-covidlessons. visible the unique and vital contributions a specific segment of html). Furthermore, the Commonwealth Fund has recognized physicians makes to the specialty of Family Medicine. the instrumental role of primary care in health emergencies like COVID-19 and the underfunding for primary care that has Yes, graduates, the pandemic has created a time of more stymied the nation’s response to the pandemic (https://www. adaptation and flux—not the message I would have wanted commonwealthfund.org/blog/2020/primary-care-and-covid-19after three years of the same in residency. However, being pandemic).

California Family Physician Summer 2020

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In this crisis, the value of family medicine as the foundation of a well-functioning health care system has been proven. PostCOVID, our nation will likely carve a new space for primary care in that foundation— but who will dictate the size and shape of that space? I believe that you, the new physician, will be instrumental in that conversation with your perspective, your innovative spirit, and most importantly, an unwillingness to accept that the way things are, is the way they should be. This issue of California Family Physician will reflect on what it means to be new in practice, as well as present thoughts about navigating this formative time. The CAFP has many resources at your disposal to help smooth this transition. You will also hear how the Academy is strategically and tactically advocating to remove the barriers that impede the care you give your patients. However, as the new frontline physicians, the academicians, the government commissioners, the entrepreneurs, the advocates and the agitators, your engagement with the CAFP is vital for our efforts to reshape primary care. Any engagement—from paying dues, to meeting your local chapter for dinner, to storming the Capitol—connects us as a specialty and makes us a stronger force for reshaping primary care in family medicine’s image. As I begin my eighth year out of residency, I am shedding that label of new physician. The past seven years were unsteady, unsettling and challenging ones that nevertheless propelled my career into a trajectory that excites me. The past seven years were a gift that I hope you will likewise enjoy. I am deeply excited about your potential and the opportunities you have for a fulfilling practice. Your success will make primary care better for all of us, our patients and our communities.

California Family Physician Summer 2020

p r e s i d e n t ’s m e s s a g e

David Bazzo, MD, FAAFP

CAFP is Listening

Recent events have created space for all of us to pause, reflect, and most importantly, begin to act. We are months into the new world of the COVID-19 pandemic. The police killing of George Floyd has shown a light on the racism and bias African American and other communities of color face every day, including in the very institutions sworn to protect and care for them. CAFP recognizes that bias and racism hurt people of color in health care as well, and to address it we must make fundamental change. We urge our members to use the momentum of this moment to push for change.

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Leaders should be inspirational, aspirational, and functional. They should empower and support others to be their best. However, in my mind, the most important qualities are to be a great listener and effective communicator. We only succeed as an organization by providing our members what they need. We are here because of you and are beholden to you. I will work this year to be an effective listener and communicator to you. This is especially important now. With the daily flood of information and misinformation about COVID-19, we need to help members assimilate the latest medical information, but more importantly, help support our members as we encounter incredible financial hurdles that impact our practices at all levels, and support each other as the emotional toll continues to mount. One of Dr. Walt Mills’ focuses last year was on the “wellness” of our members as we faced the highest numbers of burnout, mental health issues and suicide. The needs have already increased.

There is a lot of work to do, bu t I am confident that we can do it . Our local constituent chapters have become much more active and organized in the last year.

We all have witnessed and experienced firsthand the incredible influence our elected officials and government have on our practice of medicine. It is of utmost importance that we have our voices heard and that we advocate so that we have the resources available to deliver the best care to our patients. It is a self-serving but honest statement that as family physicians, and what we do in delivering primary care, we have the best insight into the health of our state and nation. We need to organize, mobilize our base, and fight for our patients. We are continuously learning and acting in ways with the prime directive of how best to support family physicians.

California Family Physician Summer 2020

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Often, I return to the words of CAFP’s mission, vision, and direction during these unprecedented and uncertain times. We have strong values, strong direction, collegiality, and a strong history to guide us. As president, I believe we must be hitting on all cylinders to serve our members.

There is a lot of work to do, but I am confident that we can do it. Our local constituent chapters have become much more active and organized in the last year. We are engaging more members and will continue to do so with ongoing outreach and support. We will continue important, timely, and effective communication. I challenge my colleagues to stay involved. Let us hear from you, become engaged, and in turn we will communicate and continue to serve you and make you proud to be a member of CAFP.

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

Family Physicians Stand Up to COVID-19 and Its Effects I’ve been amazed and inspired by the spirit of family physicians over these last few months. You everyday heroes became SUPERHEROES – fighting COVID-19 at your doorstep - triaging, testing, treating and educating patients. Many of you switched your entire practices to telemedicine at the drop of a dime. You battled for yourselves and your colleagues who faced unprecedented financial struggle as patients went without care. You stood up to the Governor who proposed slashing funding for the Song-Brown Primary Care Physician Training Program, Medi-Cal provider loan repayment and services for vulnerable populations. For years we’ve been saying that if we really want CHANGE, we can no longer be Family Medicine Nice. So far this year, I’ve been awed by your ability to be Family Medicine FIERCE! Advocating for family medicine and our patients has certainly taken on new meaning since the COVID-19 pandemic hit. It’s also had to come in different forms than we’ve been used to. Family physician advocates have been interacting with legislators and candidates for office through calls, texts and Zoom (like everyone else). In the height of the budget fight in June, I met by Zoom with State Senator Richard Pan, MD. He chairs the important Senate Budget Subcommittee on Health and Human Services. We talked about how important access to health care will be to defeat the COVID pandemic and deal with its aftermath in the years to come. His

California Family Physician Summer 2020

committee helped develop the Senate’s budget proposal – the first to reject the Governor’s proposed cuts to health services and benefits coverage if the federal government didn’t provide funding to states struggling with budget deficits as a result of COVID-19. With the Assembly following suit, your advocacy helped save the Song-Brown Physician Training Program, which provides funding to primary care residency programs located in underserved areas, serving underserved populations, and recruiting minority physicians. The decision to prioritize health care programs wasn’t made because of my one meeting. After CAFP sent out its call to action, CAFP’s Action Alert page received more than 1,000 pageviews. Family physicians from all over the state flooded their elected officials’ offices with phone calls about the shortsightedness of cutting health care programs amid a pandemic, as well as the tremendous importance of programs such as Song-Brown. CAFP members took to social media to raise awareness of these issues with tweets that reached an audience of more than 50,000 people. We must not rest on our laurels. Our colleagues and our patients will need us to advocate for them in the months ahead as we continue to battle COVID and the destruction it has wrought on community health and economic wellbeing. Thank you again for all you have done and all you will continue to do.

Jerri Davis, CHCP

continuing education

Director of CME and CPD

Learning, Connecting and Celebrating in a Post COVID-19 World

Virtual Clinical Forum CAFP is also offering a virtual Clinical Forum registration, with full access to the education, conference app, virtual exhibit program

California Family Physician Summer 2020

and more! We hope this gives many more of our members an opportunity to see what the Forum has to offer ~ even from home. And speaking of home . . . CAFP recently launched “Homeroom,” an online platform with quality education on a variety of important topics for family physicians. In fact, we have added a few “teaser sessions” from the upcoming Clinical Forum. Homeroom is part of the CAFP Campus, our spot for clinical educational and professional development activities. On Campus, you will find a wide variety of courses, tools, resources, and topics to meet your practice needs. We hope you take the opportunity to visit the website today at www.familydocs.org/campus! #FMForum20

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The Forum is an event I look forward to attending every year! I always meet amazing people and come away with valuable information and inspiration I put to use right away. — 2019 Forum Attendee

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Like everyone else, CAFP has had to postpone or cancel live events – We now await the time when we can tiptoe back into the “live” meeting space. We have optimistically rescheduled our 2020 Family Medicine Clinical Forum: Learn | Connect | Celebrate for November 13-15, 2020 at the Long Beach Hilton. Our hope is that it is safe to travel and safe to come together face-to-face to enjoy each other’s company, learn from colleagues and celebrate the incredible family of family medicine. The meeting will look different as we sit further apart, wearing facemasks and bumping elbows instead of shaking hands and hugging … but, we promise a terrific education program where we benefit from hearing more about lessons learned from, and the “silver linings” of, COVID-19 and discuss many important opportunities to advance patient care in our brave new world. A few of the sessions on our agenda include adverse childhood experiences/trauma-informed care, vaping and e-cigarettes, menopause, reducing work after clinic (WAC), dementia care, maximizing STI screening and PrEP therapy, and more! You can also take advantage of the Palliative Care and Health Behavior KSAs for MOC credit, and we hopefully will be able to offer workshops for hands-on experience in point of care ultrasound (POCUS) and Dermoscopy/Biopsy.

It was a great way to recharge me and to veer me from the direction of burnout. — 2018 Forum Attendee

Adam Francis CAFP Director of Government Relations

advocacy update

The Journey to Reform Primary Care Payment Your board and physician leaders included payment reform as a major priority in CAFP’s three-year strategic plan. This isn’t a new priority though – for dozens of years, CAFP has been on the lookout for opportunities to make sure family physicians’ payment reflects the value you bring to our health care system. It is not an exaggeration to say the deck has been stacked against you. However, through the tireless advocacy of your physician leaders, we are starting to see major cracks in the walls that have been built up against you. Ideally, family physicians would be paid: • A prospective, risk-adjusted, primary care global payment for direct patient care; AND • Fee-for-service limited to services not included in the primary care global fee; AND • A prospective, risk-adjusted, population-based payment; AND • Performance-based incentive payments that hold physicians appropriately accountable for quality and costs. This is AAFP’s Alternative Payment Model (APM) proposal. Before the COVID-19 pandemic, AAFP submitted a thorough proposal of this model to the Physician-Focused Payment Model Technical Advisory Committee (PTAC). The PTAC approved the APC-APM for limited-scale testing and forwarded that recommendation to the federal Health and Human Services Secretary Alex Azar. The Secretary commented, "this proposal from AAFP offers promise because of its emphasis on the expansion of beneficiary access to high-quality primary care and its support for primary care physicians' ability to deliver advanced primary care more effectively." For CAFP’s part, in 2015 we sponsored legislation authored by Senator and pediatrician Richard Pan, MD that would have required the state to act as a “convener,” bringing together a group of stakeholders (health plans, insurers, patients, employers, health professionals, etc.), to develop all-payer patient centered medical home (PCMH) pilots. The bill, SB 435, would have allowed the State to waive specific anti-trust liability so that plans could align payment, incentives and reporting requirements for a primary care practice. So instead of having seven different contracts, with seven different health plans, with seven different payment amounts, seven different prior authorization rules, seven different EVERYTHING – a family physician could focus on delivering the best primary care, with the financial resources to ensure the best outcomes. Public-private 14

California Family Physician Summer 2020

all-payer initiatives are unique opportunities to spread the cost of delivering high-performing primary care among all payers, creating a shared incentive for delivery system improvement. This added investment not only improves care, it SAVES money! While the bill did not pass the legislature, good ideas have a tendency to stick around. Earlier this year, CAFP revived this “convener” concept. After discussion with Covered California, the Pacific Business Group on Health (which represents larger employer purchasers of health care insurance), and others, we noticed a remarkable shift in attitudes and acceptance of this type of proposal. We put together factsheets and talking points to urge legislators to include it as part of the upcoming budget discussions. Little did we know when we re-introduced the idea back in early January that the whole world would be turned upside down because of the COVID-19 pandemic. While the rest of the world was put on hold, we believed this idea had even MORE value now than before. As reports came in of family physician and other primary care practices closing or facing severe fiscal challenges, we knew we had to push legislators to take action to immediately provide funds to struggling practices and use those payments as a stepping stone to true primary care payment and delivery reform. A recently released national study indicated that almost 80 percent of primary care clinicians are experiencing ‘severe’ or ‘close to severe’ strain as a direct result of COVID-19. A survey conducted by CAFP showed that 42 percent of family physicians in California are experiencing extreme financial impact. Thus the Care for Californians Initiative was born. The Initiative calls for: 1. Requiring health plans to provide immediate payment support for fee-for-service primary care practices. 2. Creating a stakeholder group, convened by the state, to successfully transition primary care to a payment model that sufficiently supports it, modeled after AAFP’s APM. As I write this, our coalition is deep in negotiations with the Legislature and Governor’s office to secure the Initiative’s passage. We urge you to remain engaged and attuned to CAFP Action Alerts on this topic. We cannot achieve REAL primary care payment reform without your steadfast action to ensure decisionmakers know how important primary care is to patients and our health care system.

An Interview with Your New President,

David E.J. Bazzo, MD, FAAFP, CAQSM Why did you choose family medicine? I had just completed three years of research as an undergraduate in reconstructive burn surgery when I started medical school. I went in “knowing” I was going to be a plastic surgeon. However, during my third-year rotations, I gained clinical exposure and found I liked doing many things. On my pediatrics rotation, I had the opportunity to work with two family medicine residents and spend a great deal of time with them learning about family medicine and the new field of primary care sports medicine. I had no previous exposure to family medicine up to that point. I further explored family medicine early in my fourth-year rotations and realized I had found a home. The diversity of opportunity and the relationships one could forge were like no other specialty.

Who were the role models who inspired you to go into family medicine? My first role models were those two third-year rotation family medicine residents and in my fourth year, while on my family medicine rotation and my primary care sports medicine rotation, I worked with Dr. Doug Starr on an away family medicine rotation and Dr. William Briner in my primary care sports medicine rotation. Both were inspirational and showed me what my career could be. They were happy, engaged, had a great staff

and wonderful patients. They made a difference in the lives of their patients. But … my greatest physician role model is William Norcross, my residency director, now colleague and friend, who showed me what the consummate family physician educator could be. Bill’s knowledge about medicine, history and his imagination and ideas are second to none. I’m lucky enough to be able to work with Bill to this day, and his inspiration still drives me. Finally, I can’t forget my parents and family. My mom and dad, both Italian immigrants, raised me to respect hard work and to always strive to do better. It was never a question that my brother (an attorney) and I would be professionals, even though neither of my parents got beyond the equivalent of a high school education. Despite our modest upbringing, we never wanted for anything, and their love toward entertaining and always opening up our house has stuck with me. My wife Sabrina and our beautiful children Mara and Eliana inspire me every day and confirm that my career decision was the right one.

What piqued your interest in becoming active with your county and state AFP chapters? In the mid-‘90s I was asked by San Diego Academy of Family Physicians to speak at one of the CME events that they hosted. Photo provided by David Poller Photography

As a few years passed, close colleagues became involved with the San Diego Chapter, and around the turn of the century I joined the board. I was somewhat naïve about the political process at that time but quickly learned the value and power of organized medicine. Also, it was a great way to meet colleagues who shared similar interests. The more I learned, the more I became engaged. I experienced a sphere of influence that I, as a family physician, found to be amazing. I learned about policy, resolutions, the politics in Sacramento and in Washington DC and the affect that they could have on my ability to care for patients. It was at that time I realized I could help one patient in the examination room, but I could help thousands and even millions of patients through the legislative process. I, like many, went into medicine to help people and make a difference in their lives using my love of science and interacting with people while doing it. It was through organized medicine that the influence and difference could be magnified.

What has been the best part of being an officer in CAFP so far? That’s an easy one … the people I’ve met, interacted with, learned from, cried with and become friends with have allowed me to have opportunities never imagined. CAFP is packed with people I admire and love. My greatest treasure has been interacting with the most talented, passionate, brilliant, caring and fascinating people with huge hearts. Getting to be president of an organization usually means one has devoted a lot of time and energy. However, the return in terms of making me a better person, with a greater perspective and understanding, has been unmeasurable. I will never be able to pay the debt for the treasures I have received from these interactions. Included in this group are not only fellow physician colleagues but also the incredible staff CAFP has had and maintains today. Our staff is so dedicated and understands what it is like to be a family physician without having an MD or DO after their name. We have been blessed to have the BEST staff to help take our ideas and direction and turn them into action. Just to be able to work with our incredible staff is a gift.

Undergraduate graduation for Dr. Bazzo's oldest daughter Mara in Philadelphia, PA (Pictured L-R: youngest daughter Eliana (currently entering her junior year at Colorado State), Wife Sabrina, Mara and Dr. Bazzo.)

How do you maintain the joy in your practice? Again, it’s the people and relationships. Just this week, I saw a patient for a shoulder complaint. In my pre-review, I noted I’d seen this patient four years ago for chest pain. My colleague is her primary care physician and I had not seen the patient since. I went in to reintroduce myself. Her response was, “Oh, I remember you very well, you saved my life.” It turns out that the chest pain she was suffering from during her previous appointment with me was due to a pulmonary embolus and we had acted quickly to get her to the hospital and anticoagulated. She said she felt bad that she was never able to thank me in person, but was glad that her shoulder acted up so she could see me. This is not an uncommon experience for my fellow family physicians. The gratitude and difference we make in our patients’ lives don’t need to be this obvious, but where else can we prescribe a medication, perform a pain relieving procedure or lessen suffering by lending an ear and just listening and “being” with someone where we can help a fellow human? Nothing compares! I received an email continued on next page >

Dr. Bazzo standing on the pitch for the San Diego Seals Professional Indoor Lacrosse team, where he is the head team physician.

California Family Physician Summer 2020

< continued from previous page

just today from a patient asking if I could write a letter to her daughter who is graduating from high school and going off to college. She reminded me of the day I informed her and her husband that they were going to be a family. The daughter did have some health problems that kept her in doctors’ offices for a fair amount of her young life. And, unfortunately, I also had to inform her husband that he had a terminal cancer and made home visits to help in his final days. The patient acknowledged that I must be very busy but that it would make her daughter’s day if I could share some “words of wisdom,” as I knew her father well. Needless to say, the joy and honor that I felt were incredible.

Where will family medicine be in 10 years and what role will CAFP have played in it? Wow, what a time to ask this question. We are into nearly three months of sheltering in place from COVID-19; we are worried about funding health care, losing practices and how to keep the pandemic from surging. To add to this, it’s been nearly a month since George Floyd was murdered. Protests are gaining momentum and I have never heard people acknowledge the racism, health disparities and social inequities that have existed for years as they are now. My hope and desire, nay, my efforts and actions, will be to make sure we address these unconscionable wrongs that persist. I see primary care and specifically family medicine physicians, who have always recognized these issues, to be a large part of the solution from a social and medical perspective. The United States will finally understand what the rest of the first world countries have known for years, that the medical system must be built around primary care. Year in and year out the Commonwealth report (reference: https://www. commonwealthfund.org/publications/issue-briefs/2020/jan/ us-health-care-global-perspective-2019) shows that despite spending more than many other countries (Switzerland, Germany, France, Sweden, Canada, Norway, Netherlands, United Kingdom, Australia and New Zealand), our health outcomes and life expectancy are the worst. The COVID-19 pandemic will continue to highlight what research highlights … that in order to have the optimal health outcomes for a population, to improve the lives of people, primary care must lead. Financial strains will likely serve as the sea change for true reform, and we are certainly feeling the financial strains more now than at any time in the recent past. CAFP will continue to be strong advocates educating our legislators on the realities of the data. Additionally, medicine and the science of caring for people will continue to advance by leaps and bounds, and our members will need continual updating of their knowledge. CAFP has always been a leader in providing the right education at the right time for our members, and our efforts will continue on that front. CAFP continues to win awards and be an exemplar of outstanding continuing professional development. This will not change but will continue with stronger efforts utilizing effective educational modalities to meet the needs of our members. 18

California Family Physician Summer 2020

Dr. Bazzo with Mira Mesa High School Football team where he is the head team physician.

While currently at 11,000 members strong, CAFP’s numbers will continue to grow as an increasing number of family physicians of our state understand the benefits and rewards of membership. With higher numbers comes enhanced strength and influence in order to move our agenda forward with the ultimate goal of keeping our population as healthy as they can be.

What do you do for fun outside of practicing medicine? I definitely like being around people. I find pleasure in gathering around a meal or party I’ve helped to create. Cooking is a passion. I find my creative efforts get flowing in trying new ways to prepare food. Yes, the stories are true, I have an outdoor kitchen complete with wood-fired pizza oven. The social aspect of preparing the meal with friends or family, sitting down and enjoying food, conversation and maybe even some wine, and the inevitable post-gustatory relaxation with stories and laughter are a great way to spend time. As a former athlete I have a competitive nature, mostly on the golf course these days. While I don’t get to play as often as I like, I prize my time on the links with my buddies. Finally, in pre-COVID-19 times, my family loved to travel. My work allows the benefit of travel throughout the US and internationally – having family in Italy is serendipitous to my longing to see new places and meet new people. I am truly honored to be CAFP’s president in our 72nd year as an organization. We are here for our members, and I will work to make you proud that you’re a family physician in California.

More about Dr. Bazzo David E.J. Bazzo, MD, FAAFP, CAQSM, is a clinical professor of Family Medicine at the UCSD School of Medicine. He is board certified in family medicine and has a Certificate of Added Qualification in sports medicine. He is Director of the Fitness for Duty Program for the UCSD Physician Assessment and Clinical Education (PACE) Program as well as Course Director for a number of their educational offerings. Dr. Bazzo has an active practice in Family and Sports Medicine. He is Co-Director of the Primary Care Core Clerkship for third year medical students in addition to his clinical teaching roles for all medical students, family medicine residents and sports medicine fellows. He has an active interest in physician assessment and meaningful education at all levels of medicine – medical school through active practice. He has lectured nationally and internationally on a number of topics including sports medicine, osteoarthritis, headache, neurologic issues, communications, pain management and physician assessment. Dr. Bazzo is a past-president of the San Diego County Medical Society. He serves as Head Team Physician for the San Diego Seals Professional Indoor Lacrosse team and is team physician or consulting physician for numerous sports teams including others at the professional, Olympic, collegiate, and high school levels. He was voted one of San Diego’s “Top Doctors” for the last 15 years in family medicine and/or sports medicine by his peers. He is the 2011 recipient of the Barbara Harris Award for Educational Excellence. The selection was made by the California Academy of Family Physicians Foundation Board. He also received the California Medical Association Board of Trustees 2019 Gary Nye, MD Award for Physician Health & Well-Being. California Family Physician Summer 2020

Reflecting on family medicine, practice , patients and life!

Reflections of an Early Career Physician CAFP Early Career Physicians (ECP) or New Physicians are those within the first seven years of practice after residency or fellowship. Although most of us are relatively young, some started medical school later in life and for others, medicine is a second career. We possess a unique voice with the Academy and within our respective organizations. We have a fresh perspective on medicine and practice, but also a little “real world experience” that may have refined our expectations or enthusiasm as well as brought a little more credibility to our voices. Many of us have ambitious dreams for ourselves, our practice and our patients, but also have learned how, perhaps, be more measured, nuanced and effective in our approaches. One thing is clear – we are all aware of the ups and downs on the long path from medical school to a sustainable and fulfilling career as a family physician, but we know our CAFP family will always be ready to support and encourage all of us along the way. – Alex McDonald, MD, FAAFP, CAFP Secretary/Treasurer and New Physician Director

I realized I just needed to take the first step and that a career is truly a journey, and not knowing the ultimate destination is part of the process. Instead of looking for the perfect job, I started looking for the perfect place to start my career. I started to look for the most opportunity.

Alex McDonald, MD, FAAFP I practice full spectrum family medicine and sports medicine with Southern California Permanente Medical Group in Fontana. I must admit I love my practice and the variety of opportunities provided. I practice about 60 percent primary care, including pediatrics, and do a wide array of office-based procedures, including vasectomy, circumcisions, GYN and skin procedures. The rest of my practice is 30 percent sports medicine and 10 percent inpatient hospital medicine. I also have the privilege of teaching our residents and sports medicine fellows. Lastly, I am a member of both our innovations and imaging appropriateness committees, including Point-of-Care Ultrasound education. I do lots of things, but they all help to fulfill a personal and professional interest of mine to help maintain my joy in practice.

My single best advice for any graduating resident is to get as much experience as possible. Pick up extra shifts; don’t shy away from extra work or patients; ask as many questions as you can because the time to learn on the job after residency is really limited and if you do have time, other pressing tasks will take it! Practicing medicine in residency and in practice as an early career physician is not any harder or different, but the pace and volume of appointments, patients, messages, results, meetings etc. are 10 or or 20 times greater. As such, while the pace of medicine is a little slower as a resident with protected education time, I strongly encourage residents to learn as much as they can and get as much experience as they can, because if they don’t do it or learn it in residency, it’s much harder to do it full practice.

At the end of my sports medicine fellowship, I envisioned my practice and what type of medicine I truly wanted to practice. I saw so many options and no clear path. Until then medicine and medical education had been very formulaic. I found it all very overwhelming and intimidating; I felt like I had to find or get the perfect and forever job right out of residency. After talking with some amazing mentors 20

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I think the hardest thing about the first few years of residency is the amount of time and energy it took to develop relationships with patients and build a practice … not just a collection of patients, but those who choose you or were recommended to you as the best physician for them. Every patient and physician relationship is different, and not all physicians are going to be the right fit for each patient. Now, when I meet a new patient, I tell them that outright and spend a few minutes explaining who I am as a physician and my philosophy, in part to see if we are the right fit. Although this takes a little extra time to start, it’s well worth it in the long run, and patients feel more connected and cared for as well.

Involvement in CAFP as a resident literally changed the trajectory of my career in ways I never imagined possible. I am the family doctor I am today and involved in so many amazing projects and practice opportunities in large part due to the mentors, connections, and friends I have found within CAFP. In CAFP I truly found my tribe of family doctors who understand who and what I am about and why I am a family doctor. Not only this, CAFP members support each other; they challenge and inspire each other to be better, and they share a little of this spark with their patients, colleagues and medical community. I learned leadership and advocacy skills which I’m not sure I could have obtained anywhere else, or at least not in the same way, and was able to bring those skills back to my residency as well as to my colleagues. Who better to build community with, support, understand and advocate for family medicine than family doctors?

Adia Scrubb, MD, MPH I have just finished my third year in residency, and after taking some time off and taking my family medicine board exam, I’ll start practicing at a Federally Qualified Health Center (FQHC) in Oakland in the Fall. It has been a wild ride these past few months!

What advice would I give a current resident before the transition? This one is a bit tougher, as I’m in this phase myself, but I think much of the above applies – I thought about location, patient population, expected patient volume, health care system (FQHC, private non-profit, HMO), teaching opportunity, salary and loan repayment. I emphasized what skills or value I believe I bring to my new organization. Just keep moving forward if your plans change or something unexpected happens; you may just end up right back on track.

My path to land the FQHC position, during COVID, was fraught with unanticipated challenges -- from the news that our boards scheduled for April 2020 had been canceled, to early interviews and preliminary meetings with recruiters followed by a two-month period with no follow-up communication. I certainly understood the reason for the halt, but as a graduating resident who is asked daily “what's next for you?” I was concerned about finding the right place to practice. Once virtual interviews became an option, I was invited to interview, and I successfully completed several of them. Other prospects chose not to continue interviews, but from the virtual interviews I attended, I managed to secure my new position by the end of May. My boards are rescheduled for July, and I will start my new position in the Fall after my break. I began my journey in residency with a goal of serving patients inside and outside of the clinic. I understood that legislation and advocacy that happen outside of the clinic influences what I can offer my patients inside the clinic. My work in the Susan Hogeland, CAE Health Policy Fellowship enhanced my experience as a resident because I was able to understand how the hardships and difficulties my patients encountered could be overcome by policy changes in the future. I also appreciated the important legislation and programs that needed to stay in place to help my patients. I also believe my experience as a health policy fellow has definitely inspired me to make health policy and advocacy a significant part of my future career. I want to continue contributing to projects and programs that will improve health care for more than just the patients that I see in clinic. My fellowship year fortunately coincided with the Surgeon General's ACEs campaign, and I completed my policy project on ACEs and resilience. I hope to continue this work, which fits in perfectly with my goals to continue working with disadvantaged adolescent youth. What advice would I give a student looking into residency? Easy, choose the factors that are the most important to you (i.e., location, diversity, patient population, proximity to family) and evaluate accordingly. Demonstrate an understanding and interest in the programs where you interview. Do not rank a program you definitely know would not make you happy.

Rossan Chen, MD I have been working at Kaiser Vallejo since Aug 2014. I chose to work here because of the incredible resources available to the underserved patients in our community and the Family Medicine residency program. I am currently on the core faculty of the Kaiser Napa Solano Family Medicine Residency Program, and I am one of the module leads within the Adult and Family Medicine department. My panel size is about 1,400 patients, and I work 80% time. I see the full spectrum of ages, genders and gender identities and prenatal patients. I chose not to practice in-patient medicine or L&D after residency because of the weekend and evening commitments. I was looking for a primary care position in an underserved area in the Bay Area. I interviewed at a couple of DPH clinics in San Francisco, as well as Kaiser Richmond and Kaiser Vallejo. I was drawn to the Kaiser model because it seemed very supportive for someone right out of residency. Specialty support is available by phone, email or direct clinic booking without significant wait times. The electronic health record is integrated and powerful. There are no prior authorizations or insurance companies to deal with. The Kaiser model made it easy for me to focus on learning how to be a primary care physician without worrying about the extraneous tasks that FQHC doctors often have to deal with. Prior to graduating from residency, my life was planned out in three to four-year intervals: college, graduate school, medical school and residency. I didn’t realize that after graduating from residency the next career milestone to look forward to would be retirement, which is a huge commitment of 30 years! Once you start contributing towards your pension or partnership, or accept a retention bonus and spend it all on your loans or a down payment on a house, it’s very hard to leave. The “golden handcuffs” are real!

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I have been fortunate to work with incredibly intelligent and talented teachers in the Family Medicine residency program at Kaiser Vallejo. I didn’t expect to be involved in residency education after graduating, though I always enjoyed teaching. I have been very thankful for the opportunity to teach medical students and residents as it has given more meaning and context to my own clinical care. One piece of advice I would give a student looking into residency would be to go where you feel the most at home. One piece of advice I would give a current resident before the transition would be to consider doing locums or working per diem for a few years before settling down for your “career.” If you do this, you will be able to explore different work settings to decide the best place for you. I became involved in CAFP through the TEACH program in residency. I presented a resolution on designating the copper IUD as the first line treatment for emergency contraception. The All Member Advocacy meeting was so inspiring, and I felt like I could make a difference through the resolution-writing process. I had never attended a Lobby Day before, and it was a great opportunity to meet with my state representatives. CAFP is such a supportive advocacy organization for family physicians and truly has our best interests in mind. Once I started working at Kaiser Vallejo, I began to look for ways to maintain my involvement with CAFP. With the help of my colleagues, I revitalized the local CAFP chapter in Vallejo, and we have partnered with Touro medical students and nearby CAFP chapters in submitting resolutions to the AMAM every year. I am in the process of creating a Health Policy and Advocacy curriculum for my residency program that will hopefully engage and excite future generations of family physicians to make positive changes for our field and our patients. Rob Assibey, MD I’m a new physician who will be starting as a faculty member at San Joaquin General Hospital FMRP. I will be working at a community hospital as faculty of a residency program in French Camp. I will be assisting the residents in their training in addition to helping with our geriatrics curriculum and taking care of our skilled nursing facility patients. As we are an FQHC look alike, a majority of our patients are on Medi-Cal. My transition from residency to practice is ongoing. I think it will be an easier one than most. One benefit is I’m staying at the same program, so I already know the system and the staff. There is a lot of 22

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fear of not knowing everything, but I have a great support staff. Also being chief resident helped me get a glimpse of how things are done behind the scenes. I wish I had known more about appropriate financial planning in regard to how to make the most efficient use of a new income prior to leaving my residency program. With the burden of many loans, it’s hard to navigate which loan repayment program is most beneficial and how you can factor that into your salary in order to pay off loans the fastest. One piece of advice I would give a student looking into residency would be to find a place where you think you would fit in the most with the residents, faculty and support staff. Also, try to find the ideal patient population that you want to take care of. Most programs offer similar training, but the people really make the experience worth it. One piece of advice I would give a current resident before the transition would be to take time off in between in order to reset and step away from medicine a little bit. Also, you should reach out to one of your future coworkers to have a go-to person to help you through your first few years. My involvement with CAFP gave me more leadership experiences in addition to opening up my eyes to what a family medicine physician has the potential to do. It helped me be more proactive in my residency and helped prepare me for my year as chief resident. My involvement will help me continue to advocate for my patients, and I now know how to access the resources to do that. Prior to CAFP, I didn’t even know those resources existed. Overall, I’m excited to be a new career physician, especially in California. Although I’m scared of transitioning to a new role, I’m glad to have the support of my program and the support of CAFP! Jasmeet Kaur Bains, MD “Walking the path less traveled by … made all the difference” My favorite poet of all time growing up was Robert Frost. Something about the way he wrote spoke to me, like he was trying to empower a story yet to be told. My residency training in family medicine was a difficult time in my life; my days were filled with a demanding schedule, while spending my extra time as my grandmother’s primary care giver in her battle with end-stage lung disease. I often found myself

resuscitating her or spending nights in the emergency department with her. Those were days that were very tough, but ones that will always remain my proudest accomplishment in my life. It was those days that gave me the most powerful lesson of my life. What it feels to be lost in a crumbling and insensitive health care system caring for end stage illness, the strenuous mental toll having to make tough and often irreversible decisions for your loved one, and most importantly … the need to bring much needed deep rooted change in healthcare and be a patient advocate. The day I lost Grandma, I felt I lost everything. What kind of a doctor can’t even save her own grandmother? I felt defeated and unsure of my ability to be a doctor. However, as any story goes, it couldn’t end there … it was only the beginning. I reported to my intensive care unit schedule at Kern Medical the week after losing Grandma, and as I stood reviewing a patient’s labs a woman approached me teary eyed and asked, “Are you a doctor, I need to talk to someone … nobody here makes sense.” The next 20 minutes spelled a story very similar to mine, a granddaughter fighting to be an advocate for her grandmother who was suffering an end stage lung disease and feeling lost. I led her through the entire process, having just gone through it myself. She embraced me, thanked me and asked, “Now why can’t everyone else explain things like that?” When my medical residency ended, I took a month off to reconnect with my values and myself. I made a decision that shocked many. Instead of taking on an administrative position offered to me at the time, I elected to take some time to understand the real problems of health care. How could I be expected to lead a health care system effectively if I hadn’t spent any time understanding the true problems of health care? The decision that led me to become the only female rural physician at the FQHC in Taft, California an hour away from a hospital or emergency room was fueled by my wanting to understand the real problems of society and how they can be empowered by ensuring access to a strong continuous primary health care presence in a community. When I first started in Taft, I quickly realized why this was the path less traveled. Rural communities are often plagued with high rates of unaddressed mental illness, teenage suicide, substance abuse, premature births, domestic abuse, STDs, maternal and neonatal mortality and cervical cancer. Taft is no exception. When I was asked to join the Woman Physician Ready to Lead Program with the California Academy of Family Physicians, it was like an answer from the heavens! It connected me with some powerful women in medicine who not only inspired me, but also taught me how to cultivate those internal leadership qualities that are innate to all physicians … and women. As physicians, we have been trained to be leaders. When our communities suffer, we must be the voice to lead

them and realize that access to quality healthcare is the biggest tool we have to fight racial and socioeconomic divides in America. The importance of physician voices was highlighted during the current Covid-19 pandemic and opened so many eyes to the fact that healthcare is struggling and needs real physician leadership. America is quickly learning that if we increase our primary healthcare investment we could help to eliminate problems that create socioeconomic divides in our country simply by providing access to primary healthcare... so that the father who self-medicates nightly with drugs and alcohol for his post traumatic stress disorder can get the help he needs and become a strong male role model for his children, so that they in turn get a quality education instead of entering a world of juvenile hall and drugs. America finds itself in an opioid and mental health crisis because people are trying to numb the pain where society failed them. Access to quality healthcare is at the root of socioeconomic and racial divides, and unfortunately in history whenever we have seen an economic downturn, healthcare gets offered up as the first on the chopping block, and society continues to suffer. For example, when the economy recently took a turn for the worse, equitable healthcare access programs like the Black Infant Health Program were amongst the first threatened with cuts. If we want to move forward, we have to realize that one of the biggest hurdles to progress for equality… is inequality in healthcare access. Access to quality healthcare is the biggest tool we have to fight racial and socioeconomic divides in America. The events taking place in America today are a cry for help. Whether we want to admit it or not, the biggest pre-existing condition leading to the death of George Floyd was that he was a black man raised in a society that failed him. I would like to extend my warmest congratulations to all of the newly minted physicians out there graduating from their medical training program this year. My best advice to medical residents getting ready to make the transition into the health care workforce is to be the change you want to see. Simply stating you want to advocate for an issue and actively pursuing solutions are two different things. We don’t need more voices; we need action and direction. Be the community leader your community needs, especially right now. Be a leader who leads by example and leads by empowering others, especially your community. Choosing the path that has been less traveled is not easy. You will face many challenges, many roadblocks, many heartbreaks, many quick to judge you. However, if you remain dedicated, seek to understand rather than be understood, listen rather than be quick to speak, you will hear a small voice not many hear, a voice that has been oppressed for many years. When you find that voice and dedicate yourself to being a leader for that voice, you will bring a change in society of such magnitude that mountains will move and America will finally see the change that she so desperately seeks today. California Family Physician Summer 2020

Reflecting on family medicine, practice , patients and life!

Jeremy Fish, MD Program Director, John Muir Health Family Medicine Residency

Reflections on Residency During Headwinds of Pandemics Residency training remains one of the most transformative experiences of the modern era. We begin life as ordinary human beings, become witnesses to medicine and health care as medical students — and then enter into several years of intensive training that turns us into physicians. It is one of the few modern rites of passage — a painful, sometimes death-defying adventure that challenges us to put others before ourselves and expand our capacity to serve our communities in profound and impactful ways. Pandemics create chaos, confusion, fear, and opportunity for growth. When the transformative force of residency converges with the chaotic energy of pandemics — a truly rare and painful opportunity arises that is often lost in the stress and anxiety produced. Our world is facing a new and perilous infection, with no treatments and no vaccines. We don’t know who will become infected and how, who will live or who will die. In these moments the world turns to us as physicians to step forward and risk our lives to assure everyone is cared for, even those infected with new contagions.

infected, only residents would draw their blood or get that sputum sample early in the pandemic. Orthopedic surgeons refusing to operate or only operating in Haz-Mat suits. Calls for quarantining even though it took sexual or blood-routes to become infected. Fear dominated, yet we residents knew being a physician meant stepping forward while others step away. Classmates were accidentally stuck with needles — a potential death sentence in the early days. My years of residency were filled with the heartache of caring for young people I knew would not live long with medications having limited to no benefit to them, yet they came from miles around to seek our care. Yet, we also experienced a wide array of conditions no physician had seen for decades — Kaposi's Sarcoma, once a rare disease, became a routine condition, including in respiratory conditions. Candida became a common foe, invading our patients in ways no one had ever seen. Valley Fever, CMV, PML, Cryptococcemia, and the dreaded Pneumocystis became routine conditions while we honed our clinical skills. It’s been decades since I’ve cared for anyone with these conditions — thank goodness, I hope I never do again.

Being a resident physician during a pandemic is uniquely stressful and meaningful. Residents are called to participate in the care of people when they have little more than supportive care to provide, while potentially risking their careers and lives. The entire ecosystem of residency programs can be altered by these pandemics — with hospitals, emergency departments, and primary care centers overflowing with the new illness. I was a resident when the HIV pandemic burst into hospitals across the nation in the late 1980s and early 1990s. It is challenging to quantify the impact this had on me as a resident — night after night caring for men my age withering away and dying despite everything we tried. Staff so fearful of becoming 24

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Dr. Fish on the day he finished his internship at what was Merrithew Memorial Family Medicine.

Today we face a pandemic of epic proportions — not because of its death-sentence for all who become infected — but because COVID-19 is an even more successful viral opponent than any pandemic we’ve seen for decades. It is highly contagious through droplet contact, can be deadly for the vulnerable elderly and immune-impaired, and we currently have no therapeutic treatments for the fight. So, we are left with massive public health interventions that have driven up fear. Like the early days of HIV, we lack necessary testing capabilities, so many fearful they are infected are going untested and potentially spreading the disease without knowing it. Our nation tries to limit the infection through Medieval means —

by pulling up the drawbridge to other nations, hoping to stem the tide of infection, while the infection has already become American and is racing across the nation like a grass-fire. Once again, our residents will be called to care for people who may be dying and who may infect them. We will all do everything we can to protect our residents, knowing physicians in China were some of the early fatalities. Hand hygiene is taking on a new meaning and power to protect us. N95s are now part of our neighbors' conversations with us. I actually had to ask one of my neighbors if my wife could get an N95 from him as he had several boxes he’d ordered at the onset of the pandemic. Why was he so wise to purchase all that toilet paper, rice, water and N95s? He is a gay man who lost most of his dearest friends in the HIV pandemic. Never again, he says as he tells me “the N95 is the social condom of this damn COVID-19, I’m wearing one everywhere I go. Who knows who is infected?” As a brave and resilient warrior of the HIV pandemic, he is more ready than anyone else I know — and kindly sharing with his physician neighbor who won’t take N95s from work, knowing our limited supply and the need for those caring for COVID-19 patients to be prioritized over all others. Yes, pandemics are disruptive, chaotic, frightening, and ultimately many of our fellow Americans and world-friends will become very ill or die in the coming months. Our resident physicians are on the front-line, stepping up while others step away. We must encourage them to embrace their role as frontline warriors in the battle against COVID-19 — while providing them all necessary protections to assure they will be here in the decades to come to save lives in less dramatic, though no less important ways — one patient at a time. California Family Physician Summer 2020

Shelly Rodrigues, CAE, FAAMSE Deputy EVP

CAFP and CAFP Foundation Announce the 2020 Award Winners Erika Roshanravan, MD, has been selected as the 2020 Hero of Family Medicine. This award goes to a CAFP member who has gone above and beyond the call of duty to advocate for patients, colleagues and the family medicine specialty, and Erika has done all this and more. Erika moved from Washington State in August 2018. From the moment she came to California, she has been advocating for our family physicians and patients. When the anti-vaxxers came out in full force, she headed to the Capitol to testify in support of immunization legislation and represented CAFP in a vaccination advocacy video. With 2018 mid-term elections coming up, she not only donated to FP-PAC, she attended numerous fundraisers representing us, including for Assembly Speaker Anthony Rendon and Senator Richard Pan, MD. She also helped support the 2019 Women’s Caucus at a “Women of the Year” event for legislators. As the Public Charge rule was rolling out, Erika spoke with reporters about the adverse effect it would have on patients, and was quoted in the Sacramento Bee. Her external advocacy was equally matched by her internal work on behalf of family medicine. She has helped usher in a reinvigoration and merger of the local Sacramento/ Yolo chapter of CAFP. As the local chapter president, she launched a speaker series to discuss everything from health to homelessness. She has served as delegate and co-convener for the AAFP National Conference of Constituency Leaders and is a member of the CAFP 2019-2020 Ready to Lead: Building Women Family Physician Leaders class. The list goes on and on. That is why, because of her dedication to CAFP, her patients, her community and family medicine, we are proud to award Dr. Erika Roshanravan our 2020 Hero of Family Medicine Award! 26

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Christopher Flores, MD, has been awarded the CAFP Foundation’s 2020 Barbara Harris Award for Educational Excellence. This award recognizes … Chris has been a leader in CME for many years and a is champion of researching and providing the best education based on effective adult learning principles and practices. He is a creative thinker and early adopter when it comes to education “outside the box” and has been an invaluable member of the CAFP’s Committee on Continuing Professional Development for 12+ years and co-chair the past five years. Chris jumped head first into the digital era and continues to provide CAFP with information and ideas to improve educational offerings through the digital world. He continues to be one of CAFP’s go-to faculty members for many of the initiatives they have undertaken, including the large Team-A national collaborative addressing anticoagulation therapy for A-Fib patients where he presented to sister AFP chapters across the country. He is passionate about senior care and has done research and presented on topics such as senior wellness and dementia care. Despite a busy private practice, Chris has even found time to provide Grand Rounds at White Memorial Medical Center where his lectures on geriatrics, dementia, and Alzheimer's disease prevention have received some of the highest evaluations by faculty, residents, and nursing staff in attendance. His passion for education goes beyond sharing his expertise with colleagues; he is very active in his community where he has received numerous awards, including the Palm Springs Human Rights Commission’s annual Community Service Award in 2005. Chris participates in “Walk with A Doc,” Coachella Valley Small Business Development Center Fireside Chats, and volunteers countless hours to ensure patients are provided with excellent education and resources to answer their medical questions and help them stay healthy. True to the principles of

family medicine, Chris’s work brings home the message that the word “doctor” has its roots in the Latin word docere: to teach and so is very deserving of this distinguished award. The 2020 CAFP Foundation Family Medicine Resident of the Year award goes to Lulua Bahrainwala, MD, PGY3, Emanate Family Medicine Residency Program. Lulua is an inspiring leader in both her residency program and in the Academy. Over the last two years, she has been instrumental in the initiatives of CAFP’s Resident Council, a statewide group that works to promote and advocate for family medicine interests. As she completes her final year of residency, she continues to provide unparalleled inspiration and support to her peers. Her contributions range from scholarly activities to advocacy work and mentoring and teaching medical students during procedure workshops. Lulua is actively engaged in her residency program’s Primary Care Residency Program Collaborative project, learning about and now prescribing and managing medication assisted treatment (MAT) patients with substance/opioid use disorders. She has also been a recipient of an All Member Advocacy Meeting scholarship and a two-time poster presenter at the Family Medicine Clinical Forum. Beyond Lulua’s academic success, she is an engaged learner whose extraordinary compassion, intelligence, motivation and willingness to help others truly sets her apart. She is well-deserving of this award. Jeremy Fish, MD, is the CAFP’s 2020 Family Physician of the Year. Jeremy embodies all that the award recognizes: a family physician who presents the finest characteristics of family medicine and is directly and effectively involved in public service and activities that enhance the quality of life for patients and communities in California. As program director and co-founder of the John Muir Family Medicine Residency Program, he models the way for family medicine residents by providing exceptional care in a state-of-the-art, team-based

care model he designed and shepherded through accreditation. In this regard, he has become an authority on every area of strategic interest to CAFP, including payment reform, practice transformation and the primary care workforce. He has offered to share this expertise with CAFP throughout the years by participating at every level of the Academy, from informal interactions with staff to stellar work as a member of the CAFP Board of Directors. Jeremy is an advocate for his profession, his patients and his community. He has participated in numerous CAFP Lobby Days and All Member Advocacy Meetings, meeting with legislators and providing testimony before state committees and public commissions such as the Song-Brown Healthcare Workforce Commission. He was instrumental in guiding the development of the CalMedForce GME grant program, informing CAFP’s feedback on the Advisory Council, and his vision led to the development of the CAFP Residency Network, which has grown alongside the number of family medicine residency programs in the state to more than 50 members. He has also participated in the GME Initiative, a network of western residency program directors and stakeholders concerned with reforming federal GME. Jeremy is an enthusiastic teacher and sound clinician who always creates a comfortable and welcoming learning environment for medical students and residents. He also has a deep respect for underserved and vulnerable patient populations to which he has dedicated his career. Despite having many years of clinical experience under his belt, he remains a humble practitioner with healthy curiosity and an enjoyment of learning which he loves to share with both medical students and residents. He has undoubtedly been responsible for the development of hundreds of dedicated family medicine physicians. As a physician leader, Jeremy is willing to be on the cutting edge and traverse difficult, yet rewarding, pathways to advance Family Medicine. He is fair, open minded, and practical. He makes it a priority to be present in administrative and clinical environments and always maintains an open-door policy. He even makes himself available to his residents outside of clinic hours as he is a tireless advocate for any resident. As a member of the FP PAC Board, he has been directly responsible for increasing the number of contributions from members to the PAC, and thus CAFP’s influence in Sacramento. Jeremy Fish exemplifies the values of family medicine: patientoriented, community-based, team-centered, high-quality primary care for the most vulnerable populations and is most deserving of this award. Congratulations to all our 2020 award winners. We are stronger because of your commitment to family medicine, your colleagues, Academy, and patients. California Family Physician Summer 2020

ceo message

Lisa Folberg, MPP

Under our Umbrella Throughout the COVID-19 pandemic, we have often heard people talking about returning to normal. As the police killing of George Floyd, the racist aggression against central park bird watcher Christian Cooper, the murder of Ahmaud Arbery and many other incidents not captured on camera have highlighted, normal is broken. In health care, the normal before COVID-19 included systemic racism and unconscious bias that has led to disparate outcomes for people of color. A pandemic coupled with a light shined on the public health crisis that is racism has forced us to look at normal and hopefully redefine what that means.

decisions to be made and a lot more to learn. As I wrote in our Fall 2019 issue, even good transitions are never easy and by their nature introduce the unfamiliar.

This magazine issue focuses on transitions. I hope that for our nation this is a transition into new models and modes of thinking that value and celebrate diversity. Family physicians are the most thoughtful, compassionate and kind group of professionals I have known. You are nice people. I am a nice person. AND we have work to do to look at our own biases and contributions to perpetuating and supporting a racist system.

All of this can feel like a flood even in a “normal” year. The CAFP helps make this torrent of information manageable and informative by providing resources, information, education, leadership opportunities and community.

Specifically, this issue concentrates on the transition from residency to being a new family physician. For most family medicine residents, your last year of training is really exciting. It is a point for reflecting on what was, and preparing for what will be. There is a lot to think about, many

California Family Physician Summer 2020

Whether you open your own practice or not after residency, you will face the new challenges of learning and understanding the economic and financial elements of practice, in addition to the multi-layered policy and regulatory structures of our health care system. Not to mention the abundance of new patient care information you will be learning.

Maybe Outkast’s Andre 3000 said it best, “you can plan a pretty picnic but you can’t predict the weather.” CAFP can’t control the elements, but through our resources, we can provide cover for the rainy days and help you plan and enjoy a delightful buffet of information, education and connection on the sunny days. We hope that you will stay connected to CAFP as a support, source of information, advocate and friend.

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