Winter 2019 by California Academy of Family Physicians

VO L . 70 N O. 1 Wi n t er 201 9

in this issue: ADDRESSING THE FAMILY MEDICINE WORKFORCE FOR THE FUTURE

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 Lisa M. Ward, MD, MScPH, MS Immediate Past President Michelle Quiogue, MD President-elect Walter Mills, MD

Staff Lisa Folberg, MPP

Chief Executive Officer lfolberg@familydocs.org

ŽŶƌĂĚ ŵĞŶƚĂ

Director, Health Policy camenta@familydocs.org

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

Speaker ĂǀŝĚ ĂǌǌŽ͕ D

Manager, FP-PAC and Membership mcleveland@familydocs.org

Vice-Speaker Shannon Connolly, MD

:Ğƌƌŝ ĂǀŝƐ͕ , W

Secretary/Treasurer Lauren Simon, MD, MPH Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD ĂƌŽů ,ĂǀĞŶƐ͕ D

Director, CME/CPD jdavis@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

ůŝǌĂďĞƚŚ >ƵŬƌŝĐŚ

Manager, Communications and Social Media elukrich@familydocs.org

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

AAFP Alternates Jay W. Lee, MD, MPH Lee Ralph, MD

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

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,

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

Brent Sugimoto, MD, Editor Shelly Rodrigues, CAE, Managing Editor Cover art by Elizabeth Lukrich 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 29

California Family Physician Winter 2019

California

Winter 2019

FAMILY PHYSICIAN st ron g

me d i ci ne

f o r

C al i f o r nia

The cover poem was created by 25+ attendees at the July 2018 Strategic Planning meeting in a one-word-at-a-time exercise.

features 14 Healthy Harbors: Addressing Health Consequences of Immigration Policies 16 ABFM Offering a Longitudinal Pilot and Coming to CAFP to Answer Your Questions 18 25 x 2030: New Workforce Efforts Launched 20 I Believe We Must Come Out of the Shadows

Robert Assibey, MD

21 Family Medicine Must Create a New Environment of Inclusivity 22 Future of Family Medicine is a Calling

Zachary Nicholas Cynthia Chen-Joea, DO, MPH, CPH

24 I’m Inspired by Family Physicians, and the Way They Fought California Wildﬁres

Andrea Banuelos Mota

26 California’s Projected Primary Care Physician Needs Outstrip Supply

Conrad Amenta

28 PhD instead of MD: Why Mentorship Matters in Diversifying the Medical Workforce

Danielle Jones, MPH

departments 6

Editorial

Workforce Pipeline – The Public Has Other Options for the Drought

Brent Sugimoto, MD

President’s Message

Can Expansion of Scope Address Workforce Shortfalls in California?

Lisa M. Ward, MD, MScPH, MS

10 Political Pulse

CAFP Logs Another Victorious Year in Sacramento

Carla Kakutani, MD

12 In The News 30 CEO Message

CAFP empowers, educates and connects current and future family physicians to improve the health of all Californians

Lisa Folberg, MPP

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

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Workforce Pipeline – The Public Has Other Options for the Drought

dŚĂƚ ƚƌƵƐƚ ǁŽƵůĚ ĞƌŽĚĞ ƐŚŽƵůĚ ǁĞ ďĞĐŽŵĞ ƵŶĂďůĞ ƚŽ ĚĞůŝǀĞƌ ǁŚĂƚ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ŶĞĞĚ͘ dŚĂƚ ƚƌƵƐƚ ǁŽƵůĚ ĨƌĂǇ ƐŚŽƵůĚ ǁĞ ďĞ ƐĞĞŶ ĂƐ ĂĐƟŶŐ ŝŶ Ă ƐĞůĨͲŝŶƚĞƌĞƐƚĞĚ ŵĂŶŶĞƌ͘ dŚĞ ŝƐƐƵĞ ƚŚĂƚ ƵƌŐĞŶƚůǇ ƚŚƌĞĂƚĞŶƐ ŽƵƌ ƐƉĞĐŝĂůƚǇ ŽŶ ƚŚĞƐĞ ƚǁŽ ĨƌŽŶƚƐ ŝƐ ƚŚŝƐ͗ ǁŽƌŬĨŽƌĐĞ ƉŝƉĞůŝŶĞ͘ /ƚ ŝƐ ĞƐƟŵĂƚĞĚ ƚŚĂƚ ƚŚĞ ŶĂƟŽŶ ǁŝůů ůĂĐŬ ƵƉ ƚŽ ϱϬ͕ϬϬϬ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ďǇ ϮϬϯϬ͘ /Ŷ ŚŝƐ ĂƌƟĐůĞ͕ ŽŶƌĂĚ ŵĞŶƚĂ ĚŝƐĐƵƐƐĞƐ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ŝŶ ŵĞĞƟŶŐ ŽƵƌ ƐƚĂƚĞ͛Ɛ ŶĞĞĚƐ ĨŽƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ŚŽǁ ĞǀĞŶ increased residency slots are unlikely to close the gap. The fact ŝƐ ƚŚĂƚ͕ ĞǀĞŶ ǁŝƚŚ ŵŽƌĞ ĂŶĚ ŵŽƌĞ ŵĞĚŝĐĂů ŐƌĂĚƵĂƚĞƐ ĐŚŽŽƐŝŶŐ family medicine as their specialty, medical schools produce too ĨĞǁ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ŵĞĞƚ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ŶĞĞĚƐ ŽĨ ŽƵƌ ƐƚĂƚĞ ĂŶĚ ŶĂƟŽŶ͘1 dŚĞ &ĞĚĞƌĂů dƌĂĚĞ ŽŵŵŝƐƐŝŽŶ ;&d Ϳ ƐĞĞƐ ƚŚĞ ŝŶƐƵĸĐŝĞŶƚ number of primary providers as a serious issue because it denies consumers access to the health care market. Furthermore, the &d ŝĚĞŶƟĮĞƐ ŵŝĚͲůĞǀĞů ƐĐŽƉĞͲŽĨͲƉƌĂĐƟĐĞ ůĂǁƐ ĂƐ ůŝŵŝƟŶŐ ͞ƚŚĞ supply of primary care services and giv[ing] one group of health care professionals [physicians] the ability to restrict access to ƚŚĞ ŵĂƌŬĞƚ ďǇ ĂŶŽƚŚĞƌ͕͟ ǁŚĞƌĞ ͞ŶĞǁ Žƌ ĞǆƚĞŶĚĞĚ ůĂǇĞƌƐ ŽĨ ŵĂŶĚĂƚŽƌǇ ƉŚǇƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ ŵĂǇ ŶŽƚ ďĞ ũƵƐƟĮĞĚ͘͟Ϯ It is disturbing that one group perceives physicians as denying ĐĂƌĞ ƚŽ ƉĂƟĞŶƚƐ͕ ďƵƚ ŝƚ ŝƐ ĐĂƵƐĞ ĨŽƌ ƐĞůĨͲƌĞŇĞĐƟŽŶ͘ ,Žǁ ŵƵĐŚ ĚŽ ƉŚǇƐŝĐŝĂŶƐ ĐŽŶƚƌŝďƵƚĞ ƚŽ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ƐŚŽƌƚĂŐĞ͍ dǁĞŶƚǇͲƚǁŽ ƐƚĂƚĞƐ͕ ƚŚĞ ŝƐƚƌŝĐƚ ŽĨ ŽůƵŵďŝĂ͕ ĂŶĚ sĞƚĞƌĂŶƐ īĂŝƌƐ ĂůƌĞĂĚǇ ĂůůŽǁ ĚǀĂŶĐĞĚ WƌĂĐƟĐĞ ZĞŐŝƐƚĞƌĞĚ EƵƌƐĞƐ ; WZEƐͿ ƚŽ ƉƌĂĐƟĐĞ ŝŶĚĞƉĞŶĚĞŶƚůǇ ǁŝƚŚŽƵƚ ƉŚǇƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ͘3 The &d ŝƚƐĞůĨ ŝƐ ƉƌŽŵŽƟŶŐ ƌĞĨŽƌŵ ŽĨ ƐƚĂƚĞƐ͛ ƐĐŽƉĞͲŽĨͲƉƌĂĐƟĐĞ ůĂǁƐ ďǇ ƐŚĂƌŝŶŐ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ŝŶĐĞŶƟǀĞƐ ĨŽƌ ƚŚĞ ĂĚŽƉƟŽŶ ŽĨ ďĞƐƚ ƉƌĂĐƟĐĞƐ͕ ͞ŝŶĐůƵĚŝŶŐ ƌĞƐƚƌŝĐƟŽŶƐ ŽŶ ƚŚĞ ďƵƐŝŶĞƐƐ ƉƌĂĐƟĐĞƐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͕ ĂƐ ǁĞůů ĂƐ ƉŽůŝĐŝĞƐ ƚŚĂƚ ĐŽƵůĚ ĂĐƚ ĂƐ Ă ďĂƌƌŝĞƌ ƚŽ ĞŶƚƌǇ ĨŽƌ ŶĞǁ ĐŽŵƉĞƟƚŽƌƐ ŝŶ ƚŚĞ ŵĂƌŬĞƚ͘͟Ϯ 6

California Family Physician Winter 2019

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Let California be the national model for how mid-level providers can fit to support a complex system.

“

Family physicians have helped the public understand — through ĚŝƐĐŝƉůŝŶĞĚ ŵĞƐƐĂŐŝŶŐ Ͷ ƚŚĂƚ Ă ƐƚƌŽŶŐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƐǇƐƚĞŵ ǁŝƚŚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝŶ ƚŚĞ ǀĂŶŐƵĂƌĚ ĐĂŶ ůĞĂĚ Ă ĐŽŵŵƵŶŝƚǇ ƚŽ ďĞƩĞƌ health. The public trusts that family physicians represent its interests in advancing American health care.

/ŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ŽĨ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ŝƐ ĞǆƉĂŶĚŝŶŐ ǁŝƚŚŽƵƚ ŽƵƌ ŝŶƉƵƚ ďĞĐĂƵƐĞ ůĂƌŐĞůǇ͕ ŵŽƐƚ ƉŚǇƐŝĐŝĂŶƐ ŽƉƉŽƐĞ ŝƚ ĐĂƚĞŐŽƌŝĐĂůůǇ͕ ĂŶĚ ǁĞ ƌĞĨƵƐĞ ƚŽ Ɛŝƚ Ăƚ ƚŚĞ ƚĂďůĞ͘ zĞƚ͕ ůĞŐŝƐůĂƚŽƌƐ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĂůůŽǁ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ͕ ƐƚĂƚĞ ďǇ ƐƚĂƚĞ͕ ďĞĐĂƵƐĞ ǁĞ ĐĂŶŶŽƚ ĚĞůŝǀĞƌ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ŶĞĞĚ͕ ŶŽƌ ĂƌĞ ǁĞ ůŝŬĞůǇ ƚŽ ĚŽ ƐŽ ǁŝƚŚŝŶ ƚŚĞ ŶĞǆƚ ĚĞĐĂĚĞ ǁŝƚŚ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ĂǀĂŝůĂďůĞ͘ tĞ ƐŚŽƵůĚ ďĞ Ăƚ ƚŚŝƐ ƚĂďůĞ ďĞĐĂƵƐĞ ǁĞ ŬŶŽǁ ďĞƩĞƌ ƚŚĂŶ ĂŶǇŽŶĞ ǁŚĂƚ ŝƐ ŶĞĞĚĞĚ ƚŽ ĚĞůŝǀĞƌ ŶŽƚ ũƵƐƚ ƉƌŝŵĂƌǇ ĐĂƌĞ͕ ďƵƚ ƋƵĂůŝƚǇ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ tŚŝůĞ WZEƐ͛ ŐƌŽǁŝŶŐ ŶƵŵďĞƌƐ ŝŶ ƉƌŝŵĂƌǇ ĐĂƌĞ may help bridge the gap, they are arguably doing so at the cost ŽĨ ƋƵĂůŝƚǇ ŽĨ ƚƌĂŝŶŝŶŐ͘ WZE ĐŽƵƌƐĞǁŽƌŬ ŵĂǇ ďĞ ϭϬϬ ƉĞƌĐĞŶƚ online.Т ůŝŶŝĐĂů ĞǆƉĞƌŝĞŶĐĞ ŚŽƵƌƐ ĂƌĞ ŽŌĞŶ ŽŶ ƚŚĞ ŚŽŶŽƌ ƐǇƐƚĞŵ ĂŶĚ ŵĂǇ ŝŶǀŽůǀĞ ƐŝŵƉůǇ ƐŚĂĚŽǁŝŶŐ Ă ĚŽĐƚŽƌ Žƌ ŶƵƌƐĞ͕ ŵĂŶǇ ŽĨ ǁŚŽŵ ƚŚĞ ƐƚƵĚĞŶƚƐ ŚĂǀĞ ƚŽ ĮŶĚ ƚŚĞŵƐĞůǀĞƐ͘ /ŶĚĞĞĚ͕ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ ;ŶŽǁ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ ,ĞĂůƚŚĐĂƌĞ /ŵƉƌŽǀĞŵĞŶƚͿ ŝĚĞŶƟĮĞĚ ͞ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚƌĂŶƐŝƟŽŶͲƚŽͲ ƉƌĂĐƟĐĞ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ͕ ǁŚŝĐŚ ŚĞůƉ ŵĂŶĂŐĞ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ĨƌŽŵ ŶƵƌƐŝŶŐ ƐĐŚŽŽů ƚŽ ƉƌĂĐƟĐĞ ĂŶĚ ŚĞůƉ ŶĞǁ ŐƌĂĚƵĂƚĞƐ ĨƵƌƚŚĞƌ develop the skills needed to deliver safe, quality care.”У &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŝůů ƌĞŵĂŝŶ ƚŚĞ ĐŽƌĞ ŽĨ ƚŚĞ ƉƌŝŵĂƌǇ ƐǇƐƚĞŵ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ďƵƚ ǁĞ ĐĂŶŶŽƚ ĚŽ ŝƚ ĂůŽŶĞ͘ tĞ ǁŝůů ŶĞĞĚ ƋƵĂůŝĮĞĚ ƉĂƌƚŶĞƌƐ ǁŚŽ ĐĂŶ ŚĞůƉ ƵƐ ŵĂŶĂŐĞ Ă ĐŽŵƉůĞǆ ƐƉĞĐŝĂůƚǇ ŝŶ Ă ƐƚĂƚĞ ǁŝƚŚ ĚĂƵŶƟŶŐ ĚĞŵŽŐƌĂƉŚŝĐ ŐƌŽǁƚŚ͘ >ŝŵŝƟŶŐ ĐŽŵƉĞƟƟŽŶ ĨƌŽŵ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ŝƐ Ă ĨĂůƐĞ ĞƋƵŝǀĂůĞŶĐǇ͘ &Žƌ ĞǆĂŵƉůĞ͕ ŝƚ ŝƐ ĞƐƟŵĂƚĞĚ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĐŽŵƉůĞƚĞƐ ϭϲ͕ϬϬϬ ŚŽƵƌƐ ŽĨ ƚƌĂŝŶŝŶŐ͕ ǁŚŝůĞ ĂŶ WZE ƵŶĚĞƌŐŽĞƐ Ă ŵĞƌĞ ϭ͕ϱϬϬ ŚŽƵƌƐ͘ϲ The skills of midůĞǀĞů ƉƌŽǀŝĚĞƌƐ ĂƌĞ ĨĞǁĞƌ ƚŚĂŶ ƚŚŽƐĞ ŽĨ ƉŚǇƐŝĐŝĂŶƐ Ͷ ƚŚĞǇ ĂƌĞ ŶŽƚ ĐŽŵƉĞƟŶŐ ǁŝƚŚ ƵƐ ƵŶůĞƐƐ ǁĞ ĂůůŽǁ ƚŚĞŵ ƚŽ ƌĞĚĞĮŶĞ primary care ĂƐ Ă ůŝŵŝƚĞĚ ƐƉĞĐŝĂůƚǇ ŶĂƌƌŽǁ ŝŶ ƐĐŽƉĞ͘

California family physicians should ĞŵďƌĂĐĞ ƚŚĞƐĞ ĐŽůůĞĂŐƵĞƐ͕ ĂŶĚ ǁŽƌŬ to ensure they can provide the safe ĂŶĚ ƋƵĂůŝƚǇ ĐĂƌĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ need. We need to convince our legislators and policy makers that a safe primary care system for our ĐŝƟǌĞŶƐ ĚĞƉĞŶĚƐ ŽŶ ĞŶƐƵƌŝŶŐ ƚŚĂƚ Ăůů providers are adequately trained. Let ĂůŝĨŽƌŶŝĂ ďĞ ƚŚĞ ŶĂƟŽŶĂů ŵŽĚĞů ĨŽƌ ŚŽǁ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ĐĂŶ Įƚ ƚŽ ƐƵƉƉŽƌƚ Ă ĐŽŵƉůĞǆ ƐǇƐƚĞŵ͘ DĂŬĞ ŶŽ ŵŝƐƚĂŬĞ͗ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ďĞ ůĞĂĚĞƌƐ ŝŶ ƐƚĞĞƌŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ƚŽǁĂƌĚ Ă ďĞƩĞƌ ƚŽŵŽƌƌŽǁ͘ Ƶƚ ŚĞĂůƚŚ ĐĂƌĞ ŝƐ Ă ďŝŐ ƐŚŝƉ͕ ĂŶĚ ǁĞ cannot change course alone. References 1.

ϮϬϭϴ EZDW DĂŝŶ ZĞƐŝĚĞŶĐǇ DĂƚĐŚΠ͗ Match Rates by Specialty and State. ŚƩƉƐ͗ͬͬŵŬϬŶƌŵƉĐŝŬŐďϴũǆǇĚϭϵŚ͘ ŬŝŶƐƚĂĐĚŶ͘ĐŽŵͬǁƉͲĐŽŶƚĞŶƚͬ ƵƉůŽĂĚƐͬϮϬϭϴͬϬϰͬDĂŝŶͲDĂƚĐŚͲZĞƐƵůƚͲ ďǇͲ^ƚĂƚĞͲĂŶĚͲ^ƉĞĐŝĂůƚǇͲϮϬϭϴ͘ƉĚĨ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϱ͕ ϮϬϭϴ͘ Ϯ͘ &ĞĚĞƌĂů dƌĂĚĞ ŽŵŵŝƐƐŝŽŶ ;ϮϬϭϰͿ͘ ŽŵƉĞƟƟŽŶ ĂŶĚ ƚŚĞ ZĞŐƵůĂƟŽŶ ŽĨ ĚǀĂŶĐĞĚ WƌĂĐƟĐĞ EƵƌƐĞƐ͘ 3. ͞^ƚĂƚĞ WƌĂĐƟĐĞ ŶǀŝƌŽŶŵĞŶƚ͘͟ ŵĞƌŝĐĂŶ ƐƐŽĐŝĂƟŽŶ ŽĨ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂŶƉ͘ ŽƌŐͬĂĚǀŽĐĂĐǇͬƐƚĂƚĞͬƐƚĂƚĞͲƉƌĂĐƟĐĞͲ environment. Accessed December 15, ϮϬϭϴ͘ ϰ͘ RN to DNP Programs Online. Nurse :ŽƵƌŶĂů͘ ŚƩƉƐ͗ͬͬŶƵƌƐĞũŽƵƌŶĂů͘ŽƌŐͬ ĚŶƉͲƉƌŽŐƌĂŵƐͬƌŶͲƚŽͲĚŶƉͲƉƌŽŐƌĂŵƐͲ ŽŶůŝŶĞͬ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϱ͕ ϮϬϭϴ͘ 5. /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͘ ;ϮϬϭϬͿ͘ dŚĞ ĨƵƚƵƌĞ ŽĨ ŶƵƌƐŝŶŐ͗ >ĞĂĚŝŶŐ ĐŚĂŶŐĞ͕ advancing health. ϲ͘ ĚƵĐĂƟŽŶ ĂŶĚ dƌĂŝŶŝŶŐ͗ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ǀĞƌƐƵƐ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ͘ &W͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬ ĚĂŵͬ &WͬĚŽĐƵŵĞŶƚƐͬĂĚǀŽĐĂĐǇͬ ǁŽƌŬĨŽƌĐĞͬƐĐŽƉĞͬ&WǀƐEW͘ƉĚĨ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϲ͕ ϮϬϭϴ͘

California Family Physician Winter 2019

p r e s i d e n t ’s m e s s a g e

Lisa M. Ward, MD, MScPH, MS

Can Expansion of Scope Address Workforce Shortfalls in California? ^ŝƐǇƉŚƵƐ ĐŽŵĞƐ ƚŽ ŵŝŶĚ ĂƐ / ĐŽŶƚĞŵƉůĂƚĞ ƚŚĞ ŐĂƉ ďĞƚǁĞĞŶ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ǁĞ ŚĂǀĞ ĂŶĚ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ need. Like Sisyphus, unending task of rolling a boulder up a hill, ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉŽůŝĐǇ ĂŶĚ ĂĚǀŽĐĂĐǇ ŚĂǀĞ ďĞĞŶ ƌĞƉĞƟƟǀĞ ĞǀĞŶ ďĞĨŽƌĞ &W͛Ɛ ϭϵϰϴ ĨŽƵŶĚŝŶŐ ŽŶ ŬĞǇ ǁŽƌŬĨŽƌĐĞ ƋƵĞƐƟŽŶƐ͕ ƐƉĞĐŝĮĐĂůůǇ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ƋƵĞƐƟŽŶƐ͘ &W ŚĂƐ ĂĚǀŽĐĂƚĞĚ ǀŝŐŽƌŽƵƐůǇ ĂŶĚ ƐƵĐĐĞƐƐĨƵůůǇ ĂŐĂŝŶƐƚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ĂŶĚ ŽƚŚĞƌ ƉƌŽǀŝĚĞƌƐ͘ zĞƚ͕ ƉŚĂƌŵĂĐŝƐƚƐ͕ ŶĂƚƵƌŽƉĂƚŚƐ͕ ŽƉƚŽŵĞƚƌŝƐƚƐ ĂŶĚ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ŚĂǀĞ Ăůů ƉƌŽƉŽƐĞĚ ĞǆƉĂŶƐŝŽŶƐ ŝŶ ƐĐŽƉĞ ŝŶ ƌĞĐĞŶƚ ǇĞĂƌƐ͘ Ɛ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ƉŽůŝĐǇ ĞǀŽůǀĞƐ͕ ǁĞ ŵĂǇ ƐĞĞ ŐƌŽǁŝŶŐ ƐƵƉƉŽƌƚ ĨŽƌ ƚŚĞ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ŽĨ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ͕ ĨŽƌ ĞǆĂŵƉůĞ͕ ĂƐ ŽŶĞ ƐƚƌĂƚĞŐǇ ƚŽ ŐƌŽǁ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ƚŽ ĐĂƌĞ ĨŽƌ ĂůŝĨŽƌŶŝĂŶƐ /Ĩ ǁĞ ĐĂŶ͛ƚ ĮŐƵƌĞ ŽƵƚ Ă ǁĂǇ ƚŽ ǁŽƌŬ ƚŽŐĞƚŚĞƌ ƚŽ ŐĞƚ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ďŽƵůĚĞƌ ƵƉ ƚŚĞ Śŝůů͕ ǁĞ ŵĂǇ ůŽƐĞ ŽƵƌ ĨŽŽƟŶŐ ĂŶĚ ďĞ crushed by it. &W ŚĂƐ ƐŝŐŶŝĮĐĂŶƚ ƉŽůŝĐǇ ƚŽ ƐƵƉƉŽƌƚ ŝƚƐ ŽƉƉŽƐŝƟŽŶ ƚŽ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ͕ ĂůƐŽ ŬŶŽǁŶ ĂƐ ĂĚǀĂŶĐĞĚ ƉƌĂĐƟĐĞ ĐůŝŶŝĐŝĂŶƐ ; W ƐͿ͘ dŚĞ ƵŶĚĞƌƉŝŶŶŝŶŐ ŽĨ &W͛Ɛ ƉŽƐŝƟŽŶ ŝƐ ĞƋƵŝƚǇ͗ ĞƋƵŝƚǇ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ƋƵĂůŝƚǇ͕ ĞƋƵŝƚǇ in oversight and equity for family physicians in the market place ŽĨ ŵĞĚŝĐŝŶĞ͘ &W ƉŽůŝĐǇ ŽŶ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ĂŝŵƐ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞ ƋƵĂůŝƚǇ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ͕ ǁŚŝůĞ ƌĞĐŽŐŶŝǌŝŶŐ ƚŚĞ ŝŵƉŽƌƚĂŶƚ ƌŽůĞ W Ɛ ŚĂǀĞ ŝŶ ƉĂƟĞŶƚ ĐĂƌĞ͘ &W ŚĂƐ ĂĚǀŽĐĂƚĞĚ ĨŽƌ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ƚŚĂƚ ŝŶĐůƵĚĞƐ ĞǆƉĂŶĚĞĚ ƚƌĂŝŶŝŶŐ͕ ĨŽƌŵĂƟǀĞ ůŝĐĞŶƐŝŶŐ ĂŶĚ ďŽĂƌĚ ĐĞƌƟĮĐĂƟŽŶ͕ ĞƋƵĂů ŵĞĚŝĐĂů ůŝĂďŝůŝƚǇ ŝŶƐƵƌĂŶĐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĂŶĚ ĞƋƵĂů ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ƚŚĞ ĐŽƌƉŽƌĂƚĞ ďĂƌ ůŝŵŝƟŶŐ ĚŝƌĞĐƚ ĞŵƉůŽǇŵĞŶƚ ďǇ ŚŽƐƉŝƚĂůƐ ĂŶĚ ŽƚŚĞƌ ĐŽƌƉŽƌĂƟŽŶƐ͘ YƵĞƐƟŽŶƐ ĂďŽƵƚ ŚŽǁ ůŝĐĞŶƐŝŶŐ͕ ůŝĂďŝůŝƚǇ͕ ƉƌĞƐĐƌŝďŝŶŐ ĂŶĚ ĐŽƌƉŽƌĂƚĞ ďĂƌ ŚĂǀĞ ƐƚǇŵŝĞĚ &W͛Ɛ ĂďŝůŝƚǇ ƚŽ ƐƵƉƉŽƌƚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ƉƌŽƉŽƐĂůƐ͘ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂůƐŽ ŚĂǀĞ ĐŽŶĐĞƌŶƐ ĂďŽƵƚ ŚŽǁ ƚŚĞ ĞŶƚƌĂŶĐĞ ŽĨ ŝŶĚĞƉĞŶĚĞŶƚ W Ɛ ŝŶƚŽ ƚŚĞ ŵĂƌŬĞƚ ƉůĂĐĞ ǁŽƵůĚ ŝŵƉĂĐƚ ŝŶƚĞƌĞƐƚ ŝŶ ƚŚĞ ƐƉĞĐŝĂůƚǇ͕ ƉĂǇ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ĞǆƉĞƌŝĞŶĐĞ͘ ,Žǁ ǁŽƵůĚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ W Ɛ ĐŚĂŶŐĞ ƚŚĞ ƉĞƌĐĞŝǀĞĚ ǀĂůƵĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͍ tŽƵůĚ Ă ŐƌŽǁŝŶŐ W ǁŽƌŬĨŽƌĐĞ ĚƌŝǀĞ ĚŽǁŶ ƉĂǇ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͍ tŽƵůĚ ƚŚĞ ƉŝƉĞůŝŶĞ ŽĨ ƐƚƵĚĞŶƚƐ ĐŚŽŽƐĞ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵƐ such as APCs because they are shorter and less costly than medical ƚƌĂŝŶŝŶŐ͍ tŚĂƚ ĚŽĞƐ ƚŚĞ ŝŶĚĞƉĞŶĚĞŶĐĞ ŽĨ W Ɛ ĚŽ ƚŽ ƚŚĞ ƌŽůĞ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͛ ĚĂǇͲƚŽͲĚĂǇ ƉƌĂĐƟĐĞ͍ Ž Ăůů ƚŚĞ ďƌŝĞĨ͕ ďƵƚ ƐĂƟƐĨǇŝŶŐ ǀŝƐŝƚƐ ƚŽ ƚƌĞĂƚ Ă hd/ ĂŶĚ ƚŚĞ ĚĞůŝŐŚƞƵů ǁĞůůͲďĂďǇ ĞǆĂŵƐ ŐŽ ƚŽ ĂŶ W ǁŚŝůĞ / ƉƌĂĐƟĐĞ Ă ĚĂƵŶƟŶŐ ĚĂǇ ŽĨ ŵĂŶĂŐŝŶŐ ƚŚĞ ĐŽŵƉůĞǆŝƚǇ ŽĨ ĨĂŝůŝŶŐ 8

California Family Physician Winter 2019

ŽƌŐĂŶ ƐǇƐƚĞŵƐ ŝŶ ĂĚƵůƚƐ͍ dŚĞƐĞ ƋƵĞƐƟŽŶƐ ƐƉĞĂŬ ƚŽ ƚŚĞ ŶĞĞĚ ƚŽ ƐƵƉƉŽƌƚ ŽƵƌ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ǁŝƚŚ ũŽǇĨƵů͕ ƐƵƐƚĂŝŶĂďůĞ ƉƌĂĐƟĐĞƐ ǁŝƚŚ ƚŚĞ ǀĂƌŝĞƚǇ ŽĨ ƉĂƟĞŶƚ ĐĂƌĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ƐŽ ĂďůĞ ƚŽ ĚĞůŝǀĞƌ͘ tŝƚŚ ƐƟůů ŵŽƌĞ ƋƵĞƐƟŽŶƐ ƚŚĂŶ ĂŶƐǁĞƌƐ͕ ǁĞ ŵĂǇ ǁĂŶƚ ƚŽ ůŽŽŬ ƚŽ ƚŚĞ ĞǆƉĞƌŝĞŶĐĞƐ ŽĨ ƚŚĞ ϮϬ Žƌ ŵŽƌĞ ƐƚĂƚĞƐ ǁŚĞƌĞ W Ɛ ĐƵƌƌĞŶƚůǇ ƉƌŽǀŝĚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ŝŶĚĞƉĞŶĚĞŶƚůǇ͘ tĞ ŵĂǇ ĂůƐŽ ǁĂŶƚ ƚŽ ůŽŽŬ ƚŽ ĞǆƉĞƌƚƐ ůŝŬĞ ĚǁĂƌĚ K͛EĞŝů͕ WŚ ͘ ƌ͘ K͛EĞŝů͕ ƉĂƐƚ ĚŝƌĞĐƚŽƌ ŽĨ ƚŚĞ hŶŝǀĞƌƐŝƚǇ of California, San Francisco Center for the Health Professions and an ĞǆƉĞƌƚ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƉŽůŝĐǇ͘ / ŝŶƚĞƌǀŝĞǁĞĚ ƌ͘ K͛EĞŝů ƚŽ ůĞĂƌŶ ĂďŽƵƚ ŚŝƐ ǀŝƐŝŽŶ ĨŽƌ ĐƵůƟǀĂƟŶŐ ƚŚĞ ĨƵƚƵƌĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ needed in California. Dr. O’Neil dismissed current approaches to ĐůŽƐĞ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŐĂƉ ƐĂǇŝŶŐ ƚŚĂƚ ƐŝŵƉůǇ ĞǆƉĂŶĚŝŶŐ ƚŚĞ ŵŽĚĞů ĨŽƵŶĚĞĚ ŝŶ ƚŚĞ ϭϵϱϬƐ ͞ŝƐ ŶŽƚ ŐŽŝŶŐ ƚŽ ĞŶůĂƌŐĞ Žƌ ĚŝǀĞƌƐŝĨǇ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂŶĚ ŶŽƚ ŐŽŝŶŐ ƚŽ ŵĂƚĐŚ ǁŚĂƚ ƉĂƟĞŶƚƐ ĂƌĞ ĚĞŵĂŶĚŝŶŐ͟ ƚŽ ŵĞĞƚ ƚŚĞŝƌ ŶĞĞĚƐ͘ /ŶƐƚĞĂĚ͕ ŚĞ ĞŶĐŽƵƌĂŐĞĚ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ ĨŽƵŶĚĂƟŽŶĂů changes in the model of health care delivery including the use of global payment models for reimbursement so that health care ƐǇƐƚĞŵƐ ĐĂŶ ďƌĞĂŬ ĂǁĂǇ ĨƌŽŵ ŶĂƌƌŽǁ ƉŚǇƐŝĐŝĂŶ ƌŽůĞƐ ƚŽ ĂĐŚŝĞǀĞ ƋƵĂůŝƚǇ ĨŽƌ ǀĂůƵĞ͘ ƌ͘ K͛EĞŝů ƐƚƌŽŶŐůǇ ĞŶĚŽƌƐĞĚ ĞīŽƌƚƐ ďǇ ƉƌŝŵĂƌǇ ĐĂƌĞ ůĞĂĚĞƌƐ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ŝŶƚĞŐƌĂƚĞĚ ŽƌŐĂŶŝǌĂƟŽŶƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ ƚŽ ĂǀŽŝĚ ĨƵƌƚŚĞƌ ĨƌĂŐŵĞŶƚĂƟŽŶ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂŶĚ ƚŽ ƚĞƐƚ ƚŚĞ ŶĞǁ ŵŽĚĞůƐ ƚŽ ŵĞĞƚ ĂĐĐĞƐƐ ĂŶĚ ƋƵĂůŝƚǇ ƉĂƟĞŶƚƐ ŶĞĞĚ͘ &ŝŶĂůůǇ͕ ŚĞ ĞŶĐŽƵƌĂŐĞĚ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ ŶĞǁ ŬŝŶĚƐ ŽĨ ƉĂƌƚŶĞƌƐŚŝƉƐ ƚŚĂƚ ĂĚĚ ǀĂůƵĞ ƚŽ ŚĞĂůƚŚ ŝŶ ĨƵƚƵƌĞ ďƵƐŝŶĞƐƐ ŵŽĚĞůƐ ŽĨ ŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ͘ &Žƌ ĞǆĂŵƉůĞ͕ ŐŝǀĞŶ ƚŚĞ prevalence of cardiovascular disease, a future health care enterprise ŵĂǇ ĞŵƉůŽǇ ĚŝĞƟƟĂŶƐ ƚŽ ĂƐƐŝƐƚ ǁŝƚŚ ŚĞĂůƚŚǇ ĞĂƟŶŐ ĂŶĚ ƉĂƌƚŶĞƌ ǁŝƚŚ ŐǇŵƐ ƚŽ ĐƌĞĂƚĞ Ă ŵŽĚĞů ƚŚĂƚ ǇŝĞůĚƐ ŝŵƉƌŽǀĞĚ ŽƵƚĐŽŵĞƐ͕ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ŵŽƌĞ ĞǀŽůǀĞĚ ƌŽůĞƐ ĨŽƌ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ŽĨ ƚŽŵŽƌƌŽǁ͘ Ɛ Ă ƚŚŽƵŐŚƚ ůĞĂĚĞƌ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƉŽůŝĐǇ͕ he advocates for bigger, bolder change to meet the needs of the ǁŽƌŬĨŽƌĐĞ ŽĨ ƚŚĞ ĨƵƚƵƌĞ͘ We are being asked to do more of the same or to re-design and ƌĞͲƚŚŝŶŬ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ŵŽĚĞůƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ͘ ^ŚŽƵůĚ ǁĞ ƌŽůů ƚŚĞ ƉƌŽǀĞƌďŝĂů ƌŽĐŬ ƵƉ ƚŚĞ Śŝůů ĂŐĂŝŶ Žƌ ƚĂŬĞ Ă ĚŝīĞƌĞŶƚ ĂƉƉƌŽĂĐŚ͍ /ŵƉƌŽǀŝŶŐ ŽƵƌ ƉŽůŝĐŝĞƐ ƚŽ ŚĞůƉ W Ɛ ƉƌĂĐƟĐĞ ŝŶĚĞƉĞŶĚĞŶƚůǇ ĂŶĚ ĐŚĂŶŐŝŶŐ ŽƵƌ ƐŝůŽĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƐƚƌƵĐƚƵƌĞƐ ŵĂǇ ďĞ ƚǁŽ ǁĂǇƐ ƚŽ ƐƚĂƌƚ͘ ŝƚŚĞƌ ƉĂƚŚ ǁŝůů ďĞ ůĂďŽƌŝŽƵƐ͕ ďƵƚ ĐĞƌƚĂŝŶůǇ ŶŽƚ ĨƵƟůĞ͘ dŚĞ ŐĂƉ ďĞƚǁĞĞŶ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ĂŶĚ ŽƵƌ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ŝƐ ďƌŽĂĚ͘ ŶĚ ĐůŽƐŝŶŐ ƚŚĂƚ ŐĂƉ ǁŝůů ŵĂŬĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ǁĞůůŶĞƐƐ ĂŶĚ illness for millions of Californians.

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

CAFP Logs Another Victorious Year in Sacramento dŚĞ ϮϬϭϳͲϭϴ >ĞŐŝƐůĂƟǀĞ ^ĞƐƐŝŽŶ ǁĂƐ͕ ĨŽƌ ƚŚĞ ŵŽƐƚ ƉĂƌƚ͕ Ă ƌĞƐŽƵŶĚŝŶŐ ǀŝĐƚŽƌǇ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ &W ĂĚǀĂŶĐĞĚ ƐĞǀĞƌĂů ŵĂũŽƌ ƉƌŝŽƌŝƟĞƐ͕ ƉĂƌƟĐƵůĂƌůǇ ŝŶ ƚĞƌŵƐ ŽĨ ƉĂƟĞŶƚ ĂĐĐĞƐƐ ƚŽ ƉƌŝŵĂƌǇ ĐĂƌĞ͕ ŐĞŶĞƌĂƟŶŐ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ƚŽ ƉƵƌƐƵĞ ĐĂƌĞĞƌƐ ŝŶ family medicine and increasing access to care for the underserved. DĂũŽƌ &ĞĚĞƌĂů ,ĞĂůƚŚ WƌŽŐƌĂŵƐ ZĞŶĞǁĞĚ ĂŌĞƌ &W ĚǀŽĐĂĐǇ Ɛ ƉĂƌƚ ŽĨ ƚŚĞ ĨĞĚĞƌĂů ďƵĚŐĞƚ ĮŐŚƚ͕ &W͕ &W ĂŶĚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ ĐĂůůĞĚ ŽŶ ŽŶŐƌĞƐƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ĐŽŶƟŶƵĂƟŽŶ of several crucially important health programs, and that advocacy has ƉĂŝĚ Žī ŝŶ Ă ƌĞŵĂƌŬĂďůĞ ǁĂǇ͘ dŚĞ WƌĞƐŝĚĞŶƚ ƐŝŐŶĞĚ Ă ƐƉĞŶĚŝŶŐ ŵĞĂƐƵƌĞ ƚŚĂƚ ĞǆƚĞŶĚƐ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ ŚŝůĚƌĞŶ͛Ɛ ,ĞĂůƚŚ /ŶƐƵƌĂŶĐĞ WƌŽŐƌĂŵ ĨŽƌ ĨŽƵƌ ĂĚĚŝƟŽŶĂů ǇĞĂƌƐ ;ŽŶ ƚŽƉ ŽĨ ƚŚĞ ƉƌĞǀŝŽƵƐ ƐŝǆͲǇĞĂƌ ĞǆƚĞŶƐŝŽŶͿ ĂŶĚ ŝŶĐůƵĚĞƐ ƚŚĞ ĞǆƚĞŶƐŝŽŶ ŽĨ ƐĞǀĞƌĂů ŽƚŚĞƌ ŚŝŐŚͲƉƌŝŽƌŝƚǇ ŚĞĂůƚŚ ƉƌŽŐƌĂŵƐ͕ ŝŶĐůƵĚŝŶŐ͗ • ŽŵŵƵŶŝƚǇ ,ĞĂůƚŚ ĞŶƚĞƌƐ ; , ƐͿ͗ , Ɛ ƐĞƌǀĞ ŵŽƌĞ ƚŚĂŶ Ϯϰ ŵŝůůŝŽŶ ƉĞŽƉůĞ͕ ŵŽƐƚ ŽĨ ƚŚĞŵ ůŽǁͲŝŶĐŽŵĞ͕ ĂŶĚ ĂďŽƵƚ ŚĂůĨ ŽĨ ƚŚĞŵ ŝŶ ƌƵƌĂů ĂƌĞĂƐ ǁŚĞƌĞ ŽƉƟŽŶƐ ĨŽƌ ĐĂƌĞ ĂƌĞ ůŝŵŝƚĞĚ͘ dŽĚĂǇ͕ ŵŽƌĞ ƚŚĂŶ ϭ͕ϯϬϬ , Ɛ ƉƌŽǀŝĚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ͕ ŚŝŐŚͲ ƋƵĂůŝƚǇ ĐĂƌĞ ƚŽ ϲ͘ϱ ŵŝůůŝŽŶ ƉĞŽƉůĞ ŝŶ ĂůŝĨŽƌŶŝĂ͘ /Ŷ ŵĂŶǇ ƌƵƌĂů ĐŽŵŵƵŶŝƟĞƐ͕ , Ɛ ƐĞƌǀĞ ĂƐ ƚŚĞ ŽŶůǇ ƐŽƵƌĐĞ ŽĨ ŵĞĚŝĐĂů ĂŶĚ ǁĞůůŶĞƐƐ ĐĂƌĞ ĨŽƌ ŵŝĚĚůĞͲ ĂŶĚ ǁŽƌŬŝŶŐͲĐůĂƐƐ ĨĂŵŝůŝĞƐ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞǆƚĞŶĚƐ ĂŶĚ ŝŶĐƌĞĂƐĞƐ ĨƵŶĚŝŶŐ ĨŽƌ , Ɛ ĨƌŽŵ Ψϯ͘ϲ ďŝůůŝŽŶ ƉĞƌ ǇĞĂƌ ƚŽ Ψϯ͘ϴ ďŝůůŝŽŶ ĨŽƌ ϮϬϭϴ ĂŶĚ Ψϰ ďŝůůŝŽŶ ĨŽƌ ϮϬϭϵ͘ • dĞĂĐŚŝŶŐ ,ĞĂůƚŚ ĞŶƚĞƌƐ ;d, ƐͿ͗ d, Ɛ ĂƌĞ ƉƌŝŵĂƌǇ ĐĂƌĞ residency programs located in community clinics in underserved areas. Created and funded through the īŽƌĚĂďůĞ ĂƌĞ Đƚ͕ ƚŚĞǇ ŚĂǀĞ ƐŚŽǁŶ ƚƌĞŵĞŶĚŽƵƐ ƉƌŽŵŝƐĞ ŝŶ ŝŵƉƌŽǀŝŶŐ ĐĂƌĞ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ƌĞŐŝŽŶƐ ǁŚŝůĞ ŐƌŽǁŝŶŐ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞǆƚĞŶĚƐ ĂŶĚ ŝŶĐƌĞĂƐĞƐ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ d, ƉƌŽŐƌĂŵ ĨƌŽŵ ΨϲϬ ŵŝůůŝŽŶ ƚŽ ΨϭϮϲ͘ϱ ŵŝůůŝŽŶ ƉĞƌ ǇĞĂƌ ĨŽƌ ƚǁŽ ǇĞĂƌƐ͘ dŚŝƐ ĚĞƐƉĞƌĂƚĞůǇ ŶĞĞĚĞĚ ŵŽŶĞǇ ǁŝůů ĞŶƐƵƌĞ ƚŚĂƚ d, Ɛ ŝŶ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ ǁŝůů ŶŽƚ ĐůŽƐĞ͘ • EĂƟŽŶĂů ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ŽƌƉƐ ;E,^ Ϳ͗ dŚĞ E,^ ƐĞŶĚƐ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ŵĞĚŝĐĂůůǇ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ ŝŶ ĞǆĐŚĂŶŐĞ for medical school debt repayment. The program places ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ŝŶ ĂƌĞĂƐ ŝŶ ǁŚŝĐŚ ƚŚĞǇ ĂƌĞ ŽƚŚĞƌǁŝƐĞ ƵŶůŝŬĞůǇ ƚŽ ǁŽƌŬ͘ DŽƌĞ ƚŚĂŶ ϱϬ͕ϬϬϬ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ŚĂǀĞ ƐĞƌǀĞĚ ŝŶ ƚŚĞ E,^ ƐŝŶĐĞ ŝƚƐ ŝŶĐĞƉƟŽŶ ŝŶ ϭϵϳϮ͕ ĂŶĚ ƚŽĚĂǇ ϭϬ͕ϬϬϬ E,^ ŵĞŵďĞƌƐ ƉƌŽǀŝĚĞ ĐĂƌĞ ƚŽ ŵŽƌĞ ƚŚĂŶ ϭϭ ŵŝůůŝŽŶ ƉĂƟĞŶƚƐ Ăƚ ŵŽƌĞ ƚŚĂŶ ϱ͕ϬϬϬ ůŽĐĂƟŽŶƐ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞǆƚĞŶĚƐ E,^ ͛Ɛ ĐƵƌƌĞŶƚ ĨƵŶĚŝŶŐ ůĞǀĞů ŽĨ ΨϯϭϬ ŵŝůůŝŽŶ ĂŶŶƵĂůůǇ ĨŽƌ ϮϬϭϴ ĂŶĚ ϮϬϭϵ͘ 10

California Family Physician Winter 2019

dŚĞ ϮϬϭϴͲϭϵ ^ƚĂƚĞ ƵĚŐĞƚ /ŶĐůƵĚĞƐ DĂũŽƌ ,ĞĂůƚŚ ĂƌĞ tŝŶƐ CAFP secured major victories and investments in this year’s State Budget, including medical student loan repayment, a major increase ŝŶ DĞĚŝͲ Ăů ƉĂǇŵĞŶƚ ƌĂƚĞƐ ĂŶĚ Ă ƐƚĞƉ ƚŽǁĂƌĚ ĞƐƚĂďůŝƐŚŝŶŐ ƚŚĞ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ŶĞĞĚĞĚ ƚŽ ŵĞĂƐƵƌĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ƐƉĞŶĚŝŶŐ͘ dŚĞ ϮϬϭϴͲϭϵ ^ƚĂƚĞ ƵĚŐĞƚ ŝŶĐůƵĚĞĚ͗ • ΨϮϯϯ ŵŝůůŝŽŶ ;ŽŶ ƚŽƉ ŽĨ ƚŚĞ ŵŽƌĞ ƚŚĂŶ ΨϯϱϬ ŵŝůůŝŽŶ ŝŶĐƌĞĂƐĞ ŝŶ ϮϬϭϳͿ ĨŽƌ ŝŶĐƌĞĂƐĞĚ ƉĂǇŵĞŶƚƐ ƚŽ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌƐ͘ • ΨϭϵϬ ŵŝůůŝŽŶ ŝŶ ůŽĂŶ ƌĞƉĂǇŵĞŶƚ ĨƵŶĚƐ ĨŽƌ ƌĞĐĞŶƚůǇ ŐƌĂĚƵĂƚĞĚ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƐĞƌǀĞ DĞĚŝͲ Ăů ďĞŶĞĮĐŝĂƌŝĞƐ͘ • dŚĞ ĐŽŶƟŶƵĂƟŽŶ ŽĨ ƚŚĞ ƚŚƌĞĞͲǇĞĂƌ ΨϭϬϬ ŵŝůůŝŽŶ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌǇ ĂƌĞ WŚǇƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŝƚŚ ŝƚƐ ƐĞĐŽŶĚ ŝŶƐƚĂůůŵĞŶƚ ŽĨ Ψϯϯ ŵŝůůŝŽŶ ŝŶ ϮϬϭϴ͘ • ΨϲϬ ŵŝůůŝŽŶ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ͞,ĞĂůƚŚ ĂƌĞ WĂǇŵĞŶƚƐ ĂƚĂďĂƐĞ͟ ʹ an All Payer Claims Database. • dŚĞ ƌĞůĞĂƐĞ ŽĨ ΨϰϬ ŵŝůůŝŽŶͬǇĞĂƌ ŝŶ WƌŽƉŽƐŝƟŽŶ ϱϲ ĨƵŶĚƐ ƚŽ support primary care and emergency medicine residency programs in underserved areas. CAFP sit on the program’s ĚǀŝƐŽƌǇ ŽƵŶĐŝů ĂŶĚ ŝƐ ǁŽƌŬŝŶŐ ƚŽ ĞŶƐƵƌĞ ƚŚŽƐĞ ĨƵŶĚƐ ĂƌĞ ƵƐĞĚ for their intended purpose. • ΨϱϬϬ ŵŝůůŝŽŶ ƚŽ ŚĞůƉ ĐŽŵŵƵŶŝƟĞƐ ĂĐƌŽƐƐ ĂůŝĨŽƌŶŝĂ ĂĚĚƌĞƐƐ homelessness. • ΨϱϬ ŵŝůůŝŽŶ ƚŽ ĞǆƉĂŶĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĞǆĐŚĂŶŐĞƐ ƚŽ ŶĞǁ health care providers. 'ŽǀĞƌŶŽƌ ^ŝŐŶƐ &WͲ^ƉŽŶƐŽƌĞĚ ŝůů ƚŽ ZĞŐƵůĂƚĞ WŚĂƌŵĂĐǇ ĞŶĞĮƚ Managers dŚĞ 'ŽǀĞƌŶŽƌ ƐŝŐŶĞĚ &W͛Ɛ ĐŽͲƐƉŽŶƐŽƌĞĚ ůĞŐŝƐůĂƟŽŶ͕ ϯϭϱ ;tŽŽĚ͕ ĂŚůĞ͕ EĂǌĂƌŝĂŶ ĂŶĚ ^ƚŽŶĞͿ͕ ǁŚŝĐŚ ǁŝůů ƌĞŐƵůĂƚĞ ƉŚĂƌŵĂĐǇ ďĞŶĞĮƚ ŵĂŶĂŐĞƌƐ ;W DƐͿ ĂŶĚ ƉƌŽƚĞĐƚ ƉĂƟĞŶƚƐ ĨƌŽŵ ƵŶĨĂŝƌ ĚƌƵŐ ƉƌŝĐŝŶŐ͘ dŚĞ ŶĞǁ ůĂǁ ƌĞƋƵŝƌĞƐ W DƐ ƚŽ ƌĞŐŝƐƚĞƌ ǁŝƚŚ ƚŚĞ ƐƚĂƚĞ ĂŶĚ ŶŽƟĨǇ Ă ƉƵƌĐŚĂƐĞƌ ŽĨ ĂŶǇ ĂĐƟǀŝƚǇ͕ ƉŽůŝĐǇ Žƌ ƉƌĂĐƟĐĞ ƚŚĂƚ ƉƌĞƐĞŶƚƐ Ă ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ƌĞŐƵůĂƟŶŐ W DƐ͕ ƚŚĞ ŶĞǁ ůĂǁ ƐĞĞŬƐ ƚŽ ŐƵŝĚĞ ƉĂƟĞŶƚƐ ƚŽ ƚŚĞ ůŽǁĞƐƚ ĐŽƐƚ ĨŽƌ ƚŚĞŝƌ ŵĞĚŝĐĂƟŽŶ ďǇ ďĂƌƌŝŶŐ W DƐ ĂŶĚ ŚĞĂůƚŚ ƉůĂŶƐ ĨƌŽŵ ƉƌŽŚŝďŝƟŶŐ ƉƌŽǀŝĚĞƌƐ ĨƌŽŵ ŝŶĨŽƌŵŝŶŐ ƉĂƟĞŶƚƐ ŽĨ Ă ůĞƐƐ ĐŽƐƚůǇ ĂůƚĞƌŶĂƟǀĞ ƚŽ Ă ƉƌĞƐĐƌŝďĞĚ ŵĞĚŝĐĂƟŽŶ͘ /ƚ ĂůƐŽ ƌĞƋƵŝƌĞƐ ƉŚĂƌŵĂĐŝĞƐ ƚŽ ŝŶĨŽƌŵ ĐƵƐƚŽŵĞƌƐ ǁŚĞƚŚĞƌ ƚŚĞ ƌĞƚĂŝů ƉƌŝĐĞ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ŝƐ ůŽǁĞƌ ƚŚĂŶ the applicable cost-sharing amount for that drug. EĞǁ WĂƌŬŝŶƐŽŶ͛Ɛ ŝƐĞĂƐĞ ZĞƉŽƌƟŶŐ ZĞƋƵŝƌĞŵĞŶƚ ZĞĚƵĐĞĚ &W ǁŽƌŬĞĚ ǁŝƚŚ Ă ŶƵŵďĞƌ ŽĨ ƐƚĂŬĞŚŽůĚĞƌƐ ƚŽ ƉƌĞƐƐƵƌĞ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ ; W,Ϳ ĂŶĚ ƚŚĞ 'ŽǀĞƌŶŽƌ͛Ɛ ŽĸĐĞ ƚŽ ƌĞĚƵĐĞ ŽǀĞƌůǇ ďƵƌĚĞŶƐŽŵĞ ĂŶĚ ƵŶŶĞĐĞƐƐĂƌǇ ƌĞƉŽƌƟŶŐ ƌĞƋƵŝƌĞŵĞŶƚƐ ƌĞůĂƚĞĚ ƚŽ ƚŚĞ ĐŽůůĞĐƟŽŶ ŽĨ ĚĂƚĂ ĨŽƌ ƚŚĞ ĂůŝĨŽƌŶŝĂ WĂƌŬŝŶƐŽŶ͛Ɛ ŝƐĞĂƐĞ ZĞŐŝƐƚƌǇ͘ dŚĞ ZĞŐŝƐƚƌǇ͕ ǁŚŝĐŚ ŽƉĞŶĞĚ :ƵůǇ ϭ͕ ϮϬϭϴ͕ ƌĞƋƵŝƌĞƐ ƉŚǇƐŝĐŝĂŶƐ͕ ƉŚǇƐŝĐŝĂŶ

ĂƐƐŝƐƚĂŶƚ ĂŶĚ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ǁŚŽ ĚŝĂŐŶŽƐĞ Žƌ ƚƌĞĂƚ WĂƌŬŝŶƐŽŶ͛Ɛ ĚŝƐĞĂƐĞ ƉĂƟĞŶƚƐ ƚŽ ƌĞŐŝƐƚĞƌ ǁŝƚŚ W, ĂŶĚ ƌĞƉŽƌƚ ĐĂƐĞƐ ŽĨ WĂƌŬŝŶƐŽŶ͛Ɛ ĚŝƐĞĂƐĞ͘ dŚĞ ŽƌŝŐŝŶĂů ϲϮ ƌĞƋƵŝƌĞĚ ĚĂƚĂ ĮĞůĚƐ ŚĂǀĞ ďĞĞŶ ŶĂƌƌŽǁĞĚ ƚŽ ϭϰ ƌĞƋƵŝƌĞĚ ĮĞůĚƐ ĂŶĚ ƚŚƌĞĞ ŽƉƟŽŶĂů ĮĞůĚƐ ĂŶĚ Ă ŶĞǁ /ŵƉůĞŵĞŶƚĂƟŽŶ 'ƵŝĚĞ ŚĂƐ ďĞĞŶ ƌĞůĞĂƐĞĚ͘ /Ĩ ǇŽƵ ƚƌĞĂƚ ƚŚŝƐ ƉŽƉƵůĂƟŽŶ͕ ƉůĞĂƐĞ ĨĂŵŝůŝĂƌŝǌĞ ǇŽƵƌƐĞůĨ ǁŝƚŚ ƚŚĞ ŶĞǁ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŐƵŝĚĞ ĂŶĚ ƐĞĞ W,͛Ɛ ͞ ƚ Ă 'ůĂŶĐĞ͟ ĚŽĐƵŵĞŶƚ͘ CDPH has also created an email list serve that clinicians can sign up for to receive updates on the registry. dŚĞƐĞ ǀŝĐƚŽƌŝĞƐ ǁŽƵůĚ ŶŽƚ ŚĂǀĞ ďĞĞŶ ƉŽƐƐŝďůĞ ǁŝƚŚŽƵƚ &W ŵĞŵďĞƌƐ ůŝŬĞ ǇŽƵ͘ / ĞŶĐŽƵƌĂŐĞ ǇŽƵ to reach out to your colleagues and ask if they are CAFP members. If they are, please thank them for their support of our specialty. If they are not, ƉůĞĂƐĞ ĞŶĐŽƵƌĂŐĞ ƚŚĞŵ ƚŽ ũŽŝŶ ƵƐ ŝŶ ŽƵƌ ĞīŽƌƚƐ ƚŽ ŵĂŬĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƚŚĞ ĨŽƵŶĚĂƟŽŶ ŽĨ ŽƵƌ health care system.

California Family Physician Winter 2019

IN THE NEWS Winter 2019

We’re excited to launch this new column … and to share news ŝƚĞŵƐ ĂďŽƵƚ &W ŵĞŵďĞƌƐ͘ ,ĂǀĞ ĂŶ ŝƚĞŵ ƚŽ ƐŚĂƌĞ͍ ^ĞŶĚ ŝƚ ƚŽ &W͕ ƩŶ͗ ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͕ ͕ DĂŶĂŐŝŶŐ ĚŝƚŽƌ͕ ĂŶĚ ǁĞ͛ůů do our best to spread your news!

ůĞĂĚĞƌ͕ ĂŶĚ ŶŽǁ Ă ƌĞƐŝĚĞŶƚ ŝŶ tĂƐŚŝŶŐƚŽŶ͕ ŚĂƐ ďĞĞŶ ĂƉƉŽŝŶƚĞĚ ƚŽ ƚŚĞ ŽŵŵŝƐƐŝŽŶ ŽŶ YƵĂůŝƚǇ ĂŶĚ WƌĂĐƟĐĞ͘ dŚĞ ĮƌƐƚ &W ůƵƐƚĞƌ ŝƐ :ĂŶƵĂƌǇ ϮϱͲϮϳ͕ ŝŶ <ĂŶƐĂƐ ŝƚǇ͘ ŶĚ͕ Žď ŝĚƵƐ ŚĂƐ ďĞĞŶ ĂƉƉŽŝŶƚĞĚ to the American Board of Family Medicine Board of Directors.

ŽŶŐƌĂƚƵůĂƟŽŶƐ ĂƌĞ ŝŶ ŽƌĚĞƌ ĨŽƌ &W ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚĂů īĂŝƌƐ ĂŶĚ ŚŝƐ ǁŝĨĞ ŵŝůŝĂ Ğ >Ƶǌ͕ ŽŶ ƚŚĞ ďŝƌƚŚ ŽĨ ƚŚĞ ŶĞǁĞƐƚ &DZĞǀŽůƵŝŽŶĂƌǇ͕ ǁĞŝŐŚŝŶŐ ŝŶ Ăƚ ŶĞĂƌůǇ ϭϬ ƉŽƵŶĚƐ ŽŶ :ĂŶƵĂƌǇ ϭϲ͘ tĞůĐŽŵĞ ƚŽ ƚŚĞ ǁŽƌůĚ KǁĞŶ ĚĂŵ Joaquin Francis!

CAFP Nominating Committee Proposes its Slate of Officers for 2019-2020

CAFP Immediate Past President Michelle Quoigue has been selected as an American Academy of Family Physicians Health ƋƵŝƚǇ &ĞůůŽǁ͘ ^ŚĞ ƐƚĂƌƚĞĚ ŚĞƌ ǁŽƌŬ ŝŶ Kansas City at AAFP headquarters last fall! David Bazzo, CAFP’s Speaker, is also the President of the San Diego County Medical Society. The members of District IX have elected Ron Labuguen, MD to represent them on CAFP’s Board of Directors. Ron is professor of family and community medicine at the University of California, San Francisco (UCSF) and the medical director of the Adult Urgent Care Center at Zuckerberg San Francisco General Hospital and Trauma ĞŶƚĞƌ ; ^&'Ϳ͘ ZŽŶ ƌĞƉůĂĐĞƐ ƐŚďǇ tŽůĨĞ͕ ǁŚŽ ŚĂƐ ůĞŌ ĂůŝĨŽƌŶŝĂ ĨŽƌ tĂƐŚŝŶŐƚŽŶ ^ƚĂƚĞ͘ ƐŚďǇ ǁŝůů ƌĞŵĂŝŶ ĞŶŐĂŐĞĚ ǁŝƚŚ &W ŝŶ ŚĞƌ role for the Centers for Medicare and Medicaid (CMS). ůĞǆ DĐ ŽŶĂůĚ ũŽŝŶƐ ƚŚĞ ƌĂŶŬƐ ŽĨ &W ŵĞŵďĞƌƐ ĂŶĚ ƐƚĂī ƐĞƌǀŝŶŐ ŽŶ &W ŽŵŵŝƐƐŝŽŶƐ ǁŝƚŚ ŚŝƐ ĂƉƉŽŝŶƚŵĞŶƚ ƚŽ the Commission on Membership and DĞŵďĞƌ ^ĞƌǀŝĐĞƐ͘ Ğǀ sĂƐŚŝƐŚƚŚĂ͕ a CAFP medical student leader, and ŶŽǁ Ă ƌĞƐŝĚĞŶƚ ŝŶ tĂƐŚŝŶŐƚŽŶ͕ ŚĂƐ been appointed to the Commission on YƵĂůŝƚǇ ĂŶĚ WƌĂĐƟĐĞ͘ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ MD, MPH and Shelly Rodrigues, CAE also serve on CMMS. Art Ohannessian, D ĂŶĚ ŶŶĂ ƐŬĂƌŝ ; ĚƵĐĂƟŽŶͿ͕ Resha Ramachandran, MD, MPP and ^ĐŽƩ EĂƐƐ͕ D ͕ DW ; ĚǀŽĐĂĐǇͿ͕ ĂŶĚ Shani Muhammad, MD and Shannon Connolly, MD (Health of the Public) are also serving on commissions. Dev sĂƐŚŝƐŚƚŚĂ͕ Ă &W ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ 12

California Family Physician Winter 2019

&W͛Ɛ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ĂĐĐĞƉƚĞĚ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ͛Ɛ ƐůĂƚĞ Ăƚ ŝƚƐ EŽǀĞŵďĞƌ ϯ͕ ϮϬϭϴ ŵĞĞƟŶŐ͘ dŚĞƐĞ ŝŶĚŝǀŝĚƵĂůƐ ǁŝůů ďĞ ĞůĞĐƚĞĚ ďǇ ƚŚĞ ĚĞůĞŐĂƚĞƐ Ăƚ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ͕ DĂƌĐŚ ϭϬ͕ ϮϬϭϵ͘ WƌĞƐŝĚĞŶƚͲĞůĞĐƚ͗ ĂǀŝĚ ĂǌǌŽ͕ D ^ƉĞĂŬĞƌ͗ Shannon Connolly, MD sŝĐĞͲ^ƉĞĂŬĞƌ͗ Lauren Simon, MD &W ĞůĞŐĂƚĞ ;ϮϬϭϵͲϮϬͿ͗ :ĞīƌĞǇ >ƵƚŚĞƌ͕ D &W ůƚ͘ ĞůĞŐĂƚĞ ;ϮϬϭϵͲϮϬͿ͗ Jay Lee, MD EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ;ϮϬϭϵͲϮϬͿΎ͗ dŽŶĂƚǌŝŶ ZŽĚƌŝŐƵĞǌ͕ D Elected by and from the Board ^ĞĐƌĞƚĂƌǇͲdƌĞĂƐƵƌĞƌ ;ϮϬϭϵͲϮϬͿ͗ ZĂƵů ǇĂůĂ͕ D ΎdŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ; D DͿ ŶŽǁ ŶŽŵŝŶĂƚĞƐ ĂŶĚ ĞůĞĐƚƐ Ă ƚŽƚĂů ŽĨ ƚŚƌĞĞ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ĨƌŽŵ ƚŚĞ D D ĞůĞŐĂƚĞƐ ;ĂĚĚŝƟŽŶĂů ŵĞŵďĞƌ ĂĚĚĞĚ Ăƚ ϭϵϵϲ ŽŶŐƌĞƐƐ ŽĨ ĞůĞŐĂƚĞƐ ĂŶĚ ďǇůĂǁƐ ĐŚĂŶŐĞ ĂƉƉƌŽǀĞĚ Ăƚ ϭϵϵϳ ŽŶŐƌĞƐƐͿ͖ ƚǁŽ ĂƌĞ ĞůĞĐƚĞĚ ĨŽƌ ƚǁŽͲ ǇĞĂƌ ƚĞƌŵƐ ŝŶ ŽŶĞ ǇĞĂƌ͕ ĂŶĚ ŽŶĞ ŝƐ ĞůĞĐƚĞĚ ĨŽƌ Ă ƚǁŽͲǇĞĂƌ ƚĞƌŵ ƚŚĞ ŶĞǆƚ͘ EŽŵŝŶĂƟŽŶƐ ŵĂǇ ďĞ ŵĂĚĞ ĨƌŽŵ ƚŚĞ ŇŽŽƌ͕ ĂůƚŚŽƵŐŚ ƚŚĞƌĞ ŝƐ ŶŽ ǁƌŝƩĞŶ ƉƌŽŚŝďŝƟŽŶ ŽŶ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ĨƌŽŵ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ͕ ĂŶĚ ƚƌĂĚŝƟŽŶĂůůǇ͕ ƐƵĐŚ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ŚĂǀĞ ďĞĞŶ ŵĂĚĞ͘

Healthy Harbors: Addressing Health Consequences of Immigration Policies /Ŷ ŽƵƌ &Ăůů ϮϬϭϴ ŝƐƐƵĞ ǁĞ ŝŶƚƌŽĚƵĐĞĚ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ,ĞĂůƚŚǇ ,ĂƌďŽƌƐ ƉƌŽũĞĐƚ ʹ Ă ƉƌŽũĞĐƚ ƚŽ ŬĞĞƉ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ ƵƉͲƚŽͲĚĂƚĞ ŽŶ ƚŚĞ ŝŵŵŝŐƌĂƟŽŶ ŝƐƐƵĞƐ ǁŚŝĐŚ ŵĂǇ ĂīĞĐƚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ tŚŝůĞ ƚŚĞ ĚĞƉƚŚ ŽĨ ƉƌŽďůĞŵƐ ƚŚĂƚ ŵĂǇ ďĞ ĐƌĞĂƚĞĚ ďǇ ƐĞƉĂƌĂƟŽŶ ŽĨ ĨĂŵŝůŝĞƐ͕ / ĂĐƟǀŝƟĞƐ͕ ĐŚĂŶŐĞƐ ƚŽ ƚŚĞ WƵďůŝĐ ŚĂƌŐĞ ƉŽůŝĐŝĞƐ ĨŽƌ DĞĚŝĐĂŝĚ ĂŶĚ ,/W͕ Ăƚ ƚŚĞ &ĞĚĞƌĂů ůĞǀĞů ƌĞŵĂŝŶƐ ƵŶĐůĞĂƌ ƚŽĚĂǇ͕ ŝŶĐƌĞĂƐŝŶŐ ƉŚǇƐŝĐŝĂŶ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ƐƵĐŚ ŝƐƐƵĞƐ ǁŝůů ďĞƩĞƌ ƉƌĞƉĂƌĞ ǇŽƵ ĂŶĚ ŽƚŚĞƌ ĐůŝŶŝĐŝĂŶƐ ŝĨ ĂŶĚ ǁŚĞŶ ƚŚĞ ĂĐƟŽŶƐ ĂƌĞ ŝŵƉůĞŵĞŶƚĞĚ͘ tŽƌŬŝŶŐ ŝŶ ĐŽůůĂďŽƌĂƟŽŶ ǁŝƚŚ ƚŚĞ ůĂŵĞĚĂ ŽŶƚƌĂ ŽƐƚĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͕ ^ĂŶ &ƌĂŶĐŝƐĐŽ DĂƌŝŶ DĞĚŝĐĂů ^ŽĐŝĞƚǇ͕ ŵĞƌŝĐĂŶ ĐĂĚĞŵǇ ŽĨ Pediatrics-California, Osteopathic Physicians and Surgeons of California and Sonoma County Medical Society, ǇŽƵƌ &ŽƵŶĚĂƟŽŶ ŽīĞƌƐ ĂŶ ŽƉĞŶŝŶŐ ƐĂůǀŽ͕ ƐŽ ƚŽ ƐƉĞĂŬ͕ ĂŶ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĂǁĂƌĞŶĞƐƐ ĐĂŵƉĂŝŐŶ ƚŽ ůĂǇ ƚŚĞ ŐƌŽƵŶĚǁŽƌŬ ĨŽƌ ĨƵƚƵƌĞ ƉŽůŝƟĐĂů͕ ĂĚǀŽĐĂĐǇ ĂŶĚ ĞĚƵĐĂƟŽŶĂů ĞīŽƌƚƐ ĂŝŵĞĚ Ăƚ ƉƌŽƚĞĐƟŶŐ ƚŚĞ ŚĞĂůƚŚ of California’s most vulnerable ƉŽƉƵůĂƟŽŶƐ͕ ĞƐƉĞĐŝĂůůǇ ĐŚŝůĚƌĞŶ͘

ŝŶ ĞĂƟŶŐ ĂŶĚ ƐůĞĞƉŝŶŐ͕ ĨƌĞƋƵĞŶƚ ĐƌǇŝŶŐ͕ ŝŶĐƌĞĂƐĞĚ ĨĞĂƌ ĂŶĚ ĂŶǆŝĞƚǇ͕ ĂŶĚͬŽƌ ǁŝƚŚĚƌĂǁĂů Žƌ ĂŶŐĞƌ͘͟Ϯ ^ŽŵĞ ĐŚŝůĚƌĞŶ ĞǆƉĞƌŝĞŶĐĞ ͞ƐƉĞĞĐŚ ĂŶĚ ĚĞǀĞůŽƉŵĞŶƚĂů ĚŝĸĐƵůƟĞƐ͕ ŝŶĐůƵĚŝŶŐ ƌĞŐƌĞƐƐŝŽŶ ĂŶĚ ƌĞǀĞƌƐĂů ŽĨ developmental milestones.” 3 ^ƚƵĚŝĞƐ ƐŚŽǁ ŚŝŐŚ ůĞǀĞůƐ ŽĨ ƉƐǇĐŚŝĂƚƌŝĐ ĚŝƐƚƌĞƐƐ͕ ŝŶĐůƵĚŝŶŐ ĚĞƉƌĞƐƐŝŽŶ ĂŶĚ ƉŽƐƚͲƚƌĂƵŵĂƟĐ ƐƚƌĞƐƐ͕ ĂŵŽŶŐ ĚĞƚĂŝŶĞĚ ĂƐǇůƵŵ ƐĞĞŬĞƌƐ͕ ĞǀĞŶ ĂŌĞƌ ƐŚŽƌƚ ĚĞƚĞŶƟŽŶ ƉĞƌŝŽĚƐ͕ ĂŶĚ ƚŚĂƚ ƐǇŵƉƚŽŵƐ ǁŽƌƐĞŶ ŽǀĞƌ ƟŵĞ͘ ϰ 'ůŽďĂů ƐƚƵĚŝĞƐ ĂůƐŽ ƐŚŽǁ ƐŝŐŶŝĮĐĂŶƚ ĞīĞĐƚƐ ĨŽƌ ĐŚŝůĚƌĞŶ ŚĞůĚ ŝŶ ĚĞƚĞŶƟŽŶ͕ ŝŶĐůƵĚŝŶŐ ĚĞƉƌĞƐƐŝŽŶ͕ ƉŽƐƚͲƚƌĂƵŵĂƟĐ stress, suicidal thoughts and behaviors, developmental delays, and behavioral issues.5 W ĂůƐŽ ŶŽƚĞƐ ŶĞŐĂƟǀĞ ŝŵƉĂĐƚƐ ŽŶ ƚŚĞ ƉĂƌĞŶƚͲĐŚŝůĚ ƌĞůĂƟŽŶƐŚŝƉ͘ϲ

What can family physicians do to ƌĞƐƉŽŶĚ ƚŽ ĨĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ͍ The American Academy of Family Physicians (AAFP) opposes the forced ƐĞƉĂƌĂƟŽŶ ŽĨ ĐŚŝůĚƌĞŶ ĨƌŽŵ ĨĂŵŝůǇ members or caregivers crossing the United States border unless the child’s ŝŵŵĞĚŝĂƚĞ ƉŚǇƐŝĐĂů Žƌ ĞŵŽƟŽŶĂů ŚĞĂůƚŚ Žƌ ƐĂĨĞƚǇ ŝƐ Ăƚ ƌŝƐŬ͕ ĂƐ ƐƵĐŚ ƐĞƉĂƌĂƟŽŶ poses great physical and mental health tŚĂƚ ĂƌĞ ƚŚĞ ŬĞǇ ŚĞĂůƚŚ ŝŵƉůŝĐĂƟŽŶƐ ƌŝƐŬƐ ŝŶ ƚĞƌŵƐ ŽĨ ĞŵŽƟŽŶĂů ƚƌĂƵŵĂ͕ ŽĨ ĨĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ ĂŶĚ ĚĞƚĞŶƟŽŶ͍ ƐĂĨĞƚǇ͕ ĂŶĚ ĚŝŵŝŶŝƐŚĞĚ ŽǀĞƌĂůů ǁĞůůͲ &ĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ ĂŶĚ ĚĞƚĞŶƟŽŶ being.ϳ FP and their team members ĐĂŶ ĐŽŵƉůŝĐĂƚĞ ĂŶĚ ĞǆĂĐĞƌďĂƚĞ ĂƌĞ ĞŶĐŽƵƌĂŐĞĚ ƚŽ ĞŶŐĂŐĞ ǁŝƚŚ ĞǆŝƐƟŶŐ ƚƌĂƵŵĂ ĂŵŽŶŐ ǀƵůŶĞƌĂďůĞ either the AAFP or the CAFP to join in ƉŽƉƵůĂƟŽŶƐ͘ Ɛ ŶŽƚĞĚ ďǇ ƚŚĞ ĞǆŝƐƟŶŐ ĞīŽƌƚƐ ƚŽ ŽƉƉŽƐĞ ƉŽůŝĐŝĞƐ ĂŶĚ American Academy of Pediatrics ƌĞŐƵůĂƟŽŶƐ ƚŚĂƚ ĞŶĂďůĞ ƐĞƉĂƌĂƟŽŶ ŽĨ ; WͿ͕ ƐĞƉĂƌĂƟŶŐ ĐŚŝůĚƌĞŶ ĨƌŽŵ families at the US border. Furthermore, ƚŚĞŝƌ ƉĂƌĞŶƚƐ ĞǆƉŽƐĞƐ ƚŚĞŵ ƚŽ ͞ƚŽǆŝĐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĐŽŵĞ ŝŶƚŽ ĐŽŶƚĂĐƚ stress” that can disrupt healthy ǁŝƚŚ ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ĐƌŽƐƐĞĚ ƚŚĞ h^ development and lead to lifelong border to reside in the US should inquire ŶĞŐĂƟǀĞ ŝŵƉĂĐƚƐ ŽŶ ƚŚĞŝƌ ŵĞŶƚĂů ŝŶƚŽ ǁŚĞƚŚĞƌ ƚŚĞǇ ŚĂǀĞ ĞǆƉĞƌŝĞŶĐĞĚ ĂŶĚ ƉŚǇƐŝĐĂů ǁĞůůďĞŝŶŐ͘ /Ŷ ƚŚĞ ƐŚŽƌƚ ĨĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ ŝŶ ƚŚĞ ĐŽƵƌƐĞ ŽĨ ŚĞĂůƚŚ ƚĞƌŵ͕ ƚŽǆŝĐ ƐƚƌĞƐƐ ĐĂŶ ŝŶĐƌĞĂƐĞ ƚŚĞ ĂƐƐĞƐƐŵĞŶƚ͘ dŚĞ ĐŚŝůĚƌĞŶ ŽĨ ƚŚŽƐĞ ǁŚŽ ƌŝƐŬ ĂŶĚ ĨƌĞƋƵĞŶĐǇ ŽĨ ŝŶĨĞĐƟŽŶƐ ŝŶ ŚĂǀĞ ĞǆƉĞƌŝĞŶĐĞĚ ĨĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ children as high levels of stress hormones suppress the body’s immune should be screened for signs of childhood trauma using tools associated system. It can also result in developmental issues due to reduced neural ǁŝƚŚ ĚǀĞƌƐĞ ŚŝůĚŚŽŽĚ ǆƉĞƌŝĞŶĐĞƐ ; ƐͿ͘ ĐŽŶŶĞĐƟŽŶƐ ƚŽ ŝŵƉŽƌƚĂŶƚ ĂƌĞĂƐ ŽĨ ƚŚĞ ďƌĂŝŶ͘ dŽǆŝĐ ƐƚƌĞƐƐ ŝƐ ĂƐƐŽĐŝĂƚĞĚ • ͞^ĐƌĞĞŶŝŶŐ ĂŶĚ ƐƐĞƐƐŵĞŶƚ͟ ʹ dŚĞ EĂƟŽŶĂů ŚŝůĚ dƌĂƵŵĂƟĐ ǁŝƚŚ ĚĂŵĂŐĞ ƚŽ ĂƌĞĂƐ ŽĨ ƚŚĞ ďƌĂŝŶ ƌĞƐƉŽŶƐŝďůĞ ĨŽƌ ůĞĂƌŶŝŶŐ ĂŶĚ ŵĞŵŽƌǇ͘ ^ƚƌĞƐƐ EĞƚǁŽƌŬ ;ŚƩƉƐ͗ͬͬǁǁǁ͘ŶĐƚƐŶ͘ŽƌŐͬƚƌĞĂƚŵĞŶƚƐͲĂŶĚͲ KǀĞƌ ƚŚĞ ůŽŶŐ ƚĞƌŵ͕ ƚŽǆŝĐ ƐƚƌĞƐƐ ŵĂǇ ŵĂŶŝĨĞƐƚ ĂƐ ƉŽŽƌ ĐŽƉŝŶŐ ƐŬŝůůƐ ƉƌĂĐƟĐĞƐͬƐĐƌĞĞŶŝŶŐͲĂŶĚͲĂƐƐĞƐƐŵĞŶƚͿ ĂŶĚ ƐƚƌĞƐƐ ŵĂŶĂŐĞŵĞŶƚ͕ ƵŶŚĞĂůƚŚǇ ůŝĨĞƐƚǇůĞƐ͕ ĂĚŽƉƟŽŶ ŽĨ ƌŝƐŬǇ ŚĞĂůƚŚ • ͞^ĐƌĞĞŶŝŶŐ ĂŶĚ ƐƐĞƐƐŵĞŶƚ ŽĨ ŚŝůĚ dƌĂƵŵĂ͟ ʹ ŚŝůĚ tĞůĨĂƌĞ ďĞŚĂǀŝŽƌƐ͕ ĂŶĚ ŵĞŶƚĂů ŚĞĂůƚŚ ŝƐƐƵĞƐ͕ ƐƵĐŚ ĂƐ ĚĞƉƌĞƐƐŝŽŶ͘ dŽǆŝĐ ƐƚƌĞƐƐ ŝƐ /ŶĨŽƌŵĂƟŽŶ 'ĂƚĞǁĂǇ ;ŚƩƉƐ͗ͬͬǁǁǁ͘ĐŚŝůĚǁĞůĨĂƌĞ͘ŐŽǀͬƚŽƉŝĐƐͬ ĂůƐŽ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŝŶĐƌĞĂƐĞĚ ƌĂƚĞƐ ŽĨ ƉŚǇƐŝĐĂů ĐŽŶĚŝƟŽŶƐ ŝŶƚŽ ĂĚƵůƚŚŽŽĚ͕ ƐǇƐƚĞŵǁŝĚĞͬĂƐƐĞƐƐŵĞŶƚͬĨĂŵŝůǇͲĂƐƐĞƐƐͬĐŚŝůĚŶĞĞĚƐͬƚƌĂƵŵĂͬͿ ŝŶĐůƵĚŝŶŐ ĐŚƌŽŶŝĐ ŽďƐƚƌƵĐƟǀĞ ƉƵůŵŽŶĂƌǇ ĚŝƐĞĂƐĞ͕ ŽďĞƐŝƚǇ͕ ŝƐĐŚĞŵŝĐ ŚĞĂƌƚ • DĞŶƚĂů ,ĞĂůƚŚ ĂƌĞ ^ĞƌǀŝĐĞƐ ďǇ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ;ƉŽƐŝƟŽŶ ĚŝƐĞĂƐĞ͕ ĚŝĂďĞƚĞƐ͕ ĂƐƚŚŵĂ͕ ĐĂŶĐĞƌ͕ ĂŶĚ ƉŽƐƚͲƚƌĂƵŵĂƟĐ ƐƚƌĞƐƐ ĚŝƐŽƌĚĞƌ͘1 ƉĂƉĞƌͿ ʹ &W ;ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬ mental-services.html) • ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů͕ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬ ŚŝůĚƌĞŶ ŝŶ ĨĂŵŝůŝĞƐ ǁŚĞƌĞ Ă ƉĂƌĞŶƚ ŚĂƐ ďĞĞŶ ĚĞƚĂŝŶĞĚ ĂŶĚ ĚĞƉŽƌƚĞĚ ǀŝŽůĞŶĐĞƉƌĞǀĞŶƟŽŶͬĂĐĞƐƚƵĚǇͬ ĞǆŚŝďŝƚ ƐŝŐŶŝĮĐĂŶƚ ĐŚĂŶŐĞƐ ŝŶ ďĞŚĂǀŝŽƌ ƚŚĂƚ ĐĂŶ ŝŶĐůƵĚĞ ͞ĐŚĂŶŐĞƐ 14

California Family Physician Winter 2019

dŚĞ Ɛŝǆ ,ĞĂůƚŚǇ ,ĂƌďŽƌƐ ƉĂƌƚŶĞƌƐ ŝŶ ƚŚŝƐ ƉƌŽũĞĐƚ ĂƌĞ ŝŵƉůĞŵĞŶƟŶŐ Ă ŵƵůƟͲƉƌŽŶŐĞĚ ŝŶĨŽƌŵĂƟŽŶ ƐƚƌĂƚĞŐǇ͕ ŝŶĐůƵĚŝŶŐ ŝĚĞŶƟĨǇŝŶŐ ĐŚĂŵƉŝŽŶƐ ƚŽ speak at live events and to the media; a series ŽĨ ƉŽƐŝƟŽŶ ƉĂƉĞƌƐ ĂŶĚ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ƉŝĞĐĞƐ͖ ǁĞďŝŶĂƌƐ Žƌ ƉŽĚĐĂƐƚƐ ŽŶ Ă ǀĂƌŝĞƚǇ ŽĨ ƚŽƉŝĐƐ ĂŶĚ Ă ǁĞď ƌĞƐŽƵƌĐĞ ĐĞŶƚĞƌ ĨŽƌ ĂůŝĨŽƌŶŝĂ ƉŚǇƐŝĐŝĂŶƐ͕ ĐƵůŵŝŶĂƟŶŐ ǁŝƚŚ Ă ůŝǀĞ ƉĂŶĞů ƉƌĞƐĞŶƚĂƟŽŶ Ăƚ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ͕ DĂƌĐŚ ϮϬϭϵ͘ tĂƚĐŚ ǇŽƵƌ ŝŶďŽǆ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͘ And our thanks to the California Health Care &ŽƵŶĚĂƟŽŶ ĨŽƌ ŝƚƐ ƐƵƉƉŽƌƚ ŽĨ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ project. References 1.

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<ĂŝƐĞƌ &ĂŵŝůǇ &ŽƵŶĚĂƟŽŶ͘ ͞<ĞǇ ,ĞĂůƚŚ /ŵƉůŝĐĂƟŽŶƐ ŽĨ ^ĞƉĂƌĂƟŽŶ ŽĨ &ĂŵŝůŝĞƐ Ăƚ ƚŚĞ ŽƌĚĞƌ͟ ; ĐĐĞƐƐĞĚ EŽǀĞŵďĞƌ ϮϬϭϴͿ ŚƩƉƐ͗ͬͬǁǁǁ͘Ŭī͘ŽƌŐͬĚŝƐƉĂƌŝƟĞƐͲƉŽůŝĐǇͬ ĨĂĐƚͲƐŚĞĞƚͬŬĞǇͲŚĞĂůƚŚͲŝŵƉůŝĐĂƟŽŶƐͲŽĨͲ ƐĞƉĂƌĂƟŽŶͲŽĨͲĨĂŵŝůŝĞƐͲĂƚͲƚŚĞͲďŽƌĚĞƌͬ Ajay Chaudry, et al., Facing Our Future ŚŝůĚƌĞŶ ŝŶ ƚŚĞ ŌĞƌŵĂƚŚ ŽĨ /ŵŵŝŐƌĂƟŽŶ Enforcement, ;tĂƐŚŝŶŐƚŽŶ͕ ͗ dŚĞ hƌďĂŶ /ŶƐƟƚƵƚĞ͕ &ĞďƌƵĂƌǇ ϮϬϭϬͿ͕ ŚƩƉƐ͗ͬͬ ǁǁǁ͘ƵƌďĂŶ͘ŽƌŐͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬ ƉƵďůŝĐĂƟŽŶͬϮϴϯϯϭͬϰϭϮϬϮϬͲ&ĂĐŝŶŐͲKƵƌͲ Future.PDF Ibid Janet Cleveland, Cecile Rousseau, and Rachel Kronick, dŚĞ ŚĂƌŵĨƵů ĞīĞĐƚƐ ŽĨ ĚĞƚĞŶƟŽŶ ĂŶĚ ĨĂŵŝůǇ ƐĞƉĂƌĂƟŽŶ ŽŶ ĂƐǇůƵŵ seekers’ mental health in the context of Bill C-31, Ɖƌŝů ϮϬϭϮ͕ ŚƩƉƐ͗ͬͬĐƐƐƐĚĞůĂŵŽŶƚĂŐŶĞ͘ ƋĐ͘ĐĂͬĮůĞĂĚŵŝŶͬĐƐƐƐͺĚůŵͬWƵďůŝĐĂƟŽŶƐͬ WƵďůŝĐĂƟŽŶƐͺ Z&ͬďƌŝĞĨͺĐϯϭͺĮŶĂů͘ƉĚĨ͖ :ƵůŝĞ D͘ >ŝŶƚŽŶ͕ DĂƌƐŚĂ 'ƌŝĸŶ͕ ůĂŶ :͘ ^ŚĂƉŝƌŽ͕ and Council on Community Pediatrics, ͞ ĞƚĞŶƟŽŶ ŽĨ /ŵŵŝŐƌĂŶƚ ŚŝůĚƌĞŶ͕͟ WĞĚŝĂƚƌŝĐƐ͕ DĂƌĐŚ ϭϯ͕ ϮϬϭϳ͕͖ ŚƩƉ͗ͬͬ ƉĞĚŝĂƚƌŝĐƐ͘ĂĂƉƉƵďůŝĐĂƟŽŶƐ͘ŽƌŐͬĐŽŶƚĞŶƚͬ ĞĂƌůǇͬϮϬϭϳͬϬϯͬϬϵͬƉĞĚƐ͘ϮϬϭϳͲϬϰϴϯ͕ tĞŶĚǇ Cervantes, &ĂŵŝůǇ ĞƚĞŶƟŽŶ͗ dŚĞ ,ĂƌŵĨƵů Impact on Children, ;tĂƐŚŝŶŐƚŽŶ͕ ͗ &ŝƌƐƚ &ŽĐƵƐ͕ ĞĐĞŵďĞƌ ϴ͕ ϮϬϭϱͿ͕ ŚƩƉƐ͗ͬͬ ĮƌƐƞŽĐƵƐ͘ŽƌŐͬƌĞƐŽƵƌĐĞƐͬĨĂĐƚͲƐŚĞĞƚͬĨĂŵŝůǇͲ ĚĞƚĞŶƟŽŶͲƚŚĞͲŚĂƌŵĨƵůͲŝŵƉĂĐƚͲŽŶͲĐŚŝůĚƌĞŶ͘ Ibid :ƵůŝĞ D͘ >ŝŶƚŽŶ͕ DĂƌƐŚĂ 'ƌŝĸŶ͕ ůĂŶ :͘ Shapiro, and Council on Community WĞĚŝĂƚƌŝĐƐ͕ ͞ ĞƚĞŶƟŽŶ ŽĨ /ŵŵŝŐƌĂŶƚ Children,” Pediatrics, DĂƌĐŚ ϭϯ͕ ϮϬϭϳ͕ ŚƩƉ͗ͬͬƉĞĚŝĂƚƌŝĐƐ͘ĂĂƉƉƵďůŝĐĂƟŽŶƐ͘ŽƌŐͬ ĐŽŶƚĞŶƚͬĞĂƌůǇͬϮϬϭϳͬϬϯͬϬϵͬƉĞĚƐ͘ϮϬϭϳͲ Ϭϰϴϯ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬ ƐĞƉĂƌĂƟŽŶŽĨͲĨĂŵŝůŝĞƐ͘Śƚŵů California Family Physician Winter 2019

ABFM Offering a Longitudinal Pilot and Coming to CAFP to Answer Your Questions The American Board of Family Medicine (ABFM) has announced a ŶĞǁ ƉŝůŽƚ ƉƌŽŐƌĂŵ ĚĞƐŝŐŶĞĚ ƚŽ ĂƐƐĞƐƐ ƚŚĞ ǀĂůƵĞ ĂŶĚ ĨĞĂƐŝďŝůŝƚǇ ŽĨ Ă ůŽŶŐŝƚƵĚŝŶĂů ĂƐƐĞƐƐŵĞŶƚ ŽƉƟŽŶ ƚŽ ƚŚĞ ϭϬͲǇĞĂƌ ĞǆĂŵŝŶĂƟŽŶ͘ WŚǇƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ĐƵƌƌĞŶƚ ǁŝƚŚ ĐŽŶƟŶƵŽƵƐ ĐĞƌƟĮĐĂƟŽŶ ĂŶĚ ĚƵĞ ƚŽ ƚĂŬĞ ƚŚĞ ĞǆĂŵŝŶĂƟŽŶ ŝŶ ϮϬϭϵ ĂƌĞ ĞůŝŐŝďůĞ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ŶĞǁ ƉŝůŽƚ͘ dŚŝƐ ŶĞǁ ůŽŶŐŝƚƵĚŝŶĂů ƉĂƚŚǁĂǇ ŝƐ ďĂƐĞĚ ŽŶ ƚŚĞ ƉŽƉƵůĂƌ ŽŶƟŶƵŽƵƐ <ŶŽǁůĞĚŐĞ ^ĞůĨͲ ƐƐĞƐƐŵĞŶƚ ; <^ Ϳ ƉůĂƞŽƌŵ ĂŶĚ ĚĞůŝǀĞƌƐ Ϯϱ ŽŶůŝŶĞ ƋƵĞƐƟŽŶƐ ĞĂĐŚ ƋƵĂƌƚĞƌ͘ /ŶĐŽŵŝŶŐ &D WƌĞƐŝĚĞŶƚ ĂŶĚ K tĂƌƌĞŶ EĞǁƚŽŶ͕ D ŶŽƚĞĚ ƚŚĂƚ ƚŚĞ ƉŝůŽƚ ͙͞ ǁŝůů ƉƌŽǀŝĚĞ ƋƵĞƐƟŽŶƐ ŽŶ Ă ƌĞŐƵůĂƌ͕ ůŽŶŐŝƚƵĚŝŶĂů ďĂƐŝƐ͕ ŝŶ Ă ĨŽƌŵĂƚ ƚŚĂƚ ŝƐ ŵƵĐŚ ŵŽƌĞ ĐŽŶǀĞŶŝĞŶƚ͕ ͲͲ Ă ĨĞǁ ƋƵĞƐƟŽŶƐ Ăƚ Ă ƟŵĞ͕ ŝŶ ƚŚĞ ƉůĂĐĞ ĂŶĚ ƟŵĞ ŽĨ ǇŽƵƌ ĐŚŽŝĐĞ͘ zŽƵ ŵĂǇ ƵƐĞ ĐůŝŶŝĐĂů ƌĞĨĞƌĞŶĐĞƐ ĚƵƌŝŶŐ ƚŚĞ ĂƐƐĞƐƐŵĞŶƚ͕ ŵƵĐŚ ůŝŬĞ ǇŽƵ ĚŽ ŝŶ ƉƌĂĐƟĐĞ͘ zŽƵ ǁŝůů ŶŽƚ ŶĞĞĚ ƚŽ ƚƌĂǀĞů ƚŽ Ă ƚĞƐƚ ĐĞŶƚĞƌ͕ ŶŽƌ ƐƉĞŶĚ ĂĚĚŝƟŽŶĂů ƟŵĞ ĂŶĚ ŵŽŶĞǇ ŽŶ preparatory courses.” dŚĞ &W ŚĂƐ ďĞĞŶ ǁŽƌŬŝŶŐ ĐůŽƐĞůǇ ǁŝƚŚ ƚŚĞ &D ĂĚǀŽĐĂƟŶŐ ĨŽƌ DĂŝŶƚĞŶĞŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ ;DK Ϳ ŝŵƉƌŽǀĞŵĞŶƚƐ ƐŽƵŐŚƚ ďǇ ŝƚƐ member diplomates. Last year the AAFP assembled a task force to ƐƚƵĚǇ ƐĞǀĞƌĂů ŝƐƐƵĞƐ ĂŶĚ ƚŽ ĨŽƌŵƵůĂƚĞ ĂĐƟŽŶ ƉůĂŶƐ͘ &W͛Ɛ ŝŵŵĞĚŝĂƚĞ

California Family Physician Winter 2019

past president Michelle Quiogue served on the task force. Dr. Quiogue ĂŶĚ &W ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ^ƚĞǀĞ 'ƌĞĞŶ ĂůƐŽ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ ƚŚĞ &D͛Ɛ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ƐĞƐƐŝŽŶ ůĂƐƚ ƐƵŵŵĞƌ͘ &W ĞƉƵƚǇ sW ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ ĂůƐŽ ƐĞƌǀĞƐ ŽŶ Ă ĐŚĂƉƚĞƌ ĂĚǀŝƐŽƌǇ ĐŽŵŵŝƩĞĞ ƚŽ ƚŚĞ &D͘ ƌ͘ EĞǁƚŽŶ ŚĂƐ ĂĐĐĞƉƚĞĚ ŽƵƌ ŝŶǀŝƚĂƟŽŶ ƚŽ ĂƩĞŶĚ &W͛Ɛ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ůŝŶŝĐĂů &ŽƌƵŵ͕ DĂƌĐŚ ϮϵͲϯϭ͕ ŝŶ DŽŶƚĞƌĞǇ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ĂƩĞŶĚŝŶŐ ƚŚĞ ŵĞĞƟŶŐ ĂŶĚ ŵĞĞƟŶŐ ǁŝƚŚ ŵĞŵďĞƌƐ͕ ŚĞ ǁŝůů ŚŽƐƚ ŽŶĞ ŽĨ ƚŚĞ ^ƵŶĚĂǇ ŵŽƌŶŝŶŐ ƚĂďůĞ ƚĂůŬƐ ŽŶ ƚŚĞ ŶĞǁ ůŽŶŐŝƚƵĚŝŶĂů ƉƌŽŐƌĂŵ ĂŶĚ ĂŶƐǁĞƌŝŶŐ ǇŽƵƌ DK ƋƵĞƐƟŽŶƐ͘ WŚǇƐŝĐŝĂŶƐ ŵĂǇ ŽƉƚ ŝŶ ƚŽ ƚŚĞ &D &ĂŵŝůǇ DĞĚŝĐŝŶĞ ĞƌƟĮĐĂƟŽŶ >ŽŶŐŝƚƵĚŝŶĂů ƐƐĞƐƐŵĞŶƚ ;&D > Ϳ ƉŝůŽƚ ƐƚĂƌƟŶŐ ĞĐĞŵďĞƌ ϳ͕ ϮϬϭϴ͘ ƉƉůŝĐĂƟŽŶƐ ŵƵƐƚ ďĞ ĐŽŵƉůĞƚĞĚ ďǇ :ĂŶƵĂƌǇ ϯ͕ ϮϬϭϵ͕ ƚŽ ŚĂǀĞ ƚŚĞ ŵĂǆŝŵƵŵ ĂŵŽƵŶƚ ŽĨ ƟŵĞ ƚŽ ĂŶƐǁĞƌ ĮƌƐƚ ƋƵĂƌƚĞƌ ƋƵĞƐƟŽŶƐ͘ dŚĞ ůĂƐƚ ĚĂǇ ƚŽ ĂƉƉůǇ ĨŽƌ ƚŚĞ ƉŝůŽƚ ŝƐ DĂƌĐŚ ϭ͕ ϮϬϭϵ͘ ŚĞĐŬ ǇŽƵƌ ĞůŝŐŝďŝůŝƚǇ͘ &Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ƚŚĞ ƉŝůŽƚ ƉƌŽŐƌĂŵ͕ ĐŚĞĐŬ ƚŚĞƐĞ ƚǁŽ ƌĞƐŽƵƌĐĞƐ͗ &W͗ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĐŵĞͬĨŵĐůĂ͘Śƚŵů &D͗ ŚƩƉƐ͗ͬͬǁǁǁ͘ƚŚĞĂďĨŵ͘ŽƌŐͬŵŽĐͬĨŵĐůĂ͘ĂƐƉǆ &Žƌ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ƚŚĞ &ŽƌƵŵ͗ ŚƩƉ͗ͬͬǁǁǁ͘ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͬ&D&ŽƌƵŵ

F M Wo r k f o rc e

25 x 2030: New Workforce Efforts Launched Late last summer, the American Academy of Family Physicians ĂŶĚ ƐĞǀĞŶ ŽƚŚĞƌ ŶĂƟŽŶĂů ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ŬŝĐŬĞĚ Žī Ă ĐŽůůĂďŽƌĂƟǀĞ ƚŽ ƚĂŬĞ ďŽůĚ ƐƚĞƉƐ ƚŽ ŝŶĐƌĞĂƐĞ ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ dŚĞ ŐŽĂů͗ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ h^ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŵĂƚĐŚ ŝŶƚŽ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ďǇ ƚŚĞ ǇĞĂƌ ϮϬϯϬ ;͞Ϯϱ ǆ ϮϬϯϬ͟Ϳ͕ ĞƐƐĞŶƟĂůůǇ ĚŽƵďůŝŶŐ ƚŚĞ ƌĂƚĞ ŽĨ h^ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĞŶƚĞƌŝŶŐ family medicine from the current rate. &ĂŵŝůǇ ŵĞĚŝĐŝŶĞ ďĞŐĂŶ ĂƐ Ă ƌĞǀŽůƵƟŽŶĂƌǇ ŵŽǀĞŵĞŶƚ ŝŶ ƚŚĞ ϭϵϲϬƐ ĂŶĚ ƉƌĞĐĞĚĞĚ Ă ƉĞƌŝŽĚ ŽĨ ƌĂƉŝĚ ŐƌŽǁƚŚ ĂŶĚ ĞǆƉĂŶƐŝŽŶ for the specialty. ŌĞƌ Ă ĚŽǁŶƚƵƌŶ beginning in the ϭϵϵϬƐ ǁŝƚŚ ĨĞǁĞƌ US medical students pursuing family medicine careers and, residency ƉŽƐŝƟŽŶƐ͕ ĚǁŝŶĚůŝŶŐ family medicine has regained ƚƌĂĐƟŽŶ ǁŝƚŚ Ă decade of steady Ͷ ďƵƚ ŝŶƐƵĸĐŝĞŶƚ Ͷ ŐƌŽǁƚŚ͘

WƌŽĐĞƐƐ ŽĨ DĞĚŝĐĂů ĚƵĐĂƟŽŶ͕ WƌĂĐƟĐĞ dƌĂŶƐĨŽƌŵĂƟŽŶ͕ WĂǇŵĞŶƚ ZĞĨŽƌŵ ĂŶĚ ƚŚĞ ƌĂŶĚ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͘ KŶĞ ŽĨ ƚŚĞ ĮƌƐƚ ƉƌŽũĞĐƚƐ ŽĨ ƚŚĞ ĐŽůůĂďŽƌĂƟǀĞ ǁŝůů ďĞ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ƚŽ ƐƵƉƉŽƌƚ Ă ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ ůĞĂƌŶŝŶŐ ĂŶĚ ĂĐƟŽŶ ŶĞƚǁŽƌŬ ĨŽƌ departments of family medicine to leverage the concepts of ƉŽƐŝƟǀĞ ĚĞǀŝĂŶĐĞ͕ ĚĂƚĂ ƚŽ ŝŶĨŽƌŵ ĂŶĚ ŐƵŝĚĞ ŝŵƉƌŽǀĞŵĞŶƚ͕ ĂŶĚ ĐƌĞĂƚĞ Ă ďŝĂƐ ƚŽǁĂƌĚ ĂĐƟŽŶ͘ Ŷ ĂĚĚŝƟŽŶĂů ĞĂƌůǇ ƉƌŽũĞĐƚ ǁŝůů ďĞ ĚĞǀĞůŽƉŝŶŐ ĂŶĚ ƉƌŽŵŽƟŶŐ ƚŚĞ ďƌĂŶĚ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ƚŽ ƉŽƚĞŶƟĂů ͞ƉŝƉĞůŝŶĞ͟ ƐƚƵĚĞŶƚƐ͘ ZŝŐŚƚ ŶŽǁ͕ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŵĂƚĐŚ ĮŐƵƌĞ ƐƚĂŶĚƐ Ăƚ ĂďŽƵƚ ϭϮ ƉĞƌĐĞŶƚ͕ said Clif Knight, MD, the AAFP’s senior vice president for ĞĚƵĐĂƟŽŶ͘ ͞tĞ ǁĂŶƚ ƚŽ ŵŽƌĞ ƚŚĂŶ double that,” he ƐĂŝĚ Ăƚ ƚŚĞ ŬŝĐŬͲŽī ƚŚŝƐ ƐƵŵŵĞƌ͘ ͞dŚŝƐ is an opportunity to ƉĂƌƚŶĞƌ ǁŝƚŚ ŽƚŚĞƌ family medicine ŽƌŐĂŶŝǌĂƟŽŶƐ ƚŽ tackle a goal set together during the Family Medicine for America’s Health (FMAHealth) project,” said Dr. Knight.

The eight family medicine ŽƌŐĂŶŝǌĂƟŽŶƐ͕ though they have unique missions, all share the vision ůŝĨ <ŶŝŐŚƚ͕ DW͕ &W ^ĞŶŝŽƌ sW ĨŽƌ ĚƵĐĂƚŝŽŶ͕ ŬŝĐŬƐ ŽĨĨ ƚŚĞ Ϯϱ ǆ ϮϬϯϬ /ŶŝƚŝĂƚŝǀĞ͘ ŽĨ Ă ĐŽƵŶƚƌǇ ǁŝƚŚ the robust family ŵĞĚŝĐŝŶĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ƚŽ ƉƌŽǀŝĚĞ ĂĐĐĞƐƐŝďůĞ͕ ƋƵĂůŝƚǇ͕ dŚĞ &W ǁŝůů ƐĞƌǀĞ ĂƐ ƚŚĞ ďĂĐŬďŽŶĞ ŽƌŐĂŶŝǌĂƟŽŶ ĨŽƌ ƚŚĞ ĂīŽƌĚĂďůĞ͕ ĂŶĚ ŝŶĐůƵƐŝǀĞ ĐĂƌĞ ĨŽƌ Ăůů͘ tŝƚŚ Ă ƉƌŽũĞĐƚĞĚ ƉƌŝŵĂƌǇ ĐŽůůĂďŽƌĂƟǀĞ ĂŶĚ ŚĂƐ ĨŽƌŵĞĚ Ă ƐƚĞĞƌŝŶŐ ĐŽŵŵŝƩĞĞ ǁŝƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƐŚŽƌƚĂŐĞ ŽĨ ϱϮ͕ϬϬϬ ďǇ ϮϬϮϱ ĂŶĚ ĚĞĐĂĚĞƐ ŽĨ ŵĞŵďĞƌƐ ŝŶǀŝƚĞĚ ĨƌŽŵ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͕ ŵĞƌŝĐĂŶ ŽĂƌĚ ƉƌŽŵŝƐŝŶŐ͕ ǇĞƚ ŽŌĞŶ ƵŶĐŽŽƌĚŝŶĂƚĞĚ͕ ĞīŽƌƚƐ ƚŽ ŝŶĐƌĞĂƐĞ ƐƚƵĚĞŶƚ of Family Medicine, American College of Osteopathic Family ĐŚŽŝĐĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ďǇ ĞĂĐŚ ŽĨ ƚŚĞ ŽƌŐĂŶŝǌĂƟŽŶƐ͕ ƚŚĞ ƟŵĞ WŚǇƐŝĐŝĂŶƐ͕ ƐƐŽĐŝĂƟŽŶ ŽĨ ĞƉĂƌƚŵĞŶƚƐ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͕ ŝƐ ŶŽǁ ƚŽ ƚĂŬĞ Ă ƌĂĚŝĐĂůůǇ ŶĞǁ͕ ƚƌƵůǇ ĐŽůůĞĐƟǀĞ ĂƉƉƌŽĂĐŚ ƚŽ ƚŚŝƐ ƐƐŽĐŝĂƟŽŶ ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐǇ ŝƌĞĐƚŽƌƐ͕ EŽƌƚŚ ůĂƐƟŶŐ ĐŚĂůůĞŶŐĞ͘ American Primary Care Research Group and Society of Teachers ŽĨ &ĂŵŝůǇ DĞĚŝĐŝŶĞ͘ &W ŝƐ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ǁŽƌŬŝŶŐ dŚĞ ĞŝŐŚƚͲŵĞŵďĞƌ ĐŽůůĂďŽƌĂƟǀĞ ŬŝĐŬŽī ŐĞŶĞƌĂƚĞĚ ŝĚĞĂƐ ĨŽƌ ǁŝƚŚ ƚŚĞ ĐŽůůĂďŽƌĂƟǀĞ ŽŶ ƚŚŝƐ ŶĞǁ ŝŶŝƟĂƟǀĞ ʹ ǁĂƚĐŚ ŚĞƌĞ ĨŽƌ ĞīŽƌƚƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŬĞǇ ĚƌŝǀĞƌƐ ŽĨ ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ͗ WŝƉĞůŝŶĞ͕ more details.

California Family Physician Winter 2019

Robert Assibey, MD Co-Chair, CAFP President Council

F M Wo r k f o rc e

I Believe We Must Come Out of the Shadows / ǁĂƐ Ă ďŝƚ ůĂƚĞ ƚƵƌŶŝŶŐ ŵǇ ĂƌƟĐůĞ ŝŶ ƚŽ ƚŚĞ ĞĚŝƚŽƌƐ͘ ŶĚ / ƐĞŶƚ ŝƚ ŝŶ ĂŌĞƌ ƐĞǀĞƌĂů ƐŚŝŌƐ ǁŽƌŬŝŶŐ ŝŶ ƚŚĞ / h ͘͘͘ Ă ƚƌƵĞ ƌĞŇĞĐƟŽŶ ŽĨ ƚŚĞ ďƌĞĂĚƚŚ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚǇ͘ I chose family medicine because it closely aligns ǁŝƚŚ ŵǇ ĚĞƐŝƌĞƐ ĂŶĚ ƉĂƐƐŝŽŶ͘ ĞƐŝƌĞƐ ĂŶĚ ƉĂƐƐŝŽŶƐ ŶŽƚ ŽŶůǇ ƚŽ ƚƌĞĂƚ ƉĂƟĞŶƚƐ͕ ďƵƚ ƚŽ ĂůƐŽ ĐŽŶŶĞĐƚ ǁŝƚŚ ƚŚĞŵ͘ / ŚĂĚ ƚŚĂƚ ĐůŝĐŚĠ ŵĞŶƚĂůŝƚǇ ŽĨ ǁĂŶƟŶŐ ƚŽ ŵĂŬĞ Ă ĚŝīĞƌĞŶĐĞ͘ /ƚ ǁĂƐŶ͛ƚ ƵŶƟů / ũŽŝŶĞĚ &W ƚŚĂƚ / ƌĞĂůŝǌĞĚ ŚŽǁ / ĐŽƵůĚ ƚƌƵůǇ ŵĂŬĞ ƚŚĂƚ ĚŝīĞƌĞŶĐĞ͘ EŽƚ ũƵƐƚ ŝŶ ŵǇ ŽǁŶ ĐůŝŶŝĐ͕ ďƵƚ ŵŽƌĞ ŐůŽďĂůůǇ͕ ĨŽƌ the specialty of family medicine. Being involved ŝŶ ǀĂƌŝŽƵƐ ƌĞƐŽůƵƟŽŶƐ ƚŚĂƚ ĐŽŵĞ ďĞĨŽƌĞ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ͕ ƌĞƐŽůƵƟŽŶƐ ĨŽƌ ƉŽůŝĐŝĞƐ that are changing the shape of health care in California and America, has been enlightening. /Ŷ ƚŚŝƐ ĐŚĂŶŐŝŶŐ ƉŽůŝƟĐĂů ĐůŝŵĂƚĞ͕ / ŚĂǀĞ ĂůƐŽ ƐĞĞŶ ǇŽƵŶŐ ŝŶĚŝǀŝĚƵĂůƐ ƌĂůůǇ ƚŽŐĞƚŚĞƌ ƚŽǁĂƌĚ Ă ƵŶŝĮĞĚ ĐĂƵƐĞ͘ dŚĞ ƌĂůůǇŝŶŐ ůĞĂǀĞƐ ŵĞ ǁŝƚŚ ŚŽƉĞ ĨŽƌ ĨƵƚƵƌĞ ŐĞŶĞƌĂƟŽŶ ŽĨ ǇŽƵŶŐ ƉŚǇƐŝĐŝĂŶƐ͘ / ďĞůŝĞǀĞ ƚŚĞǇ ǁŝůů ŶŽƚ ďĞ ĐŽŶƚĞŶƚ ƚŽ ũƵƐƚ Ɛŝƚ ďĂĐŬ ŝŶ ƚŚĞ ƐŚĂĚŽǁƐ ĂŶĚ ĂĐĐĞƉƚ ƚŚĞ ǁĂǇƐ ƚŚŝŶŐƐ ŚĂǀĞ ĂůǁĂǇƐ ďĞĞŶ ĚŽŶĞ Žƌ ŶŽƚ ĂĚǀŽĐĂƚĞ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽůůĞĂŐƵĞƐ͘ tĞ ŚĂǀĞ ƚŚĞ ĂďŝůŝƚǇ ƚŽ ĂīĞĐƚ ŵĂŶǇ ůŝǀĞƐ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ďƵƚ ŵĂŶǇ ƉĞŽƉůĞ ĂƌĞ ƵŶĂǁĂƌĞ ŽĨ ŽƵƌ ŝŶŇƵĞŶĐĞ͘ /Ŷ ƚŚĞ ĞƌĂ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ͕ ǁĞ ŚĂǀĞ ƚŚĞ resources to bring to light the various things that ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƵŶĚĞƌƚĂŬĞ͘ ŶĚ / ƐĞĞ Ă ŐƌŽǁŝŶŐ ŝŶƚĞƌĞƐƚ ŝŶ ƚŚĞ ĮĞůĚ͘ KƵƌ ƐƚĂƚĞ ĐŽŶƟŶƵĞƐ ƚŽ ŚĂǀĞ Ă ŐƌĞĂƚ ŶĞĞĚ ĨŽƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ͕ ĂŶĚ ǁĞ͕ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŶŽƚ ŽŶůǇ Įůů ƚŚĞ ŶĞĞĚ͕ ďƵƚ ĂƌĞ ĂůƐŽ Ăƚ ƚŚĞ ĨŽƌĞĨƌŽŶƚ ŽĨ ŵĞĚŝĐŝŶĞ͘ / Ăŵ ĂƉƉƌĞĐŝĂƟǀĞ ŽĨ the opportunity I had to become a family physician. Being a family physician has given me the venue to ŚĂǀĞ Ă ůĞŐŝƐůĂƟǀĞ ǀŽŝĐĞ ŝŶ ƚŚĞ ƌĞĂůŵ ŽĨ ĂĚǀŽĐĂĐǇ͘ dŚƌŽƵŐŚ ŽƵƌ ǀĂƌŝŽƵƐ ǁŽƌŬ ĂŶĚ ƉƌŽũĞĐƚƐ͕ / ĨŽƌĞƐĞĞ ƚŚĞ ƐŚŝŌ ƚŽǁĂƌĚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝŶĐƌĞĂƐŝŶŐ͕ ĂŶĚ / ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƐĞĞŝŶŐ ƚŚĞ ŐƌĞĂƚ ƚŚŝŶŐƐ ǁĞ ǁŝůů accomplish. ƌ͘ ƐƐŝďĞǇ ŝƐ Ă ƌĞƐŝĚĞŶƚ Ăƚ ^ĂŶ :ŽĂƋƵŝŶ &DZW͘ 20

California Family Physician Winter 2019

Robert Assibey, MD Co-Chair, CAFP President Council

F M Wo r k f o rc e

Zachary Nicholas Co-chair CAFP Student Committee

Family Medicine Must Create a New Environment of Inclusivity &ĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŚĂƐ ƉůĂǇĞĚ Ă ǀŝƚĂů ƌŽůĞ ŝŶ ƚŚĞ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ŽĨ ŵĞĚŝĐŝŶĞ ŝŶƚŽ Ă ĮĞůĚ ƚŚĂƚ ƉƌŝŽƌŝƟǌĞƐ ĂŶĚ ƚƌƵůǇ ǀĂůƵĞƐ ĚŝǀĞƌƐŝƚǇ ĂŶĚ ƌĞƉƌĞƐĞŶƚĂƟŽŶ͘ / Ăŵ ƉƌŽƵĚ ƚŽ ƐƚĂŶĚ ǁŝƚŚ ŽƚŚĞƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ĚĞĚŝĐĂƚĞĚ ƚŽ ƐĞƌǀŝŶŐ ƉĂƟĞŶƚƐ ĂŶĚ ĞĚƵĐĂƟŶŐ ƚŚĞ ŶĞǆƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ŚĂŝů ĨƌŽŵ ĂŶĚ ƐĞƌǀĞ ƚŚĞ ŐƌĞĂƚĞƐƚ ŶĞĞĚ ĐŽŵŵƵŶŝƟĞƐ͘ ŽůůĞĐƟǀĞůǇ͕ ǁĞ ĂƌĞ ǁŽƌŬŝŶŐ ƚŽ ĚŝƐŵĂŶƚůĞ ƚŚĞ ƵŶƐĂǀŽƌǇ ĂƐƉĞĐƚƐ ŽĨ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͛Ɛ ŚŝƐƚŽƌǇ ĂŶĚ ĐƌĞĂƚĞ Ă ŶĞǁ ĞŶǀŝƌŽŶŵĞŶƚ ďƵŝůƚ ŽŶ ŵƵƚƵĂů ƌĞƐƉĞĐƚ ĂŶĚ ŝŶĐůƵƐŝǀŝƚǇ͘ dŽ ĂĐĐŽŵƉůŝƐŚ ƚŚŝƐ͕ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŵƵƐƚ ƌĞǀŽůƵƟŽŶŝǌĞ ĞĂƌůǇ ĂĐĐĞƐƐ ƚŽ ĐůŝŶŝĐĂů ĞǆƉŽƐƵƌĞ ĂŶĚ ŽƚŚĞƌ ĞǆƉĞƌŝĞŶĐĞƐ ǁŚŝůĞ ĞǆƉĂŶĚŝŶŐ ĚŝǀĞƌƐŝƚǇ ŝŶŝƟĂƟǀĞƐ ĂŶĚ ƉĂƚŚǁĂǇƐ ĨŽƌ ƉŽƚĞŶƟĂů ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͘ dŚŽƵŐŚ ƚŚĞ h^ ƉŽƉƵůĂƟŽŶ ĐŽŶƟŶƵĞƐ ƚŽ ƚƌĂŶƐĨŽƌŵ ĂŶĚ ĂŐĞ͕ ŵĞĚŝĐĂů professions have remained historically inept at recognizing and addressing professional, socioeconomic and racial-ethnic diversity. Family ŵĞĚŝĐŝŶĞ ŵƵƐƚ ĐŽŶƟŶƵĞ ĂƐ ƚŚĞ ǀŽŝĐĞ ŽĨ ƚŚŝƐ ĨƵƚƵƌĞ ĂŶĚ ǁŽƌŬ ƟƌĞůĞƐƐůǇ ƚŽ ƌĞĂůŝǌĞ ŝƚ ŝŶ ŵǇ ůŝĨĞƟŵĞ Žƌ͕ ŝĚĞĂůůǇ͕ ƐŽŽŶĞƌ͘

ĮǀĞ ƉŚǇƐŝĐŝĂŶƐ͘ Ɛ ŽĨ ϮϬϬϴ͕ ϳϱ ƉĞƌĐĞŶƚ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ǁĞƌĞ ǁŚŝƚĞ͘ KŶůǇ ŝŶ ϭϵϳϯ ĚŝĚ ƚŚĞ ŵĞƌŝĐĂŶ WƐǇĐŚŝĂƚƌŝĐ ƐƐŽĐŝĂƟŽŶ ƌĞŵŽǀĞ ŚŽŵŽƐĞǆƵĂůŝƚǇ ĂƐ a mental disorder, having had a horrendous impact on LGBTQ physicians ĂŶĚ ƚŚĞŝƌ ƋƵĂůŝƚǇ ŽĨ ůŝĨĞ Žƌ ƉƌĂĐƟĐĞ ŽƉƟŽŶƐ ƚŚĂƚ ƉĞƌƐŝƐƚƐ ƚŽ ƚŚŝƐ ĚĂǇ͘ ZĞĐĞŶƚůǇ͕ ŵĂŶǇ ŝŶŝƟĂƟǀĞƐ ǁĞƌĞ ŝŵƉůĞŵĞŶƚĞĚ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŚŝƐƚŽƌŝĐ ůĂĐŬ ŽĨ ĚŝǀĞƌƐŝƚǇ ŝŶ ŵĞĚŝĐŝŶĞ ǁŝƚŚ ŵŽĚĞƌĂƚĞ ƐƵĐĐĞƐƐ͘ ^ƵĐŚ ƐƵĐĐĞƐƐ ŝƌŽŶŝĐĂůůǇ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ĂďƐƵƌĚ ůĞǀĞůƐ ŽĨ ŵŝƐƌĞƉƌĞƐĞŶƚĂƟŽŶ ĂŶĚ ƚŚĞ ĚŝƌĞ ŶĞĞĚ ĨŽƌ ŐƌĞĂƚĞƌ ĂĐƟŽŶ͘ Ɛ ĂĸƌŵĂƟǀĞ ĂĐƟŽŶ ĂŶĚ ƌĞůĂƚĞĚ ƉŽůŝĐŝĞƐ ĐŽŶƟŶƵĞ ƚŽ ďĞ ĐŚŝƉƉĞĚ ĂǁĂǇ͕ ŝƚ ŝƐ ǀŝƚĂů ƚŚĂƚ ƉŚǇƐŝĐŝĂŶƐ ůŝƐƚĞŶ ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ƚŚĂƚ ƌĞĐŽŐŶŝǌĞ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ǀĂůƵĞ ŽĨ ƐĞĞŝŶŐ ƚŚĞŵƐĞůǀĞƐ ŝŶ ƚŚĞŝƌ ŚĞĂůƚŚ ĐĂƌĞ ĞǆƉĞƌŝĞŶĐĞ͘ ^ƵĐŚ ĐŚĂŶŐĞ ŶĞĐĞƐƐŝƚĂƚĞƐ ƉĞƌƐŽŶĂů ĂŶĚ ĐŽŵŵƵŶĂů ƐĂĐƌŝĮĐĞ ƚŚĂƚ ǁŝůů ƵůƟŵĂƚĞůǇ ďĞ ƌĞǁĂƌĚĞĚ ǁŝƚŚ Ă ŵŽƌĞ ũƵƐƚ ĂŶĚ ĞīĞĐƟǀĞ ƉŚǇƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ͕ ůĞĚ ďǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ Dƌ͘ EŝĐŚŽůĂƐ ŝƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ ĂůŝĨŽƌŶŝĂ EŽƌƚŚ ^ƚĂƚĞ hŶŝǀĞƌƐŝƚǇ͘

tŝƚŚŽƵƚ ĨĂŵŝůŝĂů Žƌ ŝŶƚĞƌƉĞƌƐŽŶĂů ĐŽŶŶĞĐƟŽŶƐ ƚŽ clinicians, students from non-physician families ĂŶĚ ƵŶĚĞƌͲƌĞƐŽƵƌĐĞĚ ĐŽŵŵƵŶŝƟĞƐ ƐƚƌƵŐŐůĞ ƚŽ ĮŶĚ physicians and health systems that encourage, let alone permit, the presence of aspiring medical students. As a result, students may be discouraged from pursuing medicine or have their ĚĞĚŝĐĂƟŽŶ ĂŶĚ ŝŶƚĞƌĞƐƚƐ ƋƵĞƐƟŽŶĞĚ ĚƵƌŝŶŐ ƚŚĞ ĂƉƉůŝĐĂƟŽŶ ƉƌŽĐĞƐƐ͘ Ǉ ƌĞĐŽŐŶŝǌŝŶŐ ƚŚĞ ĞŶƟƌĞƚǇ of the individual and the role of environmental ĨĂĐƚŽƌƐ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉŚǇƐŝĐŝĂŶƐ ŬŶŽǁ ƚŚĞ ǀĂůƵĞ ŽĨ ƉƌŽǀŝĚŝŶŐ ƚŚĞƐĞ ĚĞĚŝĐĂƚĞĚ ƐƚƵĚĞŶƚƐ ǁŝƚŚ ŽƉƉŽƌƚƵŶŝƟĞƐ ĂŶĚ ŝŶƐŝŐŚƚ ŶŽƚ ĂīŽƌĚĞĚ ďǇ ĨĂŵŝůǇ Žƌ ƉƌŽĨĞƐƐŝŽŶĂů ďŽŶĚƐ͘ Ǉ ƐĞĞŬŝŶŐ ŝŶƐƟƚƵƟŽŶĂů ĐŚĂŶŐĞƐ ƚŽ ĂīŽƌĚ ƉƌŽƚĞĐƟŽŶ ƚŽ ƉƌĞͲŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ǁŚŝůĞ ƐŚĂĚŽǁŝŶŐ Žƌ ǀŽůƵŶƚĞĞƌŝŶŐ͕ ĞĚƵĐĂƟŶŐ ƉĂƟĞŶƚƐ ŽŶ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƉŚǇƐŝĐŝĂŶ ƚƌĂŝŶŝŶŐ ǁŚĞŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ƐƚƵĚĞŶƚƐ͕ ĂŶĚ ƐĞƌǀŝŶŐ ĂƐ ĂŶ ĂĚǀŽĐĂƚĞ ƚŽ ŽƚŚĞƌ ƉŚǇƐŝĐŝĂŶƐ͕ ƐƉĞĐŝĂůƟĞƐ͕ Žƌ ŝŶƐƟƚƵƟŽŶƐ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉŚǇƐŝĐŝĂŶƐ ƉůĂǇ ĂŶ ĂĐƟǀĞ ƌŽůĞ ŝŶ ƐƵƉƉŽƌƟŶŐ ƐƚƵĚĞŶƚƐ ǁŚŽ ůĂĐŬ ƚŚĞ ŵĞŶƚŽƌƐŚŝƉ͕ ƌĞƐŽƵƌĐĞƐ Žƌ ƟŵĞ ƚŽ ďĞ ĐŽŵƉĞƟƟǀĞ applicants. dŚŝƐ ŝƐƐƵĞ ĞǆƚĞŶĚƐ ŝŶƚŽ ŽƚŚĞƌ ĂƐƉĞĐƚƐ ŽĨ ƐŽĐŝĞƚĂů inequality that discriminate, overtly or subtly, on racial, ethnic and socioeconomic bases. Thirty ǇĞĂƌƐ ĂŐŽ͕ ǁŽŵĞŶ ĐŽŵƉƌŝƐĞĚ ĨĞǁĞƌ ƚŚĂŶ ŽŶĞͲŝŶͲ California Family Physician Winter 2019

Cynthia Chen-Joea, DO, MPH, CPH Co-chair, CAFP Resident Council

F M Wo r k f o rc e

“There is no medicine ůŝŬĞ ŚŽƉĞ͕ ŶŽ ŝŶĐĞŶƟǀĞ so great, and no tonic so ƉŽǁĞƌĨƵů ĂƐ ĞǆƉĞĐƚĂƟŽŶ of something tomorrow.” ʹ KƌŝƐŽŶ ^ǁĞƩ DĂƌĚĞŶ

Future of Family Medicine is a Calling

Throughout the years, family medicine has evolved into something ŵŽƌĞ ƚŚĂŶ ũƵƐƚ ƐĐŝĞŶĐĞ ĂŶĚ ŵĞĚŝĐŝŶĞ͘ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ Įůů ĞǀĞƌǇ ŶŝĐŚĞ ĨƌŽŵ ƐŵĂůů ƚŽǁŶƐ͕ ƚŽ ƌƵƌĂů ƐĞƫŶŐƐ͕ ƚŽ ůĂƌŐĞ ƵƌďĂŶ ĐŝƟĞƐ͘ tĞ ĂƌĞ ĂďůĞ ƚŽ ƐĞĞ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ ŚŽƐƉŝƚĂů͕ ƌĞŵŽǀĞ Ă ůĂƌŐĞ ƐĞďĂĐĞŽƵƐ ĐǇƐƚ ŽŶ ƚŚĞ ďĂĐŬ ƌŝŐŚƚ ĂŌĞƌ ĚĞůŝǀĞƌŝŶŐ ďƌĂŶĚ ŶĞǁ ůŝĨĞ ŝŶƚŽ ƚŚĞ ǁŽƌůĚ͘ tŝƚŚ ƐƵĐŚ Ă ďƌŽĂĚ ƐƉĞĐƚƌƵŵ ŽĨ ƉŽƐƐŝďŝůŝƟĞƐ͕ ĨĞǁ ƉĞŽƉůĞ ƌĞĂůŝǌĞ ƚŚĞ ĚĞƉƚŚ ŽĨ ǁŚĂƚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ĂďůĞ ƚŽ ĂĐĐŽŵƉůŝƐŚ ĂŶĚ ƉƌŽǀŝĚĞ͘ dŽ ĨƵƌƚŚĞƌ ƚŚĞ ĐŽŶĨƵƐŝŽŶ͕ ĨĂŵŝůǇ ĚŽĐƚŽƌƐ ŽŌĞŶ ƚĂŬĞ ŽŶ ŵƵůƟƉůĞ ƌŽůĞƐ ŽĨ ƉŽůŝĐǇ advocate, public health professional and community leader. Without ĐůĞĂƌ ŐƵŝĚĞůŝŶĞƐ ĂŶĚ ĚĞĮŶŝƟŽŶƐ͕ ĨĞǁ ƉĞŽƉůĞ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ǀĂůƵĞ ĂŶĚ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚŝƐ ƉƌŽĨĞƐƐŝŽŶ͘ ŽŶƐĞƋƵĞŶƚůǇ͕ ĨĞǁĞƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂƌĞ ĐŚŽŽƐŝŶŐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂƐ Ă ĐĂƌĞĞƌ͕ ƚŚƵƐ ůĞĂĚŝŶŐ ƚŽ ŽƵƌ ĐƵƌƌĞŶƚ ĚĞĮĐŝƚ of primary care providers in the United States. During my short three years of residency, I have come to love the diverse ƉĂƟĞŶƚ ƉŽƉƵůĂƟŽŶ ĂŶĚ ĂƐƐŽƌƚŵĞŶƚ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ĐŚĂůůĞŶŐĞƐ ƚŚĂƚ ĂƌĞ ĨĂĐĞĚ ĚĂŝůǇ ǁŝƚŚŽƵƚ ĞǀĞƌ Ă ĚƵůů ŵŽŵĞŶƚ͘ DŽƌĞ ƚŚĂŶ ƚŚĂƚ͕ ƌĞƐŝĚĞŶĐǇ ƌĞǀĞĂůĞĚ ŵǇ ƚƌƵĞ ĐĂůůŝŶŐ ǁŝƚŚŝŶ ŵĞĚŝĐŝŶĞ ʹ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ŝŶƐƉŝƌŝŶŐ Ă ŶĞǁ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ͘ dŚŝƐ ĐŽŵĞƐ ĚƵƌŝŶŐ Ă ƉĞƌŝůŽƵƐ ƟŵĞ ǁŚĞŶ ŵĞĚŝĐŝŶĞ ĂŶĚ ƚŚĞ ƌŽůĞ ŽĨ Ă ĨĂŵŝůǇ ĚŽĐƚŽƌ ĂƌĞ ƋƵŝĐŬůǇ ĐŚĂŶŐŝŶŐ͘ / Ăŵ ƉĂƌƚ ŽĨ Ă ŐĞŶĞƌĂƟŽŶ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ďƌŝĚŐĞĚ ƉĂƉĞƌ ƌĞĐŽƌĚƐ ĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ǁŝƚŚ ,Z ĂƐ Ă ƌĞƐŝĚĞŶƚ͘ >ĂƌŐĞ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵƐ ŶŽǁ ŵŽŶŝƚŽƌ ŚŽǁ ƉŚǇƐŝĐŝĂŶƐ ƉƌĂĐƟĐĞ ǁŝƚŚ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ZĞůĂƟǀĞ sĂůƵĞ hŶŝƚƐ ;ZshͿ͕ ǁŝƚŚ ƚŚĞ ƵůƟŵĂƚĞ ŐŽĂů ŽĨ ƉƌŽǀŝĚŝŶŐ ƚŚĞ ŵŽƐƚ ĞĸĐŝĞŶƚ ĂŶĚ ĐŽƐƚ ĞīĞĐƟǀĞ ŵĞĚŝĐĂů ĐĂƌĞ͘ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŝƚŚŝŶ Ă ϭϱͲŵŝŶƵƚĞ ǀŝƐŝƚ͕ ŵƵƐƚ ĞůŝĐŝƚ Ă ĐŚŝĞĨ ĐŽŵƉůĂŝŶƚ͕ ŐĂƚŚĞƌ ĚĂƚĂ ŽŶ ƉĂƟĞŶƚ ƐǇŵƉƚŽŵƐ͕ ĐƌĞĂƚĞ Ă ĚŝīĞƌĞŶƟĂů ůŝƐƚ͕ ƵƉĚĂƚĞ ŵĞĚŝĐĂƟŽŶƐ͕ ĚŽ Ă ĨŽĐƵƐĞĚ ƉŚǇƐŝĐĂů͕ ĐŽŵƉůĞƚĞ Ă ^K W ŶŽƚĞ ĂŶĚ ĐƌĞĂƚĞ Ă ƉůĂŶ ƚŽ ŝŵƉƌŽǀĞ ƉĂƟĞŶƚ ŚĞĂůƚŚ ŵŽǀŝŶŐ ĨŽƌǁĂƌĚ͘ tŚĞŶ ŽƉĞƌĂƟŶŐ ǁŝƚŚŝŶ ƚŚĞƐĞ ĐŽŶƐƚƌĂŝŶƚƐ͕ ŽƵƌ ĐĂůůŝŶŐ ĐĂŶ ďĞ ĐŚĂůůĞŶŐŝŶŐ͖ ŽƚŚ ƉŚǇƐŝĐŝĂŶ ĂŶĚ ƉĂƟĞŶƚ ŚĂǀĞ Ă ƐŚĂƌĞĚ ƐĞŶƐĂƟŽŶ ŽĨ ĨƌƵƐƚƌĂƟŽŶ ĂŶĚ ǀŽŝĚ͘ ĂĐŚ ŚĂƐ ĂŶ ŽǁŶ ĂŐĞŶĚĂ ǁŚĞŶ ĐŽŵŝŶŐ ƚŽ ĂŶ ĂƉƉŽŝŶƚŵĞŶƚ͕ ĂŶĚ ĞĂĐŚ ůĞĂǀĞƐ ǁŝƚŚŽƵƚ ĂĐŚŝĞǀŝŶŐ ǁŚĂƚ ƚŚĞǇ ŚĂĚ ŚŽƉĞĚ͘ dŚĞ ƉĂƟĞŶƚ ŚĂĚ ŚŽƉĞĚ ĨŽƌ ŝŵƉƌŽǀĞĚ ŚĞĂůƚŚ ƚƌĞĂƚĞĚ ďǇ Ă ĚŽĐƚŽƌ ǁŚŽ ƚƌƵůǇ ĐĂƌĞĚ ĂďŽƵƚ ŚŝƐͬŚĞƌ ǁĞůů ďĞŝŶŐ͘ Ƶƚ ĚŽĐƚŽƌ͛Ɛ ĂƩĞŶƟŽŶ ŝƐ ďĞŝŶŐ ƉƵůůĞĚ ŝŶ ĚŝīĞƌĞŶƚ ĚŝƌĞĐƟŽŶƐ ĚƵĞ ƚŽ ŚŽǁ ŵŽĚĞƌŶ ŵĞĚŝĐŝŶĞ ŝƐ ďĞŝŶŐ ƉƌĂĐƟĐĞĚ͘ DĞĚŝĐŝŶĞ ŚĂƐ ƋƵŝĐŬůǇ ĞǀŽůǀĞĚ ŝŶƚŽ ŶĞǁ ƵŶĐŚĂƌƚĞĚ ƚĞƌƌŝƚŽƌǇ ƚŽ ĐŽŶƋƵĞƌ͘ tŚŽ ǁŝůů Įůů ŝŶ ƚŚĞ ƌŽůĞ ĂƐ ƚŚĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ŝŶ ƐŽ ŵĂŶǇ ƵŶĚĞƌƐĞƌǀĞĚ ĂŶĚ ƌƵƌĂů ĐŽŵŵƵŶŝƟĞƐ ǁŚŝůĞ ĂƩĞŵƉƟŶŐ ƚŽ ŵĂŶĞƵǀĞƌ ƚŚƌŽƵŐŚ ƚŚĞ ŵƵůƟƚƵĚĞ ŽĨ ŽďƐƚĂĐůĞƐ ƚŚĂƚ ĨĂĐĞ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͍ /ƚ ŝƐ ƚŚĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚ ŽĨ ƚŽĚĂǇ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ǁŚŽ ŝƐ ĚƌĞĂŵŝŶŐ ƚŽ ďĞ Ă ĨƵƚƵƌĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͘ tĞ ŶĞĞĚ ƚŽ ŝŶƐƉŝƌĞ ƚŚĞ ĨƵƚƵƌĞ ŐĞŶĞƌĂƟŽŶƐ ŽĨ ĨĂŵŝůǇ 22

California Family Physician Winter 2019

ƉŚǇƐŝĐŝĂŶƐ ƚŚŽƵŐŚ ŽƵƌ ƉĂƐƐŝŽŶƐ͕ ĐŽŵŵƵŶŝƚǇ ǁŽƌŬ ĂŶĚ ĞǆĂŵƉůĞ͘ DŽĚĞůŝŶŐ ŝƐ ŝŶŇƵĞŶĐŝŶŐ ŽƚŚĞƌƐ ƚŽ ĨĞĞů ŽƵƌ ŽǁŶ ƐĞŶƐĞ ŽĨ ĞŶƚŚƵƐŝĂƐŵ͕ ƉƌŝĚĞ ĂŶĚ ũŽǇ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ǁŚĞŶ ƚŚĞŝƌ ŚĞĂůƚŚ ŝƐ ƉƌĞƐĞƌǀĞĚ ĂŶĚ ŝŵƉƌŽǀĞĚ͘ tŝƚŚ ƚŚĞ ŶĞǁ ǇĞĂƌ͕ / ĞŶĐŽƵƌĂŐĞ ǇŽƵ ƚŽ ŵĂŬĞ Ă ƌĞƐŽůƵƟŽŶ ƚŽ ďĞ Ă ŵŽĚĞů ĂŶĚ ĮŐŚƚ ĨŽƌ ǁŚĂƚ ǇŽƵ ĨĞĞů ŝƐ ƌŝŐŚƚ͕ ǁŚĞƚŚĞƌ ŝƚ ŝƐ ƚŽ ƉƌŽǀŝĚĞ ĞŵƉĂƚŚĞƟĐ ĂŶĚ ĞǀŝĚĞŶĐĞ ĚƌŝǀĞŶ ŵĞĚŝĐĂů ĐĂƌĞ͕ Žƌ ƚŽ ĞŶŐĂŐĞ ǁŝƚŚ ǇŽƵƌ ůŽĐĂů ŚŝŐŚ ƐĐŚŽŽů ƚŽ ƉƌŽǀŝĚĞ ůĞĐƚƵƌĞƐ ŽŶ ƉƌĞǀĞŶƚĂƟǀĞ ŚĞĂůƚŚ͘ WĞƌŚĂƉƐ being a mentor in family medicine is important to you, and you’d like to ƉĂƌƟĐŝƉĂƚĞ ŝŶ Ă ůŽĐĂů ƉŝƉĞůŝŶĞ ƉƌŽŐƌĂŵ ǁŝƚŚ ĐŽůůĞŐĞ ƐƚƵĚĞŶƚƐ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ŵĞĚŝĐŝŶĞ͘ /Ĩ ƉƵďůŝĐ ŚĞĂůƚŚ Žƌ ĂĚǀŽĐĂĐǇ ŝƐ ŝŶƚĞƌĞƐƟŶŐ͕ ǇŽƵ ŵŝŐŚƚ ĐŽŶƐŝĚĞƌ ƉƌŽǀŝĚŝŶŐ ŽŶůŝŶĞ ƚĞƐƟŵŽŶǇ ĨŽƌ Ă ƌĞƐŽůƵƟŽŶ ǇŽƵ ĨĞĞů ƐƚƌŽŶŐůǇ ĂďŽƵƚ͕ Žƌ ŝŶŝƟĂƚĞ Ă ƐĐƌĞĞŶŝŶŐ ƉƌŽŐƌĂŵ ŽŶ ĨŽŽĚ ŝŶƐĞĐƵƌŝƚǇ ŝŶ ǇŽƵƌ ĐůŝŶŝĐ ƚŽ ĂĚĚƌĞƐƐ social determinants of health. When students and residents observe ŵŽƟǀĂƟŽŶĂů ĞŶŐĂŐĞŵĞŶƚ͕ ŝƚ ŝŶƐƉŝƌĞƐ ƉĂƐƐŝŽŶ ĂŶĚ ĐƌĞĂƟǀĞ ƚŚŝŶŬŝŶŐ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ƚŚĞ ůŝŵŝƚůĞƐƐ ďŽƵŶĚĂƌŝĞƐ ŝƚ ĐĂŶ ĞŶƚĂŝů͘ &ĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝƐ ŽŶĞ ŽĨ ƚŚĞ ĨĞǁ ĮĞůĚƐ ŽĨ ŵĞĚŝĐŝŶĞ ƚŚĂƚ ŽīĞƌƐ ƐƵĐŚ Ă ďƌŽĂĚ ƐƉĞĐƚƌƵŵ ŽĨ ƉƌĂĐƟĐĞ ƐƵĐŚ ƚŚĂƚ ŽƵƌ ƐĐŽƉĞ ŝƐ ŶĞĂƌůǇ ĞŶĚůĞƐƐ͘ &ĞůůŽǁƐŚŝƉƐ ŝŶ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŵĂǇ ŝŶĐůƵĚĞ͕ ďƵƚ ĂƌĞ ŶŽƚ ůŝŵŝƚĞĚ ƚŽ obstetrics, adolescent medicine, emergency medicine, geriatrics, ƉĂůůŝĂƟǀĞͬŚŽƐƉŝĐĞ ĐĂƌĞ͕ ŚŽƐƉŝƚĂůŝƐƚ ŵĞĚŝĐŝŶĞ͕ ŝŶƚĞŐƌĂƟǀĞ ŵĞĚŝĐŝŶĞ͕ ŐůŽďĂů ŚĞĂůƚŚ͕ ƉƌĞǀĞŶƚĂƟǀĞ ŵĞĚŝĐŝŶĞ͕ ƌƵƌĂů ŵĞĚŝĐŝŶĞ͕ ƐƉŽƌƚƐ ŵĞĚŝĐŝŶĞ͕ ƐƵďƐƚĂŶĐĞ ĂďƵƐĞ ĂŶĚ ǁŽŵĞŶ͛Ɛ ŚĞĂůƚŚ͘ ĚƵĐĂƟŶŐ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂďŽƵƚ family medicine and inspiring them to undertake family medicine as a ĮĞůĚ ŵĂǇ ŚĞůƉ ƐƉƌĞĂĚ ƚŚĞ ǁŽƌĚ ĂďŽƵƚ ǁŚĂƚ ĨĂŵŝůǇ ĚŽĐƚŽƌƐ ĂƌĞ ĐĂƉĂďůĞ ŽĨ ĂĐĐŽŵƉůŝƐŚŝŶŐ͘ tĞ ĂƌĞ ƚŚĞ ĮƌƐƚ ůŝŶĞ ŽĨ ĚĞĨĞŶƐĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ĂƌĞ ƉƌŝǀŝůĞŐĞĚ ƚŽ ďĞ ŽŶĞ ŽĨ ƚŚĞ ĨĞǁ ƉƌŽĨĞƐƐŝŽŶƐ ĂďůĞ ƚŽ ƉƌŽǀŝĚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ƉĂƟĞŶƚ͕ ǁŚĞƚŚĞƌ ƉŚǇƐŝĐĂů͕ ŵĞŶƚĂů or socioeconomical. With such an important undertaking, our focus ƐŚŽƵůĚ ďĞ ŽŶ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ĐƵůƟǀĂƟŶŐ Ă ŶĞǁ ŐĞŶĞƌĂƟŽŶ ŽĨ ĚŽĐƚŽƌƐ ĨŽĐƵƐĞĚ ŽŶ ƚƌĞĂƚŵĞŶƚ ǁŝƚŚ ĞŵƉĂƚŚǇ ĂŶĚ ĐŽŵƉĂƐƐŝŽŶ ĚƵƌŝŶŐ ƚŚŝƐ contemporary age of technology. The intrinsic calling of helping others in need is not a quality that can be taught, but one that is nurtured and ĞŶĐŽƵƌĂŐĞĚ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ĂŶĚ ƌĞƐŝĚĞŶĐǇ͘ dƌĂŝŶŝŶŐ ǁĞůůͲƌŽƵŶĚĞĚ͕ ŝŶƋƵŝƐŝƟǀĞ͕ ƉĂƐƐŝŽŶĂƚĞ ƉŚǇƐŝĐŝĂŶƐ ŚĞůƉƐ ƚŽ ƉĂǀĞ ƚŚĞ ǁĂǇ ĨŽƌ ƌĞƐŽƵƌĐĞĨƵů ŵĞƚŚŽĚƐ ŽĨ ƉƌĞƐĞƌǀŝŶŐ ƉĂƟĞŶƚ ŚĞĂůƚŚ ĂŶĚ ǁĞůůͲďĞŝŶŐ͘ dƌƵƚŚĨƵůůǇ͕ / ĚŽ ŶŽƚ ŬŶŽǁ ǁŝƚŚ ĐĞƌƚĂŝŶƚǇ ǁŚĞƌĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ǁŝůů ůĞĂĚ͘ ,ŽǁĞǀĞƌ͕ / ŚŽƉĞ ƚŚĂƚ ǁŝƚŚ ĐŽŶƟŶƵĞĚ ƐƚƌŽŶŐ͕ ƐƵƉƉŽƌƟǀĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ƌĞƐŝĚĞŶĐǇ ƚƌĂŝŶŝŶŐ͕ ƚŚĞ ĮĞůĚ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŵĂǇ ďĞ ƐƚĞĞƌĞĚ ƚŽǁĂƌĚ Ă ƉŽƐŝƟǀĞ ĚŝƌĞĐƟŽŶ ʹ Ă ǁŽƌůĚ ǁŝƚŚ Ă ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ǁŚĂƚ ǁĞ ĂƌĞ ĂďůĞ ƚŽ ĂĐĐŽŵƉůŝƐŚ͘ ƌ͘ ŚĞŶ ŝƐ Ă ƌĞƐŝĚĞŶƚ Ăƚ ƚŚĞ >ŽŶŐ ĞĂĐŚ DĞŵŽƌŝĂů DĞĚŝĐĂů ĞŶƚĞƌ͘

California Family Physician Winter 2019

F M Wo r k f o rc e

Andrea Banuelos Mota Co-chair, CAFP Student Council

I’m Inspired by Family Physicians, and the Way They Fought California Wildﬁres /Ŷ DĂƌĐŚ ϮϬϭϴ͕ / ŚĂĚ ƚŚĞ ƉƌŝǀŝůĞŐĞ ƚŽ ĂƩĞŶĚ ƚŚĞ &W ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ; D DͿ͘ /ƚ ǁĂƐ Ă ĚĂǇ ǁŚĞŶ / ůĞĂƌŶĞĚ Ă ŐƌĞĂƚ ĚĞĂů ĂďŽƵƚ ƵƐŝŶŐ ŵǇ ǀŽŝĐĞ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ŵǇ ůĞŐŝƐůĂƚŽƌƐ͘ /ƚ ǁĂƐ ĂůƐŽ Ă ĚĂǇ ǁŚĞŶ / ŚĞĂƌĚ ƐƚŽƌŝĞƐ ĨƌŽŵ ŵĂŶǇ ŝŶƐƉŝƌŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ƌŽůĞ ŵŽĚĞůƐ ƚŽ ŵĞ͘ dǁŽ ŽĨ ƚŚĞ ƌŽůĞ ŵŽĚĞůƐ ĂƌĞ ƌ͘ >ŝƐĂ tĂƌĚ͕ ĐƵƌƌĞŶƚ &W WƌĞƐŝĚĞŶƚ ĂŶĚ ƌ͘ dĂƌĂ ^ĐŽƩ͕ ZĞƐŝĚĞŶĐǇ ŝƌĞĐƚŽƌ ŽĨ ^ĂŶƚĂ ZŽƐĂ ^ƵƩĞƌ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐǇ͘ dŚĞǇ ƐƉŽŬĞ ĂďŽƵƚ ƚŚĞ ƵŶĨŽƌƚƵŶĂƚĞ ĞǀĞŶƚƐ ŝŶ ƚŚĞŝƌ ĐŽŵŵƵŶŝƟĞƐ ĂƐ ƚŚĞ ƌĞƐƵůƚ ŽĨ ƚŚĞ dƵďďƐ &ŝƌĞ ŝŶ ϮϬϭϳ͘ dŚĞǇ ƐŚĂƌĞĚ ƚŚĞŝƌ ƐƚŽƌŝĞƐ ͙ ƐƚŽƌŝĞƐ ŽĨ ŚŽǁ ƚŚĞǇ ŵŽďŝůŝǌĞĚ ƚŚĞŝƌ ĞŶƟƌĞ ŶĞƚǁŽƌŬ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ƉƌŽǀŝĚĞ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ most unpredictable of circumstances — such as opening up a school gym ƚŽ ƉƌŽǀŝĚĞ ĐĂƌĞ ĂŶĚ ƚƌĂŶƐĨĞƌƌŝŶŐ ĐĂƌĞ ĨƌŽŵ ŽŶĞ ŚŽƐƉŝƚĂů ƚŽ ƚŚĞ ŶĞǆƚ ďĞĐĂƵƐĞ ƚŚĞŝƌ ŚŽƐƉŝƚĂů ǁĂƐ ďĂĚůǇ ĚĂŵĂŐĞĚ ĨƌŽŵ ƚŚĞ ĮƌĞ͘ dŚĞŝƌ Őƌŝƚ ĂŶĚ ƌĞƐŝůŝĞŶĐĞ͕ ŝůůƵƐƚƌĂƚĞ ŚŽǁ ďŽůĚůǇ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƐŚŝŶĞƐ ŝŶ ƚŚĞ ĐŽŵŵƵŶŝƚǇ͕ ĞƐƉĞĐŝĂůůǇ ŝŶ ƚŚĞƐĞ ĐŝƌĐƵŵƐƚĂŶĐĞƐ͘ dŚĞǇ ŝŶƐƉŝƌĞĚ ŵĞ ƚŽ ƐƉƌĞĂĚ ƚŚĞ ǁŽƌĚ ĂďŽƵƚ ǁŚĂƚ ŚĂĚ ďĞĞŶ ĂĐĐŽŵƉůŝƐŚĞĚ ĂŶĚ ĂďŽƵƚ ŚŽǁ ǁŽŶĚĞƌĨƵů ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝƐ͘ Ɛ ϮϬϭϴ ĐůŽƐĞĚ͕ ĂůŝĨŽƌŶŝĂ ĐŽŶƟŶƵĞƐ ƚŽ ƐƵīĞƌ ƚŚĞ ǁƌĂƚŚ ŽĨ ǁŝůĚĮƌĞƐ͕ ŵŽƐƚ recently the Woolsey Fire, Camp Fire and Paradise Fire. These tragic events

California Family Physician Winter 2019

ĂƌĞ ƐŽ ĚĞǀĂƐƚĂƟŶŐ ĨŽƌ ŝŶĚŝǀŝĚƵĂůƐ͕ ĨŽƌ ĞŶƟƌĞ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ĨŽƌ ĂůŝĨŽƌŶŝĂ͘ dŚĞ ĞīĞĐƚƐ ŽĨ ƚŚĞŝƌ ĚĂŵĂŐĞ ĂƌĞ ůŽŶŐͲůĂƐƟŶŐ͘ ZĞĐĞŶƚůǇ͕ ŝƚ ƐĞĞŵƐ ƚŚĂƚ ũƵƐƚ ĂƐ ǁĞ ďĞŐŝŶ ƚŽ ƉŝĞĐĞ ŽƵƌƐĞůǀĞƐ ďĂĐŬ ƚŽŐĞƚŚĞƌ͕ ĂŶŽƚŚĞƌ ƐǁĞĞƉ ŽĨ ǁŝůĚĮƌĞƐ ĞŶŐƵůĨƐ ĂƌĞĂƐ ŽĨ ŽƵƌ ƐƚĂƚĞ͘ dŚŝƐ ǀŽůĂƟůŝƚǇ ƌĞŵŝŶĚƐ ƵƐ ƚŚĂƚ ŶŽ ŽŶĞ ŝƐ ŝŵŵƵŶĞ from facing such disasters. I think that it is even more important for family ƉŚǇƐŝĐŝĂŶƐ ƚŽ ďĞ ŽŵŶŝƉƌĞƐĞŶƚ ŝŶ ĞǀĞƌǇ ĂƌĞĂ ŽĨ ŽƵƌ ƐƚĂƚĞ͘ Ɛ Ă ŐƌŽƵƉ͕ ǁĞ ĐĂŶ unite and prepare to support each other if tragedy knocks at our door. Ɛ Ă ŶĂƟǀĞ ĂůŝĨŽƌŶŝĂŶ͕ / ƚĂŬĞ ŐƌĞĂƚ ƉƌŝĚĞ ŝŶ ŚŽǁ ǁĞ ƵŶŝĨǇ ŝŶ ƟŵĞƐ ŽĨ ƚƌĂŐĞĚǇ͘ tĞ ĐĂŶ ĐŽŶƟŶƵĞ ĚŽŝŶŐ ƚŚĂƚ͕ ŝƐ ďǇ ƐƚƌĞŶŐƚŚĞŶŝŶŐ ŽƵƌ ƟĞƐ͕ ƌĞĐƌƵŝƟŶŐ ŵŽƌĞ ƉƌŽŵŝƐŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ũŽŝŶ ŽƵƌ ĨĂŵŝůǇ ĂŶĚ ĐŽŶƟŶƵĞ ƵƐŝŶŐ ŽƵƌ ǀĞƌƐĂƟůĞ ƐŬŝůůƐ ĚƵƌŝŶŐ ŐƌĞĂƚ ƟŵĞƐ ĂŶĚ ĚƵƌŝŶŐ ĚŝĸĐƵůƚ ƟŵĞƐ͘ Ɛ ĚŝĸĐƵůƚ ĂƐ ŝƚ ŝƐ ĨŽƌ ŵĞ ƚŽ ǁƌŝƚĞ ƚŚŝƐ ŚĞĂǀǇ ƉŝĞĐĞ͕ / ǁƌŝƚĞ ŝƚ ǁŝƚŚ ƚŚĞ ŐƌĞĂƚĞƐƚ ĂĚŵŝƌĂƟŽŶ ĨŽƌ ƚŚĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ƉƌŽĨĞƐƐŝŽŶ ĂŶĚ ǁŝƚŚ ƚŚĞ ƐŝŶĐĞƌĞƐƚ ŚŽƉĞ ƚŚĂƚ ƌĞŐĂƌĚůĞƐƐ ŽĨ ǁŚĂƚ ǁĞ ĂƐ Ă ƐŽĐŝĞƚǇ ĨĂĐĞ ŝŶ ƚŚĞ ĨƵƚƵƌĞ͕ ǁĞ ĐĂŶ ƉĞƌƐĞǀĞƌĞ ĂŶĚ ƚĂŬĞ ŐƌĞĂƚ ĐĂƌĞ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ʹ ĂŶĚ ŽĨ ĞĂĐŚ ŽƚŚĞƌ͘ DƐ͘ ĂŶƵĞůŽƐ DŽƚĂ ŝƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ <ĞĐŬ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ ŽĨ h^ ͘

Conrad Amenta CAFP Director of Health Policy

F M Wo r k f o rc e

California’s Projected Primary Care Physician Needs Outstrip Supply dŚĞ ŶƵŵďĞƌƐ ĂƌĞ ƐƚĂƌŬ͗ ĂůŝĨŽƌŶŝĂ ĐŽƵůĚ ĨĂĐĞ Ă ƐŚŽƌƚĂŐĞ ŽĨ ϱϮ͕ϬϬϬ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ďǇ ϮϬϯϬ͘ dŽ ƉƵƚ ƚŚĂƚ ŝŶƚŽ ĐŽŶƚĞǆƚ͕ according to a recent University of California, San Francisco report ƟƚůĞĚ ͞ ĂůŝĨŽƌŶŝĂ͛Ɛ WƌŝŵĂƌǇ ĂƌĞ tŽƌŬĨŽƌĐĞ͗ &ŽƌĞĐĂƐƚĞĚ ^ƵƉƉůǇ͕ ĞŵĂŶĚ ĂŶĚ WŝƉĞůŝŶĞ ŽĨ dƌĂŝŶĞĞƐ͕ ϮϬϭϲͲϮϬϯϬ͟ ŝƚ͛Ɛ Ă ƐŚŽƌƚĂŐĞ ŽĨ ĂƉƉƌŽǆŝŵĂƚĞůǇ ƚǁŝĐĞ ƚŚĞ ƚŽƚĂů ƐŝǌĞ ŽĨ ƚŚĞ ƚŽĚĂǇ͛Ɛ ǁŽƌŬĨŽƌĐĞ ŽĨ ĂďŽƵƚ Ϯϲ͕ϬϬϬ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ͘1

residency slots in the state. If medical students interested in ďĞĐŽŵŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĐĂŶŶŽƚ ŵĂƚĐŚ ŝŶƚŽ Ă ƌĞƐŝĚĞŶĐǇ program usually leave for another state. The number and size ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ŝƐ ŝŶĐƌĞĂƐŝŶŐ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϲϬ 'D ͲĂĐĐƌĞĚŝƚĞĚ ƉƌŽŐƌĂŵƐ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŽĚĂǇ ͙ ďƵƚ ƚŚĞ ŐƌŽǁƚŚ ŝƐ ŶŽƚ ŶĞĂƌůǇ ĨĂƐƚ ĞŶŽƵŐŚ ƚŽ ŵĞĞƚ ƚŚĞ ĚĞŵĂŶĚ ĞǆƉĞĐƚĞĚ ďǇ ϮϬϯϬ͘

tŚŝůĞ ƚŚŝƐ ŝƐ Ă ǁŽƌƐƚ ĐĂƐĞ ƐĐĞŶĂƌŝŽ͕ ĞǀĞŶ ŝŶ ƚŚĞ ďĞƐƚ ĐĂƐĞ ƐĐĞŶĂƌŝŽƐ ʹ ƚŚŽƐĞ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉŽƉƵůĂƟŽŶ ĚŽĞƐ ŶŽƚ ŐƌŽǁ ƋƵŝƚĞ ĂƐ ĨĂƐƚ͕ Žƌ ƚŚĞ ĨƌĞƋƵĞŶĐǇ ŽĨ ƌĞƟƌĞŵĞŶƚƐ ĂŵŽŶŐ ƉƌĂĐƟĐŝŶŐ ƉŚǇƐŝĐŝĂŶƐ ĚĞĐƌĞĂƐĞƐ͕ Žƌ ĂůŝĨŽƌŶŝĂ ĞŶũŽǇƐ Ă ŚŝŐŚĞƌ ŝŶŇƵǆ ŽĨ ŐƌŽǁƚŚ ĚƵĞ ƚŽ ŝŵŵŝŐƌĂƟŽŶ ĨƌŽŵ ŽƚŚĞƌ ƐƚĂƚĞƐ ĂŶĚ ĐŽƵŶƚƌŝĞƐ͕ Žƌ ǁĞ ƐĞĞ ŝŶĐƌĞĂƐĞĚ training capacity at medical schools and residency programs in ůŝŶĞ ǁŝƚŚ ƚŚĞŝƌ ƚƌĂĚŝƟŽŶĂů ŐƌŽǁƚŚ ʹ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ŝƐ ĞǆƉĞĐƚĞĚ ƚŽ ƌĞĂĐŚ ϭϳ͕ϱϬϬ͕ Žƌ ĂƉƉƌŽǆŝŵĂƚĞůǇ ƚǁŽͲ ƚŚŝƌĚƐ ƚŚĞ ƐŝǌĞ ŽĨ ƚŚĞ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ͘ dŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ǁŝůů ďĞ ĨĞůƚ ŵŽƐƚ ĂĐƵƚĞůǇ ŝŶ ĂƌĞĂƐ ŽĨ ƚŚĞ ƐƚĂƚĞ ǁŝƚŚ ƚŚĞ ǁŽƌƐƚ ƌĂƟŽƐ ŽĨ ĂĐƟǀĞ ƉĂƟĞŶƚ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ƉĞƌ ϭϬϬ͕ϬϬϬ ƉŽƉƵůĂƟŽŶ ʹ /ŶůĂŶĚ ŵƉŝƌĞ͕ ^ĂŶ :ŽĂƋƵŝŶ sĂůůĞǇ͕ EŽƌƚŚĞƌŶ ĂŶĚ Sierra and Central Coast. With about one-third of the state’s ƉŽƉƵůĂƟŽŶ ĞŶƌŽůůĞĚ ŝŶ DĞĚŝͲ Ăů͕ ĂůŝĨŽƌŶŝĂ ŚĂƐ Ă ƌĞƐƉŽŶƐŝďŝůŝƚǇ ƚŽ guarantee a level of access lest its residents rely increasingly on ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚƐ ĨŽƌ ƌŽƵƟŶĞ ĐĂƌĞ Žƌ forgo care altogether.

DĂŶǇ ŽƚŚĞƌ ƐƚĂƚĞƐ ĨƵŶĚ 'D ďǇ ĚƌĂǁŝŶŐ ĚŽǁŶ ĨĞĚĞƌĂů ĨƵŶĚƐ ǀŝĂ ƚŚĞ DĞĚŝĐĂƌĞ ĂŶĚͬŽƌ DĞĚŝĐĂŝĚ ƉƌŽŐƌĂŵƐ͘ ĂůŝĨŽƌŶŝĂ ŚĂƐ ŐŽŶĞ ŝƚƐ ŽǁŶ ǁĂǇ͕ ĚƌĂǁŝŶŐ ĚŽǁŶ ůŝŵŝƚĞĚ ĨĞĚĞƌĂů ĨƵŶĚƐ ĨŽƌ ǁŽƌŬĨŽƌĐĞ ƚƌĂŝŶŝŶŐ͘ dŚŝƐ ŝƐ ŝŶ ƉĂƌƚ ďĞĐĂƵƐĞ ƚŚĞ ĨĞĚĞƌĂů ĨŽƌŵƵůĂƐ ĚĞƚĞƌŵŝŶŝŶŐ ŚŽǁ ŵƵĐŚ ĞĂĐŚ ƐƚĂƚĞ ƌĞĐĞŝǀĞƐ ĂƌĞ ŽƵƚĚĂƚĞĚ ĂŶĚ ĚŝƐĂĚǀĂŶƚĂŐĞ ǁĞƐƚĞƌŶ ƐƚĂƚĞƐ͘ /ŶƐƚĞĂĚ͕ ĨƵŶĚŝŶŐ ĨŽƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƌĞƐŝĚĞŶĐǇ ƚƌĂŝŶŝŶŐ ŝŶ ĂůŝĨŽƌŶŝĂ ŚĂƐ ƚƌĂĚŝƟŽŶĂůůǇ ďĞĞŶ ŐƌĂŶƚĞĚ ǀŝĂ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ ,ĞĂůƚŚĐĂƌĞ tŽƌŬĨŽƌĐĞ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ ĂǁĂƌĚƐ ŐƌĂŶƚƐ ƚŽ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ŽŶ ƚŚĞ ďĂƐŝƐ ŽĨ ƐĞƌǀŝĐĞ ƚŽ ƵŶĚĞƌƐĞƌǀĞĚ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ƌĞĐƌƵŝƚŵĞŶƚ ŽĨ ƵŶĚĞƌƌĞƉƌĞƐĞŶƚĞĚ ŵŝŶŽƌŝƟĞƐ͘ &W ŝƐ Ă ůŽŶŐƟŵĞ ĐŚĂŵƉŝŽŶ ĂŶĚ ƐƵƉƉŽƌƚĞƌ ŽĨ ^ŽŶŐͲ ƌŽǁŶ͕ ŚĂǀŝŶŐ ŚĞůƉĞĚ ƚŽ ĞƐƚĂďůŝƐŚ ƚŚĞ ƉƌŽŐƌĂŵ ŝŶ ϭϵϳϯ͘ /Ŷ ϮϬϭϲ͕ &W ŚĞůƉĞĚ ƚŽ ƐĞĐƵƌĞ ΨϭϬϬ ŵŝůůŝŽŶ ĨŽƌ ĚŝƐďƵƌƐĂů ƚŚƌŽƵŐŚ ^ŽŶŐͲ ƌŽǁŶ͘ dŚĞ ƐĂŵĞ ǇĞĂƌ͕ ĂůŝĨŽƌŶŝĂŶƐ ĂůƐŽ ǀŽƚĞĚ ƚŽ ƉĂƐƐ WƌŽƉŽƐŝƟŽŶ ϱϲ͕ ǁŚŝĐŚ ŝŶĐƌĞĂƐĞĚ ƚĂǆĞƐ ŽŶ ƚŽďĂĐĐŽ ƉƌŽĚƵĐƚƐ͘ dŚĞ ƌĞǀĞŶƵĞ

Research indicates that physicians are most ůŝŬĞůǇ ƚŽ ůŽĐĂƚĞ ƚŚĞŝƌ ƉƌĂĐƟĐĞƐ ǁŝƚŚŝŶ ϱϬ ŵŝůĞƐ ŽĨ ǁŚĞƌĞ ƚŚĞǇ ĚŝĚ ƚŚĞŝƌ ƌĞƐŝĚĞŶĐǇ͕ ŵĂŬŝŶŐ ƚŚĞ ůŽĐĂƟŽŶ ŽĨ Ă ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵ ŝŶ ĂŶ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂ ĂŶ ĞīĞĐƟǀĞ ǁĂǇ to increase the physician supply in that ĂƌĞĂ͘ dŚĞ ŬĞǇ ďŽƩůĞŶĞĐŬ ŝŶ ƚŚĞ ƉƌŽĚƵĐƟŽŶ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ͕ ŚŽǁĞǀĞƌ͕ ŝƐ establishing appropriate funding to sustain ĂŶĚ ĞǆƉĂŶĚ ŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ;'D Ϳ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ train and remain in primary care. According ƚŽ ƚŚĞ <ĂŝƐĞƌ &ĂŵŝůǇ &ŽƵŶĚĂƟŽŶ͕ ϭ͕ϭϯϯ medical school students graduated in ĂůŝĨŽƌŶŝĂ ŝŶ ϮϬϭϳ͘ ƚ ƚŚĞ ƐĂŵĞ ƟŵĞ͕ ƚŚĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŵĂƚĐŚ ǁĂƐ ůŝŵŝƚĞĚ ƚŽ ƐůŝŐŚƚůǇ ŵŽƌĞ ƚŚĂŶ ϰϬϬ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ 26

California Family Physician Winter 2019

/Ŷ ϭϵϳϯ͕ ƚŚĞŶ 'ŽǀĞƌŶŽƌ ZŽŶĂůĚ ZĞĂŐĂŶ ƐŝŐŶĞĚ ƚŚĞ ŚŝƐƚŽƌŝĐ ^ŽŶŐͲ ƌŽǁŶ >ĞŐŝƐůĂƚŝŽŶ͘

ĨƌŽŵ ƚŚŝƐ ŝŶĐƌĞĂƐĞĚ ƚĂǆ ŚĂƐ ďĞĞŶ ĚŝƌĞĐƚĞĚ ƚŽ a number of health care-related programs ĂŶĚ ƉĂǇŵĞŶƚƐ͕ ŝŶĐůƵĚŝŶŐ ΨϰϬ ŵŝůůŝŽŶ annually for primary care GME. Together, ^ŽŶŐͲ ƌŽǁŶ ĂŶĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ƌĞƉƌĞƐĞŶƚ Ă ƐŝŐŶŝĮĐĂŶƚ ĂŶĚ ǀŝƚĂů ĨƵŶĚŝŶŐ ƐƚƌĞĂŵ ĨŽƌ primary care GME. We face numerous policy challenges, to ĞŶƐƵƌĞ ƚŚĞ ĨƵŶĚƐ ĂƌĞ ĚŝƐďƵƌƐĞĚ ĂƐ ĞĸĐŝĞŶƚůǇ ĂƐ ƉŽƐƐŝďůĞ͘ &Žƌ ĞǆĂŵƉůĞ͕ ƚŚĞ ůĞŐŝƐůĂƚƵƌĞ ŽƉĞŶĞĚ ĞůŝŐŝďŝůŝƚǇ ĨŽƌ ďŽƚŚ ^ŽŶŐͲ ƌŽǁŶ ĂŶĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ŐƌĂŶƚƐ ƚŽ ŝŶƚĞƌŶĂů ŵĞĚŝĐŝŶĞ͕ ƉĞĚŝĂƚƌŝĐƐ ĂŶĚ ŽďƐƚĞƚƌŝĐƐͬŐǇŶĞĐŽůŽŐǇ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ͘ hƉ ƚŽ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ŝŶƚĞƌŶĂů ŵĞĚŝĐŝŶĞ ŐƌĂĚƵĂƚĞƐ ĂŶĚ ϱϬ ƉĞƌĐĞŶƚ of pediatrics graduates subspecialize ŽƵƚƐŝĚĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ ,Žǁ͕ ƚŚĞŶ͕ ĐĂŶ ƚŚĞ state direct funding to programs that train ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌǇ ĐĂƌĞ͍ ĚĚŝƟŽŶĂůůǇ͕ ŶŽƚ Ăůů ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ĂƌĞ located in underserved areas, and those that ĂƌĞ ŵĂǇ ŶŽƚ ƐĞƌǀĞ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐ͘ &ŝŶĂůůǇ͕ ƚŚĞ ƟŵĞůŝŶĞ ĨŽƌ ĞƐƚĂďůŝƐŚŝŶŐ Ă ŶĞǁ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵ ŝƐ ŽŌĞŶ ůŽŶŐĞƌ ƚŚĂŶ ƚŚĞ ƟŵĞůŝŶĞƐ ĨŽƌ ĚŝƐďƵƌƐŝŶŐ ĨƵŶĚŝŶŐ͘ &W ŝƐ deeply involved in advising decision-makers as they develop assessment criteria and ĚŝƐďƵƌƐĞ ĨƵŶĚƐ͕ ĂƩĞŶĚŝŶŐ Ăůů ƉƵďůŝĐ ŵĞĞƟŶŐƐ of the California Healthcare Workforce WŽůŝĐǇ ŽŵŵŝƐƐŝŽŶ ĂŶĚ ĂĚǀŽĐĂƟŶŐ ĨŽƌ ƚŚĞ ĂƉƉƌŽƉƌŝĂƚĞ ĚŝƐďƵƌƐĂů ŽĨ WƌŽƉŽƐŝƟŽŶ ϱϲ funds. dŚĞ ĨĂĐƚ ƌĞŵĂŝŶƐ ƚŚĂƚ ƚŚĞ ŵŽƐƚ ĞĸĐŝĞŶƚ ǁĂǇ ƚŽ ŝŶĐƌĞĂƐĞ ƚŚĞ ƌĂǁ ŶƵŵďĞƌ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ʹ ĨŽĐƵƐŝŶŐ ŽŶ ďŽƩůĞŶĞĐŬƐ ĂŶĚ ensuring funds are used to train physicians serve the underserved and remain in ƉƌŝŵĂƌǇ ĐĂƌĞ ƌĂƚŚĞƌ ƚŚĂŶ ƐƵďƐƉĞĐŝĂůŝǌĞ ʹ ŝƐ ƚŽ ŵĂŬĞ ĨƵŶĚƐ ĂǀĂŝůĂďůĞ ĨŽƌ ŶĞǁ ĂŶĚ ĞǆŝƐƟŶŐ family medicine residency programs located in the highest need areas. Workforce remains a strategic priority area for CAFP ĂŶĚ ǁĞ ĂƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ŵĂŬŝŶŐ ƚŚŝƐ ƉŽůŝĐǇ goal a reality. References 1.

ŚƩƉƐ͗ͬͬŚĞĂůƚŚĨŽƌĐĞ͘ƵĐƐĨ͘ĞĚƵͬ ƉƵďůŝĐĂƟŽŶƐͬĐĂůŝĨŽƌŶŝĂƐͲƉƌŝŵĂƌǇͲĐĂƌĞͲ ǁŽƌŬĨŽƌĐĞͲĨŽƌĞĐĂƐƚĞĚͲƐƵƉƉůǇͲĚĞŵĂŶĚͲ ĂŶĚͲƉŝƉĞůŝŶĞͲƚƌĂŝŶĞĞƐͲϮϬϭϲ California Family Physician Winter 2019

F M Wo r k f o rc e

Danielle Jones, MPH M a n a g e r, A m e r i c a n A c a d e m y o f F a m i l y P h y s i c i a n s Center for Diversity and Health Equity

PhD instead of MD: Why Mentorship Matters in Diversifying the Medical Workforce

dŚĞ ŐŽŽĚ ŶĞǁƐ ŝƐ͕ ŵǇ ƐƚŽƌǇ ĚŝĚŶ͛ƚ ĞŶĚ ƚŚĞƌĞ͘ / ǁĞŶƚ ŽŶ ƚŽ ŶŽƚ ŽŶůǇ complete that degree but also earn a Master’s in Public Health and ĐŽŵĞ ϮϬϮϬ ;ĮŶŐĞƌƐ ĐƌŽƐƐĞĚͿ ǁŝůů ŚĂǀĞ ĞĂƌŶĞĚ Ă WŚ ŝŶ ,ĞĂůƚŚ WŽůŝĐǇ ;ƚĂŬĞ ƚŚĂƚ WƌŽĨĞƐƐŽƌ͊Ϳ͘ zĞƚ͕ / ĐĂŶ͛ƚ ŚĞůƉ ďƵƚ ŽĐĐĂƐŝŽŶĂůůǇ ƌĞŇĞĐƚ ŽŶ ŚŽǁ Ă ĂŶŝĞůůĞ :ŽŶĞƐ͕ D ĐŽƵůĚ ŚĂǀĞ ďĞƩĞƌ ƐĞƌǀĞĚ ƚŚĞ ŶĞĞĚƐ ŽĨ her community than a Danielle Jones, PhD, especially considering ƚŚĂƚ ŵǇ ĐŽŵŵƵŶŝƚǇ ŽĨ tǇĂŶĚŽƩĞ ŽƵŶƚǇ ĐŽŶƐŝƐƚĞŶƚůǇ ƌĂŶŬƐ ŝŶ ƚŚĞ ďŽƩŽŵ ϱ ƉĞƌĐĞŶƚ ŽĨ <ĂŶƐĂƐ͛ ϭϬϭ ĐŽƵŶƟĞƐ ŝŶ ƐĞǀĞƌĂů ŚĞĂůƚŚ outcome areas.1 /Ŷ ϮϬϭϳ͕ tǇĂŶĚŽƩĞ ŽƵŶƚǇ <^ ǁĂƐ ŝĚĞŶƟĮĞĚ ĂƐ ͞ƚŚĞ ƐĞĐŽŶĚ ŵŽƐƚ ĚŝǀĞƌƐĞ ĐŽŵŵƵŶŝƚǇ ŝŶ ƚŚĞ ŶĂƟŽŶ͕͟ ďĞŚŝŶĚ ƌŽǁĂƌĚ County, FL, and lacks an ethnic majority.Ϯ EŽŶͲ,ŝƐƉĂŶŝĐ ǁŚŝƚĞƐ ĂĐĐŽƵŶƚ ĨŽƌ ĂƉƉƌŽǆŝŵĂƚĞůǇ ϰϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ƉŽƉƵůĂƟŽŶ ĂŶĚ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶƐ ĂŶĚ >ĂƟŶŽƐ ĂƌĞ ĞƋƵĂůůǇ ƌĞƉƌĞƐĞŶƚĞĚ Ăƚ ĂďŽƵƚ Ϯϱ ƉĞƌĐĞŶƚ͕ ƌĞƐƉĞĐƟǀĞůǇ͘3 zĞƚ͕ ƚŚŝƐ ĚŝǀĞƌƐŝƚǇ ŝƐ ŶŽƚ ƌĞŇĞĐƚĞĚ ŝŶ ƚŚĞ ůŽĐĂů ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͕ ĚĞƐƉŝƚĞ ŚĂǀŝŶŐ ƚŚƌĞĞ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ͘ /Ŷ ϮϬϬϮ͕ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͕ ŝŶ ŝƚƐ ƌĞƉŽƌƚ hŶĞƋƵĂů dƌĞĂƚŵĞŶƚ͗ ŽŶĨƌŽŶƟŶŐ ZĂĐŝĂů ĂŶĚ ƚŚŶŝĐ ŝƐƉĂƌŝƟĞƐ ŝŶ ,ĞĂůƚŚ ĂƌĞ͕ concluded ƚŚĂƚ ŐƌŽǁŝŶŐ Ă ĚŝǀĞƌƐĞ ĂŶĚ ĂĚĞƋƵĂƚĞ ƐƵƉƉůǇ ŽĨ ƉŚǇƐŝĐŝĂŶƐ ǁĂƐ 28

California Family Physician Winter 2019

ĞƐƐĞŶƟĂů ƚŽ ƐŽůǀŝŶŐ ŝƐƐƵĞƐ ŽĨ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ ŝŶ ƚŚĞ h͘^͘ϰ 'ƌĞĂƚĞƌ ƉŚǇƐŝĐŝĂŶ ĚŝǀĞƌƐŝƚǇ ŚĂƐ ďĞĞŶ ŝŶĚŝĐĂƚĞĚ ŝŶ ƚŚĞ ƌĞĚƵĐƟŽŶ ŽĨ ŚŽƐƉŝƚĂůŝǌĂƟŽŶ ĨŽƌ ĂŵďƵůĂƚŽƌǇ ĐĂƌĞ ƐĞŶƐŝƟǀĞ ĐŽŶĚŝƟŽŶƐ͕ ŝŵƉƌŽǀĞĚ ĂĐĐĞƐƐ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ƉĂƟĞŶƚƐ ĂŶĚ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ͘ϱͲϳ While ƚŚĞƐĞ ƌĞƐƵůƚƐ ƌĞŇĞĐƚ ĚŝǀĞƌƐŝƚǇ ĂĐƌŽƐƐ Ăůů ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ͕ family physicians have a greater propensity to care for underserved ƉŽƉƵůĂƟŽŶƐ ƚŚĂŶ ĚŽ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ ŝŶ ŽƚŚĞƌ ƐƉĞĐŝĂůƟĞƐ͘ϴ It is for this reason, the American Academy of Family Physicians ůĂƵŶĐŚĞĚ ƚŚĞ ĞŶƚĞƌ ĨŽƌ ŝǀĞƌƐŝƚǇ ŝŶ ,ĞĂůƚŚ ƋƵŝƚǇ ; , Ϳ ŝŶ ϮϬϭϳ͕ ǁŝƚŚ ƚŚĞ ƐƚƌĂƚĞŐŝĐ ƉƌŝŽƌŝƚǇ ŽĨ ĂĚĚƌĞƐƐŝŶŐ ĚŝǀĞƌƐŝƚǇ ĂŶĚ ŝŶĐůƵƐŝŽŶ ŝŶ ƚŚĞ ŵĞĚŝĐĂů ǁŽƌŬĨŽƌĐĞ͘ /Ŷ ĂĚĚŝƟŽŶ͕ ĞĂĐŚ ŽĨ ƚŚĞ ĞŝŐŚƚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ƐĞƚ Ă ŐŽĂů ƚŽ ŚĂǀĞ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ĂůůŽƉĂƚŚŝĐ ĂŶĚ osteopathic medical school seniors select family medicine as their ƐƉĞĐŝĂůƚǇ ďǇ ϮϬϯϬ͘ dŚŝƐ ŐŽĂů ǁŽƵůĚ ĚŽƵďůĞ ƚŚĞ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ĂŶĚ ƚŚĞ , ǁŝůů ďĞ ĐůŽƐĞůǇ ŝŶǀŽůǀĞĚ ƚŽ ĞŶƐƵƌĞ ŝƚ ŝƐ Ă ĚŝǀĞƌƐĞ ŽŶĞ͘

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Moving beyond textbooks and theories in school, I’ve gained firsthand experience learning about the complexities of health care.

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I can remember the moment I chose to forgo applying to medical ƐĐŚŽŽů ƋƵŝƚĞ ĐůĞĂƌůǇ͘ /ƚ ǁĂƐ ƚŚĞ ĨĂůů ŽĨ ŵǇ ƐĞŶŝŽƌ ǇĞĂƌ ŝŶ ƵŶĚĞƌŐƌĂĚ͕ ĂŶĚ / ŚĂĚ ũƵƐƚ ĨĂŝůĞĚ Ă ŚŝƐƚŽůŽŐǇ ůĂď ĮŶĂů͘ / ƌƵƐŚĞĚ ƚŚĂƚ ƐĂŵĞ ĚĂǇ ŝŶƚŽ ƚŚĞ ƉƌŽĨĞƐƐŽƌ͛Ɛ ŽĸĐĞ ƌĞĂĚǇ ƚŽ ĂƌŐƵĞ ĨŽƌ ĞǀĞƌǇ ďŝƚ ŽĨ ƉĂƌƟĂů ĐƌĞĚŝƚ / ĐŽƵůĚ ŐĞƚ ƚŽ ƌĂŝƐĞ ŵǇ ŐƌĂĚĞ ĞŶŽƵŐŚ ƚŽ ƉĂƐƐ ƚŚĞ ĐůĂƐƐ͘ ŌĞƌ ĂďŽƵƚ ĂŶ ŚŽƵƌ ĂŶĚ ŵĂŶĂŐŝŶŐ ƚŽ ƐŬŝƌƚ ďǇ ƚŚĞ ƐĞŵĞƐƚĞƌ ǁŝƚŚ Ă ďĂƌĞůǇ ƉĂƐƐŝŶŐ ͕ ŵǇ ƉƌŽĨĞƐƐŽƌ ĂƐŬĞĚ ĂďŽƵƚ ŵǇ ƉůĂŶƐ ĂŌĞƌ ŐƌĂĚƵĂƟŽŶ ĂŶĚ / ĞŶƚŚƵƐŝĂƐƟĐĂůůǇ ĚŝƐĐƵƐƐĞĚ ŵǇ ĐŚŝůĚŚŽŽĚ ĚƌĞĂŵƐ ŽĨ ďĞŝŶŐ Ă ĚŽĐƚŽƌ ĂŶĚ ƚƌĂǀĞůŝŶŐ ƚŚĞ ǁŽƌůĚ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ͘ /Ŷ ůĞƐƐ ƚŚĂŶ Ă ŵŝŶƵƚĞ͕ ƚŚĂƚ ĮƌĞ ǁĂƐ ĞǆƟŶŐƵŝƐŚĞĚ ǁŝƚŚ ƚŚĞ ƐƚĂƚĞŵĞŶƚ͕ ͞/ ĚŽŶ͛ƚ ƚŚŝŶŬ ǇŽƵ ŚĂǀĞ ǁŚĂƚ ŝƚ ƚĂŬĞƐ͕ ŚĂǀĞ ǇŽƵ ĐŽŶƐŝĚĞƌĞĚ Ă WůĂŶ ͍͟ dƌƵƚŚ ŝƐ / hadn’t. I had been fortunate to have parents, teachers and school ĐŽƵŶƐĞůŽƌƐ ǁŚŽ ƌĞĐŽŐŶŝǌĞĚ ŝŶ ŵĞ Ăƚ ĂŶ ĞĂƌůǇ ĂŐĞ ĂŶ ŝŶƚĞƌĞƐƚ ĂŶĚ ƉƌŽƉĞŶƐŝƚǇ ĨŽƌ ƚŚĞ ^ĐŝĞŶĐĞ͕ dĞĐŚŶŽůŽŐǇ͕ ŶŐŝŶĞĞƌŝŶŐ ĂŶĚ DĂƚŚŵĂƟĐƐ ;^d DͿ ĮĞůĚ͘ Ɛ Ă ƌĞƐƵůƚ͕ / ǁĂƐ ŽīĞƌĞĚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ in just about every kind of pipeline program you could imagine; ĂŌĞƌͲƐĐŚŽŽů ƉƌŽŐƌĂŵƐ͕ ǁĞĞŬĞŶĚ ǀŝƐŝƚƐ ƚŽ ŚŽƐƉŝƚĂůƐ͕ ƐƵŵŵĞƌ ĐĂŵƉƐ Ăƚ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ͕ ĞƚĐ͘ / ĐĂŶ ƐƟůů ƌĞŵĞŵďĞƌ ͞ĞǆƉĞƌŝŵĞŶƟŶŐ͟ ǁŝƚŚ ŵǇ ĮƌƐƚ ĐĂĚĂǀĞƌ͊ ,ŽǁĞǀĞƌ͕ ďǇ ƚŚĞ ƟŵĞ / ŐŽƚ ƚŽ ĐŽůůĞŐĞ͕ ŝƚ ǁĂƐ Ă ĚĂŝůǇ struggle to earn that Bachelor of Science degree in biology, and unfortunately, the support, encouragement and mentorship I had ĨŽƵŶĚ ĂƐ ĂŶ ĂĚŽůĞƐĐĞŶƚ ǁĂƐ ŶŽǁŚĞƌĞ ƚŽ ďĞ ĨŽƵŶĚ ĂƐ Ă ǇŽƵŶŐ ĐŽůůĞŐĞ student.

KƵƌ ƚĂĐƟĐƐ ĂƌĞ ĞŵĞƌŐŝŶŐ ŝŶ ƚŚŝƐ ĂƌĞĂ ĂŶĚ ǁŝůů ƌĞƋƵŝƌĞ ůŽĐĂů͕ ƌĞŐŝŽŶĂů ĂŶĚ ŶĂƟŽŶĂů ŝŶŝƟĂƟǀĞƐ ĚƌŝǀĞŶ ďǇ ƚŚĞ &W͕ ĐŚĂƉƚĞƌƐ ĂŶĚ ŵĞŵďĞƌƐ͘ But if my story communicates anything, it is that mentorship ŵĂƩĞƌƐ͊ &Žƌ ŵĞ͕ ŚĂǀŝŶŐ ŚĂĚ Ă ŵĞŶƚŽƌ ƚŽ ƚƵƌŶ ƚŽ ĨŽůůŽǁŝŶŐ Ă ďĂĚ grade, discouraging comments from a professor or struggling to ƵŶĚĞƌƐƚĂŶĚ DĞŶĚĞůŝĂŶ ŐĞŶĞƟĐƐ ǁŽƵůĚ ŚĂǀĞ ŵĂĚĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ĂŶŝĞůůĞ :ŽŶĞƐ͕ D Žƌ ĂŶŝĞůůĞ :ŽŶĞƐ͕ WŚ ͘ ŶĚ ǁŚŝůĞ mentorship can occur on a grand scale, like The Ladder in Minnesota Žƌ dŽƵƌ ĨŽƌ ŝǀĞƌƐŝƚǇ ŝŶ DĞĚŝĐŝŶĞ͕ ƚǁŽ ĂŵĂǌŝŶŐ ƉƌŽŐƌĂŵƐ ĨŽƵŶĚĞĚ ďǇ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ƐŽŵĞƟŵĞƐ ƚŚĞ ŵŽƐƚ ƐŝŐŶŝĮĐĂŶƚ ůĂƐƟŶŐ ŝŵƉĂĐƚ ĐĂŶ ďĞ ũƵƐƚ ďĞƚǁĞĞŶ ŝŶĚŝǀŝĚƵĂůƐ͘ / ĂƐŬ ǇŽƵ ƚŽ ĐŽŶƐŝĚĞƌ ǇŽƵƌ ĐĂƉĂĐŝƚǇ ĂŶĚ ŽƉƉŽƌƚƵŶŝƟĞƐ ŝŶ ǇŽƵƌ ĐŽŵŵƵŶŝƚǇ ƚŽ ŵĞŶƚŽƌ ƚŚĂƚ ŶĞǆƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ǁŝůů ďĞĐŽŵĞ ƚŚĞ Ϯϱ ƉĞƌĐĞŶƚ ďǇ ϮϬϯϬ͘ ǀĞŶ ŝŶ ǇŽƵƌ ƉĂƟĞŶƚ ĞŶĐŽƵŶƚĞƌƐ͕ ǇŽƵ ŚĂǀĞ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ĐƵůƟǀĂƚĞ Ă ĨƵƚƵƌĞ ƉŚǇƐŝĐŝĂŶ ǁŝƚŚ ƐĞǀĞŶ ǁŽƌĚƐ͕ ͞,ĂǀĞ ǇŽƵ ĞǀĞƌ ĐŽŶƐŝĚĞƌĞĚ ďĞŝŶŐ Ă ĚŽĐƚŽƌ͍͟

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County Health Rankings and ZŽĂĚŵĂƉƐ ;ϮϬϭϴͿ <ĂŶƐĂƐ͗ tǇĂŶĚŽƩĞ ŽƵŶƚǇ ŚƩƉ͗ͬͬǁǁǁ͘ ĐŽƵŶƚǇŚĞĂůƚŚƌĂŶŬŝŶŐƐ͘ŽƌŐͬĂƉƉͬ ŬĂŶƐĂƐͬϮϬϭϴͬŽǀĞƌǀŝĞǁ Montgomery, Rick. This Kansas County has no ethnic majority, but ŝƐ ŝƚ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ĚŝǀĞƌƐĞ ŝŶ h͘^͍͘ dŚĞ <ĂŶƐĂƐ ŝƚǇ ^ƚĂƌ͕ EŽǀ͘ ϲ͕ ϮϬϭϳ ĐĐĞƐƐĞĚ EŽǀĞŵďĞƌ ϳ͕ ϮϬϭϴ ĨƌŽŵ ŚƩƉƐ͗ͬͬǁǁǁ͘ŬĂŶƐĂƐĐŝƚǇ͘ĐŽŵͬŶĞǁƐͬ ůŽĐĂůͬĂƌƟĐůĞϭϴϯϬϲϬϰϵϭ͘Śƚŵů U.S. Census Bureau Quick Facts tǇĂŶĚŽƩĞ ŽƵŶƚǇ <ĂŶƐĂƐ ;ϮϬϭϳͿ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĞŶƐƵƐ͘ŐŽǀͬƋƵŝĐŬĨĂĐƚƐͬ ĨĂĐƚͬƚĂďůĞͬǁǇĂŶĚŽƩĞĐŽƵŶƚǇŬĂŶƐĂƐͬ W^dϬϰϱϮϭϳ hŶĞƋƵĂů dƌĞĂƚŵĞŶƚ͗ ŽŶĨƌŽŶƟŶŐ ZĂĐŝĂů ĂŶĚ ƚŚŶŝĐ ŝƐƉĂƌŝƟĞƐ ŝŶ ,ĞĂůƚŚ ĂƌĞ͘ tĂƐŚŝŶŐƚŽŶ͕ ͗ EĂƟŽŶĂů ĐĂĚĞŵǇ WƌĞƐƐ͖ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͖ ϮϬϬϮ͘ Laditka J. Physician Supply, physician diversity, and outcomes of primary healthcare for older persons in the United States. Health Place. ϮϬϬϰ͖ϭϬ;ϯͿ͗ϮϯϭʹϮϰϰ͘ Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity ĂŵŽŶŐ ƉŚǇƐŝĐŝĂŶƐ͗ ĂŶ ŝŶƚĞƌǀĞŶƟŽŶ ƚŽ ĂĚĚƌĞƐƐ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ͍ /Ŷ ^ŵĞĚůĞǇ ͕ ^ƟƚŚ z͕ ŽůďƵƌŶ >͕ Evans CH, (eds.). The Right Thing ƚŽ Ž͕ dŚĞ ^ŵĂƌƚ dŚŝŶŐ ƚŽ Ž͗ Enhancing Diversity in the Health WƌŽĨĞƐƐŝŽŶƐ͘ tĂƐŚŝŶŐƚŽŶ͕ ͗ EĂƟŽŶĂů ĐĂĚĞŵǇ WƌĞƐƐ͕ ϮϬϬϭ͘ ŽŽƉĞƌ > ͕ WŽǁĞ EZ͘ ŝƐƉĂƌŝƟĞƐ ŝŶ ƉĂƟĞŶƚ ĞǆƉĞƌŝĞŶĐĞƐ͕ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĐĞƐƐĞƐ͕ ĂŶĚ ŽƵƚĐŽŵĞƐ͗ ƚŚĞ ƌŽůĞ ŽĨ ƉĂƟĞŶƚͲƉƌŽǀŝĚĞƌ ƌĂĐŝĂů͕ ĞƚŚŶŝĐ͕ ĂŶĚ language concordance. Washington ͗ dŚĞ ŽŵŵŽŶǁĞĂůƚŚ &ƵŶĚ͕ ϮϬϬϰ͘ Grumbach K, Hart LG, Mertz E, ŽīŵĂŶ :͕ WĂůĂǌǌŽ >͘ tŚŽ ŝƐ ĐĂƌŝŶŐ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ͍ ĐŽŵƉĂƌŝƐŽŶ of primary care physicians and non-physician clinicians in California and Washington. Ann Fam Med. ϮϬϬϯ͖ϭ;ϮͿ͗ϵϳͲϭϬϰ͘ ĚŽŝ͗ϭϬ͘ϭϯϳϬͬ ĂĨŵ͘ϰϵ California Family Physician Winter 2019

ceo message

Lisa Folberg, MPP

CAFP empowers, educates and connects current and future family physicians to improve the health of all Californians ƚ ŵǇ ĮƌƐƚ ŽĂƌĚ ŵĞĞƟŶŐ ĂƐ ŚŝĞĨ ǆĞĐƵƟǀĞ KĸĐĞƌ͕ ƚŚĞ &W ŽĂƌĚ ƌĞǀŝĞǁĞĚ͕ ĚĞďĂƚĞĚ ĂŶĚ ĂĚŽƉƚĞĚ Ă ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ĨŽƌ ƚŚĞ ĐĂĚĞŵǇ͘ KƵƌ ŽďũĞĐƟǀĞ ǁĂƐ ƚŽ ŬĞĞƉ ŝƚ ƐŝŵƉůĞ͕ ǁŚŝůĞ ĐĂƉƚƵƌŝŶŐ ƚŚĞ ĞƐƐĞŶĐĞ ŽĨ ǁŚĂƚ &W ĚŽĞƐ͘ dŚŝƐ ǁĂƐ ŶŽ ĞĂƐǇ ĨĞĂƚ͘ dŚĞ ďƌĞĂĚƚŚ ĂŶĚ ĚĞƉƚŚ ŽĨ &W ĂĐƟǀŝƟĞƐ ĂĚĚƌĞƐƐŝŶŐ ĂĚǀŽĐĂĐǇ͕ ĞĚƵĐĂƟŽŶ͕ ƉƌĂĐƟĐĞ support, and nurturing future family physicians is astounding. CAFP empowers ŵĞŵďĞƌƐ ƚŚƌŽƵŐŚ ĂĚǀŽĐĂĐǇ ĂŶĚ ĞĚƵĐĂƟŽŶ͘ &W ŚĂƐ ďĞĞŶ ƉŚĞŶŽŵĞŶĂůůǇ ƐƵĐĐĞƐƐĨƵů ŝŶ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐǇ͕ ŝŶĐůƵĚŝŶŐ ƐĞĐƵƌŝŶŐ ŵŝůůŝŽŶƐ ŽĨ ĚŽůůĂƌƐ ŝŶ ĂĚĚŝƟŽŶĂů ĨƵŶĚŝŶŐ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ programs, lobbying to increase Medi-Cal rates and taking a lead role in ĞůŝŵŝŶĂƟŶŐ ǀĂĐĐŝŶĞ ƉĞƌƐŽŶĂů ďĞůŝĞĨ ĞǆĞŵƉƟŽŶƐ͘ /ƚ ŝƐ ŶŽ ǁŽŶĚĞƌ &W ŚĂƐ ƌĞĐĞŝǀĞĚ ƚŚĞ &W͛Ɛ ůĞĂĚĞƌƐŚŝƉ ŝŶ ƐƚĂƚĞ ŐŽǀĞƌŶŵĞŶƚ ĚǀŽĐĂĐǇ ǁĂƌĚ ĨŽƌ ƚŚĞ ĨŽƵƌƚŚ ƟŵĞ ŝŶ ĮǀĞ ǇĞĂƌƐ͘ /Ŷ ϮϬϭϵ͕ ǁĞ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ĞŶŐĂŐĞ ŝŶ ƚŚĞ ƉŽůŝƟĐĂů ůĂŶĚƐĐĂƉĞ ůŝŬĞ ŶĞǀĞƌ ďĞĨŽƌĞ͘ tŝƚŚ Ă ŶĞǁ 'ŽǀĞƌŶŽƌ ǁŚŽ ŚĂƐ ĚĞŵŽŶƐƚƌĂƚĞĚ Ă ĐŽŵŵŝƚŵĞŶƚ ƚŽ ĂĚĚƌĞƐƐŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ĐŚĂůůĞŶŐĞƐ͕ Ă W ƚŚĂƚ ǁŝůů ĂůŵŽƐƚ ƚƌŝƉůĞ ŝƚƐ ƉƌĞǀŝŽƵƐ ƐŝǌĞ͕ ĂŶĚ ĞŶĞƌŐŝǌĞĚ ƐƚĂī ĂŶĚ ƉŚǇƐŝĐŝĂŶ ůĞĂĚĞƌƐŚŝƉ͕ ƚŚŝƐ ŝƐ Ă ƟŵĞ ǁŚĞŶ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĐŽƵůĚ ĂŶĚ ƐŚŽƵůĚ ďĞ ƉŽƐŝƟŽŶĞĚ ĂƐ Ă ƚŚŽƵŐŚƚ ůĞĂĚĞƌ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ŝƐƐƵĞƐ͘ Ɛ ƚŚĞ ƐƚĂƚĞ ĂŶĚ ŶĂƟŽŶ ƐƚƌƵŐŐůĞ ǁŝƚŚ ĨƵŶĚĂŵĞŶƚĂů ƋƵĞƐƟŽŶƐ ĂƌŽƵŶĚ ƚŚĞ ĐŽƐƚ ĂŶĚ ĚĞůŝǀĞƌǇ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ services, family medicine has an opportunity through advocacy and ĞĚƵĐĂƟŽŶ ƚŽ ďĞ ƌĞĐŽŐŶŝǌĞĚ ĨŽƌ ŝƚƐ ĐĞŶƚƌĂů ƉůĂĐĞ ŝŶ ďƵŝůĚŝŶŐ Ă ďĞƩĞƌ ŚĞĂůƚŚ care system. ƉĂƌƚ ĨƌŽŵ ĞĚƵĐĂƟŶŐ ĞǆƚĞƌŶĂů ĂƵĚŝĞŶĐĞƐ ĂďŽƵƚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ &W ƉƌŽǀŝĚĞƐ Ă ŚƵŐĞ ĂƌƌĂǇ ŽĨ ĞĚƵĐĂƟŽŶĂů ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ͕ ƐƚĂƚĞǁŝĚĞ ĂŶĚ ŶĂƟŽŶĂůůǇ͕ ĂŶĚ ĞǀĞŶ ŝŶƚĞƌŶĂƟŽŶĂůůǇ͘ &W͛Ɛ ĐŽŵŵŝƚŵĞŶƚ ƚŽ educate includes accredited CME ĂĐƟǀŝƟĞƐ͕ ƉĞƌĨŽƌŵĂŶĐĞ ŝŵƉƌŽǀĞŵĞŶƚ ŵŽĚƵůĞƐ ĂŶĚ ĞŶĚƵƌŝŶŐ ƚŽŽůƐ ĂŶĚ ƌĞƐŽƵƌĐĞƐ͘ Ɛ Ă ƚĞƐƚĂŵĞŶƚ ƚŽ ƚŚĞ ƋƵĂůŝƚǇ ŽĨ &W͛Ɛ ĐůŝŶŝĐĂů ĞĚƵĐĂƟŽŶ͕ ǁĞ ŚĂǀĞ ďĞĞŶ ĂƐŬĞĚ ƚŽ ůĞĂĚ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ ŶĂƟŽŶĂůůǇ ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂůůǇ ŽŶ ƚŽƉŝĐƐ ĂƐ ĚŝǀĞƌƐĞ ĂƐ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ ĐĂƌĞ ƚŽ ŚĞƉĂƟƟƐ ͕ ƐĐŽƌĞƐ ƚŽ ƉĂŝŶ ŵĂŶĂŐĞŵĞŶƚ͘ ůŝŶŝĐĂů ŬŶŽǁůĞĚŐĞ ŝƐ Ă ŚƵŐĞůǇ ŝŵƉŽƌƚĂŶƚ ƉĂƌƚ ŽĨ ƉƌŽǀŝĚŝŶŐ ƋƵĂůŝƚǇ ĐĂƌĞ͕ ďƵƚ ďĞŝŶŐ ǁĞůů ŝŶĨŽƌŵĞĚ ŽŶ ŶŽŶͲĐůŝŶŝĐĂů ŝƐƐƵĞƐ ĐĂŶ ďĞ ĂƐ ŝŵƉŽƌƚĂŶƚ ŝŶ ŶĂǀŝŐĂƟŶŐ ǇŽƵƌ ƌĞƐƉŽŶƐŝďŝůŝƟĞƐ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ Ɛ ƐƵĐŚ͕ &W ƉƌŽǀŝĚĞƐ ĞĚƵĐĂƟŽŶ ŽŶ Ă ŚŽƐƚ ŽĨ ŝƐƐƵĞƐ ƚŚĂƚ ĂīĞĐƚ ǇŽƵƌ ƉƌĂĐƟĐĞ ŝŶĐůƵĚŝŶŐ ůĞĂĚĞƌƐŚŝƉ ĚĞǀĞůŽƉŵĞŶƚ͕ ƉŚǇƐŝĐŝĂŶ ǁĞůůŶĞƐƐ ĂŶĚ ǁĞĞŬůǇ ƵƉĚĂƚĞƐ ŽŶ ŶĞǁ ůĂǁƐ ĂŶĚ ƌĞŐƵůĂƟŽŶƐ͘ 30

California Family Physician Winter 2019

&W ƐƚĂī ĂŶĚ ƉŚǇƐŝĐŝĂŶ ůĞĂĚĞƌƐŚŝƉ ĚŽ ĂŶ ĞǆĐĞůůĞŶƚ ũŽď ĂĚǀŽĐĂƟŶŐ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ĚĞǀĞůŽƉŝŶŐ ƉŽůŝĐǇ͕ ƉƌŽǀŝĚŝŶŐ ĐůŝŶŝĐĂů ĂŶĚ ƉƌĂĐƟĐĞ ƐƵƉƉŽƌƚ to members, and keeping family physicians informed. But CAFP is so ŵƵĐŚ ŵŽƌĞ ƚŚĂŶ ĂŶ ĂĚǀŽĐĂĐǇ ŽƌŐĂŶŝǌĂƟŽŶ͕ ƉŽůŝĐǇ ĂĐĂĚĞŵǇ Žƌ ƉƵƌǀĞǇŽƌ ŽĨ ƉŚǇƐŝĐŝĂŶ ĞĚƵĐĂƟŽŶ͘ tŚĂƚ ďĞĐĂŵĞ ŽďǀŝŽƵƐ ŝŶ ƚŚĞ ĐƌĂŌŝŶŐ ŽĨ ƚŚĞ ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ŝƐ ƚŚĂƚ ǁŚĂƚ &W ŵĞĂŶƐ ƚŽ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝŶ ĂůŝĨŽƌŶŝĂ ŝƐ ĂƐ ŝŵƉŽƌƚĂŶƚ ĂƐ ƚŚĞ ĂĐƟǀŝƟĞƐ ŝŶ ǁŚŝĐŚ &W ĞŶŐĂŐĞƐ͘ &W ŚĞůƉƐ ŵĞŵďĞƌƐ ĐŽŶŶĞĐƚ ƚŽ ĞĂĐŚ ŽƚŚĞƌ ĂŶĚ ƌĞͲĐŽŶŶĞĐƚ ǁŝƚŚ ƚŚĞ ƉĂƐƐŝŽŶ ĂŶĚ ǀĂůƵĞƐ ƚŚĂƚ ŝŶƐƉŝƌĞĚ ƚŚĞŵ ƚŽ ďĞĐŽŵĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŝŶ ƚŚĞ ĮƌƐƚ place. tŚĞŶ ƐƚĂī ŶĞĞĚƐ ƚŽ ƌĞͲĐŽŶŶĞĐƚ ĂŶĚ ĞŶĞƌŐŝǌĞ͕ ƚŚĞǇ ƐƉĞŶĚ Ă ůŝƩůĞ ƟŵĞ ǁŝƚŚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ͘ dŚĞ ĞŶĞƌŐǇ ĂŶĚ ĐŽŵŵŝƚŵĞŶƚ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ŝƐ ŝŶĨĞĐƟŽƵƐ͘ &W ŝƐ ŚĞĂǀŝůǇ ŝŶǀĞƐƚĞĚ ŝŶ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƚŚƌŽƵŐŚ Ă ǁŝĚĞ ĂƌƌĂǇ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ĂĐƟǀŝƟĞƐ͕ ĨƌŽŵ ƚŚĞ ĂŶŶƵĂů &ĂŵŝůǇ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ ƚŽ ƉƌŽǀŝĚŝŶŐ ƐĐŚŽůĂƌƐŚŝƉƐ ĂŶĚ ƚŚĞ ŶĞǁ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕ ,ĞĂůƚŚ WŽůŝĐǇ &ĞůůŽǁƐŚŝƉ͘ Ɛ Ă ƌĞĐĞŶƚ ƚƌĂŶƐƉůĂŶƚ ƚŽ ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ / Ăŵ ƐƟůů ůŝŬĞ Ă ƚŽƵƌŝƐƚ͕ ƐƚŽƉƉŝŶŐ ƚŽ ƚĂŬĞ ŝŶ ƚŚĞ ďƌĞĂƚŚƚĂŬŝŶŐ ůĂŶĚƐĐĂƉĞ ĂƐ ŶĂƟǀĞƐ ĂƌĞ ǁŚŝǌǌŝŶŐ ďǇ ŵĞ ŶŽƚ ŶŽƟĐŝŶŐ ƚŚĞ ƐƵŶ ƐŚŝŶŝŶŐ ŽŶ ƚŚĞ ĂǇ͘ / Ăŵ ĂůƐŽ ůŝŬĞ ƚŚĂƚ ƚŽƵƌŝƐƚ ǁĂŶĚĞƌŝŶŐ through the impressive landscape of family medicine and CAFP. With ĨƌĞƐŚ ĞǇĞƐ / ŵĂƌǀĞů Ăƚ Ăůů ƚŚĂƚ ǇŽƵ ĚŽ ĨŽƌ ǇŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ Ăůů ƚŚĂƚ &W does for you. /Ŷ ŵǇ ĮƌƐƚ ƚŚƌĞĞ ŵŽŶƚŚƐ ǁŝƚŚ &W͕ / ŚĂǀĞ ŚĂĚ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ŵĞĞƚ ŵĂŶǇ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͘ zŽƵ ĂƌĞ ĂŶ ŝŵƉƌĞƐƐŝǀĞ ďƵŶĐŚ͕ ďĂůĂŶĐŝŶŐ ƉĞƌƐŽŶĂů ůŝǀĞƐ ĂŶĚ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞƐ ƐĞĞŵ challenging enough, but the family physicians I have met do even more. zŽƵ ĂƌĞ ĞŶŐĂŐĞĚ ŝŶ ƌĞƐĞĂƌĐŚ͕ ĐŽŵŵƵŶŝƚǇͲďĂƐĞĚ ƉƌŽũĞĐƚƐ ĂŶĚ ĞĚƵĐĂƟŽŶ͘ zŽƵ ĂƌĞ current and future family physicians, mentors and innovators. KƵƌ ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ŝƐ ƐŝŵƉůĞ͕ ďƵƚ ŝƚ ĐĂƉƚƵƌĞƐ ƐŽ ŵƵĐŚ ĂďŽƵƚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ /ƚ ƌĞŇĞĐƚƐ ƚŚĞ ŚƵŵŝůŝƚǇ ĂŶĚ ƉĂƐƐŝŽŶ ƚŚĂƚ ŝƐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ ƉĂƐƐŝŽŶ ŶŽƚ ďĂƐĞĚ ŽŶ ĞŐŽ͕ ďƵƚ ŽŶ Ă ĚƌŝǀĞ ƚŽ ĚŽ ƚŚĞ ƌŝŐŚƚ ƚŚŝŶŐ ĨŽƌ ƉĂƟĞŶƚƐ͘ tŚŝůĞ ǁĞ ĚĞďĂƚĞĚ ĂďŽƵƚ ƚŚĞ ǁŽƌĚƐ ƚŽ ĐĂƉƚƵƌĞ ƚŚĞ ǁŽƌŬ ĂŶĚ ƉĂƐƐŝŽŶ ŽĨ &W ŝŶ Ă ƐŝŶŐůĞ ƐĞŶƚĞŶĐĞ͕ ǁĞ ŚĂĚ ŝŵŵĞĚŝĂƚĞ ĐŽŶƐĞŶƐƵƐ ƚŚĂƚ ƚŚĞ ĞŶĚ ŐŽĂů ŽĨ ǇŽƵƌ ĐĂĚĞŵǇ͛Ɛ ǁŽƌŬ ŝƐ ŶŽƚ ƉƌĂĐƟĐĞ ŵĂŶĂŐĞŵĞŶƚ Žƌ ĞǀĞŶ ƉĂǇŵĞŶƚ͕ it is giving family physicians the support and tools they need to help their ƉĂƟĞŶƚƐ ůŝǀĞ ŚĞĂůƚŚŝĞƌ ůŝǀĞƐ ĂŶĚ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ Ăůů ĂůŝĨŽƌŶŝĂŶƐ. Ƶƚ ƚŚĂƚ ŝƐ ŽďǀŝŽƵƐ ƚŽ ǇŽƵ͕ ǇŽƵ ĚŝĚ ĂŌĞƌ Ăůů ĐŚŽŽƐĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘

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