Summer 2019 by California Academy of Family Physicians

VO L . 7 0 N O. 3 Summer 2019

CAFP Foundation's Susan Hogeland, CAE Health Policy Fellows Drs. Jessica Farmer and Adia Scrubb Take On Washington DC.

in this issue: FAMILY MEDICINE TACKLES SEXUALLY TRANSMITTED INFECTIONS

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

Staff Lisa Folberg, MPP

Chief Executive Officer lfolberg@familydocs.org

ŽŶƌĂĚ ŵĞŶƚĂ

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

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

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

:Ğƌƌŝ ĂǀŝƐ͕ , W

Director, CME/CPD jdavis@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

Josh Lunsford

Director, Membership and Marketing jlunsford@familydocs.org

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

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

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

The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year. Call 415-345-8667 to subscribe.

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California Family Physician Summer 2019

California

Summer 2019

FAMILY PHYSICIAN s t ro n g

m e d i c i n e

f o r

C a l i f o r n ia

KƵƌ ,ĞĂůƚŚ WŽůŝĐǇ &ĞůůŽǁƐ ǀŝƐŝƚĞĚ ƚŚĞ ^ƉĞĂŬĞƌ͛Ɛ ďĂůĐŽŶǇ͘

features 14 2019 Family Medicine Advocacy Summit Brings the FMRevolution to Congress 16 STIs in California: We Are Not Winning the Battle 20 Answering Questions about HIV Pre-Exposure Prophylaxis

Adam Francis Shelly B. Rodrigues, CAE, FACEHP Scott Nass, MD, MPA, FAAFP, AAHIVS

22 Strange Bedfellows: Adventures in sex and its least intended consequences

Ina Park, MD

24 To Be Syphilis Free, It’s Best to Do Three

Robert Assibey, MD

28 CME info & Quiz

departments 6

Editorial

Catching STIs is a Good Thing

President’s Message

Sex and STIs Never Get Old: Unveiling Unconscious Bias-Sexuality, STIs and Aging

10 Political Pulse

Brent Sugimoto, MD Walt Mills, MD

Ooooh We’re Halfway There!

Carla Kakutani, MD

Stand Up and Be Counted!

Lisa Folberg, MPP

12 In The News 30 CEO Message

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

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Catching STIs is a Good Thing dŚĞ ǁĂƌŶŝŶŐ ƐŝŐŶƐ ǁĞƌĞ ĂůǁĂǇƐ ƚŚĞƌĞ͘ Ɛ / ĐůŝĐŬĞĚ ƚŚƌŽƵŐŚ ŵǇ ƉĂƚŝĞŶƚ͛Ɛ ĐŚĂƌƚ͕ / ƐĂǁ ƚŚĞŵ͕ ůŽƚƐ ŽĨ ƚŚĞŵ͗ ŐŽŶŽƌƌŚĞĂ Ăƚ ĂŐĞ ϭϮ͕ ĐŚůĂŵǇĚŝĂ ŵƵůƚŝƉůĞ ƚŝŵĞƐ ƚŚƌŽƵŐŚ ĂĚŽůĞƐĐĞŶĐĞ͕ gonorrhea again and again, sometimes alongside chlamydia. / ƌĞǀŝĞǁĞĚ ŶŽƚĞƐ ĚŽĐƵŵĞŶƚŝŶŐ ĂĚŵŽŶŝƚŝŽŶƐ ŐŝǀĞŶ ƚŽ ƵƐĞ ĐŽŶĚŽŵƐ͘ / ƉŽƌĞĚ ƚŚƌŽƵŐŚ ŚŝƐ ĐŚĂƌƚ͕ ǇĞƚ ŶĞǀĞƌ ĨŽƵŶĚ ƚŚĞ ŽŶĞ ƐŝŐŶ / ǁĂƐ ůŽŽŬŝŶŐ ĨŽƌ ƚŽ ĐŽŵƉůĞƚĞ ƚŚĞ ƐƚŽƌǇ͘ / ŵĞƚ ŵǇ ƉĂƚŝĞŶƚ ǇĞĂƌƐ ůĂƚĞƌ ǁŚĞŶ ŚĞ ƚŚŽƵŐŚƚ ŚĞ ŚĂĚ ƐƚƌĞƉ ƚŚƌŽĂƚ͘ dŚĞ ƐŽƌĞ ƚŚƌŽĂƚ ĂŶĚ ƐǁŽůůĞŶ ůǇŵƉŚ ŶŽĚĞƐ Ĩŝƚ ƚŚĂƚ ƉŝĐƚƵƌĞ͕ ďƵƚ ŽƚŚĞƌ ƉƵǌǌůĞ ƉŝĞĐĞƐ Ͷ ůŝŬĞ ƚŚĞ ŚŝŐŚ ĨĞǀĞƌ͕ ĂŶĚ ŵŽƌĞ ŽŵŝŶŽƵƐůǇ͕ ƚŚĞ ĐŚĞƐƚ ƉĂŝŶ Ͷ ĚŝĚ ŶŽƚ͘ ƉŽƐŝƚŝǀĞ ,/s ƚĞƐƚ ǁĂƐ ƚŚĞ ŵŝƐƐŝŶŐ ƉŝĞĐĞ͕ ĂŶĚ ĂŶ ƵƉƉĞƌ ĞŶĚŽƐĐŽƉǇ ĨŽƌ his chest pain finding candida esophagitis completed the ƉŝĐƚƵƌĞ͘ DǇ ƉĂƚŝĞŶƚ ŚĂĚ ĂŶ / ^ͲĚĞĨŝŶŝŶŐ ŝůůŶĞƐƐ͘ /Ŷ ƚŚĞ ĞƌĂ ŽĨ ĐĂŵƉĂŝŐŶƐ ƉƌŽŵŝƐŝŶŐ ǌĞƌŽ ŶĞǁ ,/s ŝŶĨĞĐƚŝŽŶƐ͕ ŵǇ ƉĂƚŝĞŶƚ ŚĂĚ Ă ĚŝĂŐŶŽƐŝƐ ŽĨ / ^ ǁŝƚŚ ŚŝƐ ǀĞƌǇ ĨŝƌƐƚ ,/s ƚĞƐƚ͘ ,Ğ ǁĂƐ only 17-years-old. California is the first amongst all states for chlamydia, ŐŽŶŽƌƌŚĞĂ ĂŶĚ ƐǇƉŚŝůŝƐ ; ͕ ϮϬϭϲͿ͘ KƵƌ ƐƚĂƚĞ ĂůƐŽ ŚĂƐ ƚŚĞ ƐĞĐŽŶĚ ŚŝŐŚĞƐƚ ŶƵŵďĞƌ ŽĨ ŶĞǁ ,/s ĚŝĂŐŶŽƐĞƐ͕ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϱ͕ϬϬϬ ƉĞŽƉůĞ ƚĞƐƚŝŶŐ ƉŽƐŝƚŝǀĞ ĂŶŶƵĂůůǇ ; ͕ ϮϬϭϳͿ͘ dŚĞƐĞ ƚǁŽ ƐƚĂƚŝƐƚŝĐƐ ĂƌĞ ŶŽƚ ƵŶƌĞůĂƚĞĚ͘ ^ĞǆƵĂůůǇ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶƐ ;^d/ƐͿ ĂŶĚ ,/s ǁŽƌŬ ƐǇŶĚĞŵŝĐĂůůǇ ƚŽ ƉƌŽƉĞů ƚŚĞ ,/s ĞƉŝĚĞŵŝĐ ƚŚƌŽƵŐŚ ŝŶĐƌĞĂƐĞĚ ƐƵƐĐĞƉƚŝďŝůŝƚǇ ĨƌŽŵ ^d/ ĐŽͲ ŝŶĨĞĐƚŝŽŶ͘ ŽŶƐŝĚĞƌ ƚŚĂƚ ŽŶĞ ŝŶ ϭϱ ŵĞŶͲǁŚŽͲŚĂǀĞͲƐĞǆͲǁŝƚŚͲ ŵĞŶ ;D^DͿ ǁŝƚŚ ƌĞĐƚĂů ŐŽŶŽƌƌŚĞĂ Žƌ ĐŚůĂŵǇĚŝĂ ǁŝůů ďĞĐŽŵĞ ,/s ƉŽƐŝƚŝǀĞ ǁŝƚŚŝŶ ŽŶĞ ǇĞĂƌ͕ ĂŶĚ ƚŚĂƚ ŽŶĞ ŝŶ ϭϯ D^D ǁŝƚŚ ƐǇƉŚŝůŝƐ ǁŝůů ƐŝŵŝůĂƌůǇ ƐĞƌŽĐŽŶǀĞƌƚ ǁŝƚŚ ,/s ;^ŽůŽŵŽŶ Ğƚ Ăů͕͘ ϮϬϭϰ͖ ĞƌŶƐƚĞŝŶ Ğƚ Ăů͕͘ ϮϬϬϵͿ͘ ĚĚ ƚŽ ƚŚŝƐ ƚŚĞ ƌĞĞŵĞƌŐĞŶĐĞ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ͕ ĂŶĚ ŝƚ ŝƐ ƉůĂŝŶ ƚŽ ƐĞĞ ƚŚĂƚ ^d/Ɛ ĂƌĞ Ă ƉƵďůŝĐ ŚĞĂůƚŚ ĐƌŝƐŝƐ ǁŝƚŚ ƚŚĞ ƉŽƚĞŶƚŝĂů ƚŽ ĐĂƵƐĞ Ă ůŝĨĞƚŝŵĞ ŽĨ complications. >ŝŬĞ ŵŽƐƚ ŚĞĂůƚŚ ŝƐƐƵĞƐ ŝŶ ŽƵƌ ĐŽƵŶƚƌǇ͕ ^d/Ɛ ĂƌĞ ĂŶ ŝƐƐƵĞ ŽĨ ƐŽĐŝĂů ĂŶĚ ŚĞĂůƚŚ ĞƋƵŝƚǇ͘ ĨƌŝĐĂŶͲ ŵĞƌŝĐĂŶƐ ĞǆƉĞƌŝĞŶĐĞ ,/s͕ ƐǇƉŚŝůŝƐ ĂŶĚ ŐŽŶŽƌƌŚĞĂ Ăƚ ƌĂƚĞƐ ĨŽƵƌ͕ ĨŝǀĞ ĂŶĚ ϭϬ ƚŝŵĞƐ͕ ƌĞƐƉĞĐƚŝǀĞůǇ͕ ƚŚĞ ƌĂƚĞƐ ƐĞĞŶ ŝŶ ǁŚŝƚĞ ŵĞƌŝĐĂŶƐ͘ >ĂƚŝŶŽ D^D ŚĂǀĞ Ă ŽŶĞͲŝŶͲĨŽƵƌ ĐŚĂŶĐĞ ŽĨ ďĞĐŽŵŝŶŐ ,/s ƉŽƐŝƚŝǀĞ ŝŶ ƚŚĞŝƌ ůŝĨĞƚŝŵĞ͕ ǁŚŝůĞ ďůĂĐŬ D^D ŚĂǀĞ Ă ŽŶĞͲŝŶͲƚǁŽ ĐŚĂŶĐĞ͘ Family physicians have all the tools to help alter the course

California Family Physician Summer 2019

ŽĨ ƚŚĞ ^d/ ĞƉŝĚĞŵŝĐ ŝŶ ŽƵƌ ƐƚĂƚĞ͘ / ŚŽƉĞ ǇŽƵ ǁĂůŬ ĂǁĂǇ ĂƌŵĞĚ ǁŝƚŚ ƐŽŵĞ ŶĞǁ͕ ƵƐĞĨƵů ƚŽŽůƐ ƚŽ ƐĞƌǀĞ ŽƵƌ ƉĂƚŝĞŶƚƐ ŝŶ ƚŚĞŝƌ ƐĞǆƵĂů ŚĞĂůƚŚ ŶĞĞĚƐ͘ /Ŷ ƚŚŝƐ ŝƐƐƵĞ͕ ǇŽƵ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚǇ to earn CME while learning about it! &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ƌ͘ /ŶĂ WĂƌŬ͕ Ă ŶĂƚŝŽŶĂů ĞǆƉĞƌƚ ĂŶĚ ĞĚƵĐĂƚŽƌ ŽŶ ^d/Ɛ͕ ƚĂůŬƐ ĂďŽƵƚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĐŽƵŶƚĞƌŝŶŐ ƚŚĞ ƐƚŝŐŵĂ ƐƵƌƌŽƵŶĚŝŶŐ ƚŚŝƐ ĂƐƉĞĐƚ ŽĨ ƐĞǆƵĂů ŚĞĂůƚŚ͘ &W WƌĞƐŝĚĞŶƚ ƌ͘ tĂůƚ DŝůůƐ ŐŝǀĞƐ ƵƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ĞǆĂŵƉůĞ ĂďŽƵƚ ŶĞǀĞƌ ŵĂŬŝŶŐ ĂƐƐƵŵƉƚŝŽŶƐ ĂďŽƵƚ ŽƵƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞŝƌ ƐĞǆƵĂů ŚĞĂůƚŚ͘ ƌ͘ ^ĐŽƚƚ EĂƐƐ ǁĂůŬƐ ƵƐ ƚŚƌŽƵŐŚ͕ ƐƚĞƉͲďǇͲƐƚĞƉ͕ ŚŽǁ ƚŽ ŽĨĨĞƌ Ă ƉŽƚĞŶƚŝĂůůǇ ůŝĨĞͲƐĂǀŝŶŐ ƚƌĞĂƚŵĞŶƚ͕ ,/s ƉƌĞͲĞǆƉŽƐƵƌĞ ƉƌŽƉŚǇůĂǆŝƐ ;Wƌ WͿ͕ ƚŽ ƉĂƚŝĞŶƚƐ ǁŚŽ ŵĂǇ ďĞ Ăƚ ƌŝƐŬ ĨŽƌ ,/s͘ CAFP Resident Council co-chair Rob Assibey describes his ŚŽƐƉŝƚĂů͛Ɛ ǁŽƌŬ ǁŝƚŚ ƉƌĞŶĂƚĂů ƐǇƉŚŝůŝƐ͘ ŶĚ͕ &W ĞƉƵƚǇ ǆĞĐƵƚŝǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚ ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ ƐĞƚƐ ƚŚĞ ƐƚĂŐĞ ǁŝƚŚ the data and tools and resources for your practice. DǇ ƉĂƚŝĞŶƚ͕ ĂŶ ĨƌŝĐĂŶͲ ŵĞƌŝĐĂŶ ǇŽƵƚŚ͕ ĨŽůůŽǁĞĚ Ă ƐƚĂƚŝƐƚŝĐĂů destiny in a health system that should have offered him ƚŚĞ ƚŽŽůƐ ƚŽ ĨŽƌŐĞ Ă ĚŝĨĨĞƌĞŶƚ ƉĂƚŚ͗ ƌĞŐƵůĂƌ ĂŶĚ ƐŝƚĞͲ ĂƉƉƌŽƉƌŝĂƚĞ ;ƉŚĂƌǇŶŐĞĂů͕ ƌĞĐƚĂů͕ ĂŶĚ ƵƌĞƚŚƌĂůͿ ^d/ ƐĐƌĞĞŶŝŶŐ͕ ƌŝƐŬ ƌĞĚƵĐƚŝŽŶ ƐƚƌĂƚĞŐŝĞƐ͕ ƚŚĞ ŽƉƚŝŽŶ ŽĨ ,/s Wƌ W͕ ĂŶĚ ŵŽƐƚ ĐƌŝƚŝĐĂůůǇ͕ ĂŶ ,/s ƚĞƐƚ͘ /ŶƐƚĞĂĚ͕ ŚĞ ǁŝůů ŶŽǁ ůŝǀĞ ŚŝƐ ĞŶƚŝƌĞ ĂĚƵůƚŚŽŽĚ ǁŝƚŚ ƚŚĞ ĚŝĂŐŶŽƐŝƐ ŽĨ / ^͘ dŚĞ ŵĞĚŝĐĂů ƐǇƐƚĞŵ ĐĂŶ ƐĞƌǀĞ ŽƵƌ ƉĂƚŝĞŶƚƐ ďĞƚƚĞƌ͘ >Ğƚ͛Ɛ ƐŚŽǁ ƚŚĞŵ ŚŽǁ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĐĂŶ ůĞĂĚ ƚŚĞ ǁĂǇ͘ References 1.

Bernstein, KT. JL Marcus et al. Rectal Gonorrhea and ŚůĂŵǇĚŝĂ ZĞŝŶĨĞĐƚŝŽŶ /Ɛ ƐƐŽĐŝĂƚĞĚ tŝƚŚ /ŶĐƌĞĂƐĞĚ ZŝƐŬ ŽĨ ,/s ^ĞƌŽĐŽŶǀĞƌƐŝŽŶ͘ : / ^͘ ϮϬϬϵ͗ ϭͲϳ͘ Ϯ͘ ,ĞĂůƚŚ ŝƐƉĂƌŝƚŝĞƐ ŝŶ ,/sͬ / ^͕ sŝƌĂů ,ĞƉĂƚŝƚŝƐ͕ ^d Ɛ͕ ĂŶĚ d ͘ ͘ ϮϬϭϲ͘ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬŚĞĂůƚŚĚŝƐƉĂƌŝƚŝĞƐͬ ĂĨƌŝĐĂŶĂŵĞƌŝĐĂŶƐ͘Śƚŵů͘ ĐĐĞƐƐĞĚ :ƵŶĞ ϭ͕ ϮϬϭϵ͘ 3. ,/s ŝĂŐŶŽƐĞƐ͕ ďǇ dŽƉ ϭϬ ^ƚĂƚĞƐ͘ ͘ ϮϬϭϳ͘ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ ŐŽǀͬŚŝǀͬƐƚĂƚŝƐƚŝĐƐͬŽǀĞƌǀŝĞǁͬŝŶĚĞǆ͘Śƚŵů͘ ĐĐĞƐƐĞĚ :ƵŶĞ ϭ͕ ϮϬϭϵ͘ ϰ͘ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ ^ƵƌǀĞŝůůĂŶĐĞ͘ ͘ ϮϬϭϲ͘ ŚƚƚƉ͗ͬͬ ǁǁǁ͘ĐĚĐ͘ŐŽǀͬƐƚĚͬƐƚĂƚƐ͘ ĐĐĞƐƐĞĚ :ƵŶĞ Ϯ͕ ϮϬϭϵ͘ 5. ^ŽůŽŵŽŶ͕ DD͘ <, DĂǇĞƌ Ğƚ Ăů͘ ^ǇƉŚŝůŝƐ WƌĞĚŝĐƚƐ ,/s /ŶĐŝĚĞŶĐĞ ŵŽŶŐ DĞŶ ĂŶĚ dƌĂŶƐŐĞŶĚĞƌ tŽŵĞŶ tŚŽ ,ĂǀĞ ^Ğǆ tŝƚŚ DĞŶ ŝŶ Ă WƌĞĞǆƉŽƐƵƌĞ WƌŽƉŚǇůĂǆŝƐ dƌŝĂů͘ / ͘ ϮϬϭϰ;ϱϵͿ͗ ϭϬϮϬ Ͳ ϭϬϮϲ͘

p r e s i d e n t ’s m e s s a g e

Walt Mills, MD

Sex and STIs Never Get Old: Unveiling Unconscious Bias-Sexuality, STIs and Aging :ŽŚŶ͕ Ă ϳϰͲǇĞĂƌͲŽůĚ >ĂƚŝŶŽ ŵĂŶ͕ ƐĞĞƐ ǇŽƵ͕ ŚŝƐ ͞ŶĞǁ͟ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ĨŽƌ ŚŝƐ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ ǆĂŵ͘ ,ŝƐ ƐĐƌĞĞŶŝŶŐ W,YϮ ŝƐ ϮͬϮ͘ ,ŝƐ 'ĞƌŝĂƚƌŝĐ ĞƉƌĞƐƐŝŽŶ ^ĐĂůĞ ƐĐŽƌĞ ŽĨ ϳͬϭϱ ƐƵŐŐĞƐƚƐ ĚĞƉƌĞƐƐŝŽŶ͘ ,Ğ ƚĞůůƐ ǇŽƵ ŚĞ ŝƐ ŚĂǀŝŶŐ ƚƌŽƵďůĞ ƐůĞĞƉŝŶŐ͕ ŚĂƐ ŵŝůĚ ĂŶǆŝĞƚǇ ĂŶĚ ŚĂƐ ƐƚŽƉƉĞĚ seeing friends for lunch recently. He’s lost 15 pounds unintentionally since his last visit. He has diabetes, ŚǇƉĞƌƚĞŶƐŝŽŶ ĂŶĚ ůŽŽŬƐ ͞ŽůĚ͟ ƚŽĚĂǇ͘ “My wife and I divorced 25 years ago, when my children were young. I have a roommate and am in a relationship.” dŚĞ ,ĞĂůƚŚ ZŝƐŬ ƉƉƌĂŝƐĂů ǇŽƵ ƵƐĞ ĨŽƌ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ DĞĚŝĐĂƌĞ ĂŶĚ DĞĚŝĐĂŝĚ ; D^Ϳ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ ŚĂƐ ŶŽ ŵĞŶƚŝŽŶ ŽĨ ƐĞǆƵĂů ŚŝƐƚŽƌǇ͘ ,ŽǁĞǀĞƌ͕ ǇŽƵ ũƵƐƚ ƌĞĂĚ ĂŶ ĂƌƚŝĐůĞ ƐĂǇŝŶŐ͕ ŽŶůǇ ϯϴ ƉĞƌĐĞŶƚ ŽĨ ŵĞŶ ĂŶĚ ϮϮ ƉĞƌĐĞŶƚ ŽĨ ǁŽŵĞŶ ƌĞƉŽƌƚĞĚ ŚĂǀŝŶŐ ĚŝƐĐƵƐƐĞĚ ƐĞǆ ǁŝƚŚ ƚŚĞŝƌ ƉŚǇƐŝĐŝĂŶ ƐŝŶĐĞ ƚŚĞ ĂŐĞ ŽĨ ϱϬ ǇĞĂƌƐ͕͟ ƐŽ ǇŽƵ ĂƐŬ͕ “are you sexually active?” John replies “yes.͟ zŽƵ ĂƐŬ ƚŚĞ ƐĂŵĞ ĨŝǀĞ ͞WƐ͟ ǇŽƵ ĂƐŬ ǇŽƵƌ ǇŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ ǁŚĞŶ ĚŽŝŶŐ Ă ƐĞǆƵĂů ŚŝƐƚŽƌǇ ;ƉĂƌƚŶĞƌƐ͕ ƉƌĂĐƚŝĐĞƐ͕ ƉƌŽƚĞĐƚŝŽŶ ĨƌŽŵ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ /ŶĨĞĐƚŝŽŶƐ ;^d/ƐͿ͕ ƉĂƐƚ ŚŝƐƚŽƌǇ ŽĨ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞƐ ;^d ƐͿ͕ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ƉƌĞŐŶĂŶĐǇͿ ͙ ƐƚĂƌƚŝŶŐ ǁŝƚŚ ͞ƉĂƌƚŶĞƌƐ͘͟ “Have your sexual partners been men, women or both?” (You are surprised you ĂƌĞ ĂƐŬŝŶŐ Ă ƐĞƉƚƵĂŐĞŶĂƌŝĂŶ ƚŚŝƐ͕ ďƵƚ ǇŽƵ ĚŝĚ ŚĞĂƌ Ăƚ ǇŽƵƌ ůĂƐƚ &W D ƚŚŝƐ ǁĂƐ ŐŽŽĚ ƉƌĂĐƚŝĐĞͿ͘ :ŽŚŶ ĂŶƐǁĞƌƐ͕ “Both.” Your conversation deepens and you learn John has been in Ă ŵŽŶŽŐĂŵŽƵƐ ƌĞůĂƚŝŽŶƐŚŝƉ ĨŽƌ ϮϬ ǇĞĂƌƐ ǁŝƚŚ Ă ŵĂŶ͘ “No physician has had this conversation with me. My family doesn’t know, I’m still in ’the closet’.” Trusting you, he goes on. “You know, none of my other doctors have ever asked me about who I’m dating or if I’m having sex. I’ve never had a chance to tell them I was with another guy. I think they assume because I’m older, Latino and not married any longer, I must be straight, single and not sexually active.” Fact: ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƚŝĞŶƚƐ ƐĞĞŶ ŝŶ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͛ ŽĨĨŝĐĞƐ ĂƌĞ ŽǀĞƌ ĂŐĞ ϲϱ͘ ^ĞǆƵĂů ŚĞĂůƚŚ ŝƐ ůŝŶŬĞĚ ƚŽ ŵĂŶǇ

California Family Physician Summer 2019

important health outcomes. Yet, it is not a standard ƋƵĞƐƚŝŽŶ ŝŶ ƚŚĞ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ͘ tĞ ĚŽ ĂƐŬ ĂďŽƵƚ ŝŶĐŽŶƚŝŶĞŶĐĞ͕ ĨĂůůƐ͕ ĐŽŐŶŝƚŝŽŶ ĂŶĚ ŽƚŚĞƌ ƌĞƋƵŝƌĞĚ ŐĞƌŝĂƚƌŝĐ ƐǇŶĚƌŽŵĞƐ ǁŚŝĐŚ Ăƚ ƚŚŝƐ ƉŽŝŶƚ ĂƌĞ ŶŽƚ ƌĞůĞǀĂŶƚ ƚŽ :ŽŚŶ͛Ɛ ŚĞĂůƚŚ ĐŽŶĐĞƌŶƐ͘ Fact: tŚŝůĞ ůĞǀĞůƐ ŽĨ ƐĞǆƵĂů ĂĐƚŝǀŝƚǇ ĚĞĐůŝŶĞ ǁŝƚŚ ĂŐĞ͕ ŵĂŶǇ ŵĞŶ ĂŶĚ ǁŽŵĞŶ ƌĞŵĂŝŶ ƐĞǆƵĂůůǇ ĂĐƚŝǀĞ ƵŶƚŝů ƚŚĞ ĞŝŐŚƚŚ ĂŶĚ ŶŝŶƚŚ ĚĞĐĂĚĞƐ ŽĨ ůŝĨĞ͘ ^ĞǆƵĂů ƉƌŽďůĞŵƐ ĂƌĞ ĨƌĞƋƵĞŶƚ ĂŵŽŶŐ older adults, but these problems are infrequently discussed ǁŝƚŚ ƉŚǇƐŝĐŝĂŶƐ͘ DŽƌĞ ƚŚĂŶ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƚŝĞŶƚƐ ďĞƚǁĞĞŶ ĂŐĞ ϲϱͲϳϰ ĂŶĚ Ϯϲ ƉĞƌĐĞŶƚ ďĞƚǁĞĞŶ ĂŐĞ ϳϱͲϴϰ ƌĞƉŽƌƚ ďĞŝŶŐ ƐĞǆƵĂůůǇ ĂĐƚŝǀĞ͘ :ŽŚŶ ŝƐ ŽŶĞ ĂŶĚ ǇĞƚ ŶĞǀĞƌ ŚĂĚ Ă ƉŚǇƐŝĐŝĂŶ ƉƌŽǀŝĚĞ ƚŚĞ ĞĚƵĐĂƚŝŽŶ͕ ĐŽƵŶƐĞůŝŶŐ Žƌ ƐĐƌĞĞŶŝŶŐ ǁĞ ǁŽƵůĚ Ăůů ƉƌŽǀŝĚĞ ĨŽƌ ǇŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ͘ Fact: WŚǇƐŝĐŝĂŶƐ ŵĂǇ ŵŝƐƚĂŬĞŶůǇ ĂƐƐƵŵĞ ĂŶ ŽůĚĞƌ ƉĂƚŝĞŶƚ ŝƐ ŚĞƚĞƌŽƐĞǆƵĂů͘ KůĚĞƌ >ĞƐďŝĂŶ͕ 'ĂǇ dƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŝƐĞǆƵĂů ;>'d Ϳ ƉĂƚŝĞŶƚƐ ĂƌĞ ŬŶŽǁŶ ĂƐ ƚŚĞ ͞ŝŶǀŝƐŝďůĞ ŐĞŶĞƌĂƚŝŽŶ͟ ďĞĐĂƵƐĞ ƚŚĞǇ ĂƌĞ ŵƵĐŚ ůĞƐƐ ůŝŬĞůǇ ƚŽ ĚŝƐĐůŽƐĞ ƚŚĞŝƌ ŽƌŝĞŶƚĂƚŝŽŶ ƚŽ ƉŚǇƐŝĐŝĂŶƐ͕ ĨĂŵŝůǇ Žƌ ŽƚŚĞƌƐ ǁŚŽ ĐŽƵůĚ support them better. >' d ŽůĚĞƌ ƉĞŽƉůĞ ǁŚŽ ĨŽƵŐŚƚ ƚŚĞ ĨŝƌƐƚ ďĂƚƚůĞƐ ĨŽƌ ĞƋƵĂůŝƚǇ ŶŽǁ ĨĂĐĞ ƐƵĐŚ ĨĞĂƌ ŽĨ ƌĞůŝŐŝŽƵƐ ŽďũĞĐƚŝŽŶ͕ bullying and abuse ƚŚĂƚ ŵĂŶǇ ĂƌĞ ŚŝĚŝŶŐ ƚŚĞŝƌ ŝĚĞŶƚŝƚŝĞƐ͘ / ƌĞĐŽŵŵĞŶĚ Gen Silent, a critically acclaimed documentary about >' d ƐĞŶŝŽƌƐ ŐŽŝŶŐ ďĂĐŬ ŝŶƚŽ ƚŚĞ ĐůŽƐĞƚ ƚŽ ƐƵƌǀŝǀĞ͕ ƐƚƵŵĂĚĚƵǆ͘ĐŽŵͬ&/>D^͘Śƚŵů KƚŚĞƌ ĚĂƚĂ ĂďŽƵƚ ^d/Ɛ ŝŶ ŽƵƌ ƐĞŶŝŽƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞ increases in cases in all patient categories are included ǁŝƚŚ ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͛ ĂƌƚŝĐůĞ ŽŶ ƉĂŐĞ ϭϲ͘ WůĞĂƐĞ ƌĞĨĞƌ ƚŽ it for details. My Reflection: / ŚĂǀĞ ďĞĞŶ Ă ĐĞƌƚŝĨŝĞĚ ŐĞƌŝĂƚƌŝĐŝĂŶ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ϯϬ ǇĞĂƌƐ͕ ĂŶĚ / ŬŶŽǁ / ŚĂǀĞ ĚŽŶĞ ƉŽŽƌůǇ ŝŶ ĂƐŬŝŶŐ ĂďŽƵƚ ƐĞǆ͘ Ɛ ĚŝƌĞĐƚŽƌ ŽĨ ŽƵƌ ŐĞƌŝĂƚƌŝĐƐ ĐƵƌƌŝĐƵůƵŵ Ăƚ EĂƚŝǀŝĚĂĚ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐǇ͕ / ďĞůŝĞǀĞ ƌĞƐŝĚĞŶĐŝĞƐ ĂƌĞ ŶŽƚ ĚŽŝŶŐ ĂƐ ŐŽŽĚ Ă ũŽď ĂƐ ǁĞ ŵƵƐƚ ŝŶ ĞĚƵĐĂƚŝŶŐ ŽƵƌ ĨƵƚƵƌĞ family physicians in this regard.

tŚǇ͍ ^ŽŵĞ ƐĂǇ͕ ǁĞ ĚŽŶ͛ƚ ŚĂǀĞ ƚŝŵĞ͘ WĞƌŚĂƉƐ ǁĞ ĚŽ ƐƵĐŚ Ă ƉŽŽƌ ũŽď ďĞĐĂƵƐĞ ŽĨ ŽƵƌ ůĂĐŬ ŽĨ ĞĚƵĐĂƚŝŽŶ ĂďŽƵƚ ƐĞǆƵĂů ŚŝƐƚŽƌǇ ƚĂŬŝŶŐ͕ ĚŝƐĐŽŵĨŽƌƚ ƚĂůŬŝŶŐ ĂďŽƵƚ ƐĞǆ Žƌ ŽƵƌ ŝŶĐŽƌƌĞĐƚ ĂƐƐƵŵƉƚŝŽŶƐ ĂŶĚ ďŝĂƐ ƚŚĂƚ ŽůĚĞƌ ĂĚƵůƚƐ ĂƌĞ ŶŽƚ ƐĞǆƵĂůůǇ ĂĐƚŝǀĞ͘ tĞ ƚŚŝŶŬ ŽůĚĞƌ ĂĚƵůƚƐ ĚŽ ŶŽƚ ǁĂŶƚ ƵƐ ƚŽ ƚĂůŬ ĂďŽƵƚ ƐĞǆ͘ ĐƚƵĂůůǇ͕ ŵĂŶǇ ĂƌĞ ƐĞǆƵĂůůǇ ĂĐƚŝǀĞ ĂŶĚ wish that their family physician talked with them about sex. ĐƚŝŽŶ͗ / ĂƐŬ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ͗ • /ŶĐůƵĚŝŶŐ ĐŽŶǀĞƌƐĂƚŝŽŶƐ ĂďŽƵƚ ƐĞǆƵĂů ďĞŚĂǀŝŽƌ ǁŝƚŚ ŽůĚĞƌ ĂĚƵůƚ ƉĂƚŝĞŶƚƐ ŝŶ ƚŚĞ ƐĂŵĞ ǁĂǇ ǇŽƵ ĚŽ ǁŝƚŚ ǇŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ͕ ŝŶĐůƵĚŝŶŐ ĞĚƵĐĂƚŝŶŐ ƚŚĞŵ ĂƉƉƌŽƉƌŝĂƚĞůǇ ĂďŽƵƚ ƚŚĞ ǁŽƌƌŝƐŽŵĞ ƵƉǁĂƌĚ ƚƌĞŶĚ ŝŶ ^d/Ɛ͘ zŽƵ ĚŽŶ͛ƚ ǁĂŶƚ ǇŽƵƌ ƉĂƚŝĞŶƚƐ ƚŽ ďĞ ƉĂƌƚ ŽĨ ƚŚŽƐĞ statistics. • /ŶĐůƵĚŝŶŐ ĚŽŝŶŐ ĐĞƌǀŝĐĂů ĐǇƚŽůŽŐǇ ;ƉĂƉͲŶŽƚ ƌĞĐŽŵŵĞŶĚĞĚ ĂĨƚĞƌ ĂŐĞ ϲϱ ŽƚŚĞƌǁŝƐĞͿ͕ ,Ws ƐĐƌĞĞŶŝŶŐ͕ ŚůĂŵǇĚŝĂͬ' ͕ ,/s͕ ZWZ ĂŶĚ ŽƚŚĞƌ ^d/ ƐĐƌĞĞŶŝŶŐ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ ŝĨ ƚŚĞ ŚŝƐƚŽƌǇ ƌĞǀĞĂůƐ ͞ƌŝƐŬƐ͟ ;ũƵƐƚ ĂƐ ǁĞ ǁŽƵůĚ ƉƌŽǀŝĚĞ ĨŽƌ ǇŽƵŶŐĞƌ

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ĂƚͲƌŝƐŬ ƉĂƚŝĞŶƚƐͿ͘ DĞĚŝĐĂƌĞ ƉĂǇƐ ĨŽƌ ƐƵĐŚ ƚĞƐƚŝŶŐ ĂŶĚ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞ WƌĞǀĞŶƚŝǀĞ ^ĞƌǀŝĐĞƐ ;h^W^d&Ϳ ƌĞĐŽŵŵĞŶĚƐ ŝŶƚĞŶƐŝǀĞ ďĞŚĂǀŝŽƌĂů ĐŽƵŶƐĞůŝŶŐ ĨŽƌ Ăůů ƐĞǆƵĂůůǇ ĂĐƚŝǀĞ ĂĚƵůƚƐ ǁŚŽ ĂƌĞ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ ĨŽƌ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶƐ͘ ; ZĞĐŽŵŵĞŶĚĂƚŝŽŶͿ As a family physician, you are critically important in ƐƚŽƉƉŝŶŐ ƚŚĞ ƐƉƌĞĂĚ ŽĨ ,/s ;ŝƚ ŝƐ ŐƌŽǁŝŶŐ ĨĂƐƚĞƐƚ ŝŶ ŽůĚĞƌ ĂĚƵůƚ ƉŽƉƵůĂƚŝŽŶƐͿ ďǇ ĚŝƐĐƵƐƐŝŶŐ ƉƌĞͲĞǆƉŽƐƵƌĞ ƉƌŽƉŚǇůĂǆŝƐ ǁŝƚŚ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͕ ǁŚŝĐŚ ŵĂǇ ŝŶĐůƵĚĞ ƐŽŵĞ of your geriatric patients. ŽŶƚŝŶƵĂůůǇ ƌĞĨůĞĐƚŝŶŐ ŽŶ ƚŚĞ ƵŶĐŽŶƐĐŝŽƵƐ ďŝĂƐĞƐ͕ ǁĞ all may have that affect our ability to effectively care for our older patients, given the many biopsychosocial ŚĞĂůƚŚ ŝƐƐƵĞƐ ƌĞůĂƚĞĚ ƚŽ ƐĞǆƵĂůŝƚǇ ĂŶĚ ƐĞǆƵĂů ďĞŚĂǀŝŽƌ͘

&ŝŶĂůůǇ͕ ůĞƚ͛Ɛ ƌĂŝƐĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ŝŵƉƌŽǀŝŶŐ ĐĂƌĞ ĨŽƌ ŽƵƌ ŽůĚĞƌ ƉĂƚŝĞŶƚƐ͘ ŝƐĐƵƐƐ ƚŚŝƐ ǁŝƚŚ ǇŽƵƌ ĐŽůůĞĂŐƵĞƐ͖ ƐŚŽǁ ƚŚĞŵ ƚŚŝƐ ĂƌƚŝĐůĞ ĂŶĚ ƚŚĞ ĂƚƚĂĐŚĞĚ ǀŝĚĞŽƐ͘ >Ğƚ͛Ɛ ĚŽ ŽƵƌ ƉĂƌƚ ŝŶ ĚĞĐƌĞĂƐŝŶŐ ^d/ ƌĂƚĞƐ ĂŶĚ ŝŵƉƌŽǀŝŶŐ ƉĂƚŝĞŶƚ ĐĂƌĞ in California!

California Family Physician Summer 2019

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

Ooooh We’re Halfway There!

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&ƵŶĚŝŶŐ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌǇ ĂƌĞ WŚǇƐŝĐŝĂŶ Workforce Program at $33 Million a Year in Perpetuity. dŚŝƐ ŝƐ Ă D :KZ ǁŝŶ ĨŽƌ &W͘ &ŽƵƌ ǇĞĂƌƐ ĂŐŽ͕ &W ŚĞůƉĞĚ ƐĞĐƵƌĞ ΨϭϬϬ ŵŝůůŝŽŶ ŝŶ 'ĞŶĞƌĂů &ƵŶĚ ŵŽŶŝĞƐ ƚŽ ďĞ ƐƉĞŶƚ ŽǀĞƌ ĨŝǀĞ ǇĞĂƌƐ ŝŶ ƐƵƉƉŽƌƚ ŽĨ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ ĨƵŶĚƐ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ƚƌĂŝŶŝŶŐ primary care physicians in underserved areas treating underserved populations. With that time-limited ŝŶǀĞƐƚŵĞŶƚ ƐŽŽŶ ƚŽ ĞǆƉŝƌĞ͕ ĂůŝĨŽƌŶŝĂ ŝƐ ƉŽŝƐĞĚ ƚŽ ŵĂŬĞ ĂŶ ŝŶĐƌĞĚŝďůĞ ŽŶŐŽŝŶŐ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ŐƌŽǁ ŽƵƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ ŝŶ ƚŚĞ ƌĞŐŝŽŶƐ ǁŚĞƌĞ they are needed most. &ƵůůǇ &ƵŶĚŝŶŐ ƚŚĞ WƌŽƉ ϱϲ DĞĚŝͲ Ăů WƌŽǀŝĚĞƌ WĂǇŵĞŶƚ /ŶĐƌĞĂƐĞ͕ EŽǁ ZĞĂĐŚŝŶŐ ΨϮ͘Ϯ ŝůůŝŽŶ͘ After several ǇĞĂƌƐ ŽĨ ŽŶůǇ ƉĂƌƚŝĂů ĨƵŶĚŝŶŐ͕ ƚŚĞ ŶĞǁ EĞǁƐŽŵ Administration has called for full and complete use of ƚŚĞ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ĨƵŶĚƐ ƐĞƚ ĂƐŝĚĞ ĨŽƌ ŝŶĐƌĞĂƐŝŶŐ DĞĚŝͲ Cal provider payment. ΨϱϬϬ DŝůůŝŽŶ ƚŽ ƌĞĂƚĞ Ă sĂůƵĞͲ ĂƐĞ WĂǇŵĞŶƚ WƌŽŐƌĂŵ ŝŶ DĞĚŝͲ Ăů DĂŶĂŐĞĚ ĂƌĞ͘ dŚŝƐ ŶĞǁ ƉƌŽŐƌĂŵ ƉƌŽǀŝĚĞƐ ŝŶĐĞŶƚŝǀĞ ƉĂǇŵĞŶƚƐ ƚŽ ŵĂŶĂŐĞĚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ǁŚŽ meet specific achievement on metrics targeting such areas as behavioral health integration, pediatric preventive care, prenatal and postpartum care and chronic disease management. ǆƉĂŶĚŝŶŐ &Ƶůů ^ĐŽƉĞ DĞĚŝͲ Ăů ŽǀĞƌĂŐĞ ƚŽ ůů ůŝŐŝďůĞ WĞŽƉůĞ hŶĚĞƌ ŐĞ Ϯϲ͘ dŚŝƐ ĞǆƉĂŶƐŝŽŶ ƐƉĞĐŝĨŝĐĂůůǇ covers individuals regardless of immigration status. Transitioning Medi-Cal Pharmacy Services Out of DĂŶĂŐĞĚ ĂƌĞ ĂŶĚ /ŶƚŽ Ă &ĞĞͲ&ŽƌͲ^ĞƌǀŝĐĞ ĞŶĞĨŝƚ͘ dŚĞ ĚŵŝŶŝƐƚƌĂƚŝŽŶ ďĞůŝĞǀĞƐ ƚŚŝƐ ǁŝůů ƐĂǀĞ ŶĞĂƌůǇ ΨϰϬϬ million a year on pharmaceutical costs.

^ƉĞĂŬŝŶŐ ŽĨ ŚĂůĨǁĂǇ ƚŚĞƌĞ͕ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ ƌĞĐĞŶƚůǇ ƉĂƐƐĞĚ ŽƵƚ ŽĨ ƚŚĞ ƐƐĞŵďůǇ ĂŶĚ ŝƐ ŚĞĂĚĞĚ 10

California Family Physician Summer 2019

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With the skills and training to care for the whole family, family medicine encourages continuity of care, which reduces health care costs and improves outcomes.

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tĞůů͕ ŵǇ ĨĞůůŽǁ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ǁĞ ĂƌĞ ŚĂůĨǁĂǇ ƚŚƌŽƵŐŚ ƚŚĞ ůĞŐŝƐůĂƚŝǀĞ ǇĞĂƌ ĂŶĚ ǁĞ͛ƌĞ ĚŽŝŶŐ ĨĂƌ ďĞƚƚĞƌ ƚŚĂŶ ůŝǀŝŶŐ ŽŶ Ă ƉƌĂǇĞƌ͘ dŚĞ ĐŚĂŶŐĞ ŝŶ ŐŽǀĞƌŶŽƌ ĨƌŽŵ :ĞƌƌǇ ƌŽǁŶ ƚŽ 'ĂǀŝŶ EĞǁƐŽŵ ŚĂƐ ůĞĚ ƚŽ Ă ƐŝŐŶŝĨŝĐĂŶƚ ŝŶĐƌĞĂƐĞ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ƉŽůŝĐǇ activity. This has translated into major budget proposals to ƐƵƉƉŽƌƚ ĂŶĚ ƌĞĨŽƌŵ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ͘ Ɛ / ǁƌŝƚĞ ƚŚŝƐ͕ the governor and legislative leaders are putting the final ƚŽƵĐŚĞƐ ŽŶ ĂŶ ĞǆƚĞŶƐŝǀĞůǇ ŶĞŐŽƚŝĂƚĞĚ ďƵĚŐĞƚ ƚŚĂƚ ŝŶĐůƵĚĞƐ͗

ƚŽ ƚŚĞ ^ĞŶĂƚĞ͘ ϭϲϮϮ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĂŶĚ misinformed restrictions on family physicians, no longer ƉƌĞǀĞŶƚŝŶŐ ƵƐ ĨƌŽŵ ĨƵůůͲƐƉĞĐƚƌƵŵ ƉƌĂĐƚŝĐĞ͕ ǁŚŝĐŚ ǁĞ ǁĞƌĞ Ăůů ƚƌĂŝŶĞĚ ƚŽ ƉƌŽǀŝĚĞ͘ Ɛ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ǁĞ ŚĂǀĞ ĞǆƚĞŶƐŝǀĞ and comprehensive training that enables us to provide high quality primary care to EVERY member of the family regardless of a patient’s gender, age or affected organ system, from birth to end-of-life. Over time, regulators, legislators, health systems and others have restricted and underutilized family physicians. This has limited access to care, restricted patient choice and disrupted continuity for individuals and ĨĂŵŝůŝĞƐ͘ dŚĞ ďƌĞĂĚƚŚ ĂŶĚ ĚĞƉƚŚ ŽĨ ŽƵƌ ƚƌĂŝŶŝŶŐ ĂůůŽǁƐ ƵƐ ƚŽ adapt our practices to meet the specific medical needs of our ĐŽŵŵƵŶŝƚǇ͘ tŝƚŚ ƚŚĞ ƐŬŝůůƐ ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ĨĂŵŝůǇ͕ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĞŶĐŽƵƌĂŐĞƐ ĐŽŶƚŝŶƵŝƚǇ ŽĨ ĐĂƌĞ͕ ǁŚŝĐŚ reduces health care costs and improves outcomes.

tĂŶƚ ƚŽ ŚĞůƉ ŝŶ ŽƵƌ ĞĨĨŽƌƚƐ ƚŽ ƉĂƐƐ ϭϲϮϮ͍ dĂŬĞ ŵǇ ŚĂŶĚ͖ ǁĞ͛ůů ŵĂŬĞ ŝƚ / ƐǁĞĂƌ͊ ^ŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞǇ ŽŶƚĂĐƚ ďǇ emailing our Director of Government Relations, Adam Francis, afrancis@familydocs.org.

IN THE NEWS Summer 2019 Ăƌƌ &ŝƌĞ͕ ĂŶĚ ǁŚĂƚ ǁĂƐ ĞǆĐŝƟŶŐ ŝƐ ŝĨ ǇŽƵ͛ƌĞ Ă ĨĂŵŝůǇ ƉƌĂĐƟĐĞ doctor, you can see everybody. You can see babies to adults, ĞǀĞƌǇƚŚŝŶŐ͘ ŶĚ ŝƚ͛͛ ũƵƐƚ ƐŽ ĞǆĐŝƟŶŐ ƚŽ ƐĞĞ ƚŚĞŵ ůŝŬĞ ĐůŝĐŬ ŝŶ ƚŚĞŝƌ ŚĞĂĚ͕ ǁŽǁ͕ ůŽŽŬ Ăƚ Ăůů ƚŚĞ ƚŚŝŶŐƐ / ĐĂŶ ĚŽ͕ ĂŶĚ ůŽŽŬ Ăƚ Ăůů ƚŚĞ ƉŽƉƵůĂƟŽŶ / ĐĂŶ ƐĞƌǀĞ͕ ƐŽ ƚŚĂƚ͛Ɛ ƚŚĞ ďĞƐƚ ƉĂƌƚ ŽĨ ŵǇ ũŽď͕͟ ƐĂŝĚ ƌ͘ >ƵƉĞŝŬĂ ŝŶ ƚŚĞ ƐĂŵĞ ŶĞǁƐĐĂƐƚ͘ >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW,͕ &W͛Ɛ sŝĐĞ ^ƉĞĂŬĞƌ͕ ǁŝůů ƐĞƌǀĞ ĂƐ Ă ŵĞĚŝĐĂů ƚĞĂŵ ŵĞŵďĞƌ ŽĨ ƚŚĞ /ŶƚĞƌŶĂƟŽŶĂů ^ĞƌǀŝĐĞ dĞĂŵ ;/^dͿ ĨŽƌ ƚŚĞ tŽƌůĚ ^ĐŽƵƚ :ĂŵďŽƌĞĞ ǁŚŝĐŚ ŝƐ ďĞŝŶŐ ŚŽƐƚĞĚ ďǇ EŽƌƚŚ ŵĞƌŝĐĂ Ăƚ ƚŚĞ EĂƟŽŶĂů ^ĐŽƵƚ 'ƌŽƵŶĚƐ Ăƚ ĞĐŚƚĞů ^Ƶŵŵŝƚ ZĞƐĞƌǀĞ ŝŶ :ƵůǇ͘ DŽƌĞ ƚŚĂŶ ϰϬ͕ϬϬϬ ^ĐŽƵƚƐ ĨƌŽŵ ϭϲϵ ĐŽƵŶƚƌŝĞƐ ĂƌĞ ĞǆƉĞĐƚĞĚ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ũĂŵďŽƌĞĞ͕ ĂŶĚ ƚŚĞ ŵĞĚŝĐĂů ƚĞĂŵ ;ƉŚǇƐŝĐŝĂŶƐ͕ ŶƵƌƐĞƐ ĂŶĚ DdƐͿ ǁŝůů ďĞ ĚŝǀŝĚĞĚ ŝŶƚŽ ďĂƐĞ ĐĂŵƉƐ ʹ >ĂƵƌĞŶ ǁŝůů ďĞ Ăƚ ĂƐĞ ĂŵƉ ůƉŚĂ ĐĂƌŝŶŐ ĨŽƌ ϳ͕ϬϬϬ ƐĐŽƵƚƐ ĂŶĚ /^d ŵĞŵďĞƌƐ͘ ͞dŚŝƐ ŝƐ Ă ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ƵƐĞ ŵǇ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚŚĞƌĂƉĞƵƟĐ ƐŬŝůůƐ͕ ůŝƚĞƌĂůůǇ ͛ŽƵƚ ŝŶ ƚŚĞ ĮĞůĚ͛͘ tĞ͛ůů ǁŽƌŬ ŝŶ ĮĞůĚ ƚĞŶƚƐ͕ ĂƌŵĞĚ ǁŝƚŚ ƐƚĞƚŚŽƐĐŽƉĞƐ͕ ŽƚŽƐĐŽƉĞƐ͕ W ĐƵīƐ͕ ĮƌƐƚ ĂŝĚ ƐƵƉƉůŝĞƐ ĂŶĚ /sƐ ĂƐ ǁĞ ǁŝůů ĐĂƌĞ ĨŽƌ Ăůů ƚŚĞ ŵĞĚŝĐĂů ĂŶĚ ŵĞŶƚĂů ŚĞĂůƚŚ ŶĞĞĚƐ ƚŚĂƚ ĂƌŝƐĞ ĂƐ ƚŚĞ ^ĐŽƵƚƐ ƉĂƌƟĐŝƉĂƚĞ ŝŶ Ă ƉůĞƚŚŽƌĂ ŽĨ ǁŝůĚĞƌŶĞƐƐ͕ ƐƉŽƌƟŶŐ ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂů ĐŽůůĂďŽƌĂƟǀĞ ĂĐƟǀŝƟĞƐ͘ / Ăŵ ƐƵƉĞƌ ĞǆĐŝƚĞĚ ƚŽ ƌĞƉƌĞƐĞŶƚ ƚŚĞ h^ ͕ ǁŽƌŬŝŶŐ ĐŽůůĂďŽƌĂƟǀĞůǇ ĂŶĚ ĞǆĐŚĂŶŐŝŶŐ ŝĚĞĂƐ ǁŝƚŚ ŵĞĚŝĐĂů ĐŽůůĞĂŐƵĞƐ ĨƌŽŵ EŽƌƚŚ ŵĞƌŝĐĂ ĂŶĚ ŽƚŚĞƌ ƌĞŐŝŽŶƐ ǁŚŝůĞ ĐĂƌŝŶŐ ĨŽƌ ^ĐŽƵƚƐ ĂŶĚ ƐƵƉƉŽƌƚ ƐƚĂī ĨƌŽŵ ĂƌŽƵŶĚ ƚŚĞ ǁŽƌůĚ͊͟ W^͗ ŝĚ ǁĞ ŵĞŶƟŽŶ ƚŚĞ ŵĞĚŝĐĂů ƚĞĂŵ ĂůƐŽ ƐůĞĞƉƐ ŝŶ ƚĞŶƚƐ ĨŽƌ ƚŚĞ ƚǁŽͲǁĞĞŬ :ĂŵďŽƌĞĞ͍ dŚĞ ƐƐŽĐŝĂƟŽŶ ŽĨ ůŝŶŝĐŝĂŶƐ ĨŽƌ the Underserved named &W Member Debbie Lupeika ǁŝƚŚ ŝƚƐ ϮϬϭϵ ůŝŶŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ ĂǁĂƌĚ͘ ƌ͘ >ƵƉĞŝŬĂ ǁŽƌŬƐ ǁŝƚŚ residents at Mercy Medical Center in Redding and at Shasta Community College Health ĞŶƚĞƌ ǁŚŝĐŚ ƐĞƌǀĞƐ ƉƌŝŵĂƌŝůǇ uninsured or underinsured ƉĂƟĞŶƚƐ͘ ͞^ŚĞ ůŝǀĞƐ ĂŶĚ breathes this teaching program, teaching residents, teaching young people, and passing on ƚŚĞ ŬŶŽǁůĞĚŐĞ͕ ƚŚĞ ůĞĂƌŶŝŶŐ ĂŶĚ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ƚŚĞ ŶĞǆƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĐůŝŶŝĐŝĂŶƐ ƚŽ ƚĂŬĞ ĐĂƌĞ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ͕͟ ƐĂŝĚ Dean Germano, the CEO of Shasta Community Health Center ŝŶ Ă ƌĞĐĞŶƚ ŝŶƚĞƌǀŝĞǁ ŽŶ <Z Z EĞǁƐ͘ ƌ͘ >ƵƉĞŝŬĂ ŝƐ ĂůƐŽ ďĞŝŶŐ honored for her advocacy for residency programs in rural ĂƌĞĂƐ ůŝŬĞ ƚŚĞ EŽƌƚŚ ^ƚĂƚĞ͘ ͞tĞ ǁĞƌĞ ƐĞĞŝŶŐ ƉĂƟĞŶƚƐ Ăƚ ƚŚĞ ƐŚĞůƚĞƌ ǁŚŽ͛Ě ďĞĞŶ ĚŝƐƉůĂĐĞĚ ĨƌŽŵ ƚŚĞŝƌ ŚŽƵƐĞƐ ĚƵƌŝŶŐ ƚŚĞ 12

California Family Physician Summer 2019

:ĂĐŬ ŚŽƵ͕ D ͕ &W ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ŝƐ ŶŽǁ ƚĂŬŝŶŐ ŽŶ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͘ :ĂĐŬ ŝƐ ƌƵŶŶŝŶŐ ĨŽƌ sŝĐĞ ^ƉĞĂŬĞƌ ŽĨ ƚŚĞ D ,ŽƵƐĞ ŽĨ ĞůĞŐĂƚĞƐ͘ dŚĞ ĞůĞĐƟŽŶ ǁŝůů ďĞ ŚĞůĚ ĚƵƌŝŶŐ ƚŚĞ D ,ŽƵƐĞ͕ KĐƚŽďĞƌ ϮϲͲϮϳ͕ ŝŶ ŶĂŚĞŝŵ͘ :ĂĐŬ ŝƐ ĐƵƌƌĞŶƚůǇ a member of the CMA Board of Trustees and has served as a member of the AAFP Board of Directors. He believes the ƐƚƌĞŶŐƚŚ ŽĨ ƚŚĞ ŽƌŐĂŶŝǌĂƟŽŶ ŝƐ ƚŚĞ ǀŽŝĐĞ ŽĨ ŝƚƐ ŵĞŵďĞƌƐ͘ ͞/ƚ ŝƐ ĐƌŝƟĐĂů ƚŚĂƚ ƚŚĞ sŝĐĞ ^ƉĞĂŬĞƌ ŚĂƌŶĞƐƐ ĂŶĚ ƐƵƐƚĂŝŶ ƚŚĞ ĐŽůůĞĐƟǀĞ voice of the House of Delegates and be that voice of our ŵĞŵďĞƌƐŚŝƉ ŽŶ ƚŚĞ ǆĞĐƵƟǀĞ ŽŵŵŝƩĞĞ͘ tŝƚŚ Ă ƐƚƌŽŶŐ͕ ƵŶŝƚĞĚ͕ ĂŶĚ ĨŽĐƵƐĞĚ ǀŽŝĐĞ͕ ǁĞ ĐĂŶ ƐƚƌŝǀĞ ƚŽŐĞƚŚĞƌ ƚŽ ĞŶŚĂŶĐĞ ƚŚĞ ůŝǀĞƐ ŽĨ Ăůů ƚŚĞ ƉŚǇƐŝĐŝĂŶƐ͕ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ŽĨ ĂůŝĨŽƌŶŝĂ͘͟ :ĂĐŬ ŝƐ ĨĂĐŝŶŐ ĐŽŵƉĞƟƟŽŶ ĨƌŽŵ ƚǁŽ ŽƚŚĞƌ ĐĂŶĚŝĚĂƚĞƐ͕ ďƵƚ ŽƵƌ ǀŽƚĞƐ ĂƌĞ ǁŝƚŚ Śŝŵ ĂƐ ĂŶ ƵƉĐŽŵŝŶŐ ůĞĂĚĞƌ Ăƚ ƚŚĞ D ůĞǀĞů͘ dŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ŚŽǁ ǇŽƵ ĐĂŶ ĂƐƐŝƐƚ :ĂĐŬ͕ contact Adam Francis.

Adam Francis CAFP Director of Government Relations

2019 Family Medicine Advocacy Summit Brings the FMRevolution to Congress /Ŷ ůĂƚĞ DĂǇ͕ ŶĞĂƌůǇ ϯϬϬ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ ĐŽŶǀĞƌŐĞĚ ŽŶ ŽƵƌ ŶĂƟŽŶ͛Ɛ ĂƉŝƚĂů ĨŽƌ ƚŚĞ &W &ĂŵŝůǇ DĞĚŝĐŝŶĞ ĚǀŽĐĂĐǇ ^Ƶŵŵŝƚ ;&D ^Ϳ͘ dŚĞ ŐŽĂů͗ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚƐ ŝŶ ŵĞĞƟŶŐƐ ǁŝƚŚ ŽƵƌ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ĂŶĚ ƐĞŶĂƚŽƌƐ͘ &W͛Ɛ &D ^ ŝƐ ǀĞƌǇ ƐŝŵŝůĂƌ ƚŽ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ĂŶĚ >ŽďďǇ ĂǇ͕ ďƵƚ ŝƐ ĚĞƐŝŐŶĞĚ ƚŽ ďƌŝŶŐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͛Ɛ ŵĞƐƐĂŐĞ ƚŽ ĨĞĚĞƌĂů ůĂǁŵĂŬĞƌƐ͘ &W ĮĞůĚĞĚ ŝƚƐ ďŝŐŐĞƐƚ ĚĞůĞŐĂƟŽŶ ĞǀĞƌ ǁŝƚŚ ŶĞĂƌůǇ ϮϬ ĂĚǀŽĐĂƚĞƐ ŝŶ ŽƵƌ ƌĂŶŬƐ͊ DŽƌĞ ƚŚĂŶ ϮϴϬ ŵĞĞƟŶŐƐ ǁĞƌĞ ƐĐŚĞĚƵůĞĚ͕ ĂŶĚ η&D ^ϭϵ ƚƌĞŶĚĞĚ ŝŶ ͕ ĂŶĚ ǁĞ ŚĂĚ ŶĞĂƌůǇ ĨŽƵƌ ŵŝůůŝŽŶ ƉŽƚĞŶƟĂů ŝŵƉƌĞƐƐŝŽŶƐ͘ dŚŝƐ ǇĞĂƌ͕ ŽƵƌ ĂĚǀŽĐĂƚĞƐ ĨŽĐƵƐĞĚ ŽŶ ĮǀĞ ŬĞǇ ŝƐƐƵĞƐ͗ • Teaching Health Centers ʹ &W ƵƌŐĞƐ ƉŽůŝĐǇ ŵĂŬĞƌƐ ƚŽ reauthorize and fully fund the Teaching Health Center 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ;d, 'D Ϳ ƉƌŽŐƌĂŵ͘ ^ĞŶƐ͘ ^ƵƐĂŶ ŽůůŝŶƐ ;ZͲD Ϳ ĂŶĚ :ŽŶ dĞƐƚĞƌ ; ͲDdͿ͕ ĂŶĚ ZĞƉƐ͘ ZĂƵů

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ZƵŝǌ ; Ͳ Ϳ ĂŶĚ ĂƚŚǇ DĐDŽƌƌŝƐ ZŽĚŐĞƌƐ ;ZͲt Ϳ ŝŶƚƌŽĚƵĐĞĚ ƚŚĞ dƌĂŝŶŝŶŐ ƚŚĞ EĞǆƚ 'ĞŶĞƌĂƟŽŶ ŽĨ WƌŝŵĂƌǇ ĂƌĞ ŽĐƚŽƌƐ Đƚ ŽĨ ϮϬϭϵ ;^͘ ϭϭϵϭͬ ,Z ϮϴϭϱͿ͘ dŚĞ ůĞŐŝƐůĂƟŽŶ ĂƵƚŚŽƌŝǌĞƐ ƚŚĞ d, 'D ƉƌŽŐƌĂŵ ŽǀĞƌ ĮǀĞ ǇĞĂƌƐ ĂŶĚ ƐƵƉƉŽƌƚƐ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ŶĞǁ ƉƌŽŐƌĂŵƐ ǁŝƚŚ Ă ƉƌŝŽƌŝƚǇ ĨŽƌ ƚŚŽƐĞ ŝŶ ƌƵƌĂů ĂŶĚ ƵŶĚĞƌƐĞƌǀĞĚ ĐŽŵŵƵŶŝƟĞƐ͘ dŚĞ ďŝůůƐ ǁŽƵůĚ ĂůƐŽ ŝŶĐƌĞĂƐĞ ĨƵŶĚŝŶŐ ĨƌŽŵ ΨϭϮϲ͘ϱ ŵŝůůŝŽŶ ƉĞƌ ǇĞĂƌ ;ĐƵƌƌĞŶƚ ůĂǁͿ ƚŽ Ψϭϰϭ͘ϱ ŵŝůůŝŽŶͬǇĞĂƌ ;^͘ϭϭϵϭͿ ĂŶĚ Ψϭϱϭ ŵŝůůŝŽŶͬǇĞĂƌ ;,Z ϮϴϭϱͿ͘ 'D >ĞŐŝƐůĂƟŽŶ ŝŶ ƚŚĞ ϭϭϲƚŚ ŽŶŐƌĞƐƐ ʹ &W ƌĞĐŽŵŵĞŶĚƐ ŽŶŐƌĞƐƐ ƌĞĨŽƌŵ DĞĚŝĐĂƌĞ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ĮŶĂŶĐŝŶŐ ƚŽ ĂĚĚƌĞƐƐ ŝŶĞƋƵŝƟĞƐ͕ ŝŵƉƌŽǀĞ ĂĐĐŽƵŶƚĂďŝůŝƚǇ ĂŶĚ train more family physicians. The AAFP urges legislators to cosponsor the Advancing Medical Resident Training in ŽŵŵƵŶŝƚǇ ,ŽƐƉŝƚĂůƐ Đƚ ;,Z ϭϯϱϴͿ ĂŶĚ ƚŚĞ ZƵƌĂů WŚǇƐŝĐŝĂŶ tŽƌŬĨŽƌĐĞ WƌŽĚƵĐƟŽŶ Đƚ ;^ ϮϴϵͿ͘

&WĞƌƐ ǀŝƐŝƚ ƚŚĞ ŽĸĐĞƐ ŽĨ h^ ŽŶŐƌĞƐƐŵĂŶ ZĂƵů ZƵŝǌ͕ D ͕ DW, ;ĐĞŶƚĞƌͿ ǁŚŝůĞ ĂƩĞŶĚŝŶŐ ƚŚĞ &W͛Ɛ &ĂŵŝůǇ DĞĚŝĐŝŶĞ ĚǀŽĐĂĐǇ ^Ƶŵŵŝƚ͘ 14

California Family Physician Summer 2019

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'ƵŶ sŝŽůĞŶĐĞ WƌĞǀĞŶƟŽŶ ZĞƐĞĂƌĐŚ ʹ &W ƌĞĐŽŵŵĞŶĚƐ ŽŶŐƌĞƐƐ ĂĚĚƌĞƐƐ ŐƵŶ ǀŝŽůĞŶĐĞ ĂƐ Ă ŶĂƟŽŶĂů ƉƵďůŝĐ ŚĞĂůƚŚ ĞƉŝĚĞŵŝĐ ĂŶĚ ĂƉƉƌŽƉƌŝĂƚĞ ΨϱϬ ŵŝůůŝŽŶ ŝŶ ĮƐĐĂů ǇĞĂƌ ϮϬϮϬ ƚŽ ĐŽŶĚƵĐƚ ƉƵďůŝĐ ŚĞĂůƚŚ ƌĞƐĞĂƌĐŚ ŝŶƚŽ ĮƌĞĂƌŵ ŵŽƌďŝĚŝƚǇ ĂŶĚ ŵŽƌƚĂůŝƚǇ ƉƌĞǀĞŶƟŽŶ͘ Congressional Primary Care Caucus ʹ &W ďĞůŝĞǀĞƐ ƚŚŝƐ ďŝƉĂƌƟƐĂŶ ĐĂƵĐƵƐ ǁŝůů ŵĂŬĞ ŐƌĞĂƚ ƐƚƌŝĚĞƐ ŝŶ ĞĚƵĐĂƟŶŐ ůĞŐŝƐůĂƚŽƌƐ͕ ƐƚĂī͕ ĂŶĚ ƚŚĞ ƉƵďůŝĐ ŽŶ ƉƌŝŵĂƌǇ ĐĂƌĞ ŝƐƐƵĞƐ͕ ĞǆƉĞƌŝĞŶĐĞƐ͕ ĂŶĚ ĐŽŶĐĞƌŶƐ͘ &W ĞŶĐŽƵƌĂŐĞƐ Ăůů ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞ ŵĞŵďĞƌƐ ƚŽ ũŽŝŶ ŝƚ͘ WƌŝŵĂƌǇ ĂƌĞ WĂƟĞŶƚ WƌŽƚĞĐƟŽŶ Đƚ ŽĨ ϮϬϭϵ ʹ &W ƵƌŐĞƐ ,ŽƵƐĞ ŵĞŵďĞƌƐ ƚŽ ĐŽƐƉŽŶƐŽƌ ƚŚĞ WƌŝŵĂƌǇ ĂƌĞ WĂƟĞŶƚ WƌŽƚĞĐƟŽŶ Đƚ ŽĨ ϮϬϭϵ ;,Z ϮϳϳϰͿ͕ Ă ďŝůů ƐƉŽŶƐŽƌĞĚ ďǇ ZĞƉƐ͘ ƌĂĚ ^ĐŚŶĞŝĚĞƌ ; Ͳ/>Ϳ ĂŶĚ ůŝƐĞ ^ƚĞĨĂŶŝŬ ;ZͲEzͿ͘ dŚĞ ďŝůů ǁŽƵůĚ ŵĂŬĞ ŝƚ ŵŽƌĞ ĂīŽƌĚĂďůĞ ĨŽƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ŚŝŐŚ ĚĞĚƵĐƟďůĞ ŚĞĂůƚŚ ƉůĂŶƐ ƚŽ ĂĐĐĞƐƐ ƉƌŝŵĂƌǇ ĐĂƌĞ͘

&W ŚĂĚ ŝƚƐ ůĂƌŐĞƐƚ ĞǀĞƌ ĐŽŶƟŶŐĞŶĐǇ Ăƚ ƚŚŝƐ ǇĞĂƌ͛Ɛ &D ^͘

zŽƵ ĐĂŶ ŚĞůƉ ƚŚĞ ĮŐŚƚ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ďǇ ƵƐŝŶŐ &W͛Ɛ ^W < Khd ǁĞďƐŝƚĞ ĂŶĚ ƵƌŐŝŶŐ ŽŶŐƌĞƐƐ ƚŽ ƌĞĂƵƚŚŽƌŝǌĞ ĂŶĚ ĨƵůůǇ ĨƵŶĚ ƚŚĞ dĞĂĐŚŝŶŐ ,ĞĂůƚŚ ĞŶƚĞƌ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵ͘ dĞůů ǇŽƵƌ ƉŽůŝĐǇ ŵĂŬĞƌƐ ƚŽ ^ƵƉƉŽƌƚ dƌĂŝŶŝŶŐ ĨŽƌ ƚŚĞ EĞǆƚ 'ĞŶĞƌĂƟŽŶ ŽĨ Family Physicians!

California Family Physician Summer 2019

Ta c k l i n g S T I s

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

STIs in California: We Are Not Winning the Battle In its 2019-2021 Strategic Plan, CAFP’s Board of Directors emphasized the need for CAFP to reengage in public health dialogues, from ĂǁĂƌĞŶĞƐƐ ƚŽ ĞĚƵĐĂƟŽŶ͕ ĂĚǀŽĐĂĐǇ ƚŽ ƉŽůŝĐǇ͘ dŚĞ ŽŵŵŝƩĞĞ ŽŶ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KWͿ ŝĚĞŶƟĮĞĚ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƩĞĚ /ŶĨĞĐƟŽŶƐ ;^d/ƐͿ ĂƐ Ă ƚĂƌŐĞƚ ĨŽƌ ǁŽƌŬ ŝŶ ϮϬϭϵ͘ dŚĞ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ Professional Development (CCPD) included a session at the 2019 Family Medicine Clinical Forum on STIs and has taken the lead in adding AAFP Prescribed CME credit to this issue of California Family Physician. To earn credit, please complete and return the form on page 28.

dŚĞ ŝŐ dŚƌĞĞ ^d/Ɛ Chlamydia ŝƐ ĐƵƌƌĞŶƚůǇ ƚŚĞ ŵŽƐƚ ĐŽŵŵŽŶůǇ ƌĞƉŽƌƚĞĚ ^d/ ŝŶ ǁŝƚŚ ϮϬϭϳ͛Ɛ ϱϱϮ͘ϭ ĐĂƐĞƐͬϭϬϬ͕ϬϬϬ ĂůŝĨŽƌŶŝĂŶƐ ďĞŝŶŐ Ă ϵ͘ϲ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŽǀĞƌ ϮϬϭϲ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϵϬͿ͘ ŚůĂŵǇĚŝĂ ƌĂƚĞƐ ĂŵŽŶŐ ĨĞŵĂůĞƐ ǁĞƌĞ ϲϬ ƉĞƌĐĞŶƚ ŚŝŐŚĞƌ ƚŚĂŶ ƚŚŽƐĞ ĂŵŽŶŐ ŵĂůĞ ĐŽƵŶƚĞƌƉĂƌƚƐ ǁŝƚŚ ƚŚĞ ŚŝŐŚĞƐƚ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ĨĞŵĂůĞ ĐĂƐĞƐ ŝŶ ǁŽŵĞŶ ĂŐĞƐ ϮϬͲϮϰ͘ ZĞƉŽƌƚĞĚ ĐĂƐĞƐ ĂŵŽŶŐ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ǇŽƵƚŚ ĂƌĞ ĨŽƵƌ ƟŵĞƐ ŚŝŐŚĞƌ ƚŚĂŶ ƌĂƚĞƐ ŝŶ ĂƵĐĂƐŝĂŶ ǇŽƵƚŚ͕ ǁŝƚŚ ŚŝŐŚĞƌ ƌĂƚĞƐ ŝŶ ƚŚĞ &ŝƌƐƚ ŵĞƌŝĐĂŶ ĂŶĚ >ĂƟŶŽ ƉŽƉƵůĂƟŽŶƐ ĂƐ ǁĞůů͘

tĞ ĂƌĞ ŶŽƚ ǁŝŶŶŝŶŐ ƚŚĞ ďĂƩůĞ ƚŽ ĚĞĐƌĞĂƐĞ ĐĂƐĞƐ ŽĨ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ ;^d/ƐͿ ŝŶ ĂůŝĨŽƌŶŝĂ Žƌ ŶĂƟŽŶĂůůǇ͘ /Ŷ ĨĂĐƚ͕ ŶĞĂƌůǇ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ^d/Ɛ ŽĐĐƵƌ ĞǀĞƌǇ ǇĞĂƌ͕ ĂŶĚ ŝŶ ϮϬϭϲ ŵŽƌĞ ƚŚĂŶ Ϯ ŵŝůůŝŽŶ ĐĂƐĞƐ ŽĨ ƚŚƌĞĞ ŶĂƟŽŶĂůůǇͲƌĞƉŽƌƚĞĚ ^d/Ɛ ;ĐŚůĂŵǇĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ͕ ĂŶĚ ƐǇƉŚŝůŝƐͿ ǁĞƌĞ ƌĞƉŽƌƚĞĚ͘ dŚŝƐ ŝƐ ƚŚĞ ŚŝŐŚĞƐƚ ŶƵŵďĞƌ ŽŶ ƌĞĐŽƌĚ͕ ĂŶĚ ƵŶĨŽƌƚƵŶĂƚĞůǇ ŝƚ ŵĂǇ ŶŽƚ ďĞ ĐŽŵƉůĞƚĞ ĂƐ ŵĂŶǇ ĐĂƐĞƐ ĐŽŶƟŶƵĞ ƚŽ ŐŽ undiagnosed and unreported. Sadly, young adolescents account for ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ŶĞǁ ŝŶĨĞĐƟŽŶƐ͕ ǁŝƚŚ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶƐ ĂŶĚ ŐĂǇ ĂŶĚͬ Žƌ ďŝƐĞǆƵĂů ŵĞŶ ĚŝƐƉƌŽƉŽƌƟŽŶĂƚĞůǇ ĂīĞĐƚĞĚ͘ ĂƚĂ ĂůƐŽ ƐŚŽǁƐ ƚŚĂƚ ŽƵƌ ƐĞŶŝŽƌ ĐŽŵŵƵŶŝƚǇ ŝƐ ƐŝŵŝůĂƌůǇ ĂīĞĐƚĞĚ ďǇ ƚŚĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/ ĐĂƐĞƐ͘

Gonorrhea ŝƐ ƚŚĞ ƐĞĐŽŶĚ ŵŽƌĞ ĐŽŵŵŽŶůǇ ƌĞƉŽƌƚĞĚ ^d/ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ǁŝƚŚ Ă ϮϬϭϳ ƌĂƚĞ ŽĨ ϭϵϬ͘ϱͬϭϬϬ͕ϬϬϬ ĂŶŶƵĂůůǇ ĂŵŽŶŐ ĂůŝĨŽƌŶŝĂŶƐ ĂŶĚ Ă ϭϲ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŽǀĞƌ ϮϬϭϲ ƌĂƚĞƐ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϴϴͿ͘ 'ŽŶŽƌƌŚĞĂ ĐĂƐĞƐ ĂŵŽŶŐ ŵĂůĞƐ ĂƌĞ ƚǁŽͲĨŽůĚ ŚŝŐŚĞƌ ƚŚĂŶ ĂŵŽŶŐ ĨĞŵĂůĞƐ͕ ǁŝƚŚ ŝŶĐƌĞĂƐĞƐ ƌĞƉŽƌƚĞĚ ŝŶ ŵĞŶͲǁŚŽͲŚĂǀĞͲƐĞǆ ǁŝƚŚ ŵĞŶ ;D^DͿ͕ ǁŚĞƌĞ ƚŚĞ ĞƐƟŵĂƚĞĚ ƌĂƚĞ ŝƐ Ϯ͕ϴϴϰͬϭϬϬ͕ϬϬϬ ƉĞƌ ǇĞĂƌ͘ /ŶĐƌĞĂƐĞƐ ŝŶ ƌĂƚĞƐ ĂƌĞ ĂůƐŽ ƐĞĞŶ ŝŶ ƉĂƟĞŶƚƐ ĂŐĞƐ ϭϱͲϮϰ͕ ďƵƚ ƚŚĞ ůĂƌŐĞƐƚ ŝŶĐŝĚĞŶĐĞ ƌĞŵĂŝŶƐ ĨŽƌ ŵĂůĞƐ ĂŐĞƐ ϮϱͲϮϵ ǇĞĂƌƐ͘ ŐĂŝŶ͕ ǁĞ ƐĞĞ Ă ƐŝŐŶŝĮĐĂŶƚ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ĐĂƐĞƐ ŝŶ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ǀƐ͘ ĂƵĐĂƐŝĂŶ ǇŽƵƚŚ͖ ǁŝƚŚ ŶƵŵďĞƌƐ ƐĞǀĞŶ ƟŵĞƐ ŚŝŐŚĞƌ ŝŶ ƚŚĞ ĨƌŝĐĂŶ American community.

ƵƌƌĞŶƚůǇ͕ ϯϬϬ͕ϬϬϬ ĐĂƐĞƐ ŽĨ ĐŚůĂŵǇĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ ĂŶĚ ĞĂƌůǇ ƐǇƉŚŝůŝƐ ŚĂǀĞ ďĞĞŶ ƌĞƉŽƌƚĞĚ ŝŶ ĂůŝĨŽƌŶŝĂ ʹ ƚŚŝƐ ŝƐ Ă ϰϱ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŝŶ ƚŚĞ ůĂƐƚ ĮǀĞ ǇĞĂƌƐ͊ zĞƐ͕ Ă ϰϱ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ͘ ĂƚĂ ĨƌŽŵ ϮϬϭϳ ƐŚŽǁƐ ϳϱ͕ϰϱϬ ŐŽŶŽƌƌŚĞĂ ĐĂƐĞƐ͖ ϭϯ͕ϲϬϱ ƐǇƉŚŝůŝƐ ĐĂƐĞƐ͖ Ϯϭϴ͕ϳϭϬ ĐŚůĂŵǇĚŝĂ ĐĂƐĞƐ ĂŶĚ Ϯϳϴ ĐĂƐĞƐ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ͘ ĐůŽƐĞƌ ůŽŽŬ Ăƚ ƚŚĞ data reveals much to be done, but tools and resources, including ĞĚƵĐĂƟŽŶ͕ ƉƵďůŝĐ ĂǁĂƌĞŶĞƐƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ͕ ĂƌĞ ĂǀĂŝůĂďůĞ ĂƐ ǁĞ ƚĂĐŬůĞ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ ƉƵďůŝĐ ŚĞĂůƚŚ ŝƐƐƵĞ͘

Syphilis ŝƐ ĚŝǀŝĚĞĚ ŝŶƚŽ ƐƚĂŐĞƐ ǁŝƚŚ ĚŝīĞƌĞŶƚ ƐŝŐŶƐ ĂŶĚ ƐǇŵƉƚŽŵƐ͖ early syphilis refers to primary, secondary and early latent stages of ƚŚĞ ĚŝƐĞĂƐĞ͘ /Ŷ ϮϬϭϳ ƚŚĞ ƌĂƚĞ ŽĨ ĞĂƌůǇ ƐǇƉŚŝůŝƐ ǁĂƐ ϮϬ ƉĞƌĐĞŶƚ ŚŝŐŚĞƌ ƚŚĂŶ ŝŶ ϮϬϭϲ͕ ǁŝƚŚ ϯϰ͘ϱ ĐĂƐĞƐͬϭϬϬ͕ϬϬϬ ĂŵŽŶŐ ĂůŝĨŽƌŶŝĂŶƐ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϴϳͿ͘ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ƌĂƚĞƐ ĨŽƌ ĞĂƌůǇ ƐǇƉŚŝůŝƐ ĂƌĞ ƚǁŽ ƟŵĞƐ ŚŝŐŚĞƌ ƚŚĂŶ ĂƵĐĂƐŝĂŶ ƌĂƚĞƐ͘ tŚŝůĞ ŵŽƌĞ ƚŚĂŶ ƐĞǀĞŶͲŝŶͲϭϬ ĐĂƐĞƐ ĂƌĞ ĂŵŽŶŐ ŐĂǇ ĂŶĚ ďŝͲƐĞǆƵĂů ŵĞŶ͕ ĂŶ ĂůĂƌŵŝŶŐ ƐĞǀĞŶͲĨŽůĚ ŝŶĐƌĞĂƐĞ ŚĂƐ ďĞĞŶ ƌĞĐŽƌĚĞĚ ĨŽƌ ĨĞŵĂůĞƐ ƐŝŶĐĞ ϮϬϭϮ͘ dŚŝƐ ŝŶĐƌĞĂƐĞ in female rates is important as 3,315 females of childbearing age ǁĞƌĞ ĚŝĂŐŶŽƐĞĚ ǁŝƚŚ ƐǇƉŚŝůŝƐ ŝŶ ϮϬϭϳ͕ ĂŶĚ ŶĞĂƌůǇ ŚĂůĨ ƚŚŽƐĞ ĐĂƐĞƐ ǁĞƌĞ ĞĂƌůǇ ƐǇƉŚŝůŝƐ͘ KĨ ƚŚŽƐĞ ƌĞƉŽƌƚĞĚ͕ ϭϱͲϮϬ ƉĞƌĐĞŶƚ ǁĞƌĞ ĂŵŽŶŐ ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ͘ Congenital syphilis ŝƐ ĂŶ ŝŶĨĞĐƟŽŶ ƚƌĂŶƐŵŝƩĞĚ ĨƌŽŵ ŵŽƚŚĞƌ ƚŽ ĐŚŝůĚ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐǇ Žƌ ĚĞůŝǀĞƌǇ͘ /ƚ ĐĂŶ ĐĂƵƐĞ ƐĞǀĞƌĞ ŝůůŶĞƐƐ ŝŶ ďĂďŝĞƐ ŝŶĐůƵĚŝŶŐ ƉƌĞŵĂƚƵƌĞ ďŝƌƚŚ͕ ůŽǁ ďŝƌƚŚ ǁĞŝŐŚƚ͕ ďŝƌƚŚ ĚĞĨĞĐƚƐ͕ ďůŝŶĚŶĞƐƐ ĂŶĚ ŚĞĂƌŝŶŐ ůŽƐƐ Žƌ ůĞĂĚ ƚŽ ƐƟůůďŝƌƚŚ Žƌ ŝŶĨĂŶƚ ĚĞĂƚŚ͘ &ŝŐƵƌĞƐ ĨŽƌ ϮϬϭϳ ƐŚŽǁ Ă ĮŌŚ ǇĞĂƌ ŽĨ ĐŽŶƐĞĐƵƟǀĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ƚŚĞ ŶƵŵďĞƌ ŽĨ ŝŶĨĂŶƚƐ ďŽƌŶ ǁŝƚŚ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ͘ ^ƉĞĐŝĮĐ WĂƟĞŶƚ WŽƉƵůĂƟŽŶƐ WƌĞǀĞŶƟŽŶ ĐŚĂůůĞŶŐĞƐ ƌĞŵĂŝŶ ĂƐ ǁĞ ĚĞĂů ǁŝƚŚ Ă ůĂĐŬ ŽĨ ĂǁĂƌĞŶĞƐƐ ŽĨ ^d/ ƐƚĂƚƵƐ ĂŶĚ ƐƟŐŵĂ ĂŶĚ ƉŽƚĞŶƟĂů ĚŝƐĐƌŝŵŝŶĂƟŽŶ ĂƩĂĐŚĞĚ ƚŽ

California Family Physician Summer 2019

ĚŝƐĐƵƐƐŝŶŐ ƐĞǆƵĂů ŚŝƐƚŽƌǇ ĂŶĚ ^d/ ƐĐƌĞĞŶŝŶŐ͘ ŶĚ͕ ŚĞƌĞ ŝƐ ǁŚĞƌĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ŵĂǇ ĐŽŵĞ ŝŶƚŽ ƉůĂǇ͘ ,ŝŐŚĞƌ ƌĂƚĞƐ ŽĨ ,/sͬ^d/Ɛ ĂŵŽŶŐ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ĂŶĚ >ĂƟŶŽ ƉŽƉƵůĂƟŽŶƐ ŵĂǇ ĐŽƌƌĞůĂƚĞ ƚŽ ŚŝŐŚĞƌ ƉŽǀĞƌƚǇ ƌĂƚĞƐ͕ ůŽǁĞƌ ƐŽĐŝŽĞĐŽŶŽŵŝĐ ƐƚĂƚƵƐ ;^ ^Ϳ͕ ůŝŵŝƚĞĚ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ĂŶĚ ^d/ ĞĚƵĐĂƟŽŶ͘ >ŝǀŝŶŐ ŝŶ ĐŽŵŵƵŶŝƟĞƐ ǁŝƚŚ ŚŝŐŚĞƌ ŝŶĨĞĐƟŽŶ ƌĂƚĞƐ ĂŶĚ ƚŚĞ ƚĞŶĚĞŶĐǇ ƚŽ ŚĂǀĞ ƐĞǆ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ŽĨ ƚŚĞ ƐĂŵĞ ƌĂĐĞͬĞƚŚŶŝĐŝƚǇ ŵĂǇ ĂůƐŽ ďĞ ĚĞƚĞƌŵŝŶĂŶƚ ĨĂĐƚŽƌƐ͘ dŚĞ ĞŶƚĞƌ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů͛Ɛ ; ͛ƐͿ ϮϬϭϳ EĂƟŽŶĂů zŽƵƚŚ ZŝƐŬ Behavior Survey provides the most recent surveillance data on health ďĞŚĂǀŝŽƌƐ ĂŶĚ ĞǆƉĞƌŝĞŶĐĞƐ ĂŵŽŶŐ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌǇ͘ /ƚ ƌĞƉŽƌƚƐ ƚŚĞ ƉƌŽƉŽƌƟŽŶ ŽĨ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ǁŚŽ ĂƌĞ ƐĞǆƵĂůůǇ ĂĐƟǀĞ ŚĂƐ ƐƚĞĂĚŝůǇ ĚĞĐůŝŶĞĚ͕ ǇĞƚ ŚĂůĨ ŽĨ ƚŚĞ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ^d/Ɛ ƌĞƉŽƌƚĞĚ ĞĂĐŚ ǇĞĂƌ ǁĞƌĞ ĂŵŽŶŐ ǇŽƵŶŐ ƉĞŽƉůĞ͘ dŚĞ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ƐƚƵĚĞŶƚƐ ĐƵƌƌĞŶƚůǇ ƐĞǆƵĂůůǇ ĂĐƟǀĞ ĚĞĐƌĞĂƐĞĚ ĨƌŽŵ ϯϱ ƉĞƌĐĞŶƚ ŝŶ ϮϬϬϳ ƚŽ Ϯϴ͘ϳ ƉĞƌĐĞŶƚ ŝŶ ϮϬϭϳ͕ ďƵƚ Ă ƐŝŐŶŝĮĐĂŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ĐŽŶĚŽŵ ƵƐĂŐĞ ďǇ ŚŝŐŚ ƐĐŚŽŽů ƚĞĞŶƐ ǁĂƐ ĂůƐŽ ŶŽƚĞĚ͘ ŵŽŶŐ ƐĞǆƵĂůůǇ ĂĐƟǀĞ ĂůŝĨŽƌŶŝĂ ŚŝŐŚ ƐĐŚŽŽůĞƌƐ͕ ŽŶůǇ ŽŶĞͲŝŶͲƚǁŽ ƵƐĞĚ Ă ĐŽŶĚŽŵ ƚŚĞ ůĂƐƚ ƟŵĞ ƚŚĞǇ ŚĂĚ ƐĞǆ͕ ĂŶĚ ŽŶĞ ŽŶĞͲŝŶͲƚŚƌĞĞ ƵƐĞĚ Ă ĐŽŶĚŽŵ ĞǀĞƌǇ ƟŵĞ ƚŚĞǇ ŚĂǀĞ ƐĞǆ͘ dŚĞ ĂůŝĨŽƌŶŝĂ ,ĞĂůƚŚǇ zŽƵƚŚ Đƚ ;ϮϬϭϲͿ ƌĞƋƵŝƌĞƐ ƚŚĂƚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ƐĞǆƵĂů ŚĞĂůƚŚ ĞĚƵĐĂƟŽŶ ĂŶĚ ,/s ƉƌĞǀĞŶƟŽŶ ĞĚƵĐĂƟŽŶ ďĞ ƚĂƵŐŚƚ ŽŶĐĞ in middle school and once in high school. The goal is to provide young ƐƚƵĚĞŶƚƐ ǁŝƚŚ ƚŚĞ ŬŶŽǁůĞĚŐĞ ĂŶĚ ƐŬŝůůƐ ŶĞĞĚĞĚ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞŝƌ ƐĞǆƵĂů ĂŶĚ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ ĨƌŽŵ ,/s ĂŶĚ ŽƚŚĞƌ ^d/Ɛ͘ ďƐƟŶĞŶĐĞ ŽŶůǇ ŝŶƐƚƌƵĐƟŽŶ ŝƐ ŶŽƚ ƉĞƌŵŝƩĞĚ͖ Ăůů ŝŶƐƚƌƵĐƟŽŶ ŵƵƐƚ ďĞ ŵĞĚŝĐĂůůǇ ĂĐĐƵƌĂƚĞ͕ and the curriculum must address the needs of students of all genders ĂŶĚ ƐĞǆƵĂů ŽƌŝĞŶƚĂƟŽŶ͘ KĨ ŶŽƚĞ͕ ǁŝƚŚ ƉĂƌĞŶƚĂů ƉĞƌŵŝƐƐŝŽŶ͕ ƐƚƵĚĞŶƚƐ ĐĂŶ ŽƉƚ ŽƵƚ ŽĨ ƐĞǆƵĂů ĞĚƵĐĂƟŽŶ ůĞƐƐŽŶƐ͘ tŚŝůĞ ŵĂŶǇ ŽĨ ƚŚĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/Ɛ ĂƌĞ ĂŵŽŶŐ ǇŽƵƚŚ͕ ^d/ ƌĂƚĞƐ ŝŶ ŽůĚĞƌ ĂĚƵůƚƐ ĂƌĞ ƌŝƐŝŶŐ ƌĂƉŝĚůǇ͕ ĐŽůůĞĐƟǀĞůǇ ďǇ ϱϬ ƉĞƌĐĞŶƚ ŝŶ ƚŚĞ ƉĂƐƚ ĨĞǁ ĚĞĐĂĚĞƐ͘ /Ŷ ϮϬϭϳ͕ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ ,/s ǁĞƌĞ ŽǀĞƌ ĂŐĞ ϱϬ͕ ĂŶĚ ϳϳ ƉĞƌĐĞŶƚ ŽĨ ŶĞǁ ,/s ĐĂƐĞƐ ĂƌĞ ŝŶ ƉĂƟĞŶƚƐ ŽǀĞƌ ĂŐĞ ϱϬ͘ dŚĞ ƌĞƉŽƌƚƐ ƚŚĂƚ ďĞƚǁĞĞŶ ϮϬϭϮ ĂŶĚ ϮϬϭϲ ĨŽƌ ŵĞŶ ĂŶĚ ǁŽŵĞŶ ŽǀĞƌ ĂŐĞ ϲϱ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ŚůĂŵǇĚŝĂ ŚĂƐ ƌŝƐĞŶ ďǇ ϱϲ ƉĞƌĐĞŶƚ ;ϭ͕ϭϯϰ ƚŽ ϭ͕ϳϳϮ ĐĂƐĞƐ ĂŶŶƵĂůůǇͿ͘ EĞǁ ĐĂƐĞƐ ŽĨ ƐǇƉŚŝůŝƐ ĚŽƵďůĞĚ ;ϭϮϯ ƚŽ Ϯϳϵ ĐĂƐĞƐ ĂŶŶƵĂůůǇͿ͘ 'ŽŶŽƌƌŚĞĂ ŚĂƐ ƌŝƐĞŶ ďǇ ϭϱϬ ƉĞƌĐĞŶƚ ;ϲϰϰ ƚŽ ϭ͕ϱϵϵ ĐĂƐĞƐ ĂŶŶƵĂůůǇͿ͘ dŚĞ ĚƌĂŵĂƟĐ ƌŝƐĞ ŝŶ ^d/Ɛ ŝŶ ƚŚĞ ĞůĚĞƌůǇ ŵĂǇ ďĞ ĐĂƵƐĞĚ ďǇ ŶƵŵĞƌŽƵƐ ĨĂĐƚŽƌƐ͕ ŝŶĐůƵĚŝŶŐ ƌĞůƵĐƚĂŶĐĞ ƚŽ ďƌŝŶŐ ƵƉ ƐĞǆ ;ŽŶ ďŽƚŚ ƉĂƟĞŶƚ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ƐŝĚĞƐͿ ůĞĂĚŝŶŐ ƚŽ ůŽǁ ƐĐƌĞĞŶŝŶŐ ƌĂƚĞƐ͖ ĐŚĂŶŐĞƐ ŝŶ ŝŵŵƵŶŽƐĞŶĞƐĐĞŶĐĞ ĂŶĚ ǁĞĂŬĞŶĞĚ ŵƵĐŽƐĂů ƟƐƐƵĞ ƚŚĂƚ ŵĂǇ ŵĂŬĞ ŝƚ ŚĂƌĚĞƌ ĨŽƌ ƐĞŶŝŽƌƐ ƚŽ ĮŐŚƚ ŝŶĨĞĐƟŽŶ͖ ĚĂƟŶŐ ŵŽƌĞ ƚŚĂŶ ŽŶĞ ƉĂƌƚŶĞƌ ĂŌĞƌ ĚŝǀŽƌĐĞ Žƌ ƚŚĞ ĚĞĂƚŚ ŽĨ Ă ƉĂƌƚŶĞƌ͕ ƌĂŝƐŝŶŐ ƚŚĞŝƌ ƌŝƐŬ ĨŽƌ ŝŶĨĞĐƟŽŶ ĂŌĞƌ Ă ůŽŶŐ ƉĞƌŝŽĚ ŽĨ ŵŽŶŽŐĂŵǇ ĂŶĚͬŽƌ ĂĐĐĞƐƐŝďŝůŝƚǇ ƚŽ ŵŽƌĞ ƉŽƚĞŶƟĂů ƉĂƌƚŶĞƌƐ ŝŶ ĐŽŵŵƵŶŝƚǇ ůŝǀŝŶŐ ƐĞƫŶŐƐ͖ ĂŶĚ ƚŚĞ ĂďŝůŝƚǇ ƚŽ ŵĂŝŶƚĂŝŶ ƐĞǆƵĂů ĨƵŶĐƟŽŶ ůŽŶŐĞƌ Ăƚ ĂŶ ŽůĚĞƌ ĂŐĞ ǁŝƚŚ ƉŚĂƌŵĂĐĞƵƟĐĂů assistance, e.g., phosphodiesterase inhibitors.

ĂƌĞ ŶŽƚ Ăƚ ƌŝƐŬ ĨŽƌ ^d/Ɛ ĂŶĚ ƚŚĞǇ ŵĂǇ ŶŽƚ ĐŽŶƐŝĚĞƌ ŽƌĂů Žƌ ĂŶĂů ƐĞǆ ĂƐ Ă ǁĂǇ ŽĨ ĐŽŶƚƌĂĐƟŶŐ Žƌ ƚƌĂŶƐŵŝƫŶŐ ^d/Ɛ͘ ŚĂůůĞŶŐĞƐ ĂŶĚ ^ŽůƵƟŽŶƐ Clinical measures ŚĂǀĞ ďĞĞŶ ĚĞǀĞůŽƉĞĚ ƚŽ ůŽŽŬ Ăƚ ŝŵƉƌŽǀĞŵĞŶƚ ŝŶ ƐĐƌĞĞŶŝŶŐ͕ ĚŝĂŐŶŽƐŝƐ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ŽĨ ^d/Ɛ͘ dŚĞ ƌĞĐŽŵŵĞŶĚƐ ƌŽƵƟŶĞ ,/s ƐĐƌĞĞŶŝŶŐ Ăƚ ůĞĂƐƚ ŽŶĐĞ ĨŽƌ ƚŚŽƐĞ ĂŐĞƐ ϭϯͲϲϰ ĂŶĚ ĂŶŶƵĂů ƐĐƌĞĞŶŝŶŐ ĨŽƌ ƚŚŽƐĞ Ăƚ ŚŝŐŚĞƌ ƌŝƐŬ ŽĨ ĐŽŶƚƌĂĐƟŶŐ ƚŚĞ ǀŝƌƵƐ͘ ĚĂƚĂ ĨƌŽŵ ƐƵƌǀĞǇƐ ĨƌŽŵ ϮϬϬϲ ƚŽ ϮϬϭϲ͕ ƐŚŽǁ ƚŚĂƚ ŽĨ ϭϭ͕ϲϴϴ ƌĞƐƉŽŶĚĞŶƚƐ ŽŶůǇ ϰϵ͘ϲ ƉĞƌĐĞŶƚ ŚĂĚ ĞǀĞƌ ďĞĞŶ ƚĞƐƚĞĚ͕ ĂŶĚ ŽŶůǇ ϲϮ͘Ϯ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ǁŝƚŚ ,/sͲƌĞůĂƚĞĚ ƌŝƐŬ ďĞŚĂǀŝŽƌƐ ǁĞƌĞ ƚĞƐƚĞĚ͘ PubMed: ĚŽůĞƐĐĞŶƚ ǆƉĞƌŝĞŶĐĞƐ ŽĨ ^d/ ŽŵŵƵŶŝĐĂƟŽŶ ŝŶ WƌŝŵĂƌǇ ĂƌĞ ƌĞƉŽƌƚ ƐĂŝĚ ƚŚĂƚ ĞīĞĐƟǀĞ ĐůŝŶŝĐŝĂŶͲƉĂƟĞŶƚ ĐŽŵŵƵŶŝĐĂƟŽŶ ŝƐ ůŝŶŬĞĚ ǁŝƚŚ ƉŽƐŝƟǀĞ ƉĂƟĞŶƚ ŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ ŝŶ ĂĚƵůƚƐ ĂŶĚ ĂĚŽůĞƐĐĞŶƚƐ͘ ĚŽůĞƐĐĞŶƚƐ ĞǆƉƌĞƐƐĞĚ ƚŚĞ ŶĞĞĚ ĨŽƌ ĐůŝŶŝĐŝĂŶƐ ƚŽ ĞŶŐĂŐĞ ǇŽƵƚŚ ŝŶ ĐŚĂůůĞŶŐŝŶŐ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂďŽƵƚ ƐĞǆ ĂŶĚ ^d/Ɛ͕ ďƵƚ ĂůƐŽ ĚĞƐĐƌŝďĞĚ perceived judgment from clinicians. Treatment guidelines ŚĂǀĞ ďĞĞŶ ŝƐƐƵĞĚ ďǇ ƚŚĞ ĂŶĚ h^ WƌĞǀĞŶƟǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ;h^W^d&Ϳ͘ dŚĞ ŐƵŝĚĞůŝŶĞƐ ĂƌĞ ĂǀĂŝůĂďůĞ ŝŶ ƉŽĐŬĞƚ ŐƵŝĚĞ͕ ǁĂůů ĐŚĂƌƚƐ ĂŶĚ WW ĨŽƌŵĂƚ͘ dŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵǇ ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ŚĂƐ ĂůƐŽ ŝƐƐƵĞĚ ƚƌĞĂƚŵĞŶƚ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͗ /ŶƚĞŶƐŝǀĞ ĞŚĂǀŝŽƌĂů ŽƵŶƐĞůŝŶŐ ĂƐ ƌĞĐŽŵŵĞŶĚĞĚ ďǇ ƚŚĞ h^W^d& ĨŽƌ ƐĞǆƵĂůůǇ ĂĐƟǀĞ ŝŶĚŝǀŝĚƵĂůƐ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ͘ dŚĞ h^W^d& ĨŽƵŶĚ ĞǀŝĚĞŶĐĞ ƚŚĂƚ ŝŶƚĞŶƐŝǀĞ ŝŶƚĞƌǀĞŶƟŽŶƐ ƌĞĚƵĐĞ ƌŝƐŬǇ ƐĞǆƵĂů ďĞŚĂǀŝŽƌƐ ĂŶĚ ŝŶĐƌĞĂƐĞ ƚŚĞ ůŝŬĞůŝŚŽŽĚ ŽĨ ĐŽŶĚŽŵ ƵƐĞ ĂŶĚ ŽƚŚĞƌ ƉƌŽƚĞĐƟǀĞ ƐĞǆƵĂů ƉƌĂĐƟĐĞƐ͘ • /ŶƚĞƌǀĞŶƟŽŶƐ ƌĂŶŐĞ ŝŶ ŝŶƚĞŶƐŝƚǇ ĨƌŽŵ ϯϬ ŵŝŶ ƚŽ Ϯ ŚŽƵƌƐ ĂŶĚ can be delivered through a primary care clinician or through ƌĞĨĞƌƌĂů ƚŽ Ă ƚƌĂŝŶĞĚ ďĞŚĂǀŝŽƌĂů ĐŽƵŶƐĞůŽƌ͘ dŚĞ ŝŶƚĞƌǀĞŶƟŽŶƐ ŝŶĐůƵĚĞ ƚĞĂĐŚŝŶŐ ƚŚĞ ďĂƐŝĐƐ ŽĨ ^d/Ɛ ĂŶĚ ƚƌĂŶƐŵŝƐƐŝŽŶ͕ ĂƐ ǁĞůů ĂƐ ƐŬŝůůƐ ŝŶ ĐŽŶĚŽŵ ƵƐĞ ĂŶĚ ĐŽŵŵƵŶŝĐĂƟŽŶ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ĂŶĚ ĂƐƐĞƐƐŝŶŐ ŝŶĚŝǀŝĚƵĂůƐ͛ ƌŝƐŬƐ ŽĨ ƚƌĂŶƐŵŝƐƐŝŽŶ͘ ǆƉĞĚŝƚĞĚ WĂƌƚŶĞƌ dŚĞƌĂƉǇ ; WdͿ ŝƐ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŽĨ ƚƌĞĂƟŶŐ ƐĞǆ ƉĂƌƚŶĞƌƐ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ Ă ĚŝĂŐŶŽƐĞĚ ^d ǁŝƚŚŽƵƚ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌ ĮƌƐƚ ĞǆĂŵŝŶŝŶŐ ƚŚĞ ƉĂƌƚŶĞƌ͘ dŚĞ STD Treatment Guidelines ƌĞĐŽŵŵĞŶĚƐ ŽīĞƌŝŶŐ Wd ƚŽ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ǁŚŽ ĂƌĞ ƵŶĂďůĞ Žƌ ƵŶůŝŬĞůǇ ƚŽ ĂĐĐĞƐƐ ƚƌĞĂƚŵĞŶƚ ŽŶ ƚŚĞŝƌ ŽǁŶ͘ • tŚŝůĞ Wd ŚĂƐ ďĞĞŶ ĂůůŽǁĂďůĞ ŝŶ ĂůŝĨŽƌŶŝĂ ƐŝŶĐĞ ϮϬϬϭ͕ ŝƚ ŝƐ ŶŽƚ Ă ĐŽǀĞƌĞĚ ďĞŶĞĮƚ ŽĨ &ĂŵŝůǇ WĂĐƚ ŽĨ DĞĚŝͲ Ăů ƉƌŽŐƌĂŵƐ͘ • WƌŽǀŝĚĞƌƐ ĐĂŶ ŐŝǀĞ ƉĂƟĞŶƚƐ Ă ǁƌŝƩĞŶ ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ Wd ƚŽ ďĞ ĮůůĞĚ Ăƚ ƚŚĞŝƌ ůŽĐĂů ƉŚĂƌŵĂĐǇ͘

Funding ŝƐ ĂůƐŽ ĂŶ ŝƐƐƵĞ ƚŽ ďĞ ĂĚĚƌĞƐƐĞĚ͘ dŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; ͕ ĂƐ ŝƚ ƐƚŽŽĚ ŝŶ ŵŝĚͲϮϬϭϴͿ ƌĞƋƵŝƌĞƐ ŵŽƐƚ ƉƌŝǀĂƚĞ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ƉůĂŶƐ ƚŽ ĐŽǀĞƌ ƌĞĐŽŵŵĞŶĚĞĚ ƉƌĞǀĞŶƟǀĞ ƐĞƌǀŝĐĞƐ ǁŝƚŚŽƵƚ ƉĂƟĞŶƚ ĐŽƐƚ ƐŚĂƌŝŶŐ͕ ŝŶĐůƵĚŝŶŐ ,/s ĂŶĚ ^d/ ĐŽƵŶƐĞůŝŶŐ ĂŶĚ ƐĐƌĞĞŶŝŶŐ͕ ǀĂĐĐŝŶĞƐ ĨŽƌ ,Ws ĂŶĚ ,ĞƉĂƟƟƐ ͘ DĞĚŝĐĂŝĚ ŝƐ ƚŚĞ ůĂƌŐĞƐƚ ƉƌŽǀŝĚĞƌ ŽĨ ,/s ƚƌĞĂƚŵĞŶƚ ĂŶĚ ĐĂƌĞ͕ ŝŶĐůƵĚŝŶŐ ĐŽǀĞƌĂŐĞ ĨŽƌ ^d/ ĐŽƵŶƐĞůŝŶŐ͕ ƐĐƌĞĞŶŝŶŐƐ >ŝŬĞ ŽƵƌ ǇŽƵƚŚĨƵů ƉĂƟĞŶƚƐ͕ ŽƵƌ ƐĞŶŝŽƌƐ ŵĂǇ ŶŽƚ ďĞ ĂĐĐƵƐƚŽŵĞĚ ƚŽ ƵƐŝŶŐ ĂŶĚ ƉƌĞǀĞŶƟǀĞ ǀĂĐĐŝŶĂƟŽŶƐ͘ WƌĞƐŝĚĞŶƚ dƌƵŵƉ͛Ɛ &ŝƐĐĂů zĞĂƌ ϮϬϭϴ Ă ĐŽŶĚŽŵ Žƌ ĚŽŶ͛ƚ ƵƐĞ ŽŶĞ ďĞĐĂƵƐĞ ƚŚĞǇ ƚŚŝŶŬ ƚŚĞǇ Žƌ ƚŚĞŝƌ ƉĂƌƚŶĞƌƐ ƵĚŐĞƚ ĐƵƚ ĞƐƐĞŶƟĂů ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ ƚƌĞĂƚŵĞŶƚ ĂŶĚ ƉƌĞǀĞŶƟŽŶ ŽĨ California Family Physician Summer 2019 ĐŽŶƟŶƵƚĞĚ ŽŶ ƉĂŐĞ ϭϴхх

ĐŽŶƟŶƵƚĞĚ ĨƌŽŵ ƉĂŐĞ ϭϳ

,/sͬ / Ɛ ĂŶĚ ^d/Ɛ͕ ǁŝƚŚ ƐŝŐŶŝĮĐĂŶƚ ĐƵƚƐ ƚŽ ƚŚĞ ͛Ɛ ,/s ĂŶĚ ^d/ ƉƌĞǀĞŶƟŽŶ ƉƌŽŐƌĂŵƐ ĂŶĚ ŐƌĂŶƚƐ ƚŽ ĂůŝĨŽƌŶŝĂ ĞŶƟƟĞƐ͘ dŚĞ dƌƵŵƉ ĂĚŵŝŶŝƐƚƌĂƟŽŶ͛Ɛ ƌĞĐĞŶƚ ƉƌŽƉŽƐĞĚ ĐŚĂŶŐĞƐ ƚŽ dŝƚůĞ y ƐĞƌǀŝĐĞƐ ǁŝůů ĂůƐŽ ƵŶĚĞƌŵŝŶĞ ƚŚĞ ĐĂƌĞ ŽĨ ƉĂƟĞŶƚƐ Ăƚ ƌŝƐŬ Žƌ ǁŝƚŚ ^d/Ɛ͘

Ăůů ƚŽ ĐƟŽŶ CAFP’s CHOP and CCPD are calling on family ƉŚǇƐŝĐŝĂŶƐƚŽ ƚĂĐŬůĞ ƚŚŝƐ ƉƵďůŝĐ ŚĞĂůƚŚ ĐƌŝƐŝƐ͘ ^d/Ɛ ĂƌĞ ŵĂŶĂŐĞĂďůĞ ǁŝƚŚŝŶ ƚŚĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ƌĞĂůŵ͘ tŚŽ ďĞƩĞƌ ƚŽ ŝŶƚĞŐƌĂƚĞ ƚŚŝƐ ĐĂƌĞ ǁŝƚŚŝŶ ƚŚĞ ĨƵůů ƐƉĞĐƚƌƵŵ ŽĨ ĐĂƌĞ ƚŚĂŶ ĨĂŵŝůǇ

ƉŚǇƐŝĐŝĂŶƐ͍ dŚĞ ŐŽŽĚ ŶĞǁƐ ŝƐ ƚŚĂƚ &W ŝƐ ŚĞƌĞ ƚŽ ŚĞůƉ͘ tĞ͛ǀĞ ŝŶĐůƵĚĞĚ Ă ƐĞƌŝĞƐ ŽĨ ƉƌĂĐƟĐĞ ƚŽŽůƐ ŝŶĐůƵĚŝŶŐ ǀŝĚĞŽƐ͕ ůŝŶŬƐ ƚŽ ŐƵŝĚĞďŽŽŬƐ͕ payment and coverage tables, resources and ƟƉƐ ƐŚĞĞƚƐ ŽŶ ŽƵƌ ǁĞďƐŝƚĞ͕ ŚƩƉ͗ͬͬĨĂŵŝůǇĚŽĐƐ͘ ŽƌŐͬŵĞŵďĞƌƐͬƉƌĂĐƟĐĞͲƚŽŽůƐͬ͘ W^͗ ZĞĂĚ ƚŚĞ ƌĞƐƚ ŽĨ ƚŚĞ ĂƌƟĐůĞƐ ŝŶ ƚŚŝƐ ŝƐƐƵĞ͖ ŐŽ ƚŽ ƉĂŐĞ Ϯϴ͖ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚĞ D card to earn 3 AAFP Prescribed credits.

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

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

WWW.GVHC.ORG 18

California Family Physician Summer 2019

Reference 1. Centers for Disease Control and WƌĞǀĞŶƚŝŽŶ͗ Ϯ͘ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ /ŶĨŽƌŵĂƚŝŽŶ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬ ƐƚĚͬĚƐƚĚƉͬ 3. ,ƵŵĂŶ /ŵŵƵŶŽĚĞĨŝĐŝĞŶĐǇ sŝƌƵƐ /ŶĨŽƌŵĂƚŝŽŶ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬ ϰ͘ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ &ĂĐƚ ^ŚĞĞƚƐ ĨŽƌ zŽƵƚŚ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ ŐŽǀͬƐƚĚͬ,ĞĂůƚŚ ŽŵŵͬĨĂĐƚͺƐŚĞĞƚƐ͘ htm 5. Reported STDs in the United States ϮϬϭϲ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬ ŶĞǁƐƌŽŽŵͬĚŽĐƐͬĨĂĐƚƐŚĞĞƚƐͬ^d Ͳ dƌĞŶĚƐͲϱϬϴ͘ƉĚĨ ϲ͘ zŽƵƚŚ ZŝƐŬ ĞŚĂǀŝŽƌ ^ƵƌǀĞǇ ĂƚĂ ^ƵŵŵĂƌǇ ϮϬϬϳͲϮϬϭϳ ŚƚƚƉƐ͗ͬͬ ǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚĞĂůƚŚǇǇŽƵƚŚͬĚĂƚĂͬ ǇƌďƐͬƉĚĨͬƚƌĞŶĚƐƌĞƉŽƌƚ͘ƉĚĨ͍Ƶƚŵͺ ƐŽƵƌĐĞс^d dнEĞǁƐůĞƚƚĞƌƐΘƵƚŵͺ ĐĂŵƉĂŝŐŶсϱϵĞĂĂϯϭϮϳϵͲDZͺ KWzͺϬϭΘƵƚŵͺŵĞĚŝƵŵсĞŵĂŝůΘƵƚŵͺ ƚĞƌŵсϬͺϴĐĂďϭĚϳϵϲϭͲ ϱϵĞĂĂϯϭϮϳϵͲϭϱϬϳϬϵϲϳϳ 7. U.S. Department of Health and ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͗ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ŚŚƐ͘ŐŽǀ ϴ͘ ŝǆďǇ ĞŶƚĞƌ ĨŽƌ 'ůŽďĂů ZĞƉƌŽĚƵĐƚŝǀĞ ,ĞĂůƚŚ͗ ŚƚƚƉƐ͗ͬͬďŝǆďǇĐĞŶƚĞƌ͘ƵĐƐĨ͘ĞĚƵ ϵ͘ ,ĞĂůƚŚ ĂƌĞ͘'Žǀ͗ WƌĞǀĞŶƚŝǀĞ ĂƌĞ ďĞŶĞĨŝƚƐ ĨŽƌ ĚƵůƚƐ͗ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ ŚĞĂůƚŚĐĂƌĞ͘ŐŽǀͬƉƌĞǀĞŶƚŝǀĞͲĐĂƌĞͲ ĂĚƵůƚƐͬ ϭϬ͘ U.S. Preventive Services dĂƐŬ &ŽƌĐĞ͗ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ ƵƐƉƌĞǀĞŶƚŝǀĞƐĞƌǀŝĐĞƐƚĂƐŬĨŽƌĐĞ͘ŽƌŐ 11. American Academy of Family WŚǇƐŝĐŝĂŶƐ ; &WͿ͗ ^ĞǆƵĂůůǇ dƌĂŶƐŵŝƚƚĞĚ /ŶĨĞĐƚŝŽŶƐ ŽůůĞĐƚŝŽŶ͗ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂĨƉͬ ƚŽƉŝĐDŽĚƵůĞƐͬǀŝĞǁdŽƉŝĐDŽĚƵůĞ͘ Śƚŵ͍ƚŽƉŝĐDŽĚƵůĞ/ĚсϮϯ

California Family Physician Summer 2019

Ta c k l i n g S T I s

Scott Nass, MD, MPA, FAAFP, AAHIVS

Answering Questions about HIV Pre-Exposure Prophylaxis zŽƵƌ ƉĂƟĞŶƚ :ĂŵĞƐ ŝƐ Ă ϮϳͲǇĞĂƌͲŽůĚ ĐŝƐŐĞŶĚĞƌ ŵĂůĞ ǁŚŽ ƉƌĞƐĞŶƚƐ ĨŽƌ ŚŝƐ ĂŶŶƵĂů ǁĞůůŶĞƐƐ ǀŝƐŝƚ ĚƵƌŝŶŐ Ă ĚĂǇ Žī ĨƌŽŵ ŚŝƐ ũŽď ĂƐ Ă ĐŽŵƉƵƚĞƌ ƉƌŽŐƌĂŵŵĞƌ͘ tŚŝůĞ ƵƉĚĂƟŶŐ ŚŝƐ ƐŽĐŝĂů ŚŝƐƚŽƌǇ͕ ǇŽƵ ůĞĂƌŶ ŚĞ ƌĞĐĞŶƚůǇ ŚĂƐ ĞŶĚĞĚ ŚŝƐ ƌĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ ŚŝƐ ŵĂůĞ ƉĂƌƚŶĞƌ ŽĨ ĮǀĞ ǇĞĂƌƐ͘ ͞ ŽĐƚŽƌ͕͟ ŚĞ ĂƐŬƐ͕ ͞ĚŽ ǇŽƵ ƚŚŝŶŬ / ƐŚŽƵůĚ ŐŽ ŽŶ Wƌ W͍͟ :ĂŵĞƐ ŝƐ ĂƐŬŝŶŐ͕ ŽĨ ĐŽƵƌƐĞ͕ ĨŽƌ ǇŽƵƌ ŐƵŝĚĂŶĐĞ ŽŶ ƚŚĞ ůĂƚĞƐƚ ,/s ƉƌĞǀĞŶƟŽŶ ƐƚƌĂƚĞŐǇ͕ ƚĞƌŵĞĚ WƌĞͲ ǆƉŽƐƵƌĞ WƌŽƉŚǇůĂǆŝƐ͕ Žƌ Wƌ W͘ Ɛ Ă ĐŽŶĐĞƉƚ͕ Wƌ W ŐĂŝŶĞĚ ŵŽŵĞŶƚƵŵ ŝŶ ϮϬϭϮ ǁŚĞŶ ƚŚĞ h^ &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƟŽŶ ĂƉƉƌŽǀĞĚ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ĨƵŵĂƌĂƚĞ ;dƌƵǀĂĚĂͿ ĨƌŽŵ 'ŝůĞĂĚ ĂƐ ƚŚĞ ĮƌƐƚ ŵĞĚŝĐĂƟŽŶ ŝŶĚŝĐĂƚĞĚ ƚŽ ƌĞĚƵĐĞ ƚŚĞ ƌŝƐŬ ŽĨ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ,/sͲϭ ŝŶĨĞĐƟŽŶ ŝŶ ĂĚƵůƚƐ Ăƚ ŚŝŐŚ ƌŝƐŬ͕ ǁŚĞŶ ƵƐĞĚ ŝŶ ĐŽŵďŝŶĂƟŽŶ ǁŝƚŚ ƐĂĨĞƌ ƐĞǆ ƉƌĂĐƟĐĞƐ͘ /Ŷ ƚŚĞ ĞĂƌůŝĞƐƚ ƐƚƵĚŝĞƐ ƌĞǀŝĞǁĞĚ ĨŽƌ ƚŚŝƐ ĚĞĐŝƐŝŽŶ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬ ƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ĨƵŵĂƌĂƚĞ ĚĞŵŽŶƐƚƌĂƚĞĚ ƐŝŐŶŝĮĐĂŶƚ ƌĞĚƵĐƟŽŶ ŝŶ ƌĂƚĞƐ ŽĨ ,/sͲϭ ĂĐƋƵŝƐŝƟŽŶ ĂŵŽŶŐ ŵĞŶ ǁŚŽ ŚĂǀĞ ƐĞǆ ǁŝƚŚ ŵĞŶ͘ &ƵƌƚŚĞƌ ƐƚƵĚŝĞƐ ƐŚŽǁĞĚ ƐŝŵŝůĂƌ ƌĞĚƵĐƟŽŶƐ ĨŽƌ ,/sͲĚŝƐĐŽƌĚĂŶƚ ŽƉƉŽƐŝƚĞͲƐĞǆ ƉĂƌƚŶĞƌƐ ĂƐ ǁĞůů ĂƐ ĨŽƌ ŝŶũĞĐƟŽŶ ĚƌƵŐ ƵƐĞƌƐ͘ ĂƌůǇ ƚƌŝĂůƐ ĨŽĐƵƐĞĚ ŽŶ ĞŶĐŽƵƌĂŐŝŶŐ ;ĂŶĚ ŵĞĂƐƵƌŝŶŐͿ ĂĚŚĞƌĞŶĐĞ ƚŽ ƚŚĞ ƵƐĞ ŽĨ ƚŚĞ ŽŶĐĞͲĚĂŝůǇ Ɖŝůů͘ WĂƟĞŶƚƐ ǁĞƌĞ ƐĞĞŶ Ăƚ ĨƌĞƋƵĞŶƚ ŝŶƚĞƌǀĂůƐ ĚƵƌŝŶŐ ĐůŝŶŝĐĂů ƚƌŝĂůƐ͕ Ăƚ ǁŚŝĐŚ ƟŵĞ ƚŚĞǇ ƌĞĐĞŝǀĞĚ ,/s ƉƌĞǀĞŶƟŽŶ ĐŽƵŶƐĞůŝŶŐ ĂŶĚ ǁĞƌĞ ƚĞƐƚĞĚ ;ĂŶĚ ƚƌĞĂƚĞĚ ǁŚĞŶ ŝŶĚŝĐĂƚĞĚͿ ĨŽƌ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ͘ ŽŶƐŝƐƚĞŶƚůǇ͕ ĚĂƚĂ ĂŶĂůǇƐŝƐ ƌĞǀĞĂůĞĚ ƚŚĂƚ ƌĂƚĞƐ ŽĨ ,/s ƚƌĂŶƐŵŝƐƐŝŽŶ ǁĞƌĞ ůŽǁĞƌ ĨŽƌ ƉĂƌƟĐŝƉĂŶƚƐ ǁŝƚŚ ĚĞƚĞĐƚĂďůĞ ůĞǀĞůƐ ŽĨ ƚĞŶŽĨŽǀŝƌ ŝŶ ƚŚĞŝƌ ďůŽŽĚƐƚƌĞĂŵ͘ This consistency of outcomes led the US Public Health Service ŝŶ ϮϬϭϰ ƚŽ ŝƐƐƵĞ ŝƚƐ ĮƌƐƚ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ĨŽƌ Wƌ W͘ϭ /ĚĞŶƟĨǇŝŶŐ ƉĂƟĞŶƚƐ Ăƚ ŚŝŐŚ ƌŝƐŬ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ ĂŶĚ ƉƌŽŵŽƟŶŐ ĂĚŚĞƌĞŶĐĞ ǁĞƌĞ ďŽƚŚ ŚŝŐŚůŝŐŚƚĞĚ ĂƐ ŬĞǇ ƚŽ ƌĞĚƵĐŝŶŐ ,/s ƚƌĂŶƐŵŝƐƐŝŽŶ ƌŝƐŬ͘ DŽƐƚ ƌĞĐĞŶƚůǇ ƌĞǀŝƐĞĚ ŝŶ DĂƌĐŚ ϮϬϭϴ͕ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ŝƐ ĂǀĂŝůĂďůĞ ĨƌŽŵ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ ǁĞďƐŝƚĞ͘ /ƚ ŶŽƚĂďůǇ ŝŶĐůƵĚĞƐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉŚǇƐŝĐŝĂŶƐ among those in the intended audience.

:ĂŵĞƐ ůŝŬĞůǇ ŚĞĂƌĚ ŽĨ Wƌ W ĨƌŽŵ ĨƌŝĞŶĚƐ Žƌ ƐĞǆƵĂů ƉĂƌƚŶĞƌƐ͕ Žƌ ĨƌŽŵ ĐŽƵŶƚůĞƐƐ ŵĞŶƟŽŶƐ ŝŶ ŵĂƌŬĞƟŶŐ ĐĂŵƉĂŝŐŶƐ ƚĂƌŐĞƚĞĚ ƚŽǁĂƌĚ ƚŚĞ ŐĂǇ ĐŽŵŵƵŶŝƚǇ͘ DĂŶǇ ƉĂƟĞŶƚƐ ŝŶ ĨĂĐƚ ǁŝůů ĂƐŬ ĂďŽƵƚ ƚŚĞ ŵĞĚŝĐĂƟŽŶ ďǇ ďƌĂŶĚ ŶĂŵĞ͘ ZĞŐĂƌĚůĞƐƐ ŽĨ :ĂŵĞƐ͛Ɛ ƌĞůĂƟŽŶƐŚŝƉ ƐƚĂƚƵƐ͕ ƉĂƐƚ Žƌ ƉƌĞƐĞŶƚ͕ ǇŽƵ ŶŽǁ ƐŚŽƵůĚ ĂƐƐĞƐƐ ŚŝƐ ƌŝƐŬƐ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ͘ ^ƉĞĐŝĮĐ ƚŽŽůƐ ĨŽƌ ĂƐƐĞƐƐŝŶŐ ŚŝƐ ƌŝƐŬ͕ ŝŶĐůƵĚŝŶŐ Ă ƐĐƌŝƉƚ ŽĨ ƋƵĞƐƟŽŶƐ ƚŽ ƵƐĞ͕ ĐĂŶ ďĞ ĨŽƵŶĚ ŝŶ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ͘ ^ĞůĞĐƚĞĚ ŵĂũŽƌ ƌŝƐŬ ĨĂĐƚŽƌƐ ĂƌĞ ƉƌĞƐĞŶƚĞĚ ŝŶ dĂďůĞ ϭ͖ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ ĂŶǇ ŽĨ ƚŚĞƐĞ 20

California Family Physician Summer 2019

ĨĂĐƚŽƌƐ ƐŚŽƵůĚ ƉƌŽŵƉƚ ĨƵƌƚŚĞƌ ƋƵĞƐƟŽŶŝŶŐ ĨŽƌ ƌŝƐŬ ƐƚƌĂƟĮĐĂƟŽŶ͘

/Ĩ :ĂŵĞƐ ŝƐ ŝĚĞŶƟĮĞĚ ĂƐ Ă ŐŽŽĚ ĐĂŶĚŝĚĂƚĞ ĨŽƌ Wƌ W͕ ŚĞ ŶĞǆƚ ƐŚŽƵůĚ ďĞ ƐĐƌĞĞŶĞĚ ĨŽƌ ,/s ŝŶĨĞĐƟŽŶ͘ dĂŬĞ ŶŽƚĞ͕ ĞǀĞŶ ŝĨ Ă ƉĂƟĞŶƚ ƌĞƉŽƌƚƐ Ă ƌĞĐĞŶƚ ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ƌĞƐƵůƚ ĂŶĚ ŶŽ ƌŝƐŬ ďĞŚĂǀŝŽƌƐ ŝŶ ƚŚĞ ŝŶƚĞƌŝŵ͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ϭϬ ĚĂǇƐ ƉƌŝŽƌ ƚŽ ŝŶŝƟĂƟŶŐ ƚŚĞƌĂƉǇ ŝŶ ŽƌĚĞƌ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ĂŶ ,/s ŝŶĨĞĐƟŽŶ ŝƐ ŶŽƚ ƉĂƌƟĂůůǇ ƚƌĞĂƚĞĚ͘ ^ŝŶĐĞ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ĂůƐŽ ŝƐ ƵƐĞĚ ŝŶ ĐŽŵďŝŶĂƟŽŶ ƚŚĞƌĂƉǇ ĨŽƌ ,ĞƉĂƟƟƐ ŝŶĨĞĐƟŽŶ͕ ŚŝƐ ŝŵŵƵŶĞ ƐƚĂƚƵƐ ŵƵƐƚ ďĞ ĞǀĂůƵĂƚĞĚ ĂƐ ǁĞůů͘ ĚĚŝƟŽŶĂůůǇ͕ ƐĞƌƵŵ ĐƌĞĂƟŶŝŶĞ ƐŚŽƵůĚ ďĞ ŵĞĂƐƵƌĞĚ ƚŽ ĂƐƐĞƐƐ ĨŽƌ ĚĞĐƌĞĂƐĞĚ ƌĞŶĂů ĨƵŶĐƟŽŶ ĚƵĞ ƚŽ ƚŚĞ ĂƐƐŽĐŝĂƟŽŶ ŽĨ ƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ǁŝƚŚ ƌĞŶĂů ƚŽǆŝĐŝƚǇ͘ /ŶŝƟĂů ƐĐƌĞĞŶŝŶŐ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ ŽƚŚĞƌ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ ĂŶĚ ŚĞƉĂƟƟƐ ĂƌĞ ĂůƐŽ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ͘ KŶĐĞ :ĂŵĞƐ ŝƐ ĐŽŶĮƌŵĞĚ ƚŽ ďĞ ,/s ŶĞŐĂƟǀĞ͕ ŚĞ ĐĂŶ ƌĞĐĞŝǀĞ ŚŝƐ ŝŶŝƟĂů ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ϵϬ ĚĂǇƐ ŽĨ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů͘ EŽ ƌĞĮůůƐ ĂƌĞ ƉĞƌŵŝƩĞĚ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ :ĂŵĞƐ ƌĞƚƵƌŶƐ ǁŝƚŚŝŶ ϵϬ ĚĂǇƐ ĨŽƌ ƌĞƉĞĂƚ ƐĐƌĞĞŶŝŶŐ ĨŽƌ ,/s͖ ĂƐ ǁŝƚŚ ƚŚĞ ŝŶŝƟĂů ƉƌĞƐĐƌŝƉƟŽŶ͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ϭϬ ĚĂǇƐ ƉƌŝŽƌ ƚŽ Ă ƌĞŶĞǁĂů ƉƌĞƐĐƌŝƉƟŽŶ͘ ƚ ĞĂĐŚ ĨŽůůŽǁ ƵƉ͕ ĂƐƐĞƐƐ ƌŝƐŬ ĨĂĐƚŽƌƐ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ Wƌ W ƌĞŵĂŝŶƐ ĂƉƉƌŽƉƌŝĂƚĞ͕ ĐŽƵŶƐĞů ŽŶ ƐĂĨĞƌ ƐĞǆ ƉƌĂĐƟĐĞƐ͕ ĂŶĚ ƐĐƌĞĞŶ ĨŽƌ ĂŶĚ ƚƌĞĂƚ ŽƚŚĞƌ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ͘ DĞĂƐƵƌĞ ƐĞƌƵŵ ĐƌĞĂƟŶŝŶĞ ĞǀĞƌǇ Ɛŝǆ ŵŽŶƚŚƐ ǁŚŝůĞ ŚĞ ƌĞŵĂŝŶƐ ŽŶ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ĨŽƌ Wƌ W͘ /Ĩ ŝŶ ƚŚĞ ĨƵƚƵƌĞ :ĂŵĞƐ ŝƐ ŶŽ ůŽŶŐĞƌ Ă ĐĂŶĚŝĚĂƚĞ ĨŽƌ ŽŶŐŽŝŶŐ Wƌ W͕ ŵĞĚŝĐĂƟŽŶ ƐŝŵƉůǇ ĐĂŶ ďĞ ĚŝƐĐŽŶƟŶƵĞĚ͕ ĂŶĚ ĂŶǇ ƌĞŵĂŝŶŝŶŐ ƉŝůůƐ should be disposed of.

h^W^d&͛Ɛ :ƵŶĞ ϮϬϭϵ ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĨŽƌ ƉƌĞĞǆƉŽƐƵƌĞ ƉƌŽƉŚǇůĂǆŝƐ ;Wƌ WͿ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ,/s ŝŶĨĞĐƚŝŽŶ ŶŽǁ >ĞǀĞů ĞǀŝĚĞŶĐĞ͘ ŚƚƚƉƐ͗ͬͬũĂŵĂŶĞƚǁŽƌŬ͘ĐŽŵͬũŽƵƌŶĂůƐͬ ũĂŵĂͬĨƵůůĂƌƚŝĐůĞͬϮϳϯϱϱϬϵ

&Žƌ ŶŽǁ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů ;dƌƵǀĂĚĂͿ ƌĞŵĂŝŶƐ ƚŚĞ ŽŶůǇ ŵĞĚŝĐĂƟŽŶ ŝŶĚŝĐĂƚĞĚ ĨŽƌ ƵƐĞ ǁŝƚŚ Ă Wƌ W ƌĞŐŝŵĞŶ͘ ,ŽǁĞǀĞƌ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĂůĂĨĞŶĂŵŝĚĞ ; ĞƐĐŽǀǇͿ ŚĂƐ ďĞĞŶ ƐŚŽǁŶ ŝŶ ƌĞĐĞŶƚ ƚƌŝĂůƐ ƚŽ ďĞ ŶŽŶͲŝŶĨĞƌŝŽƌ ƚŽ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů͕ ĂŶĚ 'ŝůĞĂĚ ŚĂƐ ƐƵďŵŝƩĞĚ ĂŶ ĂƉƉůŝĐĂƟŽŶ ĨŽƌ Ă Wƌ W ŝŶĚŝĐĂƟŽŶ͘ KƚŚĞƌ ŝŶŶŽǀĂƟŽŶƐ ĂůƐŽ ĂƌĞ ŝŶ ƚŚĞ ƉŝƉĞůŝŶĞ͕ ŝŶĐůƵĚŝŶŐ ůŽŶŐͲĂĐƟŶŐ ŝŶũĞĐƚĂďůĞ ĂŶĚ ŝŵƉůĂŶƚĂďůĞ ĨŽƌŵƵůĂƟŽŶƐ͘

ZĞĂĚǇ ƚŽ ƉƌŽǀŝĚĞ Wƌ W ƚŽ ǇŽƵƌ ƉĂƟĞŶƚƐ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ ĨŽƌ ĂĐƋƵŝƌŝŶŐ ,/s͍ EŽ ƐƉĞĐŝĂů ƚƌĂŝŶŝŶŐ ŝƐ ƌĞƋƵŝƌĞĚ͘ :ƵƐƚ ĨŽůůŽǁ ƚŚĞ ůĂƚĞƐƚ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ĂŶĚ ŐĞƚ ƐƚĂƌƚĞĚ ƚŽĚĂǇ͘

ƌ͘ ^ĐŽƩ EĂƐƐ ŝƐ ƚŚĞ ƉƌŽŐƌĂŵ ĚŝƌĞĐƚŽƌ Ăƚ ƚŚĞ ŝƐĞŶŚŽǁĞƌ DĞĚŝĐĂů Center Family Medicine Residency Program.

Reference ϭ͘ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ͗ h^ WƵďůŝĐ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ͗ WƌĞĞǆƉŽƐƵƌĞ ƉƌŽƉŚǇůĂǆŝƐ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƟŽŶ ŽĨ ,/s ŝŶĨĞĐƟŽŶ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐͶϮϬϭϳ hƉĚĂƚĞ͗ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŐƵŝĚĞůŝŶĞ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƉĚĨͬƌŝƐŬͬƉƌĞƉͬĐĚĐͲŚŝǀͲƉƌĞƉͲ ŐƵŝĚĞůŝŶĞƐͲϮϬϭϳ͘ƉĚĨ͘ WƵďůŝƐŚĞĚ DĂƌĐŚ ϮϬϭϴ͘

Need a little more help to get started? Ăůů ƚŚĞ EĂƟŽŶĂů ůŝŶŝĐŝĂŶƐ ŽŶƐƵůƚĂƟŽŶ ĞŶƚĞƌ Wƌ WůŝŶĞ Ăƚ ϴϱϱͲϰϰϴͲϳϳϯϳ Žƌ ǀŝƐŝƚ ƚŚĞŝƌ ǁĞďƐŝƚĞ Ăƚ ŚƩƉ͗ͬͬŶĐĐĐ͘ƵĐƐĨ͘ĞĚƵͬĐůŝŶŝĐŝĂŶͲĐŽŶƐƵůƚĂƟŽŶͬƉƌĞƉͲƉƌĞͲĞǆƉŽƐƵƌĞͲƉƌŽƉŚǇůĂǆŝƐͬ͘ >ĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ďĞŶĞĮƚƐ ĂŶĚ ƌŝƐŬƐ ŽĨ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽǆŝů Ăƚ ƚŚĞ ŵĂŶƵĨĂĐƚƵƌĞƌ͛Ɛ ZŝƐŬ ǀĂůƵĂƟŽŶ ĂŶĚ DŝƟŐĂƟŽŶ ^ƚƌĂƚĞŐǇ ;Z D^Ϳ ƐŝƚĞ Ăƚ ŚƩƉƐ͗ͬͬǁǁǁ͘ŌĐͲƚĚĨͲƉƌĞƉƌĞŵƐ͘ĐŽŵͬ͘

California Family Physician Summer 2019

Ta c k l i n g S T I s

Ina Park, MD

Strange Bedfellows: Adventures in sex and its least intended consequences Ǉ ƚŚĞ ƟŵĞ ǇŽƵ͛ǀĞ ĮŶŝƐŚĞĚ ƌĞĂĚŝŶŐ ƚŚŝƐ ƐĞŶƚĞŶĐĞ͕ ϭϬϬ ƉĞŽƉůĞ ǁŽƌůĚǁŝĚĞ ǁŝůů ďĞ ŝŶĨĞĐƚĞĚ ǁŝƚŚ Ă ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ͘ Ǉ ƚŚŝƐ ƟŵĞ ƚŽŵŽƌƌŽǁ͕ ƚŚĞ tŽƌůĚ ,ĞĂůƚŚ KƌŐĂŶŝǌĂƟŽŶ ĞƐƟŵĂƚĞƐ ƚŚĂƚ ŽŶĞ ŵŝůůŝŽŶ ŽƚŚĞƌƐ ǁŝůů ĨŽůůŽǁ ƐƵŝƚ͘ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ ; Ϳ͕ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ĐĂƐĞƐ ŽĨ ^d/Ɛ ĂŶĚ ,/s ĂƌĞ ŝĚĞŶƟĮĞĚ ƉĞƌ ǇĞĂƌ ŝŶ ƚŚĞ h^͕ ĂŶĚ ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ŵĞƌŝĐĂŶƐ ĐŽŶƚƌĂĐƚ Ă ^d/ ďǇ ĂŐĞ Ϯϱ͘ ůƚŚŽƵŐŚ ƚŚĞ ŶĞĂƌ ƵďŝƋƵŝƚǇ ŽĨ ^d/Ɛ ŝƐ ƐƵƌƉƌŝƐŝŶŐ͕ ĞǀĞŶ ŵŽƌĞ ƉƵǌǌůŝŶŐ ŝƐ ŽƵƌ ŝŶĂďŝůŝƚǇ ƚŽ ĚŝƐĐƵƐƐ ƚŚĞŵ ŽƉĞŶůǇ͘ ^ŽŵĞŚŽǁ ŚĂǀŝŶŐ ƐĞǆ ŝƐ ŝŶĮŶŝƚĞůǇ ĞĂƐŝĞƌ ƚŚĂŶ ƚĂůŬŝŶŐ ĂďŽƵƚ ƐĞǆ͕ ĞƐƉĞĐŝĂůůǇ ŝƚƐ ůĞĂƐƚ ƉůĞĂƐĂŶƚ ĐŽŶƐĞƋƵĞŶĐĞƐ͘

ƚŚĞ ĐŽŶƚĞǆƚ ŽĨ ƚŚĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ŝŶ ƚŚĞŝƌ ůŝǀĞƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ͘

With STD rates reaching historic highs in the United States, my ŝŶƚĞƌĞƐƚƐ ŚĂǀĞ ƌĞĐĞŶƚůǇ ƐŚŝŌĞĚ ƚŽǁĂƌĚ ĞĚƵĐĂƟŶŐ ƚŚĞ ƉƵďůŝĐ ĂďŽƵƚ ^d/Ɛ ĂŶĚ ƚŚĞŝƌ ƉůĂĐĞ ŝŶ ƐŽĐŝĞƚǇ͕ ŝŶ ƚŚĞ ĂƌĞĂƐ ŽĨ ƌĞƐĞĂƌĐŚ͕ ŚŝƐƚŽƌǇ͕ ƐŽĐŝĂů ƐĐŝĞŶĐĞ͕ ĞǀĞŶ ƉŽƉ ĐƵůƚƵƌĞ͘ dŽ ƚŚĂƚ ĞŶĚ /͛ǀĞ ǁƌŝƩĞŶ Ă ďŽŽŬ ĞŶƟƚůĞĚ STRANGE BEDFELLOWS͗ ĚǀĞŶƚƵƌĞƐ ŝŶ ƐĞǆ ĂŶĚ ŝƚƐ ůĞĂƐƚ ŝŶƚĞŶĚĞĚ ĐŽŶƐĞƋƵĞŶĐĞƐ ;&ůĂƟƌŽŶ ŽŽŬƐ͕ ^ƉƌŝŶŐ ϮϬϮϬͿ͘ /Ŷ ŝƚ / ĞŵƉůŽǇ ƐƚŽƌǇƚĞůůŝŶŐ͕ ŚƵŵŽƌ ĂŶĚ ŝŶͲĚĞƉƚŚ ŝŶƚĞƌǀŝĞǁƐ ǁŝƚŚ ƐĐŝĞŶƟƐƚƐ ƚŽ ĞĚƵĐĂƚĞ ƚŚĞ public on the latest trends and ĚĞǀĞůŽƉŵĞŶƚƐ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ^d/ͬ,/s ƉƌĞǀĞŶƟŽŶ͘ DŽƐƚ ŽĨ Ăůů͕ / ŚŽƉĞ ƚŚĂƚ ďǇ ĞŶĐŽƵƌĂŐŝŶŐ Society has managed to defeat ĐŽŶǀĞƌƐĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ͕ stigma surrounding other ǁĞ ĐĂŶ ǁŽƌŬ ŽŶ ƌĞĚƵĐŝŶŐ ƚŚĞ ĞŶŽƌŵŽƵƐ ƐƟŐŵĂ ƚŚĂƚ ƐƟůů previously taboo subjects such ĞǆŝƐƚƐ ĂƌŽƵŶĚ ƚŚĞƐĞ ŝŶĨĞĐƟŽŶƐ͘

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While dressed as a giant condom as a pre-med ƐƚƵĚĞŶƚ Ăƚ h ĞƌŬĞůĞǇ͕ / ƌĞĂůŝǌĞĚ ƚŚĂƚ / ǁĂƐ ǁŝůůŝŶŐ to push boundaries to ĞŵƉŽǁĞƌ ĂŶĚ ŝŶĨŽƌŵ ŽƚŚĞƌƐ ĂďŽƵƚ ƐĞǆƵĂů ŚĞĂůƚŚ ĂŶĚ ^d/Ɛͬ,/s͘ / as cancer, creating discourse and ƐƉĞŶƚ ƚǁŽ ǁŽŶĚĞƌĨƵů ǇĞĂƌƐ ĂƐ Ă ƐĞǆƵĂů ŚĞĂůƚŚ Society has managed to defeat shifting public sentiment towards peer educator during ƐƟŐŵĂ ƐƵƌƌŽƵŶĚŝŶŐ ŽƚŚĞƌ support rather than shame. my undergraduate previously taboo subjects such ƚƌĂŝŶŝŶŐ͗ ĚŝƐƚƌŝďƵƟŶŐ ĂƐ ĐĂŶĐĞƌ͕ ĐƌĞĂƟŶŐ ĚŝƐĐŽƵƌƐĞ condoms, lecturing in ĂŶĚ ƐŚŝŌŝŶŐ ƉƵďůŝĐ ƐĞŶƟŵĞŶƚ the community and ƚŽǁĂƌĚ ƐƵƉƉŽƌƚ ƌĂƚŚĞƌ ƚŚĂŶ ĐŽƵŶƐĞůŝŶŐ ƐƚƵĚĞŶƚƐ ĂŌĞƌ Ă ^d/ ĚŝĂŐŶŽƐŝƐ͘ dŚĞƌĞ ǁĂƐ ƐŽŵĞƚŚŝŶŐ ƐŚĂŵĞ͘ tĞ ŶĞĞĚ Ă ƐŝŵŝůĂƌ ƐĞĂ ĐŚĂŶŐĞ ĂƌŽƵŶĚ ^d/Ɛͬ,/s ƚŽ ŚĂǀĞ ĂŶǇ ƉŽǁĞƌĨƵů ŝŶ ƐŝŵƉůǇ ƐŝƫŶŐ ĂŶĚ ƚĂůŬŝŶŐ ǁŝƚŚ ƐŽŵĞŽŶĞ ĚƵƌŝŶŐ Ă hope of curbing the current epidemic. As a family physician and ǀƵůŶĞƌĂďůĞ ŵŽŵĞŶƚ͕ ŬŶŽǁŝŶŐ ƚŚĂƚ / ŵŝŐŚƚ ďƌŝŶŐ ƚŚĞŵ ĐŽŵĨŽƌƚ ĂŶĚ ŵĞĚŝĐĂů ĞƉŝĚĞŵŝŽůŽŐŝƐƚ͕ /͛ŵ ĞǆĐŝƚĞĚ ĂŶĚ ƉƌŽƵĚ ƚŽ ďĞ Ă ĐĂƚĂůǇƐƚ ĨŽƌ ƌĞĚƵĐĞ ƚŚĞ ƐƟŐŵĂ ŽĨ ďĞŝŶŐ ĨĂĐĞĚ ǁŝƚŚ ĂŶ ^d/͘ / ŐƌĂĚƵĂƚĞĚ ŬŶŽǁŝŶŐ this change. ƚŚĂƚ ĞŵƉŽǁĞƌŝŶŐ ŽƚŚĞƌƐ ĂďŽƵƚ ^d/ ƉƌĞǀĞŶƟŽŶ ǁĂƐ Ă ƉĂƐƐŝŽŶ ƚŚĂƚ ǁŽƵůĚ ĞŶĚƵƌĞ ƚŚƌŽƵŐŚŽƵƚ ŵǇ ŵĞĚŝĐĂů ĐĂƌĞĞƌ͘ Dr. Ina Park is an Associate Professor in the Department of Family and Community Medicine at the University of California San EŽǁ ĂƐ Ă ƉƵďůŝĐ ŚĞĂůƚŚ ƉƌĂĐƟƟŽŶĞƌ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ^d/ͬ,/s Francisco School of Medicine. She also serves as the Medical ƉƌĞǀĞŶƟŽŶ͕ / ůŝǀĞ ŽƵƚ ŵǇ ƉĂƐƐŝŽŶ ĨŽƌ ƐĞǆƵĂů ŚĞĂůƚŚ ĚĂŝůǇ ŝƌĞĐƚŽƌ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ WƌĞǀĞŶƟŽŶ dƌĂŝŶŝŶŐ ĞŶƚĞƌ ĂŶĚ Ă ƚŚƌŽƵŐŚ ŵǇ ƌĞƐĞĂƌĐŚ͕ ƚĞĂĐŚŝŶŐ ĂŶĚ ƉĂƟĞŶƚ ĐĂƌĞ͘ /Ŷ ĂŶǇ ŐŝǀĞŶ ǁĞĞŬ͕ Medical Consultant for the Centers for Disease Control, Division ŵǇ ũŽď ƌƵŶƐ ƚŚĞ ŐĂŵƵƚ ĨƌŽŵ ĐĂƌŝŶŐ ĨŽƌ ŝŶĚŝǀŝĚƵĂů ƉĂƟĞŶƚƐ͕ ƚƌĂŝŶŝŶŐ ŽĨ ^d WƌĞǀĞŶƟŽŶ͘ ,Ğƌ ƌĞƐĞĂƌĐŚ ŝŶƚĞƌĞƐƚƐ ŝŶĐůƵĚĞ ĞǀĂůƵĂƟŶŐ ƚŚĞ ŽƚŚĞƌ ĐůŝŶŝĐŝĂŶƐ͕ ǁŽƌŬŝŶŐ ŽŶ ƉƌĂĐƟĐĞͲůĞǀĞů ƋƵĂůŝƚǇ ŝŵƉƌŽǀĞŵĞŶƚ ƉŽƉƵůĂƟŽŶͲůĞǀĞů ŝŵƉĂĐƚ ŽĨ ,Ws ǀĂĐĐŝŶĂƟŽŶ ĂŶĚ ŶŽǀĞů ĚŝĂŐŶŽƐƟĐ ĂŶĚ ĚĞǀĞůŽƉŝŶŐ ƉŽƉƵůĂƟŽŶͲůĞǀĞů ŐƵŝĚĞůŝŶĞƐ͘ DǇ ƚƌĂŝŶŝŶŐ ŝŶ ĨĂŵŝůǇ ƚĞƐƚƐ ĨŽƌ ƐǇƉŚŝůŝƐ͘ tŚĞŶ ƐŚĞ ŝƐŶ͛ƚ ǁŽƌŬŝŶŐ͕ ƐŚĞ͛Ɛ ĐŚĂƐŝŶŐ ĂŌĞƌ ŵĞĚŝĐŝŶĞ ǁĂƐ ƚŚĞ ƉĞƌĨĞĐƚ ƐƉƌŝŶŐďŽĂƌĚ ŝŶƚŽ ŵǇ ĐƵƌƌĞŶƚ ĐĂƌĞĞƌ͖ ƚǁŽ ƌĂŵďƵŶĐƟŽƵƐ ďŽǇƐ͕ ƉƌĂĐƟĐŝŶŐ ǇŽŐĂ͕ ĂŶĚ ŚƵŶƟŶŐ ĨŽƌ ŐŽŽĚ ŽƵƌ ƐƉĞĐŝĂůƚǇ ŝƐ ƵŶŝƋƵĞ ŝŶ ŝƚƐ ĨŽĐƵƐ ŽŶ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ƉĂƟĞŶƚ ŝŶ ethnic food.

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California Family Physician Summer 2019

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Ta c k l i n g S T I s

Robert Assibey, MD

To Be Syphilis Free, It’s Best to Do Three ƌŝƐĞ ŝŶ ƉƌĞŶĂƚĂů ĂŶĚ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ ͙ ^ǇƉŚŝůŝƐ ŝƐ Ă ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶ ;^d/Ϳ ĐĂƵƐĞĚ ďǇ ƚŚĞ spirochete Treponema pallidum͖ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐǇ ŝƚ ĐĂƵƐĞƐ significant concern because infection can be transferred to the fetus via the placenta. Congenital syphilis can cause ŵŝƐĐĂƌƌŝĂŐĞ͕ ƉƌĞŵĂƚƵƌĞ ďŝƌƚŚ͕ ůŽǁ ďŝƌƚŚǁĞŝŐŚƚ͕ ďŝƌƚŚ ĚĞĨĞĐƚƐ͕ blindness, hearing loss, lifelong physical and mental health problems, and even death. WĞƌ ƚŚĞ ĞŶƚĞƌ ŽĨ ŝƐĞĂƐĞ ŽŶƚƌŽů ; Ϳ͕ ƌĞƉŽƌƚĞĚ ĐĂƐĞƐ ŽĨ syphilis have more than doubled during the four-year period ďĞƚǁĞĞŶ ϮϬϭϯ ĂŶĚ ϮϬϭϳ͕ ƌĞĂĐŚŝŶŐ Ă ϮϬͲǇĞĂƌ ŚŝŐŚ͘ dŚĞ majority of the cases have been reported in the Western and ^ŽƵƚŚĞƌŶ ƐƚĂƚĞƐ͕ ĂŶĚ / ŚĂǀĞ ǁŝƚŶĞƐƐĞĚ Ă ůĂƌŐĞ ŝŶĐƌĞĂƐĞ ŝŶ ŵǇ ŽǁŶ ĐŽŵŵƵŶŝƚǇ ŝŶ ƚŚĞ ^ĂŶ :ŽĂƋƵŝŶ ŽƵŶƚǇ͘ ^ǇƉŚŝůŝƐ ƌĂƚĞƐ ŚĂǀĞ ŽƵƚƉĂĐĞĚ ƚŚĞ ŶĂƚŝŽŶĂů ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/Ɛ ŽǀĞƌĂůů͘ dŚĞ ĐƵƌƌĞŶƚůǇ ƌĞĐŽŵŵĞŶĚƐ Ăůů ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ ďĞ ƚĞƐƚĞĚ for syphilis at the first prenatal appointment. Due to the labile nature of prenatal syphilis, CDC has various state-based ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĂƐ ǁĞůů͘ dŚŽƐĞ ǁŽŵĞŶ ǁŚŽ ĂƌĞ ĞƐƉĞĐŝĂůůǇ ŚŝŐŚ ƌŝƐŬ ĂŶĚ ůŝǀĞ ŝŶ ŚŝŐŚ ƉƌĞǀĂůĞŶĐĞ ĂƌĞĂƐ͕ ƐŚŽƵůĚ ďĞ ƚĞƐƚĞĚ Ă second time during the early third trimester, and some even Ăƚ ĚĞůŝǀĞƌǇ͘ /Ŷ ĂůŝĨŽƌŶŝĂ͕ ƚŚĞ ĐƵƌƌĞŶƚ ƌĞƋƵŝƌĞŵĞŶƚ ŝƐ ƚŽ ƐĐƌĞĞŶ at the first prenatal visit only. The question becomes, is that ĞŶŽƵŐŚ ƚŽ ĂƉƉƌŽƉƌŝĂƚĞůǇ ƐĐƌĞĞŶ ĂŶĚ ƚƌĞĂƚ ŽƵƌ ƉĂƚŝĞŶƚƐ͍ ,ĞƌĞ ŝŶ ƚŚĞ ^ĂŶ :ŽĂƋƵŝŶ ŽƵŶƚǇ ǁĞ ůŝǀĞ ŝŶ Ă ǀĞƌǇ ŚŝŐŚ ƉƌĞǀĂůĞŶĐĞ ĂƌĞĂ͕ ĂŶĚ ďĞĐĂƵƐĞ ŽĨ ƚŚĂƚ ŽƵƌ ŽǁŶ ƉƌĞŶĂƚĂů ĐůŝŶŝĐ ƐĐƌĞĞŶƐ ĨŽƌ ƉƌĞŶĂƚĂů ƐǇƉŚŝůŝƐ ƚŚƌĞĞ ƚŝŵĞƐ ĚƵƌŝŶŐ ĞǀĞƌǇ ƉƌĞŐŶĂŶĐǇ͗ ŽŶĐĞ ŽŶ ŝŶŝƚŝĂů ǀŝƐŝƚ͕ ƐĞĐŽŶĚ ŝŶ ƚŚĞ ĞĂƌůǇ ƚŚŝƌĚ ƚƌŝŵĞƐƚĞƌ ĂŶĚ ƚŚŝƌĚ ǁŚĞŶ patient presents for delivery. We have seen a significant increase in the number of prenatal syphilis cases over the years and have treated multiple babies for congenital syphilis. tŚŝůĞ ǁĞ ƐĞĞ Ă ƐƵďƐƚĂŶƚŝĂů ŝŶĐƌĞĂƐĞ ƉƌĞŶĂƚĂů ƐǇƉŚŝůŝƐ ĐĂƐĞƐ ŶĂƚŝŽŶĂůůǇ͕ ǁĞ ƐĞĞ ŝƚ ĞǀĞŶ ŵŽƌĞ ƐŽ ŝŶ ĂůŝĨŽƌŶŝĂ͘ /Ŷ ϮϬϭϳ͕ Ϯϴϯ ĐĂƐĞƐ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ ǁĞƌĞ ƌĞƉŽƌƚĞĚ͕ ŝŶĐůƵĚŝŶŐ ϯϬ ƐƚŝůůďŝƌƚŚƐ ŝŶ ĂůŝĨŽƌŶŝĂ ĂůŽŶĞ͘ &Žƌ ĐŽŵƉĂƌŝƐŽŶ͕ ŽŶůǇ ϯϯ ƌĞƉŽƌƚĞĚ ĐĂƐĞƐ ŝŶ ϮϬϭϮ͘ /ƚ ŚĂƐ ďĞĞŶ ŶŽƚĞĚ ƚŚĂƚ ƚŚĞ ĞŶƚƌĂů sĂůůĞǇ ŚĂƐ Ă ƐŝŐŶŝĨŝĐĂŶƚ ŶƵŵďĞƌ ŽĨ ƌĞƉŽƌƚĞĚ ĐŽŶŐĞŶŝƚĂů ƐǇƉŚŝůŝƐ ĐĂƐĞƐ ͙ ƚŚŽƐĞ ƐĂŵĞ ĞŶƚƌĂů sĂůůĞǇ ĐŽƵŶƚŝĞƐ ĂůƐŽ ĂƉƉĞĂƌ ƚŽ have high rates of homelessness, poverty and substance abuse. An active syphilis infection is easily screened and 24

California Family Physician Summer 2019

ƚƌĞĂƚĂďůĞ͕ ǁŚĞŶ ƉĂƚŝĞŶƚ ŝƐ ƚƌĞĂƚĞĚ ǁŝƚŚ ƚŚĞ ĐŽƌƌĞĐƚ ĂŶƚŝďŝŽƚŝĐƐ͕ and per the appropriate timeline. A caution should be noted for false positive testing, as it is more common in pregnancy. A confirmatory test should be ƉĞƌĨŽƌŵĞĚ ĂĨƚĞƌ Ă ƉŽƐŝƚŝǀĞ ƐĐƌĞĞŶŝŶŐ ƚĞƐƚ͘ WƌĞŐŶĂŶƚ ǁŽŵĞŶ ŵĂǇ ďĞ ĂƐǇŵƉƚŽŵĂƚŝĐ ǁŚĞŶ ƚŚĞǇ ƉƌĞƐĞŶƚ ĨŽƌ ƉƌĞŶĂƚĂů appointments, but that should not deter from appropriate ƐĐƌĞĞŶŝŶŐ͘ /ƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ŶŽƚĞ ƚŚĂƚ ŽŶĐĞ Ă ƐĐƌĞĞŶŝŶŐ ƚĞƐƚ ŝƐ

appropriately positive, all future testing ǁŝůů ĂůƐŽ ďĞ ƉŽƐŝƚŝǀĞ͘ dŚŽƐĞ ƉĂƚŝĞŶƚƐ ǁŽƵůĚ ŶĞĞĚ ĐŽŶĨŝƌŵĂƚŽƌǇ ƚĞƐƚŝŶŐ ƚŽ evaluate for active infection and for titers. tŝƚŚ ƚŚĂƚ ďĞŝŶŐ ƐĂŝĚ͕ ǁŚĞƌĞ ĚŽ ǁĞ ŐŽ ĨƌŽŵ ŚĞƌĞ͍ ^d/Ɛ ŝŶ ŐĞŶĞƌĂů ŚĂǀĞ ďĞĐŽŵĞ a significant problem in the nation, and ŝŶ ĂůŝĨŽƌŶŝĂ͘ EŽƚ ŽŶůǇ ĚŽ ǁĞ ŚĂǀĞ Ă ŵĞĚŝĐĂů ƉƌŽďůĞŵ͕ ǁĞ ŚĂǀĞ Ă ůĂƌŐĞ ƉƵďůŝĐ health issue. Syphilis is a treatable disease, and ǁŝƚŚ ƚŚĞ ĂƉƉƌŽƉƌŝĂƚĞ ƐƵƌǀĞŝůůĂŶĐĞ ĂŶĚ ƐĐƌĞĞŶŝŶŐ ǁĞ ĐĂŶ ƉƌĞǀĞŶƚ Ă ůĂƌŐĞ number of congenital syphilis case and concomitant complications. California may benefit from changing to the current CDC guidelines and possibly increasing ƚŚĞ ĂŵŽƵŶƚ ŽĨ ƚŝŵĞƐ ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ ĂƌĞ ƐĐƌĞĞŶĞĚ͘ DǇ ŚŽƉĞ ŝƐ ƚŚĂƚ ǁŝƚŚ

Aspire • Achieve • Inspire

the current screening guidelines in San :ŽĂƋƵŝŶ 'ĞŶĞƌĂů ,ŽƐƉŝƚĂů͕ ǁĞ ĂƌĞ ĂďůĞ to reduce the transmission of congenital syphilis by capturing prenatal syphilis ĞĂƌůǇ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ƋƵŝĐŬ ĂŶĚ ĂĚĞƋƵĂƚĞ treatment.

Dr. Assibey is a third-year resident at the San Joaquin General Hospital program resident and co-chair of the CAFP Resident Council.

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

Family Medicine Physicians

Eisenhower Health seeks candidates whose experience, teaching, research and community service have prepared them to contribute to our commitment to serving the Coachella Valley. Eisenhower is an EO/M employer.

(MD/DO/IM)

Qualified applicants, including recent residency graduates, are encouraged to apply. Candidates should submit a digital CV and statement of interest to Scott Nass, MD, MPA, Program Director at SNass@eisenhowerhealth.org with . cc: Tamara Dunn at TDunn@eisenhowerhealth.org.

• Board, DEA and License Reimbursement • Malpractice Insurance, including Tail Coverage • 2 Weeks Vacation, 2 Weeks Sick Pay, 11.5 Holidays • 5 Days CME + Allowance • 403b Retirement Plan, Discretionary Match up to 5% • Medical, Dental, Vision, Chiro and Life Insurance Contact Information: Website: www.achievable.org Forward CVs to employment@achievable.org

For questions, please contact Michelle Harding at mharding@eisenhowerhealth.org or 760-773-4504.

www.eisenhowerhealth.org California Family Physician Summer 2019

Join Our Team in the

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

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

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

California Family Physician Summer 2019

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For Advertising CONTACT

Michelle Gilbert mgilbert@pcipublishing.com

1.800.561.4686 ext. 120

LAC Medical Inc. Family Medicine Physician Job inBakersfield, CA Located in beautiful Bakersfield, CA, LAC Medical Inc. is a private practice with 3 Primary Care Providers, in San Joaquin Valley. Bakersfield is a great location, with easy travel to the beach or the mountains. We also have very competitive schools and affordable housing. Patient encounters average 25 – 35. 40 Patient contact hours per week. Call frequency: Approximately 1 in 10 – weekend call, weekdays shared amongst providers. This is for 1FTE. Fully Integrated Electronic Medical Record (eClinical).

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

MD/DO Please contact Dr. Cousins at Lcousin99@aol.com LAC Medical Inc.

9508 Stockdale Hwy., Suite 120 Bakersfield, CA 93311 (661) 735-1710 • Fax (661) 888-4841 Toll Free (661) 656-7245

California Family Physician Summer 2019

Family Medicine Tackles STIs in California This issue of California Family Physician ŚĂƐ ďĞĞŶ ƌĞǀŝĞǁĞĚ ĂŶĚ accepted by the American Academy of Family Physicians for three Prescribed CME credits. Clinicians should claim only the credit ĐŽŵŵĞŶƐƵƌĂƚĞ ǁŝƚŚ ƚŚĞ ĞǆƚĞŶƚ ŽĨ ƚŚĞŝƌ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ƚŚĞ ĂĐƟǀŝƚǇ͘ dŽ ĐůĂŝŵ ǇŽƵƌ ĐƌĞĚŝƚƐ͕ ƉůĞĂƐĞ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚŝƐ ƋƵŝǌ ĂŶĚ ĞǀĂůƵĂƟŽŶ ƚŽ &W͕ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ Žƌ ĨĂǆ ϰϭϱͲϯϰϱͲϴϲϲϴ͘ Ɛ ĂŶ ĐĐƌĞĚŝƚĂƟŽŶ ŽƵŶĐŝů ĨŽƌ ŽŶƟŶƵŝŶŐ DĞĚŝĐĂů ĚƵĐĂƟŽŶͲ accredited provider, CAFP is required by the ACCME Standards of ŽŵŵĞƌĐŝĂů ^ƵƉƉŽƌƚ͕ ƚŽ ŝĚĞŶƟĨǇ͕ ŵĂŶĂŐĞ Žƌ ƌĞƐŽůǀĞ ĂŶǇ ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ ĨŽƌ ĂŶǇ ŝŶĚŝǀŝĚƵĂů ǁŚŽ ŵĂǇ ŚĂǀĞ ŝŶŇƵĞŶĐĞ ŽǀĞƌ ĞĚƵĐĂƟŽŶĂů ĐŽŶƚĞŶƚ ƉƌŽǀŝĚĞĚ ďǇ ƚŚĞ &W͘ KƵƌ ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ ƉŽůŝĐǇ ŝƐ ŝŶĐůƵƐŝǀĞ ŽĨ Ăůů ƚŚĞ ĞůĞŵĞŶƚƐ ŽĨ ƚŚĞ D ĚĞĮŶŝƟŽŶ ŽĨ Ă ĐŽŵŵĞƌĐŝĂů

interest. Our policy requires us to collect disclosure forms from any ŝŶĚŝǀŝĚƵĂů ǁŚŽ ŵĂǇ ŚĂǀĞ ĂŶ ŝŶŇƵĞŶĐĞ ŽŶ ĂŶǇ ĞĚƵĐĂƟŽŶĂů ĐŽŶƚĞŶƚ͘ tĞ ĂůƐŽ ĐĂƉƚƵƌĞ ƚŚĞ ƐĂŵĞ ƌĞůĂƟŽŶƐŚŝƉƐ ĨƌŽŵ ŝŶĚŝǀŝĚƵĂů͛Ɛ ƐƉŽƵƐĞƐͬ ƉĂƌƚŶĞƌƐ͘ KƵƌ ŐŽĂů ŝŶ ŝĚĞŶƟĨǇŝŶŐ͕ ŵĂŶĂŐŝŶŐ ĂŶĚ ƌĞƐŽůǀŝŶŐ ŝŶƚĞƌĞƐƚ ŝƐ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ Ăůů ĞĚƵĐĂƟŽŶ ĐŽŶƚĞŶƚ ĂŶĚ ĐƵƌƌŝĐƵůƵŵ͕ ƉƌĞƐĞŶƚĂƟŽŶƐ ĂŶĚ ƉƌŽĚƵĐƚƐ ĂƌĞ ĨƌĞĞ ŽĨ ĐŽŵŵĞƌĐŝĂů ďŝĂƐ ĂŶĚ ƉƌŽŵŽƟŽŶ͘ dŚĞ W ƌĞǀŝĞǁƐ Ăůů K/ ĨŽƌŵƐ ĂŶĚ ĞŵƉůŽǇƐ Ă ƉƌŽĐĞƐƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ƋƵĂůŝƚǇ ŽĨ ŽƵƌ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵ͘ tĞ ĂůƐŽ ĞŶŐĂŐĞ ŽƵƌ ůĞĂƌŶĞƌƐ ƚŚƌŽƵŐŚ ƚŚĞ ĞǀĂůƵĂƟŽŶ ƉƌŽĐĞƐƐ ƚŽ ŵŽŶŝƚŽƌ ĨŽƌ ďŝĂƐͬƉƌŽŵŽƟŽŶ ĂŶĚ ĞīĞĐƟǀĞŶĞƐƐ ŽĨ ƚŚĞ ĂĐƟǀŝƟĞƐ͘

NAME

AFFILIATION

RESPONSIBILITY

DISCLOSURE

Brent Sugimoto, MD, MPH

DecodedHealth

Editor, Planner and Author

Nothing to Declare

Walter Mills, MD, MMM

Natividad FMRP

Author

Nothing to Declare

Scott Nass, MD, MPA

Eisenhower FMRP

Author

Nothing to Declare

Ina Park, MD

UCSF and SF VA

Author

Nothing to Declare

Robert Assibey, MD

San Joaquin FMRP

Author

Nothing to Declare

Shelly B. Rodrigues, CAE

CAFP

Managing Editor, Planner and Author

Nothing to Declare

>ĞĂƌŶŝŶŐ KďũĞĐƟǀĞƐ ŌĞƌ ƌĞĂĚŝŶŐ ƚŚĞ ĂƌƟĐůĞƐ ŝŶ ƚŚŝƐ ŝƐƐƵĞ͕ ůĞĂƌŶĞƌƐ ƐŚŽƵůĚ ďĞ ĂďůĞ ƚŽ͗ • /ŶĐƌĞĂƐĞ ĂǁĂƌĞŶĞƐƐ ĂŵŽŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂďŽƵƚ ƚŚĞ ŝŶĐƌĞĂƐŝŶŐ ƌĂƚĞƐ ŽĨ ^d/ ŝŶ ĂůŝĨŽƌŶŝĂ͖ • KƵƚůŝŶĞ ƚŚĞ ĐĂƵƐĞƐ ĨŽƌ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/ ƌĂƚĞƐ ĂŵŽŶŐ ƐĞŶŝŽƌ ƉĂƟĞŶƚƐ͖ YƵŝǌ͗ WůĞĂƐĞ ĐŝƌĐůĞ ƚŚĞ ĐŽƌƌĞĐƚ ĂŶƐǁĞƌ͘ 1. California ranks _____ in new HIV diagnosis. First Second Third Fourth ͕ ϮϬϭϳ͕ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƐƚĂƟƐƟĐƐͬ overview/index.html

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hƐĞ ĐĂƐĞͲďĂƐĞĚ ĂƉƉƌŽĂĐŚ ĨŽƌ Wƌ W ŝŶ ƉĂƟĞŶƚƐ Ăƚ ƌŝƐŬ ĨŽƌ ,/s ŝŶĨĞĐƟŽŶ͖ ĂŶĚ ,ŝŐŚůŝŐŚƚ ƉƌĞŶĂƚĂů ƐǇƉŚŝůŝƐ ĂƐ Ă ƚƌĞĂƚĂďůĞ ĐŽŶĚŝƟŽŶ͘

Ϯ͘ ůĂĐŬ ŵĞŶ ǁŚŽ ŚĂǀĞ ƐĞǆ ǁŝƚŚ ŵĞŶ ;D^DͿ ƉĂƟĞŶƚƐ ŚĂǀĞ ǁŚĂƚ ĐŚĂŶĐĞ ŽĨ ƚĞƐƟŶŐ ƉŽƐŝƟǀĞ ŝŶ ƚŚĞŝƌ ůŝĨĞƟŵĞ͍ KŶĞ ŝŶ ƚǁŽ One in three One in four KŶĞ ŝŶ ĮǀĞ ͕ ϮϬϭϲ͕ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬ newsroom/2016/croi-press-release-risk.html

California Family Physician Summer 2019

3͘ tŚĂƚ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ďĞƚǁĞĞŶ ƚŚĞ age of 75-84 report being sexually ĂĐƟǀĞ͍ ϲ ƉĞƌĐĞŶƚ ϭϲ ƉĞƌĐĞŶƚ Ϯϲ ƉĞƌĐĞŶƚ ϯϲ ƉĞƌĐĞŶƚ Solway E, Clark S, Singer D, Kirch M, Malani P. Let’s dĂůŬ ĂďŽƵƚ ^Ğǆ͘ hŶŝǀĞƌƐŝƚǇ ŽĨ DŝĐŚŝŐĂŶ EĂƟŽŶĂů WŽůů ŽŶ ,ĞĂůƚŚǇ ŐŝŶŐ͘ DĂǇ ϮϬϭϴ͘ ǀĂŝůĂďůĞ Ăƚ͗ ŚƩƉ͗ͬͬŚĚů͘ handle.net/2027.42/143212

ϰ͘ tŚĂƚ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ƐĞǆƵĂůůǇ ĂĐƟǀĞ ŵĞƌŝĐĂŶƐ ǁŝůů ĐŽŶƚƌĂĐƚ Ă ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ ďǇ ĂŐĞ Ϯϱ͍ ϯϬ ƉĞƌĐĞŶƚ ϰϬ ƉĞƌĐĞŶƚ ϱϬ ƉĞƌĐĞŶƚ ϲϬ ƉĞƌĐĞŶƚ

ϲ͘ ϯϬϬ͕ϬϬϬ ĐĂƐĞƐ ŽĨ ĐŚůĂŵǇĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ͕ ĂŶĚ ĞĂƌůǇ ƐǇƉŚŝůŝƐ ŚĂǀĞ been reported in California. This represents ____percent increase ŝŶ ƚŚĞ ůĂƐƚ ĮǀĞ ǇĞĂƌƐ͘ 15 Ϯϱ 35 ϰϱ

Cates JR, Herndon NL, Schulz S L, Darroch JE. (2004). Our voices, our lives, our futures: zŽƵƚŚ ĂŶĚ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ĚŝƐĞĂƐĞƐ͘ ŚĂƉĞů ,ŝůů͕ E ͗ hŶŝǀĞƌƐŝƚǇ ŽĨ EŽƌƚŚ ĂƌŽůŝŶĂ Ăƚ ŚĂƉĞů ,ŝůů ^ĐŚŽŽů ŽĨ :ŽƵƌŶĂůŝƐŵ ĂŶĚ DĂƐƐ ŽŵŵƵŶŝĐĂƟŽŶ͘ ĐĐĞƐƐĞĚ Ăƚ͗ ŚƩƉ͗ͬͬǁǁǁ͘ĂƐŚĂƐĞǆƵĂůŚĞĂůƚŚ͘ŽƌŐͬƐƚĚƐƐƟƐͬƐƚĂƟƐƟĐƐͬ

ĞƉƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͕ ŚƩƉƐ͗ͬͬǁǁǁ͘ůĂƟŵĞƐ͘ĐŽŵͬůŽĐĂůͬĐĂůŝĨŽƌŶŝĂͬůĂͲŵĞͲůŶͲƐƚĚͲ rates-20180515-story.html

ϱ͘ ĐĐŽƌĚŝŶŐ ƚŽ ŐƵŝĚĞůŝŶĞƐ͕ ďĞĨŽƌĞ ŝŶŝƟĂƟŶŐ Wƌ W͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ŚŽǁ ŵĂŶǇ ĚĂǇƐ͍ 3 5 7 ϭϬ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ͗ h^ WƵďůŝĐ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ͗ WƌĞĞǆƉŽƐƵƌĞ ƉƌŽƉŚǇůĂǆŝƐ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƟŽŶ ŽĨ ,/s ŝŶĨĞĐƟŽŶ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐͶϮϬϭϳ hƉĚĂƚĞ͗ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŐƵŝĚĞůŝŶĞ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƉĚĨͬƌŝƐŬͬƉƌĞƉͬĐĚĐͲŚŝǀͲƉƌĞƉͲŐƵŝĚĞůŝŶĞƐͲϮϬϭϳ͘ƉĚĨ͘ WƵďůŝƐŚĞĚ March 2018.

7. The most commonly reported STI in California is: Chlamydia Syphilis Gonorrhea ĞƉƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͕ ŚƩƉƐ͗ͬͬǁǁǁ͘ůĂƟŵĞƐ͘ĐŽŵͬůŽĐĂůͬĐĂůŝĨŽƌŶŝĂͬůĂͲŵĞͲůŶͲƐƚĚͲ rates-20180515-story.html

ϴ͘ ^d dƌĞĂƚŵĞŶƚ 'ƵŝĚĞůŝŶĞƐ ƌĞĐŽŵŵĞŶĚ ŽīĞƌŝŶŐ ͺͺͺͺ ƚŽ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ƚŚĂƚ ĂƌĞ ƵŶĂďůĞ Žƌ ƵŶůŝŬĞůǇ ƚŽ ĂĐĐĞƐƐ ƚƌĞĂƚŵĞŶƚ ŽŶ ƚŚĞŝƌ ŽǁŶ͍ /ŶƚĞŶƐŝǀĞ ĞŚĂǀŝŽƌĂů ŽƵŶƐĞůŝŶŐ ǆƉĞĚŝƚĞĚ WĂƌƚŶĞƌ dŚĞƌĂƉǇ Daily Suppressive Therapy

dŽ ĐůĂŝŵ ǇŽƵƌ ĐƌĞĚŝƚƐ͕ ƉůĞĂƐĞ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚŝƐ ƋƵŝǌ ĂŶĚ ĞǀĂůƵĂƟŽŶ ƚŽ &W͕ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ Žƌ ĨĂǆ ϰϭϱͲϯϰϱͲϴϲϲϴ͘͘

California Family Physician Summer 2019

ceo message

Lisa Folberg, MPP

Stand Up and Be Counted! dŚĞ h^ ŽŶƐƟƚƵƟŽŶ ƌĞƋƵŝƌĞƐ ƚŚĂƚ ĞǀĞƌǇ ϭϬ ǇĞĂƌƐ͕ ƚŚĞ ĞŶƐƵƐ ƵƌĞĂƵ ĐŽƵŶƚ ĞǀĞƌǇ ƌĞƐŝĚĞŶƚ ŝŶ ƚŚĞ ŶĂƟŽŶ͘ ĐŽŵƉůĞƚĞ ĂŶĚ ĂĐĐƵƌĂƚĞ ĐĞŶƐƵƐ ŝƐ ǀŝƚĂů ƚŽ ĂůŝĨŽƌŶŝĂ͘ ĞŶƐƵƐ ĚĂƚĂ ŚĞůƉƐ ĚĞƚĞƌŵŝŶĞ ƚŚĞ ĂůůŽĐĂƟŽŶ ŽĨ ďŝůůŝŽŶƐ of dollars in federal funds for building schools, roads, businesses and ŚŽƐƉŝƚĂůƐ͘ /Ŷ ĨĂĐƚ͕ ĐĞŶƐƵƐ ĚĂƚĂ ŝƐ ƵƐĞĚ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ ĨƵŶĚŝŶŐ ĨŽƌŵƵůĂ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ϳϬ ĨĞĚĞƌĂů ƉƌŽŐƌĂŵƐ ƚŚĂƚ ďĞŶĞĮƚ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĚĞƚĞƌŵŝŶĞƐ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƐĞĂƚƐ ĞĂĐŚ ƐƚĂƚĞ ŚĂƐ ŝŶ ƚŚĞ h^ ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ͘

ŚĂƌĚͲƚŽͲĐŽƵŶƚ ŝŶĐůƵĚĞ ŚŽŵĞůĞƐƐ͕ ƚŚŽƐĞ ŝŶ ƚŚĞ ůŽǁĞƌ ŝŶĐŽŵĞ ƐƚƌĂƚĂ͕ ŶŐůŝƐŚ ůĂŶŐƵĂŐĞ ůĞĂƌŶĞƌƐ͕ ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ ĂŶĚ ƌĂĐŝĂůͬ ĞƚŚŶŝĐ ŵŝŶŽƌŝƟĞƐ͘ ĂůŝĨŽƌŶŝĂ ŝƐ ĂƌŐƵĂďůǇ ŚŽŵĞ ƚŽ ƚŚĞ ŵŽƐƚ ŚĂƌĚͲƚŽͲĐŽƵŶƚ people in the United States. /Ŷ DĂƌĐŚ ϮϬϮϬ͕ ƚŚĞ ĞŶƐƵƐ ƵƌĞĂƵ ǁŝůů ďĞŐŝŶ ƚŽ ŵĂŝů ŝŶĨŽƌŵĂƟŽŶ͕ ǁŚŝĐŚ ǁŝůů ŝŶĐůƵĚĞ Ă ƉĂƉĞƌ ƋƵĞƐƟŽŶŶĂŝƌĞ ĂŶĚ ĂŶ ŝŶǀŝƚĂƟŽŶ ƚŽ Įůů ŽƵƚ ƚŚĞ ƋƵĞƐƟŽŶŶĂŝƌĞ ŽŶůŝŶĞ ŝŶƐƚĞĂĚ͘ dŚŝƐ ǁŝůů ďĞ ƚŚĞ ĮƌƐƚ ƟŵĞ ŝŶ ĐĞŶƐƵƐ ŚŝƐƚŽƌǇ ƚŚĞ ƋƵĞƐƟŽŶŶĂŝƌĞƐ ĐĂŶ ďĞ ĐŽŵƉůĞƚĞĚ ŽŶůŝŶĞ͘

/ ƐƉŽŬĞ ǁŝƚŚ :ƵĚǇ ZŽďŝŶƐŽŶ͕ ϮϬϮϬ ĞŶƐƵƐ DĂŶĂŐĞƌ ĨŽƌ ^ĂĐƌĂŵĞŶƚŽ ŽƵŶƚǇ͕ ĂďŽƵƚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚĞ ĐĞŶƐƵƐ ĂŶĚ ƉƌŽďůĞŵƐ ǁŝƚŚ /Ŷ ĂůŝĨŽƌŶŝĂ͕ ĂĚǀŽĐĂƚĞƐ ĂŶĚ ŐŽǀĞƌŶŵĞŶƚ ĞŶƟƟĞƐ ĂƌĞ ŝŶǀĞƐƟŶŐ ŝŶ ĞīŽƌƚƐ ƵŶĚĞƌĐŽƵŶƟŶŐ͘ ^ŚĞ ŶŽƚĞĚ͕ ͞ ĂůŝĨŽƌŶŝĂ ƌĞĐĞŝǀĞƐ ĂƉƉƌŽǆŝŵĂƚĞůǇ Ψϭ͕ϵϱϮ ƉĞƌ ƚŽ ĞŶƐƵƌĞ ĂŶ ĂĐĐƵƌĂƚĞ ĐĞŶƐƵƐ͘ 'ŽǀĞƌŶŽƌ EĞǁƐŽŵ͛Ɛ ϮϬϭϵͲϮϬ ƉƌŽƉŽƐĞĚ person per year in federal funding. ďƵĚŐĞƚ ŝŶĐůƵĚĞƐ Ψϱϰ ŵŝůůŝŽŶ ŽŶ DƵůƟƉůŝĞĚ ŽǀĞƌ ϭϬ ǇĞĂƌƐ ;ĚĞĐĞŶŶŝĂů ƚŽƉ ŽĨ ŵŽƌĞ ƚŚĂŶ ΨϭϬϬ ŵŝůůŝŽŶ ĐĞŶƐƵƐͿ ƚŚŝƐ ƌĞƉƌĞƐĞŶƚƐ ŚƵŶĚƌĞĚƐ ĂůƌĞĂĚǇ ĐŽŵŵŝƩĞĚ ƚŽ ĂƵŐŵĞŶƚ The US Census is vital to our ŽĨ ŵŝůůŝŽŶƐ ŽĨ ĚŽůůĂƌƐ ůŽƐƚ Žƌ ǁŝƚŚ Ă Ă ƐƚĂƚĞǁŝĚĞ ŽƵƚƌĞĂĐŚ ĂŶĚ democracy. It paints a picture of America successful count, dollars gained for ĐŽŵŵƵŶŝĐĂƟŽŶ ĐĂŵƉĂŝŐŶ͘ important programs and funding – who we are, what we look like, and ƚŽ ŬĞĞƉ ĐŽŵŵƵŶŝƟĞƐ ƐĂĨĞ͕ ŚĞĂůƚŚǇ What does the census have to do what our needs are – and that picture is a ǁŝƚŚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͍ 'ĞƫŶŐ ĂŶĚ ĞĚƵĐĂƚĞĚ͘ /Ŷ ϮϬϭϬ ĐŚŝůĚƌĞŶ ĂŐĞƐ ϬͲϱ ǇĞĂƌƐ ǁĞƌĞ ƐŝŐŶŝĮĐĂŶƚůǇ ĂŶ ĂĐĐƵƌĂƚĞ ĐŽƵŶƚ ǁŝůů ƚĂŬĞ ĂŶ ĂůůͲ key factor in determining the distribution ƵŶĚĞƌĐŽƵŶƚĞĚ͘ ^ƉĞĐŝĂů ĞīŽƌƚƐ ŚĂŶĚƐͲŽŶͲĚĞĐŬ ĂƉƉƌŽĂĐŚ͘ &ĂŵŝůǇ of resources in our country.” ǁŝůů ŶĞĞĚ ƚŽ ďĞ ŵĂĚĞ ƚŽ ĞŶƐƵƌĞ physicians are respected members – Senate President these children and their families ŽĨ ƚŚĞŝƌ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ƉĂƌƟĐŝƉĂƚĞ ĂŶĚ ĂƌĞ ĐŽƵŶƚĞĚ͘͟ ďĞĐŽŵĞ Ă ƉĂƌƚ ŽĨ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͛ pro Tempore Toni Atkins life landscape. Because of their ǀĞƌǇ ĚĞĐĂĚĞ ƚŚĞ ĐĞŶƐƵƐ ƐƟƌƐ ƐƉĞĐŝĂů ƉůĂĐĞ ŝŶ ƉĂƟĞŶƚƐ͛ ůŝǀĞƐ͕ Ă ĚĞďĂƚĞ ĂďŽƵƚ ŚŽǁ ƚŽ ĐĂƉƚƵƌĞ Ă ƚƌƵĞ ƉŝĐƚƵƌĞ ŽĨ ƉĞŽƉůĞ ůŝǀŝŶŐ ŝŶ ƚŚĞ family physicians add validity to an issue and are trusted messengers. hŶŝƚĞĚ ^ƚĂƚĞƐ͘ dŚĞ ϮϬϮϬ ĐĞŶƐƵƐ ŚĂƐ ƚƵƌŶĞĚ ƉĂƌƟĐƵůĂƌůǇ ƉŽůŝƟĐĂů͘ /ƚ ŚĂƐ ^ŝŶĐĞ ĂĚĞƋƵĂƚĞ ĨƵŶĚŝŶŐ ĨŽƌ ƐĐŚŽŽůƐ͕ ŶƵƚƌŝƟŽŶ ƉƌŽŐƌĂŵƐ͕ ĞĚƵĐĂƟŽŶ͕ ƌĞĐĞŶƚůǇ ďĞĞŶ ĚŝƐĐŽǀĞƌĞĚ ƚŚĂƚ Ă ZĞƉƵďůŝĐĂŶ ƉŽůŝƟĐĂů ĐŽŶƐƵůƚĂŶƚ ŬŶŽǁŶ housing and countless other services relies on its results, the census is, ĂƐ ƚŚĞ ͞DŝĐŚĞůĂŶŐĞůŽ ŽĨ ŐĞƌƌǇŵĂŶĚĞƌŝŶŐ͟ ƉůĂǇĞĚ Ă ĐƌƵĐŝĂů ƌŽůĞ ŝŶ ƚŚĞ indeed, a family physician issue. dƌƵŵƉ ĂĚŵŝŶŝƐƚƌĂƟŽŶ͛Ɛ ĚĞĐŝƐŝŽŶ ƚŽ ĂĚĚ Ă ĐŝƟǌĞŶƐŚŝƉ ƋƵĞƐƟŽŶ ƚŽ ƚŚĞ ϮϬϮϬ ĐĞŶƐƵƐ͘ ǀĞŶ ƚŚŽƵŐŚ ĨĞĚĞƌĂů ůĂǁ ƉƌŽƚĞĐƚƐ ƚŚĞ ĐŽŶĮĚĞŶƟĂůŝƚǇ ŽĨ Ăůů tŝƚŚ ďƵƐǇ ůŝǀĞƐ ŝƚ ŝƐ ŽŌĞŶ ŚĂƌĚ ĨŽƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ŬŶŽǁ ŚŽǁ ƚŽ individual responses the Census Bureau collects, advocates contend that ĞŶŐĂŐĞ ŝŶ ĂĚǀŽĐĂĐǇ Žƌ ŵŽƌĞ ůŝŬĞůǇ ŚŽǁ ƚŽ ĞĚŝƚ ƚŚĞŝƌ ĞŶŐĂŐĞŵĞŶƚ ŝŶ ƐƵĐŚ ĨĞĂƌ ƚŚĞ ŐŽǀĞƌŶŵĞŶƚ ǁŝůů ƵƐĞ ĐŝƟǌĞŶƐŚŝƉ ŝŶĨŽƌŵĂƟŽŶ ĂŐĂŝŶƐƚ ŝŵŵŝŐƌĂŶƚƐ Ă ǁĂǇ ƚŚĂƚ ůĞĂǀĞƐ ƟŵĞ ĨŽƌ ĨƌŝĞŶĚƐ ĂŶĚ ĨĂŵŝůǇ͘ ǁŽƵůĚ ĚĞƚĞƌ ŵĂŶǇ ŝŵŵŝŐƌĂŶƚƐ ĨƌŽŵ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ƚŚĞ ϮϬϮϬ ĐĞŶƐƵƐ͘ dŚŝƐ͕ ƚŚĞǇ ƐĂǇ ǁŝůů ƌĞƐƵůƚ ŝŶ ƚŚĞ ƵŶĚĞƌĐŽƵŶƟŶŐ ŽĨ ŵŝůůŝŽŶƐ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ͘ ŶĐŽƵƌĂŐŝŶŐ ƉĂƟĞŶƚƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ĐĞŶƐƵƐ ŝƐ ĂŶ ĞǆĂŵƉůĞ ŽĨ ŚŽǁ dŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ^ƵƉƌĞŵĞ ŽƵƌƚ ŝƐ ĞǆƉĞĐƚĞĚ ƚŽ ƌƵůĞ ŽŶ ƚŚĞ ůĞŐĂůŝƚǇ ŽĨ ǇŽƵ ĐĂŶ ŚĂǀĞ ĂŶ ŝŵƉŽƌƚĂŶƚ ŝŶŇƵĞŶĐĞ ŽŶ ĐŽŵŵƵŶŝƚǇ ŚĞĂůƚŚ ǁŝƚŚŽƵƚ ŝŶĐůƵĚŝŶŐ ƚŚĞ ĐŝƟǌĞŶƐŚŝƉ ƋƵĞƐƟŽŶ ďǇ ůĂƚĞ :ƵŶĞ ϮϬϭϵ͘ /ƚ ŵĂǇ ďĞ ƚŚĂƚ ďǇ Ă ŚƵŐĞ ƟŵĞ ĐŽŵŵŝƚŵĞŶƚ͘ zŽƵ ĐĂŶ ƚĂŬĞ ĂŶ ĂĐƟǀĞ ƌŽůĞ ŝŶ ŵĂŶǇ ǁĂǇƐ͗ ƚŚĞ ƟŵĞ ǇŽƵ ƌĞĂĚ ƚŚŝƐ͕ Ă ĚĞĐŝƐŝŽŶ ǁŝůů ŚĂǀĞ ďĞĞŶ ŵĂĚĞ͘ ƚŚƌŽƵŐŚ ƚĂůŬŝŶŐ ǁŝƚŚ ƉĂƟĞŶƚƐ͕ ŚĂŶŐŝŶŐ ĂŶ ŽĸĐĞ ƉŽƐƚĞƌ͕ ŵĂŬŝŶŐ Ă ĨĂĐƚ ƐŚĞĞƚ ĂǀĂŝůĂďůĞ ƚŽ ƉĂƟĞŶƚƐ ŝŶ ǇŽƵƌ ŽĸĐĞƐ Žƌ ďǇ ĞŶĐŽƵƌĂŐŝŶŐ ǇŽƵƌ ĐůŝŶŝĐƐ͕ tŝƚŚ ĂŶ ĞƐƟŵĂƚĞĚ ϭϭ ŵŝůůŝŽŶ ŝŵŵŝŐƌĂŶƚƐ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ĂŶǇƚŚŝŶŐ ƚŚĂƚ ƵŶŝǀĞƌƐŝƟĞƐ ĂŶĚ ƉŚǇƐŝĐŝĂŶ ŐƌŽƵƉƐ ƚŽ ĞŶŐĂŐĞ͘ /Ĩ ǁĞ ĚŽŶ͛ƚ ŐĞƚ ƚŚĞ ĐŽƵŶƚ ĚŝƐĐŽƵƌĂŐĞƐ ƚŚĞ ƉĂƌƟĐŝƉĂƟŽŶ ŽĨ ƚŚŝƐ ŐƌŽƵƉ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ ŝŶ ƚŚĞ ĐĞŶƐƵƐ ƌŝŐŚƚ ŝŶ ϮϬϮϬ͕ ǁĞ ǁŝůů ďĞ ůŝǀŝŶŐ ǁŝƚŚ ƚŚĞ ƌĂŵŝĮĐĂƟŽŶƐ ƵŶƟů ϮϬϯϬ͘ ĐŽƵůĚ ďĞ ƐŝŐŶŝĮĐĂŶƚ ĨŽƌ ĞǀĞƌǇƚŚŝŶŐ ĨƌŽŵ DĞĚŝͲ Ăů ĂŶĚ ƚƌĂŶƐƉŽƌƚĂƟŽŶ ĨƵŶĚŝŶŐ ƚŽ ƐƚĂƚĞ ĂŶĚ ƌĞŐŝŽŶĂů ƉŽůŝƟĐĂů ƌĞƉƌĞƐĞŶƚĂƟŽŶ͘ &W ŝƐ ŚĞƌĞ ƚŽ ŚĞůƉ͊ >ŽŽŬ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ĨƌŽŵ &W ŝŶ ƚŚĞ ĐŽŵŝŶŐ ŵŽŶƚŚƐ ĂďŽƵƚ ŚŽǁ ǇŽƵ ĐĂŶ ŚĞůƉ ĞŶĐŽƵƌĂŐĞ ǇŽƵƌ ƉĂƟĞŶƚƐ ƚŽ /ŵŵŝŐƌĂŶƚƐ ĂƌĞ ŶŽƚ ƚŚĞ ŽŶůǇ ŐƌŽƵƉ ĐŽŶƐŝĚĞƌĞĚ ͞ŚĂƌĚͲƚŽͲĐŽƵŶƚ͘͟ dŚĞ stand up and be counted!

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California Family Physician Summer 2019

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

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437