Winter 2020 by California Academy of Family Physicians

VO L . 71 N O. 1 Wi n t er 2020

in this issue: WHATâ&#x20AC;&#x2122;S NEW FOR 2020 NEW LAWS NEW POLICIES NEW OPPORTUNITIES

California Family Physician Winter 2020

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 ZĂƵů ǇĂůĂ͕ D <ŝŵďĞƌůǇ ƵƐƐ͕ D ͕ DW, Jay W. Lee, MD, MPH &Ğůŝǆ EƵŶĞǌ͕ D ͕ DW, <ĞǀŝŶ ZŽƐƐŝ͕ D

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

Melissa Grindstaff

Manager, Member Engagement mgrindstaff@familydocs.org

ƌůĂŶŶĂ ,ĞŶƌǇ

Looking for a job?

Josh Lunsford

Go to www.fpjobsonline.com

Manager, Educational Programs ahenry@familydocs.org Director, Membership and Marketing jlunsford@familydocs.org

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

YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ ǇŽƵ͘

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

Brent Sugimoto, MD, Editor Shelly Rodrigues, CAE, Managing Editor

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

California Family Physician Winter 2020

pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com 800.561.4686 ext 103 For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com EDITION 33

Winter 2020

features 14 You Do Not Want to Miss the Family Medicine Clinical Forum! We Promise! 20 2020-2021 Strategic Plan 22 Get Ready for 2020: Changes are in Store

Adam Francis

24 CAFP Foundation … Investing in the Future of Family Medicine

Marianne McKennett, MD

26 Your Values, Beliefs, and Priorities are our Foundation: New CAFP Policies and Principles 28 CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners 30 CAFP Principles for the Protection and Care of Transgender and Gender-Expansive Patients

Conrad Amenta

CAFP Scope of Practice Work Group

CAFP Committee on Health of the Public

32 Three Pathways Move Toward Achieving Value-Based Payment

Conrad Amenta

34 CAFP’s Nominating Committee Presents Its 2020 Slate

departments 6

Editorial

Are You Ready for Leap Year?

President’s Message

2020: We Need a Vision Forward

10 Political Pulse

Brent Sugimoto, MD, MPH Walt Mills, MD

CAFP Ends 2019 with a Bang!

Carla Kakutani, MD

Our Diversity is Our Strength

Lisa Folberg, MPP

12 In The News 38 CEO Message

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Physician Winter 2020

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Are You Ready for Leap Year? / ŚŽƉĞ Ăůů ŽĨ ǇŽƵ ĂƌĞ ƐƚĂƌƟŶŐ ƚŚŝƐ ŶĞǁ ǇĞĂƌ ĨƌĞƐŚ͘ ϮϬϭϵ ǁĂƐ Ă ĐŚĂƌŐĞĚ ǇĞĂƌ ĨŽƌ ĂůŝĨŽƌŶŝĂŶƐ͕ ǁŝƚŚ ĂŶŽƚŚĞƌ ĐĂƚĂƐƚƌŽƉŚŝĐ ĮƌĞ ƐĞĂƐŽŶ͕ ŵĂƐƐ ƐŚŽŽƟŶŐƐ ƚŚĂƚ ĐĂŶ ďĂƌĞůǇ ŚŽůĚ ĂŶ ĞŶƟƌĞ ŶĞǁƐ ĐǇĐůĞ ĂŶĚ ĐŽŶƟŶƵŝŶŐ ƚƵŵƵůƚ ŝŶ ŽƵƌ ŶĂƟŽŶĂů ƉŽůŝƟĐƐ͘ dŚĂŶŬĨƵůůǇ ǁĞ ŚĂǀĞ ƚŚĞ ŚŽůŝĚĂǇƐ ĂƐ Ă ĐŽĚĂ ƚŽ ŽƵƌ ǇĞĂƌ ƚŽ ƌĞůĂǆ͕ ƌĞŇĞĐƚ ĂŶĚ ƌĞĐŚĂƌŐĞ ĂŶĚ ƚŽ ďĞ ƌĞĂĚǇ ĨŽƌ ϮϬϮϬ͕ ǁŚŝĐŚ incidentally is a leap year. >ĞĂƉ ǇĞĂƌƐ ǁĞƌĞ ŝŶǀĞŶƚĞĚ ďĞĐĂƵƐĞ ƚŚĞ ƟŵĞ ŝƚ ƚĂŬĞƐ ŽƵƌ ƉůĂŶĞƚ ƚŽ ƐƉŝŶ ĂƌŽƵŶĚ ŝƚƐ ĂǆŝƐ ŝƐ ŝŶ ŶŽ ǁĂǇ ƌĞůĂƚĞĚ ƚŽ ƚŚĞ ĂŵŽƵŶƚ ŽĨ ƟŵĞ ŝƚ ƚĂŬĞƐ ŽƵƌ ĂƌƚŚ ƚŽ ƌĞǀŽůǀĞ ĂƌŽƵŶĚ ƚŚĞ ƐƵŶ͘ dŚƵƐ͕ ƚŚĞƌĞ ŝƐ ŶŽ ǁĂǇ ƚŽ ŚĂǀĞ Ă ǇĞĂƌ ĐŽŵƉŽƐĞĚ ŽĨ ŽŶůǇ ǁŚŽůĞͲŶƵŵďĞƌĞĚ ĚĂǇƐ͕ ŐŝǀŝŶŐ ƵƐ Ă ƐŽůĂƌ ǇĞĂƌ ƚŚĂƚ ŝƐ Ϭ͘ϮϰϮϮ ĚĂǇƐ ůŽŶŐĞƌ ƚŚĂŶ ƚŚĞ tĞƐƚĞƌŶ ĐĂůĞŶĚĂƌ ǇĞĂƌ͘ hŶĂĚũƵƐƚĞĚ͕ ǁĞ ǁŽƵůĚ ƋƵŝĐŬůǇ ŚĂǀĞ Ă ĐĂůĞŶĚĂƌ ǁŝƚŚ ůŝƩůĞ ƌĞůĂƟŽŶ ƚŽ ƚŚĞ ƐĞĂƐŽŶƐ͘ EŽƚ Ăůů ƐŽĐŝĞƟĞƐ ĐŚŽŽƐĞ ƚŽ ƌĞĐŽŐŶŝǌĞ ƚŚŝƐ ĚŝƐĐƌĞƉĂŶĐǇ ĂƐ Ă ƉƌŽďůĞŵ͕ ǁŚŝĐŚ ƐŚŽǁƐ ƚŚĂƚ ƚŚĞ ůĞĂƉ ǇĞĂƌ ŝƐ Ă ĐƵůƚƵƌĂů ŝŶǀĞŶƟŽŶ͘ ŶĐŝĞŶƚ ŐǇƉƟĂŶƐ͕ ǁŚŽ ĂĚŽƉƚĞĚ ƚŚĞ ^ƵŵĞƌŝĂŶ ϯϲϬͲĚĂǇ ĐĂůĞŶĚĂƌ͕ ĐŚŽƐĞ ŝŶƐƚĞĂĚ ƚŽ ĂĚĚ ĮǀĞ Žƌ ƐŽ ĚĂǇƐ ŽĨ ƉĂƌƚǇŝŶŐ ƚŽ ƚŚĞ ĞŶĚ ŽĨ ĞĂĐŚ ǇĞĂƌ ƚŽ ŬĞĞƉ ƚŚĞŝƌ ĐĂůĞŶĚĂƌ ŝŶ ƐǇŶĐ ǁŝƚŚ ƚŚĞ seasons. This, to me, highlights a strong expression of values— ůŝƩůĞ ĞůƐĞ ŝƐ ŵŽƌĞ ƉƌĞĐŝŽƵƐ ƚŚĂŶ ŚŽǁ ǁĞ ĚĞĐŝĚĞ ƚŽ ĂůůŽĐĂƚĞ ŽƵƌ ƟŵĞ͘ zĞƚ͕ ŽŶĞ ƐŽĐŝĞƚǇ ƐĂǁ ƚŚŝƐ ƐŝƚƵĂƟŽŶ ĂƐ Ă ƉƌŽďůĞŵ ƚŽ ďĞ ƐŽůǀĞĚ͕ ǁŚŝůĞ ƚŚĞ ŽƚŚĞƌ ƐĂǁ ŝƚ ĂƐ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ ĨƵŶ ĂŶĚ ĐŽŶŶĞĐƟŽŶ͘ / ǁŝůů ůĞĂǀĞ ŝƚ ƚŽ ǇŽƵ͕ ƌĞĂĚĞƌ͕ ƚŽ ĚĞĐŝĚĞ ǁŚŝĐŚ ƉĞƌƐƉĞĐƟǀĞ ŵĂŬĞƐ ŵŽƌĞ ƐĞŶƐĞ͘ /ƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ŶŽƚĞ ƚŚĂƚ ŶĞǁ ƉĞƌƐƉĞĐƟǀĞƐ ŽŌĞŶ ǇŝĞůĚ ĚŝīĞƌĞŶƚ ƌĞƐƵůƚƐ͘ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŽŌĞŶ ĚŽ ŚĂǀĞ Ă ĚŝīĞƌĞŶƚ ǀŝĞǁƉŽŝŶƚ from our colleagues throughout the country, and that is leading ƚŽ ƉƌŽŐƌĞƐƐ ĂŶĚ ƵŶŝƋƵĞ ƐŽůƵƟŽŶƐ ŝŶ ŽƵƌ ƐƚĂƚĞ͘ ĚĂŵ &ƌĂŶĐŝƐ͕ &W ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ͕ ĂŶĚ ƌ͘ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ŚĂŝƌ͕ ǁŝůů ŚŝŐŚůŝŐŚƚ ƉƌŽŐƌĞƐƐ ƚŚĂƚ ŚĂƐ ďĞĞŶ ŵĂĚĞ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉƌŝŽƌŝƟĞƐ ŝŶ ƚŚĞ ůĞŐŝƐůĂƚƵƌĞ͘ zŽƵ ǁŝůů ŚĞĂƌ ĂďŽƵƚ ƚŚĞ ƉŝŽŶĞĞƌŝŶŐ ǁŽƌŬ ƚŚĞ ŽŵŵŝƩĞĞ ŽŶ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KW͕ Ă͘Ŭ͘Ă͘ ƚŚĞ :ƵƐƟĐĞ >ĞĂŐƵĞͿ ŚĂƐ ĂĚǀĂŶĐĞĚ ƚŽ ŝŵƉƌŽǀĞ ĐĂƌĞ ĨŽƌ ŐĞŶĚĞƌͲĞǆƉĂŶƐŝǀĞ ƉĂƟĞŶƚƐ͘

California Family Physician Winter 2020

Finally, of particular note is the CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners, explained by CAFP Director of Policy and Strategic Initiatives ŽŶƌĂĚ ŵĞŶƚĂ͘ ƵƌƌĞŶƚ &W ƉŽůŝĐǇ ŚĂƐ ŶŽƚ ĂůůŽǁĞĚ family physicians nationally to engage on the topic of ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ŽĨ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ;EWƐͿ͕ ĞǆĐĞƉƚ ŝŶ ƐƚƌŝĐƚ ŽƉƉŽƐŝƚŝŽŶ͘ dŚŝƐ ŽƉƉŽƐŝƚŝŽŶ ŶŽƚǁŝƚŚƐƚĂŶĚŝŶŐ͕ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ĨŽƌ EWƐ ŚĂƐ ďĞĞŶ ƉĂƐƐĞĚ ŝŶ ϮϮ ƐƚĂƚĞƐ ĂŶĚ ƚŚĞ ŝƐƚƌŝĐƚ ŽĨ ŽůƵŵďŝĂ ĂŶĚ ŝƐ ŶŽǁ ĂůůŽǁĞĚ ŝŶ the Veterans’ Administration. Furthermore, on October 3, President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors ŝŶĐůƵĚĞƐ ^ĞĐƚŝŽŶ ϱ͕ ǁŚŝĐŚ ĚŝƌĞĐƚƐ ƚŚĞ ,ĞĂůƚŚ Θ ,ƵŵĂŶ Services Secretary to “[e]liminate excessive supervision requirements that prevent APRNs and physicians’ ĂƐƐŝƐƚĂŶƚƐ ;W ƐͿ ĨƌŽŵ ĚĞůŝǀĞƌŝŶŐ ĂƉƉƌŽƉƌŝĂƚĞ ĚŝĂŐŶŽƐŝƐ ĂŶĚ quality care.” /Ŷ ƚŚĞ ϮϬϭϵ ƐĞƐƐŝŽŶ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ >ĞŐŝƐůĂƚƵƌĞ͕ ƐƐĞŵďůǇ ŝůů ϴϵϬ ;tŽŽĚͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ďƵƚ ĚŝĚ ŶŽƚ ĂĚǀĂŶĐĞ͘ /ƚ ŵĂǇ ďĞ ƌĞŝŶƚƌŽĚƵĐĞĚ ŝŶ ƚŚĞ ϮϬϮϬ ƐĞƐƐŝŽŶ͘ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŶŽǁ ŚĂǀĞ Ă ƉŽůŝĐǇ ĂŶĚ ƐĞƚ ŽĨ ƉƌŝŶĐŝƉůĞƐ ŐƵŝĚŝŶŐ ƵƐ ĂƐ ǁĞ ĂƌŐƵĞ that patients are best cared for in a team led by physicians, ďƵƚ ǁĞ ĐĂŶ ĂůƐŽ ĞŶŐĂŐĞ ŽŶ ϴϵϬ ƚŽ ƐĞĐƵƌĞ ƉĂƚŝĞŶƚ ƐĂĨĞƚǇ through adequate NP training and oversight. In the current policy environment, this flexibility is extremely important. / ďĞůŝĞǀĞ ƚŚĂƚ ǁŚĂƚ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂƌĞ ĚŽŝŶŐ ŝƐ ƐŚŽǁŝŶŐ ƚŚĞ ŶĂƚŝŽŶ Ă ŶĞǁ ǁĂǇ ƚŽ ĂƉƉƌŽĂĐŚ ƚŚŝƐ ŝƐƐƵĞ͘ &Žƌ ŵĂŶǇ ƌĞĂƐŽŶƐ͕ ϮϬϮϬ ǁŝůů ďĞ Ă ƚƵŵƵůƚƵŽƵƐ ǇĞĂƌ ŝŶ ƉŽůŝƚŝĐƐ͘ dŚĂŶŬƐ ƚŽ ƚŚĞ ĨƌĞƐŚ ƉĞƌƐƉĞĐƚŝǀĞ ŽĨ ŽƵƌ ĐŽůůĞĂŐƵĞƐ͕ ǁĞ ĂƌĞ ƉƌĞƉĂƌĞĚ ǁŝƚŚ ƚŚĞ ƌŝŐŚƚ ƚŽŽůƐ ƚŽ ŚĞůƉ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƚĂŬĞ the leap to the next step in advancing health care for our patients, their families and communities. References ϭ͘ ,ĂŶĚǁĞƌŬ͕ ƌŝĂŶ͘ dŚĞ ^ƵƌƉƌŝƐŝŶŐ ,ŝƐƚŽƌǇ ĞŚŝŶĚ >ĞĂƉ zĞĂƌ͘ EĂƚŝŽŶĂů 'ĞŽŐƌĂƉŚŝĐ͘ ŚƚƚƉƐ͗ͬͬǁǁǁ͘ŶĂƚŝŽŶĂůŐĞŽŐƌĂƉŚŝĐ͘ĐŽŵͬ ŶĞǁƐͬϮϬϭϲͬϬϮͬϭϲϬϮϮϲͲůĞĂƉͲǇĞĂƌͲƐĐŝĞŶĐĞͲƚŝŵĞͲǁŽƌůĚͲĐƵůƚƵƌĞƐͲ ĨĞďƌƵĂƌǇͬ͘ &ĞďƌƵĂƌǇ Ϯϲ͕ ϮϬϭϲ͘ ĐĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϲ͕ ϮϬϭϵ͘

California Family Physician Winter 2020

p r e s i d e n t ’s m e s s a g e

Walt Mills, MD

2020: We Need a Vision Forward / ǁƌŽƚĞ ƚŚŝƐ ŵĞƐƐĂŐĞ Ăƚ ƚŚĞ ĞŶĚ ŽĨ Ă ǀĞƌǇ ƐŝŐŶŝĨŝĐĂŶƚ ǁĞĞŬ ŝŶ ŽƵƌ ŶĂƚŝŽŶ͛Ɛ ŚŝƐƚŽƌǇ͘ dŚĞ WƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ǁĂƐ impeached by the House of Representatives. Regardless of ŽŶĞ͛Ɛ ƉŽůŝƚŝĐĂů ǀŝĞǁƐ ĂŶĚ ƉĞƌƐŽŶĂů ŽƉŝŶŝŽŶƐ͕ ƚŚĞ ǀŽƚĞ ƐŚŽǁĞĚ ŚŽǁ ĚĞĞƉůǇ ĚŝǀŝĚĞĚ ǁĞ ĂƌĞ ĂƐ Ă ĐŽƵŶƚƌǇ͘ ^ŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ƐƵĐŚ ĂƐ ŚŽŵĞůĞƐƐŶĞƐƐ ĂŶĚ ĨŽŽĚ ŝŶƐĞĐƵƌŝƚǇ ŐƌŽǁ ĚĞƐƉŝƚĞ Ă ͞ƚŚƌŝǀŝŶŐ ĞĐŽŶŽŵǇ͘͟ dŚĞ ŽƉŝŽŝĚ ĞƉŝĚĞŵŝĐ ƐŚĂĚŽǁ ĚĂƌŬĞŶƐ͘ dŚĞ ŶƵŵďĞƌ ŽĨ ƵŶŝŶƐƵƌĞĚ ĞǆƉĂŶĚƐ ǁŚŝůĞ ƚŚĞ ͞DĞĚŝĐĂƌĞ ĨŽƌ Ăůů͟ ĚĞďĂƚĞ ĨůĂƌĞƐ͘ /Ĩ ĞǀĞƌ ǁĞ ŶĞĞĚĞĚ ϮϬϮϬ ǀŝƐŝŽŶ ƚŽ ƐĞĞ ŽƵƌ ǁĂǇ ĨŽƌǁĂƌĚ͕ ŝƚ͛Ɛ ŶŽǁ͘ ϮϬϮϬ ǀŝƐŝŽŶ ĂůƐŽ ŝŵƉůŝĞƐ ƉĞƌƐƉĞĐƚŝǀĞ͘ ƵƌŝŶŐ ƚŚĞ ĨŝƌƐƚ ŚĂůĨ of my year as CAFP President I’ve been struck by the ĚŝǀĞƌƐĞ ĂŶĚ ƌŝĐŚ ƉĞƌƐƉĞĐƚŝǀĞƐ ŽĨ ŽƵƌ ϭϭ͕ϬϬϬ ŵĞŵďĞƌƐ͘ tŝƚŚ California’s Family Medicine Revolution in its third decade, ǁĞ ŶĞĞĚ ŶŽǁ ŵŽƌĞ ƚŚĂŶ ĞǀĞƌ ƚŽ ĞŶŐĂŐĞ ĂŶĚ ůĞǀĞƌĂŐĞ our membership’s diverse perspectives to ensure “strong medicine for California” prevails. ZĞƉƌŽĚƵĐƟǀĞ ƋƵŝƚǇ I recently signed a letter representing you, CAFP members, protesting the potential merger of UCSF and a health system operating under the directives of the Roman Catholic ŚƵƌĐŚ͘ dŚĞ ĂƚŚŽůŝĐ ĚŝƌĞĐƚŝǀĞƐ ǁŽƵůĚ ŚĂǀĞ ůŝŵŝƚĞĚ ǁŽŵĞŶ͛Ɛ access to comprehensive reproductive health care, affecting ƐŽŵĞ ŽĨ ƚŚĞ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ͕ ƵŶĚĞƌƐĞƌǀĞĚ ǁŽŵĞŶ ŝŶ ĂůŝĨŽƌŶŝĂ͘ tŝƚŚ &W ůĞĂĚĞƌƐŚŝƉ͕ ŝŶ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ ŽƚŚĞƌ ŽƌŐĂŶŝǌĂƚŝŽŶƐ ĐŽŵŵŝƚƚĞĚ ƚŽ ƌĞƉƌŽĚƵĐƚŝǀĞ ũƵƐƚŝĐĞ͕ ƚŚĞ ŵĞƌŐĞƌ ǁĂƐ ĐŚĞĐŬĞĚ͘ / ĐŽŶƐƵůƚĞĚ Ă ĨĞůůŽǁ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ƚŚĞ ĐŚŝĞĨ ĞǆĞĐƵƚŝǀĞ ƉŚǇƐŝĐŝĂŶ ŽĨ ƚŚĞ ŽƚŚĞƌ ƐǇƐƚĞŵ͕ ĚƵƌŝŶŐ ƚŚĞ ƉƌŽĐĞƐƐ͘ /ƚ ǁĂƐ affirming that such a conversation could happen coming from different perspectives. Affirming, but not surprising ŐŝǀĞŶ ǁĞ ǁĞƌĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ĞǆƉĞƌƚƐ Ăƚ ĚŝĂůŽŐ ĂŶĚ ƐĞĞŬŝŶŐ ĐŽůůĂďŽƌĂƚŝǀĞ ƐŽůƵƚŝŽŶƐ ;ŝƚ͛Ɛ ǁŚĂƚ ǁĞ ĚŽ ĞǀĞƌǇ ĚĂǇ ǁŝƚŚ ŽƵƌ ƉĂƚŝĞŶƚƐ ĂĨƚĞƌ ĂůůͿ͘ tĞ ůĞĂƌŶĞĚ ĨƌŽŵ ĞĂĐŚ ŽƚŚĞƌ ŚŽǁ ƚŽ ďĞƐƚ ƉƌŽĐĞĞĚ͘ Gun Safety I signed another letter declaring the need for stronger gun

California Family Physician Winter 2020

regulation and more research to inform evidence-based ŵĞĂŶƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚŝƐ ƚĞƌƌŝďůĞ ŚĞĂůƚŚ ŚĂǌĂƌĚ ƚŚĂƚ ŚĂƐ devastated many of our patients. ĞĨŽƌĞ ƚŚĞ ůĞƚƚĞƌ ǁĞŶƚ ŽƵƚ͕ / ĐĂůůĞĚ ƐĞǀĞƌĂů ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ůĞĂĚĞƌƐ ǁŚŽ / ŬŶŽǁ ŚĂǀĞ ĚŝĨĨĞƌĞŶƚ ǀŝĞǁƐ ĂďŽƵƚ ƚŚĞ ůĞƚƚĞƌ͛Ɛ ŵĞƐƐĂŐĞ͘ dŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƚŚĞŝƌ ǁŝƐĞ ƉĞƌƐƉĞĐƚŝǀĞ ĂŶĚ ĚĞĞƉĞƌ ŬŶŽǁůĞĚŐĞ ŽĨ ƚŚĞ ƐƵďũĞĐƚ ŵĂĚĞ ƚŚĞ ůĞƚƚĞƌ ƐƚƌŽŶŐĞƌ͘ tŝƚŚŽƵƚ ƐƵĐŚ ŝŶĐůƵƐŝŽŶ ĂŶĚ ƌĞƐƉĞĐƚ͕ ŶŽƚ ŽŶůǇ ǁŽƵůĚ ǁĞ ŚĂǀĞ ŵŝƐƐĞĚ ǀĂůƵĂďůĞ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ŽƵƌ ŵĞƐƐĂŐĞ͕ ďƵƚ / ǁŽƵůĚŶ͛ƚ ŚĂǀĞ been surprised to hear of their resignation from an Academy that did not respect its members’ perspectives. /ŶƚĞƌƉƌŽĨĞƐƐŝŽŶĂů dĞĂŵͲ ĂƐĞĚ ĂƌĞ /Ŷ ϭϵϴϬ Ă ĨƌŝĞŶĚ ĂƚƚĞŵƉƚĞĚ ƚŽ ĂƌƌĂŶŐĞ Ă ďůŝŶĚ ĚĂƚĞ ĨŽƌ ŵĞ ǁŝƚŚ Ă ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌ ǁŚŽ ŚĂĚ ũƵƐƚ ŵŽǀĞĚ ƚŽ ĂůŝĨŽƌŶŝĂ͘ / ǁĂƐ Ă ƐĞŶŝŽƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ h ^ ͘ / ǁĂƐ ƚŽůĚ ƚŚĞ FNP had no interest in dating me. Her experiences in her professional role as an RN/NP had been too negative in relation to physician colleagues to begin dating a medical student. Sad testament to the culture, then prevalent, of ƉŚǇƐŝĐŝĂŶ ƐƵƉĞƌŝŽƌŝƚǇ͘ ǀĞŶƚƵĂůůǇ / ǁĂƐ ĂďůĞ ƚŽ ƉƌŽǀĞ ŵǇƐĞůĨ ǁŽƌƚŚǇ͘ tĞ ŚĂǀĞ ŚĂƉƉŝůǇ ďĞĞŶ ƚŽŐĞƚŚĞƌ ϰϬ ǇĞĂƌƐ ĂŶĚ ƐŚĞ ŚĂƐ ƐŝŶĐĞ ĚĞǀĞůŽƉĞĚ ǁŽŶĚĞƌĨƵů ƌĞůĂƚŝŽŶƐŚŝƉƐ ǁŝƚŚ ŵĂŶǇ ŬŝŶĚ ĂŶĚ thoughtful physicians. ŶĞǁ &W ^ĐŽƉĞ ŽĨ WƌĂĐƚŝĐĞ ŽŵŵŝƚƚĞĞ ǁĂƐ ĐŽŶǀĞŶĞĚ ƚŽ ĚĞǀĞůŽƉ ƉŽůŝĐǇ ĞǆƉůŽƌŝŶŐ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ ŽƚŚĞƌ ĂůůŝĞĚ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ;EWƐ ĂŶĚ W ƐͿ ƚŽ ŵĞĞƚ ĂůŝĨŽƌŶŝĂ͛Ɛ primary care needs. Longstanding AAFP policy declares allied health professionals should never be permitted to have independent practice. In unprecedented fashion, CAFP is ĂƚƚĞŵƉƚŝŶŐ ƚŽ ďĞ ŝŶĐůƵƐŝǀĞ ǁŝƚŚ EWƐ ĂŶĚ W Ɛ͘ dĂŬĞ Ă ůŽŽŬ Ăƚ ŽƵƌ ŶĞǁ ƉƌŝŶĐŝƉůĞƐ ŽŶ ƉĂŐĞƐ ϮϮͲϮϱ͘ DǇ ͞ĚĂƚŝŶŐ͟ ŵĞƚĂƉŚŽƌ ǁŝƚŚ ŵǇ ǁŝĨĞ ŝƐ ĂďŽƵƚ ŚŽǁ ƉĂƐƚ ĞǆƉĞƌŝĞŶĐĞƐ ďŝĂƐ ƵƐ ĂŶĚ ƉŽƚĞŶƚŝĂůůǇ ĐůŽƐĞ ƵƐ ƚŽ ĂŵĂǌŝŶŐ possibilities. Similarly, I am open and hopeful that our courageous leadership’s convening the Scope Committee, is Ă ďƌĂǀĞ ƐƚĂƌƚ ƚŽ ŵŽǀŝŶŐ ƚŽǁĂƌĚ ƚŚĞ ƚǇƉĞ ŽĨ ĐŽůůĂďŽƌĂƚŝŽŶ ĂŶĚ ƚĞĂŵǁŽƌŬ ŶĞĞĚĞĚ ƚŽ ŵĞĞƚ ƚŚĞ ŶĞĞĚƐ ŽĨ ŽƵƌ ŵĞŵďĞƌƐ ĂŶĚ

ƚŚĞ ƉĂƚŝĞŶƚƐ ŽĨ ĂůŝĨŽƌŶŝĂ͘ tĞ ǁŝůů ŶĞǀĞƌ ƐŽůǀĞ ŽƵƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ĐƌŝƐŝƐ ǁŝƚŚŽƵƚ ƐƵĐŚ inclusion strategies. ŝǀĞƌƐŝƚǇ͕ /ŶĐůƵƐŝŽŶ͕ ƋƵŝƚǇ͗ DǇ ϮϬϮϬ Commitment h ^& ƉůĂŶƐ ƚŽ ƚƌĂŝŶ ϭ͕ϮϬϬ ĨĂĐƵůƚǇ ƚŽ be “diversity, equity and inclusion champions” over the next several ǇĞĂƌƐ͘ / ĐŽŵƉůĞƚĞĚ ƚŚĞ ƚƌĂŝŶŝŶŐ ǁŝƚŚ many other FM faculty from multiple California programs. I learned I need to become a more inclusive leader. I ĐŽŵŵŝƚƚĞĚ ƚŽ ůĞĂƌŶ ƚŽ ƵƐĞ ŵǇ ƉŽǁĞƌ and privilege in “allyship.” Allyship is ƌĞĐŽŐŶŝǌŝŶŐ ƉƌŝǀŝůĞŐĞ ĂŶĚ ƵƐŝŶŐ ŝƚ ƚŽ amplify underrepresented voices. I have been striving to understand the ƐǇƐƚĞŵĂƚŝĐ ĂŶĚ ƐŽĐŝĞƚĂů ŝƐƐƵĞƐ ǁŚŝĐŚ ŚĂǀĞ played in my favor since before I met that ĂǁĞƐŽŵĞ &EW ůŽŶŐ ĂŐŽ͘

tŚĞƚŚĞƌ / Ăŵ ǁŝƚŚ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ struggling to survive a surgery clerkship, a teen patient “coming out,” ĐŽŵƉĂƐƐŝŽŶĂƚĞůǇ ĐŽŶŶĞĐƚŝŶŐ ǁŝƚŚ Ă ϲϬͲǇĞĂƌͲŽůĚ ŽƉŝŽŝĚ ĂĚĚŝĐƚ ŝŶ ŚŽƉĞƐ Ă ďƵƉƌĞŶŽƌƉŚŝŶĞ ƉƌĞƐĐƌŝƉƚŝŽŶ ǁŽƌŬƐ ƚŽ save a life, or a colleague struggling to make sense of the “Me Too” movement ĂƐ Ă ǁŽŵĂŶ ůĞĂĚĞƌ͕ / ƌĞĐŽŐŶŝǌĞ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ĂŶĚ ƉŽǁĞƌ ƚŚĞ ĚŝǀĞƌƐŝƚǇ ƚƌĂŝŶŝŶŐ ďĞƐƚŽǁƐ͘ dĂŬĞ Ă ůŽŽŬ Ăƚ ŚƚƚƉƐ͗ͬͬ differencesmatter.ucsf.edu/diversityequity-and-inclusion-champion-training for more on this. We must all be Diversity Champions to be real healers.

to discover “shared decision making” as Ă ďĞƚƚĞƌ ǁĂǇ ƚŽ ĚĞĂů ǁŝƚŚ ƵŶĐĞƌƚĂŝŶƚǇ ĂŶĚ ƉŽƐƐŝďŝůŝƚŝĞƐ ǁŝƚŚ ŵǇ ƉĂƚŝĞŶƚƐ͖ ůŝŬĞǁŝƐĞ͕ CAFP and you can create the best ĚĞĐŝƐŝŽŶƐ ĂŶĚ ĨƵƚƵƌĞ ďǇ ǁŽƌŬŝŶŐ ƚŽŐĞƚŚĞƌ͘ zĞƐ͕ / ƵŶĚĞƌƐƚĂŶĚ ďĞƚƚĞƌ͕ ǁĞ ĂƌĞ ƉĂƌƚ ŽĨ ĂŶ ŝŶĐƌĞĂƐŝŶŐůǇ ĐŽŵƉůĞǆ ǁŽƌůĚ ǁŝƚŚ ƵŶƉƌĞĚŝĐƚĂďůĞ ĨŽƌĐĞƐ Ăƚ ǁŽƌŬ͘ ,ŽǁĞǀĞƌ͕ / ĚŽ ŬŶŽǁ ƚŚĂƚ ǁŚĂƚĞǀĞƌ &W ĐƌĞĂƚĞƐ ĨŽƌ ĂŶĚ ǁŝƚŚ ǇŽƵ͕ ŽƵƌ ŵĞŵďĞƌƐ͕ ŝŶ ϮϬϮϬ͕ ƚŚĞ ŐŽĂů ǁŝůů ďĞ ƚŽ ďĞĐŽŵĞ ŝŶĐƌĞĂƐŝŶŐůǇ ŝŶĐůƵƐŝǀĞ ŽĨ Ăůů͘ &W ŝƐ ŐƌŽǁŝŶŐ ŝŶ ƐŝǌĞ and influence as the voice for primary care in California. Our mission is to ĞŶŐĂŐĞ͕ ĞĚƵĐĂƚĞ͕ ĂŶĚ ĞŵƉŽǁĞƌ Ăůů ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ƐŽ ƚŚĂƚ ǁĞ ŵĂǇ ƉƌŽǀŝĚĞ ƚŚĞ absolute best care for all Californians.

ϮϬϮϬ WƌĞĚŝĐƟŽŶƐ /͛ǀĞ ďĞĐŽŵĞ ŚƵŵďůĞ ŽǀĞƌ ƚŚĞ ǇĞĂƌƐ ǁŝƚŚ making predictions for my patients; EŽǁ͕ ůĞƚ͛Ɛ ŐŽ ŵĂŬĞ ϮϬϮϬ ĂŵĂǌŝŶŐ ůŝŬĞǁŝƐĞ͕ ǁŝƚŚ ƉƌĞĚŝĐƚŝŶŐ ƚŚĞ ĨƵƚƵƌĞ ĨŽƌ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ŽƌŐĂŶŝǌĂƚŝŽŶƐ͘ / ǁĂƐ ŚĂƉƉǇ together!

California Family Physician Winter 2020

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

CAFP Ends 2019 with a Bang! / ŚĂǀĞ ƚŽ ƐƚĂƌƚ ŽƵƚ ǁŝƚŚ Ă ,h' ƚŚĂŶŬƐ ƚŽ ĞǀĞƌǇŽŶĞ ǁŚŽ called, emailed and texted their legislators and the governor ŝŶ ϮϬϭϵ͘ zŽƵƌ ĂĚǀŽĐĂĐǇ ŚĞůƉĞĚ ƉƵƐŚ ŵĂŶǇ &W ƉƌŝŽƌŝƚǇ ŝƐƐƵĞƐ ƚŽ ĂůŝĨŽƌŶŝĂ͛Ɛ ůĞŐŝƐůĂƚŝǀĞ ĨŽƌĞĨƌŽŶƚ ĂŶĚ ůĞĚ ƚŽ ϮϬ &WͲ ƐƵƉƉŽƌƚĞĚ ďŝůůƐ ďĞĐŽŵŝŶŐ ůĂǁ͕ ŝŶĐůƵĚŝŶŐ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͘ ϭϲϮϮ ŝƐ Ă ďŝŐ ĚĞĂů͘ /ƚ ĨŝǆĞƐ ŽƵƚĚĂƚĞĚ ůĂǁƐ ƚŚĂƚ ƉƌĞǀĞŶƚĞĚ family physicians from receiving recognition for the true value and diversity of care they can provide. The bill adds family ƉŚǇƐŝĐŝĂŶƐ ƚŽ ǀĂƌŝŽƵƐ ĞǆŝƐƚŝŶŐ ƉƌŽǀŝƐŝŽŶƐ ŝŶ ůĂǁ͕ ŝŶĐůƵĚŝŶŐ͗ • dŚĞ EƵƌƐĞ WƌĂĐƚŝĐĞ Đƚ ƚŽ ĂůůŽǁ &WƐ ƚŽ ďĞ ŵĞŵďĞƌƐ of an existing committee to develop educational standards and associated matters relating to the ƉƌĂĐƚŝĐĞ ŽĨ ŶƵƌƐĞͲŵŝĚǁŝĨĞƌǇ͖ • The Sexual Health Education Accountability Act to modify the definition of “medically accurate” to ŝŶĐůƵĚĞ ƌĞƐĞĂƌĐŚ ƌĞĐŽŐŶŝǌĞĚ ĂƐ ĂĐĐƵƌĂƚĞ ĂŶĚ ŽďũĞĐƚŝǀĞ by the American Academy of Family Physicians; • The list of practitioners that a parent/guardian of a minor could consult regarding options available for a minor’s dental treatment; • The list of subject matter experts for purposes of the ZĞƉƌŽĚƵĐƚŝǀĞ ZŝŐŚƚƐ >Ăǁ ŶĨŽƌĐĞŵĞŶƚ ŝŶŝƚŝĂƚŝǀĞ͖ • Health promotion education programs for allied health professionals. The bill also permits a board-certified family medicine ƉŚǇƐŝĐŝĂŶ ƚŽ ƉƌŽǀŝĚĞ ǁƌŝƚƚĞŶ ĐĞƌƚŝĨŝĐĂƚŝŽŶ ĨŽƌ ĂŶ ŝŶĨĂŶƚ ƵŶĚĞƌ the age of one month to participate in the entertainment ŝŶĚƵƐƚƌǇ͘ dŚĂŶŬ ǇŽƵ ƚŽ Ăůů ƚŚĞ &W ŵĞŵďĞƌƐ ǁŚŽ ŚĞůƉĞĚ pass this bill! Today, legislators and the public have a clearer understanding of the value of family medicine because of our ǁŽƌŬ ƚŽŐĞƚŚĞƌ͘ ,ĞƌĞ ĂƌĞ ũƵƐƚ Ă ĨĞǁ ŽĨ ƚŚĞ ŽƚŚĞƌ ďŝŐ ǁŝŶƐ ǁĞ ŚĂĚ ŝŶ ϮϬϭϵ͗ ϳϰϰ ; ŐƵŝĂƌͲ ƵƌƌǇͿ ʹ ZĞƋƵŝƌĞƐ Ă ŚĞĂůƚŚ ƉůĂŶ ƚŽ ƉĂǇ ĨŽƌ a diagnosis, consultation or treatment delivered through telehealth services on the same basis as in-person diagnosis, consultation or treatment. ^ ϭϱϵ ;tŝĞŶĞƌͿ ʹ ƵƚŚŽƌŝǌĞƐ Ă ƉŚĂƌŵĂĐŝƐƚ͕ ĂĨƚĞƌ ĐŽŵƉůĞƚŝŶŐ

California Family Physician Winter 2020

a training program and HIV status has been determined, to furnish preexposure and postexposure prophylaxis to a ƉĂƚŝĞŶƚ ǁŝƚŚ Žƌ Ăƚ ƌŝƐŬ ĨŽƌ ,/s͘ ^ Ϯϳϲ ;WĂŶͿ ʹ ĨƚĞƌ Ă ĚŝƐƌƵƉƚŝǀĞ ƉƵďůŝĐ ďĂƚƚůĞ ďĞƚǁĞĞŶ legislators, the Governor and pro- and anti-vaccination ŐƌŽƵƉƐ͕ ^ Ϯϳϲ ďŝůů ǁĂƐ ƐŝŐŶĞĚ ŝŶƚŽ ůĂǁ͕ ƌĞƐŚĂƉŝŶŐ ƚŚĞ procurement and monitoring of medical exceptions to ĐŚŝůĚŚŽŽĚ ǀĂĐĐŝŶĞƐ͘ /Ŷ ƌĞĂĐƚŝŽŶ ƚŽ &WͲƐƵƉƉŽƌƚĞĚ ^ Ϯϳϳ ;ϮϬϭϱͿ͕ ǁŚŝĐŚ ƌĞŵŽǀĞĚ ƚŚĞ ͞ZĞůŝŐŝŽƵƐ ĂŶĚ WĞƌƐŽŶĂů ĞůŝĞĨ͟ exemption to vaccines, some physicians began issuing inappropriate medical exemptions, dropping the vaccination ƌĂƚĞ Ăƚ ƐŽŵĞ ƐĐŚŽŽůƐ ďĞůŽǁ ƚŚĞ ϵϱ ƉĞƌĐĞŶƚ ŚĞƌĚ ŝŵŵƵŶŝƚǇ ƌĂƚĞ͘ hŶĚĞƌ ƚŚĞ ŶĞǁ ůĂǁ͕ ƚŚĞ ƐƚĂƚĞ ǁŝůů ĐŽůůĞĐƚ ŵĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ ĞůĞĐƚƌŽŶŝĐĂůůǇ ďǇ :ĂŶƵĂƌǇ ϭ͕ ϮϬϮϭ͘ DĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ ǁŝůů ďĞ ƌĞǀŝĞǁĞĚ ǁŚĞŶ͗ • ƐĐŚŽŽů͛Ɛ ŝŵŵƵŶŝǌĂƚŝŽŶ ƌĂƚĞ ĨĂůůƐ ďĞůŽǁ ϵϱ ƉĞƌĐĞŶƚ͖ Žƌ • ĚŽĐƚŽƌ ǁƌŝƚĞƐ ŵŽƌĞ ƚŚĂŶ ĨŝǀĞ ŵĞĚŝĐĂů ĞǆĞŵƉƚŝŽŶƐ ƉĞƌ ǇĞĂƌ ďĞŐŝŶŶŝŶŐ :ĂŶƵĂƌǇ ϭ͕ ϮϬϮϬ͖ Žƌ • A school fails to provide reports of vaccination rates to ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ ; W,Ϳ͘ >ŽĂĚƐ ŽĨ ǁŝŶƐ ƐŚŽǁ ƵƉ ŝŶ 'ŽǀĞƌŶŽƌ 'ĂǀŝŶ EĞǁƐŽŵ͛Ɛ ďƵĚŐĞƚ ĐŽůƵŵŶ ĂƐ ǁĞůů͕ ŝŶĐůƵĚŝŶŐ͗ • $33 million in annual ongoing funding for the Song ƌŽǁŶ WƌŝŵĂƌǇ ĂƌĞ WŚǇƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ disburses grants to primary care residency programs ǁŚŽƐĞ ŐƌĂĚƵĂƚĞƐ ƚƌĂŝŶ ĂŶĚ ĐŽŶƚŝŶƵĞ ƚŽ ƉƌĂĐƚŝĐĞ ŝŶ underserved areas treating underserved populations. • ĐŽŶƚŝŶƵĂƚŝŽŶ ŽĨ ŶĞĂƌůǇ ΨϰϬ ŵŝůůŝŽŶ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ĨƵŶĚƐ ƚŽ ƐƵƉƉŽƌƚ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂŶĚ ĞŵĞƌŐĞŶĐǇ medicine residency programs as administered by the hŶŝǀĞƌƐŝƚǇ ŽĨ ĂůŝĨŽƌŶŝĂ ŝŶ ƉĂƌƚŶĞƌƐŚŝƉ ǁŝƚŚ WŚǇƐŝĐŝĂŶƐ for a Healthy California. • ΨϭϮϬ ŵŝůůŝŽŶ ĂĚĚŝƚŝŽŶĂů ŽŶĞͲƚŝŵĞ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ physician and dentist loan repayment program. This ŵĂŬĞƐ ΨϯϰϬ ŵŝůůŝŽŶ ĂǀĂŝůĂďůĞ ĨŽƌ ƚŚĞ ƉƌŽŐƌĂŵ ŽǀĞƌ ƚŚĞ next several years. • ΨϮϱϬ ŵŝůůŝŽŶ ŝŶ ŽŶĞͲƚŝŵĞ ĨƵŶĚŝŶŐ ĨŽƌ ǀĂƌŝŽƵƐ DĞĚŝͲ Ăů Value-Based Payments programs. • Restoration of optical, audiology, incontinence ĐƌĞĂŵƐͬǁĂƐŚĞƐ͕ ƉŽĚŝĂƚƌǇ ĂŶĚ ƐƉĞĞĐŚ ƚŚĞƌĂƉǇ ďĞŶĞĨŝƚƐ in Medi-Cal.

• •

ǆƚĞŶƐŝŽŶ ŽĨ DĞĚŝͲ Ăů ĞůŝŐŝďŝůŝƚǇ ĨƌŽŵ ϲϬ ĚĂǇƐ ƚŽ ŽŶĞ ǇĞĂƌ ĨŽƌ ƉŽƐƚͲƉĂƌƚƵŵ ǁŽŵĞŶ ĚŝĂŐŶŽƐĞĚ ǁŝƚŚ Ă ŵĞŶƚĂů health disorder. Funding for prevention and linkage to care programs ĨŽƌ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ,/s͕ ,ĞƉĂƚŝƚŝƐ ͕ ĂŶĚ ^d Ɛ͘

We cannot rest on our laurels, though. Major opportunities ͙ ůŝĞ ŝŶ ĨƌŽŶƚ ŽĨ ƵƐ͘ ^Ž ĚŽ ƚŚƌĞĂƚƐ ͙ ƚŚĞ ůĞĂƐƚ ŽĨ ǁŚŝĐŚ ŝƐ Ă ϮϬϮϬ ƐƚĂƚĞǁŝĚĞ ďĂůůŽƚ ŝŶŝƚŝĂƚŝǀĞ ŚĂƐ ũƵƐƚ ŝŶƚƌŽĚƵĐĞĚ ƚŚĂƚ ǁŽƵůĚ ĐŚĂůůĞŶŐĞ ƚŚĞ DĞĚŝĐĂů /ŶũƵƌǇ ŽŵƉĞŶƐĂƚŝŽŶ ZĞĨŽƌŵ Đƚ ;D/ Z Ϳ͘ &Žƌ ŵŽƌĞ ƚŚĂŶ ϯϱ ǇĞĂƌƐ͕ D/ Z ŚĂƐ ĞŶƐƵƌĞĚ ƉĂƚŝĞŶƚ

ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ďǇ ƌĞĚƵĐŝŶŐ ĨƌŝǀŽůŽƵƐ ůĂǁƐƵŝƚƐ ĂŶĚ ůŝŵŝƚŝŶŐ ŐƌŽǁƚŚ ŝŶ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƚŝĐĞ ƉƌĞŵŝƵŵƐ͘ ZĞƐƚ ĂƐƐƵƌĞĚ͕ &W ŝƐ ƉƌĞƉĂƌŝŶŐ ƚŽ ĨŝŐŚƚ ƚŚŝƐ ŝŶŝƚŝĂƚŝǀĞ ƚŚĂƚ ǁŝůů ultimately increase costs and decrease access to health care. If you’d like to support our efforts on this and other political matters, please consider contributing to the Family Physicians WŽůŝƚŝĐĂů ĐƚŝŽŶ ŽŵŵŝƚƚĞĞ ;&WͲW Ϳ͘ tĂŶƚ ƚŽ ŐĞƚ ĞǀĞŶ ŵŽƌĞ ŝŶǀŽůǀĞĚ͍ ^ŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞǇ Contact by emailing our Director of Government Relations, Adam Francis, at afrancis@familydocs.org.

Want to take your advocacy to the next level or just learn the basics, and have a chance to meet with your legislator? ZĞŐŝƐƚƌĂƟŽŶ ŝƐ ŶŽǁ ŽƉĞŶ ĨŽƌ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ; D DͿ͘ dŚĞ D D ǁŝůů ďĞ Ăƚ ƚŚĞ ^ŚĞƌĂƚŽŶ 'ƌĂŶĚ ^ĂĐƌĂŵĞŶƚŽ͕ Saturday and Sunday, March 14-15, 2020 followed by Family Medicine Lobby Day on Monday, March 16͕ ĚƵƌŝŶŐ ǁŚŝĐŚ ǇŽƵ͛ůů ŚĂǀĞ ĂŶ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ŵĞĞƚ ǁŝƚŚ ǇŽƵƌ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĞŝƌ ƐƚĂī͘ dŚŝƐ ŵĞĞƟŶŐ ŝƐ ŽƉĞŶ ƚŽ Ăůů &W ŵĞŵďĞƌƐ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ǁŚĞƚŚĞƌ ǇŽƵ ĂƌĞ Ă ĚĞůĞŐĂƚĞ Žƌ ĂůƚĞƌŶĂƚĞ ĨƌŽŵ ǇŽƵƌ ĐŽƵŶƚǇ ĐŚĂƉƚĞƌ Žƌ Ă ŐĞŶĞƌĂů ĂƩĞŶĚĞĞ͘ ƚ ƚŚĞ D D͕ ǇŽƵ͛ůů ŚĞĂƌ ĨƌŽŵ ƉŽůŝĐǇ ĂŶĚ ƉŽůŝƟĐĂů ĞǆƉĞƌƚƐ͕ ŐĞƚ ŚĂŶĚƐͲŽŶ ĞǆƉĞƌŝĞŶĐĞ ĂĚǀŽĐĂƟŶŐ ĨŽƌ ŝƐƐƵĞƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ŶĞƚǁŽƌŬ ǁŝƚŚ ĂĚǀŽĐĂĐǇͲŽƌŝĞŶƚĞĚ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ŵĞĞƚ ǁŝƚŚ ǇŽƵƌ ůĞŐŝƐůĂƚŽƌƐ͊ &ƌŽŵ ŝŵƉƌŽǀŝŶŐ ƉƵďůŝĐ ŚĞĂůƚŚ ƚŽ ŝŶĐƌĞĂƐŝŶŐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉĂǇŵĞŶƚ͕ ůĞĂƌŶ ŚŽǁ zKh ĐĂŶ ďĞ ƚŚĞ ĐŚĂŶŐĞ ǇŽƵ ǁĂŶƚ ƚŽ ƐĞĞ ŝŶ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƉŽůŝĐǇ ǁŽƌůĚ͘ /Ŷ ĂĚĚŝƟŽŶ͕ ƚŚĞ D D ǁŝůů ďĞ ĂĐĐƌĞĚŝƚĞĚ ĨŽƌ &W ƉƌĞƐĐƌŝďĞĚ D ĐƌĞĚŝƚ͘ ůů ƚŚŝƐ ĨŽƌ ůĞƐƐ ƚŚĂŶ ΨϱϬ ƌĞŐŝƐƚƌĂƟŽŶ ; &W ĐŽǀĞƌƐ ƌĞŐŝƐƚƌĂƟŽŶ ĨŽƌ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐͿ͊

California Family Physician Winter 2020

IN THE NEWS Winter 2020

:ĂƐŵĞĞƚ ĂŝŶƐ͕ D ͕ ;ƐĞĐŽŶĚ ĨƌŽŵ ůĞŌ ŝŶ ƚŚĞ ƉŚŽƚŽͿ ŚĂƐ ƌĞĐĞŝǀĞĚ ŽĸĐŝĂů ǁŽƌĚ ĂŶĚ ǁĞ͛ƌĞ ƉůĞĂƐĞĚ ƚŽ ƐŚĂƌĞ ƚŚĂƚ ƐŚĞ ŚĂƐ ďĞĞŶ ŽĸĐŝĂůůǇ ĂƉƉŽŝŶƚĞĚ ƚŽ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĞǀĞůŽƉŵĞŶƚĂů ^ĞƌǀŝĐĞƐ ; ^Ϳ dĂƐŬĨŽƌĐĞ͘ ^ŚĞ ǁŝůů ďĞ ǁŽƌŬŝŶŐ ƚŽ ŝŶĐƌĞĂƐĞ ƋƵĂůŝƚǇ ĐŽŶƟŶƵŝƚǇ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ƌĞƐŽƵƌĐĞƐ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ĚĞǀĞůŽƉŵĞŶƚĂů ĚŝƐĂďŝůŝƟĞƐ͘ dŚŝƐ ŝƐ Ă ĚŝƌĞĐƚ ŽƵƚŐƌŽǁƚŚ ŽĨ ŚĞƌ ǁŽƌŬ ŝŶ <ĞƌŶ ĐŽƵŶƚǇ ĂƐ Ă ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ĂŶĚ ďŽĂƌĚ ŵĞŵďĞƌ Ăƚ ƚŚĞ <ĞƌŶ ZĞŐŝŽŶĂů ĞŶƚĞƌ͘ ^ŚĞ͛Ɛ ĂůƌĞĂĚǇ ĂƩĞŶĚĞĚ ŚĞƌ ĮƌƐƚ ŵĞĞƟŶŐ ĂŶĚ ƌĞƉŽƌƚƐ͕ ͞'ƌĞĂƚ ŵĞĞƟŶŐ ĂŶĚ ĚŝƐĐƵƐƐŝŽŶ ƚŽĚĂǇ ǁŝƚŚ ^ĞĐƌĞƚĂƌǇ 'ŚĂůǇ͕ ŝƌĞĐƚŽƌ ĂƌŐŵĂŶŶ ĂŶĚ ĨĞůůŽǁ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ŶĞǁ ^ dĂƐŬĨŽƌĐĞ͘ tŽŶĚĞƌĨƵů ƚŽ ŚĞůƉ ůĞĂĚ ƋƵĂůŝƚǇ ŝŵƉůĞŵĞŶƚĂƟŽŶ ĂŶĚ ƐǇƐƚĞŵ ƌĞĨŽƌŵ ŽĨ ŽƵƌ ƐĞƌǀŝĐĞƐ ĨŽƌ ƉĞŽƉůĞ ǁŝƚŚ ĚĞǀĞůŽƉŵĞŶƚĂů ĂŶĚ ŝŶƚĞůůĞĐƚƵĂů ĚŝƐĂďŝůŝƟĞƐ ŝŶ ĂůŝĨŽƌŶŝĂ͘ tŽƌŬŝŶŐ ŽŶ ƐŽŵĞ ŐƌĞĂƚ ƉƌŽũĞĐƚƐ ĂŶĚ ŚĞůƉŝŶŐ ǁŝƚŚ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ĨƌŽŵ ƚŚĞ ĐůŽƐƵƌĞ ŽĨ ĚĞǀĞůŽƉŵĞŶƚĂů ĐĞŶƚĞƌƐ͘ /Ĩ ǁĞ ǁĂŶƚ ƚŽ ŚĞůƉ ƚƌĂŶƐĨŽƌŵ ŚĞĂůƚŚ ĐĂƌĞ͕ ǁĞ ŵƵƐƚ ĮƌƐƚ ƐƚĂƌƚ ǁŝƚŚ ƚŚĞ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐ ƚŚĂƚ ŶĞĞĚ ĂƩĞŶƟŽŶ ƌŝŐŚƚ ĂǁĂǇ͘͟ ηƋƵĂůŝƚǇŚĞĂůƚŚϰĂůů͘ ŽŶŐƌĂƚƵůĂƟŽŶƐ :ĂƐŵĞĞƚ͊

>ĂƵƌĂ DĂƌƟŶ͕ ŝĂŶĂ DŽŬĂǇĂ͕ ƌŝŬĂ ZŽƐŚĂŶƌĂǀĂŶ͕ dŽŶĂ ZŽĚƌŝŐƵĞǌ͕ DĂƌŐĂƵǆ >ĂǌĂƌŝŶ͕ /ƐĂďĞů ŚĞŶ ĂŶĚ <ĂƌĞĞŶ ƐƉŝŶŽ͘ KƵƌ ĐŽĂĐŚĞƐ ĂƌĞ ƌƐ͘ ĂƌŽů ,ĂǀĞŶƐ͕ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ ^ŚĂŶŶŽŶ ŽŶŶŽůůǇ͕ ŶŶĞ DŽŶƚŐŽŵĞƌǇ͕ ŵŝůǇ ďĞƌƚ͕ <ŝŵ Ƶŝƌ͕ ĂƚŚĞƌŝŶĞ ^ŽŶƋƵŝƐƚ &ŽƌĞƐƚ͕ >ĂƵƌĞŶ ^ŝŵŽŶ͕ ĂŶĚ >ŝƐĂ tĂƌĚ͘ tŚĂƚ ĂŶ ĂŵĂǌŝŶŐ ŐƌŽƵƉ͊ The second cohort of the Ready to Lead class of leaders and coaches ŵĞƚ ŝŶ KĐƚŽďĞƌ͘ dŚĞǇ ŚĂĚ Ă ĨƵůů ĂŐĞŶĚĂ ǁŝƚŚ ƐĞƐƐŝŽŶƐ ŽŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ǀŝƐŝŽŶ͕ ůĞĂĚŝŶŐ ĐŚĂŶŐĞ͕ ĐŽŵŵƵŶŝĐĂƟŽŶ ĂŶĚ ŝŶŇƵĞŶĐĞ͘ dŚĞǇ ĚŝƐĐƵƐƐĞĚ ĞŶǀŝƌŽŶŵĞŶƚĂů ŝƐƐƵĞƐ ĂŶĚ ƚŚĞŝƌ ŝŶŇƵĞŶĐĞ ŽŶ ĐŚĂŶŐĞ͕ ŚŽǁ ƚŽ ĚƌŝǀĞ ĐŚĂŶŐĞ͕ ŝĚĞŶƟĨǇŝŶŐ ĂŶĚ ŽǀĞƌĐŽŵŝŶŐ ďĂƌƌŝĞƌƐ ĨŽƌ ĐŚĂŶŐĞ͘ Mary Ales, MBA, FACEHP also led a special breakout core value ĞǆƉůŽƌĂƟŽŶ ͙ ƚŚĞ ǀĂůƵĞƐ ƚŚĂƚ ƉƌŽǀŝĚĞ ŽƵƌ ƉĞƌƐŽŶĂů ĨŽƵŶĚĂƟŽŶ ĂŶĚ ŽŶ ǁŚŝĐŚ ǁĞ ĐŽŶƐƚƌƵĐƚ ƚŚĞ ƐĐĂīŽůĚŝŶŐ ƚŽ ŚŽůĚ ŽƵƌ ŚŽƵƐĞƐ ŝŶ ƉůĂĐĞ͘ dŚĞ ŐƌŽƵƉ ĞǆĂŵŝŶĞĚ ƚŚĞ ǀĂůƵĞƐ ǁŝƚŚŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ ƉƌĂĐƟĐĞ ƐĞƫŶŐ ĂŶĚ ĐƌĂŌĞĚ Ă ƌĞĂůŝƐƟĐ ĂŶĚ ƐƵƐƚĂŝŶĂďůĞ ƉůĂŶ ƚŽ ŬĞĞƉ ƚŚĞŝƌ ŚŽƵƐĞƐ ƐƚĂŶĚŝŶŐ ĞǀĞŶ ĂƐ ƚŚĞ ǁŝŶĚƐ ŽĨ ĐŚĂŶŐĞ Ɛǁŝƌů ĂƌŽƵŶĚ ƵƐ͘ &Žƌ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ZĞĂĚǇ ƚŽ >ĞĂĚ ƉƌŽũĞĐƚ͗ ǁǁǁ͘ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ͘ >ĞĂĚĞƌƐ ŝŶĐůƵĚĞ ƌƐ͘ ŶũĂŶĂ ^ŚĂƌŵĂ͕ :ĂƐŵĞĞƚ ĂŝŶƐ͕ ^ŚĞƌǇů ZĞĐŝŶŽƐ͕ EǌŝŶŐĂ 'ƌĂŚĂŵ͕ ^ƚĂĐĞǇ >ƵĚǁŝŐ͕ ŚƌŝƐƟŶĞ ŚĂǀĞǌ :ŽŚŶƐŽŶ͕ ZĞďĞĐĐĂ ĞƌƟŶ͕ 12

California Family Physician Winter 2020

We’re excited to announce that Kimberly Yu, MD been appointed ƚŽ ƚŚĞ &W ĚĞůĞŐĂƟŽŶ ƚŽ ƚŚĞ D ͊ She’s joining a tremendous team ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͕ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ family medicine every day. As an AAFP ĚĞůĞŐĂƚĞ ƚŽ ƚŚĞ D ͕ ƌ͘ zƵ ǁŝůů ƐĞƌǀĞ ĂƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ ƉŽůŝĐǇ ĂŶĚ ŵĞŵďĞƌƐŚŝƉ ůŝŶŬ ďĞƚǁĞĞŶ ƚŚĞ D and grassroots physicians. They are Ă ŬĞǇ ƐŽƵƌĐĞ ŽĨ ŝŶĨŽƌŵĂƟŽŶ ĨŽƌ &W ŵĞŵďĞƌƐ ŽŶ ĂĐƟǀŝƟĞƐ͕ ƉƌŽŐƌĂŵƐ ĂŶĚ ƉŽůŝĐŝĞƐ ŽĨ ƚŚĞ D ͘͟ ηŝŶƐƉŝƌĞĐƌĞĂƚĞůĞĂĚ η&ĂŵŝůǇDĞĚŝĐŝŶĞ^ƚƌŽŶŐ η&DƌĞǀŽůƵƟŽŶ

H e r e ’s W h a t ’s N e w i n 2 0 2 0

You Do Not Want to Miss the Family Medicine Clinical Forum! We Promise! This May, the CAFP’s Family Medicine Clinical Forum comes to >ŽŶŐ ĞĂĐŚ͕ ĂŶĚ ĨŽƌ ƚŚŽƐĞ ŽĨ ǇŽƵ ǁŚŽ ŚĂǀĞ ŶĞǀĞƌ ĂƩĞŶĚĞĚ͕ Žƌ ŚĂǀĞŶ͛ƚ ďĞĞŶ ŝŶ Ă ǁŚŝůĞ͕ ǁĞ ŚŽƉĞ ǇŽƵ ƌĞĂĚ ŽŶ ĂŶĚ ŐĞƚ ŝŶƐƉŝƌĞĚ ƚŽ ũŽŝŶ ƵƐ͘ &Žƌ ƚŚŽƐĞ ŽĨ ǇŽƵ ǁŚŽ ĂƌĞ ĨƌĞƋƵĞŶƚ ĂƩĞŶĚĞĞƐ͕ ǁĞ ŬŶŽǁ ƚŚŝƐ ǇĞĂƌ ǁŝůů ďĞ ŽŶĞ ŽĨ ǇŽƵƌ ďĞƐƚ ĞǀĞƌ͊ tĞ ƉůĂŶ ƚŽ ƚĂŬĞ ŽƵƌ ƚŚĞŵĞ ʹ >ĞĂƌŶ͕ ŽŶŶĞĐƚ͕ ĞůĞďƌĂƚĞ͕ ƚŽ ĞŶƟƌĞůǇ ŶĞǁ ůĞǀĞůƐ ĂŶĚ ǁŽƵůĚ ůŽǀĞ for you to join us!

Learn tĞ ƉƌŽŵŝƐĞ ǇŽƵ ǁŝůů ƌĞĐĞŝǀĞ ƋƵĂůŝƚǇ͕ ĞǀŝĚĞŶĐĞ ĂŶĚ ĐĂƐĞͲďĂƐĞĚ ĞĚƵĐĂƟŽŶ ƚŚĂƚ ƌĞƐƉĞĐƚƐ ǇŽƵƌ ƟŵĞ ĂŶĚ ŝŶĐůƵĚĞƐ ĐůĞĂƌ ŬĞǇ ůĞĂƌŶŝŶŐ ƉŽŝŶƚƐ͕ ƉƌĂĐƟĐĂů ƟƉƐ ƚŽ ŝŵďĞĚ ŶĞǁ ŝŶĨŽƌŵĂƟŽŶ ŝŶ ƉƌĂĐƟĐĞ ĂŶĚ ĞĂƐǇ ĂĐĐĞƐƐ ƚŽ ĂĚĚŝƟŽŶĂů ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ƉƌŽǀŝĚĞĚ͘ KŶ ƚĂƉ ĨŽƌ ƚŚŝƐ ǇĞĂƌ͗ ǀĂƉŝŶŐ ĂŶĚ ĞͲĐŝŐĂƌĞƩĞƐ͕ ŵĞŶŽƉĂƵƐĞ͕ ƌĞĚƵĐŝŶŐ ǁŽƌŬ ĂŌĞƌ ĐůŝŶŝĐ ;t Ϳ͕ ĚĞŵĞŶƟĂ ĐĂƌĞ͕ ĂĚǀĞƌƐĞ ĐŚŝůĚŚŽŽĚ ĞǆƉĞƌŝĞŶĐĞƐͬƚƌĂƵŵĂ ĐĂƌĞ͕ ŵĂǆŝŵŝǌŝŶŐ ƐĞǆƵĂůůǇ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ ƐĐƌĞĞŶŝŶŐ ĂŶĚ Wƌ W ƚŚĞƌĂƉǇ ĂŶĚ ŵŽƌĞ͊ zŽƵ ĐĂŶ ĂůƐŽ ƚĂŬĞ ĂĚǀĂŶƚĂŐĞ ŽĨ ƚŚĞ WĂůůŝĂƟǀĞ ĂƌĞ ĂŶĚ DĂƚĞƌŶŝƚǇ ĂƌĞ <^ Ɛ ĨŽƌ DK ĐƌĞĚŝƚ ĂŶĚ ŚĂŶĚƐͲŽŶ ǁŽƌŬƐŚŽƉƐ ŝŶ ƉŽŝŶƚ ŽĨ ĐĂƌĞ ƵůƚƌĂƐŽƵŶĚ ;WK h^Ϳ ĂŶĚ ĚĞƌŵŽƐĐŽƉǇͬďŝŽƉƐǇ͘

Connect tĞ ƉƌŽŵŝƐĞ ĂŵƉůĞ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ŵĂŬĞ ŶĞǁ ƉĞƌƐŽŶĂů ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ĐŽŶŶĞĐƟŽŶƐ͘ zŽƵ ĐĂŶ ũŽŝŶ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŝƚŚ ƐŝŵŝůĂƌ ŝŶƚĞƌĞƐƚƐ Ăƚ ^ƵŶĚĂǇ ŵŽƌŶŝŶŐ͛Ɛ dĂďůĞ dĂůŬƐ͕ ƚĂĐŬůĞ ĚŝĸĐƵůƚ ƉƌĂĐƟĐĞ ŝƐƐƵĞƐ Ăƚ ^ĂƚƵƌĚĂǇ ĂŌĞƌŶŽŽŶ͛Ɛ ŽƉƟŽŶĂů WƌĂĐƟĐĞ /ŶƋƵŝƌǇ ƐĞƐƐŝŽŶ͕ ǁĂůŬ Žƌ ƌƵŶ ĂůŽŶŐƐŝĚĞ ĐŽůůĞĂŐƵĞƐ Ăƚ ^ƵŶĚĂǇ͛Ɛ &ŽƵŶĚĂƟŽŶ FundRun, join in the community service project, compete for the most social media posts and more. Everyone has something ƚŽ ƐŚĂƌĞ͕ ĂŶĚ ǁĞ ŚŽƉĞ ƚŽ ĐŽŶƟŶƵĞ ƚŽ ĨĂĐŝůŝƚĂƚĞ ŵĂŶǇ ŶĞǁ ƌĞůĂƟŽŶƐŚŝƉƐ Ăƚ ƚŚĞ &ŽƌƵŵ͘

“

Excellent, engaging speakers, well organized, succinct, excellent slides. Very efficient learning in just a few days instead of over an entire week. – 2016 Forum Attendee

14 14

California Ca C alilif lif ifo orrn orn rnia ia Fa Fam Fam Family mily ily ly P Ph Physician hysi yssiicia cia i n Win Winter Wi W iin ntter te err 20 e 2 2020 020 20

“

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

“

Celebrate

– 2019 Forum Attendee

We promise you’ll be inspired by family physician leaders and colleagues as you experience the joy and “family” of family ŵĞĚŝĐŝŶĞ ĮƌƐƚŚĂŶĚ͘ /ƚ͛Ɛ Ă ƌĂƌĞ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ďĞ ƐƵƌƌŽƵŶĚĞĚ ďǇ ƐŽ ŵĂŶǇ ƉĞŽƉůĞ ǁŚŽ ƐŚĂƌĞ ŵĂŶǇ ŽĨ ǇŽƵƌ ǀĂůƵĞƐ ĂŶĚ ĐŚŽŽƐĞ ƚŽ ƐĞƌǀĞ ŽƚŚĞƌƐ ƚŚƌŽƵŐŚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ zŽƵ͛ůů ĂůƐŽ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ĐĞůĞďƌĂƚĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶ ďǇ ǀŝƐŝƟŶŐ ǁŝƚŚ ƚŚĞ ďĞƐƚ ĂŶĚ ďƌŝŐŚƚĞƐƚ ZĞƐŝĚĞŶƚ WŽƐƚĞƌ ŽŶƚĞƐƚ ǁŝŶŶĞƌƐ͘

“

I wondered in reading the comments from past attendees how a conference could leave you energized, but the sense of community was palpable. Thank you.

“

The Keynotes

– 2017 Forum Attendee

tĞ ĂƌĞ ǀĞƌǇ ĞǆĐŝƚĞĚ ƚŚŝƐ ǇĞĂƌ ƚŽ ŽīĞƌ ƚǁŽ ŬĞǇŶŽƚĞ ƐĞƐƐŝŽŶƐ Ăƚ ƚŚĞ &ŽƌƵŵ͘ ƌ͘ WĂƵů 'ƌƵŶĚǇ͕ ŬŶŽǁŶ ĂƐ ƚŚĞ ŐŽĚĨĂƚŚĞƌ ŽĨ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ĂŶĚ ƚŚĞ ƐƵďũĞĐƚ ŽĨ Ă ŶĞǁ ďŽŽŬ͕ Trusted Healer͕ ǁŝůů ŬŝĐŬ Žī ƚŚĞ ĐŽŶĨĞƌĞŶĐĞ ŽŶ &ƌŝĚĂǇ ĂŌĞƌŶŽŽŶ͘ r ,Ğ ǁŝůů ƐŚĂƌĞ ŚŽǁ ƚŚĞ ĐŽŶĐĞƉƚ ŽĨ ͞dƌƵƐƚĞĚ ,ĞĂůĞƌ͟ ďƌŝŶŐƐ together leadership, an understanding of societal change and culture and a hopeful vision of the future. T.R. Reid, bestselling author of the book, The Healing of America: 'ůŽďĂů YƵĞƐƚ ĨŽƌ ĞƩĞƌ͕ ŚĞĂƉĞƌ ĂŶĚ &ĂŝƌĞƌ ,ĞĂůƚŚ ĂƌĞ, ŬŝĐŬƐ Žī ^ĂƚƵƌĚĂǇ ŵŽƌŶŝŶŐ͛Ɛ ƐĞƐƐŝŽŶƐ ďǇ ĚĞƐĐƌŝďŝŶŐ ƚŚĞ ƐƚĂƚĞ ŽĨ ŚĞĂůƚŚĐĂƌĞ ŝŶ ŵĞƌŝĐĂ ĂŶĚ ĂƌŽƵŶĚ ƚŚĞ ǁŽƌůĚ͘ ,Ğ ǁŝůů ŚŝŐŚůŝŐŚƚ ƚŚĞ ďĞŶĞĮƚƐ ŽĨ Ă ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ ƚŚĂƚ ĐŽǀĞƌƐ ĞǀĞƌǇďŽĚǇ͘ So don’t miss out . . . Check out the complete conference schedule, “Top Ten Lists” ;ĨĂŵŝůǇ ĂĐƟǀŝƟĞƐ͕ ƌĞƐƚĂƵƌĂŶƚƐ͕ ĐŽīĞĞŚŽƵƐĞƐ͕ ĞƚĐ͘Ϳ ĨŽƌ >ŽŶŐ ĞĂĐŚ ĂŶĚ ƌĞŐŝƐƚĞƌ ƚŽĚĂǇ Ăƚ ǁǁǁ͘ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͬ&D&ŽƌƵŵ͘ ^ĞĞ ǇŽƵ DĂǇ ϭϱͲϭϳ Ăƚ ƚŚĞ >ŽŶŐ ĞĂĐŚ ,ŝůƚŽŶ͊ η&D&ŽƌƵŵϮϬ California Family Physician Winter 2020

California Family Physician Winter 2020

2020 CAFP Family Medicine Clinical Forum â&#x20AC;&#x201C; Learn | Connect | Celebrate Long Beach Hilton, May 15-17, 2020 All Plenary CME Sessions to be held in International Ballroom

conitnued on next page >

California Family Physician Winter 2020

ф ĐŽŶƟŶƵĞĚ ĨƌŽŵ ƉƌĞǀŝŽƵƐ ƉĂŐĞ

California Family Physician Winter 2020

California Family Physician Summer 2019

California Family Physician Winter 2020

Adam Francis CAFP Director of Government Relations

H e r e ’s W h a t ’s N e w i n 2 0 2 0

Get Ready for 2020: Changes are in Store ZĞŐĂƌĚůĞƐƐ ŽĨ ŽƵƌ ƐƵƉƉŽƌƚ Žƌ ŽƉƉŽƐĞ ƉŽƐŝƟŽŶƐ ŽŶ ďŝůůƐ͕ ĞǀĞƌǇ :ĂŶƵĂƌǇ ďƌŝŶŐƐ Ă ŶĞǁ ƐůŽƵŐŚ ŽĨ ƌĞƋƵŝƌĞŵĞŶƚƐ ĂŶĚ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ůĂǁ ĂīĞĐƟŶŐ ǇŽƵ͕ ǇŽƵƌ ƉƌĂĐƟĐĞ͕ ĂŶĚ ǇŽƵƌ ƉĂƟĞŶƚƐ͘ dŚŝƐ ŵŽŶƚŚ ŶŽ ĞǆĐĞƉƟŽŶ͘ ĞůŽǁ ĂƌĞ ŶĞǁ ůĂǁƐ ƚŚĂƚ ŵĂǇ ĐŚĂŶŐĞ ƚŚĞ ǁĂǇ ǇŽƵ ƉƌĂĐƟĐĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ŝŶ ƚŚĞ ŶĞǁ ǇĞĂƌ͘ hZ ^ ZĞĨŽƌŵĂƟŽŶ͗ ϱϮϴ ;>ŽǁͿ ƌĞĨŽƌŵƐ ĂŶĚ ŝŵƉƌŽǀĞƐ ƚŚĞ ŽƉĞƌĂƟŽŶ ŽĨ ƚŚĞ ŽŶƚƌŽůůĞĚ hƟůŝǌĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^ǇƐƚĞŵ ; hZ ^Ϳ ĚĂƚĂďĂƐĞ ŝŶ ƚŚƌĞĞ ǁĂǇƐ͗ • ZĞĂůͲdŝŵĞ ĂƚĂ͗ WŚĂƌŵĂĐǇ ƌĞƉŽƌƚ ƟŵĞůŝŶĞƐ ĂƌĞ ƐŚŽƌƚĞŶĞĚ ĨƌŽŵ ƐĞǀĞŶ ĚĂǇƐ ƚŽ ƚŚĞ ĨŽůůŽǁŝŶŐ ǁŽƌŬŝŶŐ ĚĂǇ͕ ƌĞĚƵĐŝŶŐ ƚŚĞ ĂďŝůŝƚǇ ĨŽƌ ƉĂƟĞŶƚƐ ƚŽ ͞ĚŽĐƚŽƌ ƐŚŽƉ͟ ĂŶĚ ŐŝǀŝŶŐ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ŶĞĂƌͲƌĞĂůͲƟŵĞ ĚĂƚĂ͘ • ǆƉĂŶĚĞĚ ĂƚĂďĂƐĞ͗ WŚĂƌŵĂĐŝĞƐ ĂƌĞ ŶŽǁ ƌĞƋƵŝƌĞĚ ƚŽ ƌĞƉŽƌƚ Schedule V drugs to the database, helping to regulate some commonly misused drugs, such as cough syrups. As many ĂƐ ƚŚƌĞĞ ŵŝůůŝŽŶ ĂĚŽůĞƐĐĞŶƚƐ ĂŶĚ ǇŽƵŶŐ ĂĚƵůƚƐ ďĞƚǁĞĞŶ ƚŚĞ ĂŐĞƐ ŽĨ ϭϮ ĂŶĚ Ϯϱ ĂďƵƐĞ ĐŽƵŐŚ Žƌ ĐŽůĚ ŵĞĚŝĐŝŶĞƐ͘ • ZĞĚƵĐĞĚ ĚŵŝŶŝƐƚƌĂƟǀĞ ƵƌĚĞŶ͗ >ŝĐĞŶƐĞĚ ĚĞůĞŐĂƚĞƐ͕ ŝŶƐƚĞĂĚ ŽĨ ũƵƐƚ ƉŚǇƐŝĐŝĂŶƐ͕ ĐĂŶ ŶŽǁ ŵĂŬĞ ƉĂƟĞŶƚ ĂĐƟǀŝƚǇ ƌĞƉŽƌƚ ƌĞƋƵĞƐƚƐ ǀŝĂ hZ ^͘ dŚŝƐ ŵĞĂŶƐ ƚŚĞ ĞŶƟƌĞ ŚĞĂůƚŚ ĐĂƌĞ ƚĞĂŵ ĐĂŶ ƚŽ ďĞ ŝŶǀŽůǀĞĚ ŝŶ ŝŵƉƌŽǀŝŶŐ ƉĂƟĞŶƚ ĐĂƌĞ͕ ǁŚŝůĞ ĂůƐŽ ƌĞĚƵĐŝŶŐ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ ŽŶ ƉŚǇƐŝĐŝĂŶƐ͘ ĞůĂǇ ŽŶ WƌĞƐĐƌŝƉƟŽŶ WĂĚ ZĞƉůĂĐĞŵĞŶƚƐ͗ ŌĞƌ ƐŝŐŶŝĮĐĂŶƚ pushback by the physician community, including family physicians ǁŚŽ ŽƌŐĂŶŝǌĞĚ ĂĐƟŽŶ ƵƐŝŶŐ &W͛Ɛ ŵĞŵďĞƌƐͲŽŶůǇ ŵĞƐƐĂŐĞ ďŽĂƌĚ ;^W Z<Ϳ͕ ϭϰϵ ; ŽŽƉĞƌͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ƚŽ ĚĞůĂǇ Ă ƌĞƋƵŝƌĞŵĞŶƚ ƚŚĂƚ ƉŚǇƐŝĐŝĂŶƐ ƌĞƉůĂĐĞ ƚŚĞŝƌ ƉƌĞƐĐƌŝƉƟŽŶ ƉĂĚƐ ǁŝƚŚ ŶĞǁ ĨŽƌŵƐ ǁŝƚŚ Ă ƵŶŝƋƵĞůǇ ƐĞƌŝĂůŝǌĞĚ ŶƵŵďĞƌ ďǇ :ĂŶƵĂƌǇ ϭ ϮϬϭϵ͘ dŚĂƚ ůĂǁ ĐŚĂŶŐĞ ĚŝĚ ŶŽƚ ŝŶĐůƵĚĞ Ă ƚƌĂŶƐŝƟŽŶ ƉĞƌŝŽĚ͘ Ɛ Ă ƌĞƐƵůƚ͕ ƉƌĞƐĐƌŝďĞƌƐ ĚŝĚ ŶŽƚ ŚĂǀĞ ƟŵĞ ƚŽ ŽƌĚĞƌ ŶĞǁ ƉƌĞƐĐƌŝƉƟŽŶ ƉĂĚƐ ďǇ ƚŚĞ :ĂŶƵĂƌǇ ϭ͕ ϮϬϭϵ ĚĞĂĚůŝŶĞ ƌĞƐƵůƟŶŐ ŝŶ ĚŝĸĐƵůƟĞƐ ĨŽƌ ƉĂƟĞŶƚƐ ƚƌǇŝŶŐ ƚŽ ŐĞƚ ƉƌĞƐĐƌŝƉƟŽŶƐ ĮůůĞĚ ĨŽƌ ĐŽŶƚƌŽůůĞĚ ƐƵďƐƚĂŶĐĞƐ͘ ϭϰϵ ĂůůŽǁƐ ĨŽƌ Ă ƚƌĂŶƐŝƟŽŶ ƉĞƌŝŽĚ͕ ƵŶƟů :ĂŶƵĂƌǇ ϭ͕ ϮϬϮϭ͕ ŵĂŬŝŶŐ ĐƵƌƌĞŶƚ ƉĂĚƐ ǀĂůŝĚ ƵŶƟů ƚŚĂƚ ƟŵĞ͘ EĂůŽǆŽŶĞ ZĞƋƵŝƌĞŵĞŶƚƐ ůĂƌŝĮĞĚ͗ ϳϭϰ ;tŽŽĚͿ ĐůĂƌŝĮĞƐ ǁŚĞŶ ŽīĞƌŝŶŐ ŶĂůŽǆŽŶĞ ŝƐ ƌĞƋƵŝƌĞĚ ŽĨ ƉƌĞƐĐƌŝďĞƌƐ͘ dŚĞ ďŝůů ǁĂƐ ĂƵƚŚŽƌĞĚ in response to concerns raised by CAFP and others regarding ƉƌŽǀŝƐŝŽŶƐ ĐŽŶƚĂŝŶĞĚ ŝŶ ϮϳϲϬ ;ƐŝŐŶĞĚ ďǇ 'ŽǀĞƌŶŽƌ ƌŽǁŶ ŝŶ ϮϬϭϴ͕ ƌĞƋƵŝƌŝŶŐ ƉƌĞƐĐƌŝďĞƌƐ ƚŽ ŽīĞƌ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ŶĂůŽǆŽŶĞ Žƌ ŝƚƐ ĞƋƵŝǀĂůĞŶƚ ǁŚĞŶ ĐĞƌƚĂŝŶ ĐŽŶĚŝƟŽŶƐ ĂƌĞ ƉƌĞƐĞŶƚ͕ ĂŶĚ ƉƌŽǀŝĚĞ 22

California Family Physician Winter 2020

ĞĚƵĐĂƟŽŶ ƚŽ ƚŚĞ ƉĂƟĞŶƚ ǁŝƚŚ ĞǀĞƌǇ ƉƌĞƐĐƌŝƉƟŽŶ͕ ĞǀĞŶ ƌĞŶĞǁĂůƐ͘Ϳ ϳϭϰ ĐůĂƌŝĮĞƐ ǁŚĞŶ Ă ƉƌĞƐĐƌŝďĞƌ ǁŚŽ ŝƐ ƉƌĞƐĐƌŝďŝŶŐ ĂŶ ŽƉŝŽŝĚ Žƌ ďĞŶǌŽĚŝĂǌĞƉŝŶĞ ŵĞĚŝĐĂƟŽŶ ŵƵƐƚ ŽīĞƌ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ EĂůŽǆŽŶĞ ;Žƌ ĂŶŽƚŚĞƌ ĚƌƵŐ ĂƉƉƌŽǀĞĚ ďǇ ƚŚĞ & ĨŽƌ ƚŚĞ ĐŽŵƉůĞƚĞ Žƌ ƉĂƌƟĂů ƌĞǀĞƌƐĂů ŽĨ ŽƉŝŽŝĚͲŝŶĚƵĐĞĚ ƌĞƐƉŝƌĂƚŽƌǇ ĚĞƉƌĞƐƐŝŽŶͿ͘ dŚĞ ŶĞǁ ůĂǁ ƐƟƉƵůĂƚĞƐ ƚŚĂƚ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚŽƐĂŐĞ ŽĨ ϵϬ Žƌ ŵŽƌĞ ŵŽƌƉŚŝŶĞ ŵŝůůŝŐƌĂŵ ĞƋƵŝǀĂůĞŶƚƐ ƉĞƌ ĚĂǇ͕ ŽƉŝŽŝĚ ŵĞĚŝĐĂƟŽŶ ŝƐ ƉƌĞƐĐƌŝďĞĚ ǁŝƚŚŝŶ Ă ǇĞĂƌ ĨƌŽŵ ƚŚĞ ĚĂƚĞ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ďĞŶǌŽĚŝĂǌĞƉŝŶĞ ŚĂƐ ďĞĞŶ ĚŝƐƉĞŶƐĞĚ ƚŽ ƚŚĞ ƉĂƟĞŶƚ͕ ĂŶĚͬŽƌ ƚŚĞ ƉĂƟĞŶƚ ƉƌĞƐĞŶƚƐ ǁŝƚŚ an increased risk for opioid overdose require an accompanying EĂůŽǆŽŶĞ ƉƌĞƐĐƌŝƉƟŽŶ͘ dŚĞ ŶĞǁ ůĂǁ ĂůƐŽ ĞǆĞŵƉƚƐ ƚŚĞ ĐŽŶĐƵƌƌĞŶƚ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ƌĞƋƵŝƌĞŵĞŶƚ ŝĨ ƚŚĞ ƉĂƟĞŶƚ ƌĞĐĞŝǀŝŶŐ ƚŚĞ ƉƌĞƐĐƌŝƉƟŽŶ ĚĞĐůŝŶĞƐ ƚŚĞ ĞĚƵĐĂƟŽŶ Žƌ ŚĂƐ ƌĞĐĞŝǀĞĚ ƚŚĞ ĞĚƵĐĂƟŽŶ ǁŝƚŚŝŶ ƚŚĞ ƉĂƐƚ Ϯϰ ŵŽŶƚŚƐ͘ ĚĚŝƟŽŶĂůůǇ͕ ƚŚĞ ďŝůů ĞǆĞŵƉƚƐ ŽīĞƌŝŶŐ ŶĂůŽǆŽŶĞ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ĞĚƵĐĂƟŽŶ ǁŚĞŶ ƚŚĞ ŵĞĚŝĐĂƟŽŶ ŝƐ ƚŽ ďĞ ĂĚŵŝŶŝƐƚĞƌĞĚ ƚŽ Ă ƉĂƟĞŶƚ ǁŚŝůĞ ƚŚĞ ƉĂƟĞŶƚ ŝƐ ŝŶ ĞŝƚŚĞƌ ĂŶ ŝŶƉĂƟĞŶƚ Žƌ ŽƵƚƉĂƟĞŶƚ ƐĞƫŶŐ͕ Žƌ ŝƐ ĨŽƌ Ă ƚĞƌŵŝŶĂůůǇ ŝůů ƉĂƟĞŶƚ͘ EŽ /ŶĚĞƉĞŶĚĞŶƚ WƌĂĐƟĐĞ ĨŽƌ W Ɛ͗ dŚŝƐ ďŝůů ŽƌŝŐŝŶĂůůǇ ǁŽƵůĚ ŚĂǀĞ ĂůůŽǁĞĚ ĨŽƌ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ WŚǇƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚƐ ;W ƐͿ͘ &W ĂŶĚ ŽƚŚĞƌƐ ŝŶ ŽƉƉŽƐŝƟŽŶ ǁŽƌŬĞĚ ǁŝƚŚ ƚŚĞ ĂƵƚŚŽƌ ĂŶĚ ƐƉŽŶƐŽƌƐ ŽĨ ƚŚĞ ^ ϲϵϳ (Caballero) ƚŽ ĂŵĞŶĚ ŝƚ ƚŽ ĂůůŽǁ W Ɛ ƚŽ ŚĂǀĞ ĞƋƵŝǀĂůĞŶĐǇ ǁŝƚŚ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ ǁŚĞŶ ŝƚ ĐŽŵĞƐ ƚŽ ƐƵƉĞƌǀŝƐŝŽŶ ǁŝƚŚŽƵƚ ĐŚĂŶŐŝŶŐ ƚŚĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ŽĨ W Ɛ͘ dŚĞ ŶĞǁ ůĂǁ ĚŽĞƐ ƚŚŝƐ ďǇ͗ • Removing the requirement that the supervising physician be ƉŚǇƐŝĐĂůůǇ ƉƌĞƐĞŶƚ ĂŶĚ ŝŶƐƚĞĂĚ ĂůůŽǁƐ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ƚŽ ĚĞĐŝĚĞ ǁŚĞƚŚĞƌ ƚŚĂƚ ŝƐ ŶĞĐĞƐƐĂƌǇ Žƌ ǁŚĞƚŚĞƌ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ďĞŝŶŐ ĂǀĂŝůĂďůĞ ďǇ ƚĞůĞƉŚŽŶĞ Žƌ ŽƚŚĞƌ ĞůĞĐƚƌŽŶŝĐ ĐŽŵŵƵŶŝĐĂƟŽŶ ŵĞƚŚŽĚ ŝƐ ƐƵĸĐŝĞŶƚ Ăƚ ƚŚĞ ƟŵĞ ƚŚĞ W ĞǆĂŵŝŶĞƐ ƚŚĞ ƉĂƟĞŶƚ͘ /ƚ ĂůƐŽ ƐƉĞĐŝĮĞƐ ƚŚĂƚ ƚŚĞ WŚǇƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚ ŽĂƌĚ ;W Ϳ ĐĂŶ require the physical presence of a physician as a term or ĐŽŶĚŝƟŽŶ ŽĨ Ă W ͛Ɛ ƌĞŝŶƐƚĂƚĞŵĞŶƚ͕ ƉƌŽďĂƟŽŶ͕ Žƌ ŝŵƉŽƐŝŶŐ discipline. • ůůŽǁŝŶŐ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ƚŽ ďĞ ũŽŝŶĞĚ ďĞƚǁĞĞŶ the PA and one or more physicians, detailing the medical ƐĞƌǀŝĐĞƐ ƚŚĞ W ŝƐ ĂƵƚŚŽƌŝǌĞĚ ƚŽ ƉĞƌĨŽƌŵ ŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ health system. • /ŶƐƚĞĂĚ ŽĨ ƌĞƋƵŝƌŝŶŐ Ă ŵŝŶŝŵƵŵ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ĐŚĂƌƚ ƌĞǀŝĞǁƐ ĂŶĚ ĐŽƵŶƚĞƌƐŝŐŶĂƚƵƌĞƐ͕ ŝƚ ĂůůŽǁƐ ƚŚĞ ƐƵƉĞƌǀŝƐŝŶŐ ƉŚǇƐŝĐŝĂŶ ƚŽ ĚĞƚĞƌŵŝŶĞ ŚŽǁ ŵƵĐŚ ƐŚŽƵůĚ ĞǆŝƐƚ͕ ŝĨ ĂŶǇ͕ ĚĞƉĞŶĚŝŶŐ ŽŶ the skills of the PA (though, again, the PAB could require it as ĚŝƐĐŝƉůŝŶĂƌǇ ĂĐƟŽŶͿ͘

•

ZĞƋƵŝƌŝŶŐ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ;ƐĞĞ ƐŝĚĞďĂƌ ďĞůŽǁͿ ƚŽ ƐƉĞĐŝĨǇ ǁŚŝĐŚ PAs may furnish or order a drug or ĚĞǀŝĐĞ͕ ǁŚŝĐŚ ĚƌƵŐƐ Žƌ ĚĞǀŝĐĞƐ ŵĂǇ ďĞ ĨƵƌŶŝƐŚĞĚ Žƌ ŽƌĚĞƌĞĚ͕ ƵŶĚĞƌ ǁŚĂƚ circumstances, the extent of physician supervision, the method of periodic ƌĞǀŝĞǁ ŽĨ ƚŚĞ W ͛Ɛ ĐŽŵƉĞƚĞŶĐĞ͕ ŝŶĐůƵĚŝŶŐ ƉĞĞƌ ƌĞǀŝĞǁ͕ ĂŶĚ ƌĞǀŝĞǁ ŽĨ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ͘ dŚĞ ƉƌĂĐƟĐĞ agreement must address the diagnosis ŽĨ ƚŚĞ ŝůůŶĞƐƐ͕ ŝŶũƵƌǇ͕ Žƌ ĐŽŶĚŝƟŽŶ ĨŽƌ ǁŚŝĐŚ ƚŚĞ W ŵĂǇ ĨƵƌŶŝƐŚ ƚŚĞ Schedule II controlled substance. The W ŵƵƐƚ ƐĂƟƐĨĂĐƚŽƌŝůǇ ĐŽŵƉůĞƚĞ Žƌ ŚĂǀĞ completed a course in pharmacology covering the drugs or devices to be ĨƵƌŶŝƐŚĞĚ Žƌ ŽƌĚĞƌĞĚ͘ dŚŝƐ ůĂǁ ƐƉĞĐŝĮĞƐ that the signature of a PA on a drug order issued pursuant to the Act is deemed to be the signature of a prescriber for purposes of the BPC and the Health and Safety Code.

WŚǇƐŝĐŝĂŶͲWŚǇƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚ WƌĂĐƟĐĞ ŐƌĞĞŵĞŶƚ ^ƵŵŵĂƌǇ dŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ƐƟƉƵůĂƚĞƐ͗ • The types of medical services a PA is ĂƵƚŚŽƌŝǌĞĚ ƚŽ ƉĞƌĨŽƌŵ͘ • Policies and procedures to ensure adequate supervision of the PA, including, but not limited to, ĂƉƉƌŽƉƌŝĂƚĞ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ ĂǀĂŝůĂďŝůŝƚǇ͕ ĐŽŶƐƵůƚĂƟŽŶƐ͕ ĂŶĚ ƌĞĨĞƌƌĂůƐ ďĞƚǁĞĞŶ Ă ƉŚǇƐŝĐŝĂŶ ĂŶĚ the PA in the provision of medical services. • dŚĞ ŵĞƚŚŽĚƐ ĨŽƌ ƚŚĞ ĐŽŶƟŶƵŝŶŐ ĞǀĂůƵĂƟŽŶ ŽĨ ƚŚĞ ĐŽŵƉĞƚĞŶĐǇ ĂŶĚ ƋƵĂůŝĮĐĂƟŽŶƐ ŽĨ ƚŚĞ W ͘ • The furnishing or ordering of drugs or devices by a PA. • ŶǇ ĂĚĚŝƟŽŶĂů ƉƌŽǀŝƐŝŽŶƐ ĂŐƌĞĞĚ ƚŽ by the PA and physician. &Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͕ Žƌ ƚŽ ŐĞƚ ŝŶǀŽůǀĞĚ ǁŝƚŚ ůĞŐŝƐůĂƟŽŶ &KZ ŝƚ ďĞĐŽŵĞƐ ůĂǁ͕ ƉůĞĂƐĞ ƐŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞǇ ŽŶƚĂĐƚ Žƌ ĞŵĂŝů ŵĞ͕ Ăƚ afrancis@familydocs.org. California Family Physician Winter 2020

H e r e ’s W h a t ’s N e w i n 2 0 2 0

Marianne McKennett, MD President, CAFP Foundation

CAFP Foundation … Investing in the Future of Family Medicine /ƚ ŝƐ Ă ũŽǇ ƚŽ ƐŚĂƌĞ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ϮϬϭϵ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ͘ /Ŷ ŬĞĞƉŝŶŐ ǁŝƚŚ ŽƵƌ ŵŝƐƐŝŽŶ ƚŽ ƐƵƉƉŽƌƚ ĐŽŵƉĂƐƐŝŽŶĂƚĞ ĂŶĚ comprehensive primary health care for the people of California, ǁĞ ŚĂǀĞ ƵƐĞĚ ǇŽƵƌ ĐŽŶƚƌŝďƵƟŽŶƐ ƚŽ ďƌŝŶŐ ĚǇŶĂŵŝĐ ƉƌŽŐƌĂŵƐ ƚŽ ůŝĨĞ͘ /ŶŝƟĂƟǀĞƐ ƚŽ ƉƌŽǀŝĚĞ ŵĞŶƚŽƌƐŚŝƉ ĂŶĚ ĞĚƵĐĂƟŽŶ ƚĂƌŐĞƚ ůŝĨĞůŽŶŐ ůĞĂƌŶĞƌƐ͕ ĨƌŽŵ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ǁŝƚŚ Ă ĚƌĞĂŵ ŽĨ ďĞĐŽŵŝŶŐ Ă doctor toseasoned family physicians. &W &ŽƵŶĚĂƟŽŶ ƌĞƉƌĞƐĞŶƚƐ ŵŽƌĞ ƚŚĂŶ ϯ͕ϬϬϬ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌƐ ĂŶĚ ƐĞƌǀĞƐ ĂƐ Ă ƌĞƐŽƵƌĐĞ ŚƵď ĨŽƌ ϭϯ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂŶĚ ϲϱ family medicine residency programs. We are excited to highlight our ϮϬϭϵ ŝŶŝƟĂƟǀĞƐ ƚŚĂƚ ŚĂǀĞ ƐƵƉƉŽƌƚĞĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ in their journey to become family physician leaders.

/ Ăŵ ƉƌŽƵĚ ŽĨ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ǁŽƌŬ ƐƵƉƉŽƌƟŶŐ ŽƉƉŽƌƚƵŶŝƟĞƐ for medical students and residents as they develop leadership and ĂĚǀŽĐĂĐǇ ƐŬŝůůƐ ŝŶĐůƵĚŝŶŐ ŽƵƌ ZĞĂĚǇ ƚŽ >ĞĂĚ ƉƌŽŐƌĂŵ ƚĂƌŐĞƟŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƉƌĂĐƟĐŝŶŐ ŝŶ ůĂƌŐĞ ŵĞĚŝĐĂů ƐǇƐƚĞŵƐ͖ ƚŚĞ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ,ĞĂůƚŚ WŽůŝĐǇ &ĞůůŽǁƐŚŝƉ ƉƌŽǀŝĚŝŶŐ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ǁŝƚŚ ĂĚǀĂŶĐĞĚ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐǇ ĂŶĚ ŵĞŶƚŽƌƐŚŝƉ ĞǆƉĞƌŝĞŶĐĞƐ͖ ĂŶĚ ƚŚĞ &W WƌŝŵĂƌǇ ĂƌĞ ZĞƐŝĚĞŶĐǇ ŽůůĂďŽƌĂƟǀĞ ƉƌĞƉĂƌŝŶŐ ƌĞƐŝĚĞŶƚ physicians to address the opioid crisis. Ɛ ǁĞ ĨĂĐĞ Ă ĐƌŝƐŝƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ĂĐĐĞƐƐ͕ ŝƚ ŝƐ ƐŽ ŝŵƉŽƌƚĂŶƚ ƚŽ ĚĞǀĞůŽƉ our future health care leaders. Thank you for your support of the &W &ŽƵŶĚĂƟŽŶ ĂŶĚ ŽƵƌ ŵƵƚƵĂů ŐŽĂů ŽĨ ƉƌŽǀŝĚŝŶŐ ĂĐĐĞƐƐ ƚŽ ƋƵĂůŝƚǇ health care for all people of California.

Our Mission: dŚƌŽƵŐŚ ƉŚŝůĂŶƚŚƌŽƉǇ͕ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵǇ ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ &ŽƵŶĚĂƟŽŶ ŶƵƌƚƵƌĞƐ ĞĂĐŚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ĐĞůĞďƌĂƚĞ ƚŚĞ ũŽǇ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚǇ͘

California Family Physician Winter 2020

The Work of the Foundation Scholarships Investing in family medicine’s future means providing opportunities for students and residents to attend seminal family medicine events including the CAFP All Members Advocacy Meeting and the AAFP National Conference. Funding Building a strong primary care ǁŽƌŬĨŽƌĐĞ ŝƐ ƉŽƐƐŝďůĞ ǁŚĞŶ ǁĞ support leaders dedicated to transforming their communities through mentorship programs ĂŶĚ ŽƌŐĂŶŝǌĞĚ ŶĞƚǁŽƌŬƐ͕ ŝŶĐůƵĚŝŶŐ Future Faces of Family Medicine, Emerging Health Advocates and Family Medicine Interest Groups. ^ĐŚŽůĂƌůǇ ĐƚŝǀŝƚǇ ŵƉŽǁĞƌŝŶŐ students and residents to conduct and present clinical and educational ƌĞƐĞĂƌĐŚ ĂůůŽǁƐ ƚŚĞŵ ƚŽ ŵĞĞƚ critical academic requirements through the Student Research Grant Program and the Resident Poster Contest. Education Training the next generation of healthcare leaders ensures a ĐĂƉĂďůĞ ĂŶĚ ĚŝǀĞƌƐĞ ǁŽƌŬĨŽƌĐĞ ĂŶĚ is accomplished through activities including Procedures Workshops, the Family Medicine Summit and the Primary Care Residency Collaborative. WůĞĂƐĞ ĐŚĞĐŬ ǁǁǁ͘ĐĂĨƉĨŽƵŶĚĂƚŝŽŶ͘ ŽƌŐ ƚŽ ƌĞĂĚ ŽƵƌ ϮϬϭϵ ŶŶƵĂů ZĞƉŽƌƚ ĂŶĚ ŵĂŬĞ ǇŽƵƌ ϮϬϮϬ ŝŶǀĞƐƚŵĞŶƚ in family medicine by contributing to the CAFP-F today, https:// familydocs.secure.force.com/ foundation/.

California Family Physician Winter 2020

H e r e ’s W h a t ’s N e w i n 2 0 2 0

Conrad Amenta CAFP Director of Policy and Strategic Initiatives

Your Values, Beliefs, and Priorities Are our Foundation: New CAFP Policies and Principles

&W WƌŝŶĐŝƉůĞƐ ŽŶ ƚŚĞ /ŶĚĞƉĞŶĚĞŶƚ WƌĂĐƚŝĐĞ ŽĨ DĞĚŝĐŝŶĞ ďǇ Nurse Practitioners /Ŷ ϮϬϭϵ͕ ƐƐĞŵďůǇ ŝůů ϴϵϬ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ͘ dŚĞ ďŝůů ;ǁŚŝĐŚ is currently held in committee and may be re-introduced ŝŶ ϮϬϮϬͿ ǁŽƵůĚ ĞǆƉĂŶĚ ƚŚĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ƚŽ ĂůůŽǁ ƚŚĞŵ ƚŽ ƉƌĂĐƚŝĐĞ ŵĞĚŝĐŝŶĞ ǁŝƚŚŽƵƚ physician supervision. Existing AAFP and CAFP policy is clear in its opposition to this outcome, but does not expand upon that opposition to clarify issues related to educational standards, regulation and oversight, liability, California’s bar on the corporate practice of medicine, or accountability to provide primary care to underserved populations. /Ŷ ƌĞƐƉŽŶƐĞ ƚŽ ϴϵϬ͕ Ă ŵĞŵďĞƌ ƐƵďŵŝƚƚĞĚ Ă ƌĞƐŽůƵƚŝŽŶ to the CAFP Board asking that CAFP policy be assessed and expanded as required. The CAFP Board heard testimony from ŵĞŵďĞƌƐ ĚƵƌŝŶŐ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƚŝŶŐ ; D DͿ ŝŶ ^ĂĐƌĂŵĞŶƚŽ ŝŶ DĂƌĐŚ ϮϬϭϵ͕ ŝŶ ŽƉƉŽƐŝƚŝŽŶ ĂŶĚ ƐƵƉƉŽƌƚ ŽĨ the resolution. In response to the resolution and testimony, ƚŚĞ &W ŽĂƌĚ ĞƐƚĂďůŝƐŚĞĚ Ă ƚŝŵĞͲůŝŵŝƚĞĚ ǁŽƌŬŝŶŐ ŐƌŽƵƉ of members representing policy expertise and a diversity of practice environments and care models to make a ƌĞĐŽŵŵĞŶĚĂƚŝŽŶ ƚŽ ƚŚĞ ŽĂƌĚ͘ dŚĞ ŽƵƚĐŽŵĞ ŽĨ ƚŚĞ ǁŽƌŬŝŶŐ ŐƌŽƵƉ͛Ɛ ĚŝƐĐƵƐƐŝŽŶ ǁĂƐ CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners. <ĞǇ ƚŽ ƚŚŝƐ ƉŽůŝĐǇ ĂƌĞ ƚŚĞ ĨŽůůŽǁŝŶŐ͗ CAFP considers ordering and interpreting diagnostic procedures, certifying disability, and prescribing, dispensing, and administering controlled substances 26

California Family Physician Winter 2020

to be the practice of medicine. CAFP believes that it is of utmost importance that consistency of standards and regulations be maintained in the regulation of the practice of medicine in California. CAFP’s position on any proposed legislation and/or regulation that seeks to expand the ability of NPs to practice medicine independently of physician supervision ǁŝůů ďĞ ŐƵŝĚĞĚ ďǇ ĐŽƌĞ ƉƌŝŶĐŝƉůĞƐ ƌĞůĂƚĞĚ ƚŽ ĞƐƚĂďůŝƐŚŝŶŐ ĐŽŶƐŝƐƚĞŶĐǇ ŽĨ ƐƚĂŶĚĂƌĚƐ ĂŶĚ ƌĞŐƵůĂƚŝŽŶ͕ ĂƐ ǁĞůů ĂƐ the ability of the proposal to address the problems it purports to resolve, including but not limited to: access to primary care, cost of care, quality of care, and the ŽǀĞƌĂůů ƐƵƐƚĂŝŶĂďŝůŝƚǇ ŽĨ ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͘

“

By developing and adopting this new set of principles, CAFP now has guidance directs its involvement in both state and federal policy that has the potential to aﬀect the health and wellbeing of transgender and genderexpansive patients.

“

CAFP policies and principles articulate the positions, values, beliefs and priorities of CAFP members. Every year, the &W ŽĂƌĚ ĂĚŽƉƚƐ ŶĞǁ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ƚŽ ĂĚĚƌĞƐƐ emerging issues affecting family physicians and their patients. These documents guide CAFP staff and the Board in the positions it takes on proposed legislation and regulation ĂŶĚ ƚŚĞ ƐƉĞĐŝĨŝĐ ǁŽƌŬ ǁĞ ƵŶĚĞƌƚĂŬĞ͘ &W ĂĚŽƉƚĞĚ Ă ŶƵŵďĞƌ ŽĨ ŶĞǁ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ŝŶ ϮϬϭϵ͖ ǁĞ͛Ě ůŝŬĞ ƚŽ ŚŝŐŚůŝŐŚƚ ƚǁŽ ŐƌŽƵŶĚďƌĞĂŬŝŶŐ ŽŶĞƐ͘

dŚĞ ƉŽůŝĐǇ ŐŽĞƐ ŽŶ ƚŽ ĂƌƚŝĐƵůĂƚĞ ϭϭ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ĂŶǇ legislative proposal must demonstrate it establishes or ĂĐĐŽƵŶƚƐ ĨŽƌ ďĞĨŽƌĞ &W ĐĂŶ ŵĞĂŶŝŶŐĨƵůůǇ ĞŶŐĂŐĞ ǁŝƚŚ ƚŚĞ ƉƌŽƉŽƐĂů͘ &W ƉŽůŝĐǇ ŶŽǁ ĂĚĚƌĞƐƐĞƐ ŵŽƌĞ ĨƵůůǇ ƚŚĞ concerns of family physicians, as it takes into account, for example: compensation for education, training and

practice supervision of NPs by family physicians; obtaining and maintaining sufficient liability insurance; and a uniform, consistent education program to attain independent practice ĨŽůůŽǁŝŶŐ EW ĐĞƌƚŝĨŝĐĂƚŝŽŶ͕ ƐƵĐŚ ĂƐ Žƌ ĞƋƵŝǀĂůĞŶƚ ƚŽ ĐŽŵƉůĞƚŝŽŶ ŽĨ ƚƌĂŝŶŝŶŐ ǁŝƚŚŝŶ ĂŶ ĂĐĐƌĞĚŝƚĞĚ ƌĞƐŝĚĞŶĐǇ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵ and appropriate testing for the practice of medicine. Principles for the Protection of Care for Transgender and 'ĞŶĚĞƌͲ ǆƉĂŶƐŝǀĞ WĂƚŝĞŶƚƐ CAFP has a long record of standing up for universal coverage and access to vital care. Transgender and gender-expansive ƉĂƚŝĞŶƚƐ ŚĂǀĞ ĐŽŵĞ ƵŶĚĞƌ ŝŶĐƌĞĂƐŝŶŐ ĂƚƚĂĐŬ͕ ŚŽǁĞǀĞƌ͕ ĂƐ federal policy and regulations take aim at their rights as ƉĂƚŝĞŶƚƐ ĂŶĚ ƉƌŽƚĞĐƚŝŽŶƐ ĂŐĂŝŶƐƚ ĚŝƐĐƌŝŵŝŶĂƚŝŽŶ͘ /Ŷ ϮϬϭϵ͕ &W͛Ɛ ŽŵŵŝƚƚĞĞ ŽŶ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KWͿ ƉƌŽƉŽƐĞĚ ƚŽ ƚŚĞ &W ŽĂƌĚ ϭϬ ƉƌŝŶĐŝƉůĞƐ ƚŽ ƉƌŽƚĞĐƚ ĐĂƌĞ for transgender and gender-expansive patients. These principles outline patient rights, physician responsibilities, and supports inclusion of transgender and gender-expansive people and consideration of their needs in the development of billing systems, the undertaking of research and policy,

and the design of medical school and residency curriculum. This policy also supports safe and humane conditions for ƚƌĂŶƐŐĞŶĚĞƌ ƉĞŽƉůĞ ŝŶ ĂŶǇ ĨŽƌŵ ŽĨ ĚĞƚĞŶƚŝŽŶ͕ ĂŶĚ ƌĞĐŽŐŶŝǌĞƐ that biological sex, gender identity, and sexual orientation are separate facets of a patient’s intersectional identity. Ǉ ĚĞǀĞůŽƉŝŶŐ ĂŶĚ ĂĚŽƉƚŝŶŐ ƚŚŝƐ ŶĞǁ ƐĞƚ ŽĨ ƉƌŝŶĐŝƉůĞƐ͕ &W ŶŽǁ ŚĂƐ ŐƵŝĚĂŶĐĞ ĚŝƌĞĐƚƐ ŝƚƐ ŝŶǀŽůǀĞŵĞŶƚ ŝŶ ďŽƚŚ ƐƚĂƚĞ ĂŶĚ federal policy that has the potential to affect the health and ǁĞůůďĞŝŶŐ ŽĨ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲĞǆƉĂŶƐŝǀĞ ƉĂƚŝĞŶƚƐ͘ It also declares CAFP’s intention to stand up for equality of ĐŽǀĞƌĂŐĞ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ƵŶĚĞƌ ƚŚĞ ůĂǁ͘ ZĞƐŽůƵƚŝŽŶƐ ƚŽ ƚŚĞ &W ŽĂƌĚ dŚĞ ĂďŽǀĞ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ĂƌĞ ũƵƐƚ ƚǁŽ ĐŽŶƐŝĚĞƌĞĚ ĂŶĚ ĂĚŽƉƚĞĚ ďǇ ƚŚĞ &W ŽĂƌĚ ŝŶ ϮϬϭϵ͘ dŚĞ ŽĂƌĚ ĐŽŶƐŝĚĞƌĞĚ ϭϭ ŵĞŵďĞƌͲƐƵďŵŝƚƚĞĚ ƌĞƐŽůƵƚŝŽŶƐ ŝŶ Ăůů͘ ZĞƐŽůƵƚŝŽŶƐ ĐĂŶ ďĞ submitted by CAFP members to the CAFP Board of Directors at any time throughout the year by completing the Resolution Submission Form (https://cafponcloud.egnyte.com/dl/ ĨϱϯϭŽƌϱƋϴǀͬͿ ĂŶĚ ĞŵĂŝůŝŶŐ ŝƚ ƚŽ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ͘

California Family Physician Winter 2020

H e r e ’s W h a t ’s N e w i n 2 0 2 0

CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners California’s family physicians are on the frontline of health ĐĂƌĞ͕ ƉƌŽǀŝĚŝŶŐ ĐĂƌĞ ƚŽ ŵŝůůŝŽŶƐ ŽĨ ŵĞŶ͕ ǁŽŵĞŶ ĂŶĚ ĐŚŝůĚƌĞŶ ŝŶ ĐŽŵŵƵŶŝƚŝĞƐ ůĂƌŐĞ ĂŶĚ ƐŵĂůů͕ ƌƵƌĂů ĂŶĚ ƵƌďĂŶ͕ ǁĞĂůƚŚǇ and poor. One in five physician office visits takes place ǁŝƚŚ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ͕ ĂŶĚ ĞǆƚĞŶƐŝǀĞ ĞǀŝĚĞŶĐĞ ƉƌŽǀĞƐ ƚŚĂƚ primary care provides exceptional value for health care dollars. Family physicians save lives and costs. It is the policy of the California Academy of Family WŚǇƐŝĐŝĂŶƐ ; &WͿ ƚŚĂƚ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ;EWƐͿ ĂƌĞ ǀĂůƵĂďůĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ǁŚŽƐĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ƐŚŽƵůĚ ĐŽƌƌĞƐƉŽŶĚ ƚŽ͕ ďƵƚ ŶŽƚ ĞǆĐĞĞĚ͕ ƚŚĞŝƌ ůĞǀĞů ŽĨ ŬŶŽǁůĞĚŐĞ͕ skill, experience, licensure and training (using competency ƚƌĂŝŶŝŶŐ ŵĞĂƐƵƌĞƐͿ͕ ĂŶĚ ĂŶ EW ƐŚŽƵůĚ ŶĞǀĞƌ ŝŶĚĞƉĞŶĚĞŶƚůǇ ĚĞůŝǀĞƌ ĐĂƌĞ ǁŝƚŚŽƵƚ ŽďƚĂŝŶŝŶŐ ƚŚĞ ŚŝŐŚĞƌ ůĞǀĞů ŽĨ ĞĚƵĐĂƚŝŽŶ and clinical training of a physician. CAFP considers ordering and interpreting diagnostic procedures, certifying disability, and prescribing, dispensing and administering controlled substances to be the practice of medicine. CAFP believes that it is of utmost importance that consistency of standards and regulations be maintained in the regulation of the practice of medicine in California. CAFP’s position on any proposed legislation and/or regulation that seeks to expand the ability of NPs to practice ŵĞĚŝĐŝŶĞ ŝŶĚĞƉĞŶĚĞŶƚůǇ ŽĨ ƉŚǇƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ ǁŝůů ďĞ guided by core principles related to establishing consistency ŽĨ ƐƚĂŶĚĂƌĚƐ ĂŶĚ ƌĞŐƵůĂƚŝŽŶ͕ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĂďŝůŝƚǇ ŽĨ ƚŚĞ proposal to address the problems it purports to resolve, including but not limited to: access to primary care, cost of care, quality of care and the overall sustainability of ƚŚĞ ƉƌŝŵĂƌǇ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͘ ŶǇ ƐƵĐŚ ƉƌŽƉŽƐĂů ŵƵƐƚ ĚĞŵŽŶƐƚƌĂƚĞ ƚŚĂƚ ŝƚ ĞƐƚĂďůŝƐŚĞƐ Žƌ ĂĐĐŽƵŶƚƐ ĨŽƌ ƚŚĞ ĨŽůůŽǁŝŶŐ provisions: Educational Standards ϭ͘ ƵŶŝĨŽƌŵ͕ ĐŽŶƐŝƐƚĞŶƚ ĞĚƵĐĂƚŝŽŶ ƉƌŽŐƌĂŵ ƚŽ ĂƚƚĂŝŶ EW certification. 28

California Family Physician Winter 2020

Ϯ͘ ƵŶŝĨŽƌŵ͕ ĐŽŶƐŝƐƚĞŶƚ ĞĚƵĐĂƚŝŽŶ ƉƌŽŐƌĂŵ ƚŽ ĂƚƚĂŝŶ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ĨŽůůŽǁŝŶŐ EW ĐĞƌƚŝĨŝĐĂƚŝŽŶ͕ ƐƵĐŚ ĂƐ Žƌ ĞƋƵŝǀĂůĞŶƚ ƚŽ ĐŽŵƉůĞƚŝŽŶ ŽĨ ƚƌĂŝŶŝŶŐ ǁŝƚŚŝŶ ĂŶ accredited residency training program and appropriate testing for the practice of medicine. Residency training, or its equivalent, must include sufficient primary care hours and patient visits in multiple settings of varying acuity to ensure direct observation of clinical proficiency. 3. Initial and ongoing maintenance of certification specific to primary care. ϰ͘ ŽŵƉĞŶƐĂƚŝŽŶ ĨŽƌ ĞĚƵĐĂƚŝŽŶ͕ ƚƌĂŝŶŝŶŐ ĂŶĚ ƉƌĂĐƚŝĐĞ supervision of NPs by family physicians. ZĞŐƵůĂƚŝŽŶ ĂŶĚ KǀĞƌƐŝŐŚƚ 5. Regulation and oversight by the Medical Board of California. Liability ϲ͘ KďƚĂŝŶŝŶŐ ĂŶĚ DĂŝŶƚĂŝŶŝŶŐ ^ƵĨĨŝĐŝĞŶƚ >ŝĂďŝůŝƚǇ /ŶƐƵƌĂŶĐĞ Ăƌ ŽŶ ƚŚĞ ŽƌƉŽƌĂƚĞ WƌĂĐƚŝĐĞ ŽĨ DĞĚŝĐŝŶĞ ϳ͘ ŽŵƉůŝĂŶĐĞ ǁŝƚŚ ĂůŝĨŽƌŶŝĂ͛Ɛ ďĂƌ ŽŶ ƚŚĞ ĐŽƌƉŽƌĂƚĞ practice of medicine. WƌŽǀŝƐŝŽŶ ŽĨ WƌŝŵĂƌǇ ĂƌĞ ƚŽ hŶĚĞƌƐĞƌǀĞĚ WŽƉƵůĂƚŝŽŶƐ ϴ͘ ƌĞƋƵŝƌĞŵĞŶƚ ŽĨ ůŝĐĞŶƐƵƌĞ ƚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂƐ ŽƉƉŽƐĞĚ ƚŽ ƐƵďͲƐƉĞĐŝĂůŝǌĂƚŝŽŶ͘ ϵ͘ /ŶĐĞŶƚŝǀĞƐ ƚŽ ƉƌĂĐƚŝĐĞ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ŐĞŽŐƌĂƉŚŝĐ ĂƌĞĂƐ and/or delivery of service to underserved populations. ϭϬ͘ WƌŽƐƉĞĐƚŝǀĞ ĂŶĚ ŽŶŐŽŝŶŐ ĂŶĂůǇƐĞƐ ŽĨ ƋƵĂůŝƚǇ ŽĨ ĐĂƌĞ͕ ĐŽƐƚ ŽĨ ĐĂƌĞ͕ ŚĞĂůƚŚ ĐĂƌĞ ƵƚŝůŝǌĂƚŝŽŶ ĂŶĚ ƉƌŽǀŝĚĞƌ and patient satisfaction, upon starting independent practice. hŶŝĨŽƌŵŝƚǇ ŽĨ ZĞƋƵŝƌĞŵĞŶƚƐ ϭϭ͘ ƉƉůŝĐĂƚŝŽŶ ŽĨ ƚŚĞ ĂďŽǀĞ ƉƌŽǀŝƐŝŽŶƐ ƚŽ EWƐ ƌĞůŽĐĂƚŝŶŐ ƚŽ ĂůŝĨŽƌŶŝĂ ĨƌŽŵ Ă ƐƚĂƚĞ ǁŝƚŚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ authority.

California Family Physician Winter 2020

H e r e ’s W h a t ’s N e w i n 2 0 2 0

CAFP Principles for the Protection and Care of Transgender and Gender-Expansive Patients

Ϯ͘ KƉƉŽƐĞƐ Ăůů ƉƵďůŝĐ ĂŶĚ ƉƌŝǀĂƚĞ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ĂŐĂŝŶƐƚ transgender and gender-expansive individuals in the areas, including but not exclusive of, health care, employment, ŚŽƵƐŝŶŐ͕ ƉƵďůŝĐ ĂĐĐŽŵŵŽĚĂƟŽŶ͕ ĞĚƵĐĂƟŽŶ ĂŶĚ ůŝĐĞŶƐŝŶŐ͘ ϯ͘ ^ƵƉƉŽƌƚƐ ĞǆŝƐƟŶŐ ƐƚĂƚĞ ĂŶĚ ĨĞĚĞƌĂů ůĂǁƐ ƚŚĂƚ ƉƌŽƚĞĐƚ ƉĞŽƉůĞ ĨƌŽŵ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ďĂƐĞĚ ŽŶ ŐĞŶĚĞƌ ĞǆƉƌĞƐƐŝŽŶ ĂŶĚ ŝĚĞŶƟƚǇ ĂŶĚ ŽƉƉŽƐĞƐ ůĂǁƐ ƚŚĂƚ ĐŽŵƉƌŽŵŝƐĞ ƚŚĞ ƐĂĨĞƚǇ ĂŶĚ ŚĞĂůƚŚ of transgender and gender-expansive people by failing to ƉƌŽǀŝĚĞ ƚŚŝƐ ƉƌŽƚĞĐƟŽŶ͘ ϰ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƐŚŽƵůĚ ŶŽƚ ĚŝƐĐƌŝŵŝŶĂƚĞ ĂŐĂŝŶƐƚ ĐůĂƐƐĞƐ Žƌ ĐĂƚĞŐŽƌŝĞƐ ŽĨ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ ĚĞůŝǀĞƌǇ ŽĨ ŶĞĞĚĞĚ health care. Such classes and categories include gender ŝĚĞŶƟƚǇ ĂŶĚ ĞǆƉƌĞƐƐŝŽŶ͘ ϱ͘ ƐƐĞƌƚƐ ƚŚĂƚ ƚŚĞ ŵĞĚŝĐĂů ƉƌŽĐĞĚƵƌĞƐ ĂƩĞŶĚĂŶƚ ƚŽ ŐĞŶĚĞƌͲ ĂĸƌŵŝŶŐͬĐŽŶĮƌŵŝŶŐ ƐƵƌŐĞƌŝĞƐ ĂŶĚ ƚŚĞƌĂƉŝĞƐ ƐƵĐŚ ĂƐ ŚŽƌŵŽŶĞƐ Žƌ ŽƚŚĞƌ ŵĞĚŝĐĂƟŽŶƐ ƚŚĂƚ ĂĚŚĞƌĞ ƚŽ ƚŚĞ ƉƌĞǀĂŝůŝŶŐ ƐƚĂŶĚĂƌĚƐ ŽĨ ĐĂƌĞ ĂƌĞ ŶŽƚ ͞ĐŽƐŵĞƟĐ͟ Žƌ ͞ĞůĞĐƟǀĞ͕͟ ďƵƚ ĂƌĞ understood to be medically necessary. ϲ͘ ^ƵƉƉŽƌƚƐ ƐĂĨĞ ĂŶĚ ŚƵŵĂŶĞ ĐŽŶĚŝƟŽŶƐ ĨŽƌ ƚƌĂŶƐŐĞŶĚĞƌ ƉĞŽƉůĞ ŝŶ ĂŶǇ ĨŽƌŵ ŽĨ ĚĞƚĞŶƟŽŶ͕ ǁŝƚŚ ŝŶĚŝǀŝĚƵĂůƐ͛ ƌŝŐŚƚ ƚŽ ƐĞůĨͲŝĚĞŶƟĨǇ ƚŚĞŝƌ ŐĞŶĚĞƌ ƵŶĚĞƌ ƐƵĐŚ ĚĞƚĞŶƟŽŶ ĐŽŶĚŝƟŽŶƐ͕ and asserts that transgender and gender-expansive prisoners should have the same access to medically necessary care as non-incarcerated transgender and gender-expansive people ĂŶĚ ƚŚĂƚ ŵĞĚŝĐĂůůǇ ŶĞĐĞƐƐĂƌǇ ĐĂƌĞ ŝŶĐůƵĚĞƐ ŐĞŶĚĞƌͲĂĸƌŵŝŶŐ treatments and procedures.

California Family Physician Winter 2020

ϳ͘ ZĞĐŽŐŶŝǌĞƐ ƚŚĂƚ ďŝŽůŽŐŝĐĂů ƐĞǆ͕ ŐĞŶĚĞƌ ŝĚĞŶƟƚǇ ĂŶĚ ƐĞǆƵĂů ŽƌŝĞŶƚĂƟŽŶ ĂƌĞ ƐĞƉĂƌĂƚĞ ĨĂĐĞƚƐ ŽĨ Ă ƉĂƟĞŶƚ͛Ɛ ŝŶƚĞƌƐĞĐƟŽŶĂů ŝĚĞŶƟƚǇ͘ ϴ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ͕ ďŝůůŝŶŐ ƐǇƐƚĞŵƐ͕ and insurance be designed to respect the asserted ŐĞŶĚĞƌ ŝĚĞŶƟƚǇ ĂŶĚ ƉƌĞĨĞƌƌĞĚ ŶĂŵĞ ŽĨ ĞĂĐŚ ƉĂƟĞŶƚ ǁŚŝůĞ ŵĂŝŶƚĂŝŶŝŶŐ ĐŽŶĮĚĞŶƟĂůŝƚǇ ĂŶĚ ĂǀŽŝĚŝŶŐ ĚƵƉůŝĐĂƚĞ ĐŚĂƌƚƐ͘ dŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƐĞǆƵĂů ŽƌŝĞŶƚĂƟŽŶͬŐĞŶĚĞƌ ŝĚĞŶƟƚǇ ĂůůŽǁƐ ĨŽƌ ŵŽƌĞ ĂĐĐƵƌĂƚĞ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵĞĂƐƵƌĞŵĞŶƚ ŽĨ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ͘ ϵ͘ ^ƵƉƉŽƌƚƐ ƚŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲ expansive people in development of both health and social determinants of health research and policy, including ĐůŝŶŝĐĂů ƚƌŝĂůƐ ĂŶĚ ŽďƐĞƌǀĂƟŽŶĂů ƐƚƵĚŝĞƐ͕ ŝŶ ŽƌĚĞƌ ƚŽ ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ ĂŶĚ ƚŽ ďƵŝůĚ Ă ƐƚƌŽŶŐĞƌ evidence base for transgender and gender minority health. ϭϬ͘ ŶĐŽƵƌĂŐĞƐ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂŶĚ ŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵƐ ƚŽ ĚĞǀĞůŽƉ ĂŶĚ ŝŶĐŽƌƉŽƌĂƚĞ ĞĚƵĐĂƟŽŶĂů ŵĂƚĞƌŝĂů͕ ƚŽŽůƐ ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŚĂƚ ǁŝůů ĂůůŽǁ ƉŚǇƐŝĐŝĂŶƐ ƚŽ ƉƌŽǀŝĚĞ ŬŶŽǁůĞĚŐĞĂďůĞ ĂŶĚ ƌĞƐƉĞĐƞƵů ĐĂƌĞ ƚŽ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲĞǆƉĂŶƐŝǀĞ ƉĂƟĞŶƚƐ͘

“

The inclusion of sexual orientation/gender identity allows for more accurate information and measurement of health disparities.

“

ϭ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĞǀĞƌǇ ƉĂƟĞŶƚ Žƌ ůĞĂƌŶĞƌ ƉƌĞƐĞŶƟŶŐ ƚŽ Ă ĨĂŵŝůǇ physician, family medicine residency or other health care/ ƉƌĂĐƟĐĞ ĞŶǀŝƌŽŶŵĞŶƚ ŚĂƐ ƚŚĞ ƌŝŐŚƚ ƚŽ ďĞ ƉƌŽǀŝĚĞĚ ǁŝƚŚ Ă ƐĂĨĞ͕ ĞƋƵŝƚĂďůĞ͕ ŬŶŽǁůĞĚŐĞĂďůĞ͕ ĐƵůƚƵƌĂůůǇ ƐĞŶƐŝƟǀĞ ĂŶĚ ĂĐĐĞƉƟŶŐ ĞŶǀŝƌŽŶŵĞŶƚ ĨƌĞĞ ĨƌŽŵ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŐĞŶĚĞƌ ŝĚĞŶƟƚǇ ƐƚĂƚƵƐ͘

California Family Physician Winter 2020

H e r e ’s W h a t ’s N e w i n 2 0 2 0

Conrad Amenta CAFP Director of Policy and Strategic Initiatives

Three Pathways Move Toward Achieving Value-Based Payment the California Department of Health Care Services advising them that overreliance on pay-for-performance measures, ǁŚĞŶ ĐŽŵďŝŶĞĚ ǁŝƚŚ ŵǇƌŝĂĚ ŽƚŚĞƌ ƉĂǇŵĞŶƚ ƉůĂŶƐ͕ ĐĂŶ ĚŝƐƚŽƌƚ ĂƉƉƌŽƉƌŝĂƚĞ ďĞŚĂǀŝŽƌ ĂŶĚ ůĞĂĚ ƚŽ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͘ /Ŷ ĂŶ ŝĚĞĂů ǁŽƌůĚ͕ ĂůŝĨŽƌŶŝĂ ǁŽƵůĚ ŝŶƚƌŽĚƵĐĞ s W ƚŚĂƚ ƌĞŇĞĐƚƐ ƚŚĞ dŚŽƵŐŚ ƚŚĞ ĚĞƚĂŝůƐ ŽĨ ǀĂƌŝŽƵƐ s W ƉƌŽƉŽƐĂůƐ ĚŝīĞƌ͕ &W ďĞůŝĞǀĞƐ ƚƌƵĞ W & ŝŶŝƟĂƟǀĞ͕ ĂƐ ƚŚĞ ĞŶƚĞƌ ĨŽƌ DĞĚŝĐĂƌĞ ĂŶĚ DĞĚŝĐĂŝĚ ^ĞƌǀŝĐĞƐ ; D^Ϳ ŝŶƚĞŶĚĞĚ ƚŚĞ ƉƌŽŐƌĂŵ ƚŽ ͞ĞŶĐŽƵƌĂŐĞ ŽƚŚĞƌ ƉĂǇĞƌƐ VBP must be: ʹ ŝŶĐůƵĚŝŶŐ DĞĚŝĐĂƌĞ ĚǀĂŶƚĂŐĞ WůĂŶƐ͕ ĐŽŵŵĞƌĐŝĂů ŚĞĂůƚŚ • WƌŽƐƉĞĐƟǀĞ͗ Up-front payment that covers investments in insurers, Medicaid managed care plans, and State Medicaid upstream primary care. ĂŐĞŶĐŝĞƐ ʹ ƚŽ ĂůŝŐŶ ƉĂǇŵĞŶƚ͕ ƋƵĂůŝƚǇ ŵĞĂƐƵƌĞŵĞŶƚ͕ ĂŶĚ ĚĂƚĂ • Risk-adjusted: WĂǇŵĞŶƚƐ ƌĞŇĞĐƚ ƚŚĞ ĐŽŵƉůĞǆŝƚǇ ŽĨ ƚŚĞ ƐŚĂƌŝŶŐ ǁŝƚŚ D^ ŝŶ ƐƵƉƉŽƌƚ ŽĨ WƌŝŵĂƌǇ ĂƌĞ &ŝƌƐƚ ƉƌĂĐƟĐĞƐ͘͟ ƉĂƟĞŶƚ ƉŽƉƵůĂƟŽŶ͘ • /ŶĐĞŶƟǀŝǌŝŶŐ͗ Bonus payments for performance measures that are evidence-based, clinically relevant, and aligned ĞŵŽŶƐƚƌĂƚĞ ƚŚĞ ǀĂůƵĞ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ across payers. &W ŝƐ Ă ůŽŶŐƟŵĞ ƐƵƉƉŽƌƚĞƌ ŽĨ ƚŚĞ WĂƟĞŶƚͲ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ͘ W D, ŝƐ Ă ĐĂƌĞ ŵŽĚĞů͕ ŶŽƚ Ă ƉĂǇŵĞŶƚ ŵŽĚĞů͕ Ɛ s W ŐƌŽǁƐ ŝŶ ƉŽƉƵůĂƌŝƚǇ͕ &W ŚĂƐ ĞŵƉůŽǇĞĚ ƚŚƌĞĞ ĚŝƐƟŶĐƚ but PCMH and VBP are co-dependent; each strengthens and ƐƚƌĂƚĞŐŝĞƐ ƚŽ ƐŚĂƉĞ ŚŽǁ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŵĂǇ ƉĂƌƟĐŝƉĂƚĞ ŝŶ perpetuates the other. ĚŝīĞƌĞŶƚ ŵŽĚĞůƐ͗ tŚŝůĞ ƐƚĂƚĞǁŝĚĞ ƉĂǇĞƌƐ ŚĂǀĞ ƌĞŵĂŝŶĞĚ ŚĞƐŝƚĂŶƚ ƚŽ ĮŶĂŶĐŝĂůůǇ WƵƚ ĨŽƌǁĂƌĚ Ă ƐƉĞĐŝĮĐ ŵŽĚĞů ǁŝƚŚ ƚŚĞ ŐŽĂů ŽĨ ĐƌĞĂƟŶŐ ĂůŝŐŶŵĞŶƚ ƐƵƉƉŽƌƚ ƚŚĞ W D,͕ ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ƐĞĞŶ ƚŚĞ ǀĂůƵĞ ŽĨ ƚŚĞ between federal and state plans ŵŽĚĞů ĮƌƐƚͲŚĂŶĚ ŚĂǀĞ ŶŽƚ ŚĞƐŝƚĂƚĞĚ ƚŽ ƌĞͲŝŶǀĞƐƚ͘ /Ŷ ϮϬϭϭ͕ &W /Ŷ ƌĞĐĞŶƚ ŵŽŶƚŚƐ͕ ǁĞ͛ǀĞ ƐĞĞŶ ĞǆĐŝƟŶŐ ŵŽǀĞŵĞŶƚ ŝŶ ƚŚĞ s W ƐƉĂĐĞ͘ ƉĂƌƚŶĞƌĞĚ ǁŝƚŚ ƚŚĞ &ƌĞƐŶŽ hŶŝĮĞĚ ^ĐŚŽŽů ŝƐƚƌŝĐƚ ;&h^ Ϳ ĂŶĚ dŚĞ ĞŶƚĞƌ ĨŽƌ DĞĚŝĐĂƌĞ Θ DĞĚŝĐĂŝĚ /ŶŶŽǀĂƟŽŶ͛Ɛ ; DD/Ϳ WƌŝŵĂƌǇ Santé Community Physicians to create a PCMH pilot for FUSD’s ĂƌĞ &ŝƌƐƚ DŽĚĞů ;ϭͿ ;W &Ϳ ǁĂƐ ĚĞǀĞůŽƉĞĚ ƚŽ ƌĞŇĞĐƚ ĂŶĚ ĞǆƉĂŶĚ employees. Eight years later, the project has expanded and is ƵƉŽŶ ƚŚĞ ƉƌŝŶĐŝƉůĞƐ ŽĨ ŽŵƉƌĞŚĞŶƐŝǀĞ WƌŝŵĂƌǇ ĂƌĞ WůƵƐ ; W нͿ͘ W & ƐƟůů ŐŽŝŶŐ ƐƚƌŽŶŐ͘ dŚĞ ĞīŽƌƚ ŚĂƐ ƐĂǀĞĚ ƐĞǀĞƌĂů ŵŝůůŝŽŶ ĚŽůůĂƌƐ ŝŶ ǁĂƐ ĚĞǀĞůŽƉĞĚ ŝŶ ĐůŽƐĞ ĐŽůůĂďŽƌĂƟŽŶ ǁŝƚŚ ƚŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵǇ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ͕ ĚƌĂŵĂƟĐĂůůǇ ŝŵƉƌŽǀĞĚ ŚĞĂůƚŚ ĐĂƌĞ ŽƵƚĐŽŵĞƐ͕ ŽĨ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ ; &WͿ ďĂƐĞĚ ŽŶ ŝƚƐ ĚǀĂŶĐĞĚ WƌŝŵĂƌǇ ĂƌĞ ĂŶĚ ƚŚĞ &h^ ƌĞĐĞŶƚůǇ ƌĞŶĞǁĞĚ ŝƚƐ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ƉƌŽũĞĐƚ͘ ůƚĞƌŶĂƟǀĞ WĂǇŵĞŶƚ DŽĚĞů ;ϮͿ͘ /Ŷ ďŽƚŚ ŵŽĚĞůƐ͕ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌĂĐƟĐĞƐ ǁŽƵůĚ ƌĞĐĞŝǀĞ ƚŚƌĞĞ ƚǇƉĞƐ ŽĨ ƉĂǇŵĞŶƚƐ͗ Ɛ ŽŶĞ ǁĂǇ ƚŽ ŐĞƚ ƵƐ ĐůŽƐĞƌ ƚŽ s W͕ ĂĚĚŝƟŽŶĂů ƉĂƌƚŶĞƌƐŚŝƉƐ ďĞƚǁĞĞŶ ƉĂǇĞƌƐ ĂŶĚ W D,ͲĂĐĐƌĞĚŝƚĞĚ • A monthly capitated payment ƉƌĂĐƟĐĞƐ ƐŚŽƵůĚ ďĞ ĨƵŶĚĞĚ͘ dŚĞ ƐƚĂƚĞ ŝŶƐƵƌĂŶĐĞ ĞǆĐŚĂŶŐĞ͕ • ƉŽƉƵůĂƟŽŶͲďĂƐĞĚ ƌŝƐŬͲĂĚũƵƐƚĞĚ ƉĂǇŵĞŶƚ Covered California, should also consider requiring that • A performance-based adjustment providing an upside of ƵƉ ƚŽ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƌĞǀĞŶƵĞ ĂƐ ǁĞůů ĂƐ Ă ƐŵĂůů ĚŽǁŶƐŝĚĞ ;ϭϬ ƉĂǇĞƌƐ ĐŽŶƚƌĂĐƚ ǁŝƚŚ Ă ĐĞƌƚĂŝŶ ŶƵŵďĞƌ ĂŶĚͬŽƌ ƉĞƌĐĞŶƚĂŐĞ ŽĨ W D,ͲĂĐĐƌĞĚŝƚĞĚ ƉƌĂĐƟĐĞƐ͘ &ŝŶĂůůǇ͕ ĂĐĐƌĞĚŝƚŽƌƐ ƐŚŽƵůĚ ůŽǁĞƌ ƉĞƌĐĞŶƚ ŽĨ ƌĞǀĞŶƵĞͿ ƚŽ ƌĞĚƵĐĞ ĐŽƐƚƐ ĂŶĚ ŝŵƉƌŽǀĞ ƋƵĂůŝƚǇ͘ ƚŚĞ ŚƵƌĚůĞƐ ƚŽ ĂƩĂŝŶŝŶŐ W D, ĂĐĐƌĞĚŝƚĂƟŽŶ͕ Žƌ ƌĞĐŽŐŶŝǌĞ dŚŝƐ ǁŽƵůĚ ďĞ ĂƐƐĞƐƐĞĚ ĂŶĚ ƉĂŝĚ ƋƵĂƌƚĞƌůǇ͘ PCMH-like outcomes. /Ŷ ƐŚŽƌƚ͕ ǁŚĞƌĞ ƉĂƐƚ ƉƌŽƉŽƐĂůƐ ŚĂǀĞ ŽǀĞƌͲƌĞůŝĞĚ ŽŶ ͞ƉĂǇ ĨŽƌ ƉĞƌĨŽƌŵĂŶĐĞ͟ ďŽŶƵƐĞƐ͕ ƉĞŶĂůƟĞƐ ƚŚĂƚ ůĞĂǀĞ ƵŶĚĞƌůǇŝŶŐ ŝŶĐĞŶƟǀĞƐ ZĞƋƵŝƌĞ ŚĞĂůƚŚ ƉůĂŶƐ ƐƉĞŶĚ Ă ŵŝŶŝŵƵŵ ƉĞƌĐĞŶƚĂŐĞ ŽŶ ƵŶĐŚĂŶŐĞĚ ĂŶĚ ŝŶĐƌĞĂƐĞ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͕ W & ŝƐ ĂŶ ŝŵƉŽƌƚĂŶƚ primary care ƐƚĞƉ ƚŽ ĚŝƌĞĐƚůǇ ĂĚĚƌĞƐƐ ƚŚĞƐĞ ŇĂǁƐ͘ /Ŷ Ă ƐĐĞŶĂƌŝŽ ŝŶ ǁŚŝĐŚ ƉĂǇĞƌƐ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ĐŽŶƐŝĚĞƌ ĞŝƚŚĞƌ ƚƌƵĞ s W Žƌ ƚŚĞ W D,͕ ĂůŝĨŽƌŶŝĂ ĐĂŶ ĚŽ ǁŚĂƚ ŽƚŚĞƌ ƐƚĂƚĞƐ ŚĂǀĞ /Ŷ ƚŚĞ ϮϬϭϵͲϮϬ ĂůŝĨŽƌŶŝĂ ^ƚĂƚĞ ƵĚŐĞƚ͕ DĞĚŝͲ Ăů DĂŶĂŐĞĚ ĂƌĞ done and require that payers report the percentage of their ǁŝůů ƉŝůŽƚ ŝƚƐ ŽǁŶ s W ƐǇƐƚĞŵ͘ &W ƐƵďŵŝƩĞĚ Ă ůĞƩĞƌ ;ϯͿ ƚŽ revenue dedicated to primary care. For those payers behind At the core of the California Academy of Family Physicians’ payment ƌĞĨŽƌŵ ĂĐƟǀŝƟĞƐ ŝƐ Ă ĚĞƐŝƌĞ ƚŽ ƐĞĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƉĂŝĚ ŝŶ Ă ǁĂǇ ƚŚĂƚ ƌĞŇĞĐƚƐ ƚŚĞ ǀĂůƵĞ ƚŚĞǇ ƉƌŽĚƵĐĞ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵƐ͘ dŚŝƐ ŝƐ ƌĞƉƌĞƐĞŶƚĞĚ ďǇ ƚƌƵĞ ǀĂůƵĞͲďĂƐĞĚ ƉĂǇŵĞŶƚ ;s WͿ͘

California Family Physician Winter 2020

in their support for primary care, many states have mandated that they spend at least a certain percentage to support such ĐĂƌĞ͘ dŚŝƐ ƉĂƚŚǁĂǇ ĐŽŵďŝŶĞƐ Ă ŵĂŶĚĂƚĞ ;Ğ͘Ő͕͘ ůĞŐŝƐůĂƟŽŶ ĂŶĚ ƌĞŐƵůĂƟŽŶͿ ǁŝƚŚ ŇĞǆŝďŝůŝƚǇ ;ŝ͘Ğ͕͘ ƉĂǇĞƌƐ ĐĂŶ ŐĞƚ ƚŽ ƚŚĞ ƚŚƌĞƐŚŽůĚ ŝŶ ŵĂŶǇ ĚŝīĞƌĞŶƚ ǁĂǇƐ ĂŶĚ ƚŚĞŝƌ ǁŽƌŬ ŝƐ ƐƵƉƉŽƌƚĞĚ ďǇ Ă ƉƌŝŵĂƌǇ ĐĂƌĞ ĐŽůůĂďŽƌĂƟǀĞ ƚŽ ƐŚĂƌĞ ďĞƐƚ ƉƌĂĐƟĐĞƐͿ͘

Conclusion Health care stakeholders from consumers to payers to employers are ƌĞĂůŝǌŝŶŐ ƚŚĂƚ ƉĂǇŝŶŐ ĨŽƌ ǀĂůƵĞ ŝƐ ƐǇŶŽŶǇŵŽƵƐ ǁŝƚŚ ƉĂǇŝŶŐ ĨŽƌ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ Ɛ ƐƵĐŚ͕ ŝƚ ŝƐ ĞƐƐĞŶƟĂů ƚŚĂƚ ǀĂůƵĞͲďĂƐĞ ƉĂǇŵĞŶƚ ďĞ ĚĞƐŝŐŶĞĚ ŝŶ Ă ǁĂǇ ƚŚĂƚ ƐƵƉƉŽƌƚƐ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ &W ǁŝůů ƚĂŬĞ ĞǀĞƌǇ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ĮŐŚƚ ĨŽƌ s W ƚŚĂƚ ŝƐ ƉƌŽƐƉĞĐƟǀĞ͕ ƌŝƐŬͲĂĚũƵƐƚĞĚ ĂŶĚ ŝŶĐĞŶƟǀŝǌŝŶŐ͘

KƌĞŐŽŶ ŚĂƐ ƐƵĐŚ ůĞŐŝƐůĂƟŽŶ ŝŶ ƉůĂĐĞ ĂŶĚ ƉƌŽĚƵĐĞƐ ĂŶ ĂŶŶƵĂů ƌĞƉŽƌƚ ĚĞƐĐƌŝďŝŶŐ ƚŚĞŝƌ ƉƌŽŐƌĞƐƐ ;ϰͿ͘ &W ƐƉŽŶƐŽƌĞĚ Ă ďŝůů ŝŶ ϮϬϭϳ ; ϮϴϵϱͿ ;ϱͿ ŵŽĚĞůĞĚ ŽŶ KƌĞŐŽŶ͛Ɛ ůĞŐŝƐůĂƟŽŶ ǁŚŝĐŚ ƌĞƋƵŝƌĞƐ payers to report their primary care spend. While the bill stalled in ƚŚĞ ůĞŐŝƐůĂƟǀĞ ƉƌŽĐĞƐƐ͕ &W ƐƵĐĐĞƐƐĨƵůůǇ ĂĚǀŽĐĂƚĞĚ ĨŽƌ ƚŚĞ ƵƐĞ ŽĨ state funds to develop an all-payer claims database, a key piece ŽĨ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ƚŽ ŵĞĂƐƵƌĞ ŚĞĂůƚŚ ƉůĂŶ ƐƉĞŶĚŝŶŐ͘ ĞůĂǁĂƌĞ ;ϲͿ ĂŶĚ ŽůŽƌĂĚŽ ;ϳͿ ŚĂǀĞ ĨŽůůŽǁĞĚ ƐƵŝƚ͘ ZŚŽĚĞ /ƐůĂŶĚ͛Ɛ /ŶƐƵƌĂŶĐĞ ŽŵŵŝƐƐŝŽŶĞƌ ŵĂŶĚĂƚĞĚ ƚŚĞ ƐĂŵĞ ƌĞƉŽƌƟŶŐ ĂŶĚ ƐƉĞŶĚŝŶŐ ǀŝĂ ƌĞŐƵůĂƟŽŶ ;ϴͿ͘ &ŝŶĂůůǇ͕ ƚŚĞ DŝůďĂŶŬ &ƵŶĚ ĂƵƚŚŽƌĞĚ Ă ƌĞƉŽƌƚ ŝŶ ϮϬϭϳ ĞǆƉůŽƌŝŶŐ ǀŽůƵŶƚĂƌǇ ĨƌĂŵĞǁŽƌŬƐ ĨŽƌ ƚŚĞ ƌĞƉŽƌƟŶŐ ŽĨ ƉƌŝŵĂƌǇ ĐĂƌĞ ƐƉĞŶĚŝŶŐ ďǇ ƉƌŝǀĂƚĞ ƉĂǇĞƌƐ ;ϵͿ͘

Notes: ϭ͘ ŚƩƉƐ͗ͬͬŝŶŶŽǀĂƟŽŶ͘ĐŵƐ͘ŐŽǀͬŝŶŝƟĂƟǀĞƐͬƉƌŝŵĂƌǇͲĐĂƌĞͲĮƌƐƚͲŵŽĚĞůͲ ŽƉƟŽŶƐͬ Ϯ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĚĂŵͬ &WͬĚŽĐƵŵĞŶƚƐͬĂĚǀŽĐĂĐǇͬ ƉĂǇŵĞŶƚͬĂƉŵƐͬWZͲWd Ͳ W Ͳ WDͲϰϭϰϭϳ͘ƉĚĨ ϯ͘ ŚƩƉƐ͗ͬͬĐĂĨƉŽŶĐůŽƵĚ͘ĞŐŶǇƚĞ͘ĐŽŵͬĚůͬϳǆǆ :tď'tƵ ϰ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ŽƌĞŐŽŶ͘ŐŽǀͬŽŚĂͬ,W ͬ E >zd/ ^ͬ ŽĐƵŵĞŶƚƐͬ^ Ͳ ϮϯϭͲZĞƉŽƌƚͲϮϬϭϵ͘ƉĚĨ ϱ͘ ŚƩƉƐ͗ͬͬůĞŐŝŶĨŽ͘ůĞŐŝƐůĂƚƵƌĞ͘ĐĂ͘ŐŽǀͬĨĂĐĞƐͬďŝůůdĞǆƚ ůŝĞŶƚ͘ǆŚƚŵů͍ďŝůůͺ ŝĚсϮϬϭϳϮϬϭϴϬ Ϯϴϵϱ ϲ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ƉĐƉĐĐ͘ŽƌŐͬϮϬϭϵͬϬϭͬϭϭͬƉĐƉĐĐͲĂƉƉůĂƵĚƐͲĚĞůĂǁĂƌĞͲ report-recommending-increased-investment-primary-care ϳ͘ ŚƩƉ͗ͬͬǁǁǁ͘ůĞŐ͘ĐŽůŽƌĂĚŽ͘ŐŽǀͬďŝůůƐͬŚďϭϵͲϭϮϯϯ ϴ͘ ŚƩƉ͗ͬͬǁǁǁ͘ŽŚŝĐ͘ƌŝ͘ŐŽǀͬĚŽĐƵŵĞŶƚƐͬWƌŝŵĂƌǇͲ ĂƌĞͲ^ƉĞŶĚŝŶŐͲ ŐĞŶĞƌĂůƉƌŝŵĂƌǇͲĐĂƌĞͲ:ĂŶͲϮϬϭϰ͘ƉĚĨ ϵ͘ ŚƩƉƐ͗ͬͬǁǁǁ͘ŵŝůďĂŶŬ͘ŽƌŐͬϮϬϭϳͬϬϳͬŐĞƫŶŐͲƉƌŝŵĂƌǇͲĐĂƌĞͲ oriented-measuring-primary-care-spending/

In each of these scenarios, requiring that payers report and spend more of their revenue on primary care has resulted in greater investment in VBP models. Should the evidence of VBP and ƉƌŝŵĂƌǇ ĐĂƌĞ ŶŽƚ ďĞ ƐƵĸĐŝĞŶƚ͕ ŵĂŶĚĂƚĞƐ ƐŚŽƵůĚ ĨŽůůŽǁ͘

California Family Physician Winter 2020

CAFP’s Nominating Committee Presents Its 2020 Slate dŚĞ ƌŽůĞ ŽĨ ƚŚĞ &W EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ŝƐ ƚŽ ŝĚĞŶƟĨǇ ĂŶĚ ŶŽŵŝŶĂƚĞ ŝŶĚŝǀŝĚƵĂůƐ ĨŽƌ ƚŚĞ ƉŽƐŝƟŽŶƐ ƐŚŽǁŶ ďĞůŽǁ͕ ƚŽ ďĞ ĞůĞĐƚĞĚ ďǇ ƚŚĞ ĞůĞŐĂƚĞƐ ĂŶĚ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ Ăƚ ƚŚĞ ϮϬϮϬ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ ; D DͿ ĂŶĚ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ŵĞĞƟŶŐ͘ dŚĞ ϮϬϭϵ ĐŽŵŵŝƩĞĞ ŵĞŵďĞƌƐ ĂƌĞ ƌƐ͘ ŶƚŚŽŶǇ &ĂƚĐŚ ŚŽŶŐ͕ DŽŶŝƋƵĞ 'ĞŽƌŐĞ͕ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ͕ ƐŵĂ :ĂĨƌŝ ĂŶĚ dŽŶĂƚǌŝŶ ZŽĚƌŝŐƵĞǌ͘ >ŝƐĂ tĂƌĚ͕ ŝŵŵĞĚŝĂƚĞ ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ͕ ĐŚĂŝƌƐ ƚŚĞ ĐŽŵŵŝƩĞĞ͘ dŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ŵĞƚ ŝŶ ůĂƚĞ KĐƚŽďĞƌ ĂŶĚ ƉƌĞƐĞŶƚĞĚ ƚŚŝƐ ƐůĂƚĞ ŽĨ ŽĸĐĞƌƐ͕ ǁŚŝĐŚ ǁĂƐ ĂƉƉƌŽǀĞĚ ďǇ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ Ăƚ ŝƚƐ EŽǀĞŵďĞƌ ŵĞĞƟŶŐ͘ dŚĞ ƐůĂƚĞ ǁŝůů ďĞ ǀŽƚĞĚ ŽŶ Ăƚ ƚŚĞ D D ŵĞĞƟŶŐ͘

ůĞĐƚĞĚ ďǇ ĞůĞŐĂƚĞƐ Ăƚ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƚŝŶŐ President-elect Speaker Vice Speaker &W ĞůĞŐĂƚĞ &W ůƚĞƌŶĂƚĞ ĞůĞŐĂƚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞΎ ;ĨƌŽŵ D DͿ Rural Director

^ŚĂŶŶŽŶ ŽŶŶŽůůǇ >ĂƵƌĞŶ ^ŝŵŽŶ ZĂƵů ǇĂůĂ >ĞĞ ZĂůƉŚ DŝĐŚĞůůĞ YƵŝŽŐƵĞ DŽŶŝƋƵĞ 'ĞŽƌŐĞ ĂŶĚ ŶũĂŶĂ ^ŚĂƌŵĂ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ

ϮϬϮϬ ϮϬϮϬ ϮϬϮϬ ϮϬϮϬͲϮϮ ϮϬϮϬͲϮϮ ϮϬϮϬͲϮϭ ϮϬϮϬͲϮϭ

ůĞĐƚĞĚ ďǇ ĂŶĚ ĨƌŽŵ ƚŚĞ ŽĂƌĚ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞΎ ;ĨƌŽŵ ƚŚĞ K Ϳ ^ĞĐƌĞƚĂƌǇͬdƌĞĂƐƵƌĞƌ

California Family Physician Winter 2020

ƌƚŚƵƌ KŚĂŶŶĞƐƐŝĂŶ ĂŶĚ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ ůĞǆ DƌŽƐǌĐǌǇŬͲDĐ ŽŶĂůĚ

ϮϬϮϬͲϮϭ ϮϬϮϬ

The All Member Advocacy DĞĞƟŶŐ ; D DͿ ŶŽŵŝŶĂƚĞƐ and elects a total of three ŵĞŵďĞƌƐ ŽĨ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ĨƌŽŵ ƚŚĞ D D ĞůĞŐĂƚĞƐ͖ ƚǁŽ ĂƌĞ ĞůĞĐƚĞĚ ĨŽƌ ƚǁŽͲǇĞĂƌ ƚĞƌŵƐ ŝŶ ŽŶĞ year, and one is elected for a ƚǁŽͲǇĞĂƌ ƚĞƌŵ ƚŚĞ ŶĞǆƚ ǇĞĂƌ͘ EŽŵŝŶĂƟŽŶƐ ŵĂǇ ďĞ ŵĂĚĞ ĨƌŽŵ ƚŚĞ ŇŽŽƌ ĂƐ ǁĞůů͘ The Secretary/Treasurer ƉŽƐŝƟŽŶ ŵƵƐƚ ďĞ ĞůĞĐƚĞĚ ĨƌŽŵ among eligible board members, Ğ͘Ő͕͘ ƚŚŽƐĞ ǁŚŽƐĞ ƚĞƌŵƐ ĂƌĞ ŶŽƚ expiring during the proposed ƚĞƌŵ ŽĨ ŽĸĐĞ ;ŽŶĞ ǇĞĂƌͿ͘

California Family Physician Winter 2020

ceo message

Lisa Folberg, MPP

Our Diversity is Our Strength &W ŵĞŵďĞƌƐ ĂƌĞ ŝŶ ĞǀĞƌǇ ƉƌĂĐƟĐĞ ƚǇƉĞ ŝŶ ĞǀĞƌǇ ĐŽƌŶĞƌ ŽĨ ƚŚĞ ƐƚĂƚĞ͕ ĨƌŽŵ ƵƌĞŬĂ ƚŽ ^ĂŶ ŝĞŐŽ͘ zŽƵ ĂƌĞ ƌƵƌĂů ĂŶĚ ƵƌďĂŶ͖ ϮϬͲƐŽŵĞƚŚŝŶŐƐ ĂŶĚ ŽĐƚŽŐĞŶĂƌŝĂŶƐ͖ ŵĞŶ͕ ǁŽŵĞŶ ĂŶĚ ŐĞŶĚĞƌ ŇƵŝĚ͖ DƵƐůŝŵ͕ ŚƌŝƐƟĂŶ͕ :ĞǁŝƐŚ ĂŶĚ ŶŽŶͲĨĂŝƚŚͲďĂƐĞĚ͖ ŐĂǇ͕ ƐƚƌĂŝŐŚƚ ĂŶĚ ƋƵĞƐƟŽŶŝŶŐ͖ ZĞƉƵďůŝĐĂŶƐ͕ /ŶĚĞƉĞŶĚĞŶƚƐ͕ 'ƌĞĞŶƐ ĂŶĚ ĞŵŽĐƌĂƚƐ͘ tŝƚŚ ƐŽ ŵƵĐŚ ĚŝǀĞƌƐŝƚǇ͕ ǇŽƵ ƐƟůů ŚĂǀĞ ƐŽ ŵƵĐŚ ŝŶ ĐŽŵŵŽŶ͘ zŽƵ ĂƌĞ family physicians or future family physicians, and family medicine is ǇŽƵƌ ĐĂůůŝŶŐ͘ KŶ ƚŚĞ ǀĂƐƚ ŵĂũŽƌŝƚǇ ŽĨ ƉŽůŝĐǇ ŝƐƐƵĞƐ ŽŶ ǁŚŝĐŚ ǁĞ ǁŽƌŬ͕ you have some level of agreement. But family physicians also agree ƚŽ ĚŝƐĂŐƌĞĞ ŽŶ ƐŽŵĞ ŝƐƐƵĞƐ͘ zŽƵ ƐŚĂƌĞ Ă ƉĂƐƐŝŽŶ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂŶĚ ĨŽƌ ǇŽƵƌ ƉĂƟĞŶƚƐ ďƵƚ ŵĂǇ ĚŝīĞƌ ŽŶ ŝƐƐƵĞƐ ůŝŬĞ ĂďŽƌƟŽŶ͕ gun control or even approach on clinical issues.

“

KŶĞ ŽĨ ƚŚĞ ƚŚŝŶŐƐ / ƚƌĞĂƐƵƌĞ ĂďŽƵƚ ǁŽƌŬŝŶŐ ĨŽƌ &W ŝƐ ŽƵƌ ǀĞƌǇ ĚĞůŝďĞƌĂƟǀĞ ƉƌŽĐĞƐƐ ĨŽƌ ŝŶƚƌŽĚƵĐŝŶŐ͕ ĚŝƐĐƵƐƐŝŶŐ͕ ĚĞďĂƟŶŐ ĂŶĚ ĚĞĐŝĚŝŶŐ ŽŶ ƚŚĞ ƉŽůŝĐǇ ŽĨ ƚŚĞ ŽƌŐĂŶŝǌĂƟŽŶ͘ tĞ ŚĂǀĞ Ă ƉŽůŝĐǇ ƉƌŽĐĞƐƐ ƚŚĂƚ ĞŶĐŽƵƌĂŐĞƐ ŶĞǁ ŝĚĞĂƐ ĂŶĚ ĚĞďĂƚĞ͘ DĞŵďĞƌƐ ĐĂŶ ĞŶƐƵƌĞ ƚŚĞŝƌ ǀŽŝĐĞƐ ĂƌĞ ŚĞĂƌĚ ƚŚƌŽƵŐŚ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ &W͛Ɛ ŽŶͲ ůŝŶĞ ƉůĂƞŽƌŵ ^W Z<͕ ďĞŝŶŐ Ă ƉĂƌƚ ŽĨ ƚŚĞ ƌĞƐŽůƵƟŽŶƐ ƉƌŽĐĞƐƐ ĂŶĚ ĂŶŶƵĂů ůů DĞŵďĞƌ ĚǀŽĐĂĐǇ DĞĞƟŶŐ͕ ůŽĐĂů ĐŚĂƉƚĞƌ ůĞĂĚĞƌƐŚŝƉ͕ ĐŽŵŵŝƩĞĞ ĂƉƉŽŝŶƚŵĞŶƚƐ͕ ĂŶĚ ďĞĐŽŵŝŶŐ Ă ůĞŐŝƐůĂƟǀĞ ŬĞǇ ĐŽŶƚĂĐƚ͘ ůů ƉŽůŝĐǇ ƌĞƐŽůƵƟŽŶ ŽƵƚĐŽŵĞƐ ĂƌĞ ƉŽƐƚĞĚ ŽŶ ŽƵƌ ǁĞďƐŝƚĞ ;ůŝŶŬͿ ĂŶĚ ŝŶ &W͛Ɛ ďŝͲǁĞĞŬůǇ ŽŶͲůŝŶĞ ƉƵďůŝĐĂƟŽŶ͕ ĐĂĚĞŵǇ /Ŷ ĐƟŽŶ͘

Diversity means diversity of minds,

dŚŝƐ ǇĞĂƌ ǁĞ ĂƌĞ ĞǆĐŝƚĞĚ ƚŽ launch an all-member survey. dŚŝƐ ŝƐ Ă ďŝŐ ĞŶĚĞĂǀŽƌ ĂŶĚ ǁŝůů ƌĞƋƵŝƌĞ ǇŽƵƌ ƉĂƌƟĐŝƉĂƟŽŶ͘ tĞ ĂƌĞ ŝŶǀĞƐƟŶŐ ŝŶ Ă ƐƚĂƚĞǁŝĚĞ ƐƵƌǀĞǇ ŽĨ ŵĞŵďĞƌƐ ƚŽ ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚ ǁŚĂƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ǇŽƵ͘ dŚĞ ƐƵƌǀĞǇ ǁŝůů ŚĞůƉ ŝŶĨŽƌŵ ƉŽůŝĐǇ͕ ĂĚǀŽĐĂĐǇ ĞīŽƌƚƐ ĂŶĚ ŽƌŐĂŶŝǌĂƟŽŶĂů ƉƌŝŽƌŝƟĞƐ͘ WůĞĂƐĞ ůŽŽŬ ĨŽƌ ĂĚĚŝƟŽŶĂů ŝŶĨŽƌŵĂƟŽŶ and please consider taking the ƟŵĞ ƚŽ ƌĞƐƉŽŶĚ͘

ŝǀĞƌƐŝƚǇ ĚŽĞƐŶ͛ƚ ĂůǁĂǇƐ ŵĂŬĞ ideas, and approaches – which allows things easier, but it makes us teams to ﬁnd a solution that takes into stronger, smarter, more curious ĂŶĚ ďĞƩĞƌ ƉƌĞƉĂƌĞĚ ƚŽ ŚĂŶĚůĞ account multiple angles the problem, ĐŚĂůůĞŶŐĞƐ ƚŚĂƚ ĐŽŵĞ ŽƵƌ ǁĂǇ͘ thus making the solution stronger, A number of studies looking well rounded and optimized. Ăƚ ĚŝǀĞƌƐŝƚǇ ŝŶ ƚŚĞ ǁŽƌŬƉůĂĐĞ have found employee diversity – Anna Powers, Forbes magazine ŝŵƉƌŽǀĞƐ ƚŚĞ ďŽƩŽŵ ůŝŶĞ͘ ƐƚƵĚǇ ďǇ ƚŚĞ ŽƐƚŽŶ ŽŶƐƵůƟŶŐ 'ƌŽƵƉ ; 'Ϳ ĨŽƵŶĚ ƚŚĂƚ ĚŝǀĞƌƐŝƚǇ ŝŶĐƌĞĂƐĞƐ ƚŚĞ ďŽƩŽŵ ůŝŶĞ ĨŽƌ ǀĞŶ ǁŚĞŶ ǇŽƵ ŵĂǇ ŶŽƚ ůŝŬĞ ĞǀĞƌǇ ƉŽůŝĐǇ ƚŚĂƚ ĐŽŵĞƐ ŽƵƚ ŽĨ &W͛Ɛ companies and is an important part of a successful business. ƉŽůŝĐǇ ƉƌŽĐĞƐƐ͕ / ŚŽƉĞ ǇŽƵ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ƐƵƉƉŽƌƚ ŽƵƌ ĞīŽƌƚƐ ƚŽ advocate on your behalf around important issues like reducing 'ŝǀĞŶ ƚŚĞ ƉŽůŝƟĐĂů͕ ĞƚŚŶŝĐ͕ ŐĞŶĚĞƌ͕ ƌĞůŝŐŝŽƵƐ ĂŶĚ ŐĞŽŐƌĂƉŚŝĐ ĚŝǀĞƌƐŝƚǇ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͕ ƉƌŽƚĞĐƟŶŐ ǇŽƵƌ ĂďŝůŝƚǇ ƚŽ ƉƌĂĐƟĐĞ ĨƵůů ŽĨ ŽƵƌ ŶĞĂƌůǇ ϭϭ͕ϬϬϬ ŵĞŵďĞƌƐ͕ ĨƵŶĚĂŵĞŶƚĂů ĚŝƐĂŐƌĞĞŵĞŶƚ ŽĨ ƐŽŵĞ spectrum care if you chose to, public health, payment reform and issues is inevitable. This diversity of opinion is healthy. It is good for ŽƚŚĞƌ ŝƐƐƵĞƐ ƚŚĂƚ ĂƌĞ ĞƐƐĞŶƟĂů ƚŽ ǇŽƵƌ ƉƌĂĐƟĐĞ ĂŶĚ ǇŽƵƌ ƉĂƟĞŶƚƐ͘ ƚŚĞ ŽƌŐĂŶŝǌĂƟŽŶ͘ dŚŝƐ ĞůĞĐƟŽŶ ǇĞĂƌ ǁŝůů ƚĞƐƚ ŽƵƌ ƚŽůĞƌĂŶĐĞ ĂŶĚ ĂĐĐĞƉƚĂŶĐĞ ŽĨ ƚŚŽƐĞ sĂůƵŝŶŐ ĂŶĚ ƌĞƐƉĞĐƟŶŐ ĚŝǀĞƌƐŝƚǇ ĚŽĞƐ ŶŽƚ ŵĞĂŶ ǁĞ ƐŚŽƵůĚŶ͛ƚ ǁŚŽ ĚŽ ŶŽƚ ƐŚĂƌĞ ŽƵƌ ƉĞƌƐƉĞĐƟǀĞ͘ /ƚ ŝƐ Ă ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƚǇ ƚŽ ĂĐŬŶŽǁůĞĚŐĞ ĚŝīĞƌĞŶĐĞ Žƌ ƐƚĂŶĚ ƵƉ ĂŶĚ ĮŐŚƚ ĨŽƌ ǁŚĂƚ ǁĞ ďĞůŝĞǀĞ͘ ĐŚĂůůĞŶŐĞ ŽƵƌƐĞůǀĞƐ ƚŽ ǀĂůƵĞ ƚŚĞ ŚƵŵĂŶŝƚǇ ŽĨ ƚŚŽƐĞ ǁŚŽ ĂƌĞ Ɛ ĂŶ ŽƌŐĂŶŝǌĂƟŽŶ ŝƚ ŵĞĂŶƐ ƚŚĂƚ ǁĞ ǁŝůů ůŝƐƚĞŶ͕ ǀĂůƵĞ ĚŝīĞƌĞŶƚ ĚŝīĞƌĞŶƚ ƚŚĂŶ ƵƐ͘ Ɛ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǇŽƵ ƉƌĂĐƟĐĞ ƚŚŝƐ ĞǀĞƌǇ ŽƉŝŶŝŽŶƐ ĂŶĚ ƉĞƌƐƉĞĐƟǀĞƐ͕ ĂŶĚ ƉƌŽǀŝĚĞ ŽƉƉŽƌƚƵŶŝƚǇ ĨŽƌ Ăůů ŽĨ ŽƵƌ ĚĂǇ͘ zŽƵƌ ƉĂƟĞŶƚƐ ĚŽŶ͛ƚ ĐŽŵĞ ƚŽ ǇŽƵ ďĞĐĂƵƐĞ ǇŽƵ ǀŽƚĞĚ ǁŝƚŚ ŵĞŵďĞƌƐ ƚŽ ďĞ ŚĞĂƌĚ͘ ƚ ŵǇ ĮƌƐƚ &W ŽŶŐƌĞƐƐ ŽĨ ĞůĞŐĂƚĞƐ ƚŚĞ ƚŚĞŵ ŝŶ ƚŚĞ ůĂƐƚ ĞůĞĐƟŽŶ͕ ƚŚĞǇ ĐŽŵĞ ƚŽ ǇŽƵ ĨŽƌ ǇŽƵƌ ŵĂƐƚĞƌǇ ŽĨ ŝƐƐƵĞ ŽĨ DĞĚŝĐĂůͲ ŝĚͲŝŶͲ ǇŝŶŐ ;D / Ϳ ǁĂƐ ĚĞďĂƚĞĚ͘ / ďƌĂĐĞĚ ĨŽƌ Ă ƚŚĞ Ăƌƚ ĂŶĚ ƐĐŝĞŶĐĞ ŽĨ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͘ /Ŷ ƚŚĞƐĞ ĨƌĂĐƚƵƌĞĚ ƟŵĞƐ ƌĂƵĐŽƵƐ ĚĞďĂƚĞ ǁŝƚŚ ŶĂŵĞͲĐĂůůŝŶŐ ĂŶĚ ĂĐĐƵƐĂƟŽŶƐ͘ /ŶƐƚĞĂĚ / ŚĞĂƌĚ ǁŚĞŶ ǀŝƚƌŝŽů ĂŶĚ ĂĐĐƵƐĂƟŽŶ ƐĞĞŵ ƚŽ ďĞ ƚŚĞ ĚĞĨĂƵůƚ͕ ǇŽƵƌ &W impassioned arguments that stayed focused on the issue, not the ĐŽŶƟŶƵĞƐ ƚŽ ůŝǀĞ ŽƵƌ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ƚƌĞĂƐƵƌĞ ŽƵƌ ĚŝǀĞƌƐŝƚǇ ŽĨ ƉƌĞƐĞŶƚĞƌ͘ / ǁŝƚŶĞƐƐĞĚ Ă ŚĞĂůƚŚǇ ĚĞďĂƚĞ ŽŶ ĂŶ ŝŵƉŽƌƚĂŶƚ ŝƐƐƵĞ͘ ŽƉŝŶŝŽŶƐ ĂŶĚ ƉĞƌƐƉĞĐƟǀĞƐ͘

“

California Family Physician Winter 2020

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