vol 2 • no 1 physician-driven efforts drawing attention to ... · resident director jennifer l....

V o l 2 • N o 1

Physician-DrivenEfforts Drawing

Attention to ObesityEpidemic

The Skinny on Milk, Cheese and Yogurt

To learn more about the body of research supporting dairy’s role in weight loss and to download a free Healthy Weight Education Kit with patient education materials, visit nationaldairycouncil.org.Also encourage your patients to assess their diet at assessyourdiet.webmd.com.1Zemel MB, et al. Dietary calcium and dairy products accelerate weight and fat loss during restriction in obese adults.Obesity Research. 2004; 12(4): 582-590.

© 2005 America’s Dairy Farmers.® The 3-A-DayTM of Dairy logo is a mark owned by Dairy Management Inc.TM

3-A-Day of Dairy Increases Weight Loss When Part of a Reduced-Calorie DietResearch continues to support the relationship between dairy foods and weight management. In a clinical trial, people on a reduced-caloriediet who consumed 3 servings of milk, cheese or yogurt each day lostsignificantly more weight and body fat than those who just cut calorieswhile consuming little or no dairy.1

How It WorksCell culture and animal studies provide a strong potential framework toexplain dairy’s weight loss effect, part of which has to do with the rolethat dietary calcium, and potentially dairy protein, may play in lipolysisand lipogenesis. Low-calcium diets have been shown to increase a key calcium-regulating hormone, which in turn increases intracellular calcium concentrations in human adipocytes and results in increased fat storage. Conversely, a high-calcium intake inhibits production of the hormone, thereby decreasing intracellular calcium and ultimately the fat content of fat cells. Moreover, studies in animals and humans show that dairy foods promote substantially greater loss of body weight and fat than calcium supplements.

A Motivating Benefit:Losing Inches in the WaistResearch also indicates that including 3 daily servings of dairy in a reduced-calorie diet may help patients lose more inches and burn more fat in the abdominal region.1Visual results can help motivate patients to decrease a high waist circumference, a trait that indicates abdominal obesity and an increased risk for the metabolic syndrome,hypertension and cardiovascular disease.

Benefits Beyond Weight LossThe newly released Dietary Guidelines for Americans also acknowledges the important role of dairy products’ unique nutrient package.The guidelines recommend people consume 3 servings of fat-free or low-fat dairy foods every day as part of a healthy diet. It also recommends dairy products like lactose-free milk or yogurt first for individuals who are lactose intolerant.

3 servings of dairy a day in a reduced-calorie diet supports weight loss.

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High Calcium(1200-1300 mg daily)

Low Calcium(400-500 mg daily)

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Dairy Foods Accelerate Loss of Abdominal Fat1

Results after six-month study

Motivate patients with what they find important.Adults maylose more inches in the waist when including 3 servings of milk,cheese or yogurt each day as part of a reduced-calorie diet.

NCFP

3P.O. Box 10278 • Ra le igh , Nor th Caro l ina 27605 – 919.833.2110

Vol 2 • No 1

winter 2006PUBLISHED BY THE NORTH CAROLINA ACADEMY OF

FAMILY PHYSICIANS

The North Carolina Family Physician is publishedquarterly by the

NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

P.O. Box 10278Raleigh, NC 27605

919.833.2110 • fax 919.833.1801www.ncafp.com

2006 NCAFP Board of DirectorsNCAFP Executive Officers

President J. Carson Rounds, MDPresident-Elect Michelle F. Jones, MDVice President Christopher S. Snyder, III, MDSecretary/Treasurer Elizabeth B. Gibbons, MDBoard Chair Karen L. Smith, MD, FAAFPExecutive Vice President Sue L. Makey, CAEPast President (w/voting privileges) Conrad L. Flick, MD

The District DirectorsDistrict 1 Donald Keith Clarke, MDDistrict 2 Robert Lee Rich, Jr., MDDistrict 3 Victoria S. Kaprielian, MDDistrict 4 William A. Dennis, MDDistrict 5 Sara O. Beyer, MDDistrict 6 Thomas J. Zuber, MDDistrict 7 Shannon B. Dowler, MDAt Large R.W. Watkins, MD, MPHAt Large Richard Lord, MDIMG Physicians Constituency Ofelia N. Melley, MDMinority Physicians Constituency Claudia E. Gonzalez, MDNew Physicians Constituency Jessica J. Burkett, MDResident Director Jennifer L. Mullendore, MD, (GAHEC)Resident Director-Elect Parker McConville, MD, (GAHEC)Student Director Oritsetsemaye Otubu, (UNC)Student Director-Elect Mary Jean Deason, (UNC)

AAFP Delegates and AlternatesAAFP Delegate L. Allen Dobson, MDAAFP Delegate Conrad L. Flick, MDAAFP Alternate Mott P. Blair, IV, MDAAFP Alternate George H. Moore, Jr., MD

FP Department Chairs and AlternatesChair (WFU) Michael L. Coates, MDAlternate (Duke) J. Lloyd Michener, MDAlternate (ECU) Valerie J. Gilchrist, MDAlternate (UNC) Warren P. Newton, MD, MPH

NCAFP Council ChairsChild & Maternal Health Shannon B. Dowler, MDGovernmental Affairs Advisory Robert Lee Rich, Jr., MDHealth Promotion & Disease Prev. Mott P. Blair, IV, MDMental Health Michelle F. Jones, MDProfessional Services Brian Forrest, MDHealth Disparities Karen L. Smith, MD

NCAFP Editorial CommitteeChair William A. Dennis, MD

Shannon B. Dowler, MDElizabeth B. Gibbons, MD

Richard Lord, MDDavid C. Luoma, MD

CREATED BY:Virginia Robertson, President

[email protected] Concepts, Inc.14109 Taylor Loop Road Little Rock, AR 72223

FOR ADVERTISING INFORMATION:Steve McPherson

[email protected] • 800.561.4686

e d i t i o n 6

NCAFP Strategic Plan

Vision StatementThe vision of the North Carolina Academy of Family Physicians is to be the leader intransforming healthcare in NC to achieve optimal health for all people of NC.

Mission StatementThe mission of the North Carolina Academy of Family Physicians is to improve thehealth of patients, families, and communities by serving the needs of members with pro-fessionalism and creativity.

Strategic Objectives1. Health Promotion & Disease Prevention (Health of the Public): Assume a leader-ship role in improving the health of North Carolina’s citizens by becoming proactive inhealth promotion, disease prevention, chronic disease management and collaborating inother public health strategies.

2.Advocacy: Shape healthcare policy through interactions with government, the public,business, and the healthcare industry.

3. Workforce: Ensure a workforce of Family Physicians which is sufficient to meet theneeds of patients and communities in NC.

4. Education: Assure high-quality, innovative education for family physicians, residents,and medical students that embodies the art, science, and socioeconomics of family medicine.

5. Technology & Practice Enhancement: Strengthen members’ abilities to manage theirpractices, maintain satisfying careers, and balance personal and professional responsibilities.

6. Research: Develop and promote new medical knowledge and innovative practicestrategies through information technology, primary care research and assessment of thepractice environment.

7. Communications: Promote the unique role and value of family medicine, familyphysicians and the NCAFP to the public, business, government, the healthcare industryand NCAFP members.

T a b l e o f C o n t e n t s4 Changes in Latitudes,

Changes in Attitudes

6 Cultural Diversity in thePhysician Office: It’s Timefor CLAS!

6 Title to come??

7 Physician-Driven EffortsDrawing Attention toObesity Epidemic

8 Foundation News

10 Title to come??

11 Retirement Plan Insights forPractice Administrators

12 Membership NewsCME News

14 Do You Know the Differencebetween Fluoride andSealants?

15 North Carolina Match 2006

15 NC DHHS SecretaryCarmen Hooker OdomHonored by Academy

4 North Carol ina Academy of Family Physicians

It’s these changes in latitudes,changes in attitudes, nothing remainsquite the same.With all of our running and all of our cunning,if we couldn’t laugh, we would all goinsane.

- Jimmy Buffett

Toyota is projected to become the num-ber one automaker in the world this year,sixty-one years after the end of World WarII. This rise from the devastation of post-war Japan to domination of the automobilemarket is widely attributed to the ToyotaProduction System, an integration of W.Edwards Deming’s philosophy of qualityand Kiichiro Toyoda’s philosophy of manu-facturing. Deming’s philosophy of continu-ous quality improvement is reflected inToyota’s philosophy of business, Kaizen.Kaizen, literally translated, means change(kai) to be good (zen). Key elements of thisphilosophy include quality effort, involve-ment of all employees, willingness tochange, and communication. It emphasizesa continuous learning culture and anexpanded role for employees.

There is an opportunity for us to applythese principles to our practice of medicine.I have heard that a manager at Kaiser oncesaid that “our doctors know what to do, theyjust don’t have the time to do it.” I believethat all of us strive everyday to deliver thehighest quality care we can, given the sys-tem in which we work. It is clear that thesystem is not designed to allow us to maxi-mize the care we deliver every day. Anaccumulating body of evidence demon-strates improvements in healthcare outcomeswhen systems are redesigned to maximizeour ability to provide the best-known carefor a given illness.

The Future of Family Medicine report

outlines a vision of a world where appropri-ately paid Family Physicians function in asystem designed to provide the best care atthe best time to the right person, for bothacute and chronic illnesses. The Institutefor Healthcare Improvement envisions afuture where all patients get what they needwhen they need it. A utopian ideal?Perhaps, but the adoption of continuousquality improvement strategies and a seriouslook at the structure of how we deliver carecan certainly move us closer to that goalthan where we are now. Frustrated physi-cians and frustrated patients could find sat-isfaction again in the transformation of asystem that seems hell-bent on destroyingany semblance of a rational way to providefor anyone’s health care needs.

National and local resources are availableto help your practice become a Kaizen prac-tice? Nationally, the AAFP PerformanceImprovement Program has been piloted inseveral states. A team of representativesfrom a practice – physician, nursing, andclinical team mem-bers – spend aweekend learninghow to lead theorganization throughthe quality improve-ment process.Preparation beforethe meeting, followup support after themeeting, and another weekend togetherround out the program. We hope to have theprogram brought to NC early in the processof expansion from a pilot program. Manytools are available on the AAFP website(www.aafp.org) for you to use if you want toget started now. The Institute for HealthcareImprovement website (www.ihi.org) isanother excellent resource online.

There are a number of resources here inNorth Carolina. The Carolinas Center for

Medical Excellence, CCME, offers help forthose of you who are interested in adoptingan EHR. Through the DOQ-IT program youcan receive free help in evaluating andimplementing EHR in your practice. TheAcademy is sponsoring an EHR vendorshowcase on April 22 in Charlotte to assistyou as well. AHEC’s website includes theQuality Source (www.ncahec.net/quality)where you will find a wealth of informationabout quality improvement activities inNorth Carolina, including links to the NCCenter for Hospital Quality and PatientSafety, the Quality Council of NorthCarolina, and seminars on quality improve-ment. The North Carolina MedicalSociety’s Physician and Patient ResourceCenter ( www.ncmedsoc.org/pages/prc/-prc.html) is another excellent resource.

Your Academy is intimately involved intwo other resources for quality improve-ment: IPIP and CCNC.

Improving Performance in Practice, orIPIP, is a three-year project of the national

specialty Boards of Family Medicine,Pediatrics, and Internal Medicine in con-junction with the national specialty soci-eties, including the AAFP. Colorado andNorth Carolina were the states chosen forthe project. In North Carolina, underWarren Newton’s leadership, the NCAFP,NC Pediatric Society, AHEC, the AmericanCollege of Physicians, CCME (previouslyMRNC), the Chronic Disease section of theNC DPH, the Office of Rural Health, the

(with apologies and thanks to Jimmy Buffett) by Dr. J. Carson Rounds, NCAFP President

CHANGES IN LATITUDES, CHANGES IN ATTITUDES

I believe that all of us strive everyday to deliver the highest quality care we can, giventhe system in which we work. It is clear thatthe system is not designed to allow us tomaximize the care we deliver every day.


Community Care of North Carolina (CCNC)leadership, and recently NCMS leadershiphave all been meeting to develop this collab-orative project. It will focus on developingcollaborative improvement networks, web-based improvement modules, and collectionof quality improvement data. The modelunder consideration will bring expertise toyour office to assist you in your efforts atquality improvement and practice redesign.Local physician input and guidance are cru-cial to the design. The first phase of theproject will enroll 16 practices, with plans toadd another 50 practices in the second andthird years of the project. It is hoped thatwhat we learn in the project will be expand-able and scaleable on a statewide level.

Perhaps the best place to learn about con-tinuous improvement in Medicine in NorthCarolina is the Community Care network.Under the leadership of former NCAFPPresident Dr.Allen Dobson, CCNC hasgrown into one of the most respectedMedicaid programs in the country. Practicesthat participate in CCNC learn a great dealabout continuous improvement; the Demingcycle, Plan Do Study Act, forms the basisfor all CCNC does. Efforts to improve thequality-of-care in the network follow thesteps of planning ahead and predictingresults, doing an example with a small con-trolled change, studying the results, and act-ing to standardize or improve the process.The “employees,” the physicians and prac-tices in the networks, are intimately involvedin the process. In fact, the process ensuresthat the providers of the care are the oneswho identify the need for change and thenbring about the change. Results are commu-nicated with colleagues who can adopt bestpractices rather than edicts being issuedfrom a central office far removed from theactual delivery of care. If you see Medicaidpatients but are not a member of CCNC, youowe to yourself, your practice, and your

patients to get involved. Ibelieve the value of the learn-ing and improvement in yourpractice would be sufficientfor you to become a Medicaidprovider through CCNC if youdo not see any Medicaidpatients now. You are not like-ly to find a better resource tohelp you transition your prac-tice into the New Model prac-tice described in the Future ofFamily Medicine report.

While you are doing that, remember totake care of yourself. I keep hearing thewords ‘overwhelmed’ and ‘frustrated’ todescribe so many of us today. Yet, personalconversations with overwhelmed, frustratedfamily docs almost always reveal a profoundand deep sense of caring, dignity, and satis-faction in the day-to-day interaction withpatients. The environment we are workingin now is toxic to us and to our patients. Weneed to reach out to each other, get togetherwith each other, and talk about the things welike about medicine, the things that exciteus, the things that fuel the passion lurkinginside us. Ours is an awesome profession, afearful profession, a grieving profession, ajoyous profession, a hopeful profession, anda caring profession. We profoundly impactmany lives everyday, and are in turn pro-foundly affected ourselves. I encourage allof you to visit www.findingmeaninginmedi-cine.org and explore the idea of forming acommunity of support during these stressfultimes. If we don’t laugh, we will go insane.

My office team will tell you that I ameternally optimistic, even if I do get grumpyand sometimes enraged at the lengths I haveto go to to do what is right for my patients.It is hard to imagine doing things differentlythan I have since I started this wonderfuljourney called Family Medicine. But myeternally-optimistic self knows that the cur-

rent system cannot continue like it is. TheAmerican College of Physicians recentlyissued what is essentially their version of theFFM report. They noted the impendingdemise of general internal medicine if noth-ing changes. W. Edwards Deming said wedon’t have to change; survival is an option.We can survive, thrive, and maybe even getback to position where we don’ t have tofight to do what is right. We will have thedata we need to show that the care we deliv-er is the right thing to do. CCNC has ajump start on the process. If you are partici-pating, thank you. If you are involved inredesign on your own, thank you but consid-er coming aboard anyway. If you are stilltrying to figure out what to do to surviveand have a good personal quality of life, Iencourage you to contact CCNC. We have abright future if we can just hold on andcome together. Let’s adopt Kaizen and pro-duce the number one healthcare system inthe world.

Oh, yesterday’s over my shoulder

so I can’t look back for too long.

There’s just too much to see waiting in

front of me,

and I know that I just can’t go wrong.

- Jimmy Buffett

Changes in Latitudes, Changes in

Attitudes


Picture this: A Hispanic father brings his eighteen-year olddaughter into the emergency room early Saturday morning. Thedaughter has overdosed on her antidepressant medication and thehospital staff suspects a suicide attempt. The father and daughterhave limited English proficiency, which resulted in a misinterpreta-tion of the medication dosing instructions. Once in English, meanseleven in Spanish. How could this situation have been avoided?

Patients with a variety of languages, customs, and beliefs utilizethe healthcare delivery system every day. In North Carolina, thefastest growing population is Hispanic. Nearly half of America’spopulation will be from cultures other than non-Hispanic whitewithin fifty years. To deliver culturally competent care and meetthe needs of these patients, healthcare providers must gain newskills and understanding. Increased cultural awareness can improvepatient satisfaction and compliance while preventing medical errors.

The Carolinas Center for Medical Excellence (CCME), formerlyMedical Review of North Carolina, is offering web-based culturalcompetency training designed to help primary care providers learnskills that enhance their communication with diverse patient popula-tions. This training also orients healthcare providers to the nationalCultural and Linguistically Appropriate Services (CLAS) standardsand related requirements for physicians receiving federal funds.

Basic care processes such as making a diagnosis, explaining careoptions and obtaining informed consent can be affected by culturaland language differences. Web-based CLAS training will enhanceyour evidence-based strategies to overcome these barriers.

Do you have the tools you need to provide patient-centered careto your diverse patients? Would you like to know more about theneeds, behaviors, communications systems, and values of thediverse patients you serve?

Contact us for more information about CCME’s CLAS initiative.Visit www.mrnc.org/ncdisparities or contact project manager,Franzi Rokoske, 800-682-2650, ext. 2070, HYPERLINK"mailto:[email protected]" [email protected].

Cultural Diversity in the Physician Office: It’s Time for CLAS!

(This still needs a headline) By Victoria S. Kaprielian, MD

The new AAFP Commission on Continuing ProfessionalDevelopment met for the first time on January 19 - 22 in Phoenix,Arizona. The group had a very productive meeting, covering thescopes of the former Committees on Scientific Program and CMEAccreditation.

A major focus of the group is to move CME credit away from"seat time" in lectures to activities with greater variety and educa-tional impact. Changes were also made to improve consistencybetween AAFP and AMA CME credits. Proposals from theCommission which were approved by the AAFP Board of Directorsin March include:

1. Credit for manuscript review - members serving as peerreviewers for journals may claim up to 3 prescribed credits permanuscript, with a maximum of 15 credits per year.

2. Point of care learning -- members using approved point-of-care learning providers may claim up to 0.5 credits per Internetsearch, with a maximum of 20 credits per year.

3. Test-item writing -- members writing exam questions forNBME, ABFM, or peer-reviewed, published, self-assessmentactivities may claim credit for these activities.

4. Relevant topics on physician health and well-being will be eli-gible for AAFP elective credit. Topics that include learningobjectives about positive impact on patients and modelinghealthful behavior as part of the treatment regimen will be eligi-ble for Prescribed credit.

5. CME requirements will be simplified to establish all per elec-tion cycle (as contrasted to the current system where somerequirements are annual, and others by election cycle).

Plans for the 2006 Annual Scientific Assembly are proceedingwell, and will include a rally on the National Mall to draw legisla-tive attention to issues of importance to members and our patients.


The Academy's Adolescent Obesity Initiative has nowentered a new phase with the project concentrating on countiesthat have family physician-cooperative extension service teamsalready in place.

Funded by a grant from the N.C. Health and Wellness TrustFund, the project established physician-agent teams in 15 coun-ties across the state. The extension agents serve as a referralsource for adolescent patients deemed obese or at risk by theirfamily physician. The new phase of the effort is seeking todetermine what are the key variables for success when estab-lishing relationships with community referral sources. The cur-rent effort also hopes to better understand barriers to successfulpartnerships in order to establish outlines for overcoming suchobstacles.

Some of the recent county efforts have included celebratingHealthy Weight Week in New Hanover County and participa-tion in a school-wide nutrition program in Nash County.

In New Hanover County, Dr. Belinda McPherson's officecelebrated Healthy Weight Week on January 19th. Dr.McPherson opened the event with a brief introduction andoverview of the childhood obesity epidemic in NorthCarolina. Dianne Gatewood, the New Hanover County coop-erative extension agent, followed with a cooking demonstra-tion. After the demonstration, participants had their heightsand weights measured and their BMI calculated. A computerset up with the Fast Food and Families CD was accessible forparticipants to interactively visit fast food restaurants andchoose more healthier options than they might normally.Gatewood has plans for a series of weekly classes that willtake place in Dr. McPherson’s office.

In Nash County, Dr. Nadine Skinner is participating with aschool-wide program called Friends Unraveling Nutrition(FUN). FUN is a 12-week program for middle school and highschool students who have been declared at-risk because theyare overweight or obese. The program is voluntary, with aweekly session during school hours. The goal is to teach thestudents skills so they are better equipped to make healthierchoices when they are eating. Dr. Skinner plans to speak withthe parents of the adolescents at a session as a part of thiseffort. Her session will include a discussion of the health con-sequences of poor nutrition and inactivity in hopes to motivateboth the parents and the adolescents.

These counties are just two examples of unique physician-driven efforts to bring community attention to the growingproblem of adolescent obesity.

The Adolescent Obesity Initiative project staff would like tothank the following physicians for their continued participation:

Tamara Babbs, MDMott P. Blair, IV, MDJack Cahn, MDBill Carr, MDWilliam Dennis, MDMary Digel, MDShannon Dowler, MDElizabeth Gibbons, MDAl Hawks, MDPeter Jacobi, MDColin Jones, MDBelinda McPherson, MDMaureen Murphy, MDTommy Newton, MDKaren L. Smith, MDSusan Snider, MDChris Snyder, MDNadine Skinner, MD

Physician-Driven EffortsDrawing Attention to

Obesity Epidemic

The goal is to teach the studentsskills so they are better equippedto make healthier choices whenthey are eating.


FOUNDATION NEWS

NCAFP Foundation GearingUp for Silent Auction!!The tradition continues! The NCAFPFoundation is gearing up for its 2006Silent Auction to be held during theWinter Family Physicians Weekend at TheGrove Park Inn Resort & Spa in scenicAsheville, November 29 – December 3.Don’t be left out! Be a part of the fun bydonating something special. Do you knowof a hotel or charming bed & breakfastthat you want to share with us? Or per-haps you have a special talent, such aswoodworking, quilting, painting? Maybeyou’ve got that “dark horse” tucked awayin your attic that you’d like to donate? Youmight want to contact your college forsports memorabilia. All donated auctionitems are tax deductible, and the proceedsgo towards the various NCAFPFoundation programs and projects.

Be a part of the tradition! Look for morepublicity on this year’s Silent Auction inthe coming months. If you’re interested inhow you can be a participant, contactMarlene Rosol, Development Coordinator,at (919) 833-2110, (800) 872-9482 [NConly], or [email protected]. Thank you!

THANK YOU FOR YOURSUPPORT!The NCAFP Foundation extends a special“thank you” to all our members whomade individual contributions in 2005.With programs designed to meet the needsof children, adults and seniors, we are ful-filling our mission of providing qualityhealthcare to the people of North Carolina.With projects designed specifically formedical students, we areshowing them that the specialty of FamilyMedicine is a worthwhile choice. Pleasejoin your colleagues and make a contribu-tion towards the future of FamilyMedicine. Make a contribution to theNCAFP Foundation! For more informa-tion on how you can make a donation tothe NCAFP Foundation, contact MarleneRosol, Development Coordinator, at (919)833-2110, (800) 872-9482 [NC only], or

[email protected]. You can alsovisit the NCAFP Foundation atwww.ncafp.com. Thank you for your sup-port!

HELP THE FUTURE OFFAMILY MEDICINE – JOINTHE NCAFP LEGACYLEAGUE!The North Carolina Academy of FamilyPhysicians Legacy League is establishedto recognize those who make provisionsthrough their estate for the North CarolinaAcademy of Family PhysiciansFoundation, Inc. By making such aplanned gift, members of the LegacyLeague help ensure that the Foundationwill have the financial resources to pro-vide vital programs and services to futuregenerations. The NCAFP Foundationrelies primarily on annual financial sup-port to implement its programs. We alsoencourage consideration of gifts that canendow one of our existing programs orendow a new program. The financialneeds of the Foundation increase as theneed for more programs arise, and theFoundation must keep pace by continuallyincreasing its annual program funds.

A planned gift can help the Foundationmake a significant difference for thefuture of Family Medicine. Planned giv-ing enables donors to create a livingmemorial that will continue their support,even after their lifetime.

For information on how you can become amember of the Legacy League, pleasecontact Marlene Rosol, DevelopmentCoordinator, at (919) 833-2110, (800)872-9482 [NC only], [email protected].

FOUNDATION SCHOLAR-SHIP PROGRAMThe NCAFP Foundation wants to help ourNorth Carolina medical students! All NCmedical students are eligible to apply forone of four scholarships in 2006.

Applications are due in the Foundationoffice by May 1, 2006. There is still timefor you to apply for a scholarship.Applications are available through the fourFMIG programs or you can downloadthem on the NCAFP website(www.ncafp.com). For more informationon student scholarships, or how you canmake a donation to the ScholarshipProgram, please contact Peter Graber,Programs Coordinator, at (800) 872-9482[NC only], (919) 833-2110, or HYPER-LINK "mailto:[email protected]"[email protected].

VISIT THE FOUNDATIONON THE WEB!Pay a visit to our web site atwww.ncafp.com and discover more aboutthe NCAFP Foundation. You’ll be able toread all about our programs and projects,and how you can get involved!

THE FOUNDATION VALUESITS CORPORATE MEMBERS!The NCAFP Foundation’s CorporateMembers are important to us! Their par-ticipation and support are crucial to whatwe do, and we are proud to include themas part of our Foundation family. Thankyou to our 2005 Corporate Members – wecouldn’t do it without you!!

MAKE A SPECIAL GIFTYou can honor or memorialize a colleague,friend or family member with a gift to theNCAFP Foundation. By making a specialdesignation, the Foundation will send acard to the family of the deceased, individ-ual or organization being honored. Thecard will show your name as the donor,but not the amount of the contribution. Tomake your special, tax-deductible gift,contact Marlene Rosol, DevelopmentCoordinator, NCAFP Foundation, (919)833-2110, (800) 872-9482 [NC only], [email protected]. Thank you!


To find out more, or to speak to an Army Reserve Health

Care Recruiter, call 800-785-8867 or visit

healthcare.goarmy.com/hct/51

THANK YOU TO OUR 2005CORPORATE MEMBERS!

WE COULDN’T DO IT WITHOUT YOU!Grand PatronsFirst Citizens Bank, Raleigh, NC*NC Academy of Family Physicians,

Raleigh, NC*

SupportersECR Pharmaceuticals, Richmond, VA**MAG Mutual Insurance Company,

Atlanta, GA**MedCost, LLC, Winston-Salem, NC*Moses Cone Health System,

Greensboro, NC*Misys Healthcare Systems,

Raleigh, NC*Rudy L. & Joyce B. Snow,

Pharmaceutical & Sales Marketing Consultants, Stanfield, NC*

*Corporate Members – Unrestricted**Corporate Members – Restricted

ad


The North Carolina State Health Plan(SHP) is pleased to announce a new initia-tive called North Carolina HealthSmart, aprogram designed to help members stayhealthy and to support physicians as theycare for members with chronic medicalconditions. One of NC HealthSmart’sgoals is to encourage the 590,000 SHPmembers to partner more closely withtheir physicians when making informedhealth care decisions.

What is HealthSmart? NC HealthSmart is ahealthy living initiative that aims to:• Help the SHP members with chronic dis-eases or disease risk factors better managetheir health• Empower healthy members to stayhealthy• Offer integrated, cutting edge resourcesand programs to members at work, at homeand through their health care provider

How does HealthSmart assist physi-cians?

NC HealthSmart embraces the SharedDecision Making® principle that the bestclinical decisions are shared between physi-cians and their fully informed patients, uti-lizing the best available clinical evidence,

blended with patient’s values and prefer-ences.

NC HealthSmart will target diabetes,asthma, coronary artery disease, chronicheart failure and COPD.

By offering SHP members “whole per-son” Health Coaching, members can gaininsight about their conditions and supportwhile following their physician’s treatmentplan.

By offering decision support, memberscan more fully understand their treatmentoptions and have a fully informed dialogwith their physicians when making certaintreatment decisions. This results in moreadherent, satisfied and educated patientswith improved outcomes.

In addition to working with members,the NC HealthSmart initiative will beoffering support to physician practices.Clinicians, knowledgeable about NCHealthSmart, who have lived and workedin North Carolina, will be available to meetwith physicians and their office staff toprovide additional program informationand a variety of practice aides. Please lookfor them soon.

NC HealthSmart is a free, voluntaryservice for eligible* North Carolina StateHealth Plan members.

We invite you to communicate feedbackor concerns, or to refer a member forHealth Coaching by calling the NCHealthSmart Provider Support Line at1-800-819-7075.

*Members of the State Health Plan of NorthCarolina, including active employees, retirees,and enrolled dependents, are eligible for NCHealthSmart as long as they are not eligible forMedicare or COBRA.

Shared Decision Making® is a trademark of theFoundation for Informed Decision Making.Used with permission. ©Health Dialog 2006.

SSHHAAPPEE \\** MMEERRGGEEFFOORRMMAATT


Practice Administrators have a myriad of subject matter areaswhere they need to be well versed. One area that is complex, everchanging, and holds perils of personal liability is the companyretirement plan.

Practice Administrators frequently act as plan administrator. Assuch, they have fiduciary obligations that involve due diligence inselecting advisors. They also must ensure that they select an advisorthat is independent and competent in fulfilling the advisor role.Sometimes plan administrators rely too heavily on the advisor (ormore often, broker) to provide full disclosure of the partiesinvolved. This can lead to a breach of fiduciary obligations. Thisarticle will help the plan administrator (be it the Physician owner orPractice Administrator) become better informed on issues regardingdisclosure of conflicts of interest. Recall that under ERISA, a plansponsor and plan administrator must not only identify conflicts ofinterest, they must avoid them.

THINGS TO WATCH FORHIDDEN FEES

Do any of the plan mutual funds have 12b-1 fees? If so, it mayserve as a conflict of interest with the advisor and reduce their abili-ty to assume a fiduciary role. You should ask your advisor why youhave funds with 12b-1 fees anyway. This is an ongoing fee paid bythe Mutual Fund company to a brokerage for marketing the fund.When the 12b-1 fee was introduced by the Securities ExchangeCommission (SEC) in 1980 it was supposed to help Mutual FundCompanies pay for advertising in order to grow their funds so thatsome economies of scale could lower the ongoing managementcosts. We have seen that many of the funds charging 12b-1 feeshave grown considerably in size, but we frequently do not see a cor-responding reduction in the size of the 12b-1 fee. Alternatively, wit-ness the existence of thousands of no-load funds (with no 12b-1fees either). Clearly 12b-1 fees are not necessary, and clearly theydo nothing to help the consumer. For this reason, the SEC consid-ered repealing 12b-1 fees in 2004. In parallel with this, a bill was

introduced – The Mutual Fund Reform Act of 2004. The repeal ofrule 12b-1 was contained within the bill but it did not pass. As aninvestor, you should know that once a broker sells a mutual fundwith a 12b-1 fee, they continue to receive 12b-1 fees annually, aslong as the fund is held. Over the years, this will have an impact onreturns because you are charged the 12b-1 fee directly by theMutual Fund Company. Make sure you include the 12b-1 fee inyour comparisons of mutual funds – or better still, avoid mutualfunds with 12b-1 fees, since there is no evidence to support theclaim that funds with 12b-1 fees produce higher returns.

COMMISSIONSIf any products inside the plan are mutual funds with class A, B

or C, your participants are paying sales loads (commissions).Leaving aside for a minute that there is no evidence to concludethat mutual funds with loads perform better than no-loads, the pres-ence of commissions helps to ensure the advisor does not takemuch (if any) of the fiduciary responsibility due to conflict of inter-est. You’re on your own here.

SETTING YOURSELF UP TO PAY A HIGHER TAX RATEAs practice administrator, you may have been hired because of

great business breadth and depth, but you probably were not hiredto be a tax expert. We are not suggesting you need to be either. Weare, however, suggesting you be mindful of some basic tax implica-tions to retirement plans, and more importantly, that you hire anadvisor that educates the plan participants about the impact to theirinvestment on poor tax planning. Here is a rudimentary fact that isfrequently not taken into consideration. Federal personal income taxrates on long term capital gains, and on dividends, are only 15%.Yet, the same investments (those that are equity-based i.e., stocksand mutual funds holding stocks) held inside your company retire-ment plan will be taxed at personal income tax rates when with-drawn. Most Physicians are in the 33% federal personal income taxbracket or higher. Would they rather pay 33% or 15% in taxes?Some of you may be thinking that this argument does not holdwater because the purpose of the retirement plan is to defer incometax to the future, when personal tax rates are assumed to be lower.Good point. Now consider this: if the Physician is planning on liv-ing comfortably in retirement, they are still going to be drawingenough from their retirement plan to pay more tax than 15% intaxes (hopefully, so will you). In addition, the current status of thenation’s fiscal situation (ballooning debt, aging population, plum-meting national savings rate, lowest personal income tax structurein decades, pending social security & medicare solvency crises)mean there is considerable chance we will see higher marginalincome tax rates in the future. We’re not saying you should not holdany equities in your retirement plan (read: deferred savings plan),but you need to be aware of the tax implications of your asset allo-cation decisions. Certainly your advisor needs to educate planmembers about this and other facts.

Retirement Plan Insights for Practice Administrators

continued on Page 14


Reelection NewsIf you were last reelected in 2004, you have until the end of 2006

to report 150 hours of CME in order to maintain your Academy

membership. Requirements include at least 75 AAFP prescribed

credit hours, a minimum of 25 group learning activities, no more

than 25 from enrichment activities, plus caps on other activities.

Hours reported should be obtained between January 1, 2004 through

December 31, 2006.

For further details, review the AAFP CME Requirements for

Members reprint 101 or visit www. ncafp.com or www.aafp.org.

You can also call the AAFP at 800-274-2237 or the NCAFP at 919-

833-2110 or 800-872-9482.

Membership TidbitsDid you know that there are seven categories of AAFP member-

ship? Each classification carries certain privileges, terms of mem-

bership, requirements and, of course, dues. Once an individual

elects to join the organization, then he or she will be designated as a

Student, Resident, Active, Supporting, International, Inactive or Life

member. The NCAFP is permitted to have members in all cate-

gories except International.

Remember – membership in the AAFP and state chapters is uni-

fied. Once you join the national organization (AAFP), you are

required to belong to the state (constituent) chapter. We are pleased

to report that the NCAFP has over 2,600 members!

KEEP US UPDATED!Members – please be sure to keep all of your contact info up to

date! This includes your home and business address, phone, fax,

and email address. To update, contact Marlene Rosol, NCAFP

Membership Coordinator, at [email protected], 919-833-2110 or

800-872-9482.

NCAFP 2006 CME CALENDAR

Spring CME Lowdown Recap If you did not register for the Spring Family Physicians Weekend

in Charleston, South Carolina, you missed out on a wonderful

program with over 8 evidence-based lectures --double-CME cred-

its! Registrants earned up to 30 prescribed credits during this

short weekend getaway. On Saturday, lectures ended at 1:15 pm

to allow registrants and families to explore Charleston with

evening dine around options. The Cosmetic Procedures and

Chronic Low Back Pain workshops were available at no charge to

registrants, along with Insulin Therapy and Joint Injections work-

shops available at a nominal fee. Congratulations to Dr. Greg

Pleasants for an outstanding program!

Tell Us What You Think of Our SAMs Study Halls? SAMs (Self-Assessment Modules) Study Halls are part of the

NCAFP’s plan to assist members with completing the ABFP

Maintenance of Certification program for family physicians. The

objective of the study hall is to review the 60 objective questions

divided into several competencies. Members are being encour-

aged to e-mail the Academy Meetings Department at HYPER-

LINK "mailto:[email protected]" [email protected] of your

interest in continuing developing these seminars.

NEW TO THE CME Calendar

MID-SUMMER FAMILY MEDICINE DIGEST- Plans are under-

way for a wonderful Fourth of July week-long Summertime

Getaway for CME, July 2 – 8, 2006 at the Kingston Plantation –

Embassy Suites, Myrtle Beach, SC. Participants can earn up to

36 prescribed credits (evidence-based credits for portions of the

program are still pending). Dr. Sara Beyer has planned an out-

standing program; please continue to check our website up-to-

date information, www.ncafp.com

WINTER FAMILY PHYSICIANS WEEKEND- Grove Park Inn,

November 30 – December 3, 2006. Dr. Kevin Burroughs,

Program Chair for our Annual Meeting, has begun with the pre-

liminary planning of this wonderful winter program. Don’t forget

to make your reservations early at the Grove Park Inn; October

19, 2006 is the cut-off date.

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ATTENTION RURALPROVIDERS!

Plan now to attendHealth IT:

A Rural Provider'sRoadmap to Quality!

The online registration process will be openApril 20th, 2006 and can be accessed athttp://ruralhealth.hrsa.gov/HITMeeting.asp.Don't wait! Space is available on a firstcome, first served basis.

Health IT: A Rural Provider's Roadmap toQuality will be held Sept. 21-23, 2006 at theKansas City Downtown Marriott in KansasCity, MO. In an effort to explore the benefitsof health information technology adoption andits link to quality improvement, this confer-ence will provide an opportunity for ruralproviders to learn about the basic componentsof HIT, to focus on the initial steps of strategicplanning for HIT investments, to understandhow to find appropriate technology to meetindividual quality aims, and to share bestpractices and lessons learned about HITimplementation. Through interactive work-shops, face-to-face contact with vendors, andnetworking with rural providers who havemade HIT work, this three-day conferencewill provide a great opportunity for you tolearn more about making an HIT investmentto help achieve your quality improvementgoals.

The meeting seeks to attract rural health careproviders, including small physician practices,critical access hospitals, small rural hospitals,Federally Qualified Health Centers, and ruralhealth clinics, as well as vendors interested inserving rural health care providers. In orderto make the conference accessible for all,there is no registration fee for the first 300providers to register and reduced rates foradditional participants.

See you in Kansas City!


The Centers for Disease Control statethat fluoride and sealants are themost effective ways to prevent dental

decay, but each is unique in the way itworks. Dental sealants are thin, plasticcoatings applied to the tops of the perma-nent back teeth (molars and premolars).They prevent bacteria from getting into thepits and grooves of these teeth and causingcavities. Sealants are permanent, althoughthey should be checked regularly by a den-tal professional to make sure they remainin place. Children who have sealants placedbetween the ages of 5 and 15 will have themost benefit.

Topical fluoride works differently fromsealants by stopping or even reversing very

early tooth decay. It prevents the loss ofimportant minerals from the tooth enamel,keeping the tooth hard. Topical fluoridemust come into contact with the toothenamel at regular intervals to be mosteffective. Children and adults of all agesbenefit from fluoride, with the recommend-ed type and amount determined by individ-ual caries risk.

You can play a part in preventing cavi-ties in very young, high-risk children byproviding oral screening, parent education,and fluoride varnish. Medicaid is reimburs-ing physicians to perform these procedures(up to a maximum of six times) for coveredchildren under age three. Analysis hasshown that children receiving 4, 5, or 6procedures have significantly fewer dental

treatment needs than children who do notreceive the service. Training is available inyour office at no charge by contactingKelly Haupt, Into the Mouths of BabesProject Coordinator at 919-707-5485 [email protected]

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PREFERRED FUNDSAsk your advisor if they or their company

receive any remuneration in any form (tripsto Maui, BMWs, Rolexes etc) from fundcompanies. There are brokerages that havecharged mutual fund companies for the privi-lege of being called a preferred fund compa-ny. This status may lead to improved accessto the sales force (brokers). Failure to dis-close this- or any similar arrangement leadsto a clear conflict of interest.

TRADING COSTSWhen a plan participant sells mutual fund

shares (redeems them back to the fund com-pany), they do not directly incur a fee/costfor the trades that must be done to sell thestocks that make up the fund. Instead, theremaining fund holders pay for it. In thismanner, any short-term trading of the fundhurts returns of the long term fund holders.For Mutual Funds with high turnover (a greatdeal of buying & selling), fund holders maysee up to 1% of the value of the fund lostannually to trading costs. Trading costs arenot disclosed in the fund prospectus so theinvestor has no ability to know in advancewhat will be lost to trading costs. You may,however, ask for the “Statement ofAdditional Information” (SAI). Sometimesthe SAI will disclose trading costs for the

fund in a previous year. Look for funds withtrading costs as low as possible – ideally lessthan 0.4% of the fund’s value per year. Thisshould be something your advisor analyzesand discusses with you.

BROKER OR ADVISORYou must know whether the person(s) you

are working with to provide the plan are bro-kers or advisors. Ask them to disclose theirrole in writing. Brokers will vehementlydeny any fiduciary responsibility whenamong themselves, but some have beenknown to muddy the waters when it comes toa clear distinction of their role when they arein front of clients. The Financial PlanningAssociation has brought suit against the SECin allowing Merrill Lynch to continue to calltheir brokers advisors. An Advisor is an indi-vidual licensed to provide investment adviceand representing a Registered InvestmentAdvisor. Advisors have a legal obligation toact in the best interest of their client (1940Investment Advisor Act). Brokers do not.

OTHER SOURCES OF CONFLICT:ERISA states that you must have an advi-

sor that is independent and validate the prod-uct providers (mutual funds companies) per-formance results. This means your advisormust not be in any way affiliated with themutual fund companies represented in theplan- unless you hire a separate independent

advisor.If the advisor recommends products that

are proprietary, you need to understand theimplications to your fiduciary role. We rec-ommend avoiding proprietary productsbecause they serve to lock-in the client bypreventing them from transferring thoseassets elsewhere. Does this practice serveyour participants well, or the brokerage?

Plan sponsors and plan administrators mustnot accept services that are not offered to allparticipants- if the services are offered withinthe plan. A clear ERISA violation, but somebrokers try to offer this as a selling feature.

SUMMARYWe have provided insight into areas that

may become problematic for plan sponsorsand administrators. Many of these areas arenot disclosed very well and indeed shouldbe. The securities industry is under fire fromregulators (Spitzer et al) in part because ofpoor disclosure, and in part for failure to per-form the role of fiduciary. It is our hope thatthe pressure to reform and provide improvedtransparency continue.

Jeff Seymour is Managing Director of TriangleWealth Management LLC. His practice workssolely with Physicians and Dentists in personalfinancial planning, wealth management, assetprotection, and procurement consulting. He maybe reached from their website (www.doctor-wealth.com ), or at 919 469 3600.

continued from Page 11

According to the AAFP, the 2006 Match placed 26 more candidates in family medicine residencies this year, giving the specialty a slight uptick in numbers for the third year in a

row. The 2,318 applicants who matched into family medicine residencies filled 85 percent of available positions, a higher Match fill-rate than the specialty has had since 1998. When

compared to last year (2005), the same number of U.S. medical school seniors -- 1,132 -- matched into family medicine residencies this year. US seniors filled 41.5 percent of the

2,727 available positions this year, a percentage that has stayed steady for four years.

Within North Carolina, the Match results held steady as compared to 2005. The following table lists each state program and the results as reported at time of publishing.


NORTH CAROLINA MATCH 2006

2006 MATCH RESULTS BY PROGRAM

Program # Offered via Match # Filled via Match #Filled via Scramble # Total Slots FilledCabarrus 8 4 * 1 5 of 8Camp Lejeune Naval Hospital** 12 11 0 11 of 12Carolinas Medical Center – Charlotte 8 8 0 8 of 8Carolinas Medical Center – Rural 2 1 1 1 of 2Duke 6 2 2 4 of 6SRAHEC 4 3 0 3 of 4MAHEC – Asheville 9 9 0 9 of 9MAHEC – Hendersonville 3 1 2 3 of 3UNC 8 8 0 8 of 8Moses Cone 7 7 0 7 of 7ECU 10 10 0 10 of 10New Hanover 4 1 3 4 of 4WOMACK** 10 10 0 10 of 10WFU 10 10 0 10 of 10

* 3 filled prematch candidates who did not want to participate in the Match, for a total of 5 of 8 slots filled.** Do not participate in National Match Program.

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Each year, the NCAFP recognizes indi-viduals whose work and efforts make sig-nificant impacts on improving healthcare.NC's Secretary of Health and HumanServices Carmen Hooker Odom was hon-ored by the NCAFP on April 8, 2006 atthe Spring CME Lowdown in Charleston, SC and presentedwith an NCAFP Distinguished Service Award for her progres-sive leadership.

Appointed by Governor Easley in 2001, Hooker Odom hasbeen a strong supporter and advocate for enhancing primarycare access to citizens in North Carolina. She's also been avisionary who's recognized that big risks bring big rewards.Early on Secretary Odom saw the power that coordination and

integration can have on managing complex disease. Today, ourstate has one of the most advanced care management networksin the country with Community Care.

There's numerous other ways she's made an impact. All ofthem demonstrate a clear passion, a clear purpose and a clearunderstanding. Her progressive and inclusive leadership stylehas enabled her to take action and improve many critical areas,as well as to embrace innovative concepts.

Presorted Standard

U.S. Postage

PA I D

Little Rock, AR

Permit No.2437

The North Carolina Academy of Family Physicians, Inc.P.O. Box 10278Raleigh, NC 27605

vol 2 • no 1 physician-driven efforts drawing attention to ... · resident director jennifer l....

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