Fall 2020 • Vol. 13 • Num. 3 • Ed. 53 Happy Holidays

MARK YOUR CALENDARS THE 2021 USAFP ANNUAL MEETING & EXPOSITION IS NOW VIRTUAL!

Journal of The Uniformed Services Academy of Family Physicians 2 The Uniformed Family Physician • Fall 2020 The Uniformed Services PRESIDENT’S MESSAGE 5 Academy of Family Physicians EDITOR’S VOICE 6 1503 Santa Rosa Road, Suite 207 Richmond, Virginia 23229 CONSULTANT’S REPORT CG/PHS 8 804-968-4436 FAX 804-968-4418 CONSULTANT’S REPORT www.usafp.org NAVY 11 USAFP: BETTER TOGETHER CAMPAIGN 14 2021 USAFP ANNUAL MEETING & EXPOSITION 15

USAFP e-mail LEAD, EQUIP, ADVANCE Mary Lindsay White: [email protected] LEADER AND FACULTY DEVELOPMENT Cheryl Modesto: [email protected] FELLOWSHIP 18 COMMITTEE REPORT Newsletter Editor This newsletter is published by the CLINICAL INVESTIGATIONS 20 A. Marcus Alexander, MD Uniformed Services Academy of Family Physicians. The opinions expressed are COMMITTEE REPORT those of the individual contributors and do EDUCATION 26 VISION not reflect the views of the Department of COMMITTEE REPORT Defense, Army, Navy, Air Force, Public MEMBER CONSTITUENCIES 30 The USAFP will be the Health Service or The Uniformed Services premier professional home to University of the Health Sciences. MEMBERS IN THE NEWS 32 enhance the practice and experience of current and future COMMITTEE REPORT RESIDENT AND STUDENT AFFAIRS 34 Uniformed Family Physicians. LEADERSHIP BOOK SERIES 35 MISSION Created by Publishing Concepts, Inc. 2020 VIRTUAL AAFP David Brown President The mission of the USAFP is to , CONGRESS OF DELEGATES 38 [email protected] support and develop 1.800.561.4686 ext 103 NOTICE OF PROPOSED Uniformed Family Physicians BYLAWS AMENDMENT 39 as we advance joint readiness, health and wellness through USAFP ACADEMY AWARDS 40 education, scholarship, advocacy, For Advertising info contact USAFP VIRTUAL BOOK CLUB 40 and leadership. Michele Forinash [email protected] NEW MEMBERS 42 1.800.561.4686 ext 112

Edition 53 www.usafp.org 3 your academy leaders OFFICERS AND COMMITTEES

OFFICERS PRESIDENT Kevin M Bernstein, MD, MMS, FAAFP ARMY Debra A. Manning, MD, MBA, FAAFP Debra A. Manning, MD, MBA, FAAFP Naval Hospital Jacksonville, FL Kevin M. Kelly, MD, FAAFP Bureau of Medicine & Surgery Bureau of Medicine & Surgery [email protected] Fort Bragg, NC Falls Church, VA Falls Church, VA [email protected] [email protected] [email protected] Francesca M. Cimino, MD, FAAFP USUHS, Bethesda, MD NAVY Aaron Saguil, MD, MPH, FAAFP PRESIDENT-ELECT [email protected] James W. Keck, MD, FAAFP USUHS, San Antonio, TX Aaron Saguil, MD, MPH, FAAFP Naval Hospital Jacksonville, FL [email protected] USUHS, San Antonio, TX PUBLIC HEALTH SERVICE [email protected] [email protected] Khalid A. Jaboori, MD, MPH, FAAFP OPERATIONAL MEDICINE USCG Seattle COMMITTEE CHAIRS Adolfo Granados, DO, MHA, FAAFP VICE-PRESIDENT [email protected] CLINICAL INFORMATICS Naval Medical Center, San Diego A. Marcus Alexander, MD Matthew G. Barnes, MD, FAAFP [email protected] AFPC, TX Preciosa P. Pacia-Rantayo, MD, FAAFP Wright Patterson AFB, OH [email protected] USCG Base Cape Cod, MA [email protected] PRACTICE MANAGEMENT [email protected] Timothy L. Switaj, MD, MBA, MHA, SECRETARY-TREASURER CLINICAL INVESTIGATIONS FAAFP Maria D. DeArman, MD, FAAFP RESIDENTS Robert C. Oh, MD, MPH, FAAFP Brooke AMC, San Antonio, TX Corpus Christi, TX Alexis Aust, MD (Chair) [email protected] [email protected] Eglin AFB, FL Madigan AMC, WA [email protected] [email protected] RESIDENT AND STUDENT AFFAIRS PAST PRESIDENT J. David Honeycutt, MD, FAAFP Christopher E. Jonas, DO, FAAFP, Ryan M. Coffey, MD Heidi L. Gaddey, MD, FAAFP Nellis AFB, NV CAQSM Fort Benning, GA (Vice Chair) [email protected] Falls Church, VA [email protected] Travis AFB, CA [email protected] [email protected] Alexander C. Knobloch, MD Chris A. Cruz, MD Travis AFB, CA EXECUTIVE DIRECTOR Camp Pendleton, CA CONSTITUTION & BYLAWS [email protected] Mary Lindsay White, MHA [email protected] Barrett H. Campbell, MD, FAAFP Richmond, VA JBML, WA WELLNESS & RESILIENCY STUDENTS [email protected] Dave Riegleman, MD DIRECTORS Austin Fry Brooke Army Medical Center AIR FORCE USUHS, Bethesda, MD EDUCATION Fort Sam Houston, TX Heidi Gaddey, MD, FAAFP [email protected] Garrett J. Meyers, MD, FAAFP [email protected] Travis AFB, CA Ft. Hood, TX [email protected] Anna Priddy [email protected] 2021 PROGRAM CO-CHAIRS St. Louis University School of Medicine Kevin Bernstein, MD, MMS, FAAFP Jeanmarie Rey, MD, FAAFP St. Louis, MO MEMBER CONSTITUENCIES Naval Hospital Jacksonville, FL Fort Belvoir, VA [email protected] Janelle M. Marra, DO, FAAFP [email protected] [email protected] CLR-17, Camp Pendleton, CA AAFP DELEGATES [email protected] Sajeewane Seales, MD, MPH Kattie Hoy, MD, FAAFP Debra A. Manning, MD, FAAFP Joint Expeditionary Base - Little Creek, VA Nellis AFB, NV Bureau of Medicine and Surgery MEMBERSHIP & MEMBER SERVICES [email protected] [email protected] Falls Church, VA Janet M. West, MD, FAAFP [email protected] Naval Hospital Jacksonville, FL 2022 PROGRAM CO-CHAIRS ARMY [email protected] Stephen M. Young, MD Joshua S. Will, DO, FAAFP Aaron Saguil, MD, MPH, FAAFP Baumholder, Germany Fort Benning, GA USUHS, San Antonio, TX Anja Dabelic, MD, FAAFP [email protected] [email protected] [email protected] Personnel Cmd. Millington, TN [email protected] Mariama A. Massaquoi, MD Drew C. Baird, MD, FAAFP ALTERNATES Fort Campbell, KY Fort Hood, TX A. Marcus Alexander, MD NEWSLETTER EDITOR [email protected] [email protected] AFPC, TX A. Marcus Alexander, MD [email protected] AFPC, TX Meghan (Mimi) Raleigh, MD, FAAFP [email protected] Fort Leavenworth, KS CONSULTANTS [email protected] AIR FORCE NOMINATING Christopher E. Jonas, DO, Christopher E. Jonas, DO, FAAFP, NAVY FAAFP, CAQSM CAQSM Kelly G. Koren, MD, FAAFP Falls Church, VA Falls Church, VA USMC Wounded Warrior Regiment [email protected] [email protected] [email protected]

4 The Uniformed Family Physician • Fall 2020 president’s message DEBRA A. MANNING, MD, MBA, FAAFP

a commission, please go to https://www.aafp. Military Health System in his role as the MHS org/about/meet-our-leadership/commissions. GENESIS Clinical Functional Champion at html for more details. After reviewing the the Defense Health Agency. The USAFP has commission details, please let me know if you had other AAFP Presidents, including Drs. have any questions. You can also send a note Lori Heim, Ted Epperly, Warren Jones and to Mary Lindsay White at mlwhite@vafp. Robert Higgins (from the AF, Army and Navy Debra A. Manning, MD, MBA, FAAFP org. The time commitment depends on the respectively). I hope we get to add Dr. Ellzy to Bureau of Medicine & Surgery commission. that list! Falls Church, VA Other exciting news announced during On a final note, did you hear who won [email protected] CoD included the selection of our new AAFP AAFP’s Family Physician of the Year for 2020? President-Elect, Dr. Sterling Ransone of You did! We all did! The AAFP’s new CEO, My fellow FPs, Deltaville, VA. Sterling will spend the next Shawn Martin shared that given all that family I hope you are doing well and staying safe. three years advocating for all family physicians. physicians do and are doing during COVID, I was asked the other day how I was doing and The highlight for me at the end of CoD was we are all the 2020 AAFP Physician of the immediately made the comment that I think announcing our own, CAPT James Ellzy (Ret.) Year. Here’s to you! Thank you. Thank you all my COVID brain has ended. I had decreased is a candidate for President-Elect in 2021. for your service to our Nation, your patients and mental function and fatigue for almost 19 weeks Dr. Ellzy has maintained his membership in each other. I am honored to serve with you. from my start of COVID but am now finally USAFP during his retirement as an associate well. What a frustrating virus. Until my head faculty and Red Cross Volunteer in the Ft. was clear, I didn’t realize how unclear it was. Belvoir Community Hospital Family Medicine Again, I hope you and your families stay healthy Residency. He also continues to serve the and safe. I just finished up a great week at the Congress of Delegates (CoD) and FMX. PATIENT-FOCUSED. It would have been better in person, but the EVIDENCE-BASED. AAFP pulled off a great virtual meeting. Aaron PHYSICIAN-LED. Saguil, Marcus Alexander and I represented USAFP during the CoD meeting. With baited breath, our request to change the definition of Northwest Permanente, the region’s largest physician-led, self-governed multispecialty active duty to include the Space Force went PRIMARY CARE group, is currently seeking Family Medicine through. We also asked that residents and physicians to join our Primary Care and fellows who have to do full time out service and URGENT CARE Urgent Care teams. When you join Northwest Permanente, you are joining a programs be allowed to maintain their USAFP PHYSICIANS practice with a purpose that provides status. That also passed without discussion. As Opportunities available in Portland unparalleled opportunities for a meaningful and Salem, Oregon, and Southwest and rewarding career in medicine. the Services move some training to the civilian Washington, including Longview. sector, we wanted to maintain our support Our physicians enjoy: for these members. • A welcoming and inclusive culture During the final day of the Congress of To apply, please visit: • Best-in-class care https://nwpermanente.com Delegates, the new commission chairs were • A practice with a purpose • Meaningful rewards including announced. I have served on the Commission Please contact Sr. Recruiter, Marisa Walter, at [email protected] comprehensive benefits and for Finance and Insurance (CFI) for the past or 503-813-1045, with any growth opportunities four years and I am honored and humbled to say questions. EOE • A physician-led practice that puts that I was chosen as Chair of the Commission patients first for this coming year. I have enjoyed advocating for Family Medicine on the national level and if you are interested in serving the AAFP on ® https://nwpermanente.com Northwest Permanente www.usafp.org 5 A. Marcus Alexander, MD editor’s voice Vice-President AFPC, TX A. MARCUS ALEXANDER, MD [email protected]

HAVE AN ARTICLE YOU WOULD LIKE TO SUBMIT IN THE UNIFORMED FAMILY PHYSICIAN? PLEASE SEE THE INSTRUCTIONS FOR ARTICLES AT WWW.USAFP.ORG/ABOUT-USAFP/UNIFORMED-FAMILY-PHYSICIAN-NEWSLETTER/

Hello Family Medicine Family and Happy Holidays, medical decision making for all office based E/M codes, and requiring In this busy time of year, our USAFP peers have continued to share performance of history and exam only as medically appropriate. The total outstanding articles for this quarter’s journal. CAPT Manning gives us allowed charges for family medicine would increase 12% in 2021. Board great perspective from this year’s AAFP Congress of Delegates. Her Report D also highlights the substantial progress that has been made insight after four years on the Commission for Finance and Insurance in telehealth payment due to the sudden changes in patient care during (CFI) is always enlightening. Look forward to her continued insight from COVID-19. Legislative and regulatory changes now allow both new and her newly selected AAFP position of CFI Commission Chair. The Coast established patients to receive telehealth services in any setting, including Guard and Navy Consultant letters not only share information important their home, with payment of office visit E/M services furnished via to their individual services, but also highlight processes pertinent across telehealth at the same non-facility rate as in-person services. all services, such as the role out of standardized readiness criteria known I know that corporately this is a busy time of year from both a as KSAs (knowledge, skills, and abilities) that will be measured by the strategic and tactical standpoint. Thank you again for the value and leadership in each of the services. The Clinical Investigation committee energy each of you bring every day as Family Physicians. I hope you each highlights PI/QI scholarly projects that our members have initiated have a joyous and safe holiday season! throughout the pandemic response, such as PPE production by the 7th Special Forces Group or the 55th Medical Group’s comprehensive return to duty clinic for those diagnosed with COVID-19. The Member The USAFP family lost three constituencies Committee gives us a great reminder of the guidelines members this year that we hope for anal cancer screening. The Resident and Student Affairs Committee you will join us in taking pause shares lessons learned while deployed as a “COVID hospitalist” in a to remember. Our condolences go civilian level three trauma center. The Madigan Faculty Development out to the families, colleagues and friends for the loss of Captain (Dr.) team discusses the definition of power and how it is utilized in our Seth V. Vande Kamp (Martin Army Captain (Dr.) Kelliann Leli organizations, while also reviewing opportunities to reinvent our Community Hospital), Captain (Dr.) organizations as presented in Brave New Work: Are You Ready to Reinvent Kelliann Leli (David Grant Medical Your Organization. Col Maurer rounds out the quarter with insightful Center Family Medicine Residency) input on applications that help with COVID protocols, advanced and Commander (Dr.) Chris Joas directives, cervical cancer screening, and immunizations. (Naval Air Station Fallon) Throughout this year’s Congress of Delegates, I was reminded To all who were fortunate to how the standards and guidelines in civilian healthcare can impact know these military physicians, the standards and guidelines in the MHS. You can view the 2020 words are not enough to salve your COD Board reports at https://www.aafp.org/about/congress- bereavement or to compensate for delegates/2020/2020-congress-of-delegates-board-reports.mem.html your losses, but please know that Captain (Dr.) Seth V. Vande Kamp and you can view the Reference Committee reports at https://www.aafp. you do not grieve alone and that the loss of military and family medicine org/about/congress-delegates/2020/rcreports-amendmentform.mem. friends touches all. html. I would recommend at a minimum reviewing the BOD Report In the days and months ahead, D – Payment and Prior Authorization Issues. It is important to be aware if there is any way USAFP can help of the desired transition from volume to value based payment and from you heal, please do not hesitate to traditional fee-for-service (FFS) payments to alternative payment models. reach out. Know that you are in the On Nov 4, 2019, CMS finalized Medicare Physician Fee Schedule thoughts, prayers, and meditations changes that included allowing clinicians to choose the E/M visit level of many. based on either medical decision making or time, revising the times and Commander (Dr.) Chris Joas

6 The Uniformed Family Physician • Fall 2020 www.usafp.org 7 Preciosa P. Pacia-Rantayo, MD consultant’s report USPHS CG/PHS Regional Senior Medical Executive USCG Base Cape Cod Kaehler Memorial Clinic [email protected]

Since COVID-19 became a worldwide for Disease Control and Prevention, different issues as it relates to COVID event many things have changed and reiterated this point when he told senators -19. Lately, RADM Dana Thomas, our continue to evolve. Foremost of course, on September 16, 2020 the importance Director of Health, Safety and Work- as medical providers, has been our of (still) wearing a face mask. (Higgins- Life spoke about precautions during response to mitigate its spread and its Dunn, 2020). It appears states vary family gatherings. Past topics included impacts on our missions. In this issue in response and governors continue to discussion of COVID-19 symptoms we would mention current events, some manage the spread of cases in their own as discussed by CAPT Shane Steiner. relatable to COVID, and others that are state; some have already relaxed certain He is the Coast Guard’s Public Health agency specific. restrictions (Allen, 2020). Emergency Officer.

FEDERAL RESPONSE VIRTUAL VISITS SALIVA TESTING FOR COVID-19 As of this writing the race to have a We continue to use telehealth Steps have been implemented for the COVID -19 vaccine continues. To be medicine or virtual visits with our eventual general use of saliva testing in sure, a vaccine is needed to curb this patients. As a medical provider, this the Coast Guard. Test orders can only be pandemic. But what seems to be elusive is particular adjustment has perhaps been approved by a medical officer and patients the exact timeline for its availability. This one of the more challenging adjustments will get an email to prompt them to go to highlights the need to continue to adhere that clinics had to face. However, the patient portal to receive their results. to preventive measure such as wearing several months into the pandemic, many The official directive for agency -wide use of a face mask, especially when social clinicians find this tool helpful and have is being finalized as of this writing. distancing is not maintained. Dr. Robert started using telehealth with essentially no R. Redfield, the director of Centers resistance. Tricare’s website indicates that ELECTRONIC HEALTH RECORDS it covers medically necessary virtual visits. The Coast Guard implemented the These included office visits, preventive MHS GENESIS electronic health records health screenings, as well as Telemental (EHR) system at four Coast Guard Health services and services for End clinics starting on Aug. 29, 2020. This Stage Renal Disease (Tricare Covered long anticipated project is finally here to Services, n.d.). AAFP website cited on its support our medical communities and Virtual Town Hall that in May 81% of more importantly our patients with family practitioners have started providing efficient, current, and coordinated care. virtual visits (AAFP Virtual Town, 2020). The date of utilization of the EHR for the rest of the clinics has already COAST GUARD’S COVID WEBSITE been planned. The Coast Guard continues its stance in the fight against COVID-19. We “WEIGH INS” still have a very active website https:// Deferred in April due to the www.uscg.mil/Coronavirus/ that offers pandemic, the Coast Guard will resume multitudes of support during these Body Composition Screening starting challenging times. It includes guidelines October 1. The system uses abdominal on travel, childcare, and other information circumference ( AC) as an additional pertinent to our current environment. method of compliance and will be Likewise, it includes access to Medical used to indicate a health “ snapshot”. Monday and Wellness Wednesday. The screenings will run from October Medical Monday is a short video where 1 - October 31. COVID-19 precautions Dental examination room with modifications various speakers give a small talk about continued on page 10 related to COVID-19

8 The Uniformed Family Physician • Fall 2020 What is Clinical Pharmacology? Clinical Pharmacology is the specialty of developing answers for modern medical limitations. Clinical Pharmacologists develop drugs, vaccines, and biologics by evaluating bench research and moving it into clinical trials. They also repurpose currently available medicines and monitor the safety of medicines in use. Clinical Pharmacologists work with government, universities, and industry to translate discoveries in the research lab to the beside.

Fellowship Highlights: Current Research Interests: Fellowship Eligibility Requirements: • Conduct laboratory, animal, or clinical • Changes to antibiotic drug levels in research under the supervision of a mentor. soldiers exposed to exercise, heat exertion, • Active Duty Army PhDs /PharmDs traumatic brain injury. (71A or 71B) • Participate in the teaching of Clinical Pharmacology to medical students, house • Exploring the use of pharmacogenomics • Active Duty Army Physicians board staff, and practicing of physicans. in the military to optimize patient care eligible/ certified in primary specialty and soldier readiness • Three month rotation with a review division at the FDA. • Defining risk factors for adverse drug reactions in deployment relevant • Participate in continuing medical education, medications. research seminars, and journal clubs.

For more information contact: LTC Jeffrey Livezey, MD: [email protected] or LTC Jesse Deluca, DO: [email protected]

http://www.ushus.edu http://wrair-www.army.mil

www.usafp.org 9 continued from page 8 will continue such as maintaining we should have a bigger perspective floridas-governor-lifts-all-covid-19- social distancing, utilizing prescreening of all of the things that need to occur restrictions-on-businesses-statewide. questionnaires, and wearing face masks synchronously. Handwashing, crowd Higgins-Dunn, N. (2020, by both the taper and the member. Lastly, control, social distancing, and proper September 16). CDC director says face the taper will wear gloves and will change ventilation must be paired with the use of masks may provide more protection than gloves and wipe down tape between masks, testing, contact tracing, isolation coronavirus vaccine. https://www.cnbc. tapings (St. Clair, n.d.). and quarantine. The problem is complex, com/2020/09/16/cdc-director-says-face- therefore the solution cannot be taken by masks-may-provide-more-protection- USAFP FALL BOARD OF DIRECTORS MEETING piecemeal. than-coronavirus-vaccine-.html. Since the AAFP’s Family Medicine St. Clair, C. (n.d.). Body Composition Experience (FMX) was virtual this year, REFERENCES screening resume Oct.1. United States Coast the Board of Directors meeting was held AAFP Virtual Town Hall COVID-19 Guard : MyCG. https://www.mycg.uscg. via Zoom in November. The Executive On Demand. (2020, September 9). https:// mil/News/Article/2345224/body-comp- Finance meeting was also held virtually www.aafp.org/cme/all/covid-19/town- screenings-resume-oct-1/ on the same day. hall-on-demand.html Tricare Covered Services. (n.d.). Allen, G. (2020, September 25). TRICARE. http:// https://tricare. MOVING FORWARD Florida’s Governor Lifts All COVID-19 mil/CoveredServices/IsItCovered/ In order to stop the spread of COVID Restrictions On Businesses Statewide. Telemedicine. 19, simultaneous things must occur. https://www.npr.org/sections/coronavirus- When we conduct our daily operations, live-updates/2020/09/25/916969969/

Medical Staff enjoying Morale Day event at Base Cape Cod

10 The Uniformed Family Physician • Fall 2020 James Keck, MD, MBA, FAAFP consultant’s report Naval Hospital, Jacksonville, FL NAVY [email protected]

Greetings, my fellow FM’s! As I sit for the future thanks to her mentorship, KSA’S UPDATE down to write this article, we are still management, and detailing of our On 14 July 2020, the Surgeon laboring under the ever-evolving reality community. Thank you! General signed a package of 41 Naval that COVID has introduced. No doubt Our new detailer has penned a brief Medical Readiness Criteria (NMRC), we’ll need to continue to adjust as time introduction for this column: also known as the KSA’s. These much marches on, making it that much more My name is CDR Tara O’Connell and anticipated KSA’s are the “Knowledge, important to stay connected. If you I’m thrilled and honored to be the new Skills, and Abilities” that Naval are not getting regular emails from me, family medicine and operational medicine personnel are supposed to possess please seek me out so that I can ensure I detailer! I am originally from Long in order to do their jobs well. Navy have your correct contact info. So with Island, New York, and am board-certified Medicine has been working to define that introduction, let’s get started with in Family Medicine having done my and standardize the KSA’s for medical some important updates. residency at Naval Hospital Jacksonville. personnel, with an operational-readiness My previous tours include being an LHD focus. DETAILER CHANGE SMO on USS ESSEX and two OCONUS The NMRC’s have two main groups, This past summer, CAPT Anja tours in Rota, Spain and Bahrain. We of which FM is listed under the title of Dabelić completed a 3 year tour as our are still largely teleworking here at PERS “Non-Combat Casualty Care Team.” detailer. On behalf of our community, but if you reach out via my email, tara. (Although, as many have experienced, I want to express gratitude for her [email protected], I will be happy to set FM has a role in trauma resuscitations.) dedicated service during a time of up a time to chat. If you haven’t already, I invite you to significant change and challenges. continued on page 12 Navy FM is stronger and well poised

www.usafp.org 11 continued from page 11 review our specialty’s KSA’s (which have at the time this article was submitted, to defer the withholding of the 6.2% been emailed and can be found online and I look forward to sharing them with “FICA-SOC SECURITY” tax (as it is at the Corps Chief ’s website.) You will you when they are released. If you did labeled on your LES.) Here are some see the NMRC’s broke into 3 categories: not select for promotion, or if you are key facts: 1) Core Practice / Clinical Currency, interested in mentorship and guidance in • If your monthly basic pay is at or above 2) Expeditionary Skills for readiness / regard to promotion, please contact our $8666.66, then your social security tax Readiness Currency, and 3) Platform detailer and/or me. We can review your withholding will not be affected by the Training for Readiness. These were record and help you plan your future. temporary deferral. developed in collaboration with senior • Military members are not eligible to FM leaders as well as those of our sister NEW PROGRAM DIRECTOR SELECT FOR FT. opt-out of the deferral. It will happen services (reflecting a joint effort.) BELVOIR automatically. The Naval Medical Force After providing superior leadership • Collection of the deferred taxes will Development Center (NMFDC), a part during a period of historical change and be taken from wages between January of BUMED, is developing dashboards to challenges, Dr. Sarah Jorgensen recently 1 and April 30, 2021 (more info easily allow individuals and commands completed her tour as Program Director coming.) to see where they stand on their of the Ft. Belvoir Family Medicine • If a military member or civilian NMRCs. Once developed, it will be the Residency Program. Congratulations employee separates or retires in 2020 Navy Medicine Readiness and training goes out to CDR Franchi Cimino, who before the Social Security tax can Commands/Units (NMRTC/U’s) that was selected to take the helm of this be collected in 2021, they are still will work to get their personnel ready joint service program. Dr. Jorgensen responsible for the Social Security tax and meeting their NMRC’s. It should leaves behind a premier program repayment. be noted that NMRC’s are a work with a legacy of outstanding training As with any unexpected in progress and will continued to be and mentorship that will continue to overpayment, one option is to set aside reviewed, validated, and amended as positively impact all those we serve long the increase into a savings account in needed. Thus, I invite your feedback after she has turned over the helm... anticipation of having it recouped in as we move into the implementation not just for the Navy, but the Army and 2021. (You may also note that there is a process. For another summary, go to: Air Force as well. We are grateful for proposed 3.0% pay increase for military https://mccareer.org/2020/08/24/what- her service, and wish her fair winds and in 2021, which may mitigate the impact are-ksas/ following seas! And best of success, of the recoupment of the SS tax.) Dr. Cimino! PROMOTION NEW MC CAREER PROGRESSION TEMPLATE October saw the release of the results SOCIAL SECURITY PAYROLL TAX DEFERRAL This past year saw the development of the COVID-delayed Commander As has been widely disseminated, a of specialty specific career progression selections. Congratulations to the temporary deferral of Social Security tax templates, which were emailed out in following officers in our FM community withholdings was implemented for most September. I am grateful for all of the who were selected for promotion! service members. Effective with the input from our community’s senior Promotion stats were not available September mid-month pay, DFAS began leadership and their efforts in shaping

COMANDER

Bartles, Ryan Madsen, Clifford Sapida, Steven Bernstein, Kevin Marvin, Blake Torbet, Denise Clayton, Suzanne McClary, Margaret Tring, Visong Daughtry, Mohenish McCluney, Brendan Vincent, Brian Feist, Matthew McLendon, Anne Wooldridge, Bryan Hwang, Daniel O’Connor, Kristina Keleher, Eamon Patton, Jared

12 The Uniformed Family Physician • Fall 2020 the FM pathway. I encourage you On the other hand, it also highlights all to look at the template, especially choices which can make it difficult to

when planning the next steps in your get promoted…e.g. not completing &ALLt6OLt.UMt%D career. Some key points I would like to residency, not getting board certified. REGISTER NOW to Attend the 2016 USAFP Annual Meeting & Exposition emphasize: I invite your questions and feedback, HEALTH IS PRIMARY 18-22 MARCH 2016 • There is a “General Medical Corps as these can be used to make our Sheraton Denver Downtown Hotel Denver, Colorado Career Pathway” that highlights career template better with future updates. If www.usafp.org steps important to all medical officers you haven’t already, be sure to request • The FM template has significant Career Development Board at your overlap with the general template in current command. If a CDB is not order to avoid confusion and ensure available, or you want additional input, Journal of The Uniformed Services Academy of Family Physicians

alignment. feel free to reach out to me. www.usafp.org 1 • Operational Medical Officer (OMO) Thank you for all you do each and tours are now being emphasized as every day in service to our nation. I FOR ADVERTISING being important for promotion continue to be honored in being a voice INFORMATION It should also be noted that there for our community. Please don’t hesitate CONTACT is no ONE pathway to having a to reach out to me if I can be of any successful career and getting promoted. help with questions or advice. Stay Michele Forinash The templates are guides to help well, friends, and have a safe and happy you make decisions based on needed holiday season. 800.561.4686 ext.112 experiences and expectations that make you competitive for that next rank. OR EMAIL [email protected]

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Have a great idea for operational research but are unsure where to start or how to get approval?

Whether you are deployed or in garrison, the USAFP research judges can help! 

Visit us online at http://www.usafp.org/committees/clinical-investigations/ for resources or to find a mentor.

www.usafp.org 13 USAFP: Better Together Campaign

Greetings, Friends! I’d like to share a brief word about a new USAFP initiative called the Better Together Campaign. To give you the bottom-line up front, the USAFP is going to use this next year to implement and logistically support a series of virtual offerings to help you stay connected with your USAFP family. COVID has been a tremendous stressor, but it is not the only one we are facing. Medical billet realignment and uncertainty, special pay changes, electronic health record transitions, the move to virtual health, continued deployments, the loss of loved USAFP members—we are dealing with a lot, and it is hard to bear alone. The good news is that you do not have to— To help us gauge interest in these affinity you, and we, are “Better Together.” Over the groups (and to see what other ideas you might next months, your USAFP will be rolling out have), we’ll be conducting a series of surveys in professional affinity offerings (leadership book early 2021 (when we will have a new USAFP clubs, more robust mentoring opportunities, website!). With that information, we will start committee-sponsored groups), personal growth connecting you to one another so that you can offerings (board game clubs, fitness-oriented clubs, experience what it means to be “Better Together.” trivia clubs, investing circles), and family friendly offerings (family support club, group watch club, Cheers! OCONUS club). Aaron

Don’t Miss Out on Complimentary USAFP Membership Benefits

DAILY INFOPOEMS way you practice. Monthly, the complete set is compiled The USAFP is pleased to continue providing as a and sent for additional summary review. Ongoing since 1996, membership benefit a free subscription to Daily POEMs their editors now review more than 1,200 studies monthly from Essential Evidence Plus. Daily POEMs (Patient from more than 100 medical journals, presenting only the best Oriented Evidence that Matters) alerts and 3,000+ archived and most relevant as POEMs. The acclaimed POEMs process POEMs help you stay abreast of the latest and most applies specific criteria for validity and relevance to clinical relevant medical literature. Delivered directly to you by practice. If you want to subscribe, please e-mail the USAFP at e-mail every Monday through Friday, Daily POEMs identify [email protected] so your e-mail address can be added to the most valid, relevant research that may change the the distribution list.

14 The Uniformed Family Physician • Fall 2020 Join your Peers at the 2021 USAFP Annual Meeting & Exposition Better Together Virtual Experience

The 2021 USAFP Annual Meeting & Exposition promises to The week will conclude on Thursday, 1 April with engage our USAFP membership in ways that we only imagined programming from 1000 hours EST – 1430 hours EST and will before March 2020! As your 2021 Program Co-Chairs, we feature keynote addresses that will send you back to your “day jobs” are excited for this virtual experience and are developing an feeling energized, relaxed and in the know! outstanding program that will include not only continuing education sessions but also ways for us to engage socially and 2021 Registration Fees emotionally. The meeting will offer over 25 AAFP LIVE credits Registration Type Full Daily that will satisfy your live CME requirement for your AAFP CME Active $450.00 $100.00 re-certification cycle. Non-Member $550.00 $150.00 The meeting will begin on Friday, 26 March with a pre- conference ABFM Knowledge Self-Assessment session followed Resident $150.00 $40.00 by the opening keynote and will conclude with a fun Welcome Student $25.00 $25.00 “Reception” that will reconnect you via theme-oriented break-out RN/PA $550.00 $150.00 rooms so you can “see” all of your USAFP peers you missed seeing in April 2020. The dates of Saturday, 27 March – Wednesday, 31 March will Registration options will include a full conference registration or host CME’s running from 1000 hours EST – 1600 hours EST daily rates if you are not able to join us for the full week. The rates each day and will have programming pre and post hours for virtual are noted below for funding consideration. wellness activities, residency reunions, special interest meetings, We are working on the speaker selections currently and will be resident and student activities and much more. informing all that submitted topics back in the spring very shortly. A virtual exhibition hall will also be available during the You may be asked about virtualizable considerations for any hands- meeting so you can visit these organizations on your own time. on and workshop style submissions, so start thinking about unique We hope you will support these organizations by visiting as they ways to teach!! are a big part of why the USAFP Annual Meeting can continue to If you have any questions, please contact us at usafp2021@gmail. be so cost effective (just over $16.00 per credit hour!!). com or the USAFP Headquarters Office at [email protected]. The research competition and rise with research will continue Look forward to “seeing” you in March!! their traditions of being unparalleled scholarly opportunities for Jules Seales, MD & Kevin Bernstein, MD our members. 2021 Program Co-Chairs LOOKING FOR VOLUNTEERS! In conjunction with the virtual Annual Meeting, USAFP hopes to provide members the opportunity to attend virtual residency program reunions, member interest group meetings and other “non-cme” type gatherings. If you are interested in facilitating an event of this type, please e-mail Kristi Reynolds at [email protected]. www.usafp.org 15 It’s why you went

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www.usafp.org 17 Tyler S. Rogers, MD, FAAFP Lead, Equip, Advance Madigan Army Medical Center LEADER AND FACULTY DEVELOPMENT FELLOWSHIP JBLM, WA [email protected] Power Plays: Rethinking Power in Your Organization “Power tends to corrupt, and absolute To gain power, leaders must first the grease” is often very accurate in most power corrupts absolutely1.” This quote understand the source of that power. Whetton organizations as those with the most visible from British Peer, the 1st Baron Acton in and Cameron believe there are two sources of needs get more attention. The evidence shows the 1800’s, likely rings true to many of you power: personal and positional1. Power sources that being visible to superiors results in power. today. With political and civil unrest, a are changing as a new generation of leaders Gaining power alone is not helpful unless global pandemic, and other existential crises reject the traditional idea that power, like you can translate that power into influence. all around us, Lord Acton’s philosophy on currency, is held by a few and, once gained, Whetton and Cameron suggest three ways to power is shared by many people; however, is jealously guarded. These new leaders treat accomplish this: the three Rs are retribution, opportunities do exist to change how power power more like a current made by many, reciprocity, and reason. Retribution is the most is utilized in the work place. Many leaders, open, participatory, and peer-driven. Like destructive way to transfer power to influence. particularly those in middle management electricity or water, power is most forceful Still it is useful in certain situations, such positions, often feel powerless to effect when surging. Leaders must channel power, as emergencies with tight time constraints, change in their environments, but if you not yield it.3 when compliance is the only desired outcome. can discover ideas to leverage untapped As leaders, your sources of personal power Unfortunately this strategy constrains power, you can then help translate that into include leveraging your expertise, capitalizing creativity, commitment, and a safe working opportunities to increase influence, impact, on interpersonal attraction, displaying honest environment. Reciprocity is a healthier and success for you and your organization. effort, and aligning your actions with the strategy, involving mutual respect, dependency It is crucial to remember why power is prevailing value system of your organization1. on the team, and commitment to a greater important and necessary. Years of research Fair or not, research shows that attributes goal. The goal of reciprocity is to find ways have shown that employees prefer a leader of interpersonal attraction such as charisma, to create value for your team members and who can leverage power and influence. agreeable behavior, and physical attractiveness increase their reliance on you, allowing you to Kanter, an organizational behaviorist from significantly impact the ability of a leader transfer your positional power to influence4. the 1970s, identifies several tactics managers to gain power. Positional power is achieved Reason, or logic is often an effective way to can use with their power to help in their through political capital, flexibility, visibility, transfer power to influence. Identifying critical organization (Table 1)2, demonstrating the and the relevance of your contributions to the data points that support your proposal’s extent to which power can enable a leader to goals of the organization1. Political capital benefit to the organization at large is often take care of their people and organization. or social capital is gained by relationships; a successful way to garner support. It is It is also important to acknowledge that however, relationships alone are not enough. important to acknowledge that there is a fine power, the ability to influence the behavior of Power is only gained in relationships when line between persuasion based on reason and others, is different from authority, the right interdependency is established in a network manipulation. Persuasion is explicit and direct, to influence others1. Leveraging your power of relationships that rely on each other. Your while manipulation is implicit and deceptive1. is a learnable skill developed by three steps social and political competence have to The three Rs focus on your ability to transfer that include: focusing on how to gain power, connect you to others in a way that ensures power into influence in downward or lateral translate it into influence, and assertively they depend on you for their own political channels. Still, it is also crucial for leaders to neutralize its abuses. capital. The adage “the squeaky wheel gets understand their subordinates’ power and the onus on leaders to channel this power to influence superiors. One example of this Table 1: Indicators of a Manager’s Upward and Outward Organizational Power is issue selling, the process of intentionally, To what extent can a manager: systematically, and pragmatically bringing Intercede favorably on behalf of someone in trouble with the organization important issues to the attention of superiors Get a desirable placement for a talented subordinate and leveraging social and political competence Get approval for expenditures beyond the budget 1 Get above-average salary increases for subordinates to ensure they are visible . In a way, leaders Get items on the agenda at policy meetings who treat power as a current can serve as a Get fast access to top decisions makers surge protector and channel subordinates’ Get early information about decisions and policy shifts power to maximize influence.

18 The Uniformed Family Physician • Fall 2020 Finally, once leaders have established Spend the time necessary to understand MEMBERS IN THE NEWS themselves in a position of power, it is when someone is taking advantage of you or The USAFP Board of Directors vital that they assertively neutralize abuses misrepresenting data and facts. encourages each of you to submit of power. Power is useless if it cannot be In conclusion, power is no longer defined information on USAFP “Members in the News” for publication in the translated into influence. Identifying and by titles, positions, and hierarchal systems newsletter. Please submit “Members intervening when a toxic leader is using the in our organizations. The shift in power in the News” to Cheryl Modesto at three Rs in a negative way is as important as continues to grow as technology, social [email protected]. knowing how to use the three R’s yourself. media, and culture change, allowing larger

When a toxic leader uses retribution, it is groups of people to drive change. The battle NEWSLETTER essential to confront them directly, actively and balance of old and new power will SUBMISSION DEADLINE resist, and use your power to influence them. be a defining feature of society, business, REMINDER: The deadline People who abuse power typically do so when healthcare, and your organization in the 3 for submissions to the Winter there is a perceived discrepancy in power. coming years . Hopefully, as you continue to magazine 30 December 2020. The greater the discrepancy, the more likely lead, these principles can allow you to channel the leader will be tempted to take advantage power in impactful and influential ways that RESEARCH GRANTS of the powerless1. Using social capital, you support you, your subordinates, your peers, can demonstrate the interdependence you your superiors, and your organization. The Clinical Investigations Committee accepts grant applications on a rolling have on each other: “If I fail, you fail.” When basis. Visit the USAFP Web site at toxic leaders use reciprocity, it is prudent to REFERENCES: www.usafp.org for a Letter of Intent make sure that the “deal” is beneficial for you. 1. Whetten DA, Cameron KS. Developing (LOI) or Grant Application. Contact Confront those who seek to manipulate and Management Skills.10th ed. Pearson Dianne Reamy if you have questions. use high pressure tactics. There will inevitably Education; 2020. [email protected]. be times when you are more dependent on 2. Kanter RM. Power failure in others than they are on you and vice versa4, management circuits. Harvard Business RESEARCH JUDGES but it is important to be cautious. Last, many Review. 1979: 57(4); 65. Applications for research judges are toxic leaders use data and logic to manipulate 3. Heimans J, Timms H. Understanding accepted on a rolling basis. Please contact situations. It is critical that you simply use “New Power”. Harvard Business Review. Dianne Reamy ([email protected]) to facts, logic, and honest reasoning to neutralize December 2014. request an application. these attempts at manipulation. This concept 4. Lingo EL, McGinn KL. A New highlights the impact that personal expertise Prescription for Power. Harvard Business DO YOU FEEL STRONGLY ABOUT can have as a source of personal power. Review. August 2020. SOMETHING YOU READ IN THE UNIFORMED FAMILY PHYSICIAN? ABOUT ANY ISSUE IN FIGURE 1: MODEL OF POWER AND INFLUENCE MILITARY FAMILY MEDICINE? Please write to me... A. Marcus Alexander, MD AFPC, TX [email protected]

PROMOTING RESEARCH IN THE MILITARY ENVIRONMENT Have a great idea for operational research but are unsure where to start or how to get approval?

Whether you are deployed or in garrison, the USAFP research judges can help! Visit us online at http://www.usafp.org/ committees/clinical-investigations/ for resources or to find a mentor.

www.usafp.org 19 Caitlyn Rerucha, MD, MSEd, FAAFP committee report Fort Bragg, NC CLINICAL INVESTIGATIONS [email protected] Performance Improvement Projects During COVID-19

innovative solutions are truly performance improvement in practice! The challenges presented by the COVID-19 pandemic have spawned an environment ripe for scholarly activity. Whether formally or not, uniformed family physicians across the globe are actively engaged in clinical, academic, and operationally focused performance, process, and quality improvement (PI/QI) projects. We are innovating, adapting, and overcoming the challenges presented by COVID-19. The USAFP Clinical Investigations Committee The COVID-19 pandemic has certainly address the safety of our staff, our families, wants to encourage you to share your work affected us all. Everyone of us has experienced and ourselves. We are finding creative ways to with other members. In this article, we will some type of disruption to our lives, and manage medical readiness, transform graduate spotlight a few of the abounding number some among us have experienced personal medical education, and utilize telemedicine. of PI/QI projects that are underway by our loss, stress, and hardship. Despite these We are leading important conversations on members. We wholeheartedly look forward challenges, military family physicians across deployability, risk mitigation, quarantine/ to reading your abstracts, hearing your the globe continue to be guiding beacons, isolation, return to work, and contact tracing. presentations at the virtual 2021 USAFP steadily serving and leading our patients, our Together we are reaffirming our worth within Annual Meeting, and celebrating your communities, and our leadership through the military healthcare system by competently successes in scholarly activity that are born these difficult times. Our responses to the flexing to “fill the gaps” wherever they are out of COVID-19 challenges. Featured are challenges posed by COVID-19 have been, within our healthcare systems. Amidst all a handful of PI/QI projects that are being in many cases, rapid and remarkable. We have the new challenges, we continue to provide shared with the intent of spreading awareness been innovative, not only in the ways that we additional urgent care as well as inpatient of the hard work that is being done, inspiring have adapted to continue to take the best care and outpatient services to our patients of all others, and encouraging collaboration and of our patients, but also in the ways that we ages. Our hard work, problem solving, and information sharing amongst our members. The time is ripe for scholarly activity! It’s not too late to get started on a new PI/QI project or to share your current scholarly work! Operational Medicine. MAJ Christopher Brooks, 7th Special Forces Group Surgeon, responded to the critical shortage of protective equipment (PPE) at his military installation following an increase in COVID-19 cases in March-April 2020. On April 7, 2020, soldiers

continued on page 22

20 The Uniformed Family Physician • Fall 2020 www.usafp.org 21 continued from page 20 through the main building of the military from his unit in concert with the local military treatment facility, while simultaneously treatment facility, initiated an innovative PI preparing for an expected surge in need for project utilizing the parachute rigger’s sewing inpatient hospital beds and continuing to meet skills and the abundance of medical grade outpatient clinical needs. The specific design of materials already available on the shelf at the the outdoor clinic including “hot” and “warm” hospital to create face coverings.1 Over the zone tents, extended-PPE approach, patient course of the following month, thousands of flow and staffing models are further described. masks were produced for active duty service The FPM article features how the outdoor members and essential workers until the urgent care initiative enabled effective care for medical supply chain was able to catch up low-to-medium acuity, potentially infectious with delivering ample stocks of conventional patients at their MTF, decreased ED visits for PPE equipment. The increased availability non-severe infections by 50%, decreased the of masks proved critical in helping to “flatten utilization of housekeeping inside the facility, the curve” of COVID-19 infection in the and preserved valuable PPE. local community. 7SFG parachute riggers worked tirelessly running 24/7 mask-making Virtual Academic Curriculum in operations that produced over 500 masks per GME. U.S. Army CPT Anne Poch and day creating a total of 9,380 masks in one sports medicine literature.6-11 One aim of PGY3 residents Drs. Lea Choi, Charles month.1 Similar efforts were inspired within their process improvement project is to work Mounts, Kevin Hudson, Brenton Smith U.S. Army Special Operations Command at with local community partners to streamline and Parker Ballentine at Womack Army Joint Base Lewis-McChord with 1st Special the diagnostic work-up process for the Medical Center Family Medicine Residency Forces Group and Fort Carson with 10th service members who are deemed higher- Clinic are spearheading a prospective quality Special Forces Group.2,3 risk after initial assessment and who require improvement project during the COVID-19 more extensive diagnostic testing, such as pandemic to develop a virtual residency Post- COVID-19 Return to Duty Clinic. echocardiogram, before being cleared to return academic curriculum using a flipped learning U.S. Air Force Captain Anne Marie Kennedy to duty. This project is in the early stages of model.13 The project aims to maximize resident and her colleagues, Drs. Sara DeSpain and development. In the past month, the post- and staff learning and involvement in residency Dr. Craig Becker with the 55th Medical COVID clinic has assessed 54 of the 134 total academics while the military treatment Group (MDG) at Offutt Air Force Base, COVID-positive cases on their base. The facility’s policies related to COVID-19 Nebraska are leading efforts to establish a 55th MDG uniformed family physicians are discouraged in-person meetings (e.g. face- comprehensive return-to-duty clinic for all working closely with their Patient Safety and to-face learning). The study team divided the active duty members who have been diagnosed Quality Improvement office to continually residents, staff, and medical students based with COVID-19 at Offutt.4 Due to new improve and streamline their local COVID-19 on level of training into “academic teams” and evidence highlighting the possibility for viral active duty return to duty screening and then assigned three American Family Physician cardiomyopathy in COVID-19 positive diagnostic evaluation protocols so that their (AFP) journal articles to each team. The patients,5 as well as unknown potential long- model can be adapted by other military academic teams collaborated virtually to create term cardiovascular and respiratory sequelae of treatment facilities or expanded to benefit a virtual discussion session with corresponding COVID-19 disease, Dr. Kennedy’s team has larger populations, such as all TRICARE questions for two of their assigned AFP identified a potential need to perform baseline beneficiaries at Offutt who have contracted articles. Participant learners read the AFP clinical screening in order to return active COVID-19. articles and answered the team’s questions in duty members to duty and physical activity as advance of a live virtual discussion session that safely as possible. Their process improvement Outdoor COVID-19 Urgent Care the academic team facilitated using Zoom project is based on implementing “Appendix Services and Testing. As recently featured in and MS Teams technology. For the third H: Post-COVID-19 Cardiopulmonary Family Practice Management online journal, AFP article, the academic teams collaborated Return to Exercise Recommendations” USAF physicians Drs. David Garcia, Esther to create an interpretive video inspired by the from the most recent version of the DoD Guard, and Krystal Thumann established a content of the article. The videos ranged from COVID-19 Practice Management Guide drive-up, outdoor urgent care clinic in response serious didactics to light-hearted episodes and emerging post-COVID return-to-play to COVID-19.12 The primary goal of the of doctors rapping. A post-intervention recommendations in adult and pediatric outdoor clinic was to decrease patient flow continued on page 24

22 The Uniformed Family Physician • Fall 2020 Join Our Team We are looking for the following specialties: HOSPITALIST & OB/GYN With over 60 physicians representing 29 medical specialties, we are looking for additional physicians to join our team. Our Advantages Our Community • Competitive Salary & Incentive Plans • Home to MSU Racers - NCAA Division 1 Basketball • Student Loan Payment Assistance • Convenient to Land Between the Lakes Outdoor • Coverage of Medical Licenses & Dues Recreation - hike, camp, hunt, golf, boat, and enjoy. • Coverage of Malpractice Insurance • Top Ranked Schools in Kentucky • $15K Relocation • Friendliest Small Town in America by Rand McNally • $6K Continuing Medical Education Allowance • #1 Best Place to Live in Kentucky • Professional Fulfillment • 100 Best Communities for Young People • Flexible Work/Life Balance • Playful City, USA Designee

To find out more about joining our team - Call Stephanie Nutter-Osborne, Provider Liaison, 270.762.1583 or email [email protected] www.usafp.org 23 continued from page 22 coronavirus-7th-group-parachute- Long, B; Brady, WJ; Koyfman, A; Gottlieb, questionnaire including Likert scale and riggers-turn-skills-to-fight-against- M. Cardiovascular complications in open-ended questions was delivered to the covid-19 COVID-19. Am J Emerg Med. July 2020; learners and academic teams immediately Defense News. Special Forces Soldiers 38(7): 1504-1507. after the educational sessions. PDSA cycle 1 Make Masks for Health Care Matos, R.; Chung, K. DoD COVID-19 data is currently being analyzed and will be Workers. April 3rd, 2020. Accessed PRACTICE MANAGEMENT used to inform future process improvement September 10, 2020. https://www. GUIDE: Clinical Management of cycles. Overall, the learners highly regarded defense.gov/Explore/News/Article/ COVID-19. Version 4.0. 18 June 2020: the learning value of the videos, and Article/2136501/special-forces- 129-130. members of an academic team report having soldiers-make-masks-for-health-care- Phelan D, Kim JH, Chung EH. A game fun while collaborating to develop their workers/ plan for the resumption of sport and discussions and videos. Crail, C. 10th Special Forces Group exercise after coronavirus disease 2019 COVID-19 efforts. Defense Visual (COVID-19 infection. JAMA Cardiology. REFERENCES Information Distribution Service Retrieved 23 Jul 2020 from https:// Thompson, Jim. CORONAVIRUS: th7 Featured Video. April 16, 2020. jamanetwork.com/journals/jamacardiology/ Group parachute riggers turn skills Accessed September 10, 2020. https:// fullarticle/2766124. to fight against COVID-19. Florida www.dvidshub.net/unit/10SFG. Baggish A, Drezner JA, Kim J, et al. Health News. April 15th, 2020. Accessed Correspondence with Dr. Anne Marie Resurgence of sport in the wake of September 10, 2020. https://www. Kennedy, Offutt Air Force Base, COVID-19: cardiac considerations in nwfdailynews.com/news/20200415/ September 15, 2020. competitive athletes. Br J Sports Med. Epub ahead of print 23 Jul 2020. Doi:10.1136/ bjsports-2020-102516. Niefs AM, Bloch W, Friedmann-Bette B, et al. Position stand: return to sport in the current coronavirus pandemic (SARS- CoV-2/COVID-19). German J or Sports Medicine. 2020;71:E1-E4. Dean PN, Jackson LB, Paridon SM. Returning to play after coronavirus infection: pediatric cardiologists’ perspective. American College of Cardiology. Retrieved 23 Jul 2020 from https:// www.acc.org/latest-in-cardiology/ articles/2020/07/13/13/37/returning-to- play-after-coronavirus-infection. Elliot N, Martin R, Heron N, et al. Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med. Epub ahead of print 13 Jul 2020. doi:10.1136/bjsports-2020-102637. Garcia, D; Guard, E; Thumann K. Building an Outdoor Urgency Care Clinic During a Pandemic: One Clinic’s Experience. FPM online. July 21, 2020. Accessed September 10, 2020. https://www.aafp.org/journals/ fpm/content/outdoor_clinic.html Correspondence with Dr. Donald Chaffee, Womack Family Medicine Residency Faculty, September 10, 2020.

24 The Uniformed Family Physician • Fall 2020 Family Medicine Residency Core Faculty Physician Penn State Health St. Joseph Medical Center Reading, PA Penn State Health St. Joseph is seeking a BC/BE family medicine physician to join our team as a faculty member in our 6-6-6 Family and Community Medicine Residency Program in Berks County, PA. Priority will be given to candidates interested in inpatient medicine. The Family and Community Medicine Residency Program strives to provide excellent education in training family physicians to provide comprehensive, compassionate, coordinated and continuous high-quality patient-centered care to the community served by our Program. Duties include teaching, mentoring, advising, and supervising residents; engaging in scholarly activity; and providing patient care. The residency program fosters a supportive family-oriented environment that encourages work-life balance. Job Requirements • Medical degree - M.D., D.O. or foreign equivalent • Completion of an accredited Family Medicine residency program • Board certification/eligibility in Family Medicine • Experience in an academic setting preferred • Conversational Spanish speaking skills preferred TO APPLY, PLEASE SEND YOUR CURRICULUM VITAE (CV) TO: Greg Emerick, MHA, FASPR - Physician Recruiter Department of Human Resources • Penn State Health E-mail: [email protected] • Phone: 717-531-4725

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

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www.usafp.org 25 Douglas Maurer, DO, MPH, FAAFP committee report OTSG, Falls Church, VA EDUCATION Top Medical Apps for Your Smart Device: Fall 2020 Edition

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

Greetings, everyone! Here is my Evidence based medicine Overall curated selection of the best apps for the The Brigham Health COVID Protocols The new Brigham COVID Protocols fall of 2020 for your smart device! Happy app is the most impressive collection yet of app is now the go-to app for healthcare downloading! evidence-based and expert opinion content professionals caring for COVID patients. on COVID-19 in an iOS app. The quality The app covers everything from PPE to 1. COVID Protocols: The Brigham of the writing, Pubmed References, and current epi stats, work-up, treatment, and Hospital Approach to COVID timely content is impressive. The content guidance for specific medical specialties for/from specific medical specialties is truly from Critical Care to Palliative Care, The Brigham and Women’s Hospital unique and not commonly seen in existing etc. The app links to numerous other released a comprehensive app of all of guidelines. guidelines such as the WHO and SCCM. their COVID-19 protocols. They are also available online. This app joins a Price Available for download for iPhone, iPad, growing list of guidelines and protocols ż Free and online. Android app not available at from Johns Hopkins (via the Relief this time. Central and Hopkins Abx Guide apps), Likes ż https://apps.apple.com/us/app/covid- WHO, Society of Critical Care Medicine ż Textbook like in its protocols/id1514563997 ż https://covidprotocols.org (SCCM), National Institutes of Health comprehensiveness, but highly usable. ż Covers numerous medical specialties (NIH), and others. However, none of them unique perspectives on COVID. to date have covered the topic quite this ż Available online at https:// 2. MyDirectives MOBILE App: Create comprehensively. Over 100 physicians covidprotocols.org. and Bring Advanced Directives and allied health providers at Brigham Anywhere Health contributed to the app covering Dislikes protocols from the basics of epidemiology ż Contains some sections clearly MyDirectives.com first launched their and work-up to Critical Care, Cardiology, Brigham only applicable. companion app for iOS in 2015. Their ż Most multimedia content requires Psychiatry, Obstetrics, and many more. website and app can be used separately, internet access. ż Not available for Android at this time. but ideally they should be together. The

If interested, please send a request to [email protected]. Tools Available: • Every Doc Can Do Research Workbook Have you wanted to do a research project but were not sure • Every Doc Can Do A Poster how? Would you like a user friendly workbook to help you over • Every Doc Can Do A Scholarly Case the inertia of starting a project? The Clinical Investigation Report Workbook Committee is pleased to offer user friendly tools for Clinical Investigation Research Tools also organizing, planning, and starting a research project. available on-line at www.usafp.org.

26 The Uniformed Family Physician • Fall 2020 website discusses the goals of “create, contact information, medical information, 3. ASCCP Management Guidelines App update, and share”. Any updates made in videos, etc.). Recommended most highly. Review: Cervical Cancer Screening the app or on the website seamlessly sync Needs an Android version. App New and Improved! with one another and with the Apple Health app. The app allows the user to Available for Download for iPhone, and The American Society for Colposcopy digitally sign the plan, make a video of iPad. Not available for Android at this and Cervical Pathology (ASCCP) just your wishes, use photos and videos to time released their latest update in April 2020 confirm your identity, share the Advance ż https://apps.apple.com/us/app/ and simultaneously released an updated Care plan with others via email, text, QR mydirectives-mobile/id931433126 guidelines app. This new app looks and reader, and show on iPhone lock screen! continued on page 28

Evidence based medicine The app takes the “best practices” in advance care planning and guides the user in the creation of a valid document signed by the user. The primary website provides even more care plan options to create a truly state-of-the art advance care plan. #FDPNF
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EEO/AA/Minorities/Females/Disabled/Veterans detailed information that can be imported from the iPhone into the app (pictures, www.usafp.org 27 continued from page 27 format that works like a decision support Likes tool for your smartphone. Additionally, ż Contains the current ACIP/CDC feels dramatically different from the the app contains all of the guidelines, vaccine recommendations as well as those recommended by the military previous app. It will take users of the prior graphics and relevant publications from for Soldiers across the DOD. app some time to get used to it. The first the ASCCP. ż Abundant information about time I used it I didn’t “get it”. But after each vaccine including catch-up using it for several patients/teaching with Available for Download for iPhone, schedules, additives, and shared residents, it finally clicked. The app walks iPad, and Android. decision making, vaccine myths, etc. you through the guidelines based on your ż https://apps.apple.com/us/app/ o Available for Android. patients’ current/past data and provides asccp-management-guidelines/ id1498550832 recommendations for follow-up as well as Dislikes ż https://play.google.com/store/apps/ ż No hyperlinking from vaccine tables a risk estimate for cervical cancer that is details?id=org.asccp.app2019 individualized to that particular patient. to individual vaccines. ż Tables can appear busy on a smaller 4. Immunization Tool Kit (ITK) App smartphone screen. Evidence based medicine Review: Detailed Immunization ż Some information is challenging This new version of the ASCCP Guide for Pediatric, Adult, and to find quickly within the many Management Guidelines incorporates all Military Vaccinations from the DHA sub-menus. of the latest ASCCP recommendations and tools for cervical cancer screening The Defense Health Agency (DHA) Overall and follow-up in one outstanding POC Immunization Healthcare Division has The new ITK app from DHA is app. The app contains the full guidelines, just released the ninth edition of their outstanding. Although this is the ninth graphics, and relevant publications popular Immunization Toolkit. This year edition of the immunization toolkit, all native to the device (no internet is the first time it has been available as a this is the first time it has been released hyperlinks required). POC app. The app contains the current as an app. The information on military immunization recommendations from vaccines sets this app apart from the more Price the ACIP/CDC and military vaccine commonly recommended CDC and o $9.99. schedules. The app works more like a STFM vaccine apps. textbook/quick reference guide as it is Likes divided into numerous sections with Available for Download for iPhone, ż New design is easy, intuitive, and subsections covering risk management, iPad, and Android. more functional than the old vaccines, injections, adult and military ż https://apps.apple.com/us/ ASCCP app immunizations, vaccine storage and app/immunization-tool-kit/ ż High quality graphics, publications id1490475609 handling, and pediatric immunizations. all native to device. ż https://play.google.com/store/apps/ ż Available for Android. details?id=mil.dha.itk&hl=en_US Dislikes Evidence based medicine ż Redesign takes some getting used The ninth edition of the to if you have always used the Immunization Tool Kit (ITK) previous version. incorporates the most current vaccine ż App would benefit from improved directions, video guide, or similar. guidelines published by the ACIP/ ż PDFs can be challenging to read on CDC as well as military/DOD sources. the smaller smartphone screens. The app is packed with additional information on vaccines from the basics Overall of dosing, to catch-up schedules, to risk The newly refreshed ASCCP management, to vaccine storage and Management Guidelines app is an handling. excellent tool for anyone involved in women’s health. The app still provides the Price latest guidelines from the ASCCP in a ż Free.

28 The Uniformed Family Physician • Fall 2020 JOIN A TEAM OF PHYSICIANS CARING FOR HEROES

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www.usafp.org 29 Janelle Marra, DO, FAAFP, CAQSM committee report CLR-17 Regimental Surgeon MEMBER CONSTITUENCIES Camp Pendleton, CA [email protected] Anal Cancer Screening

Over the past 20 years, there has been an recommends anal cancer screening in men seconds). The provider would send the labeled increased awareness of the Human Papilloma who has sex with men (MSM), women with sample to the lab, with an order for cytology Virus( HPV) and the role of HPV in many a history of abnormal cervical pap smears, and (non-gyn), and high-risk anal HPV. You may cancers. Cervical cancer screening was the first all HIV positive people with genital warts. also use the liquid-based sample to test for to utilize HPV screening as a follow up test There are varied estimates of progression rectal gonorrhea or chlamydia, if your patient after an abnormal pap smear (2001), later as of anal dysplasia , with estimates of desires to be screened for this. recommended co-testing in certain age groups immunocompromised patients having up Follow up is based on the results of the (2003), and then allowing increased time to a 50% progression from premalignant cytology and HPV test, and the Cleveland interval of 5 years between co-tests (2012). to invasive disease, if left untreated. The Clinic recommendations are referenced in the Anal cancer screening, through anal cytology Anal Cancer HGSIL Outcomes Research review article on anal dysplasia by Ortoski (anal pap smear) and HPV testing has been (ANCHOR) study is examining the risk of and Kell. The follow up for dysplasia (LSIL a more recent addition to many primary progression of HSIL in HIV positive patients, or HSIL) or ASCUS with HPV+ is high care providers practice. Similarities between in a multicenter study. A study by Scholefield resolution anoscopy (HRA), typically available cervical cancer and anal cancer include the in 2011 estimated a 10% risk for progression through a referral to a trained provider (my presence of HPV (up to 88-99% in both from high grade dysplasia to invasive cancer local provider I refer to is a colorectal surgeon). cancers) and occurrence of malignancy at the over a 5-year timeframe. Early stage anal As the prevalence of vaccination for HPV squamocolumnar junction. Like many cancers, cancer has a 5-year survival rate of 80% , while increases, in all gender patients, hopefully the catching the dysplasia in the early stages has a disseminated anal cancer 5-year survival rates rates of all HPV related cancers will drop. In much more favorable outcome. Unfortunately, drop to 30%. Immune suppression, as seen in the meantime, I look forward to hearing about unlike cervical cancer, which has seen a HIV, and kidney and renal transplant patients additional recommendations and guidelines to significant drop in the incidence over the past shows a higher incidence of anal cancer, as well assist in the role of primary care providers in 50 years, anal cancer is on the rise. as an increase in the 5- year mortality rate. anal cancer screening. At this time, there are no international Performance of an anal pap smear, and consensus guidelines for anal cancer screening, HPV co-testing is straightforward. Supplies REFERENCES: but there are several guidelines available, and needed would include a dacron tipped swab Evolution of Cervical Cancer Screening in the many providers in specialty as well as primary (moistened with water, and the liquid based US and Canada https://www.ncbi.nlm.nih. care clinics have begun offering anal cancer medium(eg ThinPrep). The swab is inserted 2 gov/pmc/articles/PMC4515308/ screenings to their patients. The anal pap inches into the anal canal, rotated firmly with Anal Cancer and intraepithelial neoplasia smear was first introduced in the 1990’s, with lateral pressure using tight spiral motions on screening https://www.ncbi.nlm.nih.gov/ the addition of high-risk HPV testing around withdrawal for 15 seconds. The swab is then pmc/articles/PMC4724586/ 2014. The HIV Medicine Association of placed in the medium and the swab is swished The Study of the Prevention of Anal Cancer the Infectious Disease Society of America vigorously to remove the cells (for 15-20 (SPANC) https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3852594/ The ANCHOR study www.anchorstudy.org Anal Cancer and Screening Guidelines for HPV in Men https://jaoa.org/article. aspx?articleid=2094205 Anal Cancer Information, Obtaining a Specimen for anal cytology UCSF https://analcancerinfo.ucsf.edu/obtaining- specimen-anal-cytology

From the Anal Cancer and Screening Guidelines in Men( JAOA) https://jaoa.org/article.aspx?articleid=2094205

30 The Uniformed Family Physician • Fall 2020 FIND YOUR FUTURE WITH BAPTIST HEALTH

BAPTIST HEALTH MEDICAL GROUP IS SEEKING BE/BC PRIMARY CARE PHYSICIANS. If you are ĂƉƌŝŵĂƌLJĐĂƌĞƉŚLJƐŝĐŝĂŶůŽŽŬŝŶŐĨŽƌĂŚĞĂůƚŚƐLJƐƚĞŵǁŚĞƌĞLJŽƵĐĂŶďĞĂǀŝƚĂůƉĂƌƚŽĨƚŚĞƚĞĂŵ͕ĂƉƟƐƚ,ĞĂůƚŚ ǁŽƵůĚůŝŬĞƚŽŚĞĂƌĨƌŽŵLJŽƵ͘ƚĂƉƟƐƚ,ĞĂůƚŚDĞĚŝĐĂů'ƌŽƵƉ͕LJŽƵ͛ůůĮŶĚĂĐĂƌŝŶŐ͕ĐŽůůĂďŽƌĂƟǀĞĞŶǀŝƌŽŶŵĞŶƚ͕ǁŚĞƌĞ leadership listens, work/life balance is a priority, and there is a strong focus on family.

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ŚŽŽƐĞĂƉƚŝƐƚ͘ĐŽŵ www.usafp.org 31 MEMBERS IN THE NEWS Congratulations to USAFP President Debra A. Manning, MD, MBA, FAAFP on Her Selection as AAFP Commission Chair. Dr. Manning was selected during the 2020 AAFP Virtual Congress of Delegates to Chair the AAFP’s Commission on Finance and Insurance. This commission reviews various matters of the AAFP both as routine charges of the commission and upon referral from the Board, other commissions and committees, or the Congress of Delegates. Specifically the commission’s responsibilities include: Financial Performance, Budgets, Investments and Risk Management. Deb has served as a member on the commission for the last four years and will serve as Chair for the 2020-21 term. Congratulations Deb!!

USAFP Past President James Ellzy, MD, MMI, FAAFP announced his candidacy for AAFP President-Elect USAFP Past President James A. Ellzy, MD, MMI, FAAFP announces his candidacy for AAFP President-Elect during the 2020 AAFP Congress of Delegates. Dr. Ellzy will run for this position next fall during the 2021 AAFP Congress of Delegates in Anaheim, CA.

Congratulations to the Uniformed Services University of Health Sciences for receiving the AAFP Award for Excellence in Promoting the Scope of Family Medicine. The Uniformed Services University was named 1 of 18 medical school Family Medicine Interest Groups (FMIGs) as 2020 Program of Excellence Award winners for their outstanding efforts to promote and advance family medicine at their medical schools and in their communities. Medical students and faculty were honored during the AAFP National Conference of Family Medicine Residents and Medical Students. The Program of Excellence Awards recognize FMIGs for their efforts to promote interest in family medicine careers at a time when family physicians are in especially high demand for their comprehensive primary care expertise. Congratulations to the USU FMIG for winning in the Award for Excellence category Promoting the Scope of Family Medicine!

32 The Uniformed Family Physician • Fall 2020 Arkansas’ Premier Behavioral Healthcare System Proudly Serving Our Military Families

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TRICARE® %GTVKƂGF p64+%#4'qKUCTGIKUVGTGFVTCFGOCTMQHVJG www.usafp.org64+%#4'/CPCIGOGPV#EVKXKV[#NNTKIJVUTGUGTXGF 33 Courtney E. Halista, MD committee report Family Medicine Faculty RESIDENT AND STUDENT AFFAIRS Travis AFB, CA [email protected]

What a year! And it’s not over yet. assigned to a pod and would work at a diagnoses on admission. I did not receive any Currently, the President of the United States computer in the center of the pod. Rounds verbal sign-out. It was my responsibility to of America, the Commander in Chief, is were efficient and comprehensive because the read the admitting physicians’ note and the admitted to Walter Reed National Military nurse was easy to locate and could participate overnight nursing notes and piece together Medical Center for treatment of coronavirus. in the plan of care. Communication and the hospital course. It was laborious and time- At the same time, hospitals across the country teamwork were dramatically enhanced, consuming. In this respect, the transitions in are preparing for a Fall marked by not one, leading to more streamlined patient care. This care that I’ve experienced within the military but two deadly viruses. Simultaneously, arrangement is different than where I currently medical system have been far more efficient. restaurants, hair salons, and schools attempt to practice and something that I plan to promote At the end of August, I returned from this reopen their doors, while struggling to combat locally. deployment feeling reinvigorated. It was an the increased risk of disease transmission. I do Second, I was impressed by the amazing opportunity to compare disparate not think that anyone could have predicted the functionality of their electronic medical systems of care while providing for those in profound impact that this virus would have on record, particularly by a program for managing need. While there will always exist areas for every aspect of our daily lives. diabetes in the inpatient setting. The improvement, I can confidently say that my I was personally impacted when, in program was called Glucommander and was military medical training prepared me well. early July 2020, I was notified that I would designed to improve glucose control through I plan to use this experience to improve the be deploying to Visalia, California, a rural, automation. All patients with diabetes who education of the next generation of physicians. farming community in the Central Valley. required insulin therapy were placed on the Therefore, when they are called upon to serve, Along with 20 other physicians, nurses, Glucommander program at the time of they’ll be ready too. respiratory therapists, and technicians from admission. Throughout the hospital stay, Residents and students – as you progress David Grant Medical Center, I was tasked the program would automatically adjust the through your medical education, I challenge to provide support to a population that was patients’ basal and bolus insulin dosing based you to approach each and every rotation as ravaged by COVID-19. I was assigned to on serial blood glucose measurements. At the an opportunity for growth. I remember the work as a “COVID hospitalist” at Kaweah time of discharge, the physician could simply frustration associated with changing rotations Delta Medical Center, a level three trauma click the “Discharge” button and the program every four weeks. New Attendings, different center located in downtown Visalia. During would generate a recommended home schedules, unfamiliar expectations – it was my deployment, I had over 150 patient insulin regimen, which could be printed and difficult to achieve a sense of proficiency. contacts with individuals afflicted by handed to the patient. Needless to say, I was However, I now respect the process. This COVID-19. Some patients required minimal impressed! The only downside that I imagine deployment helped me to recognize the value supplemental oxygen and were discharged from universal adoption of an automated in change itself. I realized that I am far more home within days. Others required maximum insulin management program would be adaptable than previously imagined and able high flow and, ultimately, succumbed to their the lost learning opportunities for medical to integrate into unfamiliar systems with ease. disease. It was an emotionally and mentally students and resident physicians. However, Going forward, I encourage you to learn to challenging experience, but an excellent as the country moves toward safer, more embrace change, adapt, and overcome. The learning opportunity. evidence-based medical care, I suspect that an more you challenge yourself now, the better Between donning and doffing PPE, I had automated insulin management program will prepared you will be when called upon to serve an opportunity to reflect on the similarities become the new standard. new faces in unfamiliar places. and differences between military and civilian Third, I was astounded by the differences If you are interested in learning more about medical care. I’d like to share my observations in physician communication. As a core David Grant Medical Center’s COVID-19 with you. faculty member in a residency program, I am relief efforts at Kaweah Delta Medical First, I noticed that nursing assignments accustomed to detailed verbal sign-outs and Center, visit https://abc30.com/kaweah-delta- on the inpatient wards at Kaweah Delta thorough documentation. I quickly learned military-workers-honored-doctors-nurses- Medical Center were deliberate and that this is not the standard in a non-academic visalia-covid-team-coronavirus/6393027/ and/ thoughtful. The inpatient rooms were setting. Every morning, I was presented with or https://youtu.be/sc6Xnq3QyjU. arranged as pods with four rooms surrounding a stack of patient face sheets that contained a central access point. Each nurse was demographic information and the patients’

34 The Uniformed Family Physician • Fall 2020 Tyler S. Rogers, MD, FAAFP Leadership Book Series Madigan Army Medical Center JBLM, WA [email protected] Brave New Work: Are You Ready to Reinvent Your Organization BY AARON DIGNAN

The year 2020 has been one for the anecdotes and accounts of personal 8. Be worried about the propriety books. As organizations across the world experiences. of any decision—raise the have responded to the changes due to 3. When possible, refer all matters question of whether such action the coronavirus pandemic, and as we to committees for “further study as is contemplated lies within the navigate the intense process of selecting and consideration.” Attempt to jurisdiction of the group or whether a new set of leaders in the United States, make the committees as large as it might conflict with the policy of many organizations, including the possible—never less than five. some higher echelon. military health system (MHS), have had 4. Bring up irrelevant issues as 9. When training new workers, opportunities to explore new ways of frequently as possible. give incomplete or misleading reaching their goals. Ideally, we can take 5. Haggle over the precise wordings instructions. this chaotic (or unique) time to create of communications, minutes, 10. Hold conferences when there is some opportunities to reinvent many parts resolutions. more critical work to be done. of our organizations. Within the Leader 6. Refer back to matters decided upon 11. Multiply the procedures and and Faculty Development Fellowship at the last meeting and attempt clearances involved in issuing at Madigan Army Medical Center we to reopen the question of the instructions, paychecks, and so discussed this book to get ideas on how advisability of that decision. on. See that three people have to to accomplish this type of change in our 7. Advocate “caution.” Be “reasonable” approve everything where one fellowship, Madigan, and the MHS at and avoid haste which might result would do. large. Admittedly, I realize that our ability in embarrassments or difficulties 12. Apply all regulations to the last letter. to reinvent parts of military organizations later on. is limited in a lot of very substantial continued on page 36 ways. Even though we might not be able to accomplish all of the radical changes FIGURE 1: CI FIELD MANUAL suggested in this book, we can advocate for changes in our sphere of influence, and we should take this time to do this “brave new work.” This book opens with the following suggestions for how to be successful as a company. 1. Insist on doing everything through “channels.” Never permit shortcuts to be taken in order to expedite decisions. 2. Make “speeches.” Talk as frequently as possible and at great length. Illustrate your “points” by long Accessed at https://www.cia.gov/news-information/featured-story-archive/2012- featured-story-archive/simple-sabotage.htm

www.usafp.org 35 continued from page 35 if your operating system communicates commons” concept, which supports the At this point, you are either laughing assumptions that are not true, no amount idea that employees cannot share common or crying, depending on how much this of commitment, restructuring, or wellness resources. For each of the twelve domains, resonates with you and your organization. retreats will accomplish the change you there were several innovative and fun ideas This list of suggestions is part of the desire. He asserts that viewing your for leaders to use. “Simple Sabotage Field Manual,” a larger organization through wrong assumptions The final portion of the book may be pamphlet that the CIA developed during pushes the team to retreat to “how things one of the most significant: change is not World War II to give to citizen members used to be done.” After establishing the a finite destination. It is so vital that we of the resistance in enemy-controlled importance of the operating system, the consistently evaluate how we are doing as countries to sabotage Axis Power book identifies some ideas of how we got leaders and to evaluate the opportunities economies. Pause. Think. The fact that to this point. He discusses interesting for our organizations to improve. It is many of our organizations are burdened historical perspectives and the concept an ongoing process that should be done with the bureaucratic shackles described of organizational debt, which is any responsibly and systematically. This book in this pamphlet should raise concern for structure or policy that no longer serves outlines six patterns worth encouraging all of us. Are we sabotaging ourselves? the organization. The author suggests, when considering responsible change. It These concepts are also things that “This debt needs to be removed through is essential as leaders to ask teammates to should empower us to think differently vigilant simplification to create roles, rules, consider commitment, boundaries, priming, about how we do things. Bureaucracy and processes that are inherently agile. looping, criticality, and continuity. The book costs the United States in excess of three Unfortunately, organizational debt creates emphasizes the importance of cultivating a trillion dollars in lost annual productivity1. bureaucracy, and bureaucracy protects safe space to facilitate change with multiple More importantly, the costs to employee organizational debt.” The book then ideas on how to accomplish this. satisfaction, innovation, and mental health discusses the antidote, which it describes In conclusion, this book has given us of the humans we work with are extremely as “Evolutionary Organizations” who are a challenge to look for opportunities to high. As leaders, we must realize that “people positive” by trusting employees and “reinvent” the organizations in which we higher-order capabilities like initiative, “complexity conscious” by keeping things work, especially in these turbulent times. creativity, and passion are gifts that people as simple as possible. The overwhelming urge to stick with the choose to bring to work2. It is our duty The second portion of this book status quo in organizations with a lot of as leaders to create an environment where dives into the idea of evaluating your red tape is understandable, but you can be employees want to share these gifts. organization’s operating system by looking the change you want to see in the sphere This book addresses this critical issue at twelve domains of what he describes as that you influence. I hope that everyone and gives some very innovative ideas on the operating system canvas (Figure 2). is staying safe as we continue to navigate how we, as leaders, can begin to think For each of the domains the book offers these uncertain and interesting times. differently about work. By juxtaposing “thought starters,” which are examples Find ways to thrive now. Do not wait on some essential ideas; the need for more from evolutionary organizations to help COVID to enjoy what you do. Do not let time and the time we fill with meetings; you start to challenge the assumptions bureaucracy and the status quo win. I look the need for more information and the of your operating system in that domain. forward to seeing everyone on the same clogged lanes of communication; the need Each domain section also discusses side of the screen in the near future. Please for innovation and the aversion to risk, ways to take action, insights to consider, let me know if you have any comments or the author highlights again that “work” is and questions to ask. This discussion is questions at [email protected]. simply not working. The framework of the essence of the book and the most this book is built on the idea that every significant opportunity to learn for leaders. REFERENCES: organization operates under a set of One example of a thought starter was the 1. Hamel G, Zanini M. Assessment: Do assumptions that are communicated by idea that job titles mask the multiple roles you Know How Bureaucratic Your the design of the organization’s operating that most employees play and can stifle Organization Is? Harvard Business system. These assumptions, portrayed innovation if the employee does not feel Review. May 16, 2017. by the operating system, often do not empowered to participate outside of their 2. Iyer C. The Real Cost of Bureaucracy: align with the organization’s established specific title. Another example of ways to Lessons for HR Leaders from Gary vision and goals. Dignan highlights that take action is to remove the “tragedy of the Hamel. HR Technologist. May 30, 2018.

36 The Uniformed Family Physician • Fall 2020 FIGURE 2: THE OPERATION SYSTEM CANVAS

Accessed at https://itsyourturnblog.com/brave-new-work-by-aaron-dignan-7873f485a251

www.usafp.org 37 2020 Virtual AAFP Congress of Delegates OCTOBER 3-4 & OCTOBER 11-13

USAFP members serving as AAFP Delegates were 2020 was very interesting as the Congress was held President Debra A. Manning, MD, MBA, FAAFP and virtually. The reference committees were held on 3-4 USAFP President-Elect Aaron Saguil, MD, MPH, October and provided members the opportunity to publicly FAAFP. USAFP member serving as AAFP Alternate comment on the 28 resolutions submitted by constituent Delegate was A. Marcus Alexander, MD, FAAFP. Kevin chapters. Reference committees are committees of the M. Bernstein, MD, MMS, FAAFP served as AAFP COD that consider business (resolutions) items referred Member Constituency (New Physician) Delegate and to them for recommendation to the COD for debate Megan B. Mahowald, MD as AAFP Member Constituency and action. AAFP members were welcome to participate (Woman) Alternate Delegate. in hearings of the four reference committees: Advocacy, The Congress of Delegates (COD) is the American Health of the Public and Science, Organization and Academy of Family Physicians’ (AAFP) policy-making Finance, and Practice Enhancement. body. Its membership consists of two delegates and two The Congress elects new officers and members to alternates from each constituent chapter and from the serve on the Board of Directors during the meeting. The member constituencies including new physicians, residents, Officers and Board Members elected are noted below. students, and other constituency groups represented at the AAFP Leadership Conference. The Congress of Delegates Sterling Ransone, MD, Virginia, President-Elect meets annually to address resolutions brought forward Alan Schwartzstein, MD, Wisconsin, Speaker by constituents on topics that are of interest to physician Russell Kohl, MD, Kansas, Vice Speaker members and the patients they serve. Todd Shaffer, MD, Missouri, Director Mary Campagnolo, MD, New Jersey, Director Jennifer Brull, MD, Kansas, Director COMING SOON . . . . Danielle Carter, MD, Florida, New Physician Director Anna Askari, MD, California, Resident Director A NEW USAFP.ORG Cynthia Ciccotelli, Pennsylvania, Student Director During the meeting (held prior to AAFP FMX), the Congress of Delegates agenda included addresses from AAFP The USAFP is currently working on a new website officers, resolutions from chapters, and reports from the for the organization that will have a modern look and Board of Directors. The wide array of resolutions focused enhanced ease of use for our members. To make the on universal healthcare coverage; public health initiatives to site personal to the USAFP and our amazing mem- include vaccines and buprenorphine administration; ending bers, we are soliciting photos that can be used on police brutality; firearm safety; telehealth; reducing regulatory the site. Ideally the photos will capture the incred- and administrative burden, pharmacy services; gender ibly dedicated work you do every day. affirming care; reproductive health related issues; and medical aid in dying just to name a few. To submit photos, please e-mail the highest If you are interested in learning more about the AAFP resolution format you have to Cheryl Modesto at Congress of Delegates check out the link at https://www. [email protected]. By submitting the photos, you aafp.org/about/governance/congress-delegates.html. agree that the USAFP may use the photo on the organization’s public website.

38 The Uniformed Family Physician • Fall 2020 Barrett Campbell, MD Notice of Proposed Bylaws Amendment Chair, USAFP Constitution, Bylaws & Strategic Charter Committee

Intent: The leadership of the USAFP, before the AAFP Congress of Delegates and obtain membership in the AAFP shall to align the USAFP bylaws membership in October 2020. It was adopted by the be ineligible for membership in USAFP. criteria with the AAFP’s membership Congress as written: USAFP members include active duty criteria, recommends the following military, former active duty military working amendment to the current bylaws. Article V, Chapters, Section 1. Classification, at a military facility, and students enrolled in a item C: military accession program. Voting members Background: The Constitution, Bylaws C. Uniformed Services. There shall be one include active and resident members.” & Strategic Charter Committee, Board unformed services chartered constituent of Directors and Clinical Investigations chapter for members serving in the THE PROPOSED USAFP BYLAWS CHAPTER I: Committee reviewed the bylaws of the Army, Navy, Air Force, Marine Corps, ELECTION OF MEMBERS SECTION I READS: USAFP and recommended an amendment Space Corps, Coast Guard, and the “The Academy shall be composed of the to CHAPTER I: Membership SECTION commissioned corps of the National same classifications of membership and the 1. The recommended amendment updates Oceanic and Atmospheric Administration same requirements for election to each class verbiage to be inclusive of all eligible and the Public Health Service. of membership as are outlined in the current members. revised edition of the Bylaws of the American Article V, Chapters, Section 2. Eligibility, Academy of Family Physicians. Any member As part of a standard approval process, item B: of USAFP who fails to apply for and obtain the Uniformed Services chapter submitted B. Uniformed Services. Members of the membership in the AAFP shall be ineligible the proposed amendment to the American uniformed services chartered constituent for membership in USAFP. Voting members Academy of Family Physicians (AAFP) chapter shall be persons who qualify for include active and resident members.” for approval. The change was in clarifying membership as stated in Article III and the definition of who can be a member of 1. are members of the uniformed THE CURRENT USAFP BYLAWS CHAPTER VII: the chapter since the Uniformed Services services; or MISCELLANEOUS SECTION 2 READS: current bylaws language does not include 2. former members of the uniformed As used in these Bylaws, the term the Public Health Service. The term “armed services who practice within a federal “uniformed services” shall mean the Air forces” refers to the Army, Navy, Air Force, facility; or Force, Army, Navy, and Public Health Marine Corps and Coast Guard. In 3. resident and fellow members of Service. addition, the term “uniformed services” (as the uniformed services enrolled in defined in Title 10 of United States Code) a military residency or fellowship THE PROPOSED USAFP BYLAWS CHAPTER VII: refers to the armed forces, the space force, training program or a civilian training MISCELLANEOUS SECTION 2 READS: the commissioned corps of the National program; or As used in these Bylaws, the term Oceanic and Atmospheric Administration 4. students in a uniformed services “uniformed Services” shall mean those and the commissioned corps of the Public medical school; or serving in the Army, Navy, Air Force, Marine Health Service. 5. students who have a service obligation Corps, Space Corps, Coast Guard, and the Before the Uniformed Services bylaws to the uniformed services upon commissioned corps of the National Oceanic are changed, a review of the AAFP bylaws completion of their training and who and Atmospheric Administration and the suggested that AAFP’s bylaws should also are eligible for membership. Public Health Service. be revised to more clearly indicate who is eligible for membership based on the THE CURRENT USAFP BYLAWS CHAPTER I: ELECTION The USAFP Constitution, Bylaws current definitions in Title 10 of the United OF MEMBERS SECTION 1 READS: & Strategic Charter Committee invites States Code. “The qualifications and conditions your comments on this proposed bylaw of membership and the categories of amendment. Feel free to contact Barrett AAFP staff recommended the membership shall be the same as those Campbell, MD at Barrett.h.campbell@ following changes to the AAFP bylaws established by the Bylaws of the AAFP gmail.com or any of your board members. to the AAFP Board of Directors in April including but not limited to any and all The USAFP Board of Directors will review 2020. It was adopted by the AAFP Board continuing education requirements. Any member input and take a final vote on the as written. The recommendations were put member of USAFP who fails to apply for proposed addition in February 2021. www.usafp.org 39 USAFP Academy Awards

MICHAEL J. SCOTTI, MD, FAMILY PHYSICIAN OF THE YEAR AWARD To nominate your peers for this outstanding award, This honor is bestowed on a Uniformed Family please send a letter of support to Matt Schulte (mschulte@ Physician who exemplifies the tradition of the family doctor vafp.org) no later than 12 January 2021. and the contributions made by family physicians to the Eligibility Criteria: continuing health of the people in the Uniformed Services. 1. Demonstrated substantial contributions, dedication, To nominate your peers for this outstanding award, initiative, leadership and/or resourcefulness please send a letter of support to Matt Schulte (mschulte@ in providing patient care in any operational vafp.org) no later than 12 January 2021. environment. Eligibility Criteria: 2. Outstanding service, devotion, dedication or 1. Provides his/her community with compassionate, compassion while performing his or her duties in comprehensive, and caring medical service on a any operational environment. continuing basis. 3. Concepts, procedures or methods developed by the 2. Directly and effectively involved in community nominee which resulted in significant reduction affairs and activities that enhance the quality of life in morbidity or mortality, workload required for of his/her home area. mission accomplishment, financial expenditures or 3. Provides a credible role model as a healer and material utilization. human being to his/her community and as a 4. Involvement in continuing education as a professional in the science and art of medicine researcher, participant, organizer or sponsor which to colleagues, other health professionals, and directly and materially improves operational especially, to young physicians in training and to medicine. medical students. 5. Humanitarian or military community involvement 4. Must be in good standing in his/her medical that substantially improves the health and readiness community. of the service member, their families or the 5. Must be a member of the USAFP. supported population. 6. Any other substantial contribution directly related OPERATIONAL MEDICINE AWARD to operational medicine not described above. This honor is to recognize a Uniformed Service Family 7. Must be in good standing in his/her medical Physician that has exhibited outstanding achievement community. in the provision, promotion or research in operational 8. Must be a member of the USAFP. medical care.

Aaron Saguil, COL, MC, USA USAFP Virtual Book Club [email protected]

Greetings, Friends! Members of the USAFP I’ll be facilitating the first session of the book club, and I leadership are interested in finding additional have a couple “guest facilitators” in the wings. If you are ways for members to connect. As a pilot for interested in more information, you may sign up through building virtual community, we would like to the Google Form here: https://docs.google.com/forms/ offer a virtual professional development book d/e/1FAIpQLSfbYVLofcI35-HTfaRtO0CqHDPv- club. Our first selection will be The Power of my6JzYBlF8MEVGvVpjlOA/viewform?usp=sf_link Moments: Why Certain Experiences Have Or you can scan this QR code to fill out the same Extraordinary Impact. Originally released in form on your phone. 2017, this book discusses how to bring additional I hope to “see” you to discuss The Power of Moments! meaning to all spheres of one’s life by creating positive moments that last. Cheers, Aaron

40 The Uniformed Family Physician • Fall 2020 WHEC

The Warrior Heat- and Exertion-Related Events Collaborative (WHEC) provides resources and expert advice for health professionals to help prevent, manage, and treat heat illness and related conditions among Military Service Members.

Visit HPRC-ONLINE.ORG/RESOURCES-PARTNERS/WHEC to learn more about: • Exertional heat illness • Exertional rhabdomyolysis • Exercise-associated hyponatremia • Exercise collapse associated with sickle cell trait • Exertional sudden cardiac arrest

HPRC OPSS Human Performance Resources by Operation Supplement Safety (OPSS) CHAMP (HPRC) is the go-to source for offers tools and resources to help users the facts on human performance. make informed decisions about dietary supplements to reduce the potential Learn how to: risks to their health and careers. • Boost your workouts • Eat healthier Featured resources include: • Improve relationships • Prohibited and High-Risk Lists • Sleep better • Interactive supplement scorecard • Cope with stress & anxiety • Alerts and announcements • Recover from illness or injury • Ask the Expert

TOTAL FORCE FITNESS

www.usafp.org HPRC-ONLINE.ORG OPSS.ORG 41 new members THE USAFP WELCOMES THE FOLLOWING NEW MEMBERS…

ACTIVE David DaCosta, DO Jonathan T. McGahee, MD Lucas Vandermyde, DO Randal A. Cieslak, DO Jill Danyluk, DO Kevin McMahon, DO Charisse Villareal, MD Alexander Eye, MD Preston J. DeHan, DO Jynna McMillin, MD Wesley C. Wagers, MD Constance C. Foreman, MD Michael T. Dolan, DO Varun Menon, MD Dawn K. Ward, DO Laura A. McCain, DO Joel Drallette, DO Janel Montfort-Tunstall, DO Joshua Waxenbaum, DO Geoffrey A. McLeod, DO Carly Epstein, DO Kayla C. Mowatt, DO Chase Weber, MD Laura Orlando, MD Lauren Ferguson, DO Robert Nallenweg, DO Nicole Westphal, MD Katy Reichlin, DO John K. Fitzpatrick, DO Kyle Olsen, DO Danielle Wilkin, MD Chloe Shea, MD Catherine M. Foley, MD Virginia A. Phillips, MD Lauren E. Williams, MD Brett Frazier, DO Devin A. Rickard, MD RESIDENT STUDENT Kurry A. Gasser, MD Adam Rifaat, MD Joseph R. Adamson, MD Ervin Anies Sydney A. Giblin, MD Kaleb T. Roberts, DO Abigail Axel, MD Jacob M. Deem Kendrick Go, MD Maria I. Rodionova, DO Matthew J. Ballew, DO Brandon Khoury Quang Gonzalez, MD Carolyn F. Rosenberg, MD David I. Bermejo, DO Arturo López de Nava Kristin Greer, MD David P. Samsel, MD, MPH Andrew Bohlen, DO Paige Macky Michael C. Harding, MD Phillip M. Scheanon, MD Addison Bray, MD Gregory Murtha James Harter, MD Blake Shaffer, MD Ishan Chopra, DO Cristah Prost Hayley Hatherly, DO Deserea M. Shoemaker, DO Stephanie Churchman, MD Shubham Tomar Thomas Kotnik, MD Samuel Steele, MD Payton Cline, DO Benjamin Lampe, MD Jillian Stone, MD Luke M. Conklin, DO Matthew C. Little, MD Jamison Tate, MD Steven Cornelius, MD Sara E. McCall, DO Zachary P. Thompson, DO

WHAT AM I SIGNING UP TO DO? WHEN AND HOW WILL I GET MY MATCH? Participant responsibilities are as Matches are made on a rolling basis. follows: Mentees should expect to receive an email • Communicate with your mentor/mentee identifying their mentor within 3 weeks of Looking for a mentor? at least once per quarter signing up. Interested in mentoring others? • Before signing off, select a topic for If so, check out: www.usafp.org/mentorship discussion for the next session IS THERE ANYTHING I CAN DO TO HELP? HOW DOES IT WORK? • Continue the program for (at least) the Definitely! The success of the program The program uses a brief intake survey to next year is directly tied to member participation. complete/to identify a mentee’s needs and then • Complete a brief feedback survey at Please consider signing up and sharing matches that person with a mentor well suited the end of one year to help improve the this information widely with your military to meet those needs. program Family Medicine colleagues, including retirees.

42 The Uniformed Family Physician • Fall 2020 Make a difference in the community and still have time with those you love.

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