WiW ntere 2017 • Vool. 10 • Numm. 2 • Ed. 38

REGISTER NOW TO ATTEND THE 2017 USAFP ANNUAL MEETING & EXPOSITION LEARN – SERVE - LEAD 2017 5-9 MARCH 2017 ANNUAL MEETING SEATTLE, WASHINGTON INFORMATION WWW.USAFP.ORG SEE PAGE 36

Journal of The Uniformed Services Academy of Family Physicians Arkansas’ Premier Behavioral Healthcare System Proudly Serving Our Military Families

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2KPPCENG2QKPVG$GJCXKQTCN*GCNVVJECTG5[UVGOr(KPCPEKCN%GPVTG2CCTMYC[r.KVVNG4QEM#TMCPUCU rrwww.PinnaclePointeHospital.com

TRICARE® %GTVKƂGF p64+%#4'%# qKUCTGIKUVGTGFVTCFCFGOCTMQHVJG 264+64+%#4'/CPCIGOGPV##EVKXXKVKV[#NNTKIJVUTGUGTXGF The Uniformed Family Physician • Winter 2017 4 ACADEMY LEADERS The Uniformed Services PRESIDENT’S MESSAGE AcademyofFamilyPhysiciansAcademy of Family Physicians 5 1503 Santa Rosa Road 5 EDITOR’S VOICE Suite 207 CONGRATULATIONS TO USAFP MEMBERS Richmond, Virginia 23229 ELECTED TO THE USAFP BOARD 6 804-968-4436 CONSULTANT REPORT: FAX 804-968-4418 8 AIR FORCE www.usafp.org CONSULTANT REPORT: ARMY USAFP e-mail 10 Mary Lindsay White: [email protected] CONSULTANT REPORT 12 CG/PHS Cheryl Modesto: [email protected] CONSULTANT REPORT: NAVY Newsletter Editor 14 Dean A. Seehusen, MD, MPH, [email protected] COMMITTEE REPORTS 16 FACULTY DEVELOPMENT OPERATIONAL MEDICINE VISION 18 This newsletter is published by the Uniformed Services Academy of The USAFP will be the COMMITTEE REPORTS Family Physicians. The opinions 21 CLINICAL INVESTIGATIONS COMMITTEE premier professional home to expressed are those of the individual enhance the practice and COMMITTEE REPORTS contributors and do not reflect the EDUCATION 22 experience of current and views of the Department of Defense future Uniformed Family COMMITTEE REPORTS or Public Health Service. PRACTICE MANAGEMENT Physicians. 24 2017 USAFP ANNUAL MEETING & MISSION EXPOSITION 28 LEADERSHIP BOOK SERIES The mission of the 30 USAFP is to support and develop Uniformed Family pcipublishing.com NEW MEMBERS Physicians as we advance 32 Created by Publishing Concepts, Inc. health through education, David Brown,0RESIDENTsDBROWN PCIPUBLISHINGCOM For Advertising info contact STILL SERVING scholarship, readiness, -ICHELE&ORINASHs    MFORINASH PCIPUBLISHINGCOM 34 CAPT(RET) WILLIAM ROBERTS advocacy, and leadership.

Edition 38 UNIFORMED FAMILY PHYSICIAN INSTRUCTIONS FOR AUTHORS 36 www.usafp.org 3 your academy leaders OFFICERS AND COMMITTEES OFFICERS Kristen Koenig, MD, FAAFP James Ellzy, MD NEWSLLETTER EDITOR PRESIDENT Fort Benning, GA DHMS, Arlington, VA Deaan A. Seehusen, MD, MPH Christopher P. Paulson, MD, [email protected] [email protected] FoF rt Gordon, GA FAAFP [email protected] Eglin AFB, FL NAVY CONSULTANTS Christopher.r [email protected] Brian Smoley, MD, MPH AIR FORCE NOMINATING Bremerton, WA Marcus Alexander, MD Robert C. Oh, MD, MPH PRESIDENT-ELECT [email protected] AFMOA, San Antonio, TX Fort Bragg, NC James Ellzy, MD [email protected] [email protected] DHMS, Arlington, VA Michelle M. Lynch, MD [email protected] Camp Lejeune, NC ARMY Christopher P. Paulson, MD, [email protected] Shawn Kanne, MD FAAFP VICE-PRESIDENT Fort Bragg, NC Eglin AFB, FL Dean A. Seehusen, MD, MPH Michael G. Mercado, MD, FAAFP [email protected] [email protected] Fort Gordon, GA Camp Lejeune, NC [email protected] [email protected] NAVY James Ellzy, MD Timothy Mott, MD DHMS, Arlington, VA SECRETARY-TREASURER PUBLIC HEALTH SERVICE Naval Hospital Pensacola, FL [email protected] Kimberly W. Roman, MD Maria DeArman, MD [email protected] USCG Aviation Training Center USCG Corpus Christi, TX OPERATIONAL MEDICINE Mobile, AL [email protected] COMMITTEE CHAIRS Barrett H. Campbell, MD, FAAFP [email protected] CLINICAL INFORMATICS Command and General Staff Sarah J. Arnoldd, MD, FAAFP Matthew G. Barnes, MD School, Fort Leavenworth, KS PAST PRESIDENT Food and Drrug Adminstration Ft. Belvoir, VA [email protected] Robert C. Oh, MD, MPH Sarah.arnon [email protected] [email protected] Fort Bragg, NC PRACTICE MANAGEMENT [email protected] RESIDENTS CLINICAL INVESTIGATIONS Joshua Will, DO Stephen M. Young, MD Anthony Beutler, MD Fort Benning, GA EXECUTIVE DIRECTOR Fort Benning, GA USUHS, Bethesda, MD [email protected] Mary Lindsay White [email protected] [email protected] Richmond, VA RESIDENT AND STUDENT AFFAIRS [email protected] Brittany R. Herits, DO CONSTITUTION & BYLAWS Aaron Saguil, MD, MPH Camp Lejeune, NC James W. Keck, MD USUHS, Bethesda, MD DIRECTORS [email protected] Naval Hospital Rota, Spain [email protected] AIR FORCE [email protected] Jessica T. Seervey, MD, FAAFP Alexander C. Knobloch, MD 2017 PROGRAM CO- USUHS Eglin AFB, FL EDUCATION CHAIRS Jessica.a [email protected] [email protected] Douglas Maurer, DO, MPH, FAAFP Christopher Ledford, MD Madigan AMC, WA Eglin, AFB, FL KKirsten Vitrikas, MD, FAAFP AAFP [email protected] [email protected] Travis AFB, CA DELEGATES [email protected] Mark J. Flynn, MD, FAAFP HEALTH PROMOTION & DISEASE Gigi Rey, MD Camp Pendleton, CA PREVENTION Joint Base Anacostia-Bolling Paul F. Crawford, MD, FAAFP mark.j.fl[email protected] Debra Manning, MD, MPH, FAAFP [email protected] Nellis AFB, NV HQ Marine Corps, Alexandria, VA [email protected] Robert C. Oh, MD, MPH [email protected] 2018 PROGRAM CO- Fort Bragg, NC CHAIRS ARMY [email protected] MEMBER CONSTITUENCIES Maria DeArman, MD Mark E. Stackle, MD, MBA Luis Otero, Jr., MD, FAAFP USCG Corpus Christi, TX BG Crawford F. Sams ALTERNATES Charleston AFB, SC [email protected] U.S. Army Health Clinic, Japan Christopher P. Paulson, MD, [email protected] [email protected] FAAFP Francesca M. Cimino, MD, FAAFP Eglin AFB, FL MEMBERSHIP & MEMBER White House Medical Unit Kevin M. Kelly, MD, MBA, FAAFP [email protected] SERVICES Washington, DC Fort Stewart, GA Adam Saperstein, MD [email protected] [email protected] USUHS, Bethesda, MD [email protected]

4 The Uniformed Family Physician • Winter 2017 president’s message CHRISTOPHER P. PAULSON, MD, FAAFP

Christopher P. Paulson, MD, FAAFP USAFP President Eglin AFB, FL [email protected]

Greetings fellow Uniformed “learn, serve, lead” should connect Finally, we are all leaders. Leaders Family Physicians! I hope everyone with academy members from both a in our Uniformed Family Physician was able to enjoy the Holidays with personal and professional standpoint. roles to our teams, clinics, MTFs, family and friends. For those of you As physicians, we are charged and commands. Furthermore, as deployed, at sea, or geographically with lifelong learning. All of us Family Physicians, we have both an separated; wishing you a speedy and whether in educational billlets or opportunity and responsibility to safe return home. remote clinics are educators. We lead the inevitable transformation of We are now just two months are responsible for providing thhe our national healthcare system. My away from our annual educational latest evidence-based practice to our hope is that it will stay primary care conference. Drs. Chris Ledford and patients and teaching our healthcare focused and health-centric. Gigi Rey, our Program Co-chairs, teams. Family Medicine, more than Consider reflecting on how “learn, are now in the home stretch of more any other specialty, is about service. serve, leaad” applies to you personally. than a year of meticulous planning Service to those under our care and I am incrediibly proud and honored to along with our USAFP staff for to the communities we live in. As serve with all of you. Hope to see what promises to be one of our best officers, we also serve our nation you in Seattle at the Westin, March conferences to date. Our theme of and those entrusted to protect it. 5-9!

Dean A. Seehusen, MD, MPH Fort Gordon, GA editor’s voice [email protected] DEAN A. SEEHUSEN, MD, MPH Colleagues, I think you’ll find this issue full of interesting and valuable information. It is hard to believe that this is already my fourth edition of the Uniformed Family Physician. It was a ton of fun to act as Editor for the last year. Let me take this opportunity to thank the USAFP staff who make the UFP possible and the many authors who have contributed this year. I look forward to seeing as many of you as can possibly make it in Seattle!

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/

www.usafp.org 5 Congratulations to the Newly Elected 2017-2018 USAFP Officers and Directors

President-Elect – Douglas M. Maurer, DO, FAAFP Coast Guard/Public Health Service Direr ctor – James D. Warner, MD Vice President – Christopher E. Jonas, DO, FAAFP Air Force Resident Director – Annna Christensen, MD Air Force Director – Christopher C. Ledford, MD Army Resident Director – Nooel Dunn, MD Army Director – Edwin A. Farnell, MD, FAAFP Navy Resident Director – Sean M. Simmons, MD Navy Director – Leo A. Carney, DO, FAAFP

Congratulations to USAFP Members Selected to Serve on AAFP Commissions

In the fall of 2016, the USAFP members were selected by the Aaron Saguil, MD, MPH Chair, Board of Directors nominated AAFP Steering Committee for Commission on Membership and members to serve on AAFP service. Congratulations to the Member Services 1 year term Commissions and four USAFP physicians listed below. (NOTE: Dr. Saguil previously served for four years as a commission member.) HELP BUILD A GATEWAY FOR BETTER HEALTH Joseph Perez, MD, MBA Member, Commission on Health When you join Northwest Permanente, P.C., you’ll have the of the Public and Science chance to practice in an environment that offers ample opportunity to pursue – and achieve – your personal and 1 year term professional dreams. We invite Primary Care Physicians to (NOTE: Dr. Perez previously served join our physician-managed, multi-specialty group of over 1,500 physicians and clinicians who care for over 550,000 a three year term as a commission members throughout Oregon and Southwest Washington. member) PRIMARY CARE PHYSICIANS Debra Manning, MD, MBA Our physicians enjoy: Member, Commission on Finance • Exceptional practice support and panel management tools and Insurance • Access to an outstanding team through our integrated health care system 4 year term • Generous Sign-on bonuses • Exceptional student loan assistance program Jeffrey Quinlan, MD • Competitive compensation & extensive benefits Member, Commission on Health To apply, please visit our Web site at: of the Public and Science http://nwp.kpphysiciancareers.com 4 year term or contact Shelonda Simpson at (503) 813-3826. EOE

nwp.kpphysiciancareers.com

6 The Uniformed Family Physician • Winter 2017 Clinical Pharmacology Fellowship Program

Clinical Pharmacology Fellowship What is Clinical Pharmacology? Clinical Pharmacology is concerned with better the understanding and use of existing drugs, and development of more effective and safer drugs for the future. Clinical Pharmacology allows one to stand between the research lab and the bedside, in a unique Additional activities position to translate laboratory research include: Into new drug therapies. Clinical • Conduct laboratory, animal, pharmacologists are a bridge between the or clinical research under the science and practice of medicine. supervision of a mentor

• Participate in the teaching Who can apply for the of Clinical Pharmacology to Fellowship? medical students, house staff, The Clinical Pharmacology training program and practicing physicians is available to active duty Army physicians • Three month rotation with a review division at the FDA specialty and active duty Army PhDs/ PharmDs (71A, 71B, or 67E) who have a • Participate in continuing doctoral degree in one of the life or medical medical education, research sciences from an accredited academic seminars, and journal clubs institution in the United States, Canada, or non-U.S. degree equivalent. A research background, mathematical inclination, and pharmacology/medical experience is preferred. Civilians could be considered if they joined the Army and successfully Potential Job Assignments compete for a position in the program. • WRAIR (Silver Spring, MD) Walter Reed Army Institute of Research Uniformed Services University • USU http://wrair-www.army.mil http://ushus.mil (Bethesda, MD) • Overseas labs (Thailand, Kenya) • USAMMDA (Ft. Detrick, MD) • USAMRIID (Ft. Detrick, MD) • USAMRICD (Aberdeen Proving Ground, MD)

Contact: MAJ(P) Jeffrey Livezey, MD, Contact: Louis Cantilena, MD, PhD [email protected] [email protected] www.usafp.org 7 Antoin (Marcus) Alexana der, MD consultant report AFMOA, San Antonio, TX AIR FORCE [email protected]

Hello and Happy New Year to different provider styles – easy dragon 97% manned for our clinical positions, everyone, incorporation, dynamic documentation and every vacancy (not assigned or not The 30 degree San Antonio weather vs power notes, and the ability to use and availablb e) has a significant impact on the has been a friendly reminder that Winter is customize templates or scripts that include in garrison mission, readiness mission, and coming, and with it there are several things drop down style fill in the blanks. The reliable quality care our patients receive. on the horizon: beginning of a 5 year combination of dynamic documentationo Our consultant partnered recruitment Genesis EHR and Med-COI (Medical and customized templates could truly trip to three Kansas City residencies and Community of Interest) network role out produce a high quality and useful note in medical schools in addition to the AAFP starting at Fairchild, completion of FY17 a short amount of time once a provider is conference of Family Medicine Residents JGMESB and assignment planning for comfortable and familiar with them. 5) and Medical Students resulted in eight summer 2017 moves, implementation of The MHS is implemmenting Med-COI additional FPs this year and hopefully non-enrolled medical officer (NEMO) as an update to the infrastructure our more to come in the future. Thus, our initiative, projection of our P5 deployment EHR runs on, which may be as critical to priority this assignment season will taskings, and coordination for the USAFP functionality as the EHR itself. continue to be filling all of our anticipated annual meeting. vacant clinical authorizations. We are I had the opportunity to attend simultaneously reviewing your feedback Cerner’s annual convention last month. regarding the top challenges for our As one that is traditionally cautious and physicians, including those that are likely even skeptical, I will admit to you thaat to impact retention decisions. Thank you I was impressed. In trying to visit what for your feedback and for our common seemed one hundred stations that were goal of achieving our AFMS mission and notably running quickly and ssmoothly off delivering high quality care while also one Wi-Fi based server, I consistently felt being the preferred place of employment like the system capability would be helpful with good work-life balance plus the to our patients and providers and that bonus of our opportunity to meaningfully there was a profound focus on customer We had an outstanding FY17 Joint serve. servicee. While there will still be some GME Selection Board. We filled all 54 The AFMS leadership recognizes the growing pains related to major change, of our active duty FM residency positions somewhat steady state and predictable there were a few notable takeaways. 1) (with Eglin and Nellis each growing percent of primary care providers that are This is not a small mom and pop shop. 2 additional positions to improve our unavailable due to short-term absences. There were about 15,000 in attendance pipeline) plus six civilian sponsored They have supported an initiative that for the keynote presentations at the Sprint selections. Additionally, we selected two placed 38 contract providers at 13 MTFs Center, with representatives from health FM-OB fellows and six Primary Care for one year in FY16 and that programs systems such as Banner Health, University Sports Medicine fellows. The continued 23 GS providers (FM, IM, Peds, NP, PA) Health, Excela Health, and Children’s recruitment of quality Family Physicians at 11 MTFs in the FY18 POM that are Hospital of Orange County. 2) These is a testimony to what you all do every eligible to start the hiring process January health systems had many positive things day and a must for the readiness and 2017. If we are able to demonstrate to say about their experience in rolling out trusted care role the AFMS asks our FP’s the AFMS and patient value in this Cerner’s EHR and with Cerner’s response to fill. AFPC reports that in FY16 91 approach, we will request an additional 19 when assistance was needed. 3) The MHS FPs left Family Medicine clinical roles authorizations in the FY19 POM. While has significantly invested in training to either for retirement, separation, GME, we have more than these 42 short term accompany this roll out. 4) There are leadership positions, or transitioned vacancies, once established this could several options to improve efficiency for to another AFSC. We are currently potentially allow us to more consistently

8 The Uniformed Family Physician • Winter 2017 have the desired manpower to utilize our every 4 years. We will continue to March 2017. Your attendance is secured standardized proocesses and deliver Trusted work on improving our readiness via your routine local TDY reqquest Care. The initial 23 will likely primarily communication and transparency to and is funded by your MTF. Please fill vacancies at their chhosen “hub” MTFs, allow your best possible life planning and start this process now if you desire to with a goal to eventually grow to be able assurance of your own personal readiness attend. It is an amazing opportunity to support vacancies at “spoke” facilities. for clinical currency for readiness. This is a major shift in approach to this There are multiple presentations with challenge, and we all must do our best impact on both the clinical aspects to assure optimal utilization of these and of practice standards as well as the all AFMH authorizations to the targeted administrative and management aspects clinical AFMH outcomes. of professional practice in the military. Family physicians will continue to It is an opportunity to network, learn, play a key readiness role via our P5 and understand our role in the AFMS, deployment taskings (April 17 – Sep 17). including an opportunity to hear from With only 25 CONUS MTFs having 3 or and discuss issues with our AF Surgeon more FPs, these MTFs must consistently General, General Ediger, during our provide available and ready 44Fs in order and availability. I thinkk there is potential service specific breakout. for us to have the capability to support to also incorporate this into assignment Thank you again for all that you do 50 taskings per year. Any 44F at these planning as well as a more coordinated and for the opportunity to serve as your locations that are not ready and available band assignment (P1, P3, P5) acrross the consultant. during their assigned band, will shift that AFMS. WE ARE… FAMILY MEDICINE!!! tasking to another 44F at one of those Last but not least, winter means Antoin “Marcus” Alexander, 25 MTFs and likely negate our ability to planning to attend our USAFP annual [email protected], 210- maintain an average of one deployment conference in Seattle, Washington 5-9 3995-9037

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REGISTER NOW to Attend the 2016 USAFP Annual Meeting & Exposition HEALTH IS PRIMARY 18-22 MARCH 2016 Sheraton Denver Downtown Hotel Denver, Colorado Competitive Salary www.usafp.org No on-call schedule Flexible Scheduling NHSC Loan Repayment CME Assistance Paid Holidays JournaJournnaallofTlof offTf Thehe UnUniformedd ServiServ ces Academyd of Family Physiciysiciai nss Professional Associations

www.usafp.org 1 ͞ŽŶƟŶƵŝŶŐƚŽƐĞƌǀĞƚŚĞƉĞŽƉůĞŽĨƚŚŝƐ Cherokee Health Systems took growth in East ŐƌĞĂƚŶĂƟŽŶǁĂƐŽĨƉĂƌĂŵŽƵŶƚ Tennessee and serve the community proudly. Our ŝŵƉŽƌƚĂŶĐĞƚŽŵĞĂƐ/ƌĞƟƌĞĚĨƌŽŵƚŚĞ FOR ADVERTISING INFORMATION mission and philosophy is simple; we provide the best ƌŵLJĂŶĚ,^ƉƌŽǀŝĚĞƐŵĞƚŚĂƚ quality of care to our patients by treating both the body ŽƉƉŽƌƚƵŶŝƚLJ͘/ŚĂǀĞƚŚĞƐƵƉƉŽƌƚŽĨ,^ CONTACT and mind. We offer an array of comprehensive ůĞĂĚĞƌͲƐŚŝƉƚŽƉƌĂĐƟĐĞĨƵůůŽƵƚƉĂƟĞŶƚ services in order to do so. Cherokee is both a ĨĂŵŝůLJŵĞĚŝĐŝŶĞĂƐǁĞůůĂƐŵLJĂĚĚŝƟŽŶĂů ƐƉĞĐŝĂůƚLJŽĨĂĚĚŝĐƟŽŶŵĞĚŝĐŝŶĞ͕ŝŶĂ Federally Qualified Health Center (FQHC) and a Michele Forinash ƉƌŽĨĞƐƐŝŽŶĂůůLJĂŶĚƉĞƌƐŽŶĂůůLJƌĞǁĂƌĚŝŶŐ community mental health center (CMHC). As such we ĞŶǀŝƌŽŶŵĞŶƚ͘tŽƌŬŝŶŐŚĞƌĞǁĂƐĂŐƌĞĂƚ are able to leverage incredible resources and skills that ĚĞĐŝƐŝŽŶĨŽƌŵLJ͚ŶĞdžƚĐĂƌĞĞƌ͛͘͟ ext.112 are blended into an innovative behaviorally-enhanced -Mark McGrail, M.D. COL(ret), USA 800.561.4686 patient centered medical home model. OR EMAIL [email protected] 2018 Western Avenue • Knoxville, TN • 37921 www.cherokeehealth.com [email protected] • [email protected] www.usafp.org 9 Shane KKane, MD consultant report Fort Bragg, NC ARMY Shawnn.f.f [email protected]

There have been Seasons Greetings!! Hope Diaz about clinic OIC, Department everyone has had a great holiday Chief and WTB Surgeons. If we changes to the season and here is to a healthy, happy have not contacted you and you are conference policy and and productive 2017. To those who interested please reach out to us. In are deployed – thank you for what the near future the 60A slate will be they are good!! We you are doing, be safe!! released and I expect that we will no longer need to get Congratulations to those recently have multiple 61Hs selected for these selected for FYGME, Residenncy and strategic billets. approval at the highest Fellowships!! There have been changes to the Congratulations to thhose recently conference policy and they are good!! levels of Department of selected for promotioon to COL!! ILE We no longer need to get approval at the Army. continues to be a mam jor discriminator the highest levels of Department of for selection to COL the Army. O6 level commanders have Assignmments – we have multiple the ability to approve conference assignments that require the expertise attendance. There is no central and eexperience of senior MAJs and funding for USAFP, but all it takes is LT Cs. Don’t be surprised if you local approval and funding. are contacted by myself or COL Here is to a great 2017!!!!

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10 The Uniformed Family Physician • Winter 2017 MISSION: TOGETHER WE ARE DEDICATED TO LEAD, WITH THE COURAGE TO CARE, THE DETERMINATION TO PROMOTE PERSONAL GROWTH, AND THE COMPASSION TO CHAMPION THE CAUSE OF THOSE WHO HAVE NO VOICE.

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Explore Primary Care Opportunities in the Buckeye State Genesis HealthCare System has several employment Genesis offers Contact opportunities for primary care physicians throughout its • Patient-centered medical care Rhonda Creger, DASPR six-county service area in Southeastern Ohio,o, serservingving a • Epic EMR Manager, Physician Recruitment population of 230k. Headquartered in Zanesville, just Phone: (740) 450-6174 45 minutes east of Columbus via I-70, the system • Paid malpractice and tail Emaill: [email protected] includes a not-for-profit hospital, 3,000 employees, • Attractive base salary and and an extensive network of over 300 physicians in comprehensive benefitts multiple outpatient centers. • Relocation assisttance/sign-on bbonuus This family-friendly region offers the perfect work-life balance of suburban and rural settings with easy Visit with the Genesis accessibility to the big-city amenities in Columbus, representative at Cleveland or Pittsburgh. Booth 40. Genesis is looking for dedicated primary care physicians to expand its network of physician practices and provide access to excellent clinical care in a variety of community settings.

genesishcs.org www.usafp.org 11 consultant report Sarah J. Arnold, MD, FAAFP Food and Drug Administration CG/PHS [email protected]

Now that 2016 has ended, it is time throughout the year and throughout the “Through a story everyone to look ahead to 2017 for professional country. can relate to about a man facing development opportunities. As many of I recently participated in professional challlenges on the job and in his you know, the USAFP Annual Meeting and development training within our own family, the authors expose the Exposition for 2017 is March 5-9 in Seattle, Commissioned Corps. It’s called a “book fascinating ways that we can blind Washington. This is a great time to earn up circle,” using the book, Leadership and ourselves to our true motivations to 30.25 prescribed CME credits through Self-Deception: Getting out of the Box, by theh and unwittingly sabotage the several evidence-based presentations on Arbinger Institute. We (8 participants and effectiveness of our own efforts family medicine core topics, workshops and a facilitator) met once weekly through an to achieve success and increase the ABFM Part II Self-Assessment to fulfill online meeting platform for 6 consecutive happiness.” maintenance of certification requirements. weeks, in which we discussed the book Our annual USPHS Scientific and Tr aining and how it applied to oour daily challenges, This training is the beginning Symposium for 2017 will be June 6-9 in personal as well as prp ofessional. Our group of a continuum of training for the Chattanooga, Tennessee. This is a great consisted of PHHS Officers from several Commissioned Corps in developing and time to network with fellow officers, get different categories and different agencies, implementing an “outward mindset.” the latest updates about the Commissioned which mam de for very rich discussions and Let me know if you are interested in Corps, and earn CME credits. provided another way to meet fellow participating in an existing book circle, or For those of us preparing for the 2017 Offficers. learning how to start your own book circle, Board exam, be sure to check out the The book describes a very interesting and I’ll put you in touch with the folks who resources online through the American paradigm that I have never encountered are promoting them. Academy of Family Physicians and the before in professional or personal Thank you for all that you do. As American Board of Family Medicine. development training. The back cover of always, feel free to contact me with any Several review courses arre available the book describes this paradigm well: questions or issues.

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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.

12 The Uniformed Family Physician • Winter 2017 Our legacy is yours. Primary Care Physicians Legacy Health Portland, Oregon

At Legacy Health, our legacy is all about doing what’s right – for our employees, our patients, our communities and our world. That means helping people get healthy and staying that way. Encouraging medical professionals to set a higher standard. Tending to the little things that help patients heal. And supporting our staff in doing whatever it takes to meet the needs of those we serve.

As a system of clinics and hospitals, Legacy Health offers a unique depth of expertise and services. With 23 primary care clinics and dozens of specialty clinics currently in the Portland metro area, Legacy Medical Group is continuing our vision to be essential to the health of the region by growing our services through opening new clinics and expanding in our current locations. We are looking for patient-focused physicians dedicated to Legacy’s mission of good health for our people, our patients, our communities and our world.

Legacy Primary Care offers:

• Flexible schedules with full-time and part-time positions • Diverse clinics in urban, suburban and rural settings - clinics range in size from 2-12 providers with each location having its own unique personality • Excellent support staff for physicians including additional clinical and care management support • Primary Care Health Home transformation in process in all our clinics. Recognized as a Tier 3 health home by the state of Oregon • Educational Loan Repayment Program

Portland is a sophisticated city offering diverse cultural activities and family-friendly communities that appeal to a wide variety of needs and tastes. Beautiful parks and more biking paths per mile than any other city in the U.S. promote an active and healthy lifestyle. The temperate four seasons, spectacular surroundings of the Columbia River Gorge and the majestic Cascade Mountains, as well as close proximity to ocean beaches and long skiing seasons make this an opportunity for both a dynamic position and a wonderful lifestyle.

As we consider qualified candidates, we are committed to building a culture that values diversity and is reflective of those we care for.

To learn more about Legacy Health and to apply online, please visit our website at www.legacyhealth.org/jobs. For additional information, please contact Mandie Thorson, Physician Recruiter, 503-415-5454. Toll free: 866-888-4428 x8. Email: [email protected]. AA/EOE/Vets/Disabled www.legacyhealth.org/jobs

www.usafp.org 13 Timothy MoM tt, MD consultant report Naval Hospital, Pensacola, FL NAVY [email protected]

“This has been a BUMED Updates: As mentioned • HHealthcare support GME, challenging year, in my last update, RDML Pearigen is training and recruitment our new Chief of the Medical Corps marked by end in addition to recently becoming • Ensuring alignment with strength reductions, the lead for Navy Medicine Westt. strategic goals Additionally, his Office of the operational demands, Corps Chief at BUMED has seen a High Reliability Organizations: number of staffing changese . CAPT Hopefully the term “High Reliability recruiting difficulties, Pouget remains as his Deputy for Organizations” (HROs) is not new financial constraints the time being, continuing to add to you as it currently drives Navy stability and a persistently astute Medicine at the highest levels of and increasingly Family Medicine sensibility to the leadership. However, as Navy FPs onerous regulation, office. Shhe has proven a stalwart across the globe continue to plug presencec and profound advocate for away doing great work in countless particularly of our GME Navvy Medicine and Navy Family settings, some may not be as aware programs…” MMedicine! CDR Frank Mullens is of how this is influencing our future. the new and energetic Policy and Beginning with the end in mind, here Practice lead. You’ll see his name on is how Navy Medicine sees “Where A timely quote. Yet, from when? numerous e-mails that I forward-- We’re Going” with HROs: In fact it is from my former CO, on most of which he adds his contact CAPT Robert Hufstader Jr., MC, information as a genuine offer for • Process Improvement is a part USN as printed in the MMedical Corps availability. I see his role as that of of everyone’s job Update from the Fall of 1996—twenty an outstanding utility infielder for years ago! Welll, whether you are Medical Corps issues at BUMED. • Physicians are change agents Jean-Baptiste Alphonse Karr or Jon CAPT Alonso is the new Career for quality improvement Bon Jovi, it seems that we are not Planner. He is involved in Medical the firrst to consider “plus ça change, Corps accessions, Quality Assurance • A culture of trust exists that pluus c’est la même chose.” and litigation in addition to being encourages reporting and Last month I attended the our BUMED contact for advice on improvement by all Specialty Leaders Business meeting individual career development and on the heels of the GMESB at leadership training opportunities. • Analytics drives selection of WRNMMC. I am going to use LCDR Brett Chamberlin is the new process improvement and this article to pass some of the key Medical Corps Liaison and serves as outcome based decision making information from that meeting.Many our new lead for conference approval thanks to the multiple presenters issues. The primary goal of these • Governance and accountability as well as the copious amount of fine folks in the Corps Chief’s office model provides structure and information they shared and from is oversight and guidance for Navy process to foster communication which I’m liberally “borrowing” to Physicians through five areas: and learning across the share with you. Also, I hope you see Enterprise that Navy Medicine is changing with • Practice, Performance and a proactive vision for progress… Development • Tr ansition to outcomes based beyond “la même chose.” delivery model (Value Based) • Manpower

14 The Uniformed Family Physician • Winter 2017 • Deliberate design to meet the into a Retention Bonus (RB) pay. last name) Special Pay Tech Points- needs of our patients The Incentive Special Pay (ISP) of-Contact. is being split from the MSP and In closing, I see and hear so many With that vision in mind, what is being lumped together with the wonderful things that Navy FPs are are some examples of howw HRO Additional Special Pay (ASP) and doing across the Enterprise. It is has currently been implemented? Variable Special Pay (VSP) into the no shock to me-- our training and Most folks are probably aware of new CSP Incentive Pay (IP). The skillset uniquely empower us to be the standing-up of Chief Medical Board Certified Pay (BCP) will be the highly reliable change agents for Officers (CMOs) at BUMED, initiated annually at the same time our organization. Please know that Regions and MTFs. These could as the CSP IP. is true, be proud, and be empowered be considered our HRO Physician Probbably my most important to be that proactive difference Ambassadors and I encourage all thing to share is the following maker wherever you serve! The FPs at MTFs to seek these folks out link which should be saved in environment is primed for FPs to for advice and opportunities. Others your favorites: http://www.med. thrive in the Navy now more than may be hearing of the expansion n avy.mi l / b ume d /SS pecial_Pay/ ever! of “Clinical Communities” Pages/default.aspx On that link, I hope that each and every one which are intended to optimize there are a few very key sub-links: of you has a wonderful 2017 and patient safety and quality of care, the FY17 NAVADMIN (relleased as always, thank you for the truly reduce variation, and enhance on December 1 st), the FY17 exceptional work you do as Navy collaboration across the enterprise. “Pay Guidance”, “Specialty Pay Family Physicians. One example of a well-established Templates for Submission,” and the Clinical Community is with the individualized (by first letter of your Women’s Health Continuum of Care Advisory Board (WHCCAB) with its component working groups and Health Effectiveness Teams (HETs). Many FPs may be aware of Perinatal Advisory Boards (PABs) which are local HETs for the larger BUMED PAB. Other local HETs are certain to be developing and will serve as great opportunities for FP-involvement. Again, seek out your CMOs and get involved!

Special Pays: I will keep this short for two reasons: 1) I am still learning the ins-and-outs of this new process; and 2) I will share resources that may help far better than I. If anyone out there is completely in the dark on this transition, the gist of it is as follows-- The new pay plan is called the Consolidated Special Pays (CSP) plan. The Multi- year Special Pay (MSP) is turning www.usafp.org 15 Michael Arnold, DO teaching and learning Faculty Devellopment Fellow Madigan Armym Medical Center FACULTY DEVELOPMENT [email protected] Give the Customer What They Want: Empower Residents as Educators

We’ve all been there – that early Medicine more valuable and meaningful and doing so in an effective manner. So, morning of inpatient service. You barely to the customerr. how dod we do this? Consider starting with have a handle on your patient load. Your Businesses do this through crafting these steps. senior resident has their appropriate each customer ‘touchpoints.’ These are superhuman level of energy leaving any opportunity for customer interactiono UNDERSTAND THE LEARNER you wondering how they do it. Your with the brand. In medical student We need to recognize our learners’ internship is over and you feel like you’re education, these opportunities are their background and needs. Get to know the just beginning to keep your head above interactions with us as educatoro s, whether medical student. If the resident can’t water. You breathe a sigh of relief. Then, faculty or residents. A greeat opportunity remember their name by halfway through you turn around and a medical student for customer impact is through making the day, they should work harder on sitting there staring at you intently and our teaching approaca h more effective. We getting to know them. Show genuine eagerly. innately like teaaching as residents, but I interest in their learning and their well- I have reflected on my experience don’t feel the perception is there of access being. Show them you value their input as a resident and the many teaching to a visible didactic process for developing and involvement in the case. Be the opportunities I had. I wonder if I had some resident educators despite what’s reported supervising resident you wish you would basic teaching tools during my residency, on paper by US residencies annually. have had as a medical student. Make your I might have felt better equipped To improve the value of the product expectations and guidance clear to the to teach medical students. Research to the customer, businesses identify the medical student at the very beginning. Be suggests residents are poised as the ideal customer’s values and needs and then deliberate about creating a safe learning educators of medical studentss. Yet from appropriately position their offering to environment. This can be done by my experience, learning how to teach meet it. Several studies report medical reducing the perceived ‘threat’ of feedback seemingly gets pushed aside in favor of students feel they get most of their to the learner by normalizing feedback other clinical learning nen eds of residents. education from residents. Residents and by making it constructive. Also, consider thhis troubling trend. report spending about 20% of their A recent analysis on national residency time teaching junior learners including RIME match statistics revealed that while medical students, they view it as one of The RIME model (see Table 1) family meedicine matched positions have their primary responsibilities, and they developed by Dr. Pangaro is helpful modests ly gone up, the number of matched feel a better grasp of their knowledge after in assessing medical students in a US medical students to family medicine teaching.2,3,4,5 standardized non-judgmental way. 8 Four continues to lag behind.1 This is suggestive A couple of recent studies surveying progressive levels describe the sequential of lagging interest in family medicine medical students revealed the following:6,7 skill building of clinical education. from US medical students. Arguably, this (1) They seek a safe learning Students first develop, as reporters, the should be of particular interest to military environment – one where they feel ability of data collection and reporting residencies that recruit nearly exclusively they can stretch their knowledge free of it accurately. As interpreters, they begin US medical students. negative repercussions of being wrong. fitting data together into a pattern to My MBA program has given me (2) They want clear expectations and feedback. interpret with a firm diagnosis or at least appreciation for marketing principles that (3) They want to be stimulated through a weighted differential diagnosis. As drive successful business strategies. What involved learning opportunities. managers, they convert the diagnosis into we are seeing in family medicine is stiff (4) They seek role models in their rotations a plan of treatment or diagnostic workup. competition from other medical specialty (5) They view residents as the most As educators, they start to ask clinical residency programs for customers important teachers on the wards. questions to self-direct their learning as (medical students). We must confront Medical students (our customers) well as generate teaching topics for others. how to make the brand of Military Family clearly want residents involved in teaching,

16 The Uniformed Family Physician • Winter 2017 TABLE 1 STAGE FOCUS EMPHASIS SUMMARY LEVEL OF TRAINING Reporter Reliable, accurate data-gathering and presentation S/O portion of encounter Answer “what” questions MS II/III Interpreter Diagnostic reasoning A/P portion of encounter How details fit together MS III/IV Manager Treatment planning, diagnostic testing Plan of SOAP Data and decision making MS IV/ individualized to patient; responsibility PGY-1 Educator Asking, answering, and teaching important Global responsibility Ownership for self-improvement & PGY 1+ questions improvement of others

This can be used to set expectations at the beginning of your teaching interaction. Also, it can be used to frame feedback at throughout your interactions – telling them at what level you perceive their skills versus where they should be.

ONE MINUTE PRECEPTOR An effective framework for clinical teaching was developed by Neher et al.9 It describes five sequential steps taken during precepting as listed in Table 2. Some general recommendations are as follows. Try to find a calm, more private setting to conduct these conversations, especially in inpatient settings. Hold off on judging competence of the learner. Avoid the urge to grill the learner. Resist the urge to tell the learner what should be done, and instead prompt them to come up with a plan. Emphasize that it is preferred to commit to a diagnosis or a plan even if wrong, rather than not committing at all. Practice using tactful words as mentioned in Ta ble 2. The “Te aching General Rules” part can be skipped if learner has performed well and preceptor has no new information to add. TABLE 2 STEP DESCRIPTION & TIPS PROMPT EXAMPLE Get a Commitment Encourage learner to commit to diagnosis, workup, or treatment plan. “What do you think is going on?” “What would you like to accomplish Encourages learner to process information they collected. Clarify to this visit?” learner that making a mistake is better than not committing. Probe for Supporting Not meant to be a grilling session. Ask what evidence supported their “What were the major findings that led to that diagnosis?” “Why did Evidence commitment. Suppress the desire to pass judgment. you choose that particular medication?” Teach General Rules Keep the information general, avoid anecdotes and idiosyncratic “When you see A, always consider B.” preferences. “When A happens, you should always first do B” Reinforce what was Use whenever learner has handled a situation in beneficial way. “When ordering that medication, it was good that you considered that done right Focus on specific behaviors learner will be able to repeat consciously patient’s age and renal clearance. That will definitely reduce risk of – things they can reasonably change. adverse drug events.” Correct Mistakes Requires tact to be effective. Sometimes worth waiting for calmer, “It could be just a viral URI that explains this child’s symptoms, but private setting. Ask learner to critique own performance first. Frame without checking the ears you could be missing otitis media which can the mistake as “not best” rather than “bad.” cause problems if not recognized. So, make sure to check ears on every patient with URI symptoms.”

REFERENCES 1. Kozakowski SM, Travis A, Bentley A, Jr GF. Results of the 2016 National Residency Matching Program: 1986-2016: A Comparison of Family Medicine, E-ROADs, and Other Select Specialties. Fam Med. 2016; 48(10):763-9. 2. Morrison EH, Shapiro JF, Harthill M. Resident Doctors’ Understanding of Their Roles as Clinical Teachers. Med Educ. 2005; 39: 137-44. 3. Hill AG, Srinivasa S, Hawken SJ, et al. Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students. J Grad Med Educ. 2012 Mar; 4(1): 34-41. 4. Dotters-Katz S, Hargett C, Zaas A, Criscione-Schreiber L. What Motivates Residents to Teach? The Attitudes in Clinical Teaching Study. Med Educ. 2016 July; 50(7): 768-77 5. Busari JO, Prince KJ, Scherpbier AJ, van der Vleuten CP, Essed GG. How Residents Perceive Their Teaching Role in the Clincal Setting: A Qualitative Study. Med Te ach. 2002; 24: 57-61 6. Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How Medical Students Learn from Residents in the Workplace: A Qualitative Study. Acad Med. 2014 Mar; 89(3): 490-96 7. Montacute T, Teng VC, Yu GC, Schillinger E, Lin S. Qualities of Resident Teacher Valued by Medical Students. Fam Med. 2016 May; 48(5):381-4 8. Pangaro L. Investing in Descriptive Evaluation: a vision for the future of assessment. Medical Teacher. 2000; 22(5): 478-81. 9. Neher JO, Gordon KC, Meyer B, Stevens N. A Five-Step “Microskills” Model of Clinical Teaching. J Am Board Fam Pract. 1992; 5(4): 419-24.

www.usafp.org 17 operational medicine

Keys to Success: Career Progression

As a military physician, career development can be demanding and confusing. Developing as a physician, a clinical leader and life- long learner, balances with developing as a member of the profession of arms, sworn to protect and defend our nation’s Constitution. Stewarding our dual professions requires dedication and commitment. The third joint perspective article comes from experienced operational family physicians who demonstrate success. The last quarter before the annual conference, the topic will focus on pre-deployment readiness. If you would like to contribute, or haave additional suggestions, please contact me at [email protected].

Barrett H Campbell, MD, FS, FAAFP MAJ, MC, USA Chair, Operational Medicine Committee [email protected]

Dana John Onifer, MD, FAAFP, LCDR, USN exciting and very personally and confusing, and, if not managed Head, Clinical Investigations and Research professionally enriching experience. correctly, potentially damaging. One Integrity For mmany Family Physicians without emerges from an MTF or residency Camp Lejeune Family Medicine Residency a prior service or GMO background, assignment at the peak of their clinical [email protected] however, transition to an operational abilities only to be immersed in a The operational tour can be aan community can be intimidating, foreign world with an alien tongue of new acronyms and jargon. I hope Find the Perfect Opportunity to give you some broad principles for success in any of these environments, with EmCare to get you ready, help you remain LOUISIANA TEXAS medically competent, and to keep you CHRISTUS St. Frances Cabrini Hospital CHRISTUS Spohn Hospital - Alice (Alexandria) (Alice) competitive for promotion. Terrebonne General Medical Center (Houma) CHRISTUS Spohn Hospital - Beeville There are some things that are very CHRISTUS St. Patrick Hospital (Lake Charles) (Beeville) important to become familiar with CHRISTUS Highland Medical Center CHRISTUS Spohn Hospital - Kleberg (Shreveport) (Kingsville) that you may have only a peripheral CHRISTUS Alon/Creekside FSED understanding of from your previous KENTUCKY (San Antonio) TJ Health Cave City Clinic (Cave City) practice and training. Specifically, Murray-Calloway County Hospital (Murray) TENNESSEE issues with medical administration Tennova Hospital - Lebanon SOUTH CAROLINA (Lebanon) - like physical exams, duty status McLeod Health, 4 hospital system Physicians Regional Medical Center limitations, Limited Duty, medical (Dillon, Little River, Manning, Myrtle Beach) (Knoxville) boards, Physical Evaluation Boards, We’re seeking Family Practice Physicians with Emergency Medicine experience and PHAs, and pre-and post deployment Family Practice Physicians for Hospitalists positions. assessments - will suddenly become We have full-time, part-time, per diem and travel opportunities with competitive compensation packages and A-rated professional liability insurance with tail coverage. very important, and a regular part of your practice. Additionally, there will Ask about our provider referral bonus program! Refer a provider. Receive up to a $10,000 bonus! be regular Navy administrative things Contact us at: [email protected] or 844-437-3233 that you may be responsible for, like you and your subordinates’ Fitness Reports, your Sailors’ Evaluations, and the potential need to be a part of military discipline and UCMJ Quality people. Quality care. Quality of LIFE.

18 The Uniformed Family Physician • Winter 2017 proceedinggs. Your senior enlisted Assuming you are a “one-of-one,” leader (SEL) should give you some your FITREP should begin with a good guidance but never abdicate “soft breakout” statement where your your role as the head of your medical CO compares you against the other department. You will lose credibility officers of the same paygrade in his with your CO and the othher officers command. “Number 3 of my 9 O-4s” and that can have adverse efffects for is far better than “the best medical you, your Sailors, and your patiennts. officer I have ever knownn.” The The operational tour has somme former statement, especially when dangers for the career minded accompanied by a description of that physician. Typically, these billets coomparison group, provides context; are “one of one” assignments. As a the latter statement is well regarded Lieutenant, that isn’t much to be by most people as useless fluff and is concerned with, but as a Lieutenant disregarded. Let your CO know that, Commander or above, these if they don’t already. assignments can be damaging to Next, you need to describe your one’s competitiveness for promotion leadership position and successes, if not managed well. You need to in as much quantitattive detail as demonstrate your value to the Navy possible. Retention, promotion, as a leader, and particularly as a awards, inspection results, mission leader of other officers, if possible. accomplishment – these are the things Just like your line commander, the that separate high quality leaderss. Navy expects you to be an excellent After that, you need to demonstrate doctor by default, the board promotes your value to the enterprise. Show you because they think you can be a how you are functioning beyond your leader in Navy medicine. Your fitness billet to improve your unit, beyond reports need to show leadership above your unit to improve the next levels in all else. your operational chain of command, The best place to start for guidance and beyond that to improve the Navy on what to write in your FITREP and the DoD. That requires you to be is the precept for the promotion proactive in your involvement above boards. The precept describes what and beyond your job description. the board will find valuable and you Finally, the timing of your need to show that you are performing assignments, as best you can manage in those roles. Your FITREPs should them, is crucial. You want to be at demonstrate, as quantitatively as an MTF, or some other assignment possible, how you are being successful where you are rated against your at the assignments the precept peers, before you go before the prioritizes. Along with this part of board. By planning your assignments, board preparation, make sure your timing extensions, looking for hot fill Officer Service Record is up to date billets, and communicating closely and accurate, ensure there are no gaps with our detailer, you need to make in your FITREPS, and make sure your sure that you have several strong awards and Additional Qualification FITREPS where you are ranked well Designator (AQD) are all listed. An against peers before you go to your experienced and successful physician operational assignment, or you are mentor is invaluable in helping you back in a competitive billet early craft your FITREP. Seek them out

early in your career. continued page 20 www.usafp.org 19 continued page 19 Matthew N. Fandre, MD, FAAFP presenting lectures during academic enouo gh before your promotion board LTC, MC, SFS days will maintain a cono nection with tto get a well rated FITREP that will Deputy Commander for Clinical Services the clinical realm. Furthermore, go into your record. The latter is Munson Army Health Center if needed, you may need to pursue preferable. [email protected] mil moonlightingn to keep clinical Always consider that you will relevance. AAs someone who has spent often be the smartest person in the Preserving clinical acumen over half of his career in operational room. Do not confuse someone’s in operational assignments may billeets, the thought of being the greater knowledge of a subject with be one of the most difficult, yet attending can be frightening; your far greater ability to process most important, challenges for however, the rewards both personally information and provide rigorous an operational physician. That and professionally are worth the analysis. The very fact that you are said, there may not be a more feelings of trepidation. All you have a physician means that you are the important task; at the end of the day, to do is put your ego in check and far right edge of the bell curve of commanders expect us to be their swallow a little humble pie. human beings with regards to brain advisors on all things medical. How In my experience, most commanders power. That means that your God- better to advise the commander and and executive officers respect a given intelligence and hard fought senior leaders abob ut the health and physician that wants to see patients. academic rigor, plus the knowledge readiness of their personnel than to Just like a pilot who’s on the staff, the and experience of real multitasking be in clinic and see those individuals? physician is regarded as more than and constant frame shifting that There e’s no perfect answer as to “just” a staff officer. They need to be comes with being a Family Physician, how to maintain clinical proficiency as good as any other staff officer as well will give you an advantage over many oto her than to make an active effort as an expert in their field. Additionally, of your fellow officers. Use this to do so. Some jobs (e.g., battalion failure to remain active in the clinical advantage wisely, and with humiliity, surgeon, ship surgeon, flight surgeon) arena means that you lose touch and to be a mentor and advisor, to foster naturally incorporate clinical practice credibility with those who are actively collaboration, and to lead to your into the daily work flow. Others, practicing on a daily basis. Not only command’s success. Remember that perhaps most, require some deliberate does that make future integration with your unit is your patient and you action and dedication to regularly see clinical practice more difficult, but you have a unique opportunity to nurture patients and keep clinically relevant. lose professional standing with the rest it and promote its welfare. Arrogance Failure to do so is a slippery slope of the clinical staff of your MTF. will isolate you, but humble, servant that can result in a physician leader The reality of being an operational hearted coc nfidence will make you a with a wealth of operational and physician is that you have to be the prized counselor and invaluable asset leadership experience who is unsafe best you can in three arenas: clinical, to your commander. to see patients in either an inpatient professional/administrative, and Finally, remember that mission or outpatient setting (or at least operational. All too often, as we success is of paramount importance to without retraining). all know, it’s tough to be a master the commander. Line officers speak For those not directly assigned as in three areas at once. However, about requirements, capabilities, a unit provider who is responsible for this is the beauty, the challenge, and capacity, and mission. Learn their the day-to-day care of unit members, the reward of being an operational language, speak it correctly, and show the options to keep clinically physician. The opportunities them how you will help them do their relevant are numerous. They exist…you simply have to make the job by providing them a healthy and include scheduling a clinic within intentional prioritization of your fit fighting force. That, above all the department of Family Medicine clinical skills and talents. else, will foster your success in the on a weekly basis, volunteering to fleet. take call with the residents, or taking the inpatient service (whether it be ASK AN OP MED DOC for a night, weekend, or a week). Simply attending morning report or A QUESTION - [email protected]

20 The Uniformed Family Physician • Winter 2017 Anthony Beutler,r MD committee reports USUHS, Bethesda, MD [email protected] com CLINICAL INVESTIGATIONS

Happy Holidays froom the of interest. This is an easy and fun Committee and Research Judges. Clinical Investigations Committee! way to get involved in research. Do Drss. Dean Seehusen and Matthew We wanted to take this opportuniity you have a good question? This is Pflipsen will lead two fantastic to update you on the Omnibus a great way to get an easy, valid and sessions designed for members with project as well as the Research puublishable answer! minimal to moderate experience who Workshop scheduled during The CIC Omnibus subcommittee already have an idea for a scholarly USAFP. is curreently evaluating proposed project and may have even gotten questions for USAFP 2017. We had started. As a large group, each USAFP OMNIBUS SURVEY PROJECT more submissions this year than last idea will be assessed for strengths 2017 year and hope thhat this new venue and weaknesses. Then, in small will inspire all of our members groups, mentors will work with the If you attended USAFP 2016, to consider getting involved in attendees to improve projects and you may remember participating in the process of asking scholarly identify next steps. The goal is for the Omnibus survey. This survey questions. Please plan to participate attendees to walk out confident that is created from scholarly questions while attending USAFP 2017 and they can complete their scholarly submitted by USAFP members and keep those survey questions coming! project and will have gotten expert asked to the USAFP audience via advice on moving forward. When an audience response system at the USAFP RESEARCH WORKSHOP 2017 regiistering for the USAFP annual annual meeting. It is a fantastic Traditionally the research judges meetinng, look for Dr. Seehusen’s way to reach 300-400 members offer a workshop at USAFP annual workshop “Scholarly Mentoring across multiple services all at once. meeting. And just as traditionally, for Your Project” and Dr. Pflipsen’s Our research team selects winning almost nobody comes. We are workshop “How to Help Residents questions and topics, helps to fine not offended by this! But this and Clinic Staff Develop a QI tune these questions, and creates the year we are excited to announce Project” both Tuesdaay afternoon survey in order to get the best data that “research workshops” are March 7th. for the researchers. The results are completely member-driven and We look forward to seeing then given back to the member for developed by USAFP members everyone at the meeting in Seatttle! further use in their research area outside the Clinical Investigations

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. Mentees follows: should expect to receive an email identifying Looking for a mentor? • Communicate with your mentor/mentee their mentor within 3 weeks of signing up. Interested in mentoring others? at least once per quarter • Before signing off, select a topic for IS THERE ANYTHING I CAN DO TO HELP? If so, check out: www.usafp.org/mentorship discussion for the next session Definitely! The success of the program HOW DOES IT WORK? • Continue the program for (at least) the is directly tied to member participation. The program uses a brief intake survey to next year Please consider signing up and sharing complete/to identify a mentee’s needs and • Complete a brief feedback survey at this information widely with your military then matches that person with a mentor well the end of one year to help improve the Family Medicine colleagues, including suited to meet those needs. program retirees. www.usafp.org 21 Douglas M. Maurer, DO, MPH, FAAFP committee reports Madigan Army Medical Center [email protected] EDUCATION Top Winter Apps for Your Smartphone

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.

Here are three new apps to keep o Easy to follow NRP algorithm the ICU. The new guidelines were you and your smartphone warm this included. welcomed by many since the long winter! interval time since “Sepsis 2.0,” but Dislikes have already created a firestorm of 1. NEONATAL RESUSCITATION PROGRAM o Quality of images could be controversy. Much of this controversy (NRP) APP (FREE) improved especially for algorithm. is due to the move away from the Childbirth is typically one of o Utility of Facebook posts systemic inflammatory response the most memorable and emotional questionable since cannot post syndrome (SIRS) criteria in favor of moments in the lives of any parent from within app. the sequential organ failure assessment and providers who perform full scope o Doesn’t contain easy to locate or score (SOFA) and qSOFA scores. The obstetrics. Luckily, in 90% of cases calculate medication doses for app takes the new sepsis guidelines and infants tolerate the entire process resuscitation. creates a user friendly sepsis diagnosis without issue. However, up to 10% algorithm that incorporates qSOFA of infants will require intervention by Overall and SOFA. Both calculators are built medical providers and 1% will require The new NRP app contains the right into the app. Furthermore, the extensive neonatal resuuscitation (NRP). most current 2015/2016 NRP guideline app provides commentary and excerpts This spring the AmA erican Academy with helpful videos and a copy of the of the guidelines throughout the step of Pediatrics (AAP) released the 7th entire PDF of the updated guideline by step process. edition of their NRP course and a document. Best of all, this is a true app new compm anion app. The new NRP that works online as well as offline. Evidence based medicine app combines the easy to follow NRP Anyone who is an NRP provider/ SmartIntern Sepsis 2016 provides a alggorithm with a copy of the full instructor should have this app. point of care synopsis of the new Sepsis guideline and videos highlighting the o https://itunes.apple.com/us/app/ 3.0 guidelines. It improves upon the critical steps of NRP. nrp-app-neonatal-resuscitation-/ published guideline by operationalizing it id1125320382?mt=8&ig n- into a step by step algorithm for evaluating Evidence based medicine mpt=uo%3D4 patients at the point of care. The app AAP NRP incorporates the most o https://play.google.com/store/ contains numerous references and links current version of NRP guidelines. It apps/details?id=com.nrp.nrp to sepsis websites such as the Surviving contains a PDF version of the guideline Sepsis Campaign and PDF’s of the Feb viewable within the app as well as an 2. SMART INTERN SEPSIS (FREE) 2016 JAMA articles. easy to follow algorithm and videos of In February 2016, the Third critical resuscitation steps. International Consensus on Sepsis Likes published “Sepsis 3.0,” the first new o Includes the guideline highlighted Likes sepsis guidelines since 2003. Sepsis calculators SOFA and qSOFA built o Contains most current version of remains the 9th leading cause of into app. the NRP guidelines. disease-related death and the primary o Numerous links to sepsis websites o Helpful videos viewable offline. cause of infection-related death in and journal articles/guideline PDFs.

22 The Uniformed Family Physician • Winter 2017 MEMBERS IN o Expert commentary section helps offerings from Pusware LLC including THE NEWS decipher results of algorithm and several podcasts and books. further explains guideline. The USAFP Board of Directors Evidence based medicine encourages each of you to submitt Dislikes The IDC’s humor, concise writing information on USAFP “Members o Commentary section of app a bit and outstanding price make it a fan in the News” for publication in the too wordy in some areas. favorite. More importantly, the app newsletter. Please submit “Members o Algorithm can be difficult to foollow contains the proper mix of evidence in the News” to Cheryl Modesto at on devices with small screens. based medicine and expert opinion from [email protected]. o Not available for Android at this a practicing Infectious Disease specialist time. and numerous links to articles from PubMMed and current guidelines from the NEWSLETTER Overall Infectious Diseases Society of America SUBMISSION Another hit from the internal medicine (IDSA). DEADLINE residents at Englewood Hospital! This REMINDER: The deadline time they are one of the 1st groups out Likes for submissions to the spring of the gate with an app that addresses the o Interface is easy to use and includes magazine is 20 March, 2017. new sepsis guidelines. The app combines universal search. the new evidence and expert based o Hilarious writing covers bugs, guidelines with clinical calculators and drugs, and diseases not just dosing RESEARCH GRANTS commentary to aid in clinical decision information. The Clinical Investigations making. o Available for Android. Committee accepts grant applications o https://itunes.apple.com/au/ on a rolling basis. Visit the USAFP app/smartintern-sepsis-2016/ Dislikes Web site at www.usafp.org for a Letter id1088574777?mt=8 o May not be as up to date as the off Intent (LOI) or Grant Application. competition (sections do not Contact Dianne Reamy if you have 3. INFECTIOUS DISEASE COMPANION include date of last update). questions. [email protected]. (IDC) ($5.99 IOS/$2.99 ANDROID) o May not be detailed enough for The two most popular (and expensive) providers used to UpToDate and dedicated infectious disease guides Dynamed. RESEARCH JUDGES are Hopkins and Sanford. After using o Some sections require a lot of Applications for reseaarch judges are them both for several years now, I have scrolling and could be improved accepted on a rolling basis. Please concluded that they are essentially equal: with better organization/links. contact Dianne Reamy same outstanding up to date data, easy to ([email protected]) to requestt an use interfaces, and same price ($29.99!). Overall application. Many students and residents have The Infectious Disease Compendium recommended Dr Mark Crislip’s excellent (IDC) is an outstanding infectious app, Infectious Disease Compendium disease guide that continues to give the DO YOU FEEL STRONGLY (IDC), as a worthy and cheaper competition a run for their money. The ABOUT SOMETHING alternative to Sanford and Hopkins. It combination of humorous, yet YOU READ IN THE is not sponsored by any drug company or authoritative writing, along with an easy publishing house. It is written exclusively to use interface all at a very reasonable UNIFORMED FAMILY by a board-certified Infectious Disease price makes the app easy to recommend. PHYSICIAN? ABOUT specialist in Portland, OR. The app o https://itunes.apple.com/us/app/ ANY ISSUE IN MILITARY attempts to bridge the gap between simple infectious-disease-compendium/ FAMILY MEDICINE? drug dosing recommendations and dense id357700681?mt=8 textbooks. The writing is authoritative, o https://play.google.com/store/ Please write to me... concise and hilarious. Dr Crislip also has apps/details?id=com.pusware.id_ Dean A. Seehusen, MD, MPH a number of other outstanding (and free) compendium [email protected] www.usafp.org 23 committee reports Elizabeth Duque, MD Fort Bliss, TX PRACTICE MANAGEMENT [email protected] Playing the Access to Care Game

First, let me say that access to care clinic may be well staffed and another one Other things to think about are whether (ATC) is a good thing. We want our not as well staffed, but that doesn’t mean patiene ts prefer morning appointments patients to be able to make an appointment a provider can easily float over if they (liike our SGM academy students) or after with us when needed. But, if you are like are unfamiliar with the unique needs of school appointments (as many pediatric me, you have been so swallowed up in the those patient populations (i.e. Soldiei r clinic patients do). This is a changing access to care realm that when you hear care homes, pediatrics or inpatieent to environment and I admit we aren’t quite the words “access to care” you have to outpatient). It would require mmore time there at Fort Bliss, but it is a constant topic fight the urge not to crawl under the desk to train them up on the unique workings of conversation on how to better meet our in a ball of shivering terror. The pressure of a clinic and adjust their skill sets, than patients’ needs. to meet the ATC metrics and to prove that would be beneficial to the organization. 4) Types of appointments or template you have access has become intense and is 2) Enrollment and Empanelment – ratios – This game piece describes how highly scrutinized, especially if you have The system enncourages us to invite all many 24HR appointments versus FTR struggled to meet it historically. I intend patient types in when we have capacity. appointments you need. You also have to to discuss below how to “play the ATC This becomes a problem if a clinic then consider how many SPEC or procedure game” with a few tips that my large Army loses a provider and become short-staffed appointments are required. Is virtual care facility, with a significant FORSCOM and over-enrolled. We cannot say to something that your patients and staff can component, have used to navigate the our patients “thank you but we can’t utilize or do they all need to be face-to- game and have positive outcomes. care for you now, please go somewhere face (F2F)? Usually, this is a trial and else”. This would erode trust into the error situation based on historic demand THE GAME PIECES – (a.k.a. what affects military health system and have long term and it can ebb and flow with the seasons. ATC). consequences that will span a decade (I The best example is in the Pediatric clinic, 1) Staffing – I put thiis as #1 as it is have seen it happen). This means that where seasonal demand is important and the most important piece in the game, sometimes we have too many patients and during the cold/flu season more 24HR especially provider sstaffing. Appointments not enough providers and at others times appointments are needed and during cannot exist if tthere is no one there to we have more providers than needed. It school physical season, more FTRs are supply them.m Unfortunately, the way our is cyclical and finding a steady balance needed. That being said, appointment hiring system works, a clinic can’t have a in the dynamic environment of military ratios can vary for each medical home, let replacement on board before someone medicine is often difficult. alone for each clinic or post. leava es. Sometimes, there is a six month 3) Utilization rates – This is how 5) Efficiency – How efficient is your or longer underlap. This means six frequently your patients need to see you. staff? How is the workflow? It is very months that the clinic is over enrolled, It is a fairly good metric and is based on difficult and exhausting to see 21 patients short staffed and scrambling to keep their retrospective data and doesn’t account for a day when the clinic is inefficient. We heads above the water. Assuming the things like unit deployments, new units recognized that we do not model the facility is located in a place where hiring assigned to your post or a severe cold and PCMH workflow as we could or should in is fairly easy (this is not the case in El Paso flu season. It usually ranges from 3-5 visits many of our homes. We started to devote and many other locations), it still takes a per patient per year. Digging deeper into the time and invest in training to improve significant amount of time to get someone utilization will allow leaders to know when efficiency (yes, we reduced access for this). onboarded and up to speed.There are and where patients want to be seen. For Team PCMH workflow training should some mitigation strategies for this, such example, community based clinics do well improve efficiency and moral and reduce as backfills, contracts and overtime for in many places as they meet the demands turnover and patient utilization. providers, but it can be hit or miss whether of patients who don’t want to go onto they work. An additional concern is that post, find parking at the hospital and want not all providers are interchangeable. One to receive their care closer to their home. continued page 26

24 The Uniformed Family Physician • Winter 2017 East Carolina University, GREENVILLE, NC

BRODY SCHOOL of MEDICINE Department of Family Medicine

East Carolina University, Family Medicine has a strong faculty, a vibrant residency program, fellowships in Geriatrics, Sports Medicine, and Women’s Health along with a well-established medical student education division.

Family Medicine positions are available in the areas of general family medicine, sports medicine, and geriatrics. Direct patient care and teaching opportunities are available.

The department fosters a nurturing and supportive environment in which everyone can work together successfully. To explore our employment opportunities, visit our website to learn more about us. http://www.ecu.edu/fammed/

Contact: Chelley Alexander, MD Chair, Department of Family Medicine Phone: 252-744-2600 Jacob Sanchez Diagnosed with autism Email: [email protected]

Family Practice and Internal Medicine Providers

• Outpatient only practices located in Beaverton, Canby, North Portland, Oregon City, and Tigard • Opportunity to be a shareholder and participate in an incentive pay plan At Pacific Medical Group, our • Competitive salary, sign-on mission is to make a positive difference by bonus, and benefit package providing patient centered primary care • Fully automated EMR software and customer focused service. In living • All Pacific Medical Group our values, we foster an enriching work Clinics have received environment, provide leadership, and Recognition as a Patient- Centered Medical Home by the collaborate with others in the improvement of NCQA and the State of Oregon health. Pacific Medical Group is a busy, If you are seeking an independent, private practice with five opportunity to build and grow provider-owned clinic locations in the a solid practice that is both Portland metro and surrounding area. We professionally satisfying and Lack of eye contact is a sign of autism. are looking for dynamic providers to join financially rewarding, this may Learn the others at autismspeaks.org/signs. and expand our progressive practice. be the right opportunity for you.

To learn more about Pacific Medical Group, please visit our website at www.pacificmedicalgroup.com. To apply, submit CV and cover letter to Trudy Chimko, HR Manager, by email at careers@pacificmedicalgroup.com, or by fax to 503-914-0335. www.usafp.org 25 conco tinued page 24 There are many other metrics, to a flaw in the CHCS system that results THE RULES OF THE GAME – (a.k.a. what include F2F projected, demand and in the auto conversion being removed are the metrics) executed. These metrics are impacted by once an appointment is booked and is a variety of variables to include number not replaced whhen the appointment At least in the Army, there are several of working days in a month, utilization is cancelled. You have to manually different metrics that are measured. rates, seasonal demand, FORSCOM convert these FTR appointments into 3rd next available apppop intment – this unit deployments, etc. The Army has 24HRs. This resulted in an additional is the BIG metric and you can’t “win” the primary care empanelment tool 3-5 appointments per clinic per day without making it green. It measures (PCET) that is supposed to help capture aand reduced unbooked appointments both 24HR and FTR access. It is some of the variables, but it is admittedly slightly. measured by looking at the provider cumbersome and it does not capture all d) Do you have a problem with self- with the most available appointments things, such as last minute taskeers or generated demand? These are follow up in a home and calculating when is their provider TDYs. appointments requested by a provider next 3rd open appointment for 24HR and that could be done over the phone (i.e. FTR. The goal is to have the 24HR STRATEGIES TO WIN THE GAME lab and rad follow ups). Some of these less than 1.0 and the FTR less than 7.0. 1) Get buy –in both up, down and appointments are appropriately F2F, The metric is pulled at 0530 local time across. You can’t do this by yourself; many are not. Good workflow and but calculates open appointments from it is truly a team effort. You have to sufficient staffing ratios will help with 0830 on. This is usually helpful to the have support from leadership to make this one. department as providers that call out sick these changes and to emphasize the 3) Get into the weeds - Are your and last minute issues shouldn’t affect the importance of ATC to other areas of administrators acutely aware of metric, but it means things can’t be fixed the hospital system. Your staff must the staffing levels, the number of the morning of either. understand the goal and rules of ATC appointments needed per day and ratio Unbooked/Unused rate – this is thhe and why you are doing things the way of appointment types? Do your MSAs number of appointments that go unnused. you are. Additionally, if you have and nurses understand and support This can be from patient cancec llations FORSCOM providers who work within the ATC initiative. Details matter or unbooked appointments. It can be your medical homes, you need buy-in and require daily vigilance to adjust seen as a counter metric frrom the 3rd next from them and their understanding on schedules and proactively plan for low available. If you are wele l staffed, you may how they affect the organization’s ATC staffing times. have a high unbooked rate and if you are metric outcomes. This can be difficult 4) Creative Solutions – Be creative short staffed you may have a low one. as they have several competing demands and think outside your box for answers That is a simpm listic explanation, as there and often don’t report to you directly. to your problems. Look for untapped are many things that can affect this, such 2) Find low hangingg g fruit resources. We asked for help from our as clinnic type, patient utilization, days of a) Are all of your providers’ templated WTU, IDES, SRRC and inpatient the week, appointment types, etc. You appropriately to maximize clinic time pediatric providers during their “down” want an unbooked rate but not too high and patient care time? There are reasons times. Can you realign resources even of one, otherwise it looks like you are for providers not to have the mandated for a day or two when you know access overstaffed or under enrolled and you 21 appointments per day, just make sure will be red? We also got to a point where will get negative pressure from higher it is justified (i.e. on the PCET). we have a couple of heavily administrative headquarters to justify and correct. b) Do you have clear and concise providers who can float across homes and Leakagge – there are several leakage booking guidelines and are they being clinics during their administrative time to measurements. It measures how many followed? We found that many of our fill in when clinics are short staffed. of your patients are using the ER, urgent MSAs were trying to take care of the care or outside primary care resources. patient and booking 24HR appointments PITFALLS TO AVOID If you have good access you expect this outside the 24HR window, thus sucking 1) Overcorrection – while the 24HR number to be low (although again, it is up this resource and skewing our metrics. metric has more visibility, don’t sacrifice more complicated than that). Patient c) Are you converting the patient too many 24HR for your FTR. You have population, clinic locations and hours of cancelled appointments to 24HRs? We more flexibility and buffer room with operation can all impact this metric. discovered late in the game that there is the FTR metric, but not a huge amount.

26 The Uniformed Family Physician • Winter 2017 Additionally, don’t sacrifice the urge to providers that this ends up happening appointments. All of these can easily meet a metric for good patient care and to, as they have additional duties and slip one way or another and ensuring customer service. thus are the ones that are easiest to the right balance in order to be greenn 2) Overstaffing/Ug nderprp oduction – remove panels from and make into float in all metrics can be exhausting, if staff that are bored tend too be unhappy. providers. This creates dissatisfaction not impossible. It is essential that I personally fear that we will risk putting both from the providers who are doing you determine what are your highest our active duty providers out of business majority of the patient care and the ones priorities and balancing your attention with the intense focus on ATC and who are doing much less. to the other metrics. provider availability. There is a desire 3) Tighg troppe walking – There are Goal of the game: Ensure your to overstaff in order to create a buffer many conflicting forces here that make clinic has enough appointments open and against delayed hiring and short staffing one feel as if they are walking on a tight available in the system, low unbooked situations. The downside is that it will rope. Some of these include: balancing rates, low leakage rates, high patient create an environment where providers patient demands versus a metric, satisfaction, high staff satisfaction and are under-empanelled and see fewer balancing ATC versus productivity, high productivity. Easy, right? patients. Often, this is our military and balancing ATC versus unbooked Good luck in the ATC game!

Don’t Miss Out on Complimentary USAFP Membership Benefits POEMs process applies specific criteria for validity and DAILY INFOPOEMS relevance to clinical practice. If you want to subscribe, The USAFP is pleased to continue providing as a please e-mail the USAFP at [email protected] so your membership benefit a free subscription to Daily POEMs e-mail address can be added to the distribution list. CE activities is to update healthcare professionals on from Essential Evidence Plus. Daily POEMs (Patient advances in the diagnosis and management of medical Oriented Evidence that Matters) alerts and 3,000+ AUDIO DIGEST disorders. The primary goal of each activity is to provide archived POEMs help you stay abreast of the latest and The USAFP is pleased to provide as a membership practical information that will improve professional most relevant medical literature. Delivered directly to benefit continued access to Audio Digest MP3 files in the competence in caring for patients. you by e-mail every Monday through Friday, Daily POEMs area of Family Medicine, Pediatrics and OB/Gyn. The USAFP has an institutional subscription which identify the most valid, relevant research that may change For those not familiar with Audio-Digest, they produce allows our members to access the MP3 files in Family the way you practice. Monthly, the complete set is compiled over 300 audio CME/CE programs each year. These Medicine, Pediatrics and OB free of charge. If you are and sent for additional summary review. Ongoing since programs are derived from lectures recorded at more interested in obtaining CME for the modules, please call 1996, their editors now review more than 1,200 studies than 285 CME/CE meetings across the country, always Audio-Digest at (800) 423-2308 and they can assist you monthly from more than 100 medical journals, presenting with permission of the sponsoring organizations and the with the paid subscription of your choice. only the best and most relevant as POEMs. The acclaimed lecturers involved. The objective of Audio-Digest CME/ To access please email [email protected]

If interested, please send a request to EVERY DOC CAN [email protected]. DO RESEARCH 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. www.usafp.org 27 2017 USAFP Annual Meeting & Exposition

“Leearn…SERVE…Lead.”

REGISTER TODAY!!!

Register today for the 2017 USAFP Annual Meeting & Exposition scheduled 5-9 March 20117 at the Westin hotel in Seattle, Washington. Over 25 credits of CME will be offered along with multiple workshops. The Westin hotel is ideally situated in downtown Seattle and within walking distance of Pike Place Market, the Monorail, and the Space Needle. The hotel offers spectacular views of the city as well as Puget Sound and Mt. Rainer. Hotel amenities include a complimentary 24-hour fitness studio, heated indoor pool as well as easy access to shopping and dining. We are thrilled to be offering USAFP 2017 in the beautiful Pacific Northwest. Please join us in Seattle to “Learn…SERVE…Lead.” You don’t want to miss this premier CME event! Online registration is available at www.usafp.org. If you have any questions or want to contact the programs Co-Chairss, please email Gigi Rey MD & Chris Ledford MD, 2017 USAFP Program Co-CChairs • [email protected]

  
      





 

 
  

28 The Uniformed Family Physician • Winter 2017 Transitioning Military and Federal Healthcare Providers

CONTACT: Dr Dianna Mahoney • Relocate to the beautiful mountain resort community of Pinetop, Arizona, located within [email protected] the largest contiguous ponderosa pine forest in the (928) 205-9866 world with over 180 miles of developed hiking, mountain biking, and cross-country skiing trails throughout the community • Opportunity to practice full-spectrum medicine if desired, to include ER, urgent care, low-risk OB, inpatient and outpatient medicine • Alpine skiing and snowboarding only 36 miles away; three 18-hole courses in Pinetop and an additional four courses within 20 miles in nearby Show Low, AZ • Wonderful four season climate with sunshine more that 70% of the time year-round • Openings include both federal civil servant positions as well as positions for uniformed officers of the Public Health Service Corps • Military physicians, FNPs and PA’s have the opportunity to transfer services and retain active duty benefits, to include 20 year retirement, TSP, loan repayment, Tricare, access to military base lodging, recreational facilities and space-A flights; for compensation questions: http://www.usphs.gov/ profession/physician/compensation.aspx www.usafp.org 29 Matthew N. Fandre, MD, FAAFP Fort Campbell, KY leadership book series [email protected]

THE ADVANTAGE by Patrick Lencioni

“CULTURE EATS STRATEGY FOR issue or friction with a perspective of BREAKFAST” what can I do to make it better; this humility and focus on the organization This quote, commonly attributed builds trust and commitment for the to the great Peter Drucker, is an leadership team and the organization. embodiment of this quarter’s book Another component of a cohesive review. Patrick Lencioni’s THE team is the ability to manage conflict. ADVANTAGE explores the critical Lencioni brings a great model for where importance of organizational culture successful organizations function: and why it’s essential for success in the Ideal Conflict Point (ICP). On a any organization; not just to maximize spectrum of artificial harmony to Mean- performance and revenue, but to Spirited Personal attacks, the ICP is the weather the storms and challenges all Figure 11: Organizational Health Model; Patrick point where conflict is uncomfortable of us face. The key to organizational Lencioni and forces tough decisions but still culture rests with the leadership and remains constructive. The challenge management team; as this journal is getting the right people on the bus within our military system is how to for Family Physician leaders, my hope (ala Jim Collin’s Good to Great), maintain candid, professional, and is that its content and principlees will the paramount concern of senior at times uncomfortable discussions resonate within you and helpl you to leadership is to ensure the leadership given the added complexities of rank, improve your teams. team (i.e. the command team) are position, and medical expertise. For those that have read Lencioni’s synchronized in focus and purpose. The second discipline is the need to previous works (Figure 1), this book To build a cohesive leadership team, create clarity. In the military, we have differs in that it’s not structured as a Lencioni walks the reader through 5 a distinct advantage as we are all trained fable with a leeadership lesson but rather behaviors that the team must embrace that the mission comes first and that the incorporaates many of the teachings to be successful: Trust, Conflict, commander’s intent gives subordinates from those books and his consulting Commitment, Accountability, and the direction needed to violently execute business into 4 disciplines that lead Results. Although none of these are the plan. However, within our medical to strong organizational health (see surprising to anyone on a leadership departments, is the clarity of mission embedded diagram). The book is a team, the book challenges both the as clear as it should be? What’s most combination of step-by-step blueprint CEO, as well as each individual important? Quality care, readiness, processes as well as practical, positive member of the leadership team, to war time skills training, or GME? We and negative real world examples. evaluate what these values mean and must ensure our organizations know Of these four disciplines, by far the to then check if he or she is being why we exist, how we will succeed, and most important is building a cohesive internally and externally accountable what’s most important right now. The leadership team. As we have all seen to them. In regards to trust, the key is book progresses through six questions weak and strong leadership teams, for leaders “to sacrifice their egos for leadership teams must consider to if divisiveness and conflict exists the collective good of the team.” As provide this clarity. In my current within the leadership team, there’s written in a prior USAFP book review, organization, access to care is our no doubt that those symptoms will the essence of this is the same as in primary focus as primary care is our permeate throughout the rest of the QuestionQ Behind the QuestionQ . number one engine. To this point, the the organization. In addition to Every leader must approach the given commander’s daily report is a summary

30 The Uniformed Family Physician • Winter 2017 then become just another set of slides recovery, is in great spirits). Part off How do your orgaanization’s metrics and checklists to feed the reporting the reason I chose this book was the that are reviewed daily correlate to system. The lack of innovation and fact that the great culture of Munson what you need to focuss on today? flexibility completely runs contrary to Army Health Center allowed us to For other metrics that have their own developing and preserving the culture get through this event and emerge standard reporting mechanism, there’s the leaders and the organization have stronger. I am certainly not implying no reason to include them in your daaily fought to establish. we did everything perfectly, but we report. The final section of the book (the leadership team) built on the The third discipline is addresses the importance of well- inherent strength of the organization overcommunicate clarity. Every desiigned and well-executed meetings and used many of the principles article I’ve read on personnel surveys in furthhering or destroying the culture captured in the book to guide our or organizational improvement of the organization. Meetings have organization. Clarity, communication, starts with the need for clear different purpposes and structure to and over communication was essential; communication. Obviously if this address the statedd need (daily huddle, the command team huddled late was easy it wouldn’t keep dominating tactical staff meetinggs, quarterly off- into the night to clearly identify our these reports. Leaders must be sites, or ad-hoc topical meetings priorities, roles and responsibilities, cheerleaders for the organization as {i.e. for acute issues neediing a deep- and the mechanisms by which we well as “Chief Reminding Officers”. dive}). This section gives the reader a would reinforce and communicate All too often, people start to hear your useful and applicable summary off the everything that was happening. message at the same time you get tired meeting types. For more information,n Ultimately, in my opinion, our clearest of saying it. The final discipline is Lencioni’s Death byy Meetingg is an definition of success is that we didn’t reinforcing clarity. Highly successful essential read for those wanting to allow that incident to define who we organizations are able to do this run productive, energetic, and focused are. Organizational culture is the heart through hiring processes, feedback meetings. of the orgganization and leaders must mechanisms, and compensation. For those that aren’t aware, our do everythinng within their power to The key is for the organization to health center suffered a horrific define and preserve it. “institutionalize its culture without event in early September when one “Organizational health will one bureaucratizing it.” That phrase stuck of our nurses was violently attacked day surpass all other disciplines in with me. Throughout our Armed in our facility by another employee business as the greatest opportunity Forces we have countless examples and almost died (thankfully she is for improvement and competitive of great ideas with great purpose that doing well and despite the long future advantage.” -Lencioni

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CONTACT 3RVLWLRQ2IIHUV x ,QWHJUDWHGKHDOWKV\VWHPZLWKDFRPSHWLWLYH LQFRPHJXDUDQWHH Michele Forinash at x &RPSUHKHQVLYHEHQHILWVLQFOXGLQJKHDOWK GHQWDOYLVLRQDQG&0( x 5HORFDWLRQDVVLVWDQFHDQGSURIHVVLRQDOOLDELOLW\ 800.561.4686 ext.112 FRYHUDJH Robert C. Oh, MD, MPH Installed as 2015-2016 )RUPRUHLQIRUPDWLRQSOHDVHFRQWDFW USAFP President OR EMAIL Dr. Oh is pictured with /LVD+DXFN_-- AAFP Past President Warren Jones, MD /LVD+DXFN#0HUF\QHW (see page 8) [email protected] 0HUF\QHW)DPLO\0HG67/ Journal of The Uniformed Services Academmymy off FamFa ily Physiciansn

www.usafp.org 1 www.usafp.org 31 new members THE USAFP WELCOMES THE FOLLOWING NEW MEMBERS… ACTIVE RESIDENT STUDENT Ms. Rene MacKinnon Peter Andrew Baldwin, MD, MPH, Michelle Baker, MD Mr. Michael Azir Mr. Pattrick Michael McCarthy MBA Daniel Craig Bothwell, DO Mr. Bradley A Bishop Mr. Zachary Monahan James Daniel Bass, MD Dakota Tala Breish, MD Mr. Quinn Daniel Bott MMs. Emily Parsons Ivan J Briones, MD Roger Joel Brogis , II, DO Mr. Ryan Coffey Mr. Roland William Pomfret Samya V Cruz, MD George Walton Clement, MD Ms. Kathryn Elizabeth Driggers Mr. Alexander John Pybus Rita A Kostecke, MD, MPH Erin Irene Coyle, DO Ms. Nancy Lee Gillcrist Mr. Eric Rubado Alex John Lee, DO Samone Elizabeth Franzese, MD Ms. Rachel H Han Ms. Kristen Blair Samardzic Jared W Nelson, MD, FAAFP Elizabeth Todd Harpster, MD Mr. Colin James Harrington Mr. Douglas Trask Clifton M Nowell, DO Zachariah John Kamla, DO Mr. James Bradford Hughes Mr. Scott Brinton Whitecar Ricardo Alejandro Sequeira, MD McHuy Floyd McCoy, MD Mr. Andy Hur Ms. Jessica Wilder Heather Elizabeth Waters, DO Daniel Robert Nadeau, DO Ms. Lauren Phham Kecskes Ramon Yambo-Arias, MD Mr. Alexanded r Leeds MEMBERS IN THE NEWS Congratulations to the USAFP Members that Received the AAFP Degree of Fellow

The Degree of Fellow recognizes AAFP members who have distinguished themselves among their colleagues, as well as in their communities, by their service to Family Medicine, by their advancement of health care to the American people and by their professional development through medical education and research. Fellows of the AAFP are recognized as Champions of Family Medicine. They are the physicians who make family medicine the premier specialty in service to their community and profession. From a personal perspective, being a Fellow signifies not only ‘tenure’ but one’s additional work in your community, within organized medicine, within teaching, and a greater commitment to continuing professional development and/or research.

Michael John Arnold, MD, FAAFP Joshua Luke Latham, DO, FAAFP Michael Matthew Barna, MD, MPH, FAAFP Robert Patrick Lennon, MD, FAAFP Richard Joseph Bean, MD, FAAFP Jessica Audrey Lotridge, MD, FAAFP Deborah S Belsky, MD, MPH, FAAFP Bruce Len Lovins, MD, FAAFP Jessica Johnson Bloom, MD, FAAFP Anastasia M McKay, MD, FAAFP Theron Germaine Bryant, DO, FAAFP David Alan Moss, MD, FAAFP Michael Bybel, DO, FAAFP Laurel Anne Neff, DO, FAAFP Wilbert E Charles, MD, FAAFP James A Nicholson, MD, FAAFP Roselyn Jan Wuthrich Clemente-Fuentes, MD, FAAFP Upneet Kaur Nijjar, MD, FAAFP Katherine Erin Cocker, DO, FAAFP Charles D Noble, MD, FAAFP Jean Felix Cyriaque, MD, MPH, FAAFP Heather M O’Mara, DO, FAAFP Anja Dabelic, MD, FAAFP Dana John Onifer, MD, USN, FAAFP Edwin Alonzo Farnell, MD, FAAFP Erica D Radden, MD, FAAFP Seth Yawki Flagg, MD, FAAFP Kristen A Reineke-Piper, MD, FAAFP David William Floyd, MD, FAAFP Rowena M Reyes, MD, FAAFP Christopher D Fucito, DO, FAAFP Andrew A Rusnak, MD, FAAFP Heidi Lynn Gaddey, MD, FAAFP Kristian Evan Sanchack, MD, FAAFP David Kent Gordon, MD, FAAFP Thomas Michael Skinner, MD, FAAFP John D Hallgren, MD, FAAFP Dawn Marie Sloan, MD, FAAFP Gabriel Taff Harris, MD, FAAFP Dustin K Smith, DO, FAAFP Matthew Stanton Hing, MD, FAAFP Gerald Wayne Surrett, MD, FAAFP Darrell Edward Jones, DO, FAAFP Candace Murray Talcott, DO, FAAFP Jun Woong Kim, MD, FAAFP Wesley M. Theurer, DO, MPH, MBA, FAAFP Michael Kim, MD, FAAFP Kelly Gray Koren, MD, FAAFP Shane Lyle Larson, MD, FAAFP

32 The Uniformed Family Physician • Winter 2017 Doctor Recommended. In 22 states and nearly 200 hospitals.

Wherever you see yourself and your new practice, chancces are a

chhances are you’ll be glad you did. Approximata ely 27,0000 physicians – apprroximately 200 CHS-affiliated hospitals in 22 states. The hospitals ded liveer a wide raange of health ses rvices and function as vitally important memmbers of thheir locac l coc mmunities. Last year, physician satisfaction was higgh at 89 percr ent, and 91 pep rcent of physicians said they would recommennd the hoospitals with

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competitive recruitmennt pacckages and start-up incentives, whici h maay include medical education debt assistance and evven rese idency stipends. Hundn reds of phhysis cians choose

year – for quuality off care ana d quality of liffe. OnO e maay be righg t fof r you!

For more information, visit: www.chsmedcareers.com. Email: [email protected] Call: 800-367-6813

CHS and Community Health Systems are tradenames/trademarks of Community Health Systems Professional www.usafp.org 33 Dean A. Seehusen, MD, MPH Still Serving Fort Gorton, GA dsd [email protected] CAPT(RET) WILLIAM ROBERTS

CAPT(Ret) William Roberts When asked about what gives him retired from a 30 year career as a naval pride when he reflects on his military medical officer in 2005 while stationed career, Dr. Roberts responds, “I am at Naval Hospital Camp Pendleton most proud that I maintained my full (NHCP). Dr. Roberts is double spectrum clinical skills and acumen boarded in both family and emergency despite taking on the administrative medicine. He served as the Associate jobs and responsibilities required to Program Director at US Navy Hospital make 0-6. That was always a priiority Pensacola (1990-1994) and Program for me. I am very proud of the number Director at NHCP (1999-2004). He of superb Navy family physy icians that notes these were dream jobs and that he I, along with great staffs over the years, would, “like to think that I was involved have trained.” in leaving them better programs than I Dr. Roberts just turned 63-years- found them due largely to the efforts of old and continues to teach, practice full the staff and residents that were with spectrum family medicine including me during those time periods.” Upon obstetricsc , and serves as the geriatrics his military retirement, the new PD at subjeect matter expert at NHCP - NHCP, CAPT John Holman, offered having gained his CAQ in geriatric Dr. Roberts the first GS physician medicine in 1988. He proudly points the annual 5K race, though some Army position at the residency. He accepted out that he’s “still up at 0300 in the guy always won it during those years!,” on the spot. morning, elbow to elbow with our he remembers. residents, supervising our busy labor Dr. Roberts now considers it his deck while on call.” role to “hold down the fort” and let Dr. Roberts is currently in the the Active Duty members attend the 2017 AAFP envious situation of being a retired USAFP meetings so they can benefit Navy physician who continues to the way that he did during his time in National CME train Navy family physicians in a uniform. Dr. Roberts highlights three GS capacity. “Though no longer in reasons USAFP has been so valuable to Courses uniform, I still feel like a part of Navy him over the years. First, the military For more information, please medicine in my roles as teacher and unique perspective not found at civilian visit www.aafp.org/cme provider.” He continues, “There’s no conferences. Second, the high quality more deserving group to care for than of USAFP presentations. Lastly, the March 9-12, 2017 our active duty members, their families way USAFP advocates for its members. AAFP Family Medicine and our military retirees. I continue to When asked what advice he might Board Review Express® Live shape the future of Navy medicine in offer junior members of the USAFP, Course training family physicians and medical Dr. Roberts says, “Throughout your Hyatt Regency Reston officers.” career, stay true to your clinical roots. Reston, VA Dr. Roberts was a regular attendee We are blessed to be physicians. I thank at USAFP meetings during his career. God every day that I chose to become June 20-24, 2017 He most appreciated the camaraderie, a Navy family physician. It’s been an AAFP Family Medicine Live opportunity to catch up with friends integral part of my life.” Course and the networking that the meetings And we THANK YOU, Dr. Roberts, Hyatt Regency Reston provide. “It was fun to rub elbows with for your distinguished military services Reston, VA our brothers and sisters from the other and your continued service to the services, and I have fond memories of USAFP and its members!

34 The Uniformed Family Physician • Winter 2017 Looking for a new adventure?

If you are coming to the end of your military service, we have the next opportunity for you.

We are looking for an experienced Family Medicine Physician with emergency skills to join the RDWA Locum Team in December 2017, working in rural South Australia. Being a locum offers: • working 37 weeks over 12 months, including a week of CME • a generous salary with excellent benefits • full malpractice coverage • work travel and accommodation coverage • access to world class tele-medicine and medi-vac facilities • 15 weeks’ vacation leave • the opportunity to travel and see the rest of Australia • personalised support for licensing, visa and relocation And if you’d prefer to settle in one place for a while, we have some great locations just waiting for you. Practice the medicine you love and enjoy your next adventure in rural South Australia.

Visit www.ruraldoc.com.au and watch former US Navy Doctor Ken Wells’ story, to learn more about this experience. Contact Angela Tridente, Director Recruitment via telephone: +61 8 8234 8277 or email: [email protected]

www.usafp.org 35 Uniformed Family Physician Instructions for Authors AIMS AND SCOPE

The Uniformed Family Physician (UFP) is the official publication of Unifformed Services Academy of Family Physicians (USAFP). The USAFP is a constituent chapter of the American Academy of FFamily Physicians and is comprised of Family Physicians, Family Medicine Residents and Medical Students serving on active duty worldwide in the United States Air Force, Army, Navy, Coast Guard and Public Health Service. The USAFP has over 2,700 members serving on military installations in the United States and in many other countries throughout the world. The vision of the USAFP is to be the premier professiional home to enhance the practice and experience of current and future Uniformed Family Physicians. The mission of the USAFP is to support and develop Uniformed Family Physicians as we advance health through edducation, scholarship, readiness, advocacy, and leadership. The intended audience of the UFP is the membership of USAFP. The UFP’s mission is to provide continuing professional development for its members as well as to act as a platform for the dissemination of information of interest to the members of the USAFP. Everything published in the UFP represents the personal opinion of authors or the editor. It does not represent official policies or opinions of the Department of Defense nor specific branches of the military. It is published quarterly and is free to members.

ARTICLE TYPES

The UFP mosttly publishes recurrently features on a rotating basis. The UFP does accept unsolicited articles on topics highly ppertinent to USAFP members. Publication of these articles is highly space dependent.

• Recurrent Features are solicited articles that are written by key individuals within USAFP such as the President, consultants, and committees. These features appear on a rotating schedule.

• Unsolicited Articles can cover any topic of interest to our readership. Any USAFP member can submit and unsolicited article. Publication will be dependent upon the topic and available space.

Please visit http://www.usafp.org/about-usafp/uniformed-family-physician-newsletter/ for complete instructions.

36 The Uniformed Family Physician • Winter 2017 86 million Americans Maybe even you, have prediabetes. Person-seeking-10-amazing- ways-to-spice-up- that-casserole.

www.usafp.org 37 I’M PAUL GEORGE

WHEN I WAS SIX

NBA All-Star Paul George

MY MOM HAD A STROKE

Learn the signs of a stroke F.A.S.T. Face drooping Arm weakness Speech difficulty Time to call 911

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38 The Uniformed Family Physician • Winter 2017 Are you looking for a satisfying career and a life outside of work? Enjoy both to the fullest at Patient First. Opportunities are available in Virginia, Maryland, Pennsylvania, and New Jersey.

Open 8 am to 10 pm, 365 days a year, Patient First is the leading urgent care and primary care provider in the mid-Atlantic with over 60 locations throughout Virginia, Maryland, Pennsylvania, and New Jersey. Patient First was founded by a physician and we understand the flexibility and freedom you want in both your career and personal life. If you are ready for a career with Patient First, please contact us. To learn more about career opportunities at Patient First, contact Recruitment Coordinator Each physician enjoys: Eleanor Dowdy at (804) 822-4478 or • Competitive Compensation [email protected] or visit prcareers.patientfirst.com. • Flexible Schedules • Personalized Benefits Packages • Generous Vacation & CME Allowances • Malpractice Insurance Coverage • Team-Oriented Workplace • Career Advancement Opportunities www.usafp.org 39 The Uniformed Services Academy of Family Physicians 1503 Santa Rosa Road, Suite 207 Presorted Standard Richmond, Virginia 23229 U.S. POSTAGE PAID www.usafp.org LITTLE ROCK, AR PERMIT NO. 2437

40 The Uniformed Family Physician • Winter 2017