mark your calendars to attend the 2015 usafp annual ... usafp annual meeting & exposition equip...

www.usafp.org 1

Journal of The Uniformed Services Academy of Family Physicians

Summer 2014 • Vol. 7 • Num. 4 • Ed. 28

Mark Your Calendars to Attend the2015 USAFP Annual Meeting & Exposition

EQUIP – ADAPT – MENTOR18-22 MARCH 2015Hyatt Regency Crystal CityArlington, Virginia

The Uniformed Family Physician • Summer 201422

CHS and Community Health Systems are tradenames/trademarks of Community Health Systems Professional Services Corporation, which provides management services to a�liates of Community Health Systems, Inc.

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

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chances are you’ll be glad you did. Approximately 27,000 physicians –

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CHS-a�liated hospitals in 29 states. �e hospitals deliver a wide range of

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Email: [email protected] Call: 800-367-6813

Doctor Recommended.In 29 states and more than 200 hospitals.

*CHS-a�liated facilities included 135 hospitals in 2013.

www.usafp.org 3

The Uniformed ServicesAcademy of Family Physicians

1503 Santa Rosa RoadSuite 207

Richmond, Virginia 23229804-968-4436

FAX 804-968-4418www.usafp.org

VISION

The USAFP will be the premier professional home that provides services to enhance the experience of current and future Uniformed Family Physicians.

MISSION

The mission of the USAFP is to support and develop Uniformed Family Physicians as we advance health through education, scholarship, readiness, advocacy, and leadership.

USAFP e-mailTerry Schulte: [email protected] Lindsay White: [email protected]

Newsletter EditorChristopher Paulson, MD: [email protected]

This newsletter is published by the Uniformed Services Academy of Family Physicians. The opinions

expressed are those of the individual contributors and do not reflect the

views of the Department of Defense or Public Health Service.

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12

AcADEMy LEADERs

EDITOR’s VOIcE

cONsULTANT REPORT: NAVy

14cONsULTANT REPORT:PHs

cONsULTANT REPORT:AIR fORcE

16

5PREsIDENT’s MEssAgE

2015 ANNUAL MEETINg PREVIEw

18TEAcHINg AND LEARNINg

22 cOMMITTEE REPORTs:cLINIcAL INfORMATIcs

31 LEADERsHIP BOOk cLUB

Created by Publishing Concepts, Inc.David Brown, President • [email protected]

For Advertising info contact Michele Forinash • 1-800-561-4686

[email protected]

pcipublishing.com

Edition 28

26cOMMITTEE REPORTs:REsIDENT AND sTUDENT AffAIRs

27 cOMMITTEE REPORTs:PRAcTIcE MANAgEMENT

29MEMBERs MAkINg A DIffERENcE

32THREE yEAR REPETITION Of sAM IMPLEMENTED

33 wELcOME NEw MEMBERs

34cONgRATULATIONs TO THE UsAfP MEMBERs

THAT REcEIVED THE AAfP DEgREE Of fELLOw


your academy leaders

OFFicErSPresidentMark J. Flynn, MD, FAAFPCamp Pendleton, [email protected]

President-eleCtRobert C. Oh, MD, MPHFt. Belvoir, [email protected]

ViCe PresidentChristopher Paulson, MDeglin AFB, [email protected]

seCretAry/treAsurerJoseph Perez, MDus Coast Guardnorfolk, [email protected]

PAst PresidentPamela M. Williams, MDnellis AFB, [email protected]

exeCutiVe direCtorTerrence J. Schulterichmond, [email protected]

DirEcTOrSAir ForCeJohn Hallgren, MDoffutt AFB, [email protected]

Christopher Jonas, DOthe White House, Washington, [email protected]

Jessica Servey, [email protected]

ArMyMichael Oshiki, MDJoint Base lewis-McChord, [email protected]

Laurel Neff, DOFort Wainwright, [email protected]

Mark E. Stackle, MD, MBAFt. Bragg, [email protected]

nAVy Steve Kewish, MDnaval Hospital Bremerton, [email protected]

James Ellzy, MDBuMed, Washington, [email protected]

Brian Smoley, MD, MPHCamp Pendleton, [email protected]

PuBliC HeAltH serViCeEdgardo Alicea, MDusCG savannah, [email protected]

Maria DeArman, MDusCG Corpus Christi, [email protected]

residentsMary Alice Noel, MDFort Benning, [email protected]

Aaron Conway, DOCamp lejeune, [email protected]

Kevin Sisk, DOscott AFB, [email protected]

AAFP deleGAtesMichael L. Place, MDnational defense universityWashington, [email protected]

Pamela M. Williams, MDnellis AFB, [email protected]

AlternAtes Mark J. Flynn, MD, FAAFPCamp Pendleton, [email protected]

Robert C. Oh, MD, MPHFt. Belvoir, [email protected]

cONSUlTANTSAir ForCeAntoine (Marcus) Alexander, MDAFMoA, san Antonio, [email protected]

ArMyMark M. Reeves, MDFt. sam Houston, [email protected]

nAVyTimothy Mott, MDnaval Hospital Pensacola, [email protected]

cOmmiTTEE chAirSCliniCAl inForMAtiCs Matt Barnes, MDFt. Belvoir, [email protected]

CliniCAl inVestiGAtions Anthony Beutler, MDusuHs, Bethesda, [email protected]

Constitution And BylAWs James W. Keck, MDnaval Hospital Jacksonville, [email protected]

eduCAtion Douglas Maurer, DOMadigan AMC, [email protected]

HeAltH ProMotion And diseAse PreVention Debra Manning, MD, MBABuMed, Washington, [email protected]

MeMBersHiP And MeMBer serViCesAdam Saperstein, [email protected]

neWsletter editorChristopher Paulson, MD eglin AFB, [email protected]

noMinAtinG Pamela M. Williams, MDnellis AFB, [email protected]

Mark J. Flynn, MD, FAAFPCamp Pendleton, [email protected]

Robert C. Oh, MD, MPHFt. Belvoir, [email protected]

oPerAtionAl MediCine Jason Ferguson, DOtripler AMC, [email protected]

Barrett Campbell, MDFort irwin, [email protected]

PrACtiCe MAnAGeMentElizabeth Duque, MDFt. Hood, [email protected]

2014 ProGrAM Co-CHAirsKatie Crowder, MDHickam AFB, [email protected]

Heidi Gaddey, MDoffutt AFB, [email protected]

2015 ProGrAM Co-CHAirsMichael Mercado, MDCamp Pendleton, [email protected]

Janet West, MDnaval Hospital Jacksonville, [email protected]

resident And student AFFAirs Kirsten Vitrikas, MDtravis AFB, [email protected]

sPeCiAl ConstituenCies Luis Otero, MDCharleston AFB, [email protected]

oFFiCers And CoMMittees

www.usafp.org 5

“Aloha from the waters off of Hawaii!” As I write this I have the pleasure of participating in RIMPAC 2014, the world’s largest naval exercise. The mis-sion itself has been one that emphasized cooperation and interoperability among the participating nations. Of note, this year’s mission is a first for two reasons: 1) China was invited to participate; and 2) the USNS Mercy, one of two Navy hospi-tal ships, is a participant for the first time. I have been able to serve as the Senior

Medical Officer aboard the Mercy, and have worked with service members from China, Canada, the Philippines, Japan, and Korea. While the medical part of the mission is a small one, the opportunity to engage with other countries and foster or build relationships is important for our nation. The photo is of the many ships participating in this exercise (the Mercy is in the same row as the USS Ronald Rea-gan, 2nd from the back).

One of my primary roles while aboard has been very similar to what I do in resi-dency education – I have been able to take charge of our MEDEVAC drills as the lead planner and executor, and also do smaller group teaching as part of those same drills (see the photo on the next page).

As family physicians, we have many opportunities to take on roles in these

settings, yet often the system is short on understanding what we can actu-ally do. As an example, while this mis-sion is not heavily reliant on provision of medical care, we still have to pro-vide sick call for our own crew. As the department head for Primary Care, I have the following to provide this care: pulmonary-critical care, nephrology, hematology-oncology, adolescent and pediatric psychiatry, dermatology, and a family nurse practitioner. Clearly, not the group that most MTF’s or clin-ics would choose as the backbone of primary care, but to the credit of this particular group, they have all been willing to reengage the primary care portion of their brains. One of our general surgeons was even willing to do

Mark J. Flynn, MD, FAAFPCamp Pendleton, [email protected]

president’s messageMArK J. Flynn, Md

continued on page 6


so – practically a miracle! Along the way, I have been able to remind my col-leagues about one of the areas I covered in my last President’s note – to educate

peers about the specialty Family Medi-cine, as opposed to the no-longer-accu-rate title of family practice. Have you had the opportunity to do the same?

This time of year is also important for cultivating our younger colleagues who have just graduated residencies and are starting their first tours as new FP’s. That first few months can be challeng-ing in learning how to be an officer and a physician, and having a mentor to help, answer questions, and provide guidance can be a game-changer. While we are all busy, take the time to help out a col-league, and make a difference!

Lastly, I hope you are looking ahead to attend our 2015 Annual Meeting scheduled 18-22 March. With recent guidance about earlier submission on planned TAD’s, now seven months in advance for larger meetings, this is time to start seeking approval. I hope many of you will be able to join us at The Hyatt Regency Crystal City! Until then, thank you for what you do, and remember: I AM A FAMILY PHYSICIAN. I PRAC-TICE FAMILY MEDICINE.”

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8 4 4 . 4 N O R C A L

The University of Tennessee Department of Family Medicine invites applications from highly qualified and experienced family physicians to fill two key leadership roles at our UT-Saint Francis Residency Program. We are seeking two eager, enthusiastic individuals to serve as the PreDoctoral Director for medical students at the University of Tennessee College of Medicine and a Medical Director for the newly established Physician Assistant program in the College of Allied Health Professions.

The PreDoc director will be responsible for all four years of medical student training in family medicine. The Director role involves developing goals and objectives, curriculum, evaluation systems, faculty development, scholarly engagement in the critical appraisal of the literature, directing the medical student lecture series and working closely with the Family Medicine Interest Group. The individual will work closely with our residency programs in Jackson, Knoxville and Chattanooga to ensure standardized training and evaluation for each student.

The Medical Director of the Physician Assistant program will work closely with the PA leadership team and faculty to provide oversight of the PA program. Curriculum development, evaluation and feedback, faculty development and providing lectures are the major responsibilities.

In addition to the specific leadership responsibility, the successful candidates will have the wonderful opportunity to work with a dynamic faculty, practice the full-spectrum of family medicine that includes obstetrics in a very supportive academic and practice environment; and help train a great group of medical students, residents and fellows. Qualified applicants should hold the MD/DO degree, be board certified, and have proven experience as a physician, leader and clinician educator. Obstetrics and research are negotiable. Academic rank and salary are commensurate with qualifications and experience.

Interested applicants should submit a cover letter and CV to

Dr. David L. Maness, Professor and Chair UT Department of Family Medicine 1301 Primacy Parkway, Memphis, TN 38119The University of Tennessee is an EEO/AA/Title VI/Title IX/ Section 504/ ADA/ ADEA institution in the provision of its education and employment programs and service.

www.usafp.org 7

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8 4 4 . 4 N O R C A L


editor’s voiceCHristoPHer PAulson, Md

Greetings USAFP members! In this busy and oftentimes chaotic time of year, thank you for taking the time to read our academy’s newsletter. I think you will find the content of the summer edition both helpful in your busy profes-sional endeavors and inspiring. Family Medicine is once again in the spotlight to a great extent in each of our uni-formed services.

In this edition, Dr. Matthew Fan-dre highlights the basics of the Patient Centered Medical Home (PCMH). He provides a nice historical perspective, discusses many of the current implemen-tation challenges, and finally looks to the future of PCMH in the MHS. A com-mon component of PCMH for many of

our practices is Relay Health. Dr. Adam Sasso offers a thought provoking article on the benefits and barriers of Relay Health with additional commentary from Dr. Matthew Barnes giving us a Defense Health Agency perspective. Do you like to read? Drs. John O’Brien and Mat-thew Fandre bring us the “Leader’s Book Club” and a first installment of book reviews intended to educate, inspire, and challenge our members. Can junior Family Physicians make a difference on a global level? Four of our authors think so. Learn about Wonca from Drs. Kyle Hoedebecke, Blake Busey, Jelaun Newsome, and Caitlyn Rerucha. Also included are several articles from our esteemed Family Medicine consultants

and finally our USAFP President, Dr. Mark Flynn. Enjoy these articles and more. It’s not too early to mark your calendars for our 2015 Annual Meeting 18-22 March in Crystal City.

If you want to submit an article or pro-vide feedback on our newsletter, please contact me at [email protected]. Hope to hear from you soon.

Christopher Paulson, MDEglin AFB, [email protected]

Contact Rick Warlick, [email protected] or

843-343-6956

4303 Live Oak DrLittle River, SC 29566-9138

POSITIONS AVAILABLE IN:FAMILY MEDICINE INTERNAL MEDICINEPEDIATRICS

Little River Medical Center, Inc. is a Federally Qualified Health Center (FQHC) located in the Myrtle Beach, SC area, with 6 sites, 35 Providers, and 200 employees. We offer a stable professional work environment, with dedicated leadership.

As a Federally Qualified Health Center, Little River Medical Center can assist eligible candidates with The Federal Student Loan Payment Program through The National Health Service Corp, and, NHSC Scholars Program. As an employee of LRMC the FTCA Malpractice Insurance coverage is another great benefit. We have a very competitive compensation and benefits package.

The Myrtle Beach area is a wonderful place to live with its warm weather, beautiful wide sandy beaches, and laid back southern atmosphere. The area also offers diverse cultural and educational interests, entertainment venues, an array of restaurants, over 100 golf courses, excellent schools, and an impressive university influence. These are just a few of the reasons that make living and working here so great!

www.usafp.org 9

Clinical PharmacologyFellowship ProgramClinical PharmacologyFellowshipWhat 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 position to translate laboratory researchInto new drug therapies. Clinical pharmacologists are a bridge between the science and practice of medicine.

Who can apply for the Fellowship?The Clinical Pharmacology training program is available to active duty Army physicians who are board eligible/certified in a primary specialty and active duty Army PhDs/PharmDs (71A, 71B, or 67E) who have a doctoral degree in one of the life or medical sciences from an accredited academic 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 compete for a position in the program.

Additional activities include:• Conduct laboratory, animal,

or clinical research under the supervision of a mentor

• Participate in the teaching of Clinical Pharmacology to medical students, house staff, and practicing physicians

• Three month rotation with a review division at the FDA

• Participate in continuing medical education, research seminars, and journal clubs

Potential Job Assignments• WRAIR (Silver Spring, MD)• USU (Bethesda, MD)• Overseas labs (Thailand, Kenya)• USAMMDA (Ft. Detrick, MD)• USAMRIID (Ft. Detrick, MD)• USAMRICD (Aberdeen Proving Ground, MD)

Walter Reed Army Institute of Researchhttp://wrair-www.army.mil

Contact: LTC Kevin Leary, MD,[email protected]

Uniformed Services Universityhttp://ushus.mil

Contact: Louis Cantilena, MD, [email protected]


consultant reportAir ForCe

Hello Air Force Family Physicians. I cannot express how excited I am to have the opportunity to serve as your Family Medicine consultant. I have spent the majority of my 13 years in the Air Force enjoying teaching and patient care as faculty at Travis AFB. While I love teaching and caring for patients, one of the absolute best parts of my job has been the amazing colleagues I have had the privilege to work with in the trenches. It did not take long to realize that one of my greatest passions was making sure that “my people” were taken care of and that their voices were heard. I saw it as my role to help insure that they were given opportunities to do what they do best: be great Air Force family docs, take care of patients, and optimize our Air Force mission.

We are currently faced with several challenges and opportunities in Air Force medicine. In the face of budget restrictions, force shaping, and Family Physician shortages, we are supporting a constant deployment model while si-multaneously caring for our airmen and their families. We continue to answer the call and to show the value of Family Medicine to the AFMS mission. We are well on our way to implementing the pa-tient centered medical home and its key concepts into our daily structure and function. The active duty family medi-cine training platforms have continued to produce highly skilled and function-ing physicians, while restructuring to meet evolving milestone requirements and patient centered medical home ob-jectives. Our message has been heard, and we are in the midst of rolling out our next generation electronic health record

with the potential to streamline many of our daily tasks and communication requirements. We are moving forward with restructuring an antiquated cod-ing system while our national healthcare system overhauls an inefficient billing, insurance, and payment system.

My goals are to make sure that ev-eryone understands the barriers that our family physicians face as they work to meet the needs of our airmen and families, and to assure we provide each of you all the support possible in order to allow our Air Force team to be suc-cessful. I have been in awe for 13 years witnessing our family physicians and their teams adapt, overcome, and do amazing things. I have zero doubt that we will carry the torch, and continue the Air Force Family Medicine legacy.

Questions or concerns about Air Force Family Medicine? Feel free to contact me at [email protected]. I look forward to hearing from you.

(Antoin) Marcus Alexander, MDAir Force Family Medicine Consultant

[email protected]

I have been in awe for 13 years witnessing our family physicians and their teams adapt, overcome, and do amazing things. I have zero doubt that we will carry the torch, and continue the Air Force Family Medicine legacy.

www.usafp.org 11

MEMbErS INthE NEwS

The USAFP Board of Directors en-courages each of you to submit infor-mation on USAFP “Members in the News” for publication in the news-letter. Please submit “Members in the News” to Mary Lindsay White at [email protected].

NEwSlEttErSubMISSION

DEaDlINE

REMINDER: The deadline for submissions to the spring magazine is 20 September 2014.

rESEarch GraNtS

The Clinical Investigations Com-mittee accepts grant applications on a rolling basis. Visit the USAFP Web site at www.usafp.org for a Let-ter of Intent (LOI) or Grant Applica-tion. Contact Dianne Reamy if you have questions. [email protected].

rESEarch JuDGES

Applications for research judges are accepted on a rolling basis. Please contact Dianne Reamy ([email protected]) to request an application.

DO yOU fEEL sTRONgLy ABOUT sOMETHINg

yOU READ IN THE UNIfORMED fAMILy PHysIcIAN? ABOUT

ANy IssUE IN MILITARy fAMILy MEDIcINE?

Please write to me...Christopher Paulson, [email protected]

Family Medicine with Sentara Medical GroupLive On The Shores of the Atlantic in Virginia and North Carolina

Sentara Medical Group brings together more than 650 providers to care for patients across Virginia andNortheastern North Carolina – a vibrant and temperate region of the Atlantic Ocean and Chesapeake Bay.

We are a division of Sentara Healthcare, one of the most progressive and integrated health care organizations in the Nation employing over 25K. The region boasts exceptional well-planned community

living, breathtaking waterways, safe cities and endless entertainment.

Urgent Care, New Practice and Growth Outpatient Family Medicine OpportunitiesIn Virginia… Virginia Beach, Gloucester, Suffolk, Yorktown, Newport News, Hampton and Williamsburg.

In North Carolina… Elizabeth City.• Competitive Compensation and Benefits• Reduced Individual Risks• Administrative Support• Access to Innovative Tools and Technologies• Excellent Schools and Communities

EOE, M/F/D/V. Drug-Free Workplace

Can you see yourself here?We do. Contact Us Today.

Lisa Waterfield at [email protected] or call 757.252.3025.

www.sentara.com

Providence Medical Group offers all the benefits and choices of a large group, and—most importantly—the ability to practice independently within a physician-directed environment. You’ll experience:

• Opportunities for growth based on individual career and lifestyle choices.

• Professional operational resources to help shoulder the burden of complex practice administration.

• A path to equity partnership in a growing organization.

• Primary care practices nationally recognized as Patient-Centered Medical Homes.

Dayton Ohio’s thriving communities combine a family- oriented environment with all the amenities of a major metropolitan area. And, as home to Wright Patterson Air Force Base, the Dayton area has a tradition of supporting professionals who have contributed to military service.

Please contact Tom Gossett at (937) 269-0323 or [email protected]

Providence Medical Group2912 Springboro West • Dayton, Ohio

(937) 297-8999 • www.provmedgroup.com

“Where nothing comes between you and your doctor.”

At Providence Medical Group, that’s a promise made to each

of our patients.


consultant reportnAVy

Fellow Navy FPs, I am grateful for this opportunity to serve you. Quite honestly my intentions were to retire in a couple of years and transition into civilian academic family medicine, but the opportunity to be your specialty leader affords me an-other extraordinary chance to give back to a community that has given so much to me. It is a position that I enter with great excitement, and dare I say reverence, too.

Reflecting on my time as a resident, I was proud to be in the Navy, grateful for the HPSP scholarship that funded my edu-cation, and ready to perform my payback so I could move on. Then a strange thing started to happen. I became enamored with my colleagues and mentors. I start-ed to think, “These are my peeps! I like this canoe club!” Then my first USAFP conference sealed the deal. “All these uni-formed FPs are cool peeps!” And KODB… I didn’t know what a specialty leader was… then I did. Kind Old Dr. Bob Kiser led the Navy breakout session in a way that made me proud to be a Navy FP. He deftly acknowledged the extremely frus-trating, hauntingly unforgettable burning issues of the day (whatever they were…),

sympathized with our plight, huddled us as family, and somehow convinced us that the pains we were enduring… were vital nutri-ents! “Diego Garcia needs Tim Mott for 3 years unaccompanied? Heck yeah, Dr. Bob! Sign me up and add another year!” Thank you KODB! Thank you!

Forward in time to more recently-- Bruce Stinnett. I am sure Bruce’s pulse never goes above 45 bpm. He’s not just cool as a cucumber, but he’s the whole cucumber salad! He was like that as my residency team leader, and he still is. He worked smartly, humbly on so many is-sues influencing family medicine. Bruce, you made it look easy! Thank you Bruce!

And Jeff Quinlan. I have known Jeff for a long time- initially as GME leaders, then fellow staff on a deployment. Jeff, I am guessing that when you signed on as specialty leader you didn’t know that two programs were going to face closure and CME travel scandals were going to create a cumbersome bureaucracy of con-ference justifications needing approval from BUGOD (Bureau of Government on the Defensive)? You have shepherded us through these most recent challenges

and our community thanks you, deeply. Thank you Jeff!

I mention these three previous Spe-cialty Leaders as I worked the most closely with them. I hope that I have ab-sorbed the best parts of their style, grace, and commitment. I am just finishing a book “To Repair the World” by one of my modern day heroes, Dr. Paul Farmer, founder of Partners in Health. He en-courages us to be “accompagnateurs” with those we are blessed to serve in each of our roles, as leaders and as doctors. Farmer states, “to accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and end.” Fur-thermore, “The accompagnateur says: ‘I’ll go with you and support you on your journey wherever it leads. I’ll share your fate for awhile.’ Accompaniment is about sticking with a task until it is deemed completed- not by the accompagnateur, but by the person being accompanied.”

I am honored with the opportuni-ty to be your accompagnateur on this great mission of Navy Family Medicine. Thank you!

Tim Mott, MDFamily Medicine Specialty Leader

[email protected]

EvEry Doc can Do rEsEarchHave you wanted to do a research project but were not sure how? Would you like a user friendly workbook to help you over the inertia of starting a project? The Clinical Investigation Committee is pleased to offer user friendly tools for organizing, planning, and starting a research project.

If interested, please send a request to [email protected]. Tools Available:• EveryDocCanDoResearchWorkbook• EveryDocCanDoAPoster• EveryDocCanDoAScholarlyCaseReportWorkbook

Clinical Investigation Research Tools also available on-line at www.usafp.org.

www.usafp.org 13

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• Career Advancement Opportunities

Are you looking for a satisfying career and a life outside of work? Enjoy bothto the fullest at Patient First.

Founded and led by a physician, Patient First has been aregional healthcare leader in Maryland and Virginia since1981. Patient First has 53 full-service neighborhood medicalcenters where our physicians provide primary and urgent care365 days each year. In fact, over 400 physicians have chosena career with Patient First. We are currently looking for moreFull and Part-Time Internal and Family Medicine Physiciansin Virginia, Maryland and Pennsylvania. At Patient First, eachphysician enjoys:

To discuss available positions please contactEleanor Dowdy, [email protected] or (804) 822-4478. We will arrange the opportunityfor you to spend time with one of our physiciansto experience firsthand how Patient First offerseach physician an exceptional career.


consultant reportPHs/CG

Who hasn’t been deployed - when the call comes you respond. Usually uni-formed medical providers are called to serve overseas. As a USCG Physician, our deployments are usually CONUS and it is my opinion, having served both abroad and in CONUS - Domestic deployments present unique mental challenges. The request for assistance usually comes on the heels of a Natural Disaster, which has temporarily derailed the comfortable infrastructure of our homes & communi-ties. The mental fortitude to focus on the tasks and the physical stamina to set up emergency medical centers and provide care in spite of the environmental chal-lenges are bolstered by the knowledge that normal civilization is often within driving distance. However, in these cas-es, the proximity of the comforts of home, although reassuring, are unsettling as the disasters encroach on our homes.

In the past month such a call was made and the US Coast Guard mobilized two medical teams to provide assistance to the Southern Texas border, a three hour drive from my AOR. There had been no hurricane, although it is the season, no earthquake in spite of increased Hydrau-lic Fracturing -‘Fracking’ in this region of the country, no tornado even though Texas has seen its share. Rather the latest crisis is located within Customs and Bor-der Patrol (CBP) stations, a humanitarian crisis created by a staggering influx of un-documented families with children, unac-companied minors seeking refuge, safety, as well as employment in the United States being detained for unlawful entry into the US.

From October 2012 to September 2013, the Border Patrol apprehended approximately 24,000 unaccompanied children at the border. During October 2013 to June 2014, the number shot up to 57,000. This number is estimated to reach 90,000 by end of September 2014. Most are coming from El Salvador, Hon-duras and Guatemala.

CBP stations are not equipped to pro-vide medical care for the individuals they apprehend, rather they simply process and document illegal entry into the country and turn individuals over to Immigration Customs Enforcement Officers, who are then tasked with removal of the prisoners to their ultimate destination. The mas-sive numbers of persons arriving chal-lenged the usual processing methods, lengthening the delay between arrival and departure from 1-2 days into 6+ day stay at overcrowded CPB border stations, cre-ating highly volatile cramped conditions.

Prior to our arrival, all medical needs of the detainees were addressed by local emergency rooms at a cost of $1000+ per

trip; our assignment during this deploy-ment, triage of the undocumented mass-es, determining those who truly required emergent medical services, and treating less than emergent problems on site. The medical ailments were the usual sick call fare, which although exhausting is easily managed; what our team was not prepared for was the extent of human suffering we witnessed.

The conditions in the holding cells were beyond crowded, at times the facili-ties held 3-4 times the numbers of people it was rated for. Not surprisingly, quite a few people requested medical evaluation simply to get out of their cramped cells. Following normal sick call protocol we would open our interview with, “so what brings you here today?” Why had the pa-tient risked travel from their country of origin over uncertain terrain only to ar-rive at a CBP holding cell? The many re-plies, the innocent candor of our young patients, left us sad beyond words for their world. Most of them had similar stories, reporting credible fear, of gangs, orga-

Maria D. De Arman M.D.SECTOR/AirSta Corpus Christi

Semper [email protected]

Answering the Call – DeploymentRather the latest crisis is located within Customs and Border Patrol (CBP) stations, a humanitarian crisis created by a staggering influx of undocumented families with children, unaccompanied minors seeking refuge, safety, as well as employment in the United States being detained for unlawful entry into the US.

www.usafp.org 15

nized crime, daily violence, death threats to themselves, their families, frightening things no one should have to deal with, much less children under the age of 8.

Easily we heard over a hundred for-midable variations of reasons to leave one’s home; however, we were shocked as these pint sized, under age immigrants reported shockingly violent acts survived during their arduous journeys. One boy approximately 8 years old reported mi-grating from his native El Salvador with his 16 year old brother, traveling by bus, train, and by foot through the jungle. He told us when they got to Mexico, he and his brother were kidnapped by a local ma-fia, which specialized in abducting immi-grants for ransom. While he was held, he was tortured with burning cigarettes and his brother was beaten with sticks. Ex-amination of the child yielded the circular burn marks on his hands and arms, con-sistent with such abuse.

There were adults with similar expe-riences, reporting abduction in Mexico to “Stash Houses,” which they said were controlled by the Mexican Mafia. One woman recalled the captors threatening them with mutilation and death. She also talked about mass burials of those whose families did not pay the ransom.

Sadly, some kids, even under CBP custody could not escape abuse. A day or two before we departed Weslaco at the end of our mission, one mother brought her 11 year son to us for evaluation of “headache.” Immediately after entering the exam room, she admitted lying about her son’s headache, voicing concerns that her child was being sexually molested by an older teen in the holding cell where he was being kept. After she told us, her son tearfully confirmed her story. The aggressor was identified, removed from the cell and the local police were called. The child was then placed in the cell with his mother. This accidental exposure oc-curred and was swiftly dealt with, howev-er, one cannot even begin to imagine how

many other unaccompanied children will accidently be placed in harm’s way with predators their age or older.

During this deployment, we had the opportunity to discuss the situation ex-tensively, with both the migrants and Immigration and Customs Enforcement (ICE) and CBP Officers. It was an op-portunity to serve both of these com-munities, as both groups reported sig-nificant stress stemming from this crisis. It was surprising to discover that some children were recognized by the officers traveling with different adults posing as their parents. The agents explained that some drug cartels are using children as “VISAs” and renting them out to people that want to cross the border; as it is commonly believed that the odds of be-ing allowed to remain in the country are higher if one is immigrating as a fam-ily unit. Unfortunately, ICE/CBP can-not by law open files on minors, so they have no way to track how often a child has crossed the border or with whom. It is also difficult to verify authenticity of birth certificates presented to them.

These situations increase the stress of an already stressful job, agents reported feeling overworked and also conflicted in regards to carrying out their duties as Federal Law Enforcement Officers as they did not return the immigrants to their

countries of origin, rather they turned them over to family members in the US.

In our role as primary care medical screeners, we evaluated multiple com-municable diseases, identified and treated scabies, lice infestations, insect bites, mus-culoskeletal injuries, febrile illnesses, iso-lated chickenpox cases, and we referred to higher echelons of care when appropriate. Our systematic triage process allowed us to evaluate significant numbers of people in a very small space. We were able to track medications dispensed, treatments rendered, we accomplished our mission, by assisting CBP in limiting the numbers of unnecessary ER visits, which ultimate-ly saved time and money.

Our Deployment has ended, however, the immigration crisis remains. The mul-titudes of hopeful migrants continue to arrive; we turned over the medical opera-tions to bilingual contractors. The work will remain exhausting and the conditions deplorable, which will continue to con-trast sharply with our climate controlled existence. The chaotic situation on our border serves as a daily reminder of the American Dream. The freedoms enjoyed in this country are precious; the world wants what many in this country take for granted. Deployments remind us of this fact and further validate my decision to remain in uniform and support those willing to die for our freedoms.

Uscg PARTIcIPANTs:HS2 Zenia F. MoralesHS1 Roy M. MesenscottLT Gaspar A. RosarioCAPT Juan E. PalacioHS2 Gary E. ZunigaHS1 Kenneth SantiagoLCDR Fernando L Andreu CAPT Jose Sanchez HS1 Emmanuel GarciaHS1 Maricruz Y. Duran-Rodriguez LCDR Maria D. DeArmanCAPT Humberto Hernandez-Aponte

The chaotic situation on our border serves as a daily reminder of the American Dream. The freedoms enjoyed in this country are precious; the world wants what many in this country take for granted.


EQUIP – ADAPT - MENTOR18-22 March, 2015

Hyatt Regency Crystal CityArlington, Virginia

DON’T MIss THE 2015 UsAfP ANNUAL MEETINg & ExPOsITION!!

The Hyatt Regency Crystal City is a fabulous venue for the meeting. The hotel offers complimentary shuttle ser-vice to and from the Ronald Reagan Na-tional Airport and Crystal City Metro Stop, both located just minutes away.

Just minutes away from the Hyatt Regency Crystal City, you will find fine

dining and shopping in Crystal City and Pentagon City, including Pentagon City Mall, which includes more than 170 fascinating stores and restaurants. Explore more of the DC Metropolitan Area as you visit some of the following:• ArlingtonCemetery• OldTownAlexandria• WashingtonMall• SmithsonianMuseums

• WhiteHouse• U.S.Capitol• NationalArchives• KennedyCenter

The CME Program will focus on the theme of EQUIP – ADAPT – MEN-TOR and promises to provide a vari-ety of up to date evidence-based top-ics. Hotel and meeting registration information will be available in Octo-ber 2014. Please join us in our nation’s capital! If you have questions or want to contact the Program Co-Chairs, please e-mail [email protected].

Michael Mercado, MD, Program Co-ChairJanet West, MD, Program Co-Chair

2015 annual meeting

Announcing the2015 USAFP Annual Meeting & Exposition!!

www.usafp.org 17

We Call It lIvIngIf caring for patients is the reason you became a doctor, join the nearly 600 physicians of Carilion Clinic who share your philosophy. A nationally recognized innovator in healthcare, Carilion is changing the way medicine is practiced. Our medical-home approach to primary care lets you focus your energy on the highest risk patients, while the electronic medical record enables seamless coordination with Carilion specialists in nearly 60 fields. And with online access to their medical records, patients can become more involved in their care, too. With tools that make you more efficient and an environment that values better care, Carilion gives you the freedom to focus on your patients’ well-being — without overlooking your own.

Virginia’s western region is one of the best kept secrets. Quality of life in the Blue Ridge Mountains is high and the cost of living is low. The area offers a four-season playground for mountain and lake recreation, as well as a rich array of arts, humanities and cultural experiences.

Family Medicine outpatient opportunities are available in the following western and central Virginia communities: Bedford* Galax* Martinsville Tazewell* Urgent Care

* For information on additional incentives available for designated locations, contact Amy Silcox, physician recruiter, Carilion Clinic, 800-856-5206 or [email protected].

EOE/AA

The University of Tennessee-Saint Francis Family Medicine Residency Program in Memphis is seeking a highly qualified, full service family physician to train the family physicians of tomorrow at our unopposed (8-8-8) residency program. We seek an energetic, enthusiastic family physician that loves to teach and wants to make a difference in the lives of students, residents and practicing physicians along with patients, families and the community. We are especially interested in a physician with C-section training to teach in our well-known Advanced Women’s Health Fellowship that has produced high quality graduates for years. The residency is located in a 25,000 square foot building immediately adjacent to Saint Francis Hospital. Our physicians practice full service family medicine to include inpatient, intensive care and obstetrics. In addition, our physicians perform a variety of inpatient and outpatient procedures. We receive the best support from Saint Francis Hospital and UT. Qualified applicants should hold the MD/DO degree, be board certified, and have proven experience as a physician, leader and clinician educator. Duties include teaching students, residents, and fellows, patient care, administration, community service and research. C-section training is preferred. Academic rank and salary are commensurate with qualifications and experience.

Interested applicants should submit a cover letter and CV to

Dr. David L. Maness, Professor and Chair

UT Department of Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119The University of Tennessee is an EEO/AA/Title VI/Title IX/ Section 504/ ADA/ ADEA institution in the provision of its education and employment programs and services.

for advertising informationcontact

Michele Forinash 800.561.4686 ext.112

or [email protected]

www.usafp.org 1

Fall 2012 • Vol. 6 • Num. 1 • Ed. 21

Journal of The Uniformed Services Academy of Family Physicians

MARK YOUR CALENDARSTO ATTEND THE

2013 USAFP ANNUAL MEETING & EXPOSITION

21-26 March 2013Walt Disney Dolphin Hotel

Lake Buena Vista, FL


When you look out into a sea of blank stares in your audience, how do you grab their attention and bring them back to your lecture? What if you had an evidence-based way to use old video game tools to keep your students on task? Audience response systems (ARS) or clickers are often thought of as game show tools, but they have become an effective active learn-ing technique in many educational venues. We will review a brief history of the ARS; discuss the evidence for using an ARS in medical education and review tips for inte-grating an ARS into current lectures.

The use of audience response systems (ARS) dates back to the 1950s, however it is only recently that it has been shown to be an effective active learning technique. Originally used by the Air Force in the 1950s for instructional training, ARS was adapted for use in colleges in the 1960s. (Judson & Sawada, 2002) In the 1960s there were both German and Japanese pat-ents for different versions of ARS but no current evidence that they were built and used. The first in the US were thought to be installed in Stanford University (1966) and Cornell University (1968). These were limited by technological difficulties and complicated, extensive wiring. (Banks, 2006) Early systems were used mainly for the instructor to keep track of how many correct answers were given with little or no feedback to students. (Judson & Sawada, 2002) Because of these limitations, early machines did not have much success. In

1985 Classtalk I was built by David Banks, Fred Hartline and Milton Fabert from ‘surplus Atari keypads.’ (Banks, 2006) This system was effectively used in a phys-ics course at Christopher Newport Uni-versity. Students reported coming to class more prepared, enjoyed class more and paid more attention, while instructors felt they could use the feedback to improve the courses. (Banks, 2006) ARS became more commercially available in the 1990s. In the last 10 years they have been used extensively and effectively across all levels of education.

There is now extensive data in general and higher-level education showing the value of ARS. The limited data available in medical education has shown some prom-ising results. Schackow, et al showed inter-active lectures and lectures with integrated ARS significantly improved quiz scores for family medicine residents immediately following a lecture and one month after a lecture when compared to a traditional didactic lecture. (Schackow, Chavez, Loya, & Friedman, 2004) In 2008, Rubio, et al. showed statistically significant improve-ment in both immediate quiz scores and quiz scores three months later after embedding five ARS questions into a tra-ditional didactic lecture given to radiology residents at a children’s hospital. (Rubio, Bassignani, White, & Brant, 2008) Addi-tionally, in 2012 Pradhan, et al. evaluated the efficacy of using an ARS compared to a traditional didactic lecture with OB Gyn

residents. They found a 21% increase in scores after a lecture (pretest to post test) with ARS compared to a 2% increase in scores with a traditional lecture. (Prad-han, Sparano, & Ananth, 2005). These studies do show an increase in immediate and long-term retention with the use of an ARS as an active learning technique in residency teaching.

Using a new active learning technique can come with some challenges. There is an upfront cost to introducing an ARS into an organization or even a single lec-ture. While technology has significantly improved since the introduction of ARS in the 1950s, there is still an inherent risk of tech failure when using these systems. This can be mitigated through dress rehearsals and repetitive use over time. The first use of any form of ARS is a time investment for the educator to learn to use the system and to properly integrate the system within a lecture. Some systems also have a significant monetary cost, however many are available for free when used in smaller courses with less than 50 students. Use of an ARS may allow some students to hide within the group, they are required to provide an answer but are not required to take ownership of that answer. The instructor may also be unprepared to address student answers or unexpected gaps in knowledge.

The benefits of modern Audience Response Systems extend well beyond the enjoyment of using a fun, new system.

teaching and learning Elisa D. O’Hern, MD, FAAPFaculty Development Fellow

Madigan AMC, [email protected]

Audience Response Systems:How Old Atari Parts

Improved Medical Education

www.usafp.org 19

They have been well received by both stu-dents and instructors, especially with recent improvements in technology. Using an ARS in a university classroom environment can increase attendance, especially when use is tied to a class participation grade. (Burnstein & Lederman, 2001) The ARS allows for anonymity and is often associated with increased participation and increased student engagement throughout class. (Kay & LeSage, 2009) It can force students to answer and helps to allow all students to answer instead of a few vocal students that may tend to answer and dominate a class. The systems can be used to provide imme-diate feedback to the instructors, individual students and the class as a whole. Modern systems can be used for much more than just allowing students to answer a limited multiple-choice question. Some uses include: gathering information about an audi-ence, testing preexisting knowledge, prereading, or class preparation, starting class discussion, obtaining feedback, tracking learning progress and taking general polls.

While there are many types of ARS in use, they generally fall into two categories: equipment based or web/software based. The more tra-ditional hardware/equipment based systems have some version of a clicker or keyboard assigned to each learner. These systems allow for use in many different environments, do not depend on use of students’ equip-ment (laptop, phone, etc.) and can be easily linked to an individual for tracking and accountability purposes. Web based ARS can be accessed by learners through computers, laptops and smartphones. Web based sys-tems allow for a greater variety of question types (beyond the typical multiple choice) and many are avail-able for free but do rely on having reliable internet access with adequate

bandwidth to support multiple users at the same time. Both types of systems can be very effective tools for active learning in medical education.

When integrating ARS into a lecture you should consider the goals of the over-all lecture and the ARS. Will the ARS be used as an ice breaker or introduction? Will it be used to test students baseline

knowledge or prelecture readings? Or will the goal be to promote in class discussion or long term retention? Next consider what question format best fits your goals. The most common format would be mul-tiple choice with five answers. However, yes/no questions may occasionally be use-ful. When getting to know your audience

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continued on page 20


or trying to generate discussion, open ended questions that allow the students written answers to be displayed can be a great option.

No matter the goals or format chosen, there are a few general guidelines that can help successfully integrate an ARS into most lecture formats. Most lectures need only a few focused questions. Studies have shown that most people pay attention to the task at hand very well for the first 20 minutes. (Kay & LeSage, 2009) As the use of an ARS has been shown to increase attention during a lecture, it may be use-ful to integrate questions every 15-20 minutes in longer lectures. This can help draw the learner back to the material of the lecture. With each question you need to allow enough time for the learners to answer the question and adequate time for a follow up discussion or review of the answers as needed. When creating ques-tions it is helpful to anticipate a range of answers and how you as an educator will address the answers. When using open ended questions, the educator should be

very comfortable with the material and be able to answer questions that may be more challenging than the material in the original lecture. It is usually best to limit multiple choice answers to no more than five and to avoid multiple correct answers. Keeping your objectives and these basic tips in mind will help seamlessly integrate ARS questions into your lecture.

Once you have created a question it may be useful to ask yourself the follow-ing questions:• Isitrelatedtothelearningobjectives?• CanitfittheARSformat?• Isitclearlystated?• Doesithaveplausibleoptions?• Isitchallenging?• Canitbeappropriatelyfollowedup?

After adjusting your question as nec-essary put the question into your ARS of choice and practice using the system prior to your event.

After a few tries you will find an ARS can be an easy and welcome form of active learning that you can use in almost any learning venue. When used properly an

ARS can improve the classroom environ-ment, increase participation, help with long and short-term retention and lead to animated discussion that both the educa-tor and the students can benefit from.

Banks, D. A. (2006). Audience Response Systems in Higher Education. USA: Information Science Publishing.

Burnstein, R. A., & Lederman, L. M. (2001). Using wireless keypads in lecture classes. Phys. Teach., 39, 8-11.

Judson, E., & Sawada, D. (2002). Learning from Past and Present: Electronic Response Systems in College Lecture Halls. Journal of Computers in Mathematics and Science Teaching, 21(2), 167-181.

Kay, R. H., & LeSage, A. (2009). Examining the benefits and challenges of using audience response systems: A review of the literature. Computers & Education, 53, 819-827.

Pradhan, A., Sparano, D., & Ananth, C. V. (2005). The influence of an audience response system on knowledge retention: an application to resident education. Am J Obstet Gynecol, 193(5), 1827-1830. doi: 10.1016/j.ajog.2005.07.075

Rubio, E. I., Bassignani, M. J., White, M. A., & Brant, W. E. (2008). Effect of an audience response system on resident learning and reten-tion of lecture material. AJR Am J Roentgenol, 190(6), W319-322. doi: 10.2214/AJR.07.3038

Schackow, T. E., Chavez, M., Loya, L., & Fried-man, M. (2004). Audience response system: effect on learning in family medicine residents. Fam Med, 36(7), 496-504.

Promoting Research in the Military Environment

Visit us online at www.usafp.org/research.htm for resources or to find a mentor.

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

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www.usafp.org 21

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1) Finish AHLTA notes… 2) Answer T-Cons… 3) Review new results... These three bullets always seem to be at the top of my To-Do List, so when I heard about Relay Health, I cringed at the thought of yet another perennial “To-Do” after clin-ic. I hesitantly accepted the concept as a good idea for my patients, but questioned if this would be a good idea for provid-ers. As a result, for the first few months, I was a passive user of Relay Health. The clerk invited patients to sign up for Relay Health, but most of these patients were confused about what it was – and to be honest, I never actively asked them to sign up. Fortunately for me, our clinic’s RNs made it work – they checked each pro-vider’s Relay Health account daily. I’m eternally grateful to them because they were critical to a successful workflow. My nurses consolidated my Relay Health mail into T-Cons for providers. We could then communicate with each other in the same T-Con, place any orders necessary, and finally send the T-Con back to our RN, who responded to the patient either by copying the text of our response, or by paraphrasing it back to the patient.

At the time, this “90% solution” seemed adequate enough. It wasn’t un-til this year’s USAFP conference that I learned Relay Health is actually a power-ful tool, with the potential to help me be-come a more effective Family Physician; and capable of meeting the goals of the Patient Centered Medical Home. Since then, I have actively and enthusiastically signed patients up myself. While provid-ers don’t have to invite patients person-ally, I found that patients are much more

likely to complete the registration process when they see a Relay Health message coming directly from their provider. All I had to do was just reinforce how impor-tant Relay Health was. I was able to sign up more patients in April than the entire three months prior to USAFP.

One of the biggest areas in which Re-lay Health improved my practice is by the positive feedback that I’ve received. Pre-vious to Relay Health, I was frustrated that the vast majority of follow-ups on acute care occurred when a patient didn’t improve. It was a “reverse survivorship bias” – instead of seeing my successes, I was just seeing treatment failure after treatment failure. This often left me to wonder how well my treatment plan ac-tually worked. While I can, and certainly do, make an effort to contact the sickest patients a few days after a visit, it would be unrealistic to expect a provider to contact every patient seen for follow-up. While I hoped that if a patient didn’t follow up, he or she improved, I knew this wasn’t al-ways the case. Patients may have sought out other providers, or worse, given up on seeking treatment entirely. As my Relay Health usage has expanded, patients have been sending notes just letting me know how much better they’re doing. I have even had patients attach photos through Relay Health in the setting of dermatol-ogy cases, of how much their skin has improved. As a result, I’m not only get-ting subjective positive feedback, but also OBJECTIVE positive feedback. As a newer provider, I can now say with great-er confidence: “In my clinical experience, patients have responded very well to this

treatment.” In addition, I feel like I’m bet-ter fulfilling the PCMH model by having a panel that I know and take care of, not just a never-ending stream of new patients and problems.

Prior to Relay Health, my nurse had mainly been contacting my patients for non-urgent issues and results through T-Cons. She would relay my message on the phone (usually with a little telephone tag), and send back any questions. While there are, of course, patient issues that warrant a call directly from the provid-er, a provider’s time is already stretched thin enough. I thought it was very rea-sonable to rely on the clinic support staff to contact patients for the vast majority of times. They have always been very good at reaching the patient in a timely manner, but I have sometimes wondered, “Is my message being relayed exactly as I intended it?” Or even more worrisome, I sometimes wondered if my patients even got the message at all… I tried to be very clear and unambiguous, provid-ing the verbatim text of what to say, but when patients returned to clinic for fol-low up, I am sometimes puzzled by what they thought my intended message was. Some of this is due to the fact that the telephone is a limited synchronous inter-action – and if the patient doesn’t take notes, then they have nothing to remem-ber the conversation. Relay Health, in a very literal sense, eliminates the game of “telephone,” and ensures that 1) the patient receives the message as you in-tended, 2) the patient always has access to that message, and 3) that you can answer any follow-on questions as well.

Adam R Sasso, M.D.Ft. Leonard Wood, MO

[email protected]

Is Relay Health Really Helpful?

www.usafp.org 23

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Although some providers take the “no news is good news approach,” I would much rather confirm negative or normal results because I know that as a patient, I would appreciate that peace of mind. Although every single result should be reviewed in a timely mat-ter, and a surrogate should be assigned when the ordering provider is out, real-istically, there will always be test results slipping through the cracks. We have all seen the patient coming in 6 months later for an unrelated issue, expecting that because he or she did not hear back, everything was normal, only to have us apologize for our colleague’s (or our own) mistake in not following up. Relay Health allows me (or my staff) to quick-ly send a templated note of negative test results to the patient, without unneces-sarily burdening the clinic support staff with needing to call them. If the patient has not heard back, I encourage them to contact us just to confirm the results were negative.

A big part of having a functional PCMH is coming up with novel ways to expand access off-hours. Prior to Relay Health, it required a good deal of time and effort for a patient to ac-tively follow up on their test results, ei-

ther through a follow-up appointment, or by calling the clinic. If you’ve ever been a patient, you know how hard this is – you usually must call during busi-ness hours, and with the hope that you won’t be put on hold, or transferred from one extension to another in an endless phone spiral. It makes it easier for patients to take ownership of their healthcare by allowing them to con-tact us at their convenience through a secure message. This can also improve access and reduce the need for after-hours clinics. Like most Americans today, I spend a much larger amount of time texting than actually talking to someone on the phone. I’ll admit that sometimes I even forget that my iPhone, with its many feature and apps, actually even functions as a phone! Texting and email allows for the asyn-chronous sending and receiving of in-formation on your own schedule. This is especially helpful for the active duty population, whom I often had difficulty reaching directly before Relay Health. It also gives me the chance to research a topic or ask for another provider’s opinion, without being put on the spot for an immediate answer. Patients can also lookup self-care options as well. The message sending feature of Relay Health is, of course, the most useful function, but patients can also use it to keep track of their health conditions, medications, and basically an entire medical history, if they are motivated enough to enter it. There is an out-standing patient education section, the topics of which can be attached to your message; you can also copy and paste links to UpToDate® Patient Informa-tion handouts or FamilyDoctor.org handouts, which are also free to access.

The largest shortcoming of Relay Health would of course be its lack of in-tegration with any of our other systems. But in fact, interoperability is currently


Although every single result should be reviewed in a timely matter, and a surrogate should be assigned when the ordering provider is out, realistically, there will always be test results slipping through the cracks.


one of the biggest obstacles in health care. There is more than one interoperability challenge: the lack of interoperability be-tween Relay Health and CHCS/AHLTA on the provider side, and the lack of in-teroperability between TRICARE Online and Relay Health on the patient side. Pa-tients often think that Relay Health and Tricare Online are the same thing, and as a result, report to us that they have already registered. But in a similar respect, Relay-Health still requires the initiation of a T-Con in AHLTA to copy and paste the text from the Relay Health message. Hopefully the future EHR will have an integrated pa-tient portal. Ideally, it would be interoper-able with Relay Health itself.

Another concern is that some patients may use Relay Health as a substitution for what should be a face-to-face clini-cal encounter. Relay Health somewhat encourages this through the “WebVisit” module. This is a misnomer though – it’s an asynchronous patient questionnaire – and it is always a safe bet to err on the side of caution and recommend that a patient come in for an appointment or to the ER when we have concerns. Despite this, a WebVisit can be a great way to get his-tories prior to your visit by sending them proactively to patients. Then, your tech can just cut and paste the majority of it, which will be a fairly complete history in the patient’s own words.

Despite its shortcomings in interoper-ability I really believe there is enormous benefit in secure messaging through Re-lay Health. Since implementing these changes, I have had overwhelmingly posi-tive feedback from patients. They appre-ciate knowing that I genuinely care about and take ownership of their concerns for more than the limited time in clinic, and that they will not be lost to follow-up. Relay Health brings us one step closer to our patients, specifically by providing the convenience of electronic communica-tion, something we have come to expect in the 21st century.

Relay Health is a Transformative technology – and honestly, we’re just scratch-ing the surface of how we can use it. There are entire practice models based on asynchronous patient messaging; keep your eye on this technology. Now that Relay Health is maturing in the DoD, I wanted to add a couple points.

1. Inviting patients: Adam is right, the data shows that if you say a word or two about Relay Health, patients will be more likely to sign up. Howev-er, the most important part is SEALING THE DEAL! If you can integrate the patient finishing a Relay Health sign-up via Smartphone, Tablet or Kiosk at the visit, you’ll go up from 10s of patients to HUNDREDS of patients each month. “Sealing the deal” can (and should) be a tech-driven process.

2. Asynchronously Inviting Patients: You shouldn’t have to do all the work with invitations – you should only help a process that is already in place. Create “Sign-up Stations” at places with wait-times: waiting rooms, pharmacies, radiology, etc… Be creative! Look at base orientations as places for sign-ups! Again, ensure that patients “SEAL THE DEAL” and finish their sign-up – not just get sent an invite.

3. Webvisits = “Webhistory”: Don’t be afraid of having patients doing Webvisits BEFORE a visit. You’ll still see the patient – but you’ll have most of your history done beforehand. This can revolutionize your work-flow. Most of your histories become confirmatory, not exploratory – and your charting will be half-done. This is a boon for “Documentation-in-tensive” visits – MEBs, Retirement Physicals, etc… That way, you get to focus a little more on the exam, the assessment, the plan, and EDUCAT-ING THE PATIENT.

This could be the game-changer from Relay Health – literally, imagine a clinic where 60-80% of your histories are already done and charted before you see the patient. This is ACHIEVABLE with this technology.

4. As a PCMH tool: Your techs can use the Webvisits in RelayHealth to gather appropriate histories from patients. Your nurse and nutritionist can find great patient education sheets – literally 3 clicks away. Your disease managers can create patient lists to track your diabetics. And YOU don’t have to make furtive/hurried copies of sports medicine exercise handouts – because honestly, I have yet to work in a clinic where those things are stocked appropriately…

5. Army Tool: There is an Army macro that can automatically put Relay Health notes into T-cons. Lucky Army.

But. It is important that we advocate for ways we can make our work-flow easier. If you don’t have access to this tool, talk with your IT depart-ment or your leadership to see if this is something you can get. We won’t get it by being silent.

Have ideas, have concerns? E-mail me at [email protected]; or [email protected] to talk more about this tool.

Commentary from Matthew Barnes

Greetings from theNew Defense Health Agency

www.usafp.org 25

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committee reportsresident And student AFFAirs

The Uniformed Services University of the Health Sciences Student Family Medicine Interest Group has been cho-sen as one of ten recipients of the 2014 Program of Excellence (PoE) Awards as an overall winner. The FMIG Network Program of Excellence Awards recog-nize FMIGs for their outstanding per-formance in organizational operation, community service, promoting the value of family medicine as primary care, pro-moting the scope of family medicine, ex-posing residents to family medicine and family physicians, professional develop-ment and measures of success. The award has been a cornerstone of the FMIG Network, as it facilitates the sharing of best practices of FMIGs from across the country and recognizes the hard work of these student groups.

The synopsis from the USU FMIG that was submitted to the AAFP is not-ed below.

Family Medicine is often referred to as “the backbone of military medicine.” At “America’s Medical School,” The Uniformed Services University, (USU) our Family Medicine In-terest Group (FMIG) is dedicated to creating a dynamic, engaging environment in which students are introduced to Family Medicine. With an appreciation of the importance and increasing implementation of team-based, multi-disciplinary care, we also extend our efforts to others throughout the university, including those who teach and study in pur-suit of other advanced healthcare degrees. Our strategy has been to partner with local and national military and civilian agencies to

build effective and sustainable initiatives that meet our goals. Our chapter has two mottoes – the first, “We Got This,” pays homage to the integral role Family Physicians play in the de-livery of care regardless of the time and place, a message close to home for military physicians who often serve in austere environments. The second, “Healthcare. Lifelong” is used to em-phasize the breadth of care that family physi-cians offer and to emphasize through simplic-ity what it is Family Physicians deliver each and every day.

The USAFP extends our congratu-lations to the students, faculty and staff who helped to make this award possi-ble. We applaud your efforts, commend your achievement and thank you for promoting the values and philosophy of family medicine.

The award was presented to USU’s FMIG at the AAFP National Confer-ence of Family Medicine Residents and Students held August 7-9, 2014 in Kansas City, Missouri.

USUHS FMIG ReceivesExcellence Award

Pictured are from left to right: Faculty Advisor Major Christopher Bunt, MD, FAAFP, USAF; and student leaders ENS Megan Ohmer, USN; 2Lt Hannah Gale, USAF; and 2LT Brooke Pati, USA.

www.usafp.org 27

committee reportPrACtiCe MAnAGeMent

During this year’s annual conference, the practice management committee con-ducted its annual Clinic Management 101 Workshop. During this workshop, and throughout the conference, many of our committee members were asked to help ex-plain the basics of PCMH. As we continue to welcome new medical students, residents, and staff into our Family Medicine family, we wanted to use this quarter’s publication to provide a primer on PCMH and provide an outlook for where we are going.

The Patient Centered Medical Home is a modern adaptation of the classic clinical practice many of us and our parents grew up knowing. However, over the past 20+ years due to changes in reimbursement models, managed care, and increasing spe-cialization, our systems have drifted from its core. To combat this, multiple national organizations have adopted and voiced their strong support for the PCMH mod-el. A key feature of this model is promo-tion of patient engagement which treats the patient as an active participant in the healthcare provided by their physician-led team managing their comprehensive, coordinated, and continuous care. The team’s core components are the patients, the provider, nurses, medics, administra-tive assistants and medical management RNs (to include disease and case manag-ers). This model actively mitigates the fragmented, reactive care that too many of our beneficiaries have received in the past, shifting the focus to prevention and proactively addressing underlying causes of current or future disease. Additionally,

evolving technology, such as secure mes-saging and telehealth, are incorporated into the practice. Lastly, the entire health care organization (the Accountable Care Organization) is aligned and synchro-nized with primary care to use its resourc-es in the most efficient manner possible to maximize the health of its patients by co-ordinating care across time and treatment settings. One example of this is focusing on the population health of the practice’s patients, where patients with specific health needs (CHF, DM, etc.) are identi-fied on registries and their preventive care needs are monitored regularly ensuring optimization of their medical manage-ment. Additionally, specific focus is given to health promotion to prevent disease for persons at high risk.

Another key component to PCMH is active management of beneficiary de-mand. As we have all experienced, not all patients require face to face appointments; thus, many concerns and requests can be managed virtually. Utilizing telehealth (virtual care) increases patients’ access to their team while maximizing our provid-ers’ time to deliver face to face care; MHS telehealth initiatives include secure mes-saging and the new CONUS Nurse Ad-vice Line. With increased access to vir-tual care, overall utilization of face to face visits decreases which increases our pro-vider’s availability to meet our patients’ demands. Close monitoring and active management of provider schedules by the medical home’s leadership will optimize clinician availability and efficiency.

cURRENT IMPLEMENTATION:Within the MHS, official PCMH

implementation began in 2009 with a policy memorandum from ASD-HA. Since that time, each service has imple-mented its own PCMH model to meet Service-specific needs; however, all three services have worked closely together to collaborate and synchronize their efforts. The MHS PCMH lead is Ms. Gina Julian; for the Navy it is CDR Deb Manning; for the Air Force, Col Francis Holland; and for the Army, COL Mark McGrail (COL Mark McGrail replaced COL Reeves this summer). All three Services continue to implement PCMH into all primary care platforms.

As with many things in medicine, mea-suring success of the PCMH model is a complex and challenging endeavor; partly due to the myriad of factors affecting health and partly due to the time it takes to measure the positive effects of preventive care. Future articles will explain the met-rics used to assess implementation and suc-cess and report our current performance.

THE fUTURE…High quality patient care is every indi-

vidual and organization’s goal and PCMH is undoubtedly focused on achieving this for all our beneficiaries. Given the un-known financial pressures, predicting the exact future of PCMH within the MHS is quixotic at best. However, here are the things that rising leaders should expect and look forward to:

Matthew Fandre, MDArmy PCMH Task ForceProgram Manager Soldier Centered Medical [email protected]

Patient Centered Medical Home (PCMH): The Basics



1) Continued and increased tri-service collaboration. As the MHS matures and funding tightens, there will be added incentive and pressure to stan-dardize business practices, provide more comprehensive care in the PCMH and better coordinate care across time and treatment settings.

2) Increased utilization of virtual care/telehealth. Technology continues to adapt at an amaz-ing pace providing an expand-ing array of options to extend our clinical reach and manage demand while enhancing qual-ity and safety.

3) Focus on population health. Technology will assist greatly in our ability to proactively iden-tify, track, and monitor preven-tive patient needs and complex patients whose medical condi-tions utilize large percentages of medical resources. Tools such as CarePoint 3G and the Hud-dle dashboard greatly increase the ability for our teams to man-age patient conditions.

4) Team-based care. As we can all attest, the PCMH cannot do everything. The core team, an-cillary team, specialists and the entire accountable care orga-nization must synchronize ef-forts to maximize the benefit to our patients and utilize our re-sources most efficiently across the entire integrated delivery system in both the direct and purchased care components.

5) Continued expansion of em-bedded specialty services in primary care such as case man-agement, behavioral health, clinical pharmacy, physical therapy, diet/nutrition, and pain management.

Northwest Permanente, P.C.,Physicians and Surgeons

Help Build a Gateway for Better Health

At Northwest Permanente, P.C., we want every patient we see to receive the medical care they need to live long and thrive. We also offer NWP physicians the opportunity to pursue their personal and professional goals with equal passion through cross-specialty collaboration and work-life balance. Together, our engaging practice allows our members— from the people we treat to the practitioners we employ—to live longer, healthier, happier lives. We’re currently seeking BC/BE physicians who are interested in our non-RVU based pay structure that allows you to earn more while working less hours.

FAMILY MEDICINE & URGENT CARE OPPORTUNITIESWe invite FM and Urgent Care physicians to join us in our Salem & Portland, OR or Vancouver & Longview-Kelso, WA locations. All of our unique communities boast diverse neighborhoods, affordable housing, excellent school systems and a variety of recreational and cultural opportunities.

Our physician-managed, multi-specialty group of 1,100 physicians care for over500,000 members throughout Oregon and Southwest Washington. NWP offers physicians the opportunity to have sustained, fulfilling careers in their practices while enjoying the benefits of one of the largest integrated health care organizations in the country. Apply to: http://physiciancareers.kp.org/nw/. Or call (800) 813-3763. We are an equal opportunity employer and value diversity within our organization.

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ConnectWithCentra.com

Centra Medical Group o�ers a variety of primary care opportunities throughout Centra Virginia including family medicine, internal medicine, pediatrics, and geriatric care. As a service line, primary care is committed to extending the patient centered medical home care delivery model and continuing to work with new technologies and processes designed to improve the health of our community.

Bene�ts of working for Centra Medical Group• Exceptional quality of life with an a�ordable cost of living • Educational loan payment• Physician-led medical group• Premium compensation and bene�ts package• Accepts J-1 Visa

EXCITING PRIMARY CARE OPPORTUNITIES IN CENTRAL VIRGINIA

Make Virginia Home

For more information aboutopportunities, please contactMikael Blido at 434.200.3153

or [email protected]

www.usafp.org 29

Kyle Hoedebecke, MD, CKTPCPT, MC, FSWAFMR, Class of 2013

The Global Organization of Family Doctors – or Wonca for short – repre-sents the global body of family physi-cians to which both the American Acad-emy of Family Physicians (AAFP) and the Society of Teachers of Family Medi-cine (STFM) belong. As a chapter of the AAFP, USAFP and its constituents also fall under Wonca’s influence. My expe-rience has shown that very few of our military family physicians participate or are even aware of such a global organiza-tion. This trend, however, is changing as several residents and recent graduates of the Womack Army Family Medicine Residency (WAFMR) not only partici-pate, but have taken on leadership roles within Wonca over the last year.

Furthermore, Wonca’s Polaris, North America’s junior Family Physician move-ment, was strategically launched on 19 May 2014 – World Family Doctor Day. Until this recent unveiling, North Amer-ica was the only remaining region in the

entire world without such a junior physi-cian organization. Specifically, Polaris aims to provide an international platform for North American medical students, res-idents, and junior family physicians in or-der to augment their medical training and experiences involving teaching, research, exchanges, and leadership at the global level. Collaborating with a small group of U.S., Canadian, and Caribbean leaders, se-

lect WAFMR residents and graduates have helped co-found and lead this transforma-tion. I highly encourage uniformed medi-cal students, residents, and junior staff to get involved in Polaris in order to expand their educational, scholarship, leadership, and advocacy experiences – all of which are goals supported by USAFP itself. The following are 2 recent Polaris experiences from junior USAFP members.

USAFP Members Makinga Difference on a New Front

Kyle Hoedebecke, MD, CKTP

Blake Busey, DOCPT, MCWAFMR, Class of 2014

As a newly board certified Family Phy-sician, I am still full of questions, energy, and ambition. Many of these questions involve medical organization, collabora-tion, innovation process, and how to pro-ceed with meaningful change. For most of my training, these questions were not answered until I was introduced to the concept of Polaris in my final year of resi-

dency. I recently had the chance to par-ticipate in the Wonca Europe Conference in Lisbon, Portugal as a Polaris represen-tative and lecturer – truly a life changing event in my medical career.

The conference was attended by Fam-ily Physicians on an international scale and, though our medical systems vary, I learned that we share several of the same questions and concerns. My desire to collaborate and innovate was matched by other regions’ junior members. Polaris

has allowed many junior physicians – to include myself – to participate on the in-ternational scale to improve healthcare through collaborations such as exchang-es, internet-based face to face meetings, and research around the world. What is most exciting for me is that Polaris pres-ents international leadership opportuni-ties that are unmatched elsewhere, which we as military Family Physicians are highly suited to take on and influence.



Caitlyn Rerucha, MDCPT, MC, FSWAFMR, Class of 2014

Greetings from Kathmandu, Nepal where I sit reflecting on my past 3 weeks working side-by-side with fellow Fam-ily Medicine trainees in the resuscitation area of the emergency department under the supervision of Dr Pratap Prasad, the Wonca South Asia Region President. What an amazing experience of a lifetime! It was only this time last year that I was first introduced to this organization of global family physicians when I presented at the 2013 Wonca World Conference in Prague. There I was inspired by young family physicians in Europe and I am ex-cited to see a similar junior physician re-naissance at this time through the recent creation of Polaris. I’m excited to see the results of continued Polaris international collaborations between young motivated family doctors across the world!

Jelaun Newsome, DOCPT, MCWAFMR, Class of 2015

Many of my colleagues predicted that attendance at a Wonca conference would be an event that I would only want to at-tend once in my lifetime/career. After participating as a Polaris representative, I would have to disagree. I strongly endorse involvement in both Polaris and Wonca as a whole for young physicians from USAFP as this is a unique opportunity to repre-sent our region, present on an interna-tional stage, and interact with physicians from around the globe. During this expe-rience, I networked with physicians from Switzerland, France, Germany, Holland, Portugal, and England – just to name a few. Furthermore, I learned about foreign medical systems and training programs as well as shared best practices with these international colleagues, many of whom expressed interest in collaborating on in-ternational process improvement projects.

I also had the ability to learn about other cultures. In a time when cultural competency is at the forefront of medi-cal issues, an international conference is an exceptional opportunity to learn firsthand about other locations and the medical/social influences of varying eth-nicities and nationalities. Additionally, my involvement in Polaris allowed for more in depth discussions with interna-tional junior physician counterparts. It has been amazing to see the breakdown of social and language barriers through

the formation of various intercontinental collaborations in the realms of teaching, research, and leadership. Involvement in Polaris across USAFP and the entirety of North America allows participants to expand their horizons and join a global environment of collaboration that has ex-isted for many years throughout the rest of the world. Globalization will only con-tinue so we must learn from others, teach others, and improve our footprint in the world through our experiences, collabo-ration, and research.

Caitlyn Rerucha, MD

I learned about foreign medical systems and training programs as well as shared best practices with these international colleagues, many of whom expressed interest in collaborating on international process improvement projects.

www.usafp.org 31

Leader’s Book ClubYou are the same today as you’ll be in five years except

for two things: the people you meet and the books you read– Charlie “Tremendous” Jones

This article reenergizes a program ini-tiated by COL John O’Brien in which he provided a review of business and leader-ship books. However, in contrast to the typical military recommended reading lists in which the majority of the books relate to military campaigns or specific battles, our focus is to educate, inspire, and challenge by reviewing books outside of the military sphere. Additionally, knowing the multi-tude of demands on each of our schedules, many of the books chosen will be intention-ally short. Finally, each of these quarterly reviews (as well as the previous summaries by COL O’Brien) will be posted to the USAFP website. A recommended list of books by our current medical senior leader-ship will also be provided. If you have any recommendations for books to be reviewed or if you’d like to contribute, please let us know; we’d love to hear from you.

QBQ! THE QUEsTION BEHINDTHE QUEsTION

QBQ, by John G. Miller, is a short book (115 pages) with a simple, yet pro-found message. The structure of the book is short chapters with a poignant point or question to reflect upon that all builds and supports the concept of personal account-ability. Proper questions, QBQs, are ones that place the emphasis and onus on the individual and not on something external or out of the individual’s control. Too of-ten, and I believe we have all fallen into this trap, we ask questions that place the blame on someone else, or at least place responsibility elsewhere. These ques-tions, termed “incorrect questions (IQ)”

always ask, “When is someone else going to fix the problem?”. QBQs, however, focus on what WE can do and follow a specific format:• BeginswithWhatorHow(notwhy,

when or who)• ContainI(notthem,they,weoryou)• Focusonaction

Thus, instead of “When is manage-ment going to …” or “Why are we so short staffed,” the proper questions would be “What can I do to improve the situa-tion” or “How can I support the team.” QBQs put the focus on our responsibility to serve and contribute positively to the situation. In contrast, just as with gossip, IQs have the tendency to destroy morale and fester like an infection; flipping the script with QBQs and inserting control minimizes wasted energy and destructive individual and organizational behavior.

A common theme throughout the book that is complementary to the principle of personal accountability is avoiding the victim mentality. Obviously, unfortunate things happen on a daily basis, and all of us in medicine have seen this time and time again; however, these circumstances do not justify taking the role of the victim. Actu-ally, the opposite applies; becoming a vic-tim almost certainly worsens the situation emotionally and prevents you from taking actions to improve, or at least to limit, dam-age from the event. I recently read in an-other book that the difference between re-acting and responding is our own degree of control. When we react, others are in con-trol; when we respond, we are in control. Victims react…and typically do so poorly.

The author also addresses some key, and all too familiar, “incorrect questions.” Specifically, asking “When we’re going to get the new, best system or the new train-ing technique?” These questions fail to recognize that most success comes from utilizing and maximizing tools and re-sources already at hand. The most impor-tant of these is us! One phrase that stuck with me from this section was “succeeding within the box.” Furthermore, focusing on “who” to blame or caused the issue is wasted time. This doesn’t mean individu-als, sections, departments, and organiza-tions aren’t accountable for decisions and actions, but throughout a typical day, way too much time is spent looking for whom to blame or an excuse for non-performance rather than just getting out there and suc-ceeding. Although I’m hesitant to make an over-used sports analogy, this one is too easy to pass up. If the field is in bad shape, it’s raining, the ball is under inflated, or the opposing crowd is really loud, at the end of the day, are any of these factors really excuses when the quarterback and running back fumble the handoff or the snapper, placer and kicker mess up the field goal at-tempt or the other team has more points when time expires and the game is over?

Mr. Miller also dedicates time to or-ganizational behaviors and attitudes. He defines ownership as “A commitment of the head, heart, and hands to fix the prob-lem and never again affix the blame.” Too often, unnecessary bureaucracy, silos, and preservation of ego prevent us from remembering we’re all on the same team

Matthew Fandre, [email protected]

John O’Brien, [email protected]



and will all succeed or fail together. The heart of commitment and suc-cessful teams is beginning with our own self. QBQs don’t have “they,” “them” or “we;” QBQs contain “I.” Expecting, even demanding, this attitude of ourselves and of those we lead change the culture and per-formance of organizations. Honest, meaningful dialogue translates to real communication and addressing underlying needs and gaps. Each of us has unique talents and skills and must maximize those while trust-ing our teammates to do the same.

Mr. Miller also laments the count-less leaders who have either focused their energies on trying to change others without changing themselves or who have acted hypocritically by not following their own advice (I’m sure none of you have ever experi-enced this…). We all know it’s easy to spot things we’d change in others, but the key point to QBQ is personal accountability. By doing this daily, we also model appropriate behavior for those watching us. The final way the book encourages the QBQ con-cept is by recommending that we as leaders ask “What can I do?” when those working with and for us pres-ent with issues. However, this does not imply that we do their jobs or fail to hold them accountable for not fulfilling their responsibilities.

In summary, this book is all about personal accountability and it’s translation to personal and professional success. I highly rec-ommend it due to the value of its content as well as its brevity. In closing, I share Mr. Miller’s modi-fication of the serenity prayer that captures the essence of the book:

“God, grant me the serenity to accept the people I cannot change, the courage to change the one I can, and the wisdom to know…it’s me.”

Focus on Practicing Medicine - We’ll Take Care of the Rest.

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Effective June 2014, a change from a 5-year repeat to a 3-year repeat of a SAM has been implemented by the ABFM. If you have any questions, please contact Ashley Webb, Support Center Manager, American Board of Family Medicine – 888-995-5700 ext. 1000 or e-mail [email protected].

American Board of Family Medicine Maintenance of Certification Announcement –

Three year Repetition of sAM Implemented

www.usafp.org 33

ACTIVEBrian Charles Hanshaw, DOStephen Asher Keck, MDThanh-Thao T Le, MDRobert Quarcoo, DOKermit Chalavet Salivia, MDThomas Blake Vanbrunt, DODavid Volk, DO

RESIDENTElizabeth Lynn Albright, DOErik Lundberg Anderson, MD, USNWilliam Charles Anderson, DOHeather Annis, MDGregory Adam Baker, DOJoshua Beer, DODanièlle Elaine Berry, MDSteven Boehmer, DOKatherine Bohringer, DOAlan J Bordon, MDNatalie Rose Branton, DOJacob Michael Bright, DOVishaal Buch, MDBenjamin Kelvin Buchanan, MDKatie Lauren Buel, DOJason N Butler, DORobert Charles Callahan, DOWesley William Carr, MDKristopher Everett Carter, DOCarl Andrew Cassel, DOThomas Elliott Cayce, DOEdwin Y Choi, MDDaniel Albert Cieslak, MDErik Richard Clauson, DOStephen Larry Cook, MDBryce Lloyd Coombs, DOElise Cooper Brandon, MDWesley Charles Cowan, MDNathaniel David Cranney, DONicole Camilla Croley, MDHeather Ann Dalton, MDThomas Augustus Dear, DOLeilani Dimond, MDJoe Doc, MDAudrey Eloise Falconi, DOGeoffrey Strider Farnsworth, MDPaul Edward Flood, MDSamuel Galima, DODaniel Moses Garrison, DOCarrie Nicole Gray, DORobert Gray, MD

Taha Muhammed Haque, DOAndrew Travis Haynes, DOBrittany Rose Herits, DOMatthew Charles Hess, MDSusan Elena Hill, DOAlex Houle, DOCharles Thomas Howard, MDJocelyn Hu, MDDaniel Gordon Hurtt, MDKay L James, MDHeather Louise Jones, DOLee M Jordan, MDJennifer Mae Jupitz, MD, USNJake M Karels, MDJonathan Patrick Keenan, MDBrian Paul Keene, DOMichael Jin Kim, MDCecilia Jung Ah Kim, DORandolph Jay Kline, MDAlexander Cullinson Knobloch, MD, USAFKristopher Kohlbacher, MDAdam Walter Kowalski, MDRebecca Ann Lauters, MDBrian Lee, DOBrian Scott Lerner, DORichard K Luger, MDMegan Brousseau Mahowald, MD, James Anthony Mazzuchelli, DOMark Evan McHaney, MDErica Jean Meisenheimer, MDTravis David Miller, DOErin Alexis Murphy, DOShawn Michael Myers, MDColby Taylor Neville, MDAlexander Hoang Nguyen, MDMaria Lizette Nieves, MDJessica Anne North, DOManuel Alejandro Nunez, MDDemian Aubrey Packett, MDFahad Pervez, MDMack Andelin Peterson, DOElyse Fiore Pierre, MDCollin John Pitts, MDIan M. Porter, MDAmarateedha Hindh Prak, MDMary Elizabeth Ray, MDJohn Marion Richardson, MDAndrew Richard Romney, DOHeather Anne Ross, MDJedda Patricia Rupert, MDZachary James Rupert, MD

Sithel Larry Sar, DOSajeewane Manjula Seales, MDJames Michael Smith, MDSavannah Willson Smith, MDKelli Rae Spellman, DORobert Edward Stapleton, DOLaura Caitlin Suggs, DOMaria Guadalupe Takahashi, MDShelby Lin Takeshita, MDDerrick James Thiel, MDTroy Patrick Underbrink, DOJason Matteo Valadao, MDJeffrey Todd Vassalli, MDStephen Robert Vogel, MDJoel James Welshons, DOLynne Marie Werth, MDJames W Westbrook, MDStephen M Young, MD

STUDENTMr Rayad Hakim BarakatMr Benjamin BarringerMs Nicol BehmMr Gurdeep ButtarMr Zachariah Quincy ClarkMs Angela CurellMs Mary FordMr Nathaniel GordonMs Caitlin HaltinerMs Chelsea HayesMs Perri HopkinsMr James Daniel JonesMs Youngmi Faith KimMr Thomas Wolfgang KlotzMr Louis LachmanMr Yevgeniy MaksimenkoMs Alexandra PappMs Vinita PuriMs Emily RaetzMr Jonathan Carlos SchroederMr Nicholas Edward Singh-MillerMs Meaghan Caroline SledgeMr Benjamin Russell SmithMr Matthew Donald SmithMr Jeffrey SpiroMr Eric SulavaMr Matthew WardMr Wells WeymouthMr Richard Wu

new memberstHe usAFP WelCoMes tHe FolloWinG neW MeMBers…


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 orga-nized medicine, within teaching, and a greater commitment to continuing professional development and/or research.

Congratulations to the following USAFP members!

Congratulations to theUSAFP Members that Received

the AAFP Degree of Fellow

Drew Baird, MD, FAAFP

David Victor Bode, MD, FAAFP

Shannon Mary Brodersen, MD, FAAFP

Timothy Caffrey, MD, FAAFP

Marc A Childress, MD, FAAFP

Theresa B Goodman, MD, FAAFP

Chad David Hulsopple, DO, FAAFP

Benjamin J Ingram, MD, FAAFP

Chrisanna Johnson, MD, MPH, MSW, FAAFP

Scott C Osborn, DO, FAAFP

Reuben L Smith, MD, JD, FAAFP

Timothy L Switaj, MD, FAAFP

Kenneth Trzepkowski, MD, FAAFP

Elizabeth Werns, MD, FAAFP

The Womack Army Medical Center Department of Family Medicine and Di-rectorate of Medical Education are proud to announce the approval of our fellow-ship in Hospital Medicine for Family Physicians. The fellowship is a two-year program to prepare graduates for cer-tification under the American Board of Family Medicine Recognition of Focused Practice in Hospital Medicine.

During their first year of study, fel-lows will focus on intensive care units and skills with training in bedside ultra-

sound and procedures such as advanced airway management, central vascular ac-cess, paracentesis, and thoracentesis.

The second year fellow will master the skills and knowledge to be a full-spectrum family medicine hospitalist with rotations in family medicine inpa-tient care, newborn nursery, pediatric ward, and obstetrics. Fellows will learn about the administration of hospital medicine through committee participa-tion, quality improvement projects, and scholarly research.

Upon graduation, fellows will be as-signed as family medicine residency fac-ulty or as staff at community hospitals where they will run full-service family medicine inpatient programs, serving as subject matter experts and advisors to the hospital leadership.

We are now accepting applicants for the current application cycle. Fellows will start training in July of 2015. Inter-ested physicians are encouraged to con-tact MAJ Craig Barstow at [email protected] for more information.

FELLOWSHIPOPPORTUNITY

www.usafp.org 35

Take Care of Your Patients… We Will Take Care of the RestTake Care of Your Patients… We Will Take Care of the RestJohn C. Lincoln Physician Network – Now Recruiting PhysiciansJohn C. Lincoln Physician Network encompasses primary, urgent and immediate care facilities throughout the Phoenix metro area. We offer family and internal medicine as well as sub-specialty services.

The Network is currently seeking experienced family and internal physicians to join our award-winning team.

“I joined John C. Lincoln to practice medicine with a health system that knows our worth and treats us that way.”– James Dearing, DO, Chief Medical Officer of the John C. Lincoln Physician Network

John C. Lincoln Physician Network offers the security of working with a locally-owned and managed health network that has served the Valley for more than 80 years. We have several openings including Immediate Care with expanded evening and weekend hours as well as traditional hours for physicians with existing patient panels. Applicants must be board-certified or board-eligible.

Benefits for Physicians include:

n Competitive salary and benefits package.

n JCL Connect electronic health record system from Epic.

n Care coordination among primary and specialty care physicians to achieve optimal outcomes.

n Physician credentialing services.

n Marketing and communication programs and services.

To learn more about the Physician Network visit JCL.com/practices. For more information about physician opportunities visit JCL.com/physicians. Please submit your application or resume with references to Trina Foster, director of Practice Acquisition and Development at [email protected].

JCL.com


The Uniformed Services Academy of Family Physicians1503 Santa Rosa Road, Suite 207Richmond, Virginia 23229www.usafp.org

Explore the Possibilities.Make a Difference.As the largest community health center in the Pacific Northwest, the Yakima Valley Farm Workers Clinic offers the perfect balance between work, community and quality of life.

We offer:• Market competitive pay and great benefits

• Loan repayment

• Visa sponsorship

• Monthly stipend for residents in their final year

Contact Tanya Gutierrez-Leishman:[email protected] | 1-877-983-9247 | yvfwc.org

Yakima Valley Farm Workers Clinic

mark your calendars to attend the 2015 usafp annual ... usafp annual meeting & exposition equip...

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