Pub. 7 2023 Issue 2

Utah’s Community Health Centers and Family Physicians Why Health at Every Size Matters

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Participation by advertisers does not constitute endorsement by the UAFP. CONTENTSIssue 2 2023 © 2023 Utah Academy of Family Physicians | The newsLINK Group, LLC. All rights reserved. UAFP Journal is published two times each year by The newsLINK Group, LLC for the UAFP, and it is the official publication for this association. The information contained in this publication is intended to provide general information for review and consideration. The contents do not constitute legal advice and should not be relied on as such. If you need legal advice or assistance, it is strongly recommended that you contact an attorney as to your specific circumstances. The statements and opinions expressed in this publication are those of the individual authors and do not necessarily represent the views of UAFP, its board of directors, or the publisher. Likewise, the appearance of advertisements within this publication does not constitute an endorsement or recommendation of any product or service advertised. UAFP Journal is a collective work, and as such, some articles are submitted by authors who are independent of UAFP. While UAFP encourages a first-print policy, in cases where this is not possible, every effort has been made to comply with any known reprint guidelines or restrictions. Content may not be reproduced or reprinted without prior permission. For further information, please contact the publisher at 855.747.4003. The mission of the Utah Academy of Family Physicians: To improve the health of all Utahns by advocating for and serving the professional needs of family physicians. 27 10 | 4

Here’s to the Past Five Years! 6 President’s Message What Motivates You? 7 2023/2024 Utah Academy of Family Physicians Board of Directors 8 Annual Member Meeting Highlights 10 National Conference 12 Congress of Delegates 2023 14 Member Spotlight: Matthew McIff, MD 16 Resident Spotlight: Anita Albanese, MD 18 Student Spotlight: Hannah Berhow 20 CME & Ski 2024 22 Why Health at Every Size Matters 23 Utah’s Community Health Centers and Family Physicians 27 Recommending Medical Cannabis in Utah 31 Prognosis Negative NCQA Combines Every Quality Metric Into One Convenient Measure 34 14 12 31 Cover photo: Medical staff from Family Healthcare, a Community Health Center with locations in St. George, Hurricane and Cedar City. 5 |

Maryann Martindale: Five years ago, in late August, I was approached about applying for the position of CEO. About a decade before that summer day, and after 20 years in the corporate sector leadership roles — working in Marketing, Communications and Administration — I had left to follow more fulfilling pursuits, namely nonprofit/public service roles. At the time of this position opening up, I was a Senior Policy Advisor with the Salt Lake County Council and had been working in the area of public policy for several years. My initial trepidation over not having very extensive healthcare-related experience was easily replaced by the warm and open conversations I had with the then-executive board committee. I was immediately impressed by the level of commitment to patient care, the concern for improving healthcare delivery and policies and the fact that the committee was open, inviting, and very accessible for my litany of initial questions. They helped me realize that while I had a lot to learn, I also had a lot to bring to the organization. I was able to create my own team and immediately pursued Barbara Muñoz, who was working at AUCH at the time. I had interacted with her on a policy level, and as I got to know her more, I recognized what an incredible person she is and knew she’d be an invaluable asset to our UAFP journey. We’ve weathered many changes in our short tenure, including moving from an office format to telecommuting, the COVID-19 pandemic and the many, MANY ups and downs of healthcare policy these past few years. But while our time hasn’t been without challenges, it has also been a profound honor to dedicate our time to growing the chapter, increasing our collaborative partners, working on proactive healthcare policy at the legislative level and engaging on national issues and grant work. Five years on, I am still in awe of the dedication of family physicians and inspired by the determination and commitment of students and residents pursuing careers in family medicine. To say I love my job would be an understatement. Thank you for putting your trust in us to guide UAFP. It is a distinct pleasure and honor to serve the membership. Thank you for believing in our shared vision for the future of healthcare in Utah and for strengthening the profile and impact of UAFP. Barbara Muñoz: When Maryann reached out to me in early October of 2018 to let me know about a job opening at the Utah Academy of Family Physicians, where she had just been hired as Executive Director, I was immediately intrigued. At that point, I had already worked for two nonprofit associations, the Community Action Partnership of Utah and the Association of Utah Community Health (AUCH), so I had a good basic understanding of the purpose and function of an association. The job description included a wide array of responsibilities that I knew I would be able to bring experience to but also continue to be challenged by. The biggest unknown when considering a new job is, of course, not knowing if what looks good on paper will actually translate into a good fit for all involved. What I could not have anticipated at the time was what a solid team Maryann and I would become and how much we would both fall in love with family medicine. Over the past five years, we have met and worked alongside brilliant, loving, funny, driven, often over-achieving and complex individuals. We met individuals who went into family medicine as opposed to a potentially higher-paying Here’s to the Past Five Years! UAFP staff, CEO Maryann Martindale and Associate Director Barbara Muñoz, reflect on their respective five-year anniversaries working with family physicians. specialty because they loved long-term relationships with their patients and their entire families. We met doctors who saw the whole person rather than just problems to be solved. When COVID struck and all our lives became filled with a level of global uncertainty few in our lifetimes had seen, I saw family doctors scrambling to adjust and continue to provide care and reassurance to their patients while struggling with their own anxieties. For Maryann and me, it was an honor to support family physicians in some small way. As we move into the next five years and beyond, we are committed to continuing to be family medicine’s biggest cheerleaders! Maryann will continue to be your incredibly capable champion on Utah’s Capitol Hill, fighting for policies that help family physicians and their patients and fighting against those that could harm them. As a team, we will look for more ways to support and encourage medical students to pursue family medicine, to grow opportunities for family physicians to train and continue to work in Utah and to encourage and support a more diverse family medicine workforce. Thank you for continuing to provide exceptional care to Utahns of all ages in every corner of the state! And thank you for inspiring us to do more and strive to be as exceptional as you are! | 6

PRESIDENT’S MESSAGE Michael Chen, MD, FAAFP What Motivates You? I am excited to begin my tenure as President of UAFP. We are, first and foremost, a member organization, so our priority is to serve YOU. Please lend us your voice on committees or even just through a phone call or email to tell us what motivates you as a family physician. In Daniel Pink’s book Drive, he sets a framework for motivation based on three key factors: autonomy, mastery and purpose. As physician burnout reaches an all-time high, while many of us lose autonomy, as more and more of us become employed — remember to think creatively. We have a wide variety of practice styles within our academy and a network of physicians who can give you ideas for your practice. You can meet them at UAFP events! We have clinics and hospital systems embracing value-based care to get you off the RVU hamster wheel. Physicians are piloting generative AI to respond to messages and write your notes for you. Telemedicine has allowed for work-from-home opportunities. Utilize your peers in UAFP to innovate and bring back your autonomy. Continuous improvement and learning are essential to mastery as family physicians, and UAFP is devoted to providing opportunities for this. We are excited to offer our 8th Annual CME & Ski Conference in February. This conference attracts physicians and APCs from around the country, so you have the chance to learn, ski and network in one location — beautiful Park City, Utah. Also, you can always find other education opportunities and practice-related information on our website. Watch your inbox for the Beat email newsletter twice a month on Mondays (check your junk folder and/or let us know if you aren’t getting these) to keep you up to date on UAFP events as well as other local CME opportunities, AAFP news and events, and healthcare news. Through involvement with UAFP, you can improve your own skills and practice as you strive toward mastery. Sometimes it feels as if our job is to document for lawyers, fill out forms for insurance companies and ensure profit for administrators. This can contribute to moral injury and lead to a loss of purpose. Many family physicians, when asked, will state their purpose in their work is to “take care of patients.” A way to foster this sense of purpose is to volunteer and use your skills to benefit local nonprofits such as our UAFP Foundation, which continues to work toward increasing interest in family medicine by supporting educational activities to engage prospective family medicine students, actively address physician pipeline issues and encourage entrance by medical personnel into primary care. It can be refreshing to see the spark in the eyes of a medical student as they talk about why they want to pursue family medicine which can help reignite your own sense of purpose. If working with students is not for you, you could also help at clinics such as the Maliheh Free Clinic (Dr. David Miner, a UAFP Board Member, has served as Medical Director since 2005). Family physicians are uniquely capable of providing quality care to underserved populations. I feel like hospital administration when I ask you to volunteer time to address your burnout, but this is not a resiliency module that you are required to complete. While it may seem counterintuitive to volunteer more of your time, it is just one way that you can help renew your sense of purpose. I am hopeful that we can continue to serve the needs of YOU, the family physicians of Utah. Through connectivity with other family physicians who not only share in your moral injury but also experience the joys of patient care, UAFP hopes to help you find your motivation for your work. Our diverse physicians and practices can share innovation for autonomy, provide us the opportunity to learn from each other as we aim for mastery and revitalize purpose through philanthropy. Please do not hesitate to reach out to us and thank YOU for being a member of the Utah Academy of Family Physicians. I am hopeful that we can continue to serve the needs of YOU, the family physicians of Utah. 7 |

Tiffany Ho, MD, MPH, FAAFP President-Elect Shannon Baker, MD Craig Batty, DO Marlin Christianson, MD Matthew Johnston, MD, FAAFP Bernadette Kiraly, MD Marlana Li, MD, FAAFP David Miner, MD Jamie Montes, DO Isaac Noyes, MD Thea Sakata, MD Tyson Schwab, MD Heather Sojourner, MD, FAAFP Kirsten Stoesser, MD, FAAFP Sally Tran, MD Mark Wardle, DO, MIH, FAAFP AAFP Delegates and Alternates Nikki Clark, MD, FAAFP AAFP Delegate Thea Sakata, MD AAFP Delegate Katharine Caldwell, MD, MPH AAFP Alternate Delegate David Cope, MD, FAAFP AAFP Alternate Delegate Family Medicine Residency Representatives Andrew Steinicke, DO McKay-Dee Family Medicine Residency Representative Elise Blaseg, MD St. Mark’s Family Medicine Residency Representative Anita Albanese, MD University of Utah Family Medicine Residency Representative Spencer Lindsay, MD Utah Valley Family Medicine Residency Representative Medical Student Representatives Jake Roush Rocky Vista University — Utah Campus Annie Galt University of Utah School of Medicine Jessica Pentlarge Noorda College of Osteopathic Medicine Executive Committee At-Large Board Members Our Mission and Vision The mission of the Utah Academy of Family Physicians: To improve the health of all Utahns by advocating for and serving the professional needs of family physicians. The vision of the American Academy of Family Physicians and the Utah Chapter: To transform health care to achieve optimal health for everyone. Thank you for your service to the UAFP Board! Interested in becoming a member of the UAFP Board in the future? Contact us at for more information. Michael Chen, MD, FAAFP President Saphu Pradhan, MD, FAAFP Immediate Past President Lynsey Drew, DO, FAAFP Treasurer 2023/2024 Utah Academy of Family Physicians Board of Directors | 8

Annual Member Meeting Highlights Current Board President Dr. Michael Chen thanked our Immediate Past President, Dr. Saphu Pradhan, for her passion for family medicine and her leadership over the past year. AAFP President Dr. Stephen Furr swore in Dr. Michael Chen as President of the UAFP Board. UAFP’s Annual Member Meeting was held this year at the Davis Conference Center in Layton. To help make it accessible to our statewide membership, we have begun rotating the location each year to different areas of the state. We hope this change makes it possible for more members to attend. Each year, our annual meeting gives us the opportunity to showcase what we’ve done throughout the year, swear in our new president, confer new AAFP fellows, receive updates from AAFP leadership and give out our annual awards. It is an enjoyable and informative evening and a great way to spend time with fellow UAFP members. The 2023 Utah Family Medicine Physician of the Year is Dr. Shannon Baker. One of her nominations reads, “Dr. Baker’s dedication to family medicine shines through her role as a visionary leader in population health, exemplifying her deep commitment to comprehensive and holistic care for her patient community.” There is no question that Dr. Baker is wellrespected for her leadership as a family physician and is beloved by her patients and those who work with her on a daily basis. The 2023 Utah Family Medicine Champion of the Year is Dr. Darlene Petersen. UAFP Maryann Martindale says of Dr. Peterson, “She helps me wade through some of the confusing legislation — she is my go-to for insight and experienced UAFP President-Elect Dr. Tiffany Ho presented Dr. Darlene Petersen with the UAFP Family Medicine Champion of the Year Award. | 10

perspective. Darlene’s influence on our advocacy work is incalculable. We are incredibly lucky she is so knowledgeable about healthcare policy and dedicated to our advocacy work. It was an easy decision to give her this award.” AAFP President Dr. Steven Furr joined us this year and touched on several issues family physicians are facing this year, including updates on telehealth controlled substance Rx flexibilities, the MATE Act, the CMS G2211 add-on code, the value of serving on AAFP Commissions, AAFP’s current federal advocacy efforts and AAFP’s strategic plan for the next three years, which includes finding ways to increase family medicine’s representation in communities and how DEI work is being intentionally integrated across all AAFP’s work. Dr. Furr also conducted the swearing-in ceremony of UAFP’s new Board President for 2023-2024, Dr. Michael Chen, and conferred two new AAFP Fellows, Dr. Tiffany Ho and Dr. Jordan Knox. We hope that you can join us next year in the fall of 2024 for this annual celebration of family medicine in Utah! Newly conferred AAFP Fellows, Dr. Tiffany Ho and Dr. Jordan Knox, with Dr. Stephen Furr. Dr. Saphu Pradhan presented Dr. Shannon Baker with the UAFP Family Medicine Physician of the Year Award. 11 |

National Conference At the annual AAFP Student and Resident National Conference in Kansas City, students come from all over the United States to meet with and learn about residency programs prior to the match. This is a really important conference that helps attract top students to come to Utah for residency and then stay to work as family physicians. Each year, we sponsor and provide funds for a student and resident delegate to the National Conference Congress. This year’s student delegate was Austin White, a student at Rocky Vista Osteopathic College of Medicine, and our resident delegate was Jordan Rawlings from the Utah Valley Family Medicine Residency. We also provide stipends that help our Utah students afford to attend, providing eight student scholarships this year. As we work to increase our foundation funding, we hope to keep growing the number of students we can help attend. We’ve really upped our game and have been creating a cohesive and collaborative presentation of the four Utah residencies with banners that showcase the beauty of our state and fun activities to engage students. The following are updates from the student delegate and the resident delegate. | 12

Austin White, OMS IV — Rocky Vista University College of Osteopathic Medicine — UAFP Student Delegate Utah was well-represented by its medical students at the AAFP National Conference for students and residents in Kansas City, MO, this July. As students, we had the opportunity to engage in educational sessions, participate in leadership opportunities, and meet with family medicine residency programs from around the country. In total, we had 15 students representing Utah’s three medical schools. I am grateful for and humbled by the opportunity given to me by the UAFP to represent student interests this year at the National Congress of Student Members (NCSM). The Utah delegation was active in the authorship of three resolutions presented to the congress, and we were able to give testimony regarding several more. Some of the resolutions adopted by the student congress address the following: • Advocating for physician-led healthcare and addressing independent practice by NPs and PAs • Expanding rural training options for medical students and residents • Regulation of direct-entry midwife practice • Expanding learning opportunities in integrative medicine • Increasing access to genetic screening for cancer • Diaper accessibility for low-income families • Advocating for full insurance coverage of USPSTF grade A & B screening recommendations • Promotion of “Walk with a Doc” and similar initiatives • Patient education regarding deceptive organizations posing as reproductive health clinics These resolutions have been submitted to the AAFP for them to adopt or reject as they see fit. At that point, adopted resolutions will be available for review on the AAFP website. Jordan Rawlings, MD — Utah Valley Family Medicine Residency — UAFP Resident Delegate Having never been to the AAFP National Conference before, I was awestruck to see the quantity and quality of family medicine programs across the country that had all convened to celebrate and promote the future of family medicine. It truly was a sight to see and experience. I had been to state conferences before, specifically in North Carolina, which were such a great learning opportunity that provided both networking and inspiration to pursue a career in family medicine. This was like that state conference on steroids! Participating as a delegate provided me with a close-up opportunity to see the passion that our leaders have for the field of family medicine. Together with students, other residents and attendings, we engaged in workshops, connected with peers and experts, explored cutting-edge research and best practices and, perhaps most importantly, formed lasting connections that will likely define my career as a compassionate and competent family medicine physician. 13 |

Congress of Delegates 2023 The 2023 American Academy of Family Physicians Congress of Delegates was held October 24-27 in Chicago. As in previous years, resolutions were submitted by state chapters and debated during virtual reference committees. During the week's general session meeting, resolutions are voted on, bylaws are updated, and delegates vote to elect new leadership of AAFP. The Congress kicks off each year with a Town Hall. This is a more informal meeting where AAFP leadership makes brief statements on what the Board has been working on over the past year. The topics included AI/technology, GME funding changes to community centers, pay for family docs, continuing its ongoing work with diversity within the AAFP and several acts in the Congress, including allowing medical students to defer their loan repayments interest-free during residency. Most of the time was spent allowing the members attending to ask questions of the AAFP leaders. Some of the topics included what is being done to combat non-compete clauses in contracts, getting a wRVU assigned to the G22.12 CPT code, getting more appropriate reimbursement for primary care and how to continue to encourage underrepresented minorities to pursue family medicine. That evening, we joined with other delegations for the Western States Forum — an annual dinner meeting for delegates from Washington, Oregon, California, Montana, Idaho, Utah, Arizona, Wyoming, Colorado and New Mexico. It provided an opportunity to discuss specific areas of interest for our western states and helped encourage support for our resolutions. Day two marked the start of organizational policymaking, with remarks from President Tochi Iroku-Malize, President-Elect Steven Furr and speaker Russel Kohl, who demonstrated his evergreen talent for filling technical delays with dad jokes. The opening call for new business brought forth three late resolutions from New England states. While resolutions typically undergo a submission and review process well before the convening of the Congress of Delegates, late resolutions may be proposed from the floor on the first day of business if the submitting delegates feel that an issue cannot wait until the following year. These late-breaking resolutions must have a 2/3 supermajority to even be considered for debate, and this year, one resolution from Connecticut made the cut: a resolution to include an estimate of the reputational impact on the AAFP for future proposed organizational policy. Clearing this supermajority hurdle did not mean that the resolution passed; it would be debated on the floor the next day. The day also brought forth the report of the Elected Leadership Nominations Process Committee. Under current procedures, the AAFP found itself in a place where leadership positions (AAFP Board, president-elect, speaker and vice-speaker positions) were only being selected from a minimal number of candidates, several of whom faced no opposition and repeatedly came from a small selection of states. As a medium chapter, we Utahns understood one of the major barriers well: Scraping together the resources to launch a national campaign was much harder for us than for a larger chapter with deeper pockets and greater manpower. The Process Committee was formed to help understand this as well as other issues that might be creating an uneven playing field. A new bylaw was approved that created the Nominations Committee that will seek out viable candidates. The details of how this Nominations Committee would be formed were debated with numerous amendments and tendrils of confusing language until the speaker called for a recess, and the debate was left to continue to the next day. Our third day of the Congress began with a report to the Congress from Executive Vice President and CEO Shawn Martin. In his address, Martin highlighted several ongoing activities of the national organization, such as fighting for | 14

Utah’s 2023-2024 Delegates and Alternates Delegates Thea Sakata, MD Nikki Clark, MD, FAAFP Alternate Delegates David Cope, MD, FAAFP Katharine Caldwell, MD, MPH From L to R: Dr. Katherine Caldwell (alternate delegate), Dr. Nikki Clark (delegate), Maryann Martindale (UAFP CEO), Dr. Thea Sakata (delegate) and Dr. David Cope (alternate delegate). the G2211 code, that, if allowed to go into effect as planned in 2024, would allow primary care physicians the ability to capture some of the complexity required to provide quality longitudinal care. He also discussed an effort to understand family physician compensation across the country and encouraged members to complete the Family Medicine “Know Your Worth” survey so that the AAFP can create a benchmarking dashboard. Finally, he reviewed the AAFP strategic plan and outlined six key priorities for moving Family Medicine (FM) forward: 1. Financing for primary care and the need to secure better investment in primary care. AAFP has called upon the AMA to help modernize the current payment system to one that appropriately values FM and primary care. 2. Physician Autonomy: “FMs are at our best when in service to our patients, not corporations.” 3. Comprehensiveness and Continuity of Care: Family docs have a unique ability to meet the needs of a community; we need to better create a marketplace that allows this. 4. Practice Experience: Supporting all innovations in PC delivery; AAFP is engaged to support members to use AI correctly. 5. Inclusiveness: Family Medicine, including AAFP leadership, should be representative of the communities they serve. 6. Family Medicine Workforce: FM needs a stronger presence on medical school campuses to encourage students to go into family medicine. The day began with reference committee recommendation reports and floor debate for extracted resolutions. Utah’s resolution asking the AAFP to establish a national Family Medicine Week passed as written with reference committee support. Debate also resumed over the formation of the Nominating Committee, concluding with a new process to be enacted for the 2024 cycle. Under this new system, small and medium chapters such as Utah and many other western states will have a more level playing field upon which to run candidates for the AAFP board, speaker, vice-speaker and president-elect positions. The last day of the Congress of Delegates started off with delegates voting for a new president-elect. While awaiting the results of this vote, the Congress dealt with the remaining resolutions. We heard strong, supportive testimony for the resolution our chapter had proposed asking the AAFP to advocate for hospitals to grant trained family physicians privileges to perform deliveries and for adequate obstetrical training in residencies. We were glad to see this resolution pass and to have support for an issue we all felt passionate about, recognizing that all family physicians need to be competent in the care of the pregnant patient, even if they do not provide prenatal care. After a lighter exchange of jokes from the speakers and the Congress members, Dr. Steven Furr recognized outgoing President Dr. Tochi Iroku-Malize for her service and gave a speech to the Congress accepting his new role as President. Election results were revealed, and we are excited to welcome Dr. Jenn Brull as the new President-Elect. With the final gavel concluding the 2023 Congress of Delegates, we are pleased to see both of our resolutions pass, many good policy changes approved and new, more inclusive avenues for leadership opportunities introduced. Next year’s Congress will be held Sept. 23-25, 2024, in Phoenix, Arizona. If you’re interested in becoming a delegate, watch the Beat for more information in early January. 15 |

Matthew McIff, MD Member Spotlight moved to the Sunset Clinic and have happily been there since. Life and Work in Southern Utah Practicing medicine in St. George is very rewarding. I have felt a strong desire to develop strong relationships with my patients and earn their trust. This has helped facilitate their care by inspiring confidence in their treatment and motivating them to change their behavior. This investment in time has paid off by having some success and increased enjoyment in the workday. I also have had the opportunity to teach medical students in the clinic, where these concepts and skills are discussed regularly, in addition to the routine clinical roles of diagnosis and disease management. We focus a lot on the “art” of medicine and high-level engagement with the patient. Finally, I have had the opportunity to serve in several leadership roles both in the clinic and the medical community. One of these is serving on the Utah Cannabis Research Review Board, which meets regularly to review cannabis research and make recommendations on therapy. Another opportunity for leadership that has come up is to help open a new clinic in the Washington Fields area of St. George. The decision to move involved a lot of different factors. The clinic will be closer to my home, which is attractive, but it is also a chance to provide leadership, help organize and develop a new team and serve more patients. Thoughts on the Future of Family Medicine Family medicine has always been — and should always be — the center of medical care in our communities. However, with changing times and conditions, we will need to adapt in order to stay efficient and effective. Finding new ways to recruit students, train them effectively and make practicing medicine rewarding should continue to be our high priorities. They A Bit About Dr. McIff I grew up in Richfield, Sevier County, in the center of Utah. I went to college at Utah State University, and while there, I met and married my wife, Rachel. We have four children and now live in St. George. I have always loved the outdoors, and I continue in many activities, including mountain biking, skiing, camping, hiking, hunting and fishing, to name a few. My wife and I are actively involved in scouting with our children, where we do lots of these things. We are now also very busy watching our children’s sporting events and keeping up with them. I attended Utah State University with the intention of going into engineering. After serving a mission in Mexico, my interests changed, and I decided to go into medicine. I have always been fascinated with science, but I decided I would rather work with people than things, so I changed my major to chemistry and applied to medical school. I attended medical school at the University of Utah and had a wonderful experience. The Journey to Family Medicine After I decided to go into medicine, I was immediately drawn to family medicine and never considered anything else. Growing up in a rural area may have impressed upon me the idea that the family physician was the quintessential “doctor,” helping patients in many different ways. I completed my residency training in Fort Wayne, Indiana. While there, I had many great experiences and did a lot of moonlighting in rural hospital emergency departments, so much so that I stayed an extra year and worked exclusively in emergency medicine. I then felt the desire to return to Utah, so I sought out a position in urgent care with Intermountain Healthcare in St. George. After five years of acute care medicine, I decided to return to a traditional primary care practice, | 16

say that need drives innovation, and it is fair to say that our need is great, especially here in Utah. For practicing physicians, it is important to stay engaged, be a leader and continue to be a positive influence not only to our patients but to the community and future leaders. For medical schools and teachers in family medicine, it will be important to make training more efficient, less time-consuming and more affordable. Doing this while still maintaining high-quality standards will be the challenge. It will take the perspective of experienced physicians to help determine how the training could be altered to achieve those goals. I place a high priority on teaching students the importance of developing good judgment and decision-making capacity in addition to the knowledge base and technical skills. This is harder to achieve as it must be developed rather than taught or memorized. It also takes the most time. Together, we can continue to shape medical education and practice to keep family medicine the center of our healthcare system and our communities. Providing safe and high-quality products for the medical industry since 1991. CALL US TODAY! (800) 488-2436 Offering a broad selection of hand washing and sanitizing products, surface disinfectants and cleaners, sterilizers, soaps and more. 17 |

Anita Albanese, MD Resident Spotlight A Bit About Dr. Albanese I am originally from Las Vegas, Nevada! Moving away for college, I attended the University of Nevada Reno, where I studied chemical engineering and neuroscience. I then returned to my hometown of Las Vegas to be one of the members of the University of Nevada Las Vegas School of Medicine charter class. I met my now husband during our first year of medical school. Lennon and I were lucky to have much of our family living in Vegas when we were going to medical school. Thus, we were able to enjoy weekly family meals. In addition, Lennon and I spent every chance we got exploring the food scene in Vegas, traveling internationally and attending music festivals. We continue to embrace our passion for food, music and travel during our residencies. The Med School Journey Growing up, my dad always advised me to “Go with [my] gut.” If someone had asked me seven years ago where I would be today, I would have never guessed that I would be one year away from completing residency. At that time, I was a young, naïve, first-generation Hispanic woman living out my American Dream as I pursued a degree in chemical engineering. I felt very lost and could not seem to find a fitting career that met my goals. That “gut” feeling advised me that I needed to do some soul-searching, which led to a decision to pursue medicine. In many ways, that same “gut” feeling led me on my journey to family medicine, demonstrated by my love for broadscope practice, community involvement and curiosity for research. As a proud member of the UNLV School of Medicine charter class, I had the unique opportunity to build community with my peers and within Las Vegas. As a child, I never understood why my mom, an immigrant, had such distrust in the medical system. Now, as a medical student, I know many patient populations experience inequities in accessing care and health outcomes. Being an underrepresented minority in medicine myself, I believe it is of the utmost importance to recruit people of diverse backgrounds into medicine to help provide the best care to our patients and help resolve these inequities. One of my proudest accomplishments was collaborating with my peers to create multiple pipeline programs through mentorship in organizations such as the Latino Medical Student Association, Medical Student Ambassadors and Phi Delta Epsilon. These pipeline programs were developed to create a process of engagement with high school and college students interested in medical careers. I plan to continue community engagement during residency. Choosing Family Medicine In my third year of medical school, I discovered my passion for many specialties, which inspired my desire to pursue broad-scope practice. During surgery and obstetrics/gynecology, I loved seeing patients through their disease course, from conservative management to surgery. Then on pediatrics, I found myself excited to advocate for my patients. While on internal medicine, I had the unique experience of connecting with geriatric patients undergoing end-of-life care. Although excited by these fields, I could not shake the feeling that I was not meant to be in those specialties. Finally, on my family medicine rotation, I felt the “gut” feeling that told me I | 18

belonged there. I witnessed my mentors fulfilling various roles as family medicine physicians: community role models, educators, leaders, friends and confidants. Reflecting on my career goals — commitment to creating lifelong patient relationships, leadership in medicine, education, advocacy, community involvement and research — I felt I finally found my home in family medicine with my mentors embodying the future I imagine for myself. I applied to the University of Utah because of the wonderful opportunities to get full-spectrum training from passionate family medicine doctors. My faculty mentors exemplify that, even in an urban setting, fullspectrum medicine exists as they work in multiple settings. How to Survive and Thrive in Residency I love my co-residents! We became close through our Friday protected time called “Survival Skills,” where we would meet up afterward for “Foodie Friday.” Every week during my intern year, my class went to a different restaurant in town and invited our families, team medical students and friends. Each week someone different chose, allowing us to get to know each other through food. This became a wonderful tradition as everyone was able to share a bit of themselves by showing us their comfort food or helping us indulge in a new experience. This built lasting friendships. I am proud to be friends and colleagues with my co-residents and am excited to see what they all do in their next chapter of life. The Next Steps I am currently in the interview stage for fellowship! I applied for FMOB! After fellowship, I plan to pursue being faculty in an urban underserved setting, practicing full-scope family medicine, including outpatient, inpatient and obstetrics care. I am particularly passionate about reproductive health, genderaffirming care, LGTBQ+ health, mental health, Latino health, advocacy, healthcare policy, research and medical education. In the next 20 years, I would like to see medicine become a single-payer system so that our patients can get the most optimal medical care for the lowest, most affordable price. In addition, I hope physicians will be able to unionize to obtain more protections. All the inequities and fragility of our system were exposed and highlighted during the height of the pandemic. I think there is an energy in our society of wanting better conditions since the pandemic. This is a great time where I believe important changes will be made in many sectors, not just medicine. Advice For My Younger Self Do things you are passionate about because you never know where your journey is going to take you. I did follow my passions, but I always felt a sense of insecurity, wondering if I should be doing more traditional pre-med things. Now, in retrospect, I am incredibly happy with my journey, and if I ever walk away from medicine, I feel that I have had meaningful life experiences. 19 |

Hannah Berhow Student Spotlight Hi, my name is Hannah Berhow, and I am a second-year student at Noorda College of Osteopathic Medicine. I grew up in the town of St. Michael in Minnesota, which is where I lived for most of my life. My childhood mainly consisted of playing soccer year-round, taking piano lessons, gardening with my mom and occasionally tagging along on fishing and hunting trips with my dad and older brothers. Throughout high school, science and math were always some of my best subjects, and since I was young, I had always pictured myself doing something medical-related. A lot of my desire for that came from accompanying my dad to work as he has been in the medical device industry for over 30 years. I initially started undergrad at Iowa State University pursuing a degree in chemical engineering, thinking I would eventually get into biomedical engineering. However, this dream did not last long. I quickly learned that I would be much better suited to a career with interpersonal relationships and patient contact. So, after my first year, I transferred to the University of Minnesota – Twin Cities, where I went on the pre-med route and majored in cell biology and genetics. My goal is to be the kind of physician that my patients would recommend to their family and friends because they have had such great experiences with me. | 20

Like many undergrad students, I gained clinical experience by scribing in emergency departments and then immediately before coming to Noorda College of Osteopathic Medicine, I got a master’s degree in biomedical science at Kansas City University. Being that Noorda is a newer school, it really interested me to be a part of something that’s still growing and accommodating to student feedback. As part of the second class to start at Noorda, I have had multiple opportunities for leadership and personal development, which will help me become a great physician. Coming into medical school, family medicine has always been my number one pathway. I think I am drawn to this specialty because I picture myself living in a small town, not unlike the one I grew up in, and serving as a prominent figure in the community. I would love to have my own clinic someday where I can see a wide variety of patients and advocate for them through different stages of life. My goal is to be the kind of physician that my patients would recommend to their family and friends because they have had such great experiences with me. Although I am still early in my medical career, I am eager to start the clinical portion of my schooling so I can further explore the specialty of family medicine and see everything it has to offer. Together for: © 2023 Constellation, Inc. All Rights Reserved. We believe what’s good for care teams is good for business. Learn more at 21 |

Why Health at Every Size Matters By Sara Walker, MD, MS This version of an apocryphal quote (attributed to many people, including William Osler and Carl Sandberg) was often repeated during my medical school education, including the start of our first lecture. The challenge, of course, is revealed in the rest of the quote — namely, that we don’t know which part it will be. Despite the quote’s repetition, we were rarely told the degree of confidence we could rely upon for each fact being shoved into our brains or how strong (or not) the evidence was behind the medicine. Much like this quote, society and the medical system start to believe statements if they are repeated enough. It can then be challenging to unseat long-held beliefs, even after evidence is published to the contrary. What is common knowledge gets accepted as truth without questioning the underlying evidence basis or even the potential for implicit bias driving its origin. Such as the much-vaunted BMI. The Body Mass Index (BMI) was created by a European actuary to determine the population statistics of Caucasian males. It was never intended for widespread dissemination nor clinical use.1 BMI was never validated on the overwhelming majority of the world’s population, i.e., females and nonCaucasians, and yet it is the defining characteristic of whether someone is “sick enough” to deserve treatment coverage for multiple diseases. For example, the DSM-5 mandates that a patient must be underweight in order to receive the diagnosis of “anorexia,” and BMI is how the severity is defined — not the presence of other factors such as bradycardia, hypokalemia or low bone density, but purely on the BMI. This bias/ distinction has also spawned the fatphobic diagnosis of “atypical” anorexia, in which a patient has all the characteristics of anorexia except for low BMI.2 This bias causes treatment initiation for “atypical” anorexia to be significantly delayed because of this distinction, despite the high mortality risk of eating disorders.3 In addition to the mental struggles a patient may face of not being “good enough” at having an eating disorder, insurance companies often deny coverage for things such as inpatient/ residential stays or even regular dietician visits, purely due to coding F50.89 (other specified feeding and eating disorders) rather than F50.01 (anorexia nervosa, restricting type). A patient can be seen in a family physician’s office for fatigue after having lost 40% of their previous body weight through severe restriction, be congratulated for losing weight and then be told to lose more weight to treat their fatigue — true story. Or the creation of obesity as a disease. In addition to the BMI being extrapolated from its original purpose, being considered “normal,” “overweight” or “obese” is purely based on a patient’s BMI. For example, the population map showed a stark change in 1998, when the normal/ overweight cutoff was lowered from 27.8 (men) or 27. 3 (women) to 25.4 The change was political, as studies actually showed that higher BMI was not associated with mortality until at least 40 was used as the cutoff.5,6 Ancel Keys, head of the Minnesota Starvation Experiment and also known food company spokesperson, was the one who advocated for BMI as the general measure of “fatness” without disclosing his conflicts of interest — after all, “50% of what you learn in medical school will be proven wrong.” Figure 1. Is this person healthy? Despite what appearances may suggest, her labs show K 3.1 and WBC 4.1 from daily caloric restriction of approximately 900 cals, with no purging behaviors. These behaviors led to constant fatigue even before starting residency and losing 200 lbs of force on leg press after her body cannibalized muscle for fuel. Less than six weeks after this photo, she began anorexia treatment the same week as PR’ing a half-marathon. She started treatment almost seven years after she started meeting the criteria for (atypical) anorexia after having lost nearly 40% of her body weight. Figure 2. With the change in BMI category definitions in 1998, the prevalence of obesity appears to have significantly increased between 1990 and 2000.41 23 |

medicalizing someone at a higher weight opens up more opportunities to sell them weight-loss/health products! Actually, 77% of the NIH Obesity Task Force were weight-loss clinic directors,7 and the majority had multiple industryrelated conflicts of interest.8 Yes, our country is getting heavier as the decades go by. Agreed — this is undeniable. There are many correlations with this increase, but we have all learned that correlation does not prove causation. We cannot prove a specific cause that lets every diet-plan sect blame their forbidden fruit of choice. We need to stop blaming individuals for our society’s changing body types. We ignore studies that show people at higher weight were more likely to have been infected with adenovirus-36 and that infecting multiple animal species with this virus led to increased weight gain and body fat without changes in their caloric intake.9,10 We also ignore the true magnitude of the “obesity epidemic.” The CDC published in JAMA that “more than 400,000 Americans died of overweight and obesity every year, so many that it may soon surpass smoking as the leading cause of preventable death.”11 The retraction, which was far less publicized, acknowledged that there were computational errors in the original study, so that “obesity and overweight were only associated with an excess of 26,000 annual deaths, far fewer than guns, alcohol, or car crashes.” In 2000, there were 86,000 fewer deaths than expected of people in the “overweight” category than if they were at a “normal BMI.” Furthermore, there were slightly more total deaths of people in the “Underweight BMI” category than those in both the “overweight” and “obese” categories.12 When we continue to blame the individual for a problem that is not completely a problem, we ignore the influences of social determinants of health, of racism, of misogyny. Just like healthcare institutions want to pretend that the individual physician who is burned out was not “resilient” enough rather than having to address systemic burdens, we also pretend that a person at a higher weight is “lazy” or doesn’t have enough willpower. Studies show that people at higher weights consume approximately the same amount or even fewer calories than lean people.13-16 The myth of “calories in, calories out” is just that — a myth. Diets don’t work. It has been proven repeatedly that calorie restriction leads to higher weight rebound eventually,17-23 but the $5 billion health/ wellness industry has a very vested interest in convincing us that “this one” will be the unicorn magic pill/diet/ whatever that changes your life forever. Or you can change your life forever by choosing to opt out of the diet mentality and get off that hamster wheel. Marketing machines don’t make any money with this approach because the opportunity to capitalize on the latest fad/gimmick/or program is eliminated. Naomi Wolf says, “A culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history; a quietly mad population is a tractable one.”24 Enter Health at Every Size.25,26 Lindo Bacon, Ph.D., collated the studies in their groundbreaking book of the same name. They demonstrate that every body has a natural weight setpoint, even if it doesn’t align with our current guidelines as “healthy.”27 The body wants to return to that weight, regardless of what we eat/exercise.28 But if someone cannot control/ lower their weight setpoint, then they should not be blamed as “lazy” or “noncompliant.” The next step is this radical concept: treat people without regard for their body size. Treat their medical conditions like diabetes and hypertension, certainly. But: • Stop denying needed medical care (such as surgery or medication) until they lose weight. • Stop encouraging weight loss since studies have shown repeatedly that diets don’t work. • Recognize that we all deserve to take up space in this world — no one expects a Great Dane to look like or fit into a carrier intended for a chihuahua. • Stop asking people to change their natural body characteristics because it makes others feel more comfortable. • Start treating all people as human beings worthy of genuine care. Because we all are. All bodies are good bodies, regardless of size, gender identity, race, level of disability, social status or any other method society has created to put people into boxes. Michigan is the only U.S. state that explicitly forbids fat discrimination.29 There is a very real benefit to being thin in this society: Fat people make less money than thin people.30 They are the subject of frequent micro- and macroaggressions. They are judged as “lazy” and “less than.” The prevalence of weight-based discrimination is now as common or more so than race- or gender-based discrimination.31-33 Is it any wonder that 30 million Americans are estimated to have an eating disorder in their lifetimes? Again, we need to stop blaming the individual for a systemic problem. What can we do as family physicians? Make clinic visits more accessible: • Wider seats in all areas (so that all your patients and staff are comfortable) • Seating available that has no armrests • Sufficient weight limits on equipment Reduce patient anxiety about clinic visits: • Being weighed is a choice, except for when absolutely necessary (eg, weight-based dosing of a medication or e-prescribing for someone under 18) • Don’t mention losing weight unless someone asks about it • Don’t congratulate someone on weight loss — you don’t know what they went through to get there • Treat them for their chief concern, not for their weight • Remove “well-nourished” or mentions of BMI/weight-based terms from your physical exam template. People at a higher weight cringe when reading their notes because these terms | 24