ISSUE 2 | 2024 AAFP National Student and Resident Conference Annual Member Meeting Highlights Congress of Delegates 2024 THE OFFICIAL JOURNAL OF THE UTAH ACADEMY OF FAMILY PHYSICIANS
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Participation by advertisers does not constitute endorsement by UAFP. ©2024 Utah Academy of Family Physicians | The newsLINK Group LLC. All rights reserved. Utah Family Physician is published two times each year by The newsLINK Group LLC for 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. Utah Family Physician 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. The Utah Academy of Family Physicians Journal is now the Utah Family Physician. We have a new look along with the new name, but the content remains as thoughtful as ever. We hope you enjoy turning the pages of this informative and member-focused journal. Happy reading! 4
PRESIDENT’S MESSAGE 6 Finding a Home in Family Medicine CEO’S MESSAGE 7 Drowning Out Disinformation 8 Annual Member Meeting Highlights 10 2024/2025 Utah Academy of Family Physicians Board of Directors 12 AAFP National Student and Resident Conference MEMBER SPOTLIGHT 14 Gabriela Walsman, MD, FAAFP RESIDENT SPOTLIGHT 16 Jordan Rawlings, DO STUDENT SPOTLIGHT 18 Maddie Bernardo 20 Congress of Delegates 2024 24 Suicide Prevention and Lethal Means Safety in Health Care Settings 26 CHC Family Medicine Residency A Teaching Health Center Combining Service and Education PROGNOSIS NEGATIVE 30 Fax Machine Workers Go On Strike, Entirely Shutting Down All Healthcare Communication Table of CONTENTS ISSUE 2 2024 8 20 12 5
Dear UAFP family, As I step into my role as president of the Utah Academy of Family Physicians (UAFP), I’m excited to help strengthen our community — from premedical students to seasoned physicians. My vision? To foster engagement and create a true sense of belonging across every level, whether you’re just dreaming about medical school or have been practicing for decades. After all, family medicine is just that — family. My own path to family medicine was, well, a bit like a treasure hunt, with plenty of twists, turns, and the occasional raised eyebrow. You see, my medical school was one of those “orphan schools” without a family medicine department. So, when I proudly announced during my first year that I wanted to go into family medicine, I was shocked to meet so much resistance and active discouragement. Specialists who treated conditions rarer than a blue moon would say, “You’re too smart for family medicine.” (Really? I thought being smart was the whole point!) When I started medical school, guess how many of the 120 students in the graduating class matched into family medicine? Just one. Thankfully, I found my people through the Maryland Academy of Family Physicians (MAFP), where I was greeted with open arms — and more opportunities than I could fit into my med school planner. “Want to be a student delegate at the National Conference?” Yes! “Want PRESIDENT’S MESSAGE Tiffany Ho, MD, MPH, FAAFP President, UAFP Finding a Home in Family Medicine to know about this great scholarship for orphan-school students?” Amazing! “Need elective time at a local family medicine residency?” Absolutely! “How about joining the MAFP Board as a student rep?” Why not?! Thanks to their support, I found my home in family medicine. I connected with mentors who believed in me and rotations that reaffirmed my calling. And guess what? By graduation, there were three of us matching into family medicine — an all-time high! Now, as president of UAFP, I want to bring that same sense of joy, discovery, and community to every one of you. Family medicine is not just about practicing full‑spectrum care or treating every generation; it’s about finding your people, your purpose, and your passion in medicine. This year, I’m especially excited about supporting students who are thinking about family medicine and helping residents stay in Utah to practice. Together, we can build a stronger, more vibrant family medicine community. So, let’s keep the energy going! Whether you’re attending a UAFP event, mentoring a student, or simply connecting with a colleague, know that you’re part of something truly special. Here’s to another incredible year of family, medicine, and making a difference — together. 6
CEO’S MESSAGE Drowning Out Disinformation By the time this issue hits your homes, the election will be over. And phew, it has been a doozy. The rhetoric of politics has drowned out positive debate over issues and policy, and far too often, health care facts are thrown to the wayside in favor of divisive and inaccurate “bumper sticker” messaging. We argue over whether a procedure is good or bad without giving any credence to the scientific support or opposition of said procedure or the nuance of when a procedure may be indicated. It is easy to assume I’m speaking about abortion care, but that is far from the only polarizing medical issue, and we’re seeing encroachment on more than just the “easy” targets like reproductive health and gender affirming care. I have recently seen an uptick in posts from people who are now spreading misinformation about preventative diagnostics such as mammograms and colonoscopies, both safe and important procedures that have proven effectiveness in the early detection of cancers. According to these online experts, “Mammograms can smash open the lump causing the parasites to go wild and actually gives you cancer.” Yes, you read that correctly, and that particular tweet has several thousand retweets and likes. It had a few people trying to contradict it, but the vast majority responded with an “I had no idea” or “good information to know.” Distressing to say the least. Another, obviously scientifically based post: “Avoid getting a colonoscopy, way too many people end up with perforations of their colon (sic) and that’s how the cancer spreads.” Another one with far too many likes and retweets. We have an epidemic of misinformation unlike anything I’ve ever seen before, and I’m pointing the finger straight at those who use this disinformation to foment distrust in political opponents, gain support from people who may be less aware or who don’t know how or where to search for more accurate information, or those who are just scared of all the bad things that are out in the world and need somewhere to place the blame. The lowest form of communication is fear-based messaging, but it seems to be the norm, not the exception. The internet is many things, both good and bad. It allows for the free reign of disinformation, yet at the same time, it also gives us access to a wealth of accurate and important information. Whatever the cause, as physicians, you are faced with patients who bring you these theories. I’ve heard countless stories from physicians who have patients bringing them WebMD articles as their home-diagnosis tool. Do they expect you to confirm their suspicions or to provide them with the information needed to make a more informed decision? Good question, right? Not always easily answered, but I do believe that the most recalcitrant purveyors of disinformation are few and far between, and likely getting some sort of benefit from their participation in dissemination while the majority of your patients are looking to you for guidance and help. You are the subject matter experts. You’ve completed the education and are practicing in the largest and broadest specialty of medicine. Your patients trust you to give them accurate information while also acknowledging their fears and concerns. Whether it be countering vaccine hesitancy or educating someone on the realities of preventative care, your patients come to you for your expertise. Rely on trusted sources of information — peer-reviewed articles, AAFP resources, and trusted colleagues. But most importantly, trust yourselves. As physicians, you have the power to turn up the volume on accurate information and to help drown out the disinformation. Let’s work together to move the dialogue forward by combating disinformation with thoughtfulness, honesty, and accuracy. Maryann Martindale CEO/Executive Director, UAFP 7
ANNUAL MEMBER MEETING Highlights UAFP’s annual meeting was held this year at the Ken Garff University Club at the University of Utah. Each year, our annual meeting gives us the opportunity to showcase what we’ve done throughout the year, to swear in our new president, confer new AAFP fellows, to receive updates from AAFP leadership, and to give out our annual awards. It is an enjoyable and informative evening and a great way to spend time with fellow UAFP members. We would like to extend a special thanks to Voices for Utah Children Executive Director Moe Hickey for helping to sponsor this event! The 2024 Utah Family Medicine Physician of the Year is Dr. Erik Gulbrandsen. One of his nominations reads, “Dr. Erik Gulbrandsen can be summed up with one word: passionate. Anything that he does, he will be completely invested and passionate about it, and all of his patients get to experience that on a regular basis. Erik wants to understand patients from their point of view and is willing to care for patients in any circumstance. I have never seen him shy away from a complicated patient and will be heavily invested in that patient’s care. He has been working in value‑based care since 2019 and deeply cares about population health. Erik is not only an advocate for patients, but also for fellow physicians. He has a very positive attitude, is a joy to be around, and truly cares about his patients’ lives.” The 2024 Utah Family Medicine Champion of the Year is Rep. Marsha Judkins. UAFP Maryann Martindale says of Rep. Judkins, “She has always been a strong supporter of family physicians and understands the importance of advocating for primary care. There have been many times I’ve seen her tenacity and ability to ask hard questions help good bills get passed and keep bad bills from moving forward. She is truly one of the best legislators I’ve had the pleasure to work with.” AAFP President Dr. Jennifer Brull joined us as our keynote this year and provided updates on all the incredible work AAFP staff and board are doing at the national level. Dr. Brull also conducted the swearing‑in ceremony of UAFP’s new board president for 2024-25, Dr. Tiffany Ho, and conferred several new AAFP Fellows! Congratulations to: Colten Bracken, MD, FAAFP Daniel Chappell, DO, FAAFP Selim Wahhab Sheikh, DO, MBA, FAAFP Susan Pohl, MD, FAAFP Sara Walker, MD, MS, FAAFP Gabriela Walsman Leiva, MD, FAAFP 8
Dr. Erik Gulbrandsen, winner of the UAFP Family Medicine Physician of the Year award Newly conferred AAFP Fellows (from left to right) Drs. Gabriella Walsman Leiva, Sara Walker, Susan Pohl, Selim Wahhab Sheikh, Daniel Chappell, and Colten Bracken with AAFP President Dr. Jennifer Brull (middle) Rep. Marsha Judkins, winner of the UAFP Family Medicine Champion of the Year award Dr. Brull swears in UAFP’s new board president, Dr. Tiffany Ho Dr. Tiffany Ho, UAFP Associate Director Barbara Muñoz, Dr. Jennifer Brull, and UAFP CEO Maryann Martindale Next year, we have BIG changes in store for the annual meeting! The dinner and celebration will be held in conjunction with a CME event at the brand‑new Black Desert Resort in Ivins, Utah! More details coming in 2025. 9
2024/2025 Utah Academy of Family Physicians BOARD OF DIRECTORS THANK YOU FOR YOUR SERVICE TO THE UAFP BOARD! Executive Committee Tiffany Ho, MD, MPH, FAAFP President Lynsey Drew, DO, MBA, FAAFP President-Elect Michael Chen, MD, FAAFP Immediate Past President Tyson Schwab, MD, MS Treasurer At-Large Board Members Shannon Baker, MD Craig Batty, DO Colten Bracken, MD Marlin Christianson, MD Katherine Hastings, MD Matthew Johnston, MD, MMM, FAAFP, CPI Jessica Jones, MD, MSPH Bernadette Kiraly, MD, FAAFP Collin Lash, MD Matthew McIff, MD David Miner, MD Jamie Montes, DO Daniel Payne, MD Saphu Pradhan, MD, FAAFP Thea Sakata, MD Heather Sojourner, MD, FAAFP Chad Spain, MD, FAAFP Kirsten Stoesser, MD, FAAFP Sally Tran, MD Mark Wardle, DO, MIH, FAAFP Sara Walker, MD, MS, FAAFP AAFP Delegates and Alternates Nikki Clark, MD, FAAFP AAFP Delegate Chad Spain, MD, FAAFP AAFP Delegate Katharine Caldwell, MD, MPH AAFP Alternate Delegate Nick Duncan, MD AAFP Alternate Delegate Family Medicine Residency Representatives Akosua Hatch, DO McKay-Dee Family Medicine Residency Representative Elise Blaseg, MD St. Mark’s Family Medicine Residency Representative Mario Pucci, MD University of Utah Family Medicine Residency Representative Natalia Garcia, MD Utah Valley Family Medicine Residency Representative Medical Student Representatives Jordyn Heucker Noorda College of Osteopathic Medicine Katelyn Bercaw Rocky Vista University — Southern Utah Jake Momberger University of Utah School of Medicine 10
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AAFP National Student and Resident Conference Each summer, students and residents from across the country converge in Kansas City, Missouri, for the annual AAFP National Student and Resident Conference. This multi-day event is the largest residency fair of any specialty and gives students an opportunity to meet with residency representatives from across the United States. Utah “Residency Row” was excited to have a new participant — the new Community Health Center Teaching Residency that will be accepting their first residents in the 2025 match. This brings us to five residencies in Utah, and is our first teaching center residency. In addition to the residency expo, attendees are also able to participate in the student and residency legislative efforts as delegates from each state chapter. Delegates present and vote on resolutions that are then passed along to AAFP to help improve policy around graduate medical education. This year, our student delegate was A. Jake Roush, a fourth-year medical student at Rocky Vista College of Osteopathic Medicine. A. Jake Roush My experience as the Utah Chapter Delegate at the AAFP National Conference was both inspiring and rewarding. I had the opportunity to connect with incredible residency programs by visiting different booths and meeting their representatives, which was a highlight of the conference. The Utah and Arizona gala at the Midland theater was another memorable experience, where I enjoyed meaningful conversations with students, residents, and faculty from both states. Throughout the conference, I gained valuable insights into advocacy and the intricate processes involved in shaping policies within family medicine. It was energizing to spend time with fellow Utah students, all of us united by our excitement for the future of family medicine. The procedural workshops were a significant highlight for me, particularly the OB boot camp, which provided hands-on experience that will be invaluable as I move forward in my training. Additionally, the workshops on applying to residency and preparing for the ERAS season were incredibly informative, helping me feel more confident and prepared for the journey ahead. Leaving the conference, I felt deeply motivated to contribute to the advancement of family medicine, inspired by the knowledge, connections, and experiences I gained throughout the event. 12
UAFP provides stipends to help cover costs of attending the National Conference, and for the first time, we joined with the Arizona Chapter to co-host an evening social for all attendees from Utah or interested in matching to a Utah residency. It was a fun and successful evening that we will be repeating for future years. If you are interested in participating as a delegate, or applying for a stipend, watch your email and our website for more information in the spring of 2025. It is a great leadership opportunity and a unique way to meet with residencies. Utah Valley Residency Our new community health center residency McKay Dee Residency University of Utah Residency Students and residents from Utah Student and resident social event University of Utah residents 13
MEMBER SPOTLIGHT Gabriela Walsman, MD, FAAFP A Bit About Dr. Walsman I grew up in Quito, Ecuador, as the only daughter among two siblings. My mother, an entrepreneur, and my father, a physician, have been my greatest mentors, guiding me throughout my journey to becoming a physician in the United States. I moved to the U.S. at the age of 25 and met my husband, Wesley, in Washington, D.C., where we lived for seven years before I was accepted into a residency program in McAllen, Texas. My first two children were born in Texas, and my youngest, Isaac, was born in Utah. My children, whose ages range from 18 months to 12 years, are my constant source of motivation and joy, and they keep me grounded and active. Motherhood is a journey in itself, and I am continually learning how to balance my professional and personal life. I am practicing as a solo practitioner at Grateful Direct Primary Care, a clinic located in West Jordan, Utah. My goal is to provide quality medical and culturally sensitive care. Outside of my clinic, I am deeply committed to humanitarian efforts, serving on the board of the Leal Foundation, a nonprofit organization dedicated to providing medical missions in rural areas of Ecuador. This work allows me to give back to underserved communities and provide them with much-needed healthcare. When I’m not working, I cherish spending time with my family, attending church, exploring the outdoors, and traveling. I also have a passion for Ecuadorian folkloric dance, which helps me stay connected to my roots. Promoting wellness is a priority for both my patients and myself, and I strive to maintain a balanced and active lifestyle. The Journey to Becoming a Physician From a young age, I knew I wanted to pursue medicine. At just 11 years old, I would accompany my father, a cardiothoracic surgeon, to the hospital, where he introduced me to his patients. One experience that solidified my calling was when an 8-year-old patient in recovery, whom my father had just operated on, kissed my hand in gratitude. That moment deeply impacted me and affirmed my desire to heal future patients. I also fondly remember pretending to be a doctor in my father’s home office, where I would use his prescription pad to “prescribe” imaginary medications to my playmates. I completed my medical training at the Central University of Quito, Ecuador, and, as an international medical graduate, I pursued my dream of practicing medicine in the United States. I passed the necessary board exams after studying at Kaplan Medical Institute. During this time, I worked as a medical assistant, Spanish medical interpreter, and volunteered at various hospitals in the Washington, D.C., area to gain experience and immerse myself in the U.S. healthcare system. I completed my residency in family medicine at the McAllen Family Medicine Program and subsequently worked as an employed physician for six years. For the past three years, I have been running my own direct primary care clinic in West Jordan, Utah. I take great pride in providing comprehensive care and building long‑term relationships with my patients, which is one of the most rewarding aspects of family medicine. Choosing Family Medicine Choosing family medicine was a very intentional decision for me, shaped by my 14
me to treat not just the illness, but the whole person, while fostering long-term relationships that are truly rewarding. Practice Specifics Since completing residency, my career path has been dedicated to serving the community in various healthcare settings. I initially worked at the VA in Harlingen, Texas, providing care to veterans, which was a deeply enriching experience. Afterward, I transitioned into urgent care and occupational medicine, where I addressed a wide range of acute and work-related health issues. For four years, I also worked at a community health center, which was incredibly rewarding. This role allowed me to make a significant impact on underserved populations, but it eventually became overwhelming due to the constantly growing patient panel size, making it difficult to manage effectively. During the COVID-19 pandemic, I experienced burnout from the intense demands of healthcare work. This led me to reassess my career trajectory and ultimately decide to establish my own practice. The decision to go independent was driven by the desire for a better balance between my professional responsibilities and personal life. Direct primary care has provided me with the flexibility and autonomy to practice medicine in a way that aligns with my values, allowing for more meaningful interactions with patients and a focus on holistic care. Future of Family Medicine To ensure that there are enough family physicians to meet the growing demand, both nationally and at the state level, we must address the challenges in medical education, such as the high-cost deterring students from pursuing lower-paying specialties like family medicine, requires more scholarships and loan repayment programs. Moreover, increasing family medicine residency slots and ensuring they are well-funded can counteract residency training constraints that favor other specialties. Enhancing exposure to primary care settings early in medical education can spark interest in family medicine. Encouraging the pursuit of family medicine through mentorship from established physicians can inspire students, while emphasizing the potential for a balanced lifestyle and showcasing the profound impact family physicians have on their patients’ lives can attract those motivated by meaningful patient-centered care. By addressing these challenges and highlighting the benefits, we can foster a healthcare system that values and supports the essential role of family physicians in providing comprehensive, accessible care to all. desire to provide holistic care and build lasting relationships with my patients. During my training, I was drawn to the diversity of cases that family medicine offers, allowing me to treat patients across all stages of life, from pediatrics to geriatrics. The variety and continuity of care, coupled with the ability to manage both acute and chronic conditions, were aspects that deeply resonated with me. While I considered other specialties, such as cardiology and internal medicine, family medicine stood out because it allowed me to engage with entire families, providing comprehensive care for each member. I also appreciated the opportunity to practice preventive medicine and have an impact on community health. Ultimately, I chose family medicine because it allows 15
RESIDENT SPOTLIGHT Jordan Rawlings, DO A Bit About Dr. Rawlings I grew up as the oldest of three boys in Cary, North Carolina. I went to undergraduate school at BYU where I studied classics with an emphasis in Greek and Roman history. While there, I met my wonderful wife who has been an awesome support throughout this medical journey. After graduating from BYU, we returned to North Carolina, where I attended medical school at Campbell University. I’m currently a third-year resident at Utah Valley Family Medicine Residency. My hobbies include sports of all kinds, most recently pickleball. I also really enjoy outdoor activities, like skiing, and have recently learned to lead climb. Additionally, I enjoy reading all genres, but especially fantasy and historical fiction. A “Classic” Physician Ever since I was in high school, I have found the sciences and human body fascinating. Once I got to college and after serving a church mission in Brazil, I fell in love with teaching and briefly considered becoming a classics professor. After some careful and thoughtful discussions with mentors, I realized I could combine my love of teaching with the human body and teach patients about medical conditions and diagnoses. Additionally, I enjoy learning about and solving puzzles, so talking with patients and synthesizing their stories and experiences into solutions and diagnoses sounded very appealing. The fact that we’re encouraged to be life-long learners in medicine is another thing that attracted me. Family medicine always stuck out to me because I enjoy talking with people and hearing their stories, so it seemed like a natural fit. I ended up doing a family medicine summer experience where I spent time with various doctors in rural North Carolina which further solidified my desire to become a family doctor. Residency in Utah County I wasn’t aware there was a residency here until my third year in medical school. A fellow Campbell student, Cameron Smith, who was two years ahead of me, ended up at this program, so I reached out to him to hear what his experience was like. His description of the program immediately piqued my interest. I ended up doing a sub-internship to experience it for myself and really was inspired by the faculty who all are excellent examples of how to practice medicine and be teachers. Additionally, I could tell the residents were treated well and received great training in full-spectrum family medicine. It was clear the residents left prepared to do whatever they wanted whether that was OB, hospital medicine, clinic, or procedures of all kinds. I couldn’t resist coming back West to get some good skiing in, too. 16
These past couple of years have been some of the best in my life. I’ve developed lifelong friendships with many of the residents and received wonderful mentorship that has prepared me for my career. Not only has Utah Valley FM Residency prepared me for a career in medicine but they have prepared me to excel in a life outside of medicine as well. What’s Next? I have signed a contract to stay on with Intermountain at an outpatient practice where I hope to see patients of all ages. I am also planning on doing OB. I’m looking forward to teaching medical students and residents as well. As a Portuguese speaker, it’s been awesome having Portuguese speaking patients, and I hope to still have part of my patient panel be Portuguese speaking in the future as well. What Makes Family Medicine the Best Specialty Our field is so diverse that you can really tailor your job to your interests. No other medical specialty offers the breadth that we experience and our relationships with patients is what really sets our specialty apart. If you are interested in people and solving problems, then this is the specialty for you. Advice for Your Younger Self Enjoy the journey, and don’t focus on the destination. INDEPENDENT SCHOOL | PreK-12 | SALT LAKE CITY | ROWLANDHALL.ORG Rowland Hall offers a transformational education that gives students agency and purpose, connects them to their global community, and empowers them to make the world a better place for all. DEVELOPING PEOPLE THE WORLD NEEDS 17
STUDENT SPOTLIGHT Maddie Bernardo A Bit About Maddie Hello! I’m Maddie, a fourth-year medical student at the University of Utah. I primarily grew up in and around Boise, Idaho, before moving to Salt Lake City for my undergraduate education. I spend most of my free time trying new restaurants, exploring new trails, camping, skiing, and biking! When the call of the wild is a bit more muted, I love to get creative by cooking intricate meals and baking cakes, pies, and pastries. The Path to Medicine Growing up, I never imagined that I would pursue medicine, and it completely took me by surprise when I became enamored with my first exposure to anatomy and physiology during a sports medicine elective in high school. Special shoutout to Mr. Fitzpatrick, for being my introduction to medicine and a constant source of support! I followed in my big brother’s footsteps and came down to the University of Utah after graduating high school. I quickly became involved in neurobehavioral research while I studied biology and chemistry. I loved the process of research and designing experiments, but I didn’t feel like I’d found where I belonged in the world of science and medicine until I started volunteering with Connect2Health. This student-led organization placed volunteers in many different clinical environments, from free clinics to specialty services where we would meet with patients, discuss their social determinants of health, and craft them a personalized resource prescription to help meet their needs. After a couple years of involvement, I knew I wanted to continue learning the details of human physiology while working directly with patients — so I applied to medical school! I was ecstatic to have the opportunity to stay at the University of Utah for medical school. Not only did I have a great support system of friends and family in the area, but I had made strong connections working as an adaptive ski instructor at the National Ability Center in Park City and was determined to stay involved throughout my medical training. Furthermore, the opportunities for rural 18
medicine exposure and training caught my attention and have had a massive impact on my trajectory as I now plan to be a rural family medicine physician. I was very fortunate to have a phenomenal family medicine physician who helped me through some challenging times and served as a great source of inspiration as I started to consider a future in medicine while working on my undergraduate degree. Like he had with me, I wanted to truly connect with my patients and understand the entire person before me to best empower them to be an active participant in optimizing their health. I love the variability of this specialty, endless opportunities for continued learning, continuity of care and forming meaningful patient-physician relationships! Advice for Premeds and Young Med Students Stay true to your genuine interests and unique skills! There is so much pressure to fit a perceived mold and check the many boxes needed to apply to medical school as quickly as possible, but don’t sign up for just anything. Be intentional with your time and efforts. Medicine is an ecosystem full of niches and finding your unique corner of this world is such a special part of the journey, so dive into and develop whatever interests you may have, including those that may not seem directly related to medicine. Enjoy competitive benefits, research opportunities, adjunct faculty rank, and more! Scan the QR code to get started or email clined@noordacom.org for details. JOIN OUR PRECEPTOR PROGRAM MENTOR MEDICAL STUDENTS noordacom.org/medical-student-preceptor-program 19
This year’s Congress of Delegates was held in sunny Phoenix, Arizona. With temperatures over 100 degrees outside, we huddled in the frigid conference room for two days, working to pass resolutions that will chart the course of AAFP and its chapters. Delegates put in a lot of time working on resolutions, considering all the proposed resolutions and process changes, and traveling to Congress to vote and choose the next group of AAFP leaders. UAFP is represented very well and all our delegates are an inspiration. In a change from previous blogs, we had each of your delegates write their own perspectives, each choosing a specific day to cover. Enjoy their recaps. Day 1 Nikki Clark, MD, FAAFP Delegate Greetings from Phoenix, Arizona, for the AAFP Congress of Delegates! As in previous years, we started the Congress with the Town Hall. This is a panel discussion of several of the AAFP leadership. Each leader had a current topic that they wanted to share about the work of the AAFP over the past year. These included four main points: 1. Medicare Payment • Currently, there is a proposed 2.8% budget cut that the AAFP is fighting. • They fought hard to get the G2211 CPT code approved so you can be paid for the time it takes for our complex patients that we all have. 2. New Membership • Making improved resources available for members across all parts of your career. • Helping with the transition from residency to practice. • Decreasing the membership fees for new graduates for the first three years out of residency. $100 for first year out, $200 for the second year out and $300 for the third year out. 3. Administrative Simplification and New Technology • Continuing to work on the prior authorization issues that cause tremendous stress and lead to delay of care. • Working on processes to use AI to IMPROVE practice (not replace us as some people feel will happen). 4. Work Force • This year, 4,595 medical students matched to family medicine (88% fill rate). • Currently, there are almost 800! (In the state of Utah, there are 29 possible first-year spots.) • The National Conference for medical students and residents is now named FUTURE. • There were many thoughtful questions posed by the audience in the short meeting. Family doctors have many concerns and the AAFP is listening. We are here to represent you and the unique issues of medicine in Utah to our AAFP national leadership. It was a great couple of days here in Phoenix despite nearly melting from the heat! Delegates Drs. Chad Spain and Nikki Clark at the Utah delegation table 2024 CONGRESS of DELEGATES 20
Day 2 Chad Spain, MD, FAAFP Delegate The first full day of Congress of Delegates (COD) is typically full of debate and discussion — this year, not so much. 2024 marks the first year of significant process change. In years past, the first day of COD has opened the floor to delegates and alternate delegates from all across our nation to discuss the state submitted resolutions. This year resolutions were posted online weeks before the COD and were only open to comments on the website, which replaced the historical norm of in-person testimony. To be frank, I don’t think many chapters were aware of this process. Online comments just hit differently — context, personal experiences, tone, etc. are easily lost, and the volume of comments posted online didn’t seem to match previous years when comments were given in person. The online comments were then reviewed by committees, again, prior to COD, who then presented a revised resolution; these resolutions were then agreed to as a whole or extracted for individual review during day one of COD. Confused? Well, many states seemed to be in the same position. Fortunately, we have a great CEO in Maryann Martindale, who informed our delegation of the entire process along the way, which put us in a great position to take the microphone during times of need! Fourteen late resolutions were submitted early Monday with requests to be heard during this year’s Congress of Delegates and only two were accepted. Mississippi, please mark your calendars in order to not miss a deadline next year — j.k. we love you. Our delegation submitted four resolutions including topics of Annual Wellness Visit reform, research into why family medicine physicians are leaving the workforce, Social Security income limit adjustments, and pharmacy pricing practices; three of the four were approved (pharmacy pricing was not but with a note that similar policy from AAFP is already in place)! Lastly, we heard from Speaker Russell Kohl and AAFP President Steven Furr who made thought provoking comments regarding leadership, family medicine’s importance to righting the U.S. healthcare system, and the need to put an end to ongoing Medicare payment cuts. Since my first term (2018-19 as alternate delegate), I have had the privilege of getting to know and hear from so many of Utah’s great family physicians; attending the Congress of Delegates as your delegate gives me a great sense of pride and a role that I take seriously. Listening to you and being a voice when given a platform is a winning recipe in my book, and I look forward to serving again in 2025 COD in Anaheim, California. AAFP Speaker of the House Dr. Russell Kohl during the Town Hall meeting Drs. Chad Spain and Nick Duncan seeing the sites of downtown Phoenix, hoping to find something haunted Utah COD Delegation (from left to right): Dr. Nikki Clark, Dr. Katharine Caldwell, UAFP CEO Maryann Martindale, Dr. Nick Duncan, and Dr. Chad Spain 21
Dr. Nikki Clark asking a question during the Town Hall meeting The Utah delegation in the “Disco Uber” AAFP President Dr. Stephen Furr addressing the Congress Left to right: UAFP President-Elect Dr. Lynsey Drew, Dr. Katharine Caldwell, Dr. Nick Duncan, Dr. Chad Spain, UAFP CEO Maryann Martindale, and Dr. Nikki Clark Day 3 Katherine Caldwell, MD Alternate Delegate Tuesday kicked off with Congress formalities — salutations from other medical organizations, introductions of past presidents and chapter presidents, and a speech by our new president, Dr. Jennifer Brull. We heard from six candidates for the three open board of directors positions in the first part of the day. This year, the organization employed a new process, using a nominating committee to identify a diverse group of candidates who may not have been selected as potential leaders with the previous system, which mostly involved state chapters taking the lead on promoting candidates, and was usually quite expensive for the chapters. This is a real positive for those of us in smaller chapters who have great leaders who would be exceptional AAFP board members, but don’t have the budget to run a costly campaign. Something to consider if you’d like to get more involved on the national level. After an awards luncheon, we heard from the three previously vetted and very well-qualified candidates for president-elect. We discussed our thoughts on the candidates and had the evening to mull over our choices before voting the next day. The Utah crew (including President-Elect Dr. Lynsey Drew) enjoyed dining outside at a Mexican restaurant, the record high temperatures finally becoming tolerable at the end of the day. We had fun piling into a disco-light adorned Uber and singing along to some classic hits on the way back to our hotel. 22
Day 4 Nick Duncan, MD Alternate Delegate Nerves. One of the first feelings I recall when preparing for the Congress of Delegates this year — nerves with a mix of excitement. It was my first time to participate. First foray into health policy. So many questions. What will happen with the resolutions we proposed? Will I know what to do if I have to speak up on an issue? What are the processes for each session of the Congress? And you know what, it turned out all right. There were a lot of changes this year and we all learned together. There was a lot of discussion, apparently less than in years past, but people were able to express their views and decisions were made. And while not everyone agreed on how to address certain concerns, it was apparent that passion abounds on leading family medicine into the future. Our concerns are being discussed. Current policies that adversely affect our patients are being fought. Our need for greater support as we care for patients is the focus of the AAFP leadership. And that is how the Congress closed: with a renewed drive to continually improve on the laurels of those who have come before to lead our great community of family physicians. We have a new president, Dr. Jennifer Brull, from Fort Collins, Colorado, who brings much experience to the role and is ready to go to bat for family medicine. She takes the torch from the past president, Dr. Steven Furr, from Jackson, Alabama, who now transitions to board chair. Dr. Sarah Nosal from New York was selected as the new president-elect, and it was apparent from her speech that she brings a lot of passion and new ideas to the table. New members of the board were also selected: Dr. Shannon Dowler, Dr. Elizabeth Fowlie Mock, and Dr. Kathleen Mueller. Looking back on the experience, I express gratitude to our whole delegation: Dr. Nikki Clark, Dr. Katharine Caldwell, Dr. Chad Spain, and especially Maryann Martindale who guided us through it all. Thank you all for your insight and passion. I feel like we represented Utah well with important resolutions and will continue to work to make things better for us and our patients. The end. Well, sort of. If you care to check out the soundtrack, there were a few songs that either came to mind or actually played during our time in Phoenix, so here you go: You Don’t Know How It Feels — Tom Petty The Sound of Silence — Simon and Garfunkel Bad Medicine — Bon Jovi Runnin’ Down a Dream — Tom Petty Fly Like an Eagle — Steve Miller Band Wannabe — Spice Girls Immigrant Song — Led Zeppelin Apologize — One Republic (A reminder to get your resolutions in on time) Don’t Stop Believin’ — Journey Take On Me — A-ha Summer of ‘69 — Bryan Adams Africa — Toto The Gambler — Kenny Rogers I Wanna Know What Love Is — Foreigner (Wish Juke Box Hero played too, but oh well) UAFP members select new delegates each year for two-year terms. If you are interested, watch your email and our website in early 2025 for the nomination process. 23
Did you know that “82% of gun deaths in Utah are suicides” (Everytown for Gun Safety, 2023)? “People who die by suicide are more likely to have seen a primary care provider in the previous month before their death than any other health care provider” (Suicide Prevention Resource Center 2020). Suicidal crises can occur suddenly and unexpectedly, even among people without mental illness. People admitted to a hospital after an attempt were asked how much time passed between thinking about and making a suicide attempt; 48% said 10 minutes or less (Harvard School of Public Health, 2024). “Reducing access to lethal means, such as firearms and medication, is a critical component of suicide prevention” (Zero Suicide EDC, 2024). Most people in a crisis are deeply ambivalent, meaning they want to live and are uncertain about suicide. Lives can be saved if we can put time and distance between a suicidal person and means of suicide, like a firearm. There are two key components to consider when providing care to a patient who is at risk for suicide: 1. Assess whether an individual has access to a firearm or other lethal means for suicide. 2. Work with individuals and their family and support system to limit access to lethal means until the risk resolves. What if the Person Is Reluctant To Reduce Access to Firearms? It is important to listen to the concerns of the patient and try to understand their hesitation. Many people see firearms as a useful tool for protection, a source of recreation, or an important part of their rights and identity. With this in mind, work with the patient and their family and help them weigh their options and address specific concerns. It is important to remember that language matters. The focus should stay on the safety of the patient and the effort to create a safe environment while they are in crisis. Sample questions could be: • “Many families have firearms in the home. Is this the case for you? If so, how do you store them?” • “Have you thought about how to keep your kids safe around your guns?” or “What do you think about storing your guns off-site until the situation improves?” • “One of the best ways to keep loved ones safe during a mental health crisis is securing firearms in the home. Are you able to do that temporarily?” • “Families can also keep loved ones safe during a mental health crisis by locking up or reducing the amount of medications (prescription or over‑the-counter) in the home. Would you like some more information on how to do that?” Empower and encourage the patients to decide what is best to stay safe. Suicide Prevention and Lethal Means Safety in Health Care Settings By Alyssa Mitchell, MPA CHES, Suicide Prevention Program Manager, Utah Department of Health & Human Services, Office of Substance Use and Mental Health 24
Some options to make the environment safe could be: • Store ammunition separately or remove it from the home. • Store firearms away from the home temporarily — consider storing firearms with family or friends, law enforcement, a gun range, or firearm shop. • Change the combinations on firearm safes. • Disassemble the firearm and store parts separately. • Give someone else the key to your firearm safe. In instances where other means are considered: • Store medications safely — outside the home or locked up. • Prescribe medications in smaller amounts to reduce availability. • Remove other identified means from the home. 90% of individuals who attempt suicide do not go on to die by suicide (Harvard School of Public Health, 2024). We can decrease the risk of suicide by preventing access to lethal means and providing interventions to patients who have thoughts of suicide. Learn More The Utah Office of Substance Use and Mental Health offers virtual three-hour means safety counseling courses (CEUs included). For more information, email aamitchell@utah.gov. You can also find several other resources and materials by scanning the QR codes below. The Live On Utah Playbooks are the first of its kind — a quick‑paced, 10 lesson course with simple, specific tips on how to talk about mental health and prevent suicide. https://liveonutah.org/playbooks/ Intermountain Healthcare Counseling on Access to Lethal Means (CEUs included) https://intermountainhealthcare.org/ihcu/public/ bh/CounselingOnAccessToLethalMeansCALMToPreventSuicide/Primary/story.html?origref Zero Suicide Counseling on Access to Lethal Means https://zerosuicidetraining.edc.org/ enrol/index.php?id=20 Firearm Safety and Patient Health https://www.facs.org/media/1mtadqiv/22_tr_pdf_ firearminjuryprevention_interactive_6a_release.pdf Flyer: When Firearm Safety and Safe Storage Is Your Goal https://utahsuicidepre.wpengine.com/wp-content/ uploads/2023/12/CH_2552362-Firearm-safestorage-document-for-schools_HF042523.pdf Flyer: Four Simple Steps to a Medication-Safe Home https://jedfoundation.org/wp-content/ uploads/2023/04/Medication-SafeHome-2.16.23-FINAL.pdf Means Matter — Harvard School of Public Health https://www.hsph.harvard.edu/meansmatter/means-matter/duration/ 25
CHC Family Medicine Residency A Teaching Health Center Combining Service and Education By Frank Powers, MD, Program Director, Andy Garrison, MD, Faculty, and Jen Mair, Program Coordinator, CHC Family Medicine Residency THCGME program in the state, aiming to train primary care physicians specifically to work in rural and underserved areas. Utah Continues to Suffer Primary Care Workforce Shortages Family physicians can particularly impact health outcomes in rural and underserved areas. Access to a regular primary care physician has been linked to lower infant mortality, higher birth weights, immunization rates exceeding national standards, reduced healthcare costs, and longer, healthier lives. Yet, the Bureau of Health Workforce projects a shortage of 68,020 full-time equivalent primary care physicians by 2036 in the United States. Shortages are particularly profound in Utah’s rural and underserved populations: Across the state, Utah has fewer primary care providers per population (5.8 per 10,000) than the U.S. average (7.6 per 10,000). Utah has the lowest percentage of active primary care physicians in the United States, with a projected need for 123.9 primary care physicians per year. Additionally, 30.3% of Utah family physicians are over 60 years old, contributing to workforce gaps in the coming decades. Utah’s projected population growth (4 million people by 2030) and the increase in aging patients will increase needs for physician supply. Rural Utah, which comprises 83% of the state’s counties, has significantly fewer primary care providers compared to urban areas; 21.5% of the state’s population lives in rural areas, yet only 11% of the state’s Dr. Frank Powers and patient Imagine you had the opportunity to create your ideal family medicine residency from scratch. Given that family physicians mostly work in community settings, you’d likely situate your ideal residency in a community-based primary care setting, where most learning occurs through caring for continuity patients. Ideally, the residency might be sponsored by a community health center, rather than a hospital system, so as to maximize focus and institutional resources on a single program. You’d also want to ensure that your residents care for a highly diverse patient population, representing multiple languages and cultures. Furthermore, your residents — especially those wanting to work in rural areas — would need experience working in high-volume tertiary care centers to gain emergency medicine, obstetrics, and inpatient medicine experience. Perhaps most importantly, you’d want the funding for the residency to go directly to your program, instead of sharing funds among a multitude of competing departments. Though this vision may seem too good to be true, creating and supporting such primary care residencies is the explicit goal of the Teaching Health Center Graduate Medical Education (THCGME) program. Since 2010, the THCGME program has funded over 81 community-based residencies which have trained over 2,000 primary care physicians and dentists. To date, Utah has not benefited from this program; though this is about to change. In July 2025, the new Community Health Centers Family Medicine Residency (CHCFMR) will welcome their first class of incoming residents. The program will be the first 26
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