Washington. Family Physician. In This Issue:

Washigto Vol. XXXVI, No. 2 May 2009 Family Physicia THE JOURNAL OF THE WASHINGTON ACADEMY OF FAMILY PHYSICIANS I This Issue: 2009 Legislative Sessio Wrap-Up WAFP Pre-Med Metorship Program Committee, Commissio ad Task Force Update

Call for Proposals WAFP Pipelie GraT Program: Deadlie Exteded The Washigto Academy of Family Physicias (WAFP) is pleased to ivite medical studet ad Family Medicie residet groups to submit project proposals for the WAFP s Pipelie Grat Program i the pilot year of the program. This program was created to icrease awareess ad iterest i Family Medicie careers for middle school, high school, ad college studets across Washigto state. Two projects for the 2009-2010 year will be fuded for up to $1,000. Wiig projects may apply for a secod year of fudig if additioal work is eeded to esure the sustaiability of the project. Successful proposals will cotai the followig 7 elemets ad aswer the questios below: 1. Project Team: Who are the leaders for the project? What leadership roles do they curretly hold i their residecies, or with medical studet orgaizatios? Who is the faculty advisor for the project? A letter of support from the faculty advisor must accompay the proposal. 2. Goal of the project: What is the project beig proposed? How does the proposed project seek to icrease uderstadig of the field of Family Medicie ad promote iterest i Family Medicie? Have previous projects bee doe i the past with this same goal? What were the outcomes of these past projects? 3. Target populatio: Who will be able to participate i the project? How was this target populatio idetified? Does the target populatio have eeds that are ot curretly beig met by available resources? Have commuity parters bee idetified ad have their eeds bee cosider i the developmet of the project proposal? 4. Timelie for the project: How will the project be executed? Who from the previously idetified project team will be resposible for the various elemets of the project? Are ay barriers aticipated to the project ad how will these be addressed? 5. Project budget: A detailed descriptio of the supplies, materials, room retals, food ad other program developmet or executio costs must accompay the proposal. The budget must refer to the above timelie. 6. Project sustaiability: What is the commitmet of the leaders ad commuity parters to the project? How will the project sustai itself oce the grat period is completed? 7. Project evaluatio: How will the project be evaluated? How will success be defied? The deadlie for proposal submissios has bee exteded to Jue 30, 2009. Please sed grat proposal ad faculty letter of support to: Washigto Academy of Family Physicias Att: Karla Pratt, Executive Vice Presidet 1050 140th Aveue NE, Suite C, Bellevue, WA 98005

IN THIS ISSUE WAFP Pipelie Grat Program: Deadlie Exteded... Iside frot cover From the Presidet: Message to the 2009 WAFP House of Delegates Joatha Sugarma, MD... 2 WAFP Testifies o Key Bills Durig the 2009 Sessio Kathlee Collis...4 Lack of Moey Drives Big Cuts Kathlee Collis...5 The WAFP Policy ad Advocacy Leadership Istitute 2009 Jeae Cawse-Lucas, MD...6 Washigto State Nutritio & Physical Activity Pla Updated Jae A. Moore, MD...8 Natioal Coferece of Family Medicie Residets & Studets (NCFMRS)...8 The Future of Family Medicie: The 2009 Match Report...10 WAFP Members Metorig the Next Geeratio Richard D. Kovar, MD...12 Metorig Program: The Studet Perspective...13 Committee, Commissio ad Task Force Updates...14 WAFP Pre-Med Metorig: Stregtheig the Pipelie...15 Spirometry Pilot Program to Assist Practices i Preparig for New Regulatios Jerry Yorioka, MD...16 Prescriber s Letter Discout Available...17 WSMA Message: Compromises Must be Made Cythia A. Markus, MD...18 WAFP Upcomig Evets... back cover WFP Policy ad Purpose: The Washigto Family Physicia (WFP) Joural is the official quarterly publicatio of the Washigto Academy of Family Physicias (WAFP). It serves as the primary commuicatio vehicle to WAFP members. Its purpose is to provide timely ad relevat iformatio regardig the practice of Family Medicie, ad report results of the policies determied by the Board of Directors ad activities of members ad committees. I additio to regularly published articles from selected Officers, trustees, ad committee chairs, WFP welcomes submissio of articles o a wide variety of subjects related to the practice of Family Medicie. A d v e rt i s i g I f o r m at i o : The WFP Joural is distributed to 2,700 WAFP members i Washigto State, plus the other costituet chapter Offices of the AAFP throughout the Uited States. Advertisig sales ad publicatio productio are coordiated by WAFP. Please call for a rate sheet ad productio specificatios. Correctess of advertisig is verified through proofs to the advertiser, ad liabilities for chages after approval are the resposibility of the advertiser. The WFP Joural will accept advertisig whe it is judged to be i accord with the stated purpose of the publicatio. Advertisig i the WFP must meet the stadards of geerally accepted medical practice or be of iterest to the readers because of its relevace to the cliical or socioecoomic practice of medicie. Editorial Deadlies: Jue 15, 2009: August, 2009 Issue September 15, 2009: November, 2009 Issue December 15, 2009: February, 2010 Issue March 15, 2010: May, 2010 Issue Prited o recycled paper with soy iks WFP also welcomes articles writte i a respectful ad collegial maer that reflect opiio ad editorials if, i our opiio, publishig such articles is timely, relevat, ad will be of iterest to the geeral membership of the Academy. Such articles will be clearly idetified as a idividual writer s opiio or poit of view. The views ad opiios expressed by all authors i this publicatio are their ow ad do ot ecessarily reflect those of the Academy. Publicatio should ot be cosidered a edorsemet, expressed or implied, by WAFP. Advertisig accepted by the WFP does ot costitute a guaratee or edorsemet by the WFP or the Washigto Academy of Family Physicias. The WFP will ot accept advertisig of tobacco products or alcoholic beverages. The WFP will ot accept ew product releases. The WFP reserves the right to accept or reject ay advertisig ad to evaluate advertisig copy to esure that it does ot cotai ay false or misleadig statemets, is ot i poor taste, ad is ot offesive i either artwork or text. Advertisers ad agecies must idemify ad hold the WFP harmless of ay expese arisig from claims or actios agaist the WFP because of the publicatio of the cotets of a advertisemet. Washigto Family Physicia Published by Washigto Chapter America Academy of Family Physicias 1050 140th Aveue NE, Suite C Bellevue, WA 98005 425.747.3100 Fax 425.747.3109 Washigto Oly: 800.621.8424 www.wafp.et Presidet: ifo@wafp.et Editor: editor@wafp.et Legislative: ifo@wafp.et Members/Studets/Residets: ifo@wafp.et Web Site/Tar Wars: www.tarwars.org Editor Gregg VadeKieft, MD Officers Joh F. McCarthy, MD Presidet Joatha Sugarma, MD Immediate Past Presidet Steve Albrecht, MD Presidet-Elect Carl Olde, MD Vice Presidet Jue G. Bredi, MD Secretary Treasurer Paul Buehres, MD Asst. Secretary Treasurer House of Delegates Ae M. Motgomery, MD Speaker, House of Delegates Erika Bliss, MD Vice Speaker, House of Delegates Trustees Cici Asplud, MD (East) Luke T. Mega, MD (East) Michael Luce, MD (East) Christia Kelly, MD (West) Lillia Wu, MD (West) David Lych, MD (West) Molly Hog, MD, New Physicia Sharo Aderso, Residet Sara Swoboda, Studet Delegates to AAFP William Phillips, MD, MPH, Seattle Joh F. McCarthy, MD, Spokae Alterate Delegates to AAFP Chris Gayor, MD, Seattle Ae Motgomery, MD, Spokae Staff Karla Graue Pratt Jim Adrese Casey Evas Jessica Solberg No-Member Subscriptio Rate $40 per year To subscribe, email ifo@wafp.et

FROM THE PRESIDENT Message to the 2009 WAFP House of Delegates Joatha Sugarma, MD, MPH, WAFP IMMEDIATE PAST Presidet, Seattle I his book Bowlig Aloe, Harvard professor Robert Putam described the extet to which Americas i all walks of life have migrated away from participatio i a wide rage of group activities, icludig orgaizatios such as professioal associatios. Ideed, membership i medical associatios such as the AMA ad i some specialty societies has bee decreasig i recet decades. Such is ot the case with the Washigto Academy of Family Physicias. Our membership roles cotiue to grow, with a icrease i active members (the practicig physicia category) of over 10% i the past five years. Ad despite the prodigious demads upo their time, our active members have bee just that. Guided by the overarchig strategies set forth i our strategic pla, WAFP members have bee exceptioally geerous this year i workig to advace the iterests of our patiets ad our members. The first elemet of our strategic pla speaks to the critical importace of ehacig the family physicia pipelie by cultivatig iterest i the professio amog learers, ad by ifluecig the medical educatio system. We witessed the begiig of two major ew chapters i Family Medicie educatio i Washigto this past year. For the first time sice 1946, a ew medical school opeed its doors i Washigto state. The Pacific Northwest Uiversity of Health Scieces (PNWU) i Yakima welcomed a icomig class of 75 youg me ad wome, may of whom aspire to careers i Family Medicie. Shortly after WAFP represetatives atteded the PNWU dedicatio, your board met with Uiversity presidet ad fellow family physicia Sta Flemmig, DO, to begi a dialog about how best to work together. A key aspect of PNWU s state missio is to produce primary care physicias who will practice i the Pacific Northwest, ad it is clear that the WAFP has a stake i supportig that missio. I November, Jim Davis, MD, assumed his role as the ew Chair of the Uiversity of Washigto s 2 Departmet of Family Medicie. Eve before his formal start date, members of the Executive Committee met with Dr. Davis to welcome him, ad to begi a series of discussios iteded to sustai our logstadig ad productive relatioship with the departmet. Dr. Davis joied Steve Albrecht, MD; Joh McCarthy, MD; Karla Pratt ad me i meetig with UW Medicie dea Paul Ramsey, MD; vice dea for academic affairs Tom Norris, MD; ad the late Joh Coombs, MD, vice dea for regioal affairs, rural health, ad graduate medical educatio, to discuss issues of mutual iterest. All of us at WAFP were deeply saddeed by the death of Dr. Coombs, a visioary leader who was deeply committed to the Academy ad the disciplie of Family Medicie, ad we will devote time at this meetig to reflect o his legacy. Oe example of the syergy betwee the WAFP ad our medical schools is the success of the 2009 Studet- Residet retreat, which was atteded i record umbers by studets ad residets from both medical schools ad all campuses i the state. The Wilderess Medicie retreat, ably orgaized by staff member Jessica Solberg, was a outstadig success, i great part because of the extraordiary teachig ad metorig cotributios of Mike Tuggy, MD, ad Ed Kay, MD. Washigto cotiues to be successful i developig future leaders i Family Medicie. This year, four residets, Erik Brodt, MD; Valory Wagler, MD; Rachel Korrich, MD; ad Jeifer K. Li, DO, received the AAFP/Bristol-Myers Squibb Award for excellece i graduate medical educatio at the AAFP aual assembly i Sa Diego. WAFP also set five studets ad three residets to the Natioal Coucil of Family Medicie Residets ad Studets Coferece. A secod WAFP strategy is to improve the effectiveess of our legislative ifluece o targeted issues of importace to Family Medicie. Gle Stream, MD; Ae Motgomery, MD; CLGA co-chair Steve Albrecht, MD; Jo Jackso, MD; ad Karla Pratt cotiued o page 3 Washigto Family Physicia

Presidet s Message cotiued brought our message to Washigto DC as part of the AAFP s aual Family Medicie Cogressioal Coferece last May. Diaa Kig, MD, CLGA co-chair, participated i the AAFP State Legislative Coferece i St. Louis. Closer to home, WAFP hosted two successful Policy ad Advocacy Traiig sessios, which were particularly otable for their high studet ad residet attedace. Our iteractios with ad ifluece upo legislators has bee growig. For istace, State Seator Kare Keiser, chair of the Seate Health & Log-Term Care Committee, met with Academy members ad leaders i February to discuss a umber of legislative iitiatives iteded to support the practice of Family Medicie. Marty Levie, MD, has bee highly effective i represetig WAFP o the state Primary Care Coalitio, for which he chaired a subcommittee that developed a ifluetial report recommedig reimbursemet system chages to more appropriately compesate primary care physicias for providig a medical home. A umber of other WAFP members, icludig Erika Bliss, MD, have bee active i the coalitio as well, ad we owe them gratitude for their efforts to improve the flawed paymet system that impairs our ability to provide eeded care to our patiets. Aother WAFP strategic priority has bee to support members i ehacig the fiacial stability of their practices ad to implemet practice redesig iitiatives cosistet with the provisio of a medical home. David Lych, MD, ad Paul Buehres, MD, helped to produce a publicatio i our joural that helped members to better uderstad Medicare Advatage isurace products that are best structured to provide compesatio for optimal care delivery. Carl Olde, MD, ad Gle Stream, MD, worked to reflect member views o health iformatio techology to the state Health Iformatio Ifrastructure ad Advisory Board. Freddy Che, MD, alog with executive vice presidet Karla Pratt ad former staff member Nicole Oishi, LPN, successfully lauched the America Board of Medical Specialties/Robert Wood Johso Foudatio/ WAFP Foudatio-fuded Improvig Performace i Practice program, ad WAFP is ow ready to lauch, i collaboratio with a umber of other stakeholders, a program of techical assistace to assist members i implemetig the medical home model i their practices. Your Board has also focused attetio this year o assurig that it meets its fiduciary resposibilities to members, particularly with regard to beig prudet stewards of member resources. Uder the leadership of Secretary-Treasurer Jue Bredi MD, the Board adopted a ew ivestmet policy to assure cotiued fiacial stability for years to come. I order to better commuicate to members the progress ad achievemets of the WAFP, we have begu to develop a series of dashboard measures i chart ad graphic form to supplemet the arrative ad tabular updates upo which we have traditioally relied. This is a critical time i the history of Family Medicie. There is ow widespread ackowledgmet that our usustaiable fiacial system poses a eormous threat to the future of primary care i America. However, there is also a emergig appreciatio amog state ad federal policy makers, ad amog healthcare purchasers, that primary care must be preserved ad stregtheed as the atio moves toward reform of the healthcare system. I 2004, several years after the publicatio i 2000 of Bowlig Aloe, Robert Putam published a secod book called Better Together: Restorig the America Commuity, i which he preseted a doze case studies of effective efforts to accomplish importat societal goals. Over the past year, I have bee ispired by the passio ad productivity show by WAFP s members ad staff i their work to accomplish two importat goals: improvig the health of the public ad creatig a better professioal eviromet for Washigto s family doctors. Despite may forces to the cotrary, family doctors i Washigto State have resisted the temptatio to bowl aloe, ad have demostrated uequivocally that we are ideed better together. The accomplishmets of this past year demostrate that WAFP ca be a powerful force for chage, ad ca be a precious asset for its members. I applaud the cotributios of our members ad leaders, some amed above but may ot, ad look forward to the cotiuig successes that will cotiue to emerge from the Academy s work i the years to come. Washigto Family Physicia 3

LEGISLATIVE NEWS WAFP Testifies o Key Bills Durig the 2009 Sessio Kathlee Collis, WAFP Legislative Cosultat, Olympia The Washigto Academy of Family Physicias followed ad worked o several bills durig the 2009 Legislative sessio. Academy members also testified o three importat issues o behalf of the WAFP. HB 2114 ad SB 5891: Creatig Medical Home Reimbursemet Pilot Projects These bills will require the Health Care Authority ad Departmet of Social ad Health Services to desig, oversee implemetatio of, ad evaluate oe or more primary care medical home reimbursemet pilot projects. The projects will iclude public payors, private health carriers, third party payors, ad health care providers, ad will termiate July 1, 2013. The pilot projects will ot costitute a violatio of state or federal atitrust laws. The substitute versio of these bills added a sectio describig retaier practices ad stipulated that oe of the pilot projects could be o a retaier practice. This bill is a priority for the WAFP ad Drs. Gle Stream ad Stephe Albrecht testified i support of these bills. SB 5891 should easily pass the last few steps i the Legislature ad become law. SB 5502: Providig coditioal tuitio waivers for primary care medical studets Proposed by Seator Kare Keiser, Chair of the Seate Health ad Log Term Care committee, this bill would have improved the pipelie for primary care providers by settig up a Primary Care Physicia Coditioal Tuitio Waiver Program at the Uiversity of Washigto. Eligibility requiremets would require the applicat be: (1) a residet studet with a declared major i primary care medicie; (2) registered for at least six credit hours; ad, (3) makig satisfactory academic progress. Eligibility also requires a declared itetio to practice primary care medicie i Washigto state. The tuitio waivers would have bee subject to available fuds with recipiets icurrig a obligatio to repay the waivers, with iterest, uless they were employed as a primary care physicia i Washigto for two years for every oe year of tuitio waived. The bill also stipulated that the Uiversity of Washigto - Family Medicie Residecy Network make every reasoable effort to work with commuity physicias to establish additioal accredited ew sites i uderserved Washigto to trai primary care professioals icludig physicias i family medicie, iteral medicie, or pediatrics. Despite excellet testimoy i the Seate Higher Educatio & Workforce Developmet committees by Dr. Stephe Albrecht ad Dr. Diaa Kig ad by Dr. Albrecht i the i House Higher Educatio committee, the House committee decided ot to pass the bill. Bills itroduced i 2009 will be alive i 2010, so SB 5502 will be put back i the Seate Rules committee for possible cosideratio ext year. SB 5880 ad SB 5889: Educatioal flexibility SB 5880 would have made several chages i programs ad activities of school districts. The bill proposed to repeal two laws, both of which had WAFP support. The first is a law requirig a model policy o access to utritious foods ad the developmet of a physical educatio (PE) ad fitess curriculum for studets by all school districts. The secod law is the goal of Washigto state that, by 2010, all school districts must have school health advisory committees; provide oly healthy food ad beverages durig school hours or for school-sposored activities; provide all studets i grades oe through eight with at least 150 miutes of quality PE every week; ad have PE coducted by appropriately certified istructors. cotiued o page 5 4 Washigto Family Physicia

WAFP Testifies o Key Bills cotiued SB 5889 also makes several chages i programs ad activities of school districts. It suspeded the requiremet for visio ad hearig testig of all childre, keepig i place the screeig program oly for low icome studets. I was able to testify i oppositio of the repeal of school utritio ad physical educatio laws ad the suspesio of the hearig ad visio screeigs. SB 5880 did ot pass out of the House Committee. The Committee passed SB 5889 ad stipulated that the visio ad hearig programs should cotiue ad allow voluteer health providers to coduct the screeigs. SB 5889 must pass the House before they adjour to become law. The progress of these ad other bills is updated weekly o the WAFP Bill Tracker, which ca be viewed uder the Advocacy sectio of the website at http:// www.wafp.et/programs/public-policy-advocacy/2009-bill- Tracker.aspx throughout the legislative sessio. Lack of Moey Drives Big Cuts Kathlee Collis, WAFP Legislative Cosultat, Olympia The curret fiscal recessio has dried up reveue for the state. It hit the geeral fud budget hard. The geeral fud budget pays for the bulk of the state govermet activity, ad icludes all federal ad state provided health care. The Legislature arrived i Jauary facig a $5 billio shortfall out of a $33 billio budget. By the time they wrote their budget i April, that shortfall had grow to early $10 billio. The Democrat majorities i the House ad Seate made difficult decisios, but o April 26, they adjoured havig passed a balaced budget. The budget icluded about $4 millio i cuts to services ad other assumed savigs, approximately $3 plus billio i oe-time federal stimulus moey ad $2 plus billio i trasfers from other state accouts. Pedig a dramatic improvemet i the ecoomy, the state expects at least a $3 billio problem i the ext bieium. It is likely the budget will eed adjustig ext year as well. Because health care is such a large part of state fudig, it sustaied several sigificat cuts i the budget. The most sigificat is the reductio i the Basic Health Pla of 43 percet. These cuts will be maaged by ot takig ew erollees, ad possibly diserollig some. The state will set up a process to evaluate how to diseroll curret persos o the Pla. Aother major reductio came from phasig out uiversal purchase of vaccies. The legislative setimet was that the program cost a lot of moey ad was ot producig results. The Departmet of Health will covee a group to discuss how to provide a affordable supply of vaccies to health providers for childre who are ot low icome. The vaccies for low icome childre will cotiue to be provided. The Geeral Assistace-Uemployable program (GAU) was uder great scrutiy ad the Goveror proposed elimiatig it. I the ed, the Legislature kept GAU, but reduced it. They hope to save moey by usig a maaged care model for GAU health delivery. There were reductios i premiums for Healthy Optios ad the pediatric ad adult office visit provider rates. The Legislature raised the pediatric ad adult office visit rates recetly. Also reduced was $20 millio from public health fudig ad a similar amout for graduate medical educatio programs. The Legislature expects to save about $80 millio by switchig to geeric drugs over brad ame for state-provided care; this was part of the Goveror s prescriptio bill, SB 5892. Overall health care was reduced by $777,249,000. Washigto Family Physicia 5

WAFP ADVOCACY The WAFP Policy ad Advocacy Leadership Istitute 2009 jeae cawse-lucas, md, r3 SWEDISH FAMILY MEDICINE RESIDENCY, CHERRY HILL, SEATTLE O Tuesday, March 17, Academy members from all over the state gathered i the Seate coferece rooms i Olympia for the 2009 WAFP Policy ad Advocacy Leadership Istitute. The day started with shamrock stickers ad chattig over breakfast, but quickly trasitioed ito a full morig of advocacy traiig ad briefigs by a variety of legislators, aides, ad cosultats. While the budget woes cast a log shadow (programs icludig parts of DSHS, uiversal vaccie coverage, ad the Goveror s workig group o health care are o the choppig block) there is a lot of good work beig doe to support primary care i Washigto, icludig work towards creatig ad sustaiig a Patiet-Cetered Medical Home (PCMH) model. The first preseter was Eid Layes, a former lobbyist ad legislative staff member who ow educates ad cosults about the activities i Olympia. I additio to a orietatio to the legislative process, Ms. Layes gave a useful descriptio of how to talk to seators ad represetatives. I order to make a impact o legislators, she recommeded first establishig a coectio by lettig them kow if you live or work i their district, or if your patiets are costituets. From there, state the problem the bill i questio is addressig (i layma s terms), ad have up to three reasos that your bill solves the problem. Fially, ask for a commitmet to vote as you request. The ext several preseters were legislators o a variety of health care committees, who briefed us o importat bills. Seator Kare Kaiser, chair of the Seate Health ad Log Term Care committee, discussed the work that is beig doe to achieve better primary care i Washigto, icludig work towards a PCMH ad the primary care tuitio waver bill. Seator Cheryl Pflug, the rakig miority member of the Seate Health ad Log Term Care committee, talked about a highly fuctioal PCMH as the best opportuity for cost reductio, ad some possible tools to adapt state medical plas despite the difficulty of trasitioig i a fee-for-service eviromet. I discussig the access problem, she made the poit that may people i Washigto have isurace coverage which does ot cover much ad havig isurace that o oe will take is ot really access. Represetative Doug Erickso, the rakig miority o the House Healthcare ad Welless committee, approached health care from a free-market perspective. His mai questio was how to protect what we curretly have while expadig coverage. Represetative Eilee Cody, the Chair of the House Healthcare ad Welless committee talked about efforts to provide healthcare more efficietly, icludig a combied effort betwee a variety of medical associatios ad hospitals to reig i uecessary imagig. The last preseter was Christia Hulet, oe of the Goveror s Executive Policy Advisors. Goveror Gregoire has recetly bee appoited to the Natioal Goverors Associatio Executive Committee o Health Care, ad has amed health care delivery ad quality as a key issue i reachig uiversal coverage. While there is little moey to do aythig ew right ow, she wats to take advatage of the curret crisis to pla for better times. For example, isurace carriers have show iterest i a state-mediated discussio betwee providers ad isurace carriers to create a PCMH model right ow so that a well-cosidered model ca be fuded whe moey is available. She discussed quality as cetral to the issue of cost ad access: access is a cost problem, cost is a quality problem, ad she agreed that oe of the root causes of the quality problem is a deficiecy i primary care. The goveror seeks the iput of provider groups i uderstadig why variace i care exists i differet parts of the state, what the stadard of care is, ad how to realig the reimbursemet structure to be i keepig with the stadard of care. Over luch, we were briefed by WAFP Legislative Cosultat Kathlee Collis ad CLGA co-chairs cotiued o page 7 6 Washigto Family Physicia

WAFP Advocacy cotiued Dr. Stephe Albrecht ad Dr. Diaa Kig, o WAFP legislative priorities ad the bills supportig those priorities. The top legislative priority is to improve access to high quality, primary care focused, affordable health care for all Washigtoias. Bills supportig this priority iclude 2SSB 5945 Creatig the Washigto Health Partership Pla, ESHB 2128 Childre s Health Care, ad 2SSB 5346 Streamliig i Admiistrative Procedures i Health Care. The admiistrative simplificatio bill also improves trasparecy of cotracts betwee isurers ad providers, aother WAFP priority. ESSB 5502 Primary Care Tuitio Coditioal Waver Program supports efforts to improve the pipelie of family physicias. SSB 5981 ad 2SHB 2114 Primary Care Medical Home Reimbursemet Pilots support the WAFP priority to cotiue to educate legislators ad policy makers o the advatages of the PCMH. Other legislative priorities iclude educatio for legislators about prescriptio formulary practices ad the eed for a occupatioal tax exemptio for providers who serve patiets receivig govermet provided medical care (Medicare, Medicaid, ad BHP), icetives for physicias that ivest i EMR ad PCMH pilots, ad restrictios o the dissemiatio of physicias prescribig iformatio to pharmaceutical compaies. Durig the afteroo, participats had meetigs with legislators from their home ad work districts, with a lively coversatio with other WAFP members ad staff betwee meetigs. My district, the 43rd, received warm receptio from Seator Ed Murray ad Represetative Jamie Pederse. While budget cocers were ever-preset, these two legislators were clear i their support for primary care i Washigto. Overall, it was a fu ad iformative day, ad I felt that the morig briefigs prepared us well for afteroo meetigs with legislators. I pla to retur ext year, ad ecourage ayoe with eve a little iterest to joi i, too! v i s i o S tat e m e t As we carry out our missio, the Washigto Academy of Family Physicias has the followig visio of the future we are creatig: We cotribute to sustaied ad measurable improvemet i the health of the state s etire populatio through leadership i public health programs ad delivery of high-quality, evidece-based cliical care. As a result of our political activism, both withi our orgaizatio ad i the legislative area, all people gai access to health care for medical, detal ad metal health eeds through uiversal coverage. Family Medicie as a disciplie ad the WAFP as a orgaizatio grow i stregth. Our Academy effectively represets the diversity of the family physicias ad the people of Washigto i geography, demographics ad practice settigs. The Uiversity of Washigto Departmet of Family Medicie ad its regioal educatio program maitai their preemiet status as leaders i the professio, accomplished with the strog support of commuity-based physicia preceptors who embrace a itegrated model of care. Family physicias are at the forefrot of efforts to improve cliical care while servig as guides ad advocates for our patiets. We participate i the developmet ad traslatio of iformatio techology, value cost cotaimet, work towards advacig improvemets i cliical decisio makig, ad maitai a broad scope of cliical practice. Washigto Family Physicia 7

HEALTH UPDATE Washigto State Nutritio & Physical Activity Pla Updated Jae A. Moore, MD, FAAFP PAST Chair WAFP Committee o Child ad School Health, Tacoma We hear or read almost daily about the epidemic of obesity i the Uited States. Rates of chroic disease are rapidly risig ad threate to overwhelm health care. Both chroic disease ad obesity are related to poor diet ad lack of physical activity which cause at least 300,000 deaths i the U.S. each year. Oly tobacco use causes more prevetable deaths. Chroic diseases accout for seve of every 10 deaths ad more tha 60 percet of medical costs i the U.S. I Washigto, the cost of obesity-related medical expeses, paid by Medicare ad Medicaid, is estimated to be $365 millio per year. I 2003, the State of Washigto Departmet of Health released the first state strategy to ecourage healthy lifestyle choices to prevet obesity ad chroic disease. The pla was revised i 2008 to build upo the foudatio established i 2003. The pla focuses o developig policies to chage the eviromets where we live, work, ad play to help reduce barriers to physical activity ad healthy eatig. This will help people live loger, healthier lives by reducig the burde of chroic diseases like diabetes, heart disease, ad cacer. The pla is based o scietific evidece about obesity prevetio. Reducig the burde of chroic disease requires more tha chagig idividual behavior. As the Istitute of Medicie has oted, it is ot reasoable to expect ayoe to chage behavior whe it is very easy to make uhealthy choices. To chage the food ad activity opportuities available to idividuals ad commuities will require the cocerted efforts of may parters ad collaborators from state ad federal agecies, educatioal istitutios, oprofit orgaizatios, local health agecies, ad private idustry. The state pla emphasizes developmet of policies to ifluece physical activity ad utritio eviromets i schools, workplaces, commuities, ad healthcare settigs. The healthy choice should be the easy choice. The Washigto Academy of Family Physicias ca cotribute to the success of the pla by keepig mem- cotiued o page 9 Natioal Coferece of Family Medicie Residets & Studets (NCFMRS) Thursday, July 30 Saturday, August 1; Kasas City, Missouri Held every summer i Kasas City, Missouri, this coferece is orgaized specifically for residets ad studets. It is a pheomeal opportuity for learig about Family Medicie ad leadership developmet. The 2009 coferece theme is Health Policy: Buildig a Better Health Care System. The Residet & Studet Cogresses iclude a Delegate ad Alterate Delegate from each state. These delegates atted all busiess sessios, poll their state delegatio about issues before the cogress ad vote i the electios. Medical studets ad residets also have the opportuity to etwork with hudreds of residecy programs, recruitmet firms, health agecies, ad hospitals; dialogue with peers; participate i a variety of procedural courses to improve cliical skills; ad write resolutios ad testify o issues importat to residets ad medical studets. Those who register before July 1 will save $50. For more iformatio about the coferece visit www.aafp.org/c. 8 Washigto Family Physicia

Nutritio & Physical Activity Pla cotiued bers up to date o the issues, developig effective policies to support the pla, ad helpig to implemet the policies across the state. Idividual physicias ca support the pla by workig to implemet policies i their offices ad hospitals as well as by servig as role models. The state pla icludes six objectives, three for utritio ad three for physical activity. There are 15 priority recommedatios to meet these objectives. Nutritio Goals Objective 1 Icrease access to health promotig foods: Assure that commuities provide access to healthy foods ad beverages Assure that worksites, icludig healthcare services ad schools, provide healthy foods ad beverages Assure that schools provide healthy foods ad beverages Objective 2 Reduce food isecurity i Washigto: Stregthe food assistace programs ad improve ecoomic security for low-icome families ad idividuals Improve access to ad awareess of food assistace programs Objective 3 Icrease the proportio of mothers who breastfeed their ifats ad toddlers: Assure that healthcare settigs, child care facilities, ad worksite eviromets support breastfeedig Objective 2 Icrease the umber of physical activity opportuities available to childre: Adopt school-based curricula ad policies that provide quality, daily physical educatio for all studets Ecourage policies that provide studets with opportuities for physical activity outside of formal physical educatio classes Provide opportuities to replace sedetary behaviors, such as watchig televisio, with physical activity Objective 3 Icrease the umber of active commuity eviromets i Washigto: Use urba plaig approaches zoig ad lad use that promote physical activity Chage trasportatio policy ad fudig to promote walkig ad bicyclig Ehace the safety ad perceived safety of commuities to improve walkability ad bikeability Next Steps Here are some examples of how we ca make small chages o the way to reachig these goals: Support commuity gardes ad commuity cotiued o page 11 Physical Activity Goals Objective 1 Icrease the umber of people who have access to free or low-cost recreatioal opportuities for physical activity: Provide adequate fudig for state ad local recreatioal sites ad facilities Develop model policies to icrease access to public facilities for physical activity Icrease the umber of worksites, icludig healthcare ad school settigs, that have policies to ehace physical activity opportuities Washigto Family Physicia 9

FAMILY MEDICINE The Future of Family Medicie: The 2009 Match Report The umber of studets matchig to Family Medicie dropped this year by over 7 percet, accordig to the Natioal Residet Matchig Program. The residecy match, aouced i March, showed that 1,083 U.S. seiors chose Family Medicie this year, 89 fewer tha i 2008. The NMRP also reported a drop i the umber of Family Medicie residecy spots available this year, with 99 fewer spots offered this year compared to 2008. The umber of studets at the Uiversity of Washigto School of Medicie eterig Family Medicie residecy programs dropped from 14 percet i 2008 to 13 percet i 2009. Twety three out of the 176 graduates from the class of 2009 chose to pursue Family Medicie. I 1996, more tha 60 percet of UW studets chose careers i primary care. I 2005 that umber dropped to uder 30 percet. The cotiued declie is disappoitig ad worrisome for the future of health care; with a icreasig demad for family doctors ad a decrease i studets selectig Family Medicie, a primary care workforce crisis is immiet. Additioally, i a recet survey by the Washigto Departmet of Health, with over 700 practicig family physicias respodig, 15 percet idicated they will retire withi the ext 5 years. With this decrease i the primary care workforce, the umber of ew physicias will eed to rise substatially i order to meet future healthcare eeds for Washigtoias. To meet the atio s aticipated eed for primary care i the year 2020, the America Academy of Family Physicias predicts that the Uited States will eed at least a 30 percet icrease i the umber of family physicias. Primary care physicias curretly make up less tha 40 percet of the total physicias i the U.S. ad family physicias represet about 40 percet of those primary care physicias. The problem with these low umbers is that family physicias are most likely to practice as geeralists ad i rural ad uderserved populatios. Accordig to the Washigto State Departmet of Health, more tha half of the state is cosidered uderserved ad/or rural. As you kow, the causes for the declie are ot sigular. Family physicias ca expect to make a sigificatly lower icome tha their classmates who eter ito subspecialty practices ad their degrees are o less costly. Accordig to the Associatio of America Medical Colleges, the average debt for a medical studet i 2007 was $139,517, which was a icrease of 6.9 percet from 2006. The log hours family doctors work, the complexity of their cases, ad the decreasig rates of isurace reimbursemet ca also be discouragig. The WAFP is committed to makig the practice of Family Medicie a attractive optio for physicias i Washigto state. It will advocate for meaigful paymet reform ad for reform that values true primary care. The Academy will work diligetly to create a eviromet where primary care ca thrive ad there will be icreasig umbers of family physicias eterig the workforce. 40 35 30 25 20 15 10 5 0 17 30 18 34 17 27 13 23 Percetage of UWSOM Studets eterig Family Medicie Number of UWSOM Studets eterig Family Medicie Residecy Programs 12 2001 2002 2003 2004 2005 2006 2007 2008 2009 20 15 28 11 20 14 24 13 23 10 Washigto Family Physicia 10

Nutritio & Physical Activity Pla cotiued sposored agriculture programs. These programs ehace access to low cost fruits ad vegetables. Provide healthier choices for sacks i vedig machies. Fit Pick is a healthy vedig program piloted i Clark Couty (www.fitpick.org). Provide health-promotig foods i worksite cafeterias ask for healthier choices. Provide health-promotig foods at meetigs ad workshops. Follow the Eergize Your Meetigs guidelies for healthy foods. (http://www.doh. wa.gov/cfh/utritiopa/pdf_files/eergize-your- Meetigs.pdf) Provide breastfeedig friedly eviromets i offices, hospitals, ad other healthcare settigs. Ecourage breastfeedig durig preatal care. Provide worksite facilities ad flex time to allow for physical activity before or durig the workday. Provide poit-of-decisio prompts (posters ear elevators ad stairs) to ecourage people to use the stairs. Provide icetives for walkig or bikig to work. Provide movemet breaks durig log meetigs ad programs. Provide opportuities for physical activity before, after, ad/or durig breaks at meetigs. Statewide ad Local Nutritio ad Physical Activity Resources Statewide Access to Healthy Foods http://www.accesstohealthyfoods.org/ Washigto Coalitio for Promotig Physical Activity www.beactive.org Spokae Spokae Regioal Health District http://www.srhd.org/services/activity.asp Cowlitz Cowlitz o the Move http://www.cowlitzothemove.org/ Grays Harbor Grays Harbor Couty Public Health ad Social Services Departmet http://www.ghphss.org/page.aspx?id=159998 More iformatio o the Washigto State Nutritio & Physical Activity Pla is available at http:// www.doh.wa.gov/cfh/utritiopa/. Executive summaries ad complete copies of the pla ca be dowloaded. Backgroud iformatio, refereces, ad tools for implemetatio are also available. Kittitas Couty Shape Up Kittitas Couty http://www.shapeupkc.org/ Marysville Healthy Commuities: Marysville http://marysvillewa.gov/idex. htm?healthycommuities/idex.htm&1 Mout Vero Mout Vero Healthy Commuities Project http://depts.washigto.edu/dohuwps/ MoutVero/ Tacoma/Pierce Couty Healthy Commuities http://www.tpchd.org/page.php?id=18 Washigto Family Physicia 11

MENTORING PROGRAM WAFP Members Metorig the Next Geeratio Richard D. Kovar, MD, FAAFP, Seattle 12 Noe of us eeds to be remided that the primary care physicia pipelie has some serious leaks i it. I m ot sure if it is a crack i the mai lie or more like a garde soaker hose, but all family physicias eed to do what they ca to plug the leak. Solutios eed to ivolve educatioal istitutios, govermet regulators ad payers, commuities ad isurers, but it starts with the hearts ad mids of the youg people cosiderig a career i medicie. As family physicias we are i a uique positio to ispire studets i our commuities to cosider a career as a primary care physicia through formal ad iformal metorig opportuities. May of you are already metorig studets but you may have observed that i the last few years the requests have icreased dramatically. Perhaps that is because pre-medical studets thik we family docs remid them of the actors they see o TV, but i reality it has more to do with requiremets to apply to medical school. The Uiversity of Washigto School of Medicie (UWSOM) requires applicats to have at least 40 hours of metorship experiece to submit a applicatio. Reflect o that challege for a miute. I do t thik ay of us faced that kid of requiremet ad it presets quite a ucomfortable barrier to may studets. Imagie beig a college studet, without persoal coectios to a physicia, tryig to make those arragemets. Fortuately, the WAFP Pre-Med Metorship program makes this coectio a lot easier for both studets ad family physicias. Studets cotact WAFP, a brief profile is created alog with geographic ad time prefereces, ad we as members are cotacted to step up to the plate. This is a fatastic opportuity to ispire studets with what we do while they are arguably at the most idealistic stage of their lives. The data is very clear that this type of metorship experiece traslates ito higher iterest i primary care. I have had the privilege to metor may studets o a regular basis for my etire career ad frakly, I get as much joy doig this as I do carig for patiets. Some are ow i various stages of medical school ad Family Medicie residecies, while others are family physicias i practice. This moth I have a first year UWSOM medical studet doig a first year preceptorship with me who did a metorship last year through the WAFP program. Ay of you who have metored studets i your office kow these folks are usually icredibly ethusiastic ad idealistic. They are full of ew ideas, have fasciatig backgrouds ad possess ispiratioal iquirig mids. I may ways, it keeps us o our toes ad i my experiece, patiets almost uiversally ejoy the iteractio. I ofte fid myself thikig more critically about the care I am deliverig, ad I thik my patiet-cetered commuicatio improves with the studets i the room. This year, the Kig Couty Chapter of WAFP has prioritized ad worked hard to place as may studets as possible with metors. We eve brought a related resolutio to the House of Delegates to icrease WAFP ivolvemet i this importat activity. Some physicias have metored studets for the first time ad the feedback has bee great! Creativity is the order of the day. Some of us metor the studet cotiued o page 13 Washigto Family Physicia

MENTORING PROGRAM The Studet Perspective Shadowig opportuities are critical for studets, ad ca provide them with isight ito may importat aspects of Family Medicie. Below is a excerpt from Parhum Namdara s metorship summary, a pre-med studet who shadowed Dr. Christopher Gayor at his cliic i Seattle, WA: Throughout my college experiece, i a attempt to pursue my iterest i medicie, I have tried to gai a better uderstadig of the medical professio, both the positive ad egative aspects, through voluteerig ad other extracurricular opportuities. Before shadowig Dr. Gayor, the closest experiece I had was voluteerig i the emergecy room at the Uiversity of Washigto Medical Ceter. Though I did get to see trauma patiets, I did ot have much of a opportuity to follow doctors or ask them questios. Thus, what I was exposed to i the ER was ot as valuable as I had hoped. I have shadowed Dr. Gayor several times ad I believe, already, that it has bee a much more productive ad beeficial experiece tha those i my past. He has bee very ope to aswerig ay questios I have (e.g. curret issues facig health care professioals ad the egative aspects of beig a doctor) ad has allowed me to watch him as he iteracts with patiets. I feel that observig Dr. Gayor i actio has bee oe of my most valuable experieces, particularly because his kid ad sicere ature gives his patiets the cofidece to trust him. I see durig these visits the extreme importace of the doctor-patiet relatioship ad the ecessity to liste ad have a mutual respect for oe aother. Not oly will the doctor be able to detect all possible symptoms ad causes, but the patiet will also be more iclied to follow the ecessary measures to get better. Alog with the other great thigs I have leared thus far, I feel that this experiece has solidified my desire to pursue a career i medicie ad more importatly, egraied i me the extreme importace of primary care. Creatig strog doctor-patiet relatioships ad dealig with health issues early o ot oly helps the patiet physically ad emotioally, but also fiacially. Catchig problems before they escalate ito costly procedures is a vital task ad I feel that the more family physicias there are to do this, the greater our life expectacy ad well-beig become. Metorig Program cotiued aloe ad others arrage for them to work with colleagues i our office or other practices as well. Be aware the studet is goig to feel awkward about askig for the 40 hours they require, so help them out ad arrage somethig for them to make it easy. If that time commitmet is difficult, cosider arragig with a group of colleagues to share the studet. You could hook them up with ay umber of fasciatig experieces for which they will be eterally grateful. At the ed of the experiece, offerig a letter documetig their experiece with you would be great. Remember how awkward askig for letters was for all of us? I hear stories about istitutios that put up barriers ad restrictios to their employed physicias who wish to metor studets. I ca t really get my mid aroud that oe but to them I say, do it ayway ad remember the old adage that it is easier to ask forgiveess tha permissio. (If that does ot work, try FEITCTAJ - metor a studet ad the ask me what that meas ext time you see me). Family Medicie as a specialty is at aother critical jucture i our history. Ispirig the ext geeratio of family physicias is a critical part of the strategy to get us past this mess. It is i the oath we took ad it is a whole lot of fu. See page 15 for iformatio o WAFP s Metorship Program Washigto Family Physicia 13

Committee, Commissio ad Task Force Updates The committees, commissios ad task forces of the Washigto Academy of Family Physicias met o Saturday, February 14, prior to the Board of Directors meetig. These cluster meetigs are held twice a year, ad some groups hold coferece calls throughout the year as well. These committees, commissios, ad task forces are committed to furtherig the goals of the orgaizatio. The followig is a brief summary of their February meetigs. Commissio o Legislatio ad Govermetal Affairs (GLGA) The Commissio o Legislatio ad Govermetal Affairs (CLGA) discussed legislative priorities for the WAFP ad several bills relevat to Family Medicie. CLGA recommeded support for legislatio to develop ew paymet models to be tested i PCMH pilots ad bills to improve the pipelie of family physicias. Committee o Diverse Costituecies The Committee o Diverse Costituecies discussed committee member recruitmet ad retetio, creatig a evet that helps to make studets more culturally aware ad provides a opportuity for social etworkig. The committee also discussed a stadardized healthcare referral system, lookig at how to get people ito the best fit healthcare for discharged patiets. It was decided that this issue eeded further thought ad discussio. Commissio o Educatio The Commissio o Educatio discussed the Pipelie Grat Program ad decided to exted the deadlie for the grat to Jue 30,, 2009. At the meetig, the commissio heard about the icreasig umber of studets who are approachig the WAFP for shadowig experieces. A discussio was held about how the shadowig program could be revised to support studets who are iterested i Family Medicie ad esure that commuity physicias feel supported as well. The commissio is aware of a resolutio that will be preseted to the House of Delegates o icreasig support for premedical metorig ad shadowig programs ad supports this resolutio. Fiace Committee The Fiace Committee brought forward a recommedatio to the Board to reimburse Board members for hotel accommodatio expeses icurred while attedig Board of Directors meetigs occurrig o either side of the House of Delegates meetig. The Board agreed ad this policy will begi i 2009. The committee also looked at the status of the ivestmet pla ad approved purchasig a few more hours of cosultig assistace to facilitate implemetatio. Commissio o Health Care Services The Health Care Services Commissio discussed two resolutios referred to them by the 2008 House of Delegates, as well as the Primary Care Coalitio (PCC). The commissio was iformed that the PCC is focused o legislatio to develop alterative forms of paymet for primary care services. Leadership Developmet Task Force The Leadership Developmet Task Force discussed the eed for the task force to be a permaet group ad agreed to submit a resolutio to the 2009 House of Delegates that would make the task force a stadig committee. They also talked about ways to icrease ivolvemet i academy leadership. Commissio o Membership ad Member Services Membership ad Member Services discussed how the structurig of chapters ad committees/commissios/task forces might be evaluated to assess their fuctioality. It was agreed that some restructurig should be cosidered. The commissio also discussed implemetig a $25 aual fee for Iactive members to cover the costs of havig staff track these applicatios. New Model Task Force A update o the Patiet Cetered Medical Home Improvig Performace i Practice program was provided at the New Model Task Force meetig. The task force discussed workig with the Departmet of Health as they are workig o a parallel project. cotiued o page 15 14 Washigto Family Physicia

Committee, Commissio ad Task Force Updates cotiued Commissio o Public Health & Scietific Affairs The Commissio o Public Health & Scietific Affairs reviewed ad discussed the revised Disaster Preparedess White Paper Report directed to family physicias ad will recommed that the WAFP edorse the report whe it is completed. Additioal discussios icluded havig the commissio take over the duties of selectig the WAFP Research Extership award wier. The Aual Scietific Assembly, Bylaws, Publicatios, Child ad School Health, Commuicatios, ad Iformatio Services Committees did ot meet at this time. These groups are always iterested i expadig participatio ad require member ivolvemet to cotiue their efforts. For more iformatio o WAFP commissios, committees ad task forces, please visit http://www.wafp.et/aboutwafp/commissios-ad- Committees.aspx. If you are iterested i joiig a committee, commissio or task force, please cotact Casey Evas at casey@wafp.et or 425.747.3100. WAFP Pre-Med Metorig: Stregtheig the Pipelie Studets iterested i applyig to the Uiversity of Washigto School of Medicie are ow required to obtai a miimum of 40 hours of shadowig experiece prior to sedig i their applicatio. This gives WAFP members a excellet opportuity to ifluece the future of Family Medicie. The demad for Family Medicie metors is growig, ad at a time whe expadig ad stregtheig the ew physicia pipelie is crucial, we eed to be more ivolved tha ever before. Durig the 2008-2009 school year, WAFP received over 100 metorship requests. Out of these, 38 completed the applicatio process, ad to date, 32 have bee matched with metors. WAFP collects the applicatios, qualifies the applicats, ad seeks metors oce each quarter; doig its best to match each studet to a metor based o geographical locatio ad commo iterests. The Washigto Academy of Family Physicias Pre-Med Metorship Program is desiged to give udergraduate ad post-baccalaureate pre-med studets a opportuity to lear about Family Medicie directly from family physicias. The program is flexible ad is desiged to give the studet ad the physicia the ability to customize their time together, leavig both with a positive outlook o careers i Family Medicie. It is ot evisioed to be a major commitmet, ad ca be aythig from a shadowig experiece to a phoe call or visit to your office. Studets who participate i the program have provided resoudigly positive feedback i their metorship summaries, ad offer proof that a metor s impact o a studet is tremedous. WAFP would like to thak each of us family physicia metors for your ivolvemet i this valuable pipelie program ad hopes that you will cotiue to share your love of Family Medicie with the ext geeratio of aspirig physicias. You are makig a differece! If you are iterested i participatig as a pre-med studet metor or would like more iformatio cotact Jessica Solberg at 425.747.3100 or Jessica@wafp.et. Washigto Family Physicia 15

SPIROMETRY REGULATIONS Spirometry Pilot Program to Assist Practices i Preparig for New Regulatios JERRY YORIOKA, MD, WAFP Past presidet, mill creek The Natioal Committee for Quality Assurace (NCQA) has updated the measures for the Healthcare Effectiveess Data ad Iformatio Set (HEDIS) for 2009. These measures are updated yearly ad oe chage of ote for this year relates to spirometry use. A complete listig of the 2009 measures ca be foud at: http://www.cqa.org/tabid/855/default.aspx. The HEDIS measure regardig spirometry is specifically for COPD patiets, although it is useful i asthma as well. The ew measures will require the use of spirometry for diagosig ad assessig COPD. While havig ay exteral force tellig doctors how to practice medicie is always a bit oboxious, HEDIS has always seemed to recommed stadards that are reasoable. All family physicias are traied to iterpret spirometry, so this should be ecouraged. The aalogy ca be made that ot doig spirometry o a patiet with chroic lug disease is like ot doig a EKG o a patiet with coroary artery disease. About five years ago a trai the traier program took place uder Thomas Petty, a icoic pulmoologist who advocated more use of spirometry. After decades of focusig o pulmoary doctors, he realized he eeded M i s s i o S tat e m e t The Washigto Academy of Family Physicias is a member-drive orgaizatio committed to supportig Washigto State family physicias i their efforts to provide optimal health care to the people of Washigto State through educatio, advocacy, research ad political activism. to get the message across to primary care providers, who see the bulk of asthma ad COPD patiets. I coducted workshops several years ago for the WAFP ad the WSMA, which were desiged to ecourage primary care physicias to employ spirometry i the diagosis ad maagemet of COPD ad asthma. My biggest surprise i doig the workshops is how may already had a spirometer, which had falle ito disuse. Cocurretly, Jim Stout, MD, MPH a pediatricia at Uiversity of Washigto ad Seattle Childre s Hospital, has bee active i ecouragig pediatricias to use spirometry for their asthma patiets, ad has worked with the DOH Washigto State Collaborative. Uder his directio, a pilot program, Spirometry 360 (described a bit more below), was started i 2009 to icrease the use of spirometry i COPD disease state maagemet. If you re thikig, How ca I possibly fit oe more thig ito my already rushed schedule? Here s why it s worth your time. If you have a asthmatic eight-yearold i your office ad his mother says he s usig his Albuterol a few times a week ad he s bee wheezig. Spirometry scores could help guide the treatmet choice for a cotroller medicatio, potetially avoidig a trip to the ER with a acute attack. Besides the clear beefit to the child ad his family, it also saves your practice a urget hospital follow-up visit. It ca be a great teachig tool for patiets, too, providig a visual measure of their lug fuctio. This also might ispire more rigorous adherece to treatmet! Most cliics trai their medical assistats to operate the spirometer, so the oly extra time required of the physicia ivolves readig the results ad explaiig them to the patiet. Medicare, Medicaid, ad most private isurers reimburse providers for spirometry whe either asthma or COPD is suspected as part of a iitial evaluatio ad for ogoig maagemet of these coditios. cotiued o page 19 16 Washigto Family Physicia

Prescriber s Letter Discout Available The WAFP has reewed its relatioship with Prescriber s Letter, a ubiased drug advisory service, published by Therapeutic Research, a idepedet publisher that writes drug advisories. For a discouted price of $68, WAFP members will receive: Mothly issues of Prescriber s Letter cotaiig brief articles with ubiased, bottom-lie, cliically relevat advice ad iformatio about specific drugs ad importat developmets Access to Detail-Documets o ay subject i ay issue, which cotais comprehesive iformatio, referece citatios, patiet hadouts ad more, o the subject of the article Mobile versio ad dowloadable PDA versio, with quick ad searchable access to articles, Detail-Documets, charts ad other materials Up to 24 CME credits (up to two per moth), all accredited by ACCME ad approved for EB-CME by AAFP. Therapeutic Research has bee publishig Prescriber s Letter for more tha 20 years, ad has operated with high ethical stadards. The compay has ever accepted advertisig, sposorship or educatioal grats ad has o relatioship with ay drug compay. Editors are ot permitted to ow stock i ay drug compay. Reveues are achieved through subscriptio fees. More tha 100 researchers, reviewers ad cliicias work o each issue, aalyzig all the relevat studies, literature, treatmet guidelies ad EBM outcomes, the offerig expert cliical advice. Full package price is $112, but WAFP members may subscribe ad receive all these services for $68 a aual savigs of $44. To take advatage of this offer ow, please call 800.995.8712 to reserve your subscriptio. Or call the WAFP office at 425.747.3100 for more iformatio. Save the Date Advaced Life Support i Obstetrics (ALSO) Course November 12 13, 2009 2009 Aual Scietific Assembly November 14 15, 2009 60th Aiversary Celebratio November 14, 2009 Joi us for three-ad-a-half days of CME at the beautiful Sucadia Resort i Cle Elum, WA. The WAFP ad its Aual Scietific Assemblies Committee have itegrated two essetial CME activities to help maximize your time for cotiuig educatio credits. The sessio begis with a ALSO Course o Thursday Friday, ad is followed by the 60th Aual Scietific Assembly ad Aiversary Celebratio o Saturday Suday morig. As you have come to kow ad expect, WAFP cosistetly provides iovative, high-quality evidece-based talks o topics that matter most to family physicias; equippig physicias with up-to-date iformatio to support kowledge-based decisio makig. Ad for the third cosecutive year, WAFP is pleased to offer a educatioal eviromet without the ifluece of pharmaceutical compaies. Advaced Life Support i Obstetrics (ALSO) Course. The two day course is for materity care providers. The course provides a detailed didactic ad procedural review of emergecies, which may arise i obstetrics. 60th Aual Scietific Assembly. The WAFP provides exceptioal value to its members by offerig EB-CME certified courses that give you double-credit for attedig, the aual William F. Mead Lecture, ad ABFM Maiteace-of-Certificatio Self-Assessmet Modules (SAMs). The highlight of the weeked will be the WAFP 60th Aiversary Celebratio. Keep a eye out for further details. Washigto Family Physicia 17

WSMA MESSAGE Compromises Must be Made Cythia A. Markus, MD, Presidet Washigto State Medical Associatio, Everett A recet poll coducted by the Kaiser Family Foudatio, Natioal Public Radio ad the Harvard School of Public Health foud that people believe there is waste i the health care system, but do t associate the waste with their ow persoal physicia. As the headlie read i the Wall Street Joural o April 22, Patiets: There s Waste i Medicie, but My Doctor is Perfect. 18 Accordig to the article: Asked whether it was a major problem, mior problem or ot a problem with the US health care system that too may patiets were gettig tests ad treatmets they do t really eed, 49% of respodets chose major problem ad aother 39% called it a mior problem. At the same time, 82% of respodets said that they had t received a uecessary medical test or treatmet over the past two years. Ad 87% said their doctors durig that time had t recommeded a expesive test or treatmet whe a cheaper alterative would work just as well. Obviously we have a slight discoect. Some may cautio that public trust i doctors is misplaced; however, the public clearly trusts idividual physicias to make these decisios. I d advise us to all hold this trust dear ad use it to start a ope ad hoest discussio with our patiets about health care reform. To date, the WSMA has ot take a formal positio o ay particular health care reform proposal, istead carefully outliig the priciples of reform that should be imbedded i ay policy goig forward. There are may routes to reformig the system. What matters, ultimately, is whether they are practical, politically feasible, effective, ad meet the objectives we all share. Our criteria, as approved by the House of Delegates: 1. There should be uiversal access to affordable health isurace ad a govermet sposored safety et; 2. The health care system should ecourage the availability of differet levels of coverage beyod a basic level of protectio for those who wat it. There must be choice of types of isurace, of physicias ad of other caregivers to reflect our pluralistic culture; 3. The health care system should be based o fairess ad equity, reflectig persoal resposibility ad accoutability by all stakeholders. The federal tax code should treat those covered by employer-based isurace or idividual-based isurace equally; 4. The delivery ad fiacig of the system must iclude admiistrative simplificatio ad stadardizatio; 5. The system should iclude icetives to improve quality, cotrol cost, ehace efficiecy ad elimiate the use of ieffective services ad iappropriate variatios i care; ad, 6. The system must iclude improved patiet safety ad a reformed system for compesatig patiets ijured durig the course of their care. But regardless of the criteria above, beeficial health care reform will oly be achieved if we, physicias, isert ito the debate the issue of tradeoffs ad help the public uderstad the compromises that must be made. We all kow that, whether it is at the local level or the atioal level, the health care system will be reformed. The greatest challege, however, lies beyod the costs associated with ay particular reform proposal. It is the explicit eed to recocile the trade-offs iheret i ay reform. As physicias we ca help guide the debate by addressig the reality of the tradeoffs. What do I mea by tradeoffs? I a ideal world, the system would provide every type of care; provide it right ow ad at a affordable cost. We kow that cotiued o page 19 Washigto Family Physicia

WSMA Message cotiued such a system is usustaiable. Simply put, physicias, our patiets, eve the policy woks, eed to aswer the questio of which two of the three attributes of the optimal health care system we wat: 1. Do we wat all the care that is available? 2. Do we wat it ow? 3. Do we wat it to be affordable? The simple fact of the matter is that we will ot be able to create a sustaiable system uless we have a frak discussio about what we are willig to give up. As idividuals we make this compromise daily whe we purchase other goods ad services, yet too may feel we ca somehow be immue from this compromise whe choosig our health care. The experiece of other coutries cotradicts that assertio. I am hard pressed to fid a sigle example of uiversal coverage that provides all three attributes. Here are the possible choices: A system ca provide everythig at a low cost, but patiets are t goig to get it right ow there will be waitig periods for elective treatmets. It ca provide everythig, right ow, but it is goig to be very expesive. It ca provide care right ow at a low cost, but the patiet wo t get every service they may wat or eed. It is t our job to covice the public it ca oly pick two. But, cosideratio of these three attributes ca set the framework for discussios about health care reform ad educate the public o the various tradeoffs. Trust is ot somethig that should be squadered. As physicias we have a resposibility to make our patiets, ad policymakers, busiess ad others aware of the realities that true reform meas hard choices. I m iterested i what you thik. Email me at presidet@wsma.org ad share your thoughts o the challege of helpig the public start cosiderig what it is willig to give up i order to have a sustaiable health care system. Spirometry Regulatios cotiued There are excellet resources available to cliics that wat to trai their staff, ad to physicias who wat coachig o readig the results. Iteractive Medical Traiig Resources (imtr), a research group i the UW School of Medicie s Divisio of Geeral Pediatrics, is curretly pilotig a program called Spirometry 360, a program desiged to trai health care professioals to successfully perform ad iterpret spirometry tests i the office settig. Curretly, 52 healthcare provider teams, typically a physicia paired with a urse or medical assistat, are participatig i the five-moth Spirometry 360 s subscriber-based program scheduled to coclude i Jue 2009. This pilot icludes mostly pediatric primary care ad a few family practice teams i New York (33), Califoria (10), ad Washigto (9). Plas are uderway to expad this traiig to other primary care specialty groups. I fall of 2009, the ext iteratio of the Spirometry 360 program plas to offer tracks for iteral medicie, Family Medicie, ad pediatric practitioers; it will ru from August through December 2009. Potetial expert cliical faculty, may of whom are atioal leaders i their field, iclude: Family Practice Greg Ledgerwood, MD* Alle Dozor, MD Iteral Medicie Paul Eright, MD Lewis Smith, MD Pediatrics Edward Carter, MD Stuart Stoloff, MD Respiratory Therapist Jeff Byre, RRT* Laurie Al-Naser, CPFT* * Curretly participatig i the Spirometry 360 pilot program. More iformatio o the Spirometry 360 ad imtr ca be foud at: http://depts.washigto.edu/imtr/ spiro360/ Washigto Family Physicia 19

Family Practice with OB (Weatchee or Chela, WA) Columbia Valley Commuity Health (CVCH), a dyamic progressive commuity health ceter i the foothills of the Cascade Moutais of Washigto State, is seekig (BE/BC) Family Practice with OB ad C-Sectio skills for our ope positios i Weatchee, WA ad Chela, WA. Joi our family orieted team, ad experiece the quality of life i a Mecca of muscle powered sports ad 300 days of sushie, while practicig evidece based medicie i a moder well equipped commuity health ceter with fully itegrated EMR, itegrated behavioral health, o-site lab, radiology, ad lab. CVCH is a Joit Commissio accredited orgaizatio committed to servig the uderserved ad uisured i the Chela ad Douglas Couties. We offer very competitive compesatio/icetive program ad beefits. Spaish skills are helpful but ot required. Malpractice coverage provided as a employee. Relocatio expeses provided. CVCH is eligible for state ad federal loa repaymet programs. Please sed email or CV/Resume to Sylvia Martiez, HR Maager, at smartiez@cvch.org or fax to (509) 664-4590. For more iformatio, please check out the followig websites: www.cvch.org. A Better Way to Practice Primary Care. Iovative Medical Home Model Exceptioal Hirig Bouses Offered Group Health Permaete, the Pacific Northwest s top-rated multi-specialty group, is curretly seekig Primary Care Providers who are BC/BE i Family Medicie or Iteral Medicie to joi our Cliics i Pierce, Thursto, ad Kitsap Couties. Group Health is dedicated to providig comprehesive, iovative, ad patiet-cetered care ad leads the atio i EMR itegratio. Additioal PCP s eeded to fully implemet our Medical Home Model which utilizes more virtual ecouters daily ad smaller pael sizes. We are offerig exceptioal hirig bouses this year, i order to staff for the Medical Home Model. We seek physicias who have tremedous commuicatio skills, professioalism, high quality cliical skills, ad will excel i a team eviromet. Outdoor ethusiasts will especially appreciate our locatios at the base of Puget Soud ear moutais, water, ad the Olympic Natioal Forest. For additioal iformatio regardig this positio or to submit your CV, please cotact Josie Lavi, GHP Recruiter, at lavi.j@ghc.org or 206/448-6132 or Kelly Pedrii, GHP Recruiter, at pedrii.k@ghc.org or 206/448-2947. Is t it Time for Somethig Better? Group Health Permaete, the Northwest s premier multi specialty group, is curretly seekig a BC/BE Emergecy or Family Medicie Physicia to joi our Urget Care Ceter located at our Capitol Hill campus i Seattle, WA. Group Health is dedicated to providig comprehesive, iovative ad patiet-cetered care to commuities throughout Washigto. Cadidates should have a full rage of urget care skills & a iterest i workig with a iovative group Affordable housig, highly rated schools & pleasat eighborhoods, a uparalleled place to raise a family A flexible schedule, geerous beefits ad competitive salaries make this a opportuity worth explorig For additioal iformatio or to submit your CV please cotact Kelly Pedrii, GHP Recruiter, at 206/448-2947 or pedrii.k@ghp.org. North Cascade Family Physicias, Mout Vero, WA Nestled betwee the beautiful North Cascade Moutais ad the Sa Jua Islads, North Cascade Family Physicias is located 70 miles south of Vacouver, BC ad 60 miles orth of Seattle. The Skagit Valley has some of Washigto s fiest agricultural lad ad hosts the aual Tulip Festival. Opportuities for outdoor recreatio are ulimited. We are lookig for a BC/BE family physicia with or without OB to joi our dyamic practice o a full time basis. Our cliic facility is very spacious ad icludes lab ad x-ray o site. We are self-owed ad maaged. Please sed your CV to Pam Putey, Cliic Admiistrator or Dr. David Beso at NCFP, 2116 East Sectio St, Mt Vero, WA 98274 or by email to plputey@cfp.et Is t it Time for Somethig Better? Group Health Permaete, the Northwest s premier multi specialty group, is curretly seekig a Certified Physicia Assistat to joi our experieced Urget Care team i Olympia, WA. Group Health is dedicated to providig comprehesive, iovative ad patiet-cetered care to commuities throughout Washigto. The ideal cadidate will have experiece i the Urget Care settig, a full rage of skills ad a iterest i workig with a iovative group practice We offer competitive salaries ad geerous beefits Flexible shifts ad the opportuity to work with a great team, makes this a opportuity worth explorig Olympia offers a uparallel mix of small tow feel ad urba etertaimet. Withi the city oe ca visit the brilliat fie arts ceter, die at a umber of fabulous restaurats or ejoy plety of shoppig. Here you will fid a low cost of livig, excellet schools, breathtakig moutai ad water views ad beautiful beaches. Olympia was rated #16 o Sperlig s 2007 Best Uited States Cities ad featured as oe of the 50 Fabulous Places to Raise Your Family. For additioal iformatio or to submit your CV please cotact Kelly Pedrii, GHP Recruiter, at 206/448-2947 or pedrii.k@ghp.org. Orcas Family Health Ceter Orcas Family Health Ceter located i Eastsoud o Orcas Islad, is lookig for a BC family physicia for a flexible, part time positio (2-3 days/week) to assist i the busy upcomig summer moths with possibility for permaet placemet. Orcas Family Health Ceter is a Rural Health Ceter servig all residets of Orcas Islad regardless of ability to pay. No hospital practice. Very low volume o call resposibilities. Salary, housig, travel ad malpractice provided. Cotact David C. Shistrom, M.D. at dshistrom@orcasfamilyhealthceter.org. Imagie Quality of medicie ad quality of life. Our state-of-the-art facilities ad atioally acclaimed programs ad services ot oly allow you to fulfill your potetial as a physicia, but also give your patiets access to the best care available. Providece Health & Services has BE/BC family medicie physicia opportuities i Washigto locatios that will ispire you! Cetralia Everett Olympia Spokae Walla Walla For iformatio, please cotact: Kristie McChesey Providece Health & Services 1-866-504-8178 psd@providece.org 20 Washigto Family Physicia

WASHINGTON ACADEMY OF FAMILY PHYSICIANS 1050 140th Aveue NE, Suite C Bellevue, WA 98005 PRSRT STD U.S. Postage PAID SIPRINT UPCOMING EVENTS Strategic Plaig Meetig Jue 26-28, 2009 Sucadia Resort, Cle Elum, WA Natioal Coferece of Family Medicie Residets & Studets (NCFMRS) July 29 - August 1, 2009 Bartle Hall, Kasas City, MO WAFP Board/Commissio/Task Force Meetig September 12, 2009 SeaTac, WA AAFP Cogress of Delegates Meetig October 12-14, 2009 Bosto, MA AAFP Scietific Assembly October 14-18, 2009 Bosto, MA Pick-a-Parter, Pick-a-Practice & Practice Maagemet Semiar (Hosted by Kig Couty Chapter of WAFP) October 2009 Bellevue, WA WAFP Aual Scietific Assembly 60th Aiversary Celebratio ad A.L.S.O. Course November 11-15, 2009 Sucadia Resort, Cle Elum, WA AAFP State Legislative Coferece November 20-21, 2009 Grad Hyatt, Seattle, WA WAFP Studet Residet Retreat Jauary, 2010 Locatio TBA WAFP Policy & Advocacy Leadership Istitute Jauary, 2010 Olympia, WA WAFP Board, Committees, Commissios, ad Task Force Meetigs February 13, 2010 SeaTac, WA Natioal Coferece of Special Costituecies (NCSC) April 29 - May 1, 2010 Sherato Overlad Park/AAFP Headquarters, Kasas City, MO Aual Leadership Forum (AFL) April 30 - May 1, 2010 Hyatt Regecy Crow Ceter, Kasas City, MO 53rd House of Delegates & 61st Aual Scietific Assembly May 12-15, 2010 Sucadia Resort, Cle Elum, WA