Inside this Issue: Oregon Academy of Family Physicians
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O VOL • XV • NO 1 • FALL 2020
Inside this Issue:
• ORCA-FM Presents a Unified Front at
AAFP’s National Conference
• The Lasting Impacts of COVID on Oregon
Health Care
• Anti-racism in Family Medicine:
Then, Now, and Going Forward
THE OFFICIAL MAGAZINE OF THE
OREGON ACADEMY OF FAMILY PHYSICIANS 1
MAKING HEALTH PRIMARY www.oafp.org
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2 OREGON ACADEMY OF FAMILY PHYSICIANS
O
VOL • XV • NO 1 • FALL 2020
Oregon Academy of Family Physicians
O
FAMILY PHYSICIANS OF
1717 NE 42nd St.
OREGON is published quarterly
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503.528.0961
Web site: www.oafp.org Academy of Family Physicians.
4 President’s Message FAMILY PHYSICIANS OF
OREGON reaches more than
6 Greetings from the OAFP
1,600 family physicians and
8 2020-2021 Board of Directors their professional associates.
12 Public Policy and Legislative Affairs Medical students and staff
at Oregon Health Sciences
14 ORCA-FM Presents a Unified Front at AAFP’s National Conference
University also receive
16 My Point of View the magazine. FAMILY
18 From the Hill PHYSICIANS OF OREGON
assumes no responsibility
20 Combatting COVID-19 Through Adaptability, Coordination, and
Strong Partnerships for the loss or damage to
contributed material. Any
24 Students Speak Out!
material accepted is subject
26 2020 OAFP Membership Directory to revision as necessary.
Materials published in FAMILY
PHYSICIANS OF OREGON
remain the property of the
journal. No material, or parts
thereof, may be reproduced or
used out of context without
prior, specific approval.
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EDITION 55
MAKING HEALTH PRIMARYwww.oafp.org 3
• PRESIDENT’S MESSAGE
DAVID ABDUN-NUR, MD, OAFP PRESIDENT
MOUNTAINVIEW FAMILY PRACTICE - FAMILY PHYSICIAN
Do you remember when you had to be fitted for an companies, and more recently, governments, but a lot
N95 mask? In the hospital you would put on a mask and is fueled by social media and propagation of conspiracy
they would cover your head with a special hood and spray theories. With a hope of a COVID vaccine on the horizon,
saccharin and if you could not smell it, the mask fit. I may be OAFP will work with our colleagues in the medical
dating myself a bit, but we would keep the size of our N95 on community to develop resources for you to share with
the back of our name tag so that we could get the right size patients to help them have confidence in what comes next.
if we were treating an active TB patient. I think I treated my Finally, this September has brought the worst fire
last active TB patient in the early 1980s during my residency season Oregon has seen. My neighboring communities
in Southern California, long before N95 masks existed; we of Phoenix and Talent have been destroyed, and smoke in
usually just put a surgical mask on the coughing patient. Oregon and has made breathing difficult, at best. It is just
Fast forward about twenty years, and I found my old N95 one more challenge for many of our patients, especially
mask very useful for doing yardwork. While working around a with lung problems. The upcoming virtual AAFP Congress
tree in the back yard and cutting branches down without it, I of Delegates has resolutions to try and address climate
inhaled dust/fungus from the branches, developing a cough change on a national level.
that lingered for two years. I definitely wear my N95 around The OAFP is adapting our education and programming
that tree. to the new reality, too. As we have announced via email,
Fast forward another fifteen years and now COVID has the Board made the difficult decision last month to cancel
arrived. I had pulled the N95 out of the drawer again to meet the in-person portion of the 2021 Annual Conference.
a new microbe, then in September, my neighboring cities of Though a vaccine may be here “in time” to protect our
Phoenix and Talent were leveled by a rapidly moving fire, and members, the risks of gathering physicians together is still
my N95 was on again to protect from the choking smoke. too great. As one Board member put it, “We’ll be getting
Who would have thought that this little face covering vaccines so we can care for people, not so that we can get
would be there to offer protection from so many dreadful together.” It is especially hard to miss gathering together
health challenges? Its versatility is like our specialty; flexing two years in a row, but OAFP staff and leaders are
to meet the ever-changing challenges to the health of our already working hard to determine how to offer valuable
patients. Like the mask, family medicine has been there to educational programming, and even opportunities to
protect our patients’ health. gather virtually for the sake of community.
Ever-changing challenges indeed! COVID 19 continues Meanwhile, COVID 19 has contributed to a lot of
to be a major burden for our practices. In addition to physician burnout and many practitioners have decided
actively working for relief for our members from the state, to leave or retire from medicine during this time. OAFP
OAFP has been working to identify and bridge the gaps has started a series of lunch time lectures for CME that
between public health, primary care, and community-based were intended for our spring conference in 2020. The first
organizations fighting COVID. Among the possibilities are was a talk on physician burnout and touched on how our
creating training materials for community health workers to broken health care payment system contributes to this.
better help at-risk patients understand the role of primary OAFP is intensifying our push for reducing complexity
care in treating COVID. through payment reform in the state of Oregon through
Another challenge is acceptance of vaccines. With the flu participation in legislative and rulemaking workgroups. Part
season approaching on top of the COVID pandemic, we have of avoiding burnout is keeping our mission as physicians in
a public that has become increasingly distrustful of vaccines. the forefront; meeting these ever-changing challenges we
Much of this comes from distrust of the pharmaceutical face is the mission.
4 OREGON ACADEMY OF FAMILY PHYSICIANS
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• GREETINGS FROM THE OAFP
BETSY BOYD-FLYNN, OAFP - EXECUTIVE DIRECTOR
Troubled times and smoky skies are on my mind as in the state’s shared vision of advanced primary care
I write this in early September. While the fires have not for all, yet the lack of connections among them have
yet subsided, we know primary care clinics are parts of made the state’s ability to respond to the particular
communities hit hard or even destroyed in the latest needs of the most vulnerable even harder. We know
wave of crisis to hit Oregon this year. that in communities where these sectors collaborate
The state has an enormous challenge ahead to chart more closely, interventions such as shared testing,
a path to economic recovery, and we are still in the midst simpler pathways to food and housing assistance, and
of a health emergency that seems to have hit a stubborn collaborative efforts on contact tracing can happen.
plateau. Oregon’s recovery will need legislators from both We are working to better understand the keys to that
parties who understand the issues faced by our members kind of collaboration, and the barriers that need to be
and their clinics. The budget crisis is sure to hit the OHA removed to enable it.
in some form; our contract lobbyist, Sam Barber, has Policy and Congress: Our AAFP Delegates and
more about this on p. 12. Alternates participated in a virtual Congress of
A critical flaw in our health care infrastructure Delegates this month; the modified format of the AAFP
has been made obvious to the public during this Congress meant that our Delegates could only carry
pandemic. The effort to manage the spread of disease two resolutions forward; we ensured co-sponsorship
has revealed the gap between public health, primary for key issues on two others. Our policy handbook is
care and community-based organizations that focus updated to reflect all the resolutions from 2020. Visit
on social supports. These components all have roles our website to check it out, and start making plans for
resolutions for 2021.
Payment reform: Evidence is mounting that
Update from the payment reform that moves away from fee-for-service
Commission on Education and favors alternative payment arrangements that
feature prospective payments have critical advantages,
The OAFP 2021 Annual Conference will be virtual. We particularly during the time of COVID.
are dedicated to bringing valuable CME and other CME Offerings: We’re making a virtue of necessity
opportunities to our incredible community of members, in these physically-distanced times and offering virtual
as safely as possible.
CME programs to members each month at no charge.
We are working to provide you with an outstanding We have also converted our KSA study hall to an online
educational event that will allow you to connect with event, scheduled for December 12, on hypertension. We
your peers in new ways, and make the conference are committed to bringing our members affordable or
accessible to even more of our members. Dates for the no-cost CME options in part because we know this year
conference are unchanged, so hold April 22-24 on your has brought financial strains to many of our members.
calendars and stay tuned!
We are here for you, we continue to work for you, and
Also, make sure to mark your calendars for March we are grateful for you.
10 and 11 for our 2021 Virtual Legislative Days. Stay safe, healthy and informed.
We’re planning to pair up with the Oregon Medical
Association and others for briefings from legislators
on the evening of March 10, and we’ll have virtual visits
with our Oregon representatives and senators the
following day.
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www.oafp.org 7
board of DIRECTORS 2 0 2 0 -2 0 2 1
President 2020 - 21 AAFP Delegate 2019-21
DAVID J. ABDUN-NUR, MD EVAN T. SAULINO, MD, PHD
Mountain View Family Practice Providence Medical Group – Southeast
(Grants Pass) (Portland)
Email: abdunnur@mvfp.com Email: evan_saulino@hotmail.com
Roles: Executive, External Affairs, Nominating Roles: External Affairs
President-Elect 2020 - 21 AAFP Alternate Delegate 2019-21
STEWART L. DECKER, MD (Dan) DANIEL K. PAULSON, MD
Sky Lakes Regional Medical Center Springfield Family Physicians, LLP
(Klamath Falls) (Springfield)
Email: stewart.decker@gmail.com Email: dpaulson@springfieldfam.com
Roles: Executive, External Affairs, PAC
Vice President 2020 - 21 AAFP Alternate Delegate 2019-21
NATHALIE J. JACQMOTTE, MD (Liz) ELIZABETH C. POWERS, MD, FAAFP
Northwest Primary Care – Sellwood Clinic Winding Waters Clinic
(Portland) (Enterprise)
Email: nathalie.jacqmotte@nwpc.com Email: drpowers@windingwatersclinic.org Roles:
Nominating
Immediate Past President 2020 - 21 OMA Trustee 2020-21
T. RUTH CHANG, MD, MPH, FAAFP ERIC M. WISER, MD, FAAFP
Northwest Permanente, PC OHSU Primary Care Clinic, Gabriel Park
(Portland) (Portland)
Email: drtrchang@gmail.com Email: wisere@ohsu.edu
Roles: Executive, Nominating Roles: Education, Executive, Nominating
Secretary 2020-21 Director 2020-23
JONATHAN L. VINSON, MD, FAAFP (Jane) JANE-FRANCES A. AKPAMGBO, MD
Providence Medical Group – Lloyd Center Kaiser Permanente – West Salem Medical Office
(Portland) (Salem)
Email: jonathan.vinson@providence.org Email: akpamgbojf@gmail.com
Roles: PAC Board
Treasurer 2019-22 Director 2020-23
MICHAEL D. GOODWIN, MD HEIDI M. BEERY, MD
Providence Medical Group – Bridgeport FM Umpqua Community Health Center
(Tigard) (Roseburg)
Email: michael.goodwin@providence.org Email: beeryh@live.com
Roles: Finance
Speaker of the Congress 2020-21 Director 2018-21
MELISSA A. HEMPHILL, MD, FAAFP EVA S. MCCARTHY, DO
Providence Medical Group – Southeast Sublimity Medical Clinic
(Portland) (Sublimity)
Email: melissa.hemphill@providence.org Email: e.s.sandberg@gmail.com
Roles: Equity Task Force, External Affairs Roles: Equity Task Force, Finance
Vice Speaker of the Congress 2020-21 Director 2019-22
CARRIE PIERCE, MD BHAVESH RAJANI, MD, MBA
Cascades East Family Medicine Residency PacificSource Community Solutions
(Klamath Falls) (Marion/Polk)
Email: incongruous@hotmail.com Email:
Roles: Education, Equity Task Force bhavesh.rajani@pacificsource.com
2020-23
AAFP Delegate 2019-21 Director
DANIEL J. SENGENBERGER, DO, FAAFP
GARY M. PLANT, MD, FAAFP La Clinica – West Medford Health Center
Madras Medical Group (Medford)
(Madras) Email: bowsplash@me.com
Email: gplant@madrasmedicalgroup.com Roles: External Affairs
8 OREGON ACADEMY OF FAMILY PHYSICIANS
Director 2020-23 Resident Director 2019-21
ANNE C. TOLEDO, MD BRITTANY WHITAKER, DO
Kaiser Permanente – Mt Talbert Medical Office Samaritan Family Medicine Residency
(Clackamas) (Corvallis)
Email: atoledo27@gmail.com Email: brwhitaker@samhealth.org
Roles: External Affairs
Resident Director 2019-21 Student Director 2020-22
MADELINE BIERLE, MD AUDREY TAYLOR
Providence Hood River Rural Residency COMP – Northwest
(Hood River) (Lebanon)
Email: madeline.bierle@providence.org Roles: Email: audrey.taylor@westernu.edu
ORCA-FM Policy Scholar
Resident Director – Alternate 2020-22 Student Director 2019-21
ANNIE M. BUCKMASTER, MD ALEXANDRA HOUCK, MPH
OHSU Portland Family Medicine Residency OHSU School of Medicine
(Portland) (Portland)
Email: buckmaan@ohsu.edu Email: brwhitaker@samhealth.org
Resident Director 2020-22 Family Medicine Faculty Liaison Ex-Officio
SEBASTIAN REEVE, MD JENNIFER E. DEVOE, MD, DPHIL, FAAFP
Providence Oregon Family Medicine Residency OHSU School of Medicine
(Milwaukie) (Portland)
Email: sebastian.reeve@providence.org Email: devoej@ohsu.edu
Resident Director – Alternate 2020-22 Family Medicine Faculty Liaison Ex-Officio
ENRIQUE RIDDLE, MD ROBYN DREIBELBIS, DO, FACOFP
Providence Hood River Rural Residency COMP-Northwest
(Hood River) (Lebanon)
Email: enrique.riddle@providence.org Email: rdreibelbis@westernu.edu
Resident Director 2020-22 ORCA-FM Liaison Ex-Officio
DANIEL SLOWEY, MD, JD JUSTIN E. OSBORN, MD
OHSU Portland Family Medicine Residency Providence Oregon FM Residency (Milwaukie)
(Portland) Email: justin.osborn@providence.org
Email: slowey@ohsu.edu Roles: ORCA-FM Steering
Resident Director – Alternate 2020-22 OAFP Lobbyist Staff
ASHLEY SPARKS, DO SAM BARBER
Roseburg Family Medicine Residency LobbyOregon
(Roseburg) (Salem)
Email: asparks@umpquachc.org Email: sam@lobbyoregon.com
Roles: Equity Task Force Roles: External Affairs
Resident Director 2020-22 Executive Director Staff
SIMRAN WALLER, MD, MPH (Betsy) ELIZABETH L. BOYD-FLYNN
Roseburg Family Medicine Residency Oregon Academy of Family Physicians
(Roseburg) (Portland)
Email: waller@umpquachc.org Email: bbf@oafp.org
Roles: ORCA-FM Policy Scholar, Equity Task Force Roles: All boards, committees, commissions, etc.
Program Director Staff
Resident Director – Alternate 2020-22 LOUISE E. MERRIGAN
(Nick) NICHOLAS B. WEST, MD Oregon Academy of Family Physicians
Cascades East Family Medicine Residency (Portland)
(Klamath Falls) Email: louisem@oafp.org
Email: wesni@ohsu.edu Roles: All boards, Equity Task Force
www.oafp.org 9
board of DIRECTORS 2 0 2 0 -2 0 2 1
COMMITTEES OHSU School of Medicine, Dept. of Family Medicine (Portland)
ORCA-FM LIAISON: (Bob) ROBERT W. GOBBO, MD, FAAFP
Providence Hood River Rural Residency Program (Hood River)
Bylaws Committee AMANDA L. RISSER, MD, MPH
Reviews and revises current bylaws at the request of the Board of Central City Concern (Portland)
Directors. Members are appointed as needed. JACQUELYN L. SERRANO, MD, MPH, FAAFP
PeaceHealth Medical Group – Siuslaw (Florence)
Executive Committee FAYZA I. SOHAIL, MD
Convened when an important decision must be made but there is Kaiser Permanente - Sunset Medical Office (Hillsboro)
no time to engage the entire board. ERIC M. WISER, MD, FAAFP
CHAIR: DAVID J. ABDUN-NUR, MD Commission on External Affairs
T. RUTH CHANG, MD, MPH, FAAFP Responsible for staying up to date on state and federal regulatory
STEWART L. DECKER, MD issues. Develop position papers, engage in coalition development
AT-LARGE BOARD MEMBER: ERIC M. WISER, MD, FAAFP and participation, and oversee the Key Contacts program.
Finance Committee CHAIR: STEWART L. DECKER, MD
Reviews monthly financial statements and prepares the annual LOBBYIST: SAM BARBER
budget. DAVID J. ABDUN-NUR, MD
BRIAN E. FRANK, MD
CHAIR: MICHAEL D. GOODWIN, MD OHSU Primary Care Clinic, Scappoose (Scappoose)
GABRIEL K. ANDEEN, MD, MPH ANTONIO M. GERMANN, MD, MPH
OHSU Primary Care Clinic, Scappoose (Scappoose) Yakima Valley Farm Workers Clinic - Salud Medical Center
EVA S. MCCARTHY, DO (Woodburn)
MELISSA A. HEMPHILL, MD, FAAFP
Nominating Committee STUDENT: ALEXANDRA HOUCK, MPH
Recruits and reports slate of candidates for future positions on OHSU School of Medicine, Dept. of Family Medicine (Portland)
boards, commissions, committees and task forces. MARCY G. LAKE, DO
Kaiser Permanente - Beaverton Medical Office (Beaverton)
CHAIR: DAVID J. ABDUN-NUR, MD JUSTIN LEE, MD
RUTH CHANG, MD, MPH, FAAFP OHSU Primary Care Clinic, Richmond (Portland)
LIZ POWERS, MD, FAAFP ROBYN A. LIU, MD, MPH, FAAFP
ERIC WISER, MD, FAAFP Kaiser Permanente – Interstate Medical Office East (Portland)
(Andy) ANDREW D. LUTHER, MD
TASK FORCES Grants Pass Clinic (Grants Pass)
GINA A. MARTIN, MD
Task Force on Equity and Inclusion Samaritan Family Medicine Resident Clinic (Lebanon)
Dedicated to promoting and advocating for equity and inclusion LEONA M. O’KEEFE, MD
within Oregon’s health care systems. Siskiyou Community Health Center (Grants Pass)
GLENN S. RODRIGUEZ, MD
MELINDA C. RUBERG, MD
CHAIR: EVA S. MCCARTHY, DO
MELISSA A. HEMPHILL, MD, FAAFP OHSU Primary Care Clinic, Richmond (Portland)
CARRIE PIERCE, MD MICHAEL Z. SALADIK, MD, MPH
ASHLEY SPARKS, DO Providence Medical Group – Lloyd Center (Portland)
SIMRAN WALLER, MD, MPH EVAN T. SAULINO, MD, PHD
DAN J. SENGENBERGER, DO, FAAFP
ANNE C. TOLEDO, MD
COMMISSIONS & BOARDS STUART M. ZELTZER, MD
Kaiser Permanente - Beaverton Medical Office (Beaverton)
Commission on Education
Develops the program for the annual conference, identifies faculty, Political Action Committee (PAC)
and provides additional programming for members. Board
Provides opportunity for individuals
CHAIR: CARRIE PIERCE, MD interested in the future of health
ORPRN LIAISON: NANCY C. ELDER, MD care and family medicine to come together to contribute to the
Oregon Rural Practice-based Research Network (Portland) support of issues that conform to OAFP’s dedicated principles.
TERESA A. EVERSON, MD, MPH, CPH
10 OREGON ACADEMY OF FAMILY PHYSICIANSCHAIR: JONATHAN L. VINSON, MD, FAAFP STEERING COMMITTEES
(Robbie) ROBERT D. LAW, MD
Lower Columbia Clinic (Astoria) Oregon Residency Collaborative
AT-LARGE MEMBER: ROBYN A. LIU, MD, MPH, FAAFP Alliance for Family Medicine
SECRETARY/TREASURER: MARK S. MEYERS, MD Network supporting the continued
Springfield Family Physicians, LLP (Springfield) excellence and development of
AT-LARGE MEMBER: MICHAEL Z. SALADIK, MD, MPH family medicine residencies in Oregon.
OAFP/Foundation Board CHAIR: JUSTIN E. OSBORN, MD
Mandated to make decisions JOHN E. EDWARDS, MD, MPH, FAAFP
relating to the finances, foundation Samaritan Family Medicine Residency Program (Corvallis)
programs, awards, and fundraising ADVISOR: ROGER D. GARVIN, MD, FAAFP
initiatives. The Foundation’s mission is investing in future family EDUCATION CHAIR: BOB W. GOBBO, MD, FAAFP
physicians to serve our Oregon communities. Providence Hood River Rural Residency Program (Hood River)
VICE CHAIR: JOYCE HOLLANDER-RODRIGUEZ, MD
CHAIR: GINA A. MARTIN, MD OHSU Cascades East Family Medicine Residency Program
(Rick) RICHARD W. MOBERLY, MD
(Klamath Falls)
OHSU School of Medicine, Dept. of Family Medicine (Portland) (Kay) MARY K. NORDLING, MD, FAAFP
TREASURER: (Alex) ALEXANDRA VERDIECK, MD, FAAFP OHSU-Tuality Family Medicine Residency Program (Hillsboro)
OHSU Primary Care Clinic, South Waterfront (Portland) JOE M. SKARIAH, DO, MPH, MBA
AMY L. WISER, MD, FAAFP
OHSU Portland Family Medicine Residency Program (Portland)
OHSU Primary Care Clinic, South Waterfront (Portland) (Chip) HARRY TAYLOR, III, MD, MPH, FAAFP
EXECUTIVE DIRECTOR: BETSY BOYD-FLYNN Roseburg Family Medicine Residency (Roseburg)
COORDINATOR: LOUISE E. MERRIGAN EXECUTIVE DIRECTOR: BETSY BOYD-FLYNN
PROGRAM DIRECTOR: LOUISE E. MERRIGAN
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www.oafp.org 11•PUBLIC POLICY AND LEGISLATIVE AFFAIRS
SAM BARBER, LOBBY OREGON - OAFP LOBBYIST
Despite a $4.5 billion budget gap expected in the document is a 10% Budget Reduction Scenario that
coming biennium, the Oregon Health Authority, in lays out some devastating cuts to the Oregon Health
their 3,724 page Agency Request Budget released in Plan and its members.
early September, has requested a $1.1 billion dollar
increase to its general fund appropriation. This Some of the most notable are:
roughly 25% increase would leverage significant % Reducing Medicaid inflation for managed care
federal dollars and help pay for a number of policy (CCOs) and the fee-for-service population from
objectives aimed at achieving the agency’s strategic 3.4% down to as little as 1%
plan to eliminate health inequity in Oregon over the % Eliminating coverage of up to 25 lines on the
next ten years. Prioritized List—vision services for adults and
children, certain mental health coverage, severe
These policy option packages include: skin conditions, common painful women’s
% $69 million for public health modernization health conditions, and gallbladder cancer are
% $5 million to scale up the universally offered home all within those 25 lines
visiting program passed in the 2019 session % Eliminating adult dental coverage or eliminating
% A new tax on beer, wine and cider to pay for coverage of certain services such as crowns
behavioral health services, including substance and dentures
use disorder prevention and treatment, as well
as $100 million to implement recommendations Complicating the budget outlook for the state
developed by the Governor’s Behavioral Health are the $2 per pack tobacco tax increase on the
Advisory Council November ballot and decreasing match rates from
% $200k to refine the details of a public option the federal government for Medicaid recipients. If
plan sometimes called “Medicaid buy-in” that ballot measure fails to pass, the state could
% $19.5 million to move the Insurance need to find hundreds of millions more in revenue to
Marketplace from the Department of Consumer pay for the Oregon Health Plan.
and Business Services to the OHA, to create Though these reductions are grim, at this point,
greater opportunities for aligned policy they are just a proposal. The Governor will consider
the agency’s budget in tandem with the other state
Given the steep decline in revenue caused by the agencies requests to develop her own proposed
pandemic, and potential changes to the make-up of budget. Ultimately though, the legislature has final
the House and Senate after the coming election, it is authority over the budget and may or may not take
unclear whether legislators will be looking to expand the Governor’s recommendations.
the OHA’s budget in the coming biennium.
More likely, the legislature will be looking at
difficult cuts, and the Agency Request Budget
provides a view into where the OHA might propose
making them if they had to. Included in the
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www.oafp.org 13JOYCE HOLLANDER-RODRIGUEZ, MD, OHSU CASCADES EAST FMR – PROGRAM DIRECTOR
“KAY” MARY K. NORDLING, MD, FAAFP, OHSU HILLSBORO FMR – PROGRAM DIRECTOR
JUSTIN OSBORN, MD, PROVIDENCE OREGON FMR – PROGRAM DIRECTOR
ORCA-FM Presents a Unified Front at
AAFP’s National Conference
Entering the future while using back to the Over 2200 medical students participated in the three-
future…technology day conference and were able to meet with faculty
On July 30, 31 and August 1, all of Oregon’s Family and residents from all over the country.
Medicine residencies participated in the AAFP’s first Our newest residency program’s Roseburg Family
ever virtual National Conference. Usually, we all Medicine Residency, which welcomed its first interns
go to Kansas City with a team of residents, faculty, this year, and OHSU Hillsboro Family Medicine
administrators and meet up with upwards of 600 other Residency, which will welcome its first class in
residency programs. This year, we scrambled to build Summer 2021, were both in attendance.
virtual booths utilizing business tradeshow templates. OHSU Hillsboro’s program’s faculty signed up for
Creative minds developed innovative work arounds two-hour slots over the three days of the conference
with more personalized imagery and used images of to meet with applicants and talk about the new
their actual team, rather than the limited cardboard program in Hillsboro. Because they had concerns
cut-out premade avatars. about an overload on the system, they had created
Medical students interested in Family Medicine a back-up online meeting to utilize in case the AAFP
even came preconference and left business cards system crashed. Since medical students were able
with contact information and brief blurbs stating their to leave virtual business cards at their residency
interest at each of our booths. When the National booth prior to the beginning of the virtual fair, they
Conference began, there was only the staccato of were able to outreach them via email and invite them
frozen video and darkness of crashing servers, along to meet faculty. This approach allowed for questions
with some words not worth repeating, as the whole and answers that were geared towards a larger group
process went down. rather than dedicating time for one on one meetings.
True to real life skills in flexibility and adaptability As a result, students were at their booth consistently,
were rapidly deployed. Many attendees and residency several of whom returned to ask more questions on
folks rapidly moved to back up systems including Days 2 and/or 3.
Zoom, Web X, Microsoft Teams and even telephones! Applicants and Residencies are both feeling
The first day was slower, but the attendees seemed anxious over recruiting in this new virtual world. Most
to have reviewed our web sites and actually seemed Family Medicine Residency Program Directors agree
better informed than some of the in-person meetings. that in person interviews allow applicants to get to
They also represented a more diverse applicant pool know us on a more personable level. Many of us have
than in prior years. By the last day, it seemed like we reviewed the University of Arizona’s Internal Medicine
were busier. Residency webinar https://youtu.be/yDMaYY9_r5g
Attendance was boosted this year as there was no on best practices for virtual interviewing. They have
need to purchase pricy airline tickets or hotel rooms. been doing hybrid virtual and in person interviews for
14 OREGON ACADEMY OF FAMILY PHYSICIANSthe past three years and were willing to share their expense due to not having to travel. How this will be
learned experiences. translated into program interest or even specialty
Lessons learned from this virtual National interest remains to be determined.
Conference: We hope this translates into more genuine
1) Have backup plans and then back that up and interest by applicants who may not have travelled to
repeat… interview in Oregon.
2) Practice processes before going live ORCA-FM (Oregon Residency Collaborative
3) Have patience and practice deep breathing Affiliation- Family Medicine has been very helpful
4) Applicants are as worried, if not more worried (actually Louise and Betsy, please accept our
than the programs appreciation) with figuring out how to improve our
5) Managing scheduling is lots of work and booths and then sharing how to navigate this virtual
there are programs such as Thalamus that world. Various faculty at many different programs
are designed to help with this process shared tips too.
ORCA- FM is planning on hosting a regional and
ERAS (Electronic Residency Application Service) beyond virtual pre-interview Oregon Family Medicine
opened to applicants on 9/1/2020 and instead of Residency Fair, so that interested applicants can
programs getting access at the usual time, it has meet and get to know all of us a little better as we
been pushed way out to 10/21/2020. Since that is begin to recruit the Class of 2024 (and hone our
about the time most programs begin or have begun processes too!)
interviewing; the schedule will be quite compressed. We are stronger together, particularly in these
The barriers to interviewing are lower due to less times of change.
YOU ARE THE CHAMPIONS
To our heroes on the frontlines of healthcare for what you are doing each and every day.
14109 Taylor Loop Rd. | Little Rock, AR | 501-221-9986 | pcipublishing.com
www.oafp.org 15• MY POINT OF VIEW
JOSEPH BADOLATO, DO, CPD, CHCQM
REGENCE BLUECROSS BLUESHIELD OF OREGON - EXECUTIVE MEDICAL DIRECTOR
The Lasting Impacts of COVID on Oregon
Health Care
What makes a worker “essential”? offerings and reimbursed appointments at parity
I’ve been thinking a lot about this question as with in-person visits. As a result, telehealth visits
we grapple with a pandemic that has no end date. I have increased by more than 5,000%. We’re also
certainly have a newfound appreciation for those who proactively reaching out to members with COVID-
grow our food, stock our grocery shelves, ensure our 19 as well as high-risk individuals to offer additional
municipal services can continue to operate safely and support, and providing food gift cards for members
efficiently, and for the teachers and daycare workers who are financially struggling.
who supervise and educate our children. As employers grapple with back-to-work
Amid the uncertainties and challenges of COVID- strategies, we’re offering educational webinars and
19, this pandemic has served as an affirmation of my other resources to help them navigate next steps.
choice to serve the medical profession alongside And we’re doing our part to help address social
all of you. The courage and resiliency that Oregon’s determinants of health in our communities. Together
health care workers have shown in caring for those in with our employees and corporate foundation, we’ve
need has been nothing short of remarkable. invested $10 million in philanthropic investments to
care for people affected by COVID-19.
Adapting how we serve Oregonians
As the state’s largest health insurer, Regence 2) Deeper provider collaboration
BlueCross BlueShield of Oregon thanks you for your
service, and for your partnership. Together, we’ve In addition to telehealth expansion, we’ve taken
adapted how we care for Oregonians. It hasn’t been action to expedite credentialing, accelerate provider
an easy transition, but I wanted to take this moment payments, and ease pre-authorization requirements
to share a few of the ways the pandemic has altered for specific services such as urgent and emergent
how we operate, changes that will have lasting transportation and ER visit that results in inpatient
impacts well beyond a COVID-19 vaccine. admission for COVID-19. By helping to eliminate
barriers for care, our hope is that you can focus on
1) Ensuring members and employers have tools what’s most important: your patients.
and support to navigate the pandemic “The COVID-19 pandemic has put significant
financial pressure on primary care practices, and
To ease members’ access to safe and quality care especially on independent medical groups,” said
beginning when the stay-at-home orders were put Craig Wright, former CMO and current consultant
in place, Regence expanded access to telehealth with The Portland Clinic. “Regence has proactively
16 OREGON ACADEMY OF FAMILY PHYSICIANSunderstood this and is partnering with these Moving forward with resiliency
practices to help them emerge stronger after the While our road is far from over, I take comfort
pandemic.” in knowing that Oregon has been a leader in
responsible, science-based action to confront
3) Encouraging our employees to take care of COVID-19. Your collective leadership and resolve is a
themselves, so they can take care of others big reason that we’ve remained ahead of the curve.
Thank you for all that you do to prioritize the well-
For many workers, our relationship to our employer being of Oregonians. We look forward to continuing
and physical workplace has changed dramatically to partner with you in this mission toward better
since early Spring. At Regence—where 99% of our health.
workforce is currently working from home—we
are striving to find the right balance of safety and Joe Badolato is an Executive Medical Director
efficiency while maintaining a culture that attracts at Regence. He can be reached at Joe.Badolato@
and retains top talent. This includes offering a regence.com.
number of new online wellness and mental health
resources such as myStrength to support employees
and keep them positively engaged. Earlier this
summer, we provided employees with an extra day off
to tend to family or simply take a mental wellness day.
And we’re offering free access to care.com to help
caregivers navigate child or elder care, or simply find
an extra hand to assist with home responsibilities.
Primary Care Physician Position
Primary Care Physician Position
Good Shepherd Community Clinic, Inc. Responsibilities and Duties
(GSCC), is looking for a primary care physician The Physician will be responsible for providing
with a passion and training in lifestyle medical care to patients at GSCC, and for the
medicine who will help patients adopt and quality of services rendered. The Physician
sustain healthy behaviors, address the needs of diagnoses and treats illnesses and injuries,
Full Plate Living helps your patients add more
the whole person through root cause analysis promotes preventive care and well-being. He/ whole plant-based foods to meals they’re
and focus on preventative health interventions. She collaborates with the Chief Medical Officer
The physician will be an integral part of a in development of health care plans and already eating. It’s a small step approach that
multi-disciplinary care team that includes health quality initiatives. The Physician will also provide can lead to big health outcomes.
coaches, social and community health workers, preceptorship opportunities for medical students
pharmacists, nurses and dentists. Good Shep- at GSCC.
herd is a Federally Qualified Health Center and Prescribe nutrition improvement
located in a Healthcare Provider Shortage Area, How to Apply
so qualified individuals could receive student Apply by sending a copy of your CV along with
programs for your patients by
loan reimbursement through the National Health a cover letter to traci@gsccardmore.com. directing them to fullplateliving.org
Service Corp.
Twenty 12th Ave. NW
Ardmore, OK 73401
www.buildinghealthypeople.org
www.oafp.org 17• FROM THE HILL
AMBER HOLLINGSWORTH, OHSU - COMMUNICATIONS PROGRAM SUPERVISOR
Anti-racism in Family Medicine:
Then, Now, and Going Forward
When George Floyd was killed by Minneapolis police Kent says, “but these can be difficult conversations for us.”
in May, it was one more brutal act of violence in the 400+ She describes the challenge of having to transition back
years of violence against Black people in America. But for to work after vulnerable and sometimes confrontational
the nation as a collective, it has proven to be a turning conversations. “I remember trying to work afterwards
point. People filled the streets in protest, and everyone thinking, ‘now I’m upset again.’”
– in every sector of society – was called upon to reflect Kael agrees: “Unlearning things takes a long time – it can
on their roles in perpetuating systemic racism. OHSU be really uncomfortable and messy, but that’s how we grow,
Family Medicine faculty, residents, students, staff, and the change, and evolve. This is going to be generations of work.”
department as a whole are responding to that call. He stresses the importance of listening to BIPOC voices.
Family Medicine began as a social justice movement in The department is trying to create space for those
the 1960s, so it’s no surprise our team members have long voices while not unduly burdening our BIPOC colleagues.
been at work combatting injustices and improving care For example, the Health Equity and Social Justice (HESJ)
for the underserved. But the events of the past year have group has been in place for four years, but this summer it
shown us how much more work is left to do, not only to changed how it holds its discussion events.
advance equity in our communities, but to create a more
anti-racist and welcoming culture for all staff and learners Health Equity and Social Justice Group
within the walls of health care. HESJ creates a space for discussing and learning about
For many of our Black, Indigenous, and people of color issues of equity and structural forms of oppression, in service
(BIPOC) colleagues, this sharpened focus on systemic of healing and building departmental community committed
racism has been complicated. They’ve been asked to to eliminating social injustices. Amanda Aninwene, MD, who
process their feelings alongside their white colleagues, recently completed her Family Medicine residency, is one of
help their white colleagues process theirs, and review the group’s founding members.
and propose solutions. Sometimes this happens in a “I was the only Black resident here for three years,”
supportive group, sometimes under a spotlight. Dr. Aninwene says. “My first year, there were all these
“I’m African American. I’ve been living with this my murders of unarmed Black men. I felt alone in my struggle
whole life,” says Kimilia Kent, PharmD at Family Medicine’s – watching this happen then coming into work and no one
Richmond Clinic. Dr. Kent and Kael Tarog, medical was talking about it.”
assistant and Filipino American, led an anti-racism That’s when Brian Park, MD, MPH, a second-year
conversation at the clinic in early June. resident at the time, invited colleagues to his house
“I’m happy people are showing up and listening,” Dr. to discuss how these events were impacting them
18 OREGON ACADEMY OF FAMILY PHYSICIANSand the communities they served. The group wanted systematically learn, integrate, and put practices into
to continue the conversation, and the Health Equity place around anti-racism and anti-sexism.”
and Social Justice group was formed. The residents
partnered with faculty members like Rebecca Cantone, Looking forward
MD, Rebekah Schiefer, MSW, LCSW, and Christina What’s been great – Drs. Aninwene, Nilsen, and Lee
Milano, MD, to elevate HESJ’s profile within the agree – is that their ideas have been well-received in the
department. Participation in events has grown, with an department. They see people doing the work across all
increase in support and commitment from department levels: learners, teachers, researchers, leaders, and staff.
leaders over the last several years. But what the murders of George Floyd, Breonna
HESJ has helped foster a shared language and Taylor, and Jacob Blake have so painfully reminded us is
understanding of structural racism, and is now using that addressing racism and oppression is not the work
racial caucusing for its gatherings: The caucus of white of a few passionate people – it is all of our work. Not only
attendees focuses on learning about whiteness and to learn about and act to eliminate the internalized and
privilege, while the POC caucus focuses on self-care interpersonal forms of racism we personally perpetuate,
practices and building communities of care. The goal but just as critically, the institutional and systemic forms
of this approach is to foster healing and braver spaces of racism we each perpetuate every day. The energy
for all to engage in honest, vulnerable dialogue and co- created by the recent murders of Black individuals must
learning, without causing harm to POC colleagues. move beyond words, emotions, and committees, and
translate into department- and university-wide policy
Integrating anti-oppression into learning change and action, particularly change “that shifts
Another recent Family Medicine residency grad, Brit power and holds people accountable,” Dr. Lee says.
Nilsen, MD, saw a need to bring anti-oppression topics Dr. Nilsen reminds us that “the evaluation of our
into regular learning. “All residents meet for weekly success isn’t that our providers are culturally competent.
lectures, but sometimes a lot of time would pass It’s that these known values of inequality – these known
between sessions on anti-oppression topics,” Dr. Nilsen health outcomes don’t exist anymore. If our patients are
says. So she, fellow resident Maria Palazeti, MD, and still suffering, it’s not the end of the work.”
Rebekah Schiefer organized spring and fall sessions on Many in Family Medicine have committed their
microaggressions and discrimination for all residents. careers to making health care equitable. But as the
“We modeled how it could be done twice a year, and recent disproportionate rates of COVID-19 across racial/
the department has already allocated time to these ethnic identities demonstrate: health care remains a
topics in next year’s residency schedule to really build largely inequitable system. Re-building toward a truly
it into the curriculum.” She suggests incorporating anti-racist health care system will require intentionally
discussions of inequalities into all lectures. “For unlearning the systemic practices that have been
example, if we’re talking about kidney disease, let’s socialized within us that (unknowingly) perpetuate
reframe the presumed ‘biological differences’ as results health inequities, and re-building a system that amplifies
of a racist system and history.” the voices of BIPOC and other communities most
On this same track, third-year resident Justin impacted by systems of oppression.
Lee, MD, has been working on bringing Structural For Dr. Aninwene, it’s essential that we earn the trust
Competency into Family Medicine resident training. of the Black community now. “I want our department,
He’s co-led the OHSU School of Medicine’s Structural our hospital to be a safe place for Black people to go in a
Competency course for medical students for the world that does not protect them.
past seven years – it explores the ways that social, “This is a call to action.”
economic, legal, and cultural structures impact health,
through issues such as immigration, gender, trauma, For more examples of anti-oppression work in the
substance abuse, and racism. department and info about OHSU Family Medicine’s new
“It’s a curriculum that’s both taught and Diversity, Equity, and Inclusion/Social Determinants of
experiential,” Dr. Lee says. “We’re working to Health fundraising campaign, see the full article at on
make Structural Competency a model for how we the OAFP website at: https://oafp.org/news/.
www.oafp.org 19Combatting COVID-19 Through Adaptability,
Coordination, and Strong Partnerships:
A Community Health Center Leads the Charge in the Columbia River Gorge
CATE HOTCHKISS
FREELANCE WRITER AND PHOTOGRAPHER
In the quiet of late winter in case reported on February 28 in the coming months as it navigated the
Hood River, Oregon, before the Washington County, about seventy COVID-19 crisis.
orchards began to bloom, One miles west of Hood River.
Community Health (OCH), a non- ”From that point, it became a race Financial Challenges
profit, federally qualified health to try and figure out how to continue One Community Health provides
center, buzzed with activity. to serve patients,” said Janasik, who whole-person, integrated primary
Max Janasik, OCH’s Chief had been monitoring the spread of care including physical, behavioral,
Executive Officer, and his staff the virus worldwide, and predicted a oral, and preventive health services
to people throughout the Mid-
Columbia Gorge region, regardless
of their ability to pay. It operates
two locations, in Hood River and
The Dalles, and also offers mobile
and school-based outreach.
When the pandemic shut down
most oral health care in April,
dental volume dropped by over
90%, representing about a third of
the clinic’s revenue. Overall, patient
volume decreased more than 20%
that month, despite the center’s
new telemedicine capacity and an
uptick in teletherapy visits.
“It was an all-hands-on-deck
effort to encourage patients to
try virtual care, and to emphasize
our behavioral telehealth services,
knowing that many of us were
struggling with the mental health
“Tiger Team” busy at work
impact from COVID-19,” Janasik
said.
had just ordered 1,000 COVID-19 similar outcome in the U.S. In May, telemedicine gained
test kits, along with boxes of extra By the time Governor Kate Brown traction, while OCH ramped up its
personal protective equipment issued an executive order on March 19 COVID-19 testing, having received
(PPE). He’d also assembled a tiger that temporarily barred all elective and its second significant supply of
team, a small group of employees, non-urgent health care procedures, test kits. By June, patient visits had
to fast-track the implementation of OCH had already, for a full week, surpassed pre-pandemic levels,
telemedicine, a project originally revamped its entire workflow and though operational revenues
slated to roll out over a six-month shifted to telehealth. The problem? declined by almost 50%. Why?
period. But by then, the coronavirus Patients hesitated to use it, just one of Depending on the insurer, OCH
had already hit Oregon, its first many barriers the clinic would face in often received little reimbursement
20 OREGON ACADEMY OF FAMILY PHYSICIANSserve vulnerable populations; and a Community Partnerships
loan from the Paycheck Protection While OCH has diverted resources
Program to retain full-staffing levels. and redirected its outreach from
combatting chronic disease to fighting
Testing and Outreach COVID-19, their model, in fact, hasn’t
To date, OCH has conducted changed, Dr. Serra said. The idea,
nearly 3,500 COVID-19 tests in Hood always, in rural health is to increase
River, Wasco, Skamania, and Klickitat access to high quality health care for
counties. Of those, the Hispanic all people, with a focus on vulnerable
population has tested positive at populations. As she explained,
more than three times the rate of strong community connections have
non-Hispanics, which mirrors trends always been a cornerstone of that
across the country. approach, and, during the coronavirus,
According to OCH Lead Physician those relationships have grown
Dr. Connie Serra, MD, a family even stronger, while new ones have
medicine provider at the clinic since emerged.
2001, the disproportionate rates For instance, Dr. Serra and Trish
Dr. Connie Serra and CEO Max Janasik
stem, in large part, from crowded Elliott, RN, the Hood River County
to administer a COVID-19 test, while it living conditions among migrant Health Department Director, now
absorbed additional pandemic-related farmworkers, and a reluctance to text each other daily, if not hourly, to
costs, such as acquiring PPE and get tested. Many workers fear losing coordinate the myriad tasks involved
testing supplies, as well as safety- and hours and income should they test in preventing the spread of the virus.
infection-control expenses. positive, and worry about the stigma “Connie made the mistake of
Plus, the clinic was spending, that sometimes surrounds the virus. giving me her cell phone number
out of pocket, up to $100 for labs “Once these disparities and one time,” said Elliott, who laughs
to process uninsured patients’ barriers became evident, we started easily despite the immense stress
tests, without any reimbursement. outreach right away in our more rural she’s now endured for months. She
Furthermore, some payers areas, offering weekly COVID-19
differentiated audio-video telehealth testing and education in a culturally
visits from audio-only sessions, and language-appropriate manner,”
and, oftentimes, bundled the latter Dr. Serra said.
with any other care the patient Few people attended their first
received within seven days. This event, held outside a school in the
practice decreased the number of Hood River valley. However, the
patient encounters that qualified for following week, once the word got
reimbursement and created a time- out, dozens showed up. That led to
consuming administrative burden for more requests by orchardists and
accounting staff. other area businesses for OCH’s
The good news? The clinic onsite services. To meet the growing
formed a cross-functional grants demand, the clinic established
team and has received multiple a 10-person team comprised of
short-term grants to maintain physicians, physician assistants,
staff and services, and preserve community health workers, and
patient access to care. Grants administrative staff to conduct
included funding from the Oregon COVID-19 outreach at locations
Health Authority for farmworker convenient for farmworkers, including
outreach; Health Resources and directly in the orchards. They also
Services Administration for general invited community partners to One Community Health’s Drive-Up Testing Site
operations; their local Coordinated provide food boxes, masks, and other
Care Organization, Pacific Source, to essential services. continued on page 22
www.oafp.org 21continued from page 21
explained that these open lines
of communication have played a
critical role in containing COVID-19
outbreaks.
The largest to date erupted in
late May at a fruit packing plant,
resulting in 64 positive cases
and affecting multiple counties,
according to the Oregon Health
Authority. When Elliott sounded
the alarm, OCH, along with two
other local family practice groups,
tested, over five days, more
than 400 of the packing house’s
employees, family members, and
other close contacts. At one point,
the health department’s contact-
tracing team was monitoring about
180 people per day in quarantine
or isolation, and collaborating
with OCH and other community
Rosa and Josie Luna
partners such as The Next Door,
Bridges to Health, and local food
banks to provide those in need Despite the adjustment of a system during construction, such
with food, medical supplies, and part-time income, Rosa has made as adding negative pressure rooms
separate lodging. the most of her new schedule. and air filtering technologies
Among those impacted by the “I’ve enjoyed spending more time to help reduce transmission of
outbreak were Rosa Luna, 62, and with my family, and walking along the virus. Plus, the building’s
her daughter, Josie Luna, 35. Rosa, the Hood River waterfront,” she spaciousness naturally promotes
who grew up in Michoacán, Mexico, said. Meanwhile, Josie has upped social distancing.
has sorted pears at the packing her overtime hours, some days Of course, the clinic’s survival,
house for 16 years. She lives in translating around the clock on the like other community health
the same household as Josie, a front lines of the pandemic. centers across the country,
full-time translator at OCH. While depends on sustainable
awaiting COVID-19 test results, New Space funding and staff retention. “If
they self-quarantined at home, At this writing, the OCH staff reimbursements don’t increase,
along with Josie’s father, for several has just moved into, over a single and short-term grants run out, we
days until they received their weekend, their new, beautiful, could have a major disruption in
results: fortunately all negative. modern 38,000 square-foot care at a time when community
Before reentering the workplace, building, replacing the cramped health centers are most needed,”
temperature checks, as well as face 29-year-old facility located next Janasik said. Other risks include
coverings were required, and which door in Hood River. On July 15, it ongoing supply-chain challenges
Rosa had already been wearing opened its doors to patients, a for PPE and COVID-19 test kits,
for months. These additional source of light amid the gloom and as well as the potential that the
safeguards supplemented those uncertainty of the pandemic. Governor could shut down all non-
initiated in February, such as The facility’s construction essential medical visits again.
barriers between fruit packers and began before 2020 ushered in the Janasik and his team are
sorters, and dedicated teams that coronavirus, but OCH was able preparing, to the best of their
alternated work weeks. to make changes to the HVAC ability, for these eventualities and
22 OREGON ACADEMY OF FAMILY PHYSICIANSYou can also read
