YOUR 2012 PRESIDENT: Gregg Mitchell, M.D., Jackson with his wife, Amy, and children LtoR, James, Lilly, Clark
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YOUR 2012 PRESIDENT:
Gregg Mitchell, M.D., Jackson
with his wife, Amy, and children
Doctor Mitchell being sworn into office by
LtoR, James, Lilly, Clark Glen Stream, M.D., 2012 AAFP President
Call for nominees for 2012 Family Physician of the Year Award and John S. Derryberry M.D. Distinguished Service Award
see page 9
Mark your calendar to attend the 2012 Tennessee AFP Practice Enhancement Seminar on Saturday, March 17,
and the Tennessee Tar Wars State Poster Contest on Sunday, March 18
Paid advertisement
Medical Advances
Evidence-Based Standards of Care
Neoadjuvant Chemotherapy in Early Stage Breast Cancer
By: Vandana G. Abramson, M.D., Assistant Professor of Medicine
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University
Breast cancer is the most common cancer among women in the Herceptin is a monoclonal antibody to HER2 and lapatinib is a small
United States with over 200,000 new cases diagnosed each year. molecule tyrosine kinase inhibitor of HER2 and EGFR (epidermal
Most breast cancers present in the early stage and are treated with growth factor receptor). Neither is a cytotoxic chemotherapy. After
surgery and, when appropriate, radiation therapy, endocrine therapy, 12 weeks on therapy, 28% of the patients were found to have a
and/or chemotherapy. Chemotherapy is generally administered for pathologic complete response. Although all patients on study were
patients with tumors at a higher risk of systemic recurrence including offered a standard four to five month-long chemotherapy regimen
larger size, lymph node involvement, HER2 overexpression, and lack for HER2 positive disease after surgery, the hope is that we will
of estrogen/progesterone/HER2 positivity (triple negative tumors). be able to omit chemotherapy for a subset of these patients in the
Chemotherapy is most often administered after surgery, in the future--perhaps those who attain a pathologic complete response.
adjuvant setting. However, for patients with larger tumors, tumors Currently, Vanderbilt has an ongoing clinical trial of cisplatin
which are fixed to the chest wall, or those with clinically matted and paclitaxel with or without everolimus, an mTOR inhibitor (see
lymph nodes or skin involvement, the neoadjuvant approach to figure), for patients with triple negative breast cancer. Preclinical
chemotherapy is often used. In the neoadjuvant setting, patients data has shown that cisplatin and everolimus modulate the p53/p73/
receive chemotherapy prior to surgery to decrease the size of the p63 pathway which is important
tumor to make it more amenable to surgery. Another common reason in ensuring that cancer cells
to give chemotherapy prior to surgery is to allow for a lumpectomy appropriately undergo apoptosis.
rather than a mastectomy in a patient who prefers a lumpectomy Biopsies collected during
but in whom such a surgery would not be feasible due to tumor size various timepoints of treatment
relative to her breast size. will inform correlative studies to
As chemotherapy in the early stage setting is usually given for validate the rationale and to help
three to six months and leads to numerous toxicities, some of which guide future treatments. Another
may be long-term, neoadjuvant chemotherapy also provides an neoadjuvant study for estrogen
excellent opportunity to observe whether a particular regimen is receptor positive tumors using
actually beneficial. When chemotherapy is given in the adjuvant endocrine therapy in combination
setting, no “marker” is available to determine whether a treatment with a PI3K inhibitor (see figure)
is eradicating micrometastatic disease; neoadjuvant administration is expected to open later this year.
allows the primary breast mass to function as this marker. If the Patients receiving any type of
primary breast tumor responds to neoadjuvant chemotherapy, any neoadjuvant chemotherapy who
systemic micrometastases are also presumably sensitive to the same have residual disease with high risk
chemotherapy. If the primary tumor starts growing while a patient is features at the time of surgery may
receiving neoadjuvant chemotherapy, the treatment can be changed also qualify for clinical trials offering
to a regimen which could be more effective in targeting both the extended or alternate treatments Figure 1:
primary mass and any micrometastases. Furthermore, neoadjuvant after surgery. The PI3K/mTOR pathway
chemotherapy allows patients time to undergo genetic testing if there Despite the many benefits is being targeted in
is a suspicion for an underlying BRCA 1/2 mutation. If found to of neoadjuvant treatment, it neoadjuvant studies for
carry a BRCA 1/2 mutation, patients may consider a mastectomy or is important to realize that it is not
breast cancer
even a bilateral mastectomy rather than a lumpectomy. recommended for all patients with
From a research perspective, one of the more compelling reasons early stage disease. The most important and difficult aspect of the
for administering neoadjuvant treatment is the ability to obtain treatment of breast cancer is weighing the risk/benefit ratio carefully.
biopsies before and after treatment to better understand the true Most drugs available for breast cancer treatment carry the risk
targets of the study drug. Whether a study drug will be beneficial of substantial toxicities, and if there is a possibility that surgery could
will be evident quickly by observing whether a tumor is shrinking downstage a patient so that they would not need the therapy in
from week to week. After neoadjuvant treatment, the amount of question, it is prudent to proceed with surgical resection first. This
disease remaining in the breast at the time of surgery can serve as especially comes into play with estrogen receptor positive tumors
a prognostic indicator of likelihood of recurrence of disease. The which do not have involvement of the lymph nodes. Depending on
prognosis for triple negative tumors, which are particularly aggressive the pathological features of these tumors, many (even those greater
and have high rates of systemic recurrence, is markedly improved than 2 cm) can be treated with endocrine therapy alone.
if a patient is found to have no evidence of disease (pathological Neoadjuvant treatment for early stage breast cancer offers patients
complete response) at the time of surgery after neoadjuvant a unique opportunity to follow the effectiveness of a therapy
treatment. Information regarding the amount of residual disease and to potentially expand surgical resection options. Any patient
can also be useful in guiding treatment after surgery, in the adjuvant with a palpable tumor should be referred to medical oncology for
setting. consideration of neoadjuvant therapy. Research studies in the
A recent clinical trial in which Vanderbilt was a major contributor neoadjuvant setting are appealing because patients are able to receive
involved patients with HER2 overexpressing breast cancers which cutting-edge therapies which are often based on rational molecular
were greater than 3 cm in size. Patients were administered two targets, and correlative tissue studies can help verify the effects of
agents which target HER2 in different ways, herceptin and lapatinib. these drugs in the tumor.
All source data for this article has been provided by
2 Tennessee academy of family physicians
TENNESSEE
TENNESSEE ACADEMY
OF FAMILY PHYSICIANS
FA M I LY PH YSICI A N
An official publication of the Tennessee Academy of Family physicians
Tennessee Academy of Family Physicians
Winter 2011
500 Wilson Pike Circle, Suite 212,
Brentwood, TN 37027 Vol. 4 Number 4
CO-EDITORS
Michael Hartsell, M.D.
Greeneville
Kim Howerton, M.D.
Jackson
Sherry L. Robbins, M.D.
Knoxville
OFFICERS
President:
Gregg Mitchell, M.D.
President-Elect:
B. Alan Wallstedt, M.D.
Vice President:
Beth Anne Fox, M.D.
Secretary-Treasurer:
Kim Howerton, M.D.
4
Immediate Past President:
R. Wesley Dean, M.D.
.President’s Corner
Speaker of the Congress:
5
Lang Smith, M.D.
Vice Speaker of the Congress:
Editorial
Ty Webb, M.D. Wanted - Family Medicine Cheerleaders
6
Delegates to the AAFP:
Charles Ball, M.D.
Timothy Linder, M.D.
TNAFP 2011 “Family Physician
Of The Year”
Alternate Delegates to the AAFP:
10
Lee Carter, M.D.
T. Scott Holder, M.D.
2012 Tennessee Tar Wars Poster Contest
Executive Director/ Dates Set & Volunteer Teachers Needed
12
Managing Editor:
Cathy Dyer
Your 2012 Tennessee AFP
Please send address changes to: Officers & Board of Directors
Tennessee Academy of Family Physicians
13
500 Wilson Pike Circle, Suite 212
Brentwood, TN 37027
Leaders on the Move
16
For Advertising Information
Deborah Merritt
dmerritt@pcipublishing.com Highlights of 2011 Tennessee AFP
501.221.9986 or 800.561.4686
Annual Assembly
Created By:
19
Publishing Concepts, Inc.
Virginia Robertson, Publisher
vrobertson@pcipublishing.com
THANK YOU to our 2011
Publishing Concepts, Inc.
14109 Taylor Loop Road
Annual Assembly Supporters & Exhibitors!
EDITION 15 Little Rock, AR 72223
Tennessee Academy of family physicians 3
PRESIDENT’S CORNER
What a great time to be a on the AAFP’s Commission on Continuing Professional
Family Medicine physician! Can Development, will serve as 2012 Chair of the AAFP
you remember a time when Family Subcommittee on Annual Scientific Program.
Medicine was featured in the media The Tennessee AFP continues to be a great
as much as now? We are not only at organization for family physicians in Tennessee but we
the table of healthcare reform, we are must continue to look for ways to improve our services
leading the discussions. We are telling to our members. We will be asking members to serve on
our patients’ stories and we are telling newly formed committees to investigate different ways
Family Medicine’s story. Family
to reach our members. We are looking at different social
Medicine has been and will continue
media services to see if we can distribute information to
to be patient centered medical homes.
our members in a secure and informative manner. If you
We care for our patients in the office,
are interested in serving this year then please let us know.
hospital, emergency room and the
Our Practice Enhancement Seminar will be held on
nursing home. We should be proud
of what our specialty has become but we must not be March 17 at the Embassy Suites Cool Springs in Franklin
complacent. We have many areas to improve our skills and will be an excellent opportunity to improve your
and talents for our medical care to our patients and the knowledge and skill for your practice. The seminar will
community. also be helpful to network with other Family Medicine
I am honored to become the President of the Tennessee physicians who are involved in making improvements in
Academy of Family Physicians for 2012 and to serve their practices to become medical homes for our patients
our Tennessee Academy for the improvement of our and to meet the standards for meaningful use.
profession. I have been blessed to learn from other I would like to encourage our members to become
great family physicians in the same position over the last more involved in graduate medical education across
several years. I would like to thank Doctor Wes Dean for the state. Medical students are deeply influenced by
all of his hard work and effort for a great year. I would the experience that is provided by the Family Medicine
also like to thank everyone who has become involved in physicians across the state. We need more involvement
the Tennessee AFP either locally or on the state level. from clinical instructors to provide the best possible
We are amidst some of the biggest changes in Family education for these young students. Please consider
Medicine that we have seen in the last several years. We mentoring a student or resident for a TAR WARS
must work to strengthen our position both politically
presentation at one of your local schools. Our
and medically. If you have not donated to the AAFP’s
Tennessee Academy of Family Physicians will continue
FamMedPAC then I would urge you to consider doing
to be strong and grow as long as we have members that
so at this time. Our national PAC has helped bring
care about nurturing and mentoring these physicians and
Family Medicine to the forefront of many discussions
future physicians who will become the leaders of our
about our healthcare systems and hopefully we will see
an improvement in reimbursement for our services we state and society.
provide for patients. We will need help at the national I anticipate 2012 will be a great year for our
level this coming year in the campaign for Doctor Reid organization and I look forward to working with you on
Blackwelder for AAFP President-Elect. Reid has been these many issues that will define the future of Family
an outstanding leader in Tennessee and on a national Medicine physicians.
level. Please consider attending the AAFP Annual
Scientific Assembly in Philadelphia in October 2012. Gregg Mitchell, M.D., Jackson
On a side note, our own Doctor Lee Carter who serves 2012 Tennessee AFP President
4 Tennessee academy of family physicians
EDITORIAL
WANTED:
Family Medicine
Cheerleaders
I entered medical school knowing between medical student debt in the medical reform! There is so much to be
I wanted to do Family Medicine. My setting of primary care’s relatively low excited about!
experiences in the first two years of my reimbursement rate; they lament the My call to action is this: Medical
medical education confirmed my choice. paperwork and the struggles with insur- students need YOU to be cheerleaders
I am so excited about my future career ance companies; they lament the long for Family Medicine and for primary
in Family Medicine! I am excited about work hours and lack of respect from their care! We want to hear why you love your
serving in the capacity of a primary care specialist colleagues. career!
physician, treating the whole person, pre- Finally, these same dissenters conclude *We want to hear how rewarding it is!
venting major illnesses, serving a leader- their laments with a cry that medi- *We want to hear about how you’re
ship role in my community, and getting to cal students are NOT choosing careers able to prevent major illnesses and un-
know my patients and their families! in Family Medicine or primary care. I necessary hospitalizations!
But every step along the way I feel like WONDER WHY!? *We want to hear about the diverse
someone has been trying to convince me Unfair reimbursement, medical student range of opportunities and practice types!
otherwise. At first I thought it was be- debt, struggles with insurance companies, *We want to hear about how Family
cause I was at Vanderbilt, a traditionally the hassle of paperwork, and long work Medicine is actually a “lifestyle” specialty
specialty-focused medical school. Then I hours are challenges that are not unique because no one values family and work-
thought it might be private school-public to Family Medicine or primary care. life balance more than Family Medicine
school dichotomy. I even thought it might These are issues with which all medical physicians!
be the geographical bias of the Eastern specialties contend. In fact, one of the *We want to hear that there is a happy
United States. Then, I noticed that even many reasons I am choosing a career in place in Family Medicine waiting for us if
national organizations were lamenting Family Medicine is because it will offer we choose that pathway!
the challenges of Family Medicine and more opportunities to overcome these Yes, there are challenges, but there
primary care. I started to get confused. common obstacles. For instance, many are challenges to every career path. And
I had come across great role models for state and national organizations offer if you spend all of your time focused
Family Medicine who were excited about scholarships and loan repayment to stu- on the negatives then that is all we—as
their respective careers ranging from rural dents and physicians serving in a primary students—are going to hear about. So
primary care to academic medicine and care capacity! The diverse working envi- please, put down your picket signs pro-
research to outpatient care to full spec- ronments and career paths within Family testing medical students choosing other
trum procedure-based practices. Medicine allow new physicians to tailor specialties and pick up your pom-poms
For every Family Medicine physician their practice to suit their interests and to celebrate how great a career in Family
I meet celebrating his/her career, I meet desires for work-life balance! Progres- Medicine can be!
equally many who instead choose to sive work with Patient-Centered Medical
focus on the challenges and downsides to Home models and electronic medical Jessica Cornett, Nashville
Family Medicine. These in-house dissent- records are putting Family Medicine at Medical Student
ers are quick to outline the discrepancy the forefront of medical technology and Vanderbilt University School of Medicine
Tennessee Academy of family physicians 5
EDITORIAL NOTE
Jessica Cornett’s ‘Editorial’ takes me Medical students clearly see that we are stressed. They also see
back to those turbulent and exciting days family medicine as an exciting, vibrant, and vital specialty. They
of the late 60’s and early 70’s. A new recognize that medical schools do not champion generalists and that
wave of medical students arrived fired survival means banding together. Training in the tertiary medical
fresh from the crucible of an unpopular centers of the 1970’s was a brutal experience with few champions
foreign war and our civil rights conflicts of the primary care pathway. We banded together and pooled our
at home. For the first time in 1969, common desire to survive - we even infected the parent organization
“Family Practice” was an option in
to see the vision. The old NCFPR and NCSAM were formed and have
residency training. We answered the call
become the national filling stations for hundreds of our peers. Their
to be ‘generalists’ and not ‘partialists.’
annual gathering is still brimming with the energy and enthusiasm
We soaked up every rotation like it was our own – because we knew
of the “future of family medicine.” These organizations are now the
we would need every skill we learned. Role models were scarce but
proving grounds for student and resident leaders for the AAFP Board
generally good. The spirit of the day was an infectious energy of
of Directors.
enthusiasm – We were going to be “family practice” physicians.
The parallel from 1970’s to the present informs us that cohorts
Jessica’s words are a fitting Editorial for physicians and medical
students alike. We need to hear that our attitude matters. I dislike the need to band together. Students need Family Medicine Interest Groups
hassles of oversight, third party intervention and payment that falls short (FMIG). They need practice preceptors. For our part, we need to take
of my expectations. But at the end of the day, my glass remains filled a deep breath and visualize our glass being at least half full and never,
with abundant relationships to families I serve, the consultants I rely on no never, discourage a medical student about family medicine.
and my primary care colleagues in communities across Tennessee. The
latter impression must be conveyed to the medical students we see, not Michael Hartsell, M.D., Greeneville
the aggravations and anxieties that gnaw at us daily. Co-Editor
TNAFP 2011
“FAMILY PHYSICIAN OF THE YEAR”
Doreen Feldhouse, M.D., Dyersburg
The Tennessee Academy of Family patients in Dyersburg including hospital care, pediatrics, obstetrics
Physicians’ Family Physician of the Year and geriatrics.
Award is bestowed upon an individual She has been a dedicated Tennessee AFP Board member, contrib-
who exemplifies the ideal Family Physi- uting her wisdom and experience to issues faced by our Academy
cian and who has made an outstanding these past years.
contribution to Family Medicine, and to She is a leader, a teacher and visionary in the realm of family medi-
the advancement of health and/or medi- cine. She has a strong commitment to
cal training and medical education. This her community and is genuinely car-
year’s recipient meets all of these criteria ing, having fostered great respect.
with dignity and outstanding commit- Congratulations to Doctor Doreen
ment to Family Medicine in Tennessee. Feldhouse of Dyersburg upon receiv-
Doctor Doreen Feldhouse has served ing the Tennessee AFP’s 2011 Family
the patients of Dyersburg for seventeen Physician of the Year Award. She is
years. Prior to that she provided care in a federally funded rural the true example of the compassion
health clinic in Florida. She provides the full range of care to her and caring of family physicians.
6 Tennessee academy of family physicians
TNAFP 2011 “JOHN S. DERRYBERRY M.D.
DISTINGUISHED SERVICE AWARD”
Dianne Hall
The Tennessee Academy of Family has played a pivotal role as the nurse at the
Physicians’ John S. Derryberry M.D. Legislature in welcoming Tennessee AFP
Distinguished Service Award is presented members serving as Doctor of the Day each
to an individual, or individuals, whom
Tuesday, and in her diligence introducing our
the Tennessee AFP feels has demonstrated
members to state legislators and their staff.
exemplary leadership and character along
Dianne has helped further the image and
with outstanding and distinguished service
to the Family Physicians in Tennessee. The importance of family physicians in the State
award is named in honor of the late John S. of Tennessee through her personal advocacy
Derryberry, M.D., Shelbyville, who served and support of our members and Academy.
the Tennessee and American Academy of She has helped to improve the statue of
Family Physicians with honor and distinction Family Physicians with the Tennessee State
from 1964 until his passing in 1998.
Legislature by being one of our strong
Ms. Dianne Hall started as the nurse
proponents.
at the Tennessee Legislature in 1998. Her
Congratulations and best wishes to
tireless efforts in health care at the Legislature Dianne has been an absolute friend
have been of great benefit not just to the and supporter of the Tennessee Academy Dianne Hall upon receiving the Tennessee
Tennessee Academy of Family Physicians but of Family Physicians in efforts to improve AFP’s 2011 John S. Derryberry M.D.
to our patients as well. the health of the citizens of Tennessee. She Distinguished Service Award!
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Tennessee Academy of family physicians 7
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8 Tennessee academy of family physicians
IT’S NEVER TOO EARLY TO START
THINKING ABOUT NOMINEES
FOR THE 2012 TENNESSEE
ACADEMY OF FAMILY PHYSICIANS’
“Family Physician of the Year Award”
and “John S. Derryberry M.D.
Fammedpac
Distinguished Service Award” puts you at the
Deadline for Nominations for both
Awards will be June 1, 2012.
‘Distinguished Service Award’ was
renamed the ‘John S. Derryberry, M.D.
table when
Contact the Tennessee AFP office for
Distinguished Service Award’ in honor
of the late John S. Derryberry, M.D.,
healthcare
a nomination packet with forms for
both awards.
Shelbyville, who served the TAFP and
AAFP with honor and distinction from
1964 until his passing in 1998. Doctor
deciSionS are made.
FAMILY PHYSICIAN OF Derryberry served as President of the
American AFP in 1979.
THE YEAR NOMINATIONS:
Any member in good standing of the
Nominations received should be for
Tennessee AFP who has made an
persons who deserve recognition
outstanding contribution to Family
of their outstanding service or
Medicine, to the advancement of
contribution to the advancement of
health and/or medical training and
Family Medicine, to the Tennessee
medical education is eligible for
Academy of Family Physicians, or
nomination for this Award.
to the public welfare on Family
Nominations can only be made by
members-in-good-standing of the
Medicine’s behalf, whether of a civic,
scientific, or special service nature. Support candidateS
Tennessee Academy.
Nominees are NOT required to
be members of the Tennessee who support you.
The following support data is Academy of Family Physicians.
Support FamMedPAC. FamMedPAC is the political
required in addition to a Any member of the Tennessee AFP
in good standing may nominate a action committee of the American Academy of Family
completed Nomination Form for
each nominee: possible recipient for this Award for Physicians. It is the financial vehicle through which you
1. Updated curriculum-vitae consideration by the Tennessee AFP can support the election or reelection of candidates
2. Current photograph of the Board of Directors. who share your commitment to family medicine. Now
nominee, in its third year, FamMedPAC strengthens AAFP’s ad-
3. Up to five (5) pages of additional The following support data is
required in addition to a vocacy efforts and our presence in Washington. And
support documentation such as
personal letters or testimonials. completed Nomination Form for it needs your support.
All nominees MUST be a current each nominee:
member in good standing of the 1. A detailed statement of the
Tennessee Academy of Family scientific, cultural, or special Contribute now at www.FamMedPAC.org.
Physicians. service justification for the
nomination.
2. Biographical information on the
JOHN S. DERRYBERRY M.D.
nominee to include a recent black
DISTINGUISHED SERVICE and white photograph.
AWARD NOMINATIONS: 3. Education and training of nominee.
The Tennessee Academy of Family 4. Professional history, contributions
Physicians’ ‘Distinguished Service to Family Medicine, special
Award’ was established to recognize appointments.
outstanding and distinguished service 5. Substantial evidence of merit
by a physician or by a non-physician including printed material,
demonstrating exemplary leadership, publications, articles, or other
character, and/or dedication to citations or relevant supporting
community involvement. In 1998 the documents.
Tennessee Academy of family physicians 9
2012 Tennessee Tar Wars Poster Contest
Dates Set & Volunteer Teachers Needed
The Tennessee Tar Wars program announces the 2012 Tennessee
Tar Wars Poster Contest to be held on Sunday, March 18, at 2:00
p.m., at the Cool Springs Embassy Suites, Franklin, Tennessee.
The first place winning student, and one parent or guardian, of
the Tennessee Tar Wars Poster Contest will receive a trip to the
National Tar Wars Poster Contest in Washington D.C. in July of
2012.
If you have posters to submit, please note posters must be received
by the Tennessee AFP office by February 14, 2012, and also note
the requirements below for submission of posters to the Tennessee
State Poster Contest:
• Only 4th and 5th grade students who have had the Tar
Wars presentation are eligible to submit posters for the
contest.
• All poster entries must have a completed ‘School Poster
Entry Form’ and a completed ‘Authorized Release Form’
submitted with each poster entry. No poster will be
accepted without both forms completed. Note: Do NOT
staple, glue or tape entry forms to the backs of posters.
• All posters must incorporate creative and original artwork
and ideas. Depictions of cartoon, video games and movie/
television characters; celebrities; movie themes; past poster
designs – does NOT constitute creativity and originality.
• Posters must deliver a clear and positive message about
being tobacco-free. Death themes and art displaying
negative health consequences – cigarettes, ashtrays,
coffins, people smoking, etc. – are NOT considered
positive messages and will NOT be accepted (*A small no
smoking symbol is acceptable).
• Computer clip art, pictures from magazines and other
print media or any other copyrighted brand or product
images will NOT be accepted.
• All posters submitted for the Tennessee State Tar Wars
Poster Contest will NOT be returned.
• All poster entries, with completed ‘Entry Form’ and
‘Release Form’ must be received by the Tennessee Tar
Wars program by February 14, 2012 for inclusion in the
Tennessee State Poster Contest.
• You are requested to submit no more than one poster per
school.
If you are interested in teaching Tar Wars in your local 4th and/or
5th grade classrooms, please contact the TNAFP office in Nashville
to receive a printed hard copy of the 2011-2012 Tennessee Tar
Wars Teaching Guide (or, you can print a copy from the TNAFP
website at: www.tnafp.org). It takes approximately one hour to
teach one Tar Wars class. Please consider providing this service to
one or more of your local 4th and 5th grade classrooms.
10 Tennessee academy of family physiciansTennessee Tar Wars Lapel Pins
Order your pin(s) now to support the Support your Tennessee AFP Foundation and the Tennessee Tar Wars
Tar Wars program in Tennessee! program!!! The Tennessee AFP Foundation is offering Tennessee Tar Wars
Did you know that Tennessee ranks 46th among the states in the lapel pins at $20.00 each to raise funds in support of the Tar Wars program
prevalence of cigarette smoking among adults with 23.1% of the adult in Tennessee. Buy one for yourself and another for a friend. Spread the
population (aged 18+ years) — over 1,095,000 individuals — being current message that we are at War on Tar for under $50! The Foundation will keep
cigarette smokers in Tennessee. Across all states, the prevalence of cigarette supporting the programs that teach kids that smoking is not cool, robs them
smoking among adults ranges from 9.3% to 26.5%. of money, and threatens their health. Make a difference for Tennessee kids.
Did you know that 20.9% of high school students in Tennessee smoke? Complete the order form below and mail with your check made to the
In Tennessee, 13% of youth aged 12 to 17 years smoked a cigarette in the Tennessee AFP Foundation in the amount of $20.00 (includes postal mailing
past month. The range across all states is 6.5% to 15.9%. Tennessee ranks costs) to: Tennessee AFP Foundation, 500 Wilson Pike Circle, Suite 212,
47th among the states. Brentwood, TN 37027.
Please Print All Information Clearly
Name:____________________________________________________ Mailing Address:_____________________________________________________
________________________________________________________________________________________________________________________________
Phone Number (in case we have questions):_____________________________________________________
Email Address (in case we have questions): ____________________________________________________
Number of Tennessee Tar Wars Lapel Pins at $20.00 each ___________
Return with your check made to the Tennessee AFP Foundation with the order form above to:
Tennessee AFP Foundation • 500 Wilson Pike Circle, Suite 212, Brentwood, TN 37027
RECAP OF JULY 16, 2011
Board of Director’s Meeting
+Received for information copies of the Federal +Voted no increase in 2012 Tennessee AFP +Voted for the Tennessee AFP to pursue
Trade Commission’s letter on Texas Legislative membership dues. the purchase of an office with the Executive
Bills on the regulation of APN’s. Committee to move with expediency.
+Discussed the use of social media with
+Selected the recipient of the 2011 John S. referral to the incoming President to assign +Voted to submit a Resolution to the 2011
Derryberry M.D. Distinguished Service Award – responsibilities in exploring the use of social AAFP Congress honoring J. Kelley Avery, M.D.,
Dianne Hall, Nurse at the Tennessee Legislature. media and various other means of membership Nashville.
communications to a committee.
+From votes cast by mail ballot by members
of the Tennessee AFP Congress, received +Discussed AAFP Resolution “Healthy Benefits Members may contact Cathy at the Tennessee
notification of the selection of Doreen of Same Gender Marriage-Not Just a Social AFP office for additional information on any
Feldhouse, M.D., Dyersburg, as the recipient of Issue” being introduced by the National of these items
the 2011 Family Physician of the Year Award. Conference of Special Constituencies. Board
voted to oppose as written and presented.
Tennessee Academy of family physicians 11YOUR 2012 TENNESSEE AFP OFFICERS & BOARD OF DIRECTORS President: Gregg Mitchell, M.D., Jackson President-Elect: B. Alan Wallstedt, M.D., Brentwood Vice President: Beth Anne Fox, M.D., Kingsport Secretary-Treasurer: Kim Howerton, M.D., Jackson Immediate Past President: R. Wesley Dean, M.D., Powell Speaker of the Congress: Lang Smith, M.D., Columbia Vice Speaker of the Congress: Ty Webb, M.D., Vice Speaker Delegates to the AAFP: Charles Ball, M.D., Columbia Timothy Linder, M.D., Selmer Alternate Delegates to the AAFP: Lee Carter, M.D., Huntingdon T. Scott Holder, M.D., Winchester DISTRICT: DIRECTORS: ALTERNATE DIRECTORS 1 Jim Holt, M.D., Johnson City Robert Funke, M.D., Kingsport 2 Sherry L. Robbins, M.D., Knoxville Charles Leonard, M.D., Talbott 3 Mary Bean, M.D., Chattanooga Allen Sherwood, M.D., Ooltewah 4 Tersa Lively, D.O., Crossville Chet Gentry, M.D., Cookeville 5 Stephanie Gafford, M.D., Fayetteville J. Lynn Williams, M.D., Decherd 6 Roger Zoorob, M.D., Nashville T. Michael Helton, M.D., Smyrna 7 Joey Hensley, M.D., Hohenwald D. Gabriel ‘Gabe’ Polk, D.O., Columbia 8 Kevin Wheatley, M.D., Jackson Avinash Reddy, M.D., Jackson 9 Walter Fletcher, M.D., Martin Susan S. Lowry, M.D., Martin 10 Robert Kirkpatrick, M.D., Germantown Raymond Walker, M.D., Bartlett Minorities Ernest Jones, M.D., Carthage S. Steve Samudrala, M.D., Brentwood New Physicians D. Gabriel ‘Gabe’ Polk, D.O., Columbia Daniel Lewis, M.D., Greeneville Women Doreen Feldhouse, M.D., Dyersburg Mary Huff, M.D., Sweetwater Resident Craig Thomas Wright, M.D., Jackson Erin Koscinski, D.O., Kingsport Student Theo Hensley, Johnson City (ETSU) Leah Warren, Memphis (UT) 12 Tennessee academy of family physicians
Leaders on The Move
INFORMATION FOR MEMBERS
u Important: Please check your Tennessee AFP Mark these dates in your 2012 Calendar now!
website on a regular basis for up-to-date informa- Tennessee AFP Practice Enhancement Seminar
tion which is of importance to you, your practice March 17
and your patients: www.tnafp.org
u Charles Ball, M.D., Columbia, Tennessee Tennessee AFP 64th Annual Scientific Assembly
AFP Delegate to the AAFP, served as a member – October 30 - November 2
of the Credentials Committee of the 2011 AAFP
Congress of Delegates in September in Orlando.
u Lee Carter, M.D., Huntingdon, Tennessee
AFP Alternate Delegate to the AAFP, served as
the Observer to the Reference Committee on Ed-
ucation at the 2011 AAFP Congress of Delegates.
u Kim Howerton, M.D., Jackson, has been ap-
pointed as the Tennessee AFP representative to
the TennCare Medical Care Advisor Committee.
u Ty Webb, M.D., Sparta, has been appointed
as the Tennessee AFP representative on the State
of Tennessee’s Health Information Partnership of
Tennessee’s Medical History Advisory Group.
u Did you know if you pay your Academy
membership dues in increments in a dues install-
ment plan with the AAFP, the state chapters do
not receive any portion of your membership dues
payment until the AAFP receives their dues pay-
ment in full? Did you know that when you pay
your membership dues by credit card, the credit
card processing fee for both your AAFP dues and
your Tennessee AFP dues is 3.25% of your dues
paid, which means 3.25% lost revenue to your
Academy?
Paid advertisement
Tennessee Academy of family physicians 13RESOLUTIONS PRESENTED TO THE
2011 TNAFP CONGRESS OF DELEGATES
Resolution 1-2011: “Nurse Practitioners and Advance Practice Nurses be Required to Attend Course Designed Specifically
to Address Prescribing Practices”
Introduced By: Charles Leonard, M.D., Delegate, District #2
Whereas, M.D.’s, D.O.’s, P.A.’s, N.P.’s, and A.P.N.’s have authority in Tennessee to prescribe controlled substances, and
Whereas, the Tennessee Board of Medical Examiners requires M.D.’s to attend a one hour seminar on prescribing practices every two years, and
Whereas, the Tennessee Board of Osteopathic Examination requires D.O.’s to attend a one hour seminar on prescribing practices every two years, and
Whereas, the Committee on Physician Assistants requires P.A.’s to attend the a one hour seminar on prescribing practices every two years, and
Whereas, the Tennessee Board of Nursing DOES NOT require N.P.’s and A.P.N.’s to attend a prescribing practices course, now therefore be it
RESOLVED, That the Tennessee Academy of Family Physicians direct its President to write a letter to the new Commissioner of Health,
Doctor John Dreyzehner, urging him to persuade the Board of Nursing to require the same one hour prescribing practices seminar every
two years for nurse practitioners and advance practice nurses for licensure as does the Tennessee Board of Medical Examiners, the Tennes-
see Board of Osteopathic Examination and the Committee on Physician Assistants.
Adopted as presented
Special Resolution-2011: “Commendation of Deceased Members”
Introduced By: Wes Dean, M.D., President, On Behalf of the Tennessee AFP Board of Directors
Whereas, The Tennessee Academy of Family Physicians is extremely grateful to its many members who devote their
time and effort to the continuing growth of the Academy; and
Whereas, The affiliation of Family Physicians with the Academy of Family Physicians is necessary for the continuing expansion of Family Medicine; and
Whereas, Members of the Tennessee Academy of Family Physicians are deeply saddened by the loss of two (2) of its members who passed away in
the Year of Our Lord, two-thousand-ten; and five (5) of its members who passed away in the Year of Our Lord, two-thousand-eleven; namely:
J. Kelley Avery, M.D., Nashville – March 2011
Harvey H. Barham, M.D., Bolivar – November 2010
James A. Burdette, M.D., Knoxville – January 2011
Phillip H. Dirmeyer, M.D., Collierville – January 2011
Herbert James Michals, M.D., Kingsport – November 2010
Vikki L. Murphree, M.D., Parsons – January 2011
Lyle Richardson Smith, M.D., Kingsport – September 2011
Now Therefore Be It
RESOLVED, That this Congress of Delegates here assembled observe a minute of silent prayer in memory of these members; And Be It Further
RESOLVED, That the families of these members be made aware of the deep and sincere sympathy of the Tennessee Academy of Family Physicians.
Adopted as presented
AMENDMENTS TO THE CONSTITUTION & BYLAWS ADOPTED BY 2011 TNAFP CONGRESS
Bylaws Amendment 1-2011: FAMILY PHYSICIAN OF THE YEAR AWARD NOMINEES
TO AMEND THE BYLAWS of the Tennessee Academy of Family Physicians in Chapter VII, Section 1 (D) by adding an additional
paragraph at the end concerning nominees for the Family Physician of the Year Award as follows………….
Nominating- Section 1 (D). Nominating Committee. It shall be the responsibility of this committee to be sure there is an entity
within the TAFP in charge of assuring there are nominees received each year for the Family Physician of the Year Award.
Adopted as presented
Bylaws Amendment 2-2011: SUNSET OF THE TENNESSEE AFP MEMBERSHIP COMMITTEE
TO AMEND THE BYLAWS of the Tennessee Academy of Family Physicians in Chapter VII, Section 1 (A)
by deleting this section in its entirety, sun setting the Membership Committee.
Adopted as presented
14 Tennessee academy of family physiciansPaid advertisement
ENDING CHILDHOOD OBESITY
WITHIN A GENERATION
We support school-based nutrition and physical
fitness initiatives, such as Fuel Up to Play 60, that help
achieve these guiding principles:
1. Increase access to and consumption of affordable and
appealing fruits, vegetables, whole grains, low-fat dairy
products and lean meats in and out of school.
2. Stimulate children and youth to be more physically
active for 60 minutes every day in and out of school.
3. Boost resources (financial/rewards/incentives/
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improve physical fitness and nutrition programs.
4. Educate and motivate children and youth to eat
the recommended daily servings of nutrient-rich foods
and beverages.
5. Empower children and youth to take action at their
school and at home to develop their own pathways to
better fitness and nutrition for life.
Tennessee Academy of family physicians 15HIGHLIGHTS OF 2011 TENNESSEE AFP
2nd Place Best Group Costumes: 2nd Place Best Decorated Booth: 1st Place Best Group Costumes:
United Healthcare Community and State Outpatient Diagnostic Center of Knoxville Belk & Associates
Doctor Reid Blackwelder swears in AAFP Fellows (LtoR): Don Polk, D.O. on behalf of his
son D. Gabriel ‘Gabe’ Polk, D.O. who is deployed to Afghanistan; Christopher Landess,
M.D.; Chris Gafford, M.D.; Lesa K. Edwards-Davidson, M.D.
Tennessee AFP 2012 Board of Directors
a BIG ‘thank you’ to D octor S herry L. R obbins ,
for being the T ennessee AFP’ s annual assembly official photographer !
16 Tennessee academy of family physiciansANNUAL ASSEMBLY
Exhibitor Male Costume Winners (LtoR): 3rd place - Ruben Garcia of Next
Generation Imaging; 2nd place - Woodie Belk of Belk & Associates;
1st place - Aaron Haynes of UT GME
1st Place Best Decorated Booth: TnREC
Right: Exhibitor Female Costume Winners (LtoR): 1st place
- Tami Triplett of Depomed; 2nd place - Gayle McRae of
tnREC; 3rd place - Abby Koella of Sanofi
continued on page 18>>
Tennessee Academy of family physicians 17THANK YOU TO OUR 2011 ANNUAL ASSEMBLY
SUPPORTERS & EXHIBITORS!
SPECIAL RECOGNITION:
The Tennessee Academy of Family Physicians expresses its appreciation
to the following for educational grants and program support:
East Tennessee State University Department of Family Medicine
Le Bonheur Children’s Hospital
Primary Care Education Consortium
Vanderbilt University Medical Center
And, sincere appreciation for sponsorships and services donated:
College of Medicine, UT Health Science Center
Dr. Beautiful
East Tennessee State University Department of Family Medicine
MAG Mutual Insurance Company
ProAssurance
Tennessee Rural Partnership
State Volunteer Mutual Insurance Company
Cumberland Medical Center PathGroup TN Chapter American
EXHIBITORS: Academy of Pediatrics
Datanet Solution, Inc. Performance Business Forms, Inc.
The Tennessee AFP wishes tnREC
Depomed Pfizer
to express its most sincere
DeRoyal Pfizer Vaccines United Allergy Labs
appreciation and gratitude to
Dispensary of Hope Primary Care Diagnostics United Healthcare Community
each and every exhibiting and State
company at our 63rd Annual East TN State University Principal Financial Group
University of Tennessee Family
Scientific Assembly in Gatlinburg: eClinical Works QSource Medicine Residency Program
EmCare, Inc. Rural Health Association URL Pharma
Flex Medical (by OCERIS, Inc.) of Tennessee
US Army 2nd Medical
4UMD, LLC iPractice Group Saint Thomas Health Services Recruiting Battalion
Abbott Janssen Pharmaceuticals Sanofi UT Graduate Medical Education
AIT Laboratories Kowa Pharmaceuticals America, Inc. Selfrefind Vanderbilt University
SJ Pharmaceuticals Medical Center
Amedisys Home Healthcare Laboratory Corporation of America
Amedisys Hospice LeBonheur Children’s Hospital St. Jude Children’s Research Hospital
Ameritox LMU-DeBusk College Strategic Business Systems exhibiting
Osteopathic Medicine as GE Healthcare
Asera Care Hospice
MAG Mutual Insurance Company SVMIC When representatives of these
Avalon Hospice
Takeda Pharmaceuticals companies visit your offices,
Avee Laboratories MDAdvocate
TeamHealth please express to them your
Belk & Associates, Inc. Merck & Co., Inc.
Tennessee Academy of appreciation for their support
Bethel University PA Program Mountain States Health Alliance
Physician Assistants of your Tennessee Academy of
BlueCross BlueShield of TN Next Generation Imaging
TN Dept. of Health, Communicable Family Physicians. The TNAFP
Boehringer-Ingelheim Novartis & Environmental Disease Annual Assembly would not be
Boston Heart Diagnostics Novartis Vaccines Tennessee Rural Partnership possible without their support!
Bureau of TennCare Outpatient Diagnostic Center Teva Respiratory, LLC
of Knoxville
Caris Healthcare
Tennessee Academy of family physicians 19PRACTICE OPPORTUNITIES
If you are looking for a partner or also administers Preventive and The clinic is financially strong, has a
a practice location, send information Occupational Medicine Residency well-trained and stable staff in place
preferably by email to: tnafp@ Programs and a Sports Medicine and a supportive and engaged Board
bellsouth.net; or by snail mail to: Fellowship. For Further Information of Directors. Funding is comprised of
TAFP, 500 Wilson Pike Circle, Suite Contact: Roger Zoorob, MD, patient fees and donations or grants
212, Brentwood, TN 37027; or by MPH, FAAFP, Meharry-Vanderbilt from individuals, foundations,
fax to: 615-370-5199. Information Professor and Chair, Department corporations and churches.
for practice opportunities will be of Family Medicine, 1005 Dr. D. Clinical responsibilities (approxi-
accepted only from TAFP members B. Todd, Jr. Boulevard, Nashville, mately 75%) vs. Non-clinical (ap-
and will be placed in the Tennessee Tennessee 37208. rzoorob@mmc. proximately 25%) including: Direct
Family Physician at no charge. You edu; 615-327-6572; familymedicine. patient care; Lead clinical staff (3.2
are required to include your name, mmc.edu Meharry Medical College nurse practitioners, 2RNs, 1MA);
address and/or telephone number is an Equal Opportunity Employer Work with Executive Director and
and/or fax number and/or email Board of Directors on strategy and
address as contact concerning establishing priorities; Recruit vol-
opportunities will be made directly . America’s Family Doctors & unteer physicians to see patients for
between interested parties and not Walk-In Clinics (AFDclinics.com) specialty care; some community and
through the TAFP. Information will is looking for a Family Physician donor relations.
be placed in four (4) editions unless for full or part time work. We have No after hours call, no weekends
the TAFP is notified otherwise. locations in Brentwood, Smyrna and no managed care hassles. Most
Deadline for the next issue (Spring and Spring Hill TN. For further patients are between the ages of 19
2012) is January 20, 2012. information, contact Medical to 64.
Director S. Steve Samudrala MD Requirements: Must have
at DrSam@AFDclinics.com or 615- completed a Medical Degree from
. Department of Family and 497-9575 anytime. an approved training program and
Community Medicine Faculty hold current Board Certification
Position - The Department of in primary care specialty (Family
Family and Community Medicine . Medical Director for FAITH Medicine, Internal Medicine, or IM/
at Meharry Medical College is FAMILY MEDICAL CLINIC. Pediatrics). Preferably five years+
currently seeking a Board Certified Faith Family Medical Clinic is a experience. Leadership & computer/
Family physician to serve as a full- 10 year old primary care nonprofit EMR technology are preferred.
time faculty. The position includes outpatient clinic in Nashville, TN Financials: A competitive em-
faculty appointments at Meharry serving Middle Tennessee’s working ployment agreement will be offered
Medical College and Vanderbilt uninsured and their families. Our by the clinic’s Executive Director
University at the level of Assistant mission is “to follow the commitment to the most qualified candidate.
or Associate Professor depending of people of faith to provide hope Excellent pay and health care ben-
on experience and qualifications. and medical care for the working efits; CME, generous vacation and
Previous academic experience as uninsured by meeting their physical, pension plan. For additional info,
a residency or clerkship faculty, emotional and spiritual needs.” We please see the website at www.faith-
or fellowship training is required. are modeled after the Church Health medical.org; or contact Tony Ross,
Nashville is an excellent community Center in Memphis, TN. M.D. at 615-351-2949 or tross02@
and offers many amenities. Our current Medical Director is comcast.net; or contact Laura Hob-
The department has eighteen retiring after 10 years of service and son at 615-305-3805 or lhobson@
Family Medicine Residents and we seek to have a good “handoff.” faithmedical.org.
20 Tennessee academy of family physiciansReport of the Tennessee AFP Delegation to the 2011
Congress of Delegates of the American Academy
of Family Physicians
The American Academy of Family Physicians’ 2011 Congress of bursements as well as Resolutions asking to gather more data to refute
Delegates met in Orlando, Florida in September. The Tennessee Acad- claims of nurse practitioners passed as well. There were the usual con-
emy was represented by Doctors Tim Linder, Charles Ball, Lee Carter troversies regarding contraceptive practices but the Resolutions that
and Scott Holder. As usual, Cathy Dyer attended as well to provide the passed essentially only endorsed present policy of the Academy.
Delegation with needed information. The Tennessee AFP also proudly announced the candidacy of
A large number of resolutions were once again presented. The most Doctor Reid Blackwelder in 2012 for the position of President-elect of
controversial one dealt with advocating gay marriage and this was the AAFP. This election will also occur in Philadelphia in 2012. Doc-
once again defeated thanks in part to leadership provided by Doctor tor Blackwelder is an outstanding candidate for this position and we
Ball. encourage any and all Tennessee members to attend next year to see
A resolution asking the AAFP to withdraw from the RUC did him get elected.
not pass but the national academy leadership was made aware of the In summary, this was a typical year in the Academy with several
displeasure of members over this committee and firm action to change controversial resolutions taking the majority of time of the Congress
the RUC has been proposed. but once again common sense won the day. The Bylaws changes are
A more significant change was discussed at length at this meeting. A potentially devastating to state chapters but your Delegation is well
Bylaws working group has proposed sweeping changes to the national prepared to contest these issues next year, mostly thanks to Cathy
AFP Bylaws. Some of these changes are just dealing with changing out- Dyer. The Academy continues to support the family physician as far as
dated language but there are substantive changes to the powers of the scope, reimbursement, and quality of care.
state academies. These changes would in effect take away many of the I would like to thank all of the Delegation for their active involve-
rights of the states dealing with their membership issues and instead ment. Tennessee continues to be a leader on the national stage and
give the national academy the right to make these changes. Your Del- we will continue to be actively involved in the issues important to our
egation testified firmly that these changes would need to be addressed members.
prior to approving any Bylaws changes. This will continue to be an is-
sue over the next year and the vote on these changes is scheduled next Respectfully submitted,
year at the 2012 AAFP Congress of Delegates in Philadelphia. Charles Ball, M.D. and Tim Linder, M.D., Delegates
Thank You
Resolutions asking the Academy to work to improve our reim- Lee Carter, M.D. and T. Scott Holder, M.D., Alternate Delegates
VERY SINCERE THANK YOU TO OUR OUTSTANDING
2011 TENNESSEE AFP SUPPORTERS
As the year comes to an end, we’d like to offer a very sincere ‘thank
you’ to those companies who provided outstanding support to the SILVER SUPPORTER ($10,000 to $15,000 total 2011 support):
Tennessee Academy of Family Physicians during 2011. This support Vanderbilt Medical Center
includes educational grants provided in support of TNAFP CME
programs, function sponsorships held in conjunction with TNAFP BRONZE SUPPORTERS ($5,000 to $10,000 total 2011 support):
CME programs, Tar Wars financial support/grants and advertising in
your quarterly journal, ‘Tennessee Family Physician.’ State Volunteer Mutual Insurance Company
Tennessee Academy of family physicians 21STATE OF TENNESSEE
DEPARTMENT OF HEALTH
CORDELL HULL BUILDING
425 5TH AVENUE NORTH
NASHVILLE, TENNESSEE 37243
Date: September 7, 2011
To: Tennessee Healthcare Providers
From: Kelly L. Moore, MD, MPH, Medical Director, Immunization Program (TIP)
Re: New limitations on some federally funded vaccines given at health departments
Dear Healthcare Provider,
This letter is to share information about new limits to the availability of federally funded vaccines that our local health departments provide to patients at no
charge. Most vaccines given in health departments are to children who qualify for the federal Vaccines for Children (VFC) entitlement program: such children
are completely unaffected.
Tennessee receives well over $70 million for VFC-eligible children, but its federal budget for non-VFC eligible children and adults, which was subsidized with
federal stimulus money in 2009 and 2010, is no longer subsidized and the base budget has been cut from $4.4 million to $3.3 million, starting October 2011.
These funds are used to provide vaccine in public health clinics to adults and to children ineligible for the VFC Program. Because there are not state funds to fill
this gap, health department clinics are implementing new policies for vaccines provided to children ineligible for VFC and all adults. This letter summarizes these
changes: please review it carefully.
Important definitions (for purposes of this letter):
• Uninsured = a person has no health insurance coverage at all. Adults with TennCare or CoverTN are not eligible for vaccines restricted to uninsured
adults only.
• Underinsured (applies to children under 19 years) = a child with private insurance that does not cover recommended vaccines as a benefit. Such children
currently qualify for Vaccines for Children (VFC) Program entitlement vaccine in health departments or federally-qualified health centers. If the insurance cov-
ers some vaccines, but excludes others, the child is VFC-eligible only for the excluded vaccine.
• Fully insured (applies to children, not VFC eligible) = a child with state CoverKids insurance or private insurance that includes vaccine as a covered benefit,
even if there are co-pays or deductibles. Fully insured children are ineligible for the VFC Program.
Federal Vaccines for Children (VFC) Program for eligible children 0 through 18 years: no changes
The VFC entitlement program covers most of the children vaccinated in health departments. It is not affected by these budget cuts. Health departments will
continue to provide ALL recommended vaccines to children younger than 19 years who meet any one of the following eligibility criteria:
• Uninsured
• TennCare (even if they also have coverage by another insurance)
• American Indian or Alaskan Native (“Native American”) ethnicity
• “Underinsured” [VFC in Health Departments and Federally Qualified Health Centers only]
Changes for children ineligible for VFC (fully insured): ages 7-18 years only
• Vaccines remain available to any child exposed to a vaccine-preventable disease where vaccine is recommended by public health to prevent the spread of
illness.
• Birth through 6 years: No change. They will continue to be given the vaccines they need if they come to a health department.
• Age 7 through 18 years may be provided only vaccines needed to meet school entry requirements. o These children will be referred to a provider who
can bill insurance for any vaccine the child does not need to meet school entry requirements. This includes meningococcal vaccine, HPV vaccine, hepatitis A
vaccine, and (beginning fall 2012) influenza vaccine.
Adults (19 years and up): Changes for all ages
• Federally-funded vaccines remain available to any person exposed to a vaccine-preventable disease where vaccine is recommended by public health to
22 Tennessee academy of family physiciansYou can also read
