PO Box 424 • Hartland, ME 04943 • (207) 938-5005

The Pine Tree FPMAFP BOARD OF

DIRECTORSPRESIDENT:

Paul Pelletier, MDEagle Lake, 444-5973IMMEDIATE PAST

PRESIDENT:Richard Hobbs, MDFairfield, 861-5030VICE PRESIDENT:Elisabeth Mock, MD

BangorTREASURER:

James Smith, DOFarmington, 778-2651

BOARD OF DIRECTORS:Thomas Bugbee, MDBlue Hill, 374-5000

Minda Gold, MDDarmariscotta, 563-6623

David Jones, MDPresque Isle, 764-3142

Jeffrey Lovitz, MDFairfield, 873-1181Robin Pritham, MDBangor, 973-7973Craig Smith, DONaples, 693-6106

AAFP DELEGATES:Ronald Blum, MDPatten, 528-2067

James Raczek, MDBangor, 973-7027

AAFP ALTERNATEDELEGATES:

Dieter Kreckel, MDRumford, 369-0146Elisabeth Mock, MD

Bangor

EXECUTIVE DIRECTOR:Deborah Halbach

Tel.: (207) 938-5005Fax: (207) 938-5931

E-mail:maineafp@tdstelme.net

www.maineafp.org

Maine Is WellRepresented at

National Tar WarsPoster Contest inWashington, D.C.

L to R: Amber Isley, MD (AAFP TarWars Advisory Bd), Mel Cray(Maine Tar Wars Coordinator), IvyDow (Maine’s poster winner), RonBlum, MD (AAFP Tar WarsAdvisory Bd)

Beautiful Bar HarborWill Be the Setting!

The MAFP will be hosting its17th Annual Family Medicine

Update next spring at theAtlantic Oakes by the Sea in BarHarbor. Watch your “snail mail”in January 2009 for yourbrochure, but be sure to markyour calendar now!

Maine FamilyPhysician of the Year2009 ~ Nominations

Now Open The 2009 Maine FamilyPhysician of the Year will beannounced during the FamilyMedicine Update. Why notnominate a special colleague? Simply go to the MAFPhome page www.maineafp.organd click on “Nominate aColleague” for information.

Inside This Issue:MAFP Family Phys of Year 1President’s Column 2In Memoriam ~ 3Medical Student News 3Welcome New Members 3Kids’ Oral Health 4Consultation Project 5Foundation News 6

Official WebsiteWWW.NBCAM.ORG

U.S. House CastsHistoric Vote to

Protect Kids FromTobacco and Save

Lives! Washington, D.C., July 30,2008 - The U.S. House ofRepresentatives today cast atruly historic vote to protectchildren from tobacco addictionand save lives byoverwhelmingly approvinglegislation granting the U.S.Food and Drug Administration

authority to regulate tobaccoproducts. This is the first timethe House has ever approvedsuch legislation. Today’s voteby a clear veto-proof margin of326 to 102 underscores thebroad, bipartisan support forthis legislation and providespowerful momentum forenacting it into law this year. The House vote is a giantstep toward ending the specialprotection the tobacco industryhas enjoyed for too long and atsuch great cost to the (to pg. 4)

SEPTEMBER 2008

President’s Column

From the Desk of

Paul Pelletier, MDMAFP President

November 4, 2008

What Will It Mean for Healthcare in America? Healthcare reform seems to be a perennial topic for debate inany national election, and this fall’s election promises to be nodifferent. Although the war and the economy are currentlyforemost in the minds of many voters, healthcare reform continuesto be a pressing issue for us family physicians as well as many ofour patients. A quick look at the campaign websites for SenatorsCollins, Obama and McCain and Representative Allen revealssignificant differences in the candidates’ plans for the future ofhealthcare in America. In the Presidential race, Obama, the “candidate of change,”offers a plan for modest changes to the current healthcare system.His website promotes his plan for “universal health insurancecoverage” through efforts to: - Continue the current private health insurance system withsome regulations and reforms. - Enact an employer mandate to provide insurance or berequired to pay a payroll tax into a “national health plan.” - Offer this “national health plan” (similar to the plan currentlyoffered to federal employees) at low cost/subsidized rates to thecurrently uninsured. - Offer federal support to small businesses to provideemployer-based coverage. McCain’s website also promotes his plan to “give all Americansaccess to affordable, high quality health care.” His plan would dothis through efforts to: - “Restore control to patients themselves,” primarily through theuse of health savings accounts. - “Use competition to improve the quality of health insurance,”primarily through efforts to remove regulatory burdens on insurersby limiting the ability of individual states to regulate insurers. There are also differences as to the candidates’ expressed viewsconcerning primary care medical practice. While McCain’swebsite indicates the candidate’s desire to “promote greater accessto care through walk-in clinics in retail outlets” and to “providecheaper care for chronic disease through new treatment models

and the use of information technology,” the Obama plan statesthat “providers are not adequately reimbursed for helping patientsmanage chronic illness” and would “support providers to put inplace ‘medical home’ type models.” A look at the candidates’ websites for Maine’s Senate race alsoprovides some contrasts. Tom Allen’s website prominentlyfeatures his “universal health care plan” – which is quite similar tothe Obama plan but would also expand SCHIP and allow peopleaged 55-65 to “buy into” Medicare. Susan Collins’ website doesnot contain any reference to plans for changes to healthcare butdoes prominently feature a link to news articles praising her role inpreventing a Bush administration effort to cut $4 billion in Medicarepayments to nursing homes. Although the AAFP and MAFP must remain non-partisan, itseems clear to me that in the upcoming election the Democrats,Obama for President and Allen for Senate, would be more likely toindeed promote change in our current healthcare system. I willleave it to you to decide if the change that they are talking about isthe type of change we need. However, a review of theFamMedPAC website indicates that, as of April of ’08, they hadcontributed $2,500 to the Allen campaign and none thus far to theCollins campaign. This would be consistent with the PACs topexpressed goal of “promoting healthcare coverage for all.” Also,the AAFP’s promotion of payment reform and the medical homemodel would seem to be more in line with the healthcare reformplan offered by Obama.

MAFP Board Supports Grant Application“Building the Patient-Centered Medical Home

to Meet the Needs of Maine People” Recognizing the critical importance of primary care as thefoundation of a successful healthcare system, The MAFP Boardhas written a letter indicating our commitment to the MaineMulti-Payer Pilot to implement the Patient-Centered Medical Home(PCMH) model. We have committed to actively partnering withQuality Counts on this initiative to achieve a successfulimplementation of the model over the next three years as a keystep in promoting patient-centered integrated primary care acrossthe state of Maine. A brief summary of the plan for the proposal follows. “MeHAFIntegration Initiative: Building the Patient-Centered MedicalHome to Meet the Needs of Maine People”The Patient-Centered Medical Home model offers an exciting andpromising approach to transforming healthcare and improving theintegration of care across providers and settings of care.Implementation of the medical home model addresses both thepractice transformation and the payment reform required toachieve the system transformation needed to improve healthcarefor all people. Dirigo’s Maine Quality Forum, Quality Counts, andthe Maine Health Management Coalition (continued on page 5)

New Virtual FMIG Website We are proud to announce the launch of theAAFP’s all-new Virtual FMIG—the Academy’spremier student interest website. Users who loginto AAFP’s premier website for medical studentsinterested in family medicine, Virtual FMIG—orFamily Medicine Interest Group—will no doubtnotice some major changes. Virtual FMIG focuses on giving studentsrelevant and timely information about thespecialty of family medicine, including informationabout the scope, training and lifestyles of familyphysicians. Resources on the site includepromotional materials and presentations thatstudents can use when discussing family

medicine with their colleagues. One new feature,the Student Interest Discussion Forum, provides acommunication tool that allows students to shareinformation and experiences as they explorefamily medicine. Students can subscribe to theforum by logging on tohttp://fmignet.aafp.org/online/fmig/index.html and selecting Connect With OtherFMIGs. You can also connect to the regionalFMIG leader for Maine’s region, Brooke Sciuto,and participate in a discussion forum with yourpeers from our region.

In Memoriam

Thomas E. McDermott, MD

Nov. 1, 1949 ~ Aug. 21, 2008 The Academy was shocked and deeplysaddened to learn of the death of Dr. ThomasMcDermott of Waterville who died unexpectedlyas the result of a whitewater rafting accident onthe Kennebec River. Dr. McDermott, 58, was a family physician atKennebec Medical Associates in Waterville andalso certified in chemical dependency treatmentby the American Society of Addiction Medicine.He has been an active member in the MAFP andAAFP since completing his training. Our thoughts go out to Tom’s wife, DayleMcDermott, and his son and two daughters.

Welcome to Our New ActiveMembers!

John Bonney, MD, WatervilleMatija Burtis, DO, Lewiston

Jennifer Diehl, MD, PittsfieldNancy Filliter, MD, Oakland

Lilly Gardner, MD, BrunswickAlison Gorman, MD, PortlandJennifer Hine, MD, PortlandMelissa Ifantides, DO, SacoJohn Kootz, MD, Gardiner

Stephen Leverett, DO, PortlandLawrence McAleer, MD, Albion

Hanna Napiorkowska, MD, BrunswickWendy Nile, MD, Biddeford

William Papura, DO, BiddefordKristin Reischer, MD, Ft. KentGayle Riley, MD, Scarborough

Alisa Roberts, DO, BangorPeter Sedgwick, MD, Lewiston

Melinda Shadowitz, MD, PortlandSteve Sprague, MD, Searsport

Charles Zelnick, MD, Stonington

Central MaineMedical CenterNeelima Ganta, MDAlicia Koteles, MD

Brad Long, MDJeffrey Lynds, MD

Eastern MaineMedical Center

Molly Biehl, DOAdam Cohen-Lewe, DO

Lisa Billings-Lindsey, DODongning Chen, MDHannah Eucker, DO

Brian Frenkiewich, MDDeborah Hatanpa, MD

Peter Kirbach, DOAllison Kulikowski, DO

Maine MedicalCenter

Rachael Blake, MDErin DeLaney, MD

Yana Shaw Little, MDChristine Mahoney, DO

Elisabeth Strawbridge, MDJanneke Volkert, MD

Joon Suk Choi, UNECOMBeth Grimaldi, UNECOM

Oral Health and FamilyMedicine

As a Family Physician, how can youprevent the most common childhooddisease in America? It’s true, dental disease is five times morecommon than asthma and seven times morecommon than hay fever in children. The “good” thing about early childhoodcaries is that early prevention is effective,easy and inexpensive. This is why theAmerican Academy of Pediatric Dentistryrecommends that all children have a “dentalhome” by age one. The problem is that mostdentists don’t see children until they are atleast three years old, and access to dentalcare is a major struggle for many lowincome families at any age.

Family Physicians can be the first dentalhome for children. Oral health is a logicalcomponent of a medical home, the mouth ispart of the body after all, and there areresources in Maine to help practicesincorporate oral health for young children. The Kids Oral Health Partnership isproviding free training for non-dentalproviders on assessment, guidance andprevention. MaineCare will soon beginallowing medical offices to bill for fluoridevarnish application. To find out more,contact Bonnie Vaughan, RDH, at 622-7566ext. 216, and on the web at www.kohp.org.

(Tobacco Legislation con’t from pg. 1) nation’s health. Now the Senate shouldseize this unprecedented opportunity toprotect the nation’s health and approve thislegislation when it returns in September.With 57 sponsors and several other senators

who have committed to supporting the bill,the Senate has the votes to pass thislegislation this year. It is disappointing thatsome of the President’s advisors have saidthey would recommend a veto of the bill. Weurge the President to support this historiceffort to protect our children and addressthe leading cause of preventable death inthe United States. This legislation has strong support andhas been endorsed by the Maine Academyof Family Physicians, the AAFP and itsconstituent chapters, and more than 680public health, medical, faith and otherorganizations, as well as 70% of Americanvoters, with support across political lines,geographic regions and even by a majorityof smokers, according to a poll of May 2008.(View detailed poll results on web site.) Lastyear, both the Institute of Medicine of theNational Academies of Sciences and thePresident’s Cancer Panel issued landmarkreports endorsing FDA regulation of tobaccoproducts. For more information on thishistoric legislation and to find out how youcan become involved in the fight againsttobacco, log on to:www.tobaccofreekids.org.

Tar Wars, a tobacco-use prevention program that started in Colorado, celebrates its 20th anniversary in 2008. Since 1988, a local notion hasevolved into a campaign that involves thousands of healthcare professionals and other volunteers reaching out to millions of fifth-graders in theU.S. and 16 other countries. The message, which is delivered in hour-long classroom presentations, was originally considered radical but isnow mainstream. It has always been the same: Tar Wars shows how the tobacco industry uses advertising to manipulate potential users by making smokingappear sexy, glamorous and cool. The image-based program emphasizes short-term consequences to show why smoking actually is NOT sexy,glamorous and cool. Tar Wars is most effective when used in conjunction with other anti-smoking messages. Jeffrey J. Cain, MD of Coloradorecalls how the innovative, interactive program began. He was a second-year resident at Mercy Family Medicine Residency at Mercy Hospitalwhen his residency director, Dr. Rick Streiffer, suggested that he attend the AAFP’s National Conference for Family Practice Residents. Dr.Streiffer also told Dr. Cain to be sure to attend the workshops from the group Doctors Ought to Care (DOC). Their speaker, Dr. Rick Richards,spoke forcefully and passionately about how the tobacco industry was intentionally targeting kids with tobacco advertising. The talk inspiredthe young resident. He returned to his residency to tell the director, “We need to do something about this!” Dr. Streiffer agreed that the issuewas an important one, responding, “Yes, YOU need to do something about it!” So, Dr. Cain joined the board of the Coalition for a Tobacco-Free Colorado (CTFC) and supported a range of worthwhile tobacco-freeactivities. Along with the rest of the group, he worked on legislation that would make it more difficult for young people to purchase cigarettes.That helped on the supply side. But board members asked themselves if there might be ways to affect the demand side of the tobacco market.Together with Glenna Pember, who was a member of the coalition and a health educator with the Hall of Life at the Denver Museum of NaturalHistory, they collaborated to create a lesson that combined theories from the Hall of Life and DOC, emphasizing the short-term consequencesof tobacco use that made sense to fifth-graders - like the stinkiness of cigarettes and how the cost of smoking (con’t pg. 5)

The Consultation Project began in 2004as a collaboration between the MaineAssociation of Psychiatric Physicians andthe Maine Academy of Family Physicians.Adult and child psychiatrists who volunteertheir time are matched with primary carepractitioners with the goal of establishing anongoing consultative relationship.Consultations are “informal,” by telephoneor email, and are available for all prescribersin a given practice. Participants are alsoinvited to attend MAPP educationalconferences, such as the one held last Mayin Freeport that focused on psychiatricdisorders during pregnancy and the postpartum period. There is also a listserv for

practices and consultants to discussmutually relevant topics. Currently there are 42 primary carepractices participating in the project, andnew practices are welcome. If you would likemore information, please contact the projectcoordinator, Cindy Paradis, MSN atcindy_fox_paradis@yahoo.com or(207) 622-5811 or go to the MAPP websiteat http://mainepsych.org/project.htm.

(Med Mut’l con’t from page 7) notedGordon Smith, EVP of MMA. “Along with thepending MaineCare increase and thesuccessful advocacy enacting a newMedicare payment increase in place of theproposed cut, this decrease in a majorexpense category may help to stabilize thephysician workforce in Maine.” Maine currently has over 235 physicianvacancies, as reported by the MaineRecruitment Center. Over one hundred ofthese vacancies are in primary care.

BARGAINS DO STILLEXIST! Maine Medical

Association Now OfferingReduced Dues for MAFP

Members The MAFP Board of Directors and theMMA have been working together forsome time to assist MAFP members withtheir dues for membership in the MMA. This fall you will be receiving a letterfrom MAFP’s President, Dr. Paul Pelletier,along with your dues statement, orapplication for MMA membership,highlighting the REDUCEDMEMBERSHIP FEES in the MMA forMAFP members! If you have any questions about theprocess, call Lisa Martin, membershiprepresentative at the MMA,(207) 622-3374 or the MAFP office at(207) 938-5005.

(Grant con’t from page 2) are leading amulti-stakeholder effort to develop,implement, and evaluate a MaineMulti-payer Pilot of the Patient-CenteredMedical Home (PCMH) model as the firststep in achieving statewide implementationof a PCMH model. We are seeking MeHAFfunds to support successful implementationof this pilot, specifically to ensure that we (1)meaningfully include patients and families inbuilding the new model of care; (2) providepilot practices with support to undertake thepractice transformation needed to betterdeliver patient- and family-centered primarycare; (2) utilize the mode to ensureintegration of behavioral and physical healthneeds is adequately addressed; and (4)successfully convene and coordinate privateand public payer efforts to reform paymentneeded to sustain this new model of care.The ultimate goal of this effort is to sustainand revitalize primary care both to improvehealth outcomes for all Maine people, and toreduce overall healthcare costs."

20 Years of Tar Wars! (con’t from page 4) could be explained invideo games per month. Without a budgetfor printing, they snuck into the hospital lateat night to photocopy the first curriculum.Reaching out to the residency for support,they used residents and faculty to presentthe program in school classrooms. In 1992, the Journal of Family Practicepublished an article about Tar Wars, which“got a lot of people excited,” Dr. Cainrecalls. Among those people were LarrySmith, MD, a Family Physician in Maine, andhis wife Janie Smith, RN, MS. “We found theprogram to be exciting and successful,” Dr.Smith recalls. “A groundswell of supportdeveloped in Maine.” Among those in Mainewho were interested was the Smiths’ friendSteve Lufken, who worked for MarionMerrell Dow, a pharmaceutical company.Lufken said he thought the program shouldbe available nationally. So the five of them – Dr. and Mrs. Smith,Dr. Cain, Pember and Lufken – retreated tothe Smiths’ cabin in the Maine woods,where they ate local lobster and developedvision and mission statements for a nationalTar Wars. In the fall of 1993, a nationaltraining conference was scheduled forDenver. “We invited everybody to our campin Maine and put out some audacious ideas,and we were able to accomplish most ofthem,” Dr. Smith recalls. To read the “rest of the story” andview Maine Tar Wars Winning posters -go to: www.maineafp.org and click on TarWars.

My Donation:___ $500 ___$250___ $100 ___$50___ $25Other amount: $______Please list me as:______________________ MD __DOOther: _____________on any published rosterof contributors. Pleasedirect my contributionto the following:___ MAFP Foundation,use where need isgreatest___ Tar Wars in Maine___ Student Externship

__________________(Name(s) please print)

__________________(Street)

__________________(City)

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MAKE ADIFFERENCE BY

DONATING TODAY!

MAINE TAR WARS PROGRAMWINS AWARDS

The Maine Tar Wars program has experienceda revival and has been recognized by the AAFP asa model program for the country. For the thirdyear in a row, there was an increase in reportingof presentations done in the elementary schoolsthroughout the state as School HealthCoordinators and Family Physicians workedtogether to present the curriculum to 4th and 5thgrade students. In addition to promoting the Tar Wars programstate-wide, a pilot project was done which wasconcentrated in Piscataquis County, using fundsobtained through the Maine CommunityFoundation. Goals included ensuring 100%participation countywide in both the presentationsand the poster contest to follow, anddocumenting the methods used by theSeDoMoCha Elementary School (formerly MortonAve.) which have consistently resulted inaward-winning posters at the MAFP State PosterContest. The goals of the project were met,

Thank You Foundation Donors!

“Climbing the Mountains inMaine”

Donations Jan - Aug. 2008Cooper Hill ~ Up to $99

Dr. Ronald BlumMs. Deborah HalbachDr. Diana JeannotteDr. Vincent Michaud

Dr. Roy MillerDr. & Mr. Charlie & Elisabeth Mock

Dr. Arthur NewkirkDr. McKim PetersonDr. Sarah PrescottDr. Robin PrithamDr. Jim Schneid

Saddleback Mountain ~ $100-$249Dr. Nicole Cherbuliez

Dr. David MillayDr. David RockerDr. Denise SoucyDr. James Smith

Ms. Deborah Taylor

although the SeDoMoCha DVD remains indraft form until fall. Once completed, it will bedisseminated statewide and nationally, to eachAAFP Chapter and Tar Wars program. Ivy Dow, of the SeDoMoCha School in DoverFoxcroft, is this year’s MAFP poster winner. Acombined effort of the school, community andMAFP physicians resulted in funds being raised toallow both Ivy and her mother to attend theNational Poster Contest and Tar WarsCoordinator Conference on Capitol Hill inWashington, D.C. in July. MAFP Board Member Dr. Ron Blum, whoserves on the AAFP’s Commission on the Healthof the Public, as well as one of two nationaladvisors to the National Tar Wars Program, wasable to attend the National Conference, alongwith Maine State Coordinator Mel Cray. One ofIvy’s highlights was meeting with Senator SusanCollins and Representative Michael Michaud, andgiving them a copy of her winning poster. Thefamily extends their gratitude toward all whomade the trip possible. While in Washington, Ivy, Dr. Blum, and Mel

Cray accepted three awards for Maine Tar Warsfrom the AAFP, all recognizing the concentratedefforts at the pilot site in Piscataquis County. Melwas able to present the pilot project to the otherstate coordinators as well as discuss other bestpractice methods that Maine is implementing. The2008-2009 school year is anticipated to result in acontinued increase in participation, as Mel seeksto replicate the Piscataquis model in other areasof Maine.

Drs. Jeff Cain and Amber Isley recognize Ivy Dow’swinning poster from Maine.

Medical Mutual Insurance AnnouncesPremium CUT!

Medical Mutual Insurance Company of Maine, Maine’s largestprovider of professional liability insurance for physicians,announced on Aug. 18 that it had filed for and received approvalfrom the Maine Bureau of Insurance to reduce physician baserates and modify the relativity factors medical specialty loss planfor all new and renewal business effective Oct. 1, 2008. Thiscombined impact will result in an overall average “net” ratereduction of 10.8 percent. As some class relativities have changed,a physician’s premium change may be more or less than theaverage “net” change, depending upon the specialty. In its letter to all insureds this past week, MMIC stated that thenew rates reflect improvements in claim frequency trends over thepast few years both in Maine and in the nation. This rate reductionand change in class relativities is independent of the $4 milliondividend declared by the company this past spring. “This isanother piece of good news for Maine’s physicians,” (cont pg. 5)

Bd of Pharmacy Considers Midwifery Prescribing At its monthly meeting on Aug. 20, the Maine Board ofPharmacy reviewed a draft rule that would implement theprovisions of recently enacted Maine law which would permitpharmacists to dispense a limited category of medication to lay(non-nurse) midwives. When signing the legislation, Gov. Baldacci,after expressing reservations about the law, directed the actingCommissioner of the Department of Professional and FinancialRegulation to take steps to ensure the safety of homebirth byworking with the Bd of Pharmacy to enact rules implementing thelegislation. Pharmacy Bd members had a number of suggestionsregarding the proposed rule and a work group will reconvene toreview the recommendations. The Bd will consider theserecommendations at its next Bd meeting. Once proposed, the rulewould still have to go through formal rule-making, including anopportunity for public comments. The medications, to be used in connection with home births,include oxytocin (excluding its use to hasten labor), vitamin K, eyeointment for the infant, a local anesthetic and oxygen. The draftproposed rule would require that midwives report the use of themedications to officials at the Maine CDC. Under the legislation,pharmacists are permitted, but not required, to dispense the listedmedications to midwives certified by their national organization. The Maine legislature defeated a proposal last session tolicense lay midwives, but did narrowly enact legislation allowingdispensing of the medications. MMA continues to oppose thelicensing of lay midwives, believing that the public would confusethe CPMs and CNMs, believing that their level of education andtraining is not sufficient to provide the safest environment for homebirth. There are about 25 lay midwives providing midwiferyservices during home birth in Maine. An attorney general opinion inthe late 1970s decided the assistance provided to a woman innatural childbirth is not considered the practice of medicine.Therefore, midwives can practice midwifery and charge for theirservices.

State Panel Examines Healthcare Workforce Shortage The State’s Health Workforce Forum met for its monthlymeeting on Aug. 20. There were four meeting objectives: 1) Reviewcomments and select a goal statement for the Forum; 2) Establishthe working framework for the Forum; 3) Review and prioritize theForum themes and recommendations; and 4) Identify the strategicapproach and action steps for each priority. The Forum wasoriginally established in 2005 by the legislation that created theHealth Occupations Report. Much of the discussion at this meetingfocused on the seriousness of the healthcare worker shortage inthe state and frustration was expressed regarding prior reports andrecommendations that were not implemented. Problems previouslyidentified have become worse in the meantime. The next scheduled meetings are Sept. 15 and Oct. 17, from1 to 3:30 p.m.

PO Box 424

Hartland, ME 04943