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Advocating for Family Doctors in Maine
/ / / Spring 2021 Newsletter / / /
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/ / / Advocacy & Legislative Updates / / /
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- 2 key pieces of legislation that affect Family Physicians in Maine
- Maine Medical Association weekly legislative calls
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Bills of importance for Family Physicians
LR740, the Primary Care Investment (or PROSPECT) bill. Sponsored by Rep Sam Zager and Senator Ned Claxton, both Family Physicians. This bill will mandate an increase in the percentage health plans spend on primary care in Maine from its current 5-7% to above 10%. Based on legislation from other states like RI and OR, it will provide for a more robust primary care system that will lead to better patient outcomes and reduced overall health spending.
We are actively looking for help in supporting this bill. Please lend your voice to the process by emailing your reps or testifying before the committee when the bill comes up. Please contact Dr Pat Connolly (patrickc@martinspoint.org) or Dr Sam Zager (sam.zager@legislature.maine.gov) if interested.
Doctors for Maine Futures - This bill reauthorizes scholarship funding for medical students from Maine who go through the Maine track program at Tufts Medical School. Dr. Caleb Swanberg, one of the first Maine track students and now a Family Doctor practicing in Caribou, recently gave testimony for this bill.
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/ / / Dues & Getting Involved / / /
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Questions about dues?
Need to pay your dues?
Check your status here:
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Want to get involved with the MAFP?
Is there someone you’d like to nominate to be a board member?
Do you have someone in mind for our annual Maine Family Physician of the Year?
Are you interested in having your original writing featured in our newsletter?
We welcome all of your input and suggestions. Please contact our Executive Director, Deborah Halbach, at maineafp@tdstelme.net.
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/ / / Medical Student & Resident Corner / / /
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Congratulations to all the medical students matching into Family Medicine this March 19th. Welcome to the family!
Upcoming AAFP National Conference
Things we wish we knew as students and residents: Applying for and renewing your medical license
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Coming up July 29th-31st is the AAFP National Conference. National Conference brings together many of the most promising medical students and residents, who all share a passion for Family Medicine and a common goal—becoming the best physician possible. Make plans to join us for education, networking, and exhibitor and residency program interaction—and discover all Family Medicine has to offer. This year, the National conference is virtual, so it will be even easier to attend.
Things we wish we’d known before graduating residency:
Applying for and Renewing your medical license by Jessica Richmond, MD, Northern Light Mayo Hospital
Maine does require taking a Jurisprudence Class (included free on the website) and passing the test (also free). Make sure you set aside time to do this, an hour and a half is probably about right. For your first license application, you are not required to affirm having earned any CME (continuing medical education), having just completed residency, but subsequently, Maine requires 100 credits of CME every two years, which have to include 3 hours of opioid education. I recommend keeping track of your CME all in one place, and the AAFP website does this very well. You can potentially be audited to prove you have actually done the CME you claim, so it is also good to keep a record of all the CME certificates you earn.
There is also a license application fee to be paid. If you are joining a medical practice as an employee, your employer will likely reimburse you for this fee, so keep the receipt. Since the application is online, the turnaround time tends to be reasonable. Congratulations! You have a permanent license to practice medicine in Maine!
Here’s the other thing to remember: Your license needs to be renewed every two years. The renewal date is based on your birth month and year. For instance, if you were born in an odd numbered year, your renewal will be due in every odd numbered year, by the last day of your birth month. This came as a surprise to me – I graduated residency in 2012, my birth year is an even number and my birth month is November. I applied for and received my active medical license in the summer of 2012. Then, my renewal date came up again in November of that same year. Watch your renewal date and keep your license active! You can learn more at https://www.maine.gov/md/licensure/md-license#2
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/ / / Practice Pearls / / /
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COVID is on everyone’s mind. Learn best practices for testing and management of COVID-19:
Pros and cons of rapid testing vs PCR testing
- Where to get tested, cost-effective testing sites
- Treatment: Therapies for at-home treatment; new therapies; inpatient treatments
COVID testing and treatment practice pearls by Ben Hagopian, MD, Maine Integrative Family Care
TESTING
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Rapid antigen testing is most accurate in symptomatic patients within 4-5 days of symptoms. False negatives are common (20% false negative rate in symptomatic patients in a recent study) and very common in asymptomatic patients. Results are ready in 15-30 minutes.
- PCR testing is more sensitive than rapid testing with substantially lower false negative rates. It is best to perform PCR testing 5-7 days after a COVID exposure. Turnaround times are longer than for rapid testing, usually 1-3 days, but may be longer depending on lab capacity.
- No test is perfectly accurate so please ensure you are incorporating all appropriate factors when making clinical decisions.
WHERE TO GET TESTED - MANY OPTIONS
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I usually first send patients to the sites listed here due to being cost-effective and the sites having reasonable test capacity: https://www.maine.gov/covid19/restartingmaine/keepmainehealthy/testing
- Most of the testing thru the state is free but availability is variable
- Check with PCP office, most are doing testing
- National chain pharmacies or urgent cares, usually free testing with proper paperwork if uninsured; some require a provider evaluation which may not be covered; turnaround times vary
- As of publication, there is a pending Maine COVID patient bill of rights to require insurers to cover screenings, testing, and vaccine administration to make it free for Mainers to seek almost all care related to COVID-19
OUTPATIENT TREATMENT
- I recommend that patients with COVID eat healthy, minimize stress, and get plenty of sleep – these are all lifestyle measures that can improve immunity.
- Supportive care with analgesics and antipyretics as needed (acetaminophen, ibuprofen/naproxen); cough suppressants (dextromethorphan, benzonatate) as needed
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I suggest supplementing with 1000 IU of vitamin D3 due to the possibility of benefit. This suggestion will almost certainly not hurt any patient unless they have hypervitaminosis D or a calcium disorder. Similarly, zinc may help respiratory infections and a low dose (15 mg once daily) is reasonable. Both of these supplements are inexpensive.
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The newer monoclonal antibody treatments may help prevent hospitalization or medical visits for certain high-risk patients (with conditions such as severe obesity or immunosuppression) but they have not been shown to improve mortality. The number needed to treat for these therapies appears to be around 7-20 to prevent one event. These medications do require IV infusion in a medical setting. Costs may vary.
- Seek in-person medical care at a hospital (not urgent care) if breathing worsens. Spot-checking home pulse oximetry can help guide medical decision making. Pulse oximeters are usually available for $20-30.
INPATIENT TREATMENT
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Admission to the hospital and supportive care with oxygenation is standard of care for patients who are hypoxic or in respiratory distress. Prone positioning in awake patients who are in respiratory distress may help prevent intubation.
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The UK RECOVERY trial demonstrated the benefit of dexamethasone, especially among patients who require supplemental oxygen or are mechanically ventilated. Experts suggest a dose of 6 mg daily for up to 10 days.
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For critically ill patients who require mechanical ventilation, anticoagulation should be strongly considered as it appears to reduce mortality.
Questions about vaccines? Check out the CDC page here or the Maine state vaccine page here.
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/ / / Full Details on Upcoming Events / / /
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Maine DHHS is offering a series of 30-min COVID-19 Vaccine Info Sessions
- Tuesdays at 7:30 - 8AM
- Fridays at 12N – 12:30PM
The sessions will offer brief didactic sessions on the vaccine’s development and distribution process, along with any relevant clinical information for clinicians. Time is made for questions & discussions. Clinicians are welcome to attend one or multiple sessions. The sessions will be held via Zoom using the following log-in and/or call-in info for all sessions:
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Zoom/web: https://zoom.us/j/6218434986
- Meeting ID: 621 843 4986
- Passcode: 338847
- Phone: One tap mobile: +13017158592,,6218434986#,,,,,,0#,,338847#
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Maine DHHS Health Equity and COVID-19 Webinar Series
Maine DHHS is working to improve health equity and reduce disparities related to race and ethnicity, particularly disparities related to COVID-19. Maine DHHS is partnering with community colleagues to offer a series of monthly webinars focused on sharing creative solutions for working with Black, Indigenous and people of color with webinars on the third Wednesday of the month from 7:30-8:30 AM, with webinars currently scheduled through April 2021. View a list of upcoming webinars and register to attend
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DPC Summit, July 16-18 - Reach the Pinnacle of Professional Freedom
The DPC Summit is the premier conference for education around starting, operating and growing a direct primary care practice. Here’s your chance to revolutionize your practice without leaving home. DPC Summit, July 16–18, is the premier conference for education around starting, operating, and growing a direct primary care practice.
This exclusive virtual event is dedicated to supporting family physicians looking to provide enhanced patient care on their terms. Learn from nationally recognized faculty with years of real-world DPC experience. Plus, you’ll be able to:
- Network with others who share your passion for whole-patient care
- Discover the range of options available in defining a DPC practice
- Connect with vendors who offer the patient-centered solutions you need
If you’re ready to say goodbye to administration complexity and gain more face-to-face with time your patients, register today. Register Now
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Newsletter Created by the following MAFP Board Members
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