CME / Events

Change Gives FPs Flexibility to Choose Best Learning Formats

In the AAFP’s latest move to adapt to family physicians’ evolving needs, the Academy has eliminated the requirement for active members to earn 25 credits of CME through live activities. The change will allow active members to pick the learning formats that best suit their needs and preferences.

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Save the date! 

April 6-9, 2022
Maine AFP 30th Annual Family Medicine Update

South Portland, DoubleTree by Hilton
Schedule and registration info available after January 15, 2022

The annual MAFP Family Medicine Update is presented by the Maine Academy of Family Physicians to provide ongoing quality education through engaging didactic lectures and breakout sessions on subjects of interest to family doctors. CME is available in accordance with the AAFP. Deadline for registration is emailed/postmarked 10 days prior to the event. You can submit refund requests if you are unable to attend (minus $45 admin fee).

Oct 12-14, 2021

Maine Public Health Association annual conference will be held virtually. The theme is “Dirigo: Rebuilding and Moving Forward Together” with Penobscot Nation Ambassador Maulian Dana as the keynote speaker. Three tracks will be discussed: Political determinants of health, social determinants of health, and social determinants of equity.

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Oct 20-22: AAFP Virtual Global Health Summit. An opportunity to network and learn with global health advocates.

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Oct 21-22

AAFP State Legislative Conference. Learn about issues influencing health care and how to effect change where you live.

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Dec 6-10

Family Medicine Update Livestream. Get timely, ready-for-practice updates taught by family physicians for family physicians.

 

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New Website

We have a new website! Check it out at www.maineafp.org

We heard from you, our physician members, and want to make sure we are doing everything we can to provide you all with useful, timely, succinct, and easily navigable information that will assist you in your professional and personal lives.

Medical Training During the Pandemic

In the winter of 1918 my great grandmother was at home in South Portland, pregnant and suffering from the Spanish Flu. It was her 3rd of what would be 13 pregnancies. She went into early labor and my grandmother was born; preterm but vigorous. I could never have imagined that just over 100 years later, the clinical years of my journey through medical school would be dominated by another pandemic. Training during the COVID-19 pandemic has been a unique, sometimes frightening and intense learning experience. 

One of the main reasons for my interest in Family Medicine is that patient interaction is in my nature. I enjoy learning about people–their families, their interests, and their goals–and trying to understand the context they live in. Patient interactions during the pandemic have been unusual, to say the least. Without families or caretakers in the room, my conversations have been more intimate but perhaps less complete. It seems patients are more willing to share honest or hard truths when they don’t have to worry about the impact of these truths on people they love. However, without families in the room, I am not learning to manage the complexity of their role in the patient-physician relationship or benefiting from their synergistic memories.

Interactions are also affected by the nagging sense that patients are now dangerous. This has further been heightened as breakthrough cases in vaccinated individuals become more common. Patient visits are shorter, if for no other reason than I spend 2-3 minutes donning and doffing PPE. Given the myriad ways that COVID can present it seems that it’s always on my differential with anyone other than the completely well patient. It is frightening to know that I could bring a potentially deadly virus home to my family, including my two young kids and asthmatic mother. 

My fears came true in a sense when I contracted COVID from a patient during a recent rotation at Maine Medical Center. The patient was not under suspicion for COVID, and was vaccinated, as am I. Luckily, due to excellent contact tracing, advice from employee health, the Maine CDC and an unexpected ten day backyard camping trip, I got through the infection without severe symptoms or spreading COVID to my family. It felt like a close call and was draining to think that even after having been vigilant for nearly 18 months, one patient interaction of approximately 20 minutes could potentially reverse all the hard work. The additional cognitive and emotional load has been difficult to bear in an already challenging time in training.   

As I look toward residency, I suspect I am more prepared in some ways than past students. For instance, most patients I’ve seen during emergency department rotations have more acute illness than I would suspect was typical pre-COVID. The less acute are not present with a higher threshold to come in and thus most patients are presenting later in their disease course. Because of this there are many common conditions that I have only seen once or twice. Colds and flu seem as rare to me as melanoma or pancreatitis – the latter two of which I have seen far more of; even with months spent in primary care offices in third year. I have to trust that my training will give me the skills to treat future patients despite this difference. It will be interesting to see how my cohort performs overtime and where our deficiencies and assets lie. 

Both my great grandmother and grandmother lived into their late 90’s. Although they are not with us to experience the current pandemic I wonder what their perspective would be and what wisdom they could share about surviving and moving beyond challenging times which they both knew so much about. They were resilient, powerful women and I can only hope my colleagues and I can follow their example and learn from these demanding times. Hopefully rising as more resilient and resourceful clinicians and people from this current pandemic.     

Ben Davison is a 4th year MD candidate at Tufts University School of Medicine (Maine Track) and student board member of the Maine Academy of Family Physicians. He lives in New Gloucester, Maine with his wife and two children.

Advocacy & Legislative Updates

Reproductive Health Update – Maine AFP

  • Texas’ SB 8 went into effect on September 1 after the Supreme Court failed to intervene and subsequently rejected an emergency request to block it. This is a ban on abortion at approximately six weeks, before many people even know they’re pregnant, grants private citizens the power to sue abortion providers and anyone else who helps someone access abortion care and be rewarded with $10,000 or more. With almost no exceptions (rape or incest are not considered exceptions), people who need abortions will need to leave the state, an undue burden. More than that, communities are now polarized against each other with a “bounty hunter” scheme of suing anyone involved in providing an abortion, whether a healthcare provider or even the taxi driver that drove the patient to a clinic.
    • In response, The Women’s Health Protection Act (WHPA) was written. This would protect the right to abortion throughout the United States by creating a right for healthcare providers to provide abortion care and a corresponding right for people to receive that care, free from bans and medically unnecessary restrictions that single out abortion and block access. The house approved this bill on Friday, 9/24, and it is awaiting Senate approval.

Weekly legislative calls

The MMA Legislative Committee holds weekly conference calls during the legislative session to review and finalize the MMA’s position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week. For more information or to join the calls, please contact Dan Morin, Director of Governmental Affairs and Communications at dmorin@mainemed.com or 207-480-4199.

 

Delay in AAFP Congress of Delegates and plan for Maine AFP town hall to discuss member opinions

Every year, the American Academy of Family Physicians convenes a Congress of Delegates (COD), which is the Academy’s policy-making body. Its membership consists of two delegates and two alternates from each constituent chapter and from the member constituencies including new physicians, residents, students, and other constituency groups represented at the National Conference of Constituency Leaders.

The Congress elects new officers and three members to serve on the Board of Directors for the following 12 months. AAFP members are welcome to participate in hearings of the five reference committees: Advocacy, Education, Health of the Public and Science, Organization and Finance, and Practice Enhancement. Reference committees are committees of the COD that consider business (resolutions) items referred to them for recommendation to the COD for debate and action.

The COD generally happens just prior to FMX, but this year, due to COVID-19, the COD has been split into two different meetings.  The first meeting, occurring September 27 and 28 will only address electing new officers and members of the Board of Directors.  There will be a second meeting which will address business (resolutions) items.  Resolutions are typically submitted by the constituent chapters and debated by the congress, then voted on for action by the AAFP.  This meeting is not yet scheduled, but expected to be in February of 2022.

Your constituent chapter, the Maine Academy of Family Physicians, will be holding a townhall meeting via zoom (or similar carrier), to discuss how you would like your delegates to the COD to approach the resolutions which will come up for debate.  Keep an eye on your email for the invitation to this town hall, date and time TBD.

Dues & Getting Involved

Questions about dues? Need to pay your dues?

Check your status here:

Check My Dues
  • 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.

Medical Student & Resident Corner

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
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

As a resident, you will have had an Educational Certificate (or license to practice medicine within your residency). On graduation, you will need to apply for a permanent medical license. If you are an MD, use this link and if you are a DO, use this link. So far, so good.

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

Practice Pearls

COVID practice update

Long Covid Clinic:

Northern Light Mercy Hospital launches post-COVID care

Northern Light Mercy Hospital has launched a new effort to help those who are experiencing lingering symptoms even after they have recovered from COVID-19 infection. The hospital has brought together a select group of providers to focus on the evaluation and treatment of post-COVID patients. This approach will help Mercy clinicians work efficiently with Massachusetts General Hospital on developing evolving clinical guidelines to provide the most up to date care for these patients.

Post-COVID patients may have a range of symptoms that could require evaluation from a variety of specialists. During the initial visit, each patient undergoes a comprehensive intake and physical evaluation. A patient navigator then arranges additional imaging, testing, and/or referrals to specialists as needed.

Those seeking evaluations can call 207-857-8375 to schedule an appointment. Northern Light Mercy Hospital – Northern Light Health

OK to have flu shot and COVID vaccine at the same time:

The U.S. CDC and the Advisory Committee on Immunizations Practices recommend that if a patient is eligible, both the flu and COVID-19 vaccines can be administered at the same visit. In addition to flu vaccine, the COVID-19 vaccine can be given with other vaccines as well. Even though both vaccines can be given at the same visit, people should follow the recommended schedule for either vaccine. Previously, CDC guidance recommended healthcare professionals administer COVID-19 vaccine alone. This recommendation was out of an abundance of caution during a period when these vaccines were new and not based on known safety or immunogenicity concerns. However, substantial data have now been collected regarding the safety of COVID-19 vaccines currently approved or authorized by FDA.

Coadministration of Influenza and COVID-19 Vaccines.pdf (govdelivery.com)

Monoclonal antibodies:

The following information was accurate as of 9/23/21.

As a hospitalist currently facing the difficulty of trying to get hospitalized patients the care they need with essentially no hospital beds available in the state, I ask that you consider referring qualifying patients for monoclonal antibody treatment, both to help the patient by potentially preventing the disease from progressing, and also to help keep patients out of the hospital if possible.  

While there are currently no FDA approved therapies for the management of patients with COVID-19 in the outpatient setting, the FDA has provided Emergency Use Authorization for some monoclonal antibodies.  The approved options include both Bamlanivimab-etesevimab and carisirivimab-imdevimab.  Both are given by IV infusion. 

Inclusion criteria are either age 18 or older, or age 12-17 and weight 40kg or more, and not hospitalized for COVID-19, and not requiring supplemental oxygen (or not greater than baseline if on supplemental oxygen at baseline), and high risk of progression to Severe Covid-19, hospitalization, or death.  In addition to the above inclusion criteria, patients also have to meet the following eligibility criteria: presenting within 10 days of symptoms, confirmed COVID-19 via laboratory testing in the previous 10 days, and mild to moderate COVID-19.

There previously was an indication for prophylaxis, however, due to shortages, monoclonal antibodies are not available for prophylactic use at this time.

Infusion center sites include NL-EMMC (207-973-8286), St. Joseph’s Hospital in Bangor (207-907-3000), NL-Mercy (207-879-3355), NL-Inland (207-861-3380), NL- Sebasticook Valley Hospital (207-487-4089), NL-Mayo (207-564-4283), NL-AR Gould (207-768-4158), NL CA Dean (207-695-5270), NL Maine Coast (207-664-5470), NL Blue Hill (207-374-3996), NL Acadia (207-973-6160), Down East Community (207-255-0435), Cary Medical Center (207-762-0457), NL monoclonal antibody team (207-400-8790).  This may not be an all inclusive list.

Additional contact numbers follow, but are not confirmed to provide monoclonal antibody treatment.

Maine Health Scarborough (207-396-7705), Maine Health Biddeford (207-294-5820), Maine Health Sanford (207-459-1640), Central Maine Medical Center (207-795-0111), Maine General Medical Center (207-626-1000).

Please see attached guidance below regarding coadministration of influenza and COVID-19 vaccines.