September 2000 • Volume 6 • Number 9
Future of family practice
To the editor:
I am writing in response to the July FP Report article, "Specialty Will Assess Itself, Brainstorm Possibilities." As a second-year family practice resident, I am very concerned about the integrity of family practice in the future. I am most concerned with obtaining hospital and obstetrical privileges.
I am still convinced that family medicine is the pioneer in primary care. However, in our specialist and subspecialist society, family practice physicians are losing privileges because of competition.
I think a solution to this dilemma is for the AAFP to support the creation of additional boarded subspecialties, especially in obstetrics and emergency medicine. They would have fellowship training for from one to two years in a program that is recognized as board certified and would have board examinations equivalent to those for OB-Gyns or emergency physicians. Therefore, a family practitioner who chooses to practice full-spectrum family medicine would not be forced by today's (and tomorrow's) political environment to practice in a smaller community.
Steven Koerth, M.D.
Fort Worth, TexasBirth control services
To the editor:
I was appalled to read in the August FP Report that the AAFP has aligned itself with forces that seek to force hospitals to provide birth control services.
Let us be clear that we are talking about the elective procedures of vasectomy and tubal ligation. No Catholic hospital is refusing to provide necessary obstetrical care.
I believe that mandating convenient community access to elective sterilization procedures sets a dangerous precedent. It is only a small step away from mandating community access to other elective procedures. The pressure to provide services that conflict with the moral principles of an institution will be extended to physicians. Physicians will be dropped from insurance plans if they refuse to prescribe RU-486, the "morning- after" pill. They will be required to utilize IUDs. It is not difficult to see this scenario expanded to include mandated access to abortion, euthanasia and physician-assisted suicide. The AAFP should rethink its position on this slippery slope.
Denise Hunnell, M.D.
Niceville, Fla.Pain relief act
To the editor:
I was disappointed in your coverage of the Pain Relief Promotion Act (PRPA), "Pain Relief Act Might Inhibit Use of Drugs to Fight Pain" (FP Report, July). I would have hoped for better balance in a paper which describes itself as providing "news for today's family physician."
The article mentions the concerns of the current leadership of the AAFP but fails to note that the majority of medical organizations, including the AMA and the National Hospice Association, favor the PRPA. These organizations and many others do not share the fears being promulgated, including the specter of "agents" interfering with medical practice.
The truth is that the PRPA provides no new authority to the Drug Enforcement Administration. This legislation seeks to promote more and better pain relief with millions of dollars of funding for educational efforts to teach advanced pain management and palliative care to health care providers. In addition, rather than placing physicians "at risk," the PRPA actually provides new protections for both patients and physicians. Patients will benefit by having assurance that the best (and adequate) pain relief will be more readily accessible in all 50 states. Physicians will be protected in that for the first time, the concept of "double effect" will be codified into DEA regulations. That is, physicians will be able to give pain relief medication to whatever level is necessary to control pain even if an unintended consequence might be a hastened death.
Your article does correctly identify some of the current gaps in providing adequate pain relief to those who need and deserve help. The PRPA is a sensible and much-needed step toward filling this need. As such, I am particularly disappointed that the energy and resources of our organization are being spent in a misguided effort to undermine such sensible legislation.
William Toffler, M.D.
Portland, Ore.Editor's note: Refer to page 1 of this issue for an update on AAFP's opposition to the pain relief bill.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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