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FP Report
April 2001 • Volume 7 • Number 4

Join in: Reassessment of specialty expands to include all stakeholders

BY JANE STOEVER

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The specialty may be ripe for transformation. Consider: Research indicates the public does not understand what a family physician is or can do. In many cases, the scope of family practice is dwindling. Fewer FPs offer maternity services or provide care in hospitals. Other professionals, from homeopaths to nurse practitioners, are giving care formerly considered the domain of FPs.

Many family physicians and medical students are expressing disenchantment with the specialty and its place in the health care delivery system.

The specialty's in flux.

"This is kind of like the ultimate midlife crisis," says AAFP Board Chair Bruce Bagley, M.D., of Albany, N.Y. "We need to ask, 'Where have we been? What have we accomplished? What are we doing next?'

"We need a pause in our development. We need to look at the future and see how to cope with it, how to update our training and our practice and the business of family practice."

The rapidly changing medical environment is challenging all specialties, he adds. "We have to see how family practice can best fit into that environment. And everybody else should be doing the same. It's not just family physicians. Anybody who's sitting out there thinking they can keep doing the same old thing is going to miss the boat ... or the rocket."

Bagley says he expects the health care industry, in the next five years, to go through the same kind of downsizing, the same drive for efficiency and better service, that banking and car manufacturing and service industries outside health care went through about 10 years ago.

To read the signs of the times, each year leaders of the "family of family practice" meet at a Working Party. Participants represent the Academy and six other family medicine organizations. In January 2000, the Working Party decided to convene the Oct. 4 ­ 8, 2000, Keystone III gathering, at which 82 attendees and others online grappled with options for the specialty.

The Working Party has decided to expand the specialty's reassessment process.

This January, the Working Party reflected on Keystone III and other discussions within family practice organizations and decided to expand the reassessment to all stakeholders -- FPs, residents and medical students -- and even groups outside the specialty. The Working Party will meet again April 23 at AAFP headquarters to hammer out details of the process, which may include hearings, focus groups and consultants.

"We'll get input at the annual meetings of the family practice organizations," says AAFP Executive Vice President Douglas Henley, M.D. "And we'll do market research to find out what the public expects their family doctors to do for them, not just in a single visit but over a continuum of time."

Groups such as unions and AARP may be asked what they want their family doctor to be like.

"How can our specialty evolve to better meet our patients' needs?" asks Henley. He hopes the answers will improve access to care, quality of care, FPs' reimbursement, their satisfaction with their practices and their communication with patients.

A tall order?

Yes. But see "Changes in the pipeline?" for ways to start filling the order.

FPs, GPs in six countries to go on lookout for medical errors this summer

Family doctors in other countries might have something to learn from U.S. family physicians about avoiding medical errors, and vice versa. That thought occurred to Susan Dovey while she worked on AAFP's study of medical errors in the United States last year.

Dovey was struck by the high percentage of filing errors the FPs reported, and she suspected the glitches would be fewer in other developed countries because of differences in filing systems. A native of New Zealand, Dovey is an analyst in the Robert Graham Center in Washington.

"It seemed strange to me that there were people in the United States employed to do nothing but filing, and there were rooms full of files -- as if there were no other way to do it," says Dovey.

Her hunch blossomed into the first international study of medical errors in primary care, now being launched in six countries.

"I think the way messages are handled is probably a problem across all countries, and maybe we can find out whether there is a better way or worse way of handling messages," says Dovey. "Also, it will be interesting to see whether certain types of clinical mistakes happen more in some countries than in others -- like whether wrong decisions about drugs are made more in one country than another."

The first phase of the three-part international study is just beginning in the United States, Canada, England, the Netherlands, New Zealand and Australia. The Robert Graham Center is coordinating phase one, which is supported in part by the Commonwealth Fund, known for its funding of health policy research and international fellowships. Dovey is principal investigator for the new study.

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At least 20 FPs and GPs in each of the six countries will report on at least 10 errors they observe in their practices this summer. Key questions the physicians will answer include: What happened? What may have contributed to this error? What could have prevented it? Was any patient harmed? How often does this error occur in your practice?

The Institute of Medicine blew the whistle on U.S. medical errors in late 1999 in a report that dealt mainly with hospital errors because data on them were readily available.

The protocol for the international study accents the need for research in primary care: "Primary medical care is complex. ... Its diversity, breadth of scope, and variation in structure and infrastructure may offer more opportunity for error than hospital-based care, which tends to be more highly regulated and procedure-oriented."

The study's first phase will describe differences in types of errors recognized by primary care physicians in the six countries. Dovey hopes the phase one report will be published in the journal Health Affairs early next year.

Phases two and three are still on the drawing board. The second phase will share information about the international physicians' strategies to avert errors. The third phase will develop and test intervention strategies in international settings.

Policy tackles vaccine shortages

A new AAFP policy prioritizes the use of two vaccines in short supply and a third that may become scarce. Clinicians with shortages of tetanus and diphtheria toxoids (Td) vaccine should give highest priority to those traveling to countries where risk of diphtheria is high, followed by those requiring vaccination for prophylaxis in wound management.

For tetanus toxoid (TT) vaccine, the Academy recommends giving priority to clinics and hospitals that treat acute wounds.

The full policy -- at http://www.aafp.org/policy/camp/28.html -- addresses a possible shortage of tetanus and diphtheria toxoids and acellular pertussis (DTaP) vaccine.

Worrisome trend continues
Specialty, primary care lose ground in 2001 match

It's dropped again -- the number of individuals matching in family practice residency positions, as well as in the positions of other primary care categories. This is the fourth consecutive year that family practice and primary care have lost ground, according to preliminary data released March 22 by the National Resident Matching Program.

Data show that 2,363 family practice positions were filled out of the 3,096 available, for an overall fill rate of 76.3 percent.

That's a far cry from the halcyon days of the mid-nineties, when the family practice fill rate rose from 1992 through 1997.

And it's bad news for America, says AAFP President Richard Roberts, M.D., J.D., of Madison, Wis.

"Medical students are clearly demonstrating a preference for medical subspecialties -- and yet studies show that Americans rely on family physicians more than any other specialists for health care," says Roberts. "As America's population continues to grow, there won't be enough of us to meet future needs if the present trend continues.

"Instead, there will be more subspecialists trained to care for individual health problems -- but not enough doctors trained to care for the whole person and the whole family."

The numbers

NRMP data show that 2,363 family practice positions were filled out of the 3,096 available, for an overall fill rate of 76.3 percent. Last year, it was 81.2 percent.

Fewer U.S. seniors are selecting family practice as well. Of U.S. seniors matching this year, 11.2 percent matched in family practice, compared to 13.6 percent last year.

All primary care programs -- family practice, pediatrics-primary, internal medicine-primary and internal medicine-pediatrics -- had lower overall fill rates this year. Total positions filled by U.S. seniors decreased in all primary care programs.

Go to http://www.aafp.org/match for more details of the 2001 NRMP results.

Understanding the trend

Why are more medical students choosing subspecialties? "Some anecdotal evidence indicates that students are attracted to the lifestyle of subspecialists, especially in regard to schedule demands and financial implications," says Roberts. "Many subspecialists face fewer external productivity pressures -- and they get better pay for their work."

Medical school debt is one key concern. According to the Association of American Medical Colleges, the average student's debt is more than $94,000.

"Once they get into practice, they have to pay that off, and they also have to start building a financial base for their children and their own long-term future," says Roberts. But other specialists' salaries often are two to three times higher than primary care salaries.

Stemming the tide

The Academy's well down the road when it comes to analyzing students' growing disenchantment with family practice. Some specifics:

"We know practicing FPs are struggling right now," says Roberts. "We know it's a challenge to present a positive picture when the difficulties of daily practice are so overwhelming. We're working to make it better, so that family physicians can more easily recall why they went into family practice in the first place -- and pass the enthusiasm on to students who look to them as role models."

Specialty's critical role

How critical are family physicians to the nation's health?

For comparison, if the other kinds of physicians who provide primary care -- pediatricians, internists and obstetricians/gynecologists -- were erased from the picture, the number of whole-county primary care HPSAs would only rise to 960.

Source: The Robert Graham Center (http://www.aafppolicy.org/onepagers)

Inside the Beltway

More funds needed for family practice training, AHRQ, rural programs, says AAFP

AAFP Director James Martin, M.D., of San Antonio recently asked a panel of U.S. representatives to consider life without family doctors.

What difference does an FP or GP make? Martin's answer: Without them, more than two-fifths of the nation's counties would overnight become whole-county primary care health professions shortage areas (see charts below).

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By contrast, removing the other three kinds of primary care physicians from their counties would convert only about 6 percent of U.S. counties into new whole-county primary care shortage areas.

"Without family physicians, counties around the United States would not receive essential services," said Martin March 22 to the House Appropriations Subcommittee on Labor, Health and Human Services, and Education.

A recent study by the Robert Graham Center in Washington shows that receipt of Title VII Section 747 funds for family practice training makes a significant difference in medical students' choice of a career in primary care (including family practice), rural practice or a health professions shortage area. "Without Section 747 funding, fewer students would be making these career choices," said Martin.

He addressed the need to turn around the family physician shortage. "Medicare payment policies have contributed to the increase in subspecialist physicians and have fundamentally skewed the market," said Martin. "These policies have promoted training in the expensive inpatient specialties -- rather than in family medicine and other primary care fields. Moreover, National Institutes of Health grants, totaling billions of dollars, go primarily to subspecialist research."

Referring to Congress' interest in diversity in the medical workforce, Martin said 9.5 percent of family practice residents in 1978 were from minority groups, and by 1997, that rate had risen to 24 percent.

Section 747 includes support for family medicine, general internal medicine, general pediatrics, physician's assistants, and general and pediatric dentistry. The AAFP is seeking an increase from $91 million for Section 747 programs in 2001 to $158 million in 2002.

"The Academy is especially pleased by the boost in funding Title VII received for fiscal year 2001," said Martin, referring to the 17 percent increase over the 2000 funding of $78 million.

The AAFP testimony also requests more funds for the Agency for Healthcare Research and Quality and for federal rural programs.

AHRQ. The agency emphasizes primary care research, and Martin highlighted the need for the most effective treatment plans for patients with numerous serious conditions. He gave as an example a patient with diabetes, hypertension, depression, low back pain and heart disease.

"Traditional, disease-specific treatment is not useful in this situation," said Martin. "Treatment for one disease may exacerbate the other conditions."

The Academy is calling for 2002 funding for AHRQ to be set at $400 million, much higher than the 2001 funding of $270 million and the 2000 funding of $199 million.

Rural programs. The Academy is seeking continued support for rural health programs including area health education centers, the programs of the federal Office of Rural Health Policy, the National Health Service Corps, and the Community and Migrant Health Center Program.

The AAFP testimony has also been submitted in writing to the Senate Appropriations Committee.

Ask your lawmakers to pass Bipartisan Patient Protection Act

One piece of patients' rights legislation has passed AAFP's litmus test, its principles for managed care reform. Now all that's needed -- with your help -- is for Congress to approve the legislation.

The Bipartisan Patient Protection Act has won the Academy's backing because, for example, it would:

Leading proponents of the legislation, S. 283 and H.R. 526, are Sen. John McCain, R-Ariz.; Sen. Edward Kennedy, D-Mass.; Sen. John Edwards, D-N.C.; Rep. Greg Ganske, R-Iowa; and Rep. John Dingell, D-Mich.

Other managed care reform bills have been introduced in this session of Congress, and additional ones are being drafted, but the Bipartisan Patient Protection Act is the first one meeting key AAFP criteria. If later bills reflect AAFP principles, the Academy will most likely endorse them.

The Academy encourages you to contact your members of Congress and seek their support for S. 283 and H.R. 526. You might want to use the message the AAFP has posted in Speak Out! as an e-mail to your lawmakers or as a sample letter. Access Speak Out! at http://capitol.aafp.org. Then click on "Write to Congress" and letters supporting H.R. 526 and S. 283.

Sen. John McCain Sen. Edward Kennedy Sen. John Edwards Rep. Greg Ganske Rep. John Dingell
Sen. John McCain Sen. Edward Kennedy Sen. John Edwards Rep. Greg Ganske Rep. John Dingell

Survey takes stock of members' e-Health

BY SHERI PORTER

Chances are good that you know colleagues who have not yet taken the plunge -- or perhaps have waded just ankle-deep -- into the sea of information technology.

The Academy's goal is to have all FPs using the Internet in their offices by 2003 and using EMR systems by 2005.

The AAFP's Ad Hoc Committee on Electronic Medical Records knows many FPs fit that description. The committee decided last fall it was time to take action.

Board Chair Bruce Bagley, M.D., of Albany, N.Y., chairs the EMR committee. "The Academy's goal is to have all our family physicians using the Internet in their offices by 2003 and electronic medical records by 2005," said Bagley. "We need to know the current level of usage so we can track our progress toward that goal."

A four-page questionnaire went out to 4,500 AAFP active members in November. After a second mailing, responses from 1,436 members were tabulated. Survey results shed light on members' knowledge and use of technology in three areas: the Internet, e-mail and EMR.

"The survey is unique because it gets into the behavioral issues -- why physicians are not using technology and what influences their decisions," said Susan Rehm, AAFP manager of health information and technology. Survey responses indicated:

Physician responses to open-ended questions included requests for more technology education from the AAFP, particularly hands-on demonstrations and beginner-level training.

Bagley is optimistic about members' e-Health. "I'm encouraged because the survey shows that 70 percent of our physicians already use the Internet in their practices. If that figure were 25 percent, I'd be really worried.

"Our goal is doable. The groundwork has been laid -- most family physicians already have computers and are learning how to use them -- and that's very heartening," said Bagley.

Letters to the Editor

Addressing 'the pain problem'

To the editor:

I read "Pain, Pain, Go Away" in the March 2001 FP Report and thought, "Here we go again! Trying to solve a problem by bureaucratizing it." I looked up the Joint Commission on Accreditation of Healthcare Organizations standards on the Web and concluded that following them to the letter would take an unreasonable amount of time away from what we really need: just plain listening to our patients.

A major obstacle to addressing "the pain problem" effectively is assuming that it is a single disorder. In fact, patients in pain should be broadly categorized and managed in three groups. The first are persons with disseminated cancer. Long-term opioid use may be an important part of their total care and should be prescribed liberally when indicated. The second are those with non-fatal objectively definable diseases that cause pain. Opioids are often indicated in acute situations like ureterolithiasis or bowel obstruction, but are less likely to be useful in chronic disorders. For example, various agents classified as anticonvulsants or antidepressants may be better for zoster and other neuropathic conditions.

The third group are those in whom pain cannot be reasonably attributed to a demonstrable physical disease. Objective evidence that opioids really help is difficult to find. Improvement in functional status is seldom demonstrated, although patients may say that they feel better. This writer is familiar with one often-cited publication that seemed to show benefit in a 10-week crossover study, but a trend line drawn on the figure in that paper would show a return to the placebo line at about 14 weeks.

Our knowledge of the etiology, pathogenesis and prevention of chronic nonspecific pain is appallingly incomplete. The present evidence supports the concept of a multifactorial disorder driven by a combination of biological, behavioral, sociopolitical and (dare we say it?) iatrogenic processes. Family medicine is the discipline best qualified to perform the intensive, comprehensive longitudinal research needed to find ways to minimize the incidence and adverse impact of this problem. When will we begin?

Robert Gillette, M.D.
Poland, Ohio

Of privileges and board certification

To the editor:

I read with interest the February FP Report article about Dr. Eric Runte's lawsuit seeking Caesarean section privileges. Everyone concerned seemed to agree that privileging "should be based on training, experience and current competence." Unfortunately for Dr. Runte in particular and FPs in general, the court rejected this premise.

I see this article from a different perspective.

I have been an AAFP member for 13 years. Although I am board certified, it's not in family practice -- it's in preventive medicine. I have not found the specialty of family practice to be gracious and accepting -- even in areas of privileging where training and competence were not at issue. And a broader note: Family practice's efforts to distance itself from general practice have relied as much on certification as on training and competence. It is hardly surprising that other specialties also use certification to "rise above" the humble FP.

It is nice to be detached from this imbroglio. What goes around does indeed come around to my family practice colleagues.

W.R. Eder, M.D.
Pocatello, Idaho

'It's 2020' revisited

To the editor:

I read with interest the "It's 2020" articles in the January FP Report, which gave optimistic and pessimistic views on the specialty's future. I respectfully submit the following alternate views:

"If family practice has failed, why?" -- It bought into the flawed idea that whatever society's law said was ethical, became "ethical" for physicians. When it became legal to kill an unborn child, the specialty failed to take a stand against it. "Assisted suicide" no longer seemed objectionable. And powerful forces extended the "logic" of abortion to other areas of life, such as the elderly. Soon active euthanasia was legal by Supreme Court decree. The Academy drifted with the mainstream. But a breakaway group formed a new Academy of Hippocratic Physicians that respected all human life. It became the dominant force in primary care. The AAFP withered.

"If family practice is thriving, why?" -- When confronted with legalized infanticide and active euthanasia, the AAFP passed a sheaf of new ethical principles, establishing its members as the advocates for even the most powerless patients. It became medicine's most trusted institution. HMOs and government were forced to bring their regulations in line with the Academy promulgations since most patients refused to see any other providers.

Jeremy Klein, M.D.
Louisa, Ky.

We want letters

Write us using the FP Report email address pbinder@aafp.org or click here for other addresses. Please keep your letters concise; all letters are subject to editing.

Airlift provides powerful push for family practice in Vietnam

BY SHERI PORTER

Ho Chi Minh City, Vietnam

With a toast of fine cognac, family practice took one giant step closer to becoming a reality in Vietnam. With his glass held high, Professor Nguyen Dinh Hoi, chancellor of the Ho Chi Minh University and dean of the medical school, thanked the family physician contingent of the ninth Physicians With Heart delegation, the first to Vietnam. The celebration dinner on Feb. 24 ended the Feb. 16­26 humanitarian airlift on a high note.

"I thought it was really a landmark to get an invitation from this particular man -- he's such a storied figure in medicine in Ho Chi Minh City," said Alain Montegut, M.D., of Brunswick, Maine. Montegut has worked since 1996 to lay the groundwork necessary to bring family practice to Vietnam. The evening of Feb. 24, for the first time, Hoi publicly announced his support for Montegut's effort, which will culminate with the opening of the first three family practice residencies in Vietnam in 2002.

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Above: After a morning medical symposium, lunch provided an opportunity for John Patz, D.O., right, of Issaquah, Wash., to delve into details about family practice with medical students at Ho Chi Minh University Medical School.

Right: After the delegates distributed rice, school supplies and toys to residents of a leprosy village east of Ho Chi Minh City, this woman loaded a bag of rice onto her bicycle for the short trip home.

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Earlier in the week, the delegation celebrated the arrival, first in Hanoi and then in Ho Chi Minh City, of a Federal Express airbus that carried 23 tons of donated pharmaceuticals and medical supplies valued at $4.25 million.

The delegation members shared gifts, warm smiles and encouragement with blind school children in Hanoi and villagers in a leprosy community east of Ho Chi Minh City.

Since 1993, Physicians With Heart -- a project of the AAFP; AAFP Foundation; and Heart to Heart International, a humanitarian aid organization based in Olathe, Kan. -- has delivered more than $52 million worth of medical aid to areas of need in former Soviet republics and now to Vietnam. Go to http://www.aafp.org/airlift to read more about these airlifts.

Set your sights on Moldova

Ready -- set -- go. If you're a family practice educator, pull out a map (made after 1991) and see how fast you can find the Republic of Moldova.

Here's a hint: Look northeast of Romania in southeast Europe, the home of some former Soviet republics. Now that you've located Moldova, block off your calendar for Oct. 13 ­ 23, dates of the next Physicians With Heart airlift.

Family practice education and training are at the heart of the country's health care reform efforts, so airlift organizers are especially interested in having family physician educators join the delegation.

For an application to join the Moldova airlift, contact Miles Zinn at Heart to Heart International at (405) 787-5200, Ext. 103.

Changes in the pipeline?

Board Chair Bruce Bagley, M.D., and EVP Douglas Henley, M.D., say the following factors might fast-track the specialty's evolution.

About that interface: "Too often, we just give patients a name and a number for a referral," says Bagley. "Only for a complex patient do I write a letter, and I bet I'm not the only one remiss. The process would be much more valuable if the other professional could look at the patient's medical record online."

Once the specialty's leaders plan the reassessment schedule later this month (see story on page 1), get ready to toss your ideas into the mix.

Don't expect a once-over-lightly exercise. The process will probably take from 18 to 24 months, says Henley.

Resident & Student News

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Taking the mystery out of loan repayment

Whoever said "The best things in life are free" obviously wasn't thinking about the years of medical school and graduate training it takes to enter medicine.

If you're staggering under the burden of medical school debt, you might find help through the Association of American Medical Colleges educational debt management services.

What's even better is this -- the
services are free! You can go to http://www.aamc.org/debtmanagement to access current, objective information on how to manage your student loans during residency and beyond. The site hosts the following useful features.

"The Layman's Guide to Educational Debt Management for Residents and Graduate Medical Education Staff" is based on eight easy-to-follow strategies. A glossary of all the basic terms lets you be sure you've got the lingo down. And a rundown of the various loan types makes it easy to compare their respective benefits and drawbacks -- always helpful when the time comes to pay (back) the piper. The guide also discusses deferment options, offers tips on record-keeping and gives information on resources to consult for professional help.

Check out the Resident Repayment Program

If you're interested in rural or inner-city family practice or the full-time teaching of family medicine, you may be able to shake off some of your medical school debts through an AAFP Foundation program.

The Resident Repayment Program provides funds to selected residents to pay 75 percent of the interest that accrues on their educational loans during residency and the first year of practice. Recipients receive up to $2,500 per year, for a $10,000 maximum over the four years.

The deadline for applying to enter the RRP is Oct. 15. The foundation encourages first- and second-year residents to request an application now via http://www.aafp.org/aafpf/res-pay.html or by calling (800) 274-2237, Ext. 4470.

Get concise answers to questions about your loan portfolio from MONEYMATTERS, a listserv dedicated to residents' loan issues. Consult MONEYMATTERS for timely notices about interest rate changes, deferment and forbearance options, loan consolidation opportunities and other repayment information.

Each year, the AAMC hosts video presentations of its educational debt management workshops at teaching hospitals nationwide. The password required to access the video online has been provided to medical school financial aid officers, PGY-1 program directors and other GME staff.

For questions about access restrictions to the online video or about the AAMC debt management services, contact Paul Garrard, AAMC director of student financial services, via e-mail at pgarrard@aamc.org or by phone at (800) 828-0511.


Show your face at this year's National Conference

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Thomas Zuber, M.D., of Atlanta made good use of pigs' feet in teaching soft-tissue surgery at the 2000 National Conference.

What better place is there to voice your opinions about family practice issues, hone your clinical skills and network with your peers than the 2001 National Conference of Family Practice Residents and Medical Students?

The theme for this year's event, to be held July 25 ­ 29 in Kansas City, Mo., is "The Many Faces of Family Medicine." At a special Wednesday forum, panelists will discuss how family practice has allowed them to pursue a wide range of interests, including direct patient care, teaching, administration, research and politics.

Smash hits at last year's conference, rappers John Clarke, M.D., and Matthew Clarke, M.D., of New York are back for a return engagement. Hear about the FP brothers' success in using music to reach that most confounding of patients -- the American teenager.

Delivering this year's Stephen A. Jackson, M.D., Memorial Lecture will be AAFP President-elect Warren Jones, M.D., of Potomac, Md. Jones, who recently retired as a captain in the U.S. Navy, is the first black FP chosen to lead the Academy.

Dennis Saver, M.D., of Vero Beach, Calif., AAFP's 2001 Family Physician of the Year, will be a guest lecturer at the 2001 conference. Long an advocate of caring for the medically underserved, Saver began his family practice career with a National Health Service Corps assignment that took him to the heart of rural Appalachia.

Social events include the opening party at historic Union Station/Science City, the traditional Picnic and Square Dance, and the annual Wellness Run/Walk.

New for 2001 are workshops on topics such as how to use the Internet in family practice, getting the most out of your personal digital assistant, and the pros and cons of using e-mail to communicate with patients. Another new offering is a July 25 full-day workshop on research skills -- a program the AAFP Foundation is sponsoring.

As always, the National Congress of Family Practice Residents and National Congress of Student Members give you a forum to express your views about what's going on in family practice today and where you think the specialty should be headed.

In addition to various workshops, there will be procedural skills courses, where you can test your clinical mettle in such areas as splinting and casting, joint injection, nasolaryngoscopy and suturing techniques.

For news of National Conference awards and scholarships (and patient education conference scholarships), see the story "Keep a Close Eye on Award, Grant Deadlines."

Early-bird registration for the National Conference ends June 8, so make your travel plans now. Take advantage of one of three easy ways to register: online at http://www.aafp.org/conference; by fax at (913) 906-6083; or by mail to Housing and Registration Department, c/o AAFP, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Direct questions to conference@aafp.org or to (800) 926-6890, Ext. 6726.

AAFP backs IOM call for system-wide improvements

The nation's "disjointed and inefficient" health care system cannot provide safe, high-quality care consistently to all Americans and must be reformed, the Institute of Medicine says in a report released in March. To make reform a reality, Congress should create a $1 billion "innovation fund" to help subsidize promising projects and communicate the need for rapid and significant changes throughout the health system -- funding similar to that which supported the mapping of the human genome.

The IOM issued its new report, Crossing the Quality Chasm: A New Health System for the 21st Century, on March 1. That same day, the AAFP and three other medical groups issued a statement supporting the report.

According to the report, the reform effort should focus on improving care for common, chronic conditions such as heart disease, diabetes and asthma -- conditions that are the leading causes of illness in the nation and that consume substantial resources.

"These ailments usually require care over time by a variety of clinicians and in a variety of health care settings. But those who provide the care work so independently that they frequently don't have complete information about patients' conditions, medical histories or treatment received in other settings," says Joseph Scherger, M.D., a former AAFP director who served on the IOM committee that developed the report. He is associate dean for primary care at the University of California, Irvine, College of Medicine.

To initiate reform, IOM wants the Agency for Healthcare Research and Quality to identify 15 or more common, chronic conditions, and then wants health care professionals, hospitals, health plans and purchasers to develop strategies to improve care for the conditions over a five-year period. The revamped system also should encourage greater use of information technology, says Scherger.

In the joint statement supporting the IOM report, AAFP Executive Vice President Douglas Henley, M.D., says the organizations issuing the statement "are committed to learn about issues relating to quality and to develop solutions addressing them." For example, he said, the AAFP's Robert Graham Center and the Academy's practice-based research network are studying the nature of errors in primary care to determine how to improve quality in the medical care setting accessed by most people.

  • Go to http://www.ama-assn.org/ama/pub/article/1616-3969.html to read the joint statement.
  • Visit http://www4.nationalacademies.org/news.nsf/isbn/0309072808?Opendocument for the IOM's press release on the new report.
  • You also can go to http://www.ama-assn.org/ama/pub/article/1751-3966.html for a list of existing quality improvement projects by the AAFP, AMA and other groups.

Keep a close eye on award, grant deadlines

For more information on these programs, call (800) 274-2237 and ask for the extensions listed below (unless otherwise noted).

If you'd like a research study grant from the AAFP Foundation Joint Grant Awards Program, apply by June 1. For an application, call Ext. 4470; go to http://www.aafp.org/aafpf/jgap.html for more information.

Note the June 30 deadline for awards to be presented at the 23rd Annual Conference on Patient Education Nov. 15­18 in Seattle. Patient Care magazine and the conference will give Patient Care Awards for Excellence in Patient Education to a physician or practice group, a health care professional (non-physician) and a family practice residency program. The H. Winter Griffith Award for Excellence in Patient Education Materials will be presented to an individual, a practice or an organization. Call Ext. 5412 or visit http://www.stfm.org for details and applications.

Family practice residents are invited to apply for scholarships or educational grants to attend the patient education conference. Send the application with a letter of recommendation from your program director to the AAFP by July 16. Applications are available through your constituent chapter, family practice residencies, online at http://www.aafp.org/pec or by calling Ext. 3132.

Don't miss the May 5 deadline to apply for awards to be given at and scholarships to attend the National Conference of Family Practice Residents and Student Members July 25­29 in Kansas City, Mo. Applications are available for the family medicine interest group leadership award, minority scholarship programs for medical students and family practice residents, resident community outreach award (new this year), student community outreach award and first-time student attendee award. Request applications online at http://www.aafp.org/conference or call Ext. 6726.

Winning posters in the state Tar Wars poster contests must be received at AAFP headquarters by May 14 to be considered for the national competition. For more information, visit http://www.tarwars.org or call (800) TAR WARS [827-9277].

Official call is issued for Congress of Delegates

Pursuant to Chapter IX of the AAFP Bylaws, notice is hereby given of the 54th annual meeting of the Congress of Delegates.

The Congress, to be held in Atlanta at the Hyatt Regency Atlanta, will open at 7:30 a.m. Monday, Oct. 1, and conclude about noon Wednesday, Oct. 3.

Reference committees

AAFP members are encouraged to participate in the Oct. 1 ­ 2 reference committee hearings, where issues are debated before being considered by the full Congress.

AAFP Bylaws

Proposed amendments to the AAFP Bylaws must be submitted by June 25 to be considered by the 2001 Congress of Delegates. Proposed amendments should be signed by five or more AAFP active members.

Resolutions

Proposed resolutions for the Congress to consider should be submitted by Sept. 1 by constituent chapters.

Both the proposed resolutions and amendments should be sent to AAFP Executive Vice President Douglas Henley, M.D., at the American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672, or faxed to him at (913) 906-6093.

Douglas Henley, M.D.,
AAFP Executive Vice
President and Secretary
to the Congress of Delegates

Economist Uwe Reinhardt, Ph.D., to keynote Scientific Assembly

Uwe Reinhardt, Ph.D.

Just how dysfunctional is the current health care system, and what should be done to make it well?

Join your colleagues at the AAFP Scientific Assembly in Atlanta this October to hear health systems economist Uwe Reinhardt, Ph.D., share his perspective on these and related questions. Reinhardt will be the keynote speaker at the Assembly Oct. 3.

Reinhardt, James Madison Professor of Political Economy at Princeton University in Princeton, N.J., has studied the health system and workforce issues since his college days. He served three terms on the (then) Physician Payment Review Commission. A member of the Institute of Medicine, he has been on IOM panels studying the implications of a physician surplus, for-profit medicine, technical innovation in medicine and the nursing shortage. He currently serves on the board that guides the institute's health services research.

In 1997, he joined the Pew Health Professions Commission, which explores the implications of health systems change on the health workforce. Since 1998, Reinhardt has chaired the coordinating committee of the Commonwealth Fund International Program in Health Policy and has served on the Kaiser Commission on Medicaid and the Uninsured.

Watch your mailbox for the Assembly promotion brochure and registration materials, to be mailed to active members in May.

New for You

Order from AAFP at (800) 944-0000 unless otherwise noted.

For CME by computer, visit http://www.aafp.org/cme and click on "Online CME" for a variety of quizzes. Click on "AFP Online CME Cases" for the latest addition, on diabetes. Each case has interactive features that include questions throughout the case, a quiz at the end, and the opportunity to interact with the author, medical editor and other participants using an electronic bulletin board. Take the quiz free or take it for $5 to earn 0.5 hours of CME credit.

Send a tobacco-free message -- use colorful Tar Wars notecards (#R2965, $20). The 15 cards feature three designs showing award-winning Tar Wars posters created by youngsters. Proceeds go to the AAFP Foundation and will be used to help send state Tar Wars winners to the national poster contest.

Proven value: Visit http://www.aafp.org/policy to access updated, searchable versions of AAFP Policies on Health Issues and AAFP Clinical Recommendations. You also can get printed copies of the policies manual (#R606) and clinical recommendations manual (#R607). The first set of both manuals is free. Each additional manual costs $15, or you can get both for $20.

A shipping fee may apply; Kansas residents pay a 7 percent tax.

FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.

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