July 2001 • Volume 7 • Number 7
Bush budgets $0 for FPs' training
Specialty fights back in contacts with CongressBY JANE STOEVER
Exactly nothing -- that's what President George W. Bush allocated for family practice training in his proposed 2002 budget. Academy staff discovered this threat to the specialty's future as they analyzed budget specifics before the specialty made its spring legislative visit to Congress.
Pete Modaff points to a map of his state, Washington, as he studies maps several FPs brought to him and his boss, Rep. Norman Dicks. From left are Bob Moser, M.D., of Tribune, Kan.; Modaff; Erika Bliss, M.D., of Seattle; and Mary Frank, M.D., of Rohnert Park, Calif. See page 2 for more on the maps.About 50 FPs flew to the capital, learned of the threat and came to the specialty's defense in contacts with reporters, lawmakers and their aides.
"There's a dramatic decrease in the number of students interested in family medicine," Daniel Onion, M.D., told a reporter at the Capitol May 21. Onion directs the Maine-Dartmouth Family Practice Residency in Augusta.
"Our residency had 63 applicants this year versus 101 four years ago. It's a damn disaster. If this (Title VII) money goes away, I'm worried about the pipeline, the students we want to attract to family practice," said Onion. "We have patients banging on our doors. We can't let patients in because we already don't have enough family physicians."
President Bill Clinton had several times zeroed out the specialty's Title VII funds "with a wink and a nod," expecting Congress to replenish the Title VII money anyway, which it did, said Kevin Burke, director of the AAFP Government Relations Division.
"President Bush is saying he wants Title VII cut because of the 'glut of physicians,' and with the tax cut, there'll be less funding for discretionary spending, including Title VII," said Burke.
Bush has proposed building 100 new community health centers and expanding another 100. Family physicians would be prime candidates for staffing those centers, Burke said. "But without support from Title VII grants for family practice training, the community health centers will not be able to fulfill the added expectations. It's a formula for failure."
Burke added, "We need to let Congress know there's already a shortage of family physicians in many areas."
FPs hit the Hill
The FPs took the Title VII challenge and ran with it, straight up Capitol Hill, during the May 20 - 22 lobbying effort sponsored by AAFP and the Organizations of Academic Family Medicine.
Erika Bliss, M.D., a first-year resident at Swedish Family Medicine Residency in Seattle and a graduate of the University of California in San Diego, was one of four AAFP members who talked about Title VII with Pete Modaff, an aide to Rep. Norman Dicks, D-Wash.
"My work at the San Diego Free Clinic -- which started small with Title VII support -- very much sustained my desire to go into primary care during my four years in medical school," Bliss told Modaff. "These programs have a ripple effect." She said 75 percent of UCSD medical students are now involved in the clinic, which has become part of the local health care safety net.
"I'm worried about the pipeline," says Daniel Onion, M.D., right, explaining how cutting Title VII funds could clog the flow of medical students to family practice. Reggie Beekner, reporter with Medill News Service, listens.Dicks serves on the House Appropriations Committee; Academy members addressed Title VII issues with several members of the House and Senate Appropriations Committees because of the committees' influence in shaping the federal budget.
Modaff related Title VII concerns to the then-proposed tax cut: "Norm (Dicks) thinks the size of the tax cut is a big mistake. This Title VII situation is the chickens coming home to roost. Norm will vote with you guys on this."
Visits cover various issues
In the office of Sen. Ted Stevens, R-Alaska, (then) chair of the Senate Appropriations Committee, aide Liz Connell gave the Academy members some insights into the committee's agenda this year. "The Labor/HHS bill may be the last to move (through the committee) this year," said Connell. "And there are caps on discretionary spending. But the senator is interested in student loan forgiveness, and we are looking at a community health centers bill."
"That would really help out Anchorage Neighborhood Health Center," said Dwight Smith, M.D. He should know. He's a faculty member of Alaska Family Practice Residency in Anchorage; the residents care for many of the center's patients.
Discussing possible legislation on a patient safety reporting system, Rep. Mark Kirk, R-Ill., agreed with the FP visitors on the need to keep the system nonpunitive, so physicians won't fear that their reports could trigger lawsuits. Kirk told the family physicians, "We're all for patient safety, but I don't want you to be afraid to practice medicine."
First-timers find niche
Some FPs joined the legislative visits to the Capitol for the first time. "A lot of our members look at Washington as being a big black box -- the less we know about it, the more comfortable we are," said James North, M.D., of Toledo, president-elect of the Ohio AFP, after his first lobbying effort in Washington.
"I learned a lot. It hit home, how interested the lawmakers and their staffs are in hearing our viewpoint," said North. "They appreciate us because we're patient advocates -- we're lobbying for things for our patients. They've got a lot of constituents who are our patients."
If there were no FPs...
During the spring legislative visit (see story on page 1), about 50 family physicians gave legislators or their aides several maps -- a "teach-in" of sorts.
The maps show the current primary care health personnel shortage areas and, given the threat that Title VII funds might be axed, the sharp increase in primary care HPSAs that would occur if there were no FPs.
Chances are you may have a Title VII story to tell your lawmakers. Perhaps you got your first taste of primary care in a project funded in part through Title VII. Perhaps you're looking over your shoulder, wondering where your next partner will come from, hoping Title VII funds keep flowing to bolster family practice training.
To obtain the national maps or similar state maps for contacts with your lawmakers, call the office of your AAFP constituent chapter.
Primary care health personnel shortage areas by county*
Primary care health personnel shortage areas if there were no FPs* Current status: Counties with full or partial primary care HPSA designation. The number of FPs could substantially decrease if Title VII funding is cut. This map shows the counties that would be primary care HPSAs if the areas had no FPs. *Source: Robert Graham Center in Washington. Note: Data in the federal Bureau of Health Professions' Area Resource File for physicians and HPSAs did not include the boroughs of Alaska, so that state is not shown on these maps.
Wanted: your ideas
What would you value from the AAFP? What could you do without?The Academy is embarking on a comprehensive review of its products and services and is asking for your input.
How to submit your input
- Key in your suggestions at http://www.aafp.org/members/cgi-bin/ budgetreduction.pl by Oct. 1.
- Send them to Robert Watchinski, AAFP's chief financial officer, by e-mail to rwatchin@aafp.org; by fax to (913) 906-6090; or by mail to AAFP, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
"We're taking a very positive step designed to continue the Academy's strong financial health and also to free up funds for future projects that will be strategically important in this new century," says President Richard Roberts, M.D., J.D., of Madison, Wis. "The AAFP is in great financial shape -- our reserves are right where they need to be. But five-year projections indicate we need to prioritize our activities now to maintain this position of financial strength."
To do this, the Academy wants input from members -- suggestions for both revenue enhancement and cost reduction.
"We can't be all things to all people," says Roberts. "But with members' help, we can pare down some activities while continuing or beginning others that are important to members and contribute to AAFP's core strategic directions."
All suggestions should be submitted by Oct. 1. See the box on the right to provide input.
A subcommittee of the AAFP Board of Directors will consider all suggestions from both members and staff. The Board will act on the subcommittee's recommendations, with decisions announced by September 2002.
NEJM publishes Robert Graham Center study
BY SHERI PORTER
When you sit down to read the June 28 New England Journal of Medicine, don't miss "The Ecology of Medical Care Revisited," a study from the Robert Graham Center in Washington.
Larry Green, M.D., director of the AAFP center and principal investigator for the study, said that despite the passage of 40 years -- and major changes in the U.S health care system -- the health services delivery model described in his study closely resembles the original model published in NEJM in 1961. Even an aging U.S. population and the inclusion of children in the new model did not significantly change the outcomes.
"The ecology model is a framework that allows us to think about health care and how people make the decision to actually go see a doctor," said Green.
Larry Green, M.D., left, and Kerr White, M.D., stand in front of worksheets in the Robert Graham Center. Green calls White "a father of health service research who has championed the cause of family physicians since the 1950s."
The Ecology Scheme*
*Source: Robert Graham Center in WashingtonThe study shows, once again, the importance of health care administered outside of the hospital setting, said Green. The results suggest that policy-makers should seek a better balance in allocating funds earmarked for medical education, medical research and clinical practice, "in order to meet all the needs of all the people," he said.
"We would hope that this updated model will be used with renewed confidence that the estimates are contemporary and relevant to current health care issues," said Greene. "However, the stability of the model over the 40-year period of time doesn't mean that people necessarily have done the right thing. There were imbalances in 1961, and the model shows that there are still imbalances in 2001."
Kerr White, M.D., lead author of the 1961 study, serves on the Robert Graham Center advisory board.
The figures cited in the recent study reflect positively on FPs and other primary care physicians: For every 1,000 people, it is estimated that 113 visit a primary care physician's office in any one-month period (see graph at above).
"If there should be any primary care physicians who are feeling beleaguered today and, particularly, wondering if the work they do matters, this framework should alleviate their doubts about the importance of their role -- and not based on the world's experience up to 1961, but based on the behavior of the American people at the end of the last century," said Green.
'One person makes a difference'
Family medicine leader urges specialty to harness powerBY CINDY McCANSE
Family practice match numbers down again ... further reimbursement hassles ... yet more scope of practice battles ... Title VII funding threatened ...
Heck of a time to be a family physician, right?
As a matter of fact, it is, according to F. Marian Bishop, Ph.D., M.S.P.H., professor and chair emerita in the University of Utah School of Medicine Department of Family and Preventive Medicine in Salt Lake City. Bishop delivered the Nicholas J. Pisacano, M.D., Memorial Lecture at last month's Workshop for Directors of Family Practice Residencies in Kansas City.
"Family medicine, as an academic discipline and as a practice specialty, has been a major success story over these past three decades," she said. "And I am convinced that it will continue to be a success in the decades to come, regardless of what happens to the economy, future resident match days, health insurance coverage, HMOs, PPOs or any other alphabet soup which may come along."
The reason, as Bishop explained it, is simple enough.
The Power of Family Medicine
"Family medicine equals power," said Bishop. Although, she added, "There've been times when we have failed to recognize the unbelievable power that was available to the discipline, and consequently we failed to utilize that power to leverage improved quality care for our patients and to leverage a positive, influential position for our specialty."
Family medicine enjoys the power of numbers, Bishop noted. Consider the phenomenal growth of the specialty -- from three family practice residents in the pipeline as of 1969 to 56,910 living graduates of accredited family practice residencies three decades later.
But numbers do little in the absence of voice, said Bishop. "If you want to change the world, you have to be heard. Unless you open your mouth and sing in the choir, you're just taking up space," she said.
Witness the restructuring going on within the AMA, she added.
Despite a sharp drop in membership, the AMA remains the world's largest medical group, wielding a level of influence unmatched by any other such organization. By joining the AMA, Bishop said, FPs can help shape "the fabric of health care in the United States."
Another power family medicine holds is persistence, said Bishop. "Instant success," she jibed, "takes time. Instant success does not occur overnight."
Bishop said that since this year's family practice residency match, she's heard a lot of doom and gloom about the future of family medicine. "I even heard someone say that family medicine had hit its peak and is in a free fall, and it's unlikely to recover," she noted.
Bishop doesn't buy it.
"Balderdash," she said. "I disagree. There are always peaks and valleys; this is the cyclical nature of progress. What is discouraging in one area will be made up for in achievements in another. We have to persist and hang in. Most of the time, just hanging in helps; it works. It's called the 'pain in the ass strategy.'"
The last power Bishop discussed -- altruism -- is arguably the greatest, she noted. "Altruism is the basic fuel for power. Recognizing that you've helped someone provides the energy to persist, to voice convictions and to join with colleagues to choose the high road when choices can be made."
A Spirit of Caring and Compassion
Yet for all its power -- or, perhaps, because of it -- family medicine continues to embody a spirit of caring and compassion, as Bishop knows firsthand.
Diagnosed two years ago with recurring breast cancer, Bishop is currently under the care of a host of physicians and other health providers. Although an oncologist heads the team, she said, it is her family physician who is at the heart of it.
F. Marian Bishop, Ph.D.:
"If you want to change the world, you have to be heard. Unless you open your mouth and sing in the choir, you're just taking up space.""She's the one member of this team who routinely asks me how I feel about the setbacks that seem to come along every four months," Bishop explained. "She gives me permission to feel, to grieve, to sigh, to cry and to be frightened."
And it is her family physician, said Bishop, who has been able to give her a sense of peace about the final days of her illness simply by promising her, "I will be there" -- four words Bishop clings to.
"She's a hero, just as you are heroes. She has personal power with her patients, just as you have personal power with your patients," she said.
Ultimately, Bishop concluded, all power derives from the individual: "One person makes a difference, and everyone should try."
Stay abreast of geriatric health care
BY SHARON DICKINSON DENT
If you think you see a lot of elderly patients in your practice now, just wait a few more years.
According to the U.S. Bureau of the Census, the population of people 65 and older increased by close to 4 million between 1990 and 2000. The total of those 85 and older went up by more than 1.1 million.
Projections for 2020, compared with numbers for 2000, include a 54 percent increase in people 65 and older, as well as a 60 percent increase in those 85 and older (see table below).
As the elderly population skyrockets, research findings about geriatric health care will appear more frequently in scholarly journals and in the news. Some recent nuggets of information include:
- a recent report that says chronic disability rates are falling at an accelerating pace among white and black elderly patients, and
- the American Academy of Neurology's release of revised evidence-based guidelines for the detection, diagnosis and treatment of dementia in the elderly, with an emphasis on Alzheimer's disease.
For more on these topics and on osteoporosis and hip fracture, see the accompanying stories.
As chronic disability rates drop for elderly, FPs can help trend continue
A recent report reveals that chronic disability rates among the nation's elderly are falling at an accelerating pace. The report, published in the May 22 issue of the Proceedings of the National Academy of Sciences, details trends in chronic disability rates from 1982 to 1999 for patients age 65 and older. The report is based on data from the 1999 National Long-Term Care Survey. It cites a drop in the prevalence of chronic disability from 26.2 percent to 19.7 percent.
"I can tell you with 100 percent certainty that I have fewer disabled patients than I had 10 years ago," says Cheryl Lambing, M.D., assistant clinical professor of family medicine at the University of California-Los Angeles and a faculty member at the Ventura County Medical Center Family Practice Residency.
Lambing, an expert in musculoskeletal rheumatology, attributes disability declines to two major factors -- overall improved health and the increasing use of home health care or assisted-living facilities in lieu of traditional nursing homes.
Improved health care, immunizations, medications and sanitation have given people longer lives, she says. "Now that they're aged, how do we prevent them from being disabled? We make their environment safe. We treat all their comorbid conditions. You don't want an 80-year-old who's frail and disabled; you want an 80-year-old who's still getting around independently."
Medicine has made great strides in warding off disabilities, says Lambing. "In my waiting room 10 years ago, I had many patients who were disabled," she says. "They were disabled, for instance, with class 4 rheumatoid arthritis. They were wholly unable to take care of themselves. Many of them are in long-term facilities. Why is that? We didn't know how to treat them, and we weren't treating them effectively.
"We have new medicines now. We have a better understanding of the inflammatory process. It's the same thing in orthopedics: Instead of waiting until the last possible moment, we think about lavage, debridement, earlier joint replacement. If people are mobile, they probably report less disability."
The NAS report cites a growth in assisted-care living facilities, and Lambing says such facilities have proliferated in California. Many of her success stories involve patients living in an assisted-care residence or remaining at home with help from aides, who do everything from grocery shopping and meal preparation to in-home physical therapy. "The mind is a powerful thing," she says. "For many patients, going to the long-term care facility is essentially the kiss of death. Whereas, if you have the same patient who could be rehabbed at home and that patient is able to stay in the home environment and enjoy all their social interactions, that patient tends to do well."
Watch for the August FP Report, which will include a story on comprehensive assessment of geriatric patients. For CME on geriatrics, see "Quick Fax".
Lambing has seen that firsthand. "In my home, I have four generations," she says. "I have my grandmother, my parents, my husband and me, and my kids. My grandmother has osteoporosis; she's had fractures; she requires oxygen 24 hours a day; and she has macular degeneration, a very common cause of disability in older folks. So I can see it right under my own roof. She would do horribly in a nursing home. But at home, she has time with her great-grandchildren; she has a lot of help."
Lambing says the report is significant for primary care physicians because it spells out the benefits to society of preventing disability in the elderly. "By 2030, the largest segment of the population is going to be patients over the age of 65," Lambing says. "That's a huge group of patients, and we're the ones who are primarily going to be managing them. If we can keep them healthy for longer, we won't strap our medical resources."
Visit http://www.pnas.org/cgi/content/abstract/98/11/6354 to view a copy of the report.
Prevent osteoporosis and falls to reduce hip fracture risk
Each year, hip fractures land 350,000 people in the hospital and 60,000 in nursing homes, according to the American Academy of Orthopaedic Surgeons. And the prognosis is bleak for hip fracture patients:
- About 20 percent die within a year of complications related to the injury and the recovery period.
- Most who previously lived independently will require assistance from family members or home care professionals.
- Forty percent of those 65 and older are discharged from hospitals to long-term care facilities.
Be on the lookout
The best course of action a family physician can take is to help patients prevent osteoporosis and reduce their risk of falling, says James Mold, M.D., professor of family and preventive medicine and adjunct professor of geriatric medicine at the University of Oklahoma Health Sciences Center in Oklahoma City.
"Family physicians need to think about osteoporosis as early as possible and throughout a person's whole life," Mold says, offering these suggestions: Hound teens to get plenty of calcium to ensure they build as much bone mass as possible. Make sure elderly patients get enough vitamin D; many don't drink milk, and their skin no longer produces vitamin D in the necessary quantities. Counsel all patients against smoking, excessive consumption of alcohol and a sedentary lifestyle.
"Also, think about medicines and how they might cause problems with regard to bone mass," says Mold. For example, cortico-steroids, loop diuretics and anti-seizure medications leach calcium out of the bones, whereas patients taking chlorothiazide for years actually increase their bone mass.
James Mold, M.D.:
"Family physicians need to think about osteoporosis as early as possible and throughout a person's whole life."Identifying patients at risk of falling can prevent future disability. "For us to maintain our proper balance and posture, a number of different systems must function well," says Mold. "You have to be able to tell where you are in space, which depends upon senses in your feet, your vision and your inner ear. You also need muscle strength and reaction speed.
"All of us start to fall periodically, but we catch ourselves. People between 65 and 74 years of age are often still able to react quickly enough to catch themselves with an outstretched hand and are, therefore, more likely to break their wrist. Those 75 and older are more likely to land squarely on the ground and break a hip."
Conditions beyond frailty
Specific medical conditions also put patients at a high risk of falling. These include Alzheimer's disease, which affects visual-spatial orientation; Parkinson's disease, which causes postural instability; stroke; and peripheral neuropathy. Diabetes in the absence of neuropathy is not a strong risk factor for falling, says Mold.
Certain medications, including neuroleptic/antipsychotic drugs and benzodiazepines/anti-anxiety drugs, can increase a patient's risk of falling by slowing reaction speed.
Similarly, alcohol use is a risk factor, Mold points out. "Ten percent of falls at home may be related to drinking alcohol," he says. "Although alcoholism is not that common in the elderly, even one drink of alcohol reduces your reaction speed, and its effect can last for six or eight hours in an older person."
Genetic factors come into play for both osteoporosis and falls. Patients have an increased risk of falling and breaking bones if they have relatives who have done the same, says Mold.
At risk? Already down?
Once you determine that a patient is at risk of falling, what should you do? "List all the risk factors the person has and try to address as many as possible," Mold says. "It has to be an individualized, multipronged approach."
He also suggests getting patients into a Tai Chi class. A major study on fall prevention found that Tai Chi -- an exercise combining muscle strengthening with balance training -- reduced the risk of falling by between 30 percent and 40 percent.
Bone density testing in high-risk patients is warranted. And a new approach to fracture prevention is the use of hockey hip pads on nursing home patients to protect their hips if they do fall, he says.
If, despite your efforts, a patient takes a spill, don't disregard it. "Falls can be a clue to the onset of something new, like the first symptom of an infection or a new illness that hasn't been diagnosed yet," Mold says.
Physicians must explore the reason for the fall as thoroughly as they address the injuries that result. "In a younger person, we tend to address the injury and say, 'Don't let it happen again,'" he says. "With an elderly person, you have to think about why the fall occurred."
New guidelines offer tips on Alzheimer's disease diagnosis, management
Physicians can accurately diagnose 95 percent of patients with Alzheimer's disease and need to do so early. That's a key message from the American Academy of Neurology, which issued updated evidence-based clinical guidelines this spring on the detection, diagnosis and treatment of dementia in the elderly, with an emphasis on Alzheimer's disease.
"We're talking about a disease for which there is no cure at the present time," says FP Tom Norris, M.D., associate dean of the University of Washington School of Medicine in Seattle. "It's not a situation where catching it early allows one to get started with definitive therapy that's going to slow the progress of the disease or cure the disease. The huge advantage -- if we can catch this disease early -- is that so much of it is an educational process, helping the family understand what's going on and what they can do."
Physicians can also begin offering medications, behavioral suggestions and other support to help "avoid some of the problems that occur when the disease gets to fairly advanced stages without being recognized," says Norris, who has worked extensively with patients with the disease. For example, cholinesterase inhibitors have been shown to alleviate symptoms in some patients with mild to moderate Alzheimer's disease.
The AAN guidelines reflect the efforts of 21 experts who examined more than 6,000 abstracts. Although they don't include any major revelations, Norris says, they do feature useful information detailing the level of support for each recommendation.
Alzheimer's disease is fairly common in the elderly. According to the AAN, 10 percent of people older than 65 and 50 percent of those older than 85 suffer from the disease. Physicians should identify and monitor mild cognitive impairment (memory impairment without dementia) because from 6 percent to 25 percent of patients with MCI progress to dementia or Alzheimer's disease, the AAN says.
Norris encourages FPs to check out the new guidelines, which were published in the May 8 issue of Neurology. To access them online, go to http://www.aan.com and click on "Dementia Resources." He also encourages physicians to distribute a list of 10 warning signs (see box above) to patients or families asking about Alzheimer's disease.
Survey says ...
2000 Annual Clinical Focus hit the markEven as U.S. Surgeon General David Satcher, M.D., Ph.D., is calling on primary care physicians to take a more active role in detecting and treating mental illness, AAFP members are saying they're up to the task.
Two surveys -- one mailed to AAFP members before and one after last year's Annual Clinical Focus, Mental Health 2000 -- gauge the program's impact on members with regard to managing mental illness in their patients.
For each of nine disorders, physicians were asked to rate their pre- and post-ACF levels of knowledge and performance in recognizing characteristic signs and symptoms. Statistically significant gains were seen in reported knowledge levels about depression, anxiety, panic disorder and dementia (see graph at right). Respondents also reported statistically significant increases in levels of performance (detecting and treating) for depression, anxiety and dementia.
ACF Medical Director Stephen Spann, M.D., of Houston says the results appear to indicate that respondents did, in fact, increase their knowledge about a number of mental health problems commonly seen in family practice, although he cautioned against overinterpreting the data.
Other areas in which statistcally significant strides were made were:
- knowledge about predisposing factors for mental illness,
- knowledge of primary prevention interventions,
- knowledge and use of available psychotropic agents, and
- overall comfort level in diagnosing mental health problems.
Physicians also commented on what changes they would make in their practices as a result of having participated in Mental Health 2000. Among the changes respondents cited most frequently were:
- increased use of screening and diagnostic tools,
- expanded use of antidepressants,
- greater emphasis on encouraging patients to explore community resources,
- better implementation of patient education initiatives and
- enhanced incorporation of mental health teaching principles into family practice residency training.
Finally, respondents suggested additional educational programs they would find helpful in their practices, including coursework on cognitive behavioral counseling, emotional problems in children, marital counseling and the special emotional needs of men.
The first questionnaire went out to 2,000 members in February 2000; 228 responses were received for a return rate of 11.4 percent. Those respondents were again surveyed this past March and the results compared with the earlier self-reported knowledge and skill levels.
For more information about the surgeon general's mental health initiative, go to http://www.aafp.org/fpr/20010600/01.html . For more information about Mental Health 2000, including a listing of supporting and cooperating partners, go to http://www.aafp.org/acf/2000/ .
Last call! See you at the resident and student conference!
You've registered. You've made the hotel reservations. Got the plane tickets. Now all you have to do is ... show up. In Kansas City, Mo., that is.
Join your peers at the Bartle Convention Center July 25 - 29 for this year's National Conference of Family Practice Residents and Medical Students. Network with colleagues, sharpen your clinical skills, learn about new technology and just plain ol' have a good time.
Start off with a special Wednesday forum, "The Many Faces of Family Medicine," which just happens to be the theme for this year's event. Hear how a family practice career can let you pursue multiple interests, including patient care, teaching, administration, research and politics.
And don't miss Friday morning's Stephen A. Jackson, M.D., Memorial Lecture. AAFP President-elect Warren Jones, M.D., of Ridgeland, Miss., will talk about pathways to leadership. As a black physician, Jones is particularly interested in ensuring that all constituencies receive adequate representation at the upper levels of organizations. He is also devoted to overcoming disparities in health care given to minority patients.
New this year is a series of workshops on "techno topics," such as using the Internet in family practice, getting the most out of your personal digital assistant and communicating with patients via e-mail. Visit the exhibit hall to check out residency programs, career opportunities and a host of other offerings.
And, as always, you can air your views about what's going on in family practice today and where you think the specialty should be headed during the National Congress of Family Practice Residents and National Congress of Student Members.
Questions? E-mail them to conference@aafp.org, or call (800) 926-6890, Ext. 6726.
Ban direct drug advertising?
To the editor:
I am a retired family physician whose only current contact with drug companies is as a consumer. I spent 15 years as a practitioner, 16 years as a residency director (I was a RAP consultant for eight years) and then 10 years as a full-time investigator for clinical drug trials.
One thing that I learned during my research years is that drug pricing is based on what the market will bear -- not on the cost of development. I heard one vice president of a major drug company state this in a closed meeting.
A major portion of current drug pricing is the cost of advertising prescription drugs to the public. This practice should be outlawed, and it is an area where practicing physicians can make an impact. Physician organizations, such as AAFP, should recommend to their members that they not prescribe such drugs if other drugs can be substituted without influencing quality of care.
Frank Snyder, M.D.
Albuquerque, N.M.From Title VII to NP issues
To the editor:
I'm not sure about my opinion of Title VII; however, we are oversupplied with primary care providers in our area.
In addition, the issue of nurse practitioners being equivalent to family physicians in their own eyes and in their advertising needs to be seriously addressed. We certainly don't need more primary care physicians if NPs are infiltrating everywhere and are not willing to work closely with doctors.
Randall Stoltz, M.D.
Evansville, Ind.
To the reader: Write us letters of 200 words or fewer (subject to editing), using the FP Report address pbinder@aafp.org or FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
Fact sheets can help you lobby for family practice issues
Suppose you're interested in lobbying your lawmaker and want to encourage more funding for the National Health Service Corps.
To give you background information for your advocacy efforts, the Academy has put online some fact sheets about NHSC and other topics. The NHSC fact sheet covers issues such as loan repayment.
At a May 20 legislative briefing in Washington, Tanya Jones, M.D., of Atlanta, chair of the AAFP Commission on Legislation and Governmental Affairs, told about 50 family physicians, "There has been tremendous hardship and controversy about NHSC physicians not receiving contractually promised educational loan repayment assistance. The money was cut. A lot of people, especially in rural and underserved areas, are critically dependent on this program. It is essential to address any lawmaker's suggestion that poor management should result in dropping the NHSC program. Don't let Congress throw the baby out with the bath water."
The NHSC fact sheet says Congress should reauthorize the corps, increase its funding, and offer tax relief for NHSC scholarships covering tuition and educational fees.
Access AAFP's legislative fact sheets at http://www.aafp.org/gov/fed/bg.html .
Jones also discussed other fact sheets used by the family physicians during the next two days in meetings with lawmakers and their aides on Capitol Hill (see story on page 1).
The other fact sheets cover Title VII funding for family practice training, support for the Agency for Healthcare Research and Quality, managed care reform, the Medicare Education and Regulatory Fairness Act, a Medicare prescription drug benefit and patient safety reporting systems.
Order from AAFP at (800) 944-0000 unless otherwise noted.
The POL Microscopy Atlas (#R725, $98) boasts more than 130 photos of cellular elements with matching descriptions and clinical associations for the physician office lab. The atlas also contains procedures for urine sediment and vaginal wet prep examinations and for peripheral blood smears. Earn up to 8 hours of Prescribed credit with this office lab tool. Call (800) 274-2237, Ext. 4143, for more information. Order online at http://www.aafp.org/catalog, or fax your order to (913) 906-6075.
Proven value: The CME program Fundamentals of Management for Family Physicians is tailor-made for FPs acting as physician-managers. Topics include leadership and management skills, finances, quality improvement and strategic planning. Physicians pay $1,250; physician/administrative teams pay $1,995 (register by Aug. 31 to save $100). For more information, visit http://www.aafp.org/fom/, or call (800) 274-2237, Ext. 4114.
Proven value: "Patient Education in Your Office: A Handbook for the Office Setting" (#R953, $34.95) offers strategies to help you develop effective teaching systems, evaluate your efforts and increase your chances of being reimbursed for your patient education services. Plus, by using it, you can earn up to 8 hours of Prescribed credit.
A shipping fee may apply; Kansas residents pay a 7 percent tax.
FP Report is published by the AAFP News Department.
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