April 2002 • Volume 8 • Number 4 |
You can testify, too
Patients ensnared in web of regulations, physicians tell
HHS
Patients suffer when doctors and hospitals are flooded with excessive paperwork and Medicare and Medicaid audits. So said FP Jesus Llanes, M.D., of Miami during the Feb. 25 - 26 hearing in Miami of the HHS Advisory Committee on Regulatory Reform.
You, too, can testify before the committee -- or in writing -- about invasive HHS regulations. Get help with information from the Academy (see details at end of story). But first, here's what some physicians discussed at the panel's first regional hearing.
Llanes, who cares for an underserved population, said his practice is filled with patients with HIV and AIDS. Recently, he was investigated for alleged overcharges. Llanes answered the Medicare carrier's allegations with many patient records, most of which were never even opened by the investigator, he said.
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"Patients are dying because of what the
government is doing." |
The case advanced to a hearing, but Llanes said the process led him to believe he was "guilty until proven innocent." He closed his practice during the year it took him to prove his innocence. "Over 20 of my patients with AIDS -- who didn't have to -- died within eight months," Llanes told the HHS panel.
"Patients are dying," he said, "because of what the government is doing. It's costing practices, and -- worst of all -- it's costing lives."
In another case, a recent "strange application" of Emergency Medical Treatment and Labor Act regulations nearly ended the life of a 15-year-old patient with hydrocephalus, testified Michael Dennis, M.D., a Washington, D.C., neurosurgeon.
Dennis had operated on the child at birth to implant a shunt. The girl was uninsured and living in West Virginia when she was taken to an ER with a shunt obstruction and became comatose.
The ER staff called Dennis and said they were transporting the patient to him in Washington -- a four-hour drive away. He urged them to transport the girl to the closest hospital with a neurosurgeon on call so she would get immediate care. The hospital staff refused and told Dennis that if he didn't accept the patient, he would be guilty of an EMTALA violation.
"He (the ambulance driver) passed 13 hospitals with that little girl, and I saved her life," Dennis said. "There's no statement (within EMTALA), no reference to the closest hospital that can provide services anywhere, and I think that is one of the big missing links."
MICROMANAGING MEDICINE
EMTALA has many unfunded mandates and on-call responsibilities for which physicians won't get paid, said FP G. Kristin Crosby, M.D., of Bellingham, Wash., who serves on the HHS advisory committee. "There's a lot of stupid stuff in those regulations that we need to change."
This committee, she said, is looking for a mechanism HHS can use to change the regulatory system. "If HHS is going to micromanage the practice of medicine, it must stay current," she said.
HHS committee chair Douglas Wood, M.D., told speakers at the hearing, "You bring valuable experience to this table. Each of you, from your different backgrounds, brings something else to this process."
That process, Wood said, stems from HHS Secretary Tommy Thompson's intention to find "concrete, tangible solutions and recommendations on ways that we can make the rules and regulations less onerous, less burdensome, to providers and beneficiaries across this country."
GET IN ON THE ACTION
Visit http://www.aafp.org/fedgov/x2451.xml to download AAFP testimony, talking points and a fact sheet that can help you prepare for a panel hearing. Talking points on topics of particular interest to the Academy include HIPAA, Advance Beneficiary Notices, graduate medical education and home health. Also on the site are hyperlinks to the HHS advisory committee's site, where you will find meeting locations, times and complete agendas as they become available. Written testimony on any of the topics should be faxed to Wood at (202) 401-7321.
At press time, the committee's second regional hearing, planned for March 20 - 21 in Phoenix, was to include discussion about Medicare+Choice and ABNs.
On the agenda at future meetings:
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New Mexico psychologists gain prescribing privileges
Citing the need to increase access to mental health care for rural populations, New Mexico Gov. Gary Johnson signed legislation March 6 authorizing Ph.D.-trained psychologists to prescribe psychotropic drugs to patients. It's the first time a state has authorized this expanded scope of practice for psychologists.
However, a psychologist first must complete 450 hours of additional training and a two-year patient practicum under physician supervision, pass a national certification exam, and maintain a collaborative relationship with the patient's physician.
The American Psychiatric Association and the New Mexico AFP urged the governor to veto the bill. Daniel Derksen, M.D., a member of the NMAFP Board of Directors, paid Johnson a last-minute visit to lobby against the bill.
In addition, FPs sent the governor nearly 300 letters opposing the bill, Derksen said. However, it was signed into law because Johnson said he was "satisfied there were sufficient safeguards in the bill to protect state residents."
The American Psychological Association stated that 72 percent of New Mexicans live outside of Albuquerque and Santa Fe, and only 18 psychiatrists serve the rural population. The New Mexico Psychological Association reported that 176 members serve the same population. Practicing family physicians in these rural areas number 246, according to the 2002-2003 Physician Characteristics and Distribution in the U.S. report issued by the AMA.
"The reality is that family physicians already do the vast majority of prescribing in mental health cases in this state," said AAFP Director Arlene Brown, M.D., of Ruidoso, N.M. "So we, as physicians, need to do a better job at documenting the extent to which we are capable and willing to provide mental health care services."
American Psychiatric Association President Richard Harding, M.D., called the prescribing law "bad medicine for patients." "We believe that the legislature and the governor in New Mexico have placed patient health and safety at risk," he said.
Rick Kellerman, M.D., of Wichita, Kan., chair of the Academy's Commission on Legislation and Governmental Affairs, agreed. "This clearly will further fragment the care of an individual patient," he said, "especially for those of us who are trying to manage a patient's total care.
"If we're really going to increase mental health care access, this plan just missed the boat. Because access already is there with trained family physicians."
Brown sees the prescribing law as the result of a push by the national psychological organization to "get it on the books somewhere" and to advocate this expanded scope of practice elsewhere in the country.
"There are very few psychologists in the state who actually want to pursue it," she said. "Many of them lobbied against the bill, saying they didn't want the responsibility or liability of prescribing drugs."
"I see this as a very limited experiment that eventually will die a natural death," Brown added.
However, in anticipation of the bill's approval, a curriculum designed to satisfy the educational requirements is available at New Mexico State University in Las Cruces. About 20 psychologists are enrolled in the program, said a representative of the state psychological group's task force on prescriptive authority.
Kellerman said the Academy would continue to monitor the situation and provide support if similar legislation emerges in other states.
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Here's help on following patient privacy regulations
When you're consulting with your staff about office management, it's likely that a certain acronym increasingly peppers those discussions: HIPAA.
It stands for the Health Insurance Portability and Accountability Act of 1996 -- and the "accountability" aspect for protecting patients' privacy has kicked in. HIPAA regulations on the confidentiality of patient information took effect April 14, 2001. You have until April 14, 2003, to bring your practice into compliance with them.
"The physicians in our practice met recently to do some planning with the company that manages our business operations, and we focused heavily on HIPAA," says Leonard Fromer, M.D., of Santa Monica, Calif., chair of the AAFP Commission on Health Care Services.
"As physicians, we all safeguard the privacy of the patient," says Fromer. "And as family physicians, we can multiply that ethic of privacy for any patient by the number of people in the patient's family." Besides, says Fromer, FPs -- who often make referrals -- are at the center of a universe of people who need information to help the patient.
HIPAA Privacy Manual
Each day, several family physicians call the Academy asking questions about the HIPAA privacy rules and saying, "I need help!"
Here it is: AAFP's new HIPAA Privacy Manual. Practice consultants and lawyers drafted this step-by-step guide, and practicing FPs reviewed it. "It gives us a track to follow," says Fromer. "The path to compliance will be rocky. There'll be noise; there'll be bumps in the road. But this manual is one way the Academy is helping us deal with the bumps."
The manual summarizes the regulations and offers checklists and sample documents for your practice. See the story below for some suggestions from the manual.
"Everyone has to comply with the regulations," says Fromer. "The government agencies will recognize, though, that there are different solutions for a practice with one doctor than for a large multispecialty group."
A practice with more than 20 physicians may need to hire a privacy officer to oversee compliance, says the manual. Smaller practices may give this responsibility to current staff.
You may purchase the manual online at http://www.aafp.org/hipaa/ or by calling (800) 944-0000. The online HIPAA Privacy Manual (item # R710) costs $50; the paper version (item # R709) costs $100; the CD-ROM (item # 745) costs $100.
GAPS GALORE
The proliferation of electronic communications about patients has heightened the need for privacy regulations. And paper records and orders are also often less than secure.
"In my office, we worry tremendously about people not being able to see patient information on computer screens," says Fromer. "But you could put on a janitor's outfit, walk in with a broom and go through the medical records room 400 times, and nobody would blink an eye."
So the HIPAA privacy regulations just might do some good. "We ultimately may be better able to provide comprehensive care in a setting that systematically protects patient information," says Fromer. "That's the challenge."
Pointers from HIPAA Privacy Manual
The Academy's HIPAA Privacy Manual (see story, "Here's help on following patient privacy regulations") is packed with suggestions and comments, including these:
e-prescribing: cure for your scribbles
If you haven't yet thought about electronic prescribing, you probably will soon. Why? For starters, patient safety. Also, federal regulations about patients' privacy may be easier to meet via the computer than the prescription pad.
A few comments from family physicians who write electronic prescriptions may help you make decisions about e-prescribing.
PROS AND CONS
"My prescriptions are legible, refills are a snap, and I always have the available doses on my handheld computer, so I cannot accidentally prescribe a strength that isn't available," says Lorne Bigley, M.D., of Eugene, Ore., who uses a personal digital assistant. "I always have the patient's medication history on my PDA -- in case I'm in the hospital or see the patient without a chart."
Bigley cautions that with a patient's first e-prescription, it takes time to input the patient's name, date of birth, sex and health plan. It also takes time to print the prescription. Then Bigley has to leave the exam room, pick up the prescription from the printer in his office and sign the prescription.
The family practice residency at the Fort Wayne (Ind.) Medical Education Program uses a system that faxes prescriptions straight to pharmacies.
However, implementing e-prescribing takes time, says Frederic Jackson, D.O., the residency director. "We have used the system about four months, but we're still in the implementation phase," says Jackson.
"Despite the slow implementation, I'm a big supporter of electronic prescribing," says Jackson. "It retains information, produces a legible prescription and does a lot of cross-checking that doctors don't always remember to do." For each prescription the system checks for drug-to-drug and drug-to-food interactions, customary duration of treatment and earlier adverse reactions the patient has had to the medicine. "If I order a drug for a month and the usual time would be 10 days, the system flags me," says Jackson. "It helps me use safe prescribing practices."
TO PAY OR NOT TO PAY?
Some FPs have received free software for electronic prescriptions, but at least one suggests the value of paying. "We have written over 28,000 prescriptions electronically," says Louis Spikol, M.D., of Allentown, Pa. "The company has performed a number of upgrades, consistently improving the product. We do pay for the system, but I think it's worth it. You can hold the company accountable for any problems."
PDA OR EMR?
One FP suggests avoiding PDAs for prescribing.
"Do your prescription writing from your EMR software and fax it from your main computer network or server," says Alan Falkoff, M.D., of Stamford, Conn. "A PDA that sends prescriptions has database problems with formularies and changes of insurance companies. The size of the database eats up the whole of your handheld computer. There are limitations on where it may work. The PDA must then be backed up to a PC file and/or printed out to keep a record of the prescriptions that have been written, for whom, what and when. Otherwise, it is potentially a medicolegal nightmare."
But Michael Cole, M.D., of Roland, Okla., says he has no problem using his PDA for prescribing. He has many Medicaid patients, knows the formulary for Medicaid and hasn't entered any formulary in his PDA.
He maintains his patients' medicinal history both in his PDA and his patients' paper charts. And at least once a year, the hardware vendor doubles the amount of memory in Cole's PDA.
LIFE SPAN OF VENDOR
One key question, says Cole, is whether the software company will be around awhile. "There's no assurance -- none, and never will be -- that the whole system I've grown to depend on so much will be available to me next week," he says.
DISCUSSION GROUP
If you'd like to join AAFP's PDA and Wireless Technology e-mail discussion group and share questions and answers with your peers, follow the directions at http://www.aafp.org/members/lyris/ (have your AAFP ID number handy).
Match results mixed across primary
care
Overall family practice fill rate up
from last year
The gap between the number of family practice residency positions offered and those filled closed slightly this year, according to preliminary results released March 21 by the National Resident Matching Program. Of 2,983 residency slots available, 2,357 were filled, for an overall fill rate of 79 percent compared with 76.3 percent last year.
That's a hopeful sign, says AAFP President Warren Jones, M.D., of Ridgeland, Miss., but this is no time for the specialty to relax its advocacy efforts. "We must continue to educate medical students, legislators, our patients and the public about the critical role family physicians play in the nation's health care," he says.
Studies by the Robert Graham Center in Washington have shown that Americans rely on family physicians for their care more than on any other specialists.
"Increasing the number of subspecialty physicians at the expense of primary care limits our capacity to meet the needs of vulnerable populations, including the uninsured, underinsured, and underserved urban and rural patients," says Jones.
 *Source: National Resident Match Program |
U.S. SENIORS STILL HESITANT
Granted, the percentage of family practice positions filled with U.S. seniors declined slightly from 2001 to 2002 -- from 49 percent to 47.4 percent -- but that's not nearly the 8.2 percent dip seen between 2000 and 2001. The total percentage of U.S. seniors choosing family practice also showed a modest decline, with 10.5 percent matching in family practice compared with 11.2 percent last year.
Even so, it can't be ignored that this year, 2,357 individuals selected family practice as their specialty of choice -- only six fewer than last year. These data appear to herald a leveling off of the downward trend seen in the family practice fill rate since its record high 90.5 percent in 1996, says Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education.
The results seem to confirm the wisdom of the specialty's recent shift in priorities -- focusing less on increasing the number of people choosing family practice and more on continuing to ensure the quality of those entering the specialty, he says.
"In addition to selecting intellectually qualified medical school applicants who possess the personal characteristics that predispose them to caring for medically underserved populations, it's essential that we ensure an ongoing high level of professionalism in medical schools," Pugno says.
OTHER PROGRAMS VARY
Among other primary care programs, overall fill rates varied this year. Pediatrics-primary and internal medicine-pediatrics saw lower fill rates in 2002 than in 2001. The internal medicine-primary fill rate, however, increased this year.
As for U.S. seniors filling residencies in these programs -- again the results were mixed. For pediatrics-primary and internal medicine-primary, the 2002 fill rate by seniors went up. For internal medicine-pediatrics, the proportion dropped this year.
Visit http://www.aafp.org/match/ for the full slate of this year's NRMP results.
The results continue to illustrate some students' hesitancy to enter primary care in the face of mounting medical school debt and declining reimbursement levels. Lifestyle issues have also been shown to play a role in specialty choice, as has the perception of primary care as a less prestigious area of medicine.
AAFP ADDRESSES CONCERNS
The AAFP is addressing these issues, says Jones. The Academy continues to lobby vigorously on behalf of Title VII funding for family practice training. And it keeps bending lawmakers' ears to correct the flawed Medicare conversion factor formula that results in insufficient physician reimbursement.
A University of Arizona study is expected to shed light on medical students' choice of specialty and offer tools to better engage their interest. In addition, the Future of Family Medicine project, a collaboration between the AAFP and six other organizations, promises to provide insight into the strategic direction the discipline should take, says Jones.
"This collaboration is intended to evaluate the health care needs and expectations of our patients, improve the delivery of care, and enhance training and lifelong learning for family physicians," Jones says.
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Check out AAFP plan to help the increasing numbers of uninsured
More Americans are losing their health care coverage or are concerned about losing it. That's the bad news from recent studies.
The good news -- from the Academy -- includes two new ways you can share AAFP's plan, "Assuring Health Care Coverage for All." The Congress of Delegates approved the plan last fall, and you may want to circulate it to your colleagues as you continue caring for the uninsured.
STUDIES PROJECTIONS
The U.S. Census Bureau estimated in 2000 that 39 million Americans lacked health insurance. That number grew by 2.2 million last year as people lost jobs and therefore lost insurance, the consumer group Families USA said recently.
The recession's end was ballyhooed in the media last month. However, Ron Pollack, executive director of Families USA, says a significant increase in the number of the uninsured is likely regardless of whether the recession is officially over. His reasons:
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Families USA executive director |
"The confluence of all these forces makes concern about the uninsured of even greater urgency than before," he notes.
A January survey of 800 registered voters supports Pollack's views. Among the insured, 21 percent of respondents said their out-of-pocket costs (premiums, deductibles, copayments) might rise so much this year that they'd have to drop the coverage they have through their employers. The survey was conducted for the Robert Wood Johnson Foundation.
Where do family physicians stand vis-a-vis the uninsured? "Many family doctors become the safety net for the uninsured and are looked to for heroic service in the face of the worsening situation," says Pollack.
WHAT CAN YOU DO
Since 1989, the Academy has championed health care coverage for all, and you may have the opportunity to share AAFP's plan to achieve such coverage.
A new PowerPoint presentation with highlights of the AAFP plan is now online for your use. It builds from this premise: "Family physicians believe that a deliberate investment in assuring basic health care coverage will result in a healthier, more productive society."
You can access the presentation at http://www.aafp.org/unicov/.
The full plan, sample questions and answers, and a summary of the plan just became available by fax. To request these materials, see "Quick Fax" on page 8. The materials are also online at http://www.aafp.org/unicov/ for you to download.
 Participants in this educational session in a chilly room in Cahul take careful notes as they learn from the American FPs. |
Airlift delivers aid and education as Moldova overcomes odds
The next time you find yourself grousing about Medicare red tape and insurance company hassles, think about the plight of physicians in Moldova. This former Soviet republic was the site of the 10th Physicians With Heart humanitarian airlift Feb. 18 - 25, a project the Academy helped sponsor.
Imagine a system in which physicians earn $30 - $50 a month. Granted, their cost of living is lower than it would be in the United States, but Moldovan physicians often give up medicine or supplement their medical incomes with part-time work as translators, waiters and musicians.
Physicians With Heart delegates learned that Moldova is revamping a health care system left over from the Soviet era, a system top-heavy with specialists.
According to Dr. Victor Puiu, director of the regional clinics in the Botanica District of Moldova, the health care budget for his country's state-run system caps yearly health care expenditures at $10 per person. And 20 percent of that amount -- just $2 -- is allocated for primary care.
Dr. Grigore Bivol, chair of the family medicine department at the State Medical and Pharmaceutical University in Chisinau, spelled out some of the roadblocks family practice proponents face, including low physician salaries, lack of equipment, supply shortages, the disdain of other specialists, and the dearth of educational opportunities.
Despite the barriers, Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities, expressed optimism when he spoke at family practice symposia. "It is exciting to hear the ambitious plans for the implementation of family practice in Moldova," he said. "I think Moldova will serve as a model for other former Soviet republic countries."
 Children at the Sarata Galbena orphanage in Chisinau sport smiles after entertaining their American guests with Romanian songs. |
Sandwiched in between the medical education sessions were team visits to clinics that had received a portion of the record-setting $15 million worth (U.S. wholesale value) of pharmaceuticals and medical supplies delivered to the country before the delegation arrived.
On-site project partners included physicians and administrators from Eastern Virginia Medical School, Norfolk, Va. The EVMS project, funded by the American International Health Alliance, involves long-term family practice development in Moldova and will open its second family practice clinic there next fall.
Each Physicians With Heart airlift includes a children's project. This year, team members left a portion of their hearts with nearly 140 children in the Sarata Galbena orphanage and with 22 youngsters in a foster home on the outskirts of Chisinau. Basic necessities as well as toys, treats and the orphanage's first television set were unloaded to choruses of "mult'umesc" -- "thank you" in Romanian.
Go to http://www.aafp.org/airlift/ to see photos and to read more about this and other Physicians With Heart projects. The airlifts are cosponsored by the Academy, the AAFP Foundation and Heart to Heart International, a humanitarian aid organization based in Olathe, Kan.
State Department praises airlifts
The U.S. State Department has commended the AAFP for its work in bringing humanitarian aid to former Soviet republics through Physicians With Heart airlifts.
In a recent letter to AAFP President Warren Jones, M.D., of Ridgeland, Miss., Jerry Oberndorfer, the department's director of humanitarian programs to the newly independent states, said, "The AAFP has brought a medical component and personal touch to humanitarian assistance that is unparalleled in our experience."
Oberndorfer said the projects have aided in the "cultivation of a climate of responsiveness to the U.S. and democratic interests" throughout the newly independent states.
Press releases can help you promote your practice
Want promotional help for you or your practice? You may find assistance in AAFP's online press releases.
Consumer-oriented press re-leases, based on American Family Physician articles, are posted on the AAFP Web site twice a month. Additional press releases based on current topics in the news also are posted on the site.
You can distribute the releases to local journalists, perhaps personalizing with quotes from you or another physician in your practice. Or use the articles in your patient education newsletter.
Go to http://www.aafp.org/news/ to see the range of topics available online. If you have any questions, contact a member of the AAFP public relations team at (800) 274-2237, Ext. 8712.
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Next Physicians With Heart airlift will aid Uzbekistan
Ready for some adventure? Then join the next Physicians With Heart airlift to a former Soviet Republic. Physicians With Heart will airlift medical supplies to Uzbekistan and present family practice symposia there. Airlift dates are Oct. 24 - Nov. 3.
Family practice education and training constitute a key component of the airlift -- so if you're a family practice educator, consider joining the Uzbekistan airlift delegation. You'll personally deliver medicines, provide education and offer friendship to thousands of people.
For an application to join the delegation, contact Maya Singh at Heart to Heart International by e-mail at msingh@hearttoheart.org or by phone at (405) 787-5200.
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Drowning in debt? Here's help staying afloat
Back in your medical school days, you probably had more than a passing acquaintance with peanut butter and jelly, mac and cheese, or whatever your poverty food of choice was. Most likely you worked part time; if you were lucky, it was in a quiet spot where you could study. And splurging meant taking in the occasional Saturday matinee or having a cheap beer at the local tavern.
So it hardly seems fair that despite all your efforts at frugality, you're still looking at a mountain of student debt as you now prepare to enter residency. But take heart! There are lots of ways to chip away at that load -- some of them relatively painless, others a bit more daunting.
Let's start with credit cards.
PLACATING THE PLASTIC GODS
Sure, it seemed like a good idea at the time to take all those credit card companies up on their offers. But now that you've amassed enough of the shiny little jewels to tile your bathroom floor, it might just be time to take a closer look at what they're costing you.
According to James McKenna, M.D., director of the family practice residency at The Medical Center, Beaver Falls, Pa., the average American throws away about $450 on credit card interest annually. McKenna, a perennial presenter on managing money and debt at the National Conference of Family Practice Residents and Medical Students, has several pieces of advice on this score, starting with the obvious: Don't use the darn things! If you do, limit your spending to what you're able to pay off each month.
Realizing that's a pretty tall order, McKenna offers these practical hints to help bring those card balances under control:
Check out http://www.bankrate.com for more advice on how to handle credit card debt.
SPEND WISELY AND WELL
Of course, the credit card bill is only one of many you receive each month. But once again, a few common-sense measures can add up to significant savings, says McKenna.
Choose your battles wisely, says McKenna. "Don't put your efforts into paying off the wrong thing," he says. "If you're focusing on paying off a student loan with a 5 percent interest rate and you're still using a credit card with an 18 or 20 percent rate, you're not concentrating your efforts in the right place."
LOOK AT LOAN CONSOLIDATION
The Association of American Medical Colleges Educational Debt Management Services program offers lots of information to help guide you to financial health. Visit http://www.aamc.org/stuapps/finaid/debtmgmt/start.htm to review the many options available. One of the resources listed is a comprehensive primer on consolidating your student loans.
Loan consolidation offers many borrowers convenience, increased monthly cash flow and a means of renewing deferments or taking advantage of additional deferments.
Making payments on multiple loans from different loan servicers is simply more of a hassle than making one payment each month, right? And you can often negotiate a lower fixed rate on your entire loan portfolio through loan consolidation, thereby reducing both your monthly payment amount and the overall cost of your loans.
PHYSICIAN, KNOW THYSELF
Most important to bring that debt down, says McKenna, is to live within your means, or even slightly below that level. Sit down and figure out all your income, and then do the same for your expenses. Set short- and long-term financial goals for yourself, and then do what it takes to meet those goals. Don't overspend, but don't put yourself on bread and water, either. The key here is being realistic in your expectations.
"You have to know what your means are and what you can afford," says McKenna.
NHSC to award $89 million in FY 2002
The National Health Service Corps has upped its ante of loan repayments and scholarships to be granted this year to a record $89.4 million. The funds are awarded to physicians and other health professionals who agree to serve in rural or inner-city areas lacking adequate access to health care services.
"We are looking for the best and brightest to work where they can turn people's lives around and provide health care to people not used to getting it," said HHS Secretary Tommy Thompson when he announced the funding.
"Many students go into medicine hoping to improve the lives of the poor and the uninsured but graduate with too much debt to pursue such a calling," said Thompson, noting that the NHSC makes such service possible. The increased funding -- nearly $19 million more than last year -- will support 900 new and continuing loan repayment awards and 400 new and continuing scholarships.
Visit the NHSC Web site at http://www.bhpr.hrsa.gov/nhsc/ for more information on the corps' programs and opportunities.
Save these dates for National Conference!
It's time to start making arrangements to attend this year's National Conference of Family Practice Residents and Medical Students. Reserve July 31 - Aug. 3 on your calendar, and plan on being in Kansas City, Mo., for family medicine's premier resident and student meeting.Check the AAFP Web site at http://www.aafp.org/conference/ for a rundown of this year's events.
 Kurt Stange, M.D., Ph.D. |
Editor selected for new research journal
The new Annals of Family Medicine, now out of the conception stage, has an editor eager to take the reins. Kurt Stange, M.D., Ph.D., a family physician from Cleveland, will lead the primary care research journal.
Stange is professor of family medicine, epidemiology and biostatistics, oncology and sociology at Case Western Reserve University. He also directs the Center for Research in Family Practice and Primary Care, one of three research centers funded by the Academy.
Stange says the journal, scheduled to start publication in spring 2003, will serve a key role of supporting research for the specialty.
"This new journal will create an interactive forum for those who generate and use new knowledge about health and primary health care. We look forward to working with authors and the many constituencies who are affected by research about, and for, family practice," Stange says.
Joining Stange on the Annals staff will be William Phillips, M.D., M.P.H., who will serve as senior associate editor. Phillips is a clinical professor of family medicine at the University of Washington, Seattle, and has served as president of the North American Primary Care Research Group.
The AAFP is one of six primary care organizations that will collaborate on the journal, which will offer articles on original research. Perspectives to be featured in the Annals include biomedical research, health services research, reflective practice by clinicians, and insights from patients, families and communities.
AAFP Candidates
 The Arizona AFP announces the candidacy of Karla Birkholz, M.D., of Phoenix for AAFP president-elect. |
 The Florida AFP announces the candidacy of Daniel Van Durme, M.D., of Tampa for AAFP president-elect. |
 The Illinois AFP announces the candidacy of Carolyn Lopez, M.D., of Chicago for AAFP speaker. |
 The Iowa AFP announces the candidacy of Laine Dvorak, M.D., of Humboldt for AAFP vice speaker. |
 The District of Columbia AFP announces the candidacy of Darlene Lawrence, M.D., of Washington for AAFP vice speaker. |
 The Indiana AFP announces the candidacy of Thomas Kintanar, M.D., of Fort Wayne for AAFP director. |
 The Nebraska AFP announces the candidacy of Dale Michels, M.D., of Lincoln for AAFP director. |
 The Oregon AFP announces the candidacy of John Sattenspiel, M.D., of Salem for director. |
OB training and the Titanic
To the editor:
I wanted to respond to the February 2002 FP Report article "Should OB Training Remain a Residency Requirement?" During my residency training in 1970, a number of preceptors assured me that "surgical care in family practice isn't going away," but of course it did. Medicine had changed during the '50s and '60s. It no longer made sense to train all FPs in surgery, and our specialty's founders made surgery training optional.
Things also have changed during the '80s and '90s. Women usually have one or two babies, not four to eight. The technology, the malpractice climate and young physicians' desire to place more importance on family have been major changes. Almost four out of five FPs don't do OB, and we're still debating whether it should remain a residency requirement. The number of medical students matching in family practice has been going down, and we wonder why. The Titanic is sinking, and we need to quit playing our old songs and get serious about how to save family practice.
Bill Manahan, M.D.
Mankato, Minn.
JFP doesn't just focus on original research
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To the reader Write us a letter of 200 words or fewer (subject to editing). FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; fax them to (913) 906-6089; call (800) 274-2237, Ext. 5230; or contact fpreport@aafp.org via e-mail. |
To the editor:
We applaud AAFP's decision to co-sponsor the new Annals of Family Medicine. However, I'd like to correct the January FP Report story that said the need for such a journal had increased because the "Journal of Family Practice has shifted from a focus on entirely original research to an emphasis on articles translating research into practice."
JFP has never focused entirely on original research. For example, we publish clinical review articles in the series "Applied Evidence." We support the academic work of the Family Practice Inquiries Network financially and by publishing their work in "Clinical Inquiries." We have also published over 600 POEMs (evidence-based summaries of Patient-Oriented Evidence that Matters), introducing the concepts of evidence-based medicine and information mastery to thousands of clinicians.
We have pioneered "electronic long/print short" publication for articles that speak to researchers rather than practicing clinicians, a way to make the best use of limited editorial pages and better serve international readers. And we are proud to be the leading journal of original family practice research and have no plans to decrease this emphasis.
We look forward to assisting the new editor as he or she defines the mission of Annals of Family Medicine.
Mark Ebell M.D., M.S.
Editor,
Journal of Family Practice
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Join the Academy in recognizing April as National Minority Health Month and promote improved health for minority populations. Find guidelines, activities and information to use in your community and practice at http://www.nmhm.org. Additional resources and links are posted at http://www.aafp.org/special/products.html.
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Promote a tobacco-free America by using new Tar Wars® zipper pulls and temporary tattoos when you teach the program to fourth- and fifth-grade students. One hundred zipper pulls (#1950) cost $49.95, and 100 tattoos (#1951) cost $11.95. Go to http://www.tarwars.org/promoitems.xml to order.
Proven value: Join other physicians June 2 - 8 in Greensboro, N.C., for an intense six-day CME course to prepare you for the American Board of Family Practice certification or recertification exams. Register by May 3 for the early registration discount. Visit http://www.aafp.org/meetings/ and click on "Family Practice Board Review -- Greensboro" to register online, or call and request item #R225.
Proven value: Get hands-on experience treating difficult skin disorders during the Skin Problems and Diseases course June 12 - 16 in Fort Lauderdale, Fla. The early registration deadline is May 13. Go to http://www.aafp.org/meetings/ and click on "Skin Problems and Diseases" to register online, or call and request item #R210.
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A shipping fee may apply; Kansas residents pay a 7 percent tax. |
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FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.
