 February 2003 • Volume 9 • Number 2 |
BY JANE STOEVER
Surgeons in the Wheeling, W.Va., area quit working New Year's Day -- except for emergencies -- and the nation discovered the medical liability crisis.
About 100 miles south of Wheeling, FPs met with colleagues from other specialties each week last month to consider joining ranks with the surgeons.
"Several physicians were ready to walk out. Several physicians said they never would," said David Avery, M.D., of Vienna, W.Va., a past president of both the West Virginia AFP and the West Virginia State Medical Association.
"We came to consensus that we'd give the legislature a little time, perhaps a few weeks," said Avery. "We've heard promises before and haven't seen any action. We just might all have to close our doors and handle only emergency care."
Nearly every major insurance company has left the state, and the high cost of malpractice premiums is driving doctors away, too. "If there's no reform, we'll move to Ohio," said Avery. He and the other physicians he practices with work close to Ohio. "Our patients would follow us. There would be no other physicians available," he said.
A few other family physicians in the west central part of the state have already moved, and some physicians have retired early. The base rate for liability coverage for many family physicians is $28,000 per year, and several are paying more than $30,000, said Avery.
Strategy
The state's physicians participated in the annual White Coat Day at the statehouse in Charleston Jan. 13. They held a rally, ate lunch with the legislators and sought tort reform in meetings in legislators' offices.
They reiterated the West Virginia CARE Coalition's platform for reform, including these points:
The West Virginia AFP is one of the key leaders of the CARE Coalition, said Avery. The AAFP supports the reforms it is seeking, and other states have had success implementing similar changes.
New day dawning?
On Jan. 8, West Virginia Gov. Bob Wise, in his State of the State address, endorsed some of the CARE Coalition's reforms, leaving out the notion of making sure a patient would receive more of an award than an attorney would.
"It's not surprising our governor didn't call for curbing attorneys' pay -- he's a trial lawyer," said Avery. "But for him to call for reforms such as a $250,000 cap on noneconomic damages would have been unthinkable six months ago."
Court reform, not just tort reform
West Virginia may get tort reform this year, said Avery. "But the state Supreme Court will tear it down in two or three years." All five judges on the court are trial lawyers. "Only one or two are reasonable. The others are very anti-physician," he said. Repeating a theme from the AAFP State Legislative Conference last November, he said, "We need court reform, not just tort reform."
Coverage problems in one-third of states
According to the AAFP Division of Government Relations, liability coverage problems have hit family physicians in about one-third of the states. For example, in Pennsylvania, PAFP President Paul Williams, D.O., of Harrisburg just switched insurance companies because his former insurer got out of the business of medical liability coverage.
"I wanted to go with a reputable, established company, and my premium went up from $5,100 to about $11,000," said Williams. "I have a clear claims history. What did I do wrong? I'm in a solo practice, and now any equipment I considered purchasing, any added CME I wanted to take, any bonuses for staff -- all those take a back burner to liability coverage."
Facts, figures, how to share ideasFacts on federal legislation. Reforms such as those promoted by the West Virginia CARE Coalition (see story above) were passed by the U.S. House of Representatives Sept. 26 by a vote of 217-202. However, the Senate did not act on the companion bill. The measure needs to be reintroduced in 2003 and go through the legislative process. Figures. According to an AAFP survey in June 2002:
How to share ideas. Join AAFP's medical liability e-mail discussion list. You'll be able to share comments on liability issues and get updates on state and federal reform efforts. Go to http://www.aafp.org/myacademy/. Login using your AAFP ID number. Select "My Subscriptions" on the left, then choose "E-mail Discussion Lists." Scroll down to "Medical Liability Issues" and hit "Subscribe." Once registered, you can post messages by sending e-mails to medliability@mail.aafp.org. |
To reach writer Jane Stoever, e-mail jstoever@aafp.org.
At the invitation of the West Virginia AFP, Richard Roberts, M.D., J.D., of Madison, Wis., an AAFP past president, discussed the liability crisis with key legislators Jan. 6 in Charleston.
"The West Virginia legislature is in the eye of 'The Perfect Storm,' and the rest of the nation is watching to see what it will do," Roberts said. He spoke to the Legislative Interim Committee on Insurance Availability and Medical Malpractice.
"The other state legislatures faced with similar challenges -- Mississippi, Nevada and Pennsylvania -- have all recently passed significant tort system changes," said Roberts. "Failure to enact meaningful tort reform in West Virginia will be the legislative equivalent of malpractice."
Malpractice coverage crises have recurred in seven- to 15-year cycles for some time, said Roberts. "Medical malpractice is a complex topic. It is tempting to try to reduce it to caricatures of greedy or inept insurance companies, arrogant or incompetent doctors, or conniving lawyers."
In the 1990s, Wisconsin adopted the same proposals that West Virginia's CARE Coalition backs, said Roberts. He offered comparisons: In 1998, a Wisconsin family doctor who did not do surgery or deliver babies paid a base rate of $4,903 for coverage for $1 million per claim and $3 million per year (aggregate). In West Virginia, the base rate was $10,517. By 2002, the Wisconsin doctor's premium rose 5 percent to $5,148. The West Virginia doctor's premium rose nearly 100 percent to $20,524.
"Wisconsin ranks among the top states in the percentage of our people who have health insurance coverage," said Roberts. "We are in the top 10 for health status. While not perfect, Wisconsin's approach works."
The West Virginia Register-Herald on Jan. 7 reported Roberts' comments at a press conference Jan. 6 in Charleston: "This is about expectant mothers driving longer distances to find someone to deliver their baby. This is about workers settling for wage concessions because of rising health care costs. Something is out of control in West Virginia, and the people in this state risk losing access to quality medical care."
BY CINDY McCANSE
You'd think that with all the media hubbub surrounding the announcement of President Bush's comprehensive smallpox vaccination plan, few questions would remain. The details have been scrutinized for weeks, the issues debated in both the public forum and the medical literature. What query could possibly have gone unasked?
Here's a biggie: If family physicians are on the front line of bioterrorism defense, shouldn't they be vaccinated against the deadly smallpox virus? In the absence of contraindications, of course.
Not necessarily, according to Jonathan Temte, M.D., Ph.D., of Madison, Wis. Temte is associate professor of family medicine at the University of Wisconsin, Madison, and a researcher and lecturer on bioterrorism.
"As sentinel physicians against bioterrorism, family physicians play a vital role in recognizing aberrant diseases, such as smallpox, and in notifying public health agencies of suspected cases," he noted. That said, however, immunization of all family physicians against the disease is not warranted at this time, Temte added, for the following reasons:
The president's current strategy, Temte explained, is "to create a small cadre of health care workers in each state who are maximally immunized against smallpox. These people will form the core of responders providing care to patients with possible smallpox in designated hospitals and will also conduct case and contact investigations."
All such vaccinations are to be administered on a strictly voluntary basis according to detailed plans submitted by each state to the CDC last year, said Herbert Young, M.D., director of AAFP's Scientific Activities Division.
"Once these initial immunizations have been given, then states can move on to the broader first responder and health care worker groups," he said.
Go to http://www.bt.cdc.gov/agent/smallpox/vaccination/ for more information about both the federal vaccination plan and the vaccine itself.
The Academy has already expressed its concern about use of the live vaccinia virus vaccine used to immunize against smallpox. In a Dec. 17 press statement, AAFP President James Martin, M.D., of San Antonio agreed that voluntary immunization of emergency smallpox response teams was appropriate but cautioned physicians and others who make up those teams to educate themselves about the medical and legal issues involved.
Above all, he advised that the immunization program be closely monitored and that the knowledge gained from it be used to inform future decisions.
FP Steven Marks, M.D., of Eugene, Ore., pointed out a specific aspect of physician vaccination: How should physicians who choose to be vaccinated contend with the risk of spreading live vaccinia to their patients for up to three weeks after vaccination?
Marks is public information officer for the Lane County Medical Reserve Corps, a disaster preparedness task force of the Lane County Medical Society. From his perspective, such practical considerations will continue to generate concern about the immunization strategy until further answers or better solutions are available.
"Given the lack of any evidence that smallpox is an imminent threat and the rates of complications from the vaccine, is it even appropriate to start immunizing large numbers of health care workers or the public?" Marks asked. "The only potential epidemic at this point appears to be fear of smallpox ... not the disease itself. Are we proposing to use immunization to treat the fear?"
Go to http://www.aafp.org/x16645.xml to read the AAFP press statement. AAFP policy statements on smallpox vaccination are available at http://www.aafp.org/x16643.xml and http:// www.aafp.org/x10636.xml.
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More reading on smallpox vaccination For an overview of smallpox vaccination in the
primary care context, consult the following source: Historical data on the adverse effect profile of
the smallpox vaccine Lane JM, Rubin FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968. National surveillance in the United States. New Engl J Med 1969;281:1201-8. Lane JM, Ruben FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968: results of ten statewide surveys. J Infect Dis 1970;Sm122:303-9. Data on the adverse effect rates for the oral
polio vaccine and the whole-cell pertussis vaccine Data on the long-term protective effects of
previous immunization with vaccinia vaccine |
Press time updateAt press time, an Institute of Medicine advisory committee had just released a report calling for greater caution in implementing the federal smallpox vaccination program. The report came shortly before vaccination of some 500,000 emergency first responders was scheduled to begin as early as Jan. 24. The report, commissioned by the CDC, listed as concerns the vaccine's high risk profile and the lack of a dedicated compensation fund for those injured by the vaccine. The Homeland Security Act exempted vaccine makers from liability for adverse effects of the vaccine. Vaccinees who suffer adverse effects may be covered by state worker's compensation programs, but those programs are unlikely to pay for all medical expenses or time lost from work. People receiving the vaccine should understand they are doing so for the public good, rather than for any likely personal benefit, said the report. Go to http://www4.nationalacademies.org/news.nsf/isbn/01172003 to read a press release and to access the full report. |
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
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BY CINDY McCANSE
The conference room was pretty well packed during a recent staff meeting here at the Florida State University College of Medicine.
On the table: how best to mark -- and market -- the mid-February groundbreaking ceremony for the new medical school's state-of-the-art facility. Around the table: associate and assistant deans, department chairs, program coordinators, and other school supporters and staff. And, of course, the college's founding dean, family physician Joseph Scherger, M.D., M.P.H.
Here, every opinion is welcome, and every idea has merit. Throughout the institution, there's a palpable aura of equal parts excitement and determination. It's part of being in on a "startup" venture: The college is the first allopathic medical school established in the United States in two decades. And while it's a work in progress -- literally -- the school is already well down the road to forming its own identity.
Much of that identity -- and the esprit de corps that goes along with it -- has to do with how Scherger, a former AAFP director and Family Physician of the Year, has run the school since taking the helm in July 2001.
 Florida State University College of Medicine founding dean Joseph Scherger, M.D., M.P.H., has integrated family medicine into the new school's mission of serving the underserved. |
Serving the underserved
When the Florida Legislature authorized creation of the medical college in June 2000, it made a promise to the people of Florida, said Scherger. The school would exist to serve the state's citizens, particularly those whose medical needs had not been adequately met -- the elderly and those living in rural and other underserved areas.
It was a challenge Scherger said he couldn't turn down, and now that mission guides every decision he and his colleagues make. It has prompted investment in state-of-the-art educational tools (see story below), but it has also driven home the need to teach students to provide old-fashioned, hands-on patient care. And it's absolutely critical when deciding who gets into the school and who doesn't.
Here, numbers can take a back seat to attitude, said Myra Hurt, Ph.D., associate dean for student affairs, admissions and outreach.
"There isn't a magic number for us," she explained. How an applicant looks on paper is only part of the whole picture -- the interview can tell volumes about a candidate. Personal warmth and well-developed communication skills are two crucial traits admissions committee members look for.
"The way I look at it is: 'Is this the doctor I want holding my hand when I'm 90 years old?'" Hurt explained. "These students are going to go out into the community to practice medicine the way it's meant to be practiced."
Creating a pipeline
 Students in the Florida State University College of Medicine's SSTRIDE program learn both in and out of the classroom. Here, students go online to learn about the physical sciences. |
A common recruitment concern for any medical school is how to attract students with "the right stuff." At the FSU medical college, that concern focuses on drawing in those who traditionally have been underrepresented in medicine.
The solution: Create educational opportunities early on that help level the playing field and open a pathway for students who otherwise might never conceive of a career in medicine.
FSU has made -- if you'll pardon the pun -- great SSTRIDEs in this regard.
Science Students Together Reaching Instructional Diversity and Excellence, or SSTRIDE, is an outreach effort now run by the FSU College of Medicine with support from Florida's Area Health Education Centers.
SSTRIDE offers area middle- and high-school students a chance to hone their science knowledge. There's also an undergraduate component, run with the aid of the Minority Association of Pre-health Students.
Students in the program learn by going online as well as by going on field trips. Areas of emphasis, said program coordinator Thesla Anderson, include anatomy, physiology, chemistry and standardized test preparation.
It's a fun, yet challenging, opportunity for the middle- and high-school students who participate, Anderson said. As for the undergrads: "If they get through this, they're ready for medical school," she said.
And just in case an applicant to the FSU medical college doesn't quite make the cut when coming before the admissions committee, the school gives those on the cusp some extra help.
The Bridge Program selects several students from medically underserved, rural and inner-city areas who do not gain direct admission to the medical college for a three-semester, intensive training course that encourages growth in both the academic and health care settings. Candidates who successfully complete the program are admitted to the medical college following their post-baccalaureate year.
Social responsibility
All this attention to ensuring the right people develop the right skills and wind up in the right places is what Scherger refers to as being socially responsible.
"When I take the long view," he said, "I look at several things. How can I keep this medical school focused on its primary mission?"
At FSU, the state has made a serious commitment to educating students dedicated to providing affordable, accessible, compassionate care. "My job and the job of the founding team is to lay the groundwork for that ongoing mission," Scherger said.
The school's departmental structure reflects that goal. Five departments -- biomedical sciences, clinical sciences, medical humanities and social sciences, family medicine and rural health, and geriatrics -- bear witness to the school's focus on integrating social with clinical science to best serve patients.
Because the discipline of family medicine is so closely tied to the school's raison d'ˆetre, it has its own departmental identification. Coursework pertaining to other medical specialties is shared among the remaining clinical departments.
That structure opens up a new way of viewing other specialties, said family physician Alma Littles, M.D., chair of the school's department of family medicine and rural health. Mutual experiences foster mutual understanding -- and mutual respect.
"Even the neurologists and the orthopedists understand where the family doctor fits into the picture," she explained. "We want our surgeons to know what it's like to practice in a rural setting."
"We've got to keep our focus on the needs of the state," said Scherger, "on elder and rural care. As more and more doctors are dropping out of Medicare, and now even Medicaid, there's a disconnect there."
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
BY SHIRL KASPER
In the North Carolina high country, where patients often drive miles to get to a drug treatment center, FP Sharon Sweede, M.D., anticipates the good that will come from recent FDA approval of the drug buprenorphine. Other medications to treat addiction are available only at drug treatment facilities. Buprenorphine, however, can be prescribed by physicians in their own offices.
"I think it's a good thing for a lot of patients," said Sweede, chair of AAFP's Commission on Public Health. "It will allow patients to live a normal life." With the new sublingual tablets, she explained, patients can go to their local family doctors for treatment rather than drive miles to an addiction clinic.
"When we opened a new (addiction) clinic here in Asheville, we had patients driving in from Tennessee, Virginia, South Carolina and Georgia because there was no methadone clinic in their small town," said Sweede, who works at the Julian F. Keith Alcohol and Drug Abuse Treatment Center in Black Mountain, N.C. "The thing is, buprenorphine is something the patient takes home. Once they get stabilized on it, the doc can give them a whole month's supply."
The FDA approved buprenorphine on Oct. 8 to treat addiction to heroin or other opioids, including prescription painkillers. Buprenorphine, which blocks the craving for drugs, is available from pharmacies now, said Charles O'Keeffe, CEO for Reckitt Benckiser, which markets buprenorphine.
To dispense and prescribe buprenorphine, physicians must complete eight hours of training and obtain a waiver, according to the federal Drug Addiction Treatment Act of 2000.
Web-based training is available, as well as on-site training at national meetings and regional workshops. For workshop locations or to register for Web-based training, go to http://www.buprenorphine.samhsa.gov/training.html. Among organizations offering training are the American Academy of Addiction Psychiatry, American Psychiatric Association and American Society of Addiction Medicine. To request a waiver form or, if you wish, to complete one online, go to http://www.buprenorphine.samhsa.gov/howto.html.
"The thing is, it's so easy for docs to do. They don't actually have to go anywhere," said Sweede, who completed the eight-hour training course when it was offered in conjunction with the ASAM annual meeting. Because Sweede already was ASAM certified, she was not required to take the training but did so anyway.
The Substance Abuse and Mental Health Services Administration, which is leading an initiative to raise awareness about buprenorphine, said more than 2,000 physicians have completed training so far, and more than 300 have received the necessary waivers.
"This major advancement in substance abuse treatment will expand availability of addiction services and permit doctors to treat heroin and other opioid addiction just like any other medical condition, such as diabetes or hypertension," said Charles Curie, SAMHSA administrator.
Estimates vary, but the National Clearinghouse for Alcohol and Drug Information, using 1996 data from the National Household Survey on Drug Abuse, estimated that as many as 2.9 million U.S. residents had used heroin in their lifetime and that about 660,000 had used it in the previous year. Only about 100,000 users were in treatment, the data indicated, in part because of limited access to treatment centers.
"Not everybody on methadone is going to be able to switch to buprenorphine, but a lot of them will," Sweede said. "And a lot of people who have never been on methadone will be able to be stabilized on buprenorphine."
Sweede suggested that FPs even put little signs in their waiting rooms, saying, for example, "Buprenorphine-approved site."
"All the docs have to do is get approved to provide this and give it to one person, and the word will spread," Sweede said. "I bet there are a lot of family doctors out there who have opiate addicts in their practice, and they just don't know it. The addicts are afraid to tell them."
Additional information is online at http://buprenorphine.samhsa.gov/. You can also get further information by calling SAMHSA's Buprenorphine Information Center at (866) 287-2728 or by sending an e-mail request to info@buprenorphine.samhsa.gov.
BY SHERI PORTER
Seems there's a downside to every good idea -- and physicians know that's true of patient assistance programs, set up by pharmaceutical companies to get medicine to indigent patients who might otherwise go without. There's no question that the PAPs are working. According to the Pharmaceutical Research and Manufacturers of America, 3.5 million patients received medications valued at $1.5 billion (wholesale) for free through PAPs in 2001.
The problem is that physicians have been assigned as gatekeepers, and that role takes time. To help cover their administrative costs, some FPs are assessing a small fee.
One unidentified FP recently fired off this comment to an AAFP e-mail discussion group: "We charge a $3 fee per (PAP) prescription. I know it doesn't cover all the costs, but at least we're setting a precedent that there is a limit to the cr-p we are willing to do for free."
Strong words ... but an indication of much pent-up frustration.
Tactics to try
There are many PAPs, and each program has its own rules. "Some programs only ask us to hand patients the literature," said FP Meetul Shah, M.D., of Battle Ground, Wash., "while others require us to complete part of the application."
Shah said his office assigns a medical assistant to the PAP paperwork detail each day. "Our assistants are getting stressed out, and as a result, there's been discussion by our administrators of possibly discontinuing our participation in the programs," he said.
Shah doubted most of his patients -- farmers and blue-collar workers in a semirural community -- could afford to pay even $5 to $10.
Patients will pay, said Debbie Heck, M.D., an FP from Muncie, Ind., who uses the programs extensively. Initially, she did the paperwork for free. Now Heck charges $10 each time her nurse enrolls a patient in a program.
"Patients realize the paperwork takes considerable time, and they're willing to personally pay the fee," she said.
But maybe they don't have to.
Kent Moore, AAFP manager of health care financing and delivery systems, said physicians may be able to bill for such services and pointed out CPT code 99080, which reads: "Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form."
Moore suggested physicians bill this service in conjunction with another service, such as an office visit. "Whether or not the insurance company will pay is a different question," he cautioned.
Tackling the paper pile
This paperwork burden has not gone unnoticed by AAFP's Commission on Health Care Services. A draft policy, "Physician Rights Relative to Imposed Administrative Costs," was on the table at the commission's Jan. 16 18 meeting in Tucson, Ariz. According to James Bare, AAFP policy analyst, the wording in the draft would include the administrative work generated by PAPs. At press time, FP Report did not know the outcome of that meeting.
"For years we've struggled with the whole issue of paperwork and compensation," said Leonard Fromer, M.D., of Santa Monica, Calif., immediate past chair of the commission. "While the concept that someone should be reimbursing the physician in this situation is reasonable, who is going to pay the bill? The patient? These are the very people who are most likely already on assistance for their health care.
"Perhaps reimbursement should be looked at in terms of the PAP that is requesting the paperwork."
Tweaking PAP procedures
Jan Weiner, executive director of public affairs for Merck & Co. Inc., said Merck considers the physician's role vital "because physicians are in the best position to understand the circumstances surrounding a patient's need for free medication." Weiner said Merck is sensitive to the time issues involved in completing paperwork and last year enhanced Merck's PAP to "maximize convenience for physicians and be more responsive to patients."
Changes in the Merck program included providing direct patient access to forms, so paperwork can be completed before the visit; enabling physicians to write prescriptions for a full year --an initial 90-day supply with up to three refills; allowing delivery of prescriptions to the patient's home, thus avoiding an office visit; and giving patients a toll-free number to order refills.
"These changes have been well received by physicians and their office staffs," said Weiner.
Other companies are also trying to simplify their programs. "We don't want to overburden physicians," said GlaxoSmithKline spokesperson Mary Anne Rhyne, of GSK's program. "But we're committed to providing low-income patients access to medicines, and physicians are key players in that process."
Scott Morris, M.D., a family physician from Memphis, Tenn., who provides health care for the working uninsured, said PAPs are "an invaluable source for us to care for our patients -- but that doesn't mean they don't require a lot of work."
"While there is great room for improvement in the PAPs, much good has been done because of them," he said.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
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To learn more about patient assistance programs, discount drug cards, and state and local patient aid programs, read "How to Help Your Low-Income Patients Get Prescription Drugs" in the November/December Family Practice Management, available online at http://www.aafp.org/fpm/20021100/51howt.html. A list of physician resources appears with the article. |
Adults with high cholesterol and other risk factors for cardiovascular or other diet-related chronic disease should receive intensive behavioral dietary counseling, says a new recommendation from the U.S. Preventive Services Task Force. This counseling may be provided by primary care physicians or through referral to dietitians or nutritionists.
The Jan. 2 recommendation is a B recommendation, meaning that clinicians should routinely offer the dietary counseling to eligible patients. In classifying it as B level, the USPSTF has at least fair evidence that the dietary counseling would improve important health outcomes and has concluded that benefits outweigh harms.
The evidence is insufficient to recommend for or against routine dietary counseling in the general adult population, the task force said, but patients with known risks for cardiovascular disease can benefit from a combination of education about healthy diet and behavioral modification counseling.
Go to http://www.ahrq.gov/clinic/uspstf/uspsdiet.htm to view the recommendation and related materials, including a press release.
The AAFP Commission on Clinical Policies and Research discussed the USPSTF recommendations at its Jan. 16 18 meeting in Tucson, Ariz. Further review is planned before the commission decides whether to act in response to the recommendation.
 Robert Brooks, M.D., center, associate dean for health affairs at the medical college, reviews a standardized patient's differential diagnosis with second-year students Julie Gladden and Adam Ouimet. |
 Brooks offers Ouimet advice on auscultation techniques. This standardized patient, "Mr. White," presented with respiratory complaints. |
The Clinical Learning Center at the Florida State University College of Medicine, Tallahassee, is where the rubber meets the road. Here, the college's first- and second-year students get their first taste of real-life, hands-on "doctoring."
Students practice their medical interviewing and physical assessment skills using so-called standardized patients -- community members trained to act out the roles of patients with specific health conditions. Often, these individuals actually have the signs and symptoms characterizing a given health problem.
Standardized patients are used by roughly three-fourths of the nation's medical schools. At FSU, as elsewhere, each student's performance is critiqued by faculty. What's unusual about FSU's program, however, is that patient-student interactions are videotaped, allowing additional teaching and self-evaluation opportunities.
Another innovation: Right from the get-go, these students are entering their findings in an electronic medical record. Here and throughout the medical college, the emphasis is on making best use of today's technology. It's a cause the college's founding dean, FP Joseph Scherger, M.D., M.P.H., has long advocated. By using online communications and informatics tools, physicians can revolutionize patient care, he noted.
Take e-mail, for example. "Once you've got an e-mail relationship with your patients, you've incredibly personalized your interactions with them," said Scherger. "You've created an open conduit. They don't have to go through an answering service; they don't have to go through the front office."
Eugene Trowers, M.D., seconded Scherger's thoughts on the value of electronic interchange. Trowers is assistant dean of the Tallahassee regional medical school campus, where some members of the Class of 2005 will begin their clinical training later this year.
"Telecommunications will be key in reaching out to all these far-flung areas," he said, referring to the two other regional medical campuses in Pensacola and Orlando, as well as three more planned for Jacksonville, Sarasota and Fort Myers. Students will rotate among community-based training environments at these regional campuses during their third and fourth years, with the Tallahassee college serving as "home base."
Everyone found out after Sept. 11, 2001, just how wrong the stereotype of the self-absorbed New Yorker was. Well, if anyone needed further proof, here it is.
New York/New Jersey Regional Family Medicine Interest Group Coordinator Assaf Yosha, M.D., recently had a chance to find out just how keen area medical students were to explore a career in family practice. In November, the Weill Medical College of Cornell University hosted a family medicine student conference.
"I could never have believed that students from New York City could be so inquisitive and enthusiastic about family medicine," said Yosha. "They were thirsting for exposure to our specialty."
Evidence of that enthusiasm could be seen in fact that 95 medical students participated in the event.
Yosha shared a few pointers on how it all came together:
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
The AAFP has collaborated with the CDC Office on Smoking and Health in sending stop-smoking patient education materials to a group of selected FPs. "Got a minute? Give it to your kid," the materials suggest, urging parents to be active in the stop-smoking effort. A brochure offers tips for connecting with teens and preteens, separate from actual advice on quitting smoking.
"Focus groups conducted by the CDC revealed that people trust their doctor's advice," said AAFP President James Martin, M.D., of San Antonio. That is why the CDC is sending the materials free of charge to 10,000 FPs, he added.
Letters detailing the campaign will go out this month to FPs who have recently ordered AAFP patient education/public health materials. Free tent cards and brochures can be ordered from the CDC by calling (770) 488-5705 (press 3 for a publications specialist) or by e-mailing tobaccoinfo@cdc.gov. Go to http://www.cdc.gov/tobacco/educational_materials/parenting/gotaminbrochure.htm for more information on the campaign.
You might want to post some of these deadlines on your calendar. For details, call (800) 274-2237 and the extensions noted. Or, you can correspond via e-mail where indicated or check the Web address given for more information.
Practice-Based Research Network Stimulation Grants support the initiation of research projects. Submit your proposal by Feb. 22. For more information, go to http://www.aafpfoundation.org/x445.xml, e-mail smorantz@aafp.org or call Ext. 4470.
Do you know a physician or another individual who deserves the AAFP Public Health Award? Encourage your chapter to nominate your candidate. The chapter should e-mail ncrossfi@aafp.org or call Ext. 3142 for a nomination form, to be submitted by March 1.
March 14 is the deadline for proposals for workshops, seminars, lectures, papers, poster displays and special interest discussions at the 2003 Conference on Patient Education. This 25th anniversary meeting will be held Nov. 20 23 in San Antonio. Submit your proposals online at http://www.aafp.org/pec.xml.
Two deadlines are near for Tar Wars®, AAFP's tobacco-free education effort aimed at fourth- and fifth-graders. Applications for scholarships to attend the Coordinator Leadership Conference July 13 14 in Alexandria, Va., are due by March 28. Nominations for the Star Award, which honors individuals or groups that have significantly contributd to the Tar Wars effort, are due by April 15. The Star Award nomination form is at http://www.tarwars.org/x812.xml, and the scholarship application is at http://www.tarwars.org/coordinator.xml.
Want to present your research, your scientific exhibit or an international poster at the Scientific Assembly this fall? The meeting will be held Oct. 1 5 in New Orleans. Go to http://www.aafp.org/assembly.xml to find online applications to make family practice research presentations and to present scientific exhibits. Submit those applications by April 4. Go to http://www.aafp.org/x13831.xml to access applications for international poster presentations. Those applications are due by April 14.
All people in the United States should have health care coverage. The Academy has championed this goal since 1989. Now -- with leadership from the AAFP -- the AMA has pledged to seek a U.S. Congress resolution endorsing coverage for all.
"Getting the AMA committed to this resolution is important because 'think leaders' and lawmakers see AMA as the 'go-to' organization for the medical profession," says AAFP President James Martin, M.D., of San Antonio. "This resolution tells Congress the American physician is willing to come to the table, try to be part of the solution and forge a way to improve health care for all Americans."
The coalition that introduced the AMA resolution, including the AAFP, focused on bringing a proposal to the U.S. Congress and used the AMA process as a stepping stone. Staff members from the Academy and the American College of Physicians-American Society of Internal Medicine drafted a statement that could be submitted to the U.S. Congress. Then the Academy took the lead in seeking agreement from other specialty groups. That process is continuing.
The resolution originally sent to the AMA read as follows:
"Resolved that our American Medical Association and interested medical specialty societies and state medical societies jointly advocate for enactment of a bipartisan resolution in the U.S. Congress establishing the goal of achieving health care coverage for all persons in the United States by Jan. 1, 2009."
The AMA House of Delegates passed the coverage-for-all resolution during its Dec. 6 11 interim meeting in New Orleans. The AMA reference committee that heard debate on the resolution made changes the house passed, including these: Coverage for all should occur "through a pluralistic system" and in a way "that is consistent with relevant AMA policy." Both revisions reflected some delegates' concerns that the original resolution could have been misconstrued as promoting a single-payer insurance system, totally operated by the government (which currently pays for 45 percent of health care services, according to data for 2001 from the Centers for Medicare & Medicaid Services).
"This resolution and the AAFP are not endorsing in any form or fashion a single-payer system," says Martin. "Our own AAFP proposal clearly calls for a broad-based, public-private system, including payments through private insurance companies."
At the AMA meeting, the AAFP and other medical societies argued against the need to add "consistent with AMA policy" but were outvoted. "We left AMA unhappy with the resolution that was passed -- it does not make sense to ask U.S. lawmakers to pass a resolution 'consistent with AMA policy,'" says Martin, noting that whatever is proposed to the U.S. Congress will be revised and negotiated.
"But, even though we didn't get exactly what we wanted at the AMA, we did get the AMA on record favoring a U.S. Congress resolution on health care coverage for all," says Martin. "This is a major step. When the AMA house began debating the matter, the first vote was too close to call and there had to be a count. Finally getting the resolution passed was great progress."
Besides the AAFP and ACP-ASIM, other groups sponsoring the AMA resolution were the American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons. Many other specialty societies, including the American Psychiatric Association, testified in favor of the resolution.
In general, the Academy, with 16 delegates, is viewed as having increasing clout within the AMA. "We're seen more and more as the conscience of the AMA," says Martin. "Medicine must be dedicated to the health of all Americans, and our Academy delegation is viewed as helping lead the AMA in that direction."
To reach writer Jane Stoever, e-mail jstoever@aafp.org.
At press time, it appeared the U.S. Congress might find a way to salvage federal funds for training in primary care, including family practice. The funds -- called for in the Public Health Service Act, Title VII, Section 747 -- had been zeroed out in budget proposals for 2003.
Congress was scheduled last year to pass many appropriations bills, including one covering Title VII, but was still working on the bills last month. Key bills were introduced in the House and Senate that would fund Section 747 at about $90 million -- close to the 2002 funding level. At press time, the final level of funding that the House and Senate would agree on was not known.
It's easy to switch from receiving the printed FP Report by mail to receiving the e-mailed table of contents with links to the online issue. Just visit http://ww.aafp.org/myacademy/. You'll be asked to give your password, then select "My Subscriptions" on the left. Click on "Publications Delivery Options" and choose how you would like to receive FP Report.
While you're at the Web page, you can update your e-mail address and fax number in your member record. And you can click to receive AAFP Direct, the biweekly source of "insider" news for AAFP members, by e-mail, fax or mail -- and to receive the e-mailed AAFP This Week, your best source of the latest news for family physicians.
You can also get news from the Academy right on the AAFP home page -- and it's updated every workday. Just go to http://www.aafp.org and click on any of the headlines shown in the upper left corner, under "News from the AAFP."
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Accenting access to care, physician leaders conducted a D.C. fly-in last month to explain the impact Medicare pay cuts may have on the nation's elderly.
"What will happen to rural health if doctors aren't there?" AAFP President James Martin, M.D., of San Antonio asked legislative aides to four senators Jan. 8.
At press time, it was not known whether Congress would find a way to lift the 4.4 percent Medicare physician pay cut scheduled to take effect March 1.
The Centers for Medicare & Medicaid Services recently issued instructions to Medicare carriers about the physician fee update and participation process. Highlights:
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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:
I read with interest your article on the Future of Family Medicine project in the December FP Report (quoting AAFP President James Martin, M.D.).
As a private practitioner, chairman of the Lancaster General Hospital's family practice department and a member of the hospital's board of directors, I've seen our medical system from several points of view, and I've occasionally expressed these views to AAFP officials and government officials without response of significance.
Dr. Martin has hit the nail on the head. Our specialty will wither away without immediate response to reimbursement and respect issues. Patients do love us, and we them. But when certified nurse anesthetists earn as much (as family physicians) for a 36-hour week, the lure of radiology or invasive cardiology will be too strong for medical students, and our field will die off to be replaced by physician assistants and certified registered nurse practitioners employed by large subspecialty groups. Please don't let that happen.
J. Clair Hess, M.D.
Lancaster, Pa.
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You'll soon receive the free video/monograph CME program "Prevention Strategies in Family Practice," part of the 2003 Annual Clinical Focus on Prevention. To order the AAFP Video CME series or additional copies of the prevention program (#840), go to http://www.aafp.org/catalog/ and click on "Continuing Medical Education," then "Video CME." |
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Proven value: Help your patients give tobacco the boot with the AAFP's Patient Stop Smoking Guide, #915 in the online catalog at http://www.aafp.org/catalog/. Click on "Patient Education & Public Health," then select "Stop Smoking Kit." A pack of five guides costs $10. |
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Proven value: February is American Heart Month -- consider ordering AAFP Family Health Facts patient education brochures online at http://www.aafp.org/catalog/. Click on "Patient Education & Public Health," then choose #1503, "Healthy Living and Prevention: Cholesterol," or #1571, "Healthy Living and Prevention: Heart Disease." Each pack contains 50 copies; price varies by the quantity ordered. |
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A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
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FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
