BY CINDY McCANSE BORGMEYER
The shape of things to come
(Online-only content)
 Really into it: Henry Francis, M.D., left, of Brooklyn, N.Y., and Lloyd Van Winkle, M.D., of Castroville, Texas, enthusiastically participate in a brainstorming session on envisioning the specialty's future. |
The year is 2013. It's Sunday -- the one day you don't have to rush to the office -- and you've decided a leisurely morning is in order. You pad out to the kitchen to start water boiling for tea, then pluck the paper off the front porch and head back inside, when -- WHAM! -- the front-page headline hits you: Health Care For All Achieved!
"Hot damn!" you say to no one in particular. "The AAFP finally did it!"
That's one of many scenarios created May 2 by participants at the Academy's Annual Leadership Forum-National Conference of Special Constituencies. The day's program focused on the specialty's future and, specifically, the Future of Family Medicine project currently under way.
The day started off with a solid reality check delivered by futurist Edward Barlow Jr. Barlow is president of Creating the Future Inc., an organization formed "to enhance an understanding of the future and the influences that will affect personal, professional, organizational and community settings."
The main thrust of Barlow's presentation: You don't know the half of it. Fully 80 percent of what you need to know to make your business -- whatever that may be -- successful in the coming years is completely outside your frame of reference, he told an audience of about 350 family physician leaders and chapter executives.
To have any hope of maintaining your current standard of living, quality of life and leadership position within your profession, you've got to work smarter, he said.
"It's going to take collaboration in an unprecedented fashion," said Barlow. He calls it alignment.
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"The feds are ready and willing to shed themselves of the health care responsibility ... Health care is coming back down to the local level." -- Edward Barlow Jr. |
Align yourself with partners outside your industry who have the expertise you need, Barlow urged. "Part of that alignment means opening up to diversity and taking advantage of the intellectual capital that lies outside our own borders."
Realize, too, that you've got to come up with a "value-added" approach that puts you out in front of the field. For that, Barlow advised, think about the rapidly changing demographics of the United States.
The population of younger Americans is shrinking, while the number of older citizens grows. This sea change is already being reflected in, for example, greater emphases on management of chronic illnesses and long-term care. In addition, less than half of the U.S. population in 2050 will be white. It all comes down to figuring out what it is you can offer these patients that other health professionals can't.
"This is the new America," Barlow declared. "Are you ready for this?"
As the U.S. population continues to diversify, the American workforce cannot but follow suit. That, said Barlow, necessitates courting more culturally and ethnically diverse candidates to family medicine all the way down the education pipeline.
Yet another factor is a shift in the way Americans acquire their health benefits. Barlow estimated that by 2010, only about 50 percent of the American workforce would have traditional employer-subsidized coverage. Rest assured, he added, the American health care consumer would be shopping around for the best care at the best cost.
"You have to come to the table and figure out how to offer health care that workers are able and/or willing to afford," Barlow said. "If the health care community can't figure it out, the private sector will.
"The feds are ready and willing to shed themselves of the health care responsibility. It's coming home, folks. Health care is coming back down to the local level, and you need to be thinking about that and preparing for that."
 AAFP President-elect Michael Fleming, M.D., of Shreveport, La., applauds participants' ideas at the session's end. |
Thinking about the future is exactly what AAFP President-elect Michael Fleming, M.D., of Shreveport, La., asked attendees to do when he introduced the next activity -- an interactive exercise. Fleming divvied participants up into small groups and set each a three-fold task:
Conference-goers took up Fleming's charge with all the zeal of the converted.
Many groups, including the one whose headline is quoted on page 1, focused on access to care issues, although pathways to that goal differed. Some chose pursuing medical liability reform as the chief means of attaining coverage for all, while others urged continuing to press for equitable reimbursement. Still others claimed that nothing less than a revolutionary change in the way health care is delivered would effect that end.
But other issues also hit home with attendees. Among them were development of a signature electronic medical record system and real-time patient care tools; further expanding family medicine's base of ethnically diverse, culturally sensitive physicians; and increasing family medicine's value to the public by promoting its professional identity.
Fleming closed the session by applauding his colleagues' efforts and assuring them their ideas would be taken up as the Future of Family Medicine project continues its work.
To reach writer Cindy McCanse Borgmeyer, e-mail cborgmey@aafp.org.
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What can you expect in health care and other sectors of the economy in the coming years? To find out, check out this representative list of resources recommended by futurist Edward Barlow Jr. during his presentation at the 2003 Annual Leadership Forum-National Conference of Special Constituencies May 2 in Kansas City, Mo.
Creating the Innovation Culture: Leveraging Visionaries, Dissenters
and Other Useful Troublemakers in Your Organization.
Frances Horibe.
New York, N.Y.: John Wiley & Sons, 2001.
Creative Destruction: Why Companies That Are Built to Last
Underperform the Market -- and How to Successfully Transform Them.
Richard Foster and Sarah Kaplan. New York, N.Y.: Doubleday/Currency,
2001.
Differentiate or Die: Survival in Our Era of Killer Competition.
Jack Trout. New York, N.Y.: John Wiley & Sons Inc., 2000.
Dinner at the New Gene Cafe: How Genetic Engineering Is Changing
What We Eat, How We Live and the Global Politics of Food.
Bill
Lambrecht. New York, N.Y.: St. Martin's Press, 2001.
Free Agent Nation: How America's New Independent Workers Are
Transforming the Way We Live.
Daniel Pink. New York, N.Y.: Warner Books
Inc., 2001.
Good to Great: Why Some Companies Make the Leap … and Others
Don't.
Jim Collins. New York, N.Y.: HarperCollins, 2001.
Impending Crisis: Too Many Jobs, Too Few People.
Roger
Herman, Tom Olivo and Joyce Gioia. Winchester, Va.: Oakhill Press, 2002.
Our Molecular Future: How Nanotechnology, Robotics, Genetics and
Artificial Intelligence Will Transform Our World.
Douglas Mulhall.
Amherst, N.Y.: Prometheus Books, 2002.
Who Moved My Cheese? An A-Mazing Way to Deal with Change and
Win!
Spencer Johnson, M.D. New York, N.Y.: G.P. Putnam's Sons,
1998.
BY J.M. BRODIE
Medical liability insurance turmoil
sparks discussions in several states (Online-only content) U.S. Senate unlikely to act soon on liability
issues, but senators seek debate (Online-only content)
When Marilyn Courtright came to Connecticut 30 years ago, she searched high and low for a physician. She ultimately found Neil Brooks, M.D., of Rockville.
"I have diabetes, and he treated me for that; I have high cholesterol, he treated me for that; I also had a stroke, and he got me through that. I have had several surgeries, and he's seen me through every one of them. I have a lot of faith in him," Courtright explained.
Unfortunately, she is losing her long-time physician. Brooks was scheduled to retire May 2, a victim of the rising costs doctors face in securing malpractice insurance. "I feel very, very sad that Dr. Brooks is retiring," Courtright said. "He's a wonderful doctor."
In Florida, 80-year-old Olive Ogle fears that her doctor of nearly 20 years may also be forced to close his doors because of high malpractice insurance costs.
"When I left his office the other day, I told him, 'Don't abandon the ship. At least not until I die,'" quipped Ogle, a retired high-school guidance counselor. "The malpractice insurance situation is so bad, he's afraid he's not going to be able to stay put."
Ogle's doctor, Charles Barniv, M.D., of Destin, Fla., lost his insurance coverage earlier this year because his carrier left the state. The few remaining malpractice carriers in the state would not insure Barniv for reasons such as these: His physician assistant was involved in an alleged medical error 15 years ago, and Barniv does X-rays in his office.
"The excuses varied depending on whom you talked to, suggesting they were looking for a way to avoid writing any new policies in Florida," said Barniv, who found himself virtually uninsurable. He ended up taking out a letter of credit from his bank to keep his doors open.
At press time, Florida Gov. Jeb Bush had promised to call a special session if the House and Senate in that state failed to approve a $250,000 cap on the noneconomic damages that juries can award to malpractice victims.
For Barniv, such relief can't come fast enough. "Malpractice settlements on pain and suffering are the big piñata," he said.
In January, 74 percent of Americans said that the issue of medical malpractice insurance was either a "crisis" or a "major problem," according to a Kaiser Family Foundation health report released in April.
 What Americans think about medical liability insurance situation Source: Kaiser Family Foundation |
Americans hold individuals who bring lawsuits at least partially responsible for problems with the malpractice system, according to the Kaiser report, "Public Opinion on the Medical Malpractice Debate." Sixty percent of adults polled said the number of malpractice lawsuits is a very important factor in causing rising health care costs.
"You find somebody you want to trust your life with and you kind of want to stick with him," said Destin, Fla., restaurant owner Tim Edwards, another Barniv patient. "I'm 47. I have my own business. I know about human error and how continuity reduces the likelihood of error. There's a great comfort in knowing you are not going to have to re-educate a doctor and hope they really have enough time to learn your history."
In Connecticut, the malpractice insurance crisis has intensified, forcing insurers and physicians to leave the state, according to the Hartford Courant. Connecticut Medical Insurance Co. is one of the few companies that has not bailed out. CMIC paid $42 million to settle claims in 2002, compared with $19 million six years ago. Last year's total included 19 settlements or jury awards of $1 million or more, compared with nine such payments six years ago. As a result, CMIC doctors are paying about 30 percent more in premiums than a year ago.
"Connecticut is now one of the crisis states. In my town, more physicians are leaving their practices," said Brooks in a recent FP Report interview. He was on his way to Hartford to ask key legislators to support policy similar to California's Medical Injury Compensation Reform Act.
"Up here, we are right in the middle of trying to get the full MICRA implemented," said Brooks, AAFP president from 19 98 to 1999. "In 1996, we got several parts of MICRA, but we didn't get the cap. We thought we had gotten a limit on the amount the lawyers collect, but we found that they are simply having their clients sign a waiver which allows for a greater percentage to the lawyers."
He added, "I am retiring now in large part because of the malpractice insurance crisis. It was an extremely difficult decision to make."
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
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Rising costs for medical liability insurance, plus the need for caps on damages for a patient's pain and suffering, stirred debate in several states this spring.
The largest malpractice insurer in Massachusetts will raise doctors' premiums 20 percent on July 1, an unusually large increase that physicians predict will force colleagues to close their practices, stop providing high-risk medical services or squeeze in more patients to make up lost income, the Boston Globe reported.
ProMutual Group, which covers about 10,000 of the state's doctors -- just more than half of the total -- has told the Massachusetts Medical Society that average premiums will rise 20 percent, but that individual doctors will get credits or penalties depending on their malpractice history. The company, which covers most Massachusetts doctors not affiliated with Harvard Medical School, raised premiums 9 percent in 2000, 14 percent in 2001 and 12.5 percent last year.
In Texas, H.B. 4, which at press time was out of committee and expected to be debated on the Senate floor soon, called for limiting noneconomic damages to $250,000, the Houston Chronicle reported.
In Ohio, lawmakers were considering legislation to limit jury awards in cases of medical malpractice. The Ohio bill proposed capping jury awards at $250,000 for pain and suffering and $100,000 for punitive damages -- down from limits of between $350,000 and $1 million approved last November, the Cleveland Plain Dealer reported.
In Georgia, the House Judiciary Committee failed to act on S.B. 133, the Civil Justice Reform Act of 2003, and the bill is expected to be carried over to next year's legislative session. On the final night of the 2003 session, H.B. 792, which deals with reform of class-action litigation, was amended to include a few tort reform components. At press time, H.B. 792 was on the governor's desk for signature, and S.B. 133 remained in the House Judiciary Committee for potential action in 2004. The Georgia AFP was urging family physicians to keep seeking legislative support for S.B. 133.
In Pennsylvania, physicians urged state lawmakers to pass S.B. 50, which could pave the way for caps on pain and suffering in malpractice lawsuits. Such limits are banned by the state constitution. But the bill would allow the public to vote to lift that ban and give lawmakers the authority to pass caps. The physicians were hoping damages could eventually be capped at $250,000, the Philadelphia Daily News reported.
The Daily News also said the New Jersey State Senate had passed a bill in March that would cap damages for pain and suffering paid by private insurers at $300,000. An excess liability fund would pay for damages between $300,000 and $700,000. The bill was sent to the New Jersey Assembly as an amendment to a bill the Assembly passed in December. At press time, the Assembly had yet to vote on the Senate's amended version.
On April 8, North Carolina physicians held a rally at the General Assembly in support of a preferred bill that would, for example, cap noneconomic damage awards, enact a sliding fee scale for attorney fees, and prohibit the use in court of routine and complaint-based investigative reports on nursing homes. A few other medical malpractice bills have been introduced in the statehouse. The Senate has created a select committee to examine the legislation and make recommendations.
And less than four months after Wheeling, W.Va., surgeons staged a dramatic two-week walkout, West Virginia gained a new law limiting jury awards in medical malpractice cases. In addition to a $250,000 cap on noneconomic damages, the new law, passed in April, includes tort reform language, according to the Pittsburgh Post-Gazette.
 This spring, the states in yellow have been considering changing their laws to provide relief from the medical liability insurance crisis. Some other states may consider reforms in the future; some may already have passed reforms. Source: National Conference of State Legislatures |
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At the federal level, the House of Representatives passed a medical liability bill similar to California's Medical Injury Compensation Reform Act on March 14, but the Senate appears unlikely to take action on a companion bill this year. The Academy for several years has aggressively sought liability reform at the federal level and is now assisting state chapters in their efforts.
Sen. Kit Bond, R-Mo., and Sen. Pat Roberts, R-Kan., in an April 23 Op-Ed column in the Kansas City Star, called for a "national policy " on noneconomic damages that is large enough to promote a full measure of compensation for someone who has suffered as a result of a doctor's error and small enough to discourage "get rich quick " lawsuits.
"It is time for the Senate to start the debate, " they wrote. "We have to act now before the problem gets worse. "
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ADDITIONAL INFORMATION Medical Liability Crisis Hits FPs Hard AAFP Chapters Tackle Coverage Emergency House Passes Liability Reform Bill FPs Share Info on Impact of Liability Insurance
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BY CINDY McCANSE BORGMEYER
WEB EXTRA!"Been there; done that." For many physicians these days, this is the sentiment they associate with medical malpractice litigation.
But John Davenport, M.D., J.D., has a unique perspective on the issue. Chair of the family medicine department and an attorney and risk manager at Kaiser Permanente Orange County in Irvine, Calif., he addressed the issue at length in an October 2000 Family Practice Management article, available at http://www.aafp.org/fpm/20001000/33docu.html. Much of what was true then still holds today, he notes.
The bad news, says Davenport, is that the typical family physician can expect to be sued about once every seven to 10 years.
For that very reason, says V. Franklin Colon, M.D., physicians shouldn't take being sued personally. Formerly a professor of family medicine at the University of Cincinnati College of Medicine and director of the Bethesda Hospital Family Practice Residency there, Colon began delving into the arcane no-man's-land where medicine meets the law after a yearlong stint in law school. He's presented numerous seminars on the topic and in 2001 co-wrote Medical Malpractice Risk Management with attorneys James Scheper, J.D., and Nicholas Bunch, J.D.,
"What I try to make physicians understand is that being sued for malpractice doesn't mean the person isn't a good physician," Colon says. "There are all kinds of reasons for suing a doctor, and a lot of them don't have anything to do with quality of care."
The good news, he says, is that only about 10 percent of potential malpractice claims are ever filed in court. And of cases that make it that far, 80 percent to 90 percent are either dismissed or are decided in the physician's favor.
So what can you do to protect yourself? Perhaps more than you think.
Not to be missedOf the failure-to-diagnose allegations that eventually wind up in court, chest pain leading to myocardial infarction is the chief offender: More malpractice award dollars stem from a missed heart attack than from any other diagnosis. Specific oversights include failing to review and compare previous electrocardiograms with a current tracing and neglecting to explicitly advise a patient with noncardiac chest pain when to return for re-evaluation. Breast cancer ranks a close second, with failure to recognize a suspicious lesion and neglecting to aggressively follow up on abnormal mammograms being frequently cited as delaying appropriate diagnosis and causing injury to the patient. For the remaining "most often missed" diagnoses -- appendicitis and lung and colon cancers -- the primary complaints again center on misreading the significance of signs and symptoms present and dropping the ball on proper follow-up. |
Know the relative risks
For FPs, the greatest liability risk arises from errors of omission, rather than of commission. According to Davenport, missed diagnoses of myocardial infarction; appendicitis; and breast, lung and colon cancers top the list (see sidebar for more details).
To remedy these shortcomings, Davenport suggests consulting with staff to institute fail-safe measures to guarantee that:
See "Utilize technology for record keeping" in this issue to read how Davenport uses a computerized system in his practice to track test results, monitor patient care and perform other tasks.
Document, document, document
Always a key element of practice, complete and careful record keeping becomes even more critical when one of the five conditions listed above is part of the differential diagnosis, Davenport notes. Each aspect of the medical encounter -- personal and family histories; physical exam findings; imaging and lab test results; and discussions with patients, including specific advice given -- should go in the patient record. When the diagnosis is unclear, it behooves the physician to document his or her thought processes, as well as the follow-up plan.
All chart information should be legible and clearly dated, says Davenport. Avoid sounding defensive in chart notes, and keep the editorial comments to yourself. Few things rankle jurors so much as a doctor who makes pejorative remarks about patients, he advises, so stick to the facts when recording the interview.
Keep communication flowing
Davenport cites a study published in the Journal of the American Medical Association that identified specific communication behaviors associated with fewer malpractice claims against primary care physicians (go to http://jama.ama-assn.org/cgi/content/abstract/277/7/553 to read the article abstract).
"Primary care physicians who spend more time educating their patients and orienting them to what happens during an exam -- and those who use humor -- have a lower claims incidence," he notes. "This reflects our common observation that friendly and compassionate family physicians seem to be rarely sued."
Informed consent -- as well as informed refusal -- hinges on careful consideration of the available information, followed by formulation of an appropriate management course in consultation with the patient. And though it may seem painfully obvious, remember that the "hoped-for" result here is that seen from the patient's, not the physician's, perspective.
Above all, says Colon, learn to look at the threat of being sued as "a cost of doing business."
"We are looked upon by the law as purveyors of health," he says, "just as the guy at the paint store is looked on as a purveyor of paint. So in that sense, a medical liability lawsuit is no different from a product liability case. If doctors start understanding that, it sure is a lot easier on their psyches."
WEB EXTRA!
It makes no difference whether it's a handful, a dozen, or a hundred test results and lab reports that filter through your family practice each week -- each one requires close scrutiny, proper documentation and appropriate follow-up.
"We use a computerized system that holds results on a 'review screen' until the physician affirmatively checks them off," explains FP John Davenport, M.D., J.D. "The system prevents a physician from checking off an abnormal test (and that includes X-rays, labs and path reports) without adding a comment. Since implementing this system, our primary care physicians have received zero lawsuits involving 'lost' or 'unaddressed' tests."
But it doesn't end there, says Davenport. That same interface between computer and staff enables him to track far more than the results of tests he's ordered for his patients; it can also remind him about tests he needs to order for them.
"Using our computer systems, we monitor a variety of clinical indicators -- mammography, Pap smears, hemoglobin A1c readings and others -- and generate monthly reports showing which patients are due for what tests," he says. "We assign the reports to nurses, who contact the patients and encourage compliance. Recalcitrant patients are called by their physicians. It's important to document these calls in the medical record.
"We also use these same computer systems to trigger real-time reminders for the physicians when they see their patients during office visits so that, for example, when Mrs. Jones is seen for bursitis of the shoulder, her physicians will be aware that she may be overdue for mammography."
WEB EXTRA!
The problems posed by malpractice litigation are immense and far-reaching, as evidenced by President Bush's decision to highlight the issue in his State of the Union address earlier this year.
"To improve our health care system, we must address one of the prime causes of higher cost: the constant threat that physicians and hospitals will be unfairly sued," Bush stated. "Because of excessive litigation, everybody pays more for health care, and many parts of America are losing fine doctors."
"No one has ever been healed by a frivolous lawsuit," the president added, calling on Congress to pass medical liability reform.
Some states are making progress in reforming their medical tort systems while federal lawmakers continue to wrestle with the national implications of the malpractice crisis. See "Medical liability insurance turmoil sparks discussions in several states" and "U.S. Senate unlikely to act soon on liability issues, but senators seek debate" to read more about states' and constituent chapters' reform efforts.
Meanwhile, patients are the ones who ultimately suffer when physicians -- confronted with mounting liability insurance premiums -- are forced to cut back on the services they can provide or the patients they can see.
What's the worst-case scenario? Physicians are left with no choice but to close their practices altogether, leaving patients to seek health care from faraway, unfamiliar sources -- or go without. See "Patients worry liability fees may cost them their doctors" in this issue for more on the toll the malpractice crisis is taking on patients.
BY J.M. BRODIE & TONI LAPP
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Family physicians, many of them representing their AAFP constituent chapters, adopted a number of resolutions at the National Conference of Special Constituencies May 1 3, held here.
Resolutions passed at NCSC are referred to the AAFP Board of Directors or the Congress of Delegates for further action. Here's a sampling of the resolutions from the five constituencies -- women, minority and new physicians; international medical graduates; and the gay, lesbian, bisexual and transgender constituency.
 Theresa Garcia, M.D., of Grain Valley, Mo., speaks out on an issue at AAFP's National Conference of Special Constituencies. |
Adoption policy
Fearing that the adoption policy passed by the 2002 Congress of Delegates could be overturned in 2003, members of the GLBT constituency brought the issue to the fore again at NCSC in a resolution. The 2002 resolution called for the AAFP to "establish policy and be supportive of legislation which promotes a safe and nurturing environment, including psychological and legal security, for all children, including those of adoptive parents, regardless of the parents' sexual orientation."
In this year's reference committee testimony, participants discussed whether the 2003 resolution should specify that the AAFP definition of family includes families with same-gender parents.
Some thought this would be needlessly divisive. "If we bring it with the tag that includes same-sex parents, it's like waving a red flag in front of a bull," said Judith Chamberlain, M.D., of Brunswick, Maine.
Others said retaining language about same-sex parents was the crux of the matter. "If we don't affirm same-gender parenting, there's no point in the resolution," said George Gay, M.D., of Cambridge, Wis.
Ultimately, the group removed from the proposed resolution the clause defining family as including same-gender parents.
Co-author Peter Meacher, M.D., of New York City said he was disappointed the resolution had been watered down. "This has lost very important content for me," he said. "The more we disguise what we're really saying ... the less clear and less powerful these resolutions become."
The adopted resolution called for a revision of current policy to state: "The American Academy of Family Physicians is supportive of a safe and nurturing environment, including psychological and legal security for biological, adopted and foster children of all families, using the AAFP's definition of family."
That definition is: "The family is a group of individuals with a continuing legal, genetic and/or emotional relationship."
Immunization disparities
The minority constituency sought Academy support to explore factors generating disparities in immunization rates between minority and nonminority children cared for by family physicians. The authors argued that the information gathered could be used to develop an educational plan to address the disparities.
Scope of practice
The women's constituency reaffirmed a current policy about protecting FPs' scope of practice. The group's concern was sparked by anecdotal reports of physicians being disciplined for providing reproductive care at hospitals with religious affiliations.
With hospital systems becoming increasingly consolidated, this is a major concern, said Linda Prine, M.D., of New York City. "Are we doing anything?"
James Bare of the AAFP Socioeconomics Division said that anything that restricts a physician's scope of practice is a concern for the Academy. He writes some letters to insurers on behalf of FPs when there is a conflict in policy -- such as refusal to reimburse FPs for maternity care or cover contraceptives for women. Bare said the Academy has yet to receive many complaints from FPs about scope of practice being threatened at institutions with religious affiliations.
"The mechanism (to complain) is already there; we just need to hear the voices," Bare said.
Years since graduation
The IMG constituency recommended that the number of years since graduation from medical school should not be used as a sole criterion for or against acceptance into a family practice residency program. "A person's growth should be measured," said Ofelia Melley, M.D., of Southern Pines, N.C.
Miguel Balderrama, M.D., of Tacoma, Wash., who went to medical school in Mexico, said the current policy for residency acceptance was problematic for many qualified international family physicians. "It took me seven years and a different career before I could practice again," said Balderrama.
 "The leadership is giving us a significant chance to determine our own future in the Congress of Delegates," says Melissa Behringer, M.D., of Huntsville, Ala., during debate about seats in the Congress of Delegates for special constituencies. The NCSC eventually called for six delegate positions. |
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Families with special concerns
The minority constituency also recommended creating a series of Annual Clinical Focus programs to study the health care needs of military, ethnic, underserved, under- and uninsured, rural, urban, and inner-city families. Some NCSC participants voiced concerns about the potential costs and limited resources for an ACF, AAFP's initiative to enhance FPs' care in a different area each year. But resolution authors Manuel Crespo, D.O., of Oklahoma City and Kern Low, M.D., of Pueblo, Colo., argued that the issues of these families reflect an unmet need in the education of family physicians. "No one has really looked at this," Low said. "There is a hole in our coverage."
Congress of Delegates seats
The NCSC asked the AAFP Congress of Delegates to designate six delegate seats and six alternate seats to be divvied up among the special constituencies other than new physicians, who are expected to retain their two delegate and two alternate seats. The Board recommended this spring that four delegate seats and four alternate seats should be shared among the constituencies other than new physicians. In 2002, seats for the women's delegation sunsetted, the IMGs and minority physicians had delegates, and the GLBT constituency requested delegate status.
Conference attendees said the six delegate seats would guarantee they are heard. "For the past seven years, we worked hard to have a voice in the Academy," said IMG Jose David, M.D., of Albany, N.Y. "We worked hard for our two seats, and we're not going to give them up."
"We are not asking for anything more than what we have had," said Leslie Knight, M.D., a Uniformed Services physician stationed in Lakenheath, England. "We just don't want less."
You're looking at the association newspaper judged best for general excellence in a recent national competition.
FP Report placed first in the "newspapers -- general excellence" category in the Society of National Association Publications' EXCEL Award competition. The award will be presented this month in Washington, D.C.
Competition judges had this to say about FP Report: "It screams, 'I'm fresh, I've arrived.' We thought the overall design was excellent. Very crisp editorial and well positioned for the audience."
Are you a family physician or family practice educator with an interest in humanitarian work? If the answer's yes -- consider participating in the 2003 Physicians With Heart airlift to Kyrgyzstan in October. Airlift dates are Oct. 8 19.
Physicians With Heart is a joint project of the AAFP; the AAFP Foundation; and Heart to Heart International, a humanitarian aid organization based in Olathe, Kan. Each year, Physicians With Heart delivers needed medicines and other supplies donated by U.S. companies to a former Soviet republic with the assistance of the U.S. State Department.
Airlift delegates -- many of them family physician volunteers -- travel in the recipient country to verify delivery of the donated supplies, provide education on family practice to the country's physicians, and participate in a "children's project" that helps youngsters in orphanages and schools.
For an application to join the delegation, contact Linda Cannata at Heart to Heart International by e-mail at lcannata@hearttoheart.org or by phone at (405) 787-5200, Ext.100.
 "Family physicians are trained to provide most of the care most of the people need over a continuing period of time," says Warren Jones, M.D. |
The Academy sought continued federal funding of family physicians' training May 8 on Capitol Hill. AAFP Board Chair Warren Jones, M.D., of Ridgeland, Miss., asked for Congress' support for the Public Health Service Act, Title VII, Section 747, including $96 million for family medicine training in 2004.
 Rep. Don Sherwood reinforces the AAFP's testimony regarding Title VII funding. |
Jones testified before a subcommittee of the House Appropriations Committee. He said Title VII funding "is important to all of the members of Congress and your committee because family medicine is the only specialty that has a practicing physician in every district in the nation."
Illustrating the continued need for Title VII funding, Jones said Jefferson Medical College, Philadelphia, uses the funds to send physicians to rural locations.
Jones' testimony sparked a positive response. Rep. Don Sherwood, R-Pa., replied: "I think we have lost sight of something, and that is that every person needs a family physician. (Patients) go from one specialist to another, and sometimes the whole picture is not looked at."
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Mix equal parts tradition, camaraderie, diversity and innovative learning -- and you've just described the 2003 National Conference of Family Practice Residents and Medical Students Aug. 6 9 in Kansas City, Mo.
Celebrating its 30th year, AAFP's National Conference is still the only national meeting catering to today's and tomorrow's family physicians. This year's speakers and faculty bear witness to the Academy's commitment to prepare residents and students for the challenges and opportunities of the current practice environment -- and to ensure they will flourish in the health care delivery system of the future.
AAFP President James Martin, M.D., of San Antonio will bring the Academy's traditional greetings to students and residents at the meeting, but he'll depart from the norm of years past by delivering the conference's keynote address. As chair of the Academy's Future of Family Medicine Project Leadership Committee, Martin is in a unique position to catalog the discipline's past accomplishments while outlining goals it's now working to achieve.
A special addition to the speaker lineup this year, Kevin Soden, M.D., M.P.H., is an AAFP Fellow and national medical correspondent for NBC. He is also medical director for Texas Instruments and the Celanese Corp. and author of a book published this spring, The Art of Medicine: What Every Doctor and Patient Should Know. In his presentation, Soden will focus on contemporary health issues and the critical importance of the doctor/patient relationship.
Lori Alvord, M.D., associate dean of student affairs and multicultural affairs and assistant professor of surgery and psychiatry at Dartmouth Medical School, Hanover, N.H., was the first woman Navajo surgeon in Gallup, N.M. Her book, The Scalpel and the Silver Bear, forms the core of university courses on women's health and cross-cultural medicine, especially issues specific to American Indians. Alvord will present the Stephen J. Jackson, M.D., Memorial Lecture.
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The AAFP 2003 Family Physician of the Year, Darrell Carter, M.D., of Granite Falls, Minn., is a rural health aficionado with many years' experience in stretching limited resources to meet whatever health challenges come his way -- from advanced life support crises to addictions counseling. He'll present two workshops -- "A Night in the Life of a Rural Emergency Medicine Team" and "Open Dialogue With the Family Physician of the Year."
Elizabeth Garrett, M.D., M.S.P.H., is immediate past president of the Society of Teachers of Family Medicine. A clinical professor of family medicine at the University of Missouri-Columbia, she directs the family practice clerkship and required ambulatory clinical experience for first- and second-year students there. Garrett will lend her perspective on the current health care environment and how FPs are increasingly being looked to as leaders and innovators.
For more meeting details and registration information, visit http://www.aafp.org/conference.xml. Register by June 18 to save $25!
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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'm a third-year medical student. I am writing to let you know how many of my classmates and I feel about getting into family practice these days.
I attended a family practice conference recently and was approached by a family physician who began telling me that if he were me, he'd "go into some sort of specialty." He said that nurse practitioners were going to practice the bulk of primary care within 10 years, his reimbursements were going down and so on. He acted as if he were a pretty miserable guy.
My fear is that nurse practitioners will, indeed, take over what was historically the family physician's role as the primary care provider for the entire family. I know nurse practitioners now have rights to prescribe narcotics, in some cases, and continue to lobby hard for prescriptive and other privileges, thus taking an even larger slice of the pie away from family practice.
Name withheld by request
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Want to start your own practice but have questions about the process? Check out "On Your Own, Starting a Medical Practice from the Ground Up" (#749, $50). This booklet provides information specific to FPs, including tips on privileging issues, office design, supplies and medical records. To order online, go to http://www.aafp.org/catalog/ and click on "Shop Catalog," "Practice Management" and then the publication title. |
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Online registration is now open for the 2003 Scientific Assembly Oct. 1 – 5 in New Orleans. Beat the July 9 early-bird deadline and save $100 on your registration fee. The Academy has blocked rooms at hotels in a variety of price ranges. By staying in the AAFP block, you will have access to shuttle service daily to the convention center and to AAFP evening events. Go to http://www.aafp.org/assembly.xml to register for Assembly, then follow the link to book your hotel room. |
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Travel plans in your future? Take advantage of the AAFP Car Rental Program available through Avis. Members enjoy discounted daily, weekly and weekend rates. Go to http://www.avis.com/AvisWeb/html/bridge/assoc/members/go.html?A685100 to enroll in the Avis Preferred Service Program. For phone reservations, call (800) 698-5685 and reference AWD# A685100 to receive your AAFP discount. |
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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
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Copyright © 2003 by
American Academy of Family Physicians.
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