News for members of the American Academy of Family Physicians
AMA's first female president:
'What's best for patients?'
Nancy Dickey, M.D., center, chats with residents Garth Morgan, M.D., left, and Anna Lichorad, M.D., right, and observer Zenia Nicolwala, M.D., at the Brazos Valley Family Practice Residency. COLLEGE STATION, Texas -- More than 300 people at a recent fund-raising luncheon for a low-income clinic here were captivated by keynote speaker Nancy Dickey, M.D.
What the crowd didn't know was that the soon-to-be AMA president had just breezed into town to find that the speech she'd written on her computer while flying from Chicago wouldn't print. A back-up plan to read the speech from the laptop screen fizzled; the battery ran down. So the family physician extemporaneously addressed issues of medical ethics and professionalism.
"Even as we struggle with the new technology, even as we struggle with delivery systems, we are committed to doing what's right for our patients," she said.
The luncheon was just one activity in a nonstop day that would jangle the nerves of most people. But Dickey was unflappable.
Following Dickey's talk, she and her administrative assistant touched base regarding the goings-on at the Brazos Valley Family Practice Residency Program, where Dickey is director. Then Dickey headed to the county courthouse, where she successfully defended her $50,000 funding request for the residency. From there, she popped into the residency to read messages, meet briefly with residents, review her schedule and collect a fresh pile of work. And she was off. Destination -- an Oklahoma Medical Society meeting in Oklahoma City.
Dickey said her high energy level and supportive family and staff enable her to maintain such a hectic lifestyle. Her husband, Frank, and children -- Danielle, 21; Wilson, 19; and Elizabeth, 16 -- have tagged along to AMA meetings all over the world.
The second of seven children, Dickey said her life has always been packed with activity. "I could write the book on the 'type A' personality," she said with a laugh.
She has continued to see patients, deliver babies and take call during the time she's served on the AMA Board of Trustees, although she'll cut back in the coming year. "I do think leaders need to continue to see patients. Otherwise we're talking about something that you do and I don't," she said. "Frankly, for all I enjoy the policy and the administration and the challenges of problem solving, my heart is still in patient care."
The Academy nominated Dickey for a seat on the AMA board and supported her candidacy for board chair and ultimately president. Recognizing that she "has two parents" -- the AAFP and the AMA -- has kept her sensitive to issues of representation in the house of medicine. "The AMA must recognize that the federation of medicine is more than just geographic units," she said. "More and more we have to look at how physicians define themselves."
What's the significance of being the AMA's first female president? "Clearly, it's an indication that medicine is changing," Dickey said. "We have watched over the years as states, counties and specialty societies celebrated their first women trustees or their first women presidents, so to finally breach one of the last bastions is simply a confirmation that there is substantial change happening."
However, she quickly pointed out that being the first isn't nearly as significant as being the fourth or 10th female president. "If one woman gets elected against all odds, then it's not change; it's a fluke," she said. "I hope it's a sign that there will be some increasing diversity -- gender diversity, ethnic diversity, branch-of-medicine diversity -- among the people bringing their talents, commitments and voices to organized medicine."
As AMA president, Dickey has a lot to do in one short year. "The kinds of things I'm interested in are clearly indicative of the personality that made me a family physician," she said. "There's no one issue that has consumed my interest or energy, but rather a whole series of issues. It's never boring." Some of those issues are:
Medical ethics. Dickey said she "grew up" on the AMA's Council on Ethical and Judicial Affairs. "I was only two years out of residency when I was elected to that council, and biomedical ethics exploded on the scene. So I have a deep, abiding interest and affection for issues such as what it means to be a physician, end-of-life care, and the conflicts between continuing technology and cost constraints."
Health system reform. In her early years on the AMA board, Dickey addressed the Clinton administration's proposed national health plan. She spent her mid-years on the board dealing with managed care issues.
"Now for my presidential year, I hope it's time for the AMA to get to a relatively simple answer, easily understood, that has the goal of putting the doctor and the patient back into the decision-making process," she said. "I hope we'll address universal coverage and a way to pay for it. In a country that is spending hundreds of millions of dollars each weekend on new movies and heaven only knows how many millions of dollars on pet food and Nike tennis shoes, I find it hard to believe that we can't afford some defined level of health care for every American."
Women's health. "It's part of my agenda because I am a woman and because I have taken care of scores of women and because, while we have begun to address women's health issues, we still haven't eliminated the disparities both in access to care and in perceptions of care," Dickey said. "Any woman who has an opportunity to be a spokesperson has to look at those issues."
Nonphysician practitioners. Dickey said groups representing physicians and nonphysician practitioners are missing opportunities to cooperate and work together efficiently as they butt heads over who is qualified to do what.
"On the other hand," Dickey said, "it's terribly important for patients to be given appropriate information about different players in the health care arena. A nurse practitioner is not the same as a physician. Five hundred hours of clinical training is not the same as four years in medical school and three years in postgraduate training. We have to resolve the issue based on what's best for the patients."
By Sharon Dickinson Dent,
Associate Editor
Tobacco legislation must meet five key criteria ...
... otherwise, it's just a lot of smoke
The Academy is lobbying for strong tobacco legislation that will reduce smoking by adults as well as children.
AAFP Director David West, M.D., of Grand Junction, Colo., wrote AAFP members who are key legislative contacts last month. "We think there is a very good chance tobacco legislation will not pass, or that it will be so weak that it will have little effect on tobacco use rates," said West. "Members of Congress are likely to push for strong legislation only if they hear from constituents like you."
The Academy is now asking all AAFP members to take action. Call or write your senators and representative today and tell them: I, along with more than 85,000 members of the American Academy of Family Physicians, say that tobacco policy needs to measure up to five important criteria (otherwise, it's just a lot of smoke):
- End tobacco use by children, with real timetables and penalties.
- Reduce tobacco use by adults, with real timetables and penalties.
- Pursue full disclosure of all documents related to the harmful effects of nicotine.
- Allow victims to seek reparations, with no immunity for tobacco companies from individual or class action lawsuits.
- Give the FDA unrestricted authority over all tobacco products.
As my (senator, representative), you must fight for the life and health of all Americans. As a family physician and your constituent, I say that if final legislation does not contain the above elements, it does not measure up!
News from Headquarters
Advanced research training grants
Wanted: your letter of intent
The Academy's new research initiative could make a big difference to you and your practice or teaching career.
Submit a letter of intent to pursue an advanced research training grant, and -- if you make a good case for your intent to combine research with your clinical practice or academic work -- you may be able to plunge into serious study.
The grants will provide up to $50,000 per year for two years to as many as 10 AAFP members in the program's first cycle.
The AAFP Task Force to Enhance Family Practice Research, headed by AAFP Director Joseph Scherger, M.D., of San Diego, coordinates the initiative. "The objective of the grants is to increase the number of family physicians who can and will become published researchers," said Scherger.
The task force will ask a limited number of FPs submitting letters of intent to follow up with complete grant proposals.
Applicants should be:
- practicing FPs who want to devote significant time and energy to research,
- junior faculty who want to become investigators,
- family physicians who are currently investigators or
- fellows.
The grant program is the second phase of AAFP's five-year, $7.72 million research initiative. In the first phase, geared to establishing research centers, 65 institutions submitted letters of intent. The task force will ask eight of the 65 for full grant proposals. The three institutions to be selected by Sept. 1 will receive up to $450,000 during the first two years of the four-year program, and up to $450,000 during a subsequent two-year period.
To obtain the task force's call for letters of intent for an advanced research training grant, use AAFP Express.
CME, entertainment highlight 50th Assembly
AAFP's 50th Annual Scientific Assembly Sept. 16-20 boasts new CME and entertainment for you and your family. Here's a taste of what's in store in San Francisco.
New clinical procedures workshops will cover advanced techniques in vasectomy and in casting and splinting. A new computer offering will give you a personal consultant on your computer questions. The annual research skills workshop for the first time will require no added fee and will last a full day.
In honor of the Assembly's 50th anniversary, 10 of the highest-ranked speakers from other Assemblies will present case studies and field your questions. Two "critical issues" lectures will address quality improvement and the human genome project. Clinical seminars will include 13 new topics, such as hospice care, natural family planning and care of the weekend warrior (the exercise-impaired baby boomer).
At the All-Member Event, Carl Reiner will interview Mel Brooks, the 2,000-Year-Old Man whose jumbled memories result in crazy quips. It'll be fun for the whole family, perhaps topping off their guest tours, courses or the Youth Program's exploration of San Francisco.
Available on AAFP Express
Call the AAFP Express toll-free number -- (800) AAFP EXP [223-7397] -- and supply your AAFP ID number to have selected materials sent almost immediately to your fax machine for free. Some documents available:
Description of Document Document # Weekly "Washington Update" 8009 Fundamentals of Management application 8000 Call for letters of intent for advanced research training grants 7006 Applications for scholarships and grants for the Conference on Patient Education 7003 Flier on Conference on Patient Education
Nov. 19-22, Orlando, Fla.7004 Information and registration forms for: Family-Centered Maternity Care
- July 22-26, Minneapolis
2010 ALSO (Advanced Life Support in Obstetrics) Instructor's Courses
- July 21, Minneapolis
2014
- Sept. 15, San Francisco
2015 Geriatric Medicine
- Oct. 15-18, Scottsdale, Ariz.
2002 Infant, Child and Adolescent Medicine
- Oct. 28-Nov. 1, Portland, Ore.
2012 State Legislative Conference
- Nov. 13-15, Hilton Head, S.C.
8001
Resident & Student News
Jazz it up at 25th resident/student meeting
Max out on educational sessions, mix with your peers from across the country, help create AAFP policy, connect with community service projects and "get down" with the sound of Kansas City -- jazz.
Do all this and more at the 25th National Congress of Family Practice Res-idents/National Congress of Student Members from Wednesday, July 29, to Sunday, Aug. 2.
Accenting the anniversary, the meeting's theme is "Building on Our Tradition: Becoming Leaders for To-morrow." The plenary talks will be by two former resident/student leaders: AAFP Past President Douglas Henley, M.D., of Fayetteville, N.C., and Raye Maestas, M.D., of Seattle. Workshops -- some to be given by NCFPR/NCSM veterans -- will cover topics such as AIDS, alternative medicine and tobacco. Procedural skills courses range from no-scalpel vasectomy to chest tube placement. Both the educational program and community service activities start Wednesday.
If you're a resident, you can job hunt as you talk with exhibitors hiring FPs and as you visit AAFP Placement Services in the Technology Center. If you're a student, you might meet your future at the specialty's largest residency fair.
Be ready to write resolutions and defend your views during debate with other residents and students. Win their support, and your ideas may evolve into AAFP policy.
Friday night fun will include Worlds of Fun, a Kansas City Royals game, and a visit to the newly renovated 18th & Vine District, featuring a jazz museum, a jazz club and baseball memorabilia from the Negro Leagues.
For the lowest fees and the most options for procedural skills courses, register by June 12, using the brochure the Academy mailed in May. Questions? Contact Judy Schmid in the AAFP Division of Education at jschmid@aafp.org or (800) 274-2237, Ext. 5234.
Now introducing ... Jones scholars
A few Native American medical students will soon become the first James G. Jones, M.D., scholars. Here's how.
Jones, of Durham, N.C., has created a charitable remainder trust the AAFP Foundation may begin using for a student program when the trust matures. For now, Jones is making annual contributions to the foundation for various student grants and scholarships, under the umbrella of the James G. Jones Scholars Program.
Jones' first annual contribution, supplemented by two other donors, will send four or five Native American students to the National Congress of Student Members, a way to increase Native Americans' interest in family practice.
Jones, a member of the Lumbee tribe and past president of the Academy and the foundation, has spent most of his professional life working with medical students. The foundation has asked the American Association of Indian Physicians to help select the first Jones scholars. Please welcome them to NCSM.
More schools win awards for training future family physicians
In 1992, the Academy started an award program, and no medical school managed to go for the gold.
That's changed -- dramatically.
This year, seven schools qualified for gold awards. That means at least 30 percent of their graduates entered family practice residencies, averaged over the last three years (1995-97).
The total number of Family Practice Percentage Awards has also escalated, from 14 in 1992 to 46 this year. In addition to gold awards, silver awards go to schools with 25-29.9 percent of their graduates opting for family practice, and bronze awards recognize schools with 20-24.9 percent of their graduates becoming first-year family practice residents.
The Academy bestowed this year's awards during the Society of Teachers of Family Medicine's annual meeting in April in Chicago. The award program tracks the graduates of schools accredited by the Liaison Committee on Medical Education and pertains to graduates who enter residencies accredited by the Accreditation Council for Graduate Medical Education.
Reader's Forum
60 Minutes statements on NPs: 'explosive'
I hope the segment on nurse practitioners aired April 19 on 60 Minutes has provoked the deserved level of alertness in most practicing family physicians.
The Oxford Health Plan, defined by 60 Minutes' Morley Safer as one of the largest HMOs in the Northeast, is listing Edwidge Thomas, R.N.P., in its roster of participating physicians. For the first time, managed care companies are paying nurse practitioners the same fees as doctors.
The dean of the Columbia University nursing school, Dr. Mary Mundinger, is described as the force behind a pilot project, Columbia Advanced Practice Nurse Associates, which opened an ambulatory facility in Manhattan run solely by nurses. Mundinger raised money from various foundations to pay for a million-dollar ad campaign to get the word out. Here are some quotations from the interview:
Mundinger: "Nurses can pick up when something's going wrong very early because of their engagement with people. They really know the individual they're working with."
Safer: "The nurse is no longer the bedpan-fetching slave to the genius doctor. For primary care, the nurse is in, and the doctor may well be on his way out. ... Twenty-six states now allow nurses a full range of responsibilities. They receive Medicare and Medicaid payments. A congressional study concludes that they deliver primary care as effectively as doctors."
Thomas: "We can do anything a primary care physician can do."
Nancy Dirubbo, A.R.N.P., of Laconia, N.H.: "I think you will see more nurse practitioners doing preventive health care and perhaps having a stronger foothold in an outpatient setting. And maybe we're going to be seeing physicians' roles evolving to the point where they do more inpatient setting. ... You don't need an astronaut to fly an airplane."
Each one of the above statements is potentially explosive. We must be able to ask ourselves if there is a future for primary care physicians, we must be able not to feel uneasy when our medical students ask about the future and the promise of family practice. The resources of the AAFP should be mobilized for this battle for the preservation of present and future generations of family physicians.
ALESSANDRO BERTONI, M.D.
Naples, Fla.Editor's note: Academy leaders have objected to the negative publicity Columbia Advanced Practice Nurse Associates is generating about nurse practitioners' roles vs. physicians' roles. AAFP President Neil Brooks, M.D., wrote 60 Minutes April 23, saying, "Edwidge Thomas' statement that '(nurses) can do anything that a primary care physician can do' sounds as if the provision of primary care is no longer about medicine."
Brooks said a typical NP program requires a baccalaureate in nursing or the equivalent, plus two years of classroom and clinical course work. "This is appropriate, comprehensive training for a nurse practitioner," Brooks said. "It certainly is not acceptable on an application for a physician's license."
In addition, AAFP Director Bruce Bagley, M.D., of Albany, N.Y., was featured in an April 30 Physicians Financial News story on CAPNA. Bagley is part of a 10-physician practice employing two physician assistants and an NP.
"Our nurse practitioner does not work when there is not a physician available. It has nothing to do with trust. It's just that, much like my own training as a family physician is to know what my limits are, when to ask for help ... both NPs and PAs have that same bent. They will see things up to a level at which they feel uncomfortable, and there needs to be readily available consultation," Bagley explained.
Right on! on E/M documentation guidelines
Editor's note: The April FP Report quoted AAFP President Neil Brooks, M.D., as saying the 1997 E/M guidelines were "too flawed to be fixed."
To the editor:
WELL SAID!!! The comments of AAFP President Neil Brooks are most appreciated. The arguments you (Brooks) made to the Physicians Advisory Council were reflective of my own observations on the E/M guidelines.
I have tried to use the guidelines several times to see how much extra time it takes, and it takes quite a bit! One elderly woman, a longtime patient, said, "Why are you writing something down already ... we haven't even done anything yet!" I told her I was just trying to satisfy my government that I was taking proper care of her by "treating the chart." This is where the process comes between the physician and the patient.
EDWARD C. WHITE, M.D.
Cleveland
To the editor:
Three cheers to a family physician (Dr. Neil Brooks) who understands our practice and speaks out. The E/M guidelines are a burden that family physicians should not have to endure.
MICHAEL J. TUROCK, M.D.
Scranton, Pa.P.S. I have been in solo practice for 25 years.
To the editor:
The new E/M documentation guidelines are the "straw that broke the camel's back." I have opted out of Medicare and will now contract privately with each Medicare patient that I see.
These same patients still qualify for traditional Medicare reimbursement at emergency rooms, hospitals, laboratories, etc. The only things they must pay for are office visits and office procedures performed in my office.
A recent study has shown that the average Medicare patient spends $2,149 for out-of-pocket expenses annually. So the expense of a routine office visit is not going to make that much of a difference, but will make the practice of medicine more enjoyable to the physician.
G.E. WIDDIFIELD, M.D.
Indianapolis
To the editor:
Please pass on to Dr. Neil Brooks my complete support for an all-out effort to block Medicare E/M billing. I fully agree with all the points discussed in the April FP Report. As a practicing FP for 38 years, it (the 1997 E/M guidelines proposal) is easily the worst assault on patient care I have ever seen.
WALT MORGAN, M.D.
Sacramento, Calif.
Against Satcher, needle exchange
To the editor:
I agree heartily with the comments of Dr. Sigurd Daehnke printed in the May FP Report. I think it is wonderful than an FP (Surgeon General David Satcher, M.D.) holds the position but am saddened by the fact that we could not find a better representative.
I must also disagree with AAFP's current stance on needle exchange for IV drug abusers. Despite the claims of success in limiting the spread of HIV, I feel strongly that this is a poor way to do it. There is absolutely NO way the U.S. government can exchange needles for IV drug abusers without sending a message condoning this illegal and dangerous behavior.
GEORGE BARRON, M.D.
Rock Hill, S.C.
No federal legislation against tobacco industry
To the editor:
I wish to express a contrary view to that opined in the FP Report. Many of us family physicians in real practice abhor tobacco use. However, we do not feel that there should be federal legislation directed against the tobacco industry. The tobacconists should not be held liable for the volitional act of individuals. Denial of or more expensive health insurance, maybe. Freedom of choice should supersede any altruistic emotion we feign.
The more authority we give the feds, the more responsibility we shift to others, the less we all possess.
KARL N. HANSON, M.D.
Kenner, La.Copyright © 1998 American Academy of Family Physicians. All rights reserved.
