December 1998
News for members of the American Academy of Family Physicians
State lawmakers tell family physicians to get involved
HILTON HEAD, S.C. -- State legislators want to learn about health care issues, and FPs have the credibility to provide the education. This sentiment was a common thread woven through many of the sessions presented at the AAFP's State Legislative Conference Nov. 13-15.
State Sens. Angela Monson of Oklahoma and Dave Syverson of Illinois offered firsthand evidence during one workshop. "The legislative process is open and ripe for people to inform us, to provide credible, accurate, dependable information," said Monson, D-Oklahoma City.
The senators encouraged FPs to develop long-term relationships with lawmakers in their states. Over time, the legislators will turn to chapters for help with health care and medical issues, they said. So, how do you build those relationships?
Do your homework. Each chapter's government relations staff should research their state's legislators, staff and bureaucrats, and then distribute that information to FPs in each district. Get details on the lawmakers' educational backgrounds, previous jobs and families, and find out how they rank with their colleagues. "When you're dealing with a legislator who, for example, may have a child with a severe disability, you'd better believe he has strong feelings about disability issues," said Syverson, R-Rockford.
All politics is local. Hold a coffee or other small group event for a legislator, inviting family physicians who also are constituents. "Let the lawmaker know that you are in his district and that you represent a lot of influential people who have certain concerns, and keep him apprised about these things," Syverson said. "That has an awful lot of influence on legislators, oftentimes even more than money."
Lose the tunnel vision. Politics is all about negotiation and compromise, so lawmakers will be less likely to listen to your concerns if you sound self-serving. "Demonstrate that you have an understanding of both sides of the issue," said Monson. "Then you appear more credible. We're looking for a place to start, some common ground. When you polarize the issues, it makes the fight much harder."
Correspond effectively. Many organizations have people sign form letters or postcards and mail them to lawmakers. Such correspondence will get little attention, the senators agreed. "My staff has been told that if it's a form letter or a postcard, just pitch it," Syverson said.
A more effective approach is to have people rephrase the form letters, or at least transcribe letters into their own handwriting. Show your lawmakers that you respect their time (and lack of it) by keeping it simple. "If it's more than one page, it's probably not going to get read," Syverson said. Don't forget to include a return address!
Be visible. To get heard, you must first be seen. Develop alliances or coalitions with other groups that share your concerns, the senators said. An AAFP chapter could join forces with a state medical society to lobby for a particular bill, recruit other primary care organizations to help support a candidate, or team up with child-focused nonprofit organizations to promote children's health insurance programs in the state. There is power and visibility in numbers.
Show them the money. Chapters should form political action committees and raise the money necessary to be players in the political process, the senators said. Although some people think campaign contributions imply corruption or "buying votes," they said, money generally won't sway a vote. It will, however, help an FP-friendly candidate get elected and buy you access once he or she is in office, they said. "You're helping to elect people who support what you believe in," Syverson said. "That's crucial because the opposition -- managed care, business, the medical society -- is doing it."
Physicians With Heart helps Russian hospitals
Former AAFP Director Ron Christensen, M.D., of Anchorage, Alaska, helps unload pharmaceuticals at Municipal Hospital No. 3 in Akademgorodok.
Photos and story by Leigh Anne Bathke
Two physicians-in-training were among more than 200 attendees at a medical symposium on family practice at Novosibirsk Medical University.
The Physicians With Heart airlift provided education and supplies to hospitals in Novosibirsk and Akademgorodok, Russia.
For J.V. Morsch, it all came down to a hug.
While he was visiting Novosibirsk, Russia, as a delegation member with the Physicians With Heart airlift, a local government official approached Morsch and asked to hug him.
"Of course I said all right," Morsch said. "Then he told me he wanted to thank me and my country for all of our help." The man told Morsch that 50 years ago, American soldiers saved his life after World War II. "'Now is my chance to thank you, not only for the assistance your soldiers gave me, but for the help you're bringing now,' he told me," Morsch said with tears in his eyes. "It's encounters like these that make these trips so special."
Morsch was part of a 35-member delegation, including 15 family physicians, to take medical supplies and equipment to hospitals in Novosibirsk and Akademgorodok, Russia, Oct. 3-13. The shipment to Russia was worth more than $1 million wholesale. This was the largest shipment of medical supplies and pharmaceuticals ever sent to the Siberian region of Russia.
The medical supplies, which included stethoscopes, otoscopes and crutches, and the pharmaceuticals, which included antibiotics, pain medications and vitamins, are desperately needed in a country on the brink of economic collapse.
Morsch is the father of Gary Morsch, M.D., executive director of the humanitarian organization Heart to Heart International. This group, the Academy and the AAFP Foundation were collaborating in their sixth annual airlift to a former Soviet republic.
Physicians With Heart delivered products to four hospitals in Novosibirsk and three hospitals in Akademgorodok. The hospitals were chosen because of the large number of patients they serve. The delegation split into seven teams, with several family physicians on each team, to ensure the medical aid reached each hospital and was securely stored.
"Although the supplies have been placed in secure areas inside the hospitals, more signatures are required before the products can be released for patient use," said Daniel Ostergaard, M.D., AAFP vice president for education and scientific affairs. "This is part of the consternation of dealing with the Russian bureaucracy."
Heart to Heart officials are working with Novosibirsk and U.S. State Department officials to assure patient access to the products soon.
Delegation members participated in a day-long medical symposium at Novosibirsk Medical University. More than 200 physicians and physicians-in-training attended the symposium, which included several panel discussions by family physicians.
The visit to Siberia was the first phase of the 1998 airlift. An additional $4 million in medical supplies and equipment will be sent to Uzbekistan this month.
News from Headquarters
AAFP recommendation to parents
Contact family physicians about rotavirus vaccine
Parents and guardians of infants should consult with FPs on whether to use the new rotavirus vaccine, says AAFP's recommendation on the vaccine.
Recently approved by the FDA, the oral vaccine can reduce the risk of an infant having diarrhea caused by rotavirus, which is estimated to cause 5-15 percent of all episodes of diarrhea in the United States in children under age 5. In some cases, the diarrhea can be severe enough to require visits to physicians or even hospitalization.
"The decision to use this vaccine should be made by the parent or guardian," says Stephen Spann, M.D., of Houston, chair of the AAFP Commission on Clinical Policies and Research. "The additional costs must be weighed against the benefits." The vaccine is thought to be able to prevent up to 68 percent of rotavirus diarrhea and to be even more efficacious in preventing severe diarrhea that would require hospitalization.
Three doses of the oral vaccine are given at the 2-, 4- and 6-month well-child visit. The cost of being immunized will vary by health care system. Older children become immune to the virus over time, and the occurrence of fever with the vaccine increases with age.
The vaccine should not be given before 6 weeks of age nor started after 6 months of age. Its greatest benefit will be during the winter months.
CME deadline for re-election approaches
If you are due for Academy re-election to membership at the end of this year, you must accrue the required CME hours by Dec. 31. All credits earned should then be reported to the AAFP as soon as possible.
Active and Supporting (FP) members must accrue at least 150 hours of AAFP Prescribed and Elective credit within each three-year re-election period. Information may be submitted via the address or fax number on your personal CME reporting form, or at www.aafp.org/cme on the AAFP web site.
To receive information on CME requirements for continuing AAFP membership, a new CME reporting form, a copy of your personal CME record or assistance in identifying CME opportunities, call a CME records representative at (800) 274-8043.
Advanced Research Training Grant winners announced
The first eight recipients of the AAFP's Advanced Research Training Grants have been selected.
The grants are part of the AAFP's five-year, $7.7 million research initiative.
Winners represent a broad range of research concepts and a broad range of individuals, from junior faculty members to more established physicians.
Grant recipients are:
- Patricia Fontaine Conboy, M.D., assistant professor at the University of Minnesota family practice and community health department in Minneapolis;
- Michael Parchman, M.D., associate professor at the University of Texas family practice department in San Antonio;
- Theodore Ganiats, M.D., associate professor at the University of California-San Diego family practice department;
- Tillman Farley, M.D., of the Salud Family Health Center in Fort Lupton, Colo.;
- Linda Weinreb, M.D., associate professor at the University of Massachusetts family medicine and community health department in Worcester;
- Sara Warber, M.D., lecturer at the University of Michigan family medicine department in Ann Arbor;
- Kevin Oeffinger, M.D., associate professor at the University of Texas Southwestern Medical Center in Dallas; and
- A. John Orzano, M.D., clinical associate professor, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in Piscataway, N.J.
More grants will be awarded in 1999 and 2000.
Resident/Student News
Unions: a new look
The NLRB is looking at the case for unionization for residents in private hospitals.
In 1976, the National Labor Relations Board ruled that residents in private hospitals were more students than employees and therefore lacked protection under the National Labor Relations Act.
However, residents in public hospitals have been protected in collective bargaining by state laws for public employees.
With the current mix of unions and union wannabes (see story below), the NLRB is considering a request to overturn its 1976 ruling. The request, submitted by residents in the Committee of Interns and Residents at Boston Medical Center, a private facility, asks for residents in private hospitals to come under the protection of the National Labor Relations Act. The act prohibits unfair retaliation for collective bargaining activities including strikes. However, many residents say they would not engage in strikes.
Deb McPherson The NLRB chair resigned in August, no replacement has been nominated by the president and the Senate will need to confirm the nomination. A new chair may be needed to break a possible 2-2 tie on the NLRB concerning the request.
The bottom line: The NLRB ruling may not matter to many family practice residents.
"At our annual meeting of family practice residents and students, there has not been a lot of discussion about unionizing because we have more pressing issues: scope of practice, credentialing, hospitalist issues," said Deborah McPherson, M.D., of Omaha, Neb., resident member of the AAFP Board.
"We're not considered to be just cheap labor," she said. "We get decent benefits, our hours aren't horrendous -- they're hard, but realistic in terms of what we'll do in practice -- and overall we're treated very fairly."
As the NLRB considers whether HMO physicians may unionize, residents are paving the way.
For 41 years, residents in some public hospitals have been able to unionize. And during the past 25 years or so, residents in some private hospitals have formed union "look-alikes" with clout.
"The resident community may lead the way in physicians' collective bargaining," said Andrew Thomas, M.D., of Columbus, Ohio, residents' representative on the AMA Board of Trustees.
"Residents know if there aren't enough EKG machines or techs or nurses," said Thomas, a general internist who's taking an administrative fellowship. "They see problems before they ever reach the quality assurance chart."
One way to tackle problems in public institutions: Join a union.
Family practice resident Felix Aguilar, M.D., of Torrance, Calif., is a vice president of the residents' union in the Los Angeles area Committee of Interns and Residents. The national CIR has nearly 10,000 members, including about 1,800 in the Los Angeles area.
"Medicine is no longer the 'solo practitioner,'" said Aguilar. "Being in CIR prepares us to fight for physicians' and patients' interests. It prepares us for the new environment."
Los Angeles CIR leaders are trying to derail a plan to consolidate county hospital labs in a single location to cut costs. "That's a money-saving step," said Aguilar. "But if I'm on rotation in the ER, I might need a heart enzymes test immediately, to see if the patient had a myocardial infarction. If the lab's across town, I won't get results for hours."
Residents in some private hospitals have come one step short of unionizing.
For example, family practice co-chief resident Geoffrey Jones, M.D., of Ann Arbor, Mich., belongs to the University of Michigan Medical Center House Officers' Association.
"The association makes sure our training is humane," he said. The group negotiates residents' contracts, protects their four days off each month and has a direct link to medical center administrators to address residents' complaints.
About 900 residents belong to the association. "I've always considered it a union," Jones said.
National Conference of family practice residents and medical students
New name, more information
Make plans now to attend the National Conference
It's been revised, revamped and made better than ever.
The summer meeting for residents and medical students has a new name, new look and new energy.
Renamed the National Conference of Family Practice Residents and Medical Students, the meeting will still offer much of the same stuff that made the National Congress of Family Practice Residents and National Congress of Student Members so much fun.
So yes, you'll still get the chance to visit Kansas City, Mo., in the summer -- the National Conference will run from July 28 through Aug. 1 next year.
Yes, you'll still be able to voice your opinion on important issues to the congresses.
And yes, you'll still get to square dance and eat barbecue and ice cream. Why mess with perfection?
But there will be some changes:
- The exhibit floor, open for two days, will encompass both residency and technical exhibits.
- More educational events will take place on the exhibit floor, including video learning and using a CD-ROM library.
- The opening session will be late afternoon on Wednesday, instead of Thursday morning, followed by an opening party at Barney Allis Plaza.
- The closing ceremony will be Saturday, right before the annual square dance.
"We want the National Conference to be as educationally diverse as possible, yet still schedule elements that make this event fun for residents and medical students," said Julea Garner, M.D., assistant director of the AAFP's Education Division. "We'll be looking for input from attendees to improve this meeting each year."
Information will be mailed to medical students and family practice residents in 1999, and will be available on the Academy's web site. Look for it.
Applicants wanted for Mead Johnson Awards
The application period is open for the Mead Johnson Awards for Graduate Education in Family Practice.
Applications must be submitted to the Academy by March 1. Award winners will each receive $2,000 and a free trip to the Academy's Scientific Assembly.
Applicants must be in the second year of a family practice residency approved by the Accreditation Council for Graduate Medical Education when they apply for the awards.
To obtain an application, contact Penny Fletcher at (800) 274-2237, Ext. 4116, or visit www.aafp.org on the Internet. The awards are available through a grant from Mead Johnson, a subsidiary of Bristol-Myers Squibb Co.
If you're a resident or fourth-year student ...
Vote for the AAFP within the AMA
Vote for the AAFP, and the Academy might win another delegate to the AMA.
You're eligible to vote if you belong to the AMA and are a resident or fourth-year medical student.
Every 2,000 votes gain a society another delegate and alternate, and once you vote, you don't need to vote again. Thanks to family physicians' high "voter turnout" in the last two years, the Academy now has the largest medical specialty delegation to the AMA -- eight delegates and eight alternates. If you haven't yet voted, please do so, and give family practice an even stronger voice within organized medicine.
Voting deadline: Dec. 31. All you have to do to vote is call (800) 652-0605 or access ballot@ama-assn.org. Provide your AMA medical education number, which is on your AMA membership card; you can also call the AMA at (800) 262-3211 for your number.
Say you're voting for the AAFP, code 060.
News from Washington
1998 Congress brought mixed results
The AAFP totaled up its victories and a few losses after the 105th Congress adjourned Oct. 21. Congress hiked funding for family medicine training and the Agency for Health Care Policy and Research -- as the AAFP requested.
Funds appropriated for family medicine training jumped from $49.2 million for the 1998 fiscal year to $51.1 million for 1999. The funds apply to programs covered by Title VII, Section 747 of the Public Health Service Act.
In a separate authorization bill, Congress provided a funding floor greater than the current year and maintained a set-aside for the specialty -- measures both in line with AAFP lobbying.
Congress appropriated $171 million for the AHCPR, a hefty $24.5 million increase from the current $146.5 million. The AAFP and other health care groups have lobbied for several years for a sharp increase for AHCPR.
However, Congress' appropriation for the subspecialty-oriented National Institutes of Health far overshadows funding for AHCPR, the only federal agency devoted to primary care research. NIH's new funding of $15.6 billion exceeds its current funding by $1.9 billion.
Congress acted in line with AAFP priorities in not adopting Medicare user fees, in not requiring parental notification for teens seeking contraceptives from federally funded clinics, in not acting on a bill that could penalize physicians for prescribing "lethal" drugs and in requiring federal employees' health plans to cover prescription contraceptives if the plans cover other prescriptions.
However, Congress fell short of several AAFP goals. Next year the Academy will continue to seek:
- comprehensive tobacco reform,
- patient rights/managed care reform and
- technical corrections to the Balanced Budget Act of 1997, which includes graduate medical education provisions unintentionally problematic to family medicine.
Proposed rule would hinder rural care
People living in rural areas of the country may find it harder to get medical care if the Bureau of Primary Health Care proceeds with its proposal to redesignate health professional shortage areas and medically underserved populations. The AAFP opposed the proposal in a Nov. 2 letter to the bureau from Board Chair Neil Brooks, M.D., of Rockville, Conn.
The letter spelled out the AAFP's opposition to several aspects of the proposal, including the plan to make the ratio of population-to-primary-care-provider only one of many factors in designating a HPSA. Other factors, such as rates of poverty, low birthweight, minority status and linguistic isolation, would also be considered.
"The Bureau of Primary Health Care anticipates that 300 counties, and about 8 million people, would lose their HPSA or their existing MUA (medically underserved areas) status," Brooks wrote.
The proposed regulation also would count nurse practitioners and physicians' assistants as "half" physicians in calculating the population-to-primary-care-provider ratio. "While the Academy views mid-level providers as a valuable component of a cooperative practice arrangement, we recommend that the final regulation count mid-level providers only if they are confirmed to be practicing in a collaborative primary care setting under the direct supervision of a practicing, licensed primary care physician," Brooks wrote.
Election: U.S. House has four family physicians
Election Day 1998 increased the number of family physicians in the U.S. House of Representatives by one.
Ernest Lee Fletcher, M.D., of Lexington was elected to represent the 6th District of Kentucky. Fletcher is a Republican.
The other family physicians serving in the House are Tom Coburn, M.D., a Republican from Muskogee, Okla.; Vic Snyder, M.D., a Democrat from Little Rock, Ark.; and Donna Christian-Green, M.D., a Democrat who serves as the delegate from the Virgin Islands. All three of these incumbents were re-elected.
Thanks to Fletcher's win, FPs are now officially .9 percent of the entire House, which is more than any other specialty. Other specialties in the House membership, at one apiece, are obstetrics-gynecology, plastic surgery, internal medicine and ophthalmology. The Senate has one physician member, a surgeon.
More News
AAFP Candidates
The Colorado AFP announces the candidacy of David West, M.D., of Grand Junction for AAFP president-elect.
The Maryland AFP announces the candidacy of Rose Mary Hatem Bonsack, M.D., of Aberdeen for AAFP president-elect.
The Washington AFP announces the candidacy of John Anderson, M.D., of Cle Elum for AAFP Board of Directors.
Past President James Weber dies
James Weber, M.D., the 1994-95 AAFP president, died at home Oct. 29 at age 65 after a lengthy illness caused by a brain tumor. Condolences may be sent to his wife, Cynthia, at No. 2 Cleveland Circle, Little Rock, Ark. 72207. The funeral was held Nov. 2 at Temple B'nai Israel in Little Rock. Donations may be made to the Weber Scholarship Fund of the Arkansas AFP Foundation, 11330 Arcade #8, Little Rock, Ark. 72212.
Reader's Forum
Academy should not legislate social responsibilities
To the editor:
I am totally in agreement with Dr. Richard Olson's letter published in the FP Report in July. It is not for the AAFP to legislate our social responsibilities. Our responsibility is to educate and not to legislate. It is our responsibility to educate our patients to live a healthy life. At times, this may necessitate the use of drugs.
The use of drugs should be permitted according to the needs of the patient's illness. The needs of patients can vary greatly. Actually, for some patients the use of specific drugs that are presently considered to be illegal may, in fact, be beneficial to that particular patient's health and comfort. Therefore, all drugs should be decriminalized.
As medical doctors, our number-one responsibility should be prescribing appropriate treatment that promotes the patient's health and comfort. The patient's number-one responsibility should be the appropriate use of prescribed treatment that promotes good health and comfort.
If we all accept our social responsibilities, the misuse and abuse of drugs should not occur.
CARL A. RODEN, M.D.
Hamilton, OhioGovernment research dollars should be focused on real illness, helping sick
To the editor:
Three studies were published in three separate peer-reviewed medical journals. All published in February with strikingly similar conclusions: There is no evidence of an association between silicone breast implants and systemic disease. If the recent research findings from Sweden, Canada and Scotland strike a familiar chord, it is because they echo more than 20 other medical studies which have found no association between silicone breast implants and disease.
Yet, in June, Sen. Barbara Boxer, D-Calif., introduced a bill before Congress calling for more research on silicone breast implants. The fact of the matter is that the research Sen. Boxer is seeking already exists. More to the point, the government should be concerned that precious research dollars get refocused on finding the real causes of the illnesses many women with and without implants are experiencing. What is truly needed is better communication about the existing research, not more scientific study on an issue most of the medical community considers settled.
My concern as a family physician and member of the American Academy of Family Physicians is that women with breast implants are blaming these devices for their suffering and not receiving the proper diagnosis and treatment for their illnesses. As critical players in the medical community, family physicians must work actively to set our national health priorities and to put a halt to medical misinformation.
MICHAEL HUNTER, M.D.
New OrleansScience should explore reasons behind 'tobacco-related illnesses'
To the editor:
The "medical profession" states that X number of deaths each year are "tobacco-related illnesses."
What has happened to science? Is it fair to say that tobacco caused the death of a lung cancer victim if he/she never smoked?
It is said that prohibition was a failure in spite of all the attendant miseries of alcohol. Tobacco might cause a patient to die at 70 rather than 80, but it will not make him a paraplegic at 18.
ERNEST THORSGARD, M.D.
Thief River Falls, Minn.
FP Report * December 1998* Volume 4/Number 12
The official news publication of the American Academy of Family Physicians. Published monthly by the News Department, Communications Division, for distribution to all AAFP members. Opinions expressed in the FP Report do not necessarily reflect the policies of the AAFP.
Paula Haas Binder, Editor, News Department
Leigh Anne Bathke, Managing Editor
Todd Simchuk, Associate Editor
Sharon Dickinson Dent, Associate Editor
Jane Stoever, Associate Editor
Renee Campbell, Production/CirculationAddress comments and inquiries to the FP Report, 8880 Ward Parkway, Kansas City, MO 64114-2797; fax them to (816) 822-8857; call (800) 274-2237, ext. 4230; or send them to pbinder@aafp.org via electronic mail.
Copyright © 1998 American Academy of Family Physicians. All rights reserved.
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