June 1999
News for members of the American Academy of Family Physicians
Women, minorities, new physicians meet
'We've changed the face of leadership in the AAFP'
KANSAS CITY, Mo. -- Opening the 10th annual National Conference of Women, Minority and New Physicians, convener Maggie Blackburn, M.D., proclaimed, "We've changed the face of leadership in the AAFP."
"We've had rising numbers of women, minority and new physicians on AAFP commissions and committees," says Maggie Blackburn, M.D., convener of NCWMNP.The data back her up.
Two current AAFP directors honed their leadership skills at NCWMNP, a training ground where the three constituencies network, run for office and propose AAFP policies.
"Since we first held this conference in 1990, many participants have gone on to be presidents of their local and state academies," said Blackburn, of Stamford, N.Y.
The AAFP Board, commissions and committees -- with a total of 192 positions -- now include 61 women, 26 minority physicians and 19 new physicians.
At NCWMNP's urging, the AAFP Congress of Delegates for seven years has seated delegates representing the three constituencies. In addition, four of 10 candidates for AAFP national offices this year are veterans of NCWMNP.
Some 112 registrants -- most of them delegates from chapters -- attended the April 29-May 1 meeting here.
Recalling the April 20 high school massacre in Littleton, Colo., and assaults on abortion providers, registrants debated nine resolutions related to guns and violence.
"The more difficult you make access to guns and firearms, the more difficult it is for someone to carry out violence," said Doris Page, M.D, of Tacoma, Wash.
"The time is now for us to stand up and protect our patients and children from firearms," said Christopher Gaynor, M.D., of Seattle.
But James Schouten, M.D., of Payson, Ariz., cautioned, "Unlike tobacco, there are legitimate uses for guns."
Conference delegates asked the AAFP to oppose private ownership of assault weapons and support legislation to mandate trigger locks, restrict all gun sales and raise the minimum age for gun licensing from 18 to 21.
The delegates debated a wide range of topics, including restrictive drug formularies. "If a managed care organization chooses not to pay for a procedure or a medication, the patient doesn't have any choice. That to me is practicing medicine, any way you look at it," said Arlene Brown, M.D., of Ruidoso, N.M. The delegates objected to the rationing of care imposed by drug formularies.
Wanting to give a voice to international medical graduates, the delegates asked the Academy to add an IMG caucus to NCWMNP and establish seats for IMG delegates at the AAFP Congress. "There are special problems for IMGs," said Ruby Amaku Ibekwe, M.D., of Baker, La. "Some insurance companies will not allow them. Some hospitals discriminate against IMGs."
The delegates also asked the AAFP Board of Directors to place new physicians -- those in practice seven or fewer years -- on AAFP commissions and committees. "We've had a three-year struggle to try to get a new physician on the Board of Directors," said Glenn Loomis, M.D., of Andrews Air Force Base, Md. "Last year, in going down in flames with our resolution at the AAFP Congress, we were told by Board members and state delegates to try instead to get new physicians on the commissions and committees."
In all, the delegates sent 17 resolutions to the AAFP Congress and 41 to the Board. The Congress meets Sept. 14-16 in Orlando, Fla., to consider items including Board reports and resolutions from AAFP constituent chapters, NCWMNP, and the National Conference of Family Practice Residents and Medical Students.
AAFP announces plan to revamp CME categories
The AAFP Board of Directors and the Commis-sion on Continuing Medical Education are taking steps to maximize fairness and consistency during the CME review process.
"This started because of increasing difficulty in accrediting complementary and alternative practices CME," said Norman Kahn, M.D., AAFP vice president for education and science.
This problem was especially apparent in states that require CME for relicensure.
"We know members want to take some CAP courses," said Kahn. "But the state boards were concerned about the value of CME that advocates or teaches unproven therapies. We want to make sure members can get the CME credit they need and get relicensed in their states without a challenge."
The AAFP Board approved the concept of these changes during its March meeting. The Commission on CME will meet again in June to determine the criteria and prepare a report for the September meeting of the AAFP Congress of Delegates in Orlando, Fla.
The commission has proposed modifying the AAFP system of evaluating and categorizing clinical CME content as follows:
Eligible for Prescribed or Elective credit -- content covering evidence-based or customary and generally accepted practice, or teaching the evidence to elucidate the danger of clinical practices.
Eligible for Elective credit -- content about neither evidence-based nor customary and generally accepted practice, but not determined to be dangerous.
Ineligible for Prescribed or Elective credit -- content for which evidence basis determines clinical practices to be dangerous or clinically unacceptable and without demonstrable clinical efficacy.
A minimum number of hours on evidence-based or generally accepted practice would be required under this system. The Commission on CME would determine specific criteria for deciding how topics and therapies would be assigned to the three categories of clinical content for CME.
"We feel these are important improvements," said Kahn.
"If this new system is approved," he added, "we will work with members, other national accrediting organizations and constituent chapters to achieve acceptance and application of these principles."
News from Headquarters
AAFP recommends routine influenza vaccine for patients 50 and older
You may want to order extra influenza vaccine for the 1999 fall flu season. A new Academy policy encourages family physicians to offer the vaccine to patients at age 50 as a routine annual immunization, rather than at age 65 as was previously recommended.
"We're not talking about a small public health problem; we're talking about a major problem," said Richard Zimmerman, M.D., M.P.H., of the department of family medicine and clinical epidemiology at the University of Pittsburgh (Pa.). The AAFP's liaison to the Centers for Disease Control and Prevention Advisory Committee on Immunization Prac-tices, he also serves on the AAFP Commission on Clinical Policies and Research, which submitted the policy to the AAFP Board of Directors for approval.
Zimmerman explained that influenza poses the greatest risk to people with chronic medical conditions, such as cardiovascular disease, diabetes mellitus or chronic obstructive lung disease. He also noted that the fatality rate from influenza is higher in middle-aged individuals with chronic medical conditions than it is for healthy elderly people. In fact, the mortality rate curve for influenza deaths begins to rise appreciably by age 50.
"Approximately 20,000 to 30,000 die in this country every year from influenza. If you had 30,000 people who died in plane crashes within a few months, you'd probably see substantial action," he said.
Recent studies have shown that use of the influenza vaccine in healthy adults is safe and cost-effective, reduces absenteeism and significantly lowers the risk of getting the flu, Zimmerman said.
Save $50
Register for Assembly by June 23
You can study manipulative medicine and other clinical procedures at the Assembly.Register for the AAFP Scientific Assembly by June 23, the early-bird deadline, and save $50. With 277 different CME offerings, the Sept. 15-19 meeting in Orlando, Fla., will give you lots of choices.
New this year are 90-minute minicourses covering such topics as new medicines, addictive personalities, digital medical photography and the human papillomavirus.
The Assembly will kick off the Annual Clinical Focus on Mental Health 2000. The ACF programs will cover, for example, the grieving or traumatized patient, geropsychiatry, and adolescent depression and suicide.
Want more insight into your diabetic patients? Attend "Diabetes: the Patient's Perspective" Thursday, Sept. 16. It will feature a presentation by Deanna Herrera, Miss New York 1999, and a video of Nicole Johnson, Miss America 1999, who both have diabetes, plus input from an endocrinologist, an education specialist and a family physician.
AAFP active members should have received registration materials by May 31. Access http://www.aafp.org/assembly to register online, beginning June 1.
Resident & Student News
AAFP's new resident/student staff leader sets her course
Deborah McPherson, M.D.Deborah McPherson, M.D., has always wanted to be a family physician. It just took her a little longer than most.
"When I was in high school, my mother was involved in a serious car accident," McPherson said. "She was hospitalized for nine months, and during that period, her family physician called the house every day. He wanted to make sure that we were coping all right and that my mother would come home to an intact family. That's what inspired me."
What didn't inspire McPherson was her college guidance counselor, who told her she wasn't smart enough to go to medical school.
"I believed it," McPherson said. "So I got married and had babies."
McPherson, 38, currently the resident member of the AAFP Board of Directors, will become the Division of Medical Education's assistant director Aug. 10. Her responsibilities will include overseeing programs for medical students and family practice residents.
Despite the obstacles thrown in her path, McPherson's dream of becoming a family physician never left her. And when her husband died, she knew it was time to take a shot at accomplishing her goal.
"His death was a turning point," McPherson said. "I stopped and took a look and told myself I needed to go to medical school."
McPherson applied to the University of Nebraska Medical Center in Omaha and was accepted. Her new husband, Jeff, became her biggest supporter. He watched their three children as she attended medical school, had another baby and finished her family practice residency at the medical center.
"I've got a good perspective on medical school, family practice residencies and balancing roles," she said. "One of my goals in my new job is to help more residents stay interested in family practice. I think we need to do a better job explaining to both medical students and residents the history of family practice and the fact that we have always been vital to health care."
AAFP membership does have its privileges
Soon, gaining and maintaining AAFP membership may be more resident- and student-friendly than getting a credit card.
The AAFP Commission on Membership and Member Services has been working for more than a year on a plan to attract members earlier in their careers and help them stay involved.
One way the AAFP hopes to achieve this goal is by making membership more attractive and easier for medical students and residents.
"Our new plan addresses this need to recruit members earlier," said Robert Graham, M.D., AAFP executive vice president. "And this plan shows how easy it is to become a member of the AAFP as a student and stay a member through your entire career and into retirement."
The following recommendations were approved by the AAFP Board of Directors in March. Unless otherwise noted, these recommendations will go to the AAFP Congress of Delegates in September before being implemented.
Changes for students
Medical students would need to pay only a one-time fee to join the AAFP. This $15 fee would grant students AAFP membership for their entire medical school career, no matter how far along they were in their education when they signed up.
Changes for residents
Resident members of the AAFP would be automatically upgraded to active membership status and transferred to their new chapter of membership if they changed states.
"New ideas and innovations are vital to the continued success of the AAFP," said Graham. "One way of getting to the new ideas is through identifying the differing experiences of all our members. If residents are automatically upgraded to active status, they can more quickly become part of the vital active membership of our organization."
In another proposal, physicians new to practice would be offered a reduction in dues via a graduated dues payment structure for the first three years after residency.
"The AAFP wants to provide even more support to new physicians in this most critical -- and potentially unstable -- time of their careers," Graham said. "Our newest members are telling us that this graduated payment could be one of the biggest advantages of membership."
Recent residency graduates will also receive a $25 "graduation gift" certificate good for AAFP products and services in the Academy catalog. This gift certificate program will begin this summer.
Summer conference to explore patient advocacy
Want to learn more about serving as a patient advocate? Then make plans to attend this year's National Conference of Family Practice Residents and Medical Students July 28 - Aug. 1 in Kansas City, Mo.
"Patient Advocacy: Beyond the Exam Room" is the theme of this year's conference. The meeting will include workshops and events geared toward developing family physicians who can translate their skills into patient advocacy.
U.S. Surgeon General David Satcher, M.D., Ph.D., will deliver the opening address July 28, and Patch Adams, M.D., the inspiration for the movie, will bring his unusual brand of humor to his lecture July 31.
You also will have the chance to influence the policies shaping family practice through the resident and student congresses. This is your chance to write resolutions, voice your opinions and vote on important issues.
Other events will include community service projects, educational workshops and procedural courses. The exhibit floor will feature both residency programs and technical exhibits.
A registration form was included in the promotional brochure sent to all AAFP student members and family practice residents. You also can register at http://www.aafp.org/conference online.
Legislation
AAFP backs bill on doctors' right to negotiate with health plans
A bill in Congress that would allow physicians to bargain collectively with health plans has won AAFP's support.
"Right now, health plans can present a contract to physicians and say, 'Take it or leave it,'" said AAFP Board Chair Neil Brooks, M.D., of Rockville, Conn.
The Quality Health Care Coalition Act, H.R. 1304, would fix that. Under the bill, health professionals could analyze contracts, talk with each other about what's good and bad, and negotiate terms.
"It's a matter of quality of care," said Brooks. "If an insurance company offers you a contract that forces you to see an unreasonable number of patients a day, and you're not offering proper services to your patients, then the company is not only decreasing physician income but actually hurting patient care."
The bill would give health professionals the same protections from antitrust regulations as employees covered by the National Labor Relations Act.
"Now, if two or three of us talk about a contract, we're per se in violation of antitrust regulations," said Brooks. "That's been a tremendous threat hanging over our heads."
However, the bill precludes the right to strike. In that sense, said Brooks, "this is not a unionization bill."
H.R. 1304 was introduced March 25 by Reps. Tom Campbell, R-Calif., and John Conyers, D-Mich. No companion bill had been introduced in the Senate at press time.
Physicians have tried to get negotiating clout through, for example, independent physician associations, said Brooks, but federal rules now restrict IPAs' negotiating ability.
The AAFP Board of Directors decided April 27, during its meeting in Kansas City, Mo., that the Academy would back the bill. About 30 other medical groups endorse it, including the American Medical Association. The Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education oppose the bill on the grounds that it might apply to residents, but Campbell's staff said the bill is not intended to affect residents.
"The greatest opposition to the bill will come from insurance companies," predicted Brooks.
President seeks funding hikes
AAFP President Lanny Copeland, M.D., of Albany, Ga., testified before a House appropriations subcommittee April 13. He sought $87 million for family medicine training programs, compared with the current $51 million; increased funding for the Agency for Health Care Policy and Research; and continued support for rural health care.
Pharmacists should not expand scope except under supervision
A pharmacist should not administer immunizations or alter doses of prescribed drugs except in an integrated practice supervised by a physician. That's the point of a policy adopted by the AAFP Board of Directors in March. The statement is AAFP's answer to pharmacists' efforts to expand their scope of practice in many states.
"With mail-order drug companies, patients bypass pharmacists, and pharmacists want to make sure their profession survives," said family physician and pharmacist Leah Raye Mabry, M.D., R.Ph., of Pleasanton, Texas. "And many health plans have reduced the time physicians spend with patients, so physicians look more to the team concept."
The Texas Medical Association and Texas Pharmaceutical Association hammered out an agreement last year for changing the Texas Pharmacy Practice Act, and the legislature made the change. If a physician and a pharmacist work out a protocol, the pharmacist may now immunize a patient who is at least 12 years old. Then the pharmacist informs the physician.
Mabry, who worked as a pharmacist for 15 years and is immediate past president of the Texas AFP, helped forge the Texas agreement. "We came to the table and developed a proposal in order to avoid a fight on the floor of the legislature," she said.
They decided what didactic material the pharmacists would need, and the Centers for Disease Control and Prevention offered courses on immunizations.
Idaho, Louisiana, Nebraska, Ohio, Tennessee, Wyoming, Virginia and Guam are among jurisdictions that permit pharmacists to develop collaborative practice agreements with prescribers.
"Some pharmacists want to manage disease states, such as hypertension, diabetes and asthma, but continuous, comprehensive care by a physician is best," said Mabry. "A patient is a whole, not just a disease state."
Other News
Think Uzbekistan
Help fund specialty's international activities
Family physician Dick Westerman, M.D. (right), of Kalamazoo, Mich., distributed good cheer and peanut butter cookies to orphans in Novosibirsk, Russia, last year.The annual Physicians With Heart airlift to a former Soviet republic has a new twist this year. It's you and your checkbook.
In former years, you were asked to contribute used medical equipment to the humanitarian effort. For this year's airlift to Uzbekistan, you're invited instead to donate funds. Your generosity will cover the costs of such items as:
- new medical supplies, including otoscopes and stethoscopes;
- medical education materials, including computer equipment and CD-ROMs; and
- food, clothing and a party for children in an orphanage.
Family physicians and others may also join the Sept. 25-Oct. 5 airlift to Uzbekistan.
The Academy, the AAFP Foundation, and Heart to Heart International, a humanitarian organization based in Olathe, Kan., have sponsored the multimillion-dollar Physicians With Heart projects each year since 1993. The sponsors ask pharmaceutical and medical supply companies to donate to the airlift. This year, materials funded by family physicians will supplement the companies' donations.
To make a tax-deductible contribution toward the purchase of new supplies, educational products and assistance for an Uzbek orphanage, please send your contribution to the AAFP Foundation International Fund, 8880 Ward Parkway, Kansas City, MO 64114-2797.
For more information or to contribute by credit card, call AAFP Foundation EVP Sandy Panther at (800) 274-2237, Ext. 4450.
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ASPN office to shut down; Academy may open new research network
The Ambulatory Sentinel Practice Network, the backbone of the specialty's practice-based research, will close by the end of the year, and the AAFP will explore the feasibility of starting a new network.
The ASPN Board of Directors, grappling with a financial shortfall, decided May 4 to accept AAFP funding this year and then close the ASPN office.
The Academy will cover ASPN's $400,000 in past-due debts and provide between $80,000 and $100,000 to help support ASPN's Denver office this year.
"As the ASPN board examined our current financial condition, we didn't feel there was any way to keep the organization viable for the long run," said ASPN President John Hickner, M.D., of Escanaba, Mich. "We believe having a firm institutional association is the only way for the ASPN endeavor to survive."
Hickner made clear it was the central administrative office that would close, not the practice-based research efforts. "The heart of ASPN is the 125 practices that participate in ASPN, and they're not vanishing," he said.
"We think this is an inevitable step in the evolution of practice-based research for family medicine," added Hickner. "We anticipate a vigorous discussion over the next two or three months with ASPN practitioners and the Academy about rekindling the research network."
In August, the AAFP Board of Directors will consider a plan for launching a new network.
"The Academy is very willing to look at taking on the responsibility of sponsoring a practice-based research network," said AAFP EVP Robert Graham, M.D. "We recognize that will require the enthusiastic participation of a large number of practices currently affiliated with ASPN. That's a decision only they can make."
ASPN has 750 members, including some 700 FPs in the United States and Canada. The members will meet Dec. 2-5 in Colorado Springs, Colo., and may consider an AAFP proposal to form a new network.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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