 Sept. 30 - Oct. 4, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
One of the most contentious issues considered in this year's Congress of Delegates received neither a thumbs-up nor a thumbs-down from delegates. The issue: the American Board of Family Practice's new Maintenance of Certification for Family Physicians program, or MC-FP. The decision: Refer the whole matter to the AAFP Board of Directors, with a report back to the 2004 Congress of Delegates.
 American Board of Family Practice Executive Director James Puffer, M.D., responds to AAFP members' concerns about the board's new maintenance of certification process. |
For specifics on the new program, visit the ABFP Web site at http://www.abfp.org. You can also stop by the ABFP practice center in Technology Central, Booth 4904 in the Morial Convention Center, to ask questions of ABFP staff. In addition, the ABFP Certification and Recertification Demonstration is being given from 8 to 9:15 a.m. today in Room 217.
Academy members had plenty of opportunities to voice their concerns about the new process, starting with a jam-packed town hall meeting on Monday night. ABFP Executive Director James Puffer, M.D., and ABFP President Ronald Christensen, M.D., of Anchorage, Alaska, addressed the more than 300 people who showed up with questions about the new program. Some common themes emerged, among them the timetable for implementation.
Why now?
"One of the questions we've been asked is, 'Why are you doing this now? With all the other problems besieging family physicians in the trenches, this is the worst possible time you could do this,'" Puffer said.
Strictly speaking, Puffer said, the ABFP had little choice in the matter. The directive to develop and implement specialty-specific maintenance of certification processes came from the American Board of Medical Specialties, which oversees the ABFP and the other 23 medical specialty boards.
ABMS acted in response to increasing concerns about patient safety and physician accountability -- concerns first expressed in the landmark Institute of Medicine report, To Err Is Human: Building a Safer Health System.
As for the timing of implementation -- that, too, is according to the ABMS schedule, Puffer said. "The ABFP is probably on track with the other large specialty boards in rolling out this maintenance of certification process."
The prospects of added cost and added burden were also sticking points for members who attended the meeting, as well as for those who testified on the matter in Wednesday's reference committee hearing.
 Oregon alternate delegate John Saultz, M.D., of Portland testifies about the need to educate family physicians about the ABFP's role. |
Puffer sought to quell the financial concerns at Monday's meeting, saying the ABFP has estimated the cumulative cost of the complete MC-FP cycle -- that is, the cost in 2010 -- as equivalent to what it would be under the current recertification system. That's after discounting, he added. Diplomates would have the option of either paying up front for the entire seven-year cycle or paying incrementally.
As for the time needed to complete the program, Puffer said: "Let me reassure you: Maintenance of certification as currently envisioned will not take any more time than the current recertification process."
Communication breakdown
Perhaps one of the most galling issues for some members grappling with MC-FP was the ABFP's failure to consult its Diplomates, who see themselves as major stakeholders in the venture, in developing the project.
Puffer replied that the ABFP's role is to ensure the quality of the nation's family physicians. "Each of the 24 medical specialty boards has a sacred covenant with the American public," he stated. "The American Board of Family Practice does not serve you; it serves the American people."
Nevertheless, insisted Arkansas delegate Joseph Stallings Jr., M.D., of Jonesboro, "We are stakeholders. We represent the people who take care of the majority of people from New Mexico to New York."
South Carolina delegate Audrey Boyd, M.D., of Columbia said she would be among the first group to enter the new process. "I would have liked to have been given the opportunity to give input on why and how (this program) should be implemented," she said.
Broken health system
Hawaii delegate Randall Suzuka, M.D., of Haleiwa voiced another aspect of the issue -- namely, the new process addresses only the physician's role in an arguably dysfunctional health care system. "Maintenance of certification only covers a small part of the quality problem," he said. "We need to look at other areas of the system, at reducing medical errors, at using information technology."
"We're doing what we can do in our small little sphere to prove to the American people that we are working to improve quality," Puffer responded. "We can do nothing or we can fix the part of the health care system we can fix."
To be continued ...
(Then) AAFP President James Martin, M.D., of San Antonio on Monday complimented the ABFP on what it is trying to accomplish with MC-FP: "I think we ought to applaud the board for seeing a problem coming and trying to address it proactively." The AAFP Board of Directors "has been very supportive of the general principles of maintenance of certification," he added.
The executive committees of the two organizations have met twice since early summer, when the Academy first learned about MC-FP. While Martin said those meetings had proven fruitful in helping define the Academy's participation in the new process, there clearly remains much yet to be accomplished by the two organizations.
FP Report is published by the
AAFP News Department.
Copyright © 2003
by American Academy of Family Physicians.