During the AAFP's 2015 Congress of Delegates, family physicians gathered here for several days of impassioned discourse and brainstorming to tackle tough issues and consider ways to improve their training, their practices, and the lives of their patients.
Kansas alternate delegate Jennifer Bacani McKenney, M.D., of Fredonia, elicits laughter during a Sept. 28 reference committee hearing when she says the collective age of her two practice partners (one of whom is her father) is 144 years. She's been trying to recruit another physician to her town of 2,500 people for the past six years.
During the Sept. 28 Reference Committee on Education hearing, the plight of rural and underserved communities that desperately need to recruit family physicians was highlighted by a steady stream of FPs eager to provide input on a resolution offered by the Washington AFP.
The resolution, titled "Medical Education Support for Practice in Rural and Underserved Areas," asked the AAFP for help in preparing medical students for rural practice and increasing the likelihood that students ultimately would choose to practice rural family medicine.
Several physicians spoke to the challenges of recruiting and keeping physicians in their small towns.
"I come from a community of 6,000 -- 30,000 for the county. Probably some of the people living in the big cities have more people living on their block than I have in my county," observed Wayne Strouse, M.D., of Newfield, N.Y.
He added, "We had nine family physicians when I first arrived 15 years ago; we now have five. I wonder how many people would do well if 40 percent of their workforce suddenly left?"
- During the 2015 Congress of Delegates in Denver last week, the Reference Committee on Education dealt with numerous issues, including the shortage of rural family physicians and the increasing predominance of human trafficking.
- The Congress adopted a number of measures and referred others to the AAFP Board of Directors for further investigation, including a resolution that directed the AAFP to develop educational materials on buprenorphine.
- Other issues delegates tackled included transparency in medical education and access to training in settings affiliated with a religious health care organization, as well as simplification of maintenance of certification requirements.
Iowa delegate Mary Barinaga, M.D., of Boise, echoed that sentiment. "We're very rural and in desperate need of doctors, so we're very much in favor of this," she said.
Resident physician constituency alternate delegate Alex McDonald, M.D., of Fontana, Calif., drew a round of applause after telling his colleagues how he came to appreciate family medicine.
"I was going to be a pediatrician for the first three and a half years of medical school. And then I saw the light," said McDonald. "One of the big reasons for that was I was forced to go to Holton, Maine. It's about three miles from Canada and Nova Scotia and I would never have gone there of my own accord, but I was told to go there, and so I did.
"I worked with a wonderful doctor, and I found out what family medicine was all about -- and what working in a rural community was really about," he said.
McDonald said most medical students will never have a similar eye-opening experience. "We're not exposed to that in the university setting" where most students receive their medical education, he said.
A substitute resolution offered by the reference committee removed wording that asked the AAFP to "create" rural curriculum; delegates voted to adopt the substitute resolution after adding language directing the AAFP to also identify and disseminate model elements of medical school "admission practices" that would increase student interest in rural medicine.
The New York and Texas chapters introduced a resolution on human trafficking that elicited plentiful and riveting testimony.
Texas alternate delegate Troy Fiesinger, M.D., of Sugar Land, said trafficking was a huge issue in his state. "I've seen these people in the exam room and didn't realize it; they die in the desert, they're imprisoned in homes and we don't realize it.
"In Texas, a state that likes to argue about everything, we've got Republicans and Democrats together advocating to protect these people," he said.
New York alternate delegate Marc Price, D.O., of Mechanicville, said he was shocked to discover during a patient visit that "this was someone who was trafficked -- and was sold for sex. This is a much bigger problem than any of us realize," he said.
California delegate Jeffrey Luther, M.D., of Long Beach, said, "We have a fair amount of similar troubles in California, and I think this is not only a pervasive problem but an underemphasized one."
Sonya Sidhu-Izzo, M.D., M.B.A., of Queensbury, N.Y., a member constituency delegate, noted that the National Center for Missing and Exploited Children website indicates that 100,000 U.S. children under 18 become entrapped in the sex slave market every year, and the average age of entry is 12 to 14.
"This is obviously a huge societal issue, and any societal issue is a national issue and, by definition, a family medicine issue," she said. "Just as we are trained in how to recognize child abuse, elder abuse, domestic violence, we should be trained in how to recognize victims of human trafficking" and the special health problems these patients may have, Sidhu-Izzo concluded.
Ultimately, the Congress adopted a substitute resolution that directed the AAFP to
- provide human trafficking-related health care education, including at least one educational workshop;
- work with the Council of Academic Family Medicine to encourage its four member organizations to identify opportunities to advocate for the integration of education about human trafficking;
- investigate the feasibility of human trafficking-related CME; and
- develop a position statement on human trafficking.
Testifying on a resolution that asked the AAFP to encourage residency programs to train physicians to be certified as medical examiners for the Federal Motor Carrier Safety Administration, Iowa alternate delegate Douglas Martin, M.D., of Sioux City, tells the reference committee that he served on the national committee that wrote the exam. On Sept. 29, delegates adopted a substitute resolution that would encourage -- but not mandate -- programs to facilitate resident training and certification.
Two separate resolutions related to buprenorphine -- a drug used to treat patients with opioid dependence -- elicited lengthy debate from attendees. The first resolution, which called for residents to be trained to use the drug to treat patients with opioid dependence, was not adopted.
A second resolution asked the AAFP to develop buprenorphine educational materials, including a position paper, periodic CME lectures and chapter resources.
During reference committee testimony, resolution author Lucinda Grande M.D., of Olympia, Wash., said the purpose of the resolution was to draw attention to a highly effective tool that was "almost invisible" to family physicians.
"Every day in my clinic, I see the striking effectiveness of buprenorphine, more commonly known by its brand name, Suboxone. I currently prescribe it to 60 patients who formerly suffered from addiction to opioids, either legal or illegal," said Grande.
She told a story about a phone call she received from the father of a 25-year-old man who was a heroin addict. She recounted that father's plea: "Please, Dr. Grande, I need you to save my son's life."
Grande said no physicians who would accept buprenorphine patients lived within an hour of the patient's home, so Grande stepped in.
She soon had not only the son stabilized on buprenorphine but also his pregnant sister, who had also been using heroin, as well as their parents, who, according to Grande, "were miserable at the end of every month when their prescription pain medications ran out."
Ultimately, delegates agreed with the reference committee's recommendation to refer the issue to the AAFP Board of Directors.
Delegates considered several other resolutions that dealt with issues important to family physicians, including
- transparency in medical education and access to training in settings affiliated with religious health care organizations,
- simplification of maintenance of certification requirements,
- improvement in procedural training through state licensure reciprocity,
- provision of resources related to debt relief, and
- standardization of visiting medical student elective medical history forms.
The Congress also reaffirmed a measure that asked the AAFP to support miscarriage management residency training.
Related AAFP News Coverage
2015 Congress of Delegates
Delegates Put Focus on Patients, Environment
Storify: 2015 AAFP FMX: Day Four(storify.com)