A policy of the Accreditation Council for Graduate Medical Education (ACGME) is discouraging some family medicine residency programs from recruiting minority candidates and unfairly jeopardizing the accreditation of programs that do, said family physicians who supported a measure to address the issue during the 2017 AAFP Congress of Delegates, held here Sept. 11-13.
Arizona alternate delegate Melody Jordahl-Iafrato, M.D., of Tucson, testifies during the Reference Committee on Education hearing on Sept. 11 in support of a resolution asking the Academy to develop tools and resources to help physicians improve clinical efficiency and reduce burnout.
The Congress agreed, adopting a substitute resolution that calls on the Academy to urge the ACGME to study its policy regarding initial certification exam pass rates and how it impacts diversity; the measure also asks the AAFP to recommend policy to achieve greater diversity in family medicine.
The ACGME's Review Committee for Family Medicine requires that at least 90 percent of a residency program's graduates from the previous five years who take the American Board of Family Medicine (ABFM) or American Osteopathic Board of Family Physicians certifying exams for the first time must pass.
"It discriminates against small programs," said Alan David, M.D., a Wisconsin AFP alternate delegate from Brookfield and chairman of the family medicine department at the Medical College of Wisconsin, in testimony during a Sept. 11 Reference Committee on Education hearing.
- The Reference Committee on Education at the 2017 Congress of Delegates heard testimony from AAFP members about improving the family medicine pipeline, reducing burnout and other issues.
- One substitute resolution the Congress adopted calls on the AAFP to urge the Accreditation Council for Graduate Medical Education to study how its policy on initial certification exam pass rates affects diversity.
- Another substitute resolution asks the AAFP to consider expanding the search terms students can use in the Academy's residency directory.
Heather Paladine, M.D., director of the New York Presbyterian/Columbia University Family Medicine residency, agreed. Speaking for herself, Paladine said her program takes six residents a year. If one fails the exam, that puts the program below the pass rate for that class. Paladine said some underrepresented minorities tend to do worse on standardized tests, and such tests don't necessarily indicate whether a new graduate will be a good physician.
Linda Prine, M.D., also spoke for herself on the issue, saying she teaches at two residency programs in New York. The director at one of those programs won't interview medical students with lower test scores, but the director at her other program does.
"The difference in diversity between the two programs is wide," she said. "We don't have enough black doctors, and we're not going to if we keep doing it this way."
Former AAFP President Ted Epperly, M.D., of Boise, Idaho, a member of the ACGME Board of Directors and president and CEO of the Family Medicine Residency of Idaho, noted in his testimony that other specialties have much lower pass-rate requirements and said the ACGME likely would be receptive to hearing from the AAFP about diversity and the unintended consequences of the 90 percent pass-rate requirement.
Seek Advice on Residency Directory Changes
Delegates adopted another substitute resolution that calls for the AAFP to survey various constituencies, including attendees at the National Conference of Family Medicine Residents and Medical Students, to recommend "searchable program characteristics" to include in the AAFP's residency directory.
Alternate student delegate Anna Askari, of Upper Arlington, Ohio, testified that students have so much difficulty determining which residency programs will meet their needs that some visit more than 20 sites during the National Resident Matching Program process.
"It would be very helpful to have this directory expanded," she said.
Paladine agreed that such changes would simplify the process for both students and programs.
Study Clinical Efficiency, ABFM Actions
Delegates also adopted a resolution that calls on the Academy to address professional burnout from work after clinic by studying strategies to improve physicians' clinical efficiency and developing tools and education accordingly.
Arizona AFP alternate delegate Melody Jordahl-Iafrato, M.D., of Tucson, asked the Academy to identify skills physicians may be lacking and help members improve in those areas. Ravi Grivois-Shah, M.D., also of Tucson, speaking for himself, said that could be as simple as improving typing skills.
"If we continue to wait for someone else to solve the problem for us, we're going to continue to fail," he said.
Finally, delegates also adopted a measure that asks the AAFP to study the impact of ABFM revocation of board certification based on state licensure actions and to work with the ABFM "to arrive at a fair and rational approach to these issues that is in the best interest of the public and fair to family physicians."
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