Just like the rest of the family physician population, direct primary care (DPC) piqued the interest of students who attended the National Congress of Student Members here on Aug.7-9, and they responded by adopting resolutions on the topic. The congress was held during the 2014 AAFP National Conference of Family Medicine Residents and Medical Students.
Sarah Franklin, of the University of Arkansas for Medical Sciences College of Medicine in Little Rock, discusses a resolution she co-authored that asks the Rural Health Member Interest Group to include student and resident representatives.
Congress participants also adopted resolutions that focused on helping students become part of the solution in medically underserved rural areas, as well as measures that addressed student loan forgiveness, among other topics.
Direct Primary Care
The first of two substitute resolutions on DPC that students adopted calls for the AAFP to provide educational activities and seminars on this model of care during the 2015 National Conference. It also asked the AAFP to explore the creation of an online database of family physicians who practice DPC and would be willing to serve as mentors to family medicine residents and students.
Brian Blank, of the University of North Carolina at Chapel Hill School of Medicine, was a co-author of both original resolutions and testified in a reference committee hearing that he was excited about the AAFP's recent support of the DPC movement. He acknowledged that the Academy had already organized a number of regional conferences intended to train physicians who are interested in converting their existing practices to the DPC model. But Blank said he and his fellow co-authors sought specifically to call for DPC education and resources to extend to the student and resident level.
- AAFP medical student members met recently in Kansas City, Mo., to consider resolutions intended to help guide AAFP policy decisions.
- The National Congress of Student Members adopted resolutions on topics that included direct primary care, serving rural areas and student loan forgiveness.
- The students also called for the AAFP to consider updating educational resources on buprenorphine/naloxone training for family medicine residents and creating a health policy and legislative advocacy opportunity for medical students.
"We are asking that the AAFP consider expanding those options for folks who are interested, especially when they are in residency and medical school," said Blank. "Because it is not something lots of students have exposure to. What's exciting is that the students and residents who do have exposure to it really come away feeling like they are in control of their future in primary care."
The second measure asked the AAFP to create a DPC startup toolkit for family physicians interested in establishing a DPC practice from the ground up. The toolkit would include information gleaned from current AAFP regional DPC workshops that could be tailored to this group.
"There is a very big difference between being in a current practice where you may have signed contracts with insurance companies and that sort of thing" and starting a DPC practice from the ground up, said Blank, noting that a toolkit currently being developed by the AAFP speaks more to resolving issues associated with moving from an existing practice to the DPC model. "This is asking, 'If you are starting from scratch and are just leaving residency, how do you approach adopting the DPC model?'"
Underserved Rural Areas
Students also sought to determine what they and residents could do to increase interest in practicing in underserved rural areas around the United States.
One resolution students adopted requested that the AAFP appoint one student and one resident representative to the Working Group on Rural Health.
Resolution co-author Sarah Franklin, of the University of Arkansas for Medical Sciences College of Medicine in Little Rock, said finding physicians to serve rural areas logically starts with reaching out to students and residents.
"We all know of the present and serious physician shortages in the United States and the great need we have for physicians in underserved areas, which are often rural areas," she testified. "(Students and residents) are the future of medicine in these underserved areas."
Students also adopted a substitute resolution that asked the AAFP to encourage rural medicine education and networking through the Rural Health Member Interest Group's resources and collaborative efforts.
Liberty Foye, of the East Tennessee State University James H. Quillen College of Medicine in Johnson City, spoke to the value of rural health care education. Foye, who is in the rural primary care track at her school, said that although there are excellent programs on rural health care at universities around the United States, these programs alone are not going to solve the shortage of rural physicians.
Alexander Pappas, of the Medical University of South Carolina College of Medicine in Charleston, speaks about a resolution he co-authored that asks the Academy to oppose any effort to cap student loan forgiveness under the Public Service Loan Forgiveness Program.
"If the AAFP were able to reinforce the rural health care education of these programs (with additional resources), that would expose more medical students to rural education and get them interested, curious and out in rural communities," Foye said.
Student Loan Forgiveness
Arguably, student loan debt is always top-of-mind for medical students. Small wonder, then, that the students took exception to a provision in the administration's proposed 2015 budget that seeks to cap the federal Public Service Loan Forgiveness (PSLF) Program at $57,500 per person.
In response, students adopted a combined resolution that calls for the AAFP to oppose any effort to cap student loan forgiveness under the PSLF Program. The measure also asks the AAFP to advocate that PSLF eligibility be expanded to include all federal educational loans held by family medicine physicians.
Alexander Pappas, of Medical University of South Carolina College of Medicine in Charleston, co-authored one of the original resolutions and testified that family physicians should show solidarity with other public service students and professionals in universally opposing a cap on the PSLF Program.
"We believe, specifically, as young doctors who have longer training and a higher debt burden, that there should be a specific exemption for medical practitioners," said Pappas. "This should help attract people to primary care and the types of service work that are meaningful to our specialty."
A co-author of the second resolution, Blair Cushing, of the University of North Texas Health Science Center College of Osteopathic Medicine in Fort Worth, said that although the AAFP has existing policy regarding medical student debt and its repayment, the authors thought there were certain areas that hadn't been addressed.
"In particular, medical students often have many additional sources of debt, including additional loans they are taking out to cover the costs of either their education or (related items)," Cushing said.
Students also adopted measures that call on the AAFP to
- revise its Recommended Curriculum Guidelines for Family Medicine Residents on Substance Use Disorders(12 page PDF) to include buprenorphine/naloxone training;
- consider revising the Recommended Curriculum Guidelines for Family Medicine Residents on Nutrition(9 page PDF) to include the potential benefit of culinary nutrition education;
- create a health policy and legislative advocacy opportunity for medical students looking to design, develop and execute national advocacy projects;
- advocate for universal access to the hepatitis C virus drug sofosbuvir (Sovaldi) regardless of ability to pay; and
- recognize recently retired AAFP Vice President for Education Perry Pugno, M.D., for his many years of service to the Academy, its members and family medicine by exploring the recognition of one student and one resident with an award in his honor to be presented during the National Conference to individuals who exemplify dedication to leadership in family medicine.
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