Until a paradigm shift occurs in the way medical education is financed, students will continue to worry about paying for their training and then digging out from the resulting debt. Those and related concerns formed a common theme during the National Congress of Student Members held here as part of the 2015 AAFP National Conference of Family Medicine Residents and Medical Students July 30-Aug. 1.
Allen Rodriguez, of the David Geffen School of Medicine at the University of California, Los Angeles, speaks about a resolution he co-authored that asks the Academy to advocate for undocumented medical students' eligibility for federal loan programs.
After spirited debate in reference committee hearings on July 31, congress participants adopted resolutions the next day that addressed such financing issues. A number of other resolutions also received a thumbs-up from students, including measures on medical student burnout and transparency in drug pricing.
Those and other resolutions students adopted will now move through the AAFP's policymaking channels for review, referral and, when appropriate, further action by AAFP leaders and the AAFP Congress of Delegates.
Student Loan Eligibility, Repayment
One resolution students adopted asked the AAFP to write a letter to the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine that would encourage accredited medical schools to annually publicize and release to students a breakdown of how student tuition and fees are used.
- During this year's National Congress of Student Members, participants adopted resolutions addressing financing medical school, burnout and drug pricing transparency.
- The student congress was held in conjunction with the 2015 AAFP National Conference of Family Medicine Residents and Medical Students.
- The students also adopted a measure calling on the AAFP to develop a policy on the FDA's approval process for new antibiotic and antifungal agents.
One of the resolution's co-authors, Allen Rodriguez, of the David Geffen School of Medicine at the University of California, Los Angeles, testified about the measure before reference committee members.
"We believe students have a right to know where their tuition goes," Rodriguez explained, "what services it pays for -- if it pays for their dental colleagues, if it pays for hospital upkeep, if it pays for the dean's salary."
Rodriguez said such transparency could help guard against abusive lending practices and misuse of student tuition and fees for things that might not be appropriately related.
A second resolution Rodriguez co-authored sought the AAFP's support for medical students in their quest to gain financial aid and loan repayment resources regardless of their U.S. citizenship status.
Specifically, the resolution asked the Academy to advocate that undocumented medical students who are enrolled in accredited medical schools be eligible for federal loan programs. Rodriguez said he knows students in his own program who are dealing with this issue.
"Students with unique immigration statuses are able to receive Social Security numbers, work permits and get accepted into medical school, often as in-state residents at public schools," he said. "But they are not eligible for the federal loans that almost all American medical students depend on."
According to Rodriguez, many of these students didn't even know they were undocumented until they became adults. "Many are now physicians working in family medicine and healing their communities," he testified. "But by and large, the cost of medical school serves to prohibit many of these bright, compassionate students from even trying to apply."
Sarah Waterman, of the Creighton University School of Medicine in Omaha, Neb., discusses a resolution she co-authored that directs the AAFP to advocate for burnout prevention during medical school training.
After all, Rodriguez asked, who would be better advocates for disenfranchised and underserved communities than empowered members of those communities who become physicians?
Burnout is a concern for busy practicing physicians, but it also is a hot topic for those who have yet to earn their medical degree. Two resolutions students adopted addressed this issue.
The first measure directed the AAFP to advocate for burnout prevention during medical training by addressing a culture of dehumanization common in the educational environment and to suggest that medical educators model behaviors and attitudes to help prevent medical trainee burnout.
Co-author Sarah Waterman, of the Creighton University School of Medicine in Omaha, Neb., said the Academy has well-documented resources on burnout at the practicing physician's level but not for residents and students.
"This resolution targets medical educators and asks them to reflect upon how they affect the burnout culture and how they can help improve the lives of the residents and students to help prevent burnout in the future," she said.
A second resolution asked the Academy to explore avenues for conducting evidence-based investigations of medical school wellness programs, as well as potential partnerships with interested stakeholders, such as the Association of American Medical Colleges, to gauge these programs' impact on student perceptions of primary care and their decisions to choose it as a specialty.
Drug Pricing Transparency
The hepatitis C drug sofosbuvir (Sovaldi) has been front and center in recent news reports because of its $84,000 price tag(cvshealth.com) for a 12-week course of therapy. That led students to craft a resolution that addressed drug pricing transparency.
Joseph Brodine, of the Georgetown University School of Medicine in Washington, D.C., testifies about a resolution he co-authored that addresses drug pricing transparency.
Resolution co-author Joseph Brodine, of the Georgetown University School of Medicine in Washington, D.C., testified that the cost of certain novel drugs is a financial burden that is destabilizing the U.S. health care infrastructure.
"The massive costs of such drugs present a threat to the financial solvency of state Medicaid programs (and) raise new ethical questions on who should be treated in the context of limited financial resources," he said. "Cost should never be a limiting factor in achieving access to a treatment when there is a cure available."
Six states have already proposed legislation that would require drug companies to disclose the costs of drug production, Brodine said. "Such legislation would create social pressure on companies to price their products reasonably and also enable payers and policymakers to see where higher drug prices might be justifiable," he added.
Brodine and his co-authors suggested providing state chapters of the AAFP with information on how to lobby for this type of legislation, which he said would be consistent with the Academy's strategic objective to "advance health care for all" by ensuring that all patients have access to treatment.
Students agreed, ultimately adopting the measure.
Students also adopted measures that called on the AAFP to
- support strong FDA standards for the approval of new antibiotic and antifungal agents,
- support the implementation of policies that allow licensed providers to prescribe naloxone to patients using opioids or to individuals close to those patients,
- send a letter to the FDA supporting its proposed changes to nutrition facts labels to include daily percentage values for added sugar,
- consider including a category on CareerLink http://www.aafpcareerlink.org/ for direct primary care job opportunities; and
- endorse the Advancing Care for Exceptional Kids Act of 2015(www.speaknowforkids.org).
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