Marie-Elizabeth Ramas, M.D., minority physician delegate from Mount Shasta, Calif., testifies before the Reference Committee on Education during its May hearing at the National Conference of Special Constituencies.
Despite recommendations(14 page PDF) against adopting measures focused on, respectively, demystifying the visa application process for residency directors and improving parity for international medical graduates (IMGs), delegates to the National Conference of Special Constituencies (NCSC) here called on the AAFP to do just that.
After spirited debate, NCSC delegates voted May 5 to override the Reference Committee on Education's recommendations and adopt the two resolutions, along with numerous other education-related measures.
The first resolution called for the AAFP, in cooperation with the IMG constituency, to create a presentation for residency directors attending the annual AAFP Residency Program Director Workshop "aimed at educating them about the visa application process related to admission of qualified IMG residency applicants."
During a May 4 reference committee hearing, resolution co-author and IMG delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, Wash., said this would allow residency programs to benefit from a pool of highly qualified IMGs who might otherwise be unavailable.
- NCSC delegates voted to override the Reference Committee on Education's recommendations and adopted two resolutions that, respectively, focused on demystifying the visa application process for residency directors and improving parity for international medical graduates (IMGs).
- Delegates said the visa resolution would allow residency programs to benefit from a pool of highly qualified IMGs who might be otherwise unavailable.
- Although the reference committee deemed the parity resolution to be "beyond the scope of the AAFP," delegates voted to approve an amended measure to help establish respect and aid in removing stereotypes.
"I will not be asking you to lower the bar, but equate the bar for all," Brzezny said. "There are a number of qualified (U.S. medical)-licensed international medical graduates who may not be offered the opportunity to apply to U.S. residency programs because of perceived problems with visa applications. We have identified a good number of such programs and have identified this as a problem."
The reference committee questioned the figures Brzezny presented, however, in its recommendation against adoption, citing data from the 2011 residency census, which indicated only 8.41 percent of family medicine program directors (18 out of 214) had residents who had difficulties with the visa process. Although the committee agreed that some program directors may benefit from education on the process, in many cases, the sponsoring hospital determines whether a visa is accepted, not the program director.
In response to committee members' concerns, Brzezny submitted an amendment to the resolution on May 5 that asked the Academy to "offer support and education to residency program coordinators responsible for assisting applicants in the visa application process."
The amended resolution passed, with delegates citing the need to make sure qualified FPs are not being turned away by administrative red tape.
"If you are trying to hire a family physician who is American-trained, you're looking at forking over about $80,000 as a signing bonus and a starting salary in excess of $175,000, which, for a practice like mine that focuses on medical assistance, is not feasible," said IMG delegate Julio Menocal, M.D., of Frederick, Md. "If you hire an IMG, the fees are lower -- around $10,000 in moving expenses and a salary around $110,000-$120,000. So, from my point of view, the more competition there is, the more opportunity we have to hire physicians -- especially considering that by 2014, we (as a country) are going to have to hire another 50,000 (doctors). Anything that is going to help address that (need) is welcome."
National Conference of Special Constituencies (NCSC) delegates voted to address concerns about the duty hour standards set out by the Accreditation Council on Graduate Medical Education (ACGME) in 2010, as well as recommend that the AAFP improve education about mentoring medical students.
During the May 4 Reference Committee on Education hearing, delegates gave testimony regarding how the ACGME's 2010 duty hour changes affected family medicine residents' educational experience. After resolution co-author and new physician delegate Janet West, M.D., of Pensacola, Fla., stated that impact data for these residents are lacking, the reference committee recommended that delegates adopt a resolution asking the AAFP to urge the ACGME to research the impact of the duty hour standards reform. Delegates also voted to recommend that the AAFP collect data on graduating family medicine residents -- specifically, self-assessments of their skill sets and overall preparedness for independent practice after implementation of the standards.
On the question of mentoring, the reference committee heard strong support for the resolution and suggested that resources available through organizations such as the Society of Teachers of Family Medicine be identified and used to create live workshops or online CME courses to train community family physicians to incorporate medical student mentoring into their practices efficiently.
The parity resolution asked the Academy to formally state that IMGs who have completed equivalent training and successfully completed U.S. medical licensing exams should be recognized as being on par with U.S. medical graduates (USMGs). The reference committee gave the resolution a thumbs-down because it was deemed "beyond the scope of the AAFP to recognize or assess the parity of international medical education."
Marie-Elizabeth Ramas, M.D., minority physician delegate from Mount Shasta, Calif., disagreed with the reference committee's take.
"I believe it is totally within our (AAFP's) scope to discuss the level of equality between these (medical) colleges," she said. "And (IMGs) have a right to equality and the right to address how they are perceived by their colleagues."
IMG delegate and resolution co-author Adnan Ahmed, M.D., of Lexington, Ky., said that although there is parity between IMGs and USMGs on paper, it is imperative that the AAFP maintain an ongoing dialogue with the Association of Family Medicine Residency Directors (AFMRD) to urge that group to continue to consider candidates from a wide variety of backgrounds.
"While we need more doctors, the response is to make more U.S. student slots, but that's not necessarily translating into more family physician slots," Ahmed said. "Look at the entire picture, and you will see that we may get candidates from other sources, as well, who can be just as qualified. Don't look at their background so much as look at them individually, and, as long as you continue to do that, no one should have any problems."
IMG delegate Kiran Khanolkar, M.D., of Keokuk, Iowa, who offered the amendment to the original resolution, said the declaration was important for two reasons: it would both help establish respect and aid in removing stereotypes.
"We, as family physicians, know how it is to be disrespected by our specialty colleagues and we, as international graduates, do have to deal with a bit more discrimination," Khanolkar said. "So, what we are asking is that if we have completed our training and our licensing exams, then that training and licensing should put us on par … academically equivalent to a U.S. graduate.
"As you can see, the current AAFP policy on discrimination has various guidelines, but international medical graduates should be added to that to reaffirm that … you need to consider them on an equal basis right from the residency level up to when they graduate."
Among other measures considered by the Education Reference Committee, NCSC delegates also voted to recommend that the Academy
- survey its members regarding their interest in CME on medical Spanish, with a goal of eventually introducing a self-study CME packet to improve medical Spanish skills;
- engage in dialogue with the Liaison Committee on Medical Education, the American Board of Family Medicine (ABFM), the Review Committee for Family Medicine and the ACGME supporting the inclusion of gay, lesbian, bisexual, and transgender (GLBT) health knowledge and skills as a required element of their various curriculums, as well as encourage the ABFM to develop a self-assessment module on GLBT health and include questions relevant and specific to GLBT health in the family medicine board exam;
- recognize disparities involving transgender care training and offer courses or workshops at the AAFP Scientific Assembly that focus on transgender health care, as well as acknowledge that the care of transgender individuals, including providing cross-gender hormonal treatment, is within the scope of family medicine and take a leadership position in educating family physicians about the care of transgendered individuals;
- promote tools for family medicine residents and practicing physicians to help adequately prepare them to perform self-assessment and action planning regarding personal work-life balance; and
- reaffirm its existing policy on substance and alcohol abuse and addiction, while also supporting the National All Schedules Prescription Electronic Reporting Act and advocating that all states develop a prescription drug monitoring system.