2015 NCCL

Delegates Tackle Tough Advocacy Issues

May 06, 2015 03:00 pm Sheri Porter Kansas City, Mo. –

During the 2015 National Conference of Constituency Leaders (NCCL) held here April 30-May 2, AAFP members hammered out language on dozens of resolutions aimed at improving the lives of family physicians and their patients.

Testifying during the 2015 National Conference of Constituency Leaders about a resolution discussing mandatory drug testing for pregnant women, Margaret Vitiritto-Khan, D.O., a new physician delegate from West Des Moines, Iowa, says the best time to intervene is before birth. "We need to take action as physicians, because we are dealing with two lives at that point," she told reference committee members.

Family physicians attended the meeting either as general registrants or as representatives of one of five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and gay lesbian, bisexual or transgender (GLBT) physicians or physicians who support GLBT issues.

During testimony on May 1, the Reference Committee on Advocacy focused its attention on issues that ranged from mandatory drug testing of pregnant women to the expansion of practices in underserved areas and physician participation in capital punishment.

Drug Testing of Pregnant Women

A resolution that opposed mandatory drug testing of pregnant women drew impassioned testimony during the reference committee hearing. Lauren Oshman, M.D., a women's constituency delegate from Wilmette, Ill., said such drug testing "could cause women to avoid prenatal care because of harsh penalties in some states like Tennessee."

Story Highlights
  • During the recent National Conference for Constituency Leaders in Kansas City, Mo., the Reference Committee on Advocacy took up a number of issues aimed at improving the lives of family physicians and their patients.
  • Family physicians testified on tough topics, including mandatory drug testing for pregnant women, student debt and physician participation in capital punishment.
  • Delegates also voted to reaffirm AAFP current policy on topics such as the Academy's stance that medical decision-making is a process reserved for physicians and their patients.

Furthermore, she said, drug treatment for affected women was not always available, making some physicians "ambivalent about screening patients" because appropriate follow-up could not be provided.

Jaividhya Dasarathy, M.D., an IMG delegate from Cleveland, simply had questions for the resolution authors. "What drug? What trimester?" She added that in some situations, she was able to effectively counsel women about their drug use.

Robyn Liu, M.D., M.P.H., a general registrant from Portland, Ore., testified in favor of the resolution. "The consequences of drug abuse in pregnancy are devastating; we've all seen it," she said. "But there's no evidence that drug testing during pregnancy mitigates that problem. In fact, it makes it worse."

But Valerie Mutchler-Fornili, M.D., a women's delegate from Mechanicsville, Va., told the committee she had a unique perspective as a physician treating patients ages 2 to 22 at a rehabilitation hospital. "I take care of children affected by this," said Mutchler-Fornili.

She testified that many of her patients sustained brain injuries before birth "because nobody stopped the mother from using drugs," she said.

"We protect the children because they can't protect themselves," said Mutchler-Fornili in an interview with AAFP News after the reference committee hearing. "I'm the advocate for my patient who, in this case, is the child."

Margaret Vitiritto-Khan, D.O., a new physician delegate from West Des Moines, Iowa, also opposed the resolution. "The state has a strong vested interest in recognizing when these children might be born addicted," she said.

In the end, delegates adopted a substitute resolution that asked the AAFP to oppose legislation that would require physicians to impose mandatory drug testing on pregnant women.

During the meeting's May 2 business session, Arthur Ohannessian, M.D, a general registrant from Santa Monica, Calif., addresses an extracted resolution on student debt saying, "We need to form a larger coalition; the original language purposely did not just include family physicians."

Student Debt

The advocacy committee also handled three resolutions related to student debt, including one that focused on tax reform and student loan interest payment.

Co-author Arthur Ohannessian, M.D., a general registrant from Santa Monica, Calif., provided a plethora of financial figures to back up the resolution, including the fact that the current adjusted gross income limit for students looking to qualify for loan interest payment deductions is $80,000.

"The people hardest hit (physicians with student loan debt as high as $400,000 and an average family physician annual income of $176,000) are the first people excluded from the tax benefit that (other) students get," said Ohannessian.

Some physicians expressed concern about keeping the family medicine pipeline full.

For instance, Daniel Chappell, D.O., a general registrant from Bountiful, Utah, testified that he was just 1 1/2 years out of residency with a family to support and was unable to get a home loan of any kind because of his debt-to-income ratio.

He said he loved his specialty, but from a financial standpoint, "it's very difficult to recommend" that medical students follow his course.

Ultimately, delegates adopted the original resolution language that asked the AAFP to advocate at the federal level for tax reform for student loan debt repayment.

Delegates also adopted a substitute resolution asking the AAFP to lobby for legislation that would allow student loans to be financed -- and refinanced -- at the current prime rate; another substitute resolution delegates adopted asked the Academy to, among other things, encourage chapters to advocate for a graduated primary care loan repayment scale at the state level.

Other Issues

Delegates also asked the Academy to, among other things,

  • advocate the elimination of barriers to access for oral treatment for hepatitis C and continue to encourage family physician education in the treatment of the disease,
  • support chapters seeking to collaborate with local law enforcement to develop partnerships that would allow police to report to prescribers instances of legally seized controlled substances,
  • work with federal policymakers to identify funding sources and payment mechanisms that would help expand and sustain practices in underserved communities,
  • write CMS to ask the agency to provide full access to coverage for all contraceptive options, including implantable long-acting reversible contraceptives for women of child-bearing age, and
  • refer to the 2015 Congress of Delegates a resolution that asks the AAFP to oppose physician participation in capital punishment.

Finally, NCCL delegates adopted a resolution that directed the AAFP to reaffirm as current policy the Academy's stance that medical decision-making is a process that takes place between patients and health care professionals without interference from legislators. The same measure called for the AAFP to reaffirm its position that physicians should provide accurate, evidence-based, culturally proficient and meaningful patient education and, in support of that ideal, issue a public statement opposing any law that would require health care professionals to distribute false medical information.

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