AAFP members who attended the 2016 National Conference of Constituency Leaders (NCCL) held here May 5-7 spent many hours crafting resolutions and perfecting language aimed at making physicians' lives -- and the lives of their patients -- better.
Rachel Franklin, M.D., a women's delegate from Oklahoma City, Okla., strongly supports international medical graduates (IMGs) but raises a question about a resolution (later amended, then adopted) asking for greater use of the AAFP's resources to help reduce discrimination. "We now have more U.S. medical grads coming out of medical school than we have slots in residency programs. It may be better to first fight to make sure slots are available so we can then advocate for our IMG colleagues to have access to those slots," she testifies.
Some family physicians attended as general registrants and others came to represent one of five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and gay, lesbian, bisexual or transgender (GLBT) physicians or those who stand in support of GLBT issues.
During testimony on May 6 before the Reference Committee on Education, family physicians spoke passionately about issues that touched on student debt, racism, HIV/AIDS and more.
Strengthen HIV/AIDS Training
A number of physician experts testified in favor of a resolution calling for a strong push for formal family medicine training opportunities for chronic care management of patients with HIV/AIDS. Resolution authors noted that HIV is now recognized as a chronic disease state and affects an increasingly older population.
That fact was reaffirmed by Karen Krigger, M.D., a minority delegate from Louisville, Ky., who serves as co-director of the southeast region of the American Association of HIV Medicine. Krigger told the committee that her eight-state region covers a swath of southern states that have the highest HIV population in the country.
- The 2016 National Conference of Constituency Leaders (NCCL) was recently held in Kansas City, Mo.
- The NCCL's Reference Committee on Education tackled a number of tough issues related to physician education.
- Topics addressed in the committee this year included HIV/AIDS training, student debt and physician training on issues related to racism and bias.
"Last year we reached the 50 percent mark of patients with HIV over 50," said Krigger.
"Patients are marching toward geriatricians at a fast past and they're not going to be prepared for it. My oldest HIV patient is 83. The one I've been taking care of the longest -- 30 years -- died last year but not of HIV," she added.
Santina Wheat, M.D., M.P.H., a new physician delegate from Chicago, coauthored the resolution and testified in support of it. "When I talk to my colleagues about providing HIV care, they're open to it; they're just wishing there was more CME available so they could feel comfortable precepting our residents and providing that care."
Ada Stewart, M.D., a minority constituency delegate from Columbia, S.C., noted that she is a family physician and an HIV specialist. "If we can push this forward, we would encourage our Academy to at least have more questions on our board exams. I don't know about the rest of you, but there are only one or two questions total on our board exams regarding HIV," said Stewart.
"This is a chronic disease -- this is something that we will all see whether we realize it or not because our patients are aging, they are outliving the disease and passing away from other comorbidities."
Delegates adopted a substitute resolution that directed the AAFP to explore ways to enhance existing educational resources and to develop new resources for family physicians and family medicine residents to teach them how to care for patients with HIV/AIDS in a chronic care model.
Relieve Student Debt
Family physicians crafted three separate resolutions that touched on issues related to the huge debt burden most newly trained family physicians carry with them into practice.
Two resolutions -- one on student debt and tax reform and the other covering student loan deductibility -- were combined by the reference committee, amended slightly during the combined business session and eventually adopted by delegates.
During testimony before the reference committee, Arthur Ohannessian, M.D., a new physician delegate from Santa Monica, Calif., said he coauthored a similar resolution last year that was reaffirmed by the AAFP Board of Directors. "I wonder if the board understands the impact this issue can have on membership?" asked Ohannessian.
Heather Kinsel-Evans, M.D., a women's delegate from Anacortes, Wash., said simply that the debt-to-income ratio for family physicians was "deterring students from wanting to pursue family medicine."
Delegates adopted an amended combined resolution that asked the AAFP to use its legislative advocacy and lobbying efforts to work to allow the deduction of student loan interest payments, to relay to Congress the detrimental effect student loan debt has on the health and economic well-being of the U.S., and to create a toolkit for state chapters to use in in their own legislative efforts to lobby for state income tax deductions of student loan interest.
Delegates also adopted a resolution asking the AAFP to promote and support the Public Service Loan Forgiveness Program.(studentaid.ed.gov)
Tabatha Wells, M.D., a general registrant from Chicago, coauthored the resolution and testified in support of it during the committee hearing, suggesting that information about the program should be easy to find on the AAFP website.
During the same hearing, Kevin Bernstein, M.D., M.S., a new physician delegate from the Uniformed Services chapter, called it a "damage control resolution."
He said if bureaucrats and politicians were to come through and decide that physicians don't qualify for the program, "it would be a huge problem for a lot of people in a couple of years."
Curb Racism, Bias
Family physicians also introduced a resolution asking the AAFP for member education on racism and bias because, as the coauthors wrote, both "directly impact the health of patients and communities."
Syeachia Dennis, M.D., a minority delegate from Tulsa, Okla., tells her colleagues that physicians need to have their eyes opened to racism and bias so they can understand "the long history" that racism has played in the health of populations.
They noted that the AAFP has policies against discrimination and that family physicians provide care to vulnerable populations.
Rebecca Lundh, M.D., a women's delegate from Waukesha, Wis., coauthored the resolution. She told the reference committee that the AAFP "needs to bring this discussion to the big audience of the FMX (Family Medicine Experience) -- so we can listen, learn, hear the stories of racism. We're all family doctors. Once we hear the stories we will understand."
Another coauthor, Rachel Franklin, M.D., a women's delegate from Oklahoma City, Okla., said that because of the importance of the topic, authors specifically asked the AAFP to provide mainstream presentations and keynote speakers at upcoming conferences.
Syeachia Dennis, M.D., a minority delegate from Tulsa, Okla., put it this way: "We all have our bubbles, and oftentimes we're getting information within our bubbles. We need to take it outside. Within my bubble as an African-American physician, I'm reading stories about how African-Americans who present with pain are often treated by other physicians with less medication, less care.
"I'm reading about medical students who believe that African-Americans have thicker skin than other races. So how do we educate the broader community of physicians who are treating patients of other backgrounds -- so that we can we dispel some of these myths?"
The resolution was adopted by delegates on May 7.
Other topics that were covered by the committee included resolutions asking the AAFP to
- create a list of resources and materials that address medical training that is unintentionally biased,
- work toward changes in the American Board of Family Medicine's Maintenance of Certification for Family Physician process, and
- develop observer guidelines and evaluation tools for physicians who host international medical graduates.
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