The AMA will begin promoting training in the patient-centered medical home, or PCMH, as a way to encourage medical students and residents to choose a career in primary care. It also will start encouraging medical schools and residency programs to develop strategies to attract physicians to practice in rural and other underserved areas.
That's according to delegates who attended the 2010 annual meeting of the AMA House of Delegates, June 12-16 in Chicago. The delegates adopted two reports from the Council on Medical Education that address primary care workforce shortages and access to care.
The AAFP delegation to the AMA house played a key role in fine-tuning the language of one of those reports, according to AAFP President-elect Roland Goertz, M.D., M.B.A., of Waco, Texas. Goertz testified on the report, "Enhancing Primary Care as a Medical Career Choice," during a June 13 hearing of the AMA's Reference Committee on Medical Education.
The recommendations in the report direct the AMA to:
- work with the Accreditation Council on Graduate Medical Education, or ACGME, to develop an accreditation environment that promotes innovations in training that use progressive, community-based models of integrated care focused on quality and outcomes, such as the PCMH;
- advocate that public and private payers develop enhanced funding and related incentives to provide graduate medical education for residents and fellows in such models of care "in order to enhance primary care as a career choice";
- advocate that these payers do the same for undergraduate medical education for students -- again, as a way of boosting the appeal of primary care; and
- advocate that these payers develop physician reimbursement systems to promote primary care and specialty practices in community-based models of care, such as the PCMH.
A report by the AMA Council on Ethical and Judicial Affairs, or CEJA, that aims to guide physician-learners and CME providers in managing their relationships with industry will -- for the fourth time -- be returned to CEJA for yet more scrutiny.
Delegates to the 2010 annual meeting of the AMA House of Delegates referred the report on June 14. AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, said in prepared testimony that the AMA and the profession of medicine are best served by not adopting the report.
"The current iteration of the CEJA report continues to confuse the issue of relations between individual physicians, which the AAFP clearly supports, and the financial supporters of CME and the organizations that are accredited by the ACCME (Accreditation Council for Continuing Medical Education) and comply with its Standards for Commercial Support," Epperly said in his testimony before the AMA Reference Committee on Amendments to Constitution and Bylaws on June 13.
The CEJA report "steps into the relationship between industry and accredited organizations unnecessarily and blurs those boundaries," he noted. "CEJA's purview is individual physician behavior, whereas the ACCME and the Council of Medical Specialty Societies' code of conduct clearly regulate the standards for professional societies and organizations."
"Any time we can get the house of medicine to come out in favor of our policy on medical education and go to bat for us with the ACGME is a win," Goertz told AAFP News Now. "Having the entire house of medicine recognize the new model of care that is the PCMH and its importance in teaching and delivering care for the future is very positive for everybody in family medicine."
Advocating to enhance primary care as a specialty choice will correct imbalances in the physician workforce and, ultimately, lead to improved care delivery for patients, Goertz said.
According to the reference committee's report, those testifying expressed "strong support" for the recommendations. Among the points made by various speakers were:
- support is needed for new models of training;
- enhancing interest in primary care careers is important, although it need not come at the expense of specialty care;
- international medical graduates have made important contributions to primary care in the United States; and
- subspecialty physicians have a role within the medical home model.
Recommendations in the second council report adopted by delegates, "Educational Strategies to Promote Physician Practice in Underserved Areas" direct the AMA to
- encourage medical schools and residency programs to consider developing admissions policies and practices aimed specifically at attracting physicians to practice in rural and other underserved areas;
- encourage medical schools and residencies to continue to provide courses, clerkships and longitudinal experiences in rural and other underserved areas as a way to influence graduates' choice of practice locations;
- encourage the schools to include criteria in their admission processes that can predict whether graduates are likely to practice in underserved areas and with underserved populations; and
- continue to advocate for funding from public and private payers for educational programs that provide experiences for medical students in rural and other underserved areas.
The reference committee noted in its report that support for these recommendations was unanimous. The report also highlighted that "testimony expressed appreciation for the important contributions made by international medical graduates practicing in underserved areas."