2009 Congress of Delegates Reaffirms Support for GME Funding Changes, ACGME Oversight of Resident Duty Hours

Delegates to the 2009 AAFP Congress of Delegates here made a clear statement Oct. 13 when they voted to reaffirm the Academy's current policy on graduate medical education, or GME, funding. They also reiterated the AAFP's stance on resident duty hour restrictions, and then took it one step further by declaring that any further work hour changes should have an evidence-based rationale.

In testimony before the Reference Committee on Education on Oct. 12, Michigan AFP delegate Karen Mitchell, M.D., of Southfield, was first to address a resolution submitted by the Michigan chapter that asked the AAFP to work with medical schools and state and federal governments "to seek no-loan medical school financial aid policies for students who choose primary care specialties."

"One of the ways to get medical students to choose family medicine is to make medical school cost less," Mitchell told reference committee members. The measure, she added, simply seeks the same sort of financial aid policies that increasingly are being seen in colleges around the country.

California AFP alternate delegate Jeffrey Luther, M.D., of Long Beach, testified that the measure would go a long way to "support medical students who are family docs at heart but who don't think they can afford to become family doctors."

Mitchell also spoke to a second resolution introduced by the Michigan AFP that asked the Academy to work with the U.S. Congress and CMS to boost both the overall number of family medicine residency positions and the funding for those positions as the number of medical school graduates increases.

"We will not solve our health care delivery problems unless we increase the number of primary care -- and especially family medicine -- physicians," she told the reference committee.

Others who testified in the Oct. 12 hearing, including Illinois AFP delegate Michael Temporal, M.D., of Belleville, suggested that the reference committee consider adding a second resolved clause asking the Academy to support federal legislative proposals currently under consideration that are specifically intended to provide parity between primary care specialty training programs and those of other medical specialties. Enactment of such proposals, said Temporal, would have the effect of "rightsizing what's already there."

Tricia Elliott, M.D., director of the family medicine residency program at Baylor College of Medicine/Kelsey-Seybold Clinic, pointed out that current GME funding mechanisms, which fail to route funding directly to residency programs, are one of a number of factors threatening the survival of family medicine residency programs.

But a number of delegates who testified advised caution in proceeding with an out-and-out call for more family medicine residency slots, pointing to the AAFP's newly released family physician workforce reform policy, which encompasses GME funding for family medicine training, as well as other aspects of workforce reform, such as enhancing payment for practicing FPs and reducing overall medical student debt.

That last issue, in particular, rang true with Dale Moquist, M.D., of Sugar Land, Texas, chair of the AAFP delegation to the AMA, who told reference committee members, "You're not going to get medical students to look at family medicine when their debt (coming out of school) is more than $150,000."

Missouri AFP alternate delegate Lawrence Rues, M.D., of Kansas City, also warned against moving too precipitously. He testified that although he agreed with the spirit of the resolution, many family medicine programs now are struggling to fill their current residency positions in an environment of uncertain funding.

Delegates seemed to take the cautionary messages to heart, adopting both resolutions on the reaffirmation calendar as representing current Academy policy or already being pursued in ongoing projects.

Another resolution included on the reaffirmation calendar called for the AAFP to "support the position that the Accreditation Council for Graduate Medical Education (ACGME) retain oversight of residency duty hours," rather than have that oversight become the purview of CMS or The Joint Commission, as recommended in a recent Institute of Medicine report to the U.S. Congress. That measure, however, was extracted for separate consideration, and delegates voted Oct. 13 to tack on a second resolved clause and adopt the entire measure.

The added clause, put forth by Indiana AFP delegate Richard Feldman, M.D., of Indianapolis, calls for the Academy to support the position that additional changes to residents' duty hours should be evidence-based.

"The current duty hours (policy) on family medicine residents is minimally disruptive," Feldman testified in the Oct. 12 hearing. "Further restrictions could be more disruptive, however.

"This needs to be an evidence-based process, rather than a political one, as it is now."