AAFP Delegates Split on How to Support FPs Who Practice Emergency Medicine

Academy members are unquestionably united in their desire to support the specific interests and needs of family physicians who practice emergency medicine -- that much was clear from reference committee testimony given Oct. 12 during the 2009 AAFP Congress of Delegates here. But what delegates couldn't reach consensus on was how, precisely, to show that support. In the end, they voted to refer two resolutions dealing with this issue to the AAFP Board of Directors for more study.

Both resolutions -- one from the Michigan AFP and the other from the Indiana AFP -- asked the Academy to "establish a subcommittee on emergency medicine to provide ongoing representation and support on emergency medicine workforces issues."

The Michigan measure, however, also sought to have the AAFP develop a workforce plan focused solely on FPs who practice emergency medicine.

Testimony on the issue during the Oct. 12 Reference Committee on Organization and Finance hearing was overwhelmingly in favor of providing a professional home for family doctors who practice in emergency settings.

Michigan alternate delegate James Applegate, M.D., of Grandville, summarized that sentiment, telling reference committee members, "The Academy should be home to FPs practicing emergency medicine," just as it is to all other family physicians.

The need for this support stems from the fact that discrimination against FPs seeking positions in emergency medicine settings is rampant, said many of those who testified. Moreover, they said, FPs who do secure ER positions are likely to be compensated less than their emergency medicine-trained physician colleagues.

All this is despite the fact that emergency medicine-trained ER physicians are in short supply across the country, especially in rural areas, where FPs often are the only physicians available to act in this capacity.

"This places family physicians where they've always been," observed Michigan AFP alternate delegate Danny Grieg, M.D., of Midland, "rising to the task, providing care and support to the American people."

The rural shortage, in particular, shouldn't come as any great surprise, said Alaska delegate John Cullen, M.D., of Valdez, who testified that "ER-trained physicians are not going to be providing emergency care in rural emergency rooms."

And, according to Kim Yu, M.D., of Novi, Mich., the shortage situation isn't about to change anytime soon. "Lots of family doctors grandfathered into emergency medicine in the 1980s," she testified. "They will soon be retiring, so there will be a huge need."

Some who spoke at the reference committee hearing were concerned, however, that the proposal to develop a workforce plan aimed solely at FPs who practice emergency medicine would undermine the integrity of the AAFP's newly released overall policy on physician workforce reform.

John Bucholtz, D.O., an alternate delegate from Columbus, Ga., and then-chair of the Commission on Education, pointed out that his commission and others throughout the Academy had just completed a yearlong process of developing and vetting a comprehensive physician workforce plan. To create and promulgate a workforce policy for FPs practicing in emergency departments, he said, "diverts the energy and policies of our (overall) workforce plan."

In the end, delegates agreed, voting to refer both resolutions to the Board for further consideration.

In testimony before the Reference Committee on Health of the Public and Science, members again voiced their support for the AAFP's Tar Wars tobacco-free education program, and delegates adopted a measure that calls for the AAFP to

In addition, delegates also directed the AAFP Board to report on the progress of the Tar Wars program and its funding at the 2010 Congress of Delegates.

The delegates also adopted a resolution that called on the AAFP representative to the Relative Value Scale Update Committee, known as the RUC, to ask for increased valuation of the relative value units for physician home service visits.

Dale Moquist, M.D., of Sugar Land, Texas, chair of the AAFP delegation to the AMA, testified during the Reference Committee on Practice Enhancement hearing on Oct. 12 that family physicians who make home visits to patients are "meeting an unmet need" that often results in the discovery of undiagnosed conditions.

According to Moquist and others who testified on the home visits issue, this type of care is undervalued. "Reimbursement needs to go up," Moquist said.

In other actions, the delegates adopted a resolution that calls for the AAFP to "support national efforts to ban the use of text messaging while operating motor vehicles or machinery." They referred a second, similar measure, however, that asked the Academy to "support federal legislation restricting the use of wireless communications devices while driving, except in an emergency situation."

Although members who testified on these two measures were unequivocal in their opposition to texting while driving, some raised questions about the necessity of various types of wireless communication devices to commercial drivers, such as over-the-road truckers.

In addition, the delegates adopted a resolution that further clarifies the Academy's stance on violence against physicians. That resolution calls for the AAFP to publicly condemn acts of violence committed against physicians that occur as a result of their legal practice of medicine. In keeping with the resolution, the Academy released a statement of condolence denouncing the May 31 murder of AAFP member George Tiller, M.D., of Wichita, Kan.