The Academy's National Conference of Special Constituencies debated issues from a Medicaid "tax" to liability insurance for part-time practice during its meeting here May 5 - 7.
The 156 participants, most of them sponsored by their AAFP constituent chapters, represented these groups: women physicians; new physicians; minority physicians; physicians interested in gay, lesbian, bisexual and transgender issues; and international medical graduates.
Four resolutions the NCSC sent to the AAFP Congress of Delegates are covered in AAFP News Now stories on pharmacy issues and gender identity. Here's a sampling of other resolutions, all sent to the AAFP Board of Directors (they may be referred to commissions for consideration):
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Constituencies Tackle Issues, Develop Policies
By Sheri Porter & Jane Stoever • Kansas City, Mo.
A resolution encouraging the prorating of liability insurance for part-time practice prompts testimony from Diana Nguyen, M.D. "As a woman and soon-to-be mother, I hope the AAFP could promote part-time coverage," she said.
"Tax" on physicians in Medicaid. AAFP should help chapters oppose state legislation requiring physicians to collect a co-pay from Medicaid patients, a form of physician tax, said the minority constituency.
Education on immigrants' health. The minority constituency asked the Academy to develop educational materials and programs on health and safety issues affecting immigrants.
Mentoring. The minority constituency called on the AAFP to explore the possibility of a pilot program to assist practicing family physicians and residencies in mentoring minority high-school students. The resolution also said the Academy should encourage chapters to form liaisons with state boards of education to increase mentoring for minority students.
Alternative business models. The Academy, according to the minority constituency, should identify and promote successful alternative business models that would help family physicians regain control of their practices and would promote the patient-physician relationship. The resolution highlighted the need to explore business models for delivering health care to the uninsured and underinsured. Several members presenting testimony described opting for a low-overhead solo practice as a quality-of-life decision; some members said "cash-only" practices freed them from managed-care regulations.
Resident education issues. The new physicians' constituency passed resolutions regarding resident education issues that included broadening the availability of resources and instruction on end-of-life care. The new physicians also asked the AAFP to offer management training courses at the National Conference of Family Medicine Residents and Medical Students and to recommend to the Residency Review Committee on Family Medicine that management training courses be offered as part of residency curriculum.
The Future of Family Medicine. The FFM project spurred two resolutions from the new physicians, one asking the Academy to educate physician employers and third-party payers about FFM concepts so that FFM principles will be considered when policy changes and payment decisions are made. The second resolution asked that knowledge gleaned from the FFM project be used as a recruitment tool for medical students.
Quality improvement organizations. The new physicians also asked the AAFP to educate members about resources provided by quality improvement organizations. "If we're moving toward an era of getting paid for our performance, it's best we get familiar with these organizations -- the sooner the better," said Bruin Rugge, M.D., of Portland, Ore.
Access to prescription medications. The women physicians' constituency asked the AAFP to go on record urging pharmacies that are the only source of medication in their service areas to provide a full range of medication, including emergency contraception. "Clearly there are issues of access," said Laura Knoble, M.D., of Walpole, Mass., during testimony. "If we could dispense in our offices, we could eliminate this problem." Another resolution addressed Knoble's concern by asking the AAFP to investigate issues involved in making it possible for FPs to dispense medications from their offices.
Human papillomavirus and comprehensive sex education. The women's constituency asked the Academy to help increase awareness of HPV as a risk factor for cervical, oral and rectal cancers and to encourage FPs to expand their health history questions of adolescents to include oral and anal sexual habits. One of the six authors of the resolution testified that she had seen a dramatic increase in HPV in her practice in recent years. Another resolution on evidence-based sex education asked the AAFP to provide resources (that FPs can use with patients) "that have been proven effective in reducing unintended pregnancy and sexually transmitted infections." The resolution also asked the AAFP to urge schools to adopt sex education programs that include information on abstinence, contraception and sexually transmitted infection prevention.
CME on cultural proficiency for IMGs. "I grew up in India where the only religion, other than Indian religions, was Roman Catholic," said Kiran Khanolkar, M.D., of Keokuk, Iowa. He soon learned America had many religions. "I naively asked one of my patients here, 'Are you a Catholic?' He said, 'No, I'm a Methodist,'" said Khanolkar. He was a co-author of a resolution the IMG constituency passed asking the Academy to post material online and offer CME for IMGs concerning Americans' cultural differences. S. Ram Ramalingam, M.D., of Pittsford, N.Y., testified, "The success and failure of IMGs is based on cultural competencies." At the State University of New York, Buffalo, he said, IMG residents had an extra week of training in cultural proficiency topics such as how American medical practice differs from that of other countries.
Liability insurance for part-time practice. The joint constituency (a gathering of all the five special constituencies) asked the Academy to encourage chapters to seek prorated malpractice coverage for physicians who practice part time. "As a woman and soon-to-be mother, I hope the AAFP could promote part-time coverage," said Diana Nguyen, M.D., of Fountain Valley, Calif., offering testimony. "We lost the ability to recruit a physician in Rolla (Mo.) because she was not offered part-time rates," said Debra McCaul, M.D., of Rolla. The idea of graduated coverage is common in insurance, she said, noting that homeowners' coverage may be based on square footage and employees' coverage may be based on the number of employees in a company.
Insurance rates, payment for medication, abortion. The joint constituency urged the AAFP to advise chapters to work for equitable liability coverage rates and health insurance payment rates for FPs who provide a range of services, including medication and early-aspiration abortion.
Donation of body fluid, tissue or organ. On May 6, the Associated Press reported that the FDA planned to bar men who had engaged in homosexual sex in the previous five years from being anonymous sperm donors because of the risk of AIDS transmission. In response, the GLBT constituency adopted a late resolution asking AAFP to advocate "evidence-based policy-making regarding body fluid, tissue and organ donation," with the policy focusing on behavior, not on any specific population or group.
Education on immigrants' health. The minority constituency asked the Academy to develop educational materials and programs on health and safety issues affecting immigrants.
Mentoring. The minority constituency called on the AAFP to explore the possibility of a pilot program to assist practicing family physicians and residencies in mentoring minority high-school students. The resolution also said the Academy should encourage chapters to form liaisons with state boards of education to increase mentoring for minority students.
Alternative business models. The Academy, according to the minority constituency, should identify and promote successful alternative business models that would help family physicians regain control of their practices and would promote the patient-physician relationship. The resolution highlighted the need to explore business models for delivering health care to the uninsured and underinsured. Several members presenting testimony described opting for a low-overhead solo practice as a quality-of-life decision; some members said "cash-only" practices freed them from managed-care regulations.
Resident education issues. The new physicians' constituency passed resolutions regarding resident education issues that included broadening the availability of resources and instruction on end-of-life care. The new physicians also asked the AAFP to offer management training courses at the National Conference of Family Medicine Residents and Medical Students and to recommend to the Residency Review Committee on Family Medicine that management training courses be offered as part of residency curriculum.
The Future of Family Medicine. The FFM project spurred two resolutions from the new physicians, one asking the Academy to educate physician employers and third-party payers about FFM concepts so that FFM principles will be considered when policy changes and payment decisions are made. The second resolution asked that knowledge gleaned from the FFM project be used as a recruitment tool for medical students.
Quality improvement organizations. The new physicians also asked the AAFP to educate members about resources provided by quality improvement organizations. "If we're moving toward an era of getting paid for our performance, it's best we get familiar with these organizations -- the sooner the better," said Bruin Rugge, M.D., of Portland, Ore.
Access to prescription medications. The women physicians' constituency asked the AAFP to go on record urging pharmacies that are the only source of medication in their service areas to provide a full range of medication, including emergency contraception. "Clearly there are issues of access," said Laura Knoble, M.D., of Walpole, Mass., during testimony. "If we could dispense in our offices, we could eliminate this problem." Another resolution addressed Knoble's concern by asking the AAFP to investigate issues involved in making it possible for FPs to dispense medications from their offices.
Human papillomavirus and comprehensive sex education. The women's constituency asked the Academy to help increase awareness of HPV as a risk factor for cervical, oral and rectal cancers and to encourage FPs to expand their health history questions of adolescents to include oral and anal sexual habits. One of the six authors of the resolution testified that she had seen a dramatic increase in HPV in her practice in recent years. Another resolution on evidence-based sex education asked the AAFP to provide resources (that FPs can use with patients) "that have been proven effective in reducing unintended pregnancy and sexually transmitted infections." The resolution also asked the AAFP to urge schools to adopt sex education programs that include information on abstinence, contraception and sexually transmitted infection prevention.
CME on cultural proficiency for IMGs. "I grew up in India where the only religion, other than Indian religions, was Roman Catholic," said Kiran Khanolkar, M.D., of Keokuk, Iowa. He soon learned America had many religions. "I naively asked one of my patients here, 'Are you a Catholic?' He said, 'No, I'm a Methodist,'" said Khanolkar. He was a co-author of a resolution the IMG constituency passed asking the Academy to post material online and offer CME for IMGs concerning Americans' cultural differences. S. Ram Ramalingam, M.D., of Pittsford, N.Y., testified, "The success and failure of IMGs is based on cultural competencies." At the State University of New York, Buffalo, he said, IMG residents had an extra week of training in cultural proficiency topics such as how American medical practice differs from that of other countries.
Liability insurance for part-time practice. The joint constituency (a gathering of all the five special constituencies) asked the Academy to encourage chapters to seek prorated malpractice coverage for physicians who practice part time. "As a woman and soon-to-be mother, I hope the AAFP could promote part-time coverage," said Diana Nguyen, M.D., of Fountain Valley, Calif., offering testimony. "We lost the ability to recruit a physician in Rolla (Mo.) because she was not offered part-time rates," said Debra McCaul, M.D., of Rolla. The idea of graduated coverage is common in insurance, she said, noting that homeowners' coverage may be based on square footage and employees' coverage may be based on the number of employees in a company.
Insurance rates, payment for medication, abortion. The joint constituency urged the AAFP to advise chapters to work for equitable liability coverage rates and health insurance payment rates for FPs who provide a range of services, including medication and early-aspiration abortion.
Donation of body fluid, tissue or organ. On May 6, the Associated Press reported that the FDA planned to bar men who had engaged in homosexual sex in the previous five years from being anonymous sperm donors because of the risk of AIDS transmission. In response, the GLBT constituency adopted a late resolution asking AAFP to advocate "evidence-based policy-making regarding body fluid, tissue and organ donation," with the policy focusing on behavior, not on any specific population or group.
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