Special Constituencies Recommend AAFP Policies

Tackling topics such as retail health clinic information and immigrants' care, the AAFP National Conference of Special Constituencies proposed AAFP policies during its meeting May 4-6 in Kansas City, Mo. Some 146 family physicians attended the meeting, including about 130 official representatives of special constituencies from AAFP chapters. Participants represented five constituencies: women physicians; minority physicians; new physicians; international medical graduates; and gay, lesbian, bisexual and transgender physicians.

Here's a sampling of topics the constituencies addressed. Following each topic is an indication of whether the NCSC submitted the resolution on the topic to the AAFP Congress of Delegates, which will meet Sept. 26-28 in Washington, D.C., or to the AAFP Board of Directors for its consideration and possible referral to a commission.

Retail health clinic information (to the Board). The NCSC asked the AAFP to develop a handout for patients that compares the "medical home" family medicine practices offer and the care other facilities, including retail health clinics, provide. The Academy should post the handout on familydoctor.org so family physicians can access it easily for discussions with patients, said the NCSC. Participants warned against placing such AAFP information in retail health clinics, however, because that might make patients think the Academy endorsed the clinics. "I'd rather have these materials in my office than in these clinics," said Teresa Lovins, M.D., of Columbus, Ind.

Immigrants' medical care (to the Board). NCSC participants expressed concern that federal and/or state legislators might make it a crime to aid and abet immigrants who lack legal status in the United States, and that the legislators might ask physicians to obtain and report data on immigrant patients' status as residents. "We are physicians. We are trained to heal," said Dario Lizarraga, M.D., of Florence, Ariz. "We are not law enforcement officers." Lisa Corum, M.D., of Fort Mill, S.C., agreed. "I take care of patients who work in the mills and patients who work in the fields," said Corum. "I tell my patients repeatedly, 'I want you to tell me the truth. I will not tell on you.'" The NCSC called on the Academy to fight legislation that would require physicians to collect and report data on patients' status as residents. The NCSC also asked the AAFP to oppose bills that would criminalize the provision of medical care to patients who may not have legal status as residents.

Restrictions on prescribing (to the Board). According to NCSC participants, Blue Cross and Blue Shield of Massachusetts now requires prior authorization for prescribing certain statins unless prescribers are board-certified cardiologists or endocrinologists; other insurers apparently are putting similar restrictions on prescribing proton pump inhibitors and antifungal drugs. The NCSC took action on this issue, asking the Academy to begin discussions with major insurers regarding formulary restrictions or limitations based solely on a prescriber's specialty or area of board certification. During debate on a similar resolution passed by the women's constituency, Yvonne Rodriguez-Conesa, M.D., of Newbern, Tenn., objected to the need for patients to see subspecialists to meet insurers' requirements. "It's just a strategy to make the patient go around like a rat in a maze," she said.

Invocations (to the Congress). Invocations at the beginning of the annual AAFP Congress and Scientific Assembly may offend some members and should be replaced with moments of silence, said several NCSC participants. Debate on the issue was mixed. Some participants defended the current practice; some favored moments of silence; and some asked for nonreligious, inspirational statements. In a standing vote of 34-30, the NCSC asked the Academy to eliminate the formal invocations.

Foster care (to the Congress). The Academy should support legislation that would promote a safe, healthy, nurturing environment for children in foster care, regardless of the sexual orientation of the foster parent or parents, said the NCSC. Participants noted that 11 state legislatures already were considering or soon would consider prohibiting foster care by gay, lesbian, bisexual or transgender parents.

The resolutions discussed above were passed by the joint constituency business session, where all five groups represented convened. Resolutions on the following topics came from business sessions of the separate constituencies, as identified.

Interpretive services (to the Board). The women physicians asked the Academy to help secure appropriate payment for interpretive services provided by physicians. They also asked for AAFP's help in locating existing Web-based translation services. Karen Smith, M.D., of Raeford, N.C., pointed out that physicians who refuse services to non-English-speaking patients are "out of compliance" with Medicare and Medicaid regulations. "The government should increase the (Medicare) payment rate so physicians can afford to hire a translator," she said.

Childhood obesity and diabetes (to the Board). The minority physicians expressed concern about increasing rates of childhood obesity and childhood diabetes and linked both conditions to children's overall lack of physical activity. They asked the Academy to continue to emphasize the importance of daily physical education, or PE, in all years of schooling. Barbara Matthews, M.D., of Macon, Ga., said her son's school district had completely eliminated PE, yet nearly half of the 20 students in her son's kindergarten class were either obese or overweight. "We need to make it clear how important physical activity is," she said. "To cut physical education out completely is insane."

Increasing minorities in family medicine (to the Board). "There's not enough people who look like me serving patients," said Jenel Wyatt, M.D., of Odenton, Md., speaking as a black woman in favor of a resolution that would encourage medical schools to increase their numbers of medical students and faculty members from underrepresented minorities. This resolution from the minority physicians constituency also contains language addressing the need to reach minority students early in the educational process. "We're losing some of our best minority minds in junior high," said Lois Steele, M.D., of Tucson, Ariz. In addition, the resolution addressed the need for the AAFP to post resources online to educate students at all stages of education about a career in family medicine.

Visa processing (to the Board). The international medical graduates asked the AAFP to encourage the U.S. State Department to make visa issuance and visa work permit extensions and renewals more convenient for family physicians in underserved and rural communities.

Home HIV testing (to the Board). The gay, lesbian, bisexual and transgender constituency asked the Academy to encourage the FDA to change its HIV testing policy so that HIV tests could be taken at home. The GLBT physicians said current FDA policy mandates personal counseling before the release of HIV test results, which prevents approval of home testing.

Denial of payment (to the Board). The new physicians asked the Academy to keep providing CME on practice management issues and sought tools to teach family physicians how to respond to payers who deny payment for services rendered.