NCSC Representatives Tackle Diverse Issues

Official chapter representatives who attended the Academy's National Conference of Special Constituencies, or NCSC, here May 3-5 hit the ground running and kept up a breakneck pace throughout the meeting, debating and voting on scores of resolutions, as well as choosing new leaders.

During the meeting, chapters' special constituency representatives endeavored to set Academy policies on such diverse topics as personal health records, or PHRs; FP hospitalists; and racial and ethnic health disparities.

This year's conference, which was attended by more than 170 physicians, highlighted issues important to each of the Academy's five recognized special constituency groups: women physicians; minority physicians; new physicians; international medical graduates, or IMGs; and physicians interested in gay, lesbian, bisexual and transgender, or GLBT, issues. In addition, the joint constituency group, which comprises all of the conference representatives, addressed issues that affect all five constituencies.

Below is a sampling of the topics addressed in resolutions adopted by the groups; each item is followed by an indication of whether NCSC representatives submitted the resolution to the AAFP Congress of Delegates, which will meet Oct. 1-3 in Chicago, or to the AAFP Board of Directors for its consideration and possible referral to a commission.

Personal health records in the medical home (to the Board). The NCSC called for the Academy to continue its support of PHRs as "a communication tool" between physicians and patients and to study options to provide education about and promote integration of PHRs into the workflow of physicians' electronic health records systems. "I think the intent of this resolution is to move the PHR to the next generation" of medical records technology, said minority constituency representative Karen Smith, M.D., of Raeford, N.C.

Patient/physician confidentiality (to the Board). NCSC representatives asked the AAFP to advocate to legislators, insurers and laboratory corporations that providers of medical services cease violating patient confidentiality by mailing explanation of benefit forms, medical bills and related paperwork to patients' homes and instead work out alternative arrangements.

Promotion of the cost-effective, high-quality care provided by FPs (to the Board). The NCSC directed the Academy to create educational materials describing the cost-effective, high-quality care FPs provide that specifically target health savings account holders and patients with high-deductible health plans. The representatives further called for the AAFP to develop a marketing strategy to disseminate that information to policy-makers, payers, other providers and patients.

Support and parity for FP hospitalists (to the Board). Discussion focused on concerns about the American College of Physicians' and the Society of Hospital Medicine's advocacy of a hospitalist training track for internists that would lead to a certificate of added qualifications, or CAQ, in hospital medicine. The fear, said chapter representatives, is that FPs could be marginalized if hospitals were to demand such a CAQ from physicians applying for hospital privileges. The original resolution included a resolved clause directing the AAFP to "encourage the American Board of Family Medicine to assist in maintaining qualifications on par with those of the American Board of Internal Medicine for hospitalists." The joint constituency reference committee recommended a substitute clause that asked the Academy to encourage the ABFM "to engage or maintain communication with other interested parties to ensure that family physicians maintain equal status as hospitalists." The chapter representatives voted to keep the new clause while also restoring the old, adopting a final measure that included both resolved clauses.

Alternative models of practice (to the Board). Acknowledging a growing call among all medical specialties to boost physicians' quality of life by offering greater career flexibility, NCSC representatives called for the AAFP to compile data on existing alternative practice models and practice sharing into a policy statement that then would be "published in a timely manner in an AAFP publication."

Loan repayment for part-time physicians (to the Board). The NCSC asked the Academy to support "federal loan repayment opportunities for physicians who choose to work less than full time in underserved areas."

Legal marriage for same-gender couples (to the Congress). Adopting a resolution forwarded from the GLBT constituency, NCSC representatives called for the Academy to support legal marriage for same-gender couples as a means of preventing health care inequities. Chapter representatives supporting this resolution argued that same-gender partners of gay and lesbian individuals often are denied insurance coverage because they are not legally married. "There are over 1,100 rights granted to married couples that are not granted to same-gender couples," said GLBT representative Lillian Wu, M.D., of Renton, Wash.

Human papillomavirus, or HPV, testing (to the Congress). NCSC representatives asked the AAFP to support anal pap testing in all patients at risk for anal HPV infection and anal cancer, develop educational materials on performing this procedure, advocate development of appropriate billing codes, and endorse coverage for this service by third-party payers.

"Reparative" or "conversion" therapy (to the Congress). The NCSC asked the Academy to oppose the use of so-called reparative or conversion therapy "that is based upon the assumption that homosexuality and transsexuality per se are mental disorders or based upon the a priori assumption that the patient can change his/her sexual orientation or gender identity." Referring to this practice as "brainwashing," Laura Ellis, M.D., of Dothan, Ala., who was elected to serve as a special constituency delegate to the AAFP Congress, said it had been shown to be not only ineffective but actually harmful.

Family planning options (to the Board). Acting on a measure forwarded from the women's constituency, representatives in the joint constituency business session called for the Academy to adopt a policy stating that "women receiving health care paid for through health plans funded by state or federal governments should be provided with access to the full range of family planning options." Speaking against a proposed amendment to change the phrase "reproductive options" to the eventual "family planning options" language, minority constituency representative Jesus Lizarzaburu, M.D., of Grafton, Va., said, "to use our tax dollars to terminate a pregnancy is not a reproductive option, it's a termination option." Women's constituency representative Anne Kittendorf, M.D., of Dexter, Mich., observed, "This amendment is not about whether abortion should be legal, but it is about ensuring access to care." The resolution, as amended, passed by a vote of 25-24.

Criminalization of medical practice (to the Congress). A second resolution sent from the women's constituency to the joint constituency asked the AAFP to "create an official policy statement on criminalization of medical practice in line with (those of) colleague organizations." The resolution's background information cited the April 18 U.S. Supreme Court decision upholding a ban on intact dilatation and evacuation as evidence of governmental interference in medical decision-making. NCSC representatives apparently agreed with sentiments expressed by women's constituency representative Linda Prine, M.D., of New York when she decried the fact that the American College of Obstetricians and Gynecologists had taken a stand against such interference, "but the AAFP was silent"; the measure was adopted 29-16.

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

Patient education about the medical home (to the Board). The new physicians constituency adopted a resolution calling for the Academy to develop a patient education handout on the importance of having a medical home with a family physician.

Regulation of nurse practitioners (to the Board). New physicians' representative John Bender, M.D., of Fort Collins, Colo., spoke in favor of a resolution asking the AAFP to demonstrate its support of state-based legislation that would move oversight of nurse practitioners from state nursing boards to state boards of medical examiners. "Once they become nurse practitioners, they should be brought out from under the nursing board and placed under the purview of the medical board," said Bender. "We need standardized rules for everyone who is going to diagnose, prescribe and contract with insurance companies and market to the public."

Programs targeting racial and ethnic disparities (to the Board). Minority constituency representatives adopted multiple resolutions aimed at eliminating racial and ethnic disparities in health care, including measures that call for the Academy to establish minority health fellowships "to train FPs specializing in racial and ethnic health disparities, explore development of a minority health leadership institute, encourage further research into identifying and eradicating these disparities, and continue to support relevant legislation and build partnerships with other groups that share this goal.

Verification of credentialing (to the Board). IMG constituency representatives, after lengthy testimony about the difficulty of obtaining academic and professional documentation from some foreign countries -- especially after political upheaval -- adopted a resolution asking the AAFP to advocate to the Federation of State Medical Boards, or FSMB, that it urge state medical boards to utilize FSMB's Federation Credentials Verification Service. This service gathers, verifies and permanently stores physicians' medical credentials in a single, central repository, making them available -- at the physician's -- request to any state medical board that has an established agreement with the service.