Delegates Focus on FPs as ER Physicians, Mothers and Infants as Family Unit, IMGs, Health IT

Despite a nationwide shortfall of certified emergency physicians, family physicians face numerous hurdles when seeking work in emergency departments. To address that problem, delegates to the 2009 National Conference of Special Constituencies, or NCSC, here on April 23-25 adopted a resolution that calls on the AAFP to advocate to the American Hospital Association and other organizations that board-certified family physicians are qualified to staff ERs.

The resolution was one of more than a dozen recommended for adoption by the Reference Committee on Practice Enhancement during this year's conference. Other resolutions introduced focused on keeping mothers and infants together as a family unit during health care processes, providing more information for international medical graduates, and proposals focused on health information technology and electronic health records.

Kim Yu, M.D., an international medical graduate constituency representative from Novi, Mich., was co-author of the resolution calling for recognition of FPs as qualified to staff ERs. Yu told AAFP News Now after the April 24 reference committee hearing that the Academy already has a position paper on emergency medicine; however, members need the AAFP to work with other organizations to ensure that hospitals and insurers know that FPs are adequately trained, able and willing to work in both rural and urban ERs.

Yu said FPs face privileging issues, insurance hassles and pay disparities in ER settings. She said a board-certified emergency physician, or EP, can make as much as $100 an hour more than a board-certified family physician for the same job in the same ER.

"It doesn't seem right, does it?" she asked.

A study published earlier this year in Academic Emergency Medicine reported that in 2005, the tally of board-certified EPs in the 4,828 emergency departments studied was about 22,000. Based on current usage statistics, the study authors said, more than 40,000 EPs would be needed to staff all those ERs today.

Yu testified to the reference committee that 43 percent of the nearly 40,000 physicians now working in ERs are not board-certified in emergency medicine.

"Most of those people will be family physicians," she said after the committee hearing. "Many of those (physicians) started working in the emergency room in 1999 or prior to 1999, when the stringent requirements for working in emergency rooms were not as difficult."

According to Yu, many of those "legacy physicians" will be retiring in the near future, creating a huge shortage.

NCSC delegates also adopted a resolution directing the AAFP to create a policy on postpartum and neonatal care that preserves mothers and their infants as a family unit. The resolution also asks the AAFP to advocate that the mother/infant unit be preserved when transfer of either patient to another facility is medically necessary. In addition, the AAFP should work with hospital and insurance organizations to create payment structures when such transfers are necessary.

According to Laura Martin, D.O., a women's constituency representative from Fayetteville, N.Y., and co-author of the proposal, if either mother or infant experiences health problems in the immediate postpartum period, the two can end up in two different hospitals in two different cities.

In her testimony before the reference committee, Martin said that under the current system, if an infant requires consent for procedures, the mother isn't there to discuss the procedure or give consent.

Martin told AAFP News Now in an interview after the hearing that she experienced the problem as a mother and patient when her son was transferred to another facility after birth because of a collapsed lung.

"He was sent two hours away to another hospital," she said, "and I saw him three days later."

Martin said the practice doesn't make sense because studies have shown that newborns feed and gain weight better, sleep better, and respond better to treatment when kept with their mothers.

"What we'd like to have happen is that some dialogue starts happening with these insurers, (who) really are the people (who) are stopping these transfers," she said. "We'd like to lump the payments together and somehow develop a fee schedule that allows for (mothers and infants) to be treated together."

Another resolution that NCSC delegates adopted calls on the AAFP to add an icon to its Web site home page that links international medical graduates, or IMGs, to a Web page with comprehensive information and resources for IMGs, including programs experienced with IMG residents, a list of potential IMG mentors and a list of current IMG residents.

Faozan Narvel, M.D., of Dublin, Ohio, co-convener of the IMG caucus, testified during the reference committee hearing that nearly 50 percent of residents placed in family medicine programs through the National Resident Matching Program this year were IMGs. He added in a subsequent interview with AAFP News Now that this figure tops the 34 percent seen in 2008. He also said IMGs account for 17 percent of the AAFP's active membership.

Narvel said that improved information on the AAFP's Web site would help attract IMG candidates who are committed to the specialty.

"We want them to prefer and choose family medicine when they apply for a residency program in the United States," he said. "I think the reality is sinking in that international medical graduates will play a very major role in the future of family medicine."

Narvel testified that many countries don't have a family medicine specialty. Instead, these countries have general practice programs that do not allow doctors to deliver babies or work in hospitals. This can be confusing for IMGs.

"(FPs) provide everything possible for the patient so they don't need to go to 10 different doctors to seek care," Narvel said. "This aspect isn't known to most international medical graduates when they are graduating from medical schools. Once they realize that the real doctors in the world are family doctors, they'll automatically choose family medicine as their career."

Finally, delegates adopted a number of resolutions related to health information technology, or HIT, and electronic health records, or EHRs, including