NCSC Delegates Back Measures to Ease Education Debt, Retain New Physicians

Special constituency official chapter representatives who attended the AAFP's 2010 National Conference of Special Constituencies, or NCSC, here on April 29-May 1 came together on measures that aim to ease medical education debt and encourage students to choose family medicine.

The delegates also adopted proposals that seek to increase and retain new physicians in the AAFP and to help international medical graduates, or IMGs, obtain clinical experience and enter family medicine residencies.

Unless specifically referred to the Board of Directors or the Congress of Delegates, adopted resolutions are distributed to AAFP commissions for additional analysis and recommendations for Board action.

On April 30, the Reference Committee on Education heard testimony on a resolution from the women's constituency that asked the AAFP to evaluate creating a partnership with businesses to fund scholarships for medical students interested in family medicine.

In its report, the committee agreed that such debt assistance would help more students choose this career, but it had concerns about engaging directly with industry.

Instead, the committee proposed that the Academy evaluate the creation of such a partnership with businesses through the Patient-Centered Primary Care Collaborative, a 600-member coalition of employers, consumer groups, health plans, labor unions, health professional organizations and other groups. The Academy is an active member of the PCPCC.

But one of the co-authors of the original resolution, Madalyn Schaefgen, M.D., of Allentown, Pa., representing the women's constituency, said in the May 1 business session that the partnership should be open to all businesses, as initially proposed.

"They should be able to help out students and encourage them to go into family medicine," she said. "We're in a crisis right now, and we need to have more family medicine doctors. This would be one way to encourage more people to go into family medicine."

Speaking for the substitute resolution, however, Ravi Shah, M.D., of Chicago, a representative of the gay, lesbian, bisexual and transgender constituency, had no argument with the incentive of scholarships, but said it would be better for the Academy to go with the already established PCPCC. The delegates agreed, adopting the substitute measure.

In keeping with the goal of easing medical education debt, delegates asked the AAFP to encourage sharing between constituent chapters regarding successful state loan repayment programs. In addition, delegates said the Academy should provide chapters with lobbying tools to help them advocate the creation of new and the continuation of existing repayment programs at the state level. They also called for the AAFP to educate members about loan repayment opportunities available nationally.

In addition to easing medical education debt, special constituency representatives were unified in their desire to encourage family medicine program directors and faculty members to actively participate in the AAFP as a way of modeling for residents the importance of that involvement. The resolution they adopted also included a measure intended to bolster the number of graduating residents who continue their AAFP membership as new physicians.

Resolution co-authors Kim Yu, M.D., of Novi, Mich., and Sylvia Gail Martin, M.D., of Ridgeland, Miss., both minority constituency representatives, testified before the education committee on April 30 that more engagement of program directors in promoting the AAFP could boost the proportion of graduating residents -- now about 68 percent -- who choose to renew their membership.

However, debate during the May 1 business session focused on whether state chapters should collect data and prepare a report on the participation of program directors and faculty in the AAFP, as called for in the original resolution. Some delegates said that data collection is vital in getting program directors involved. Others were skeptical about the data's purpose.

In the end, delegates agreed that program directors should be actively involved in recruiting graduating residents to continue their membership in the AAFP, but they stopped short of asking chapters to report on program directors' Academy involvement. They did, however, call for the Academy to investigate developing a program to recognize residency programs that have 100 percent AAFP membership retention among their graduating residents.

Finally, delegates adopted a resolution asking the AAFP to create a database of family physicians, institutions and residency programs that allow IMGs to gain exposure to family medicine, as well as permit them to gain U.S. clinical experience that could help them obtain a family medicine residency position.

Although the education committee noted in its report that "there is a desire to make family medicine more visible to international medical graduates and to recruit IMGs into family medicine," committee members were concerned about offering graduates of international medical schools hands-on clinical experience because of malpractice coverage issues. Therefore, they recommended that the measure not be adopted.

Delegates disagreed, however. Suben Naidu, M.D., of Edmond, Okla., an IMG co-convener, was emphatic in his support for the resolution. "We are talking about a shortage of primary care physicians and we are looking for out-of-the-box ideas for this issue,” he said.

“(The IMGs) are ready to be included in the pool of physicians to provide care to patients. The only lack is understanding of the culture."