Residents Tackle Tough Issues During AAFP National Conference

America's future family physicians have a passion for the specialty of family medicine and a desire to deliver the best care possible to their patients. Those messages came through loud and clear in the resolutions introduced, debated and voted on during the AAFP's 2011 National Conference of Family Medicine Residents and Medical Students here July 28-30.

In particular, residents who participated in the National Congress of Family Medicine Residents asked the Academy to help create recommendations to guide pharmacies that provide vaccinations and explore the feasibility of a primary care interest rate reduction program for primary care physicians.

Family medicine residents also debated a resolution regarding family physician representation on the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which is the committee that reviews and values CPT codes and makes payment recommendations to CMS.

Lacey Millet, M.D., of Sulphur, La., co-authored a resolution that the congress adopted -- despite the reference committee's recommendation otherwise -- that called for the Academy to work with state pharmacy boards to require pharmacies to report vaccinations they provide patients to the patient's primary care physician; enter vaccines given into state databases, if applicable; and require pharmacists who administer vaccines to attend formal vaccination training.

Millet testified in a July 29 reference committee hearing that some pharmacies offer more than just influenza vaccines, but she said the lack of pharmacy reporting requirements hinder the ability of states to collect vaccination information. "We don't know who is receiving vaccines," said Millet, adding that patients "are bypassing family physicians" in favor of pharmacies.

Resolution co-author Danielle Rushing, M.D., of Lake Charles, La., testified that when pharmacists administer routine vaccines, patients don't get important health screenings they would normally receive in a primary care physician's office. "This is a major concern," said Rushing.

Jill Campbell, M.D., of Anchorage, Alaska, stepped to the microphone and said simply, "Pharmacists have no training in giving vaccines."

Although they adopted the portion of the resolution that pertained to reporting requirements, residents at the congress did not adopt another portion that asked the Academy to support research into populations that were receiving vaccines from pharmacies.

The National Congress of Student Members, however, which considered a similar resolution, did approve a substitute measure that included a request that the AAFP support research into who was receiving pharmacist-administered vaccines.

Margarette Shegog, a student member from Dayton, Ohio, said in a student reference committee hearing that a lot of pharmacies now are giving vaccines without notifying treating physicians or documenting the administration of vaccines in patient registries.

"We feel we should know what is going on," said Shegog. "Moreover, there are more states that are starting to do this, and we would like the AAFP to be on the boat before it leaves us."

Residents also adopted a substitute resolution aimed at exploring the feasibility of a federal primary care interest rate reduction program.

Mohammad Shahsahebi, M.D., of Raleigh, N.C., introduced the resolution. He noted that interest rates for federal medical school loans are higher than the current market rate for private loans, and he suggested that high interest rates likely were the product of loan restructuring efforts undertaken several years ago, as well as the recent economic downturn.

Shahsahebi testified in the resident reference committee hearing that the availability of lower interest rates for those who choose to pursue primary care specialties could help increase the number of primary care physicians. This kind of loan program "could possibly create downward pressure on physician subspecialization if federal loans to primary care physicians were offered at a lower interest rate," he said. "We need to move forward with this now before all of the health care legislation is enacted."

Some of the liveliest debate in the resident congress came in response to a resolution introduced by Christopher Baumert, M.D., of Billings, Mont., that asked the Academy to formally withdraw from the RUC if the committee did not implement recent AAFP recommendations regarding voting transparency, primary care representation and third-party engagement. Baumert was the only resident who rose to support the resolution.

In reference committee testimony, Janet West, M.D, of Pensacola, Fla., said, "I've seen what happens when physicians step away from the table; it ties our hands when it comes to making meaningful change. It's not appropriate to say we need more representation and then pull out when we don't get it."

Leslie Dempsey, M.D., of Lincoln, Neb., agreed that representation on the RUC was unbalanced, but said she could not support the resolution. "I will advocate for more primary care representation on the RUC until I'm blue in the face. But a small voice on the committee is better than no voice at all," said Dempsey.

Brent Smith, M.D., of Brandon, Miss., put it this way: "The 'take my ball and go home theory of diplomacy' leads to one of two things: You get invited back to play or you're home alone with your ball."

One or both congresses also adopted a number of other resolutions -- some with little or no discussion -- including resolutions recommending that the Academy