Medical Students' Issues Range From Scope of Practice to Valuation of Services

Expansion of educational opportunities was a central theme that emerged from medical students during the AAFP's National Conference of Family Medicine Residents and Medical Students here on July 28-30. In particular, the students asked the AAFP to take steps to enhance the health and well-being of the public by supporting policies that expand the scope and reach of family medicine, especially among rural and underserved populations.

Training in procedures was an area students specifically expressed an interest in during the National Congress of Student Members. For example, students passed a resolution calling on the AAFP to support and promote colonoscopy training in family medicine residency programs and to advocate the credentialing of family physicians to perform colonoscopy procedures.

During reference committee testimony, David Johnson, of Huntsville, Ala., a co-author of the resolution on colonoscopy training, described colon cancer as a “big problem in America, especially in rural areas.”

Colon cancer screening is “something that we as family physicians can do and (should) take it upon ourselves to (do),” said Johnson.

Students also approved a substitute resolution asking the AAFP to advocate that obstetrical/perinatal care be preserved in residency training.

Benjamin "Tate" Hinkle, a student member from Birmingham, Ala., and co-author of the resolution on obstetrical/perinatal care, said during reference committee testimony that the new duty hour guidelines for residents have significantly affected residents' exposure to obstetrics, prompting concerns that "family medicine's ability to care for obstetrics patients, especially in rural areas," will be adversely affected.

In addition, students approved a substitute resolution calling on the AAFP to support establishment of a comprehensive national prescription drug database that would be searchable by specific patient identifiers across state lines, yet remain in compliance with the Health Insurance Portability and Accountability Act.

Lindsey Latteman, a student member from Wauwatosa, Wis., and co-author of the resolution, said during reference committee testimony, "It is impossible to manage patients when you are not sure what medications they are taking or if they have filled their medications.

"My co-authors and I thought it would be important to support the creation of a national prescription drug database as it relates to meaningful use and electronic health records."

Catherine Louw, a student member from Bellevue, Wash., also spoke in favor of the resolution, saying underserved populations often don't have a regular source of care, which makes it more likely they will be prescribed a medication that is contraindicated or one that causes an adverse reaction.

The establishment of a national drug database also came up during the National Congress of Family Medicine Residents, where a similar resolution was introduced. Joseph Behn, M.D., of La Crosse, Wis., who co-authored that resolution, said management of prescription medications is important to the provision of quality health care. Certain medications "are at a high level for possible misuse," he testified to a resident reference committee. He added that it would be helpful to know when and where prescriptions were filled. "We need an electronic database that is searchable by specific patient identifiers."

Behn stressed that he was not asking the AAFP to fund the database; rather, he said, "The AAFP is in a unique position to urge HHS to look into the possibility of doing this."

The resident reference committee that heard testimony on this issue offered a substitute resolution that asked the AAFP to "support efforts toward the establishment of a universal patient prescription database," which the resident congress adopted.

A resolution calling on the AAFP to formally withdraw from the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, if that committee does not implement recommendations made recently by the AAFP generated much debate among student members.

Elizabeth Wiley, a student member from Arlington, Va., testified in support of the resolution during the reference committee testimony. "I think it is pretty well known in the family medicine community that the RUC processes and deliberations have been somewhat questionable for a long time," said Wiley. "It is important that the AAFP take a stand, a very public stand, to force the issue."

Although debate on the resolution during the student congress was slow to get under way, students seemed to understand the issue better after student Board member Kevin Bernstein, M.D., of Pensacola, Fla., reported on the AAFP Board of Directors' activities regarding the RUC.

Margarette Shegog, of Dayton, Ohio, said she thought the resolution was in line with the AAFP's current stance on Medicare payment. In addition, she said adopting the resolution "tells Washington that we need to be heard in a more serious way.

However, Dylan Bindman, of St. Paul, Minn., noted that withdrawing from the RUC was not the right way to approach the problem. "That is closing the door rather than keeping it open," he said.

In the end, the students voted to not adopt the resolution.

A student resolution calling on the AAFP to not renew its collaboration with The Coca-Cola Co., or TCCC, and to consult with state chapters before initiating new Consumer Alliance Program partnerships generated a great deal of discussion. Despite a reference committee recommendation against adoption, in the end, students adopted the original resolution.

"Come on guys, we can do better than this," said Richard Bruno, a student member from Portland, Ore., and co-author of the resolution, during the student congress. "There are hundreds of other companies that promote healthy lifestyles," said Bruno. "We should look at aligning ourselves with those that do."

Larissa Thomas, of New Orleans, spoke against the resolution, saying that the student congress debated the issue thoroughly last year and came to the conclusion to allow the Board of Directors to do its job. "This body would be better served to highlight companies we would like to partner with," said Thomas. "People will always be consuming soft drinks no matter where you go. It should be our role to work with these companies to ensure people know how to use these products consciously and in moderation."

The students also adopted the following: