Residents, Students Wrestle With Health System Reform, Other Issues

Tomorrow’s family physicians want to see more progress toward health system reform, stronger language regarding retail health clinics, and an arm’s length between the pharmaceutical industry and medicine. They voiced those opinions in resolutions adopted during the Aug. 2-4 resident and student congresses held during the National Conference of Family Medicine Residents and Medical Students here.

Access to care ranked high among the concerns expressed by residents and students. A successful proposal in the National Congress of Student Members urged AAFP to expand its advocacy on health insurance reform to include criteria that would ensure that health insurance coverage in America would be automatic, guaranteed, not-for-profit and comprehensive.

Calling health insurance reform his "passion," student Parker Duncan of Irvine, Calif., said it was "absolutely the time to remove profit from our health insurance system."

An access proposal that urged Academy support for a single-payer system failed in the National Congress of Family Medicine Residents, however. Supporters of the resolution cited research that shows America’s health care system fails to ensure universal access to care and results in poorer outcomes and higher costs.

"When you compare the U.S. health system (to other industrialized nations), by all metrics, we lose," said Shirish Balachandra, M.D., of the University of Rochester/Highland Hospital Family Medicine Residency Program, Rochester, N.Y. "Whether the (U.S.) system is ultimately guided by the invisible hand of government, you have to recognize that it’s now guided by the invisible hand of profits."

Opponents supported the resolution's intent but asked that their peers await final recommendations from the AAFP Task Force on Health Care for Everyone, a suggestion that was adopted by the residents.

"We need to work for universal health care, but there’s not any reason to think that a single-payer system would work in the United States," said Kate Rowland, M.D., of the University of Illinois at Chicago/Illinois Masonic Family Practice Residency.

In identical resolutions, students and residents called on the AAFP to incorporate stronger language regarding retail health clinics' potential for conflict of interest and fragmentation of medical care into the Academy's "Desired Attributes of Retail Health Clinics."

The Academy's list of attributes for the clinics, "while providing some guidance for retail health clinics, leaves room for gray space," said resolution author Ron Chacko, M.D., of the Lawrence Family Practice Residency, Lawrence, Mass.

Chacko wrote his resolution out of concern that practitioners employed by retail health clinics write prescriptions that patients then fill at the clinic's sponsoring pharmacy, which may affect prescribing habits. Moreover, Chacko said he doubted the clinics would inform patients' medical homes about interactions.

After animated discussion on the issue, both the residents and the students approved their individual resolutions.

The potential influence that pharmaceutical companies may have on physician treatment decisions prompted students and residents to adopt resolutions seeking to expand the Academy's efforts in this area. Students asked the AAFP to encourage the National Research Network to assess the impact of pharmaceutical company interactions with family physicians on patient outcomes.

Student Jacob Bryan of Columbus, Ohio, summarized student testimony, saying, "There is tremendous potential for abuse, and there is tremendous potential for good." But, he added, "If doctors are getting information from drug companies, it's biased information."

Residents generally agreed and adopted a resolution calling on the Academy to investigate nonpharmaceutical funding sources for annual conferences and to adopt as a goal the elimination of pharmaceutical advertising for annual conferences by 2012.

Among other resolutions that got the nod from students and residents were those calling for