Family Medicine Residents, Students Tackle Medical Home, Loan Deferment, Drug Industry Issues

Future family physicians recently looked to the AAFP for help in bolstering the patient-centered medical home, or PCMH, concept in academic settings and residency training. They're also seeking the Academy's help in getting certain hardship-based medical school loan deferments reinstated, and they'd like more guidance on how to deal with pharmaceutical representatives, along with additional scrutiny of pharmaceutical funding for various resident and student scholarships and other activities.

Those were some of the issues raised in resolutions that resident and student delegates considered during the 2008 National Conference of Family Medicine Residents and Medical Students July 30-Aug. 2 here.

Delegates to the National Congress of Student Members showed their strong support for the PCMH -- which one resolution characterized as "rapidly becoming the recognized best practice in delivery of primary care in America" -- by asking the Academy to draw up medical home curriculum objectives that would be incorporated in medical schools and family medicine residency programs. They further called on the AAFP to "challenge" the nation's medical schools and family medicine residency programs to adopt these objectives by 2015.

Delegates to the National Congress of Family Medicine Residents joined the students in lauding the merits of the PCMH, passing a similar measure that sets a more ambitious timeline of 2010 for adoption of standardized PCMH curriculum guidelines.

Resident delegates also asked the Academy to find ways to support family medicine residencies seeking to become medical homes and explore ways to recognize residencies that achieve that goal.

According to Kristen Kelly, M.D., a third-year resident in the University of Washington, Seattle, Family Medicine Residency Program and co-author of a resolution dealing with support for and recognition of residency programs that implement elements of the medical home, such incentives could go a long way in promoting the PCMH as the standard of medical practice.

"In our residency program, we're experimenting with some ways of improving our patient access and communication," Kelly explained in an interview with AAFP News Now during the conference. "But we don't have a lot of access to a formalized database of information; we don't have additional support from family medicine programs that would enable us to do this in an effective manner.

Her hope, she said, is that the Academy can encourage other residency programs to become involved in adopting the medical home model.

"We are going to be practicing physicians very soon," Kelly added. "So if we start doing this now, then it will become part of our practice and our expectation, and we're more likely to push for this and to actually implement it in our own practices in the future."

In addition, both congresses adopted resolutions designed to help FPs working in medically underserved areas implement the principles of the PC-MH, with resident delegates specifically asking that a medical home model for the urban underserved integrate "services that address the unique social and economic needs of this patient population." The delegates in each congress also asked that the 2009 resident and student conference include educational offerings on "the role and utilization of social services in the context of the medical home for urban underserved populations."

Resident and student delegates also want the Academy to go to bat for them on reinstating a popular three-year economic hardship loan deferment program. And they're convinced the best way to accomplish that goal is to blanket high-level federal government officials with letters making that case.

The deferment allows residents to postpone repayment of their federal education loans during the first three years of their residency training without interest penalties. But the U.S. Department of Education plans to eliminate the deferment after July 1, 2009.

Will Nicholson, M.D., a third-year resident at the University of Minnesota St John's Hospital Family Medicine Residency Program in Saint Paul and a co-author of the resident resolution on the topic, called it "a line-in-the-sand issue" for family medicine residents in his state.

The best way to tackle the problem, Nicholson told reference committee members on Aug. 1, "is to reverse the executive order that caused this in the first place." He advocated sending federal officials a clear message calling for that reversal.

Elizabeth Menzel, one of the authors of the student resolution on deferment, told a student reference committee she's concerned that the elimination of the deferment would affect the entire specialty of family medicine. That prospect, she said, calls for action that is both swift and decisive.

"It's a good idea to make changes now," Menzel said. "We need to take action now to keep this deferment."

Both congresses adopted measures calling for the AAFP to send letters opposing the deferment elimination to the president, the vice president, the HHS secretary, the Department of Education secretary and the U.S. Surgeon General. Student delegates also said they want FamMedPAC to make reinstatement of the deferment one of its top priorities.

Students and residents who attended the conference considered several resolutions that addressed various aspects of pharmaceutical companies' interactions with physicians and physicians-in-training.

The student delegates adopted a resolution that asks the Academy to "review and update practice guidelines for physician interactions with pharmaceutical sales representatives" in light of the newly strengthened Code on Interactions with Healthcare Professionals from the Pharmaceutical Research and Manufacturers Association, or PhRMA. The delegates also adopted a measure asking that educational programming on pharmaceutical influences, the new PhRMA code, and tools to guide residents and students in their interactions with the drug industry be among topics considered for inclusion at the 2009 resident and student conference. And they asked the Academy to consider developing other educational resources on interacting with drug representatives.

Both the student and resident congresses adopted resolutions asking the Academy to investigate funding sources other than the pharmaceutical industry for scholarships to attend the National Conference, with resident delegates including other awards and travel expenses among those costs. That request came despite testimony acknowledging that such action might mean less overall support for prospective attendees.

But both congresses stopped short of asking the AAFP to phase out pharmaceutical support of its CME activities, although a number of students and residents spoke passionately about eschewing such support.

"It's very important" that the Academy takes this stance, said Melissa Hemphill of Portland, Ore., in a student reference committee hearing on Aug. 1. "I want my patients to know I'm going to take the best care of them that I can" without influence from pharmaceutical companies, she added.

Nicholson agreed with that view in testimony he gave during a resident reference committee hearing the same day, "If we don't start moving in this direction of our own accord," he predicted, "public pressure stands to do it for us."

The resolutions adopted by the resident and student congresses now go to the Academy's Board of Directors and/or appropriate AAFP commissions for further consideration.