Family Medicine Residents, Students Call for Wide Range of Changes to Specialty Training, Health Care System

Future family physicians want the AAFP to take "bold action" to help double the number of U.S. medical students entering family medicine residencies by 2020. They also want the AAFP to work on getting more federal funding for family medicine residencies; more debt-reduction options for residents; and graduate medical education, or GME, financing that sticks with residents as a way to encourage training in rural areas.

These were some of the medical education and financing issues raised in resolutions that resident and student members considered during the 2009 National Conference of Family Medicine Residents and Medical Students here July 30-Aug. 1.

But residents and students didn't stop there. They also made their views known on what is, arguably, the premiere issue in the health care community today -- health care reform. In a show of solidarity, both the National Congress of Family Medicine Residents and the National Congress of Student Members voted their support of the AAFP's endorsement of system reform that could include a carefully designed public health plan option.

Members of the resident congress adopted a resolution that asked the Academy to "support the establishment of a national priority to double the number of U.S. medical school graduates entering family medicine residencies, based on 2009 statistics, by 2020." Members of the student congress, on the other hand, considered a virtually identical measure but ended up not adopting it amid concerns about the deadline.

In testimony before the resident reference committee considering the measure, Preston Hatlestad, M.D., of St. Paul, Minn., one of the resolution's co-authors, said that although current health care reform efforts make this an "amazing time for family physicians and primary care in the United States," American medical schools are not turning out enough primary care physicians. "So we want to be bold and try to double the number of graduates entering family medicine residencies," he said.

Robert Stenger, M.D., M.P.H., of Portland, Ore., agreed, but noted that instead of raw numbers, some percentage-based goal would be more appropriate.

For their part, student members considered a similar measure, actually amending it twice to try to address concerns about what many deemed overly specific language before, ultimately, rejecting it as already being addressed by the AAFP.

When it comes to financing medical school education, resident and student members asked the Academy to continue to promote increased federal funding for family medicine residencies and to advocate "meaningful health care reform" that supports debt-reduction programs for physicians who choose to practice primary care.

Resident members specifically want the Academy to encourage the National Health Service Corps, or NHSC, to award multiple loan repayment terms, including for periods longer than two years, and distribute those awards at the beginning of residents' NHSC service.

In reference committee testimony, resident member Lacey Millet, M.D., of Sulfur, La., pointed out, "In addition to the monetary benefits, this would serve communities well, and physicians are likely to stay in the community."

Both the resident and student congresses sought to encourage rural residency rotations by asking the Academy to advocate that GME funding follow residents to their residency training locations. GME funding policies now mandate that money for residency training go to hospitals, so there's a disincentive for programs to allow rural or other training experiences that take residents away from their primary training sites, said resident members in reference committee testimony. That disincentive would be remedied if GME funds were paid to the programs directly.

The resident congress also adopted three resolutions related to health care reform legislation that could include a possible public plan option:

Resident member Tamaan Osbourne-Roberts, M.D., of Denver, said that the public plan option may entail "substantial risk," but, he said, the greater imperfection would be maintaining the current broken system. He insisted that the nation needs "excellent, affordable care for all people."

Meanwhile, members of the student congress not only adopted a proposal supporting the AAFP's endorsement of a public plan option and another calling for reciprocity and portability under such a plan, but they also gave the thumbs-up to a third resolution that pointed to a single-payer model "as a viable method of health care reform."

Student member Michael Goodwin, of Oregon Health & Science University in Portland, who was a co-author of the resolution supporting the Academy's stance on the public plan option, told reference committee members, "There has been push back from physicians, and we wanted to come out in support."