Family physicians expect organizations that do business with the AAFP to turn to Academy members -- family physicians -- for the provision of health care to those organizations' employees.
That was the gist of a substitute resolution adopted by the Congress of Delegates here on Sept. 13.
Alternate delegate David Ashley, M.D., of Saunderstown, R.I., told the Reference Committee on Organization and Finance that the intention of the original resolution was to take advantage of the relationships that the Academy has forged with corporate America.
"We should take the opportunity to advise these companies and teach them about the patient-centered medical home (PCMH)," said Ashley. The Academy could help corporate leaders improve employees' health and positively affect employee attendance and productivity -- "all the buzz words that corporations want to hear," he said.
Delegate Dennis Saver, M.D., of Vero Beach, Fla., took issue with the tone of the original resolution. "It's not appropriate for the Academy to require things of other people -- much as we don't like other people to require things of us." Saver added that he would favor language asking the AAFP to "encourage" commercial entities and employers to have their partners request medical homes from their insurers.
Alternate delegate Brian Bachelder, M.D., of Akron, Ohio pointed out during testimony in the COD that many family physicians only now are working toward achieving a PCMH, meaning there is not yet an abundance of medical homes available to patients.
The substitute resolution adopted by the COD asks the Academy to "encourage organizations that enter into mutually beneficial arrangements with the AAFP to utilize the services of family physicians for their workforce."
- At the 2011 COD, delegates voted on several resolutions debated in the AAFP's Reference Committee on Organization and Finance.
- Delegates asked the Academy to encourage organizations that partner with the AAFP to utilize the services of family physicians.
- Delegates adopted a resolution that would have the AAFP work to ensure that content on FamilyDoctor.org promotes only the specialty of family medicine.
- Delegates rejected two separate resolutions asking for changes to the Academy's Consumer Alliance Program and its partnership with The Coca-Cola Co.
Delegates and members then stepped away from the realm of clinical practice to debate content on the Academy's consumer website FamilyDoctor.org(familydoctor.org), as well as the placement of commercial advertising on that site.
Jennifer Brull, M.D., of Plainville, Kan., told the Reference Committee on Organization and Finance that she was "horrified to find materials on FamilyDoctor.org that referred our patients to gynecologists."
Although further testimony showed that contractual changes had already given the AAFP more control over content on the website -- including the removal of the content to which Brull objected -- the COD passed a substitute resolution that asked the AAFP to work to revise content on FamilyDoctor.org -- and in other patient education materials -- that promotes medical specialties other than family medicine.
Delegate William Phillips, M.D., M.P.H., of Seattle, testified on a separate resolution that would prohibit placing commercial advertising adjacent to patient information on FamilyDoctor.org.
"Adjacent ads target users of Familydoctor.org when those consumers seek health information on key questions about a disease," said Phillips. "They (advertisers) make sure that when you send a patient there for information about diabetes, he or she sees an ad for a specific brand of a blood glucose monitor or, worse yet, for a program promoting big brand soft drinks," said Phillips. "It is extra revenue, but is it the kind of revenue that we want?"
Alternate delegate James Fieseher, M.D., of Portsmouth, N.H., said, "I deplore the commercialism in medicine and feel that it shouldn't be there at all, but unfortunately that's the game that we're playing." Fieseher told the reference committee that if the Academy wants to reach patients with messages about smoking and obesity, "we need the commercial support."
David Hagan, M.D., of Gibson City, Ill., president of the Illinois AFP, was blunt about the prospects of foregoing advertising for prime placement of ads on the website. "The site (FamilyDoctor.org) goes away unless we find another way to fund it," he noted.
(Then) AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, also reminded members that the conversation was only about consumer advertising. "As far as advertising to medical professionals, we abide by all the rules," said Goertz. The AAFP follows the Council of Medical Specialty Societies' Code for Interactions with Companies and all guidelines for professional or physician-directed publications.
Goertz asked delegates to consider one more thing: "Maybe, every once and a while, a patient will see an ad and remember something that they forgot," said Goertz.
In the end, the COD followed the reference committee's recommendation and did not adopt the resolution.
The Academy's Consumer Alliance Program -- and specifically its partnership with The Coca-Cola Co., or TCCC -- was still on the minds of some members a year after bruising debate at the 2010 COD. That still-simmering frustration produced two resolutions.
Alternate delegate Christopher Gaynor, M.D., of Seattle, told the reference committee, "There's no way you can look at Coca Cola and say it is promoting health." Gaynor said it was confusing to patients to see the Academy's name associated with TCCC.
Delegate Phillips agreed. "We cannot be an organization that supports patients and public health and have a relationship with Coca-Cola."
However, despite some ongoing objections to the partnership, the momentum in 2011 seemed to shift in favor of the Academy's alliance with TCCC; delegates did not adopt either resolution regarding TCCC.
Opposition to the resolution was best summed up by alternate delegate Andrew Carroll, M.D., of Chandler, Ariz., "There was lots of debate and argument last year. In the past 365 days, I've seen no material change in the AAFP's performance ...nor have I seen any mass exodus from the AAFP" that relates to the Academy's relationship with this company, said Carroll.
That statement was backed up by (then) AAFP Board Chair Lori Heim, M.D., of Vass, N.C. "If you look at our student interest and student membership during the past year, it has increased by 26 percent. The bad impact some (members) feared from the consumer alliance has not been borne out by our numbers," said Heim.
Heim also corrected erroneous testimony; the Academy's contract does not allow any Consumer Alliance Program partner to use the AAFP's logo.