Every year about this time, the AAFP Board of Directors gets some of its marching orders for the coming year from the Academy's Congress of Delegates. What Board members will be getting from this year's Congress promises to keep them -- and the AAFP's various commissions -- busy for quite some time.
"The nature of the job that PAs have is that they're in collaborative agreements with us and do not practice on their own," says Nebraska delegate David Hoelting, M.D., about a resolution asking the AAFP to create a non-voting membership category for physician assistants.
A number of resolutions discussed during the Reference Committee on Organization and Finance hearing here on Sept. 23 revolved around specific groups of people -- namely, nurse practitioners (NPs), physician assistants (PAs), and family physicians in solo and small-group practices. After spirited debate on each resolution, AAFP delegates voted to refer all of them to the Board for further study.
NP, PA Membership
First up at the reference committee hearing was a resolution asking the AAFP to "create a dues-paying, non-voting membership category for nurse practitioners who work within a direct practice environment of an AAFP active member."
Proponents of the measure focused their comments on how such a move could enhance the team-based care component of the patient-centered medical home (PCMH).
- The AAFP Congress of Delegates in San Diego vigorously debated several resolutions during the Reference Committee on Organization and Finance.
- Delegates opted to refer resolutions on nurse practitioner and physician assistant membership in the Academy to the Board.
- The special challenges faced by solo and small-group physicians and the need to create a special category for those physicians also were a focus of the reference committee.
"We're in a very odd position," observed Florida delegate Dennis Saver, M.D., of Vero Beach. The AAFP has a long track record of espousing a team-based approach to caring for patients, said Saver, but "are we backing up the talk with the walk?" The Academy offers no specific CME, for example, that brings all team members together for "tabletop" exercises, he noted, saying that many AAFP members would value this type of training.
Other speakers agreed with this line of thought, testifying that establishing some sort of AAFP membership category for NPs would "foster collaboration and collegiality."
"Bringing these people in the same way we've included students and residents could give us a fresh perspective," said resident delegate Andrew Lutzkanin, M.D., of Ephrata, Pa.
Opponents, however, voiced concerns about how such a move could potentially dilute the effectiveness of the Academy's ongoing advocacy efforts. Some questioned why NPs would be tempted to join the AAFP when they already have their own membership organizations. Others, like Illinois alternate delegate David Hagan, M.D., drew from personal experience to point out that NPs' loyalties lie elsewhere.
"I work with a nurse practitioner, and I very much value her services," Hagan testified, "but I value the other members of my team, as well."
According to Hagan, NPs don't share the same investment in a practice that physicians do. "They work, they move on, or they change positions." The task of tracking NPs to ensure they were working with an active AAFP member would be substantial, he and others noted. And there would be no guarantee that the revenue generated would offset the cost of doing so.
Social Media at the COD
AAFP members and delegates at the AAFP Congress of Delegates kept busy during the two-and-a-half-day event as they tweeted, posted on Facebook and found other ways to reach out via social media. For a roundup of their efforts, see Storify entries posted by AAFP staff members.
A second resolution, which sought to create a similar non-voting membership category for PAs, met somewhat milder resistance.
"The nature of the job that PAs have is that they're in collaborative agreements with us and do not practice on their own," said Nebraska delegate David Hoelting, M.D., of Pender. Admitting them as members to the Academy could strengthen that relationship.
Pointing back to the time when the AAFP decided to establish a membership category for international family physicians, former AAFP Director Dale Moquist, M.D., of Horseshoe Bay, Texas, said of the current PA resolution, "I think it is time to look at this issue -- I'm not saying pro or con -- but just look at it."
Concerns voiced were similar to those raised about the NP proposition. What would be the value to PAs of joining the AAFP? Would they be chapter members, too? All of which eventually led to the call for referral.
Representation in the AAFP
Physicians in solo or small-group practices were the focus of two other resolutions referred by delegates. Each of those measures asked the Academy to form a special interest group devoted to physicians in such practice arrangements.
"I think we should have the courage to study this, and, if the evidence is there, move forward," says Texas delegate Erica Swegler, M.D., of a resolution that asked the AAFP to establish a task force to consider changing the current representation schema in the Congress of Delegates to one "based on limited proportional representation."
New Jersey delegate Arnold Pallay, M.D., of Montville, testified that such practices face unique challenges that require special support. "While the American Academy of Family Physicians moves forward -- including with patient-centered medical homes -- we need to be sure that we are aware of what these solo and small-group practices need," he said.
After all, Pallay added, "We're not the American Academy of Patient-Centered Medical Homes; we're the American Academy of Family Physicians."
Others agreed that forming such a group to address these practices' needs would help safeguard their interests. One supporter testified that "solo and small-group (practice) physicians are the foundation of this Academy."
Despite the fact that the AAFP currently has a task force working to determine how best to serve the needs of specific membership groups, some felt that the need was more immediate and sought adoption of the measure. Acknowledging the ongoing work of the Academy, however, delegates agreed to refer the issue to the Board.
Although not adopted by delegates, another resolution that sparked considerable discussion -- including on the floor of the Congress -- asked the Academy to establish a task force to consider changes to the current representation schema in the Congress of Delegates to "one based on limited proportional representation as a means to increase member involvement and representation in AAFP activities."
"This isn't about bigger states versus smaller states," said Texas alternate delegate Douglas Curran, M.D., of Athens, "this is about doing a better job of thinking about how we do family medicine."
According to AAFP Past President Lori Heim, M.D., of Vass, N.C., "This has the advantage of giving more members the ability to voice their positions on issues." The downside, she added, would be that some smaller states' voices could be overwhelmed.
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