Family physicians came to the defense of rural hospitals, the environment and their own role in end-of-life health care through resolutions adopted here Sept. 30 during the AAFP's 2015 Congress of Delegates.
South Carolina delegate Ada Stewart, M.D., of Columbia, tells the Reference Committee on Organization and Finance that closures of rural hospitals hit the most vulnerable populations hardest.
Members who participated in the Reference Committee on Organization and Finance hearing Sept. 28 set the stage for that work with thoughtful debate about how family physicians can best be champions for their patients and their specialty.
A resolution co-sponsored by the South Carolina and Georgia chapters called for the Academy to advocate for and support federal legislation that provides multiple funding strategies to save rural hospitals.
It's an important issue all across the United States, as the Medicare Payment Advisory Commission reports that 44 percent of hospitals are rural. Many of them are struggling with decreased payments, difficulty recruiting physicians and other problems, members told the reference committee.
Losing a local hospital to such challenges is especially hard on rural populations.
"The closures of these hospitals impact the poor and therefore the most vulnerable of those who need care," said South Carolina delegate Ada Stewart, M.D., of Columbia. "We've had a number of hospitals here in South Carolina that have closed and greatly impacted access to care for a lot of patients."
- Delegates to the 2015 Congress of Delegates in Denver directed the AAFP to press for federal legislation that saves rural hospitals from closure.
- Pointing out that family physicians are trained to take the lead on end-of-life health care, delegates called on the Academy to oppose any efforts that would limit their role in hospice and palliative medicine.
- After hearing debate about climate change, delegates reaffirmed the Academy's longstanding position in defense of the environment.
According to Georgia alternate delegate Leonard Reeves, M.D., of Rome, five of the 57 rural hospitals nationwide that have closed since 2010 were in his state, and 14 others in Georgia are "teetering on the brink."
Reeves talked about one farming community whose hospital has closed.
"Where are they going to go when they have a farming accident? Where are they going to go when their kids get sick?" he asked. "As an academy, we need to go on the record and say we support the health care system for our neediest, rural sections of the country, where there are few doctors and fewer hospitals."
The AAFP has long fought for equal payments to rural hospitals to help make quality care available to all populations.
Following the strong reference committee testimony, the Congress adopted the resolution without further discussion.
The reference committee also heard from members about a resolution that defends the central role of family physicians in end-of-life care, including hospice and palliative medicine. After all, said those who testified, it's an important aspect of a specialty that encompasses health care from birth to death.
"End-of-life care is an integral part of what we do as family physicians," said Mississippi delegate and resolution author Luke Lampton, M.D., of Magnolia. "The best hospice physicians I know are family physicians,"
Academy policy notes that family physicians are trained to and experienced in providing leadership in hospice care, and Lampton suggested that more CME at the local and state levels could encourage more family physicians to take on this important role.
Certainly, said Maria de Arman, M.D., of Corpus Christi, Texas, a member constituency alternate delegate, such key duties should not be limited to subspecialists.
Family physicians have the training to take the lead on end-of-life care, Mississippi delegate Luke Lampton, M.D., of Magnolia, testifies.
"This is the essence of what family medicine does. This is what this resolution speaks to," said de Arman. "We do not require additional certifications to do this job."
And Kansas delegate Jen Brull, M.D., of Plainville, pointed out that making it difficult for family physicians to provide end-of-life care makes it difficult for patients to receive the care they need.
"In a rural place, you may not have access to someone who has gone through additional certification," said Brull, "and by making changes that would require hospices to hire directors who have added certifications, you may eliminate care for patients in those areas."
After slight modifications to the original resolution's language, the Congress adopted a measure asserting that end-of-life care is an integral part of family medicine, and asking the AAFP to oppose any efforts that would prevent family physicians from serving as hospice physicians and medical directors.
The reference committee also heard divergent viewpoints about what, if anything, the AAFP should say about climate change when it considered a resolution calling for the Academy to concur with the "overwhelming majority of current published climate scientists" that human behavior contributes to climate change, as well as support policies that limit and monitor fossil fuel use and production of environmental pollutants. Some delegates argued that the issue was outside the Academy's scope; others contended that it was the Academy's duty to weigh in with the voice of science.
Wayne Strouse, M.D., of Newfield, N.Y., took the latter position: "Sometimes it's necessary for us to stand up and say this is the right thing in areas of public health. Outside of nuclear holocaust, I can't think of anything else that would be more devastating to public health and our patients than climate change."
Montana delegate Dennis Salisbury, M.D., of Butte, took the opposite view: "There are things about which we don't necessarily, as the AAFP, have to speak. And in that way, we allow more diverse inclusion of our members who are doing brave work around the country on behalf of their patients."
Ultimately, delegates noted that AAFP policy dating back to 1969 already recommends strong action to limit and correct pollution and reaffirmed the measure as current policy.
The Congress also adopted resolutions that call on the AAFP to
- continue to combat the negative impact and financial burdens of implementation of ICD-10,
- support the elimination of nuclear weapons, and
- ask the Department of Veterans Affairs to participate in any and all state prescription drug monitoring programs.
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