Academy members weighed in on a diverse range of issues during the 2016 Congress of Delegates here, including resolutions considered by the Education Reference Committee on Sept. 19. When all was said and done, AAFP delegates adopted measures that addressed -- among other things -- professional burnout, student loan repayment and family medicine certification.
Testifying on a resolution about physician burnout during the 2016 AAFP Congress of Delegates, Illinois delegate David Hagan, M.D., of Gibson City, tells the Education Reference Committee, "Every day in this country, a physician commits suicide. We need to do more to help them combat that."
Mitigating Burnout, Promoting Wellness
Reference committee members heard testimony on two different resolutions that focused on burnout among medical students, residents and practicing physicians.
One measure asked the AAFP to explore available resources related to burnout, including a 24-hour hotline, and promote those resources to Academy members. The second sought to increase member awareness of depression, burnout and suicide; tear down barriers physicians, students and residents face when accessing mental health services to deal with these problems; and expand and promote resources that emphasize resilience and mental wellness.
"Every day in this country, a physician commits suicide," Illinois delegate and a resolution co-author David Hagan, M.D., of Gibson City, told committee members. "We need to do more to help them combat that."
- Family physicians considered a wide range of resolutions during the 2016 Congress of Delegates Sept. 19-21.
- Spirited testimony before the Education Reference Committee reflected the complexity and importance of the issues considered.
- Delegates ultimately voted to adopt resolutions dealing with professional burnout, student loan repayment, family medicine certification and other topics.
Hagan recalled a colleague who had floated the idea of a toll-free hotline to connect physicians with a professional specifically trained in physician wellness. "As far as I know, that doesn't exist," he said. "Let this Academy be a leader."
Washington alternate delegate Gregg VandeKieft, M.D., M.A., of Olympia, spoke about his chapter's resolution. Noting that the AAFP "is well ahead of most groups in promoting wellness and recognizing burnout issues," he expressed concern that the measure's provisions would be dismissed as existing policy.
After all, VandeKieft pointed out, "We've got a separate page on the AAFP website on resiliency."
However, he added, "It turns out, that's mostly descriptive. It talks a lot about burnout, but there's very little that's proactive."
The AAFP should do more to stave off the problem before it takes hold, VandeKieft said. "When you talk to the people who are experts in burnout -- when a person reaches the point of burnout, recovery is difficult and uncommon. Let's get out in front of it."
Even the way one approaches a colleague who is experiencing depression or burnout can help or harm that individual's chances of achieving wellness, said Maine alternate delegate Jessica Richmond, M.D., of Milo. Recounting experiences from her own institution, she warned against placing blame "or a requirement that you save yourself" on the person struggling with these issues.
Other speakers took the discussion in another direction, railing against various causes of burnout, such as the "15-minute treadmill" and the demands posed by electronic health records.
Maine alternate delegate Jessica Richmond, M.D., of Milo, tells reference committee members that it's essential to avoid placing blame "or a requirement that you save yourself" on a colleague struggling with depression or burnout.
In its report, the reference committee acknowledged the fact that the Academy has identified the issue of burnout as a top strategic priority and launched a comprehensive initiative to tackle it head-on. Still, committee members recommended adoption of a substitute measure combining most elements of the two original resolutions, plus a request that the AAFP continue dialogue with the Federation of State Medical Boards (FSMB) to reduce the stigma of and barriers to seeking mental health care. Delegates adopted that substitute in their Sept. 20 business session.
Loan Repayment for FP Faculty
Relieving the burden of student debt is a perennial issue for the Congress of Delegates, and this year was no different. Three different resolutions addressed loan forgiveness strategies that would benefit family physicians who serve as faculty for future FPs, especially in medically underserved areas. The reference committee offered a substitute resolution that combined the sense of all three measures.
First up to the mic was Georgia alternate delegate Harry Strothers III, M.D., of East Point. He pointed to background information for one of the measures that references a Health Resources and Services Administration program that awards teaching grants to the tune of $40,000 for a two-year commitment.
"The problem," said Strothers, "is that they actually funded 19 out of 143 applications, and a lot of schools don't even recommend that people apply for them because that gets up the hopes of your junior faculty, and then they get dashed because -- 19 out of 143? In the whole country?"
As a department chair at Mercer University School of Medicine, he's well aware of this shortfall. "While the income of family physicians has increased rapidly in the last couple of years, especially for new graduates, the academic institutions have not been able to keep up with that increase," said Strothers. As a result, he's lost faculty members to "large integrated health systems."
"So we need some help recruiting and retaining our faculty," Strothers concluded.
Speaking on behalf of the Resident/Student Caucus, Elizabeth McIntosh, of Cortland, N.Y., observed that when it comes to sealing the deal among students considering a career in primary care, it's not so much about a specialty's prestige or importance as it is about retiring student debt load.
"If we want to change the workforce, a large part of that is to look at the numbers and how we can do loan repayment to help encourage students who are interested in primary care to keep going in that direction," said McIntosh.
West Virginia alternate delegate Kimberly Becher, M.D., of Clendenin, agreed that money looms large in the decision-making process about what specialty to choose and what career opportunities to pursue within that specialty. She applauded the frank talk about compensation and called for more transparency in discussing those numbers.
"I'm in a rural area; I make $30,000 more than anybody who's on faculty at the residency programs," said Becher.
She then recounted the persistent message she's heard from AAFP candidates and Board members: "Pipeline is everything."
"Well, we don't have a pipeline if we don't have people teaching who like what they're doing," said Becher.
Delegates also adopted a measure calling for the Academy to work with groups such as the Society of Teachers of Family Medicine to "study the feasibility of pursuing legislation to allow family medicine faculty, both volunteer and employed, to qualify for loan repayment programs."
Modifications to Certification Process
Another enduring issue -- family medicine certification -- sparked considerable testimony during the reference committee hearing and drew further discussion in the following day's business session.
The reference committee recommended rejecting the first of two resolutions on the topic, and delegates agreed. That measure reflected concerns about the PRIME Registry, a population health and performance improvement tool introduced by the American Board of Family Medicine (ABFM) to collect physician and patient data.
The second resolution covered far more territory, calling first for an "immediate end to the ABFM's mandatory high-stakes recertifying examination." The measure also asked the AAFP to impress upon the ABFM the need to make "immediate changes" to the maintenance of certification process and to ease the requirements for re-entry into the certification pathway for FPs whose certification has lapsed. Finally, the resolution asked the Academy to work with the American Board of Medical Specialties to ensure no barriers would stand in the way of accomplishing the other goals.
Texas delegation member Amer Shakil, M.D., M.B.A., of Dallas, says the family medicine certification process is itself a source of burnout. He questioned the value of the standardized cognitive exam, in particular.
"We all get colleagues who have fallen off the wagon," said Mississippi alternate delegate Susan Chiarito, M.D., of Vicksburg, an author of the second resolution, "and they're not going to get back on, because the onerous and costly process to get board-certified again is insurmountable for many -- especially if you're self-employed."
According to Texas delegation member Amer Shakil, M.D., M.B.A., of Dallas, the recertification process itself is a source of burnout. He questioned the value of the standardized exam, in particular.
"I've taken it three times," Shakil testified. "I think I've learned from the modules, the CME and the articles, but not from the one-day exam."
In his reference committee testimony, Texas alternate delegate Douglas Curran, M.D., of Athens, shared Shakil's skepticism about the exam's value as a learning tool.
"If you look at your board scores -- I don't know if any of you do that -- mine have consistently gone down," he said. "But I think my clinical ability has consistently gone up."
Still, Curran and others voiced concerns about the unintended consequences that could result from eliminating the exam -- let alone the entire certification process -- outright.
"I think we need to assess where we are and where we're going, and how we're going to do this," he said. "The worst thing we can do is just throw it all away; we don't want to do that. We want to figure out new ways to learn and encourage innovation."
In its report to delegates, the reference committee offered a substitute resolution that removed the resolved calling for elimination of the cognitive exam -- which incited more passionate discussion on the floor of the Congress. Ultimately, however, delegates went along with the committee's recommendation, adopting the stripped-down substitute measure with only minor edits.
Delegates also adopted resolutions that asked the AAFP to
- develop and disseminate materials aimed at high-school and college students -- in addition to medical students -- that highlight the breadth and depth of family medicine,
- encourage residencies to offer point-of-care ultrasound training and offer CME and other learning sessions on this topic at Academy meetings, and
- promote training licensure reciprocity to the FSMB.
Related AAFP News Coverage
2016 Congress of Delegates
Family Physicians Focus on Tough Patient Care Issues
2016 Congress of Delegates: Day One(storify.com)