Delegates to the 2017 Congress of Delegates (COD) here addressed a number of issues, including investigating how to provide the patient's voice to the Board of Directors and how to support employed physicians in their efforts to participate in AAFP leadership activities.
Kansas AFP delegate Gretchen Irwin, M.D., M.B.A., of Wichita, testifies during the Reference Committee on Organization and Finance hearing that a patient's voice should be considered in decisions the AAFP Board of Directors makes.
Patient Voice on the Board
Members who participated in the Reference Committee on Organization and Finance hearing here on Sept. 11 discussed a proposal for the AAFP to investigate a process for representing the voice of the patient to the Board of Directors, eventually adopting the resolution during the following day's business session.
The resolution submitted by the Kansas AFP said this patient representation could occur through several means. Currently, the AAFP gains insight into the patient perspective through its membership in the Patient-Centered Primary Care Collaborative, said the measure's authors. The Academy also hears the patient's voice through a working relationship with the National Partnership for Women and Families, they noted.
- During the 2017 Congress of Delegates in San Antonio, AAFP members who participated in the Sept. 11 Reference Committee on Organization and Finance hearing discussed a proposal to have the AAFP investigate a process for representing the voice of the patient to the Board of Directors; delegates later adopted the resolution.
- A substitute resolution delegates adopted asked the AAFP to create tools that members can use to demonstrate the value of being involved in leadership roles, such as serving in the Congress of Delegates, on the Academy's Board of Directors, and in other national and chapter leadership positions.
- Delegates also adopted measures that called on the AAFP to advocate for legislation for paid sick leave, as well as for that banning the use of so-called reparative therapy aimed at changing a person's sexual orientation or identification.
In fact, the consumer voice is represented in several coalitions in which the AAFP participates, including the National Coalition on Health Care, multiple coalitions on Medicaid and the Children's Health Insurance Program, and other groups focused on specific diseases and public health issues.
However, the authors pointed out, the proposal under consideration focuses solely on bringing the patient's voice directly to the Board of Directors.
Kansas delegate Gretchen Irwin, M.D., M.B.A., of Wichita, testified during the hearing that a Kansas AFP member raised the question of how the patient's voice is considered in decisions the AAFP Board of Directors makes.
"I think we all know that discussions that have a diversity of viewpoints -- where all stakeholders are represented -- are going to be richer and will allow better decision-making from all those involved along the way," she said.
"We should take a deliberate pause in 2017 and ask, 'Where are we hearing the voice of the patient in our discussions?' and 'Are we doing that in the best way possible to make decisions?'"
Fellow Kansas delegate and resolution co-author Jen Brull, M.D., of Plainville, added that there are multiple agencies that assist in identifying and training patients to become effective and efficient board members.
Brull also said that when she joined the Family Medicine for America's Health (FMAHealth) Board, she was skeptical about having a patient advocate included. She had served on previous boards where patient representation proved to be a barrier to efficiency.
"I now am a convert," Brull said. "The patient voices that I've been privileged to serve with on the FMAHealth Board lent a perspective that I never could have brought myself. And it has on more than one occasion changed my mind about what I believed based on that experience."
FMAHealth Board Chair and former AAFP President Glen Stream, M.D., M.B.I., of La Quinta, Calif., seconded Brull's sentiment that patient advocate members really made a difference for that organization and its board.
"You're looking for a public member or a patient advocate member, not somebody with a single disease or issue to bring on the board," he said. "During the tenure of our board, we've had two incredible people who have been willing to commit the time and effort necessary. Like Dr. Brull, this is the first time I've been on a board with a public member and I've found it invaluable in expanding my understanding of the work that we're doing."
Of the eight family medicine sponsoring organizations that participate in FMAHealth, three currently have patient advocate board members and two (not including the AAFP) are in the process of adding them, Stream said.
"There was a time when there wasn't a student voice on the AAFP's Board; then this Congress of Delegates chose to put forward a member representing students. And the same thing subsequently happened for residents and, most recently, for new physicians," Stream said. "The question to this Congress: 'Is it time for a patient to be on our Board of Directors or in some other meaningful way to provide input to the important work that we do -- not just on behalf of our members -- but also for the patients, families and communities we serve?"
Another former AAFP president and leader of FMAHealth's Engagement Tactic Team, Ted Epperly, M.D., of Boise, Idaho, pointed out that a fiscal note is attached to this proposal and said that's why he supported the notion to "investigate the process" of how best to represent the patient's voice.
New Mexico AFP alternate delegate Bridget Lynch, M.D., of Belen, speaks about a resolution asking the Academy to encourage inclusion of education on the Health in All Policies approach at AAFP educational events.
Still, he agreed on the importance of adding a patient advocate to the AAFP's Board of Directors.
"We must do this. If not, I think we fail to advance the agenda of what we're trying to accomplish," Epperly said. "That's making sure we tie our understanding of patient-centeredness, person-centeredness and patient voice into what we do. So, I strongly stand in favor of this resolution. It's time for the Academy to move forward on this and be a role model for it."
Supporting Employed Physicians
Another measure delegates adopted asked the AAFP to create tools members can use to demonstrate the value of involvement in leadership roles, such as serving in the Congress of Delegates, on the Academy's Board of Directors, and in other national and chapter leadership positions.
The original resolution, submitted by the Minnesota AFP, specified that these tools would be particularly useful to the almost 68 percent of Academy members categorized as employed as a means of demonstrating "the value of the AAFP to their employer in a way that the employer would understand."
The resolution's background explained that, for example, although there currently are materials that describe the role of Board members and the time required to serve as a director or an officer, these materials don't explain the value to the employer of having their employees serve in these roles.
Minnesota AFP delegate Julie Anderson, M.D., of Saint Cloud, testified about the resolution she co-authored. She said she explained during the Town Hall meeting on Sept. 10 that a large health care system had purchased her private practice. On top of the employer limiting some physicians' scope of practice, she now had to prove the value of her leadership roles to the employer.
"When I met with my boss to explain what I do at the AAFP as a commission member or foundation trustee or as a delegate here and ask for their support, I was asked for an ROI (return-on-investment) statement," Anderson said. "'What's in it for our organization to have you involved at Academy functions?'"
In short, this led the Minnesota AFP to ask the AAFP to create an employer value statement that would provide messaging family physicians could use to self-advocate with their employers -- to help explain why the employers should back the time member FPs donate and the resources needed to support them in these leadership roles.
"It would also be helpful if it were written in a language that the C-suite anesthesiologist boss of mine could understand," Anderson joked.
Delegates also adopted measures that called on the AAFP to
- advocate for legislation on paid sick leave, as well as for that banning the use of so-called reparative therapy aimed at changing a person's sexual orientation or identification; and
- recognize all Academy chapters on their platinum anniversaries.
Finally, after considerable reference committee testimony and continued discussion during the business session, delegates referred to the Board a resolution that asked the AAFP to add an option for chapters to include political action committee contributions as a checkbox on the AAFP dues invoice.
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