October 15, 2018, 01:26 pm David Mitchell New Orleans – Delegates to the 2018 Congress of Delegates (COD) took action on a wide range of education-related issues here Oct 8-9.
During Monday's Reference Committee on Education hearing, family physicians discussed resolutions on paid leave for new parents, CME changes meant to encourage precepting and meet other family medicine needs, physician well-being, and more. Delegates voted on those measures the following day.
Delegates considered a resolution that called on the Academy to support a "comprehensive national paid family and medical leave program" that guarantees at least 12 weeks of paid leave following a birth or adoption.
Washington delegate Jonathan Sugarman, M.D., M.P.H., of Seattle, said during the reference committee hearing that one-fourth of women return to work after just two weeks of maternity leave, and that outcomes for mothers and babies would be better with more paid time off.
General registrant Anne Montgomery, M.D., M.B.A., of Indian Wells, Calif., agreed, pointing out that many women stop breastfeeding early because of inadequate leave.
Lalita Abhyankar, M.D., M.H.S., of Brooklyn, N.Y., testifies Oct. 8 during the Reference Committee on Education hearing at the 2018 Congress of Delegates in New Orleans. Abhyankar spoke in support of a resolution that called for the AAFP to increase the number of CME credits physicians can claim for precepting medical students and residents.
"That's not acceptable," she said during the hearing. "It's an investment in our population we need to make."
Others, however, questioned whether employers or government programs would be responsible for covering paid leave and whether small employers should be exempted.
General registrant and solo physician Wayne Strouse, M.D., of Penn Yan, N.Y., said that if either of his two employees missed 12 weeks of work with pay he might have to close his practice. Finding -- and paying -- a short-term replacement in his rural area would be difficult, he added.
The reference committee offered the Congress a substitute resolution with added language that called for the Academy to adopt a policy that would meet the employer standards of the Family and Medical Leave Act, meaning small businesses would be excluded. A subsequent motion to return the resolution to its original wording failed, and the issue was ultimately referred to the Board.
Delegates also adopted, without debate, a revised policy statement that encourages all members to prioritize role modeling and teaching, including "providing clinical preceptorships and shadowing experiences for medical students and premedical students."
However, physicians in the reference committee hearing had a more difficult time agreeing on a resolution that called on the Academy to allow family physicians to increase the amount of CME credit they can report for teaching medical students and physicians. The AAFP allows members to claim 60 CME credits for teaching per three-year cycle. The resolution called for an increase of 15 credits, which would put the Academy in line with American Board of Family Medicine (ABFM) lifelong learning CME requirements.
Kansas alternate delegate Diane Steere, M.D., of Wichita, pushed back on a peer's testimony to the reference committee that suggested the change could "dumb down" CME if some preceptors don't present evidence-based information.
"I'm always learning new things and looking things up for students, so I do think precepting is worth CME," said Steele, who added that as the number of medical students increases, it's becoming harder for schools to find enough preceptors, and that increasing the limit on CME reporting related to education might motivate more physicians to be mentors.
The Congress ultimately agreed with the reference committee's recommendation to refer the issue to the AAFP Board of Directors for further study.
The Congress also followed another recommendation from the reference committee to reject a resolution calling for the Academy to provide CME that could help members meet state opioid prescribing requirements. The reference committee heard considerable testimony for and against the resolution.
Michigan alternate delegate Robert Jackson, M.D., M.M.M., of Allen Park, testified during the reference committee that due to variances in state requirements, chapters likely would be better equipped to meet members' CME needs on this topic, and the Academy might actually be taking a CME opportunity away from chapters by offering its own CME activities.
Director Windel Stracener, M.D., of Richmond, Ind., speaking for the Board of Directors, agreed with that assessment, saying it would be difficult to produce a single CME product that met the requirements of all 50 states.
Delegates did find common ground on two other areas for which members sought more CME. Specifically, the Congress adopted substitute resolutions that asked the Academy to "optimize" CME offerings at AAFP conferences related to women's reproductive health and to health issues linked to climate change.
Delegates also acted on two measures related to physician well-being. Delegates rejected a reference committee recommendation to refer to the Board a resolution that called for the Academy to support the Council of Emergency Medicine Residency Directors' National Physician Suicide Awareness Day and instead adopted the resolution.
Delegates adopted a substitute resolution that calls on the Academy to work with other stakeholders to support and suggest new language for medical board applications that would limit questions about medical and mental impairment solely to current conditions, not past issues.
Utah delegate Kirsten Stoesser, M.D., of Salt Lake City, said such questions don't help improve mental health, and they make physicians less likely to seek care.
In other actions, delegates rejected a resolution that called for the AAFP to develop and implement its own board certification process as an alternative to the ABFM's high-stakes exam by 2020. Testimony was overwhelmingly against the idea. Outgoing Board Chair John Meigs., M.D., of Centreville, Ala., summed up his exasperation with the concept during the reference committee by asking, "Lord have mercy, why?"
Meigs urged delegates to vote against the resolution because, he said, the timeline was impractical, the cost prohibitive and there would be no guarantee employers would accept a new certification.
The following day, the ABFM announced during COD that it will pilot an alternative to its exam during 2019.
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