October 02, 2019 08:37 am Chris Crawford Philadelphia –Delegates to the 2019 Congress of Delegates here addressed a number of education-related issues, including the pros and cons of the American Board of Family Medicine's Family Medicine Certification Longitudinal Assessment; the desire for more CME on health care systems, economics and policy; and how to best approach issues with family medicine residencies.
Family physicians who participated in the Reference Committee on Education hearing on Sept. 23 discussed a resolution that said the ABFM FMCLA was inconsistent with the American Board of Medical Specialties' Continuing Board Certification: Vision for the Future Commission's Final Report.
Based on testimony from the hearing, the reference committee had recommended not adopting the measure, but it was extracted and amended during the business session Sept. 24, and delegates ultimately adopted it as amended.
The amended version called on the AAFP to express its concern that the ABFM's FMCLA is the only alternative to the one-day certification exam and asked that the Academy urge the ABFM to offer a longitudinal self-assessment process (similar to that used by the American Board of Obstetrics and Gynecology) and that this process satisfy the cognitive component of ABFM's continuing certification requirement.
Alex Mroszczyk-McDonald, M.D., of Claremont, Calif, a new physician constituency alternate delegate, opened the testimony. "There is an intangible aspect to having children at Academy meetings," he said. "It creates a more relaxed atmosphere, improves physician wellness and helps remind us why we're involved."
Family physicians who participated in the 2019 Congress of Delegates Reference Committee on Education hearing on Sept. 23 discussed a resolution about the American Board of Family Medicine's Family Medicine Certification Longitudinal Assessment.
Delegates also debated two resolutions that addressed family medicine residency closures and shortages, respectively; both were ultimately referred to the Board.
Another pair of resolutions submitted by the Colorado, New York and Utah chapters that were referred to the Board suggested adding a CME category for "health care systems, economics and policy."
Two resolutions that delegates referred to the Board addressed family medicine residency closures and shortages, respectively.
First, a resolution submitted by the Colorado chapter charged the AAFP with, among other things, requesting that the ABFM expand and alter its definition of "hardship" to create a new hardship category that defines a residency program hardship as the period of time before closure is formally announced during which a program experiences significant decrements in financial, faculty or educational support, requiring advanced planning for residents in their second or third year of training.
Additionally, the resolution asked the Academy to work with the ABFM to allow a waiver of continuity requirement for residents under the newly created hardship category and create a resource within the AAFP or ABFM to assist residents who find themselves involved in a program closure.
Colorado AFP delegate Brian Bacak, M.D., of Highlands Ranch, testified that while he was serving on the Colorado AFP's Education Committee, the group dealt with a residency closure in the state.
"This resolution is trying to address the period of time before a residency closure is actually announced," he said. "In residency programs where the resources are being slowly strangled through the gradual withdrawal of community preceptorships, educational funding and poor teaching elements, residents often have no recourse. You can see this happening usually long before the institution or sponsor organization announces a closure."
Bacak testified that residents he spoke with about this issue said they wanted an opportunity to discuss their future. "They want to be able to network with programs that might be able to assist them," he explained. "But for peace of mind, they need to fall under some sort of ABFM waiver that would allow them to transfer programs."
ABFM President and CEO Warren Newton, M.D., M.P.H., testified that the organization is typically involved in one to three residency closure cases a year.
"We are committed to working with individual residents," he said. "From year to year, we typically extend hardships in these cases. And we have a full-time employee who is available to help with these residents along with Elizabeth Baxley and myself.
"We believe the spirit of this resolution is already being met," Newton continued. "But it is absolutely critical that we know well in advance and as it is happening about these situations. The faster we know, the better."
Finally, AAFP Director James Ellzy, M.D., of Washington, D.C., spoke on behalf of the Board, stating that the Academy has good relationships with the ABFM and the Accreditation Council for Graduate Medical Education and has worked closely with these organizations as residencies have closed during the past three or four years.
"The Board believes that this is a big issue that needs more study and broader solutions than the specific asks in the resolve clauses," he said.
Another resolution the Utah chapter submitted that delegates referred to the Board suggested financial incentives might encourage graduating medical students to choose residencies in family medicine and remain in primary care practice.
Utah AFP delegate Kirsten Stoesser, M.D., of Salt Lake City, pointed to the severe shortage of primary care physicians in the United States, especially in rural areas.
In response to that, she said, the AAFP has taken a leading role in an initiative that has the ambitious goal of having 25% of U.S. medical school graduates join family medicine residencies by 2030; an aligned goal is to expand the number of family residency positions to 10,000.
"Within 10 years, we're calling to more than double the number of U.S. medical school graduates going into family medicine and more than double the current number of family medicine residency slots, while at the same time facing a decline in the number of M.D. seniors" who matched into family medicine residencies last year, Stoesser said.
To better incentivize graduating medical students to choose family medicine, she said the chapter's resolution suggested more dramatic measures.
"Our resolution focuses on providing financial incentives to ease student debt for those who go into primary care and family medicine and further reward those who go into practice in rural and underserved areas," Stoesser said, including through tax incentives.
LaTasha Seliby Perkins, M.D., of Arlington, Va., who was finishing her term as the AAFP's new physician Board member, testified that the Board thinks the issues raised in the resolution are important and need further study given the local complexities involved.
A final pair of resolutions delegates referred to the Board were submitted by the Colorado, New York and Utah chapters and addressed adding an explicit CME category for "health care systems, economics and policy."
The resolutions' authors argued that the intent was to help facilitate the development of online educational materials, CME lectures at AAFP conferences and other educational platforms to cover these undertaught subjects.
Ellzy, again speaking for the Board, testified that the Board agreed that it didn't see these topics fitting into current CME categories.
"The AAFP is currently revising our CME categories as the ABFM is reviewing its blueprint, as well," he said.