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Wednesday Jun 05, 2019

FPs Steer the AAFP With Plenty of Ways to Influence Course

Governance of an organization as big as ours can be messy. Since becoming AAFP president last fall, I have read many of your letters and comments, and I have noted a lot of confusion regarding how the Academy deliberates over and creates its policy and decisions. I have reached out to many of our members personally, but I would like to use this platform to more broadly review how policy and strategic objectives are set within the AAFP.

Family physicians at the 2018 Congress of Delegates in New Orleans consider proposals that aim to improve family medicine for their fellow FPs.

The AAFP has been very effective at creating policy that has moved our objectives forward. In part, this is the result of the values that family physicians share regardless of our practice style or location. I have also noted that the deliberations of our Congress of Delegates are an excellent bellwether of societal trends. This is not surprising, given that family physicians live and practice in every region and nearly every community in the country. We listen to our patients. We are professional problem-solvers.

First, let me assure you all that our top priorities are reducing administrative burden and increasing family physician income. These efforts occupy the majority of our advocacy resources both in our Washington, D.C., office and in our efforts with the AMA.

We are facing many challenges, not the least of which is a broken health care system that does not prioritize primary care, burdens physicians with misguided documentation requirements, and is saddled with unsustainable and increasing costs. Those brave enough to seek solutions do so in the face of competing interests and a unlevel playing field.

The question, then, is how do we, as a national organization with a diverse membership, respond to controversial issues? Individually, we may have coherent, consistent and deeply held beliefs, yet across the entire membership, these often yield irreconcilably different judgments about what is ethically permissible in the care of our patients and what will work for the future of health care.

The AAFP is a member-run organization and its policymaking body is the Congress of Delegates. The delegates elect the Board of Directors, the president-elect, the speaker and the vice speaker, as well as set Academy policy.

Each chapter chooses two delegates and alternate delegates for COD in accordance with each organization's individual bylaws. All told, there are 122 delegates, and they encompass nearly every practice style and viewpoint. There is representation from direct primary care, independent small-practice physicians, employed physicians and academic physicians. It is up to the chapters to choose which family physicians will represent their state or territory. This highlights the importance of being involved at the chapter level and of reviewing resolutions before the COD.

In addition, medical students and residents are represented in the Congress by two delegates and two alternate delegates who are elected during the National Conference of Family Medicine Residents and Medical Students and confirmed by the Board of Directors. Two new physician delegates and two alternate delegates are chosen during the National Conference of Constituency Leaders, as are six delegates and six alternate delegates representing the following constituency groups: women; minorities; international medical graduates; and physicians who identify as LGBT or who support LGBT issues.

Resolutions passed by the COD become policies of the AAFP and are sent to the Board of Directors for implementation. Those resolutions also may be referred by the Board to the commissions, along with items needing more study, to ensure that the voice of the members carries powerfully in deliberations and in deployment of AAFP policies.

There are additional ways of influencing AAFP policy. Board members attend chapter meetings, the National Conference of Constituency Leaders, the Annual Chapter Leader Forum, and the National Conference of Family Medicine Residents and Medical Students. Both NCCL and the student and resident conference have their own business sessions similar to those of the COD, and the Board pays close attention to their voices and concerns.

In addition, the Academy's Member Interest Groups are focused on more than a dozen different aspects of family medicine. These groups not only provide family physicians with an opportunity to connect with their peers who have similar interests, but also allow members to deliver a unified message to AAFP leadership on specific issues.

My role as president is to represent the Academy in advocating for policies approved by the Congress of Delegates. Although I am informed by my 25 years of experience in a small, independent clinic where I practice full-scope family medicine in rural Alaska, I rely on the policies that have been approved by our Congress to guide my actions.

There are a lot of moving parts in governance and policymaking for a 134,600-member organization. I assure you that the Board and our excellent senior staff pay close attention to the various forums and needs expressed by you, our constituency. I have faith that, as long as we meet and discuss ideas using evidence and avoiding hyperbole and personal attacks, we will arrive at the best course of action for our specialty and our nation.

This does not mean we will always agree, but there is no group in this country better able to identify the best course of action for fixing our broken health care system. Despite our differences, we have a commonality of experience and a willingness to listen that is evident by the decisions made by the Congress of Delegates. I look forward to our discussions this fall.

John Cullen, M.D., is president of the AAFP.

Posted at 01:21PM Jun 05, 2019 by John Cullen, M.D.

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