Family medicine residents want to take good care of their patients, and many have a particular passion for the most vulnerable patients in their communities. That message was a predominant theme voiced by physicians during the 2015 National Congress of Family Medicine Residents.
Lane Aiena, M.D., tells his colleagues that federal funding for teaching health centers is vitally important to patients. "I know a lot of people serve the underserved and do good work --- but a lot of the people we see, no one else is willing to see."
The congress convened in conjunction with the larger National Conference of Family Medicine Residents and Medical Students held here July 30-Aug. 1.
A total of 38 resolutions were presented for discussion during reference committee hearings on July 31. Those that were adopted by the resident congress the following day will move through the AAFP's policymaking channels for review, referral and, when appropriate, further action by AAFP leaders and the AAFP Congress of Delegates.
Fighting for Teaching Health Center Funding
Some of the most passionate debate centered on a resolution that called for expansion of teaching health center funding. Jessica Reader, M.D., of the McGaw Medical Center of Northwestern University Program in Chicago authored the resolution.
She noted that teaching health centers recently received a two-year extension of federal funding based on the success of existing pilot programs. "But unfortunately, (the legislation)(www.congress.gov) as written is at a lower amount per resident given that there now are over 60 programs that are utilizing this funding," said Reader. "Death of the teaching health center would be tragic."
- Family medicine residents gathered in Kansas City, Mo., recently to debate and vote on issues of importance to their medical training, their patients, their communities and their specialty.
- Funding for teaching health centers drew passionate debate from a number of residents, as did clinical issues such as mandatory drug testing of pregnant women and support for postpartum intrauterine device placement to prevent subsequent unwanted pregnancies.
- Residents also voted to adopt resolutions on issues such as nutrition education, bullying, training in the use of naloxone and climate change.
Lane Aiena, M.D., of the Conroe Medical Education Foundation Family Medicine Residency Program in Conroe, Texas, described his program as a federally qualified health center. "One of the best things I heard when I was interviewing was, 'We see patients no one else will see,'" said Aiena. He described a patient who presented at the clinic with a large diabetic foot wound and who'd been turned away from other clinics because she was uninsured.
She became one of the clinic's many success stories.
"There are very few investments where you get an immediate bang for your buck," said Aiena. "This is a slam dunk: For $50,000 -- we saved someone's foot."
Sreela Namboodiri, M.D., also of the McGaw program in Chicago, noted that the majority of residents who graduate from teaching health center programs continue to work in underserved areas. "We shouldn't accept thinning out of money," she said.
William Martin, M.D., of the Lawrence Family Medicine Residency in Lawrence, Mass., said, "We were one of the first teaching health centers started in 1994 … and there were no other forms of medical care available in the city of Lawrence." Now, nearly 12 years later, the community is no longer considered an underserved area. "So many of the providers that trained in our teaching health center stayed in the area and continue to provide care for our underserved patients," said Martin.
Residents ultimately adopted an amended substitute resolution that asked the Academy to advocate for the expansion of teaching health center funding and for a permanent stream of such funding.
Addressing Resident Burnout
A resolution addressing burnout during medical training also hit a nerve with residents -- so much so that they overturned the reference committee recommendation against adoption.
The resolution specifically asked the AAFP to address a "culture of dehumanization within medical training" and to work with medical educators to encourage modeling of positive behaviors and attitudes to help prevent trainee burnout.
Chetan Patel, M.D., testifies in favor of a resolution that asks the Academy to increase its leadership training pipeline to include specific programming for underrepresented populations. "We're missing out on a lot of folks who have a lot of things to offer because they're not sure where they fit in," said Patel. The residents adopted a substitute resolution on the issue.
Douglas Borst, M.D., of Kootenai Clinic Family Medicine Coeur d'Alene Residency in Idaho, one of five co-authors of the resolution, testified that the development of mentorships at residencies was one avenue to pursue. Borst acknowledged that solving the burnout issue would take time. "But I think that this is a discussion that is relevant to the current time and is worth having and is worth having at the AAFP."
Chetan Patel, M.D., of the Columbus Family Medicine Residency in Columbus, Ga., testified that residency programs needed to help residents reconnect with the passion that led them to medicine in the first place.
Looking Out for Patients' Health and Welfare
Residents' keen interest in their patient's health and welfare was evident in a number of resolutions. For instance, residents voted to adopt a substitute resolution that asked the AAFP to support both postpartum intrauterine device placement before hospital discharge and insurance coverage for the procedure.
Kaitlin Hollander, M.D., of the Contra Costa Regional Medical Center Family Medicine Residency in Martinez, Calif., co-author of one of two combined resolutions, said her patients needed postpartum devices placed "very immediately" after delivery and that family physicians needed specific training in how to do so.
"Many women we see are uninsured except when pregnant, so if we don't place long-acting contraceptives soon after delivering, they get pregnant again very soon," said Hollander.
Exploring New Practice Models
Three separate resolutions related to an emerging practice model called direct primary care (DPC) were adopted by the 2015 National Congress of Family Medicine Residents.
Charles Willnauer, M.D., M.B.A., of the Texas Tech Family and Community Medicine Residency Program in Lubbock, co-authored all three.
One resolution asked the AAFP to create an online list of physicians working in DPC clinics who would welcome residents and students in on-site training rotations.
Another resolution asked the AAFP to create a specific category on its Career Link(www.aafpcareerlink.org) Web page dedicated to DPC job opportunities.
And a third resolution urged the AAFP to continue to offer presentations at the AAFP National Conference of Family Medicine Residents and Medical Students about alternative practice models. Willnaur testified that it was important for future family physicians to understand all of their options. "Direct primary care is just one example -- I would love to see others," said Willnauer. "Happy physicians make happy patients."
The residents also voted to adopt a substitute resolution that asked the AAFP to oppose any legislation that would require physicians to perform mandatory drug testing on pregnant women. A second resolved clause went even further, asking the AAFP to adopt a policy against such testing.
Valerie Ebel, M.D., of the Santa Rosa Family Medicine Residency Program in Santa Rosa, Calif., was one of the resolution's co-authors. "A number of states have legislation that criminalizes women for substance abuse while pregnant, and 18 states consider it child abuse … but this is a public health issue," Ebel testified.
Natalie Hinchcliffe, D.O., of the Mount Sinai Beth Israel Residency in Urban Family Medicine in New York, N.Y., said she couldn't imagine meeting a patient for the first time and saying, "I have to drug-test you at some point in your pregnancy."
"We're not saying, 'Never drug-test a woman,' but it shouldn't be mandatory for every single woman," added Hinchcliffe.
Residents also adopted a resolution calling for the Academy to explore clinical tools that physicians could use to assess patients' social determinants of health.
Kresta Antillon, M.D., of the University of New Mexico Family Medicine Residency in Albuquerque said residents were well aware of the extent to which social factors affected their patients' health.
Physicians need to be able to identify these patients and their "unique social determinants" to properly refer them to community health workers, Antillon noted.
Tending to Other Business
The resident congress adopted a number of other resolutions and substitute resolutions that touched on a variety of issues. For instance, members asked the AAFP to
- investigate and implement strategies that would increase the adoption of comprehensive nutrition education by family medicine residencies,
- look for evidence-based screening tools to help deal with the issue of bullying,
- create a student liaison position to the Latino Medical Student Association,
- support physician access to and training in the use of naloxone,
- develop a standardized physical exam form for group home residents,
- promote transparency in medical education and access to training in settings affiliated with religious health care organizations, and
- support climate change mitigation and adaptation strategies.
Related AAFP News Coverage
Health is Primary Session Energizes Residents, Students
Panelists Discuss Variety of Opportunities Family Medicine Provides
Storify: National Conference: Day One(storify.com)