Family medicine residents took Kansas City by storm during the AAFP's recent National Conference of Family Medicine Residents and Medical Students held here July 28-30. And some of those 1,210 residents took part in the important work conducted by the 2016 National Congress of Family Medicine Residents.
Jason Woloski, M.D., of the Milton S. Hershey Medical Center Family Medicine Residency Program in Hershey, Pa., tells a resident reference committee he was surprised to learn that someone in the United States is diagnosed with dementia or Alzheimer's disease every 66 seconds.
Participants wrote, debated and finalized decisions on some 66 resolutions that covered a myriad of issues, such as the health of their patients, residency training sites and health policy education.
Resolutions were discussed at length during reference committee hearings on July 29; those that were adopted the following day by the resident congress will be shepherded through the AAFP's policymaking process for review, referral, and when necessary, additional action by AAFP leaders and the AAFP Congress of Delegates.
Here is a sampling of that work.
Taking Care of Patients
First and foremost, family medicine residents want to provide their patients with good and compassionate care. For instance, Jason Woloski, M.D., of the Milton S. Hershey Medical Center Family Medicine Residency Program in Hershey, Pa., doggedly tackled the tough topic of dementia.
- Family medicine residents debated 66 resolutions -- a new record -- during the 2016 National Congress of Family Medicine Residents.
- Resolutions on patient care included topics such as dementia, contraceptive implant training and OTC contraceptive access without age restriction.
- Residents also worked to protect rural osteopathic training sites and asked for the inclusion of health policy training in curriculum and at Academy conferences.
He authored a resolution calling for the AAFP to work to boost dementia awareness, including creating a task force and a toolkit to aid primary care physicians. In his reference committee testimony, Woloski recounted recent experiences running support groups for the Alzheimer's Association in which people told him they needed more support, more resources and more help from their primary care physicians.
When the reference committee recommended that delegates not adopt the resolution -- citing existing Academy resources on this topic -- Woloski took his case to the floor of the resident congress with an amendment that struck all but one resolved clause and asked the AAFP to advocate for comprehensive dementia research and awareness initiatives.
"Everyone in this room would probably want to live to age 65, and one in nine of us will have Alzheimer's by that age," said Woloski. At the age of 80, "one in five men is going to have some form of dementia," he added.
Britt Gayle, M.D., of the UPMC (University of Pittsburgh Medical Center) McKeesport Family Medicine Residency Program in McKeesport, Pa., stepped to a microphone and added his support. "As family physicians, we often refer to 'cradle to grave' care, and dementia is part of that and should be part of our concern. Not only that, but dementia impacts patients' ability to take care of themselves and it impacts their caregivers," said Gayle. "If family physicians care about our communities and our geriatric patients in our communities, we can support this."
Delegates adopted the amended resolution.
Residents also discussed a resolution that would support contraceptive implant training for family physicians. Co-author Margot Brown, M.D., of the Santa Rosa Family Medicine Residency Program in Santa Rosa, Calif., testified that about half of U.S. pregnancies are unintended and that about 40 percent of women who get pregnant use contraception.
"Long-acting reversible contraception has been cited numerous times as one method that could help reduce unintended pregnancies," said Brown, but its use is underutilized because of a lack of physician training -- both for residents and for physicians trained before the implant came on the market in 2006. Mandatory manufacturer-based training is also a barrier, she added.
Ashlin Mountjoy, M.D., M.P.H., of the Swedish Family Medicine Residency First Hill Program in Seattle, said, "I've heard of multiple providers who actually would like to be able to place these implants and are limited by the availability of the industry-sponsored training."
Amber Robins, M.D., of the University of Rochester/Highland Hospital Family Practice Residency Program in Rochester, N.Y., introduces a resolution on resident wellness. "As we all know, residency is demanding, and we don't take care of ourselves the way we should," she said. Residents adopted one substitute resolution asking the AAFP to continue its work on wellness efforts and another seeking resident access to nutritious food during all clinical shifts.
The residents adopted a substitute resolution that calls for the AAFP to offer hands-on contraception insertion and removal training for residents, provide CME for practicing family physicians, and petition the FDA to eliminate the mandatory industry-sponsored training and replace it with a peer-based training model.
Another resolution asking the AAFP to endorse access to OTC oral contraceptives, without age restriction, generated much debate.
Resolution author Alex M. McDonald, M.D., of the Kaiser Permanente Family Medicine Residency in Fontana, Calif., noted that unintended pregnancy was a major public health problem, especially for teens. "We want these young people to take charge of their lives," he said.
However, Jason Butler, D.O., of the Womack Army Medical Center Department of Family Medicine in Fort Bragg, N.C., cited safety concerns. "We don't know what the dangers are for adolescents who don't have adequate education about these drugs," said Butler. "I agree with increased access, but the way this is written could bring harm," he added.
Jessica MacHue, M.D., of the East Tennessee State University Family Medicine Residency Program in Kingsport, also opposed the resolution. She said OTC availability of these medications precludes having a physician present to answer a young person's questions. "Oral contraceptives are available at the health department where a clinician can seek out the form best for that patient," she argued.
Jeremy Cristol, M.D., of the Christiana Care Health System Family Medicine Residency Program in Wilmington, Del., spoke in support of the measure: "The benefits to getting these people the access they need to avoid an unwanted situation outweigh those risks."
The congress adopted a substitute resolution that asked the AAFP to work with the appropriate entities to ensure that adolescents are included in OTC oral contraceptive studies to determine whether OTC access is appropriate for this population.
Protecting Rural Training Sites
Residents sought to protect vulnerable residency programs with a resolution that addressed the consequences of merging the Accreditation Council for Graduate Medical Education (ACGMA) and the American Osteopathic Association into a single accreditation system by 2020.
Co-author Julie Petersen, D.O., of the Grant Family Medicine Residency Program in Columbus, Ohio, testified that osteopathic programs were reporting logistical and financial barriers in meeting the requirements of the ACGME.
Julie Petersen, D.O., of the Grant Family Medicine Residency Program in Columbus, Ohio, testifies that her resolution presents multiple options for helping osteopathic programs in rural settings deal with the financial burden of the American Osteopathic Association/Accreditation Council for Graduate Medical Education merger.
"The majority of these programs are in rural critical-access hospitals that don't have a lot of the funding that the larger academic centers have," said Petersen. "A lot of the traditional D.O. programs are at risk of closing at this point due to the heavy administrative and financial burden of this transition," she added.
Matthew Varallo, D.O., of the Eisenhower Medical Center Family Medicine Residency in La Quinta, Calif., testified that D.O. residencies often are set in underserved areas. Closing these residencies would be a "huge loss" to many patients in rural towns, said Varallo.
Residents adopted the resolution, which calls for, among other things, protecting the continued viability of traditionally osteopathic family medicine residencies, expanding CMS funding caps on the number of residents, and expanding resources to help guide osteopathic programs through the ACGME requirements.
Health Policy Training
Residents also asked for additional training on health policy. Laura Doan, M.D., of the Kaiser Permanente Los Angeles Family Medicine Residency, co-authored a resolution asking for the incorporation of such education into medical schools and residency programs.
"A lot of my colleagues, myself included, had to seek master's degrees in public health and business to better understand health policy," said Doan. "Now with the ever-changing landscape created by the (Patient Protection and) Affordable Care Act and increased reimbursements for primary care physicians, it's imperative that we as family physicians become well versed on health policy," she added.
Alex M. McDonald, M.D., said he participated in a two-week health policy elective, and the experience changed his life. "I stand here as an individual truly passionate about our health policy system."
Megan Chock, M.D., of the Kaiser Permanente San Diego Family Medicine Residency Program, also co-authored the resolution. "Family physicians have to be aware of the many influencers and aspects of policy in order to advance the health of our patients, our communities and the public as a whole," she testified.
The reference committee ultimately combined language from two resolutions that addressed health policy and training into one substitute resolution adopted by the residents. That resolution asked the AAFP to, among other things, encourage residency programs to support advocacy and policy education, strengthen existing educational materials in this area, develop a curriculum guideline and encourage the ACGME to consider using the AAFP's curriculum guidelines concerning health policy in its accreditation guidelines for family medicine programs.
Residents also voted to ask for resources to help them understand the Medicare Access and CHIP Reauthorization Act (MACRA). Elizabeth Pionk, D.O., of the McLaren Bay Region Family Medicine Residency in Bay City, Mich., co-authored a resolution that asked the AAFP to create resources specifically for medical students and residents -- including lectures at future conferences -- on various aspects of MACRA.
"I think a presentation about MACRA specifically for 2017 would be more than appropriate and get everybody up to speed in addressing these issues. I think not only is it something students and residents don't understand, I think it's something a lot of our attending physicians don't understand," said Pionk.
Related AAFP News Coverage
2016 National Congress of Student Members
Students Seek to Protect Patients, Spotlight Rural Training Options
Storify: 2016 National Conference: Day Three(storify.com)