A throng of family medicine residents -- 1,147, to be precise -- traveled to the AAFP's National Conference of Family Medicine Residents and Medical Students held here July 27-29. Many of these residents wrote and discussed resolutions on patient care, advocacy and residents' needs as participants in the 2017 National Congress of Family Medicine Residents.
Chetan Patel, M.D., of the Columbus Regional Medical Center in Columbus, Ga., tells a resident reference committee that residents and students need personal finance training to ensure they have a solid personal financial foundation.
During reference committee hearings on July 28, residents spoke their minds on nearly 30 resolutions, and then delegates voted on which of these measures to adopt the following day in the resident congress.
Adopted resolutions will work their way through the AAFP's policymaking process, where they will be reviewed and referred, when applicable, for further action by AAFP leaders and the AAFP Congress of Delegates.
Take a look at some of what this group accomplished in just three days.
Acknowledging Residents' Needs
Family medicine residents are passionate about their patients, but they also recognize that they must protect their own health and well-being even as they care for others.
With that in mind, Scott Hippe, M.D., of the Family Medicine Residency of Idaho in Boise, co-authored a resolution asking the AAFP to implement an objective assessment of resident burnout. He noted in testimony that there is an increased focus on physician wellness, as well as on how burnout affects residents' quality of life and patient care.
- Participants in the 2017 National Congress of Family Medicine Residents debated nearly 30 resolutions on a variety of issues.
- Residents voted on topics related to physician well-being and burnout, personal finance education, patient advocacy, health care as a human right, and more.
- Adopted resolutions will work their way through the AAFP's policymaking process where they will be reviewed and referred, when applicable, for further action by AAFP leaders and the AAFP Congress of Delegates.
"It's important to measure levels of burnout and wellness and come up with objective ways to know which residency programs are doing that well and which ones are not," he said.
Stephanie Arnold, M.D., of the Columbia Presbyterian Family Medicine Residency Program in New York, N.Y., brought nods of agreement from her colleagues with her reference committee testimony.
"The increased awareness about burnout is fantastic, but unfortunately, I think many of us find ourselves sitting through lecture time devoted to discussing burnout as a cure for burnout, and it does not really feel restorative or rejuvenating."
The resident congress ultimately adopted a substitute resolution that asks the AAFP to work with the Accreditation Council for Graduate Medical Education to develop objective measures to quantify resident physician burnout.
Chetan Patel, M.D., of the Columbus Regional Medical Center in Columbus, Ga., authored a resolution on a topic that causes many residents a good deal of stress: personal finance.
"Newly minted physicians are trying to learn more about financial planning," said Patel. Unfortunately, personal financial issues such as budgeting, insurance, tax planning and retirement planning are not adequately addressed in medical school or residency, he said.
Patel asked the AAFP to include an educational session on personal finance at future National Conferences, which would be taught by a certified financial planner who does not receive commission payments for selling financial products.
The resident congress adopted the measure.
Vivian Jiang, M.D., of the University of Rochester Family Medicine Residency in Rochester, N.Y., introduced a resolution asking the AAFP to improve feedback on actions taken regarding resolutions presented by residents and students.
"This is basically about people who write resolutions and don't know what happened to them," said Jiang. "We want to keep those leaders engaged and let them know that they do actually have a voice when they speak up."
Kaci Larsen, M.D., of the University of Missouri-Columbia Family Medicine Residency, described participation at the resident and student congresses as learning opportunities.
"Providing some feedback to the future leaders of family medicine would be beneficial," said Larsen. Specifically, residents and students could learn how to write clear and succinct resolutions now before they become "the real leaders of the Academy."
Mansi Shah, M.D., of the Duke Community and Family Medicine Residency in Durham, N.C., tells a resident reference committee that food insecurity "contributes to a number of diseases."
The congress adopted a substitute resolution asking the AAFP to explore the development of an online resource summarizing downstream actions related to adopted resolutions from the student and resident congresses.
Advocating for Patients
Residents understand that sometimes they need to fight for their patients' most basic needs.
Mansi Shah, M.D., of the Duke Community and Family Medicine Residency in Durham, N.C., co-authored a resolution on screening, intervening and advocating on behalf of patients to address food insecurity.
Jonathan Jimenez, M.D., a co-author who also is from the Duke program, pointed to mounting evidence that shows "food insecurity affects disease and nutrition, and as family doctors, it is our role to advocate for our patients."
Raman Nohria, M.D., of the Lawrence Family Medicine Residency Program in Lawrence, Mass., testified that his site, a federally qualified health center, screened 1,500 patients and found a 66 percent positive screening rate for food insecurity.
"We partner with a Boston food bank to serve 1,000 families and more than 100,000 pounds of food. If adopted nationally, this could be a great benefit," said Nohria.
The resident congress adopted a substitute resolution that calls on the AAFP to
- support efforts to screen patients for food insecurity and connect patients to federal nutrition programs,
- create a policy that supports a strong national nutrition safety net by defending federal nutrition programs from structural changes and budget cuts, and
- educate members about food insecurity.
In another resolution, residents asked the AAFP to collaborate with other organizations to develop resources to help family physicians become community advocates and collaborators for public health.
Co-author Courtney Pilkerton, M.D., Ph.D., of the West Virginia University Family Medicine Residency in Morgantown, said, "Health is more than what happens in the clinic and patient care. There's been a strong movement to integrate family physicians into public health."
Health is more than what happens in the clinic and patient care. There's been a strong movement to integrate family physicians into public health.
— Courtney Pilkerton, M.D., Ph.D.
She noted the AAFP's support for the movement but said there's not a lot of "practical guidance" available.
"Family physicians need targeted information on how we can become advocates in our own communities -- and in communities in rural areas where we are the public health professional as well as the family physician," said Pilkerton.
Delegates adopted the resolution.
The residents also tackled the topic of health care as a human right. Resolution co-author Kyle Leggott, M.D., of the University of Colorado Family Medicine Residency Program in Aurora, said considering health care to be a human right "is an ethos change" and a new way to think about health care.
"This is an opportunity for the AAFP to lead both professional organizations and patients to change the way we think about national health care reform," he added.
Delegates adopted a substitute measure asking the AAFP to recognize health care as a basic human right, rather than a privilege, for every person.
Keeping Patients Safe
Family medicine residents introduced several resolutions aimed at keeping their patients safe.
For instance, David Kennedy, M.D., of the Swedish Family Medicine First Hill Residency Program in Seattle, fought hard for a resolution he authored that addresses harm-reduction strategies to prevent opioid overdose-related events.
Kennedy provided testimony about experiences at his public health clinic in downtown Seattle, where he sees homeless and uninsured patients, as well as patients on Medicaid.
"We see a lot of mental illnesses and substance abuse. We're blessed to have a robust policy when it comes to chronic opioid dependency and management," including a needle exchange program and a Suboxone (naloxone and buprenorphine) maintenance program, said Kennedy.
David Kennedy, M.D., of the Swedish Family Medicine Residency First Hill Program in Seattle, testifies that "any day patients are not injecting or using heroin, and are instead taking Suboxone, is a day they have reduced their risk of any kind of injection-related harm."
He acknowledged there was a scarcity of data to prove the success of such programs, "but hopefully, eventually when the data bears results, we can be leaders on this front in advocating for these types of programs."
When the reference committee recommended that the resolution not be adopted, Kennedy took up his cause in the resident congress and brought the resolution back to life by striking the original resolved clause and writing a new one.
Kennedy got support in the congress from colleagues such as Jessica Malachowski, M.D., M.S.P.H., of the Baptist Health Madisonville Family Medicine Residency Program in Madisonville, Ky. "There is lots of concern in my area; this would be beneficial to Kentucky," she said.
The amended resolution the congress adopted asks the AAFP to partner with and support the AMA in developing harm-reduction strategies, including safe injection facilities.
Residents also took up federal funding cuts to reproductive health programs.
Author Yakira Teitel, M.D., of the San Francisco General Hospital Family and Community Medicine Residency Program, told the reference committee that HHS recently cut $213 million in funding for family planning and reproductive health education -- and in the middle of a five-year grant cycle, at that.
The cuts, said Teitel, "affect 81 programs across the country that are doing evidence-based research and program implementation and evaluation around preventing teen pregnancy. At the same time, HHS is increasing funding for abstinence-only education."
Astrud Villareal, M.D., of the University of Texas Southwestern Medical Center Residency Program in Dallas, offered her support.
"Data show that states with abstinence-only sex education have the highest rates of teen pregnancy, and that's even after controlling for socioeconomic status, teen educational attainment and ethnic composition," she said. "On the contrary, teens who receive comprehensive sex education were 60 percent less likely to get pregnant or to get someone pregnant."
The resident congress adopted a resolution asking the AAFP to issue a statement in support of reproductive health access and education programs and against cuts to such programs.
The congress adopted numerous other measures, including resolutions
- supporting legislation aimed at reducing adverse childhood experiences,
- advocating against all-terrain vehicle use in children ages 12 and younger,
- supporting the safety of personal care products,
- creating an AAFP minority pipeline program,
- connecting international students with AAFP chapters and
- encouraging holistic selection of family medicine residency applicants.
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