Physicians-in-training got a boost from the AAFP during this year's Annual Meeting of the AMA House of Delegates June 8-12 as they sought to ensure that their instructors are able to devote adequate time to teaching duties.
During a reference committee hearing at the annual meeting of the AMA House of Delegates, AAFP President-elect Gary LeRoy, M.D., testifies about the need to protect the clinical learning environment by ensuring that residency faculty members aren't required to engage in patient care at the expense of their teaching duties.
During the June 9 hearing of Reference Committee C (Medical Education), emergency medicine physician Scott Pasichow, M.D., M.P.H., testified on a resolution submitted by the AMA Resident and Fellow Section that calls for the AMA to work with the Accreditation Council for Graduate Medical Education and other relevant stakeholders "to amend the ACGME Common Program Requirements(www.acgme.org) to allow flexibility in the specialty-specific ACGME program requirements enabling specialties to require salary reimbursement or 'protected time' for resident and fellow education by 'core faculty,' program directors and assistant/associate program directors."
Pasichow, the newly elected speaker of the RFS and author of the resolution, said in his testimony that although the ACGME had taken "a great step in creating more uniform standards across residency programs in a number of places" in the amended Common Program Requirements released earlier this year that are set to take effect on July 1, "when it came to faculty protected time -- core faculty, specifically -- they, however, drew a line."
"(Program directors) and (assistant program directors) would have protected time; core faculty would not," he explained.
- Physicians-in-training got help from the AAFP delegation to the AMA House of Delegates in their efforts to ensure that instructors can devote adequate time to teaching.
- A resolution from the AMA Resident and Fellow Section asked the AMA to work with the Accreditation Council for Graduate Medical Education to allow "protected time" for core faculty members to engage in educational activities.
- AAFP President-elect Gary LeRoy, M.D., testified in support of the measure, noting that the Academy also has taken up this issue with the ACGME.
The emergency medicine community has tried to address this issue, said Pasichow, meeting with ACGME representatives about creating an allowance that would pertain to core residency teaching faculty for emergency medicine programs but would not force other specialty programs to follow suit.
American College of Physicians delegate Nathaniel Nolan, M.D., spoke in support of the measure, testifying that the ACP has policy on this issue that states that "GME funding should be transparent and appropriately allocated to support the educational mission of the institution."
"So, we believe that physician educators should be compensated fairly for the work that they're doing educating our next generation of physicians," he said.
But another ACP delegate, Lynne Kirk, M.D., had a word of caution for the measure's proponents. Explaining that she had recently completed a term on the ACGME Board of Directors, Kirk warned against attempting to dictate specific ways to address the situation. Rather, she said, "I would urge this resolution to really focus on the outcome, which I think is appropriate support for faculty teaching residents and fellows, and less on the process of how the ACGME should do it.
"I think that will give much more flexibility and make it much more likely that that goal can be achieved," she said.
AAFP President-elect Gary LeRoy, M.D., of Dayton, Ohio, was next up to the mic. Speaking for the AAFP delegation, LeRoy expressed support for the spirit of the resolution while calling for "more intentional language" regarding the ACGME Common Program Requirements on this issue.
"We have great concern about the language used: 'allow flexibility,'" LeRoy said. "This could be interpreted as a license to effectively reduce the dedicated administrative teaching time for program directors (and) core faculty, resulting in an increase in patient care time, as well as a reduction in teaching and supervision of residents. This could ultimately harm the clinical learning environment."
LeRoy went on to note that the AAFP has, in fact, addressed this issue directly with the ACGME in testimony that AAFP Medical Education Division Director Karen Mitchell, M.D., recently presented on behalf of the Academy, the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine.
According to LeRoy, that testimony called on the ACGME to
- increase program directors' protected time for administrative and teaching duties to 70%,
- support the Family Medicine Review Committee's recommendation that associate program directors should have 60% dedicated time, and
- allow specialty Review Committees to set their own amount of dedicated teaching time for core faculty.
Next up, Liana Puscas, M.D., M.H.S., incoming chair of the ACGME Otolaryngology Review Committee, took the testimony in a different direction by stating that what changed in the Common Program Requirements was merely how "core faculty" was defined and had nothing to do with the details of that position.
Previously, she said, "if you spent 15 hours a week with a resident, you were considered core faculty."
"There was nothing mentioned about dedicated time or protected time or salary support," Puscas contended. "The salary support and the protected time were in reference only to the program director because of the administrative issues that are related to -- the paperwork, disciplinary, programmatic development -- all the things you do as a program director that are independent of teaching."
Removal of the 15-hours-a-week language when referring to core faculty was intended to recognize that some individuals in the program had key roles to play even if they did not meet that threshold, Puscas continued. And although she acknowledged the concern arising from that 15-hour block being perceived as protected time for teaching, she insisted that was never truly the case.
Texas Medical Association delegate Kevin McKinney, M.D., meanwhile, warned of possible unintended consequences of protecting faculty time, noting that doing so in academic institutions that base physician compensation on productivity could actually result in faculty members devoting more time to providing clinical care and less to their teaching responsibilities.
Still, support for the resolution proved to be overwhelming, and the House of Delegates adopted it without further discussion during the following day's business session.
The House of Delegates adopted a number of other education-related measures that stand to benefit family medicine and primary care, including
- a resolution that directs the AMA to promote greater awareness and implementation of the Project ECHO (Extension for Community Healthcare Outcomes) and Child Psychiatry Access Project models, which enhance access to care by connecting subspecialists with community-based primary care physicians, and to work with stakeholders to identify and mitigate barriers to broader implementation of these care models;
- a set of recommendations from an AMA Council on Medical Education report that address burnout, depression and suicide in physicians, residents and medical students by calling for education about signs and symptoms of these conditions, access to confidential and stigma-free mental health care services, and further research into risk factors for these problems; and
- a measure that calls for the AMA to study issues associated with rural physician workforce shortages, including federal payment policy issues and other causes and potential remedies (e.g., telehealth), in the interest of alleviating these shortages.
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