A large group of family physicians devoted to their specialty flocked here to attend the AAFP's 2017 National Conference of Constituency Leaders (NCCL) April 27-29. They spent many hours discussing a wide range of topics that affect the ability of physicians across the country to provide the best possible health care to patients of all ages.
"We need to place as much of an emphasis on the social determinants of health as we do on learning about pathophysiology of heart disease and diabetes," says Roshan Najafi, M.D., of Seattle, a member of the minority physician constituency, during a reference committee hearing at the National Conference of Constituency Leaders.
Chapter delegates represented the five constituency groups at the meeting: women; minorities; new physicians; international medical graduates (IMGs); and lesbian, gay, bisexual and transgender (LGBT) physicians and those who support LGBT issues. Non-delegate members also participated as general registrants.
During testimony before the Reference Committee on Education on April 28, family physicians presented and discussed resolutions on, among other issues, buprenorphine therapy, physician well-being and the social determinants of health.
Addressing Social Determinants of Health
Attendees considered two separate resolutions that noted a lack of residency curriculum on the topic of health care disparities and social determinants of health.
Kelly Ussery-Kronhaus, M.D., a women's constituency member from Brick, N.J., co-authored one of the resolutions. "Programs are required to evaluate residents on their competency in evaluating patients' social determinants and health care disparities," she said, adding that it would be beneficial for physician educators to have the tools to do so.
A second co-author of the measure, Jacqueline Ysique, M.D., a new physician constituency member from Paramus, N.J., said such tools would "bridge the gap" and enable her to improve the health of her patients.
- Delegates to the 2017 National Conference of Constituency Leaders took action on various issues regarding physician training and patient care during the April 27-29 event.
- The Reference Committee on Education heard testimony on a number of topics, including buprenorphine therapy, physician well-being and the social determinants of health.
- Delegates also adopted resolutions or substitute resolutions on issues such as family planning, physician education on "undesired and nonviable pregnancy," international medical graduate mentorship, and transgender medicine training.
The resolution's third co-author, Roshan Najafi, M.D., of Seattle, a member of the minority physician constituency, spoke passionately about the topic. "I've taken steps independently, but I wish that I had a more structured curriculum within our system to teach me about how social determinants of health can affect our health care system and our communities," said Najafi.
The reference committee combined the two resolutions into a substitute measure. During the business session on April 29, delegates adopted the substitute, which asked the AAFP to develop a residency curriculum guideline that aligns with the Accreditation Council for Graduate Medical Education competencies on the topics of health care disparities, social determinants of health and community needs assessment.
Recognizing Physician Wellness
Members also discussed a resolution asking for family physicians to have the opportunity to earn up to 30 AAFP elective credits per year by self-reporting wellness activities.
Bernard Richard, M.D., of Greenfield, Ind., a member of the minority delegation, co-authored the resolution. It's OK for physicians to take care of themselves, he said, and allowing elective credit for doing so "is a very strong message for our Academy to send."
Unfortunately, physicians are trained to be selfless, he added. "You know, work through lunch -- your lunch, you don't need it, just keep going," he said.
LeeAnna Muzquiz, M.D., of Polson, Mont., also a minority constituent, said she and the other resolution co-authors were looking for a tangible way to support physician well-being. "The definition of physician wellness activities -- and the amount -- is debatable," said Muzquiz. "But there is lots of credit available for activities we self-report, and this should be viewed as just as important."
However, Katherine Jacobson, M.D., a new physician delegate from Catonsville, Md., stated her opposition to the resolution as written. "I agree with the sentiment and believe self-care is important, but I'm concerned that people are going to do yoga (for credit), and we're going to lose some of the integrity of our specialty."
Jacobson said she could already hear other specialists saying, "Hey, we're learning about heart failure and you're doing yoga."
"I'm having trouble defending that; if the resolution were more specific about particular wellness programs, then I could be more supportive," she added.
Eventually, delegates adopted a substitute resolution that called for the AAFP to investigate the feasibility of having members self-report approved physician wellness activities for AAFP elective credit.
Treating Opioid Use Disorder
Physicians who testified in this reference committee hearing made a strong case for the need to improve physician education on buprenorphine treatment for opioid use disorder.
Co-authors of a resolution targeting this topic noted that
- some 2.5 million people in the United States have opioid-related substance use disorder,
- more than 33,000 people died of opioid overdose in 2015,
- only 3.6 percent of family physicians have waivers to prescribe buprenorphine, and
- less than half of U.S. counties have a physician who can prescribe buprenorphine.
Kevin Wang, M.D., an LGBT delegate from Seattle, co-authored a resolution urging the AAFP to, among other things, work with the American Society of Addiction Medicine (ASAM) and others to co-sponsor addiction medicine CME, including buprenorphine waiver training.
Wang noted the Academy's focus on the nation's opioid epidemic. In light of that, "I think it's really important that we get more continuing education for our providers out there," said Wang.
He pointed out a particular lack of information to help physicians "get the waiver necessary to prescribe buprenorphine."
Peggy Sue Brooks, M.D., of Kingsport, Tenn., a member of the women's constituency, introduced herself as "a resident of Appalachia -- the epicenter of this problem" and told her colleagues that neonatal abstinence syndrome was becoming increasingly prevalent.
Grace Chiu, M.D., an international medical graduate (IMG) delegate from Chester, Va., speaks in favor of a resolution that would support IMG mentorship by asking the AAFP to promote the availability of elective continuing medical education teaching credits for the provision of direct training and mentorship to international medical graduates.
"Comprehensive knowledge about the treatment of addiction is of supreme importance" and is included in the scope of family medicine, said Brooks.
Allison Bacon, M.D., a general registrant from Vallejo, Calif., said over the course of about two years, she treated "a couple hundred" patients with opioid addictions, "particularly, mothers having babies."
She said primary care was partially responsible for the high number of opioid overdose deaths. "We participated in overprescribing … and now we need to also take the lead in helping people get help when they need it," said Bacon.
"We have the opportunity to care for the whole family -- including the neonatal abstinence syndrome babies in the NICU and also the pregnant moms; it's extremely satisfying and very helpful for the moms who are in this situation," she added.
During the business session, delegates adopted a substitute resolution asking the AAFP to work with other organizations to offer addiction medicine CME on opioid agonist therapy, including buprenorphine waiver training, and to "create a link to" ASAM and other relevant organizations to give members information about existing addiction medicine CME.
Tackling Other Issues
This reference committee heard testimony on a variety of other issues, and delegates at the business session adopted resolutions or substitute resolutions on topics related to
- fertility awareness-based methods of family planning;
- physician education on "undesired and nonviable pregnancy";
- IMG mentorship;
- transgender medicine training; and
- live and enduring CME on treating gender, sexual and romantic minorities -- in part because these minorities are only recently becoming widely recognized and many physicians do not know where to find relevant resources.
The delegates also adopted a substitute resolution that asked the AAFP to "support the elimination of the American Board of Family Medicine recertification board exam as a mandated requirement of maintenance of certification."
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