AAFP members gathered here last week for the Academy's annual National Conference of Constituency Leaders (NCCL) to labor over resolutions they deemed important to improving the specialty of family medicine and helping family physicians do what they do best -- take care of patients.
Gerald Banks, M.D., M.S., an international medical graduate delegate from Corpus Christi, Texas, speaks passionately about family physicians who've contacted him after losing longstanding positions in emergency departments to newly graduated emergency medicine physicians.
From April 27 to 29, family physicians worked together to represent themselves or one of five constituency groups recognized at this conference: women; minorities; new physicians; international medical graduates (IMGs); and lesbian, gay, bisexual and transgender (LGBT) physicians and those who support LGBT issues.
During the Reference Committee on Practice Enhancement hearing on April 28, AAFP members discussed a number of issues, including protecting the jobs of FPs in the ER, supporting privileging for operative obstetrics and providing resources for physicians who are diving into private practice.
Protecting Emergency Department Positions
Gerald Banks, M.D., M.S., of Corpus Christi, Texas, a member of the IMG constituency, introduced a resolution regarding ER physicians. Banks, who also chairs the AAFP member interest group on emergency medicine/urgent care, testified that family physicians are losing their jobs.
- Family physicians who attended the AAFP's 2017 National Conference of Constituency Leaders worked to protect family medicine's scope of practice in emergency departments with a resolution considered by the Reference Committee on Practice Enhancement.
- Delegates also adopted resolutions related to the provision of full-scope maternity care, including operative obstetrical privileges.
- The reference committee also considered resolutions concerning resources for physicians opening private practices and the adoption of core measures sets.
"There's been a pervasive workforce issue where family doctors who've been practicing emergency medicine and urgent care have been getting displaced from their jobs and replaced by new ER grads," said Banks.
"Family docs who've been working in emergency rooms for 10-15 years have been private-messaging me saying, 'What's going on? I just lost my job to a recently graduated ER resident. Can you help us? What can we do?'"
Banks referred to the AAFP's policy on privileging, which states that physicians should be granted clinical privileges based on training and competency rather than board certification. Banks argued for "a little more teeth" in addition to that policy and urged the AAFP to create a sample legal opinion on the issue "so we can cement our status as broad-scope-of-practice physicians."
Christopher Buelvas, M.D., M.B.A., M.H.A., an IMG delegate from Altamonte Springs, Fla., co-authored the resolution. "I work in a city where I'm not allowed to work in the emergency department because I'm a family medicine physician -- although I was trained and spent extensive time in the emergency department," he told the reference committee. He called for the AAFP to "take a stand" against those who oppose family physicians in the ER.
Sara Thorp, D.O., a member of the new physician constituency from Albuquerque, N.M., said she trained at one of the country's premier residency programs in terms of emergency medicine.
"Every single resident is certified in advanced trauma life support. My third year, we had a train derailment in the area with multiple trauma cases coming in at once, and I was the resident on call running that," said Thorp. At one point, "we were a 100 percent family medicine-trained trauma center for our county," she said.
By the time she graduated, a noticeable shift was taking place. "More and more new ER guys were coming in," said Thorp.
After hearing the testimony, the reference committee recommended that the resolution not be adopted, citing the need for clarification regarding the "sample legal opinion." However, the resolution was discussed further during the April 29 business session with a focus on the committee's concerns and, ultimately, was adopted.
Supporting Operative Obstetrical Privileges
Two separate resolutions from this committee addressed barriers family physicians face when they want to obtain operative obstetrical privileges.
The first resolution asked the AAFP to help family physicians navigate the credentialing process by creating a toolkit with specific resources that outline general credentialing processes within hospital systems.
Danielle Carter, M.D., a women's constituency delegate from Jacksonville, Fla., and a co-author of the resolution, spoke in favor of the measure.
"We believe that OB, especially operative, is core to what we do. There are a number of stories about people who have lost or were unable to get privileges," said Carter. She counted herself among those physicians denied privileges "despite completing an OB surgical fellowship."
The fact that the number of family physicians with operative obstetrical privileges keeps dropping is a sign that FPs need more resources than the AAFP currently offers, she added.
Karla Booker, M.D., of Lawrenceville, Ga., speaking on her own behalf, as well as for the women's constituency, drew applause from her colleagues with this introduction: "I'm in a rather, I guess I'd say, 'special situation' because I'm also a fellow of the American College of OB/Gyn and previously did an OB/Gyn residency prior to becoming an amazing family physician."
Booker noted that she provided credentialing from the OB/Gyn side before she became a family physician. "The conversation was always a matter of competence," said Booker.
"As a family physician who is now director of women's health for my residency program, I recognize that if we don't have good numbers of family physicians continuing to do obstetrics at the highest level, then that part of education from a family medicine perspective will be lost.
"I know that family medicine residents that rotated through OB/Gyn residency did not get the quality of experience in obstetrics; they were allowed to slide on through if that's what they wanted to do. And being able to have an attending who provides obstetric care at the highest level is essential in our continuing identity as family physicians in training," she added.
The second resolution dealt with increasing the ranks of family physicians providing operative obstetrics and asked the AAFP for help by actively working to eliminate barriers for family physicians who want to provide full-scope maternity care services, including high-risk and surgical obstetrics.
Thorp rose once again to testify and noted that medical students who rotate through her program at the University of New Mexico get excited when they learn that obstetrics is, indeed, part of family medicine.
"This is an issue for the future identity of family medicine," said Thorp. "How are we going to continue to make this part of our full spectrum of care?"
Delegates adopted both resolutions during the business session.
Assisting Start-up Practices
Family physicians at NCCL were united in asking the AAFP to assist members who were looking to start a private practice. One resolution asked the Academy to develop a toolkit with resources for physicians and to create a live workshop that could be included as part of a national conference.
Keisha Harvey, M.D., a member of the new physician constituency from Covington, La., shares her excitement about opening a private practice, a decision that she says will give her more autonomy and help her work to her highest ability.
Keisha Harvey, M.D., a new physician delegate from Covington, La., and a resolution co-author, stepped to the microphone and drew applause when she said she was going into private practice. "I open May 1, which is Monday," she said.
Harvey described her dissatisfaction with her previous job and the constant push to see more and more patients each day. "I want our new physicians and our residents entering the market and choosing jobs to know they have options. And if they're in a job and they don't feel appreciated -- or they feel like they could do so much more if they had their own autonomy," the AAFP can provide resources to help them enter into private practice, she said.
Another resolution co-author, Michelle Henne, M.D., a new physician delegate from Winter Haven, Fla., announced she, too, will be opening a practice -- in September.
"One of the things I wanted to bring to light was that as I've been talking to students and residents about the fact that I'm opening up a practice, the first question that everyone has is, 'How do you do that?' To me, that shows that within our medical schools and residencies, there's not an adequate amount of training on how to open a practice," said Henne.
"As I've been going about doing this, it's sad to me that my main resources have been my attorneys and accountants." That information needs to come from family physicians, she added.
Delegates adopted the resolution during the business session.
They also adopted resolutions or substitute resolutions that addressed
- payment for radiologic services,
- adoption of core measures sets by insurance companies,
- coverage of assisted reproductive technologies,
- support for income transparency and equity among family physicians,
- development of a physician procedure network, and
- creation of a data interface to support accountable care communities.
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