2008 Interim Meeting

AMA Backs Measures That Benefit Primary Care Physicians

By Barbara Bein
11/25/2008

The AAFP and other primary care groups continued their winning streak in the house of medicine when the AMA House of Delegates recently voted to support several measures designed to encourage physicians and physicians-in-training to choose careers in primary care. The measures included calls to enhance payment for primary care physician services and decrease debt loads.

Moreover, the AMA also agreed to advocate creation of various programs to encourage physicians to practice in underserved areas, including the permanent reauthorization and expansion of the Conrad State 30 J-1 visa waiver program. The actions came during the 2008 interim meeting of the AMA House of Delegates, Nov. 8-11, in Orlando, Fla.

"We feel we won a trifecta," Dale Moquist, M.D., of Houston, chair of the Academy's delegation to the AMA, told AAFP News Now. "We got the adoption of the patient-centered medical home. We got the adoption of the (AMA Council on Medical Education report recommendations on) primary care as a medical career choice. And we got the actions to promote physicians to practice in underserved areas," he said, referring to another CME council report.

Barriers to Primary Care

Noting that patients' access to care is "negatively impacted" by a shortage and maldistribution of primary care physicians, the council report on barriers to primary care directs the AMA, in collaboration with primary care specialty organizations, to advocate the adoption of recommendations from the AMA/Specialty Society Relative Value Scale Update Committee that address payment for evaluation and management, or E/M, services and coverage of services related to care coordination. The report also directs the AMA to work to ensure that private payers recognize the value of E/M services.

The delegates directed the AMA, in collaboration with relevant specialty groups, to study matters related to new models of providing primary care services, such as the medical home. Topics for study include

the impact of these models on primary care physicians' work-life balance and satisfaction,
the growth and expansion of new models in the public and private sectors,
the availability of expanded public- and private-sector funding at national and local levels to support implementation of new models, and
the impact of these models on primary care physician compensation.

AMA Wants to Set Limits on 'Dr. Nurse' Tests

Noting that state-based licensure of physicians is a "hallmark of American medicine," delegates at the 2008 interim meeting of the AMA House of Delegates called on the AMA to develop model state legislation designed to avoid any perception that doctors of nursing practice, or DNPs, are equivalent in training to doctors of medicine or doctors of osteopathy.

Adopting a resolution introduced by nine specialty organizations and medical societies, the delegates directed the AMA Council on Legislation to develop and circulate to all state medical and national medical specialty societies legislation that would prohibit the National Board of Medical Examiners, or NBME, from using past, present or future content of the U.S. Medical Licensing Exam Step 3 in the certification processes for nonphysician providers.

The model legislation also would prohibit the National Board of Osteopathic Medical Examiners from using the past, present or future content of its COMLEX Exam Step 3 in those certification processes.

AAFP President Ted Epperly, M.D., of Boise, Idaho, told AAFP News Now, "We highly value nurses and nurse practitioners. However, the DNP issue crosses the line into public confusion as to the credentials and equivalency of providers claiming to be doctors.

"The training, the ability to understand the broad scope of practice and the depth of differential diagnostic skills are markedly different" between physicians and nonphysician providers, he said. "The model state legislation will help the states with ensuring that these test items, as administered by the NBME, are prohibited."

Included in the council report were recommendations specifically addressing medical education issues, including calls to develop programs to recruit medical students interested in primary care, train primary care physicians, and enhance the image of primary care practice. The report also recommends urging medical schools to develop policies and programs that encourage students to select primary care specialties.

Furthermore, said the delegates, the AMA should support existing programs and advocate the establishment of new programs that decrease the debt load of physicians who choose primary care.

Melissa Cunningham, M.D., of Columbus, Ohio, a second-year resident at the Ohio State University Family Medicine Residency and a member of AAFP's delegation to the AMA, said the council's recommendations were on track.

"Medical students just aren't going into family medicine," she told AAFP News Now. "One of the big barriers is that medical students come out with increasing amounts of debt and primary care isn't as highly reimbursed."

She added that students would likely benefit from having more contact with family medicine and primary care physicians both in the classroom and during clinical rotations.

Strategies to Promote Practice in Underserved Areas

A second CME council report, "Effectiveness of Strategies to Promote Physician Practice in Underserved Areas," provided some good news: About 25 percent of graduating medical students who responded to a survey by the Association of American Medical Colleges indicated they planned to locate their practices in underserved areas.

However, the report added, "This enthusiasm needs to be maintained as the students continue through training and enter practice." According to the report, some federal and state programs that have succeeded in promoting practice in rural areas have been jeopardized by funding uncertainties.

The report's recommendations call for the AMA to advocate

the continuation of scholarship and loan repayment programs, including the National Health Service Corps;
permanent reauthorization and expansion of the Conrad State 30 J-1 visa program; and
adequate funding for federal legislation that supports educational experiences for medical students and resident physicians in underserved areas.

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