CHICAGO — Should unparalleled medical school graduates be recruited to help in rural and underserved areas? Members of the American Medical Association (AMA) House of Delegates appeared divided on the issue.

“Our patients who live in underserved and rural areas do not deserve a lower standard of care than those who live in more urbanized areas,” said Sterling Ransone, Jr., MD, president of the American Academy of Family Physicians. annual meeting of delegates here. “Furthermore, the complexity of primary care services and chronic care management cannot be adequately handled by those without comprehensive education and training.”

Physician Assistant Program Questions

Ransone was speaking during a discussion about a resolution by Missouri delegates, where the state passed a law allowing physicians who did not fit a residency program to obtain a license called an Assistant Physician to practice. as primary care physicians in underserved areas in conjunction with a licensed physician.

The Missouri delegates’ resolution called on the AMA to work with the Centers for Medicare & Medicaid Services (CMS) to obtain Medicare reimbursement for the services of these physicians, as is already done by some private insurers and state programs. Medicaid. The resolution also called on the AMA to allow these physicians to become a subgroup of the AMA and to oppose any effort to let them become board-certified physicians without completing their residency training.

However, an AMA reference committee had recommended that the resolution not be adopted, and Albert Hsu, MD, an obstetrician/gynecologist delegate from Columbia, Missouri, proposed a superseding resolution calling on the association to study the program. of Physician Assistant in Missouri, as well as similar programs in other states, and report with recommendations on whether these programs should limit the maximum number of years an individual could be in such a program . It was Hsu’s resolution that Ransone was commenting on.

Hsu said he suggested the alternate resolution because, although he knows two doctors who were matched to residencies after spending time in the Physician Assistant program, he feared “it could develop a new class of mid-level providers…I think this question could benefit from further study.”

Alisha Reiss, MD, speaking on behalf of the Young Physicians Section, opposed Hsu’s resolution. “Let’s be honest, folks, this is about the integrity of our profession and the protection of our patients,” she said. “We [do not] need to consider what the creation of a subset of undertrained physicians will do for our profession and for our patients. We have to make that go away.”

But Woody Jenkins, MD, an alternate delegate from Oklahoma who spoke for himself, liked the idea of ​​a study on how to support unmatched graduates. “We have to find a way to help these people and help each other out with our labor shortage,” he said. “Missouri has been working on this for a while, and I can tell you that in rural Oklahoma we need help in our underserved areas… Unmatched doctors have more training than other practitioners non-physicians. Doing a study can help identify any unintended consequences” of such programs.

Matt Gold, MD, speaking on behalf of the Organized Medical Personnel Section, also liked the idea of ​​a study — but not the one suggested by Hsu. “This is the wrong study,” Gold said. “To tell you the truth, a proper study would be whether medical graduates who don’t have residencies are, in fact, superior to mid-level practitioners. I think that would be very interesting information.” Ultimately, Hsu’s replacement resolution was voted down, and delegates accepted the reference committee’s recommendation not to pass the original resolution either.

Debt relief for cash-strapped doctors

Delegates passed a resolution calling on the AMA to advocate at the federal level for debt relief or loan forgiveness for independent physician practices facing financial risks related to COVID. The resolution, which was proposed by the Texas delegation, noted that at the start of the COVID-19 pandemic, many medical practices relied on funding from the Economic Disaster Loan, a federal small business loan program. companies, to keep their doors open.

“Smaller independent practices are at a severe disadvantage when it comes to overhead costs and the ability to obtain commercial loans,” said Ray Callas, MD, on behalf of the Texas Medical Association. “These practices often provide care to some of our most underserved areas… Focusing financial relief and loan forgiveness for our smaller independent practices allows them to remain independent, and that’s what we expect.” of the House of Medicine.”

Ramin Manshadi, MD, a cardiologist in solo practice with the California delegation who spoke for himself, noted that a federal loan has helped him keep his office doors open during the pandemic. “And even though my employees were away for 2 weeks, I still paid them to help them earn a living,” he said. However, “larger entities that can weather this storm are better than us. For example, one of my employees wanted to raise her hourly wage from $17 to $35, because Kaiser was offering her that much.”

Learn more about the issue of gun violence

WADA members also continued their discussion on the issue of gun violence. Delegates first voted on a resolution to convene a WADA task force on the subject that would work with other advocacy groups to find ways to end the gun violence crisis; they agreed to send the resolution back to the WADA Board with a November 2022 deadline for a decision. But later that day, Melissa Garretson, MD, speaking on behalf of the American Academy of Pediatrics, called for that decision to be reconsidered.

Garretson responded to the board’s concern that forming a task force could impede the work the board is already doing on the matter. “I would like to hear from my WADA Board Chair regarding the official position of why the Board feels a task force would halt its work on this incredibly important issue for our country,” she said. “I would also like to provide information regarding the additional working groups that this Assembly has set up which may not have stopped the work of the council” on other issues.

In response, AMA Board Chairman Bobby Mukkamala, MD, addressed the delegates. “I can assure you that I and the rest of your board hear loud and clear the testimony of this House,” he said. “We are hearing that our existing efforts have not been enough, that we need to rethink our approach to this outbreak, that we need to consider new options.”

Mukkamala noted that the next day, outgoing AMA President Gerald Harmon, MD, was scheduled to participate in a White House call to explain the doctors’ experience with gun violence. And he added that the council “will push for stronger action from Congress and the administration.”

After Mukkamala’s remarks, a tearful Garretson thanked him and said those comments “were what I needed to hear”, and she withdrew her motion. At the urging of Bruce Scott, MD, Speaker of the House of Delegates, all delegates rose and applauded.

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. Follow

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