AAFP Debates OTC Contraception, NPs, Same-Sex Marriage

ORLANDO – Although some proposals at the American Academy of Family Physicians’ Congress of Delegates ignited relatively little debate, one could almost perceive a collective exhale when some of the more contentious resolutions were finally put to a final vote.

With more that 100,000 members among its ranks for the first time, the academy was careful to deliberate and consider where its official stance should be on such issues as access to over-the-counter contraception for low-income women, the health benefits of same-sex marriage, the development of collaborative agreements with nurse practitioners, and the protection of open communication between physicians and patients when it comes to gun safety.

Here’s at look at how resolutions on some of the more high-profile issues fared:

• OTC contraception. The "Removing Barriers to Over-the-Counter Contraception for Low-Income Women" resolution yielded considerable debate. In its initial form, the resolution called for the AAFP "to urge the U.S. Congress and federal and state agencies to provide Medicaid coverage for all family planning drugs and supplies approved by the [Food and Drug Administration] for over-the-counter sale and to not require a prescription for such coverage."

The Reference Committee on Advocacy, in its recommendations to the full academy, stated that it acknowledged the need for low-income individuals to have access both to OTC and prescription contraception. The committee discussed whether it was advisable to require prescriptions for OTC contraception, weighing the desire to discuss contraception as part of a comprehensive patient encounter vs. the potential barrier a prescription requirement could pose.

Ultimately, the AAFP passed a substitute resolution that addressed many of the issues raised, including the less-controversial call for expanded insurance coverage. The approved resolution stated that the AAFP "supports policies and legislation that would require public and private insurance plans to provide coverage for family planning drugs and supplies that are FDA approved, including those for sale over the counter."

• Same-sex marriage. The discussion over a proposed resolution entitled "Healthy Benefits of Same Gender Marriage – Not Just a Social Issue" was notable for both the polarity and prolonged duration of the testimony. Proponents of the resolution pointed to an American Medical Association resolution, approved earlier this year, that states that exclusion from civil marriage contributes to health care disparities that affect same-sex households. Supporters also noted that evidence on behalf of improved health associated with civil marriage is strong, according to recommendations from the Reference Committee on Advocacy.

Opponents of the resolution said its approval would make the AAFP the only physician organization to fully support marriage equality for same-sex couples. They also stated that the resolution would essentially legislate morality, and that marriage is a state issue and therefore outside the realm of the academy as a whole.

Ultimately, the reference committee recommended a substitute resolution, one that "would convey the AAFP’s commitment to oppose discrimination and support equality but would not need to use the controversial term of ‘marriage’ to arrive at the desired conclusion." Based on that recommendation, the following resolution was adopted: "That the AAFP support full legal equality for same-gender families to contribute to overall health and longevity, [to improve] family stability and to benefit children of Gay, Lesbian, Bisexual, Transgender (GLBT) families."

• Nurse practitioners. The Reference Committee on Practice Enhancement tackled another controversial resolution: that the AAFP, "through an appropriate avenue, study and develop a functional, mutually beneficial practice collaborative agreement template between nurse practitioners and family physicians."

Supporters of this amended, substitute resolution pointed to a lack of standardization on the content, detail, or scope of such agreements across the country, including in states that require such agreements. Opponents said the resolution could be seen as a tacit approval of independent practice by nurse practitioners. An alternate delegate from Arizona, Dr. Andrew Carroll, pointed out that "when you endorse nurse practitioners but don’t have anything for physician assistants ... you risk offending every PA who works with a physician." The resolution did not pass.

• The RUC, guns, and pseudoephedrine. Of the 46 proposed resolutions at the congress, most were either approved or referred. Put on hold, or officially referred to the AAFP Board of Directors for further evaluation, were four resolutions that called for immediate withdrawal of the AAFP from the RUC (Relative Value Scale Update Committee) or creation of alternatives to the RUC, including an independent relative value scale advisory board to the Centers for Medicare and Medicaid Services.

Also deferred was a resolution to send a letter to the National Rifle Association that outlined a shared recognition of the importance of gun safety while also condemning any impingement on physicians’ ability to counsel patients on that issue, in reference to a Florida law passed earlier this year.

Not adopted was a resolution to support federal legislation that would designate pseudoephedrine a controlled substance available only by prescription. Also voted down was a resolution for the AAFP to officially promote the drinking of tap water vs. bottled water. Proponents cited the municipal monitoring of tap water safety and the environmental impact of discarded plastic water bottles. Opponents pointed to an inability to vouch for the safety of all tap water throughout the country.

A resolution was put forth to not renew a collaboration between AAFP and the Coca-Cola Co. – an alliance that was hotly debated at the 2010 congress and still controversial at this year’s meeting. That resolution was not adopted.

Another industry relationship resolution was adopted, however – one that would "encourage organizations that enter into mutually beneficial arrangements with the AAFP to utilize the services of family physicians for their workforce." Initially crafted to state that employees should be directed to patient-centered medical homes, the resolution was seen by some delegates as premature, given the limited number of such homes available.

In the passed-with-very-little debate category, delegates approved a resolution against the expansion of the scope of practice for naturopaths. Similarly, a resolution to emphasize the dire situation regarding graduate medical education passed as follows: "The AAFP recognizes [that] the funding for and distribution of positions for graduate medical education (GME) is in crisis in the United States, and that meaningful and urgent reform is urgently needed."

ORLANDO – Although some proposals at the American Academy of Family Physicians’ Congress of Delegates ignited relatively little debate, one could almost perceive a collective exhale when some of the more contentious resolutions were finally put to a final vote.

With more that 100,000 members among its ranks for the first time, the academy was careful to deliberate and consider where its official stance should be on such issues as access to over-the-counter contraception for low-income women, the health benefits of same-sex marriage, the development of collaborative agreements with nurse practitioners, and the protection of open communication between physicians and patients when it comes to gun safety.

Here’s at look at how resolutions on some of the more high-profile issues fared:

• OTC contraception. The "Removing Barriers to Over-the-Counter Contraception for Low-Income Women" resolution yielded considerable debate. In its initial form, the resolution called for the AAFP "to urge the U.S. Congress and federal and state agencies to provide Medicaid coverage for all family planning drugs and supplies approved by the [Food and Drug Administration] for over-the-counter sale and to not require a prescription for such coverage."

The Reference Committee on Advocacy, in its recommendations to the full academy, stated that it acknowledged the need for low-income individuals to have access both to OTC and prescription contraception. The committee discussed whether it was advisable to require prescriptions for OTC contraception, weighing the desire to discuss contraception as part of a comprehensive patient encounter vs. the potential barrier a prescription requirement could pose.

Ultimately, the AAFP passed a substitute resolution that addressed many of the issues raised, including the less-controversial call for expanded insurance coverage. The approved resolution stated that the AAFP "supports policies and legislation that would require public and private insurance plans to provide coverage for family planning drugs and supplies that are FDA approved, including those for sale over the counter."

• Same-sex marriage. The discussion over a proposed resolution entitled "Healthy Benefits of Same Gender Marriage – Not Just a Social Issue" was notable for both the polarity and prolonged duration of the testimony. Proponents of the resolution pointed to an American Medical Association resolution, approved earlier this year, that states that exclusion from civil marriage contributes to health care disparities that affect same-sex households. Supporters also noted that evidence on behalf of improved health associated with civil marriage is strong, according to recommendations from the Reference Committee on Advocacy.

Opponents of the resolution said its approval would make the AAFP the only physician organization to fully support marriage equality for same-sex couples. They also stated that the resolution would essentially legislate morality, and that marriage is a state issue and therefore outside the realm of the academy as a whole.

Ultimately, the reference committee recommended a substitute resolution, one that "would convey the AAFP’s commitment to oppose discrimination and support equality but would not need to use the controversial term of ‘marriage’ to arrive at the desired conclusion." Based on that recommendation, the following resolution was adopted: "That the AAFP support full legal equality for same-gender families to contribute to overall health and longevity, [to improve] family stability and to benefit children of Gay, Lesbian, Bisexual, Transgender (GLBT) families."

• Nurse practitioners. The Reference Committee on Practice Enhancement tackled another controversial resolution: that the AAFP, "through an appropriate avenue, study and develop a functional, mutually beneficial practice collaborative agreement template between nurse practitioners and family physicians."

Supporters of this amended, substitute resolution pointed to a lack of standardization on the content, detail, or scope of such agreements across the country, including in states that require such agreements. Opponents said the resolution could be seen as a tacit approval of independent practice by nurse practitioners. An alternate delegate from Arizona, Dr. Andrew Carroll, pointed out that "when you endorse nurse practitioners but don’t have anything for physician assistants ... you risk offending every PA who works with a physician." The resolution did not pass.

• The RUC, guns, and pseudoephedrine. Of the 46 proposed resolutions at the congress, most were either approved or referred. Put on hold, or officially referred to the AAFP Board of Directors for further evaluation, were four resolutions that called for immediate withdrawal of the AAFP from the RUC (Relative Value Scale Update Committee) or creation of alternatives to the RUC, including an independent relative value scale advisory board to the Centers for Medicare and Medicaid Services.

Also deferred was a resolution to send a letter to the National Rifle Association that outlined a shared recognition of the importance of gun safety while also condemning any impingement on physicians’ ability to counsel patients on that issue, in reference to a Florida law passed earlier this year.

Not adopted was a resolution to support federal legislation that would designate pseudoephedrine a controlled substance available only by prescription. Also voted down was a resolution for the AAFP to officially promote the drinking of tap water vs. bottled water. Proponents cited the municipal monitoring of tap water safety and the environmental impact of discarded plastic water bottles. Opponents pointed to an inability to vouch for the safety of all tap water throughout the country.

A resolution was put forth to not renew a collaboration between AAFP and the Coca-Cola Co. – an alliance that was hotly debated at the 2010 congress and still controversial at this year’s meeting. That resolution was not adopted.

Another industry relationship resolution was adopted, however – one that would "encourage organizations that enter into mutually beneficial arrangements with the AAFP to utilize the services of family physicians for their workforce." Initially crafted to state that employees should be directed to patient-centered medical homes, the resolution was seen by some delegates as premature, given the limited number of such homes available.

In the passed-with-very-little debate category, delegates approved a resolution against the expansion of the scope of practice for naturopaths. Similarly, a resolution to emphasize the dire situation regarding graduate medical education passed as follows: "The AAFP recognizes [that] the funding for and distribution of positions for graduate medical education (GME) is in crisis in the United States, and that meaningful and urgent reform is urgently needed."

ORLANDO – Although some proposals at the American Academy of Family Physicians’ Congress of Delegates ignited relatively little debate, one could almost perceive a collective exhale when some of the more contentious resolutions were finally put to a final vote.

With more that 100,000 members among its ranks for the first time, the academy was careful to deliberate and consider where its official stance should be on such issues as access to over-the-counter contraception for low-income women, the health benefits of same-sex marriage, the development of collaborative agreements with nurse practitioners, and the protection of open communication between physicians and patients when it comes to gun safety.

Here’s at look at how resolutions on some of the more high-profile issues fared:

• OTC contraception. The "Removing Barriers to Over-the-Counter Contraception for Low-Income Women" resolution yielded considerable debate. In its initial form, the resolution called for the AAFP "to urge the U.S. Congress and federal and state agencies to provide Medicaid coverage for all family planning drugs and supplies approved by the [Food and Drug Administration] for over-the-counter sale and to not require a prescription for such coverage."

The Reference Committee on Advocacy, in its recommendations to the full academy, stated that it acknowledged the need for low-income individuals to have access both to OTC and prescription contraception. The committee discussed whether it was advisable to require prescriptions for OTC contraception, weighing the desire to discuss contraception as part of a comprehensive patient encounter vs. the potential barrier a prescription requirement could pose.

Ultimately, the AAFP passed a substitute resolution that addressed many of the issues raised, including the less-controversial call for expanded insurance coverage. The approved resolution stated that the AAFP "supports policies and legislation that would require public and private insurance plans to provide coverage for family planning drugs and supplies that are FDA approved, including those for sale over the counter."

• Same-sex marriage. The discussion over a proposed resolution entitled "Healthy Benefits of Same Gender Marriage – Not Just a Social Issue" was notable for both the polarity and prolonged duration of the testimony. Proponents of the resolution pointed to an American Medical Association resolution, approved earlier this year, that states that exclusion from civil marriage contributes to health care disparities that affect same-sex households. Supporters also noted that evidence on behalf of improved health associated with civil marriage is strong, according to recommendations from the Reference Committee on Advocacy.

Opponents of the resolution said its approval would make the AAFP the only physician organization to fully support marriage equality for same-sex couples. They also stated that the resolution would essentially legislate morality, and that marriage is a state issue and therefore outside the realm of the academy as a whole.

Ultimately, the reference committee recommended a substitute resolution, one that "would convey the AAFP’s commitment to oppose discrimination and support equality but would not need to use the controversial term of ‘marriage’ to arrive at the desired conclusion." Based on that recommendation, the following resolution was adopted: "That the AAFP support full legal equality for same-gender families to contribute to overall health and longevity, [to improve] family stability and to benefit children of Gay, Lesbian, Bisexual, Transgender (GLBT) families."

• Nurse practitioners. The Reference Committee on Practice Enhancement tackled another controversial resolution: that the AAFP, "through an appropriate avenue, study and develop a functional, mutually beneficial practice collaborative agreement template between nurse practitioners and family physicians."

Supporters of this amended, substitute resolution pointed to a lack of standardization on the content, detail, or scope of such agreements across the country, including in states that require such agreements. Opponents said the resolution could be seen as a tacit approval of independent practice by nurse practitioners. An alternate delegate from Arizona, Dr. Andrew Carroll, pointed out that "when you endorse nurse practitioners but don’t have anything for physician assistants ... you risk offending every PA who works with a physician." The resolution did not pass.

• The RUC, guns, and pseudoephedrine. Of the 46 proposed resolutions at the congress, most were either approved or referred. Put on hold, or officially referred to the AAFP Board of Directors for further evaluation, were four resolutions that called for immediate withdrawal of the AAFP from the RUC (Relative Value Scale Update Committee) or creation of alternatives to the RUC, including an independent relative value scale advisory board to the Centers for Medicare and Medicaid Services.

Also deferred was a resolution to send a letter to the National Rifle Association that outlined a shared recognition of the importance of gun safety while also condemning any impingement on physicians’ ability to counsel patients on that issue, in reference to a Florida law passed earlier this year.

Not adopted was a resolution to support federal legislation that would designate pseudoephedrine a controlled substance available only by prescription. Also voted down was a resolution for the AAFP to officially promote the drinking of tap water vs. bottled water. Proponents cited the municipal monitoring of tap water safety and the environmental impact of discarded plastic water bottles. Opponents pointed to an inability to vouch for the safety of all tap water throughout the country.

A resolution was put forth to not renew a collaboration between AAFP and the Coca-Cola Co. – an alliance that was hotly debated at the 2010 congress and still controversial at this year’s meeting. That resolution was not adopted.

Another industry relationship resolution was adopted, however – one that would "encourage organizations that enter into mutually beneficial arrangements with the AAFP to utilize the services of family physicians for their workforce." Initially crafted to state that employees should be directed to patient-centered medical homes, the resolution was seen by some delegates as premature, given the limited number of such homes available.

In the passed-with-very-little debate category, delegates approved a resolution against the expansion of the scope of practice for naturopaths. Similarly, a resolution to emphasize the dire situation regarding graduate medical education passed as follows: "The AAFP recognizes [that] the funding for and distribution of positions for graduate medical education (GME) is in crisis in the United States, and that meaningful and urgent reform is urgently needed."