AAFP Congress Endorses Same-Sex Civil Marriage

PHILADELPHIA – The American Academy of Family Physicians concluded its 3-day Congress of Delegates meeting with a bold move forward – but it was probably not in an area that most members were expecting.

Debate among the 223 delegates and alternates regarding the academy’s participation in the American Medical Association’s Relative Value Scale Update Committee (RUC) ended up taking a backseat to controversy over resolutions urging the organization to endorse same-sex civil marriage*. In the end, delegates decided to maintain the status quo on the AAFP’s RUC efforts, but ended a 3-year gridlock over same-sex civil marriage by endorsing it by a vote of 75 to 44.

Alicia Ault/IMNG Medical Media

Debate over civil marriage for same-sex couples was intense and heated, with at least an hour of impassioned discussion at the Reference Committee on Advocacy, and close to that on the floor before the delegates voted to close debate.

Many supporters testified that their own same-sex partnerships had suffered as a result of their being denied the ability to marry.

Dr. Mark Dressner, president-elect of the California chapter, said that he felt that he and his partner had been treated as second-class citizens. Others spoke of the emotional and physical damage they had witnessed in patients and family members as a result of discrimination against homosexuals.

Dr. Lloyd Van Winkle of Castroville, Tex., who was just elected to the AAFP board, said that his cousin's son Christopher committed suicide at age 19 because he felt persecuted about his homosexuality.**

Dr. Paul W. Davis, a delegate from Alaska, spoke about his long journey from "the extreme conservative religious right wing on this debate to a committed solidarity with the opposite pole."

Dr. Davis said that he had watched patients struggle with major depression over their sexual and gender identity. "I am not proud of the fact that I am a late adopter on this important issue," he said, urging his fellow delegates that "we need to boldly make a decision and move forward."

But opponents said that the AAFP should not be wading so deeply into what they considered largely treacherous political waters.

Dr. Justin V. Bartos, a delegate from Texas, said that his state’s chapter opposed the resolution because it was too much of a political statement and diverged from the AAFP’s mission.

Members of the Texas Academy of Family Physicians "do not want us to endorse such a politically polarizing issue," Dr. Bartos said. He noted that family doctors in Texas are struggling to get their state legislature to restore funding for community-based residencies, and that lawmakers in the largely conservative state would note the AAFP’s support of gay marriage.

The Tennessee delegation also opposed the policy change for the same reasons – that it would politicize the AAFP.

Another Texas delegate, Dr. Erica Swegler, said that current AAFP policy was enough to indicate the organization’s support for equal access to health care for all Americans*.

During testimony before the reference committee charged with weighing the policy change, an Arkansas delegate said that more than 300 members might leave the AAFP if it gave its approval to gay marriage.

The AAFP policy will now state that the organization supports "civil marriage for same-gender couples to contribute to overall health and longevity, improved family stability and to benefit children of gay, lesbian, bisexual, transgender (GLBT) families."

That language was crafted in two resolutions brought forward by the resident and student sections. The AAFP joins the American Psychiatric Association and the American Psychological Association in supporting same-sex marriage. The psychiatrists approved a resolution of support in 2005, and the psychology association made it official policy in 2011.

The American Medical Association has not backed gay marriage specifically, but has a host of policies supporting equality for same-sex households.

The American College of Obstetricians and Gynecologists in 2009 issued a policy statement that same-sex couples should get the same legal rights as married heterosexuals.

Staying the Course on RUC

Many AAFP members have been dissatisfied with the RUC’s handling of primary care valuations and family medicine valuations in particular. Several resolutions were put forward at the congress to create a family medicine–specific set of codes and to make the AAFP the exclusive body for establishing billing codes for preventive and primary care services for Medicare.

The resolutions fostered some discussion – but most of it was fairly muted. The delegates, in the end, decided to instruct the organization to continue its efforts to seek higher valuations for primary care.

"This congress is very familiar with family medicine’s frustration with the RUC," said Dr. Glen Stream, whose term as AAFP president ended at the meeting. But he said that for the moment, "remaining in the RUC allows the opportunity to advocate and press for [the] changes" that the AAFP has requested.

Among those: creating primary care–specific E&M codes, valuing the codes to reflect the intensity and complexity of primary care, and paying for certain non-face-to-face services.

The AAFP has also hired Avalere Health to come up with data to support higher valuations, which the academy will take to the Centers for Medicare and Medicaid Services to use as a basis for the 2014 Medicare Physician Fee Schedule, said Dr. Stream, who now serves as AAFP board chair.

In Other Issues

The Congress of Delegates also approved a controversial resolution to end age restrictions on over-the-counter emergency contraception (EC). Under current law, women under age 16 must get a prescription to get EC. Supporters said that there is no scientific basis to prohibit younger women from getting the drug over the counter, and that it could help avert many abortions. Opponents, however, said that OTC availability would lead to fewer counseling opportunities with those young patients, and might lead to even greater sexual activity.

Among other resolutions, a proposal to oppose telemedicine when it is provided in the absence of a preexisting physician-patient relationship, was referred to the board of directors for study.

The board will also report back to the congress next year on developing model legislation that would exempt primary physicians from antitrust laws so they can collectively negotiate with health insurers. The goal is to help independent practices survive in the changing health delivery system.

Much discussion also centered on how to advance the patient-centered medical home model of care, including which, or how many organizations should certify the entities.

Dr. Douglas Henley, AAFP executive vice president, said that the medical home is the perfect environment to help control health costs and improve quality of care. The family physician can help prevent patients from becoming victims of unnecessary care, he said. Dr. Henley coined a new acronym to describe those patients: VOMIT, or "victims of multiple interventional technologies."

Finally, the AAFP leadership said that the board had given approval to generate a new report on what family medicine should look like over the next decade. The AAFP developed just such a blueprint 8 years ago; however, the research supporting that paper has become dated, said Dr. Henley.

"Now is a critical time to begin a discussion and perhaps revisit research or even initiate new research about what comprehensive primary care means in 2012 and into the future," said Dr. Henley.

That process has begun, he said, adding that AAFP members should expect to hear more in January.

*Correction, 11/06/12: A previous version of this story misstated the number of delegates and alternates at the meeting and misstated Dr. Erica Swegler's last name. The photo caption also misstated the name of the governing body.

**Correction, 12/10/12: A previous version of this story misstated Dr. Van Winkle's relation to Christopher.

PHILADELPHIA – The American Academy of Family Physicians concluded its 3-day Congress of Delegates meeting with a bold move forward – but it was probably not in an area that most members were expecting.

Debate among the 223 delegates and alternates regarding the academy’s participation in the American Medical Association’s Relative Value Scale Update Committee (RUC) ended up taking a backseat to controversy over resolutions urging the organization to endorse same-sex civil marriage*. In the end, delegates decided to maintain the status quo on the AAFP’s RUC efforts, but ended a 3-year gridlock over same-sex civil marriage by endorsing it by a vote of 75 to 44.

Alicia Ault/IMNG Medical Media

Debate over civil marriage for same-sex couples was intense and heated, with at least an hour of impassioned discussion at the Reference Committee on Advocacy, and close to that on the floor before the delegates voted to close debate.

Many supporters testified that their own same-sex partnerships had suffered as a result of their being denied the ability to marry.

Dr. Mark Dressner, president-elect of the California chapter, said that he felt that he and his partner had been treated as second-class citizens. Others spoke of the emotional and physical damage they had witnessed in patients and family members as a result of discrimination against homosexuals.

Dr. Lloyd Van Winkle of Castroville, Tex., who was just elected to the AAFP board, said that his cousin's son Christopher committed suicide at age 19 because he felt persecuted about his homosexuality.**

Dr. Paul W. Davis, a delegate from Alaska, spoke about his long journey from "the extreme conservative religious right wing on this debate to a committed solidarity with the opposite pole."

Dr. Davis said that he had watched patients struggle with major depression over their sexual and gender identity. "I am not proud of the fact that I am a late adopter on this important issue," he said, urging his fellow delegates that "we need to boldly make a decision and move forward."

But opponents said that the AAFP should not be wading so deeply into what they considered largely treacherous political waters.

Dr. Justin V. Bartos, a delegate from Texas, said that his state’s chapter opposed the resolution because it was too much of a political statement and diverged from the AAFP’s mission.

Members of the Texas Academy of Family Physicians "do not want us to endorse such a politically polarizing issue," Dr. Bartos said. He noted that family doctors in Texas are struggling to get their state legislature to restore funding for community-based residencies, and that lawmakers in the largely conservative state would note the AAFP’s support of gay marriage.

The Tennessee delegation also opposed the policy change for the same reasons – that it would politicize the AAFP.

Another Texas delegate, Dr. Erica Swegler, said that current AAFP policy was enough to indicate the organization’s support for equal access to health care for all Americans*.

During testimony before the reference committee charged with weighing the policy change, an Arkansas delegate said that more than 300 members might leave the AAFP if it gave its approval to gay marriage.

The AAFP policy will now state that the organization supports "civil marriage for same-gender couples to contribute to overall health and longevity, improved family stability and to benefit children of gay, lesbian, bisexual, transgender (GLBT) families."

That language was crafted in two resolutions brought forward by the resident and student sections. The AAFP joins the American Psychiatric Association and the American Psychological Association in supporting same-sex marriage. The psychiatrists approved a resolution of support in 2005, and the psychology association made it official policy in 2011.

The American Medical Association has not backed gay marriage specifically, but has a host of policies supporting equality for same-sex households.

The American College of Obstetricians and Gynecologists in 2009 issued a policy statement that same-sex couples should get the same legal rights as married heterosexuals.

Staying the Course on RUC

Many AAFP members have been dissatisfied with the RUC’s handling of primary care valuations and family medicine valuations in particular. Several resolutions were put forward at the congress to create a family medicine–specific set of codes and to make the AAFP the exclusive body for establishing billing codes for preventive and primary care services for Medicare.

The resolutions fostered some discussion – but most of it was fairly muted. The delegates, in the end, decided to instruct the organization to continue its efforts to seek higher valuations for primary care.

"This congress is very familiar with family medicine’s frustration with the RUC," said Dr. Glen Stream, whose term as AAFP president ended at the meeting. But he said that for the moment, "remaining in the RUC allows the opportunity to advocate and press for [the] changes" that the AAFP has requested.

Among those: creating primary care–specific E&M codes, valuing the codes to reflect the intensity and complexity of primary care, and paying for certain non-face-to-face services.

The AAFP has also hired Avalere Health to come up with data to support higher valuations, which the academy will take to the Centers for Medicare and Medicaid Services to use as a basis for the 2014 Medicare Physician Fee Schedule, said Dr. Stream, who now serves as AAFP board chair.

In Other Issues

The Congress of Delegates also approved a controversial resolution to end age restrictions on over-the-counter emergency contraception (EC). Under current law, women under age 16 must get a prescription to get EC. Supporters said that there is no scientific basis to prohibit younger women from getting the drug over the counter, and that it could help avert many abortions. Opponents, however, said that OTC availability would lead to fewer counseling opportunities with those young patients, and might lead to even greater sexual activity.

Among other resolutions, a proposal to oppose telemedicine when it is provided in the absence of a preexisting physician-patient relationship, was referred to the board of directors for study.

The board will also report back to the congress next year on developing model legislation that would exempt primary physicians from antitrust laws so they can collectively negotiate with health insurers. The goal is to help independent practices survive in the changing health delivery system.

Much discussion also centered on how to advance the patient-centered medical home model of care, including which, or how many organizations should certify the entities.

Dr. Douglas Henley, AAFP executive vice president, said that the medical home is the perfect environment to help control health costs and improve quality of care. The family physician can help prevent patients from becoming victims of unnecessary care, he said. Dr. Henley coined a new acronym to describe those patients: VOMIT, or "victims of multiple interventional technologies."

Finally, the AAFP leadership said that the board had given approval to generate a new report on what family medicine should look like over the next decade. The AAFP developed just such a blueprint 8 years ago; however, the research supporting that paper has become dated, said Dr. Henley.

"Now is a critical time to begin a discussion and perhaps revisit research or even initiate new research about what comprehensive primary care means in 2012 and into the future," said Dr. Henley.

That process has begun, he said, adding that AAFP members should expect to hear more in January.

*Correction, 11/06/12: A previous version of this story misstated the number of delegates and alternates at the meeting and misstated Dr. Erica Swegler's last name. The photo caption also misstated the name of the governing body.

**Correction, 12/10/12: A previous version of this story misstated Dr. Van Winkle's relation to Christopher.

PHILADELPHIA – The American Academy of Family Physicians concluded its 3-day Congress of Delegates meeting with a bold move forward – but it was probably not in an area that most members were expecting.

Debate among the 223 delegates and alternates regarding the academy’s participation in the American Medical Association’s Relative Value Scale Update Committee (RUC) ended up taking a backseat to controversy over resolutions urging the organization to endorse same-sex civil marriage*. In the end, delegates decided to maintain the status quo on the AAFP’s RUC efforts, but ended a 3-year gridlock over same-sex civil marriage by endorsing it by a vote of 75 to 44.

Alicia Ault/IMNG Medical Media

Debate over civil marriage for same-sex couples was intense and heated, with at least an hour of impassioned discussion at the Reference Committee on Advocacy, and close to that on the floor before the delegates voted to close debate.

Many supporters testified that their own same-sex partnerships had suffered as a result of their being denied the ability to marry.

Dr. Mark Dressner, president-elect of the California chapter, said that he felt that he and his partner had been treated as second-class citizens. Others spoke of the emotional and physical damage they had witnessed in patients and family members as a result of discrimination against homosexuals.

Dr. Lloyd Van Winkle of Castroville, Tex., who was just elected to the AAFP board, said that his cousin's son Christopher committed suicide at age 19 because he felt persecuted about his homosexuality.**

Dr. Paul W. Davis, a delegate from Alaska, spoke about his long journey from "the extreme conservative religious right wing on this debate to a committed solidarity with the opposite pole."

Dr. Davis said that he had watched patients struggle with major depression over their sexual and gender identity. "I am not proud of the fact that I am a late adopter on this important issue," he said, urging his fellow delegates that "we need to boldly make a decision and move forward."

But opponents said that the AAFP should not be wading so deeply into what they considered largely treacherous political waters.

Dr. Justin V. Bartos, a delegate from Texas, said that his state’s chapter opposed the resolution because it was too much of a political statement and diverged from the AAFP’s mission.

Members of the Texas Academy of Family Physicians "do not want us to endorse such a politically polarizing issue," Dr. Bartos said. He noted that family doctors in Texas are struggling to get their state legislature to restore funding for community-based residencies, and that lawmakers in the largely conservative state would note the AAFP’s support of gay marriage.

The Tennessee delegation also opposed the policy change for the same reasons – that it would politicize the AAFP.

Another Texas delegate, Dr. Erica Swegler, said that current AAFP policy was enough to indicate the organization’s support for equal access to health care for all Americans*.

During testimony before the reference committee charged with weighing the policy change, an Arkansas delegate said that more than 300 members might leave the AAFP if it gave its approval to gay marriage.

The AAFP policy will now state that the organization supports "civil marriage for same-gender couples to contribute to overall health and longevity, improved family stability and to benefit children of gay, lesbian, bisexual, transgender (GLBT) families."

That language was crafted in two resolutions brought forward by the resident and student sections. The AAFP joins the American Psychiatric Association and the American Psychological Association in supporting same-sex marriage. The psychiatrists approved a resolution of support in 2005, and the psychology association made it official policy in 2011.

The American Medical Association has not backed gay marriage specifically, but has a host of policies supporting equality for same-sex households.

The American College of Obstetricians and Gynecologists in 2009 issued a policy statement that same-sex couples should get the same legal rights as married heterosexuals.

Staying the Course on RUC

Many AAFP members have been dissatisfied with the RUC’s handling of primary care valuations and family medicine valuations in particular. Several resolutions were put forward at the congress to create a family medicine–specific set of codes and to make the AAFP the exclusive body for establishing billing codes for preventive and primary care services for Medicare.

The resolutions fostered some discussion – but most of it was fairly muted. The delegates, in the end, decided to instruct the organization to continue its efforts to seek higher valuations for primary care.

"This congress is very familiar with family medicine’s frustration with the RUC," said Dr. Glen Stream, whose term as AAFP president ended at the meeting. But he said that for the moment, "remaining in the RUC allows the opportunity to advocate and press for [the] changes" that the AAFP has requested.

Among those: creating primary care–specific E&M codes, valuing the codes to reflect the intensity and complexity of primary care, and paying for certain non-face-to-face services.

The AAFP has also hired Avalere Health to come up with data to support higher valuations, which the academy will take to the Centers for Medicare and Medicaid Services to use as a basis for the 2014 Medicare Physician Fee Schedule, said Dr. Stream, who now serves as AAFP board chair.

In Other Issues

The Congress of Delegates also approved a controversial resolution to end age restrictions on over-the-counter emergency contraception (EC). Under current law, women under age 16 must get a prescription to get EC. Supporters said that there is no scientific basis to prohibit younger women from getting the drug over the counter, and that it could help avert many abortions. Opponents, however, said that OTC availability would lead to fewer counseling opportunities with those young patients, and might lead to even greater sexual activity.

Among other resolutions, a proposal to oppose telemedicine when it is provided in the absence of a preexisting physician-patient relationship, was referred to the board of directors for study.

The board will also report back to the congress next year on developing model legislation that would exempt primary physicians from antitrust laws so they can collectively negotiate with health insurers. The goal is to help independent practices survive in the changing health delivery system.

Much discussion also centered on how to advance the patient-centered medical home model of care, including which, or how many organizations should certify the entities.

Dr. Douglas Henley, AAFP executive vice president, said that the medical home is the perfect environment to help control health costs and improve quality of care. The family physician can help prevent patients from becoming victims of unnecessary care, he said. Dr. Henley coined a new acronym to describe those patients: VOMIT, or "victims of multiple interventional technologies."

Finally, the AAFP leadership said that the board had given approval to generate a new report on what family medicine should look like over the next decade. The AAFP developed just such a blueprint 8 years ago; however, the research supporting that paper has become dated, said Dr. Henley.

"Now is a critical time to begin a discussion and perhaps revisit research or even initiate new research about what comprehensive primary care means in 2012 and into the future," said Dr. Henley.

That process has begun, he said, adding that AAFP members should expect to hear more in January.

*Correction, 11/06/12: A previous version of this story misstated the number of delegates and alternates at the meeting and misstated Dr. Erica Swegler's last name. The photo caption also misstated the name of the governing body.

**Correction, 12/10/12: A previous version of this story misstated Dr. Van Winkle's relation to Christopher.