An AAFP Request:
An AAFP work group is working on updating the policy (located at: http://www.aafp.org/online/en/home/policy/policies/r/obperinatruralhealthcare.html
and would appreciate your feedback to ensure that your OB delivery needs/issues are met within the policy language. Please let us know what kinds of changes you would like to see made to the policy to increase its effectiveness. The policy is also listed below:
Rural Health Care, Obstetrics/Perinatal Care
Recognizing that a deepening crisis currently exists in access to perinatal care in rural areas and that this crisis has the potential of significantly increasing perinatal morbidity and mortality, the AAFP supports actions by governmental and private agencies, as well as by other professional organizations, directed at defining the causes of the crisis and formulating possible solutions.
The AAFP further reaffirms its willingness to participate with other organizations in joint efforts to respond to this crisis by defining ways that family physicians in rural areas can deal with the professional liability crisis and other financing and delivery system issues so they can continue to provide quality obstetrical/perinatal care. (1988) (2006)
WMR Responds:
The original AAFP-ACOG guidelines for specialty neutral credentialing in deliveries were never effective. Bruce Bagley, Patrick Harr, and others from ACOG refreshed them in 2006. We had high hopes for an end to the widespread discrimination against family physicians who wished to receive training in obstetrics. The watershed issue has been credentialing for Cesarean Section. To this day places like Anchorage Alaska hold FP's hostage at the grail of the dreaded Cesarean hysterectomy. Klamath Falls Oregon had the same issue for years. One or two influential obstetricians could literally veto any attempts for family medicine privileges.
The rare tragedy of bleeding which require Cesarean Section cannot and should not be used to prevent cesarean training for family physicians in rural and other settings. We were never able to get the residency review committee to put teeth into the requirement that this training be available at every program. Particularly in middle Tennessee this is openly flaunted. The AAFP has never instructed its delegates to the RRC on this issue. They should demand it.
Meanwhile, many a young physician embarks on the recuritment trail only to find out that the programs promise much more training than they can provide. The half life of a resident's dream for training in surgical family medicine obstetrics is 18 months. Welcome to the need for independent fellowships in surgical family medicine obstetrics.
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
Clinical Professor and Chair
Medicos para la Familia
Comments