The AMA House of Delegates adopted several policies aimed at alleviating medical student loan debt, integrating mental illness and addiction treatment into training programs, and giving physicians in training more leadership and community health work opportunities.
Some medical practices in underserved areas have difficulty recruiting staff physicians. Offering student-loan repayment assistance could provide a significant inducement and help to alleviate physician shortages in these areas. However, the current tax code requires funds given by employers to physicians to repay student loans be considered ordinary income and, therefore, a tax liability.
To offset the liability, these employers—many of whom cannot offer salaries competitive with those in more affluent geographic areas—would need to provide additional funds, significantly increasing their employment costs.
The AMA, at its 2016 Interim Meeting in Orlando, Fla., adopted policy to support eliminating the tax liability when employers provide funds to repay student loans for physicians who agree to work in underserved areas.
Behavioral health training
Half of primary care visits in the U.S. involve concerns about behavioral health comorbidities, according to a study published in the Journal of Health Care for the Poor and Uninsured. The same study noted that 60 percent of mental illness is treated by primary care physicians and other primary care health professionals.
But primary care physicians often feel unprepared to manage patients with complex psychiatric comorbidities. Internal medicine, family medicine and pediatric residents often do not receive collaborative psychiatric supervision during their residency. Likewise, most psychiatry residents and fellows receive no training in how to liaise with primary care offices.
The AMA adopted policy to advocate the incorporation of integrated services for general medical care, mental health care and substance-use disorder care into existing psychiatry, addiction medicine and primary care training programs’ clinical settings. It encourages primary care, addiction medicine and psychiatry residency training programs to provide opportunities to residents and fellows to obtain clinical experience working in integrated models. The new policy also advocates payment to support the practice of integrating physical and mental health care in clinical care settings.
Chances to lead
Current training curricula for physicians are designed to ensure the development of essential clinical skills, but there is little framework for teaching leadership skills required for independent practice. Physicians with insufficient leadership skills may face unnecessary clinical, operational and financial challenges, and the care they deliver could suffer.
Delegates directed the AMA to support the creation of leadership programs and curricula that emphasize experiential and active learning models to include knowledge, skills and management techniques integral to leading interprofessional team care, in the spirit of the AMA’s Accelerating Change in Medical Education initiative.
“As our health care system continues to evolve, medical schools must do more than simply prepare young doctors to care for patients—they must prepare them to take leadership roles in their practices,” said AMA board member Jesse M. Ehrenfeld, MD. “The new policies adopted today will further our mission to create the medical school of the future by ensuring future physicians are prepared to quickly adapt to the changing health care landscape and provide care to patients, populations and communities as soon as they enter practice.”
Furthermore, delegates voted for the AMA to work with the Liaison Committee on Medical Education, the Association of American Medical Colleges and other governing bodies to implement programs early in medical training to promote the development of leadership capabilities.
Community health learning
The AMA also adopted policy to encourage training opportunities for medical students and residents—as members of the physician-led team—to learn cultural competency from community health workers insofar as such exposure can be integrated into existing rotation and service assignments.
According to the resolution the AMA adopted, physicians in training could have much to learn from community health workers, who effectively promote health in their communities, are culturally competent, understand the socioeconomic challenges of the community they work in and help deliver cost-effective care for patients with chronic diseases.
Finally, delegates directed the AMA to issue a statement in support of U.S. health professionals, including those training as medical students, residents or fellows who are recipients of Deferred Action for Childhood Arrivals (DACA) status. The “Dreamer” executive action taken by President Obama is one which President-elect Trump has pledged to reverse. Thirty-one DACA-eligible students matriculated into medical training programs in 2014 – 2015. More than 40 percent of medical schools have said they will consider admitting applicants with DACA status.
Read more news coverage of the 2016 AMA Interim Meeting.
