The AAFP research initiative - American Academy of Family Physicians - Editorial

Journal of Family Practice, March, 1998 by Joseph E. Scherger, Herbert F. Young

Tell me, Doctor, what evidence do you have about the quality of care of family physicians? Do they deliver state-of-the-art care for diabetes, asthma, coronary artery disease, and congestive heart failure? Do family physicians accurately recognize skin rashes? What evidence do you have that family physicians provide quality of care in hospitals, nursing homes, hospices, or at home? How important is it to have a long-term personal physician? Does continuity of care matter? Can anyone really be a generalist today with exploding medical information? Is the whole person really different from the sum of the parts when it comes to health care? Does focusing on the family matter?"

There was a time when a medical license was all that was necessary to become a family physician. Then residency training and board certification became the requirements for privileges. The industrialization of health care in the United States is intensifying the public scrutiny of physicians as never before. Family physicians are going to have to pass muster if they want to maintain their central place in the new delivery systems. The questions above are being asked and answered by health plans, medical groups, and new health care delivery systems. Family practice physicians must study themselves, or all of the studying will be done by researchers outside the specialty, often by groups eager to take over the roles traditionally held by family physicians.

The American Academy of Family Physicians (AAFP) has responded to this evolving situation by investing $7.72 million over the next 5 years in family practice research. The call for this effort was initiated in 1996 by two AAFP leaders in full-time private practice: then AAFP President Patrick Harr, MD, from Maryville, Missouri, and then Board Chair Doug Henley, MD, from Fayetteville, North Carolina. The AAFP Board of Directors charged the Commission on Clinical Policies and Research with devising a strategic plan. The Commission formed a subcommittee that worked intensely for 1 year to come up with a five-part strategy.(*) Fortuitously, the AAFP's positive financial situation in 1997 allowed the organization to adopt the entire plan at its annual Congress of Delegates meeting in September 1997. A task force has now been appointed to implement the research plan.([dagger]) The five components of the AAFP Research Initiative are advocacy, research centers, advanced research training, practice-based research networks, and managed care organization projects.

ADVOCACY

The AAFP initiative, as generous as it is, cannot support family practice research by itself. The task force will develop an action plan to increase external funding and support of family practice research. Target groups include foundations, the federal government, managed care organizations, private industry, and others with the potential to fund, advocate for, or advance family practice research. A key element of the plan will be to convene a national research conference early in the project. The Academy will also seek to form partnerships with other organizations that share the AAFP vision to support the various programs that are part of the plan. Other activities will be developed to ensure that a sustained educational and advocacy program will result in increased financial and other support for family practice research.

RESEARCH CENTERS

The second component of the research initiative is partial financial support of three family practice research centers. These centers will be selected competitively from proposals sent to the AAFP. The task force will establish objectives and criteria for the centers, issue a call for proposals, and then select those centers that have the highest probability of achieving the stated objectives. These centers may represent a variety of organizations and interests including departments of family medicine, residencies, clinical practices, practice-based research networks, and other organizations. Innovative approaches will be encouraged, including the possibility of a "virtual" center, or one that has a major virtual portion. The virtual approach connects researchers and physicians across a large area, as opposed to the more traditional research center that is geographically defined. Also of interest to the Academy will be centers that can train and nurture new researchers, form partnerships with other key groups, obtain additional funding from the federal government, foundations, or other organizations, and can conduct research that has an impact on the practice of medicine, for example, studies that can be used to develop useful evidence-based tools such as clinical guidelines and performance measures.

ADVANCED RESEARCH TRAINING

This component recognizes that the most successful family practice researchers have had research training beyond their formal medical training. Currently, only a few family practice residents choose to take a research fellowship. Physicians in clinical practice are also candidates for advanced training, but the cost of leaving practice is prohibitive. Salaries for many family medicine fellowships are lower than salaries for third-year residents, one third of starting faculty salaries, and a fraction of what family physicians often command in clinical practice. The objective of the advanced research training component is to increase the number of residents and established clinicians who obtain research training. Funding will be provided to enhance current research fellowships, to develop innovative new programs, and in other ways increase the pool of family physicians who conduct significant research. This AAFP Scholars Program will ensure that competitive programs will be available to increase the pool of needed family practice researchers.