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
The American Academy of Family Physicians held its 2012 Congress of Delegates in Philadelphia.*
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.