[Insert usual “sorry I haven’t written in a while” statement here. #mdphdproblems]

As a MD/PhD student, I consider myself a master at fitting as many things into my schedule as possible. This week is no different. It is the final week of exams for the M1 class, and since I am an eternal M1 while completing my PhD, it is also exam week for me. Luckily, one of the M1 classes I opted to take this year ended in March and the other class I took this semester is anatomy, which had its final written and practical exams earlier today. I left Illinois soon after my practical exam and am now writing this in Washington, DC!

Why Washington, DC? I’m here to attend the American College of Physicians’ Leadership Day and Internal Medicine Meeting. The American College of Physicians (ACP) is the largest medical specialty group in the United States with 137,000+ members. As an aspiring oncologist (we’ll see if this changes once I reach my clinical years), I must first specialize in internal medicine, which is essentially medicine focused on adults. I have also been involved in my school’s internal medicine interest group since starting my MD/PhD program and know that it is the specialty that interests me the most. So naturally, if I had the opportunity to attend an ACP event, I would take it.

The Leadership Day is actually a two-day event, which focuses on educating attendees on policy changes that would benefit the practice of internal medicine (and most importantly patients!) and then giving representatives from each state the opportunity to meet with congressional staff to discuss these proposed policies. This is not my first Leadership Day. I attended two years ago (see my blog post). As I read over the material provided by ACP to prepare for this event, I was stricken by the difference in focus from two years ago. To illustrate these changes, here are the key policies from 2014 and 2016:

2014

• Eliminating the SGR (sustainable growth rate), a formula for physician payment
• Extending Medicaid payment policy for primary care services
• Medical liability “safe harbor” legislation and pilot health courts
• Graduate Medical Education (GME) financing
• Sufficient funding for federal health care workforce programs

2016

• Improving care of patients with chronic disease
• Improving health information technology
• Improving telemedicine
• Integrating behavioral health into primary care
• Stemming the increase in opioid abuse
• Addressing the rising cost of prescription drugs
• GME financing

One of the biggest differences I noticed right away is that the focus in 2014 was much more on paying for medical services – mainly via repealing SGR and extending Medicaid payment policy – while 2016 is much more focused on promoting certain areas of improvement – such as chronic disease, behavioral health, opioid abuse and prescription drugs, and medical technology. Of course some things stay the same, mainly the need to increase the number of physicians going through GME.

One reason for this change is that the SGR was finally repealed in 2015! The SGR was enacted by the Balanced Budget Act of 1997 (which also limited the amount of GME spots funded by the government) and has been a problem for quite a while. Basically, it was like a rollover system like some cell phone plans – don’t use all of your minutes in the month? They’ll carry on to the next month – except for it was for how physicians get paid by Medicare. The problem is the converse, however, such that if the expense one year was too high, the payment to physicians was proportionally decreased the following year, which likely made some physicians not want to care for Medicare patients.

I still have a lot to learn about healthcare policies, but I am so glad to have the opportunity as a medical student to get a taste of advocacy. No matter your skill as a doctor, systemic hurdles may still make it difficult for you to offer help to the patients who need it the most. That’s why I think it is so important to make our voices heard in the realm of policy and why I’m attending this Leadership Day.

In addition to the Leadership Day, I am also attending the Internal Medicine Meeting, ACP’s national meeting, where I am presenting a poster on one of my projects looking at how the scaffolding protein I study protects the liver against damage. Just from carrying my poster through the airport it has given me the opportunity to tell non-scientists about the importance of the liver and health in general. Looking forward to the week!