Fitting in a week in DC

[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!

I went to Washington, DC, and all I got was this…

…amazing opportunity to represent my state and medical students to speak with staff of various members of congress and advocate for healthcare policy.

2014-05-22 09.51.47

While the idea of advocating for change in policy that could affect more people than I ever could one-on-one has fascinated me, I never thought I would actually be able to do anything about it. I figured that by going into research and medicine I would have enough on my plate and I would leave this kind of thing for people who are more well versed in political science.

Then this year I found out about an opportunity with the American College of Physicians, a 137,000-member-strong organization of internists, internal medicine subspecialtists, residents, and medical students interested in internal medicine as a specialty (which I am because it will lead me to a fellowship in oncology and because I am simply drawn to internal medicine.) This opportunity would help finance a trip to Washington, DC so that I could participate in the College’s annual Leadership Day. I applied for the opportunity and luckily, my state’s chapter was so kind as to offer some funding to help make this possible.

This year’s Leadership Day was this past Wednesday. It started with just medical students and residents seated by state so that we could be briefed on the issues and given a little bit more information about how to advocate for our top priority issues.

But first, each state had to take a selfie.

2014-05-21 14.34.02

There was an emphasis on using social media, which I was glad to see, and it started by having this picture posted on Twitter. Perhaps if you follow me on Twitter, you noticed me saying a lot of things with the hashtag #ACPLD, which stood for American College of Physicians Leadership Day that we used to track the experience.

We then were joined by our more experienced counterparts as we delved a little deeper into how to speak about these issues as we critiqued and learned from the communication style of some examples of how a conversation with a staff member may go. We listened to a talk titled: “To Boldly Go: How Will Congress Influence the Trek to Health Care Reform? And How Can You Help Chart the Course?” that was chocked full of Star Trek references (winning) and, of course, inspiration. After some more panels and presentations, we were done for the day and we were able to meet as a chapter to discuss the next day’s events, the medical students/residents were able to attend our own reception, and the Downstate Illinois chapter representatives went out to dinner.

Thursday was then to take what we learned the previous day and put it into action. Each group had meetings lined up with various members of congress from their state (or more likely staff for those representatives). We split up our priority issues so that the medical students really focused on Graduate Medical Education (GME) since that is the most immediate issue we face. Other issues of interest were getting rid of the Sustained Growth Rate (SGR), continuing the Medicaid Pay Comparability program past the end of the year, and enacting medical liability reform through a bipartisan bill proposed by both a lawyer and a doctor, the Saving Lives, Saving Costs Act that would crease a “Safe Harbor” protection for physicians who document adherence to clinical practice guidelines. I won’t get into these issues now, but look forward to some thrilling Almost Docs pieces about them in the future!

ACP 2

Throughout the day, my group of ACP representatives met with staff from the offices of one senator and seven representatives both Democrat and Republican who represented constituents of downstate (southern) Illinois. I was apprehensive at first to give my spiel about GME as many of us other first-timers were, but throughout the day our whole group became much more comfortable with talking to these Congressional staff members.

After all of our meetings, we went our separate ways with most leaving that night for home. Since my flight wasn’t until the morning, I took the time to walk around the city and see some of the sites that I had seen almost exactly 10 years before on my first trip to Washington, DC including the White House as you can see below. While a brief trip, it was a great opportunity and I look forward to having more opportunities to advocate for healthcare in the future!

White House

Update 6/3/14: As I said, Almost Docs articles would be coming about these issues and here is the first: The Real Issue with the Match. This is partially in response to a couple Forbes articles (this and this), but mostly inspired by my trip to DC.