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When one contemplates the impact of the decisions being made in
Washington, D.C., concerning our nation's health care system, most
individuals can acknowledge that our health care system is both
imperfect and far too costly. Regardless of political affiliation
or ideology, almost everyone can agree that reform is needed.
However, there are as many opinions about reforms as there are
people. More importantly, understanding those reforms and how they
should be implemented is the most focal point of political
Stressing the importance of advocacy is often difficult and even
the mere thought of politics in medicine is distasteful to some.
However, there is no doubt that decisions in government are made by
individuals who have no idea about practicing medicine. Now we find
ourselves at the dawn of a new era of health care in the United
States. While more Americans will have access to affordable
healthcare, insurance companies and governmental regulation have an
increasing role in determining how health care is delivered. The
result is that topics such as the looming catastrophic shortage of
doctors, loan repayment for students, sustainable growth rate (SGR)
repeal, and reforming the medical liability system are not decided
by those who are largely affected by such changes.
One ongoing issue is the flawed sustainable growth rate (SGR),
an antiquated formula used to calculate physician reimbursement for
Medicare services. In addition, the cost to deliver health care
grows every year, but physician reimbursements are rarely increased
to match the increase in costs. This leads to some internal
medicine physicians being fiscally unable to provide quality care
to their patients, provide for their families, and pay back medical
student debt while keeping their doors open. ACP and other medical
organizations have been successful in delaying any decreases in
physician reimbursement. However, Congress has not taken up the
issue of repealing the SGR formula, so the result has been that
physicians must battle each year just to maintain this defective
With the recent health care reform, 32 million previously under-
or uninsured Americans are now in need of a primary care physician.
However, incentives for medical students to enter primary care
through student loan forgiveness were hardly addressed in the bill.
In addition, the number of medical students is expanding while the
number of residency positions remains stagnant. Therefore, it is
crucial to address medical student debt, primary care physician,
and residency shortages so that graduates continue to pursue
primary care and Americans have access to primary care physicians.
With increases in health care coverage for the uninsured and
underinsured, the next barrier will be access to physicians.
"To find health should be the object of the doctor. Anyone can
find disease," according to Dr. A. T. Still. While more Americans
have access to care, we must continue to advocate for access to
preventive services and reimbursement for such services so that
physicians can continue to provide that care. Our health care
system needed some type of reform and although many are
disappointed with what Congress passed, we can still work for more
change. Important lobbying issues include SGR repeal, increasing
residency slots, incentives to pursue primary care through
increased loan forgiveness, and reforming medical liability.
Through physician and student advocacy, the SGR cuts were
postponed, and it should be encouraging that our collective voice
was heard and will continue to be heard.
Policymakers respond to volume, and this is a key component for
influencing reform; writing, e-mailing, calling, and meeting with
representatives adds to this influence. As leaders of the
profession through advocacy, the ACP acts as our united voice. I
urge you to join the ACP Advocates for Internal
Medicine Network (AIMn) and to attend the ACP
Leadership Day in April or to work for health care reform on a
local level. Second, it only takes a few minutes to sign up for
advocacy updates from AIMn to be informed of what the ACP
is fighting for. The program provides links so you can contact your
congressional representatives. While there will always be
provisions that you strongly support and some that you strongly
oppose, our objective should always be to preserve the health of
our patients, support positive changes, and improve those that we
Each year about 400 students and physicians congregate in
Washington, D.C., for Leadership Day. As a student, the reforms of
today will transform the physicians of tomorrow. Working hard to
influence legislation being developed in Congress should be the
role of both physicians and patients. As a third-year student, I
have realized the role that students need to play in advocating for
the profession we have chosen. We need to be part of advocacy today
because our future is rapidly changing. I urge you all to be
involved in advocacy with the same intensity you had when you
sought acceptance into medical school. To learn more about advocacy
in the ACP, please visit www.acponline.org/advocacy/aimn.
Shane R. Sergent
Osteopathic Medical Student III
Michigan State University College of Osteopathic Medicine
January 2012 Issue of IMpact