Commentary Corner: Being a Lifelong Advocate

Commentary Corner: Being a Lifelong Advocate

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 debate.

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 system.

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 oppose.

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

Shane R. Sergent
Osteopathic Medical Student III
Michigan State University College of Osteopathic Medicine

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