Medical Student Perspectives: Doctors' Day: Learning How to Advocate
Half-listening to the agenda items of the Arizona House Health and Human Services Committee, I flipped hurriedly through one-page papers about the issues important to the American College of Physicians. In a few hours, I would be face-to-face with a state senator, then a district representative - I had no clue what I would say to either of them. I thought I'd arrive at the state capitol to learn how to advocate for my chosen profession by shadowing seasoned lobbying physicians. It never crossed my mind that I'd be chatting up state politicians with the hope of educating them about matters important to the more than 3,000 doctor and medical student members of the Arizona Chapter of the ACP.
"Just speak from your heart," advised Dr. Ana Maria Lopez, governor of the ACP's Arizona chapter.
With barely two quarters of medical school behind me, I can tell you that my heart didn't have much to say in terms of health policy.
I had just completed a week of daily final exams and had not had much time to review the Arizona health policy landscape. How was I going to be able to have a conversation about issues relevant to patient care and the practice of internal medicine, while remembering to promote specific pieces of legislation? I was worried how I would even go about introducing myself.
Thank goodness that the purpose of the Arizona ACP chapter's third annual Doctors' Day was to give physicians and aspiring physicians the opportunity to learn about the state political process.
In a state senate conference room, with the Doctors' Day "freshmen" and veterans, we reviewed the bills and issues meant to be discussed with our legislators: health information exchanges, patient-centered medical home (PCMH) models, and graduate medical education funding. Health organization representatives, with experience lobbying legislators, answered questions on what to say, what to ask, how to respond.
Throughout the day, a few policymakers would talk to us about the importance of civic engagement and the general political process. We also had time to observe the legislature in action from the committee level to the house and senate galleries.
Sometime during the working breakfast, the working lunch, the briefings, a few of us would leave - furnished with our growing fund of political knowledge - for individual or small-group meetings with our legislators.
It is true that internists can advocate for their profession and their patients at industry-related conventions and conferences. They can effect change and educate the public via community-outreach efforts. In talking with policymakers, however, I see that doctors may have the greatest influence and impact by engaging those in politics: These policymakers do craft the laws that determine how physicians can actually practice.
But how are politicians to make decisions affecting the health care industry when doctors and patients aren't updating them on the issues? Aspiring and working physicians can effect change and improve patient care, just by sharing their stories with policymakers.
Regardless of how I'd like to practice medicine three years from now, political decisions made in 2010 (i.e., Patient Protection and Affordable Care Act), last year or last week, will influence ultimately how I practice medicine and care for my patients.
Lack of funding for a capped number of graduate medical education positions, for example, will limit my career options. Partisan discord about the implementation of probable cost-effective measures, such as health information exchanges and PCMHs, will influence my relationships with patients and colleagues. The PCMH model seeks to foster the growth of coordinated health care teams, improving patients' access to quality, cost-effective care throughout their lives. A health information exchange for physicians and other medical professionals would hopefully strengthen this coordinated care approach.
I may not be able to persuade politicians to support programs specific to physicians and patient care, as financing such measures could mean diverting funds from small businesses, community services, or public schools. I can, however, share my story and my hopes so my community representatives are at least aware of the issues important to me.
As a voter and future physician, I can help my political representatives understand how their legislative decisions affect my livelihood and the health of my future patients.
The conversations I had with Arizona state representatives were exhilarating and educational. With the support of the ACP and Arizona Hospital and Healthcare Association, I was able to learn how politicians weigh decisions, how lobbyists educate and sometimes influence policymakers, and how doctors can advocate for patients outside of the medical office.
Leslie Tamura, OMS-1