From lobbying on Capitol Hill to learning more about federal priorities for residency training, the 2014 Family Medicine Congressional Conference was a whirlwind of activity. I attended with fellow UVM College of Medicine student Jen Makrides, representing Vermont and the College alongside medical students and physicians from 47 states. The conference opened with remarks from Representative Henry Waxman, who retires after this term leaving behind a legacy of health policy rooted in evidence and a tireless focus on whether the policy works for patients and providers alike. In a year where we’ve faced enormous change in healthcare, Rep. Waxman reminded us all that programs like Medicaid are critical because “Poor people are not visible. Poor people are not valuable.” For some attendees, their state opted not to expand Medicaid coverage, and physicians spoke about the impact of that decision on their practices and patients. Vermont has expanded Medicaid, covering households with incomes up to 133 percent of the federal poverty level. From the opening remarks to our visits on the Hill, it was evident that Vermont and the College of Medicine are far ahead of many states in terms of prioritizing primary care and training primary care physicians.
At the conference, we were seated by delegation and not surprisingly, Vermont only had two delegates! As such, we didn’t earn our own table and instead had a spot with the Nebraska delegation and some spillover from Alabama. In speaking with the physician from Nebraska, the conversation turned to medical school and what medical schools can do to train more primary care physicians. It was his impression that the medical school contributes to the trend of the “-ologist,” rather than making the case for primary care. He was impressed to learn that the emphasis on primary care starts in our first year with Doctoring in Vermont, and that UVM turns out a high percentage of primary care physicians on every Match Day. Whether the institution drives the support at the state level or the state’semphasis on primary care drives the institution, it is clear that UVM is doing something right to address the physician shortage problem.
As a first year medical student, the issue of most interest was federal level activity to support (or thwart) residency training and new physicians. There are three major issues during this fiscal year.
Reauthorization of Teaching Health Centers
Teaching Health Centers (THCs) train residents in community-based settings that are more similar to where most physicians practice. Research presented at the conference found that residents generally stay within 100 miles of where they complete residency, making the argument that THCs improve access to healthcare for communities and better prepare residents to practice in those communities. (Bill S. 1759).
Investment in Primary Care Workforce and Health Services Research
Title VII, Section 747 provides direct federal support for the education and training of family physicians. The Agency for Healthcare Research and Quality (AHRQ) conducts research that supports evidence-based primary care medicine. Appropriating $71 million for Title VII and $375 million in base funding for AHRQ would sustain both of those resources.
Modernizing Primary Care GME
This project requires congressional support for new models of primary care graduate medical education, including community-based models and shared programs between smaller hospitals. The goal is to use creative solutions to expand primary care training into rural communities or communities with infrastructure that isn’t centered on a main teaching hospital.
On Tuesday, the real fun began. Fresh off an afternoon of training on effective lobbying and perfecting our “asks,” Jen Makrides and I headed to the Hill to meet with staff from Senator Leahy and Representative Welch’s offices. We met with a staffer from Senator Sanders’ office on the first day of the conference. Unlike other states where delegates met with staff and Congressional leaders who did not necessarily support primary care or health care reform, we were met with open arms, which made our “ask” process easy. Our biggest success was sharing information about the need for modernizing primary care GME, sparking great conversation about what models might work for Vermont.
The conference was full of fantastic quotes from speakers and audience members alike so I’ll close with the two thought provoking quotes and one that is excellent advice, regardless of what career you’re in.
“Your birth certificate did not say Orthopedic Surgeon. You have to fit your career aspirations around the needs of the country.”
“People have been led to believe that care received from an ‘ologist is better than that received from a PCP.”
“What gets you up in the morning? What keeps you up at night? Those are the issues worth advocating for.”
If anyone is interested in learning more about techniques for advocacy from the conference or specific information on legislation, let me know. Enormous thanks to the American Academy of Family Practice for awarding me a scholarship and offering the opportunity to attend this conference.