On April 11-12, faculty member Dr. Kathe Miller and students Andrew Foley and Mark Herzog traveled to Capitol Hill to represent Harvard Medical School at the annual Family Medicine Congressional Conference. During the first day, they met with family physicians from across the country to discuss the American Academy of Family Physician’s (AAFP) legislative priorities for the upcoming year and share how these priorities resonated with their clinical practice and education. On day two, they traveled to the Hill as part of the Massachusetts delegation to discuss these priorities with their Representatives and Senators.
What did you find inspiring at the conference?
Mark: I was inspired by meeting family physicians who came from across the country to advocate for the communities they serve. I feel fortunate to have connected with Dr. Karen Smith, a family physician practicing in rural North Carolina. Last year, Dr. Smith spoke as an innovator at the AAFP’s National Conference for Students and Residents. After connecting with her in DC, I hope I can convince her to speak at HMS this summer and possibly stop in for one of our Family Medicine Interest Group meetings. Additionally, it was inspiring to see how excited physicians were to include medical students in the conversation. I had the pleasure of connecting with Dr. Doug Henley, the Executive Vice President and CEO of AAFP at breakfast on the first day of the conference. He was enthusiastic about getting medical students involved in AAFP and helping them learn how to be advocates for the issues they care about.
Andrew: What was inspiring for me was seeing all of the ways of how one can act as a physician-advocate. We met physicians from all walks of primary care advocacy life: those who work on identifying and framing policy issues at the AAFP’s Robert Graham Center, others who organize their local AAFP chapters around specific community issues, and some who serve as advisors to representatives in Congress. Additionally, it was exciting to meet some extremely passionate physicians. For example, we met Dr. Thomas Cornwell, who is doing inspiring work on home-based medical care. He founded the Home Centered Care Institute (HCCI) in 1997 to address the needs of homebound patients and high utilizer patients whose care is complex and expensive because their needs are not easily met by the current healthcare system. Dr. Cornwell has done over 32,000 home visits in his career and, through HCCI, has been a leader in the Independence at Home Demonstration, a Medicare demonstration project that attained $25 million overall cost savings in its first year. It was inspiring to meet someone working at the intersection of so many key areas in healthcare, such as building cost-saving programs that still promote patient-centered care.
How did this experience impact your view of advocacy and the role of physicians as advocates for their patients?
Mark: I helped to represent both the Massachusetts and Tennessee delegations. As a result, I attended meetings across the political spectrum ranging from the office of Senator Warren in Massachusetts to Congressman Phil Roe, a Tea Party Republican who represents my home district in Tennessee. I gained an appreciation for how important it is to identify and highlight advocacy points that can span across the political spectrum. The talking points I shared on behalf of the AAFP were every bit as relevant for each meeting. As family physicians and students, we focused on common interests of serving our communities. Our delegations were able to advocate a unified message across seemingly insurmountable political divides.
Andrew: I gained a greater appreciation for the role of the physician as an advocate as a result of this conference. We need data to drive our health policy decisions, but we also need to understand the context out of which that data arises. Stories that come directly from the communities that are affected by policies are powerful tools for transmitting understanding. I witnessed how a physician can be that storyteller on behalf of his or her patients on Capitol Hill. In terms of my view of advocacy more generally, I found our time physically inside the halls of Congress very illuminating. It brought me face to face with the question: who truly gets represented here? It would come as a surprise to no one that the diversity of the country, particularly by race and gender, is not reflected among the representatives, their staff, or the lobbyist and advisers who walk the halls. Yet the issues that get brought to the table, as I learned first-hand, are dependent upon who can be physically present in those offices to receive or deliver the story and evidence that supports one’s agenda. This drove home to me that while the front line of advocacy may be at the table in a representative’s office, the most powerful tool for every advocate is his or her vote.
What unique perspective do you felt you brought to the conference and your conversations on Capitol Hill?
Mark: Coming into the conference, I wasn’t sure what perspective I would contribute to the conversation. The AAFP decided to make funding for the Nation Health Service Corps (NHSC) one of the key budget appropriations priorities. As a current NHSC scholar, I was able to bring a story and a face to this budget request. Senators and Representatives were eager to hear why I had applied and how the program would shape my future career. Hearing my story helped put into perspective the consequences of the current low funding levels. Last year over 2,000 health professional students applied for fewer than 200 spots for the NHSC. Representatives were able to better recognize the shortcomings of current funding levels for a program that can fill many of our public health gaps: the geographic maldistribution of clinicians, lack of healthcare workers in underserved communities and a shortage of primary care clinicians.
Andrew: At the conference, people were often surprised that we were first-year medical students and eager to hear what we thought of the experience. Both at the conference and in the legislative offices, however, people were more often surprised that we were representing Harvard Medical School. “Harvard does not even have family medicine, right?” the legislative aid for one Senator from Massachusetts remarked. Indeed, the fact that not a single Harvard-affiliated hospital had graduated a Family Medicine physician in over 40 years — despite a massive shortage of primary care physicians and an aging population — was used at the conference to demonstrate how out of touch some medical schools, such as Harvard, Johns Hopkins, and Stanford, continue to be with the growing needs of the communities they purport to serve. It was, at times, an awkward situation to be in, yet I think it ultimately helped us provide a unique perspective. Our voices helped demonstrate that passion for family medicine is strong and growing, such that even students like us, from a school that does not have a family medicine department, are eager to fight for greater educational and career opportunities in primary care.
What role did your clinical experience or medical knowledge play in the discussions?
Mark: Many representatives were eager to discuss policies that will address the opioid epidemic and the role of clinicians and medical treatments. In constructing policy around this issue, various medications are being considered, and the details and distinctions among these medications can be confusing for providers and policymakers alike. As a medical student who had recently learned about how these drugs work, I was ready to convey the different actions and clinical roles of buprenorphine/suboxone in combination, methadone, buprenorphine and naloxone to legislators and their aids in a concise way. In my conversation with Representative Nikki Tsongas (D-MA3), in fact, this exact issue came up and I was able to help clarify the role that each of these medications can play in the clinical setting to address addiction and overdose.