While this is a serious essay and I should probably first allude to a great literary work, I’ll just keep it real and reference Inception. There’s a fantastic scene in which Ellen Page has her first go at building a dream. She builds a cityscape with ease and is quickly bored. With a spark in her eye she remarks: “What happens when you start messing with the physics of it all?”
Likewise, we are questioning the fundamental ways in which our health care system works–we are literally “messing with the physics” of the system. How will we deliver care? How will we insure patients? How will we sustain the future of health care itself? This is simultaneously one of the most exciting and most frightening points in our history. Nothing is certain and everything can change.
I had the privilege to be a Fellow with the Ohio State Medical Association (OSMA) during this pivotal time. Remember when the Supreme Court decision came out? June 28 at 10 a.m.! I was in a meeting with the Ohio Department of Health (ODH) and various societies from around the state to discuss an unrelated matter. And here I was, 21 years old and a second-year medical student, sitting among these important movers and shakers in our state, right when the decision was announced. It was like a front-row seat at the Super Bowl.
It got me thinking about an important question that I wanted to answer this summer: “In these pivotal times, who is able to make and break policy?” Think about it. Who comes to mind? The honest answer is whoever shows up to the policy-making table. And that includes you, dear medical student. We need doctors who can navigate the complicated world of policy, get the right people involved, and do what is best for our patients and profession. I have certainly learned the importance of a physician’s (and even a medical student’s) presence at the policy-making table when our life’s work is on the line.
During the fellowship, I was able to work on major issues facing the state of Ohio and our nation. Currently, the state and nation are facing a prescription drug abuse crisis. In response, OSMA has stepped outside of its conventional scope and taken a leadership role by organizing multiple CME events. My first task was to develop and design a handy pocket reference card for physicians to be handed out at CMEs. The card tackles issues inherent in pain management and prescription drug abuse. This was a hefty task for someone who had just completed her first year of medical school. Quite frankly, the extent of my clinical experience included some good handshakes and checking vitals. This project threw me right into the clinical world. I researched and called on leading physicians and pharmacists in our state to understand how we treat pain patients, what caused the crisis, and how we could best empower our physicians. Then I translated all of that wisdom into a tiny card that can fit in your white coat pocket.
The Ohio Department of Health is also tackling the prescription drug abuse crisis with a legislative sword. The intent of ODH’s proposed law is to regulate how physicians manage high-risk opioid patients. The OSMA has been an important stakeholder in the development process. I was able to understand the impetus for policy and how stakeholders work together to solve a common problem. On multiple occasions, I provided input and language changes to the legislation. I also made personal ties with Dr. Ted Wymyslo, MD, Director of the ODH, as we were able to provide guidance to each other while tackling the prescription drug abuse crisis.
On the political front, I attended candidate screenings in which a few members of OSMA and the Columbus Medical Association interviewed candidates running for state legislature. With no media involved, it was a unique opportunity to have a candid conversation. What we learn at these screenings helps inform our ultimate OSMA Political Action Committee endorsement. From attending the screenings, I offered personal insights and influenced our final decisions. The importance of being at the table really hit me at this meeting. The physicians were counting on those present at the screening to help make the final decision. Had we not been at the screenings or the endorsement, I am unsure that our final decisions would have mirrored what they are now. Talk about make-or-break decisions!
Also on the political front, I joined the Focused Task Force on State Legislation, a dedicated group of OSMA members who review all health-related bills in the state legislature. This meeting dealt with multiple bills regarding abortion. In the past, OSMA has never taken a stance on abortion issues; however, a recent resolution requires that we consider all health-related bills. The abortion bills gave me much grief. It was a struggle to decide what would be the best stance to take as an association. We have numerous considerations to make. What are the implications as far as access to care, patient harm and criminalization of medicine? These are all weighty issues to juggle and on top of this we wonder: should we even take a stance? Protecting our patients and profession can be a difficult cross to bear.
The last two weeks of my fellowship came time to pump some real health policy iron, so to speak. I drafted House Bill 607, termed the “Transparency in Health Care” bill. The legislation arose from deep-seated patient confusion about “who is who” in health care. In a world where anyone can wear a white coat and call him or herself “Doctor” (denoting any doctoral degree), how can we expect patients to know who is the physician? If roles aren’t clarified, we allow for undue patient expectations and risk patient safety. Similar bills have passed in other states with bipartisan support. I met with other state lobbyists and then proposed legislation to Rep. Anne Gonzalez (R-Westerville) who introduced the legislation into the House of Representatives. This was refreshing to work on because, in concept, the legislation is void of politics. It is solely about protecting patients and their safety. Of course, I’ll be watching this bill like a hawk during my MS2 year.
While I was working on various other projects, I was constantly thinking about how OSMA can better serve our physicians, residents and medical students. Yes, I advocated for you! Facing dynamic shifts in health care, OSMA underwent a period of critical re-analysis of itself to remain sustainable. I was able to specifically identify emerging shifts in the health care landscape. On my last day, I presented a bold, innovative model which accounts for these shifts and provides a strategic plan to better serve the Ohio physician community. The model ensures organizational sustainability and efficacy into the future. The staff was very receptive to my thoughts, and I hope that we will be seeing some changes in the future. Keep a look out!
As I work through MS2 year, I will continue to cherish the time I have spent with OSMA this summer. I will take the knowledge and experience I have gained back to my peers. It is imperative that we open their eyes to this “other” side of medicine. OSMA provides an accessible means to turn the “great unknown” of health policy into an exciting and educational journey. I am deeply indebted to those at OSMA for their wisdom and, simply, for rocking my world. They have made a serious investment in me and I will carry this forward by investing in my peers. I urge you, as future health policy leaders, to do the same. We owe this to our patients and futures. Best of luck, and I hope to see you at the policy-making table.