Leading the Way

Jen Hartmark-Hill, MD

Jen Hartmark-Hill, MD

One of my top priorities for staying involved in health care advocacy is to promote a better future for my students.

As a medical educator, I often ponder the uncomfortable paradox of training medical students to become “ideal” physicians, only to send them out into a far less than ideal health care system upon graduation. Preparing and educating future physicians to lead health care transformation is essential, but we who serve as educators and role models cannot stop there.

I believe we have a duty not only to provide knowledge, skills, and resource tools but also to go on ahead of our students to pave the way. 

Having been involved with state level advocacy for a number of years, my learning curve since introduction to advocacy in residency (thanks to my state AAFP chapter) has been steep, yet still I know so little. Given my minimal experience advocating at the national level, I have been contemplating the need to expand my skills. This year, I had an opportunity to attend the Family Medicine Congressional Conference in Washington, DC, through a scholarship from the Society of Teachers of Family Medicine.

Lessons Learned

At the conference, an amazing line-up of national leaders in health care policy opened my eyes to current areas of need and opportunities to educate our leaders and lawmakers. A few of the many take-home points were these:

SGR Repealed

For anyone with residual doubts regarding whether or not persistent advocacy really works, the opening statements of the Family Medicine Congressional Conference provided solid evidence of critical value. As one speaker noted, “The acronym no one need utter during this conference is ‘SGR,’” which was followed by volleys of heartfelt applause. The speaker referenced an unprecedented milestone. For the first time anyone in attendance could remember, the Damoclesian sword of devastating payment cuts embodied in the unsustainable Sustainable Growth Rate (SGR) formula was no longer hanging over our heads. Family medicine efforts, year after year, have been key to this bipartisan accomplishment. Thankfully, we can now move forward to so many other advocacy opportunities to enhance care and access for our patients.

Money Matters

The call for reform in Graduate Medical Education (GME) funding has been tolling recurrently in recent years, due to outdated funding methods that placed a choke hold on the purse strings back in the late 1990s. Many states with significant underserved patient populations have lobbied for increases in dollars to be able to train resident physicians in communities where they will then likely stay and practice. Rather than again championing a reform plan to congressional leaders, the strategy we enacted this year was to go with a strength for family physicians—evidence-based decision-making. We urged our representatives in Congress to direct the Governmental Accountability Office to issue a non-partisan report looking at locations and demographics for where yearly GME funding currently flows. Transparency in the data will allow family medicine advocates to call for accountability in federal government spending—for our leaders to use taxpayer derived funds to improve the primary care pipeline and increase patient access to care.

Advocacy in Action

 Armed with cutting edge tools and current knowledge of legislative hot topics, we left the halls of the conference for face-to-face meetings with Congressional leaders and their expert staff.  In addition to the topics mentioned above, we also had the privilege of sharing with our legislators the value of primary care, such as the fact that if a patient has a PCP, the cost of their health care tends to be about 33% lower, and risk of dying is 19% lower than those who see only a subspecialist.1 Ensuring that American citizens have access to high-quality health care and a PCP equates to growing the primary care pipeline. This message, and the fact that incentivizing medical student seniors to choose family medicine specialty training has a higher return on graduating residents staying in primary care (compared with all other specialties), was well received by the legislators with whom we spoke.

In the future, with continued education and advocacy on our parts, lawmakers will continue to consider funding new models for training physicians that bring down health care costs over time while effectively improving the health of the nation. The journey will take some time, but this experience has already hugely impacted me for the better.  I can now share these lessons learned with my students from a first-hand perspective, making me simultaneously a stronger educator and an agent of change.

My message to students and colleagues alike—get involved and stay involved. Your patients and your profession are counting on you!

  1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457-502.

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