A Summer at the Capitol: An Insider’s View Into the Daily Activities of Running Our Country
With health reform passing at the end of my first year of medical school, I decided to spend my summer interning at Capitol Hill in a congressman’s office in hopes of determining a physician’s place in the politics of healthcare. While I certainly did not find politics to be the most beautiful of decision-making processes at times, I accepted it as our current reality in hopes of learning something from my summer. In the end, I discovered a Capitol in need of the unified presence of physicians.
I learned early on that congressmen are actually quite responsive to their constituents, as my fellow interns and I answered constituent calls and logged the mail and faxes each day. There is a constant eye toward what the constituents want. In fact, the desires of constituents seem to be the decisive factor in how the congressman votes each day. In addition, those constituents who make their interests readily apparent, or those constituents that are doing something beneficial for the district, seem to bear greater influence. For example, I discovered during my stay that while the congressman has limited stance on agricultural issues because there are no farms in the district, he is a proud advocate for facilitating the important advancements being made by the biotech industries in San Diego. Thus, I got to thinking how many doctors lived in the district, and, in combination with their patients, I envisioned their vast potential to positively influence the politics of each day. Their potential further amassed in my head when I realized that, whereas a district may lack farms or miners or fisherman, no district lacked doctors.
The second thing I found particularly striking at the Capitol was the overwhelming workload of the congressmen and staffers. This has direct implications on how they treat physicians. It means that they regard doctors as doctors, and care little for their specialty of choice. They do not have the time to learn and track the needs of each specialty. Thus, I came to believe that the differences between specialties need to be worked out among doctors before they talk with the people in political power if doctors want to wield any power themselves. This applies to the physician research community as well. During a committee hearing regarding the best PTSD treatments to be adopted by the VA, I watched the committee chairman ask a discordant Duke neurosurgeon and physician specializing in hyperbaric oxygen therapy why they couldn’t talk to each other a bit before coming to talk to him.
The last and most influential lesson that I took from my summer is the huge potential for physicians to become involved as educators in the formation of health policy. Physicians are seen by politicians as experts in the provision of healthcare. From my first day in the office, I was respected and utilized as a source of specialized knowledge in science and healthcare for merely deciding to embark on the path to becoming a physician. As I said, congressmen and their staff are highly overworked. They are not capable of becoming experts on every issue, especially an issue as complicated as healthcare. The vast majority of their day is spent seeking guidance as to the best course of action to take — whether through lunch talks on healthcare reform, sharing information with other offices, or calling Health and Human Services. As recognized experts in their field, doctors need to be more available as a source of this guidance.
Furthermore, the debates surrounding the Sustainable Growth Rate (SGR) in June led me to understand that guidance from physicians should be as productive as possible. As experts in their field, physicians should be a source of knowledge not only about the problems that physicians face, but also the problems that the provision of healthcare in the United States faces. For politicians, SGR is a budgetary issue. Most politicians agree that it’s important to adequately reimburse physicians, but when faced with reforming and fixing SGR, politicians are worried about the deficit. Their underlying concern is how healthcare spending is going to be limited in the future. As highly knowledgeable, educated, and practiced as they are, physicians should have an answer to this question, and they need to have an answer if they want to be effective in protecting their own interests.
My summer in a congressman’s office gave me a brief insider’s view into the daily activities of running our country, and I found a much-needed place for physicians in the process. I met a Capitol that had not yet come to terms with the health reform legislation passed more than five months ago. I ate countless free sandwiches at lunch talks dedicated to deciphering the Patient Protection and Affordable Care Act (PPACA) and swaying congressmen and their staff on its implications. I experienced a Capitol asking, what did we pass? What does it mean? What do we do next? A Capitol yearning for a unified body of physicians with a clear and strong voice to help them find the answers.