American College of Physicians: Internal Medicine — Doctors for Adults ®

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Drawn to political issues, these female physicians advocate for health care reform

From the July-August ACP Observer, copyright 2007 by the American College of Physicians.

By Sarah Pressman Lovinger, ACP Member

An increasingly overwhelming amount of paperwork and administrative tasks were detracting Susan E. Sprau, FACP, a Los Angeles pulmonologist and geriatrician, from spending time caring for her patients. Dr. Sprau, not being one to sit back and wait for change, decided to tackle the "hassle factor" head on by getting involved in politics.

Medicare's coding requirements and fraud and abuse rules were cutting into Dr. Sprau’s practice time. She was also bothered by unreasonable contracts from third-party payers and health maintenance organizations, and long reimbursement delays.

Today, she participates in action days in Sacramento several times each year and is ACP's representative to the California Medical Association (CMA). She participates in a monthly phone conference with the CMA and regularly answers e-mails about health policy issues.

Women like Dr. Sprau are becoming more of a force in health care advocacy. It doesn't have to be overly time-consuming, they say, and the Internet allows even women with young families to participate in lobbying legislators on important issues. Whatever the level of involvement, they feel that it's critical for physicians to weigh in on important health care policy issues and speak up for the needs of patients.

"I started seeing how little our legislators know about health care," said Jacqueline Fincher, FACP, 47, who began her political involvement nine years ago by serving on the Georgia ACP chapter’s health and public policy committee. "That really worries me as a physician."

Finding time

Getting involved politically, beyond sending e-mails to legislators, is a challenge for a busy internist who may also be juggling family responsibilities or other professional commitments.

Dr. Sprau's husband manages her practice and plays a critical role in keeping things running smoothly, she said.

This year, Dr. Sprau, 61, sees Gov. Arnold Schwarzenegger's proposal to expand insurance coverage as the state's most important issue, and she's worked within the state ACP chapter to promote bipartisan support for legislation to expand access to health care. ACP advocates in California are also focused on improving primary care in the state and in blocking future Medicaid cuts. Overall, Dr. Sprau estimates that she contributes about 10% to 15% of her work time to her political action efforts.

Dr. Fincher, who has a private practice in Thomson, Ga., still spends 95% of her time on outpatient care. But with no call and more predictable hours than other physicians, she finds time to work on legislative issues. Political advocacy work is sporadic, she said, with more time required when the state legislature is in session.

Dr. Fincher shares her practice with three other doctors, including her husband. They have a 16-year-old daughter, who attended meetings and banquets from an early age as her mother balanced work, advocacy and family. But Dr. Fincher adds she hopes the early exposure to political activism will instill a passion in her daughter to make a difference.

Dr. Sprau pointed out that different levels of involvement may be suitable at different stages in of woman's life. For example, younger women with young children and who are establishing a practice may only have time to answer e-mails, whereas women in their 40s and 50s, who may not have as many child-care responsibilities, may be able to devote more time to attending meetings.

While the number of hours spent can vary, timing often is important, noted Dr. Fincher. Knowing how and when to contact her legislators as well as when important bills are coming up for a vote is critical, she said. "Things happen fast," she said, "it's important to respond quickly."

Sarah T. Corley, FACP, balances full-time as chief medical officer for an electronic medical records company based in Horsham, PA, with seeing patients one day a week and serving as the ACP Governor of Virginia. But she still makes time to contact her elected officials to advocate for payment reform, increased financing for electronic health records and the creation of a realistic pay-for-performance model.

It does not really take that much time," she said. "They [elected officials] just want to hear from physicians."

Doctors speak out

Doctors have an important role to play in public health issues, said Dr. Fincher. For example, she said, increasing cigarette taxes are a complex issue in the tobacco-producing state of Georgia. Public health officials push for higher taxes because research shows that they deter smokers, particularly teen-agers, while tobacco industry lobbyists resist any price increases.

Physicians can provide a much-needed health perspective on the issue, she said. While some legislators decry any tobacco tax with the slogan "No new taxes," physicians can point out the overall health benefit and decreased health care expenditures that go along with reducing smoking rates. "The more people smoke in the state, the more taxpayers will pay for smoking related illnesses," Dr. Fincher added. "It is a taxpayer issue."

Business people tend to look at the bottom line, observed Dr. Fincher, and lawyers focus on liability. It's up to doctors to advocate for patients and their health care.

"No one thinks about the patient's best interest but us," she said. But without more participation from doctors, "All these other people are going to dictate how health care runs in this country."

Spreading the word

Vineet Arora, 33, ACP Member, completed a residency in internal medicine, a masters in Public Policy in 2003 and a general medicine research fellowship in 2004. She now works as a hospitalist and serves as an Associate Program Director for the University of Chicago Internal Medicine Residency.

Vineet Arora, ACP Member, continues to be involved with issues that affect medical students and residents. She shakes hands with former CMS administrator Mark McClellan before delivering testimony to the House Energy and Commerce Committee in November 2005.


Vineet Arora, ACP Member, continues to be involved with issues that affect medical students and residents. She shakes hands with former CMS administrator Mark McClellan before delivering testimony to the House Energy and Commerce Committee in November 2005.



She recalls the first time she participated in an ACP-sponsored legislative event. "It was eye-opening" to be able to talk to legislators about the issues, she said.

Now, she's trying to spread that enthusiasm to current medical students and residents. As ACP's Council of Associates Chair starting in 2005, Dr. Arora worked to secure funds that would cover travel expenses so that students and residents from every state could participate in ACP's annual Leadership Day on Capitol Hill. "Not every student and resident can get to D.C.," she said.

Directing students to local community health projects is another way that she promotes activism among trainees. Physicians at all stage of their careers can stay involved at a comfortable level, she said. "I think all too often interested residents get discouraged and apathetic during their training. It is important to present advocacy opportunities that can engage them at any level."

Though few medical schools offer formal training for medical students in health care policy, Dr. Arora said, knowing about how these decisions are made is an extremely important part of medical education. "It's really hard to change the system if you don't know the history and how to get involved," she said.

Dr. Corley, who lives near Washington, D.C., often takes medical students and residents with her to meetings so they can learn about the political process.

Several years ago, Dr. Corley asked a medical student to accompany her to Virginia's Leadership Day. The experience gave the woman her first opportunity to see how activities in the state legislature can affect funding for graduate medical education, reimbursement and malpractice issues. The student subsequently became active in advocacy as a medical student and later as an ACP Key Contact.

Dr. Fincher encourages other physicians to contact their legislators by e-mail and fax. She also asks patients to get involved in important issues, and puts up posters in her office with guidance for patients on how to contact legislators.

The bottom line, said Dr. Sprau, is improving patient care. "We have the guiding principle that we as a specialty want what is best for our patients."

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College's advocacy efforts aided by network of 'Key Contacts'

ACP's more than 5,000 Key Contacts communicate with their members of Congress on issues of importance to medical students, internists and their patients, and report the results back to ACP. As key issues approach the decision-making stage on Capitol Hill, the College emails or faxes legislative alerts to Key Contacts. Enroll online.

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