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When my twin sister and I started our residencies in ophthalmology, we never predicted that less than a year later we would be in Washington, D.C., on Capitol Hill, meeting with legislators to preserve the quality of eye care in our nation. We did not imagine we would be presenting to the Council of the Academy, expressing our gratitude for their efforts in preserving the future of our profession. This is how it happened...
Somewhere around the second month of our residency, we were invited to attend a local meeting where senior members of our state society informed us of important issues occurring at the state and national level regarding the care of our patients. Michael Sulewski, MD, chief of ophthalmology at the Philadelphia VA Medical Center and Academy Councilor representing the Association of Veterans Affairs Ophthalmologists, and Daniel Will, MD, retinal specialist at the Scheie Eye Institute, informed us of scope-of-practice battles in which non-physicians such as optometrists have requested surgical privileges.
Requests for this breadth of scope have been made in 26 states and, in some states, they have succeeded — allowing optometry to perform certain surgical and laser procedures. Drs. Sulewski and Will informed us of current efforts and the role residents could play in the important initiative to challenge scope-of-practice expansion.
At the meeting, we also heard from David Pao, MD, president of the Pennsylvania Academy of Ophthalmology, who explained the sustainable growth rate (SGR) — an inequitable and flawed formula that determines Medicare physician payment updates. Based on the SGR, physicians face payment cuts each year, and are expected to incur a 21 percent reduction in Medicare reimbursement this year if Congress does not intervene.
Drs. Mehta Go to Washington
Motivated by the examples of those around us, we soon found ourselves in Washington, D.C., with 90 other energetic and passionate residents concerned about the future of vision care for our patients. Our first night, we were briefed about several major discussions occurring on Capitol Hill.
In addition to updates on scope of practice and Medicare physician pay cuts, we discussed vision care for veterans, children and the public, learning that:
- Combat eye trauma is the second most common injury experienced by military personnel serving in Iraq and Afghanistan. The Military Vision Center of Excellence is a program proposed by the Department of Defense and Veterans Affairs to prevent, diagnose, treat and rehabilitate military eye injuries.
- Ambylopia is the leading cause of visual impairment in children. The Vision Care for Kids Act was proposed to provide grants for screening and followup eye care in children to detect and treat diseases like ambylopia and prevent childhood blindness.
- The NEI facilitates prevention and treatment of the most common causes of vision loss in the United States, yet has seen an 18 percent reduction in purchasing power over the past several years.
The next day — Advocacy Day — we met with legislative aides and, in some cases, representatives and senators, to discuss these issues, share our concerns and perspectives and request their support on these issues in order to preserve quality eye care for Americans.
A senator once said, ”In politics, if you ask for nothing, I can guarantee you will get everything you ask for.” So we asked! We asked for support of the Vision Center of Excellence for war veterans returning with combat eye injuries, as well as the Vision Care for Kids Act, to help prevent childhood blindness. We asked for increased NEI funding to invest in research to help low-vision Americans. We asked for Congress to intervene to stop Medicare physician pay cuts and preserve access to care. We asked for Congress to support surgery by surgeons.
Information is the Key to Action
The next day, during the Mid-Year Forum, we attended many informative presentations on topics such as physicians’ relationship with industry, electronic medical records and communication. A particularly interesting session was on the baby boomer crisis and potential solutions for the soon-to-be doubled demands on primary eye care physicians. Potential models discussed included restructuring of practices to run more efficiently in a team-based approach to integrate eye care.
Later that day, we participated in a mock trial, which recreated the recent situation of a hearing before the South Carolina legislative committee on scope of practice. In this mock trial, optometrists and ophthalmologists presented their points of view and underwent questioning by a panel of legislators. Participating in this mock trial made it clear how difficult it can be to enhance legislator understanding of the intricacies of scope of practice and the degree of preparation involved in such a hearing.
The last day of the Mid-Year Forum, the Academy Council gathered to vote on Council Advisory Recommendations (CARs). We heard ophthalmologists from across the country present CARs on various issues of concern. It was enlightening to hear the debate and we couldn’t help but notice how similar situations were in different parts of the country.
YOs: Get Involved
For all YOs reading this, our hope is that you will feel as inspired and motivated by the issues discussed at the Mid-Year Forum as we were. Most of all, we hope you are as eager as we are to know how we can all help in this initiative.
First, become a member of your state ophthalmology society. Second, contribute to OPHTHPAC. Financial contributions, no matter how small, can be helpful in supporting this important endeavor. Third, meet your state legislators and request their support on issues important to the preservation of quality eye care for our patients. Finally, consider taking a day away from your busy practices to attend Advocacy Day and the Mid-Year Forum next year!
The field of ophthalmology has seen tremendous advancements in the past several decades. As our first year of residency comes to an end, we are excited to see how the field will expand and what new developments the 21st century will bring to enhancing the care of our patients.
We would like to acknowledge the Pennsylvania Academy of Ophthalmology for their generosity in supporting several residents in attending Advocacy Day/Mid-Year Forum this year, as well as our respective institutions for relieving us of our clinical duties and responsibilities so that we may participate in this event. Finally, many thanks to the Academy for setting up the Advocacy Ambassador Program and for their continued commitment to young ophthalmologists.
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About the authors: Sonia Mehta, MD, is currently a first-year ophthalmology resident at the University of Pennsylvania Scheie Eye Institute. Sonul Mehta, MD, is a first-year ophthalmology resident at Georgetown University-Washington Hospital Center. Over the past several years, these twin sisters have been actively involved at the state and national level in organized health care reform via the AMA, AMSA and their state medical societies.