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YO Perspective: Change Will Happen Whether or Not You Speak Up
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Editor’s note: Every year, the Academy’s Advocacy Ambassador program brings young ophthalmologists to the Mid-Year Forum through a partnership with state and subspecialty societies and training programs. Two of this year’s 123 participants, Azadeh Khatibi, MD, and George Scarlatis, MD, PhD, report on their experiences at Mid-Year Forum and Advocacy Day. Dr. Scarlatis was a unique ambassador, in that he chose to participate on his own accord and his own dime – without the sponsorship of a state or subspecialty society. Get even more stories on Mid-Year Forum group blog by ambassadors Leslie Garay, MD; Tyler Kirk, MD; and Christianna Stuber, MD.

Being a non-sponsored Advocacy Ambassador (the designation given to members-in-training who participate in Advocacy Day), and given Baltimore’s proximity to Washington D.C., I elected to commute to the Hill from home on Advocacy Day. My day started bright and early as I caught the 7:40 a.m. MARC train to ensure that I would be on time for our 9:30 a.m. meeting at the office of Sen. Barbara Mikulski, D-Md.

Having caught the first train (keeping the next train as a backup for a “just in time” arrival), I arrived on the Hill by 9 a.m., making me the first person from our party to arrive at Sen. Mikulski’s office. Since I was commuting to Advocacy Day, I had not yet met the other Mid-Year Forum participants who would be joining me. One by one, the many members of our party (about eight or nine in all) arrived and we introduced ourselves.

Making Our Case
As we went into a conference room, we met with Sheldon D. Fields, PhD, RN, a nurse practitioner doing the Robert Wood Johnson health policy fellowship with Sen. Mikulski. The other Advocacy Ambassadors and I were nervous, given that none of us felt fluent in all five of the issues we were scheduled to discuss. Fortunately, the Academy’s secretary for federal affairs Michael X. Repka, MD, led the way and presented our positions on all of the topics to Dr. Fields.

We led with the least controversial topic, the 25th anniversary of the EyeCare America program, which provides free eye care for those individuals in the United States who cannot afford it. We asked each representative to support H. resolution 1226, recognizing the volunteerism of Eye M.D.s and the service this program has provided for over one million people since its inception.

The next two requests were for increased funding of vision-related research. We asked for $35 billion for the FY2011 NEI budget and $10 million for the Department of Defense peer-reviewed medical research for vision.

The next topic was the recurrent vote on the sustainable growth rate (SGR) for Medicare, which has been postponed and passed along from one congressional session to the next. Historically, each time Congress acts on the issue, severe cuts to Medicare reimbursement for physicians are deferred for a few weeks to months at a time. We stressed the importance that Congress act to pass a permanent solution to this issue so that physicians don’t have to face the specter of an acute and significant drop in income.

Save the Best for Last
The most controversial issue we saved for last: our request for support of the 2010 Medicare Physician Fee Schedule and the denial of attempts to circumvent it. A few years ago, Congress created a fee schedule based on surveys conducted up to a decade apart for different specialties, without any correction for inflation or any other factors. This was accepted on the condition that a new survey would be conducted for everyone at the same time and that the fee schedule would be corrected accordingly.

That survey was finally done, but specialties that had seen a disproportionate increase in Medicare reimbursement due to having had more recent data are now facing reimbursement cuts. An initiative led by cardiology would have their reimbursement for certain codes considered separately from every other specialty.

We oppose this because the funds to cover this would likely come from other medical specialties and would set a precedent that Congress would have to meet and legislate funding code-by-code. The cardiologists have been lobbying hard to pass a bill giving them special budgetary consideration. Some congressional staffers we met with said we were the first to present the other side of the issue to them.

Practicing Medicine on the Spot
As we moved down the hall to the office of Sen. Benjamin Cardin, D-Md, we met one of his legislative fellows, Elizabeth Baden. When we entered the conference room, she eyed us nervously and asked, “You’re all eye doctors, right?” After responding in the affirmative, she sheepishly asked, “Would it be alright if we asked you for your professional opinion about something?”

It turned out that another staff member had arrived to work that morning with epiphora and a foreign body sensation in her right eye. Dr. Repka and several of the other attendings looked at the offending eye and another staffer was kind enough to loan us a key-chain light. A small corneal foreign body was identified.

When asked to remove it, however, the staffer was advised to make an appointment that day to be seen at an ophthalmologist’s office, where anesthetic could be applied first and she would have appropriate follow-up. Needless to say, Ms. Baden was very attentive to our legislative requests during our subsequent meeting. On our way out, we ran into Sen. Cardin at the elevators and took a group photo with him.

One Congressman, Many Eye M.D.s
As we were leaving the senators’ offices, I found out that I was the only person scheduled to see the congressman from my district, Rep. C.A. Dutch Ruppersberger, D-Md. Fortunately, he had already arranged for an attending to accompany me. Since the other members of our party did not have another appointment that morning, the entire group volunteered to accompany us to the meeting, where we met with the senior policy advisor, Walter Gonzales. Once again, Dr. Repka led the way and conveyed our points to Mr. Gonzales.

Implementing My Day’s Lessons
After lunch, our party split up near the congressional buildings to attend various further meetings. Since I had no more scheduled meetings and the rest of the Maryland group was going off together, I offered to accompany a resident scheduled to meet with Rep. John Sarbanes, D-Md. One doctor originally scheduled to accompany her was going to another meeting, and she did not want to risk being the only person there.

Upon arriving, we waited until our appointed time, but still did not see the other doctor who was supposed to be joining her (eventually we learned he was looking for a parking spot). Having other appointments immediately after ours, Rep. Sarbanes’ deputy chief of staff, Dvora I. Lovinger, asked if we could start the meeting and have the other doctor join us once he arrived.

I asked the resident if she wanted me to present, and she happily acquiesced. I did my best to replicate the presentation Dr. Repka had so effortlessly demonstrated for me three times that morning. Apparently, the third time was the charm, as I felt quite comfortable discussing the issues and our recommendations for what position Rep. Sarbanes should take.

During the presentation of the last issue, the other doctor arrived and had a chance to share his perspective as well. He was then kind enough to drive the resident and me back to the conference hotel for the Mid-Year Forum, but our adventures there are a story for another day.

Lessons Learned
Two important lessons I learned were that, like anything else, you learn best by doing and changes will happen whether or not you make your voice heard. If we don’t make our voice heard, most of those changes will be to our collective detriment. One staff member had never heard that there was even another side of the story and another told us a story of how the representative had taken the wrong stance on an issue because a group of delegates had cornered the representative at the end of a fundraiser and pressured support of their agenda by presenting only part of the story. That representative is now politically pressured to maintain the “wrong” position on the issue due to making a verbal commitment before evaluating all the facts.

If we don’t step forward and educate our legislators on the effects their votes will have on the practice of ophthalmology, we will continue to see a decline in our autonomy and level of reimbursement as medical practitioners as well as more of our scope of practice being encroached upon by paramedical services.

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About the author: George N. Scarlatis, MD, PhD, received his medical degree from Northwestern University Medical School, completed his internship at Evanston Northwestern Healthcare, received his PhD in biomedical engineering (retinal prostheses) from the University of California, Los Angeles, completed his ophthalmology residency at the University of Louisville, and completed a retina research fellowship at the National Retina Institute.

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