From 2022 to 2023 I had the honor of serving as the Academy’s inaugural medical student representative, a role that was the culmination of my pursuit of advocacy throughout medical school.
However, this was just the beginning of my role as a physician advocate.
During my undergraduate studies at the University of Pennsylvania Wharton School of Business, I was exposed to the interplay between medical practices, insurance companies, and the pharmaceutical industry and how these complicated dynamics impact patient care. I studied biochemistry and organic chemistry but was also in classes to learn about the drug approval process, how insurance works, and limitations in health care.
All this, combined with my clinical knowledge, provided me with a holistic understanding of the field where I, as a physician, not only prescribe medications but prescribe medications that are efficacious, covered by patients’ insurance, and are in line with Food and Drug Administration guidelines.
In my first semester of medical school, I attended an American Medical Association (AMA) meeting that significantly shaped my career. At first, I was just excited for a trip to an AMA meeting in San Diego. During the meeting, I was encouraged to speak on an important policy (vision screenings) to a room full of medical and PhD students. I was neither an expert on the topic, nor on speaking at the microphone to push for policies, but I did it. That’s when I got hooked.
What started off as a chance to get involved in an extracurricular club became an opportunity to be part of something much bigger. I started to get involved with the school advocacy organization, which led to an opportunity to go to the state capital with the Florida Medical Association in Tallahassee, meet with state legislators and discuss bills affecting health care within our state in person.
I remember speaking on one of the bills that would allow pharmacists to test for and treat some chronic conditions: flu and strep. I spoke on how my six-month experience in medical school already showed me that there is much more that goes into treating and diagnosing such conditions. Even though there is a physician shortage, we should work on improving the shortage to improve access to care instead of putting the burden on pharmacists or other nonphysician specialties.
This was my first experience speaking on policy to actual legislators. As students, we had so much to offer from our experiences and stances. COVID-19 put a halt on some of these in-person experiences, but the AMA did not stop providing virtual opportunities to advocate through virtual conferences and the virtual Medical Student Advocacy Conference (MAC).
My fourth year of medical school is when I took on the role of the Academy’s medical student representative. This role allowed me to combine my two passions within medicine: ophthalmology and advocacy. I provided insight on medical education topics that I was experiencing firsthand, such as curriculum changes, maternity leave, and wellness while fighting against scope of practice threats and payment reform as a future ophthalmologist.
For example, the expansion of optometry’s scope of practice has a big impact on the entire ophthalmology specialty. Several states, such as Oklahoma, have already lost the battle against optometrists performing surgery. As the medical student representative, I had the opportunity to speak on the U.S. Department of Veterans Affairs’ plans to change national standards of practice, also known as the Federal Supremacy Project, which could extend surgical privileges to optometrists and other allied health professions.
Such bills attempt to expand access to care for the patient population while ignoring the time and extended apprenticeship required to master ophthalmic surgery. Allowing nonphysicians to perform surgery can also limit future access to adequate, quality, surgical training for medical students and trainees.
“... As trainees we should not be fighting for OR time and procedures with optometry residents, this is our precious time to train and we have to protect it,” I told the audience at the AMA meeting in San Diego. “Additionally, we deserve to learn from trained ophthalmologists in the field, so by placing optometrists in surgical ORs and in teaching roles, our training opportunities will be limited and/or lower quality which in the end affects our patients.”
Advocating on the county, state and national levels have shaped the kind of physician I hope to become.
Actively participating in advocacy organizations allows medical students and YOs to be engaged on a larger playing field and understand nuances in patient care that you wouldn’t see day-to-day. Some of the biggest issues we will face are uninsured patients, scope of practice expansion, and the rising costs of the medical system.
Early exposure to policy creation and advocacy initiatives is what inspired me to take an active role in this aspect of medicine. I hope I can inspire other YOs to venture into this area, as an avenue to champion for important issues faced by ophthalmologists and advocate for better ways to care for our patients. Although most of us are not directly impacted yet, we are in a unique position to learn about them during our training and advocate for an improved system for our future selves and patients. As YOs, there are many opportunities to be a physician advocate:
- Start with the Academy and your state ophthalmology society. Send an email and ask how you can get involved. See if your state ophthalmology society has a young ophthalmologist committee or group.
- Get involved in your local medical society, though it may not be ophthalmology specific, it’s a great way to be in tune to local health care issues and form connections with your colleagues.
- Join the Academy’s Advocacy Ambassador Program, a component of its Mid-Year Forum in Washington, D.C., that brings residents and fellowship trainees sponsored by state and subspecialty societies, along with training programs, to Congressional Advocacy Day to discuss ophthalmology specific issues with Congress.
- The AMA is involved in many advocacy campaigns, from prior authorization to Medicare payment reform. Trainees can get involved by staying up to date on upcoming bills in Congress, writing policy or speaking to lawmakers at visits on Capitol Hill.
Advocacy starts from the ground up, so from your local mayor all the way to the national government passing laws, we can make an impact at every level.
Advocacy can help us, as young ophthalmologists, find our voice within medicine.
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About the author: Aaishwariya A. Gulani, MD, is a PGY 1 at the Hamilton Eye Institute in Memphis, Tenn. She served as the Academy’s medical student representative from 2022 to 2023. |