• Mid-Year Forum Lessons Learned: ‘If You’re Not at the Table, You’re on the Menu’

    During the Academy’s 2018 Congressional Advocacy Day in Washington, D.C., more than 400 ophthalmologists descended on Capitol Hill to remind members of Congress and their staff why medical and surgical eye care is integral to the lives of millions of patients nationwide. Among the passionate 400 in attendance were more than 175 ophthalmology residents and fellows participating in the Academy’s Advocacy Ambassadors Program. Generously sponsored by the Texas Ophthalmological Association, I was joined by my co-residents Jeff Mattingly, MD, and Austin Nakatsuka, MD, as part of the larger Texas advocacy ambassador cohort.

    The lessons learned were vital to our young careers: Our expertise and voice matter. And we can’t do it alone. To advocate for our patients and ourselves, we will be more effective sitting at the table and working together, across levels of training, across cities and states and even across specialties and professions.

    Remembering Robert A. Copeland Jr., MD

    “Advocacy comes naturally for [all of us]. We advocate daily for our patients and individuals less fortunate, [those] who need our intervention. ... When we advocate, we are first advocating for our patients’ safety and well-being. … If you do not advocate for what is morally right, then others will determine our fate.”

    —Robert A. Copeland Jr., MD

    Wednesday, April 18. The Congressional Advocacy Day dinner briefing began with a remembrance of the life and legacy of one of the most dedicated and passionate patient-advocates, Robert A. Copeland Jr., MD. I met Dr. Copeland once a few years ago. It was one of the most inspiring and authentic conversations I have had with a role model for serving patients locally and globally. He was a great supporter of resident advocacy and was especially well known for encouraging the ophthalmology residents at Howard University to actively participate in Congressional Advocacy Day. His legacy will continue with the Robert A. Copeland Jr., MD, Advocacy Education Fund, which supports one notable fellow to attend the Academy’s Mid-Year Forum and Congressional Advocacy Day each year. Congratulations to the first awardee, Meron Haile, MD, an advocacy ambassador and a resident at California Pacific Medical Center in San Francisco.

    Advocacy Is a Team Sport

    “Do just once what others say you can’t do and you will never pay attention to their limitations again.”

    —James Cook, 18th-century British explorer

    Thursday, April 19. In addition to advocating for our patients on the Hill, one of the most invaluable experiences as an advocacy ambassador is learning how to work with others as a well-oiled machine. Joined by my entire Texas cohort of Advocacy Ambassadors and our more seasoned physician leadership, our team was able to tackle two main objectives at Congressional Advocacy Day:

    1. We encouraged our House representatives to support bipartisan bills H.R. 4841 “Standardizing Electronic Prior Authorization for Safe Prescribing Act” and H.R. 2871 “Preserving Patient Access to Compounded Medications Act” and asked our senators to work with others and sponsor counterpart bills. The two house bills address regulations that unnecessarily limit patients’ timely access to sight-saving medications and treatments. These bills will have a particularly significant impact on patients with age-related macular degeneration and corneal ulcers, two conditions for which time lost can mean permanent vision loss.
    2. We also urged members of Congress to continue supporting important vision research and outreach programs, including the Department of Veterans Affairs’ Technology-Based Eye Care Services (TECS) program. This program expands access to essential eye care services for veterans by providing rural primary care facilities closer to their homes. About 20 percent of the first program participants had not seen an eye care provider in five years. With a focus on screening veterans for serious eye conditions, the program can help with early diagnosis and appropriate referrals for treatment. The program already has a 95 percent patient satisfaction rate.

    Bringing It Home

    Friday, April 20. Led by the Young Ophthalmologist Committee, the L.E.A.P. Forward (Leadership, Engagement, Advocacy, Practice Management) program helps advocacy ambassadors take these experiences on Capitol Hill and apply them at home. For most of us, the more entrenched we become in our ophthalmology training and careers, the more distant and disdainful policy-making can seem. However, as Tamara Fountain, MD, an Academy leader and president of the American Society of Ophthalmic Plastic and Reconstructive Surgery, put so poignantly, our patients need us to “show up, speak up and follow up.” And so during the L.E.A.P. Forward networking break, we turned our attention to one another and discussed our dreams and the ways in which we can take patient advocacy back home. Looking around my table at such a bright group of female advocates was a particularly humbling and memorable experience.

    Local Is Global: Preserving Patient Safety and Surgical Scope

    One of the key takeaways from Mid-Year Forum 2018 was the realization that advocating for our patients is seamlessly entwined with advocating for ourselves and our profession. There is no doubt our colleagues in optometry are integral partners in providing patient care. However, with the power of a well-funded political action committee, our optometry colleagues are lobbying heavily for the ability to perform ophthalmic surgery in states across the country. Certifications such as “32-hour training” or OD fellowships in ophthalmic surgery are a growing trend, but these programs are nowhere near equivalent to medical and surgical training at medical school and a four-year ophthalmology residency.

    In Texas, our law prohibits surgery by non-physicians, but, next year, an organized movement by the Texas Optometric Association will lobby to expand optometry’s scope of practice. Similar pushes for scope-of-practice expansion are occurring in Illinois, Florida and North Carolina as well. Because these issues are not handled on a federal level, this is a unique opportunity for us to be proactive at the local and state levels.

    At the very least, be sure to donate to the Academy’s Surgical Scope Fund, because. as L.E.A.P. Forward keynote speaker Arvind Saini, MD, MBA, reminded us, “If you’re not at the table, you’re on the menu.”

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    About the author: Malkit “Mona” Singh, MD, MPA, is a PGY3 at the University of Texas Medical Branch in Galveston. She was sponsored by the Texas Ophthalmological Association to attend the Academy’s Mid-Year Forum 2018 as an Advocacy Ambassador Program participant.