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  • Seeing the Importance of Speaking Up

    Let me kick things off by sharing an analogy every ophthalmologist can relate to: Advocacy is like using glaucoma drops. It doesn’t always seem like anything is happening, but if you don’t do it, the consequences can be devastating. 

    As someone who grew up in India, where civic engagement and advocacy were challenging due to bureaucratic barriers, I feel incredibly fortunate to have had the opportunity to participate in the Academy’s Congressional Advocacy Day in April. This event brings ophthalmologists from across the country to Capitol Hill to advocate for key issues in the field of ophthalmology. I was honored to have been selected as one of the Advocacy Ambassadors for North Carolina and was funded by the North Carolina Society of Eye Physicians and Surgeons (NCSEPS). 

    Alan Skipper, NCSEPS executive director, was a huge asset! He organized our meetings, familiarized us with the process, and prepared us for the meetings with members of Congress and their staff. I will admit, the first timers felt intimidated and apprehensive at first, but senior members of our group guided us through our meetings, and we quickly became proficient in our roles. 

    Here are some of the key issues our group passionately advocated for: 

    1. Medicare Physician Payment: It's no secret that the cost of medical education in the United States is astronomical, with the average medical student graduating with about $200,000 in debt, according to the Association of American Medical Colleges. For most of us our training takes more than 15 years, and although we may dream of the high salaries we’ll earn as physicians, the reality is often different.

    In fact, physicians are facing steep cuts to their Medicare payments due to changes in payment policies. When we account for inflation and rising practice costs, Medicare payments to physicians have declined by a staggering 26% over the past 22 years. As physicians, we all entered this field for altruistic reasons. However, rather than simply working harder, we need to work smarter and advocate for fair compensation for the critical care we provide to our patients.  

    During our meetings with members of Congress and their health care staff, we advocated for the passage of Strengthening Medicare for Patients and Providers Act (HR 2474) which calls for a permanent, annual inflationary update to Medicare payments. We also emphasized the urgent need for broader reforms to address deficiencies in the current Medicare physician payment plan. 

    2. Ensuring Quality Care at the VA: This was an issue that really fired up the residents in our group — the Veterans Health Administration removed a line from important guidance governing referrals to private sector providers through the community care program: “Only ophthalmologists can perform invasive procedures, including injections, lasers, and eye surgeries.”

     As residents, we work at the VA for a significant portion of our training, and we want to provide our veterans with the best possible care. In most of our meetings, congressional staff members were unaware of this change, and were often taken aback. In fact, during one of our meetings, a staff member was so interested in our concerns he requested more information so he could explore options for implementing change. It was nice to see that our conversations were impactful and making a difference. 

    3. Increasing Federal Vision Research Funding: This is a no brainer! We have seen during the COVID-19 pandemic the profound impact of federal research funding on our lives. We are aware of the many eye disorders that can lead to permanent vision loss, and research in these areas is crucial. To convey this message, we relied on the power of numbers.  

    For instance, the annual cost of vision disorders is projected to cost a whopping $717 billion by the year 2050 (adjusted for inflation)! The average annual NEI increase over nine fiscal years (FY2012 – 2021) was around a meager 2.1%, which is less than the average annual biomedical inflation rate of 2.7%. 

    4. Securing Prior Authorization Reform: This was one of the most popular topics among our team members (shout out to my senior James Tian!). It was a great way to end the meetings on a positive note by thanking lawmakers for their support.

    5. Addressing Pediatric Ophthalmology Challenges: One thing that really stood out in this meeting was the impressive number of vocal pediatric ophthalmologists. There were many residents who were passionate about pediatric ophthalmology, and it showed! 

    Not ‘If,’ But Why Should You Get Involved

    As physicians, we have a responsibility to advocate for the best possible patient care. I understand that physicians are apprehensive about raising our voices and challenging the system, but it is more crucial than ever before to get involved. As the saying goes, “If you don’t speak up, you will never be heard.”

    Optometrists have been pushing to expand their scope of practice, which could be detrimental to patient care. As ophthalmology residents, we see so much pathology throughout our training and have one-on-one supervision for procedures and surgeries, and this allows us to recognize and manage complex eye cases and potential complications. Optometrists play an integral role in our practices; however, our patients deserve the highest quality clinical and surgical care.  

    Where to Start

    With our busy schedules as physicians, adding another task to our seemingly endless to-do list can seem overwhelming. However, there are several easy ways to get involved. First, consider joining your state ophthalmology society or the Academy to stay informed and connected.  

    Second, sharing personal anecdotes and patient stories with lawmakers, and contacting your representatives and senators can be a powerful way to inform them about your concerns and potential solutions. Additionally, donating to the Academy’s OPHTHPAC® fund to strengthen our collective voice. Lastly, mark your calendar and plan to attend Mid-Year Forum 2024, including Congressional Advocacy Day! 

    Sri Meghana Konda, MD About the author: Sri Meghana Konda, MD, is a PGY3 resident at the Duke Eye Center, Durham, N.C.. She is passionate about advocating for both patients and our profession and was sponsored as an Advocacy Ambassador to attend Mid-Year Forum 2023 by the North Carolina Society of Eye Physicians and Surgeons.