Interest in rheumatology continues to grow, with more than 240 new adult and pediatric fellows to begin their training in the coming academic year. Given the broad and diverse career opportunities, it is an ACR goal to help guide trainees in their career decisions and professional development.
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Explore This IssueMay 2017
Rheumatology fellowship often marks the transition from large residency programs to smaller, more intimate educational training experiences. The ACR aims to foster and strengthen the collegial network among trainees from different programs by granting scholarships to attend conferences, educational premeetings, and sponsoring networking events. Although critical, the benefits of these events may not reach all trainees equally due to different resources and time commitments. This may leave our home institutions as our primary source of information regarding fellowship-related issues.
The Fellows-in-Training (FIT) Subcommittee will now be contributing to the Fellows’ Forum column in The Rheumatologist to provide an alternative and diversified platform for fellows to share and receive information related to their education, career, research, work–life balance and advocacy. Because this is a column for fellows written by fellows, we highly encourage you to submit articles to highlight and discuss aspects of fellowship you would like to address nationally.
Given the recent changes to the healthcare landscape and inevitable return of the political agenda to this topic, we wanted to highlight the importance of advocacy and how fellows can both become and maintain involvement in their careers. We are happy to present our inaugural article, by Drs. Alexandra Perel-Winkler and Chris Mecoli.
Take Action Now
Have you ever found yourself …
Rubbing your eyes with exhaustion after a long afternoon of clinic, facing multiple sets of prior authorization forms? Wishing there were a more efficient way to manage your patients’ treatment?
Frustrated that your patient with scleroderma has used all of their physical therapy by April and can no longer afford to participate in OT/PT for the remainder of the year?
Questioning your aspiration of becoming a clinical investigator upon hearing the low pay line for NIH K- and R-series grants?
These scenarios are all too familiar to rheumatology fellows across the nation. Tackling these systematic challenges is more than individual trainees or physicians can achieve on their own, but not more than can be accomplished in concert with our colleagues. Improving practice workflow and patient access to care, and increasing research funding are just a few of the many issues that the ACR/ARHP advocates for on our behalf.
For fellows-in-training (FITs) who may be unaware, the advocacy arm of the American College of Rheumatology includes RheumPAC, our nonpartisan political action committee; the Government Affairs Committee (GAC); and the Committee on Rheumatologic Care (CORC). Together, these committees work to prioritize pertinent issues and educate elected officials on the needs of our profession and our patients.
Historically, physicians have tended to be apolitical. We spend our days working hard to improve the health and lives of our patients. Some may feel this is sufficient; some may feel they have no more to give. Many physicians find that the intrinsic values of our profession are out of alignment with the partisan nature of the political system. Unfortunately, as our country’s population has grown and medicine has become more complex and sophisticated, the government and the factions it oversees (FDA, insurance companies, etc.) have inextricably entwined with our professional and personal lives. Thus, encouraging, supporting and participating in political advocacy can be seen as an extension of our Hippocratic Oath.
“To do no harm” is our tenet, yet without having a voice in the verdicts and resolutions that govern our practice, can we truly feel that no harm is done? As in medicine, in advocacy and politics, doing nothing can be as significant as taking action.
Why Advocate as a Fellow?
Our elected officials make decisions every day that directly affect our work and the lives of our patients. These decisions are based on education and awareness presented by advocates, constituents and fellow lawmakers. The truth is that many members of Congress have very little idea what a rheumatologist is, much less what we do. To mitigate this, RheumPAC, GAC and CORC committee members, alongside other ACR/ARHP members and patient advocates, communicate both on and off The Hill with lawmakers and their staff. Whether in an office, at fundraising events or trying to catch a few minutes on a walk between meetings, our volunteers share the stories of our challenges and barriers to providing necessary care, the difficulties faced by our patients and the value of our research.
It is important to understand that to stay in office a member of Congress must raise an average of $18,000 a day. That number is not a typo. For better or worse, organizations that contribute to legislators’ campaigns have more opportunities to have their voices heard. This is why nearly every professional association has a political action committee (PAC) and why the ACR created RheumPAC 10 years ago. Regardless of personal ideals, it is political contributions that facilitate access to legislators and their staff.
In 2016, less than 4% of ACR/ARHP members invested in RheumPAC (and only 1% of fellows). Since its inception, RheumPAC has never had more than 5% (400 members) of members invest in our advocacy undertakings. To put these numbers in perspective, Medical PACs associated with orthopedic surgery, physical therapy and cardiology receive donations from 10, 20, even 40% of their members. Outside of medicine, PACs in other fields, such as real estate and trial law, receive donations from over half of their membership. Although the amount of money is always a focus, the number of members contributing that money is equally important, because it tells legislators how engaged the membership of a group is in policy and advocacy.
Many FITs have told us their hesitation to participate is largely due to financial strains and/or uncertainty around how to participate. We are sensitive to rheumatology fellows’ relatively low salaries and other financial burdens, especially those with families. But it’s important to know three things:
- No dollar amount is too small: $5, $10, $20—the price of a few Starbucks beverages per year, whatever you think you can afford—is sufficient and will increase our important participation rate.
- You are investing in the future of your career and profession: Money invested now can pay dividends later by supporting policy that supports us.
- Make an investment of your time: Rheumatology needs more of its members actively involved in advocacy to ensure its future.
It’s not just about money; there are many ways to get involved in advocacy during fellowship. In May and September, the ACR hosts annual advocacy days in Washington, D.C., when ACR/ARHP members visit congressional offices to advocate on the most timely and relevant issues.
The ACR has created a program, called Advocacy 101, through which fellows and program directors can attend the fall fly-in. Attendees participate in an intensive one-day crash course in politics and advocacy, followed by a day on Capitol Hill to meet with their members of Congress. This program has operated for two years and has received overwhelmingly positive reviews. We expect interested fellows will be able to apply in June or July for the fall 2017 fly-in. And by the way, all costs are supported by the ACR!
Not interested or unable to fly anywhere? The ACR is always looking for fellows (and members) to meet with Congressional leaders in their district offices, at local events and/or campaign fundraisers to speak about our issues. These are often intimate settings of 10–20 people with the member of Congress, allowing longer and more extensive conversations (for example, providing examples of how certain policies affect your work as a constituent in their district).
The ACR will arrange this and provide talking points and any other information necessary you need to feel comfortable. I have done this in the past and it is a very rewarding and enlightening experience.
Not sure how to keep up with what’s going on? Join the ACR advocacy listserv and read ACR@Work and the other ACR publications that provide continual updates on policy issues affecting our profession and the treatment of our patients. Go to http://lists.rheumatology.org/read/all_forums, and click on subscribe for the acradvocacy group.
Current ACR/ARHP Advocacy Priorities
Amid the associated uncertainty over future healthcare policies, one thing remains clear: We must increase our engagement with our elected officials and educate them on the needs of our profession and our patients. The College’s current advocacy priorities are:
- Increased research funding: The NIH, Centers for Disease Control and Prevention and Department of Defense are all sources of funding for rheumatology research projects around the country. We educate lawmakers on the importance of federal research dollars to ensure the advancement of both clinical and basic science research.
- Repealing physical and occupational therapy caps on patients.
- Tailoring MACRA to the field of rheumatology. For many fellows rising to practice throughout the country, MACRA will most likely affect you.
- One universal prior authorization form to be used by healthcare providers, regardless of patient insurance type or drug class.
- Making biologics more affordable by eliminating specialty tier copayments, and by supporting the FDA approval process, so that more effective biosimilars can enter the market and bring down prices.
- Healthcare reform legislation that prioritizes affordable coverage for chronically ill patients, including coverage for Americans with preexisting conditions, limits on out-of-pocket costs and tax credits based on income.
- Repeal of the Independent Payment Advisory Board, an ACA-created agency that has the power to impose arbitrary and crippling payment cuts on rheumatology providers. These cuts would disproportionately impact small and rural rheumatology practices already struggling to stay financially viable.
- Proper valuing of cognitive specialty care, including new service codes that more adequately reflect rheumatology care in reimbursement.
- Adequate funding for FDA biosimilars review to ensure the introduction of additional safe and effective therapies and lower biologic drug costs.
- Interventions to address the rheumatology workforce shortage, including funding for more rheumatology residency spots through Medicare General Medical Education funding and support for the Pediatric Subspecialty Loan Repayment Program.
If you’re interested in a fellow’s perspective of the Advocacy 101 course, reach out to Alexandra. If you’re feeling fired up to support your practice and patients, visit www.rheumatology.org/Advocacy. This page has lots of information and links to connect with RheumPAC and GAC staff members and chairs, as well as ways to connect with your local policy makers.
Alexandra Perel-Winkler, MD, is a second-year fellow at Columbia University who has an interest in the integrative and holistic management of autoimmunity, with a particular interest in ANA-related diseases and quality improvement. She hails from Vancouver, British Columbia, and loves travel, art, nature and international cuisine.
Christopher A. Mecoli, MD, is a third-year rheumatology fellow at Johns Hopkins and current chair of the Fellows-in-Training Subcommittee. He is originally from New Jersey and plans to pursue a research career after his fellowship.
The authors thank Harry Gewanter, Angus Worthing and Doug White for their helpful commentary for this article.
Advocacy in Minutes
In under five minutes, you can do the following:
- Visit the Legislative Action Center to learn about current bills and send messages to your lawmakers.
- Follow ACR on Facebook, Twitter or LinkedIn for news on ACR advocacy efforts, and join the conversation.
- Email or call your local, state or federal decision maker about an issue you care about.
- Visit Vote Smart to learn where your senators and representatives stand on issues you care about.
In under 30 minutes, you can …
- Identify a state or federal legislative issue that is important to you, and find one way that you can weigh in to influence the process.
- Contact elected officials about specific issues:
- By phone—Calling your members of Congress is one of the easiest ways to bring the issues of the rheumatology community to their attention. Use the AMA’s Grassroots Hotline at 800-833-6354.
- By email—You can use the ACR’s Legislative Action Center (site above) to identify your local policy makers, quickly draft a letter and send it to multiple people immediately.
- By social media—As we have all seen, the current president has made social media a very current way for the government to reach you. We can also gain traction for our advocacy efforts using these methods.
In an hour or more, you can …
- Meet with policy makers.
- Attend an ACR advocacy meeting in Washington (if interested, check out Advocates for arthritis to apply for the next meeting).
- Attend a local city council, county commissioner meeting, state legislative hearing or congressional town hall in your area on an issue that you care about.
Adapted with permission from the AAP Advocacy Guide from the American Association of Pediatrics.