Osteopathic Health Policy Intern Blog

Mianna Armstrong,
OMS-IV, MS
March 2019 Intern

May 7, 2019

It is hard to believe that my time in Washington is coming to a close, and I am heading back to the Midwest soon! During my time here, I have often felt like a sponge, listening to and learning from everything that is going on around me, including the scope of actions that AACOM’s Office of Government Relations (GR) carries out on behalf of colleges of osteopathic medicine (COMs) across the country. These include providing testimony to Congress regarding issues that directly affect COMs and osteopathic medical students; nominating osteopathic medical education (OME) professionals to federal advisory committees, councils, agencies, boards, workgroups, and task forces; posting public statements on issues that directly affect osteopathic medical schools and students; and publicizing federal grant opportunities COMs can apply for, among many other things!

THCGME Program

One of the main programs that AACOM GR advocates for is the Teaching Health Center Graduate Medical Education (THCGME) Program, which is a federal program established in 2010 focused on the development and expansion of primary care residency programs in community-based ambulatory patient care settings. More than half of the THCGME centers are located in medically underserved communities, with 65% of trainees being family medicine residents. Funding for this program is set to expire after September 30, 2019, without congressional action. AACOM leads a THCGME Coalition focused on reauthorization of this crucial program, and has worked closely with U.S. Senator Collins’ (R-ME) office to introduce and support a reauthorization bill, the Training the Next Generation of Primary Care Doctors Act of 2019 (S. 1191). AACOM played an active role in ensuring that that the bill included provisions critical to the OME community and encourages you to reach out to your Senators in support of this vital bill.

Higher Education Act

Of all the osteopathic medical students graduating in 2018, only The Higher Education Act was passed in 1965 with a goal of expanding access to all students wishing to pursue an advanced education. At the federal level, this involves providing access to financial aid and federal loans, which AACOM advocates for through ED to MED. ED to MED is a grassroots campaign focused on addressing the physician workforce shortage by protecting federal financial aid and loan repayment programs such as Grad PLUS and Public Service Loan Forgiveness (PSLF).

Seventy percent of osteopathic medical students who graduated in the 2017-2018 academic year relied on Grad PLUS. Grad PLUS loans cover the full cost of attendance minus any other financial aid received, including tuition, textbooks, room and board, and other important living expenses. Grad PLUS loans are not currently capped. Imposing borrowing limits or caps (as proposed in the PROSPER Act) could force students to take out private loans with higher interest rates, fewer borrower protections, limited repayment options, and stricter credit checks.

The PSLF Program was signed into law in 2007 and encourages providers to work in public service positions in medically underserved areas in exchange for forgiveness of the remaining balance of their loans after 120 qualifying monthly payments. 55 percent of osteopathic medical students graduating in 2017-2018 indicated their intention to enter a loan forgiveness program; of those, 70 percent said they planned to participate in the PSLF Program. Every osteopathic medical student can help advocate to #SavePSLF and #SaveGradPLUS by joining ED to MED today!

Opioid Crisis

While underserved and rural communities tend to be particularly hard hit by the opioid crisis, substance use disorder is a disease that doesn’t discriminate based on age, race, gender, or socioeconomic status. The first event I attended that focused on the opioid crisis, Tracking Federal Funding to Combat the Opioid Crisis, was hosted by the Bipartisan Policy Center where I learned that nearly 50,000 Americans died from an opioid overdose in 2017 alone. This event focused on the 57 programs, under 6 different federal agencies, that distributed $3.3 billion in fiscal year (FY) 2017 and $7.4 billion in FY18 and assessed the success and long-term sustainability of the funding opportunities.

The second event was the Action Collaborative on Countering the U.S. Opioid Epidemic, hosted by the National Academy of Medicine. The collaborative consists of over 100 organizations, including AACOM, that have committed to implementing recommendations produced by four working groups. The focus areas include education and training; prescribing guidelines and evidence standards; prevention, treatment, and recovery; and research, data, and metrics. AACOM is particularly active with this collaborative, as Dr. Shannon, AACOM’s President and CEO, serves as a member of the Health Professional Education and Training Working Group. The goal of the collaborative is to identify the complex challenges and research gaps of the opioid crisis, elevate and accelerate evidence-based and interprofessional solutions, and catalyze action on shared priorities to overcome the crisis.

Thank you all for following along on my eight-week journey as an OHPI. I would strongly encourage anyone who is interested to apply for this opportunity! Medical school has taught me how to be a strong advocate for my patients within the context of the clinical setting, and the internship has shown me that advocacy in the public policy world can have a tremendous impact on patient lives, both directly and indirectly!

---

April 24, 2019

Hi Everyone! My name is Mianna. I am currently a fourth-year student at Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM) and will be graduating in May, going on to complete my OB/GYN residency in Columbus, OH.

I didn’t always know I was going to be an OB/GYN, or even a doctor. I grew up in a farming community of less than 300 people in rural Alberta (that’s in Canada), and graduated from high school in a class of just ten people. I played every sport imaginable as a kid and was recruited to play volleyball in college. I chose Hampton University in Virginia, a historically black university, where I was a first-generation student and completed my bachelor’s degree before deciding to go to medical school.

Spoiler alert: I chose KCU-COM, and as a third-year medical student found that I had a passion for women’s health. Between my third and fourth years of medical school, I took time to complete a yearlong, on-campus teaching and research fellowship, exposing me to the policy and administrative side of medicine, which encouraged me to apply for the AACOM Osteopathic Health Policy Internship Program!

Appropriations Season

On March 11, 2019, just one week before I arrived in DC, the President’s budget for fiscal year (FY) 2020 (October 1, 2019 – September 30, 2020) was released. As you may have heard, the U.S. government shut down for a record 35 days just a few months ago. This was because the remaining appropriations bills for FY19 could not be agreed upon.

• What is the process for appropriations? The President releases a budget proposal in the early months of the calendar year for the following fiscal year. (It is very important to note, however, that the President’s annual budget proposal is received by Congress as a statement of the Administration’s priorities and does not serve as a directive of federal funding.) Congress holds a series of hearings on the President’s budget request to discuss the funding priorities and numbers requested. Then, lawmakers must determine the high-level spending numbers by passing a budget resolution, and attempt to agree on bipartisan, bicameral appropriations bills. These bills appropriate dollar amounts to specific initiatives, tasks, or purposes in the final budget that is then sent to the President for signature, all before the next fiscal year.

• What does this mean for me, the intern? It means that I have been to several Senate and House hearings, hosted by multiple committees and subcommittees, to hear testimony for the priorities President Trump has outlined in his proposed budget. I’ve heard Secretaries Betsy DeVos and Robert Wilkie testify about the proposed budgets for the U.S. Departments of Education and Veterans Affairs, respectively. I’ve also heard testimony from Francis Collins, MD, PhD, the Director of the National Institutes of Health, and listened to Robert Redfield, MD, Director of the Centers for Disease Control and Prevention, regarding the proposed cuts in their budgets and the long-term impact they would have on the American people.

AACOM Annual Conference

Big data was the theme of Educating Leaders 2019, AACOM’s Annual Conference, from April 10 – 12 in Washington, DC. Kyu Rhee, MD, MPP, was the Wednesday morning plenary speaker. He spoke about the functionality of incorporating IBM Watson, an artificial intelligence system, into the future of health care. On Thursday morning, Dr. Eric Warm, MD, FACP, described how novel methods of assessing and evaluating residents could be used to help better instruct and prepare them for their future practice.

Jennifer Golbeck, PhD, MS, (pictured below, at right) was Friday morning’s plenary speaker (and is also behind The Golden Ratio social media accounts) who utterly captivated the crowd. She discussed the research her team does using public data from social media profiles by analyzing patterns of behavior that when detected among millions of people can become predictive. Through this process, one of the amazing things they have been able to accurately predict is postpartum depression from public Twitter feeds (remember, future obstetrician here)! Even if you think your privacy settings are secure, there are ways for data collection to compute and predict your location, spending habits, and the multitude of devices you use, even if they are not linked in any way.

I also had the opportunity to take part in the Residents and Fellows Council (RFC) activities, which included a fantastic workshop on employment contracts for new physicians by Susan Sanford, JD. On Saturday, the RFC hosted a Leadership Track that offered personal and professional learning opportunities as well.

I also attended sessions that covered graduate medical education expansion, an update on the single accreditation system, increasing diversity in medicine, responses to the opioid epidemic, and of course the awards banquet! At the awards banquet I had the honor of seeing Mustafa Basree (pictured below, center) receive the 2019 ED to MED Outstanding Advocate of the Year Award. The organizing committee also did a great job surprising Dr. Shannon, AACOM’s President and CEO, (pictured below, at right) with the presence of his family and friends to celebrate all that he has done to advance the osteopathic profession in his tenure at AACOM.

 

Thank you for reading, and I can’t wait to tell you all about the next four weeks!

 

Nicole Lighthouse, OMS-IV September 2018 OHPI

October 18, 2018

Hello everyone and welcome back! Throughout my experience as an Osteopathic Health Policy Intern, I must underscore how grateful I am to have had this opportunity to be informed on critical issues in osteopathic medical education, health care, policy, and advocacy. More importantly, being informed in this capacity has significantly changed my perspective on critical issues facing these avenues, and my responsibility as a medical student and future provider moving forward. I am excited to share resources with you to learn more about the U.S. Government Accountability Office (GAO), the Public Service Loan Forgiveness (PSLF) Program, updates from the Medicare Payment Advisory Commission (MedPAC), and novel approaches to opioid therapy.

GAO: Purpose and Watchdog Report

An amazing agency I was introduced to during this internship is the GAO, part of the legislative branch that serves as the government’s audit institution. It acts as an independent, nonpartisan agency commonly referred to as a “congressional watchdog.” GAO evaluates how taxpayer dollars are allocated and provides Congress and federal agencies with information to aid the government by saving costs and working more efficiently.

They also run a podcast, the GAO – Watchdog Report, that features interviews with GAO officials on significant issues and new reports. The podcast is recorded, hosted, and produced by GAO staff.

Financial Literacy and Public Service Loan Forgiveness

It is never too early to become informed about your financial future and seek resources to aid in this process. That’s why I’m excited to share with you AACOM’s Financial Aid Debt Management Modules, an online series designed to help osteopathic medical students and recent graduates become more financially literate. The modules include information about:

• Borrowing Considerations and Repayment Options
• Student Loan and Financial Best Practices
• Choosing Between Federal and Private Repayment and Forgiveness Programs
• Modern Student Loan Repayment Case Studies for Osteopathic Medical School Graduates
• Managing Your Income and Finances Early in Your Career

In planning for their financial futures, many students are considering the PSLF Program to offset the burden of debt while caring for underserved populations. AACOM’s ED to MED blog published an informative post alerting applicants to common PSLF mistakes. If you are pursuing PSLF, reading through this blog post could help ensure you’re on track for loan forgiveness.

Students interested in advocacy can stay informed about the status of the PSLF Program and ways to protect it by participating in ED to MED’s #SavePSLF initiative.

End Opioid Use: MedPAC

As a brief review from my previous blog post, the MedPAC is an independent congressional agency that advises Congress about issues affecting the Medicare program. MedPAC public meetings serve to discuss policy, and consider results of researchers, policy experts, and public comment. The results of these meetings are translated into recommendations for Congress toward Medicare programs.

The opioid crisis in this nation has led to a formidable challenge for policy makers and providers on how to properly and safely address opioid use and responsibly prescribe pain management care plans to patients. During a recent MedPAC meeting, the Commission analyzed the extent of prescription opioid use among Part D enrollees and reviewed claims regarding adverse drug events associated with opioids. The Commission described steps taken by the Centers for Medicare & Medicaid Services (CMS) to monitor prescription opioid use and manage misuse. One example of a monitoring tool discussed was to evaluate Medicare beneficiary claims. Commission members brainstormed innovative ideas to expand resolutions to the opioid epidemic. The Commission also reviewed Medicare payments for opioids and non-opioid alternatives in inpatient and outpatient hospital settings. Included in their discussion was the consideration of an opioid monitoring program for Part A and Part B.

As the Commission examined Medicare’s role in the future supply of primary care physicians (PCPs), they addressed current access to PCPs and the Health Resources and Services Administration (HRSA)’s options to increase PCPs in workforce shortage areas. It was interesting to listen to the Commission review factors that influence physicians’ choice specialty, such as lifestyle, income expectations, and student debt.

Examples of HRSA programs to increase the PCP workforce included the National Health Service Corps (NHSC) and the Primary Care Loan Program, which offer debt forgiveness or low interest loans to those who pursue primary care. AACOM has strongly supported the NHSC as it helps to strengthen and grow our primary care workforce in underserved communities in the United States. The Commission discussed concerns regarding the expiration of NHSC funding in 2019. As a medical student, I was grateful for the opportunity to listen to members discuss potential innovative resolutions by granting funding and autonomy to states to address quality and efficacy in primary care issues.

Ending Opioid Use: Novel Approaches to Therapy

Continuing on the topic of addressing the opioid crisis, I was introduced to a fascinating novel approach to therapy at a House Science, Space, and Technology Committee-sponsored briefing on technology that treats pain and reduces the need for opioids, titled, “Ending Opioid Use: The Science and Promise of Photobiomodulation.” The expert panelists included: James D. Carroll, CEO, THOR Photomedicine, Inc.; Professor Praveen Arny, PhD, University of Buffalo, NY; and Annette Quinn, Registered Nurse, Program Director of Radiation Oncology at UPMC Hilman Cancer Center, Pittsburgh, PA. They presented on photobiomodulation therapy as an alternative opioid treatment. They began by introducing the mechanism of action and effectiveness of this therapy mode on patients seeking treatment for cancer. The panel introduced additional uses for tissue repair to reduce inflammation and pain. Patient cases were illustrated in addition to research and clinical studies in Canada, the United Kingdom, and Brazil.

Thank you so much everyone for the opportunity to share these experiences with you! It is difficult to fathom that this is my third blog and next week will mark the conclusion of this amazing experience. There are so many more exciting updates left ahead to report.

Stay tuned and stay informed! Always remember that AACOM is here to serve as your bridge to advocacy on many issues impacting osteopathic medical education and health care.

A reminder of AACOM programs and resources, and an upcoming webinar opportunity:

AACOM is hosting a webinar on October 25 with the NHSC on their Students to Service Loan Repayment Program, which provides up to $120,000 to fourth-year medical and dental students who are pursuing degrees in primary care and committed to practice in underserved communities. Learn more.

Register and become an ED to MED advocate.

As always, if you want to become involved in advocacy call, write, or email your legislators.

---

 

October 4, 2018

Welcome back everyone. The last few weeks have been extraordinary. Between AACOM’s COM Day on Capitol Hill on September 27th, meetings ranging from the U.S. Department of Veteran Affairs (VA) to the U.S. Department of Education (USDE), and webinars focused on clinician well-being and pain management, I have been deeply inspired by everyone I have met on this journey. I look forward to sharing these experiences with you.

Advocacy through Teamwork and Leadership 

From left to right: Dr. Margaret Wilson, Dean, ATSU-KCOM, Maurice Dale, OMS-II, Nicole Lighthouse, OMS-IV, and Kyle Oney, OMS-II.

AACOM set the stage for a phenomenal advocacy day, COM Day on Capitol Hill. Leadership and students from over 70% of osteopathic medical schools across the country united to meet with legislators regarding critical topics impacting their education and the health care climate. Key topics included reauthorization of the Higher Education Act (HEA) to maintain the Federal Direct Graduate PLUS (Grad PLUS) Loan Program and preserve the Public Service Loan Forgiveness (PSLF) Program. Student and academic leaders relayed their narratives about how Grad PLUS loans have made their education possible. Though loan forgiveness is critical to alleviating burden for future providers, the PSLF Program symbolizes a fundamental principle in the osteopathic community of providing outreach and caring for underserved and vulnerable populations and is the only federal program that incentives public service.

 

In addition, advocates urged Congress to preserve and strengthen funding for graduate medical education (GME). The Teaching Health Centers GME (THCGME) Program, administered by the Health Resources and Services Administration (HRSA), provides funding for primary care medical and dental residency training in community-based settings. The intention of the THCGME Program is to address the primary care workforce shortage by creating opportunities for students in regions with the greatest need. Such efforts strive to fill health service gaps in underserved communities as most students who train in these high need areas tend to practice there.

The sense of camaraderie and pride among COM Day participants was palpable from the welcome dinner the evening prior to the final moments of COM Day. I must express my sincere gratitude to AACOM for providing students with this foundation and for serving as a pillar of the osteopathic community.

Improving Outreach and Care to Veterans

The purpose of the VA National Academic Affiliations Council (NAAC) is to provide feedback to the VA Secretary through the Under Secretary of Health on matters affecting its partnerships and academic affiliates. AACOM nominee Thomas A. Cavalieri, DO, Dean, Rowan University School of Osteopathic Medicine (RowanSOM) was selected to serve on the Council. Topics of note during this September 2018 meeting included electronic health records modernization, diversity, the MISSION Act, telehealth, GME expansion, and rural health.

The Council discussions were energizing to witness and underscored the Council’s unwavering commitment to thoroughly examining these issues. I was very impressed to learn about the advancements and capabilities behind telemedicine. I have always been a proponent of house calls, and telemedicine serves as a wonderful bridge to mimic this experience. Most importantly, it is an opportunity to provide accessible health care to patients without the challenges of transportation to a medical center.

Perspectives on Foreign Medical Education

Most recently authorized by the Higher Education Opportunity Act of 2008, the USDE National Committee on Foreign Medical Education and Accreditation (NCFMEA) evaluates the standards of accreditation for foreign medical schools in comparison to standards of medical education in the United States. A determination of comparable accreditation standards of foreign medical schools is required to participate in the William D. Ford Federal Direct Student Loan Program. AACOM nominee Thomas A. Cavalieri, DO, Dean, RowanSOM, was recently reappointed to this Committee by USDE Secretary Betsy DeVos.

Countries represented included but were not limited to Canada, Ireland, and Hungary. Education curriculum has remained a life-long interest of mine. Committee members combed through standards of measurement, markers of success, and areas of improvement such as board examinations, safety measures for GME, counseling availability for students, and faculty development. It was evident that the Committee’s goal was to establish common ground to provide the best foundation for students.

Improving the Health and Quality of Life for Clinicians

The gravity of clinician burnout is an issue that cannot be emphasized enough. There are many dedicated individuals and organizations committed to changing the climate that has led to this very serious public health crisis. One such organization is the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience, of which AACOM is a sponsor. Launched in 2017, the intention of the Action Collaborative is to:

• Raise visibility of clinician anxiety, burnout, depression, stress, and suicide
• Improve baseline understanding of challenges to clinician well-being
• Advance evidence-based, multidisciplinary solutions that will improve patient care by caring for caregiver

On October 1st, the National Academies of Sciences, Engineering, and Medicine’s ad hoc committee, the National Academy of Medicine, presented, “Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being”. The committee shared devastating statistics on the rates of physician suicide and mental health crises that underscore the urgency of this topic. One by one, they shared personal narratives and their dedication toward improving the health, well-being, and quality of life experienced by providers. The resounding message was the call to reintegrate meaningful work into the life of providers by underscoring the patient-physician relationship.  

Economics and Health Care

I had the sincere pleasure and honor to attend the conference, The Economist Group: Leading on Value: Solutions for an Evolving Health Care System. Leaders from the Centers for Medicare & Medicaid Services, Harvard, Sanofi, Dana-Farber Cancer Institute, Johns Hopkins, and US Finance convened to discuss the challenges met by the health care system to deliver quality and compassionate, yet affordable, care to patients. The overarching summary was the necessity to advocate for innovation in health care and academic environments, to emphasize social determinants of health, and to promote competition in the health care market to help drive costs down for patients.

One major lesson I have learned, both from COM Day and this conference, is the sheer complexity that defines health care costs. What educators have underscored is that there is never one solution to this problem and the contributing factors. Instead, it is critical to adopt a systems perspective to this and similar challenges. Similar to clinician burnout and physician workforce shortages, cost challenges are multifactorial in nature and must be addressed as such. More importantly, none of these complex, critical issues can be solved in isolation. Such challenges call for collaboration, persistence, and patience.

I cannot believe how quickly one month has flown by. I look forward to learning so much more from this experience. The wisdom, insight, and dedication of everyone I have met has been remarkable. Thank you for the honor of sharing this experience.

September 21, 2018  

Welcome everyone, it is a sincere honor to serve as an Osteopathic Health Policy Intern (OHPI) with the AACOM Office of Government Relations for the next two months. My name is Nicole Lighthouse, and I am a 4th year medical student from A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine (ATSU-KCOM). I have specific interests in mental health care with respect to advocacy, policy, access to care, and social determinants of health.

As an advocate for the Eating Disorder Coalition since 2006, with my first Lobby Day in Washington, D.C. the following year, I began my commitment to promote awareness of mental health. Personal experience with recovery and service as a family therapist have inspired my advocacy in mental health and patient care. Clinical work, community engagement, and international outreach have magnified my awareness of factors that compromise mental health and quality of life, particularly in underserved regions. My conviction for advocacy is inspired by homeless Native Americans I have counseled, accounts of at-risk youths that I have mentored, and patients I have cared for in women’s health clinics. My dedication to patient advocacy is underscored because of the countless individuals I have met that struggle to afford and access mental health services.

Caring for patients as a family therapist and medical student has been a tremendous honor. Listening to the narratives of patients and families has shifted my attention to underscore the perspective of the patient’s experience. Through my career in patient care and advocacy, I will promote awareness of social determinants of health, access to care, and human rights to improve quality of life and psychosocial well-being.

Regarding access to care, I have always focused my attention to factors that contribute to primary care workforce shortages in underserved regions. I wish to develop a better understanding of the unique factors behind the shortages in primary care within these regions. Of course, it is difficult to discuss workforce shortages without identifying the complex scope of factors contributing to them, such as mounting graduate student loan debt. Taking this into consideration, I am interested in understanding the challenges of recruiting and retaining primary care clinicians within these regions. I am incredibly grateful to be serving as an AACOM intern. This program is an amazing opportunity for students. As I embark on my second week, I am deeply inspired by the dedication that I have witnessed by advocates, policy experts, educators, and fellow interns that have served before me. I look forward to sharing my experiences with you.

Medicare Payment Advisory Commission (MedPAC)

During my first week of internship, I attended the September 2018 Medicare Payment Advisory Commission (MedPAC) public meeting. Established by the Balanced Budget Act of 1997 (P.L. 105-33), MedPAC is an independent congressional agency that advises Congress about issues affecting the Medicare program. MedPAC public meetings serve to discuss policy, and consider results of researchers, policy experts, and public comment. The results of these meetings are translated into recommendations for Congress toward Medicare programs.

It was incredible to witness the resolve of the Commission as they addressed some of the most complex issues facing the health care system. The Commission underscored several foundational topics throughout the two-day public meeting. Integral to their discussion included Medicare payment models with respect to coordination of care and patient outcomes. The Commission magnified the importance of how to approach caring for our nation’s aging and underserved populations with respect to social determinants of health and quality of life. Learn more about the topics discussed during the September meeting.

Advisory Committee on Training in Primary Care, Medicine and Dentistry (ACTPCMD)

One week into my internship, I was honored to attend the Health Resources and Services Administration (HRSA)’s Advisory Committee on Training in Primary Care, Medicine and Dentistry (ACTPCMD). Established in 1998 by the U.S. Department of Health and Human Services (HHS), ACTPCMD provides recommendations for the HHS Secretary on policy and program development in primary care fields. It was moving to be a part of this experience, and to reflect on the level of intelligence and ingenuity that takes place at HRSA.

Listening to the committee, it was inspiring to learn from these visionaries dedicated to addressing primary care workforce shortages. Innovative programs addressed through this discussion include the Teaching Health Center Graduate Medical Education (THCGME) Program, dedicated to caring for patients in underserved regions. ACTPCMD also approached the challenges that providers face with patient care concerning the nation’s opioid epidemic. Topics encompassed how to best approach training for health providers with respect to the prevention and treatment of opioid addiction. In addition, the committee addressed the critical topic of provider mental health and suicide awareness, detailing supportive and multisystemic approaches for provider well-being.

Coalition for Health Funding: Public Health Fair

On September 12, the Coalition for Health Funding hosted its 3rd Annual Public Health Fair, sponsored by the Congressional Public Health Caucus. This event hosted most HHS agencies, as well as other nonprofits and corporations, to educate Members of Congress, congressional staff, and the community about efforts to improve health. It was remarkable to witness and participate in this community collaborative to educate one another about avenues in science, medicine, advocacy, and education. It was inspiring to learn that the Coalition for Health Funding is the oldest and largest nonprofit alliance working toward our nation’s efforts to preserve and promote public health endeavors. Learn more about the event.

Looking ahead: Stay informed, participate, advocate

I want to encourage students and the community that you can make a significant impact through advocacy. Every small step, conversation, letter, or email contributes to meaningful change. As a champion for osteopathic medical students, AACOM serves as your foundation to begin or continue your pursuit toward improvements in education and health care.

AACOM programs and resources:

Register for ED to MED.

Participate in the Advocacy Challenge.

Call, write, or email your legislators.

Shawn Hamm, OMS-IV May 2018 OHPI

Osteopathic medical students that are interested in becoming an OHPI should reach out to AACOM GR! I would highly recommend the internship as a unique opportunity during your third- or fourth-year clerkship rotations for exposure to advocacy, research, and professional growth in a way unlike any other experience in medical school.

Just as we started, I want to leave you with some final thoughts on the topics of awareness, advocacy, and action!

AWARENESS: KEEPING YOU IN THE KNOW

The U.S. Government Accountability Office (GAO)

Considered the “congressional watchdog,” the GAO is an independent, nonpartisan agency that works for Congress by investigating how the federal government spends taxpayer dollars. They provide Congress with timely information that is objective, fact-based, nonpartisan, nonideological, and balanced, typically at the request of congressional committees and subcommittees, such as the Senate Committee on Health, Education, Labor and Pensions and the House Committee on Education and the Workforce. I had the opportunity to review multiple GAO reports that specifically discussed issues related to federal student loan debt and higher education, which were extremely insightful and informative. If you are ever looking for information on ways to make government more efficient, effective, ethical, equitable, and responsive, I suggest adding GAO reports to your list of objective resources. You should also consider subscribing to the GAO podcast Watchdog Report, which features interviews with GAO officials on significant issues and new reports that are recorded, hosted, and produced by GAO staff.

ICYMI: Congressional Committees

On my last blog post, the congressional committees that directly impact osteopathic medical education, federal financial aid, and the health care workforce were discussed. Keep in mind that the hearings, testimonies, reports, and other documents related to the committees are all posted on their websites. If you want to stay informed and watch committee hearings, but have a scheduling conflict, remember to access these important resources online! For instance, the House Committee on Veterans’ Affairs held a hearing, VA Research: Focusing on Funding, Findings, and Partnerships, which highlighted the important partnerships between medical schools and the U.S. Department of Veterans Affairs. If you happen to watch the recorded hearing, keep an eye out for me in the audience!

ADVOCACY: MAKE TIME AND PREVENT BURNOUT

On Advocacy and Burnout

When I attended the Commonwealth Fund’s Centennial Celebration a few weeks ago, I had the pleasure of having a very engaging discussion about advocacy with a fellow attendee. I commented that I was happy to see so many interagency collaborative efforts to address clinician well-being and resilience, and how increased advocacy is having an impact on the burnout crisis in health care right now. Her response to my comment still resonates with me today—advocacy is the antidote to burnout. No matter our field of work or walk of life, she argued that when we make time to advocate for what we believe in, a cause we are passionate about, or a policy change affecting our profession, we get excited about that passion all over again. That excitement turns into a visceral response that pushes out the burnout we may face if we lose sight of why we do what we do, of what motivated us in the beginning. In medicine, advocating for our profession, for students, for patients, for protecting the future health care workforce, for education—this has the power to turn the tide on the overwhelming power of stress, anxiety, depression, and burnout. We both agreed that resilience and advocacy go hand-in-hand, and now more than ever it’s important to join an advocacy effort or grassroots movement to capitalize on this antidote to burnout!

Preparing for Public Service Loan Forgiveness (PSLF)

You have graduated from medical school and you start residency soon. Your massive amounts of student loans weigh heavy on your mind. I know, I am right there with you. I advocate every single day to #SavePSLF because I intend to utilize this federal loan repayment option to pay off my loans in the next 10 years. To do this, it is critical to be aware of the many steps it takes to ensure you are meeting the criteria to participate in the PSLF Program. Here is the process I went through to get the ball rolling for my loans (all Direct Loans—subsidized, unsubsidized, Grad PLUS). My residency program and my employer are nonprofit tax-exempt 501(c)(3) organizations, so I highly recommend each person research the following details to ensure the steps you take fit your specific financial and employment situation.

1. Graduate—all loans become eligible for grace period or repayment.
2. Apply for Direct Consolidation Loan—I consolidated all my 16 loans into one loan, with one interest rate, and one loan servicer. This approach also allowed me to get out of the mandatory six-month grace period so that I could start making qualifying payments toward PSLF immediately (in my case, $0.00 payments for the first 12 months).
3. Apply for Income-Driven Repayment Plans (IDRPs)—this is done as a step within the Direct Consolidation Loan application, therefore only apply separately for an IDRP if you are not consolidating.
4. Submit the PSLF Employment Certification Form—this form must be completed by you and a representative from your residency program, so as a general rule, get this completed during your residency orientation. You want to submit this as soon as possible so that your qualifying payments are tracked appropriately over the years. Remember to submit this every year.

Once these key steps are completed, you should be well on your way toward PSLF!

For more information, learn more from the U.S. Department of Education (USDE)’s frequently asked questions on PSLF! Additionally, the USDE has launched a process for federal student loan borrowers to reapply for loan forgiveness under a Temporary Expansion of the PSLF Program. AACOM encourages borrowers that may qualify to carefully read the requirements and contact the USDE as instructed. Read AACOM’s information alert to learn more.

ACTION: WHAT YOU CAN DO NOW

New #SaveGradPLUS Facebook Profile Frame!

As you can see with my profile picture above, the ED to MED campaign has developed a new Facebook profile frame to help spread the word about the #SaveGradPLUS initiative. As we have stressed time and time again, it takes a unified group of advocates to make sure our lawmakers hear us loud and clear about the importance of Direct Grad PLUS loans. Today, I ask that you join me in changing your Facebook profile picture to #SaveGradPLUS. Find more details on the recent ED to MED blog post!

Share the Washington Insider!

Staying current with policy changes and legislative updates happening on Capitol Hill can be daunting, unless you have an incredible resource like the Washington Insider. Take a moment to share the registration link for the Washington Insider with your networks on social media today! Retweet AACOM GR (@AACOMGR) when they post the newest edition of the Washington Insider and consider adding your own comment on why the issues discussed impact you.

I appreciate you joining me on my journey as an AACOM OHPI! I hope that you gained some insight into becoming an advocate, making your advocacy more effective, and staying informed in this constantly changing political environment. By making time in your busy schedule for advocacy, you will find it takes only a few minutes to reach out to your lawmakers to impact the future of health and medical education policy, and to strengthen your passion for the work you do each and every day. I look forward to working with you all in the future on the issues that impact the future health care workforce and our osteopathic medical profession! Take care everyone!

---

May 18, 2018  

G

reat to have you back! Today marks the end of my sixth week at the AACOM Government Relations Office, and my time is quickly coming to an end. Each week brings new discoveries, ‘ah-hah’ moments, important congressional hearings, and continued advocacy to build on our grassroots movement, ED to MED.

Speaking of change, this week marks the end of my medical school career, and the beginning of my life as an osteopathic family physician. What an incredibly surreal moment to be graduating from the Alabama College of Osteopathic Medicine! I want to mark this occasion with some inspiration for all graduating medical students and health professional students this year. Now that we are joining the healthcare workforce and facing the student loan repayment process, it is critical that we remain engaged in advocacy to raise the profile of graduate student debt issues in the halls of Congress. The Higher Education Act (HEA) is still working its way through the process to become reauthorized. The PROSPER Act threatens to dismantle the Public Service Loan Forgiveness program and would create borrowing limits for Grad PLUS loans, impacting future health professional students. I plan to remain involved and help grow the ED to MED campaign well beyond graduation, and I hope that you will join me in this grassroots advocacy effort.

AWARENESS: KEEPING YOU IN THE KNOW

Key U.S. House and Senate Committees to Follow

When you make the decision to become an advocate, it can sometimes be a daunting task to figure out where to begin, know which lawmakers you should focus on, whether there is a congressional committee that has jurisdiction over your cause, and so on.  On the osteopathic medical education, student debt, and HEA front, here are the key players you should be aware of. Be sure to explore their websites and follow them on social media!

U.S. Senate Committee on Health, Education, Labor, & Pensions



The jurisdiction of the Senate Health, Education, Labor, and Pensions (HELP) Committee encompasses most of the agencies, institutes, and programs of the U.S. Department of Health and Human Services, and ensures our country’s workforce is prepared to meet the challenges of the 21st Century.

                                                                            

HELP Committee GOP

HELP Committee Dems

Chairman Lamar Alexander (R-TN)

Ranking Member Patty Murray (D-WA)

U.S. House Committee on Education and the Workforce

The jurisdiction of the House Committee on Education and the Workforce is over education and workforce matters generally, including pensions, labor rights, and workforce protections.

House Ed & Workforce GOP

House Ed & Workforce Dems

Chairman Virginia Foxx (R-NC)

Ranking Member Robert C. ‘Bobby’ Scott (D-VA)

Remember to follow your own Members of Congress on social media, and identify whether they sit on any of these important Committees. No matter what, it is important to regularly attempt to connect with them through all forms of advocacy – letter writing, social media posts, phone calls etc. When there is an opportunity to share important information with them or make key points about your cause, I have found that Twitter is the easiest mode of communication to reach out to all your members of Congress, for instance:

Find your Members of Congress here.

ADVOCACY: BECOME A CAMPUS AMBASSADOR

ED to MED Campus Ambassador Program

Imagine stepping your advocacy efforts up to the next level by becoming a leader in advocacy at your school. ED to MED Campus Ambassadors are campus leaders committed to being the voice of ED to MED at their school and organizing their classmates to become advocates for their financial future.

Below are the colleges of osteopathic medicine (COMs) with the highest number of ED to MED Campus Ambassadors to date:

1. Lincoln Memorial University – DeBusk COM
2. Ohio University Heritage COM
3. Pacific Northwest University COM
4. University of Pikeville – Kentucky COM
5. Touro COM – Middletown

If you are interested in becoming an ED to MED Campus Ambassador at your school and joining the campaign, please contact Christine DeCarlo at cdecarlo@aacom.org

ACTION: WHAT YOU CAN DO NOW

1. Sign up to be an ED to MED Campus Ambassador TODAY!
2. Follow your Members of Congress and key committees on social media!
3. Read the latest ED to MED Blog!
4. Review important updates in the Washington Insider!

See you all in two weeks for my final OHPI blog post! Thanks again for joining me this week.

---

May 18, 2018  

W

elcome back! The last two weeks here at the AACOM Government Relations office have been packed full of exciting opportunities to engage in the health policy conversations that are happening currently here in the Capitol. Since my last post, I was fortunate to attend meetings in-person at the National Academy of Medicine, the American Academy of Family Physicians’ Robert Graham Center, and  the Washington Post, and listen to multiple webinars regarding important work of various U.S. Department of Health and Human Services advisory committees.

                   

Fun Fact: The Albert Einstein Memorial bronze figure outside of the National Academy of Sciences building,unveiled in1979, weighs approximately 4 tons and is 12 feet in height.

AWARENESS: HEALTH POLICY MEETINGS & EVENTS ON THE HILL

National Academy of Medicine: Action Collaborative on Clinician Well-Being and Resilience

At some point or another, we have all heard of or been directly impacted by the concerning rate of burnout among medical students, residents, and physicians. This week, I wanted to share with you a very important initiative facilitated by the National Academy of Medicine to combat the future loss of health care professionals to burnout. The Action Collaborative on Clinician Well-Being and Resilience, of which AACOM is a member, is a network of more than 60 organizations committed to reversing trends in clinician burnout. I had the privilege of attending their third meeting in a series of meetings, where I could listen to key stakeholders on panels, engage in open dialogue during breakout sessions, and meet many leaders in the health care profession who are committed to making clinician well-being a national priority. I encourage you to explore the Action Collaborative’s website and learn about the Knowledge Hub and Expressions of Clinician Well-Being Digital Art Gallery.

Our Lawmakers Can Advocate, Too!

Ever wonder how our government and lawmakers provide checks and balances on private corporations and businesses to advocate for patients at the national level, just as we try to advocate for them locally in our clinics and hospitals? One example that I experienced this past week was at a House Committee on Energy and Commerce Oversight and Investigations Subcommittee hearing, Combating the Opioid Epidemic: Examining Concerns About Distribution and Diversion. The purpose of the hearing was to investigate the role of wholesale drug distribution and its effect on the opioid epidemic in the U.S.¹, which directly impacts osteopathic medical students, residents, physicians, and all health care professionals. One important lesson I am learning here in Washington, DC, is that interprofessional, interagency, and public-private partnerships are important to finding solutions for the health care policy and health care delivery challenges we see today, and combating the opioid epidemic is one example of how important collaboration is.

ADVOCACY: SOCIAL MEDIA TIPS & MORE

#Hashtags to Know

Want to follow a specific theme or filter the endless social media content for topics that are important to you? Use and follow hashtags. When constructing a social media post in preparation for sharing your personal story, you can use the hashtags in this graphic to expand your audience and join the collective voice. Here at AACOM’s Office of Government Relations, we use #SaveGradPLUS to reach a target audience and help readers like yourself filter information directly related to this important movement. The most relevant hashtags may change over time, so it is important that you are always prepared with the “hashtags to know.” Stay tuned on future blog posts for updates!

Having Trouble Developing a Tweet?

Do you have what it takes to be a social media advocate on Twitter? YES! With some tips and tools from ED to MED, you can make the most of your advocacy tweets! For example, in this recent ED to MED tweet, an important tip is to use key components of a highly engaging tweet—a strong message, profile handles (@), hashtags (#), and links to additional stories and information. By using these key components, you will reach a larger audience to share your very important story and message. I have found as an ED to MED Campus Ambassador that using this technique has been very helpful when I engage my lawmakers on social media on issues such as #SavePSLF and reauthorization of the Higher Education Act.

ACTION: WHAT YOU CAN DO NOW

Being an active advocate means feeling empowered to regularly share your thoughts, concerns, stories, and interests with a target audience. This includes taking the necessary steps to take action at critical moments and sustaining your advocacy over the long-term. Here are some ways for you to get started:

1. Consider becoming a member of the Omega Beta Iota (OBI) National Osteopathic Political Action Honor Society! OBI was founded in 2007 to emphasize the importance of the work medical students do for our political system. Induction into OBI is an honorary recognition for politically active medical students and professional mentors who demonstrate excellence in health care politics. As a member of OBI, you have the privilege of hearing from a wide variety of key players on the frontlines of health policy and legislative affairs, including Pamela Murphy, AACOM SVP of Government Relations. In her address to OBI in Spring 2017, she shared with new inductees the importance of making advocacy sustainable. You can find the application and requirements for induction into OBI here.
2. The ED to MED campaign would like to hear from you! We need to hear your stories about how you are impacted by graduate student debt, how having access to federal financial aid programs like Grad PLUS opens opportunities for career success, and why advocacy is important to you. Consider writing a post for the ED to MED blog, like Jamie Sawver, OMS-IV at AZCOM did, and share your story today!

I would love to hear your feedback on this week’s blog post and suggestions for any topics I might be able to cover in future posts. Thank you for joining me this week to explore health policy advocacy, awareness, and action here on Capitol Hill!
________

¹https://docs.house.gov/meetings/IF/IF02/20180508/108260/HHRG-115-IF02-20180508-SD002.pdf

---

May 04, 2018  

W

elcome everyone to an exciting new journey with your newest AACOM Government Relations Osteopathic Health Policy Intern (OHPI)! My name is Shawn Hamm, and I am a fourth-year osteopathic medical student from the Alabama College of Osteopathic Medicine. It is hard to believe that we are coming to the end of another amazing academic year of OHPIs here in Washington, DC. The interns that have come before me have truly been an inspiration to me, and I encourage each of you to read their previous blog posts below.

It is also hard to believe that in one month I will be graduating from medical school, and then shortly after my internship, begin my Family Medicine Residency Program at St. Vincent’s Medical Center Riverside in Jacksonville, Florida. I am excited to have you on board for the next few months as I transition from medical student to doctor of osteopathic medicine, and share in my journey as I gain invaluable knowledge of federal health care policies and learn how to have a foundational impact on public policy formation for osteopathic medical education (OME). My goal with the OHPI blog is to help you gain insights on how to become a better advocate for our profession, inform you of health policy and legislative issues impacting OME, and share resources with you that I gather along the way.

The main areas of interest that I hope to focus on during my internship include:

• The complex factors influencing the primary care physician workforce shortage, including the impact of graduate student loan debt and the changing landscape of graduate medical education;
• Realistic solutions needed to develop a more robust primary care physician workforce in the U.S.;
• How to have meaningful grassroots advocacy outcomes, through appropriate advocacy techniques; and
• How to synthesize and communicate difficult health policy topics into easily digestible formats.

Throughout my blog posts, you will find that I try to touch on the general themes of awareness, advocacy, and action. So, let’s begin!

AWARENESS: HEALTH POLICY MEETINGS & EVENTS ON THE HILL

Forum on Opioids: Strategies and Solutions for Minority Communities

What an incredible opportunity to listen to some of the brightest minds in America on a very critical and important topic that is at the forefront of most health care conversations today: the opioid epidemic. It was exciting walking into the Department of Health and Human Services building, taking my seat in a very intimate auditorium, and then seeing the U.S. Surgeon General, Jerome Adams, MD, MPH, walk on stage. His opening remarks set the tone for a very informative, inspiring, and thought-provoking forum. 

The four panelists that followed provided data updates on the epidemic, personal stories about the impacts of opioids and substance use disorders, statistics from and effective strategies to combat the epidemic in Baltimore, MD, and a physician perspective on caring for patients affected by the crisis.

I was encouraged by the many solutions and strategies that these panelists discussed and proposed as effective tools for combating the opioid epidemic. The forum showed me just how important it is to partner with those on the frontlines of the epidemic and to work interprofessionally and collaboratively to build awareness, mutual understanding, and a united effort to tackle such a major health crisis.

First Experience with an Appropriations Public Witness Hearing

Each year, the U.S. House of Representatives Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies holds a public witness hearing for the coming fiscal year (FY). This past week, 21 witnesses—leaders of major organizations, associations, and agencies—shared their testimony requesting appropriation funding for FY19. AACOM submitted testimony to highlight programs important to OME, such as Teaching Health Center Graduate Medical Education and the National Health Service Corps.

Click on the links to read witness testimonies or watch the hearing.

ADVOCACY: ED TO MED TOWN HALL & MORE

Annual ED to MED Town Hall

The annual ED to MED Town Hall was a huge success and I am very thankful to have been a panelist at this event during Educating Leaders 2018, AACOM’s Annual Conference. Through this experience, I built a new appreciation for how important partnerships are in advocating for the future health care workforce. Graduate students throughout all health care professions are directly impacted by student debt and the uncertainty of continued congressional support for federal financial aid programs. In medical school, we are often taught about the importance of interprofessional relationships and working as a cohesive health care team to care for patients. The ED to MED campaign, in conjunction with 17 national partner organizations, is showing us in a similar fashion how working as a cohesive team gives us a united voice for the reauthorization of the Higher Education Act, saving the Public Service Loan Forgiveness Program, and bolstering support for the Grad PLUS Loan Program for all health professions.

Stay Current on the Issues

Wondering how to get more information on the health policy and advocacy issues currently impacting OME? I highly recommend exploring the many resources on the Issues & Advocacy page on the AACOM website.

ACTION: WHAT YOU CAN DO NOW

Here are three easy ways to get involved and become an advocate today!

1. This week, I am encouraging everyone to sign up for the free Washington Insider, a biweekly e-newsletter aimed at keeping AACOM membership (students, educators, schools) and partners informed and involved in the policy discussions that impact OME.
2. If you have already subscribed to the Washington Insider, then I encourage you to identify five students, colleagues, or friends that do not know what the Washington Insider is, and share this link with them!
3. We need your voice! With over 100,000 osteopathic medical students and physicians in the US, we need more advocates to join the ED to MED grassroots campaign. We need you to help us tell Congress to invest in the future health care workforce. Currently, we have just over 9,500 advocates engaging on social media, spreading the word, and calling on Congress to #SavePSLF and #SaveGradPLUS. If you will join me, my goal is to get 20,000 ED to MED advocates signed up by November 2018. Join the movement!

Thank you again for reading my first OHPI blog post! Please feel free to reach out to me at any time, I am always here to help. Until next time…

Owais Durrani, OMS-IV February 2018 OHPI

April 03, 2018  

W

elcome back for my fourth and final blog post from my time as an AACOM Osteopathic Health Policy Intern. The last two months have taught me so much, with the most important takeaway being that I am more inspired and motivated than ever to continue my advocacy efforts and encourage my peers to do so as well. During my time with AACOM, one of my primary responsibilities was covering congressional hearings on topics pertinent to osteopathic medical education (OME). In this post, I will be sharing my experiences from these hearings, and since this is my last blog post, I will also share some common misconceptions that students have about advocacy as well as some helpful advocacy resources.

Attending a Congressional Hearing

Both the U.S. Senate and House of Representatives are divided into committees. Congress considers almost every issue imaginable and it would be virtually impossible for Members of Congress to develop a firm understanding of all policies in a timely manner. The committee system allows for Members to become experts on the select topics under the purview of their committees. For example, the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) and the House Committee on Education and the Workforce have jurisdiction over the Higher Education Act.

Currently, there are 21 permanent committees in the House of Representatives, 20 in the Senate, and four joint committees with Members from both chambers. Each committee has a chair, who is the most senior member on the committee from the majority party in that chamber, and a ranking member, who is the most senior member from the minority party. The chairman of the Senate HELP Committee is Senator Lamar Alexander (R-TN) and the ranking member is Senator Patty Murray (D-WA). Committee hearings are open to the public and schedules are posted on the committee’s website beforehand. Most hearings have a live webcast available on the committee’s website, and C-SPAN (Cable-Satellite Public Affairs Network) covers a significant number of hearings as well.

Attending hearings in person seemed surreal after seeing so many on TV through the years! Hearings start with an opening statement from the chair and ranking member, which are followed by opening statements from the witness panel. Depending on the topic of the hearing, the witness panel could include one person or many. For example, at the Senate HELP Committee hearing on the fiscal year (FY) 2019 U.S. Department of Health and Human Services (HHS) budget, the witness was HHS Secretary Alex Azar. Another the HELP Committee hearing I attended on the opioid crisis had a panel of four witnesses ranging from physicians to non-profit founders.

After opening statements, Members begin asking the witnesses questions. The committee chair sets the time limit for each Member’s question and answer period—in most cases, each Member is allowed five minutes. There may be a second round of questioning if the chair decides it is appropriate, and after that the chair adjourns the hearing.

Common Advocacy Misconceptions and Resources

I will be the first to admit, advocacy can be intimidating. Just like anything worthwhile, successful advocacy requires energy and dedication. That being said, medical students sometimes have misconceptions about advocacy. I would like to debunk some of these misconceptions and provide helpful resources along the way.

• Advocacy takes too long and is hard

  As medical students, most of our personalities dictate that we pour every ounce of energy into our endeavors. Many students believe that becoming an advocate requires constant letter writing, trips to capitols, and a mastery of policy issues. These activities are important, but they don’t have to be part of everyone’s advocacy. In AACOM’s Office of Government Relations (GR), we like to use the term “slacktivist,” an activist that may retweet an ED to MED tweet or like a Facebook post from time to time. We use that term in a positive sense because everyone knows medical school is tough, and any level of engagement from medical students is commendable. I am here to tell you that if you don’t know where to start, be a slacktivist. Sign up for the ED to MED campaign, follow them on Twitter, and like them on Facebook. Then, when you see an ED to MED post or tweet, and share or like it—you are advocating! Sometimes our course and rotation schedules are busier and more demanding, and sometimes they’re lighter. As you see fit, attend a COM Day on Capitol Hill, host an on-campus event, or join a conference call, but know that, quite simply, being engaged on a baseline level goes a long way.

• Government does not affect me

  Many of the issues our government considers or the news covers may not directly mention programs like Public Service Loan Forgiveness (PSLF) or Teaching Health Center Graduate Medical Education (THCGME), so it is easy for us to think the ongoing debates may not impact us, but that couldn’t be further from the truth. For example, the Bipartisan Budget Act of 2018, passed in February, included funding for the THCGME Program through 2019. This is a program many osteopathic medical students depend on for their residency training and something AACOM and osteopathic medical students have advocated for consistently. In many cases, bills being passed or issues being debated may not seem to affect us, but after a second look their relevance is revealed. A favorite saying I have heard many times is, “You are either at the table or on the menu.” So as student advocates, let’s make sure we always have a seat at the table.

• I am too busy now and will advocate after medical school or residency

  It is human nature to think that in the future we will have more time. The reality is we will be busier as residents than we are as medical students and busier as practicing physicians than as residents. On top of that, many of the issues we advocate for affect us now—waiting for the future is simply not an option. Will there be a THCGME Program I can match into or will PSLF allow me to get student loan assistance so I can practice in my preferred setting? Remaining engaged throughout the journey doesn’t have to be hard—just be a slacktivist!

• We have a victory, now we can stop

Achieving a goal always feels amazing and we all deserve a break afterwards, but we must remember there is always work to be done. We all know after graduating from medical school and residency, we will still have recertification exams, continuing medical education hours to fulfill, and will be lifelong learners. I like to think of advocacy in the same way—advocacy never stops but is a lifelong journey. Our advocacy efforts may ebb and flow at certain points, but persistence is vital. For example, the recent legislative victory funding the THCGME Program through FY19, which is not that far into the future, demands we continue advocating to ensure the program’s permanence.

 

Thanks for Joining Me on This Journey

It is hard to grasp how fast these two months passed—a sign of the amazing time I had with the AACOM GR team. I would like to thank them for everything. Thanks for teaching me so much, for allowing me to grow as a student and advocate, and for being all around cool humans! We are lucky to have these tireless individuals advocating for us day in and day out.

In my first blog post I stated that advocacy was a simple concept—organizing citizens around an issue they are passionate about and engaging with our democratic institutions to influence public policy. Over the past two months I have learned so much about the world of health policy, OME, and advocacy, but I still believe it all boils down to citizens having a conversation with their representatives so that we can move forward as a country. I know residency will keep me busy, but I pledge that I will continue to have this conversation with my representatives. I urge you to do the same, my friends—we are the future and must be at the table, not on the menu. Thank you for taking the time to ready my blog posts and I wish you luck in achieving everything you set out to do.

---

March 26, 2018  

H

ello friends! I hope everyone is having an amazing March and getting a chance to enjoy some spring weather. March is one of my favorite months for many reasons including match season (I matched into emergency medicine!), March Madness (yes my bracket has been busted many times over), warmer weather, and advocacy days! Over the past few weeks I had the opportunity to attend several student advocacy events. I’d like to share my experiences from these events and my personal experience of being a student advocate. I will also my share my experiences from attending the Medicare Payment Advisory Commission (MedPAC)’s meetings.

Advocacy Days and My Tips

As a medical student advocate, I have learned so much about advocacy and how students can effectively impact policy. I could speak about the topic for hours, but would like to boil what I have learned into three points.

Advocacy at all levels is important. Omega Beta Iota (OBI) is the National Osteopathic Political Honor Society. I had the opportunity to be inducted into OBI and went on to serve on the national executive board for two years. The organization honors students who have been politically active throughout medical school and enables them to network with each other. As an executive board, we saw a trend of the organization being comprised mostly of students who had the opportunity to attend various national conferences, such as AAOM’s Council of Osteopathic Student Government Presidents and Student Osteopathic Medical Association (SOMA) events. These students are amazing advocates and make OBI strong, but at the same time we felt we also needed to include students active on the local advocacy fronts. As an executive board, we made the decision to ensure advocacy activities at the county and state levels, such as state advocacy days and county medical association involvement, were valued on our application as much as advocacy efforts at the national level. Many of our national policies in the history of our country have taken hold on the local level before they went national, with recent examples including health care reform and LGBTQ protections.

As students, going to the statehouse is just as important as visiting the Capitol (and a lot of times more convenient). I had the opportunity to intern at the Texas State Capitol with my state congressman during my undergraduate career, and participated in state-level advocacy. As someone with first-hand experience advocating both locally and nationally, I can see the benefits to both. The result of OBI’s decision to count advocacy at all levels led to a greater diversity of inductees from osteopathic schools across the nation and made OBI a stronger grassroots organization.

There is no advocacy without social media in 2018. Attention is what drives us as a society. Whether it is business or policymaking, the exchange of ideas has always happened where society intersects. This began in marketplaces, then radio, television, and in 2018, our attention centers around social media. Our elected representatives have Facebook profiles, Twitter accounts, and every other social media platform you could think of, and so do students. The exchange of ideas, viewpoints, and conversations happen on these platforms.

AACOM’s innovative ED to MED campaign works to enable students to use social media to effectively engage with legislators. There are numerous examples of how ED to MED empowers students to advocate on issues that we care about, such as the preservation of Grad PLUS loans in the reauthorization of the Higher Education Act (HEA). HEA reauthorization is a long process, and at certain points, an advocate’s input and voice can have a greater impact.

One of these moments occurred when Senator Patty Murray (D-WA), the Ranking Member on the Senate Health, Education, Labor & Pensions Committee, requested student stories regarding HEA programs. The ED to MED campaign activated its network, and within the day osteopathic medical students were sharing their stories on social media with Senator Murray. This example demonstrates how important it is to have an engaged and ready-to-act social media network. I encourage you to sign up for ED to MED if you haven’t, and if you have, find that one friend that needs a little nudge and encourage them to sign up too.

Showing up for events like advocacy days matters. We can organize and engage on social media all we want, but virtual advocacy actions must translate into actions in the real world. When you sit eye to eye with a legislator or staffer and tell your genuine, unique story, that has an effect. Interactions like these stick with people, and can have a lasting impact on policy. As osteopathic medical students, we are fortunate to have active state organizations that arrange state advocacy days for us, and at the national level, AACOM organizes COM Day on Capitol Hill, and the American Osteopathic Association (AOA) arranges DO Day on Capitol Hill. These events cover various topics and differ slightly in how large or intimate the groups may be, but they all allow us to be the face to a tweet or phone call.

During the week of DO Day this year, AACOM GR briefed students from SOMA and the American Medical Student Association to prepare them for their legislative visits. It was exciting to see my fellow students engaged and asking thoughtful questions about advocacy on the Hill. It reinforced for me the idea that showing up matters, whether it be AACOM speaking with students or students speaking with their representatives.

DO Day itself was as exciting as ever for me and a little bittersweet since it was my last as a student—I loved everything from catching up with friends to speaking about issues I am passionate about. If you are like me, then you can’t wait for the next advocacy day! Good news—this year AACOM’s COM Day on Capitol Hill has been moved to the fall and is only a few short months away. With the current ongoing reauthorization of the HEA, COM Day will be an important avenue for students to continue to tell their stories and help legislators understand how policies affect medical students.

The MedPAC’s meetings

MedPAC is an independent, nonpartisan congressional agency that provides the U.S. Congress with analysis and policy advice on the issues impacting Medicare. The Commission was established by the Balanced Budget Act of 1997 and consists of seventeen members from diverse backgrounds with expertise in the financing and delivery of health care services that are appointed to three-year terms. Brian DeBusk, PhD, currently serves on the Commission—AACOM supported his nomination by the AOA.

What stands out most from my attendance at the meetings on March 1 – 2 was how the conversations had so much detail and substance. I pride myself on being health policy savvy, but I admit some of the topics of discussion had my head swirling. As medical students, we are lucky that one day we will be able to take care of our fellow humans. What a simple thought that can be, but so many complex policies and discussions must take place to ensure we can care for others. It is our duty to our patients to remain engaged and in-the-know about these ongoing changes to the health care system. Subscribing to newsletters like the Washington Insider can help with keeping up-to-date with these changes.

Another Blog Post Comes to an End

As I write this, I have two weeks left in my internship with AACOM—it is unbelievable how fast time flies when you are having a great time. As in previous blogs, please reach out to me if you would like to discuss any topics I mentioned or would like me to cover a certain aspect of the internship in my next post. I hope everyone has an exciting rest of March and I look forward to updating you one last time about the adventures I embark on during the next two weeks.

---

March 13, 2018
 

W

elcome back! It has been only a few short weeks since I last updated y’all, yet I have experienced so much in that time. I have truly enjoyed the process of learning something new every day. One thing that has taken some getting used to is the number of acronyms that are used in DC. It reminds me of anatomy from the first week of medical school! The two themes that stand out since my last update are the release of the President’s fiscal year (FY) 2019 budget and the continued emphasis on finding solutions to the opioid crisis.

FY19 Budget Release

Each year, the President of the United States submits a budget request to Congress for the following fiscal year as required by the Budget and Accounting Act of 1921. The law’s goal was to consolidate spending across agencies in both the executive and legislative branches of government. The act also created the Office of Management and Budget (OMB), which reviews funding requests from government departments and assists the President in formulating the budget. Once the budget is submitted, it is referred to the House and Senate Budget Committees. There have been many years when Congress was unable to pass a budget resolution by the end of the fiscal year. In these instances, Congress can pass a continuing resolution, under which the previously passed budget remains in effect until legislators enact a new budget deal. One final note about the process is that the President’s budget serves as a guide for Congress and indicates where the President’s priorities lie. The recommendations for spending and tax policy signify to Congress the President’s preferred agenda, but ultimately, Congress decides how federal money is allocated and divided.

In mid-February, the President submitted his budget for FY19. To say our office was busy that morning would be an understatement! The osteopathic medical education issues under AACOM’s purview fall under various government agencies. My assignment was to look at the proposed budget for the U.S. Department of Health and Human Services (HHS). HHS manages many crucial programs, including the Teaching Health Center Graduate Medical Education Program, the National Health Service Corps, and health professions opportunity grants, to name a few. I helped analyze how the proposed budgets for these programs changed from their current levels. Once we studied the budget proposals, we had a better idea of how the President’s proposals meshed with AACOM’s policy agenda. Read AACOM’s statement on the President’s FY19 budget proposal.

The FY19 budget fun doesn’t stop there!

The next step in the process is for members from the Administration to attend hearings on the budget called by Committees of Jurisdiction. I had the opportunity to attend the U.S. Senate Committee on Budget and the U.S. House Ways and Means Committee hearings with OMB Director Mick Mulvaney and HHS Secretary Alex Azar as witnesses, respectively. During the hearings, legislators had the opportunity to ask Administration officials about various components of the budget, how it would affect their constituencies, and ways Congress and the Administration could work together to achieve mutual goals. The in-depth conversations taught me how every nut and bolt of the budgeting process has a purpose and deep meaning to constituents across our country.  

More On The Opioid Crisis

Funding for the opioid epidemic was included in the President’s FY19 budget as well as in the Bipartisan Budget Act of 2018, which passed in February.

Educating providers on how to manage pain is a topic that has come up in many committee hearings. In addition to the use of non-opiate medications, committee hearings I have attended have emphasized treating pain with a long-term mindset, rather than only acutely. Any treatments ring a bell? Yes, Osteopathic Manipulative Treatment (OMT)! As osteopathic medical students and future osteopathic physicians, OMT is an important non-pharmacologic treatment that can complement, or even replace, drugs. Our training allows us to bring an important dimension to standard medical care.

Thanks For Coming Back

If you have not already, I encourage you to sign up for the ED to MED campaign! Medical school can be overwhelming at times with the course work, rotations, boards, and the thousand other things in our lives—the ED to MED campaign makes it easy to keep on top of important issues affecting us and provides clear steps on how to get our voices heard. Thanks for joining me again and even more so for your advocacy! We have many state and national level advocacy days coming up, so if I can be of any help, please let me know. I am always happy to share any resources or talk more about my experiences.

Lauren Delana, OMS-IV September 2016 OHPI

Nov 18, 2016

Student loan interest rates. Federal funding for graduate medical education.  Health insurance for our future patients.  These are just a few issues currently being debated at the national level, and each of you have a vested interest in these issues.  That being said, I know firsthand how busy and stressful medical school can become.  Hopefully, this post will highlight some ways that you can be an effective advocate while still handling the rigors of medical school and just life itself.

Sadly, this is my last post for the blog as my time in Washington, DC as one of AACOM’s Osteopathic Health Policy Intern has come to an end.  I really want to take this opportunity to emphasize how important it is for medical students to be advocates both in their communities and on the national stage.  Levels of involvement can vary greatly and there are ways for everyone to be involved.  It is important that we let OUR voices be heard so that those making such critical decisions on Capitol Hill have a clear understanding of how their actions will affect not only our futures, but the future health care of this nation.

For those who would like to create more of an advocacy presence on your campuses and need a point of reference, I’d like to share what I did at Pacific Northwest University several years ago.  I organized a health policy week on my campus where we had the following speakers address ways medical students could become more politically active in various ways: faculty at my school who completed a health policy fellowship, a local elected official, and AACOM Government Relations.  It took a significant amount of work and time to organize and pump up my classmates, but help from other classmates and assistance from my school administration really worked to make that week a success. 

In one particular instance during the health policy week, I recall a student who presented the local elected official who came to speak with a letter he had recently received regarding his medical student loans.  The representative was surprised at the amount of debt accrued and spoke with the student about what he could possibly do to help address this issue.  This was a prime example of how students could be an advocate for themselves and their classmates.  

Obviously, organizing an event this isn’t the only way you can be an advocate.  You can write a letter to your elected representative and attend local and national advocacy events (e.g. AACOM’s COM Day on Capitol Hill, etc.) - the options are limitless.  The important message of here is that lawmakers want to hear YOUR story.  A personal story carries much more weight in the political and policy world than pages of data and research; so NOW is time for us to share our stories.

Also, I cannot emphasize how important social media is when it comes to politics.  Many elected officials monitor these platforms to evaluate the position of their constituents.  Following @AACOMGR on Twitter or joining ED to MED on Facebook and simply retweeting or sharing the message can make a significant impact.  Strong social media presence has shown to greatly influence a legislator’s decision.  So when you have a study break, take a couple of minutes to click the “share” or “like” button; the strength of our message can spread and carry more weight.  

I’d like to close this post out by thanking all the work that osteopathic medical students have already done to promote our profession and advocate for students.  The road to becoming a physician is challenging, but it is crucial we stay up-to-date on health care policy because it will affect us not only as students and physicians but will greatly impact our future patients as well.  

If you have any questions about how to become involved, either on social media or with event planning, please feel free to reach out to me.  I would love to help get as many students involved as possible and will do whatever work it takes to assist you in the process.

Keep up the great work as advocates and as students!  I’m honored to call you future colleagues and I look forward to working with you as physicians and as advocates for our profession and patients!

Sincerely,
Lauren Delana, OMS IV
AACOM Osteopathic Health Policy Intern 2016

Hello Fellow Osteopathic Medical Students!

Nov 7, 2016  

I hope that you enjoyed the first blog post that talked about the Osteopathic Health Policy Internship (OHPI) Program with AACOM’s Office of Government Relations, and my experience during the first month of my term. I’m hoping this blog will serve as a resource for students who want to learn more about health care policy and also show that medical students can have a significant impact when it comes to national politics.

Since my last post, there have been two key events I attended that I want to share more about. One was a discussion on the national opioid epidemic and how public policy can help address that issue, and the other focused on the current state of and next steps on health care for military veterans. Both issues are hot topics in Washington DC right now, and are receiving much attention from national organizations and the media.

The first event, “The Opiate Crisis: How Can Public Policy Promote Recovery?” was hosted by the American Enterprise Institute (AEI). Three featured panelists were former Speaker of the U.S. House of Representatives Newt Gingrich, former White House Advisor and political analyst Van Jones, and former U.S. Representative Patrick Kennedy. The discussion, moderated by Sally Satel, MD, Resident Scholar at AEI, highlighted an organization called Advocates for Opioid Recovery, which was founded by the three panelists. When asked why they created the group, the panelists responded that they all have interests varying from addressing the misuse of opioids to mental health awareness to criminal justice reform to research on brain function, and so they decided to join together for this cause. Since many of the issues are interrelated, they realized that focusing on the opioid crisis would also have an impact on the other aspects of society that they are passionate about.

There were two main themes from the discussion: the need to look at substance abuse as a disease, and not just as an addiction, and access to long-term and behavioral treatment. If we do not address the biochemical processes associated with addiction, then we will not be able to make strides in treating this problem. The panelists highlighted the importance of advocating for increased access to long-term treatment and stated that insurance companies need to assist with the cost of such therapy. The speakers remarked that addiction cannot be cured with a two-week inpatient treatment and that it is a lifelong process that requires significant dedication and motivation by the patient. Thus, in order to truly make an impact, we need to provide evidence-based methods for long-term therapy, the same way in which we provide treatments for all other diseases. They also discussed that taking on the opioid crisis could decrease rates of incarceration and could also help provide patients with the appropriate mental health resources. One of the barriers identified by the panelists to making these advancements is the federal budget, as it will cost money for these ideas to come to fruition, and even with bipartisan support for the actual issue, obtaining appropriate, and reliable funding, is another issue.

Overall, it was reassuring to see leaders of our country, from various backgrounds and political parties, come together to address an issue that affects nearly 2.5 million people. We need to change the stigma of addiction so that those who need help aren’t afraid to seek it and are willing to share their stories and the importance of treatment and follow-up care.

The second event I attended was “Health Care for Veterans: Where Things Stand and Next Steps” hosted by the Alliance for Health Reform. In August 2014, the Veterans Access, Choice and Accountability Act of 2014 (VACA) was enacted with the goal of improving access and quality of care to veterans. It set forth a way for veterans to seek care outside of the U.S. Department of Veterans Affairs (VA) if they met certain requirements. The panelists for the event discussed the progress that has been made, areas that still need to be improved, and other topics. They talked about how veterans now have better access to care, but stressed the importance of improving communication between electronic health records and physicians in order to provide more consistent and comprehensive care. It was also noted that the system needs to be simplified so that veterans can better understand qualification requirements and payment structures. One major issue that the panelists agreed on was that private care should supplement the work of the VA, but should not be a replacement. Funding for VACA expires in August 2017, so work needs to be done now to determine if the program is effective enough to continue, and if so, how more sustainable funding can be provided.

During my time as an OHPI, I was able to work on the ED to MED campaign, which is AACOM’s national grassroots campaign, which advocates on behalf of medical students regarding student loan debt and other important issues. The success of this campaign relies heavily on student involvement, so I encourage you to visit www.edtomed.com and join. Lastly, I summarized a recently-published research article on the effectiveness of competency-based education programs. Medical education is branching out into a new teaching model of mastering competencies versus required time for a program. For more information, you can read the full article at http://www.air.org/sites/default/files/downloads/report/Path-to-Success-Postsecondary-Competency-Based-Education-Programs-Oct-2016.pdf. 

As always, please feel free to reach out to me if you have questions about any of the topics above or if you want to learn more about the OHPI Program!  I’d love to chat and share my experience!

Sincerely,
Lauren Delana, OMS-IV
AACOM OHPI

Hello Fellow Osteopathic Medical Students!

Oct 27, 2016

My name is Lauren Delana and I am an OMS-IV from the Pacific Northwest University of Health Sciences College of Osteopathic Medicine.  This fall I have had the opportunity to work as an intern in the American Association of Colleges of Osteopathic Medicine’s (AACOM) Office of Government Relations in the heart of Washington, DC.  One of my goals during the internship was to increase awareness among medical students across the country about current federal health policy issues and how students can take a more active role with health care legislation.  I also wanted to share my experience in hopes of encouraging others to think about applying for this wonderful opportunity.  This first post will be about the Osteopathic Health Policy Internship (OHPI) Program and what I have been up to during my first month in DC.  From here on I will have weekly posts about meetings I have attended, projects I am working on, and how you can get involved.  The plan is that each OHPI will continue the blog during their time.  There are three interns throughout the year, each working for two months, so we will make sure to announce when the blog will be active. 

AACOM’s Office of Government Relations selects three osteopathic medical students each year to be OHPIs.  Any student can apply, but an interest in health policy and experience with political advocacy are recommended.  Each intern spends two consecutive months in Washington, DC, helping with projects in the office and covering meetings on and off of Capitol Hill.  Interns are expected to take notes for the office at hearings and briefings and also stay up to date with the news by providing summaries of important articles.  It is a wonderful opportunity and I am more than willing to chat with anyone interested in the program. 

Needless to say, there has been a lot to learn during my first month in DC.  There is so much going on and I have had the privilege of hearing presentations about the direction of health care and medical education.  Thus far, I have had the opportunity to attend briefings on the hill on topics including: the use of technology to increase access to health care, Vice President Joe Biden’s Cancer Moonshot Initiative, future directions for mental health research, and the future of health care in America.  I also attended the National Academy of Medicine’s presentation on “Vital Directions in Health and Health Care,” organizational panel discussions on graduate student debt, and attended the Medicare Payment Advisory Commission’s (MedPAC) most recent meeting.

Aside from attending meetings, I have been working with the office to review articles regarding graduate medical student debt and helping to monitor and summarize proposed legislation regarding medical education and debt.  This includes attending a webinar for the National Advisory Council on the National Health Service Corps and working to help develop new content for the ED to MED campaign, which is AACOM’s national grassroots effort to advocate for lower loan interest rates and more stable loan repayment programs for medical students.  This campaign focuses on the reauthorization of the Higher Education Act (HEA), which addresses topics such as debt interest caps and public service loan forgiveness.  This legislation will be discussed in the upcoming Congress, and it is crucial that we convey the importance and impact of medical student debt while legislators are drafting policies to address these issues.  There is much more information available on this topic, and you can join the campaign, and make your voice heard by signing up at www.edtomed.com.

Most importantly, I have learned that students can make their voices heard, and it is easy to make an impact.  Even if you share a Facebook post, or retweet an ED to MED post on Twitter, you are helping to spread the word, and Congress will notice the volume of students who engage.  I highly recommend following AACOM’s Office of Government Relations on Facebook and Twitter to not only stay up to date on issues, but also to help spread the word and share your story.

I look forward to keeping you all updated on my experience and developments in DC!  I would love to talk to anyone interested in learning more about the issues or events I have attended, and if you are interested in becoming an OHPI, please reach out to me, because I am more than willing to answer any questions! 

Sincerely,
Lauren Delana, OMS-IV
AACOM OHPI