2006 Internship Reports

The 2006 installment of GRIP was a great success, with seven AMA-MSS members completing six- to eight-week policy internships in Washington, DC in a wide variety of settings. One of the requirements of the GRIP program is a written report due upon completion of the internship.

2006 GRIP participants completed internships in the following settings:

• American Society of Anesthesiologists
• American Academy of Pediatrics (2)
• AMA’s Washington, DC Office
• Office of Senator Edward Kennedy (D-MA)
• Office of Representative Danny Davis (D-IL)
• Office of Senator Dianne Feinstein (D-CA)

Brooke Albright
Miami University School of Medicine
American Society of Anesthesiologists

No other experience has granted me the opportunity to directly engage in learning and enhance my involvement in my future specialty, as well as learn firsthand how our health care system is shaped and changed, than the AMA’s Government Relations Internship Program with the American Society of Anesthesiologists. The freedom that the program offered me to attend Capitol Hill hearings, debates, panel discussions, fundraising events, dinners and lunches has provided new insight for how I may facilitate change and truly contribute to the betterment of our healthcare system. The knowledge I gained through this experience has allowed me to think independently to formulate my own resolutions for change. This internship came at the most opportune time for me - a time when I was approaching a fork in my path and needed to decide which avenue to take. These six weeks confirmed the direction my career path needed to go; that is, a career focused in anesthesia, patient advocacy, and health care system efficiency, reform and improvement.

Before I came to Washington for the GRIP, my belief was that I would only be an observer of lobbying and reform. However, in my first few weeks, I met a number of deadlines in a timely manner, which were for researching ways to make resolutions and bills stronger. Also, I attended fundraising events, where I conversed directly with Congressmen and Senators about my opinions of health care bills, either thanking them for supporting a good one or encouraging their involvement in another. Eventually, I reassessed my goals and decided to become an effective lobbyist of healthcare reform, someone the society and the AMA may confidently call upon to help give healthcare issues a voice. Among my goals for the summer internship was later to apply for membership on the Committee of Legislation and Advocacy (COLA) for the MSS and utilize the relationships built, contacts made, and the knowledge gained through the AMA GRIP as valuable tools for the enhancement of our health care system.

Having been granted the opportunity to attend several seminars, hearings, and panel discussions, I was able to formulate ideas about issues I never before gave much thought. One such panel of tax analyst experts discussing tax subsidies for health care taught me about our country’s health care crisis and proposed innovative solutions on their best ideas to improve coverage to the uninsured. Some suggested providing health insurance with after tax dollars, whereas others suggested subsidizing every citizen’s healthcare with pre-tax dollars. The discussions by the panel stimulated me to formulate my own ideas, including a paper I have since drafted on Assisted Health Plans to Post Secondary Institutions. During my time in Washington, I was able to bounce proposal ideas off of various legislative leaders, including congressmen, AMA lobbyists, politically active physicians, the ASA’s government relations office staff, and other interns, whose knowledge and experience in the field of legislative health care reform helped guide me towards implementation. They were able to advise me how best to research, author, and then publish my ideas, and since the panel discussion, I have come a long way.

I truly consider this sponsored internship with the ASA to be superior to all other activities I have accomplished throughout my medical school experience. I have learned about issues related directly to my future specialty, including Medicare reimbursement bias, scope of practice issues related to the supervision of CRNAs, the teaching bill aimed at helping teaching hospitals maintain funding, the effects of the practice costs survey on each medical specialty, misrepresentation by other non-medical doctors to patients, and even medical liability claims specifically affecting the field of Anesthesiology. Because the ASA office is conveniently located on the 6th floor of the AMA building, I was able to sit in on several round-table meetings including the specialty society presidents discussions and the SGR workgroups. The staff at the ASA and AMA office could not have been warmer or more welcoming to students. They invited me to share with them my passion for improving our flawed health care system with the best interest of both the patient and doctor at heart. I highly encourage all future physician leaders to learn how to become more involved in health care reform and advocacy through participating in the Government Relations Internship Program in Washington D.C. You will see just how rewarding and career-directing the experience will be for your future in medicine.

Alyce Belonis
Drexel University College of Medicine
American Academy of Pediatrics

The AMA Government Relations Internship Program (GRIP) provided me with the opportunity to pursue my interest in policy and advocacy at the American Academy of Pediatrics (AAP) this summer. It opened the door and allowed me to spend an incredible six weeks in Washington, D.C. learning how a specialty society interfaces with the government, its members, and other nonprofit organizations to advocate issues.

Before starting my internship, I couldn’t have imagined how many current and ongoing issues related to pediatrics actually exist. The AAP Washington staff works on not only those that are of direct interest to its members (pediatricians), but also to the population the members serve, children. To paraphrase one of the staff, the organization is the American Academy of Pediatrics, not the American Academy of Pediatricians, for a reason. Some of what they work on benefits both their AAP members and the children, such as increased access to Medicaid and CHIP (Children’s Health Insurance Program), as well as stem cell research and human subjects protections. The staff also works on children’s health issues on behalf of children, whose voice can only be heard in Washington through the efforts and actions of such advocacy organizations. Some of those issues include recreation safety, drug abuse, child maltreatment, assistive medical devices, and internet safety. I was able to participate and learn about all of those topics during my six short weeks.

One of the issues I was able to work on in some depth was access to care for uninsured and low-income children. Medicaid and CHIP are two very important issues to the AAP. I attended hearings on Capitol Hill--even one hearing on the topic of Medicare where some of the Representatives chose to discuss Medicaid--and I went to the Medicaid Commission (the group that makes recommendations to the Secretary of the Department of Health and Human Services) meeting in July. I was able to see the value in grassroots advocacy. At the Medicaid Commission meeting, an AAP member testified during the public comment period about the work he does related to uninsured children--mainly thanks to the coordination of one of the AAP Washington staff. The other AAP interns and I worked to increase the number of Representatives who support HR. 3055, a bill that would establish safety-net health insurance for all children, which would benefit children whose parents do not have private insurance and whose income levels preclude their children from being eligible for Medicaid or SCHIP.

The Friday seminars at the AMA were all excellent. We covered topics that included lobbying, Medicare, health savings accounts, crafting the right message, and how to approach making a change in the system. It was a great chance to talk with other GRIP interns and the GRAFs who were (and I’m sure still are) doing great work at their offices.

The AAP provided me with an enriching Washington experience, one that allowed me to gain insight into the world of advocacy and lobbying for the health and well-being of children. I only wish I could have had more time off this summer to have a longer internship, to be able to see how some of the issues develop and resolve. It was, however, still a truly amazing experience that inspired within me a pride in the good work that advocacy organizations can do.

Vinh Nguyen
Texas Tech University School of Medicine
American Academy of Pediatrics

“The purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experiences.”- Eleanor Roosevelt

Before this year I had never been to our nation’s capitol. Curious as to what the district had to offer and in a move to understand further the inner workings health policy, I decided to visit DC for AMA’s Lobby Day in the spring. Needless to say I was sold and knew I had to return for the summer.

My experience with the AMA Government Relations Internship Program (GRIP) this summer at the American Academy of Pediatrics (AAP) has been incredibly enriching for me. I work at AAP with another GRIP intern and we really hit the ground running as we were at the end of the Congressional session with elections around the corner. Quite a few important health policy bills were being talked about on the hill include topics of Medicare physician reimbursement reform, Children’s Health Act of 2000, and electronic medical records. My responsibilities at AAP consist of attending hearings in the Senate and House, analyzing new and upcoming policy, and lobbying our congressmen to sponsor bills that benefit children’s health just to name a few. The work was exciting to me because I was able to see up close how a career in advocacy could bring positive change to healthcare. Our office was fast paced and I was encouraged to take on bigger and bigger responsibilities as the summer went on. The position really allowed me to take the knowledge I had in health policy and economics and apply it to an active office whose primary goal was to improve healthcare for all American children.

In addition to this were our Friday lunches at the AMA DC office. Not only did they feed us exceptionally well (especially those cookies) but the speakers we had were phenomenal. I was exposed to experts in lobbying, attorneys in medical patent law, and other leaders in the medical community. Many of the topics were those that I had not previously thought would be under the scope of the AMA. My thinking was definitely broadened by those AMA visits. The speakers and meals weren’t what I enjoyed the most about those Fridays though. What I enjoyed most was sitting around a table with around 7 or 8 other medical students and discussing the endless number issues facing our healthcare system. AMA has truly invested into us as medical students and I saw why when I was around our other GRIP interns. They all had such a wealth of knowledge and a true commitment to the cause of healthcare reform.

With all this said, I must add that it has been really enriching to spend time in Washington, DC. The city itself has so much to offer. I’ve spent afternoons at the ballpark watching the Nationals, been to hordes of museums and conservatories, and listened to different types of live Jazz music from local musicians. In every elevator and on every train were young idealists here working hard to change the world for the better. I couldn’t have had such an enriching experience this summer if it weren’t for the welcoming staff at the AAP and the support of the AMA. I recommend that any medical student even remotely interested in health policy should take advantage of this chance and come spend a summer in this city. At the end you’ll be like me: changed forever and yearning to return.

Michael Chapman
University of Pittsburgh School of Medicine
AMA Washington, DC Office

Miriam Fischer
George Washington University School of Medicine and Health Sciences
Offices of Senator Edward Kennedy (D-MA)

Justin List
Loyola University Chicago- Stritch School of Medicine
Offices of Representative Danny Davis (D-IL)

“This moral center of the doctor-patient relationship is the very essence of being a doctor. It also defines the outlines of the covenant that exists between physicians and their patients, their professions, and their society. The covenant is a promise that the profession makes-a solemn promise-that it is and will remain true to its moral center. In individual terms, the covenant is the basis on which patients trust their doctors. In social terms, the covenant is the grounds for the public's continued respect and reliance on the profession of medicine.”
-Cardinal Joseph Bernardin to the AMA House of Delegates, December 5, 1995

Referring to the historically learned professions, Cardinal Bernardin imparted timeless wisdom about medicine when he spoke these words to the House of Delegates back in 1995. Watching the health care system become increasingly cumbersome for both physicians and patients in recent years has charged my desire to better understand health policy, and where needed, join voices for change. The more I realize that the health care industry and those outside the clinical encounter influence policy decisions rather than health care professionals, the more I believe how pressing it is for physicians to enter the health policy forum voicing constructive ways to help doctors best help patients. True, encouraging and motivating physicians to become more politically active means that they have yet one more thing to add to their already busy lives. But as Bernardin argues elsewhere in his speech, the moral nature of medicine requires nothing less. The need for groups, such as the AMA, to speak on behalf of physicians, is more important than ever in that light. This leads me to a reflection on my GRIP internship.

For me, a few questions preempted my interests in health policy and applying for the AMA GRIP summer internship. Are politics and politicians as polarized and stodgy as the media sometimes portrays them? What differences make a difference in health care policy making? How does a voice or an idea get heard and gain political capital? What can I do politically and institutionally with colleagues to voice concerns of justice, fairness, and economics in the health care system? These questions have been answered in part through the wonderful opportunities structured into the GRIP program, an experience for which I am most thankful to all those at the AMA, Loyola University Chicago—Stritch School of Medicine, and the office staff of Representative Danny K. Davis that helped me get here.

My time on the Hill had many dimensions. Let me start with those outside the office. I attended congressional hearings, such as a hearing on Health Savings Accounts. I went to themed meetings that addressed important health issues. For example, I attended and learned a great deal from luncheon presentations on HIV microbicides, fetal alcohol spectrum disorders, and student debt. I had the opportunity to attend with Alyce, another GRIP intern, a Medicare Academy session to learn about the structure of and issues in Medicare at the Kaiser Family Foundation in DC. I had a meeting with the Physicians for Human Rights DC office staff and began conversations that would help facilitate joint work between our AMA and PHR chapters at Loyola, where I will serve as president of both chapters this upcoming year.

Our AMA GRIP intern Friday meetings provided an excellent way for discussion, education, and advocacy. Speakers came and spoke on issues of lobbying, agenda setting, media relations, and the future of medicine. The friendships and contacts established through these meetings enhanced the DC internship that much more. This was one of the formative ends of the internship program: students encouraging and motivating peers on important issues, such as universal health care coverage frameworks. There was room for diverse opinions and yet shared core convictions.

My time in Congressman Davis’ office also opened me to a world of learning and opportunity, and the Congressman and his staff are committed to playing an important part in improving health care access, quality, and affordability to all with special attention paid to people of racial/ethnic minority status. I came in with a particular interest in racial/ethnic health disparities, Medicaid, covering the uninsured, and global health issues, such as physician brain drain from sub-Saharan Africa which has been on my mind after returning from volunteer work in Kenya two days before moving to DC.

Here are some of the tasks I performed as a fellow in Representative Davis’ office:

•  “Dear Colleague” letter supporting H.R.910 (Medicaid Community-based Attendant Services and Supports Act of 2005)
• Statement for the Congressman recognizing 100 years of work of the FDA
• Backgrounder for our health legislative assistant (LA) on Direct-to-Consumer Pharmaceutical Advertising after a recent AMA statement on the topic was put forth
• Backgrounder on 2007 Children’s Health Insurance Program (CHIP) Reauthorization
• Backgrounder and advocating for funding of the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (Public Law 109-18)
• Addressing issues in a constituent letter that resulted in getting the Congressman to sign onto H.R.1020 which addresses pain management and education
• Backgrounder on immigrants and health care access
• Discussion and research on reimbursement issues for radiologists and imaging centers
• A slight divergence from the health care arena, I also had the opportunity to write an extension of remarks congratulating an award for the Field Museum of Natural History in Chicago, my favorite hometown museum
• I continued to work in bits and pieces on disseminating information on a draft bill that seeks to address physician brain-drain in sub-Saharan Africa

As the contingent of GRIP interns on the Hill agreed, there are many services for Hill staff that were particularly helpful. Of them, the Congressional Research Service (CRS) was by far the most useful. A veritable cornucopia of information, I read educational CRS reports on Medicaid, SCHIP, HSAs, and patient health cost-related bankruptcy, for example.

In addition, I sat in on a variety of constituent and advocate/lobbyist meetings in our office. Some were health-related; many were not. For example, a Catholic priest from Sri Lanka came in and spoke with us about the ongoing strife in that country. Sojourner’s Call to Renewal came in to speak about people of faith and eliminating poverty. I sat in on meetings with the American College of Cardiologists and the Patient Advocate Foundation. I came to understand very quickly how many issues, think tanks, and groups exist, and they all have a political voice and vested interest in policy outcomes. Who gets the ear of a politician? I am leaving this internship having learned in a small way an answer to that question and how I can use that knowledge to hopefully make a difference in the near future.

In a sense, the internship has technically ended but the knowledge I have gained that will keep me more politically involved has just begun. This leads me to another point. I experienced a sense of hopefulness and renewed spirit about the US and American politics in general. I took a Capitol Building Tours class, which provided me a sense of history of that beautiful building and an aspect of our communal history. A quote above a set of doors there that struck me in particular reads as follows: "Man is not made for the state but the state for man and it derives its just powers only from the consent of the governed." Yes, there are frustrating setbacks and polarization that persists on the Congress floor. But there are movements forward, alliance building, and new ways of thinking that energize an intern despite these things. For example, there was very little political rhetoric spoken in my office, and it was refreshing to talk about issues as such. I came away feeling all the more thankful for experiencing the cogs of democracy in the center of DC, and for all its weaknesses and strengths, it is an institution for the people which is in jeopardy or lacking in many other countries.

Make no mistake; there is a lot of work to be done here, especially with regard to an increasingly complex health care system, a system requiring more justice and a much clearer articulation of the key moral values guiding it. Democracy demands involvement. It’s a responsibility that we all bear. There are more causes and rights to fight for on behalf of physicians and patients whose voices do not get heard loudly enough on the Hill. All this brings me to the following conclusion: the AMA GRIP program is a needed and essential one for physicians-in-training who also want to make a difference in patient’s lives through the policy arena. It is a program where activism and policy meet, where student-teacher lines blur, where dreams and realities can intersect. Thank you all for the opportunity.

Amber Sabbatini
Loma Linda University School of Medicine
Offices of Senator Dianne Feinstein (D-CA)

“What lies behind us and what lies before us are small matters compared with what lies within us.” – Ralph Waldo Emerson

Changing the American healthcare system to one that is equitable, fiscally viable, and restores the time-honored relationship between patient and doctor is no small feat. Now depending on which side of the bed I roll out of on any given morning, I am either brimming with the idealism of youth and self-appointed health policy revolutionnaire or completely jaded and disillusioned at this hodgepodge soup we call US healthcare. So it is not that I don’t understand why many docs check out of the politics of medicine, I just envision a different standard for us all.
 
I came to Washington DC as a GRIP to learn – to learn about issues like tort reform, HIV, and Medicare – but also to gain perspective on my role as a physician in organized medicine and healthcare policy, and to create a vision of how I might take part in or inspire others to take part in reform. In many ways, coming to DC was the natural extension of my graduate school experience in public health.

Senator Feinstein’s office was a unique place to intern. Firstly, there were 20 other poly-sci, law-school aspiring interns (all undergrads) who shared the office. We were all paired up with a legislative analyst in our area of interest, and unlike the undergrad interns who spent half their day in an administrative function (providing an ample supply of free labor for the staff), I spent my entire time on health policy. In many ways, I had the ideal internship: my work for the most part was self-directed, I could come and go as I please, and I was given the opportunity to present fairly progressive ideas to the Senator.

Early in the internship, I was told to choose a couple of issues in healthcare that interested me that I would then present to the Senator and perhaps even ask her to sponsor a bill. The caveat was to choose those topics that she was relatively unfamiliar with, so that the issues presented were issues that she was not currently engaged in. I tossed around some ideas with my legislative analyst and we decided that I should research individual mandates as a solution for covering the uninsured and the merits of a new proposal, universal healthcare vouchers. I also researched palliative care for the Senator’s National Cancer Act, as well as spent some time working on a memo to the Senator asking her to introduce the Senate companion to the National Nurse Act.

In addition these ongoing research projects, I was encouraged to attend as many conferences, luncheons, hearings and meetings as I wanted, which I did readily. In the first few weeks I went to hearings on antitrust regulation of the insurance industry, tort reform, HSAs, health information technology and stem cells. I attended an all day conference hosted by the Center for Strategic and International Studies that looked at maintaining US global leadership in the fight against AIDs through the money allocated by the President’s Emergency Plan for AIDS Relief (PEPFAR), and heard speeches by Senators Frist, Feingold, and Durbin. A few days after AIDS conference, I attended another luncheon on microbicide research and the potential use of microbicides to prevent HIV among women in developing nations. Pursuant to my research, I set up a meeting with Dr. Ezekiel Emanuel, Chair of the Center for Bioethics at the NIH and talked to him about his proposal for Universal Healthcare Vouchers. In each of these cases I learned a great deal about the issue at hand and made several important contacts.

The Friday AMA luncheons were a nice way to complete my week. In general, I did not go in to the Senator’s office on Fridays, but read up on my research at Starbuck’s before and after the luncheons. Each of the speakers brought in by the AMA staff were fantastic, but I really enjoyed meeting up with the other medical students and sharing ideas on healthcare reform.

The GRIP program was a markedly defining time in my medical education. I feel that I have been empowered with a wealth of information in health policy, and I have participated in the legislative process first-hand. Looking forward to the next three years of medical school, I believe the true challenge will be to apply everything I learned and empower others so that we can really make progress towards improving healthcare in this country.

For more information on this exciting internship opportunity, please visit the GRIP site, or contact Keith Voogd, MSS Policy Analyst, in the Department of Medical Student Services at (312) 464-4745.