There’s passion and there’s action. For Nishanth Ganeshbabu, a third-year medical student at Tufts University School of Medicine, the two converged in the adoption of new policy at the 2023 AMA Annual Meeting.
Ganeshbabu, a member of the AMA Medical Student Section (AMA-MSS), was the lead author of an amended resolution that was adopted by the AMA House of Delegates (HOD). This resolution sought to include resident programs, residents and fellows in existing policy already in place for medical students.
Resident physicians face barriers to accessing mental health assessments including cost, time, stigma and pervasive cultures of stoicism, even when mental health services are available and free, resulting in low use. The AMA-MSS resolution that was adopted, and which Ganeshbabu led in writing, calls for resident physicians to automatically get mental health screenings unless they opt out, and have access to mental health, substance-use awareness and suicide-prevention screening programs.
Data indicates that opt-out and automatic-enrollment mental health and wellness programs are effective in engaging residents. One program for first- and second-year resident physicians at West Virginia University yielded 93% attendance in auto-enrolled wellness appointments.
“When the resolution was adopted, it was satisfying,” he said. “That was my first resolution that I authored. I did the research myself. I assembled the team myself and it was great to know the Medical Student Section and the HOD found it to be something important that needed to be addressed.”
When he began pondering a career in medicine, Ganeshbabu was surprised to learn about the prevalence of suicide among physicians. The rates of depression and burnout are particularly alarming among resident physicians.
“When I joined the AMA, the seed was planted that I had an opportunity to do something about this problem,” Ganeshbabu said. “I looked into what had been done already and what could be improved upon which is when I found other policy about preventing resident suicide. Through research, it was clear that opt-out mental health screening was an avenue to protect residents. There had been literature about it and we had that policy for medical students.”
Ganeshbabu “saw the opportunity, wrote the resolution and thankfully it passed.”
Taking a concept from idea to execution to finished policy is a process that may seem daunting. But the AMA-MSS is equipped to help on that journey.
“If you're a med student with a policy idea, the first step is to jump on our open forum, which is the place where all resolutions start,” said Laurie Lapp, a fourth-year medical student at the University of Wisconsin School of Medicine and Public Health and the AMA-MSS alternate delegate to the HOD. “It’s a big online forum where any medical student in the MSS can post any idea they want for a resolution. When you do that, if a policy is going to move forward, hopefully you’ll gain some collaborators and can move forward from there.”
Identifying an issue is the first step of the process, but issues require actions, said Rajadhar Reddy, the AMA-MSS delegate to the HOD. “You have to ask yourself: What are the existing solutions to the problem you are addressing?” said Reddy, a fourth-year medical student Baylor College of Medicine. “How can that be solved through legislative or regulatory advocacy? Or in this case, how could the AMA work with both medical schools and graduate medical education institutions to actually implement this? Our goal, of course, is to make sure all the resolutions we pass are actually implemented into advocacy with other parties.”
Writing a resolution that has any chance of becoming AMA policy requires extensive research, but Ganeshbabu said that part wasn’t so daunting. Following the processes set in place by both the AMA-MSS and HOD was another matter. For that he leaned on his colleagues in the Medical Student Section.
“The nitty gritty of the process is a challenge,” he said.
As the AMA-MSS delegate and alternate delegate to the HOD Reddy and Lapp coordinate the AMA-MSS’ rigorous multi-step resolution process. At each stage, MSS leaders work with medical student members to comment on the best way to proceed, improve language, and verify whether a resolution has met all format requirements. Similar to the HOD, the MSS then posts all resolutions onto an online forum, called the Virtual Reference Committee, where any MSS member can comment their stance on the resolution.
The MSS convenes its own internal Reference Committee to review all comments and make recommendations on each item. The MSS Assembly—comprised of delegates from each medical school chapter and various specialty societies, professional interest medical associations and national medical student organizations—meets during the AMA Annual and Interim meetings each year. The MSS Assembly debates and votes to determine whether they agree with the MSS Reference Committee recommendations.
In the end, the resolution, Ganeshbabu said, offered tangible measures to address a pressing issue.
“My overall goal is to destigmatize the issue of mental health, especially among health care professionals,” Ganeshbabu said. “Making it that everyone is automatically enrolled in the program establishes that as the status quo, and then something that we can all talk about. It's a safe space, as opposed to your privately trying to seek out mental health care.”