This past September, I had the opportunity to participate in AGA Advocacy Day, where I went with a coalition of other New York gastroenterologists to speak with our representatives and senators about two pressing issues that face our profession — payment for colon cancer screening and funding for research from NIH. During the event, we heard from congressional members and health policy professionals to prepare ourselves for our meetings. I consider myself to be in touch with current events and politics, but not until this transformative experience did I have a clear understanding of how policy decisions could impact the day-to-day reality of health-care delivery for me and my patients.
As a GI specializing in GI care for the older adult, I see a diverse range of patients in my practice, from various backgrounds, who are predominantly older. After Advocacy Day, I read current events and articles in health journals with a deeper understanding of how health care is shaped, both locally and nationally. In my geriatrics fellowship, I learned about health-care financing and the forces that impact older adults. This curricula was vital, as most geriatric patients receive some health-care insurance from a public source. I felt better equipped to talk to my geriatric patients, their families and other providers when there are changes in our Medicare and Medicaid programs.
The past few years have been filled with health policy issues directly impacting gastroenterologists and hepatologists. There continues to be a threat to decreasing payment and access to colonoscopy for colon cancer screening. A larger number of patients are being diagnosed with hepatitis C; however a portion cannot afford treatment. There is also a growing number of programs for value-based purchasing and newer care delivery models stemming from the Affordable Care Act. The research budget is at risk of decreasing, limiting the pace of discovery for treatment and cures. It is important for our fellows to understand how these events have come to pass and to understand how they can change the course of actions to improve health for our patients, irrespective of their ultimate path.
As physicians, we serve as advocates within our communities for better health and access to care for the populations we care for. We disseminate what we have learned about GI and liver diseases, frequently to patients and families, so they can understand their health and improve their own lives. Our patients and our societies also expect us to apply our knowledge to better the health of many,advocating for health-care delivery, access and services that we know will improve the lives of as many patients as possible. To do this, we have to educate our fellows about what health-care policy is, how health care is financed and how changes in policy are made. Only after learning this important history and background information can the current and future generations of GIs advocate for the best for our patients.
“Only after learning this important history and background information can the current and future generations of GIs advocate for the best for our patients.”
Health-care policy encompasses a broad category of topics including health-care financing, how policy is designed and implemented, issues in health-care delivery, and programs that assess quality and value. Curricula can include discussion of these issues at the local, national and global levels, which can encompass resource allocation and health-care disparities within populations.
Health-care policy falls with under the Accreditation Council for Graduate Medical Education domain of systems-based practice and the subcompetency of identifying forces that impact the cost of health care and advocates for and practices cost-effective care.3 In the milestone narrative, the fellow is to learn and demonstrate the forces impacting health-care costs and resource utilization, both at the individual and societal levels. The aspirational goals for the practicing physician include advocacy and teaching about these forces, which are shaped by health policy. With the changes in health-care delivery, our fellows must understand how to work within the systems they practice to measure and improve the health of various populations, understand the disparities and learn how to best advocate for resources. I’ve included published examples of health-policy curricula in my references.
The rising generation of gastroenterologists and hepatologists are a connected generation. Most of our training programs are situated in health-care facilities, systems and communities that are seeing dramatic changes to the health-care and technology landscapes. As stewards of their professional education, we should find opportunities to teach them about the forces at play, open a dialogue about what this means for our patients, and determine how they can use their education and role as health-care leaders to advocate for what they believe is best. These discussions in training may help to develop a more socially engaged generation of gastroenterologists who may be interested in political action for the well-being of their patients and the profession at all levels.
Dr. Shah has no conflicts to disclose.
1. https://www.acgme.org/acgmeweb/Portals/0/PDFs/ Milestones/InternalMedicineSubspecialtyMilestones.pdf
2. Fiebach NH, Rao D, Hamm ME. A curriculum in health systems and public health for internal medicine residents. Am J Prev Med. 2011 Oct; 41(4 Suppl 3):S264-9. doi: 10.1016/j.amepre.2011.05.025.
3. Mitchell JD, Parhar P, Narayana A. Teaching and assessing systems-based practice: a pilot course in health care policy, finance, and law for radiation oncology residents. J Grad Med Educ. 2010 Sep;2(3):384-8.