IUSM students and alumni advocate for future physician training

September 4, 2014

A year ago, Meagan King, a former student at IUSM-Northwest, and Ian Stamps, a fourth-year medical student at IUSM-Evansville, never expected they would be traveling to Washington to discuss policy issues with members of Congress and other legislative staff members.

IUSM alum Meagan King, left,  and fourth-year medical student Ian Stamps, right, with Congressman Larry Bucshon, who represents Indiana's eighth district. | Photo By IU Office of Government Relations

However, on April 3, the students found themselves discussing rules changes proposed under the 2014-15 federal budget with members of Congress and staffers from the Senate Finance Committee, the Ways and Means Committee and other legislative offices affiliated with Indiana.

The students talked about several topics of importance to medical education in the United States, including the role of indirect costs for continuing medical education to support residencies at hospitals affiliated with large academic medical centers. The Training Tomorrow’s Doctors Today Act, or House Resolution 1201, supports raising these levels.

In August, Rep. Susan Brooks, R-Ind., added her name as a co-sponsor to the bill, which has nearly 70 supporters in Congress. The other three Indiana co-sponsors are Republican Larry Bucshon and Democrats Andre Carson and Jackie Walorski.

"I had no experience with any sort of lobbying or educating on political topics. Bbut I think that being a representative, and being vocal -- and being an advocate for and educating others about what we do -- is very, very important," said King, a native of Gary, Ind., and now a first-year resident in anesthesiology at The Ohio State University.

She, along with Stamps, met with Bucshon and members of Brooks' office.

"I think we're all, as future or brand new physicians, interested in the education of both ourselves and future generations," added Stamps, who first developed an interest in political advocacy after participating in activities related to the construction of a new multidisciplinary academic medical education building in his hometown of Evansville. "You don't always hear about legislative or political activities early in your medical training, but you do later as you gain experience and start to hear physicians talking about it during your rotations."

He added that indirect costs for continuing medical education are often threatened with cuts because they tend to support the hidden costs associated with training new physicians.

"Direct costs are always fairly well supported because it's obvious where that money goes… it goes to pay the residents as well as time lost to education for the attending physician, he said. "What tends to be on the chopping block for funding are the indirect costs, which go to offset the most intangible costs of training residents."

These costs may include lost time from slower work due to residents' relative inexperience or extra tests ordered by new physicians who don't yet recognize every symptom at a glance, King said, noting "it's not always financially lucrative for hospitals to train physician." Yet if hospitals don't receive the support they need for their physicians to educate new doctors, they would never be able to create the next generation of physicians.

Now is a particularly important time to advocate for indirect costs because rising healthcare costs increasingly put pressure on hospitals to try to budget for indirect costs in advance.

"However," King said, "you can't really do that ahead of time because you can't know ahead of time where we're going to cost extra."

Her own residency experience attests to the way physician training can increase costs but save money over time, said King, who recalled a recent experience when she administered a costly test to a heart attack patient because an elevated chemical level in the blood seemed to indicate immediate risk of a second attack. Only later did she learn from a senior physician that elevated levels of this chemical are also a common side effect of heart catheterization. She had not yet encountered such a a situation because a change in typical admissions procedures meant the patient had received this procedure before receiving bloodwork.

"Now I know not to call in the troops when I see elevated troponin levels after a heart catheterization," she said. "It was a very important learning experience, and I guarantee you that I will never do it again, but it did cost the hospital money."

In addition to cuts to indirect costs for resident training, Stamps said the current administration also proposes limits on student loan forgiveness for public service, with a proposed cap at $67,000 after 10 years of public service and income-based repayments.

"Right now, any remaining debt that you have would be absolved if you spend 10 years in what qualifies as public service," he said. "So really what we're talking about [with these proposed reductions in loan forgiveness] is losing one of the major incentivizes for doctors to participate in educating the next generation, especially in rural or underserved areas."

It's an issue with particular response for both students, who hail from regions of the state that could be classified in this category.

Both are also the sort of real-world examples of the costs and incentives for medical training affected by proposed budget changes that lawmakers cannot easily comprehend from a ledger sheet.

The students were accompanied during their visit to Capitol Hill by Doug Wasitis, assistant vice president for federal relations at IU. This is the second year that the IU Office of Government Relations has provided the opportunity for lawmakers to speak directly with new physicians who can speak from experience about how proposed changes in law could affect their futures as physicians.

As a consequence of the experience, King and Stamps both said they're interested in continuing to speak out in support of causes they feel passionate about, with King currently pursuing a role as a government representative for the Ohio Society of Anesthesiologists.

According to Wasitis, IU continues to garner support for H.R. 1201, which must pass a vote in the House of Representatives before it can be considered for a vote in the Senate or House as a whole.