Clif Knight, M.D., photographed during the final week of the 2011 Indiana legislative session, is set up and waiting in the office of the physician of the day to provide medical care to legislators and other statehouse staff members. (Photo courtesy of Indiana AFP)
While serving as physician of the day, Thomas Felger, M.D., center, works on relationship-building after he's pulled into a conversation with Indiana State Sen. Tom Wyss, left, and Indiana State Rep. Win Moses, both of Fort Wayne. (Photo courtesy of Indiana AFP)
Indiana State Sen. Jean Leising, left, drives home a point during the Indiana AFP's 2010 legislative breakfast. She's conversing with, left to right, Paul Daluga, M.D., program director of the Union Hospital Family Medicine Residency program in Terre Haute; Richard Feldman, M.D., program director of the St. Francis Family Medicine Residency program in Beech Grove; and Tricia Hern, M.D., of Indianapolis. (Photo courtesy of Indiana AFP)
Why would a busy family physician put in a 14-hour day to serve as physician of the day for the Indiana Statehouse? Ask Indiana AFP Board Chair Jason Marker, M.D., of Wyatt, who volunteers for his chapter's Physician of the Day program several times every year. On those legislature duty days, Marker's alarm rings at 5 a.m. because his journey begins with a three-and-a-half-hour drive south to Indianapolis.
"I am physician of the day for six hours, make the trip back and arrive home around 7 p.m.," said Marker. "The cost to me to do this is the cost of not seeing patients for a day," which averages about $1,000 in lost income. But in Marker's view, it's time well spent.
The Indiana Statehouse reflects the sunlight from beneath a brilliant blue sky.
Every year, the Indiana AFP, in a partnership with the Indiana State Medical Association, recruits physician volunteers to staff the Indiana Statehouse each day the General Assembly is in session.
"Immeasurable and invaluable." That's how Indiana AFP President Deanna Willis, M.D., of Indianapolis, describes the chapter's Physician of the Day program(www.in-afp.org) -- an initiative so successful that its run exceeds 35 years.
"One of the reasons the Physician of the Day program is so important is that we're able to demonstrate to the legislature that we value their activity, and we support them in a general way," said Willis. "That creates positive synergy."
"I would say that the biggest value of the program is that it helps make sure that our legislators are in the statehouse doing their jobs; they're not spending the day driving back to their home community to see their doctor about a cold," said Marker.
"You want your legislators working, whether they're making decisions you like or decisions you don't like," he added. And it's also good for doctors to be down in the statehouse "understanding how the laws are made that affect how we practice medicine."
According to Willis, the program opens up lines of communication and builds relationships between legislators and the Indiana AFP. She said those connections -- further enhanced by the chapter's yearly legislative breakfast during which legislators have a chance to visit with family physician constituents in an informal setting -- can make a real difference when it comes to lawmaking that supports family medicine.
- The Indiana Academy of Family Physicians operates a long-standing initiative called the Physician of the Day program.
- A partnership between the Indiana AFP and the Indiana State Medical Association ensures that a physician is on call in the statehouse every day of each legislative session.
- Physicians take care of immediate health needs of legislators and other statehouse staff members, and they get to see the political process at work.
For the upcoming 2012 session, the Indiana AFP will ensure that a family physician is on call in the statehouse every Monday through Thursday in January and March; February falls to the Indiana State Medical Association. Each of the state's 10 family medicine residency programs is given two days to fill during the session. Third-year residents can serve alone; first- and second-year residents can attend with a faculty member.
The physician of the day reports for duty around 8:30 a.m. and sees patients in a small cinderblock office on the lower level of the statehouse. The room is modestly equipped with an exam table, a small desk, a log book, Internet access and a cabinet stocked with OTC medications. There is no receptionist.
Physicians bring their own stethoscope and prescription pad. Their instructions are to provide first aid, acute care and emergency services to elected officials and other statehouse staff members as needed and until further medical support is available. Physicians carry a pager so they are not tied to the medical office.
Only a handful of life-threatening emergencies have arisen in years past. One legislator suffered a stroke, and another, while on duty at the statehouse, developed sepsis after a prostate biopsy. At least two lawmakers have suffered heart attacks while on the floor of the Indiana House of Representatives.
Indiana AFP President Deanna Willis, M.D., of Indianapolis, said the chapter's visible and healthy relationship with the state legislature pays dividends when it comes to chapter members' efforts to advocate issues important family physicians and their patients.
In 2010, for example, a scope-of-practice bill was introduced in the legislature that would have required physicians to be granted hospital privileges to do surgical procedures.
"This bill would have had a substantial impact on our rural members, who often do surgical procedures in the office because they don't have a local hospital," said Willis. The chapter's advocacy efforts prevailed, and the bill did not pass.
Meredith Edwards, the Indiana AFP's director of legislative and regional affairs, ticked off other legislative priorities of the chapter that succeeded -- albeit with collaboration from other organizations. In the 2011 legislative session, the Indiana AFP saw the
- preservation of $1.9 million in family medicine residency funding in the state budget at a time when all state agencies incurred a 15 percent cut;
- passage of an amendment to allow residents to sign death certificates;
- clarification of a physician assistant law and the easing of burdens on primary care physicians without an expansion of scope of practice; and
- halt of an expansion of scope of practice for physical therapists in the state who had lobbied hard for the right to see patients without a physician referral.
Although the Indiana AFP's legislative efforts encompass much more than the Physician of the Day program or the annual legislative breakfast, Edwards said keeping the face of family medicine in front of legislators via the Physician of the Day Program most certainly has played a part.
Family physicians who serve as physician of the day generally say it's easier than a day at their office, where they often juggle a daily deluge of complicated chronic care patients. Instead, the environment at the statehouse is more akin to a retail health clinic setting, where patients present with such complaints as coughs and colds, a sore elbow, or a bout with poison ivy.
An added bonus of the program is that patients who do not indicate
a primary care physician for follow-up care are provided with names of family physicians for referral.
"It's a good medical opportunity, a good political opportunity and a neat experience," said Marker, who's looking forward in 2012 to expanding the reach of the program to medical students.
"They're going to have their first exposure to the politics of medicine, and at least in my case, they're going to be trapped in the car with me for six hours if I want to talk to them about the importance of family medicine," joked Marker. "This could be a nice easy intro for them and a key to enhancing the pipeline workforce issues that (family medicine has)."
Timothy O'Donnell, M.D., of Plainfield, is a family physician in his first year of practice. He accompanied his family medicine residency director to the statehouse during his first year of residency as a way to fulfill the residency program's community service requirement. He volunteered again during his second and third years.
O'Donnell said he'd never given much thought to the political process before that first experience. "Realizing how much impact policymaking has on public health was eye-opening and a little concerning too, because not many of the legislators are involved in health care, so they don't always understand what they're voting on," said O'Donnell.
The family medicine resident saw firsthand how the political process worked; he observed legislative floor debates and lobbyists scrambling in the hallways to schedule meetings with legislators.
Once he gets established in his new practice, O'Donnell said he intends to re-involve himself in the political side of medicine. The Physician of the Day program "opened up my awareness to the role of politics and how that impacts overall patient care. I do need to be involved, and I understand that now more than ever," he said.
Indiana State Rep. F. Dale Grubb has been in the Indiana legislature for 23 years. Having served as both a majority and a minority caucus chair, Grubb said he's had some responsibility for oversight of the Physician of the Day program.
"I assure you that every elected person, and staff people, too, are very appreciative of them being there," said Grubb.
"Most of us live somewhere else in the state and have no personal physician to take care of us in Indianapolis," he said, noting that sometimes a legislator's day begins at 7 a.m. and isn't over until midnight. "It can be pretty consuming, and it's very convenient for members to have a physician close by when we have those lengthy days."
Having physicians from around the state visit the statehouse also gives legislators a chance to hear a practicing physician's perspective on pending health care legislation, said Grubb.
The Indiana AFP's 2010 annual legislative breakfast provides a good opportunity for Kevin Gebke, M.D., left, chair of the department of medicine at the Indiana University School of Medicine in Indianapolis, to connect with Indiana Rep. Timothy Brown, M.D., of Crawfordsville, a family physician and (then) chair of the House Public Health Committee.
Richard Feldman, M.D., is the director of medical education and residency training at Franciscan St. Francis Health in Indianapolis. Feldman was responsible for O'Donnell's first statehouse experience. He's also Grubb's personal physician, even though Grubb's hometown of Covington is more than 80 miles northwest of Indianapolis.
Feldman counts at least three other state legislators among his patients, and those relationships were born and cemented as a result of Feldman's many stints over the years as physician of the day.
"The whole experience is such a powerful public relations tool for the Academy because the legislators truly appreciate our help and our presence there," said Feldman, who also served as the Indiana state health commissioner for four years.
"We create relationships, appreciation and a lot of good will," said Feldman. And that means when family physicians go to the statehouse to testify about a public health issue, like tobacco or immunizations or patients without insurance, legislators are more willing to listen.
Each morning of the legislative session, the physician of the day is introduced in the House and the Senate, and when the physician is not tending to a patient, he or she is free to observe the work of the legislature.
Physicians on volunteer duty are asked to refrain from lobbying legislators or testifying in any official capacity. But they are free to mingle with legislators, and sometimes, those back-of-the-room conversations have resulted in positive changes in legislation.
Chapter EVP: Kevin Speer, J.D.
Number of chapter members: 2,300
Date chapter was chartered: 1948
Location of chapter headquarters: Indianapolis
2012 annual meeting date/location: July 26-29, JW Marriott, Indianapolis
Clif Knight, M.D., of Indianapolis, another regular on the volunteer list, served as physician of the day last spring and recalled a bill related to supervision of physician assistants that was discussed during the final week of the 2011 legislative session.
"I was there as those discussions were going on, and I had a chance to speak with one of our senators who was helping to shepherd that bill and give her my opinion and advice on how to make that a better bill," said Knight. "I believe that the final wording was adopted as it went through," he added.
"I think our Academy is highly regarded by our legislature," said Knight. "We're not knocking on their door about 30 bills every year; we're very selective about what we prioritize and what has the greatest impact on patient care and our members."
Chapter president Willis put it this way: "I think we've really set the stage for some amazing work at the statehouse."
Related ANN Coverage