Indiana AFP Values Opportunity to Serve, Mingle With State Legislators
Family Physicians Volunteer for Physician of the Day Program
By Sheri Porter
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)
"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.
"Immeasurable and invaluable." That's how Indiana AFP President Deanna Willis, M.D., of Indianapolis, describes the chapter's Physician of the Day program -- 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.
The Day's Agenda
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 Chapter Counts Legislative Wins
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.
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.
"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)."
A Resident's Eye-opening Experience
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.
Legislator Praises Program
"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.
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.
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.
Facts About the Indiana AFP
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
"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."
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