According to the Association of American Medical Colleges, Tennessee has more than 17,000 active physicians. Approximately 43% of those that train in the state stay to practice (AAMC).1 The Tennessee Medical Association (TMA) is the most active organization representing this state’s doctors and student doctors, particularly concerning healthcare legislation. They work through Political Action Committees, empowering physicians to reach out to legislators and organizing advocacy events that place constituents in the offices at Capitol Hill. Known as “Day on the Hill” by those at the TMA and simply as “Doctor’s Day” by those in the offices.
When I arrived for my first Day on the Hill, I expected the legislators to be standoffish and unapproachable. Additionally, I thought there would be multiple barriers to engaging in nuanced discussions of health matters. I also thought that, at the least, the politicians we met with would feel that our presence disrupted their already busy schedules. I don’t believe I have ever fully understood what happens when the legislators are in session, but I imagined it would be busy. With the recent increase in turmoil over our political climate, I also expected whatever debate we had to become heated. This understanding seemed reasonable, given the outcome of conversations I witnessed among people with differing political views. I was genuinely curious about what I would find but not overly hopeful of a positive experience.
From the moment I walked through the security gates, I found things were not as I expected. The security officer exclaimed, “Oh yay, the doctors must be here today!” as he passed us through. Moving up to the floor reserved for our check-in, I found many welcoming faces confirming why I was there. I arrived early, but a large group was already accumulating at the desk. With the TMA, I was glad to see a mix of faces representing many regions of Tennessee, including OBGYN, orthopedic surgery, family Medicine and Internal Medicine. Medical students, residents, attendings, and those nearing retirement were all in attendance, ready to discuss the issues.
We had scheduled meetings, but as I wore my white coat and ventured throughout the building during my free time, I was likely to be approached by people from my district who wanted to connect with me and find out what I was doing away from Memphis. Instead of acting as if we were a bother, most really enjoyed it when the doctors “came to town,” as one said! It made me smile and somewhat inwardly groan when I heard one say, “Oh, I feel healthier already with all these great doctors around. I shouldn’t have to go see mine for quite some time”. Those casual conversations were surprisingly the most fruitful and collaborative of my day. While in the offices, the groups paired to speak with certain legislators varied. I met people from all over the state, and I loved that they paired inexperienced alongside well-seasoned veterans of such a day. With the groups that they formed, there is a broad range of knowledge amongst all the issues, ranging from independent practice from mid-level providers to complicated insurance policies, that I didn’t fully understand. You could choose whether you wanted to speak, but you could be sure you would learn quite a bit from the lively discussion that arose. We encountered some on opposing sides of our stance, and it was enlightening to hear more than one say they were against the bill simply because the opposite side of the political aisle was pushing it. Those discussions tended to last longer, fueled by many questions and responses from both sides. Despite not starting in agreement, we always left with a sense of being heard fully and understood.
I learned a few things. First, that even my few years of experience caring for patients had established enough of a relationship with them for me to be aware of their struggles. I realized that listening to them well had given me real stories to share that would make these issues more tangible. When I can speak with passion, I can speak with conviction, and their stories impassioned my conversations that day. It was also humbling to have a moment of recognition that I was speaking on behalf of people I hold very dearly in my heart. I wanted to not only speak with conviction but also with clarity and to be equipped with accurate information. As I reflected on the day, I had some retrospective encouragement as I thought about what I learned from men and women that have been representing their patients at the Capitol for many years. I observed some of their styles of speaking and explaining and incorporated them into my own. While I walked in, I was unsure of how I would be able to contribute to the conversation, given my level of training. As physicians, we will continue to experience a feeling of imposter syndrome and inadequacy in different ways. Many acted as mentors who eagerly offered words of advice that emboldened me to speak in these groups that visited legislators’ offices. Lastly, I’d like to circle back around to my first point. I may have been able to share some real examples at Day on the Hill because I listened to my patients, but it was not lost on me that I do not come from a place of lived experience. So while I have some awareness of their challenges, the biggest place I need to learn is in my encounters with my community, actively listening. Asking questions so that I may hear about needs that I may not encounter every day. Asking how prescriptions and recommendations I make may or may not be able to happen because of governmental barriers. I hope over time as I gain experience with patients and advocate for them, I’ll be able to effect some change to their benefit.
Advocacy, Health Policy & Advocacy, SGIM
Dr. Flatmann (email@example.com) is a third-year internal medicine-pediatrics resident at the University of Tennessee Health Science Center in Memphis, TN. Dr. Jackson (firstname.lastname@example.org) is an associate professor of medicine at the University of Tennessee Health Science Center in Memphis, TN. He is also assistant dean of student affairs at the UTHSC College of Medicine in Memphis, TN.
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