RAMS Health Policy Roadmap

Health Policy Physician involvement in local, state, and federal legislation is essential to advocating for and protecting the patients we serve. The involvement of emergency physicians in health policy is vital to upholding the standard of care and seeking justice for all individuals in need of medical assistance.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

background

Senior RESIDENT

Resources

AUTHOR: Aaron R. Kuzel, DO, MBA Contributor: Philippa Soskin, MD, MPP Welcome to the Health Policy Emergency Medicine Roadmap, your definitive step-by-step guide on how to succeed in health policy at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and podcasts can be found in “Resources.”

For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

insider Advice

1 - SENIOR MEDICAL STUDENT (MS3 and MS4) Take on leadership roles, apply for health policy electives, and increase your involvement in national organizations.

Senior medical students should look for additional roles of responsibility for health policy events (e.g., team lead on an advocacy topic). This provides you an opportunity to mentor junior students in health policy, but also ensures that a topic is advocated appropriately to your legislator.

Further, senior medical students should consider becoming involved with the American Academy of Emergency Medicine/Resident and Student Association (AAEM/RSA) Advocacy Committee and the Emergency Medicine Residents’ Association (EMRA) Health Policy Committee on projects that seek to affect positive change for emergency medicine residents and interested medical students. Additionally, senior medical students can apply for the EMRA Health Policy Academy to receive formal training on resolution writing and advocacy, or apply for an AAEM/ RSA policy and advocacy congressional elective in Washington, D.C. For osteopathic medical students, there are opportunities to apply to the American Association of Colleges of Osteopathic Medicine (AAACOM) Osteopathic Health Policy Internship and for induction into the Omega Beta Iota , the national osteopathic political advocacy honor society.

A word about residency: senior medical students who are considering a career in health policy, may find it helpful to seek out programs that offer health policy fellowships as this provides an easier opportunity for mentorship and access to fellows in the field. That said, many emergency physicians are involved in health policy at some level; thus senior medical students may want to make this a question on the interview trail and demonstrate this interest to interviewers.

2 - JUNIOR RESIDENT Congratulations! Through all those long nights of studying, the travel, and the interviews you persevered. You made it!

What’s next? The first priority of residency is to develop into the best emergency medicine resident and physician possible.

From a health policy perspective, there are many opportunities to become involved as a junior resident. Continue to be active with health policy events and in EMRA and/or AAEM/RSA. In addition to these opportunities, find opportunities with your local and state medical societies.

Junior residents can run for positions as in-training delegates to the House of Delegates or take advantage of other opportunities to submit resolutions to local and state medical societies. Further, junior residents can submit scholarly activity projects related to health policy, such as research projects or community outreach programs.

3 - SENIOR RESIDENT Senior residents should continue their involvement in health policy and seek further leadership opportunities through state and local medical societies, EMRA, RSA, and RAMS. The latter years of residency also offer opportunities to use elective time to travel and experience health policy opportunities available to emergency physicians. By this time, you should have prepared your application for fellowship and begun to make contacts within the health policy community in emergency medicine.

Health policy emergency medicine events:

Making contacts:

Grants available for research specific to health policy:

• EMRA Job & Fellowship Fair • SAEM/RAMS Residency & Fellowship Fair • SAEM and EMRA mentorship opportunities

• AAEM/RSA Advocacy Day • American College of Emergency Physicians (ACEP) Leadership & Advocacy Conference • American Medical Association (AMA) National Advocacy Conference • AOA DO Day on Capitol Hill • Association of American Medical Colleges (AAMC) • Emergency Medicine Foundation (EMF) • National Institutes of Health (NIH)

Electives:

• Robert Wood Johnson Foundation

PGY-3 and 4 of residency provide more flexibility and time to attend health policy electives in Washington, D.C. or explore other internships in health policy.

• Society for Academic Emergency Medicine Foundation (SAEMF)

• AAEM/RSA Congressional Elective Scholarship • American Osteopathic Association Training in Policy Studies (TIPS) Program • EMRA/ACEP Resident Fellow Health Policy Elective • EMRA mini-fellowship

• The Commonwealth Fund Grants

5 - BACKGROUND Definition and Purpose

Emergency medicine health policy fellowships are designed to cultivate future emergency physician leaders in health policy. The fellowships are available for future leaders who have a desire to affect positive change and improvements within the health care system. Emergency medicine health policy fellowships provide opportunities for emergency physicians to acquire the skills to advocate for the betterment of patients and, in so doing, better the profession and practice of emergency medicine. Health policy fellows receive the skills to tackle issues within the health care system as well as issues that will impact the future of emergency medicine practice and health care delivery.

History

Emergency medicine is largely a safety net specialty that cares for all patients. Because of this, many issues facing health care systems are often experienced by emergency physicians on a daily basis (e.g. the Affordable Care Act, gun violence, Medicaid expansion, etc.). Emergency physicians find themselves advocating for patients and are well suited for speaking on their behalf in hospital committees and the legislature. Health policy fellowships are designed to provide the tools for emergency physicians to become effective advocates and provide them experiences to become well versed in political processes to affect positive change for patients and emergency medicine practice.

Current information

There are currently 12 fellowships in health policy offered by emergency medicine residency programs and departments. Graduates of health policy fellowships often develop a focus and continue their advocacy or research in this field. While there are limitations to academic positions that are focused on health policy work, this provides opportunities for one to create a niche in one’s institution. Further, academic physicians trained in health policy may also serve in hospital leadership positions and on committees with a health policy focus.

To find employment outside of their academic institutions, health policy fellowship graduates can also network with connections made during away rotations.

Most emergency medicine health policy fellowships offer rotations at health policy offices and institutions such as Centers for Medicare & Medicaid Services, National Quality Forum, National Institutes of Health, and other congressional health care committees and congressional and legislative offices. These connections can provide additional opportunities to your academic position as approved by your chair.

The Future

The increasing interest and involvement of emergency physicians and residents with health policy is a positive indicator for the future of this academic track.

More and more emergency physicians are advocating for their patients locally and among state legislatures and in Congress. While the number of fellowships available have not necessarily increased over the last few years, the level of interest in the field has grown.

While it is unlikely that ACGME will provide accreditation to this fellowship in the coming years, due to growing interest, it is not implausible. There are certainly benefits to being outside ACGME accreditation, such as flexibility for moonlighting, potentially higher salary, and less restriction to duty hours for fellow education and opportunities.

Health policy fellowships also often offer the additional opportunity of extending the fellowship from one to two years to obtain a Master of Public Policy or Master of public health. While some programs may offer a second year to obtain a masters, other programs are two years with a masters program already built into the curriculum.

6 - RESOURCES Professional Societies:

• Alliance for Health Policy • AAEM Government and National Affairs Committee • ACEP Emergency Medicine Practice Management and Health Policy Section • American Medical Association • American Osteopathic Association • Benjamin Rush Institute • Doctors for America • EMRA Health Policy Committee • Physicians for Human Rights • Physicians for Patient Protection • AAEM/RSA Advocacy Committee • State and regional emergency medicine organizations • State and regional medical societies

Honor Societies:

Omega Beta Iota: The National Osteopathic Political Action Honor Society (osteopathic medical students only)

Emergency Medicine Health Policy Fellowships: One-year programs with two-year option

• Baylor University College of Medicine • Georgetown University College of Medicine • University of Colorado School of Medicine

Two-year programs

• George Washington University School of Medicine & Health Sciences • Harvard Affiliated Emergency Medicine Residency, Brigham and Women’s Hospital/Massachusetts General Hospital • Oregon Health Sciences University • Stanford Emergency Medicine • University of California-Davis Department of Emergency Medicine • University of Maryland Department of Emergency Medicine • University of Pennsylvania Department of Emergency Medicine

Nonuniversity-Affiliated Health Policy Fellowships:

• • • • • • •

AMA Government Relations Advocacy Fellowship American Public Health Association Public Health Fellowship in Government National Academy of Medicine American Board of Emergency Medicine Fellowship National Clinician Scholars Program Osteopathic Health Policy Fellowship Robert Wood Johnson Foundation Health Policy Fellowship The Commonwealth Fund

Medical Student and Resident Opportunities:

• AAEM/RSA Congressional Elective Scholarship • AOA Training in Policy Studies (TIPS) • EMRA mini-fellowship • EMRA and ACEP Health Policy Academy • EMRA/ACEP Medical Student Health Policy Elective • EMRA/ACEP Resident Fellow Health Policy Elective • Osteopathic Health Policy Internship • Student National Medical Association Health Policy and Legislative Affairs Program • State medical society Physician Day on the Hill

Health Policy Journals and Publications: • Health Affairs • Health Economics • Health Policy • Journal of Health Politics, Policy and Law

EM Political Action Committees:

• American Academy of Emergency Medicine PAC • National Emergency Medicine PAC (NEMPAC)

Other Resources:

• EMRA Emergency Medicine Advocacy Handbook

7 - INSIDER ADVICE If you have a desire to advocate for your patients and become involved in the development of policy while increasing your academic opportunities, this is the fellowship for you. Health policy fellowships offer opportunities to develop leadership abilities and prepare you for working with national organizations to affect positive change on emergency medicine practice and patient care in health care systems.

The fellowship offers opportunities that would be otherwise difficult to obtain on your own, such as structured rotations and internships with Congressional officials, the Centers for Medicare & Medicaid Services, Agency for Healthcare Research and Quality, Health Resources and Services Administration, state and local departments of health, and advocacy firms. Health policy fellowships have established relationships with these programs, therefore making it much easier to find connections in these offices.

To be a competitive candidate for a health policy fellowship, a candidate should first show enthusiasm and interest in the field. Further, a candidate should demonstrate this interest and enthusiasm by exploring the issues facing our health care system. Candidates can do this through involvement in advocacy days, electives, or research in health policy. If you need ideas of how to get involved check out the medical student and resident opportunities section of this guide.

While there are a few resident training programs in health policy, such as the EMRA Health Policy Academy, there are no specific certifications.

A Masters in Business Administration and Public Health does add value to the application, as does scholarly activity directed to quality assurance projects and administration areas.

The health policy fellow will have clinical responsibilities in an academic emergency department and may or may not have the opportunity to supervise residents. Fellows will be provided an internship component as part of their fellowship and will be embedded with health advocacy teams and other health policy organizations. Health policy fellows will also attend journal clubs that discuss health policy literature, research, and issues currently facing health care systems. Fellows can also attend networking events to establish future career opportunities within the health policy field.

The role of a health policy-trained attending is not well-defined, which provides both challenges and opportunities. The role varies dramatically as does approval from the chair of an academic institution. Because of this, health policy attendings should negotiate protected time to work on health policy projects, apply for grants that support this time or work, and serve in an education or mentorship role for residents and medical students who desire to work in health policy. Additionally, health policy-trained attendings can supplement their income by working in health policy-related organizations.

In addition, health policy-trained attendings should consider serving as health services or public health commissioners, joining advocacy organizations, authoring policy pieces, and acting as spokespersons for hospitals.