Residents in a Room

Episode Number: 66

Episode Title: Nontraditional Pathways – Advocacy

Recorded: July 2024

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VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

Whenever you take the time to volunteer, get involved, and actually show up. It helps you feel better about yourself.

If we don't do it, I guarantee you opposing voices are doing it.

It's important to just know that this doesn't have to be completely time consuming for the individual that's wanting to participate.

DR. TILMAN CHAMBERS:

Welcome to Residents in the Room, the podcast for residents by residents. I'm your guest host for today's episode, Tilman Chambers. I'm a CA3 at the Memorial Healthcare System in Fort Lauderdale, Florida. I'm joined by Dr. Lisa Solomon and Dr. Bill Hauter, who is a member of the Illinois House of Representatives, for another episode on non-traditional career work, the many things we do as anesthesiologists, like go beyond the clinical. Both guests are involved in advocacy work in different ways, so they'll share information about incorporating advocacy into our careers.

All right, so starting off with our first question, Dr. Solomon and Dr. Hauter, can you kick us off by telling us about yourself, your career and your advocacy work?

DR. LISA SOLOMON:

Great. Thanks for having us here. Currently, I've been in practice for the past 12 years. I've had experience in both private as well as in academic practice, and I specialize actually in cardiac anesthesiology. In terms of my experience with respect to advocacy work, I had a lot of great mentors when I started out as an early career physician that really exposed me to the importance of advocacy with respect to how it really ties into the daily work and caring for our patients. Presently, I serve as a chair for the committee on governmental affairs through the Illinois Society of Anesthesiologists, as well as also on our national committee through the American Society of Anesthesiologists. But I'd love to introduce you a mutual colleague, Dr. Hauter, who is doing amazing work as state representative here in Illinois. So, Dr. Hauter.

DR. WILLIAM HAUTER:

Well, thanks, Lisa. Thank you for having me. So I originally graduated from medical school and did a residency in emergency medicine. So I'm a board certified in emergency medicine. And then right after that I did a residency at Indiana University in anesthesiology, and I have practiced since 2003, in Peoria, Illinois, at a large tertiary referral center. I also specialize in cardiac anesthesia, both pediatric and adult cardiac anesthesia, and I still practice a little bit of emergency medicine as well, so I've kept that up. I also have been involved in my society, especially based in anesthesia advocacy.

But my political journey kind of started with just a local level. I decided to run for my county board because I had been, as a lot of people do, and in my particular state, just complaining to family and friends about decisions being made about politics in Illinois and policy of Illinois that I just decided to start contributing and stop complaining. So I ran for Tazewell County Board, which is my county, and that was really fulfilling. And that was a good way to start local and learn the local political players and you know, how to do a campaign. And that was all I needed to do. That was enough. And then Covid hit and let's just say I had, uh, just a real eye-opening experience and, as we all did, I think, in public health emergency and how it's dealt with on a state level. And I saw the Illinois State General Assembly had not one physician, not one medical person in all of the General Assembly, all of the 118 state representatives, the 59 state senators, the whole constitutional officers. Not one physician, not one nurse in a public health emergency that required, you know, really, um, perspectives of people that were dealing with patients and new public health and, and public health policy. So I just felt really compelled, uh, that that's wrong. And the Illinois State General Assembly, there's a lot of lawyers and a lot of business people and activists and farmers and did not have one physician in all of the General Assembly representing 12.4 million Illinoisans. I thought was wrong, and I just felt really compelled to run for office. And, uh, and in 2022, I, uh, was elected to be, uh, an Illinois state representative for the 87th Illinois House district.

DR. SOLOMON:

I just really wanted to point out that, you know, while Dr. Hauter represents, um, physicians and is a voice in the the state of Illinois, that there is an opportunity. We do have approximately 19 physician members also in Congress, one that is an anesthesiologist. So this is definitely a pathway that early career physicians can think about or those that are in practice moving forward of getting involved and being part of presenting solutions at this particular level.

DR. CHAMBERS:

All right. Well, that is, uh, really interesting to hear about. That is absolutely fascinating. And I want to definitely tip my hat to you for being involved in such large advocacy work and also representing us on such a big level. Um, my next question for you is when you hear advocacy, often we think about legislation and lobbyists. Is that how you think of it, and what does advocacy mean to you?

DR. SOLOMON:

Well, I actually think of advocacy in terms of how it really relates and what it means to our patients. Ultimately, what we are here for is to be able to advocate for the health and well-being of the patients that we serve, and to also be a voice to the physicians on what resources are needed to be effective in doing that. So while there's definitely a role with respect to that we communicate with legislators. We have lobbyists that also participate in that. I think the roots of advocacy actually come down to supporting the health and the wellness of our patients on an everyday basis. Sometimes individuals might think that this is taboo or that this is a controversial topic, but what you do every day in educating key stakeholders at your local hospital, your local community members about the health and well-being and your role involved as a physician, as an anesthesiologist, that's what we're doing already as being a patient advocate. Uh, Dr. Hauter, any feedback from you?

DR. HAUTER:

Well, I'm just going to say from the start, Lisa is a very articulate voice. Lisa and I are friends from way back. We've been in the Illinois Society of Anesthesiologists together for a long time at different levels, and we've been advocating together for a long time. So I totally agree with her. You know, I just think of advocacy as just advocating for our patients. And that can be on so many levels. You can start at the hospital levels. And I think one of the things that, we're talking to, I think the target audience here is, is residents and young early career physicians. And just to start with participation. It's so important to show up to your hospital committees, to be before your administration. You can advocate if you're in a private group or even if you're not in a private group. If you're an employed at a contract group, you can start in leadership in that area. As I said earlier, I started, you know, with the county board and you can start with your town council or you can start, uh, with your school board. It's just important to start getting involved and start early. It's really important for anesthesiologists to be visible, and we're then establishing advocacy for our patients. And it's just another way to take care of our patients.

DR. CHAMBERS:

So whenever you started working with an advocacy, was there any assumptions that you had that were proven wrong once you actually started to work within the field of advocacy? Or is there any sort of assumptions that other people made about the field that you discovered were incorrect?

DR. HAUTER:

You know, when you start off, you think, what do I have to offer? And I know that's kind of what I was thinking. You know what's special about me individually? What do I have to offer over anyone else? You know, you you feel like, especially when you're, you know, early career physician, you have so much that you're thinking about and there's patient care, there's your family, there's a lot of things that, starting off, you may not want to take on something like starting to advocate for your specialty. You also may feel a lack of confidence. And I just feel like, again, just wanting to contribute and showing up. Half the battle is just being there and showing your face and making yourself available and actually taking that step and starting to contribute and to get involved in different areas, whether it be your society, your hospital committees, your group practice, your local politics, it's just showing up. I think that's huge.

DR. SOLOMON:

I agree. I would like to echo that comment. I think as an early career physician you're establishing yourself or perhaps in residency, you may feel that you don't have all of the knowledge base to be a voice and to provide insight. But I think you really do have experience. You know, you're training, you're there with the long hours and seeing what's occurring with our patients. You're like troops on the ground. And so your insight to that is definitely valuable and helpful to speaking to, uh, individuals that may not necessarily understand or are making decisions that don't have experience in healthcare. So definitely encourage you to have the confidence and be open minded to listening, as well as also contributing in that particular level.

I think that the misconception that I had is that somebody else is doing this, and that the reality is that we all have to be unified and develop a strong voice and be able to be visible, as what Dr. Hauter had mentioned earlier, that it really does take a village to be able to extend our messages and to bring that to those key decision makers. And what we've seen. And when it comes to tangible pieces of legislation, like the legislation that's going to impact residents pertaining to, um, medical education, debt and providing student loan assistance that ASA is working on and that we're working on at the state that is meaningful or close, in addition to helping protect that anesthesiologists are always involved in the care of patients. That takes everyone's effort. So the idea that somebody's doing it and it's being taken care of, I think was a big misconception.

DR. HAUTER:

Yeah. Just to build on that, you know, if we don't do it, I guarantee you opposing voices are doing it. And I see that in the statehouse every day. You know, I think oftentimes physicians are really busy and they're reluctant. And sometimes they think, like Lisa said, somebody else is doing it. But we really need physicians to show up and to be there and be present and and with numbers too, because I see every day, you know, opposition groups on all levels, not just the specialty of anesthesia, but the whole House of medicine is being opposed strongly and in great numbers to expand their scope of practice. I'm going to one of our committees in Chicago for a huge hearing on the pharmacists’ scope of practice. They're pushing to practice medicine, they're pushing for test and treat. They want to be able to test for strep throat, for a flu, for RSV, for Covid, for, uh, HIV, and prescribe the medications for that, totally bypassing physicians. And they have successfully passed the bill. And we are trying to roll that back. And so we're fighting all areas. I'm telling you, our opposition is very organized and militantly for their, you know, goals. They're showing up.

DR. CHAMBERS:

Within your time working either within the House or in general advocacy work that you've done in the past, are there any particular issues that you've encountered that you think are extremely important that people should pay attention to right now as residents?

DR. SOLOMON:

One particular piece of legislation that I think is really important for physicians or resident physicians is the Resident Education Deferred Interest Act, or what we call the Ready Act. This is something that the ASA has been working on to really serve as a voice for um, physicians that are in training. We know that the cost to graduate medical education is substantial, and this has been growing for physicians in training, um, majority of physicians in residency are really unable to begin repaying the medical student loan debt immediately. And what results is that they may accrue high interest over the loan balance. And so what this particular act, again, it's the Ready act. It's something that every resident can contact their federal representative or senator to support this. This is really part of an overall student loan repayment reform. And it would defer interest that would occur during their medical internship or residency program. So please, please, please get involved. Contact your local representative, congress person or Senator. Let them be aware of this and to support the Resident Education Deferred Interest Act or the Reddy Act. Um, and also encourage your fellow residents to also be a voice in this

And also the terminology of anesthesiologists. I think every resident should be aware that the use of it by non-physicians or non anesthesiologists is very detrimental to the level of training that you've experienced, the expertise that you're acquiring when you are finished and you have completed residency. Utilizing that term, anesthesiologists or the term nurse anesthesiologist, is completely inappropriate. And I'm hoping that, you know, these conversations and the education piece would really spark an interest for residents moving forward to create a movement about this, to to go to programs and to express how this is important for patients to really understand, especially in emergent situations or patients that may not have an awareness about how to navigate through the health care system when they hear certain terms like doctor, similar to anesthesiologists, that this is a physician that's taking care of them. I think that's something important for you guys to know.

DR. HAUTER:

I agree. They are attempting, in a very clear and stepwise fashion to control the language, and part of controlling the language is, number one, conceivably they can call themselves doctors and they want to be called anesthesiologists. They want to be able to present to their administration of their hospitals, or even to an insurance company or big contract group, listen, we are doctors and we are nurse anesthesiologists, and that is clearly controlling the language. I think that's a huge issue for our specialty going forward. Um, you know, title misappropriation is going to be a huge issue. And scope of practice.

DR. CHAMBERS:

Thank you. So we've touched on a lot of different issues. We've touched on your previous work. Um, and we've also already touched on this question a little bit, but what does involvement with advocacy look like it's not your stereotypical career choice.

DR. SOLOMON:

Well, I think for someone that is becoming, um, early involved in advocacy. I would like to just reiterate that this doesn't really actually take a lot of time. So small investment goes a long way, and it can look as something of spending perhaps maybe a half an hour just getting to know your local state representative, being able to connect with your leadership at your institution, being informed about the issues, and taking perhaps ten minutes out of the week to understand there's the broader amount of topics. But I think that's something for an early career physician or those that are in residency to recognize that that is the starting point of it. And even afterwards, when you're done with residency, it does not necessarily require a lot of time consuming participation. But you can get involved at your state society, you can get involved in the national level as well, and participate in lobby days that these particular days are times that you would make visits and meet with your local legislator at at your state capitol or even in Washington, DC. And you can also connect with them throughout the year through various important issues. For example, what we're working on in the state of Illinois is addressing certain payment changes with respect to insurance companies. It's important to just know that this doesn't have to be completely time consuming for the individual that's wanting to participate.

DR. HAUTER:

And what it looks like for me, I think, is it should be a part of your career. It should be a part of everyone's career as a physician. You know, you're always continuing to educate yourself and you're continuing to look at the literature, and you should be continuing to advocate for your specialty throughout your career. And physicians are in such a unique position to advocate for themselves because of their instant credibility with their state legislators, even with their national representatives and senators. I could tell you, the politicians want to be friends with physicians. They really enjoy it when physician groups come to their office or meet with them in their district. There is prestige and credibility in being a physician, there's no doubt about that. And that translates really well for when you advocate for your specialty or the house of medicine in general. We have a unique position that we can go almost anywhere and be admired and accepted still, even to this day. And I know we feel like that's changing, but I'll tell you, there's a lot of goodwill built up in our profession as instant credibility.

DR. SOLOMON:

The other piece is providing education to your peers and those that follow behind you in terms of training. I think that's really important, especially as I mentioned earlier, I had a significant amount of wonderful mentors that provided insight onto being able to have these conversations, how advocating for our patients really affects our day to day activities, how that translates from a clinical level. And I think that is something that's important. So although you might not directly be speaking with various legislators, really providing that type of awareness and education, whether or not you remain in academics and private practice, that's something that I see that I'm currently involved in and continue, because I think it's really part of you as a physician being informed. You want to be able to be part of the process. You want to be able to contribute to how we're able to deliver that care. And your voice needs to be heard in order for that to be really effective. So that's another piece. I want to just encourage you to continue to learn and understand and educate others around you.

DR. CHAMBERS:

One big word that you used there was informed. And so it kind of brings me to another question that I have is, you know, it's really difficult, especially with a lot of the back and forth that we have in the current political landscape, to kind of keep up with everything. Is there a resource that you recommend to get a good, true capture of what the political landscape looks like in, particularly in how it impacts anesthesiologists or the field of anesthesia.

DR. SOLOMON:

Yes, I think that ASA has great resources. They definitely have an area that talks about information pertaining to the issues that involve our specialty. There's also curated items for residents in your section. There is a made for this moment link or a platform that provides you pieces of education. There's diagrams and handouts also to to distribute that as well. I think where I learned the most, though, because I find the value in institutional memory, is connecting also at the state society level, or with your attendings or colleagues that are around you, because I think they have perspective in terms of seeing what issues may have occurred perhaps ten years ago. Is this something that is still ongoing? So I use a combination of those various resources in order to be informed. The main thing is just a willingness to be engaged and to understand that about what the issues are out there.

DR. HAUTER:

I would echo that. I really think your state society is a great resource, and they are just desperate for young career physicians to get involved. I know when I started with the Illinois Society of Anesthesiologists, I was a little bit hesitant. I didn't know what you know, what would I do? And and I was really welcomed with open arms. And it's really been a fun group. It done so much, traveled so much to different conferences. And a lot of times you get paid for and you meet a lot of people all over the state and you get this great network. Um, and you get, uh, up to date information about what is, uh, on the front burner of issues with our specialty. So I would say the state society was a great resource.

DR. CHAMBERS:

Uh, a word that you both have used that I truly have come to value over my time, both in graduate school, medical school and residency is perspective. So, um, whenever you kind of look at the political landscape and just the landscape of medicine in general, you have the complicated intersection of Medicare coming up with resident salaries, and then you have these predatory student loans that occur that kind of add a lot of pressure into, uh, the medical training. Um, so it kind of creates this complicated landscape where you also get the introduction of these ideas of, you know, unions. And I know this is a little taboo. Do you see there being any sort of advantage to a union from your position?

DR. SOLOMON:

So I would say the conversation of collective organization to be a way for residents to advocate for themselves, I'm really actually proud of that concept. I think that energy in which your collective voices are being able to move forward these issues, is something that is the initial framework and exposure of what we'd like to see with residents and even continuing on and and being engaged afterwards. So I think there is that concept. Um, while it is, it's not a new concept. It's something that has occurred, although it's gaining a lot more traction lately. I think the core issues are residents being able to speak on their issues and have their voice heard at that, that platform. So I like the energy.

I would say from perspective, I haven't really yet sorted out how that's going to mean in terms of is it really going to be effective with training, how that's going to impact also the career of these early career physicians and translate into practice after residency. But I think there's definitely some concepts there that are important in terms of looking at the value of residents contributing to the health care system. I do believe that residents are extremely valuable in delivering patient care, um, that they are very important in the safety of our patients and the training that you're receiving, and concomitantly, helps with their outcomes in the hospital's ability to be effective in the community. So it's wonderful to hear and to see that hospitals are really taking the time to listen, because they recognize that that this action of residents coming together is something that should not be ignored. Dr. Hauter?

DR. HAUTER:

Well, you know, I'm always a little conflicted when I hear about physician unions. It just, you know, the final action of a union, you know, the ultimate leverage you have is always a strike. Right. And I just have a yeah, a little bit of hesitancy when I think about my oath, when you bring in the words like striking and things like that. So that's my conflict. I know other people, you know, the same thing. It's sort of how do you jive that with your commitment to patients, etc..

But, I think, you know, when we look at the changing landscape of the work models for most physicians, including anesthesiologists, it's more and more of an employed model. Right? And when you have an employed model, you need some protections for your workforce that may include collective bargaining if you want to use those words in some way. When you talk about due process, when you talk about contracts and and non-competes and, you know, compensation and how that all works as an employee physician, that there may need to be some protections of, you know, the collective bargaining model. And when you say those words, you always kind of think union.

You know, I'm kind of puzzled and maybe you can answer this, but how do we get the younger career physician, the resident physician, how do we get them involved? I just see it's really, really hard to get them involved at every level in my group and at my hospital, in our in the Peoria medical society, which I'm the president of the Peori Medical Society. It's our local medical society at the Illinois Society of Anesthesiologists, at the local, state and and national level of politics. It just really hard to get younger physicians involved at all. Is there a reason and is there a solution?

DR. SOLOMON:

Or a magic recipe perhaps.

DR. HAUTHER.

Yes.

DR. SOLOMON:

What is it that helps really excite this group of physicians to participate and get involved?

DR. CHAMBERS:

That's a really good question. I'm glad you asked it. Actually, it was probably the perfect question for me. So, um, a little background about myself. I am part of a new residency program, and I have been working very, very hard to get everyone involved. I'm the current gmec rep for our whole hospital system, so I am the head of actually resident involvement as well. So it is a it is a complicated thing. But the truth is, is to be honest with you, a lot of residents are overwhelmed whenever you're throwing in, you know, trying to figure out how to pay your student loans, whenever you're trying to figure out how to pass this board exam, how to learn. I don't know if you guys struggle during residency, but I personally, you know, uh, my first year was really tough. It was, to use an analogy, it's like drinking through a fire hydrant. You're just doing your best to pick it all up as fast as you can and just be a sponge. And so whenever you you come home, you sometimes you're a little it just mentally and physically exhausted. But you know, a lot of people forget that, um, and this is part of my spiel that I give to my co-residents. But you forget the joy that you get whenever you give to other people and whenever you make your life better for not only your peers, but you know your patients as well. Uh, happy physicians are smart physicians are good physicians. And so whenever you take the time to volunteer, get involved and actually show up, um, it helps you feel better about yourself. But there's a lot of tough pressures that, uh, really complicate things. And I think, ah, a lot of residents are tired and a lot of them are overwhelmed. And I will say, the answer, um, I have discovered is a lot of helping people stay informed. It's really easy to, to get lost. So the way that I found that I helped get everybody involved is I made everything that I was doing almost like step by step written out. There is an entire calendar that you can get that will tell you when our events are. There are constant reminder emails and everything, and it's just because a lot of us are just overwhelmed and we're like ostriches with our our heads in the sand, so we're just trying to find our way through. So it's good to have somebody come along and tap our little ostrich selves in the back, if you will, and get us to take our head out of the sand and take a look around. So just helping people stay informed is really, really helpful.

DR. SOLOMON:

That's great advice, I appreciate that.

DR. CHAMBERS:

Well, thank you so much for being with us today, Dr. Solomon, Dr. Hauter.

DR. SOLOMON:

Thank you, Dr. Chambers, for having us. Appreciate it.

DR. HAUTER:

I really appreciate the opportunity. This was fun. Thank you for having me.

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DR. CHAMBERS:

This was really interesting conversation I feel inspired. Thanks to our listeners as well. We appreciate your ears and your likes and follows. Please be sure to join us again soon for some more Residents in a Room, the podcast for residents by residents.

VOICE OVER:

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