Just like every physician, I want to be the best doctor for my patients. There is the obvious way – as a capable diagnostician and clinician. While a necessary and valuable role, as clinicians we only impact one person at a time. To have a bigger impact on the health of our communities we must take medicine outside of the exam room and engage in health care advocacy.
Supporting patients requires recognizing the multiple factors that affect their health and offering solutions to improve it. I can only do so much as one doctor, but through organized medicine, I can collaborate with physicians and providers advocating for better health care for all.
I have been involved with the Texas Medical Association and American Medical Association (AMA) since I was a first-year medical student in 2013. The wonderful thing about organized medicine is there are many ways to be involved, such as crafting policy, sitting on various councils and committees, and leading a section. Members range from the medical student to the senior physician, so the ways we can serve our patients come from diverse perspectives and experiences.
My first lasting impact in organized medicine was crafting policy. In 2015, there was concern that the growing number of undocumented children at the southern Texas border were not getting adequate health care. At the time, TMA had no policy on undocumented immigrant care, so I co-authored a resolution with two other medical students to address this need.
With the help of the Medical Student Section and input from pediatrician Jason Terk, MD, the resolution was presented to and adopted by the House of Delegates. It is now TMA Policy 55.057. Our policy advocates that undocumented children be able to receive non-emergency and preventive care, and it supports health care professionals delivering medical care to children regardless of immigration status.1 Given our current political climate, this policy is even more timely now. This shows that if you see a problem with wide-ranging implications and raise your voice through the right channels, you can improve the lives of countless patients.
As a family medicine physician, a cornerstone of my specialty is preventive care. Vaccines play a large role. With the ongoing anti-vaccination movement, it is frustrating to live in an era where diseases that were considered rare a generation ago are on the rise again. In 2000, the U.S. declared that the country had eliminated measles thanks in part to “a highly effective measles vaccine and a strong vaccination program that achieves high vaccine coverage in children.”2
Sadly, this is no longer the case. So far, the Centers for Disease Control and Prevention reports that more than 1,200 individual cases of measles have been confirmed in 30 states and 6 outbreaks have occurred in New York, Washington, California, and Texas. Seventeen outbreaks were reported in 2018.3 This problem is significant enough that the World Health Organization has declared “vaccine hesitancy” – the reluctance or refusal to vaccinate despite the availability of vaccines – as one of the 10 threats to global health in 2019.4
Thankfully, organized medicine has not sat idly by.
In December 2014 through January 2015, a large measles outbreak occurred in California, totaling 125 cases. Of these patients, 45% were unvaccinated, and 43% had unknown or undocumented vaccination status.5 This outbreak led to California Senate Bill 227. The bill, which is now law, removes personal belief exemptions to vaccination requirements for enrollment in private or public elementary or secondary schools and day care centers.6
A pediatrician senator saw the ongoing threat and co-authored the bill with the strong support of the California Medical Association. Three years later, the American Academy of Family Physicians investigated the fallout of this law and reported that immunization rates for children entering kindergarten are nearing an “all-time high.”7 This is advocacy in action. A pediatrician saw a problem, had the power to make a legislative change, and – with the support of his fellow physicians – crafted a law that is showing positive effects.
For the past six and a half years, I have been taking care of our population through advocacy. I have participated in policymaking and witnessed the implantation of stronger vaccination laws. Health care advocacy has lasting effects, and there are many opportunities to get involved. As a single voice, my impact is within the exam room, but as a collective voice through organized medicine, our impact extends into the community, state, and nation, leading to better health care for all.
Theresa Phan, MD, MPH is a third-year resident at The University of Texas at Austin Dell Medical School Family Medicine Residency. She is currently serving as the resident alternate delegate to the Texas Delegation to the AMA, and as the AMA Resident and Fellow Section Vice Speaker for the 2019-20 year.
References
1. Texas Medical Association. (2015). 55.057: Health Care of Undocumented Children. Retrieved from TMA Policy Compendium: https://www.texmed.org/Template.aspx?id=42578&terms=undocumented%20children
2. Centers for Disease Control and Prevention. (2018, April 2). Measles (Rubeola). Retrieved February 2, 2019, from https://www.cdc.gov/measles/about/faqs.html
3. Centers for Disease Control and Prevention. (2019, August 19). Measles (Rubeola). Retrieved August 22, 2019, from https://www.cdc.gov/measles/cases-outbreaks.html
4. World Health Organization. (2019, January). Ten health issues WHO will tackle this year. Retrieved February 3, 2019, from https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
5. Centers for Disease Control and Prevention. (2015, February 20). Measles Outbreak - California, December 2014–February 2015. Retrieved February 02, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm
6. California (State). Legislature. Assembly. An act to amend Sections 120325, 120335, 120370, and 120375 of, to add Section 120338 to, and to repeal Section 120365 of, the Health and Safety Code, relating to public health. (SB 277). 2015-2016 Reg. Session (June 30, 2015). California State Assembly. Web. 02 Feb 2019. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277
7. Devitt, M. (2018, November 27). Study Examines Fallout of California Vaccine Exemption Law. Retrieved February 2, 2019, from https://www.aafp.org/news/health-of-the-public/20181127califvaccstudy.html
Tex Med. 2019;115(11):4-5
November 2019 Texas Medicine Contents
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