Policy Playbook: The Hitchhiker’s Guide to Health Policy

Authors: Kenneth Kim, MD (MS-4) and Summer Chavez, DO, MPH, MPM (Attending Physician, The University of Texas Health Science Center at Houston) // Reviewed by: Alex Koyfman, MD (@EMHighAK)

Hi everyone, my name is Kenneth Kim, and I’m an incoming intern at the UCLA RR | OV Emergency Medicine Program. For this edition of the Policy Playbook, instead of our usual deep dive into a specific piece of legislation, we’re going to try to provide some insight into how an interested newcomer can get involved in the wide world of health policy.

Though I personally had (and still have) no advanced public health or policy degrees when I started medical school 4 years ago, I recognized the importance of health policy and systems in the practice of medicine for all physicians, and I tried my best to learn as much as I could about health policy outside of the classroom. Through my journey, I’ve learned that despite how intimidating policy can seem at first, there are many great ways for newcomers to learn more and grow in their burgeoning policy interests. Below are some resources and avenues for medical students and young physicians like me (and even seasoned attendings) to get involved with health policy for themselves.

What is Health Policy? How Can I Get Involved?

To begin, let’s talk about what health policy even is. Health policy is a pretty nebulous umbrella term that can cover everything from the laws that govern our insurance coverage to the QI research that influences our local workflows. Rather than delineating every single area and niche within the policy sphere, I’ll just cover some of the bigger ways that physicians are involved in the policymaking process and some avenues to get started in those fields.

First, a general tip for your health policy journey involves something that’s important in every aspect of medicine: Find a mentor. I think of mentors as a guide at a frozen yogurt shop. They’re not necessarily a model you have to replicate, just someone who can show you some of the ropes so you can build your own adventure. Having multiple mentors is definitely allowed and even encouraged so you can see both the depth and the breadth that the policy world has to offer. Now let’s get into the many realms of health policy.

Research

We start, as we often do, with research. As many medical students and trainees are located at academic institutions that may prioritize research output for their faculty, this for many often feels like an easy entryway into the policy conversation. Research in this sphere can range from workflow QI projects within a single department to broader, multi-hospital studies looking at healthcare utilization. As with most research, there is a ton of it out there, so finding good resources to stay up-to-date with the literature is important. Personally, I like reading the EMRA-PolicyRx Journal Club, the Annals of Emergency Medicine, and Health Affairs.

Getting involved with research often requires finding a research mentor and funding. Again, as I said before, you don’t have to perfectly replicate your mentor, so it’s ok if they aren’t doing exactly the sort of research you hope to do in the future. What’s more important is that they are able to teach you the building blocks for your future work. There are many resources for research grant funding including the Emergency Medicine Foundation, which sponsors the EMRA/EMF Resident/Medical Student Research Grants for trainees and the EMPI/EMF Health Policy Research Scholar Award for residency graduates, and mentors should be able to point you to even more sources for funding.

Hospital/Health System Protocols

In the second arena, we find the overlap between health policy and health administration. This is perhaps the most accessible avenue for early-mid career physicians who feel comfortable becoming involved with their hospital or group’s protocols and governance. Many residency programs will also have opportunities for committees within the ED and the hospital as a whole, though this will depend heavily on the program and hospital. As a fresh intern, I can’t say much about this avenue quite yet, but as I’ve said before, reaching out to mentors and residency/department leadership may help leaps and bounds in finding cool opportunities to change your department’s policies.

Government Policymaking

Third, physicians can become involved with local, state, or federal advocacy and policymaking. This includes physicians who are acting as advisors to government officials such as a Health Legislative Advisor to a State Representative or as officials themselves in public health departments or other appointed/elected office. While this can be one of the most direct ways for physicians to influence health policy outside of their hospital, it can be the most challenging as these opportunities tend to be less accessible to physicians due to their relative lack of precedent and increased time cost. There’s not a clear beaten path in this lane, but reaching out to local and state representatives is often a good first step to gauge their interest and willingness to work with you in writing laws and providing expert opinion on health policy.

Organized Medicine

My personal favorite way of entering health policy is through organized medicine. Organized medicine is exactly what it sounds like: a group of physicians coming together to work on initiatives that push their and their patients’ priorities forward. As larger bodies of advocacy-minded physicians, these organizations can be a great community to learn about, grow your interest in, and launch a career in health policy. Within medicine at large, there is the American Medical Association which has Sections specifically geared towards Medical Students, Residents/Fellows, and Young Physicians. Within the specialty of Emergency Medicine, there is the American College of Emergency Physicians (ACEP), the American Association of Emergency Medicine(AAEM), and the Emergency Medicine Residents Association (EMRA). As I am most familiar with EMRA, most of my conversation will focus on their resources and opportunities, though other organizations may have similar corollaries.

One accessible way to see advocacy in action is through an organized advocacy day, such as ACEP’s Leadership and Advocacy Conference, the AMA’s National Advocacy Conference, or state chapter advocacy days. These conferences not only consist of keynote talks on important health policy topics, but also contain “lobby days” – opportunities for physicians to speak directly to legislators and their staff on the issues that affect doctors and patients the most. These are amazing and humbling opportunities to learn about policy while also sharing the expert opinions and experiences unique to us emergency physicians.

Another way to actively influence the policy of the organization is through writing resolutions. Where governments have laws, organized medicine is guided by resolutions – member-written directives that tell the organization’s leadership what priorities they want to pursue. These are often presented to democratic councils who vote on such resolutions at specific times. As bodies like the AMA, ACEP, and other organizations have large voices in guiding health policy and practice, these resolutions too can have downstream effects on our practice and patients outside these organizations.

Physicians can get involved with leadership opportunities available within these organizations on health policy-focused committees, as advocacy fellows, or through awarded scholarship opportunities. Like I said before, though most of these opportunities are through EMRA, other organizations may have similar awards and opportunities for those looking to become involved.

Health Policy Fellowships and Advanced Degrees

Lastly, I wanted to mention health policy fellowships and advanced degrees such as an MPH, MPP, or MBA. While these opportunities are great ways to dive even deeper into health policy, the opportunity cost can be high, especially to newcomers. If you’re unsure about whether you need an advanced degree to hold your own in the policy realm, rest assured that there are plenty of ways to get a taste of policy first without the extra letters or fellowship. On the other hand, if you’re excited about a specific policy topic or want to raise your expertise level in a condensed 1-2 years, going to the right program might be well worth your while.

If you do decide to pursue this avenue, these programs can vary widely in terms of what the actual lessons learned and future career implications may look like, so good research on the strengths and weaknesses of certain degrees/programs will be important. Also, some fellowships and departments will provide financial and/or scheduling support to obtain an advanced degree, alleviating program costs. Again, I highly recommend reaching out to mentors who may have completed a policy fellowship or MPH/MPP program to learn more about their pros and cons.

Resources To Learn More

After talking about ways to get involved with health policy, here are some resources to learn more about the actual content of policy so you don’t show up to the meeting table with nothing to say:

To Read:

• Kaiser Family Foundation/Kaiser Health News – KFF is a non-profit that does strong health policy research and creates great policy analyses. KHN is the news division of KFF (neither associated with Kaiser Permanente) and provides amazing coverage on national and local health policy news. They’re both stellar resources for learning about general health policy issues in context.
• Health Affairs – NEJM but for policy. As a research journal, HA provides deep dives into the research behind certain health policy issues, so it may be a tough read for newcomers at first.
• Major news media – Whatever your opinion may be on major cable news, many of the major written journalism outlets out there provide good, simplified-for-the-layperson, overviews of topics relevant to their news. While this shouldn’t be the staple of your health policy consumption, it is a good appetizer to get you interested and introduced to various topics. My personal favorites are Vox and the New York Times.

To Listen:

• What The Health? – An all-female podcast by KHN that does a great job of covering health policy (and health politics) news with not-too-basic, not-too-wonky, just-Goldilocks-right context.
• Tradeoffs – A podcast that looks at a wide variety of specific, health policy topics with a focus on the human impact.
• A Health Podyssey – A podcast by Health Affairs that contains conversations with researchers about their research and potential implications in the health policy world.

Why Is This Important?

To close out this article on “how” to get involved with health policy, I wanted to touch on “why”. To many, health policy seems like a complex web of finance terms and legislative bureaucracy that is hard to wrap their heads around. Is tackling this all really worth it? I would argue a resounding yes.

When physicians are armed with the knowledge of health policy and how the many parts of our system work, we are able to influence policy and improve our patients health beyond the 4 walls of our emergency departments. Whether it be gun violence or opioid treatment or physician workforce stability, when our smartest, most passionate physicians work towards the issues that they find most important, health care improves in leaps and bounds. I hope this article has helped guide and get you get excited to join us as we work towards our better tomorrow.

This post was a collaboration between emDocs and the EMRA Health Policy Committee.