A First-Timer's View of First Tuesday

Brett Stauffer, MD, an internist and hospitalist from Dallas, participated in his initial First Tuesday at the Capitol on March 1. Several of his colleagues at Baylor University Medical Center had spoken about the experience and encouraged him to take part.    

My First Tuesday began at 7:15 a.m. at TMA headquarters with an update from TMA lobbyists. We learned about the topics of the day and TMA’s position on them. I met lots of physicians who were interested in the impact of policy decisions and were committed to working toward legislative outcomes that would benefit patients. Of the important issues being considered, I was most interested in continuing state support of Medicaid to protect vulnerable patients and ensuring scope of practice definitions are clear so patients get care coordinated by a physician.     

 Several busloads of medical students (and a few Ph.D students) from UT Galveston joined physicians during their legislative meetings. It was great that UT Galveston had a medical student day to visit the Capitol to coincide with First Tuesday activities.  

 As an aside, when I was in medical school, there was little to no focus on the impact of public policy on the practice of medicine. So, I involved myself at the national level with the American Medical Student Association, which promoted student activism and political engagement. My participation largely was due to the lack of opportunities at the state level. On several occasions, I visited with my congressional representatives or their staffs as part of medical student “white coat” visits to the Hill.     

 When I was a resident at Parkland, Mark McClellan, MD, spoke to my class while he was administrator for the Center for Medicare and Medicaid Services. He detailed how he had gravitated toward medicine while the rest of his family members were lawyers or politicians in Texas. Most interesting was his view that everything had come full circle. He went into medicine so he could help people; however, he found that to make a big difference he had to influence policy because so much of healthcare is influenced by state and national regulations and reimbursements. His view has stuck with me — part of the art of medicine is working to ensure these systems work for patients and physicians.      

 Now, back to First Tuesday.… The Senate Health and Human Services Committee meets on Tuesdays, so I was able to witness the committee hearings in the Senate chamber. The agenda included bills regarding the Texas Medical Board, and DCMS past president Les Secrest testified about them. I joined my colleagues in “putting in a card” in support of SB 355 that would institute a statewide smoking ban in public places. Although I didn’t testify on the issue, the card I filled out shows the committee that I support that bill. 

The committee process was interesting. The testimony process was formalized, and the legislators seemed engaged and tried to find solutions that addressed the speakers’ concerns. Although I found it more rewarding to interact with legislative staff members, I suspect that public testimony might reach a wider audience and definitely has its place in influencing the political process.      

 The further we get into the session, which runs through May 30, the more likely we are to meet with legislators’ staff members rather than with legislators. However, the staffers seemed dedicated and interested in hearing our position on various issues. They were careful not to commit their legislator to a particular course of action but would bring up counterpoints from discussion with other constituents to highlight thorny issues. In many cases, the staffers appeared to be undecided about a particular topic but interested in gathering information about the topic to determine the appropriate next step. 

 I was convinced of the value of forming relationships with lawmakers and their staffs after my college roommate was elected to Congress. He regularly has said that legislators are not experts on everything and often do not have an opinion on a particular issue. Their staffs are small and aides have numerous demands on them, so it’s impossible for the staffers and the lawmakers to learn the intricate details about every issue. Input from practitioners in a specific field can have a big influence, especially in complex fields such as health care, and the concerns of those practitioners carry more weight than messages delivered by paid lobbyists.      

 The First Tuesday spent away from my practice definitely was worth it. I plan to attend more First Tuesdays during the 2013 legislative session and to reach out to my representatives in the interim. I want to stay involved and continue to work at the state level, as it is sometimes more effective (and convenient) than trying to influence decisions in Washington, DC. 

First published, Dallas Medical Journal (PDF), April 2011. Reprinted with permission of the Dallas County Medical Society.