Every odd-numbered year, when the Texas Legislature crams two years’ worth of lawmaking into 140 days, it’s part slog and part sprint.
So what do Corpus Christi pediatrician Daniel Vijjeswarapu, MD, and hundreds of other physician advocates do to compete in such a challenging, paradoxical race? They don their white coats, lace up their shoes, and … they walk.
During the monthly First Tuesdays at the Capitol events, physicians hike from the Texas Medical Association building in Austin to meet lawmakers under the Pink Dome and let them know what medicine needs. It’s only 0.3 miles from TMA to the Capitol, but physicians log many more steps navigating the sprawling building.
Events begin in February and continue on the first Tuesday of each month until session ends. The monthly pilgrimage started in 2003, the year medicine’s united front yielded historic tort reforms that reversed a disturbing physician exodus from Texas. Every legislative year since, First Tuesdays have been medicine’s bullhorn.
During 2019’s inaugural First Tuesdays event on Feb. 5, Dr. Vijjeswarapu and his wife, Martha — a member of the TMA Alliance and of the TEXPAC Board of Directors — join other members of a Nueces County Medical Society (NCMS) contingent as they make their case during a busy morning in one lawmaker’s office after another.
Granted, there’s no magic shift in medicine’s fortunes when physicians sit down with a legislator. Politicians listen but promise nothing — beyond, at most, their efforts. And sometimes, their schedules require a surrogate to meet with physicians on their behalf. That is the case multiple times on Feb. 5; the Vijjeswarapus catch the legislature on a morning with the House in session and Gov. Greg Abbott about to deliver his State of the State address.
But First Tuesdays are important not only for getting medicine’s message across in the moment, but also for building and maintaining relationships that pay dividends in the future. There are serious discussions, but there are also laughs, hugs, and even tears. The Vijjeswarapus experience it all as Texas Medicine follows them on the morning of this year’s first First Tuesdays.
“This is a very good forum for us to come here and talk to [lawmakers],” Dr. Vijjeswarapu says early in the day. “And every time we go back, it [reinforces] the message that resonates with our patients and with our legislators.”
Hunting for an inroad
As the morning begins at TMA headquarters, the association’s lobby team briefs the crowd on what topics and bills physicians should discuss with their local lawmakers. It’s early in the session, so lobbyists have only a handful of specific bills so far to highlight. But there are plenty of broad objectives to give physicians their marching orders for what’s also known as the White Coat Invasion.
The majority of Dr. Vijjeswarapu’s young patients are covered by Medicaid, so he and Martha, an administrator for his practice, have Medicaid top of mind. In particular, payments, TMA President Doug Curran, MD’s top priority for this session, have gone without a meaningful increase for about two decades.
“When the payments are not [sufficient], the overhead is … causing some physicians to feel the burnout, and also probably thinking, ‘Maybe I should not practice,’” Dr. Vijjeswarapu says. “That really bothers me as a physician, and we are here for our physicians and also our patients.”
Ms. Vijjeswarapu notes the importance of Senate Bill 580 by Sen. Donna Campbell, MD (R-New Braunfels), a measure that takes aim at nonmedical reasons for switching medications.
“These days insurances control a lot of the medications that the doctors can or cannot prescribe, and I know me as a patient, I have even had that happen with my asthma,” she says. “It is so frustrating to be on a medicine that really works, and then all of a sudden, they switch you off to something that doesn’t even work at all, and you end up in the ER, the hospitals, and it just costs so much money to health care. But yet, [insurers are] trying to save a buck on medication.”
The first stop: Rep. Todd Hunter (R-Corpus Christi), a winner of multiple TMA Friend of Medicine awards. A dozen or so NCMS foot soldiers pile into Representative Hunter’s office, with the Vijjeswarapus assuming the two seats right in front of his desk.
Representative Hunter is straightforward with the group: He expects property taxes, education, and Hurricane Harvey recovery to be high priorities for the legislature. Large issues like those might occupy more of lawmakers’ attention, he says. Meanwhile, the March 8 filing deadline and the May 27 adjournment of session will come quickly. At one point, he tempers expectations with this sobering reminder: “It’s always easier to kill a bill than it is to pass.”
Noting those realities, he says TMA and medicine should prioritize their biggest needs. On the all-important topic of increasing physician payments in Medicaid, Representative Hunter drives home his point about boiling medicine’s agenda down to its essentials:
“You fire [TMA] up to make that a priority. That’s why we have these meetings. If that is a big deal, we need to not hear crickets. We need to get the fire rolling,” he says. “I’m a strong supporter and will continue [to be]. But I need your help sometimes on putting it on the radar, just so that people know that it’s important.”
Toward the end of that meeting, the NCMS group stresses the importance of keeping Texas medical school graduates in state with a sufficient number of residency training slots. Dr. Vijjeswarapu mentions a medical school in South Texas that needs a pediatric residency. He says medical students interested in primary care who leave Texas for their residency may never return to the Lone Star State.
“So we are wasting our dollars,” he emphasizes to Representative Hunter across the table.
After the 45-minute meeting ends, these NCMS lobbyists-for-a-day march up a steep Capitol staircase and make some friendly pit stops. First, a quick stop at the office of Senator Campbell, who gets teary-eyed as the Texas Ophthalmological Association presents her with its Champion of Vision award. Then, a brief greeting and photo op in the Senate gallery with a cheerful Sen. Juan “Chuy” Hinojosa (D-McAllen) — sporting his trademark cowboy hat.
“My constituents are great,” said Senator Hinojosa. “They tell me when I’m doing something right, and they tell me when I’m doing something wrong.”
Making an impact
Next stop: Rep. J.M. Lozano (R-Kingsville). But with the House in session and the State of the State drawing closer, the group instead gathers around a long rectangular table with Matt Lamon, Representative Lozano’s chief of staff. The early stages of the House session filter in from a TV in the background.
In the midst of a cordial, laughter-sprinkled conversation that wanders off-topic to exacting seafood tastes and smoking in the bar area at an Abilene Applebee’s, the group and Mr. Lamon get to the point. Like Representative Hunter, Mr. Lamon is direct.
“We just have not been really apprised of things in the health world at this time,” he says. “I have never had a session that’s been so busy this early. Getting in to see J.M. has been really hard, because we have more meeting requests than we’ve ever had.”
As he did with Representative Hunter, Dr. Vijjeswarapu explains the difficulty with keeping doctors in Texas because of residency allotment. The NCMS group again emphasizes the importance of increasing Medicaid funding.
“If we increased [funding] for the patient care, that would help us be able to run our offices more efficiently and effectively,” Ms. Vijjeswarapu says. She adds that there are pediatricians in Corpus who “are ready to sell out, because it’s just not happening. It’s really sad, and it’s because we have a great system; it’s just that the money’s not being funneled in through the correct parts.”
Physicians’ own experiences seem to make an impact in the conversation.
After Dr. Vijjeswarapu says it’s hard to replace good physicians who leave because of overhead and expenses, Mr. Lamon relates the experience of Representative Lozano’s father, Falfurrias family physician Jose M. Lozano, MD.
“I know Dr. Lozano is really struggling down in Falfurrias,” Mr. Lamon says, “and he was here for opening day [of session], and he goes, ‘I really want to retire, but I can’t, because I can’t find anybody to take over my practice, and my patients are too old to drive to Corpus.’”
The NCMS group doesn’t leave without discussing medicine’s push to extend postpartum care in Medicaid from 60 days to one year (see “AIMing to Save Lives,” page 21), and to raise the state’s tobacco-purchasing age to 21.
“Vaping is included in that,” Ms. Vijjeswarapu emphasizes. “I’m amazed at how many young people think vaping is safe, and that it’s an alternative to smoking, when it really is a tobacco use that’s probably even higher than the normal cigarette.”
Adds her husband, “We still have a high number of parents who continue to [smoke and] now feed it into the [next] generation.”
In their next meeting with Jamie Klein, the director of policy and community relations for Rep. Abel Herrero (D-Robstown), the group sharply criticizes Medicaid’s bureaucracy.
“We are asking for the best care for our kids,” Dr. Vijjeswarapu says, “and we can only provide it when we are healthy, rather than burned out.”
As Dr. Vijjeswarapu noted between meetings earlier in the day, medicine and the groups that often want something different out of health care policy — such as hospitals or insurers — can send lawmakers conflicting messages. Making the most of First Tuesdays ultimately requires drowning that out — putting it out of your mind, he says.
“You can send your message across because you care for what your mission is: That is taking care of patients. We cannot worry about the other forces.”
Tex Med. 2019;115(4):24-27
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