Guest Post: My Journey to Women’s Health Advocate

E. Christine Brousseau, MD

E. Christine Brousseau, MD

For many years I had no interest in politics. I focused my energy on caring for my patients and my family. My interest in public policy wasn’t cultivated in college, medical school, or at work. Instead, it was born of necessity, groomed by mentors, and became a passion.

In 2010, I was elected the Rhode Island Section vice chair/legislative chair. I was expected to testify at the State House, meet with legislators, and write op-eds. I was invited to ACOG’s Congressional Leadership Conference, which emphasized and trained proper advocacy. Two days into the conference, I met with Rhode Island’s federal lawmakers—alone. I returned home inspired to advocate on behalf of women and women’s health practitioners. Advocacy did not come naturally, but my passion for the issues did.

I was thrilled to be selected as a 2013 McCain Fellow. On my second day, I met with a coalition of lobbyists supporting maternal and childhood health formed to educate Congress on sequestration’s negative effects on families. I was surprised to learn how many bills affect maternal-fetal health. Briefings on the Pregnant Workers Fairness Act and a reproductive rights bill seemed obvious, but the Toxic Substances Control Act hearings were unexpectedly relevant.

I attended numerous meetings with congressional leaders. At one, I sat beside Rep. Tammy Duckworth (D-IL), an Iraq War veteran and one of the first females to fly combat missions in Iraq. During one mission, her helicopter was shot down; she lost both legs and partial use of her arm. When I asked how she handles today’s partisan politics, she replied, “Listen, I’ve been blown up! I think my worst day at the office is behind me.” Rep. Duckworth traces her family’s legacy of military service back to the Revolutionary War. A career in service seemed to be her calling, but she could not have predicted that her greatest service would be in politics, not combat.

Many of my academic and career choices have also been guided by family legacy. My father, Patrick Sweeney, also was a McCain Fellow, something I learned only recently. His dedication to women’s health policy and advocacy led me to practice medicine and has had a tremendous positive influence on countless women. While I never envisioned being involved in politics, advocacy presented me with an opportunity to improve women’s health in Rhode Island and beyond. Like Rep. Duckworth, I will embrace the opportunity with persistence and, hopefully, a sense of humor.

E. Christine Brousseau, MD, is an ob-gyn in Providence, RI and serves as Vice Chair for ACOG’s Rhode Island Section.

Guest Blog: How I Learned to Speak Up for Women

Susan P. Raine, MD, JD, LLM

Susan P. Raine, MD, JD, LLM

ACA, SGR, CR, E&C—the list goes on. I thought once I became an ob-gyn, my days of being lost in the world of strange acronyms were over. Then I arrived on Capitol Hill. Thanks to the wisdom of the District XI leadership, I proudly accepted the honor of becoming the first McCain Fellow from our district. This opportunity allowed me to spend two weeks this past September with the Government Affairs staff of the American Congress of Obstetricians and Gynecologists (ACOG).

Every February, I attend the ACOG Congressional Leadership Conference (CLC) in Washington, DC. During an exciting three-day meeting, ob-gyns learn about the legislative issues most likely to impact us and our patients. We then visit congressional offices to present ACOG’s legislative “asks.” It is an invigorating process—particularly when you are doing it with 300 other ob-gyns. Personal politics aside, this was an amazing opportunity for me and for the women I was there to represent.

When I came back to DC this past September as the McCain Fellow, I was worried that I had forgotten all I had learned seven months earlier at the 2013 CLC. However, after a day of warm-up, I felt ready to speak intelligently to Congressional members and their staff about ACOG’s legislative priorities. That doesn’t mean I felt I could do it as well as the lobbyists or that I did it without anxiety. But I did it. And it’s not enough. That’s the great responsibility that comes with my “forever” status as a McCain Fellow. It’s not enough to advocate for my colleagues and our patients; I have to convince others that they need to do the same. We must be the voice of those who have none.

Many doctors tell me that they hate politics and that they can’t stand the partisan bickering. When I was younger, a little more naïve, and very idealistic, I wanted a career in politics but became disillusioned by what I saw happening in our government. With the benefit of a little age, wisdom, and perspective, I now realize that we live in the greatest country in the world. I can speak up and disagree with our leaders without going to jail. I am not tortured for my opinions nor is my family taken from me. As a woman with two doctorates and two master’s degrees, my opinions are valued. Not just because I am educated and not despite the fact that I am a woman, but because I am an American. Our system is far from perfect, but it’s ours. If we really want to make a difference for women, we will embrace it rather than rail against it.

So what can you do? If you have a few days to get away, plan on coming to next year’s CLC. If you have a little more time or a particular interest in advocacy and health policy, apply to serve on ACOG’s Government Affairs Committee. Don’t forget, local opportunities offer a chance to get involved with minimal time away from your practice. Most of all, be aware of every opportunity to advocate—for yourself, for the next generation of ob-gyns, for your patients, and for women everywhere. It is an honor and a privilege to do what we do. With your contribution to our advocacy efforts, maybe we can keep the legislators out of our exam rooms.

For information on getting involved in advocacy, go to http://bit.ly/1brBOLV.

Susan P. Raine, MD, JD, LLM, is vice chair of Global Health Initiatives, and associate professor in the department of obstetrics and gynecology, at Baylor College of Medicine in Houston.

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Guest Blog: My Life As A Gellhaus Fellow

An introduction by Thomas Gellhaus, MD: ACOG has an incredible commitment to advocacy for our patients and our members. For many years, ACOG has offered programs—such as the annual Congressional Leadership Conference and the McCain Fellowship—that provide ob-gyns with an interest in advocacy an opportunity to learn more about the legislative process and speak to Congress about women’s health issues. However, there were no programs specifically geared toward our younger MDs, ACOG Junior Fellows, and ob-gyn residents.

I founded the Gellhaus Resident Advocacy Fellowship in 2010 to provide just such an opportunity. Since then, we’ve had 14 residents complete the program, and three additional residents have been selected for 2014. During their month-long advocacy and policy immersion experience with ACOG’s Government Relations division, residents complete a project and also write a short summary of their experience. Many, if not all, of the past Gellhaus Fellows have gone on to do further advocacy and policy work.

I was bitten by the advocacy bug in 1994, and hopefully many more ACOG members will with this opportunity. It is evident from Sara Tikkanen’s article below that she has also been bitten!

Sara Tikkanen, MD

Sara Tikkanen, MD

My Life as a Gellhaus Fellow

When I first found out I had been chosen as a Gellhaus Fellow, I was ecstatic. I was excited to go to Washington, DC, for a month during my chief year to learn more about ACOG, our government, and advocacy. After my initial excitement had settled, I was somewhat nervous, primarily because I wondered: “Do I know enough to make a difference?”

Soon after my arrival, I was put at ease by the fantastic staff at ACOG who gave me a crash course on women’s health advocacy. After attending my first few Hill meetings and other government relations events, it became clear that I indeed knew a thing or two about medicine, and I was in a unique position to provide a new and different perspective to the legislators who actually make decisions that directly impact our ability to practice medicine.

During my time at ACOG, I have mainly focused on the issue of the ob-gyn workforce as it relates to the Affordable Care Act. In my opinion, now is the time to focus on the impact that 10 million more women needing gynecologic care will have on hard-working physicians already stretched thin with time and resources. I have tried to highlight the importance of continued Graduate Medical Education funding so that we can increase our workforce. A great example of this is the The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act which would help create more residency slots.

I have also focused on the importance of tort reform so that current practitioners can continue to provide care without the burden of high medical liability insurance premiums. I have participated in discussions addressing the implications of the Medicare Sustainable Growth Rate, the flawed formula used to determine physician payment rates, and the efforts to repeal it. A vast majority of the lawmakers I have spoken with agree that we need a fix. While few seem to have a concrete solution in mind, all are open and eager to discuss possible solutions.

My time here has been wonderful and eye-opening experience. It’s motivated me to become more involved as a resident at the University of Iowa, and upon graduating, as practicing obgyn in the great state of Wisconsin. I’d like to thank Dr. Gellhaus and the staff at ACOG for making this month possible.

In reflecting on my experience, the most important thing I’ve learned is that I have an obligation to be an advocate, not only for my patients but also for ob-gyns and physicians as a whole. Decisions which directly impact our ability to care for our patients and ability to practice medicine are being made by legislators who do not know nearly as much about medicine and the day-to-day challenges associated with being a physician as the physicians themselves. I challenge each Fellow and Junior Fellow to take an active role whether that be at a hospital, state, or federal level. Only by being involved can we make a difference.

Sara Tikkanen, MD, is an ob-gyn resident at the University of Iowa Hospital and Clinics.

Sara Tikkanen, MD, with Senator Tom Harkin

Sara Tikkanen, MD, with Senator Tom Harkin

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Guest Blog: Fighting Violence Against Women Together

Susan M. Lemagie, MD

Susan M. Lemagie, MD

Every day news from around the world highlights acts of egregious violence against women: the rape and murder of a female medical student in India, acid throwing and subsequent suicides of women in Central Asia, and the Taliban bullet to the brain of a 15-year-old girl in Pakistan who was targeted for promoting education for girls and women. While the scale here at home may be different, women in the US are not immune to violence.

Today, 1 in 4 women in the US has been physically or sexually assaulted by a current or former partner. Homicide is a leading cause of pregnancy-associated mortality in the US, with the majority being committed by an intimate partner. And as demonstrated in the last election, there are still many people who attempt to dictate a woman’s relationship with her doctor and her ability to make her own reproductive health choices. These efforts teeter on the edge of reproductive and social coercion.

In defense of women, ACOG has issued several recent documents—including committee opinions on reproductive and sexual coercion, sexual assault, intimate partner violence, and human trafficking—to raise awareness of the abusive treatment that some women in the US regularly face. ACOG has also developed patient outreach materials that provide information and resources to women in need.

ACOG has partnered with Futures without Violence on a guide titled Addressing Intimate Partner Violence, Sexual and Reproductive Coercion, which encourages ob-gyns to screen patients for domestic violence and recognize the signs of abuse. It also provides tools for health care providers to help women build healthy relationships and be safe in their own homes. Many thanks to ACOG’s Committee on Health Care for Underserved Women and the ACOG National staff for their ongoing efforts to advocate for women.

Now it is our turn as ob-gyns to speak up for our patients and their families. At this year’s Congressional Leadership Conference, March 3–5, 2013, more than 300 ob-gyns will lobby Congress to support ACOG’s Women’s Health Resolution. The resolution lists 14 non-negotiable rights that every woman in the US should be allowed, including the right to be free from gender-based violence. We will also convey to our legislators that our highest professionalism emerges when we base our care on the best scientific evidence, without legislative interference in our role as women’s health care physicians.

As we prepare for our lobby day, I’m filled with both a sense of duty and of pride. We can once again stand up as supporters of our patients and champions of women. It’s what we signed up for as ob-gyns, and it’s the right thing to do.

Susan M. Lemagie, MD, is an ob-gyn in Alaska and a member of ACOG’s Executive Board.

Health Care Hope for Millions after Supreme Court Ruling

The lead up to the US Supreme Court’s decision on the Affordable Care Act (ACA) has been a bumpy road at best. But beneath all the rhetoric and partisanship surrounding the ACA lies a solemn and unfortunate truth: Too many Americans are uninsured, and lives are being lost because of it. An estimated 18,000 Americans between the ages of 25 and 64 die prematurely each year because they lack health insurance. The uninsured receive less preventive care, disease diagnoses at more advanced stages, and fewer medical interventions post-diagnoses than people with insurance.

The ACA is important and necessary legislation. It helps ensure insurance reforms that guarantee availability and renewability, prohibit preexisting condition exclusions, and prohibit gender rating—insurance reforms that will work best under an individual mandate. Beginning in 2014, the ACA prohibits new insurance plans from denying women coverage on the basis of pregnancy, previous cesarean delivery, history of domestic violence, or other preexisting medical conditions. These protections are landmark improvements in women’s health. The ACA also guarantees women direct access to obstetric and gynecologic care. My own state of Nevada and 42 other states already allow direct access—now, with this new national ob-gyn direct-access standard, all women in every state will no longer face costly and burdensome delays and denials.

Today’s Supreme Court ruling affirming the constitutionality of the ACA is a victory for women indeed. It gives the US Congress the opportunity to act now to improve the legislation to ensure that America’s practicing physicians are able to provide quality health care for all. ACOG supports the many elements of the ACA that have enormous potential to improve women’s health, and we urge all states to act swiftly to implement these important access and coverage guarantees.