“A drink of water from Niagara Falls”

Rob Fernandez.jpeg

The U.S. health care system is undergoing an unprecedented transformation that will inevitably change how health services in this country are delivered, measured and financed. The practice of medicine and how physicians organize in given health markets is also in flux. Emerging health care delivery models such as Accountable Care Organizations (ACOs) and the Patient-Centered Medical Homes (PCMH) are being implemented countrywide. Even the delivery of undergraduate medical education (UME) and graduate medical education (GME) is actively evolving to keep pace with systemic changes, population health needs and workforce challenges. Health reform is a reality. And for better or worse, the status quo in U.S. health care is being erased and replaced.

As a fourth-year medical student about to start residency, I look at these changes optimistically. They suggest to me that physicians-in-training will have an opportunity to experiment with these new delivery models and provide critical input that will affect the end product. We all have an opportunity to make a positive impact and weigh in on these key health policy issues, IF — if we make a concerted effort to engage ourselves in the process; if we commit to being informed rather than putting on blinders and assuming our various membership organizations will advocate on our behalf; and if we continually remind ourselves of the basic reasons we all wanted to become health professionals and keep our patients always at the forefront.


It is not easy to stay involved and engaged in health policy. With so many competing demands (family, work, continued medical education, commitments within our communities, etc.), it is far easier to keep our opinions to ourselves and just “go with the flow.” I would argue that this tendency to focus only on the direct clinical medicine, only on our daily work routine, and only within our professional silos in a local geographic area is also indeed changing. That is not to suggest that these are not in fact important priorities, nor does it imply that as doctors of the future we will pay less attention to these objectives. Rather, I would simply offer that our changing global and domestic health care landscape is changing in such dramatic ways as to demand a great deal more from the modern-day physician. As such, the training of physicians in the coming years will increasingly need to include a broader focus. Considerations must be given to interprofessional education and collaborative practice, health care delivery and health systems improvement, health policy, leadership and governance, international health issues, health economics, and public health. In fact, a population health perspective will become imperative in the future. In a recent article that appeared in Academic Medicine entitled “Teaching Population Health: A Competency Map Approach to Education,” the authors do a fine job of explaining how public health education can be more diffusely incorporated in a traditional medical education. I’m all for it!

They say going through medical school can feel a lot like taking a drink of water from a fire hose. That metaphor is not too far off. As a health policy intern for AACOM having received a brief exposure to the vast scope of policy knowledge (even within the health sector itself) and continual advocacy efforts undertaken by various interest groups, or just the sheer volume of daily information that must be processed and acted upon if one is to be effective in the policy arena…well, I must say it’s a lot like taking a drink of water from Niagara Falls!

I have noticed that there is also a lot of uncertainty. Things change quickly on Capitol Hill, despite an overall feeling that things seem to move incredibly slowly in government (which, to a degree, is also accurate). There are just so many working parts. So many players needed to participate.  Unanswered questions and competing priorities lead to ongoing debates and multiple congressional hearings on various issues. The current budgets proposed by the president and versions from the House and Senate further add to a heap of uncertainty (never mind the added complexity of the recent sequestration effects). Incrementalism is the name of the game. It is actually a bit mind-boggling that our elected officials grapple with this same, complex budgetary headache year after year. So much is at stake — from proposed cuts to GME to decreased funding support for our nation’s leading health and research agencies; everything is on the table.


And yet we (as physicians, as health professionals), are not at the table (i.e., the decision-making table) as much as we ought to be. Our education and training are intense, and we become very specialized in the knowledge we acquire. When it comes to health care, we (along with other health professionals working in tandem) comprise a significant chunk of the expertise, and we can have a tremendously powerful influence in the policy-making process…IF. The choice is yours. The health care system will change whether we participate in the decision-making and policy-making process or do not. So let’s make our collective voices heard!

Scroll to Top