Medical Students Shaping Health Care Policy in the California State Capitol

By Cecilia Bonaduce, second-year medical student at UC San Diego School of Medicine

When you hear the phrase “medical interns,” your mind may conjure up a scene from Grey’s Anatomy, but for those working at the California State Capitol, it means the annual arrival of medical students ready to intern with members of the legislature.

The UC San Diego School of Medicine has been setting the bar for medical student engagement in politics for the past several years. Under the direction of Dr. Bob Hertzka, medical students like me have the opportunity to take a course on health care policy, which includes two trips to the Capitol to lobby legislators on health care issues and culminates in a one-of-a-kind summer internship in Sacramento. This internship placement, possible with support from the California Medical Association (CMA), provides us with a completely immersive experience in state policymaking.

This summer, medical student interns were placed with all types of legislators — from Republican to Democrat, rural to urban, and northern to southern members — including Speaker Emeritus Toni Atkins, Assemblymembers Shirley Weber and Brian Maienschein, and State Senators Joel Anderson and Dr. Richard Pan, among others.

Interns are working on developing new bill ideas, drafting letters to the governor and/or working with legislative offices on issues like sudden cardiac arrest in student athletes and dementia. One second-year medical student, Robby Turk, is working with Assemblymember Shirley Weber on AB 2298 (related to the recent CalGang audit) that exposed serious inadequacies in the criminal intelligence database.

With only one free summer during the medical school process, it’s natural to wonder why medical students would dedicate their only time off to taking on an internship related to state politics instead of working in a clinic/lab or simply taking a vacation. Bottom line? We believe that the future of medicine should have a say in the future of medicine.

With the Affordable Care Act housing 20,000 pages (and counting) of regulations, there’s no denying the complexity of the American health care system. This complexity spills over to state-level health care policy. As future physicians, this is our playing field, and we know it best.

Currently, there are only two physician members of the California state legislature, and yet, the legislative body drafts and votes on bills impacting health care all of the time. In this legislative session alone, the Assembly and Senate voted on bills dealing with issues ranging from mental health treatment, prescription drug practices, colorectal cancer screening, concussions in youth sports, licensure for chronic dialysis clinics and the use of epinephrine auto-injectors in emergency medicine.

Given the extensive amount of health care-related policies passed and implemented by state government, the need for physician political participation is undeniable. Whether participating in state medical associations like CMA, building relationships with legislators or even running for elected office, any form of political participation by physicians can make a big difference in the direction of health care policy in California.

The problem? Many physicians aren’t politically active. Arguably the easiest form of engagement is showing up at the polls, yet studies have found that physicians are much less likely to turn out to vote compared with other fields including lawyers, teachers and farmers.

If physician voter turnout is low, just think about voter turnout for physicians and future physicians under the age of 30. Millennials have notoriously low voter turnout, a problem that the current presidential contenders are grappling with at this very moment. What makes the Politics in Medicine program at UCSD so invaluable is that it gets young and future physicians to participate in the political process. These students then share their work with their colleagues to increase the overall level of awareness and interest of other medical students.

The face of medicine is changing. Young physicians and current medical students are more heterogeneous and diverse with respect to gender, race, religion and political affiliation than any time in the history of medicine. The legislative decisions we make today will impact California for decades and, thus, should reflect the values and opinions of those whose future patient care will be impacted by these policy choices. From this macro perspective, medical students can clearly articulate what they see on the horizon because they are the horizon. We need their input.

That input, as my classmate Daniel Trujillo in Assemblymember Maienschein’s office put it, “gives policymakers a broader perspective on issues facing the medical field and opens the discourse regarding health care to politicians and organizations that may be more ideologically aligned with medical students, rather than practicing physicians. All-in-all, by diversifying the face of the medical field, it strengthens our ability to champion legislation that is in the best interest of our patients, our careers, and the American health care system as a whole.”

The internships are much more than a lightning speed Politics 101 course — they afford medical students the opportunity to have a direct impact on public health policy in the state of California.

Just last year, two 2015 medical student interns from UCSD worked with Assemblymember Lorena Gonzalez to create AB 2121, a bill related to drunk driving prevention. And, the 2016 medical student interns witnessed this bill pass on the Senate floor last week!

The trope of the hopelessly idealistic medical student intern blocked at every turn by seasoned politicians can happily be put to rest. While working on my legislative goals for the summer, the word “no” I anticipated hearing never came. Instead, I was confronted with a different word: “How?”

In fact, talking to legislators sometimes reminds me of complicated conversations I have had with patients in the clinic this past year.

Helping government understand why they should, as an example, develop a vaccine law to prevent outbreaks of measles in California is akin to telling a patient struggling with hypertension why they should just lose weight. It can be done (and was with the passage of SB 277!) but the real legwork is not identifying the endpoint but in carving out a path to get there. It takes careful examination of various possibilities, preempting potential pitfalls and forming a broad coalition of supporters to push the initiative and see it through to the end.

Classmate Abhishek Kumar and I have been using this model in approaching new bill ideas with open minds and reaching out to people from very different backgrounds to form broad coalitions of support.

We’re working on food policy legislation in Speaker Emeritus Toni Atkins’ office. Though we want to keep our latest work under wraps, for now, stay tuned for updates on a new bill that Abhishek and I will be working on during the next legislative session!

Coming from Washington, D.C., I thought my understanding of the political process was fairly astute, but my time in the Capitol introduced me to a much more complex legislative world than I could have ever imagined. This is a place where real progress requires flexibility, creativity and collaboration with people across the aisle and industries, including medical experts, educators, business owners and mission-driven nonprofit organizations.

It’s important work, and I urge all medical students to get more involved in the legislative and political process so we can ensure future policies protect the practice of medicine and provide all Californians with quality health care.

Cecilia Bonaduce is a Los Angele native and second-year medical student at the UC San Diego School of Medicine. Her research at UCSD is in obesity medicine. She acts as school delegate for the American Medical Association and CMA, and serves as the Legislative and Advocacy Chair for the Region 1 AMA Medical Student Section.

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The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit cmanet.org, and follow CMA on Facebook, Twitter and YouTube.