Mariana Montes, MD, MPH
When I applied to the ASA Resident Policy Research Rotation in Political Affairs in February of 2020, I don’t think any of us could have imagined the turn of events that would follow. At the time, I was a CA2 resident, concerned about the prospect of pediatrics fellowship interviews, inching one year closer to becoming a senior resident, and hoping to be selected for this rotation in D.C. Instead, coronavirus descended across our country, profoundly touching every single American life, including mine. Shortly after my interview with ASA, I was sent to the frontlines, standing up and staffing the first of what would eventually become four COVID ICUs at the University of Chicago.
As of September 2020, the time of this writing, over 200,000 Americans have perished, a devastating loss to us in the healing professions. As a society, we have rearranged facets of our lives, limiting contact with friends and family, wearing facemasks, and transitioning to work from home via Zoom. But for those of us who are physician anesthesiologists practicing on the frontlines of the pandemic, work has continued with a greater sense of risk and urgency as we care for the sickest patients in the world, all the while placing our safety, and that of our families, on the line. Through all the chaos of those months in the ICUs and operating rooms, I never imagined I would be selected for this once-in-a-lifetime opportunity with ASA, and how my experiences would inform my perspective on this rotation in political affairs. It was clear to me that there has never been a more critical time in our lives to take up the mantle of advocacy and exercise our professional citizenship as physicians. If Congress was able to figure out how to legislate via Zoom, then ASA was going to figure out how to make the Resident Scholar month a success, even if virtually. And I was determined to make the most of it.
At the beginning of September, ASA sent a laptop to my home in Chicago prepped with the necessary drives to do my work, and loaded with the weekly calendar meetings I would need to become acquainted with the workflow of ASA. I went out of my way to email and meet as many folks within the first week as I could; I figured the organic interactions in the meeting rooms and hallways of the D.C. office needed to be replaced with Zoom invites. In the process, I learned more about the vast breadth of activities that ASA does for everyday physician anesthesiologists like me. From Matt Popovich in Quality and Regulatory Affairs, who graciously met with me and asked insightful questions to understand a day in my life as a clinician, to Sharon Merrick, expert in Payment and Practice Management, who walked me through the ins and outs of billing and coding, ASA is constantly striving to improve the practice of anesthesia on the ground. I was excited to work with Jason Hanson and the State Affairs team, who I had previously met in Springfield during the Illinois Society of Anesthesiologists’ legislative action day. I worked on projects with his team examining the impact of the public health emergency on a state-by-state basis. And I made a home with the Congressional and Political Affairs team, listening to Congressional hearings via Webex and transitioning from in-person meetings to Zoom events with members of Congress. While it would have been wonderful to be in Washington and meet them person, this was just as fun, and second best. Learning to be an articulate advocate for our patients and our specialty takes practice, perseverance, and passion, and I am grateful to Nora Matus and Manny Bonilla and their teams for showing me the ropes.
As we are all too aware, the coronavirus pandemic has shed light on the cracks within our health care system and the issues our patients and our profession are facing. The advocacy issues I had the opportunity to confront were profound and vast. I spent my days discussing with lawmakers my concern over ensuring access to adequate PPE and tackling drug shortages, especially after seeing how lack of access impacted our ability to deliver safe care to patients in the COVID ICUs. I contributed to a document written by Dr. Crystal Wright and CEO Paul Pomerantz on the effects of COVID-19 in widening the racial and socioeconomic disparities of our patients, and what we are doing as anesthesiologists to address them. Despite making great bipartisan progress before the onset of the pandemic, surprise medical bills continue to be a significant concern for patients and providers alike. I discussed with policymakers how patients shouldn’t have to go bankrupt simply because the hospital or surgeon they thought was in-network contracted with an out-of-network anesthesiology practice, while insurance companies are off the hook for covering none or only a portion of their care. Further, CMS released the proposed 2021 Physician Fee Schedule with expected cuts to specialties like anesthesiology. All of us across every specialty have risen to the occasion of this pandemic and the profound calling of our profession at great personal cost in caring for patients with COVID-19.
Sharing my personal story in the COVID ICU, and those of my co-residents and attending physicians at the University of Chicago, helped to illustrate for lawmakers that we never stopped working, we just threw all of our efforts into caring for COVID patients despite the cancellation of elective surgeries. Lawmakers across the political spectrum agreed with me – in the face of a global pandemic when many small business private practices and hospitals are struggling to make ends meet and care for patients– now is not the time to decrease reimbursements. This continues to be an issue at the forefront of ASA, especially if new coronavirus relief bills are introduced in Congress. Unsurprisingly, the pandemic has also reignited concerns over scope of practice. As states renew their public health emergency orders, nurse anesthetists have continued their crusade for expansion of practice, now insinuating they are able to work in an intensivist-like capacity in COVID units. Describing to lawmakers how the use of a global pandemic as an opportunity for CRNAs to obtain a field promotion and the impact it will have patient care, particularly for America’s Veterans, is something ASA continues to fight for.
While the issues facing our patients and physicians seem insurmountable, this month has taught me an important kernel of truth about civic engagement from one of my mentors at the ASA, Nora: we just have to keep talking. As an immigrant to this country, I learned early on in my grade school history books about the Founding Fathers’ zeal for civic engagement. I was inspired by them and their continued conversations that lead to the creation of this amazing country. Like many Americans, I share concerns about decreasing engagement in the civic life of our nation and an erosion in civility in today’s society, especially as the presidential election looms near. But in my experience this month, what I have found to be true is that a compelling story about why we must always put patients first, why our experience and our role in patients’ care matters, and why lawmakers should care about it, goes a very, very long way. We just have to keep talking. And not let the conversation stop.
So what can you do? First, you can go to ASAHQ.org and start by taking the short advocacy modules to learn more about advocacy and be better prepared for conversations like these with hospital and community leaders. You can engage your local and state leaders by taking action on any of our ASA Grassroots campaigns, all of which are aimed at addressing the advocacy issues that matter to our patients and you. Join and contribute to the ASAPAC, the political arm of the ASA that provides political support for our advocacy efforts and helps physicians like you and me participate in the political process. If you are a resident, apply for the Resident Scholar program, or similar programs in your state that emphasize health policy. Engage with your state society, join them for their state legislative action day in your capital, and join us at the Annual Legislative Conference where we bring our concerns to Capitol Hill. There are so many ways to get involved. So let’s get to talking.