We Are Not Alone!
A medical student's humble reflections on the health care system.
 
Poornima Oruganti, MS-2
Northeast Ohio Medical University


Point of clarification: I am not a city girl. I grew up in suburbia, went to
college in a tiny city in northeast Ohio, and now attend medical school in rural
Ohio. Rather than waking up to the sounds of city traffic and bearing the delays of
public transportation every morning, I wake up to cows groaning (nope, not
mooing) outside my bedroom and have a five-minute commute by car to class,
past horses and chickens, supply shops, and family homes. When I received the
opportunity to spend the summer of 2013 in Washington, D.C. as an American
Medical Association Government Relations Intern with the American Association
of Public Health Physicians and a Research Associate with Atlas Research, a
health services consulting firm, I could not have been more excited for a taste of
city life. But a part of me was terrified. Poornima, we aren’t in Rootstown
anymore!

Upon arriving in D.C., I immediately knew that my experience in the city
would be challenging. I had to acclimate not only to city living, but also to the city
attitude. D.C. is a city of young, career-driven, working professionals. Whether in
the office, at work events, or at off-the-clock happy hours, they are always looking to make connections and expand
their network. As a medical student whose happy hour special consists of physiology textbooks and hundreds of
power point slides, the environment was completely new to me. However, as the summer continued, I came to
realize that the field of health care is also an interconnected network: one of physicians, nurses, allied health
professionals, hospitals, health consulting firms, government health systems, and insurance companies, among
others. As a future physician, I am just a single, developing star in the health care galaxy. An intimidating thought,
but I was intrigued. What are the methods by which this system functions, and what are the roles of the entities
involved?

During my first year of medical school, I took a course on health care systems and delivery methods,
which sparked my interest in the subject and in part led me to pursue the D.C. summer internship. Living and
working in the midst of such dynamic systems change brought me a new perspective. Changes in the healthcare
system require policy change. Policy change is determined by our political representatives and is based on research,
expertise, personal belief, debate and sometimes, political horse-trading.
Health policy change involves many players in the system. Think tanks are non-government agencies that
play a role in research and present information on many issues in the health care status quo. These organizations
include the Brookings Institution and the Alliance for Health Reform. I attended a briefing held by the Alliance for
Health Reform at the Dirksen Senate Office building titled “Shifting Challenges: Mental Health in the ACA Era.”
The Alliance for Health Reform brought together mental health experts from clinical medicine, psychology and
policy to present information to congressional staff, thereby affecting policy change. I was able to voice my
questions directly to industry experts and was witness to the early stages of policy development. I was excited,
inspired, officially hooked to the policy process.

Basic science research and the development of new treatments and protocol are activities of the National
Institutes of Health (NIH) and the Food and Drug Administration (FDA). The NIH is federally funded, and the FDA
is a federal agency. Human research is required to follow ethical standards set by an Institutional Review Board.
Advocacy organizations, such as the American Medical Association or the American College of Nurse Practitioners,
often call on research by think tanks and the NIH to develop statements and positions on health care issues. Then,
the organizations lobby representatives to take those positions in order to affect local, state, and national policy
change. However, advocacy organizations often disagree. While watching a webinar titled “The _________
(Doctor/Nurse/Other) Will See You Now: Rethinking Scope of Practice” hosted by the Alliance for Health Reform, I
learned that the American Medical Association and the American College of Nurse Practitioners disagree on the
issue of non-physician scope of practice, or to what extent non-physician medical professionals can practice without
physician oversight. Conflict and debate make advocacy more complicated. Once policy is created, the work is far
from done. As a Research Associate at Atlas Research, I got an up-close view of the consulting world and it’s
interactions with government health programs. Firms like Atlas are awarded project work by government health
agencies and are then responsible for the management and implementation of programs recommended by new health
policies.

Pharmaceutical companies play a large role in drug development and availability. Public health
departments are often managed and staffed by public health professionals, not medical professionals, calling for
cooperation between the two in order to achieve community health goals. Overseen by Recovery Audit Contractors
by the Centers for Medicare and Medicaid Services, physicians and hospitals can be fined penalties for over-billing
to Medicare or Medicaid. To complicate matters further, recent funding cuts due to government sequestration
represent billions of dollars in lost resources. Many government health agencies, such as the NIH, fell victim to such
funding cuts proving for yet another reason that, now more than ever, politics are a permanent part of medicine.

The days of paternalistic medicine are coming to a close. We are in a system where our patients expect a
patient-centered system. With the advent of websites like WebMD.com and Healthline.com, medical information is
readily available to patients and many patients are taking charge of their health. On the other hand, there are
populations for which health literacy is a major roadblock to achieving wellness, let alone self-managed care.
Government agencies such as the Centers for Disease Control and Prevention and state and local health departments
implement programs to promote health literacy in communities, shifting the focus from biological determinants of
health to the social determinants of health. The Patient Centered Medical Home is the future of primary care, and
even research is reflecting the shift towards patient-centered methods. At the Biomedical Innovation Conference
hosted by the Brookings Institution, I learned about PatientsLikeMe, a for-profit company that focuses on health
data sharing, performs research studies based on patient experience forums and data collection. Although the
methods of study used by PatientsLikeMe will not replace randomized clinical trials, the shift in focus shows the
development of alternate research platforms, hence the development of more players in the health care system.
We are not alone in the system. Hundreds of organizations and agencies, millions of people. It’s
overwhelming, especially for a young medical student. You have to make an effort to be aware of the multiple
players and the system evolution, otherwise you will get lost.

But I learned something from D.C.: there is good news. By engaging in the system, we can make it more
manageable. As developing stars in the health care galaxy, we need to begin by learning about the entities involved
in the system, and identifying areas of interest to direct our efforts. Then, we need to take charge and take action.
Want to develop the next miracle diabetes drug? Check out what the NIH is doing, and how the FDA approves new
medication. Do you agree with the process? What would you change? Let’s say you have a passion for helping the
underserved. Research what the Patient Protection and Affordable Care Act does to help eliminate health disparities,
and become an advocate for change in your community. Afraid that your student loans won’t let you pursue a career
in primary care? Schedule a visit to talk to your representative about graduate student loan policy and tell your story.
Have a general interest in learning how policy will affect your career? Take part in advocacy through organized
medicine. Want a say in the training of future medical professionals and medical education? Look into what the
American Association of Medical Colleges is involved with. Have an idea for a new medical device or a better way
to administer health care? Scope out the Centers for Medicare and Medicaid Services Innovation Center, and enter a
case competition to present your idea. No matter your interest, there’s a place and need for your involvement. Get
active, and see the change that’s possible!

My summer in D.C. showed me that even a young medical student from rural Ohio can make a difference.
By engaging in the system I can be a star amongst many, working to better the health of our patients and
communities. And I can’t wait to get started.

Poornima Oruganti is a second-year medical student attending Northeast Ohio Medical University (NEOMED) in
Rootstown, Ohio. She is a former American Medical Association (AMA) Government Relations Internship Program
participant with the American Association of Public Health Physicians (AAPHP). Poornima has an interest in
primary care, prevention, public health, policy and advocacy, and plans to continue pursuing these interests through
the AMA, AAPHP, the American College of Physicians, and service work at NEOMED.