Appreciate the Challenges, Advocate for What's Important

February 24, 2009


By Sara G. Austin, MD, FAAN

In 2008, I took a sabbatical from my practice for a year to do the Kenneth Viste Public Policy Fellowship, sponsored by the American Academy of Neurology, American Neurological Association, and the Child Neurology Society. As I reflect back on that time, I remember how exciting it was to be in the midst of negotiations on a bill one day, and then read about it in the Washington Post the next day. It was amazing to be able to walk through the Capitol building or to go into the Senate gallery and watch debates.

The Public Policy Fellowship

The Public Policy Fellowship starts in September and is managed by the American Academy for the Advancement of Sciences (AAAS). Of the 35 AAAS fellows, only three were physicians, and two were residents. After three weeks of orientation, we interviewed for positions where we would spend the subsequent eleven months. I landed in the health shop of the Health, Education, Labor and Pensions committee (HELP), working for the ranking member, Senator Michael Enzi (R-Wyoming). The two committees that deal with health affairs in the Senate are:

  • The HELP committee—works with the FDA, NIH, public health bills and some health care workforce issues
  • The Finance committee—deals with the entitlement programs such as Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP)

The senators sitting on these committees heavily influence health care in the US, and those who sit on both committees—such as Orrin Hatch from Utah, or Jeffrey Bingaman from New Mexico—are especially influential .

Daily Life

My days working in the Senate were not nearly as busy as those working as a physician seeing patients. I had a portfolio of issues for which we would arrange briefings to learn background knowledge about the issues or meet to negotiate the bill. A briefing is a nonpartisan informal meeting among staff to learn about a subject. A hearing, on the other hand, is a formal partisan event in which the senators participate, either to get knowledge about a subject or to try to influence the debate.

As bills would come through the committee, organizations affiliated with the executive branch (such as the NIH or other divisions of the Department of Health and Human Services) would weigh in. I got a much better idea of how huge the federal government is and how it promulgates rules, many of which have a direct impact on the way we practice medicine.

Good Advocacy

I also attended many meetings between advocacy groups and staff. I learned that good advocates understand both the policy and the procedure of how bills get made into law: They are armed with real information (not just anecdotes), they present it in a concise manner, and above all, they are honest. I was surprised to learn that congressional staffers and their congressmen have a vast amount of background knowledge about the issues brought forth by the advocacy organizations.

Absence of Physicians

There were surprisingly few physician fellows working on the Hill. In addition to the three in AAAS, there were another six Robert Wood Johnson Fellows. There are only a few physicians employed as full-time staff. It seems ironic that an institution with so much influence over the practice of medicine has so few physicians working in it. This helped me appreciate the emphasis the AAN and the other neurological societies place on advocacy by offering this fellowship.


My year working in the Senate was quite an experience and I am immensely grateful for the opportunity. It forced me out of my comfort zone, it taught me that I was not too old to learn, and it made me proud of how my country works. Now that I’ve seen the process in action, I have a much greater appreciation of how difficult it is to govern such a huge, diverse group of people. It also made me appreciate the value of advocating for the things that are important to me, my fellow physicians, and my patients.

Author Disclosure

Within the past 24 months, Dr. Austin has written an affidavit for the Texas Medical Association about EMG.