DEC 2012


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December 2012 EW NEWS & OPINION 13 Chief medical editor���s corner of the world When anecdotes matter more than data P arag Parekh, M.D., is an impressive young ASCRS member who practices with my good friend Skip Nichamin, M.D., at the Laurel Eye Clinic in western Pennsylvania. His clinical training is exceptional���he completed his residency at the Johns Hopkins Wilmer Eye Institute and an anterior segment fellowship with Minnesota Eye Consultants. What makes Parag unique among ophthalmologists, however, is that he studied U.S. health policy, economics, and management at Harvard���s Kennedy School of Government, where he earned a master���s degree in public administration. With this distinctive background, it is not surprising that Parag is one of the most politically knowledgeable members of our ASCRS Government Relations Committee, and I have gotten to know him through this capacity. For this month���s column, I asked Parag to share some of his thoughts on legislative advocacy with us. He has the unique experience of having served on a U.S. senator���s staff, working on healthcare policy issues while in medical school. When I have visited Capitol Hill, I have often ended up meeting with staff members rather than the actual legislator. I have wondered how effective this is compared to meeting with my representative in person, and Parag���s insights surprised me. Finally, Parag and Skip recently invited Congressman Glenn Thompson to visit the Laurel Eye Clinic, and I asked about the visit. I would especially encourage our younger ASCRS members to follow Parag���s lead by becoming actively involved in political advocacy. Please write to him at parag2020@gmail.com if you would like his advice on how to do this. David F. Chang, M.D., chief medical editor Dr. Chang: Why did you decide to work on a U.S. senator���s staff, and how did you get this position? Dr. Parekh: We had a significant amount of time off between the first and second year of medical school. All my classmates had research projects lined up, but I hadn���t loved that first year of medical school and wanted to do something different. I certainly didn���t know (yet) that I wanted to be an ophthalmologist. I had an interest in health policy and public health since college, so I took a chance and applied to all the U.S. senators and representatives on the healthcare committees. Landing the position was actually fairly easy. The legislator���s offices were very impressed and excited to have a medical student in their office. I think they thought I might be able to bring some ���real world��� knowledge to the relevant health issues of the day. Dr. Chang: How much did the senator rely on you for education on the issues and for policy decisionmaking? Dr. Parekh: Let me start off by saying that staffing on Capitol Hill is not at all how you might picture it. It is run by an army of 20-somethings who answer to just a few senior staffers, and they report to the chief of staff and the elected member. As a first-year medical student, I didn���t think I had a lot of clinical healthcare experience, but by Capitol Hill standards, it turns out that an average medical student is a treasure trove of information about insurance, hospitals, medical education, health systems, etc. I was flattered and shocked by this. I can recall many occasions where the healthcare legislative assistant asked me to write a memo for the senator, to succinctly explain both sides of a given issue, and to make a recommendation. Once again, flattering, shocking, and tremendously satisfying���a first-year medical student informing and influencing the vote of a U.S. senator! A corollary from this is that talking to a staffer about an issue of concern to you can be just as valuable (and sometimes more valuable) than talking to the actual senator or representative. The member almost always turns to the staff for advice and guidance, and if you���ve already convinced the legislative assistant, the deck is stacked in your favor. Dr. Chang: Given your firsthand experience, what about the legislative process would surprise the rest of us the most? Dr. Parekh: In addition to the young age of so many staffers, I think the decision-making process isn���t what you���d expect. First off, once an issue has become a politicized hot topic, the facts no longer matter. Washington is too polarized. For example, it would be a fool���s errand to try to convince the typical conservative member about the need for even a marginal gun safety measure. Similarly, don���t even bother talking to a liberal member about how expensive defensive medicine is or how tort reform is needed for any healthcare cost control to work. Those issues are going to be decided by political forces far outside our control. Fortunately for us, most of our issues are not so political or polarizing, and therefore there is a lot we continued on page 14 Explaining DSEK to Congressman Thompson. From left to right: Skip Nichamin, M.D., Peter Winkler (Congressman's staff), Congressman Glenn Thompson, Dr. Parekh From left to right: Dr. Parekh, Peter Winkler, Congressman Glenn Thompson, Dr. Nichamin Source (all): Parag Parekh, M.D. Congressman Thompson scrubs in to the OR with Dr. Parekh

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