Pre-meds & Policy: An Essential Relationship

As a pre-medical student, my academic and extracurricular pursuits have often felt pre-determined. I enroll in science classes to fulfill prerequisites, study for the MCAT, and am overwhelmingly encouraged to pursue scientific research and clinical volunteering on the side. In an election year when many of us are paying closer attention to politics, it is strikingly apparent that the pre-medical experience, more often than not, does not include public policy and government.

To most of my peers, this is neither surprising nor concerning. Indeed, the conventional wisdom suggests we should be keeping up with the latest research from the NIH, not new legislative proposals in Congress. We assume admissions committees look more favorably upon a summer spent pushing wheelchairs and pipetting than one spent interning at the mayor’s office or on Capitol Hill. The idea of using some of our precious extracurricular time to engage with politics or public policy probably doesn’t occur to most pre-meds. However, as an aspiring doctor who has paid close attention to health care reform (with an eye for how it will affect his future), I wanted to get involved.

When I realized that I had developed a strong interest in health policy, I questioned whether pursuing it would place my medical career at risk. I was afraid that if I left the lab for a government office, I was distancing myself from the mold of the prototypical pre-medical student. If I end my involvement with laboratory research, would I become a less competitive applicant? I struggled with how to reconcile the time-tested formula for success in medical school admissions with my interest in policy initiatives to transform American health care. I knew that health policy would be just as relevant to my career as basic science, but it felt a bit unnatural. Eventually, I summoned the courage to make a decision that causes me anxiety to this day, more than a year later. I decided to leave my molecular microbiology laboratory for an internship in government at the Centers for Medicare and Medicaid Services, or CMS. At the time, it felt like a leap of faith.

I’m glad I made the shift. I enjoyed that first summer working on health policy, and decided to continue my exploration with another internship this summer at a think tank in Washington, DC.  While I was originally scared I was venturing into a field too far outside the purview of the traditional medical school applicant, I have realized that distancing myself from the norm should not have discouraged me. In fact, I have been heartened by my experience thus far. The issues I work on are very relevant to my future career as a physician, to my future colleagues, and to my future patients. Physician reimbursement reform, prescription drug payment reform, and improving affordability for Affordable Care Act enrollees are fascinating topics that I feel excited to work on precisely because I understand their relevance to my medical pursuits.

However, I am one of very few pre-meds I know pursuing interests in government and public policy. Not just at my university, but also across the nation. It’s a scary position to be in, sometimes wrought with self-doubt. The biology, chemistry, and physics I learned for my introductory classes and for the MCAT aren’t applicable in this space, which often makes me feel I shouldn’t be here.

But when I remind myself why I learned those sciences, I remember why I’m in this space. My goal is to serve patients, and learning physiology and understanding health policy both contribute to that goal in meaningful ways.  I have had the opportunity to work and speak with physicians who have weaved both clinical care and policy work into their careers. I have been inspired by how they utilize their experience of caring for patients to make macro-level impacts on the health care system through policy making and advocacy. I am motivated to follow a similar path.

I have repeatedly heard from role models of mine about the lack of practicing physicians involved in the policymaking process. Whether we consider issues of cost, access, or quality in American health care, it is clear that we need physicians trained in health policy and prepared to be leaders in government. The synergy between clinical experience and policy acumen will be a guiding force as we continue to tackle the systemic problems in health care. With millions uninsured, billions of dollars in waste, and burgeoning costs that crowd out spending in sectors like education and social services, there is so much work to be done. As we promote efficiency, accessibility, and quality in health care, having physician-leaders at the helm will ensure that both providers and patients are not only protected but uplifted by the next wave of reform.

I hope to one day apply my scientific aptitude and critical thinking skills in the service of patients. But helping patients requires more than clinical know-how. For the millions of people who cannot afford health care in the United States, helping my patients will demand changes in the financing of care. For the millions who live in rural areas and have limited access to health care professionals, helping my patients will require delivery system reforms. For the millions who are forced to manage their own care in a fragmented system, helping my patients will mean pushing for structural reforms in the organization and administration of health care. I could go on, but the bottom line is this: policy provides the route by which we can address all these problems. For me, shaping effective reforms goes hand in hand with providing excellent care, because so many of my patients will need both.

My hope is that other future doctors feel similarly.