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Ms. Adams and Mr. Hinkle are both PharmD Candidates at the University of North Carolina, Chapel Hill.
Why should pharmacists care about policy and how it is made? This is a question and topic that intimidates many pharmacists. All sorts of questions begin to ferment in one?s mind, especially the question of where to begin. The fight for sound and fair pharmacy legislation is not an easy one, but a better understanding of the process is a good start.
Lisa Adams on the east steps of the Capitol building.
The influence of the federal government is ubiquitously connected with every aspect of pharmacy practice. As a result, the daily act of providing patient care is subject to whimsical changes at any given moment. Changes in government-implemented health care policy are the ?hot button? subject of countless daily discussions, testimonies, campaign debates, and briefings on the Hill and around the nation. The Association of Community Pharmacists (ACP), a national independent pharmacy grassroots organization based in North Carolina, spearheaded the creation of an internship upon realizing that their influence in Congress was much greater when congressional staffers were knowledgeable about pharmacy issues. Officials from the ACP felt that final-year pharmacy students would be perfect candidates for working in the offices of the North Carolina congressional delegation, as they would have knowledge of health care, pharmacy issues, and would gain an insider?s perspective of how Capitol Hill operates. Working with the North Carolina Association of Pharmacists (NCAP), ACP brought the idea to the schools of pharmacy at the University of North Carolina (UNC) at Chapel Hill and Campbell University. Seeing the immense opportunity and the need for pharmacist involvement in health care policy, both schools agreed and teamed up with ACP and NCAP to facilitate a 2-month clerkship for fourth-year PharmD students, allowing them to work as intern-fellows in congressional offices on Capitol Hill. ACP, NCAP, and both universities agreed that having students participate in this unique experience would foster professional responsibility and political action, thereby furthering the pharmacist?s role in national health care.
Imagine, as a pharmacist (or future pharmacist), walking through the historic Capitol building on your way to work every day. You proceed through the labyrinth of tunnels and subway cars, frequently getting lost at first, until you arrive at your office, where you have a stack of ?Dear Colleagues,? 4 newspapers, and an inbox that is bursting at the seams. Such is a typical morning for the first 2 UNC pharmacy students to intern in congressional offices of the North Carolina delegation.
Jordan Hinkle, Lisa Adams, and Rep Brad Miller (D, NC)
We were the first 2 students chosen for the 2-month congressional elective rotation. During October and November, we worked in the offices of Reps Bob Etheridge (D, NC) of Lillington, North Carolina, and David Price (D, NC) of Chapel Hill, North Carolina. We did give some tours of the Capitol building and took some phone calls like many Hill interns do, but much of the work that we did involved looking at new legislative bills and determining whether our congressman should cosponsor the bill or how they should vote when it gets to the House floor. This process was anything but simple. Often, the cosponsorship requests or the pleas for votes on legislation come in the form of ?Dear Colleagues? or constituent mail. ?Dear Colleagues? are 1-page documents sent out by sponsoring members of a bill in search of more supporters and are an informative way of helping the legislative assistants (LAs) to gather useful information about a bill.
In looking at new legislation, we had to take into account how our congressman would likely feel about the issue based on their voting history, what the proposed bill actually meant from an operational standpoint, and how much it would cost taxpayers. Another thing to take into consideration was whether something like it was already on the books, but simply was not being enforced. Once we gathered all the information about a bill, it was time to make a decision. The LA, legislative director, chief of staff, and congressman each provided their recommendation on what action the office should take on the bill.
Despite all the research our positions entailed, we certainly did not spend too many of our days inside the office. The most exciting thing we saw outside the office was the House Judiciary Committee meeting on HR 971, a bill that would allow independent pharmacies to negotiate on third-party contracts through an exemption of federal antitrust laws. A few weeks later, the bill was scheduled for a markup by the committee, passed with few changes, and now awaits scoring from the Congressional Budget Office. We also attended many briefings to learn about various health policy issues.
When we were not in briefings, we spent considerable time responding to constituent letters and reviewing their opinions on legislation. This process involves looking at how constituent concerns related to how the congressman felt about a particular issue, the history of the issue, and reasoning behind the congressman?s opposition or advocacy of the issue. Each letter must be carefully crafted to include empathy, background on the issue at hand, and how the congressman will consider the issue going forward.
What we learned in our short stint on the Hill will forever be impressed upon us. We know much more about not only the legislative process, but what our elected officials do to see that they look out for those who depend on them. We saw how they were hardly ever in the office, as they are on a relentless merry-go-round of hearings, briefings, receptions for colleagues or organizations, debating a bill on the House floor, or voting. We learned that the term ?networking? is really all about making and fostering relationships.
Relationships are a crucial piece of how things get accomplished regardless of whether you are working in a community store, protesting on the street corner, or serving in Congress. As our profession continues to evolve and seeks more recognition for the services we can provide, we will need to be more involved in the political landscape on the federal and local levels. It is imperative for all of us to understand where candidates stand on the issues that will directly impact our profession, especially those candidates who are seeking a new seat or re-election in the fall of 2008. We firmly believe that experiences like this are going to be instrumental in providing future pharmacists with a politically oriented knowledge base to rely on for years to come.
So how does all this relate to you? Your practice is changing, will change, or can change at the hands of the local, state, or federal government, and you have a voice. If you do not know who your representative is in Washington, then find out (www.house.gov), and invite him or her to visit your practice site and relay the impact their actions on the Hill have on the patients you care for on a daily basis. We also urge you to contact your congressman and set up a time to sit down with them or their health LA to discuss the issues that are important to you and your pharmacy. If you cannot get to Washington, then try to get them when they come back to the district. We must do this for our patients and our profession.