When political science meets medicine
A one-of-its-kind rotation for medical residents and public health students is helping to bridge the gap between practice and policy in health care.
“In the last 60 years, despite the increasing complexity of our health care system, health care providers have become less relevant in public policy decisions and discourse,” said James Ronayne, assistant professor of clinical pediatrics in the College of Medicine, citing a 2014 article from the New England Journal of Medicine.
“At the same time, doctors are frustrated and are, more often than not, stuck practicing defensive medicine and asking the question: ‘What else can I do?’” Ronayne said.
The answer, perhaps, is political advocacy, he says.
“Only a small percentage of morbidity and mortality issues are being reduced by care in the clinic,” Ronayne said, “the rest of it comes from other influences, and policies are a big part of that.”
The Legislative Education and Advocacy Development course, or LEAD, is a two-week rotation designed to bring together different types of learners and teach the basics of the state legislative process, policy research and analysis, and preparing and presenting policy recommendations. Nearly 40 learners, from schools around Chicago, have participated in the program, which is offered in February — right before the Illinois General Assembly heads into session.
Ronayne says it is about empowering health care professionals to share “their voices and ears” and advocate for change.
Ronayne tapped UIC professor of political science Dick Simpson to help develop the course and teach about the legislative process in Illinois.
“Most legislators are learning about the issues themselves and they don’t have health policy advisors,” Simpson advised learners. “They need tailored advice tied to legislation — about how to vote and what bills to propose — not a medical degree.”
The LEAD rotation advances the “knowledge translation” approach taught in traditional advocacy courses and instead teaches “knowledge interaction.” This means the learners not only present their personal points of view, but they also develop recommendations that align public health needs with legislator values.
In addition to lecture, and unlike other rotations, LEAD takes learners out of the hospital and pairs them directly with Illinois legislators.
“The number one goal is to help learners engage in the democratic process, on either side of the aisle and on any issues that are important matters of public concern,” Ronayne said. “What better way to do that than to connect them directly with the legislators who are proposing, debating and voting on health care policy in Illinois.”
For the course, each participating legislator issued a question: What are the potential impacts of establishing another casino in Illinois? What impact has a state bill in Maryland had on generic prescription drug prices, and should Illinois adopt something similar? What are the implications of legalizing recreational marijuana?
The learners worked in groups to research the topic and develop a policy brief. At the end of the course, the students met with the legislators and presented their findings and recommendations.
Representative Patti Bellock, deputy house minority leader, has worked with LEAD for the past three years and says working with the residents has been valuable.
“Their research and assistance in developing public policy proposals on important medical issues is of great value,” Bellock said. “Their contributions will have a positive impact on legislative negotiations regarding various health care-related bills this spring and beyond.”
LEAD learner Anna Rodenbough described the LEAD rotation as “immensely different” from any other residency rotation.
“It’s a really unique look at a very broad aspect of medicine — how medicine and policy interact,” said Rodenbough, a third-year pediatric resident from the University of Chicago. “Medical education is very focused on the practice of providing care to patients and there is not a lot of context provided on how medicine fits into society and the framework of policy and government.
“The course really showed me how I can use my voice,” she said.
Darian Esfahani, a sixth-year neurosurgery resident at UIC, said he opted to take the LEAD course because he wanted to become more comfortable talking to legislators.
“Doctors can get caught up in doctor language, but the key is how you translate that, especially when talking to legislators,” Esfahani said.
Esfahani estimates that LEAD is one of up to 18 or 20 rotations he has participated in over the course of his residency.
“I haven’t been in any other program like this,” Esfahani said. “It gives us a chance to build a skill set that we can’t in any other circumstance.”
“I’ve participated in legislative advocacy events before, and plan to continue to do so throughout my career, but now, I feel much better equipped to speak about many of the issues,” said Wendy Shue, a third-year family medicine resident at Northwestern University. “The LEAD course taught me how to systematically research, summarize and present a health care policy issue… I feel much more confident in my ability to advocate for legislation I believe in.”
Ronayne says LEAD has worked with approximately 10 state legislators so far.
“I am confident that each one of the residents in the LEAD program will go on to have promising and successful careers in medicine, thanks to the education and hands-on experience they are getting during the pursuit of their training at UIC,” Bellock said.