Lawmakers offer support to AAPI legislative agenda

Dr. Ajeet Singhvi, Dr. Sanku Rao, Nicholas Rathod, Director of White House Office

WASHINGTON: A record number of 19 US Congressmen descended on Capitol Hill's Rayburn House Building recently to offer their unstinted support to the legislative agenda of American Association of Physicians' of Indian Origin (AAPI).

At the Legislative Day organized by AAPI, the Senators and Members of House belonging to both Democratic Party and the Republicans were unified in their support to AAPI's efforts in making the US a healthier nation.

The Congressmen urged AAPI to engage their representatives to continue their activism and expressed concern on some of the policy positions taken by the Obama Administration, especially in healthcare arena.

On the issue of health care rationing, the lawmakers spoke of the negative effects of a single-payer government system on the current health care sector and there was general agreement that while there are gaps that need to be filled, and those who fall outside the traditional safety nets of Medicare and Medicaid should be assisted, America still has the world's leading health care delivery system, where innovative pharmaceuticals come to the market every year, where increased preventive medicine saves more lives, and where Indian American physicians are making a long-lasting impact as health care deliverers in this premiere system, they opined.

The morning session began with the address by three eminent physician Congressmen - Jim McDermott, M.D. (D-WA) and followed by Phil Gingrey, M.D. (R-GA) and Bill Cassidy, M.D. (R-LA). As many as 16 Congressmen addressed the reception hosted by AAPI in the evening and the list includes Tom Price, M.D. (R-GA); Paul Broun, M.D. (R-GA); Phil Roe, M.D. (R-TN) ; Marsha Blackburn (R-TN); Steve Israel (D-NY); Dave Camp (R-MI) ; Bob Etheridge (D-NC) ; Michael McMahon (D-NY) ; Steny Hoyer (D-MD) ; Ed Royce (R-CA) ; Blaine Luetkemeyer (R-MO); Eliot L. Engel (D-NY) ; Frank Pallone (D-NJ) ; Howard Coble (R-NC)  and  Mike Rogers (R-MI).

 Senator Tom Coburn, (R-OK), a practicing obstetrics and gynecologist in Oklahoma said the health care provisions in the House stimulus bill represent ideological and partisan overreach of epic proportions. It is ludicrous to ask a body that can't track its own spending to determine which medical treatments are best for individual patients suffering from complex diseases.

Nicholas Rathod, director of White House Office of Intergovernmental Affairs, and one of the highest ranking Indian-American in the White House, said the need of the hour was civil action and involvement in political process. He said Indian-Americans have laid the foundation long ago and the time has come to harness their power and make the change.

Dino Teppara, AAPI's newly-appointed Director of Legislative Affairs said: "AAPI's successful conference is a sign of a new, political maturation, where AAPI will institute a professional, grassroots based advocacy operation that effectively represents Indian American physicians. We will engage Congress and tirelessly advocate policies that are mutually beneficial to our community and to the US health care sector."

AAPI President Sanku Rao said nearly 4500 foreign medical graduates who do all kinds of odd jobs unable to pursue their chosen career of medicine in this country. AAPI has started six centers where externship or observership programs are being conducted to help them get into mainstream residency programs with the help of experience certificates given at the end of the program. Institutions like Oklahoma State Medical Associations or AAPI would issue the certificates at the end of the training program. This will help them get a valuation from the preceptors and this made all the difference in their careers.

AAPI is fighting to increase the size of entering medical school classes and residency positions nationwide.

 Between 1980 and2005, medical school enrollment remained flat, the U.S. population increased by more than 70 million. Also, the percentage of baby-boomer generation doctors who are 55 and older rose from 27 percent to 34 percent during this time, the Association of American Medical Colleges (AAMC) had predicted 250,000 active physicians will retire by 2020.

To meet future health care needs, AAPI lays emphasis on increasing class sizes in medical schools, hike in number of residency positions nationwide, and issue of work visas to accommodate highly-skilled physicians, he added.

According to the AAMC, average medical student debt in 2007 was $140,000 and the average stipend earned during residency was less than $44,000. Unlike other professions, physicians undergo a lengthy training period upon graduation with little remuneration, making it difficult to pay back federal loans during their residencies, Dr. Rao added.

Dr. Vinod Shah, president-elect of AAPI, said there is a greater demand to increase residency slots in view of the pathetic shortage of physicians in the US. He said only 42 percent of the foreign medical graduates find residency slots putting other qualified physicians in the dock. "It's not ethical for a doctor to sit at home when hundreds of people require medical attention on a priority basis. "

In this connection, Dr. Shah emphasized the need to energize AAPI by more youth involvement. AAPI is concerned over these costs, which results in fewer doctors practicing in crucial specialty areas and fewer medical residents willing to enter such fields. AAPI supports federal and state legislation that places effective caps on non-economic damages, limits the use of joint-and-several liability, and limits the statutes of limitations for filing medical malpractice claims, he added.

The 20/220 pathway is a federal Economic Hardship Deferment program administered by the U.S. Department of Education, allowing most residents to defer student loan payments for three years using a debt-to-income ratio not exceeding 220 percent of the Federal Poverty Level. Congress slated this vital program for elimination July 1, 2009 when it passed the "College Cost Reduction and Access Act," in 2007.

AAPI strongly supports permanent reinstitution of this crucial program to assist residents in deferring student loan payments. Without the 20/220 program, medical residents will be forced to pay back a defined percentage of their loans on a monthly basis using a new, untested Income Based Repayment (IBR) program, or have their loans enter forbearance, adding thousands of dollars of interest to their student loan debts, Dr. Rao said.

AAPI has urged Members of Congress to cosponsor the "Medical Economic Deferment for Students (MEDS) Act," H.R. 1615 and S. 646, to ensure continuation of the 20/220 program. International Medical Graduates (IMGs) comprise more than 20 percent of incoming residents in the US and outnumber US medical graduates by a 3:1 ratio in rural, underserved areas. Many highly skilled Indian physicians successfully use the J-1 visa to practice medicine in underserved areas across the US.

 AAPI supports initiatives that protect Medicare and Medicaid physician reimbursements while eliminating unnecessary medical costs. These reimbursements are in constant jeopardy of being reduced, adversely affecting doctors and hindering physician-accessibility for patients.

On any given day, there are 125,000 lawsuits pending against physicians. In 2005, the Physician Insurers Association of America (PIAA) found that 75 percent of medical liability claims were closed without any payment to the plaintiff. Only 7 percent of cases went to trial, and in those, physicians prevailed 83 percent of the time but incurred nearly $100,000 in legal costs.

According to the Centers for Medicare and Medicaid Services, medical malpractice insurance premiums paid by physicians rose 15 percent over just two years. Such steep insurance premium rises fosters an unhealthy environment of "defensive medicine," where health care costs are inflated by unnecessary tests and defensive spending.