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A physician's view from the Hill.

The Robert Wood Johnson (RWJ) Health Policy Fellowship is a one-year program designed for promising mid-career health professionals in academic and community-based settings. Individuals are selected who have exhibited the capacity and potential to assume leadership roles in health policy and management. The program began in 1973, funded by the Robert Wood Johnson Foundation and conducted by the Institute of Medicine of the National Academy of Sciences. Six Fellows are selected each year to participate in an eight- to 10-week orientation process followed by full-time work assignments in the administration or on Capital Hill.

The application and selection process of the Fellows is nonpolitical. Individuals chosen are usually midcareer in the age range of 38 to 55; however, there are no explicit age criteria. Appropriate candidates are nominated by their sponsoring academic or community-based institution, with the expectation that they will return upon program completion.

I applied for the Fellowship to complement my clinical and administrative background with health policy. I viewed it as primarily a leadership training program, as well as a vehicle to build credibility in the health policy arena. This was an opportunity to gain a unique hands-on experience at the highest levels of our government and expand the range of my expertise and, most likely over the long term, aide in my continued involvement in federal and local health policy.

When I received the letter that I had been accepted as a Fellow, I knew this would have a major impact on my career. I was nominated by two very different organizations, a private not-for-profit hospital and an academic health center. The latter, my academic appointment and the former where much of my clinical practice was generated. Before starting the Fellowship, I transferred my clinical practice to other capable physicians and set out for a totally different experience.


The orientation phase was filled with a rush of excitement and the anticipation of participating in the policy process, or at least meeting the people who were. The daily schedule for the briefings initially did not seem as compact as I had expected. Our Program Director, Marion Lewin, however, warned us that our days would be filled with mountains of information we would have to absorb, accompanied by plenty of reading material to take home.

The individuals we met were awe-inspiring--White House advisors, officials from the Congressional Budget Office and the Office of Management and Budget, representatives from think tanks and associations, lobbyists, and congressional commitee staffs. I was impressed with the. range of health policy information they provided. I, like the rest of the Fellows, was excited about the prospect of some type of comprehensive federal health care reform. We believed that we would be present for the tail end of this legislative effort, and certainly for its implementation.

Over the course of the first few weeks, our optimism for radical change began to fade as we realized that the efforts of the "mainstream group" were too little, too late. There was a sense of remorse, disappointment and, to many we met, bitter failure. This overshadowed the orientation briefings, especially with the policy people. Some were battle weary, others disillusioned and frustrated. Many were cynical, feeling that they had been through this legislative dance before. That is not to say that the briefings were lacking in quality, quite the contrary.

Early on, we were told that the orientation phase was a distinct part of the Fellowship, and we should not overly concern ourselves with the prospect of finding a place to work on the Hill. But the Fellows did not hesitate to ask for guidance at almost every opportunity with naive anticipation. The advice, while well intentioned, was all over the map and, in retrospect, only added to my confusion in finding the "best" place to work. Helpful hints included: on the "House side," opt to work for a committee, and on the "Senate side," work for a member; and work for the majority, since they will control the course of the legislation, while the minority will merely be in the role of responding. We were told to take our time in the selection process, and we always had the option of changing our mind.

The second part of the orientation phase was with the American Political Science Association (APSA) Congressional Fellows. The emphasis of the APSA briefings was more general but equally as interesting. This was a significantly larger group of Fellows, and, by necessity, the setting was not as intimate. It was also a clear advantage for the RWJ Fellows to have been together. We were already more savvy about the political process, and at least we could identify the buildings on the House and Senate side, not to mention most of the national monuments. Toward the end of the APSA briefings, the scheduling of appointments for Capital Hill assignments began.

Finding a Hill assignment

We had agreed that only one Fellow would be assigned to any particular office so we could share our collective experiences. After gathering advice from previous Fellows, colleagues, and people we met at briefings, I set out on my journey to find an assignment. It was easier than I had imagined, since the RWJ Fellowship Program had already scheduled meetings with many of the offices in which we were interested. Most of the people we met had already worked with Fellows.

The Senate committees, such as Finance. Judiciary and Labor, and Human Resources were anxious to bring on new staff with the postelection change of majority. The House side was just as enthusiastic, but they were disorganized because of the dramatic results of the congressional elections. I did meet with a House Democrat of the Ways and Means Committee right after the election, and he said their prospects for bringing on someone new were rather slim. As I left, he handed me his CV and whispered that if I heard of anything, I should keep him in mind. I scheduled follow-up meetings with Senators Daschle, Hatch, Packwood, Kassebaum, Dole, and Bradley.

I narrowed my choices down to the new Senate majority. I believed that the Republicans would be initiating legislation and the Democrats would be either responding to it or not in the game. I focused on the major committees of health policy jurisdiction: Finance, Labor, and Judiciary, as well as the Office of the Majority Leader. After observing the highly structured levels of authority and anticipating little, if any, "face-time" with the Senator, I eliminated the Office of the Majority Leader from consideration. Despite my interest in the Senate Finance Committee, especially with its jurisdiction of Medicare and Medicaid, I ruled it out because of the professional and personal indiscretions of its Chairman.

I selected the Senate Judiciary Committee for several reasons. My interest in vertically integrated health systems, mergers, and acquisitions fit with the committee's federal antitrust jurisdiction. Additionally, Senator Orrin Hatch, the Chairman of the committee, was a member of the Senate Finance Committee and former Chairman of the Labor and Human Resources Committee, which fit nicely with my interest in Medicare and Medicaid legislation.

The work assignment experience

Working with Senator Hatch and the Senate Judiciary Committee was an excellent choice. Hatch--a great supporter of the Fellowship--and his staff were quick to give me as much responsibly and work as I could handle, and then some. I was readily accepted as part of the team. I found that I did not just take up desk space. The acquisition of a physician added more credibility to many of the health policy issues for which the Senator was responsible.

My general job description was to do anything that needed to be done and to put out fires. This involved extensive writing assignments, including speeches, policy statements, briefing memos, case work, and constituent letters. I spent a lot of time with the Senator and often accompanied him when he gave health policy speeches, press conferences, legislative policy meetings, and meetings with interest groups and constituents. In his absence, I even gave a few speeches to industry groups and associations. To this day, I often wonder if the people in the back of the room knew I had taken his place.

It was fascinating to watch the political process from the "inside" as a Senate staffer, even though I was afforded no special privileges. In fact, I made it a point not to emphasize to my colleagues or members that I was a physician unless it was related to a pertinent issue. The amount of information and resources available from the Senator's office is incredible. In addition to the Congressional Research Service and Senate Library, I made it a point to get first crack at the health staff office mail. It seemed that everyone, including think tanks, lobbyists, and foundations, wanted to share their policy views and reports. The difficulty was sifting through all of the material in a timely manner.

In summary, the RWJ Fellowship has been one of the best professional experiences of my, albeit young, medical career. The education, skills, and networking I obtained will be a fine complement to my clinical, management, and finance background. My concept of the political process and the system are forever changed. Contrary to conventional wisdom, the members and their respective staff are dedicated and work incredibly long hours comparable to any profession, including that of medicine. More importantly, aside from the technical skills gained, it was the communication skills--working with people from different socioeconomic and cultural backgrounds and understanding their needs--that I found most valuable. And this, of course, is not unlike what we are called upon to do as physicians when treating our patients.

RELATED ARTICLE: The Power of the Constituent

It never ceased to amaze me, the power of the constituent. Each day, Senator Hatch received literally bags of mail. Letters from constituents were a priority and were always answered. With rare exception, if a constituent was persistent enough, he or she could arrange an appointment to meet with the Senator or at the very least an appropriate staff members. The Senator wanted to please his constituents above all since ultimately they were responsible for his presence. It was interesting to watch as individuals outside of Congress attempted to influence the process. Some of the mistakes made included:

* By passing the member's staff.

* Not doing their homework on the particular issue.

* Not knowing the voting history of the member or hiss general philosophy.

* Not calling the staff member before a meeting to brief the him/her on the subject to be discussed.

* Not being a constituent or at least a registered voter.

* Attempting to convey more than one or two issues or not clearly articulating a complicated issue.

* Not articulating the purpose of the meeting.

* Reporting inaccurate information or not being totally honest.

* Not following up on an issue or otherwise not available for follow-up

* Arrogant, rude, or condescending behavior to the member or staff.

* Not getting as many constituents as possible to support the issue.

I was also as astonished at how ill-prepared some individuals were when meeting with a senator, representative, or their respective staff member. It is important to articulate the issue as concisely as possible to the member and describe how it will affect his/her constituents. Get to know the name of the staff members who will be working on your particular issue. Often, it is that person who can get keep you abreast of pertinent legislation.

Be courteous to the office staff, because they may be instrumental in furthering your particular legislative issue. So often, individuals would come to the Hill to meet with one of the members and totally disregard the staff, foregoing a valuable resource. If there is a take home message, it is do your homework and never underestimate the knowledge and influence of the staff.

Philip Jordan Marion, MD, MS, MPH, recently completed the 1994/95 Robert Wood Johnson Health Policy Fellowship. Dr. Marion is starting a health services management company in Washington, D.C. and can be reached by calling 202/726-1873 or via fax ar 202/291-4695. Further information regarding the RWJ Health Policy Fellowship can be obtained from the IOM of the National Academy of Sciences in Washington, D.C. by calling 202/334-2169.
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Title Annotation:Robert Wood Johnson Health Policy Fellowship
Author:Marion, Philip Jordan
Publication:Physician Executive
Date:Jun 1, 1996
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