Advocacy Matters: A Resident’s Perspective on the Midyear Forum
Dr. Harris Ahmed, DO, MPH
Resident Physician
Department of Ophthalmology
Loma Linda University Medical Center
Loma Linda, CA
We are really excited to interview Dr. Harris Ahmed where we discuss the current landscape of policy and advocacy in ophthalmology. Dr. Harris Ahmed is currently completing his residency training in Ophthalmology at Loma Linda University. He completed his undergraduate education at the University of California at Irvine in 2014 with a bachelor’s degree in Sociology. He then completed a Master’s degree in Public Health at the University of Southern California in Los Angeles in 2016, whereafter he began his medical education at Burrell College.
Editor: Zoha Mian, BS
Tell us a little bit about yourself.
I was born and raised in Southern California. I have a wife and two children that keep me busy and with purpose. I am a huge Lakers, Dodgers, Rams and USC fan.
What motivated you to get involved in policy and advocacy?
Could you share your background and experience in this field?
I’m the first in my family to attend college or beyond and as such mentorship is something I am passionate about. I was raised in the Inland Empire within California and saw firsthand issues that arise with disparities in access to equivalent standard of care (IE physician lead care) and became passionate about initially based on personal experiences. As a graduate student at USC I learned policy and advocacy formally and noticed that the physician voice was largely lacking in the policy realm. As an aspiring premed I made it a personal goal to represent the patient and physician perspectives in policy decisions and discourse locally, regionally and federally.
While doing the health policy fellowship during medical school, what was it like learning about policy from a student interested in a surgical subspecialty?
We recently published a paper that showed the significant activity and involvement of ophthalmologists in politics, which is a decent proxy to gauge policy involvement. As a field, ophthalmology is one of the more active societies in policy work. However, in the public health, legislative and healthcare realms the dealings, focus and discourse are largely focused on primary care and public health. As such, when completing my policy internship, I was in a unique position to include the surgical subspecialist perspective into discussions about healthcare in the United States.
For example, I examined physician supply in the US which is now published and argued then and now that the data shows the physician shortage is better characterized as a distribution issue. In some cities, counties, states or regions there is a surplus of primary care doctors and shortages of surgical specialists. Surgical subspecialists need to be part of loan forgiveness programs and our fields should also be targets of specialized GME programs such as Teaching Health Center Graduate Medical Education (THCGME). Surgical care is also critical and lack of access to surgical specialists is an issue that needs to be addressed.
What are some of the key challenges or issues currently facing the field of ophthalmology from a policy and advocacy perspective?
1. Reimbursement: Ophthalmology relies heavily on Medicare as most of its patient population is Medicare eligible. Medicare reimbursements have not followed inflation, and physician cuts loom yearly. Within the fixed Medicare “pie”, we are seeing a trend of surgical subspecialists continually being cut while primary care receives increases. The pie itself needs to be increased, rather than one specialty benefiting at the expense of another. HR 2474 is a critical bill that ties inflation to Medicare reimbursement and would help tremendously in being able to keep up with rising medical school debt and cost of practicing medicine (staff, machines, tools, etc.).
2. Scope of Practice: Nonphysician provider societies have made it a point of emphasis to become more profitable through increasing their scope, thereby doing more procedures even if they are not trained to do so. In our realm, organized Optometry has also attempted this, and have been successful in a few states. Optometrists are excellent, highly specialized and critical to eye care. However, their training and role is not in surgery, procedures or medical care Although the majority of Medicare beneficiaries are within 30 minutes of an ophthalmologist, organized Optometry argues there is a systematic nation-wide access crisis. This is problematic because this is not statistically or factually accurate. Additionally, in states that have passed increase scope for optometrists, they have not changed their practice pattern or locations in a meaningful way to provide care to patients needing increased access to eye care. Optometrists are still working in the major cities. Lastly, we reject the notion that resolving a physician shortage can be accomplished with nonphysician providers. If there is a pilot shortage, we will not have flight attendants start flying planes. While it takes eye surgeons (MD/DO) 12-14 years after High School to be able to perform procedures or surgeries on eyes, organized Optometry believes it is safe to do so after a weekend course. All patients, including lower socioeconomic patients, deserve physician led care. For example, the Federal Supremacy Project at the VA is potentially allowing optometrists to perform laser procedures they are not trained to perform on our nations veterans.
3. Step therapy, prior authorization, safely and effectively integrating artificial intelligence into tele retina screening, minimizing waste in ophthalmology, to name a few are other major topics.
In your opinion, what are the most pressing policy changes needed to improve access to quality eye care or address other critical issues in ophthalmology?
See above answers to question 3. We need to maintain high quality, safe and efficient physician led care for all patients, regardless of their background.
How does the mid-year forum facilitate this advocacy work?
Who can attend these?
The Mid-Year forum is an organized, efficient and effective platform that allows ophthalmology attendings, fellows, residents, and private practice doctors come together from across the country and meet systematically with legislators and staff to discuss targeted action items that directly impact patient care. For example, in the last Midyear forum, we focused on the VA Federal Supremacy Project, Pediatric Ophthalmology reimbursement, Medicare reimbursement and inflation (HR 2474) and other practical action items. I was sponsored to attend by the California Academy of Eye Physicians and Surgeons.
Can you describe a recent policy or advocacy campaign related to ophthalmology that you have been involved in?
In 2022, California nearly passed AB 2236, a bill that would allow Optometrists to perform certain laser eye surgeries and eye procedures. Due to a combined, systematic effort until the finish line, the proposal was vetoed by Governor Newsom on the grounds of patient safety.
What were the goals, strategies, and outcomes?
The goal was to use the legislative mediums at our disposal and legal processes to try and block the bill from passing at the Governor level despite being passed by the Senate. The goal was to disseminate talking point and communications to legislators in our locale in a sincere manner, and to do so swiftly. The outcome was that after hearing feedback from our organization, individuals, and most importantly patients the Governor decided to veto the bill.
How do you stay informed about the latest policy developments and changes in the field of ophthalmology?
Our Physician societies do a great job of sending weekly or biweekly emails with legislative or policy updates. I personally am subscribed to the AMA, AAO, ASRS and CAEPS.
How do trainees engage with policymakers and other stakeholders to influence policy decisions related to ophthalmology?
Can you provide examples of successful collaborations or advocacy efforts?
Trainees are often more effective and moving than attendings in policy meetings. Trainees are viewed as more innocent and “pure” and you will notice that in meetings with staff and legislators that they pay more attention to trainees. While in medical school I was able to help my medical school and state society pass a bill at the state level that would make medical students in the state eligible for more loan forgiveness for service. I created a task force, drafted talking points and had individuals call legislators on the committees in charge of the bill.
Are there any specific policy or regulatory barriers you have encountered while advocating for the field of ophthalmology?
I truly believe the biggest challenge or barrier is lack of activity or presence on the part of physicians. This trend is changing however and over the last few years I have noted subjectively an increase in physician presence and activity on the policy front as well as more physician society collaboration on common ground issues.
How have you worked to overcome these challenges?
By creating easier ways for people to be involved, a few Tweets can make a huge impact. An email or phone call to a legislator or staff can make a difference. Making involvement easier is a significant change. Advocacy involves background research, data collection, networking, financial contributions, and many other steps. There are many ways people can help.
What role can ophthalmologists play in shaping healthcare policies at the local, national, or international level? Any gaps?
A significant role in maintaining quality physician lead eye care and working on expanding successful mission trips. Being a voice for surgical subspecialists.
How can individual practitioners, trainees, or students contribute to policy and advocacy?
Google your state medical societies and email them, at minimum subscribe to their emails so you are aware of the relevant issues and then go from there.
Last words of advice before we end our interview!
Remember that the patient is the star of the show. We must advocate for their safety and protection and are in a unique position to do so. Do not become cynical, it is the easy way out. There are many examples of success (stopping scope bills in some states, reversing prior authorization for all cataract surgeries, stopping an anti VEGF injection yearly limit).
