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Saving Medicare for future generations is high on the list of priorities for Ami Bera, MD, the winner of a hotly contested race in California's 7th Congressional District. Dr. Bera wants more physicians to become involved in national and local advocacy. Doctors “should not just be at the table, they should be sitting at the head of the table.” Photo by AP / Wide World Photos

New physician faces in Congress

The freshmen doctors in the House are first-generation Americans who say the same factors that pushed them into medicine also led them to public service.

By Tanya Albert Henry — Posted Jan. 7, 2013

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The 113th Congress has begun with the same number of physician lawmakers as the previous Congress: 20. But there are two new faces in that contingent on Capitol Hill — both Democrats.

That shift doubles the number of Democrats in the House of Representatives who place MDs after their names. In addition to the four Democratic physicians in the House, 13 Republican physicians serve in the House, and three GOP physicians serve in the Senate.

There are several similarities between the two newly elected physicians. Rep. Ami Bera, MD, and Rep. Raul Ruiz, MD, MPP, MPH, both hail from California. Both are sons of immigrants. And while both are passionate about health care issues, they also want to work to improve education and the health of the overall U.S. economy.

American Medical News spoke with the congressmen-elect as they prepared for their freshman year in office.

Ami Bera, MD (California's 7th Congressional District)

From a young age, Dr. Bera loved working with people and wanted to go into a profession where he could help others. When he was an undergraduate, he did some volunteer work in medicine and found that area really clicked for him.

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Raul Ruiz, MD, MPP, MPH, is the first Hispanic to earn three graduate degrees from Harvard University. He plans to focus on education issues as well as health care policy during his first term in the 113th Congress. “My life story was created because of the opportunity I had through education.” Photo courtesy of Raul Ruiz, MD

After graduating from the School of Medicine at the University of California, Irvine, he completed a residency in internal medicine in San Francisco before moving to the Sacramento area, where he eventually became the county's chief medical officer. Since then, he has worked as a clinical professor and administrator at University of California, Davis School of Medicine.

His desire to run for Congress, he said, grew out of the same set of values a doctor has: “As a physician, you are in a unique position to help people. As a congressman, you are given an incredible honor to help people. It is another way to serve.” He defeated Rep. Dan Lungren (R) after losing to the congressman in the 2010 general election.

Dr. Bera said his time as the top doctor in Sacramento County helped him prepare for the new responsibilities he takes on in Congress, such as finding ways to improve efficiencies in the health system without reducing access to care. He and his team in Sacramento County worked to create public and private alliances to meet the county residents' health care needs. They also looked at improving patient care and lowering spending by helping patients obtain care in more appropriate places than the emergency department.

In Sacramento County, “we always faced doing more with less. … At the national level, we face that same challenge,” Dr. Bera said.

As the nation moves toward implementing the Affordable Care Act, Dr. Bera said patients need to be the focus. “The ACA is not the legislation I would have written, but let's take that framework and start addressing cost of care.”

For example, he said, ED overuse needs to be addressed by directing those patients to more appropriate care settings. He sees the ACA's support of prevention as beneficial.

DID YOU KNOW:
17 physicians are in the new U.S. House of Representatives: 13 Republicans and 4 Democrats.

“Lets shift to preventive care,” Dr. Bera said. “It is good medicine — good for the patient, and it also reduces costs in the long run.”

Some other big health care questions that he says need to be tackled include making sure the nation has enough doctors and addressing their training. It is important for physicians to get engaged in transforming medicine over the next decade, he said.

“They should not just be at the table, they should be sitting at the head of the table,” he said. “It is not necessarily running for office. But it is supporting your professional organization. It is going to city council meetings. This is a time for us as a profession to be involved.”

In addition to tackling health care issues, Dr. Bera also wants to improve the economy and give Americans the sense of middle-class fairness. His parents immigrated to the United States from India without much money. His mother became a public school teacher, and his father an engineer.

“They always instilled in us the privilege of what we had and the opportunities that we had,” he said. “We should strive to restore that sense of opportunity for others — the promise that if they work hard, they can move up the ladder.”

One key part of enabling that mobility is improving the education system to give children a chance to compete in the global economy, he said. “Education played an important role in my life, and we need to make sure we have a strong education system that invests in the future of our society.”

Dr. Bera also wants to move Washington beyond the impasse that has stymied so many accomplishments in recent years. He said elected officials shouldn't compromise on their values, but “the public expects the parties to work together and find areas where they can agree and compromise to get things done.”

He said his experience as a physician will help when it comes to being part of the solution.

“We are trained as physicians to listen to patients and work with them and help them. In many ways, that is the same with constituents,” Dr. Bera said. “What constituents want right now is someone who is going to listen to their needs and work for them.”

Raul Ruiz, MD, MPP, MPH (California's 36th Congressional District)

Even as a 4-year-old, Dr. Ruiz knew he wanted to help people.

The son of immigrant Mexican farmworkers in California's Coachella Valley, he witnessed his mother helping people in the community. When he asked her what he could do to help people when he grew up, she told him to become a doctor.

When the time came to get the education to pursue that dream, he went from business to business in the valley, asking owners to invest in their community by investing in his education. He raised thousands of dollars and promised he would be back.

After earning his medical degree, master's in public health and master's in public policy from Harvard University in Boston, Dr. Ruiz kept his promise and returned to the valley as an emergency physician in 2007.

“My upbringing really pushed me to become a physician, and becoming a physician pushed me to become a congressman,” he said.

Dr. Ruiz used his master's degrees to found and direct the Coachella Valley Healthcare Initiative, a program to improve access to health care in the area. The grassroots effort used forums to bring together people from all over the region to talk about health care access issues and possible solutions. The plan they developed is being implemented, and funding is being sought.

“I want to be a catalyst for these things to happen at the federal level,” Dr. Ruiz said. “I want to look at how we can improve health care access around the country.”

The Affordable Care Act is just a start to improving health care in the U.S., Dr. Ruiz said. “We need to figure out what will work and what won't work in it and continue to improve upon it.”

Physician shortages are one big issue that will need to be tackled if Americans are going to have access to care, he said. It is a pressing problem in primary care and in rural areas such as his district, where he said there is one doctor per 9,000 residents.

“The recommendations are that there should be one doctor to 1,000 to 2,000 people. So we can lower costs and improve upon the number of people that have service, but who are they going to see? We need to take the next step in training more physicians,” he said.

Figuring out how to strengthen Medicare and make it sustainable also is high on Dr. Ruiz's health care agenda. He said the government should allow Medicare officials to negotiate lower drug prices. “By lowering health care costs, we strengthen and preserve programs like Medicare.”

Energy policy, the economy and education are other issues Dr. Ruiz hopes to tackle in Washington. He wants to expand wind, solar and geothermal energy, so the U.S. is less reliant on foreign oil. During his campaign against Rep. Mary Bono Mack (R), Dr. Ruiz said Congress needs to take actions to restore consumer spending, such as a payroll tax cut that would amount to more than $1,000 for each working family.

Education is a particular area of interest for Dr. Ruiz. “My life story was created because of the opportunity I had through education,” he said. He said many schools are behind the times technologically because they aren't connected with the Internet, and they lack other technological resources to compete nationally and globally.

He hopes his training and experience as a physician can help break the congressional gridlock with which the American people have grown so frustrated.

“As an ER doctor, I don't ask anyone if they are a Republican or a Democrat,” Dr. Ruiz said. “I work with a team to talk to patients about their problems and figure out solutions. That is what we need in Congress — we need people to cooperate and find common ground and solutions.”

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ADDITIONAL INFORMATION

Veteran physicians on Hill offer newcomers advice

With health system reform implementation as well as health access and cost issues front and center in Washington in 2013, veteran physician lawmakers said having two new doctors in the House will be a great asset to Congress.

The newly elected Reps. Raul Ruiz, MD, MPP, MPH (D, Calif.), and Ami Bera, MD (D, Calif.), have had recent experience on the front lines of medicine, said Rep. Jim McDermott, MD (D, Wash.), who has been serving in the House since 1989. They also have valuable administrative and regional health office experience, he said.

“As we are talking about ways to make changes in health care, it is nice to have someone who can put their hand up and say, 'It doesn't work that way,' ” said Dr. McDermott, a psychiatrist.

Physicians on the other side of the aisle said they plan to reach out to Drs. Ruiz and Bera. Rep. Phil Gingrey, MD (R, Ga.), who along with Rep. Phil Roe, MD (R, Tenn.), leads the GOP Doctors Caucus, said the two plan to talk to the incoming physicians about issues they can work on in a bipartisan way. Those issues might include medical liability reform, the Medicare Independent Payment Advisory Board and liability for physicians serving on health insurance exchange panels.

“I would bet these doctors would agree with us that there are similar concerns by doctors all over the country that we can address,” said Dr. Gingrey, an obstetrician-gynecologist elected to Congress in 2003.

Drs. McDermott and Gingrey had similar advice for Drs. Ruiz and Bera. Both lawmakers referenced what they learned in medical school when they were taught how to interact with patients: Listen more than you speak.

“The first thing a doctor does is take a patient's history. A physician needs to come to Washington and apply that same skill to the political process,” Dr. McDermott said. “We are making laws that affect 300 million people. We need to hear what is being said.”

Dr. McDermott also said it will be important for the newcomers to earn the trust of other lawmakers. “You don't trust a doctor because they have an MD after their name. You trust a doctor because you get to know him or her,” he said.

Dr. Gingrey said physicians' experience with long work days combined with their type-A personalities typically serve them well as they transition to being lawmakers. “We get up earlier and go to bed later than most in other professions,” he said. “It is a way of life that will make them very good members of Congress.”

— By Tanya Albert Henry

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Meet the doctors joining Congress

Raul Ruiz, MD, MPP, MPH

Hometown: Palm Desert, Calif.

Education: B.S., University of California, Los Angeles (1994); medical degree, Harvard Medical School, Boston (2001); master's in public policy, Harvard Kennedy School (2001); master's in public health, Harvard School of Public Health (2007)

Medical experience: General surgery intern, Beth Israel Deaconess Medical Center, Boston (2001-02); emergency medicine resident, University of Pittsburgh (2003-06); attending physician, Brigham and Women's Hospital, Boston (2006-07); emergency medicine physician, Eisenhower Medical Center, Rancho Mirage, Calif. (2007-present)

Ami Bera, MD

Hometown: Elk Grove, Calif.

Education: B.S., University of California, Irvine (1983); medical degree, University of California, Irvine, School of Medicine (1991)

Medical experience: Internal medicine intern, internal medicine resident, California Pacific Medical Center, San Francisco (1991-95); internal medicine physician, chief of internal medicine, assistant medical director, MedClinic Medical Group, Sacramento, Calif. (1995-99); medical director for care management, Mercy Healthcare Sacramento (1998-99); chief medical officer, Sacramento County Dept. of Health and Human Services (1999-2004); clinical professor of medicine, University of California, Davis, School of Medicine (2004-present)

Family: wife, Janine; daughter, Sydra

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20 physicians in the 113th Congress

With the retirement of Rep. Ron Paul, MD (R, Texas), and the election defeat of Rep. Nan Hayworth, MD (R, N.Y.), the election of two new Democratic physicians in Congress keeps the total number of doctors on Capitol Hill at 20.

House

Rep. Dan Benishek, MD (R, Mich.), general surgery
Rep. Ami Bera, MD (D, Calif.), internal medicine
Rep. Charles Boustany, MD (R, La.), cardiothoracic surgery
Rep. Paul Broun, MD (R, Ga.), family medicine
Rep. Larry Bucshon, MD (R, Ind.), thoracic surgery
Rep. Michael Burgess, MD (R, Texas), obstetrics-gynecology
Rep. Bill Cassidy, MD (R, La.), gastroenterology
Del. Donna Christensen, MD (D, V.I.), emergency medicine
Rep. Scott DesJarlais, MD (R, Tenn.), family medicine
Rep. John Fleming, MD (R, La.), family medicine
Rep. Phil Gingrey, MD (R, Ga.), obstetrics-gynecology
Rep. Andy Harris, MD (R, Md.), anesthesiology
Rep. Joe Heck, DO (R, Nev.), emergency medicine
Rep. Jim McDermott, MD (D, Wash.), psychiatry
Rep. Tom Price, MD (R, Ga.), orthopedic surgery
Rep. Phil Roe, MD (R, Tenn.), obstetrics-gynecology
Rep. Raul Ruiz, MD (D, Calif.), emergency medicine

Senate

Sen. John Barrasso, MD (R, Wyo.), orthopedic surgery
Sen. Tom Coburn, MD (R, Okla.), family medicine
Sen. Rand Paul, MD (R, Ky.), ophthalmology

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External links

Campaign website for Raul Ruiz, MD, MPP, MPH (link)

Campaign website for Ami Bera, MD (link)

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