Internships on the Hill Illustrate the Importance of Pharmacy Advocacy

Ms. Adams and Mr. Hinkle are both PharmD Candidates at the University of North Carolina, Chapel Hill.

Why should pharmacistscare about policyand how it ismade? This is a questionand topic that intimidates manypharmacists. All sorts of questionsbegin to ferment in one?s mind, especiallythe question of where to begin.The fight for sound and fair pharmacylegislation is not an easy one, buta better understanding of the processis a good start.

Lisa Adams on the east steps of the Capitol building.

The influence of the federal governmentis ubiquitously connected withevery aspect of pharmacy practice.As a result, the daily act of providingpatient care is subject to whimsicalchanges at any given moment.Changes in government-implementedhealth care policy are the ?hotbutton? subject of countless dailydiscussions, testimonies, campaigndebates, and briefings on the Hilland around the nation. The Associationof Community Pharmacists(ACP), a national independent pharmacygrassroots organization basedin North Carolina, spearheaded thecreation of an internship upon realizingthat their influence in Congresswas much greater when congressionalstaffers were knowledgeable aboutpharmacy issues. Officials from theACP felt that final-year pharmacystudents would be perfect candidatesfor working in the offices of theNorth Carolina congressional delegation,as they would have knowledgeof health care, pharmacy issues,and would gain an insider?s perspectiveof how Capitol Hill operates.Working with the North CarolinaAssociation of Pharmacists (NCAP),ACP brought the idea to the schoolsof pharmacy at the University ofNorth Carolina (UNC) at ChapelHill and Campbell University. Seeingthe immense opportunity andthe need for pharmacist involvementin health care policy, both schoolsagreed and teamed up with ACPand NCAP to facilitate a 2-monthclerkship for fourth-year PharmDstudents, allowing them to work asintern-fellows in congressional officeson Capitol Hill. ACP, NCAP, andboth universities agreed that havingstudents participate in this uniqueexperience would foster professionalresponsibility and political action,thereby furthering the pharmacist?srole in national health care.

Imagine, as a pharmacist (or futurepharmacist), walking through thehistoric Capitol building on yourway to work every day. You proceedthrough the labyrinth of tunnels andsubway cars, frequently getting lost atfirst, until you arrive at your office,where you have a stack of ?DearColleagues,? 4 newspapers, and aninbox that is bursting at the seams.Such is a typical morning for the first2 UNC pharmacy students to internin congressional offices of the NorthCarolina delegation.

Jordan Hinkle, Lisa Adams, and Rep Brad Miller (D, NC)

We were the first 2 students chosenfor the 2-month congressional electiverotation. During October andNovember, we worked in the officesof Reps Bob Etheridge (D, NC) of Lillington,North Carolina, and DavidPrice (D, NC) of Chapel Hill, NorthCarolina. We did give some tours ofthe Capitol building and took somephone calls like many Hill internsdo, but much of the work that we didinvolved looking at new legislativebills and determining whether ourcongressman should cosponsor thebill or how they should vote when itgets to the House floor. This processwas anything but simple. Often, thecosponsorship requests or the pleasfor votes on legislation come in theform of ?Dear Colleagues? or constituentmail. ?Dear Colleagues? are1-page documents sent out by sponsoringmembers of a bill in search ofmore supporters and are an informativeway of helping the legislativeassistants (LAs) to gather usefulinformation about a bill.

In looking at new legislation, wehad to take into account how ourcongressman would likely feel aboutthe issue based on their voting history,what the proposed bill actuallymeant from an operational standpoint,and how much it would costtaxpayers. Another thing to take intoconsideration was whether somethinglike it was already on the books,but simply was not being enforced.Once we gathered all the informationabout a bill, it was time to make adecision. The LA, legislative director,chief of staff, and congressman eachprovided their recommendation onwhat action the office should take onthe bill.

Despite all the research our positionsentailed, we certainly did notspend too many of our days insidethe office. The most exciting thingwe saw outside the office was theHouse Judiciary Committee meetingon HR 971, a bill that would allowindependent pharmacies to negotiateon third-party contracts through anexemption of federal antitrust laws.A few weeks later, the bill was scheduledfor a markup by the committee,passed with few changes, and nowawaits scoring from the CongressionalBudget Office. We also attendedmany briefings to learn about varioushealth policy issues.

When we were not in briefings, wespent considerable time respondingto constituent letters and reviewingtheir opinions on legislation. Thisprocess involves looking at how constituentconcerns related to how thecongressman felt about a particularissue, the history of the issue, andreasoning behind the congressman?sopposition or advocacy of the issue.Each letter must be carefully craftedto include empathy, backgroundon the issue at hand, and how thecongressman will consider the issuegoing forward.

What we learned in our short stinton the Hill will forever be impressedupon us. We know much more aboutnot only the legislative process, butwhat our elected officials do to seethat they look out for those whodepend on them. We saw how theywere hardly ever in the office, as theyare on a relentless merry-go-roundof hearings, briefings, receptions forcolleagues or organizations, debatinga bill on the House floor, or voting.We learned that the term ?networking?is really all about making andfostering relationships.

Relationships are a crucial piece ofhow things get accomplished regardlessof whether you are working in acommunity store, protesting on thestreet corner, or serving in Congress.As our profession continues to evolveand seeks more recognition for theservices we can provide, we will needto be more involved in the politicallandscape on the federal and locallevels. It is imperative for all of us tounderstand where candidates standon the issues that will directly impactour profession, especially those candidateswho are seeking a new seator re-election in the fall of 2008. Wefirmly believe that experiences likethis are going to be instrumental inproviding future pharmacists with apolitically oriented knowledge baseto rely on for years to come.

So how does all this relate toyou? Your practice is changing, willchange, or can change at the handsof the local, state, or federal government,and you have a voice. If you donot know who your representative isin Washington, then find out (www.house.gov), and invite him or herto visit your practice site and relaythe impact their actions on the Hillhave on the patients you care foron a daily basis. We also urge youto contact your congressman andset up a time to sit down with themor their health LA to discuss theissues that are important to you andyour pharmacy. If you cannot get toWashington, then try to get themwhen they come back to the district.We must do this for our patients andour profession.