Once a year podiatrists and podiatric medical students from across California meet in Sacramento in order to learn about and support bills that will change the way podiatrists’ practice medicine. This is a short synopsis of our experience and a peek into what it takes to change California law.
During our didactic years, we rarely think about how our scope of medical practice is influenced by federal and state government. However, the federal and state laws define how we can treat patients, what type of licensing is required to practice, and how much we are paid for procedures. Any change to the scope of medical practice requires lawmaker involvement.
During our experience at the Legislative Leadership Conference (LLC), we quickly learned that it doesn’t take extensive training to impact which laws are passed. Legislators are often learning about the issues and concerns of the public through relationships with active community members lobbying at the capitol. Lobbying often has a bad connotation but, in most cases, it is used to inform legislators about the issues that the community faces. Our job at the LLC was to provide a student’s perspective on the current bills and learn about why getting involved is so important.
What is the LLC?
The Legislative Leadership Conference, hosted by the California Podiatric Medical Association (CPMA), is a grassroots effort to advocate for the podiatric profession & patients. It is a one-day conference split between listening to committee leaders and Assemblymen and visiting the capitol. During our visit, we learned about the current bills we would be supporting and how they will impact our practice. We also met practicing podiatrists from across California and students at the Northern California podiatric medical program California School of Podiatric Medicine (CSPM). We ended the day by visiting the capitol building to personally speak with Assemblymen and Senators and meeting as a group one last time to debrief.
Each state in the US has a chapter or organization which advocates for podiatrists and their patients. CPMA advocates for the specialty of podiatric medicine and the public health of the people of California which includes doctors of podiatric medicine and their patients. CMPA works with legislators, state officials, doctors, hospitals, and community leaders to ensure that access to podiatric care is available to all Californians. It is through events like the LLC that CPMA works directly with students to engage in these goals.
This year the LLC focused on supporting two bills: AB407 and AB678. These bills were drafted in the Assembly to address fluoroscopy licensing requirements and the inclusion of podiatric services in the MediCal program. Bill AB407 is important for updating licensing requirements for all physicians including doctors of podiatric medicine. The current law requires any physician practicing in California who operates a fluoroscopy machine to pass an exam that requires considerable knowledge of physics. The exam, originally created in the 60’s, was supposed to make sure that physicians were competent enough to safely handle & calibrate the machines. There is no more need to manually calibrate these machines with modern advances in technology. The exam takes away valuable time that could be spent seeing patients because, in most cases, it takes ~6 months to study for and take the exam. Additionally, most hospitals already require physicians to be certified according to their standards. Bill AB407 would remove the redundancy of taking two exams that both fulfill the same purpose.
Bill AB678 deals with access to care and removing some of the obstacles podiatrists face while trying to care for patients insured by MediCal. Patients on non-managed care MediCal often require pre-authorization, or a referral from their PCP, in order to be treated by a podiatrist even though the same procedure could be done by an orthopedist without pre-authorization. Patients are also allowed only two visits a month with certain providers. This prevents podiatrists from administering immediate care and increases the overall treatment time. Podiatrists are required to attain authorization in order to bill for any service they provide to MediCal patients. In many cases, podiatrists end up caring for their patients for free due to the restricted billing process. Bill AB678 would remove the prior authorization needed for treatment as well as simplify the billing process.
Our visit to the Capitol Building
Entering the capitol was a bit intimidating as you are directed by security guards to pass through metal detectors, much like airport security. The building is distinctly divided into a “historic” wing, beaming with neoclassical architecture, and a “new” wing which is known for its lackluster ambiance. What stands out the most, is the number and variety of community members swiftly moving through the halls.
This is where the real work begins. Each podiatrist was paired with one or two students and scheduled to meet with an Assemblyman or Senator to share their expertise and the importance of our two bills. The meetings were brief, so we are prepared with a short script and a designated speaker, which CPMA had organized. Some students even had the opportunity to meet with the chair of the appropriations committee. The appropriations committee manages the financial aspects of every bill, so it was considered a very important meeting. A few lucky students were invited to enter the Senate chamber where Senators officially discuss and vote on the legislature.
We learned that lobbying is sometimes a thankless job as Senators are often unavailable and meetings are sometimes conducted in the entrance-way by staff. Furthermore, some Senators may not connect to the issues you present or find other issues more pressing. It is continual effort like this that educates our legislators on issues we care about and how we can create a more personal connection with them.
What it takes to pass a bill
Changing California law starts with an idea from constituents (voting community members), large organizations, or government member’s themselves. The author of a bill is deemed the legislator and they are a member of one house within the California State Legislature, either the Senate or the Assembly. There are several checkpoints along the journey to becoming a fully enacted bill. After being drafted in the Legislative Counsel, a bill will be introduced, undergo committee hearings, and be read two more times in front of the house of origin before it is voted on. If a majority vote in favor of the bill, then it is passed to the other house (the Senate or the Assembly) where the procedure is repeated. If the majority of both houses vote in favor of the bill, then it is passed on to the Governor, where he or she can sign the bill into law or veto it. Most bills are “killed” as they move through this process because there are often opposing parties that do not agree with the views of the people it will positively impact.
Why do we care?
Being involved outside of the classroom and outside of our institution is so important because it brings a new perspective to our studies. After attending the LLC, we realize how many people are involved in the process of amending the law and why this process takes so much time. Just last year, AB1153 was passed thanks to the help of Assemblyman Evan Low. This was a triumph for all podiatrists’ as it expanded our scope of practice to include treating leg ulcers in the state of California but this process took several years. CPMA and the dedicated podiatrists at the LLC are at the forefront of making these changes, but the future of podiatry is up to us. As medicine evolves we must stay informed and support those who are willing to put in the hard work which allows us to practice legally & safely. As bright-eyed students, we have so much to learn and we hope that more students take the time to get involved in the local & national level.
WesternU students: (back row) Quinton Wong, Travis Rich, Brodie Collins, Miguel Ruiz, Garrett Wiremen, (middle row) Dy Chin, Imran Peer, Kira Cramer, Faiza Zahid, Anthony Wright, Kaitlyn Flavin, (bottom row) Eduardo Glass, Jeffrey Sanker, Parth Patel
LLC Members 2019
On behalf of the students from WesternU, we would like to thank CPMA and the podiatrists who helped plan this event and created an opportunity for student involvement. We would also like to thank our Assemblymembers, Senators, and all of the people at our Capitol for the hard work they put in.
For more information on the current state of podiatric law please see the following links:
California Podiatric Medical Association
www.podiatrists.org
California Legislative Information
Bill AB407
Author: Assemblymember Miguel Santiago
Amendment: To allow physicians, surgeons, and doctors of podiatric medicine to provide fluoroscopy services without a fluoroscopy permit.
Bill AB678
Author: Assemblymember Heath Flora
Amendment: To reinstate treatment performed by a podiatrist in the Medi-Cal system and eliminate the unnecessary authorization.
REFERENCES
California Healthline (2016). California Capitol Building. [image] Available at: https://californiahealthline.org/news/last-minute-deal-may-resolve-dispute-over-managed-care-tax-in-california/california-capitol-building/.
“Legislative Process.” Legislative Process, www.senate.ca.gov/legislativeprocess.
“Who We Are.” California Podiatric Medical Association, www.podiatrists.org/aboutcpma/who-we-are.
Photographs 2, 3, and 4 by Randy Licht
ARTICLE WRITTEN BY KIRA CRAMER & SHANE SATO
