Advocacy in action

DO Day 2023 in review

This year’s DO Day discussions focused on three major issues: Protecting access to patient care through Medicare physician payment reform, expansion of graduate medical education funding through the THCGME program and encouraging student loan reform.


On April 20, 2023, over 350 osteopathic students and physicians gathered in Washington, DC, for the AOA’s DO Day. These osteopathic students and physicians represented 43 states and met with 197 representatives and 88 senators, for a grand total of 285 Congressional meetings. 

The discussions with staff and, in some instances, the members of Congress were fruitful in many ways. In-person meetings help develop relationships, keep health care topics on lawmakers’ radars and bring a level of relatability as we are people who not only serve the communities in our clinical roles but also live and thrive in the districts they represent.

During these meetings, bipartisan discussion among the advocates and Congressional offices focused on three major issues: protecting access to patient care through Medicare physician payment reform, expansion of graduate medical education funding through the Teaching Health Center Graduate Medical Education (THCGME) program and encouraging student loan reform to bolster the physician workforce in places that need it the most.

My colleague Aerial Petty, DO, has already expertly written on THCGME, so I intend to focus on the other two topics that were addressed during DO Day 2023.

Physicians and medical students met on Capitol Hill to represent DOs during Congressional meetings.

Encouraging student loan reform

Student loans are skyrocketing, with no end in sight. Interest rates loom over trainees who work long hours yet have comparatively low take-home pay. Higher-paying specialties seem more appealing to students genuinely interested in a primary care specialty or a rural area. Yet they know the truth – it is immensely difficult to face student loan repayments as a physician due to the typically high loans required to attend school. It is said that on average, a U.S. medical school graduate may have approximately $200,000 in debt.

Before even taking that leap, pre-medical students may hesitate to attend medical school with the fear of added financial burden, particularly if they already had prior student loans. Deterring potential future physicians from the practice of medicine simply due to the cost of education could be detrimental to the creation and retention of more primary care physicians in resource-poor locations.

The Resident Education Deferred Interest (REDI) Act is a start in the right direction toward positive student loan reform. Currently, postdoctoral trainees can defer student loan payments during training, but interest would still accrue. This bill would allow physicians in training to defer student loan payments without accrual of interest during this lower-income time period. 

Establishing stable physician payments

Though Medicare physician payment (and physician payment via health insurance in general) is quite complex, one issue remains the same: concern for payment cuts. Inflation, overhead and staffing costs continue to rise for physician offices and health care systems but without an appropriate pay increase when it comes to delivering care. For many smaller practices or resource-poor locations, this may lead to closures due to increased expenses and relatively low Medicare payment rates. Closures of health care facilities hamper access to care, and this becomes an even bigger problem.

The Strengthening Medicare for Patients and Providers Act aims to establish stable, annual payment updates to the Medicare Physician Fee Schedule based on the Medicare Economic Index (MEI), which is a specialized index used to determine allowed charges for various physician services by average annual prices. Between 2010 and 2022, the MEI increased by nearly 24%, yet physician payment only increased by 6%. Using this as a guide would ensure adequate payment to physicians to maintain their offices and continue to see patients, particularly where the need is greatest.

The next DO Day will take place in April 2024.

Back together

It was wonderful to have the in-person Congressional meetings again, and to be quite literally at the table with our Representatives, Senators and their staffers.

Before the crew departed for the morning’s meetings, we gathered for a group photo in the lobby of the hotel.

Don’t you wish you were there?  

Well, save the date! The next DO Day will take place with virtual conferencing on April 13-14, 2024, and in-person conferencing and Congressional meetings on April 17-18, 2024.

I’ll see you there!

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

The DO Day experience: Why advocacy means so much as a physician

The extinct X-waiver: What every DO should know about the future of opioid use disorder management

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