Common Sense

An Interview with Congressman Dr. Michael Burgess (R-TX)


Issue: March/April 2022

Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM
President, AAEM

For this issue, it was my pleasure to interview Congressman Dr. Michael Burgess (R-TX), an obstetrician-gynecologist by training. Dr. Burgess’ bio follows.

LM: What factors contributed to your decision to run for public office?

MB: Actually, I never planned on this! I have always loved medicine. In my early 50s, like many doctors at that age, I began cutting down on practice. I was part of a group practice with six other physicians, and while I continued to take obstetrics call, I made the decision to have no OB patients of my own. I was very happy in the practice. In September 2001, I found myself in the operating room, doing a case with a urologist when the events of 9/11 started. The twin towers went down, and you know how that went: one tower is hit and you think it’s some horrible accident. The second tower is hit, and you know it’s terrorism. I immediately became concerned about my son, who was at the time in the Air Force and stationed in New Mexico. I was also concerned for a general surgery colleague who was in New York City at the time, taking a review course. When this surgeon came back, he told me about how the course was abruptly stopped, and the doctors were instructed to go to the lobby of the hotel. Details of the attack shortly became available, and the doctors were informed that a bus would arrive to take volunteers to Ground Zero to attend to the wounded. As I listened to my colleague speak, I had to honestly question whether I would have had the courage to get on that bus. At that point, I made myself a promise that “if a door opens, I will walk through it.”

Shortly thereafter I found out that Dick Army was going to retire. I asked myself, “Is this the door that has opened, and I am supposed to walk through it?” All over Texas, TV news anchors were asking, “Who is going to be next for the 26th District?” During this time, I often reflected on how my son was serving in the military, but what was I doing to serve the country. So, I went online and I learned that it’s actually very easy to register to run for Congress. The forms are not complicated to fill out, but to actually run? Well, it’s very difficult to actually run. In Texas, the winner must have 51% of the vote. I came in second in a race of several candidates so I had a four week run off with the number one candidate. Up until now, I had not had to restrict my medical practice. There was a three month wait for appointments with me, so I was continuing to honor the scheduled appointments. I easily won the primary since it was in a Republican District. Texas requires 90-day notice to patients before leaving a practice, so I sent a letter letting my patients know I was leaving the practice of medicine to serve in Congress. I expected them to continue their routine care with one of my partners, but almost all of them decided they wanted one last appointment with me. It was during these visits that I really became aware of the power that physicians have just in the care that we give patients every day. My patients share with me examples of how I had changed their lives. This wasn’t something I had previously thought about. It was a little like having your eulogy read and not having to die to hear it.

LM: It isn’t something we often think about, and yet we have this privilege of impacting people’s lives so profoundly.  I remember being in Walmart and having a young woman run up to me and tell me that she thinks about me every day when she puts her makeup on because I had sewn a laceration of her face. “You promised me I’d barely have a scar, and you were right!” she told me. But discussing the impact we have on patients, there are some very disturbing statistics related to our outcomes in OB/GYN. The US is arguably the richest nation in the world, and we spend more by far on health care per capita than any other nation, yet the US maternal mortality rate is 6.2 and the rates in PR and the US VI are 8.4 and 7.5.  As an OB/GYN, how do you make sense of this and what is the government's role in improving this critical metric?

MB: This is one of my major areas of focus. There are many OB health shortage areas in the United States. In 2018, I was the Chair of the Health Subcommittee of Energy and Commerce. Rep. Butler from Washington State had a bill that passed which outlined the structure on State Directed Maternal Mortality Review Committees. At that time, I recalled the maxim of an epidemiologist friend of mine, “A chance to measure is a chance to fix, but you can’t measure if people are afraid to tell you the truth.” So, we decided to keep trial lawyers out. This was not going to be an investigation. We would try to drill down on what happened in cases of maternal mortality, and what went wrong is usually multifactorial. We have had two hearings on this, one when Republicans were in charge and one when Democrats were in charge. The first case was from a hospital in California. The woman died in the recovery room less than 12 hours after a Caesarian section. When I reviewed the deposition, it seemed to me that any number of people should have realized that the new mother needed to go back to the OR. There were so many indications that she was hemorrhaging from a laceration to the uterine artery. It was a tough case for me to read as an OB. I asked myself, “How do I write legislation that mandates that doctors do the right thing—the thing that any reasonable doctor would have done.”

The second case was a Georgia patient who was herself a member of the public health service. According to the deposition, she went home from an appointment, came back, presented to the Emergency Department, saw different care givers at different levels of expertise, and despite a diastolic blood pressure of 118 mm/Hg, she was sent home to rest. Again, how can you legislate that doctors and other health care workers do the right thing?

Honestly, I think it comes down to training. Many people believe that race and ethnicity are factors in maternal mortality, and while the statistics bear that out, that’s not the way it has to be. I trained in Parkland. Parkland takes care of the highest risk obstetrical patients: Black and Brown, uninsured or underinsured, late to getting prenatal care, and yet Parkland has some of the best mortality statistics in the country. They have post-partum hemorrhage crash carts all over the place. And they have strict protocols about who does what. When a patient is crashing, everyone has a job to do, and they do it simultaneously. And then they have a debriefing. We know that even the best doctors have complications, but at Parkland, complications happen in a setting that is prepared to respond to the complications. You can’t tell me that it can’t be done. If you can do it at one of the hospitals where the highest risk OB patients in the nation are treated, you can do this anywhere.  It comes down to training. It comes down to being prepared for the complications.1

The Joint Commission has a role to play here. When they do an accreditation, we’re all familiar with their citations for dust on a shelf. Why are they worried about that? OB units should be scrutinized. Anything that can happen that can be lethal, how is the hospital prepared to deal with this to prevent it from becoming lethal? Our country counts maternal mortality as anyone who dies within one year of giving birth. This is not the same in other countries, where the time since delivery is shorter for a death to be considered a maternal mortality. But this is not an excuse. The numbers are still too high, and we can get it down. All the agencies need to work together. Fragmentation of care contributes to this. CMS might have a role in this, but here’s the bottom line: We have to care as doctors---I mean, we have to set the tone there. We need to make sure that we don’t get the “agency practice of medicine”—they don’t always know what’s best for patients.

LM: Your comments are so in line with the AAEM philosophy that all health care teams need to be led by a board certified physician. We also believe that it all comes down to training, to being adequately prepared to deal with all the exigencies of your specialty through the rigorous process of residency training and board certification. Midwives, nurse practitioners, and PAs all have a role in the health care team, but as you say, we physicians have to set the tone, we have to set and maintain the standards. AAEM is also in alignment with your contention that we physicians, and not agencies and administrators, know what’s best for patients.  Our education and training uniquely qualify us for that.

AAEM is also focused on the need for physician advocacy. As both a legislator and a physician, you are uniquely qualified to identify the most critical health related issues facing the nation currently. Could you talk about that?

MB: PHYSICIAN WORK FORCE! Without a doubt, this is the biggest issue. As we age out, younger doctors are leaving because it’s hard work and doesn’t pay as well as other professions. At a meeting of the Congressional Doctors Caucus, the Surgeon General told us that he is seeing significant physician burnout throughout the nation since the pandemic, but I think burnout started long before this. Practicing physicians are constantly facing reimbursement issues, fee cuts by CMS, an aggregate of issues that make it difficult for doctors to feel that they are valued. Look what happened in the midst of the pandemic when physician employers said, “Hey hero, here’s your pay cut.”

Other major issues are physician mental health and physician opiate abuse and how we deal with this. We need to allow people to get the help they need without being penalized. Even medical students and young docs are experiencing so much pressure that fewer people are signing up to do the job.

Another issue: There are those that don’t care if the nation does not have enough physicians—just use MD extenders—but this is not acceptable. We need to have physicians leading the team in order to insure patient safety.

I’m also concerned about the time it takes for knowledge translation from the lab to the bedside. I am introducing a bill called CARE FOR THE 21st CENTURY. We demonstrated our ability to do this with OPERATION WARP SPEED in development of the COVID vaccine. Traditionally, we have not paid attention to how is anyone going to be able to afford the things we are developing. Will patent rights and individual ownership rights be taken over? These issues can be disincentives to drug and clinical practice development. Look, it’s been 40 years since a sickle cell drug has been developed! It’s hard to believe that we have not seen improvement in something like sickle cell disease in so long. But if we hit a home run with some of these things, wow. But what if it’s so expensive that no one can afford the drug? And what is the cost of doing nothing for 40 years? What is the cost in human life, quality of life? Insulin is a prime example. The cost of the medication is so high! When we ask pharma why, they tell us that this is because the rebates they have to pay to the federal government are so high. Why shouldn’t the rebates be given to the patient? Our goal, after all, is create the situation in which the patient is taking their medication. So much of what we are doing is not logical, but the problem is multifactorial, so the answers will require collaboration between several entities.

LM: The Academy shares your concerns about the appropriate use of non-physician health care professionals, and we are firmly committed to the model of the physician led team to protect the safety of our patients. We’ve also been outspoken about the pay cuts and decreased work hours that so many corporate groups imposed on physicians who had given their all during the pandemic. Your comments really demonstrate how you combine your skills as a physician and as a legislator. What are the traits that made you a good physician that are now making you an effective legislator?

MB: Physicians are lifelong learners, having to sort through a huge volume of information and cull out what really matters. This is what you must do in Congress. Another trait of a good doctor and a good legislator is being a good listener. In both jobs, you need to understand what people are concerned about, what matters to them, what they are worrying about. Both physicians and legislators need to realize the tremendous impact that we have on people’s day to day lives. And physicians especially need to realize the power that we have. I recall how Ross Perot once told me that doctors have a lot of power. Perot said that if his staffer hands him a stack of letters and one is from his doctor, he opens that first. Physicians hold a position of huge respect in the population. When I am asked whether I prefer to be addressed as “Congressman” or “Doctor,” there’s no contest. I prefer to be called DOCTOR.

LM: Dr. Burgess, thank you so much for taking the time to talk with me today. Regardless of specialty, we physicians put patients first. It was a pleasure to explore the issues that impact our patients’ daily lives, and AAEM looks forward to continuing our relationship with you to ensure the highest level of care for the nation.

References
1. The bolding in this paragraph is the author’s emphasis.

Congressman Dr. Michael Burgess Bio

After spending nearly three decades practicing medicine in North Texas Dr. Michael Burgess has served the constituents of the 26th District since 2003 in the United States House of Representatives. He currently serves on the House Energy and Commerce Committee, House Rules Committee, and House Budget Committee.

As part of the 115th Congress, Dr. Burgess is the most senior medical doctor, on both sides of the aisle, currently serving in the House of Representatives. Because of his medical background, he has been a strong advocate for health care legislation aimed at reducing health care costs, improving choices, reforming liability laws to put the needs of patients first, and ensuring there are enough doctors in the public and private sector to care for America’s patients and veterans. He has voted to repeal the Affordable Care Act over 50 times, and has played an important role in bipartisan efforts to reform the Food and Drug Administration.

Ever since he came to Congress, Dr. Burgess has made repealing Medicare's Sustainable Growth Rate (SGR) formula a top priority. At the beginning of the 114th Congress, over 90 percent of both chambers of Congress supported the formula's repeal and it was signed into law. As one of the largest entitlement reforms in the past few decades, this landmark policy will ensure greater access and quality for seniors, more stable reimbursements for providers, and a more fiscally solvent Medicare system as a whole.

As a member of Congress representing one of the fastest growing areas of the country, transportation is also a top priority. In 2005, Dr. Burgess successfully amended the Highway Bill to include development credits, design-build, and environmental streamlining. During his time on Capitol Hill, he has worked to build, maintain, and improve the safety of our roads, bridges, air service, and transit in the North Texas region.

As a fiscal conservative, Dr. Burgess believes Americans deserve a federal government that is more efficient, more effective, less costly, and always transparent. He is a proponent of a flat tax and has introduced a flat tax bill every term he has served in Congress. He follows a strict adherence to the Constitution and opposes unnecessary expansion of the federal government’s control over the personal freedoms of Americans. Instead, he believes in giving people more control over their lives and their money. Dr. Burgess is committed to reducing illegal immigration into our country and has taken action to ensure our borders are secure and our immigration laws are enforced. He strongly opposes any proposal to grant amnesty to illegal immigrants.

During his time on Capitol Hill, Dr. Burgess has earned a reputation as a problem-solver who seeks sensible solutions to the challenges Americans face and has received several awards including the Guardian of Small Business award by the National Federation of Independent Business (NFIB), the Spirit of Enterprise award by the U.S. Chamber of Commerce, and the Taxpayer Hero award from the Council for Citizens Against Government Waste, among others. In 2013, he was named to Modern Healthcare’s 50 Most Influential Physician Executives and Leaders.

Today, Dr. Burgess represents the majority of Denton County and parts of Tarrant County. He was raised in Denton and attended The Selwyn School, graduating in 1968 as valedictorian. In addition, he graduated with both an undergraduate and a master’s degree from North Texas State University, now the University of North Texas. He received his MD from the University of Texas Medical School in Houston, and completed his residency programs at Parkland Hospital in Dallas. He also received a master’s degree in Medical Management from the University of Texas at Dallas, and in May 2009 was awarded an honorary Doctorate of Public Service from the University of North Texas Health Sciences Center. Dr. Burgess and his wife, Laura, have been married for more than 40 years and have three children and two grandsons.

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