Why Rep. Arvind Venkat Says Clinicians Must Lead the Fight for Better Care

<p>The most important way to get started is to find like-minded individuals. It's very hard in our system of government and policy and really in society as a single individual to make a profound difference. You need to build coalitions. You need to build alliances. [Music] Hello everyone.</p> <p>This is Cole from the American Journal of Healthc Care Strategy joined by a really special guest today who has just done so many incredible things through his career and is now serving the community in in such a tremendous way. Uh one of our wonderful state representatives here, Representative Venett. Uh Representative Venett, can you please just introduce yourself and kind of give a a brief overview of of what you do right now? My name is Arvin Venet.</p> <p>I'm the state representative for the 30th legislative district which is in the northill suburbs of Pittsburgh in Alageney County. I was elected in 2022 and reelected in 2024. And uh I am also an emergency physician. I am a practicing emergency physician and the first physician to serve in our state legislature in over 60 years. I was not aware of that at all. That's an interesting fact there. Uh we need more physicians.</p> <p>I think we need more clinicians in in leadership both in institutions but also in government. So that's awesome and thank you so much for coming on. It's a meaningful conversation to me. Can you just for our audience tell me a little bit uh you know I'm here in Philadelphia, Pennsylvania. So it's definitely geographically I think a little bit of a ways from where you are but can you tell me a bit about the population that you serve both as a physician but also as a representative?</p> <p>As an emergency physician, I I really serve everyone. I practiced in the Pittsburgh area for close to 20 years. Before I was elected, I was at Alageney General Hospital, which is a level one trauma teaching center, very similar to the large urban hospitals that exist in the Philadelphia area. After I was elected, I moved my practice to a smaller community hospital that's actually in the district that I serve. Uh my district uh in the north hill suburbs of Pittsburgh.</p> <p>It's a suburban bedroom community. Uh it's the the communities of the western part of Hampton Township and all of Mandless, Franklin Park, Ohio Township, Kilbuck, Emworth, Ben Aavin, and Benavin Heights. And it's a a very well- educated population.</p> <p>Um and it has a lot of individuals who are have either healthcare backgrounds or scientific backgrounds or engineering or business backgrounds, but it also has a lot of people who are retired senior citizens as well as those who are um you know doing work that doesn't require a college education or hasn't required a college education but are very skilled. So we have a lot of skilled trades people.</p> <p>We have a lot of people who are workers in the meds and eds economy in our area and so um having a healthcare background like I do hopefully fits the community well as their state representative. That is great and and that makes sense why you would be a physician one of the first in 60 years elected by of course that community. That makes a lot of sense. I I have to ask though you know being a physician I talk to a lot of physicians.</p> <p>I really try to keep my kind of finger on the pulse of what they're feeling. I'm sure some of our audience has seen shows like The Pit on HBO and they're going to be thinking of you know Alageney Health Network or um you know Pittsburgh. Uh and so one of the questions is when they when we think of that we think of emergency medicine it's stressful it's difficult you are dealing with individuals in a lot of times who have very difficult situations and it's not easy to do that job.</p> <p>What would draw you to then kind of take on this additional responsibility of then being a a state rep? I mean that's a huge responsibility and and from my perspective very stressful. So what got you into that? For me, you know, one of the great joys of being an emergency physician is that you get to care for everyone. No questions asked. And I, by the way, I love the show The Pit based on my old hospital where I worked, Alageney General.</p> <p>The aesthetic of the show and the acuity of the patients and very similar to what I saw there. And my career actually spans kind of Noah Wley's portrayal of physicians. He was in medical school as John Carter in ER when I was a medical student. Remember watching the show. Now he's playing, you know, Dr. Robbie as a grizzled emergency physician in Pittsburgh. And that might be an apt description for me. Uh but I really, you know, I I think this is an extension of my role as an emergency physician.</p> <p>you get to see the strengths and the challenges in your community as an ER doc and during COVID I was president of the state emergency physicians organization and clearly we as emergency physicians were on the front lines and I saw the divisions that existed in my community when it came to science and healthc care that really have extended to this day and the combination of understanding the challenges in my community and als Also knowing that we needed more people with scientific and healthc care backgrounds in politics in policym because of the challenges we're facing.</p> <p>That's what motivated me to run for office. Wow. And that's an impressive motivation. I mean I know we've all seen a tremend uh I have seen but during co a lot of lot of very difficult things after co as you've now become a state rep. I believe 2022 is when you uh Okay, we're elected. Is that right? Yep. Okay. So, we're now past CO or you know, we're really getting to the spot where people aren't really thinking about CO as much.</p> <p>The general public is kind of, you know, we're not seeing masks and things. Uh vaccine rates have gone down, unfortunately. But I think that shows again people aren't paying as much attention to it. They're not thinking of it. What are what are the issues that you are now seeing very clearly in the in your population, in the community in regards to health care that you really want to address? So the two biggest issues are access and affordability.</p> <p>Uh coming out of the height of the COVID pandemic, we saw a lot of health professionals who left the bedside and that has created huge access to care issues. We are seeing continued difficulties with affordability of healthcare. Uh we're seeing challenges to the financial viability of hospitals and really a number of health care settings.</p> <p>And so the combination of how are we recruiting and keeping people with clinical skills at the bedside, how are we making sure that the health care system is transparent and affordable to patients and the public and as well as to clinicians and to those who administer the health care system. And how do we make sure that all of this system eventually leads to better health care outcomes?</p> <p>Because let's be frank as the United States, we are well behind other industrialized countries when it comes to healthcare outcomes. And so all of that together are the challenges that we're facing. How do you identify these? Are these people who are, you know, individuals in your community who are calling your office? Are you reading reports? How do you keep your uh, you know, mind attuned to what's happening? I think it's all of the above.</p> <p>Certainly the most important thing is what I hear from my constituents. That by far is the most important thing. But being the only position in the legislature, I really hear from health professionals and those with an interest in health care from across the state. Uh and so that really um plays into it. And then what's happening in Washington DC and the threats to Medicaid and the threats to the affordable care act.</p> <p>All of that as well plays directly into the what I hear from constituents and stakeholders from across the state that motivates me and the type of legislation and the type of policies for which I advocate. When you talk about access, why do you what are some of the reasons you think uh you know I know you talk about the staffing. Is that a problem that's unique to Pennsylvania or do you think that everyone across the country is dealing with this?</p> <p>And if it's, you know, why do you think Pennsylvania because I'm I'm just thinking about the amount of medical schools here, right? I think it's like one in in five or one in four, you know, come through, you know, Philly. Uh, and I'm sure, you know, if you include the whole state, it's probably even more. So, we have a lot of facilities and medical training here, right? And you'd almost think that Pennsylvania would be a state with not a lot of access issues at all, right?</p> <p>because of the the hospitals that we have, but yet we are having that issue. Is there any reasons why Pennsylvania, you know, has has a challenging dynamic? Well, it's not unique to Pennsylvania. We've seen so many people who have left the bedside as clinicians and it's expensive and a long process to become a clinician, whether it's a physician or a nurse or a PA or nurse practitioner, you name it.</p> <p>Uh it's a it's a very long process and it's a very expensive process and you're right to say in Pennsylvania we have a disproportionate number of educational institutions but we don't necessarily create the best practice environment. We've allowed a lot of consolidation in health care and so many health professionals feel that they are widgets. They're not respected as the professionals that they are.</p> <p>uh we see that there's been a lot of increases in expenses uh related to insurance and affordability. And frankly, we have a reimbursement system in healthcare that re that rewards volume as opposed to value. And it also um motivates healthcare institutions to try and staff at the most minimal level necessary to reach whatever uh clinical outcome or clinical goal that they are doing.</p> <p>So every system is perfectly designed to get the results that uh it wants and the problem is is that we are incentivizing results that are not of benefit to our fellow Pennsylvania. You just used one of my favorite quotes of all time there. That's it's I I use that so often because we we get frustrated sometimes at ourselves when we say why why isn't this system working? Why isn't this happening? We have to realize that the results we're getting uh the system is perfectly built for it.</p> <p>And and that's what we have here. I I have a couple questions though on this.</p> <p>Um the the first one is when you talk about consolidation the argument I hear a lot is that you know Kaiser of course has acquired Guisinger and so a lot of systems are saying well you know if Kaiser's coming to PA we need to prepare we need to to compete with some of these larger systems so we have to consolidate we have to buy up practices what could be done what would you like to see happen is there any way that we could encourage like healthy competition I mean in your mind what does that look I think there are two very important things we can do.</p> <p>The first is we're either the only state or one of only two states that does not have a state level antirust statute. And so I think we have essentially abdicated our responsibility when it comes to regulating the market and competition. And I would like to see a strong antirust statute enacted that empowers uh state government to scrutinize these uh efforts at consolidation and potentially even break up large monopolies or large duopolies that exist in western Pennsylvania.</p> <p>We essentially are a two-horse town between UPNC and ali health network. Both health systems do important work. Both insurance companies do important work. But a monopoly and a duopoly are essentially the same thing. And we don't have competition the way that we need to have across the state.</p> <p>The second thing that we have to do is we have to move away from a reimbursement system that rewards and and incentivizes health care to be delivered like a just in time warehouse um like what exists in FedEx or something like that. That's not the nature of healthcare.</p> <p>And so when we talk about issues like private equity or we talk about metrics or we talk about you know driving patients through without valuebased patient care and looking at outcomes a lot of that is because of the reimbursement system that we have.</p> <p>uh and I can speak to this especially in emergency care where we have to pay for readiness even when the volume of patients aren't there because the expectation is we will be there in your time of need and that means changing the reimbursement system so that it is more based on a global basis of health care and outcomes as opposed to the fee for service system that we have. Those are the two things that I think we have to do. I I agree with that a lot. I'm a huge proponent of value based care.</p> <p>Everyone knows, you know, that I am. I'm trying to get a PhD in population health. So, I'm on the train of value based care. And I think that it doesn't even have to be the existing model that we think of, but you know, switching to a valuebased instead of this this kind of unit like you said in a warehouse, right, which is where we're at now. I agree. But I still have some concerns with the new administration.</p> <p>Even as I'm preparing to start my PhD, I worry is this going to be all back to fee for service is, you know, are we going to really push things out into the private sector with no restriction? There's some concerns there, right? That this uh this value uh population health, public health approach that really kind of looks at the community uh holistically isn't going to to really be there in the next four years.</p> <p>What are what is your outlook over the next four years for Pennsylvania and and specifically your constituents? The most immediate threat coming out of the new administration is the threat to Medicaid and the threat to the Affordable Care Act. I think the Affordable Care Act is the American vehicle for making sure that everyone that we possibly can is covered by health insurance. What the the affordable care act did not do was really take a an effort to reduce prices.</p> <p>And I am not seeing any effort from the incoming administration from the Trump administration to look at how do we expand healthc care access. Instead, what I see is an effort to tear away healthc care access from hundreds of thousands if not millions of our fellow Pennians. And Medicaid is the key.</p> <p>Uh, you know, the House Republicans have passed a budget that would gut Medicaid and that would have a devastating effect for my constituents, particularly children and senior citizens and the disabled and the working poor, but really for all Pennians, because the costs from the increase in uncompensated care will be passed on to all of us and it will threaten the viability of hospitals.</p> <p>So when we're talking about access and affordability, what the Trump administration and congressional Republicans are doing now are a direct threat to that. What do you think can be done to fix this so that in 2030 we're not or in 2028 we're not in a in a really bad spot because I think you know we have elections coming up right in a year. What what do what do you think can is this a fixable situation? Yeah. Oh, we have elections this year which will send a message next year.</p> <p>So when we talk about official elections and local elections and schoolboard elections, trust me when I say that as an elected official, I pay very close attention to what's going on in my local community. So the elections in 2025 are important. Then of course the elections in 2026 are incredibly important.</p> <p>But right now, you know, my fellow Pennians and really my fellow Americans need to raise their voice to their federal elected officials and their state- elected officials that we're not going to go backwards. Beyond that, I think, you know, what the Biden administration did with negotiation on drug pricing was a good step. They recognize that health care is a different market and we need to move in that direction related to um how we you know regulate the marketplace on you know essential goods.</p> <p>I think we do need to look at the accountability for the insurance companies. I have legislation that would penalize insurance companies who are denying claims for medically necessary treatments. Um, and th and those denials are being overturned at a high high rate. That to me suggests that that is a systematic and longheaded approach to their responsibilities to pay for medically necessary care and there should be accountability on that.</p> <p>uh medical debt relief is a hugely important issue that I've championed as well. And then we need to look at cost savings through market-based mechanisms. Uh you know, should we be looking at reverse auctions related to pharmacy benefit managers that other states have done and have saved billions of dollars related to uh healthcare expenses. I think these are all things that we should be looking at. But the first thing is to not go backwards when it comes to health insurance coverage.</p> <p>accessibility and affordability. One of the questions I want to ask based on on kind of what you've said, you've outlined some some good steps going forward and I think involvement is very important based on everything you've said. We, you know, none of that can be done with just one individual alone, right? A lot of clinicians like yourself, they would probably want to get involved and still practice, right? Because you said that you still practice as an emergency physician.</p> <p>One of the concerns is how will that interact with their employer? And I kind of ask I know it's it's a little bit of an odd question, but do you how do you deal with a situation where let's talk about consolidation for example. You might feel something different in consolidation than does an employer on the the medical side. As a professional, how do you deal with that situation?</p> <p>Do you have any advice for other clinicians out there who want to get involved in this political work, maybe run for political office themselves? It's very important. It needs to be done, but I hoping that we could maybe, you know, remove some of the fears that they might have. So, when I first ran for office, I did meet with my sensible employers who do have a very active advocacy program and we were very clear with each other.</p> <p>I was not a candidate reflecting their views and I did not have an expectation that they were going to be supportive of my efforts automatically or anything along those lines. Uh and in my role as a legislator now obviously I take the positions that I think are in the best interests of my community in Pennsylvania and some of those are going to align with where I am uh in my other profession or not.</p> <p>Uh I think the first rule is is that you don't do politics when you're caring for patients actively in the context of your your clinical realm. But there's a long history of physicians and health professionals advocating for patients and the public health beyond their role as clinicians. And it it is a balance. You know, my wife's a physician, too. We have three kids.</p> <p>You know, there's a work life balance issue, but it ultimately comes down to what are your priorities and what are you how do you feel that you can best affect change? That may be running for office. It may be becoming very active with your professional organizations. It may be organizing likeminded positions to take action in a particular way and to advocate in a particular way. or it may be at a very grassroots level in terms of organizing things that advance the health of your local community.</p> <p>All of which are important, but it does require a decision about what you're going to do outside of your time as a clinician. And then the last thing is, you know, I now work part-time as an emergency physician. I don't work full-time as an emergency physician. We have a full-time legislature in Pennsylvania.</p> <p>And so I, you know, it was a personal decision with my wife, you know, that we were going to be taking a financial haircut because the salary of a legislator is not the same as a salary of a full-time position. And so, uh, that's a that's a decision that people have to weigh as well. I didn't want to bring that up because I I didn't want to say anything out of turn, but that's another thing I was wondering is the financial pressure, you know, it it's there for everyone.</p> <p>I think we've even, you know, even physicians, right? People always assume, oh, you know, doctors are doing well, but as you mentioned, tuition costs are rising drastically. Reimbursement has not kept up with the tuition cost or the interest rates on the loans. It's a tough situation for a lot of physicians out there as well. So, I was wondering um when you talk about impact, right, you you took this this pay cut, you added to this some of the stress of of the work.</p> <p>Do you feel like you have made impact in your role? Do you even anything anecdotal that you can share on the impact of what you've done in the last two or three years? I mean I think it you know I I think I absolutely have made an impact and it it's it's apparent both in legislation. You know I've had legislation that has passed related to the actions of insurance companies when it comes to reimbursement.</p> <p>The governor of our state is a champion for medical debt relief out of the legislation that I've proposed.</p> <p>uh we've been able to stop things that I think are very dangerous for health when it comes to uh you know turning back abortion rights in our in our state that my victory and you know my advocacy was directly related to that and then there's lots of anecdotes being the only position even though I'm a relatively junior member of the legislature on healthc care issues I think it's pretty clear that my voice matters in terms of the advocacy for my community for health professionals across the state and for the health and well-being of our state.</p> <p>And so I take that responsibility seriously as well that that comes about from having that background in the legislature. And you know obviously at the state legislative level we're dealing with issues across the state. So as impactful as my work was, you know, in caring for patients here and, you know, the academic work I did and others, this is a larger stage where there's hopefully the opportunity to advance the health and wellbeing of our community. I really appreciate you saying that.</p> <p>I wanted to give something to encourage those who are listening to really kind of take up the torch. One last question for you. You uh when you got into to you the being a state rep, you of course are experienced. you have many years of experience. Some of as we're seeing physicians even in residency now are really doing some great work when it comes to uh unionization and organizing.</p> <p>Any advice or tips for those who are early in their career who want to make a big impact on their community of where to get started? Yeah, I think the most important way to get started is to find like-minded individuals. It's very hard in our system of government and policy and really in society as a single individual to make a profound difference. You need to build coalitions. You need to build alliances. So I think it's a matter of deciding what is your most important priority.</p> <p>You bring up unionization that has really been championed by residents and fellows because they're of a different generation of physician than I am or older physicians and they came together in order to then be able to advance that agenda and I think that's really an important way to do so. Thank you so much Representative Venet for coming on. I really appreciate it. What a wonderful conversation uh we've had. I've I've learned a lot about you and uh I feel a lot more passionate.</p> <p>I hope that the passion comes through the screen and we have people this year and next who are ready to to really uh let their voices be heard and take up the torch. It's so important and I hope that we can speak again soon. All right. Thank you.</p>