Richard Gunderman, MD, PhD

By Richard Gunderman, MD, PhD
ISMA President-elect
ISMA Wellness Steering Committee Chair

Co-authored by Salil Gupta, MD/MBA
Candidate, Indiana University

One of the principal contributors to burnout, along with overwork and depersonalization, is inefficacy, the sense that there is little or nothing we can do about the challenges and opportunities before us. Hence, one way of combating demoralization and promoting fulfillment is to prove to ourselves and our colleagues that we can make a difference.

Ideally, such difference-making would begin early in medical careers, and here we report on one such experience. Salil, an IU student anticipating receipt of MD and MBA degrees in 2027, has been venturing beyond traditional curricular boundaries to serve in state and national government, and his experiences offer inspiration to other learners and practitioners.

His story begins with Hoosier Boys State, part of a nationwide American Legion-sponsored series of annual events that give high schoolers experience in setting up and running a mock state government. While an undergraduate at IU, he served as an intern with U.S. Senator Todd Young in Washington, D.C., where seeing national government leaders became a daily experience.

At the IU School of Medicine, Salil has served as an intern in the Indiana Family and Social Services Administration under Mitch Roob and with Senators Scott Baldwin and Daryl Schmitt. He is currently developing an elective course for IU medical students to serve in the state government’s executive branch, to complement an existing legislative elective.

How does he find time, amid the rigors of medical studies, to serve in these capacities? He is helped by the fact that he is currently devoting a year to business studies in a program whose classes are held in the evenings, providing time during the day to devote to state government.

He emphasizes that no one should pursue such internships for the money. He is paid approximately $450 per week, and his parking is covered. No one could live, let alone attend medical or business school, on such a salary. But he sees his time in government as an investment.  He is learning a lot and preparing himself to serve in the future. 

Why does he do it?  Partly, he says, because he has seen how powerfully government impacts the practice of medicine. For example, he points out that there are 7 million people in Indiana, and a full 1.7 million of them are on Medicaid, with coverage and reimbursement policies that shape access to care, how care is delivered, and the constraints under which it is delivered.

Moreover, he has learned more about scope of practice. He recalls being lobbied by a nurse who did not know that he was a medical student, arguing that advanced practice nurses are equivalently qualified for clinical roles as physicians, in part because they start seeing patients earlier in their training than medical students. Salil knew better, but many others may not.

He also laments the fact that physicians are relatively underrepresented in the state legislature, comprising only one senator and one representative out of 150 legislators. He points out that many legislators, through no fault of their own, know relatively little about healthcare, and physicians can play an outsize educational role when it comes to such legislation.

Even if physicians do not serve in the legislature, he says, it is vital that our voices be heard. He describes the “Doctor of the Day” program, in which physicians volunteer to be present at the statehouse for a day in case someone needs medical attention, and each volunteer is honored on the chamber floors with applause.

For physicians who are still practicing, getting involved with state government is rendered easier by the fact that our legislature only meets for the first few months of each year, enabling those who so wish to maintain their practice for at least two-thirds of the year. The current IU elective pairs fourth-year students with a lobbyist for a month.

Salil describes how rewarding it is to get to know the legislators, gain their trust, and represent patients' interests in the halls of government. He notes how impressed some lawmakers prove to be when articulate and passionate physicians show up to argue on behalf of patients and communities.

In many cases, he finds physicians telling stories about their patients can prove at least as influential as professional advocacy organizations or industry representatives, because legislators know that physicians are not being paid to be there, and they are speaking on behalf of neighbors and fellow citizens whose health and lives they are responsible for protecting.

Some in medicine, Salil says, may think themselves above politics and focus only on science and clinical medicine.  But if individuals who truly understand the science and patients' needs do not step up, others with less knowledge or different priorities may rule the day. Democracy can only work if lawmakers are well-informed and committed to doing the right thing.

He urges the state’s medical schools and residencies to expand opportunities for future physicians to serve and gain government experience. If physicians ignore public service, the profession and the patients it serves will suffer. But if we recognize such service as an educational priority and ensure that policies are well-informed, millions of our fellow Hoosiers will benefit.