and also our United States Senators as well. And really the opportunity came about because seeking ways to be involved and when we were asked to give any talks, any times on which we were called upon to advocate and just educate, we tried to do that. And so through that experience was able to develop a relationship with one of our Senators, Shelley Moore Capito, United States Senator, and she asked if I could come and represent the status of what was going on in Appalachia regarding the addiction epidemic at the time. And so we're going to share with you that testimony and then we'll move on to the next stages here of our talk and then reserve any questions for either that experience or other experiences at the end. Does that sound okay? Okay, good. Thank you. If you could go ahead and show that for us. So Dr. Berry, thank you again for being here and go ahead and start. Ranking Member Murray and members of the Senate Labor HHS Subcommittee. My name is Dr. James H. Berry and I'm a physician from West Virginia University who specializes in treating addiction and mental illness. I've been invited by Senator Shelley Moore Capito to share my experience and thoughts with you regarding our nation's addiction epidemic. Having completed medical school in Michigan, I moved to West Virginia in 2002 to pursue residency training in psychiatry. At that time, I had no idea we were on the eve of an evolving opioid crisis and that West Virginia would prove to be the bellwether of the rest of the nation. Early in my tenure, most of the patients seeking addiction treatment were doing so because of alcohol problems. Before long, patients began trickling in seeking help for addiction to opioid pain pills. In a relatively short amount of time, the trickle became a tsunami and we became overwhelmed by the incredible demand to provide services for opioid use disorders. We quickly had to adapt and develop innovative strategies to expand access to and keep people in treatment. Over the past decade and a half, we have treated thousands of these patients through our university-based treatment program and have learned much from them about the nature of addiction and the path forward. I would like to share with you a few brief observations. First and most importantly, addiction is a treatable condition. There are very few areas of medicine where a healthcare provider can witness dramatic change in a patient's health and well-being like that afforded in addiction treatment. The process can be slow and often painful, but the rewards are unparalleled. People get their lives back. They become better parents. They finish school. They enter the workforce. They inspire others. Unfortunately, it is estimated that only 20% of the people who need addiction treatment ever receive it. We desperately, desperately need to expand access to evidence-based treatment that works. Second, addiction is a multifaceted problem that requires multifaceted solutions. There is no silver bullet. Addiction is biologic, psychological, social, and spiritual manifestations. Genetics, environment, and experience all play a part. Addiction is a mental disorder that is often present with other mental disorders, such as anxiety and depression. There are incredibly high rates of traumatic experiences, such as sexual and physical abuse during childhood that lead to the development of addiction. None of this can be ignored, and the best treatment incorporates all elements. Medications proven to improve outcomes should be readily available, and barriers preventing widespread use should be removed. People should also have ready access to psychological therapies known to improve functioning and increase the quality of life. We are creatures that thrive in community, and addiction is a very isolating condition. Supporting the use of peer support groups, such as 12-step programs, are incredibly valuable in forming healthy connections that are reparative. In addition, we are creatures hungry for meaning and purpose. Involvement in faith-based and other purpose-driven community organizations foster healthy relationships in addition to supporting a drive to reach beyond one's limits. Third, our addiction epidemic extends beyond opioids and is rapidly evolving. Opioids have captured our national attention, and rightly so, due to the staggering jolt of acute overdose deaths. However, please note that these deaths remain outpaced by the number of people who die every year from alcohol or tobacco-related causes. Furthermore, many of us in the addiction treatment and research community are preparing for a significant increase in cannabis-related health problems as states move to legalize marijuana and the public perception of harm diminishes. The epidemic continues to evolve as more and more people are using stimulants such as methamphetamine and incredibly lethal synthetic opioids such as fentanyl that account for the sharpest increase in overdose deaths over the past several years. Finally, the epidemic will require long-term solutions. There is no quick fix. We now have two generations that are severely impacted. Turning this epidemic around will require strategic investment in mental health treatment and prevention resources to meet today's adult generation and the ballooning child and adolescent population at risk. We are woefully short of such personnel nationally, and even more so in rural areas hardest hit by the epidemic such as Appalachia. Investment in much-needed addiction training programs and incentives to encourage laborers to work in areas of greatest need are paramount. Thank you for your time and attention, and know that I'm happy to answer any questions you may have. All right, thank you. Next up we have Ms. Holly Sheehan. So we started with Mary's testimony. I almost feel like that should have come at the end, because what we're going to try to lay out here is a little bit what's going on in DC, what are AAAP's priorities that we've been advocating for, and how to do it, nuts and bolts, how to actually go talk to a member of Congress. When you put all those things together, what you get is what you just saw. Advocate on the Hill, advocating clearly and forcefully and thoughtfully for good, solid policy, because you've built, over time, a good relationship with the congressional delegation. So we started at the back, and now we'll look at how we get there. Okay, so they made me hand over my slides on Tuesday, and I was almost like, come on, this is going to keep changing. So it's already out of date, and I apologize. But to give everybody an update on where we are in DC, and I should take one step back too and say, I'm Holly Strain, as Dr. Shorter said earlier, and I'm with Advance Coit Companies, and my colleague, Ed Long, and I represent AAAP in Washington. So we work with the board and with AAAP's leadership to do the advocacy on Capitol Hill that we are talking about today. So where are we in DC? So they called the House. That is going to be under Republican control on October. What are their high-level trends? So we know that first president to serve two non-consecutive terms since Grover Cleveland in 1892. So you can take that. When that comes up in Jeopardy, you'll be prepared. Democrats are a really poor map. They had a lot of defending to do. The House trends, as I already said, it was out of date. The trends that suggested that Republicans were going to take the House, that is what happened. I pushed the wrong button. OK. Just a little bit of where I think everybody's pretty familiar with this map. I know it's probably kind of small, but you see Trump at 312 electoral. I think this is a surprise to everyone, right? That Trump won the popular vote, unlike in 2016. So I think that that, why we're mentioning that, is because I think that we are feeling a lot of a mandate coming in. So there's not this feeling like, oh, you didn't really win, you lost the popular vote. No, won the popular vote, right? So whether you were upset or happy with the outcome of the election, the majority of Americans, this is what they said that they wanted to have, who they wanted to have in the White House. So the House races, there are still some that are not called, but. that have not been called, the Senate will be at a 53 to 47 margin. So as I'm sure everyone is aware if you've watched any kind of news over the last few years, to accomplish most things in the Senate, you need 60 votes. That's the filibuster threshold. So that means that they can't just go hog wild with everything. It's going to take some time. You still have a zero majority there, and the House is still going to be a tight majority. But there's this process called budget reconciliation, where you don't need, you just need majority, 51 votes. It has limits on it. You have to have something that has a budgetary impact, or is actually having a very nerdy conversation with a House committee staffer the other day about whether or not something would qualify for that or not. But this will have implications for next year. So as you're reading the news and you're thinking, oh my god, everything's going to change overnight. No, probably not, because we're still at a 60-vote threshold. But there are still opportunities for Republicans certainly to move some of their priorities, and they expect to move through the budget reconciliation starting that process pretty early into next year. Who's going to be in charge? So Senator Collins of Maine will probably, and these are all probably's until they're definite, they're kind of trickling in. It's a little bit of a domino effect. If one member takes this slot, then they don't get the other one and everything. I won't bother you with all the details, but this is what we expect right now. Senator Collins will chair the Senate Appropriations Committee of Maine. And then Senator Murray, who has been the chair, will go into the ranking member position, so lead Democrat. For the Finance Committee, which has jurisdiction over Medicare and Medicaid, Senator Crapo, not Crapo, Crapo of Idaho will chair the Finance Committee. And Senator Wyden, who has been the chair, will go into the ranking member position. So not too much change there, just who has the bigger staff and the better office. At the Health, Education, Labor, and Pensions Committee, which is the committee that has jurisdiction over SAMHSA, we're expecting Senator Cassidy, who is a physician by training of Louisiana, to take over that committee. And then there may be some shuffling here. So we have been expecting Senator Sanders of Vermont to be in the ranking member position. He has been chairman, but he was a little noncommittal about that with Trade Press this week. So it's possible that he won't take the slot and we'll have a change there. By seniority, if that were to happen, then we might end up with Senator Baldwin of Wisconsin or Senator Murphy of Connecticut. But as of right now, we've been expecting Bernie to be in the ranking member position. Between us kids in here, as I'm thinking about next year and substance use, I'm kind of OK if it's not Sanders or to have him or someone else in the ranking. He has not prioritized addiction like I would have liked, to be totally honest with you. We have not seen reauthorization of the SUPPORT Act, which is legislation that addresses the opioid misuse and overdose epidemic. And in a meeting this summer that Dr. Berry and I were doing, we were talking to some very knowledgeable staff on this issue. And I said, do you think this has been a priority of the chairman? And they said no. So from a substance use perspective, some of these changes may be good things. Senator Cassidy is a very thoughtful person. He's kind of an academic. He considers himself to be really a thought leader. He likes to get down to the nitty gritty and to the details for better or worse. And as I said, he's a physician. So it'll be interesting to see what he does with this leadership role. Over on the House side, we're looking at some other changes. So at Appropriations, we'll say pretty much the same. Tom Cole, who is a long-term legislator, will stay as chairman of the Appropriations Committee. If you are a big House nerd, you probably saw that he took over from Congresswoman Granger last year when she gave him the gavel. And then Rosa DeLauro will be in the ranking member position. Mrs. DeLauro is very liberal. If she had her way, we would have all the money that we want. So we'll see how that goes. She also chairs the Labor HHS subcommittee at the House Appropriations Committee. There is a race going on to be chair of the House Energy and Commerce Committee. That committee was chaired by Kathy Morris-Rogers of Washington state. She retired. And so Congressman Guthrie of Kentucky and Congressman Latta of Ohio are competing to be the chairman. Guthrie, in particular, being from Kentucky, which is obviously a state that's been hit particularly hard, is pretty good on these issues, very reasonable. He hires good staff. So we'll see how that shakes out. My gut is that he may be in the leading position, but we'll see how that goes. And then Congressman Pallone of New Jersey, also a longtime member, will stay in the ranking member spot. And then at Ways and Means, which has jurisdiction over Medicare, so less of AAAP's issues, but still a key health care committee, will be still held by Jason Smith of Missouri with Congressman Neal of Massachusetts in the ranking member position. All right. So what are we going to do for the next six weeks in Congress, right? We're going to take a deep breath. And then, so Congress is out for all of October. They just came back this week. This week has been largely leadership elections, figuring out what they're going to do with themselves. And then they're in next week. And then they're out again for Thanksgiving, right? And then they're back in for most of the month of December, which is both an eternity and very little time in congressional terms. To date, they have not enacted or passed into law any of the 12 fiscal year 2025 spending bills. So there's a continuing resolution, which is basically flat funding, which is keeping the federal government open through December 20th. So that's like the big, flashing date right now for a deadline. Whether or not they are going to pass those bills before that deadline, or punt them into next year, or maybe for a whole year, another CR, which the fence folks in particular do not like, remains very much to be seen. Time is running short for them, because they don't have an agreement between the House and Senate on even what the top line numbers would be like, right? So you have to agree how much money you're going to spend, and then divide it up. And they haven't agreed even how much they're going to spend. So if they are going to do it in December, they need to get a move on. We are tracking that really carefully for two reasons. One, obviously, there's AAAP spending priorities in there, things like loan repayment and the other things that Dr. Welsher's going to talk about are tied up in that bill. So we're watching that from a funding perspective. We're also watching it, because should that package move forward, that would likely be the vehicle for any health policy legislating that they're going to do this year. Frankly, we've been kind of in a desert of health policy legislating for the last couple of years. They just keep punting. It keeps falling apart. Last spring, there was a good effort, and they just couldn't get an agreement. So things like the SUPPORT Act that I mentioned earlier, its authorizations have expired. They've been expired since last year, and they just haven't been able to bring them over the finish line. In practical terms for us, it hasn't had that much of an implication, because Congress has continued to fund those programs. But we would like to see them enacted. We would like to see them do some actual legislating. Imagine that, right? There's also some other expirations that happen at the end of the year, like Medicare telehealth flexibility is being extended from the public health emergency. Some of those extensions, I don't think they're at risk. They will figure out a way to do them. Just maybe for a short period of time, like they did last year. Last year, they just punted them into March, and then we started the process all over again, like Groundhog Day, constantly. So the goal is to do that at the end of the year. Right now, they might punt it into next year. We're not really sure yet. I will say that Speaker Johnson has said there will be no Christmas tree package in December. We'll see if that comes to fruition or not. There's lots of ways that they could do that. Maybe it's smaller packages. Who knows? But my money at this point is on that they punt. When in doubt, Congress will punt, but we'll see. And the appropriators would very much like to have a package. So they come back in January, right? We're in the 119th Congress. Congress will come back and certify the results in early January, hopefully less dramatically than last time. As I mentioned, the Republicans will likely use a budgetary process called reconciliation that avoids meeting a 60-vote threshold. That could be where we see some things like Medicaid subsidies for the Affordable Care Act for insurance may be at risk, because those do have budgetary implications. If you remember, part of the Affordable Care Act was enacted through the budget reconciliation process. So we'll be keeping an eye on that. But like I said, it does have strict rules about what can be included. So that wouldn't, for example, not be an opportunity for, let's see, what are some new priorities? Maybe fluoride repeal or something. Can't go through reconciliation. It's unclear next year how much substance use will be a priority for the administration and for Congress. There has been somewhat waning interest, somewhat personal, perhaps because Chairman Sanders has cared about some other things more than this, perhaps because the overdose numbers have ticked down a little bit, which is good news. But it takes a little bit of pressure off of them to act. In 2016 and 2018, during election year cycles, we saw substance use bills move, because there were things that they wanted to brag about. I would have put money earlier in the year on that happening again this year, and it so far has not come to fruition. So we'll see where that fits into the larger priorities for next year. That being said, even if it's not a priority, we still have seen bipartisan support. Even in that House Labor HHS budget released this spring, where there are some pretty dramatic cuts to other areas, we did not see that in the substance use side. And that's because of long-fought advocacy from folks in this room and others in the substance use and recovery field of getting people to understand more and more that this is a disease, as Dr. Berry was talking about in his testimony. And I think, frankly, the impact of opioids and everyone knowing someone who's affected by this has just changed the conversation. I tag it back to when Philip Seymour Hoffman overdosed. I felt like that at that moment, around that time, the conversation started to change. And that's when we started to see more interest from legislators and less of a, you know, oh, that issue, we don't want to talk about those people, into more of a, oh, those are our friends and our neighbors, and more importantly, our constituents. So as I mentioned, the budget reconciliation process may be an opportunity to repeal some of the subsidies for people to help to get insurance, maybe some tinkering with Medicaid, and there may be other attempts also to weaken some of the patient protections through the Affordable Care Act. I think full repeal is not really in the table, but Republicans are definitely talking about strengthening the law, and so we'll see what that looks like. Some bad news here. So there's something called the Congressional Review Act, which Congress can use to overturn recently passed or released rules to an administration. If you were tracking the parity rules that were released in September, those could be vulnerable to that, and so Congress could pass laws to repeal that in other rules that have been released this fall. So that's another thing we'll be keeping an eye on. We really, on the whole, really like those rules, thought they were really strong for patient protections. Health plans do not like them, and I'm sure we'll be lobbying heavily to try to get those overturned. So with that, I'm gonna turn it over to Dr. Walsh to talk more specifically about what AAAP is gonna do. Thank you. Thank you. And thank you so much, Holly. Just a shout out to you and your team, and your leadership has just been incredible in elevating AAAP, and I think really giving us a voice and a level of credibility that we have not carried at the Hill before, so thank you for that. So I'm now going to be speaking about the top legislative priorities of AAAP, and some of what we've been up to in FY24. So you'll notice a common theme here, that all of these areas are really focused on increasing the addiction psychiatry workforce. So the first one being to increasing the availability and the number of addiction psychiatrists who are not only eligible, but also receive loan repayment. The second, to formally authorize and ensure the long-term viability and sustainability of PCSS, or Provider's Clinical Support System. The third, to increase funding for addiction fellowships. And then the fourth was an interesting one this year, where we had to actually restore the funding for the Opioid Response Network, and AAAP actually just received the grant for $54 million, so we were somewhat successful in this arena, although it took some lobbying and some effort, so again, thank you, Holly, on that. All right, so let's walk through these. So let's start with loan repayment. The first really is to increase the number of addiction psychiatrists who are eligible and receive loan repayment under the Substance Use Disorder Treatment and Recovery Loan Repayment Program, also known as STAR LRP. And two ways of doing that would be to modify what's called the direct service requirement, and then also to increase the appropriation or the funding to this program. So a little bit of background here. Addiction psychiatry slots are going unfilled. So we're advocating, we're saying, we need more slots, but by the way, we're not even filling the slots that we currently have. So this data's probably about a year old now, but at the time, 16 of the 50 programs across the country did not fill all of their addiction psychiatry fellowship slots, and I'm out of Emory, and I would say the last couple years, we've also had issues doing this. And in FY 2021, under STAR LRP, so this Loan Repayment Program for Addiction Providers, they received over 3,000 applications, 3,000. They funded 255 of those, and only 12 awards went to physicians. That's 5%, that's not a lot. So one of the major barriers that we've identified is this direct service requirement, and this direct service requirement states that individuals must at least provide 36 hours per week of direct patient care to be eligible for loan repayment under STAR LRP. Administrative duties, supervision, research, none of that counts towards your 36 hours. So I'm just curious here. Show of hands, who engages in 36 hours or more of direct patient care per week? Good for you, I love it. Are you working an 80-hour week? No. Well, so many of us aren't, because a lot of addiction psychiatrists are getting pulled in so many different directions, including training the next generation of addiction psychiatrists and supervising. So without that, you're not eligible. So we've been working with HRSA, and we've been trying to gain support from both the House and the Senate to really modify that language so we at least would be eligible as addiction psychiatrists to receive funding. And then the second part here is actually to increase the allocation of funding for STAR LRP. So there's just a greater fund available. And so right now, the current authorization is at 25 million. We've been asking for at least 40 million. And in the House, it's at 40. And then the Senate, I think the most recent numbers, it's about at 65 million. So we're gonna have to reconcile that in the near future. This is all looped under the SUPPORT Act, so we'll be watching this really, really closely. All right, so next here, PCSS MOUD. So our goal really has been to formally authorize PCSS to at least get it as a line item within the legislation so that it's continually funded. Because right now, it's actually roped under the Data Waiver Program with SAMHSA, and it's getting funded continuously each year, but that places it at risk. So for those of you who are not familiar with the Provider Clinical Support System, it's a SAMHSA-funded grant program, and it's intended to train providers in evidence-based prevention and treatment of OUD. Now, there are two kind of counterparts of PCSS. AAAP oversees PCSS MOUD, Medication for Opioid Use Disorder. ASAM oversees PCSS AUD, Alcohol Use Disorder. But the legislature is closely and intimately tied together, so we work alongside our ASAM partners. And just the scope of PCSS is incredible if you're not familiar with it. But more than 186,000 clinicians took the SUD 101 curriculum since January of 2023. I mean, that's just an incredible amount. Another 62,000 completed the MOUD 8-hour training in 2023, and that's an increase from 2022. And they have over 1,000 training and education activities for clinicians. So the scope and the reach of this program is incredible. So our goal here is really to create a sustainability of PCSS. And so one of the things that Holly's really been spearheading as well as the rest of AAAP leadership is working towards an authorization of legislation. And so Congressman Tonko, who's a Democrat out of New York, has agreed to cosponsor a bill to authorize PCSS as long as there is a Republican cosponsor. And we have been on the search. So if you all know of a Republican cosponsor who's going to be on the committee, let us know. But we are still looking. We've made some valiant efforts to date and have not been successful. At the note. Yeah, I don't know how much PCSS is right now. Yeah. I'm not sure of the specific amount there, but good question. So then the next item here is to increase addiction psychiatry fellowships. So the Addiction Medicine Fellowship Program was authorized in 2016 as part of the 21st Century Cures Act, and that expanded the number of fellows, both addiction medicine and addiction psychiatry, who worked in underserved community-based settings. And so in FY 2024, Congress appropriated $25 million for this program, and we've really been asking for $30 million. It's a limited avail because it's stagnant at $25 million in both the House and the Senate at this point. And then this was an interesting activity. So the Opioid Response Network. So ORN, it provides low-cost, no-cost technical assistance for opioid use disorder, stimulant use disorder, and co-occurring disorders. So over 26,000 individuals were trained through ORN last year alone, and the target here was actually 20,000, so we went beyond that. The request for technical assistance across the country has increased greater than 100% since the grant started about six years ago. One of the things that happened this year, we had to really quickly pivot, especially in our Hill Day, was that we got caught in a crossfire between SAMHSA and an HHS report for FY25. And what happened is SAMHSA ended up looping in RODA-R, which is the Rural Opioid Technical Assistance Regional Centers. I'm happy I was able to say this. Holly's nodding at me. Thank you. Into the NOFO for ORN. And this is a big grant for us. We just secured $54 million over the next three years for ORN, which is overseen by AAAP. And when they did that, it ran the potential of undermining the funding for those Rural Opioid Technical Assistance programs. And so as a response, the HHS report said, we're just not going to fund you for FY25 if you continue this language. And so everybody had to very quickly pivot and advocate for SAMHSA to fund RODA-R in a different way, which they did. And they fully restored. And they pulled it out of the NOFO. And then AAAP was actually able to get awarded. Now, it's still to be seen what's going to happen in FY25. And we're hoping we don't have to reapply for the three-year funds. That's just to give an example of something where we really quickly had to pivot and to advocate for some of these agencies who are maybe at odds. And we were caught in the middle to work it out because we are a neutral party within this. And here's just a summary slide of our appropriations as they currently stand. So on the far left, you can see where the FY24 was as far as the current appropriations. Our requests, which include an increase of STAR LRP. We actually asked for $50 million. And then that increased to $30 million for addiction psychiatry fellowships. And then where we lie both with the House and the Senate. And so these are proposed approved bills out of the House and the Senate. And they're going to have to be reconciled between the two before they actually get signed into law. So there's some potential reasons for optimism. So STAR LRP supported by the Senate at $65 million, whereas our current appropriation is only $40 million. So we're anxiously awaiting some of these next steps of the current administration. All right. And with that, I'm going to turn it over to Jose. Dr. Vito. All right. Good afternoon, everyone. It's kind of lame. We're going to do this one more time. I want to hear everyone. Good afternoon, everyone. Much better. Okay. So my name is Jose Vito. I'm an addiction psychiatrist. I'm also a child psychiatrist. I was a congressional fellow in Washington, D.C. I have no disclosure. So why should I advocate? It is human nature that we tend to make excuses. I'm too busy. I'm just a doctor. Who will listen to me? Will my opinion really make a difference? The answer is an empathic yes. Yes, you can make a difference. Legislators see us as experts in medical health, including mental health issues. So you're probably saying, what made you, Jose, such an expert about advocacy? So just a quick background. In my fourth year as a psychiatric resident, I applied and was awarded the Congressional Fellowship in Capitol Hill in Washington, D.C. I was fortunate that I have mentors who recognize that besides Jose's keep complaining on and on, that they recognize that advocacy is my passion. I was one of the staffer in Capitol Hill in Washington, D.C. And at that time, I was working with Democrat Senator Hillary Clinton from New York and also with Republican Gordon H. Smith from Oregon. I was actually thrown in and started working as a staffer on day one as soon as I got my I.D. I had to quickly learn and adapt to the different lingo and languages of legislation. I had to learn how to move a bill and how a bill becomes a law. So as a congressional fellow, what was my typical day like? My training helps me explain complicated medical concepts in layman's terms, like what is substance use, what is bipolar disorder. I advise them where the system falls apart and what alleviates the issues. Such as workforce issue, student loans. When I work in the Senate as a congressional fellow, part of my role was to meet with the senator's constituents. That means you who vote and hear their concerns. They would hand me written documents with data about why their issue was important. I communicated the concerns to the senators. I also kept their handouts and their contact information in our files for future reference. As bills were introduced, I and some of the staff would call on these contacts and relevant documents in deciding how to vote. You're probably asking, why would my elected legislator listen to me? Why me? Because you are the experts. You are who the legislator wants to hear from. You are in the front lines and you know what is going on in your practice, student loans, and also in your hospital. Therefore, you are an asset to them. Especially if you mention that you are constituents and that you vote. Because you will be the voice of your patients and you represent our profession. So, there are different ways you can be an advocate. You can meet with your legislators in person or virtually. Attend a town hall meeting where your legislators will be speaking. Call your representative's office with a clear message. If you do want to meet with your elected legislator, my advice is to contact your professional organizations first, such as AAAP. Nowadays, you can do Zoom meetings if you cannot make it in person. So, when you have these meetings, here is a list of do's and don'ts to guide you. The first five meetings set the tone. Usually, you will be meeting with a key staff instead of legislators. Do not be disappointed if you meet with the staff instead of the legislators. Key staff aides are the most often more familiar with the specific policy issues than their bosses. They are in the best position to listen to your point of view and advise the legislators of your concern. So, let's take the analogy of the emergency room. The patients will meet with a nurse first, then a medical student, the residents, perhaps a social worker, psychologist, and eventually the attending. So, keep in mind about the gatekeepers. It is important to establish a good rapport. Generally, politicians want to avoid controversy. They want to get re-elected. As seeing a patient for the first time, develop a rapport. Make them feel at ease. Facilitate the process. Start with a compliment, like, Thank you for taking the time for meeting with me. Believe me, this makes a big difference. Why? They will think that you are not a very hostile person. So, preparation is key. You will have about 10 to 15 minutes to present your case. It's imperative that you know exactly why you are meeting with them and what you hope to accomplish. You are an asset to their office. You offer a professional expertise and the knowledge that goes with it. When it comes to mental health issues, you possess a wealth of information regarding the current state of mental health back home. Communication is critical. Be concise. Be clear. What is your message? Try to pick three points that you want them to remember. Since time is limited, don't try to cover too many things in one meeting. If you talk about too many things, your message might not get across well. For example, I saw constituents who actually came in, she brought a laptop with a PowerPoint, and she was talking 100 miles a minute without taking a breath. My boss actually had to stop her because she was talking on and on and on. So, therefore, keep it simple. So, don't threaten, insult, offend, preach, or even write off anyone. Try not to be too confrontational during your meeting. You know, this has happened many times. People can get very passionate about their causes. So, get yourself in check. Present your case in a straightforward and persuasive manner. Be proactive and make sure you have enough time to discuss your issue. Do take the initiative, offer solutions, and ask for specific action. State the issue you want to discuss, what is your position, and what action you want the legislator to take. Back up your position with facts and personal anecdotes about why it is important for the legislator to take your position. Do tell personal stories. Explain how your issue affects real people. It is not always clear to legislators how their votes on bills impact their constituents. If you illustrate how individuals are personally affected, the legislators may realize the impact their bill in question could have on the people that they represent. Show how the issue affects everyone, not just you. How the policy is or isn't working locally. How the policy is impacting you, your practice, and your patients. How the policy can be improved to make things better locally. Stick to the issue, and remember, you are educating the staffer. Avoid clinical terms that could be misunderstood, and medical jargons. This happened actually one time, and the staffer actually walked out not feeling stupid, but also feeling offended. The message did not come across. Therefore, focus on limited issues. You, as the constituents, carry a lot of weight. You are a priority because you vote. If you are their constituents, identify yourself as such and describe your role within your community. You are not just an asset because of your knowledge. You also vote. So, why should we advocate? Because workforce issue and access to mental health remains to be an issue. There is a persistent restriction and discrimination in the treatment of psychiatric patients. I learned when I was there that the stigma is alive and well in Capitol Hill, and the mentally ill population that we serve is often ignored during the budgetary decisions. Research has shown that if doctors see other doctors and mentors and role models engage in advocating for patients and our profession, they will experience advocacy as part of their professional identities. Research has also shown that if doctors learn advocacy skills, they will be empowered to use them in whatever settings they choose to work. This is not just based on research, but I'm also speaking from my own experience. Many doctors are increasingly interested in being more effective advocates on behalf of better care for our patients and our communities. As professionals, we are all frustrated by the cultural stigma of mental illness and the misinformation about mental and emotional disorders that's rampant in our society. What was the experience for those doctors who did advocacy? They found it energizing and empowering. They realized how little legislators know about their training and the medical profession. They were a very important part of the grassroots efforts that they can improve people's lives and medical profession. And yes, you can definitely make a difference. Thank you. Thank you. All right, thank you all. We'll be opening it up for questions or comments from the audience, so please feel free to come to the microphone in the middle of the aisle. You know, the fact that you're actually on this workshop, you know, this is a good step. The fact that you're here, you're interested about advocacy and learning about advocacy is a very good step. It is a skill, right? And knowing the skills and having a support system like AAAP with Holly, you have all this information that you can bring back to your program and really encourage the trainees in your program about advocacy. So this is the first step. Now, in terms of what else can you do? You know, start meeting with your legislators. I think we, as professionals, we should really put in our brain that we have all this knowledge. We should educate the staffers and the legislators about the issues, what is going on. Again, remember, as I said, your constituents, you vote. They need to listen to you. And I'll just add that you don't have to take on the world, that local policy matters, state-level policy matters. So don't forget about that. And when you identify an area that needs improvement or needs to change, don't be afraid to reach out to your state or local medical society. Let them know about the issue. Get partnered. Speak with state legislators. Let them know there's a problem. In our committee earlier today, I talked about there was an issue with us putting naloxone vending machine in our addiction center to give out free naloxone because it was a misdemeanor in the state of Georgia to stock medications in a vending machine. And so I used our state affairs team to notify the state legislature that this was preventing us from saving lives and distributing naloxone. And so then, next, I found myself down at our state capitol advocating to the state legislature to actually have that removed. And it was passed into law so that now it is no longer a misdemeanor to stock a vending machine with naloxone. So I just encourage you, when you identify an issue or a barrier, and it's defined, work with people that you know to make change. And when it's something that seems nearly impossible, reach out to AAAP and brainstorm with the collective knowledge that AAAP brings. So you don't have to take on the world. Start somewhere. So there was another question just about a practical approach. So say the first thing I'm. advocacy efforts. What would be like the first or second practical thing that I would do after I come to something like this? I would say public policy. And talk to the co-chairs of those. Okay, so joining the Public Policy Committee for AAAP would be a first great step for anyone interested in getting active along those lines. I have a question because I'm in West Virginia. I work in West Virginia, but I live in Virginia. How do the staffers feel about those of us that are advocating for our patients, but we are not voters in that state? Do they look down on that and should we be looking to our colleagues that do live in their area? I just wonder how they look at that. So it actually gets weird sometimes, but on the average, most offices, if you say I am a practitioner in X area, they don't ask for your exact zip code. There are some offices that will. And I'm actually seeing increasingly if you ask for a meeting with a member of Congress that they want the exact hometown. So there are some cases where I'll get a response that says something like I'm only meeting with people that are specifically constituents. And they do that because they get so many meeting requests that they will call them out. But on the average, if you say I work in this place and I'm talking about your constituents, they will meet with you. But every so often, it's just their way of sometimes literally just calling down on their number of meetings that they won't. But like a Virginia, West Virginia situation, I think they also understand. More of what I think they're trying to avoid is someone from like a corporate office coming in, you know, representing Hospital X. Although I do that all the time. I will have someone who's in the corporate office who has, you know, we work with a client that has chains of hospitals and say, okay, they're in your state. Like this is still relevant. We're talking about access for people. So we make that case. But they do get inundated with meeting requests. For those of you who participated on, we did an advocacy webinar last spring. And we had Emily, who is Congressman Tonko, who we mentioned earlier has agreed to sponsor some of AAAP's legislation, his legislative director. And she talked about what her day is like. And she is literally doing meetings every 30 minutes on a variety of health topics throughout the day and then has to brief the Congressman on those topics. And so that's why sometimes they're kind of do a block and tackle. But I think in that case, I would make a good case like you should take the meeting probably 90% of the time. Sorry, that's a long answer for they probably will take it. Oh. Yeah. So the question was how do you request a meeting? So the first step, especially if you're going to do it with AAAP, would be to find me. And if you go to the AAAP website and there's, I guess, a contact us, you can fill it out and say I would like some help or I need to identify who my staffer is. And Michelle and the team at AAAP will forward it to me. And I have directory services that we pay for that give you that kind of information. And that's true, too, if you have a personal issue or something else in your state or district like a passport problem, they have staff that will help you with those things. And so, you know, you can just call the office, too, and say I would like to know who handles health care. And they will, the intern or staff assistant will tell you, oh, yeah, it's Susie Q. She handles health care. Would you like me to spell out her email address for you? And you say, yeah, that'd be great. Thank you. So you can do that. You can get in touch with us. The way I do it is that I will email the staffer who's in charge of the issue or the scheduler. So each office has someone who manages the schedule for the member of Congress or the senator, sometimes more than one for Senate office. And they will get these requests. They look at them, decide what the member can do in a day and set up the meeting. Then they have legislative staff that handle their meeting. So a lot of times I just go straight to the legislative staff. We're not going to bother with the member of Congress. And I will say, can you meet with Dr. Berry virtually on June 22nd? We want to talk about these three priorities for AAAP. And they'll come back and say, can you do 11 o'clock? And I'll say, sure, here's the link. And we set it up from there. Or it'll be an in-person meeting. And generally, it's pretty much that simple. It's actually probably a lot times easier than it is to get hold of your dentist and schedule an appointment. I can do this a lot faster than doing that. Does that answer that question? So I, yeah, I am a little bit, I know each state is different. So I'll start with, so on the federal level, I generally recommend doing meetings with the DC staff. And as Dr. Vito mentioned, you can do those virtually if you can't make it. That being said, the staff will travel back to the district or state occasionally when they have breaks. Otherwise, I would not, on the average, meet with the in-district staff because they're not really the policy experts. They will write a memo and inform the DC staff. But otherwise, I'd stick with them. With offices in the state, I think it probably varies because some states are full-time. They're every other year. They're that kind of thing. And so at that point, I would probably just contact their office and say, how do I do this? But most of them have a website. They have clear contact information. Some of the DC offices now have a form where you can request a meeting or you can also request through that form if you would like them to come to an event that you're doing. So if you have a ribbon cutting or you want them to come do a tour or whatever it might be. And I would add, in addition to leaving here and making sure you're on the Public Policy Committee, I would assume everyone here is registered to vote, first step. Second step, I would follow their member of Congress' social media and or most of them have newsletters that they will send out. If you live in a district, you probably get mail from them because they can send that for free through their congressional budget. But a good way to keep track of them is also, a lot of them do weekly newsletters or other things and or they're pretty active, not all of them, but a lot of them. So, the rule that they released was clearly like a political, oh, vote for us, we're going to reschedule, right? And that's not going to become, I don't think, in the federal register in the next month or two. So, I think there's interest. I'm sure people have seen that Congressman, or not former Congressman Gates has been nominated to be Attorney General. He's kind of a, I think, interesting different things, like he was against the Florida ballot initiative, but otherwise has been for loosening marijuana restrictions. So, we'll kind of see how the new administration feels. I feel like, on the average, we're probably heading in a direction of less loosening of marijuana next year under the new administration, but we shall see how that shakes out. It's going to be interesting. I think, just in a whole, we're looking at more, less harm reduction, more of a law enforcement approach under the new administration, but that being said, Trump is Trump. Who knows what he's going to, I guess he doesn't tweet anymore, but I mean, it'll be interesting to watch. But I don't think that the folks who, especially on the House side, are coming into power are particularly keen on some of those ideas. You're at the mic, I don't know. I'm from Nevada, and I've been doing advocacy in Nevada for about 15 years, and so, a couple of things to add to what you all have suggested, one is your district branch of the APA, because they almost all have a lobby set up. And then I've gone to the APA's advocacy days many times, and so you can do that, where they have arranged all this stuff, and APA doesn't tend to use substance abuse issues very much, but it's a way to get in there. The other thing you were saying about locals, register to vote, maybe give a little money here and there, and then you get on all these lists, and I go to fundraisers for our senators this year, and in the past, so you get to know them that way, because there's not that many people at these fundraisers, so you can really talk to them. So there's a lot of things you can do from home to make the contact, and become one of the experts for these people. Fundraising is a whole separate thing, and God bless you for getting all those texts and messages, I'm sure, in a swing state. Fundraising, some of these meetings, the minimum is $2,500, but a lot of them it's $100. And so it's not that expensive for us to put a little bit of money and get your name out there. And I think people are intimidated by some of it, but like she just said, a lot of them can be smaller dollars, especially back in the state or district, just compared to DC, and certainly they're paying attention to who their donors are. I will say that I don't think Dr. Vito has expressly said that, but talking about campaign contributions in a federal building is a big goal. That's always in our disclaimer. You cannot say, I gave you so much money, do this. No, please don't. To add on to what you said as a medical student and kind of feeling like hopeless and powerless, I'm in Ohio, and I will just say we've had a statewide legislative win where OSAM, because there's a state chapter of ASAM, does some policy work, so like APA, ASAM, AAAP doesn't have necessarily state chapters, but working with Holly's team and through our organization, you can do these things as well. But we were able to, there was a cap on buprenorphine as part of state policy that you can go above 24 milligrams as of October 31st, 2024. That has been lifted because of advocacy work from OSAM and others, and writing letters and other addiction providers coming together to say we need to change this. That will really help a lot of patients and save lives, and so that's all I have to say. Thank you. I have two questions, if that's okay. Yeah. So the first is, I'm curious, as a novice, if your strategies change based on who the political party, who's ruling the house, or the Senate. Do you have a different strategy, and do you tend to see more success when one party is in power versus the other? It depends on what issue you're talking about, but yes, we 100% tailor our messaging to who the audience is, and we will tell people before they do a day in the hill, look at the name on the door. We give them bios so that you get some background information. You want to approach Elizabeth Warren very differently than you approach Ted Cruz. The arguments are going to land in offices are just different. So for example, Democrats, particularly liberal Democrats, they don't care as much about saving money. They're more willing to spend. You'll hear them say things like, we have plenty of money. We just bought a new F-16. Surely we can invest in X, Y, and Z. I think all of them care from the perspective of the patient, and that is universal to the extent that you can couch an argument and not so much what we were talking about earlier in the policy committee meeting about loan repayment. Yes, it's important for physicians to receive loan repayment, but the reason why it's important is because then you get more physicians who are there when you have a kid in crisis who can see them. So why is it important? It's because it's important in patient access. So the extent that you can always couch it in how that affects their constituents and patients is true across the board. But yes, we definitely change argument depending on who you are talking to and what is going to kind of resonate with that office. In terms of success based on who is in charge, yeah, I mean, I don't think that under Republican control Congress would be the Affordable Care Act, right? I mean, things change. Like different members of Congress and different parties have priorities of different things. And so like I said, next year I think we're going to see more of a law enforcement perspective, maybe more interest in things like some of those state ballot initiatives that if you're involved in giving someone fentanyl and they die that you're prosecuted for it. Like some of that kind of stuff may be kind of bubbling to the surface. I think there's some general opposition to harm reduction. We saw this year, last year, for example, a provision in the House report. And so everyone understands that when they do appropriations, they write a bill that spells out like, CDC will get this amount of money. And then there's a report that goes with it that has all the details and it has more plain English writing. And so that's where we kind of dig through and that's where like the language that was in the notice of funding opportunity was in there. And so it said like no funds could be used for harm reduction. Like that kind of stuff. And then there's a question of like what is harm reduction? Does harm reduction include your naloxone dispenser? Does harm reduction just include needle exchange, supervised injection? Like what does that mean? So and like I think naloxone, for example, is more mainstream now than it used to be, but still somewhat caught up in that. But some of those other things like, you know, and I think people are looking at like Portland like, oh, look what they've done over there, you know. And so we'll see kind of next year how that shakes out. At the same time, we had this conversation with the board yesterday. I know it can be intimidating to talk to members of Congress. And I've used the example a few times that I had a cop from Philly who was like, did you tell I was shaking? And I was like, are you kidding me? Like most staff are young, right? The average house staff are probably about 25, give or take. Senate staff are a little bit older, probably in their 30s before they leave the hill and make some real money. And I think, yes, there are in every Congress the kind of outsiders or the rabble rousers or whatever. But the average rank and file member, they want to do the right thing. You may come at it from different perspectives, but they're hiring smart staff who are probably class president in high school, maybe college too. And they want to do the right thing. So if you can build that relationship with them and explain to them why this is important, explain it to them in terms that they understand without being condescending, and build that relationship over time. One meeting will not do it. You will need to meet with them. And then when you have that ribbon cutting, invite their boss to come to it. And then maybe give them a little money. And then meet with them a year later and be that expert. Then you can build that kind of relationship over time. But you have to be in it for the long game. Okay. I guess my second question is. Oh, sorry. Yeah. Thank you. That was very informative. My second question is I kind of noticed that there wasn't any mention of anonymous and breach. I'm curious as to what their role is in advocacy. Are they involved? Or do you involve them? Because it's an agency of the government. So I would think they are like right there. So I'm wondering how you integrate the agency with the work in the world. So NIMH and NIDA are definitely, for those who aren't familiar, it's the National Institute of Mental Health and National Institute on Drug Abuse, are definitely agencies who we're interacting with, along with the whole other federal alphabet soup. We were talking about earlier that AAAP has to prioritize what things you want to bring up in a meeting. And Dr. Vito was saying you can't go in with 100. And so the things that we've talked about are the top priorities for this year. But we're having discussions about what should be AAAP's top priorities in the future. And I think feedback from the membership, too, on what is most important to you, what is most impactful. Because it feels like the things we've picked from what I hear from people are. But if research dollars or other things are more important than maybe we realize, then that net would rise more to the top. So I describe an advocacy plan as ranking. Right? So you maybe have A, B, and C. And so A and B, maybe you talk about in these meetings. And C, you just sign on to a letter. So in that case, if that was a C priority for us, we would sign on to a letter of support for certain funding levels but not talk about it in our meetings. But if folks are saying that that is actually more important to them, then that would bump it up on the scale. So maybe also thinking about a survey, the membership, on what might be something worth. No. No. Yeah. Yeah. I'm sorry. That was the question. Yeah. So those agencies are not. They don't qualify for their budget, but they're kind of hamstrung to whatever the administration's request is. And then outside entities advocate to increase their budget because then in those cases, it's more research dollars going out the door. This is kind of just your perspective type of question. I work in two different clinical settings that are in two completely different political worlds. I can't believe they're even that geographically close to each other. And I find myself thinking like we as physicians, I'm a child psychiatrist and addiction psychiatrist, and I see that we as physicians, we have to represent, we're representing all of our patient population. And regardless of where we feel politically, our patient population is probably sort of split, if they even care about politics. This presentation was interesting to me because I feel like it was fairly nonpartisan and I appreciated that. And I've been to others that didn't feel that way at all. And I guess I worry a little bit when I think about our advocacy, and this is where I'm just curious of your perspective. I worry at times, particularly one of my clinical settings, that if our field is seen as political, we ostracize half, one way or the other, roughly speaking. And I just wanted to ask your guys' thoughts, like advocacy, and I'm not asking any of you to talk about your own politics, but advocacy, how can advocacy be an effort for the moderate independent, or if advocacy is an effort for someone who's passionately political, how do you navigate sort of nonpartisanship? I should have worn purple. So I, my political affiliation doesn't matter. So I will email and request a meeting from Elizabeth Warren and from Ted Cruz, and we go in, and I think the beauty of AAAP is that we're talking about the evidence and the science. And so, you know, and again, we customize our message to who we're talking to, but in a way to try to make sure that it's resonating. But at the end of the day, the message is still the same, that we're ensuring access, and that we're trying to make sure that people have access to evidence-based services, and they have access, even more basically, to a provider to begin with. And so that is not a political argument. I mean, it's my take. That's just a common sense, okay, I am Dr. X. I live in your district. These are the issues I'm seeing on the ground. And that, you know, Dr. Vito mentioned, you being the expert, CDC or NIH or whatever data is usually six months to, what, a year behind. So you're an invaluable resource when you can say, I don't know that we've seen this yet, but like Dr. Berry was saying, you know, yeah, we're seeing a lot of opioids, but I've heard other people be like, I don't know that it's showing up yet, you're hearing about it, but meth is on the rise. Like, that's what we're seeing. That's not political. Some people would call that even just educating, beyond the point of even advocating for anything. And then the advocating part is, hey, I want you to pass X bill. I want you to fund this at that level. I want you to write this letter. And that's advocacy, but none of those things, to me, are particularly political, and we've tried very hard to be nonpartisan or bipartisan and not be seen as affiliated with one way or the other. That being said, you as an individual, if you're giving a lot of money, and that's public, then they will know. Those are things that you can do. Nobody knows who you voted for, but they do know if you're making contributions in one shot of over $250. Thank you, Peter. That was a great question. I would also just reiterate that there is a difference between personal and professional advocacy and knowing the situation you're in and who you're representing. So when I'm representing AAAP, I have the doctor hat on, and I've basically sussed out what I'm going to say with AAAP staff, and I have my narrative, and I have the backup in the room. When I'm doing something at the state level, I'm often representing Emory, and so then that is a different professional affiliation, and I'm working with my state and government affairs team. We've jointly crafted the narrative. It's been approved in that way. But then I'm also a staff member in a different way, but then I'm also a human, so I have personal advocacy and sometimes some science in the front yard. And that is a different me, and it has less constraints, but I always am cognizant of making sure that I'm not necessarily blurring those lines and I'm very clear about that, because it can be misconstrued if it's a personal advocacy moment that if you slip and you say, I'm a physician representing such and such, it is going to get pinged onto that professional organization, and a lot of organizations are very clear about when and when you do not wear your white coats and how you introduce yourself to staff. So when I'm introducing myself with the AAAP, I'm often introducing myself as the chair of AAAP public policy. I'm not necessarily saying I'm an Emory representative, but I might be saying I'm from Atlanta, Georgia, if it's someone from my state. I know for myself and a lot of my early career colleagues, loan forgiveness is a big concern, especially moving forward. Does the AAAP have any plans to advocate for protecting loan forgiveness in the new administration? Yeah, so, oh, sorry. Specifically things like public service loan forgiveness. So, we're continuing to advocate for star LRP, so it's the two pieces to that to make it more accessible. So, one is to increase the funding level overall since 93% of applicants right now are getting turned down, and that's across the substance use provider spectrum because there's not enough money. And then the second issue is addressing that direct service requirement so that more addiction psychiatrists would qualify for that. So, as Dr. Walsh mentioned, we're waiting to see what happens with the FY25 bill and trying to get more money. We also advocated this last year, first report language, and then we were using, so that report that comes with the appropriations bill that has all the instructions, we were trying to tell HRSA to change their definition of direct service through that process because it's not in law, it's just their interpretation. So, we weren't as successful as we wanted to be, but advocacy is a long game. And so, we will try again this year. We also had Congressman Rogers of Kentucky, who's a former chair of the Appropriations Committee, and Congresswoman Spanberger of Virginia reach out to HRSA about it as well. And so, we're gonna continue to be pounding on that. So, it continues to be one of AAAP's top priorities. And if others have thoughts about other programs or things that are out there that maybe if they were tweaked could be helpful, like we'd be all ears, because we recognize that this is something that is really difficult. I would say also to the extent that you have personal stories, it's helpful for us to have them because we use them. Sometimes when we're doing the board meetings, I'll have someone say something that's really useful, talking about maybe, oh, I treat all these Medicaid patients, but I don't qualify. And so, in the next meeting, I'll say, well, just had someone. So, making that kind of personal story is helpful. So, again, if people can reach out to us and then also want to be involved in advocacy themselves, we'd be happy to have you. Thank you. Hey, similar to what other people have said, thanks so much for y'all's session. So, I remember you said something earlier about some kind of favorable rules related to parity that passed earlier on. I recently graduated from residency and fellowship over in Dallas, Texas, and just started with the VA. And my experience with getting out of training was seeing a lot of residents and co-fellows and things like that, kind of look at, well, what are the comparative salaries between academic institutions serving public hospitals, county hospitals, more underserved populations, and those salaries were just fairly, significantly less competitive than some of the kind of outside opportunities, whether that's even the state hospitals or the private practice options, of course, things like that. So, I was just wondering, and I know in the committee you also mentioned about the kind of disparity between how Medicare reimbursement is not keeping up with inflation, things like that. So, I was just wondering if you could kind of talk a bit more about those kind of efforts and that relationship between the kind of parity rules and how that might kind of relate to those kind of disparities in compensation that kind of leads to less people being attracted to staying into those fields, serving those populations. Yeah, so in 2008, Congress passed the parity rule or parity law, which was intended to make sure that people get equal access to mental health and substance use treatment as they do for medical surgical. And what we know over the last, don't even want to count many years, experience is that the plans have continued to be non-compliant with the law, throw up obstacles at every opportunity. And one of those things that continues to be an issue is provider reimbursement. But I should also note that parity only applies to Medicaid plans and it applies to the expansion benefit and it applies to employer-sponsored. It does not apply to government insurance like Medicare or the VA. And so, like DoD, for example, has complied with some of it voluntarily, FEHBP also for the same, but they don't have to. So this year, new rules were released to try to further tackle these issues and the administration really put an emphasis on actual meaningful access as opposed to just like what the rules are, but really measuring whether or not people are getting access. And they also included, especially out-of-network reimbursement rates as a non-quantitative treatment limit, which I know is a mouthful, and making plans to really analyze those, quantify them, and look at whether or not there's meaningful differences between medical, surgical, and mental health and substance use. And so the rules are pretty strong. The issue is, well, besides, so there's a Congressional Review Act which might result in them being overturned. Then there's also the issue if they go to court that as people may realize in June that the Supreme Court overturned something called the Chevron Doctrine, which had given longstanding flexibility to the agencies. And I can tell you, having worked on the original parity law, that there's definitely some interpretation in the rules as compared to the underlying statute. So that would be another problem, would be potentially going to the courts. So I don't think the story is over yet and I think that it continues to be a problem that we see plans under-reimbursing. We continue to see other barriers, prior authorization, utilization review, all the medical management techniques that we know that they're using. And I think that they feel like it's a business decision to basically just not comply because it's worked for them so far. So, and I would imagine that the new administration will be more favorable on the business side as opposed to the more patient, consumer-friendly perspective and provider. So we'll see how this shakes out. But honestly, it's been a little bit discouraging to me to have worked on the original law and then still be fighting this. Like, I didn't really wanna be employed still doing this. I would like to move on, but here we are. So, but I'm hopeful still that maybe the rules will stand and we'll actually see some meaningful changes. But my hope, my husband would say hope is not a strategy. So. So. One more, okay. I'm an addiction psych fellow in Boston. So, and I guess this question might be slightly outside the purview of this meeting, but speaking of recruitment of residents for the subspecialty have, and I guess this question sort of directed towards everyone in the room in general. Have there been any sort of recruitment strategies that you guys have found like helpful in terms of convincing a resident to go into addiction psychiatry? And if so, would you be able to share some? That's a great, great question to close on. Talking to people, one, about the joy of the work that we do, I think is really the beginning and the end of that conversation. And then sort of the bread to talk about how people's lives are absolutely transformed as a result of just evaluating their relationship to substances sometimes not even necessarily talking about. But in addition to that, you know, we talk about some of the options that are available for loan repayment within our local health care system. So I happen to be attached. You know, Harris County is a health professional shortage area. So there are also other types of clinical environments where people can work, where they become eligible for loan repayment as well. And really talking about how you can invest in your career in that way by, on the back end, getting some dollars from the Loan Forgiveness Program. This has been wonderful. Thank you so much for your questions and brilliant comments. I'm sure that the panelists will be happy to stand up here and answer additional questions or comments from you. But with that, thank you. Thank you.

addiction treatment

mental health

Dr. James H. Berry

opioid crisis

Appalachia

advocacy efforts

stimulants

synthetic opioids

addiction psychiatry

legislative priorities

PCSS

healthcare advocacy