By Richard L. Schilsky, MD, FACP, FASCO
ASCO Chief Medical Officer
What is the ASCO Health Policy Fellowship?
A 1-year fellowship program combining didactic small-group teaching sessions delivered by ASCO professional staff and qualified volunteers; a mentored research program that advances or leverages an ASCO policy initiative with mentorship provided by ASCO professional staff collaboratively with a research mentor from ASCO’s Government Relations Committee or relevant policy committee (e.g., Cancer Prevention, Health Disparities, Clinical Practice, Quality, etc.); practical experience working with ASCO policy/advocacy staff and policy counsel in crafting policy positions and statements, participating in relevant committee meetings, the State Affiliate Council, and Congressional/agency visits. Topics to be covered in the fellowship curriculum will include but are not limited to the Congressional authorization/appropriation process, NCI organization and programs, FDA organization and authorities, drug and device approval processes, CMS organization and reimbursement policies, payment reform initiatives proposed by ASCO, and others. Additionally, the program will include training in communication skills (e.g., message training on key ASCO issues, speaking with media, etc.), advocacy strategies, and leadership skills.
Working with appropriate staff and volunteers, the fellows will develop a project proposal aligned with current ASCO policy initiatives, during the first 2 months of the fellowship. The proposal will include a timeline, a clear statement of the primary research or policy objective, the rationale for undertaking the project, the proposed project methods, the project endpoints, and a method for assessing whether or not the primary project objective is met. The completed project will be presented to the ASCO committee with oversight of the project topic area and, potentially, be presented at an ASCO meeting (e.g., the ASCO Quality Care Symposium/Cancer Center Business Summit).
Upon completion of the fellowship, the fellow will be assigned membership on one of ASCO’s policy committees.
Why now?
The move to precision medicine in oncology has led to more effective treatments for many cancers and better outcomes for patients with cancer. This progress, driven by decades of investment in basic science research, is in jeopardy because of: 1) declining NIH appropriations to support scientific discovery, 2) an increasingly complex regulatory environment that threatens to slow product development, and 3) variable and complicated reimbursement policies that may limit access of some patients to life-prolonging treatments. The increasing costs of health care, driven to a great extent by a fragmented and inefficient delivery system and the skyrocketing costs of new drugs, place enormous economic burdens on patients, providers, and purchasers of health care alike. These challenges have led to calls for improved care coordination and new payment models that incentivize cost-savings while preserving the quality of care. Economic pressures, growing emphasis on value, and increasingly unsustainable administrative burdens require new tools and strategies for oncologists to succeed in today’s environment and, in many cases, are forcing privately owned oncology practices to merge or be acquired by hospitals and health care systems—steps that risk further reducing efficiency and increasing cost. Thus, at this time of unprecedented opportunity to develop scientific insights into new products and services that benefit patients, every aspect of the discovery-development-delivery paradigm is under threat due to reduced funding, increased regulatory burden or reimbursement reform and practice organization.
Clearly, the array of policy concerns for oncologists has expanded well beyond the core issues of Medicare reimbursement and NIH funding that comprised the bulk of ASCO’s policy agenda just a decade ago. The Society has responded to growing environmental and strategic challenges with expanded professional staff and increased investment in data collection/analysis to better support trend-spotting and monitoring for a rapidly growing portfolio of research, regulatory, reimbursement and practice issues. This investment has enhanced ASCO’s position as a “go-to” oncology resource for policymakers, with routine outreach by senior representatives from Congress and the White House seeking ASCO input on practice and research. As the expertise of the ASCO staff has expanded with the addition of a Chief Medical Officer and physician-leaders of several ASCO departments (Education, Science, and Professional Development; Quality and Guidelines; Clinical Affairs), an enormous opportunity now exists for ASCO to train and equip a cadre of volunteers skilled in today’s complex and highly charged policy environment—an environment unlikely to change in the near future and where decisions about how research will be organized and funded, how product development will be regulated, and how care will be organized, delivered, and compensated will be in evolution. ASCO’s experience working with members who have policy experience—either from previous professional roles or from longstanding involvement with ASCO policy work—has demonstrated the power of combining a dedicated professional staff with skilled physician advocates.
Who may apply?
Applicants must be a licensed physician (MD or DO or international equivalent) working as an oncologist in any discipline for 10 years or less or who are currently enrolled in the final year of an accredited U.S. clinical oncology training program (medical oncology, radiation oncology, surgical oncology, gynecologic oncology, pediatric oncology). Trainees must have completed at least 2 years of clinical oncology training to be eligible. Applicants must be an ASCO member (Full Member or Member in Training) and be a U.S. citizen or permanent resident.
How can I apply?
Applications must be submitted online using the ASCO Grants Portal. Applications must be submitted by no later than December 15, 2015. Nominations must be submitted by the division or department chief, practice lead, or training program director, who must certify the applicant’s eligibility for the program and indicate the program director’s, chief’s, or practice lead’s commitment that the applicant will have sufficient protected time available to fully participate in the program, including regular travel to ASCO HQ, estimated at 1 week per month. The program director, chief or practice lead must also confirm the commitment of the home institution to continue to pay the full salary and fringe benefits (or other for practicing physicians as agreed upon with the applicant) of the candidate throughout their participation in this program.
Applicants must submit a curriculum vitae and bibliography and a letter of commitment to participate in the program. The letter must also include a statement of how participation in the program will advance their career goals. In addition, applicants must provide a rationale for choosing a particular project on which to focus from a list of topics or issues active in one of ASCO’s policy committees, task forces or working groups. The expectation is that candidates would spend at least one week each month at ASCO headquarters during the course of the year. Two applicants will be selected each year for the initial 3 years of the program.
How is the program supported?
The fellows’ full salary and benefits will be provided by the home institution. ASCO will support all travel to ASCO HQ and all living expenses while the trainee is working on site at ASCO HQ or traveling as required by the training program. ASCO conducts and administers the fellowship with funding support from the Conquer Cancer Foundation Mission Endowment.
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