When medicine meets politics

Name: Ralph Alvarado, M.D., Winchester, Kentucky

Education

Undergraduate: Loma Linda University, California

Med school: Loma Linda University School of Medicine

Residency: Internal Medicine/Pediatrics, Chandler Medical Center, University of Kentucky

Ralph Alvarado, M.D., represents District 28 in Kentucky’s state senate. He serves as the chair of the Senate Standing Committee on Health & Welfare and is a Medicaid Oversight and Advisory Committee member. He has practiced both as a solo practitioner and with other physicians and nurse practitioners. 

Senator Alvarado currently serves as director of several long-term care facilities. Additionally, he serves as a medical director for substance abuse/recovery center Isaiah House, all while representing the 28th District in the state legislature.

What’s the best part about being both a physician and a politician?

In my role as a state senator, and especially chairman of the Senate Health and Welfare Committee, I finally have the opportunity to remedy some of the problems I see.

Because I am a doctor, I can draw attention to issues that many people are not even aware of. Suppose I see a policy problem or a health care-related problem that can be aided by sound policy. In that case, I work to address it with legislation or by working with state agencies on regulations.

Several changes have come into play because of the attention other lawmakers within the medical field and I have brought to it. There are also tobacco-free policies in Kentucky, which is a state that is historically and continues to be a heavy-use state. Lives have been saved because of the implementation of policies to reduce tobacco use among citizens of the state. Most of those calls to action were from medical professionals like myself.

We have recently taken significant steps forward on telemedicine expansion in Kentucky. As a doctor who wants to see problems remedied, it is rewarding to see such legislative efforts yield positive results and benefit people.

Bettering health outcomes is what matters, but it is satisfying to get wins along the way. Then, after a legislative session, come back home, practice medicine, see patients, and talk with colleagues. It feels like I’m back home having delivered a win for the home team. I do it for the practice of medicine. That’s what it’s all about.

What’s the hardest part?

In the doctor’s office, you diagnose the problem and provide a plan to help. As a politician, there is often someone standing between you and the solution to the problem, blocking you because a group or organization with political influence disagrees, or whatever the case may be. 

In medicine, physicians are trusted to give our professional diagnosis and expect someone to carry it out. In the political arena, it’s not that simple, so it takes teamwork and building a majority consensus. 

As an M.D., I am used to being more authoritative in health care. In the Kentucky General Assembly, it is not just offering a policy proposal to address an issue. I have to convince my colleagues to support it or be persistent with legislative leadership to understand it needs to advance through the legislative process. That is the most challenging and frustrating aspect of having a physician’s mind in a politician’s world.

Was there anything about being a politician that surprised you?

As a part-time lawmaker in Kentucky, we make around $32,000 a year, depending on how many days we spend at the state capitol. That does not replace the income earned as a doctor. Also, the time that is required to earn another term as a state senator is incredibly demanding. 

That is why, no matter who the person is or how much I may disagree philosophically or on policy, I have nothing but respect for them if they put their name forward for public office. You are always more likely to hear from someone upset with you than from someone you pleased. Anyone who goes into public office looks back and realizes they did not know how much is going on.

Do you have any advice for physicians who wish to enter politics?

If you are serious about going into politics, you have to find the time to attend the meetings and community events necessary to serve. Counties have local party affiliates that usually meet once a month. When you participate in those meetings, introduce yourself, get to know your state legislators and local officials, and become familiar with the necessary local issues in voters’ minds. 

Do not be afraid to express an interest in running. You need to get to know people. Make sure you are involved in community organizations, such as the Chamber of Commerce. Sometimes it is tough to get people to dedicate their precious free time and money to your election efforts. The dedicated will lose some personal income as well. However, it you are willing and committed to doing what it takes, just jump in and do not be discouraged by failure.

Anything else to add?

There are many non-medical minds making decisions on public policy that impact the practice of medicine. Professionals in medicine are waiting for issues to be addressed, but we cannot just be on the sidelines. We must be engaged. You may not want to run for office, which is understandable. You can still build relationships with your local officials and political movers and shakers. It is those people who will have the most significant impact on your practice of medicine.