For Representative Kim Schrier, MD, (D-WA) a diagnosis of type 1 diabetes during adolescence set the stage for two different but intersecting career paths: first as a community pediatrician, and now as a new member of the US House of Representatives, with healthcare as her signature issue.
Schrier, 50, was elected November 6, 2018 and sworn in January 3, 2019. She represents Washington State's 8th Congressional district, which includes the city of Issaquah, where she practiced general pediatrics for 17 years before running for Congress.
She's currently the only female physician in Congress and the first one who's a Democrat. She's also the first pediatrician ever to serve in the US Congress, according to the American Academy of Pediatrics.
A mother of one, she may also be the first member of Congress who personally has type 1 diabetes, although several others have had children or other family members with the condition.
Her campaign website details her vision for America's healthcare system, starting with the principle that "quality healthcare is a fundamental human right."
She describes how her own type 1 diabetes diagnosis and experience as a pediatrician led to her commitment to "moving us toward a Medicare-for-all system that guarantees affordable, high-quality care for every American."
In the short-term she supports four initiatives: expanding Medicare to all through an immediate public option on state health exchanges, restoring the Affordable Care Act by stabilizing insurance markets and protecting people with pre-existing conditions, lowering the costs of care including prescription drug prices, and "solving the healthcare issues of tomorrow" by investing in medical research.
She also vows to help combat the opioid epidemic, to advocate for women's healthcare — including supporting Planned Parenthood — and to promote rural healthcare access by incentivizing specialists to work in those areas and encouraging the use of telemedicine.
Naturally, she's already joined the bipartisan Congressional Diabetes Caucus, which has the mission "to educate members of Congress and their staff about diabetes and to support legislative activities that would improve diabetes research, education, and treatment."
From Living With Diabetes to Tackling it in Congress
On January 16, 2019, just 2 weeks into her new job, Schrier sat down in her Capitol Hill office with Medscape freelance journalist Miriam E. Tucker to share her story and her agenda.
Tucker: What were the circumstances around your type 1 diabetes diagnosis?
Schrier: I was 16 years old and was drinking a ton of water. We didn't have water bottles in those days, so I remember going to English class and lining up five or six plastic cups full of water from the drinking fountain on my desk. They were gone during the first minute of class, and then [I recall] running to use the teachers' bathroom because I couldn't make it all the way to the other bathroom.
My mom, who was a public school teacher, picked up on the symptoms and took me to the doctor.
At that time, the only thing I knew about diabetes was that a friend's father had it and had died from it. So that really weighed in my head. But I was a good student and a first [eldest] child who wanted to do everything right. So [clinicians] would tell me what to do and I just did it.
At that time, blood glucose testing was brand new and each test took about 60 seconds. I did a lot of those. I've had a pump since about 1989-1990, and now I also wear a [continuous glucose monitor].
Tucker: How has your diabetes management been in the past 2 weeks in Congress?
Schrier: I always find that it's juggling, and the more data I have the better. I always carry a granola bar or gummy bears or dried cranberries. Something [to treat low blood glucose] is always with me. I've noticed that all the walking around helps, but it's set me low several times.
Tucker: How old is your son, and how did your pregnancy go with the type 1 diabetes?
Schrier: He's 10. The pregnancy went well. He came out big but healthy and I'm eternally grateful for that. I did it once, at age 40 — talk about adding risk factors — but it was fine and actually pretty easy.
Tucker: How did you decide to go into medicine, and why pediatrics rather than endocrinology?
Schrier: I had a fantastic pediatric endocrinologist who took care of me, Fran Kaufman. What a role model! She was sweet and smart, and had graduated top of her class. She was an inspiration, and that's what directed me towards medicine.
I chose to stay away from endocrinology. It felt a little too close to home. But I had a handful of patients with diabetes in my pediatric practice, and I took them under my wing. That was a perfect way for me to have a diversity of patients to care for and still have my little ones I could connect with personally.
Tucker: Are you still practicing pediatrics?
Schrier: I can't now. I wish I could do both, but this is a full-time job. Even running for office was a full-time job, so I had to take a leave of absence for a year. It paid off, and I'm here now and hopefully I can do a lot more good for more kids from here than I could do just from my office.
Tucker: Why did you decide to run for Congress?
Schrier: I've always been interested in politics, but this was never on my radar, not in a million years. It was really the 2016 election, which hit me on a personal level in a lot of ways. Part was the change in character of our country, part was as a woman concerned about reproductive rights, and of course, a big part was these threats, the constant drumbeat of wanting to repeal the Affordable Care Act and what that would mean for the [30 million Americans with diabetes] like me.
I met with my [now former] congressman's [Republican Dave Reichert] office and explained that it would be really harmful for my patients and for people in the district to dismantle the Affordable Care Act and to not have a better replacement. I said that the first "Trumpcare" bill would not be adequate. Days later he voted for it in committee, and for me, that was really the last straw. That was when I thought, "Who better to speak to this than a community pediatrician with her own pre-existing condition."
Tucker: What are your goals for healthcare, particularly with regard to people with diabetes, children, and women?
Schrier: I will lead on making healthcare more affordable, more accessible, and making sure people with pre-existing conditions are protected, and making sure women have access to a full range of reproductive rights and options.
More broadly, I'm a pediatrician and a mom, and I see things through that lens. I look at affordable healthcare, at nutrition programs, [the Special Supplemental Nutrition Program for Women, Infants, and Children] programs, early childhood education, and climate change all as issues of supreme importance to children and families.
Tucker: How do you hope to help children in disadvantaged neighborhoods who don't have access to healthful food or activities and are at risk for obesity and chronic health problems later in life?
Schrier: I would say this is a reason to have a pediatrician in Congress because I am acutely aware of that intersectionality between socioeconomic background, food accessibility, no safe place to run around, video games, television, and sedentary lifestyle. All of those things factor in. The cheaper foods are the most calorie-dense and less healthful, while fresh fruits and vegetables are incredibly expensive, which is why our supplemental nutrition programs are so important.
Tucker: And what about drug prices, particularly with insulin and some of the more costly type 2 diabetes drugs that are now preferentially recommended for some patients because they carry cardiovascular benefit but are quite expensive?
Schrier: We're seeing that problem throughout medicine. Every time there's a new drug, you have to make that calculation about how much better is it, and is it worth this very high price? There's this gap between the pharmacy and the doctor's office, so the physician doesn't always know the cost unless they set out to look at it. I think it's very important to bridge that gap so that we understand the cost of the medicines we're prescribing.
There's also a gap when people who have insurance don't really pay the full price — there are these information gaps that allow drug companies to really raise prices. This means that the underinsured, the people with high deductibles, who don’t have insurance and don't qualify for Medicaid, end up bearing the brunt of this. And they're exactly the people least able to afford it. They're the ones who end up in bankruptcy because of medical costs.
So that's my over-arching goal: nobody goes bankrupt because of medical costs, and everybody can afford access to the care they need.
Tucker: Of the 16 physicians in the current Congress, 13 are Republicans. Do you think you can find common ground with them?
Schrier: Oh yes. We all went to medical school to serve. We all went to medical school because we wanted to help people and keep them healthy. And so, of course we can find common ground. We will sit down in a room and we will figure out how to make healthcare affordable and accessible to every person in this country. I'm chronically optimistic. That's my personality.
Tucker [smiling]: Another chronic condition?
Schrier [laughing]: Yes.
Tucker: Have you sponsored any bills yet?
Schrier: I've cosponsored HR8, a bill for universal background checks for gun safety and safe gun ownership, which I consider a priority as a pediatrician. As a medical professional, it is definitely in "my lane."
I also cosponsored HR1, a bill for more transparency, to get corruption out of politics, and make the government work for the people again and not for special interests. I think that is really key to some of the progress we want to make on medical care and on prescription drug pricing.
Tucker: As the only woman physician in Congress, what final messages do you have for clinician readers of Medscape Medical News?
Schrier: It's really exciting to be one of us here in Congress making policy. I think one of the ways that we'll do better for our communities is by having this critical missing voice. Whether it's about children's outcomes, primary care, rural health, or women's reproductive rights, that is the voice I bring.
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Cite this: Meet Kim Schrier: Diabetes Patient, Physician, Congresswoman - Medscape - Jan 17, 2019.