As part of MedPage Today‘s occasional series on healthcare clinicians running for office, Washington Editor Joyce Frieden spoke with ob/gyn Kristin Lyerly, MD, a Democrat who is running for a U.S. House seat in Wisconsin. The winner of the election will fill both the unexpired term of Rep. Mike Gallagher (R), who left Congress in April, as well as the upcoming 2-year term. Lyerly is a plaintiff in an ongoing court case involving her work as an abortion provider with Planned Parenthood. The interview, which was conducted via phone, has been edited for length and clarity.
How did you end up becoming an ob/gyn?
Lyerly: Well, that was not really in the grand plan for Kristin Lyerly — or Kristin Schmalz back then. I grew up in a small town called Kaukauna, which is about 20 miles south of where I live right now. My family has been in this region for six generations, and I’m actually a first-generation college student. Medicine was never really part of the plan, but once I got to college and I started meeting people and exploring the world and understanding what my potential was, medicine was a perfect match for someone who was good at science and loved helping people. So I made my way to medical school and found ob/gyn. There was just something so special about being able to help women during some of the most joyful — but also some of the most terrible — times in their lives.
And I also really appreciated the advocacy piece [of the specialty]. I’ve got this strong streak of justice that is just part of who I am. I’m sure it’s having grown up in a challenging situation. My father struggled with alcoholism, and I always as a young child was really forthright in my interactions with him: Why does it have to be this way? Why can’t we do it better? I lost him when I was 11, but I always kind of had this beacon about what I thought was right and what was worth fighting for. As I was making my way through the early days of my career, that justice piece was so important to me and so badly needed in obstetrics and gynecology.
Tell us more about the abortion case that you’re involved in.
Lyerly: When the Dobbs decision happened, I was working at a Planned Parenthood clinic in Sheboygan, Wisconsin, and we shut down all abortion care in the state, because we had an old law from 1849 that made all abortion illegal, with an exception [only] for the life of the mother. And the district attorney in Sheboygan County specifically said, “I am going to prosecute physicians who perform abortions.” Well, that was me. I was the only physician who performed abortions in Sheboygan.
Where does that case stand now?
Lyerly: In [the] circuit court, the law was deemed not relevant with regard to abortion — they said it was a law about feticide, not abortion. So at that point, we started resuming abortion care back in the state. The case has been appealed, and both sides agreed to expedite it to the Wisconsin Supreme Court, which has taken it up. We are anticipating oral arguments in October.
Also, my medical license was attacked by anti-abortion groups who accused me of breaking the law. It was an egregious attack; it was dismissed. And furthermore, I don’t practice in Wisconsin because I know that my practice, my license, my livelihood, are under threat. So I actually practice in rural Minnesota, delivering babies and providing general ob/gyn care.
When did you make that change?
Lyerly: I started that about a year and a half ago, a few months after the Dobbs decision, when I realized that because I live in northeast Wisconsin — which is a Catholic community and not a big city — I knew that I would have to take steps to protect my professional career. So that was when I made that decision.
It’s 7 hours [to travel there]. The hospital where I work should have three ob/gyn doctors, but they’re down to one. I have a standard practice; I have regular patients that I see. They desperately need more doctors, not just in this setting, but all across the northern region of Minnesota, and this is a state that’s good for ob/gyn doctors and for women and families. In states like Idaho, they’ve lost 25% of their ob/gyns and they’re not coming back because they’re under threat.
How did you end up running for Congress?
Lyerly: I’ve been doing advocacy work for decades, and I realized during the COVID pandemic that advocacy wasn’t enough. Here in Wisconsin, we have a state legislature that hasn’t been working for us for over a decade, and they weren’t listening to the doctors, they weren’t listening to the patients. They were doing what they wanted to do for their own reasons. That was when I realized that I had to do more.
[I ran for the state legislature in 2020.] I knew I wasn’t going to win that election because our state maps were so gerrymandered, and my district was really, really difficult, but I also knew that it wasn’t about the seat, it was about moving the needle and making incremental change that ultimately would get us where we needed to go. And so when I lost that election, I got involved in the fair maps movement to fight back against gerrymandering. And it turns out, we got our fair maps.
Once we got the maps, we needed candidates. I’m really proud to be that person who is not just a candidate, but the candidate surrounded by other candidates as volunteers and staff and other people who understand the potential that we have to make a difference, not just in our little corner of the world, but really across the country. I’ll be the first pro-choice ob/gyn doctor elected to Congress.
What healthcare issues are you running on?
Lyerly: Our healthcare system is fundamentally broken. I’m deeply involved in advocacy work through ACOG [the American College of Obstetricians and Gynecologists] — it’s physician payment, Medicaid expansion — Wisconsin still hasn’t expanded Medicaid; we’re one of 10 states that hasn’t. We haven’t even expanded Medicaid for postpartum moms. So in Wisconsin, moms lose their insurance coverage at 6 weeks. These Republican legislators are saying that they care about moms and babies, but they’re literally robbing them of life-saving medical care. These are things that, in many ways, we need to partner with our states as leaders to be able to push across the line.
On reproductive health, it would be my joy to partner with Sen. Tammy Baldwin (D), my senator here in Wisconsin, to get the Women’s Health Protection Act across the line and ensure national protection for abortion care, for contraception, for IVF [in vitro fertilization], for reproductive healthcare, because that’s the only solution in places like Idaho and Arkansas and Texas.
But I want to take it much further. I want to make sure that every single person in this country has access to quality, affordable healthcare. They do it in other countries. It’s not going to be perfect, but we have to start taking steps in that direction.
Are you talking about single-payer healthcare?
Lyerly: I think it’s complicated. There is no magic bullet here, Medicare for All is an easy way for people to talk about ensuring that everybody has access to healthcare, but Medicare itself is really broken. Medicare now is making it really difficult for rural hospitals to continue to provide care, and I see that in my own practice, so I’m reluctant to sign on as someone who is a firm supporter of Medicare for all. I think it’s a good start, but I think that there is much more work that needs to be done.
On a related note, what are your thoughts on the proposed cuts to the Medicare Physician Fee Schedule?
We’ve lobbied on this for years as well. You know, doctors have taken a giant pay cut over the last couple of decades, especially when you take into consideration inflation, and that is a huge problem for a lot of reasons. It obviously makes it very difficult for physicians to have an independent practice, and that forces physicians to join large hospital practices, which takes away your ability to run your practice the way that you need to run it. It takes away physician autonomy. It causes burnout, and that reduces the physician workforce, and it has an impact on all of us. It is something that needs to be solved.
We need a sustainable growth formula for physician reimbursement. We can’t just continue to reimburse every other aspect of care and leave the physicians behind. And this is all part of the better solution that we have to see. And the only way to get there is to have physicians at the table making these decisions.
Do you favor indexing Medicare physician payment increases to inflation?
Lyerly: That just makes sense, doesn’t it? Reimbursement needs to go up similarly, so we get a growth formula that takes into account inflation. And when you look at inflation in healthcare, it’s greater than the general rate of inflation.
What about prior authorization? Does that need to be addressed?
Lyerly: I will celebrate the day that we can take down the onerous prior authorization system for physicians. It is really hard to let our patients walk out the door knowing that there is a very significant possibility that our patients will not be able to follow through on the treatment plan that we discussed because of the arbitrary barrier that is prior authorization. You know, I just want my patients to be able to get the medications they need and the therapy that they need, and to have this arbitrary barrier is not healthcare.
What are your concerns regarding the workforce shortage? Are you concerned about the Medicare cap on residency slots?
Lyerly: That is something that I’ve personally advocated for at Capitol Hill. We are really hobbled by this bottleneck that is the residency training cap, and there have been some creative ways around that, but truly, the way to fix this problem is to remove that bottleneck and ensure that we have enough residency training programs so that we can get more physicians out into the workforce.
But also, it’s not just physicians, it’s making sure we have enough physician assistants and nurse practitioners who are trained and well supported to participate, particularly in urban and rural areas, where we’re seeing massive shortages of providers and we don’t have time to get physicians through that whole training process to get into those areas.
How are you juggling running for Congress with your professional and personal responsibilities?
Lyerly: I started residency with four kids under 10, and it was challenging, but it was also the thing that I knew was right for me, so we figured out how to do it, and that required a lot of creative childcare. It required me to sacrifice a lot of personal things, but it was all worth it for my family.
Now my boys now are older. My oldest son is a public school teacher here in Wisconsin, one who just graduated from college, one who just started college, [and one is a] sophomore in high school, so I’m still a mom, but the way I interact with my kids has changed. They don’t need as much of that hands-on stuff as they did when they were little. They’re excited about the campaign.
I personally can’t do any one of these things — be a mom, be a doctor, be a candidate — I can’t do any one without the other, because all three of them are what works so beautifully together to help me understand and bring forward the message that I need to.
What message do you have for your fellow physicians?
Lyerly: The more we can get physician voices out there — physicians have a role here to play, and it’s a really unique role — the more we’re going to be able to fix our healthcare system, and ultimately, that’s the goal.
Do you know of a non-incumbent physician, nurse, or other clinician who is running for a U.S. House or Senate seat? We would like to interview them! Please email Joyce with the information and we will be in touch.
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