Hoekstra, Williams & Jensen; |
Mary Haas, MD;
Brian Potts, MD MBA FAAEM;
Kevin Rodgers, MD FAAEM
University of Michigan
Originally Published: Common Sense March/April 2017
In December I traveled to D.C. with the AAEM Board of Directors, for my first Advocacy Day. I admit I did not know what to expect, and although I looked forward to actively advocating for our specialty, the idea of lobbying intimidated me. Would I know how to “speak the language?” How would I make Congressional staffers understand the importance of our cause, let alone care about it? I was both excited and nervous for this new and very important experience.
It was eye-opening and incredibly educational. On the morning of our visit to Capitol Hill we reviewed our big issue, due process, one of critical importance for emergency physicians. “Due process” refers to a fair hearing in front of peers on the hospital medical staff, prior to the termination of a physician's privilege to practice there.
Although due process is important for many reasons, the most important is that it allows us to do the right thing for our patients without the fear of being unfairly terminated. With the increasing corporatization of medicine and expansion of CMGs (contract management groups, such as EmCare and many others), there is increasing pressure on emergency physicians to practice in a way that puts profit first. As providers to the most vulnerable patients and the safety net for the most under-served, emergency physicians must be able to practice in a way that puts patients first — as physicians have sworn to do for millennia. We must fight to protect our professional ethics.
As we lobbied for due process, I walked away with a few key points about successful lobbying on the Hill that I will take with me to future Advocacy Days.
Make it personal.
At the beginning of each meeting, we provided the staffer with our cards so that they had our names and contact information. We opened each meeting by introducing ourselves and identifying our home states. We asked each staffer about themselves and their background. One was in the process of applying to medical school. Identifying such common ground allowed us to more effectively engage him in the conversation. As emergency physicians, connecting with others quickly is our strong suit, and we can use this to our advantage when advocating for important issues.
Another important strategy is to provide specific stories that illustrate the problem and its solution. When discussing due process we shared examples of emergency physicians who have been unfairly terminated for trying to take good care of patients, such as Dr. Wanda Cruz, an emergency physician who was fired from her job in Florida for answering her hospital CEO's questions about dangerous conditions in the ED. She was fired the next day, after the hospital CEO called the CMG to discuss recent cutbacks in coverage. Telling a story makes the issue real, and helps non-physicians understand its importance.
Don’t just talk, have a conversation.
When lobbying, it is easy to talk at someone for 30 minutes, but much less effective than having a conversation. The advice I received was to talk for a few minutes, ask a question to engage the person we were speaking with, and then provide additional thoughts and details.
Do your homework and know the issue.
While providing specific anecdotes is necessary and powerful for making a point, numbers and statistics also have their place. The more you have researched your issue and know about the topic, the less intimidating it is to speak about it and the easier it is to speak with passion and conviction. I spent time prior to our lobbying sessions reading about due process, and that gave me a much greater appreciation for the topic and a deeper understanding of it.
To a seasoned lobbyist my learning points may seem obvious. Lobbying is rarely discussed in residency, however, and advocacy is not a major focus of the curriculum. Many residents will never acquire the skills to be an advocate, unless they take it upon themselves to seek knowledge about the issues facing our field and the means by which to make change happen. This is critically important, however, as we are the future of our field. We have a duty to ourselves, our colleagues, and most importantly our patients to have a voice and use it effectively. One of the most important benefits of RSA is its ability to fill this gap in residency education by providing advocacy resources and opportunities. We are working on expanding Advocacy Day this year, to include a day of didactics to facilitate and maximize the lobbying experience. RSA also continues to offer the Congressional Elective in D.C. (www.aaemrsa.org/leadership/opportunities-for-involvement/congressional-elective).
As for due process, AAEM will continue to work with both Congress and CMS to make it an undeniable right under Medicare's Conditions of Participation, so that emergency physicians cannot be forced to waive due process and peer review in employment contracts. If you would like to learn more about due process, listen to Larry Weiss’s excellent podcast on the website under the publications/podcasts tab. (www.aaem.org/publications/podcasts/emergency-physician-advocates).