Surgeons as state advocates

The American College of Surgeons (ACS) advocates for several health policy issues that affect health care at the state level. As the strained political climate intensifies in Washington, DC, due to the upcoming 2014 elections and the many effects and implications of the Affordable Care Act that have surfaced, much of the action on major health policy issues is increasingly occurring at the state level. Hence, surgeons need to be prepared to advocate in their state legislatures for policies that move the needle toward establishing a high-quality, high-value health care system. This article outlines why the surgeon’s voice is critical in health care policy debates, how surgeons can be effective advocates, and how the College can support such efforts at the regional level.

The importance of surgeon advocates

In 1932, former U.S. Supreme Court Justice Louis Brandeis wrote in the opinion New State Ice Co. v. Liebmann that “a state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”* Justice Brandeis’ statement rings true now more than ever in health policy, where states are looking for innovative ways to address the problems facing the U.S. health care system, including stabilizing Medicaid, fighting for medical liability reform, expanding scope of practice, improving public health, increasing transparency with respect to cost and quality, and implementing the Affordable Care Act. With the current partisan gridlock in Washington, little is being accomplished at the federal level, making state governments that much more powerful. In 2014, statehouses considered hundreds of bills addressing various facets of medical liability reform, scope of practice, and health care reform, as well as policies related to specific health care issues, such as cancer prevention, treatment, and diagnosis, as well as injury prevention.

As the state legislatures turn their focus increasingly toward health care policy issues, input from those constituents most affected by the policies being discussed, particularly surgeons, is increasingly important. For surgeons, the responsibility to patients extends far beyond the operating room. State lawmakers are making decisions that directly affect the practice of surgery and surgeons’ ability to provide high-quality care to patients. Surgeons are natural leaders who can and should capitalize on the power they have as thought leaders and respected members of the community to influence the health care policy formulated in state legislatures.

One surgeon who is actively advocating for colleagues and patients at the state level is J. Patrick Walker, MD, FACS, Immediate Past-President of the South Texas Chapter of the ACS. “No one knows more than we do what is best for our patients,” noted Dr. Walker, a general surgeon at East Texas Medical Center, Crockett (e-mail communication with the authors, May 6, 2014). “Don’t count on the beneficence of the government to do what is right for your patient.”

Seasoned College staff view surgeons as the best advocates on health care issues, providing a strong and experienced voice as a guide for state legislators as they consider policies that have wide-ranging effects on surgical practice and the practice of medicine overall. In fact, it is widely understood that lawmakers want and need to hear what surgeons have to say.

Building important relationships

Advocacy is about influencing the individuals who make policy decisions in order to advance a cause. Before undertaking any sort of advocacy campaign, it is important to build relationships with elected officials, their legislative staff or state agency staff, peers, and other organizations.
“The first step in the political process has to be building a relationship with your legislator,” Dr. Walker said. It is important to cultivate relationships with both elected officials and other stakeholders before you need to lobby an issue, because these individuals are more likely to be responsive than are legislators or policymakers who are just getting to know you and what you do and are uncertain as to why they should listen to you.

Reaching out to your ACS state chapter is a good place to start. Many chapters already have legislative committees and advocate on surgery’s behalf, so they can steer advocates in the right direction or provide useful contacts. The ACS also provides funding to chapters for state lobby days, and attending one of these events can be a great introduction to state lawmakers and the legislative process.

Attend a fundraiser

Fundraisers for political candidates provide a great venue for building a relationship with current and aspiring lawmakers. Although not always viewed in a positive light, attending a fundraising event or donating a small amount to a campaign can help improve access to legislators when action is necessary.

Dr. Walker recommends participating in an event in the legislative off-season, when the legislators are less likely to have their attention pulled in multiple directions. “There is no question that fundraising is a great way to get to know a politician,” Dr. Walker said. “You don’t have to raise massive amounts of money. They appreciate your effort.” It is critical to keep in mind that laws vary from state to state with regard to how much an individual may contribute to a candidate’s campaign, and it is recommended that any Fellow wanting to make a contribution first consult with the state elections board to determine what is permissible. If a surgeon is unable to make a financial contribution, other ways to support a campaign include volunteering in the campaign office and serving as a health policy advisor.

Benefits of face-to-face meetings

Another powerful tactic in building a relationship with legislators and their staff is to meet with them face-to-face, either in their office or by inviting them to visit your practice. “Legislators and their staff love hearing front-line stories from us about the care we provide to our patients, who live in their districts and are their constituents,” said Naveen Sangji, MD, a surgical resident at Massachusetts General Hospital, Boston (e-mail communication with the authors, May 13, 2014). “We can highlight our requests, which are typically patient-centered, with personal stories and experiences. The impact of that is immeasurable. We have the power to make a real difference in our home states.”

Indeed, personal stories and information are vital to make a lasting impression, and these meetings offer a way to relay those stories and information. A site visit provides an opportunity for the legislator to see where surgeons work, to interact with the patient care team, and to learn what it takes to run a successful practice. Lawmakers also get to experience firsthand how the policies they make affect patients, physicians, and constituents.

Leverage legislative staff

It is also important to build a rapport with legislative staff. Legislators are responsible for a range of issues and can’t possibly be experts on every issue that affects surgery. Hence, they leave much of the research and fact gathering to their staff, who help prepare legislators for hearings, write correspondence, make scheduling decisions, and more. Quite often advocates are discouraged when they find they will be meeting with legislative staff rather than their elected officials directly; however, meetings with staff can be as beneficial as meeting with a legislator. Keep in mind that legislators will always go back to staff for advice and recommendations on how to move forward with a policy position or how to vote. Remaining on good terms with legislative staff can go a long way toward gaining access to the legislator and achieving advocacy goals and gaining access to the legislator.

Communicate effectively

The cornerstone of a productive relationship with state lawmakers is effective communication. Advocates can communicate via letter, fax, e-mail, telephone, in-person meeting, and social media outlets, such as Facebook and Twitter. Legislators want to hear from their constituents and are sensitive to their opinions. Thoughtful, sincere, and precise comments are extremely useful and may be used by a legislator or regulator when debating or discussing a bill or proposed rule, and can help build a solid, long-term relationship. When preparing to advocate on an issue, “Know what you want, and know how to explain it succinctly and with persistence,” Dr. Walker suggested.

An easy way to write an e-mail to a legislator is through the Surgery State Legislative Action Center (SSLAC), described in the “ACS resources” section of this article. The ACS State Affairs team will send several SSLAC alerts throughout the year, and it is important for surgeon advocates to take action when these alerts are received.

Telephone communication is useful when the issue is urgent and an opinion must quickly be provided. The call is usually directed to the staff person who manages health care issues, which in itself can be seen as positive because it can be a step toward developing that important personal connection.

An in-person meeting, either in the capitol or in the district office, is a more effective tactic when building a long-term relationship with policymakers and their staff. Lastly, attending a town hall meeting hosted by your legislators can also be an effective way to raise a specific issue in front of not only legislators, but also their other constituents. By their nature, town halls do not allow for much one-on-one interaction, but they are a chance to increase awareness of an issue affecting surgeons and surgical patients in the community.

Understanding the issue is important, but it is equally important to connect with legislators and their staff. Tell them your story. Tell them why this issue is important to you and your patients. Provide strong, convincing data. Nothing is better than a good narrative about a real situation backed up with good data to explain how an issue is affecting their constituents.

ACS resources

One substantive resource for Fellows who want to get involved in state advocacy is the ACS State Affairs team. The College not only provides support to ACS chapters in their advocacy efforts, but also works with state medical and specialty societies, allowing a broad understanding of what is happening on the ground and where surgeons may be most effective.

The ACS State Affairs team offers a wide variety of services, including the following:

  • Speaking at chapter events or other stakeholder group meetings. Topics range from specific, regional issues to advocacy training workshops. A sample program outline, objectives, and a timetable are provided.
  • Coordinating plans for a lobby day at the state capitol or a legislative site visit.
  • Assisting with advocacy efforts for or against legislation introduced in the state legislature.
  • Providing input on advocacy planning and strategy issues, including development of a chapter advocacy and health policy committee.
  • Developing background information/briefing materials and researching legislative issues.
  • Drafting testimony for presentation at state legislative committee hearings.

Dr. Walker noted that the ACS State Affairs staff was helpful in his advocacy efforts. “The College State Affairs team was always supportive and helped me with briefs, supplied a copy of the bill and some testimony from other states. They offered to come to Austin, but, in truth, the best testimony is always a physician who only has the best interests of his or her patient at the center of the issue,” Dr. Walker added.

As previously mentioned, the College provides an online tool, the SSLAC, where the ACS, along with more than a dozen other surgical specialty societies, posts alerts on critical issues pending in state legislatures. The SSLAC can be accessed at This online tool is easy to navigate, user-friendly, and an excellent way for surgeons to begin to participate in state advocacy. The SSLAC is a public website, and any interested party may use and share alerts with others. In addition to serving as the conduit for e-mail campaigns, the SSLAC also contains general information on state lawmakers.

The ACS Facebook and Twitter pages are useful in promoting advocacy, disseminating SSLAC alerts, and interacting with industry and political leaders. Follow the ACS on Twitter, and “like” the College on Facebook. As the use of social media continues to grow, online social media is becoming a more acceptable form of professional communication at the College. If you come across material that should be featured on ACS social media platforms, contact the ACS State Affairs team.

The ACS State Affairs staff also coordinates the State Advocacy Representative (StAR) Program, through which the College and StARs share information, mainly through regular conference calls. Each state has at least one StAR whose main responsibility is to be the eyes and ears for the College at the state level. StARs monitor legislation in their state and then confer with the State Affairs team. Becoming a StAR for your state is a great way to stay informed and can be a precursor to becoming more actively engaged in advocating for the College’s state legislative priorities.

Get involved

As Dr. Walker’s and Dr. Masiakos’ stories indicate (see “Success stories“), surgeons can effect real change in the state legislatures. If you are interested in getting involved in advocating for your patients and the practice of surgery in your state, contact the ACS State Affairs team:

These individuals will work with you to identify opportunities to advocate for policies that affect surgical practice and patient care in your state. With a can-do attitude and perseverance, surgeons can help to shape policy that ensures patients have access to high-quality care in their states.

*Brandeis J. Dissenting. New State Ice Co. v. Liebmann, 285 U.S. 262, 311. 1932. Available at: Accessed May 15, 2014.

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