For many years, the American College of Surgeons (ACS) has sponsored an annual spring Leadership & Advocacy Summit in Washington, DC. I have had the good fortune of participating in several of these events, which provide a wonderful chance for Fellows, ACS chapter officers, Governors and Regents, as well as young surgeons to learn about the legislative process and to gather with colleagues who face similar challenges. The program is growing: nearly 450 surgeons attended in 2014, up from 350 in 2013. However, we must do more to encourage greater participation of Fellows in advocacy and to foster collaboration between surgeons and policymakers, especially considering the relative number of representatives (435), senators (100), and Fellows of the College (approximately 79,600).
Faced with this realization, the Massachusetts Chapter of the ACS has promoted a novel grassroots advocacy concept on behalf of the College. This has become a core element of SurgeonsVoice, the College’s new advocacy instrument. This article discusses the rationale behind the District Office Contact by Surgeons (DOCS) program and how it works.
Introducing Fellows to advocacy
The notion of advocating with legislators about health care matters likely is unfamiliar to most Fellows, beyond what they read in publications such as the Bulletin. Although the ACS Advocacy Summit concentrates on active legislative issues, it occurs only once annually and attendance at the meeting can be costly to individual surgeons and to their chapters. Furthermore, such a limited encounter does not guarantee the opportunity to build relationships with legislators.
The goal of the DOCS program is to encourage grassroots advocacy among surgeons. Under this system, Fellows are to regularly meet with their U.S. representatives and senators and/or their staffs in their home district offices, typically every three to four months. Through this regular in-district contact, we have the ability as constituents to develop relationships with our members of Congress without traveling to Washington, DC. Furthermore, with none of the distractions of a typical day on Capitol Hill, program participants will have more time to discuss issues and reinforce our message. Fellows who are veterans of the ACS Advocacy Summit meetings and, perhaps, chapter officers or Governors, lead small groups of interested and locally respected Fellows—ideally from various specialties—to meet their elected representatives. It is a bonus if the surgeon-advocates personally know the representatives.
The DOCS program partners Fellows with ACS Washington Office staff who possess the knowledge of the issues and of the legislative process to educate Fellows before their visits. Briefings are conducted via teleconferences, webinars, and the SurgeonsVoice Web page. The material covered in these resources is regularly updated so that surgeons have the background necessary to comprehend contemporary health policy issues and to support specific requests of their legislators. This preparation also addresses meeting protocol and expectations for novice visitors. Different surgeons should participate throughout the year, cultivating a lasting “farm system” of Fellows over time. Debriefings follow the meetings, and the Fellows’ impressions of their legislators’ opinions will be conveyed to the ACS Division of Advocacy and Health Policy via their chapter staff.
What makes this model so attractive is that it empowers ACS chapters, giving them a clear raison d’être with respect to advocacy, while actively enlisting rank-and-file Fellows. Moreover, this program does not impose significant financial burdens on the chapter, nor will it require surgeons to take large amounts of time away from their practices. A greater number of Fellows will presumably become involved in the advocacy process and gain a deeper appreciation of the relevance and value of both the College and its chapters.
This is a “bottom-up” effort that the chapters will organize, including enrolling advocate surgeons, coordinating visitation schedules with district offices, and collecting surgeons’ residential zip codes. (It should be noted that the College database usually contains Fellows’ workplace addresses, which may be located in different congressional districts than where surgeons reside and vote.) It also is anticipated that individual chapters and the College as a whole will benefit from the experiences of Fellows who have served as representatives and senators at the federal and state levels.
Expanding the advocacy program
It is more practical for this grassroots advocacy program to begin with a national rather than a state focus. There are far fewer federal congressional districts than state districts, although the program may eventually serve as a model for statewide advocacy as the network of active Fellows matures. In addition, Fellows who are new to advocacy will probably be more enthusiastic about working on federal rather than state issues.
As members of Congress become acquainted with surgeon-constituents, it is expected that they will establish mutual trust and call upon surgeons to discuss health care matters, both legislative and personal. Furthermore, surgeons will become confident about inviting members of Congress and staff members to tour their operating rooms and clinics so that lawmakers will have a better understanding of how surgeons serve their patients. This system will also permit a rapid mobilization of engaged Fellows when urgent legislative situations arise.
The Massachusetts Chapter has developed the DOCS program in conjunction with College staff, including John E. Hedstrom, JD, and Christian Shalgian, Deputy Director and Director, respectively, of the ACS Division of Advocacy and Health Policy, Washington, DC. The DOCS program also benefitted from inspiration and guidance provided by ACS President Andrew L. Warshaw, MD, FACS, FRCSEd(Hon); Charles D. Mabry, MD, FACS, Chair, ACS Health Policy Advisory Council (HPAC); Ronald I. Gross, MD, FACS, HPAC Region Chief; and Peter T. Masiakos, MD, FACS, HPAC member. Oscar D. Guillamondegui, MD, FACS, Past-President of the Tennessee Chapter, played an influential role in introducing the Massachusetts grassroots advocacy program to the ACS Tennessee Chapter, a state with decidedly different politics than those in Massachusetts. In fact, this home-district office advocacy concept was presented at the executive planning session during the annual meeting of the Tennessee Chapter in Paris Landing on August 8, 2014. Notably, other chapters have expressed a strong desire to participate in this pilot program as well.
Grassroots activities via SurgeonsVoice form a critical component of the College’s overall advocacy efforts, which also include direct lobbying by ACS staff and the work of the ACS Professional Association’s political action committee, ACSPA-SurgeonsPAC. Successful advocacy requires that all three elements complement each other and function at a high level.
The participants in the Massachusetts grassroots advocacy program appreciate the College’s support and look forward to a rewarding collaboration among the ACS, its chapters, and Fellows through SurgeonsVoice and the DOCS program. We intend to create a model that can be implemented by all chapters and coordinated by the College’s Washington, DC, advocacy staff, which will be responsible for the education component of this program.
Fellows who are interested in nominating their chapter for participation in this grassroots advocacy effort should contact Sara Morse, Manager of Grassroots and Political Affairs, at email@example.com. How powerful it will be when members of Congress return from recesses at home and learn from their colleagues that, as a group, they have met with thousands of surgeons from across the nation.