Editor’s note: The American College of Surgeons (ACS) presented the 2019 SurgeonsVoice Advocate of the Year award to Sherry Cavanagh, MD, FACS, at Clinical Congress for her commitment to the College’s advocacy and political efforts, particularly through her involvement with the ACS Health Policy Advisory Council. In this article, Dr. Cavanagh describes why she decided to become a surgeon-advocate and offers advice on getting involved in the advocacy process.
Knowing about the issues and the College’s position on them is essential to becoming an actively engaged and effective surgeon-advocate.
Because of our unique perspectives, expertise, and personal experiences in patient care, surgeons are well positioned to serve as effective advocates at the local, state, and federal levels. Deciding to become involved in surgical advocacy often begins with asking yourself if health care legislation, regulations, and insurance plans are affecting how you practice and care for patients. Do these policies impede your ability to provide quality care? Are insurers providing fair reimbursement or causing unnecessary delays in care with burdensome prior authorization requirements? Have you experienced a disgruntled patient who has received a surprise medical bill? These are merely a few situations where residents, Fellows, and young surgeons can advocate for surgical patients and the profession.
Find your passion
As I entered surgical practice in 2015, the opioid epidemic was emerging as a broader crisis than many policymakers understood it to be. New laws were being implemented with additional requirements and limitations on prescribing, which led me to question who the decision makers were and whether they were receiving physician input. I also experienced the time-consuming process of obtaining prior authorization from insurers. The need to effect change was apparent, and remaining a bystander was no longer an option.
I began my journey by identifying these two issues of particular interest to my patients and my practice. I learned more about the ACS advocacy programs and activities, and I developed a sense of the various areas where I could make an impact. Knowing about the issues and the College’s position on them is essential to becoming an actively engaged and effective surgeon-advocate.
Locate your legislators and understand policymakers’ positions
The next step on my journey to effect change was to identify the legislators and policymakers best positioned to influence public policy. Several online resources are available to assist you in locating your legislators and learning about their positions on important issues. Additionally, determining if your representative or senators serve on key congressional committees that have jurisdiction over health care policy is helpful. These committees are as follows: the House Committee on Energy and Commerce Health Subcommittee; the House Committee on Ways and Means; the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; and the House and Senate Appropriations Committees.
Before you meet with your U.S. representative or senators, gather some information about them. How have they voted in the past on the issues that matter to you? What kind of work do they do outside of the political arena? You can find some general information on members of the House of Representatives and on senators online.
It’s also important to know whether any bills related to the issues of concern to you have been introduced and how far along they are in the legislative process. You can learn what is on the congressional docket online.
It is helpful to know what the ACS is doing to address the issues. You can learn more about ACS federal legislative priorities on the ACS website.
The same concepts apply when advocating at the state level. Gather information about your governor and his or her background, past experience with health care issues, and so on. A handy resource is the Contact Your State Governor tool on USA.gov.
To locate your state legislator, visit the OpenStates website. To learn more about pending legislation in your state, visit Congress.gov. And be sure to contact ACS State Affairs staff and learn more about the College’s state initiatives on the ACS website.
Recognizing staff roles and responsibilities
After requesting a meeting with a state or federal legislator, it can be frustrating to learn that you are meeting with congressional staff.* It is important to note that staff serve as key advisors to their legislators on the issues and provide lawmakers with valuable insights into complex policy issues. Getting to know the health care staff and offering to assist with future health policy priorities is a productive way to build a relationship with members of Congress and state legislators. Working to establish and maintain communication could lead to other opportunities to join “insider” health care advisory committees, physician roundtable events, and more. The following are common congressional staff roles and responsibilities:
- Chief of Staff: Oversees the legislator’s office, provides legislative, policy, and political counsel, and assists with Washington, DC, and district office operations.
- Legislative Director: Manages the legislative team, prioritizes legislative efforts, and directs the policy agenda.
- Legislative Assistant (LA): Serves as the policy expert on an issue or portfolio of issues. Examples include agriculture, budget, education, health, military (typically referred to as “MLA”), taxes, transportation, and so on.
- Legislative Aide: While some offices use LA and Legislative Aide interchangeably, aides are typically Senior Legislative Correspondents who work on at least one legislative issue.
- Legislative Correspondent: Responsible for monitoring and responding to incoming constituent mail.
- Counsel: As the name suggests, this staffer typically assists with drafting legislation, provides detailed analysis on legislative text, and often specializes in a specific legal area of expertise. This position often is staffed at the committee level.
- Communications Director or Press Secretary: Serves as the chief spokesperson to the media and external interest groups. This individual organizes press conferences and relays the member’s stance on issues. He or she also drafts newsletters and composes press releases.
Tips to elevate your engagement
The involvement of surgeon-advocates is paramount to establishing an active relationship with federal and state legislators. The key to successful advocacy is an engaged membership, and you can help support this work by engaging in the following activities:
- Regularly visit SurgeonsVoice online† and familiarize yourself with the College’s tools and resources that are available to all surgeon-advocates.
- Take action on important advocacy priorities that interest you.
- Consider joining the Health Policy and Advisory Council—a diverse group of nearly 180 surgeon-advocates who are skilled or have an interest in ACS advocacy priorities and activities, educating their colleagues about making an impact, and ensuring lawmakers hear surgery’s perspective.
- Attend the annual ACS Leadership & Advocacy Summit in Washington, DC. During the Advocacy Summit, you will learn about the issues that the College has identified as priorities, have the opportunity to meet with members of Congress and their staff on Capitol Hill, and gain insights into effective grassroots advocacy.
- Meet with your member of Congress in-district through the 2020 Advocate at Home Program.
- Join your ACS Chapter, advocate with other colleagues at organized state Chapter Lobby Day visits, and consider inviting a legislator to visit your hospital or practice.
- Join your local and state medical societies and attend their meetings. There are several advocacy sessions featuring local legislators that members are encouraged to attend.
- Learn more about the ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC) and its role in helping to elect and establish relationships with members of Congress.
- In an era when information is communicated in real time and more government offices and officials are communicating via social media, be sure to follow and tag @SurgeonsVoice and your legislators via Twitter. Other ACS handles include: @AmCollSurgeons, @yfaacs, @RASACS, @ACSTrauma, @StopTheBleedACS, and @CoC_ACS. Learn more and create a profile.
- Join the discussion and network with your peers via the ACS Communities.
Practice makes perfect
Advocacy is a marathon, not a sprint. Continuous active participation is key to seeing results.
Advocacy is a marathon, not a sprint. Continuous active participation is key to seeing results. Meeting with your legislators and their staff on a regular basis, serving as a valuable resource, proposing solutions to complex problems, and understanding policymakers’ positions on various issues helps build credibility. Your first meeting might be brief and with health care staff, but your follow-up visit could be a lengthy discussion with your member of Congress. Unlike surgery, which tends to offer a quick fix, effective advocacy takes time. Recognizing that from the outset is critical to your success.
*Society of General Internal Medicine. The role of Congressional staff. Available at: www.sgim.org/File%20Library/SGIM/Communities/Advocacy/Advocacy%20101/The-Role-Of-Congressional-Staff.pdf. Accessed January 14, 2020.
†Carmody M, Oehmen K. Advocacy and grassroots: Leveraging local issues at the national level. Bull Am Coll Surg. 2015;100(10):23-27. Available at: bulletin.facs.org/2015/10/advocacy-and-grassroots-leveraging-local-issues-at-the-national-level/. Accessed January 14, 2020.