Importance of surgeon engagement in surgical health policy advocacy

The health care system and health care professionals have been under intense scrutiny during the coronavirus 2019 (COVID-19) pandemic. There has been particular uncertainty regarding vaccination requirements as a consequence of the extreme partisanship that developed related to distribution, mandates, the role of public health officials, and individual rights. Many news sources also were called out for having inconsistent or unreliable sources, and anchor rhetoric increased. Even the World Health Organization was called biased by some outlets.

The American College of Surgeons (ACS), as a professional organization, issued reliable information throughout the pandemic but struggled with messaging of surgery appropriateness during an unprecedented time in health care delivery.¹ Bipartisan leaders are needed to unify the states with the same message: “Save lives. Get vaccinated.” An opinion piece on CNN, “Blue states are blowing the Covid-19 response, too. We need a national response,” speaks to responding to a virus that doesn’t recognize state borders.² The relationship between a public health concern and the policy that is enacted to prevent it is sometimes unclear.

We point out these recent and ongoing challenges related to the pandemic to highlight the fact that we need strong and unified health policy advocacy at all levels for our surgical patients. The 117th Congress has 17 physician members, including four senators and 13 representatives. To put that in perspective, this number is out of a total of 535 seats—less than 4 percent—and only six are surgeons. Out of 50 governors, only one is a physician.

In addition to COVID-19, the obesity and firearm injury epidemics continue to worsen. The Centers for Disease Control and Prevention reports that 42.4 percent of the U.S. population is obese (2017–2018).³ Obesity-related comorbidities such as heart disease, stroke, and type 2 diabetes are some of the leading causes of preventable death.⁴ Gun violence and related fatalities also have increased. Between 2006 and 2013, there was an annual decline of 2.7 percent of emergency department admissions with a diagnostic code of firearm-related injury; however, from 2013 to 2016, there was a 19.4 percent annual increase.⁵ With this in mind, we need to come together as surgeons with a shared voice and purpose in order to effect change in the health care system. Surgical health policy advocacy is needed now more than ever.

History of health policy and advocacy

Medicine has a long history of interaction with U.S. health policy, although it may not always be clearly evident initially. One such example is the obesity epidemic, which can be related to nutritional and farm policy effects over time; another is the opioid epidemic as it relates to drug and device policy development, licensure, quality metrics, and professionalism. However, these examples of interplay between government policy and the practice and regulation of medical and surgical practices have been the exception rather than the norm.

In the last several decades, numerous medical societies and professional organizations have called on physicians to engage in public advocacy. The American Medical Association (AMA) published an article, “Physicians have plenty of tools to help grow advocacy grassroots,” which describes how the organization was able to suppress the Surprise Billing and Consumer Protection Act in 2017.⁶ The AMA discusses how many physicians want to get involved—they just don’t know how.

The ACS, AMA, American Osteopathic Association, American College of Osteopathic Surgeons, and many other groups recognized and invested in the importance of advocacy. Thirteen surgical professional organizations joined together and established the Surgical Care Coalition in 2020 with a common goal of improving the quality of care, and quality of life, for all patients.

There is a broad spectrum of opportunities to engage in health policy and advocacy, from affiliation with (and potential financial support of) an organized medical society to running for public office. Gruen and colleagues found that 91.6 percent of surveyed physicians considered political involvement important, but only 25.6 percent had been politically active at the local, state, and/or national level (other than voting) in the last three years.⁷ Recent changes in health care policy at the national level have brought a new and more pressing interest for physicians to become engaged. It has become much more apparent that actions at the federal level can have an effect on patient care, either directly on care decisions or, just as importantly, through impact on the delivery of surgical care and the profession of surgery.

Getting involved

For effective and sustained advocacy to take root, a culture of personal relationships must be forged with legislators in order for surgeons to be trusted and preferred advisors. They cannot only appear when a specific crisis arises. For this reason, a sustained investment over time of building relationships is imperative. The result or payoff for this work often is not immediately apparent, and some of the greatest effects may occur by avoiding intervention until the statute or regulatory policy is developed.

Involvement in advocacy need not be an overwhelming or excessively time-consuming responsibility. Although physicians and surgeons generally need to be involved in policy development and evaluation, not everyone needs to be active in this manner. However, greater involvement and support from those surgeons who can help evaluate and guide policy development and decisions is essential. Also necessary is involvement in the building of local relationships that can grow over time to serve a strong and respected local force of surgeon advocates. This activity often is perceived as a daunting task, but it does not need to be.

During the initial COVID-19 pandemic, the Society of Thoracic Surgery (STS), AMA, ACS, and other medical organizations strongly advocated for personal protective equipment and physician and health care resources. The STS, AMA, and ACS were successful in making necessary changes to the Coronavirus Aid, Relief, and Economic Security Act. This is just one example of how advocacy works. It is vital that groups advocate for themselves to create change. Now, more than ever, it is critical to pull together and build our advocacy network to help create positive change in our nation.

References

1. American College of Surgeons. COVID 19: Elective Case Triage Guidelines for Surgical Care. March 27, 2020. Available at: https://www.facs.org/-/media/files/covid19/guidance_for_triage_of_nonemergent_surgical_procedures.ashx. Accessed October 27, 2021.
2. Filipovic J. Blue states are blowing the Covid-19 response, too. We need a national response. November 19, 2020. CNN. Available at: https://www.cnn.com/2020/11/19/opinions/covid-19-response-failed-in-blue-states-too-filipovic/index.html. Accessed October 27, 2021.
3. Hales C, Carroll M, Fryar C, Ogden C. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief No. 360, February 2020. Available at: https://www.cdc.gov/nchs/products/databriefs/db360.htm. Accessed October 27, 2021.
4. Hruby A, Hu FB. The epidemiology of obesity: A big picture. Pharmacoeconomics. 2015;33(7):673-689.
5. Tedesco D, Adja K, Rallo F, Reno C, Fantini M, Hernandez-Boussard T. Is the firearm epidemic in the U.S. getting worse? Eur J Public Health. 2020;30(5).
6. Robeznieks A. Physicians have plenty of tools to help grow advocacy grassroots. February 12, 2018. Available at: https://www.ama-assn.org/delivering-care/patient-support-advocacy/physicians-have-plenty-tools-help-grow-advocacy-grassroots. Accessed October 27, 2021.
7. Gruen R, Campbell E, Blumenthal D. Public roles of U.S. physicians: Community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.