The coronavirus 2019 (COVID-19) pandemic disrupted the regular order of business in state legislatures in 2020 and 2021 and, with it, the American College of Surgeons (ACS) and state chapters had to react quickly and adapt our advocacy strategy as the health care environment changed with the trajectory of the virus. However, the pandemic also has provided an opportunity to reevaluate the tools and resources the College provides for surgeons and ACS chapters to engage in state advocacy, as well as take a closer look at the challenges surgeons face in participating in the public policy process.
In the summer of 2021, the ACS State Affairs staff in the Division of Advocacy and Health Policy, Washington, DC, organized a series of focus group meetings, including sending a questionnaire in advance of the virtual meetings, with ACS chapter leaders, the chapters’ Council members, Governors, Advocacy Chairs, and executive staff. The goal of the focus group project was to determine if the current inventory of resources is meeting the needs of surgeons to advance the College’s legislative priorities in the states.
The College makes a significant investment in surgeon advocacy at both the federal and state levels of government. The resources made available by the College for state advocacy—including SurgeonsVoice, grassroots-related materials, state legislative toolkits, state legislation tracking, the State Chapter Advocacy Grant Program, and ACS staff support—are designed to simplify surgeons’ ability to advocate on behalf of their patients and practices.
However, the pandemic forced us to acknowledge that these state advocacy resources might be less helpful as the workplace demands and stresses on surgeons have increased substantially during the pandemic and as the role of surgeons evolves in the health care system. The time was right for us to listen to surgeons, asking what resources they believed would help them to be better advocates in their states.
A question of time, energy, and training
Interesting findings from the focus group participants include the following: the most perceived challenge to surgeon engagement in advocacy is the lack of time surgeons have outside of their practice and a strong belief that elected officials neither care nor listen to what surgeons have to say, reinforced by the perception that the legislative process is slow and cumbersome. The challenge for the College is to address these concerns with targeted communication resources and to maintain flexibility in our programs, taking into consideration the time constraints of surgeons.
The belief that the legislative process is inefficient or nonresponsive is not exclusive to surgeons. It is a widely held perception that often changes with frequent practice and participation in advocacy-related activity. Just as a surgical procedure is confusing to the average person, the “sausage-making” process of passing legislation is foreign at first but becomes familiar as you get your hands into the ingredients of policymaking. The reality is that legislators and their staff are pulled in many different directions and have many different people asking for favors; yet, they have great respect for surgeons and do, in fact, want to hear the surgeon perspective on health care legislation.
In addition to citing challenges surgeons face to engage in state advocacy, participants provided noteworthy suggestions to overcome those challenges, including a need to develop and train surgeons on how to get involved in advocacy, especially starting early with residents and medical students. The College strongly supports the development of surgeon-advocates early in their careers, providing scholarships for residents to attend the ACS Advocacy Summit in Washington, DC, and engaging with the ACS Resident and Associate Society Advocacy and Issues Committees. There remains an opportunity for experienced surgeons to mentor and talk to younger surgeons and older colleagues on how and why to participate in advocacy.
The focus group project has provided insights into what the College can do to improve communications and resources to help facilitate engagement in state advocacy as the ACS and chapters plan for a busy year in 2022 and beyond.
Changes in 2022
Just as with the last two years, in 2022, state legislatures are expected to work on contentious health care policy issues, especially those related to the continued impact of the COVID-19 pandemic on states’ citizens and economy. In addition, the legislative process will be significantly influenced by the November 2022 state elections. Governors in 36 states will be up for reelection in 2022, and it will be the first election after redistricting of state legislative districts. Surgeons will need to increase the volume of their state advocacy voices to break through the political noise and competition for attention from other advocates and lobbyists in 2022.
The ACS is structured with state chapters as the first line of surgeon engagement with state policymakers. The state legislative tracking system, SurgeonsVoice, and ACS State Affairs staff are among the resources surgeons and chapters can use to identify legislation that could affect their patients and practice and to contact their state legislators and key policymakers to educate them on the impact the legislation will have on the delivery of quality surgical care.
In response to COVID-19, the ACS made changes to the State Chapter Advocacy Grant Program to permit more flexible use of the grant funds for state advocacy in this unpredictable health care environment. Historically, the grant program focused on organizing a lobby day at the state capitol. The change to the grant program has been permanently adopted for 2022 to support other state advocacy activities, such as hosting legislators at other chapter meetings, hiring a lobbyist, and organizing virtual advocacy. The increased flexibility is intended to encourage innovative state advocacy to increase engagement.
ACS chapters have started the work to increase surgeon advocacy engagement opportunities. The New York and Brooklyn−Long Island Chapters jointly organized a virtual advocacy program on May 20, 2021, setting aside a full day for meetings with key state legislators and staff, and the Louisiana Chapter had Lt. Gov. Billy Nungesser (D) speak at its virtual annual meeting. In addition, in 2020, the Tennessee Chapter used advocacy grant funding to support the creation of the Coalition for Collaborative Care to educate legislators on the importance of physician-led care and the need for more integrated and coordinated health care delivery, rather than fragmented delivery of care by nonphysician practitioners. These activities are examples of the different ways to create state advocacy engagement activities and opportunities for surgeons, especially in an uncertain health care environment.
In addition to the resources provided by the ACS, surgeon advocacy is amplified when carried out in collaboration with other physician organizations and coalitions. Surgeon advocacy is not defined simply by interacting with legislators; rather, it is equally important to advocate on behalf of surgical positions on public policy issues within state medical societies and health care groups to influence their advocacy objective because these groups have staff and contract lobbyists who regularly interact with state legislators.
As ACS chapters plan their state advocacy goals for 2022, the ACS State Affairs staff is available to provide guidance and research on the top issues facing surgeons in individual states, as well as help with creating tailored advocacy resources specific to the needs of surgeons in a state. The College will continue to evaluate and update state advocacy resources and programs to ensure that surgeons have every opportunity to participate in advocacy.
