July 1, 2013 Volume 77, Number 7
Advocacy 101 Nicole A. Weiss, M.D. Committee on Governmental Affairs

Many physicians choose to watch politics from the sidelines. We follow the news, discuss it in the doctor’s lounge and show up to the voting centers every other year. While this may have sufficed in the past, health care has become one of the most controversial topics in politics. Legislation is under way that will affect all aspects of the practice of medicine, including the quality of care we are able to provide to our patients.

This year I had the opportunity to participate in the ASA Legislative Affairs Research Elective. The American Board of Anesthesiology (ABA)-approved rotation let me spend a month working in the ASA’s Washington, D.C. Advocacy Office. The experience was an amazing opportunity to integrate myself into the inner workings of the politics of medicine; I attended House and Senate committee hearings, sat in on Supreme Court oral arguments and regularly met with legislators. Perhaps the most important thing I took home from the rotation was a firm understanding of how the political advocacy system works and how important it is to health care legislation.

Despite having spent nearly my whole life in school, I have to admit that before my D.C. rotation, my grasp on how lobbyists actually went about lobbying was somewhat lacking. For those in the same boat, here is a quick review:

The process often starts with a new candidate announcing his or her candidacy for office. Almost immediately, the candidate’s team has to start fundraising, and one of the best ways to do this is to ask an established political action committee (PAC) to donate to the campaign. PACs raise money specifically to support politicians; in turn, this often provides the affiliated organization with face-time with the candidates.

While it sounds easy, the process of finding the right candidates to support can be challenging. A questionnaire is sent out to the candidates to gain insight into their viewpoints on issues that affect anesthesiologists. The ASA PAC staff then meet with the candidate and grill him or her on the politics of health care; the goal being to identify candidates who are likely to support anesthesiology and the specialty’s policy interests. The selected candidates are then presented to the ASAPAC Executive Board (which is made up of anesthesiologists) for approval. A financial donation is considered.

Politicians cannot be elected, or do their jobs, without financial support. Speaking engagements, staff salaries, travel funds, television advertisements, radio commercials – they all cost money. Whether we like it or not, our political system revolves around money; and our political system affects the care we can give our patients.

Another point of contest is the fact that the PAC may support a candidate from a party with which some disagree. For example, a Republican in one district may be discouraged that the PAC is supporting the Democrat candidate. Unfortunately, this is just part of the process. PAC support crosses party lines and reaches out to all candidates. The only thing the ASAPAC’s recipients necessarily have in common is their health care beliefs. This is the same with most PACs in the country. Big oil PACs look for candidates who will support big oil policies. Automotive dealers look for candidates who will support the interests of automotive dealers. Health care PACs are no different.

So where do you fit in? Lobbyists and PACs are just part of the process. Legislators who are on good terms with an organization are more likely to make time to listen to the organization’s concerns; but, ultimately, politicians want to hear from their constituents. Most legislators go into politics to represent their community. They want to make a difference. They also want to earn your vote. In order to do that, they need to hear from you.

There are many ways to reach out to your elected officials. Probably the easiest way is to simply call them and set up an appointment in your hometown. All elected officials and their staff have appointments available to constituents. Putting in a visit to the office before you want to ask them to support a particular piece of legislation is invaluable.

Joining the Grassroots Network is another way to get involved. The network will notify you when important medical legislation is pending. The list isn’t activated often; messages only go out when the D.C. or state offices really need anesthesiologists to contact (email or phone) their elected officials. When it is enacted, the entire process usually takes less than five minutes and can change the way a legislator may vote on an issue.

Lastly, every anesthesiologist should be engaged politically. It shouldn’t be a burden to the select few who avidly follow the political battles that surround the practice of anesthesiology. Payment policies and health care regulations affect everyone in practice. Without financial funding, our voice in Washington is often overlooked. If our PAC doesn’t have money, our competitor probably does; and with the overwhelming amount of health care legislation pending, physicians need to be heard. We are obligated to ensure that the changes enacted to our health care system will provide quality care for our patients. Just as politicians initially seek office to change their community, physicians go into medicine to care for patients. Advocating for patients is just one aspect of that commitment.

Nicole A. Weiss, M.D. is a CA-3 resident, Tulane University Medical Center, New Orleans. She is President, ASA Resident Component.