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Strategies for effective advocacy in state chapters

From the November ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

QUEBEC—Two critical legislative issues for physicians came before the U.S. Congress this fall: The House of Representatives passed a liability insurance reform bill, while the Senate debated legislation to improve Medicare pay for physicians.

Both issues came to legislators' attention because of advocacy efforts from the College and other national organizations—and because of grassroots activities among state chapters. While chapters play a critical role in helping shape the federal legislative agenda, they can exert even more influence on state laws and regulations.

The ability to advocate successfully in chapters, however, doesn't happen overnight. "To be effective, you have to develop a plan and build a tradition within your chapter of valuing advocacy efforts," said Frederick E. Turton, FACP, Governor for the Florida Chapter.

At a presentation at the fall Board of Governors Meeting, Dr. Turton and other College Governors shared the following tips to help boost College chapters' advocacy efforts:

  • Develop a focused agenda. Rather than advocating for or against every problem that affects physicians, craft an agenda that hones in on those issues that are most important in your state. According to Dr. Turton, the Florida Chapter each year writes an agenda that is typically no more than one page to make sure its efforts stay focused. Check to see what issues are slated to come up in your state legislature's next session to make sure pertinent issues become part of your chapter's plan.

  • Nurture talent. The Florida Chapter starts fostering physician advocates when they're residents. This year, the chapter is sending residents, accompanied by older and more seasoned physicians, to the state capital to meet with legislators. Chapter leaders also brought a resident member with them as part of their state delegation to Washington for the College's Leadership Day event in May.

  • Work with other state organizations. Forming partnerships with other state organizations is an important strategy for large and small chapters alike. Small chapters can use state alliances to leverage limited resources, while larger chapters can use their clout to help steer statewide efforts.

    David Sandvik, FACP, Governor for the South Dakota Chapter, said his chapter members participate in the state medical association's "Doctor for a Day" program at the state legislature and its "Lobbyist for the Week" program. During the latter program, physicians volunteer to spend a week away from their practices to lobby for legislative and regulatory issues in the state capital.

  • Avoid partisanship. While internists' political affiliations range from hardened conservative to firebrand liberal, Governors said that political persuasions have no place in chapter advocacy efforts.

    "Medical issues are not partisan ones," Dr. Turton explained. "You have to put aside your political differences and find common ground."

    In training physician advocates to meet with legislators, he said it's important to emphasize the discipline needed to stick to only those items on your legislative agenda. "Legislators always ask your opinion on 'hot-button' topics like abortion and gun control," he said. "You have to be able to say, 'I really can't speak to that issue.' "

  • Use the media. Letters to the editor placed in big city dailies reach a lot of people and can produce quick results. Melvyn L. Sterling, FACP, Governor for the Southern California Region II Chapter, for instance, said that after the Los Angeles Times published a letter from him about the College's seven-year plan for universal coverage, he received a call from a government official asking for a copy of the plan.

    Don't pass up opportunities in smaller venues, however. Yul D. Ejnes, FACP, Governor for the Rhode Island Chapter, said that small-town newspapers often have too few reporters trying to fill a lot of space. Doctors can often place op-ed pieces or even articles in small community newspapers that will be read by many patients and voters, particularly seniors.

    If you live in a city with a daily newspaper and television stations, foster relationships with science and health reporters, said Ralph Schmeltz, FACP, Governor for the Pennsylvania Western Chapter. Make yourself available for off-the-record background comments, he said, and reporters often will return the favor by calling you for quotes on a political or business issue that involves physicians.

    Return reporters' phone calls in hours, not days, or else deadlines will come and go without your views getting represented, Dr. Schmeltz said. And try suggesting stories to reporters, particularly if you can provide the names of physician contacts they can call.

    Richard L. Neubauer, FACP, Governor for the Alaska Chapter, said he recently called a reporter from the Anchorage Daily News to suggest a story on physicians leaving the state or closing their practices to Medicare patients because of falling reimbursements—and supply the names of physicians involved in the story. The result was a page-one Sunday feature, "Medicare fails Alaskans in need of doctors," in September.

  • Take advantage of College resources. Dr. Sandvik pointed out that the College's Washington office has many resources members can use to enhance their advocacy efforts. The College regularly drafts letters to the editor and press releases that physicians can tailor to their local markets.

    The College's Key Contact Program also helps internists reach out to their members of Congress on a wide range of issues. The program operates a grassroots hotline (888-218-7770) and other services to keep internists up to date.

    The Washington office can also give chapters the names and addresses of media contacts in their state. For media names, contact Jack Pope, the College's Director of Communications/Public Affairs, at 800-338-2746, ext. 4556, or at jpope@acponline.org.

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