ACP's enormous political capital is an often underappreciated reason for belonging to the College. Policymakers in Washington, D.C. know ACP as an honest advocate of thoroughly researched, evidence-based and well-crafted arguments. But for any organization's policy to succeed, it must capture the attention of the Congressional staff who sort through the reams of materials on myriad issues, often from competing interests, reducing each to a size manageable enough for the senator or representative to cast an educated vote.
There is an array of issues coming before the multiple committees and subcommittees on which each legislator serves. Additionally, members of Congress vote on 500-700 measures annually. Every issue has its constituency. On any given issue there are usually groups holding varying views, each eager for an opportunity to offer an opinion. Legislators and their staffs are pulled in as many directions, as is the most harried physician. Successfully representing ACP's membership in this setting requires expertise bolstered by the impact of being the voice for such a large organization.
To appreciate the magnitude of the task, we need to appreciate the world in which legislators work. When Congress is in session, representatives and senators are typically in their Washington offices Tuesday morning through midday Friday. A typical member of Congress serves on two major committees and one minor committee. He or she may also serve on up to two subcommittees. Party leaders may assign additional service on a select, special or joint committee, each facing a vast number of issues and innumerable groups vying for support.
Like most primary care physicians, members of Congress have an office volume that limits appointments to little more than 15 minutes. An administrative assistant to one senator recently offered some insight into the frenzied competition for a legislator's attention. The senator's schedule on a recent day is illustrative:
8:30 a.m. – Meeting with fellow senator to discuss GOP caucus race
9 a.m. – Legislative staff meeting to review constituent letters and discuss climate change, upcoming trip to Africa, and health care legislation relating to his state's hospitals
10 a.m. – Committee on Health, Education, Labor and Pensions hearing on food safety
10:30 a.m. – Constituent meeting related to drought
11 a.m. – Committee on Environment and Public Works – GOP members meeting on climate change
11:45 a.m. – Meet with GOP floor messaging team to strategize on the week's floor message
12:30 p.m. – Weekly GOP policy lunch
1:15 p.m. – Legislative staff meeting on upcoming climate change hearing
2:05 p.m. – Constituent photo
2:30 p.m. – Constituent meetings on Middle East issues
3 p.m. – Constituent meetings on mortgage issues
3:30 p.m. – Constituent meeting on transportation issues
4 p.m. – Constituent meeting on OSHA issues
4:15 p.m. – Constituent meeting on higher education issues
5:15 p.m. – Ethics Committee meeting
6:30 p.m. – Constituents holiday reception
The senator's schedule is often interrupted by trips back and forth to the Senate floor to cast a vote. When he is working on a time-sensitive legislative issue, he will make calls on his way to and from other meetings. When the Senate is in session there are numerous hallway chats, floor conversations and more phone calls, the assistant added.
The ear of a senator or representative is also sought in his/her state or district. Most members of Congress try to leave by early Friday afternoon for the trip home. Fridays and Saturdays provide opportunities to travel about their state to hear constituent concerns or to raise funds for the next election. Monday is spent traveling as they return to Washington to begin another week's work.
In this atmosphere, internists need an influential surrogate to speak on their behalf. Poorly articulated positions have little chance of success. Positions that are not heard have no chance of succeeding. Even the most determined physician, busy with career and family, cannot single-handedly affect policy outcomes. No physician has that amount of time. Likewise, simply wringing one's hands over the unfairness of payment issues, the lack of liability reform, the cost of electronic medical record systems, and the consequences of 47 million uninsured Americans is futile. Assuming that it is someone else's responsibility to fund advocacy is foolish. ACP must make a substantial financial commitment to advocate successfully.
Our livelihoods and practice environments are in large measure dictated by legislators through the laws they pass and the regulators they oversee. Policy makers in the private sector generally follow the lead of lawmakers or at least work in concert with them. Thus Congress and state legislatures are at the center of health care. A portion of member dues funds the critical work of the College and its Washington staff. A portion, along with chapter dues, can be used for advocacy efforts in state capitals. Successful advocacy also requires working with health plans and medical and health-related associations to help shape health policy, medical education, research, and the practice environment.
Collectively, these endeavors give internists and our patients a voice amid the din of competing interests. This is one of the most compelling reasons for you to urge every internist in your community to become a member of and engage in the College.
Please remind your colleagues that advocacy is a member benefit of inestimable value. Internists will enjoy thousands of dollars of increased annual earnings because the ACP successfully advocated on their behalf for increased Resource Based Relative Value Use payments for evaluation and management. Suggest that from the savings, they might consider $425 for national membership in ACP, and the modest sum for their state chapter dues. It is a wise investment.