Q&A: Physicians should ‘start small and local’ to advocate for themselves, patients
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Key takeaways:
- Physicians can get involved in the political arena by picking a topic they are passionate about and comfortable discussing, Melinda M. Rathkopf, MD, MBA, said.
- Get to know your representatives, she advised.
Our political system ensures that everyone throughout the country has representation, Melinda M. Rathkopf, MD, MBA, told Healio. Leveraging that representation is essential when physicians need to advocate for their patients and themselves.
Rathkopf, medical director of allergy/immunology at Children’s Healthcare of Atlanta, associate professor of pediatrics in the division of allergy and immunology at Emory University School of Medicine and a Healio Women in Allergy Peer Perspective Board Member, and colleagues discuss how public policy can affect physicians and their ability to treat patients in an editorial titled, “Why is advocacy important in allergy?” published in Annals of Allergy, Asthma & Immunology.
“We are the experts and need to shape the narrative and educate the policymakers, other advocates and patients,” Rathkopf and colleagues wrote. “If we do not stand up for our patients and our ability to care for them, who will?”
Healio spoke with Rathkopf on the importance of physician advocacy and tips to get started, including by getting involved locally and building relationships with representatives.
“I didn’t start by walking on Capitol Hill,” Rathkopf told Healio. “I started by walking into my local representative’s office, then I went to the state level, then I went to Capitol Hill. Find a topic you’re passionate about already and remember, you’re the expert.”
Healio: In your editorial, you emphasize the effect that public policy set by federal, state and local governments can have on the ability to treat patients and maintain successful medical practices. What are some recent examples of how public policy has affected your ability to practice medicine?
Rathkopf: The most recent example that comes to mind is when GSK stopped production of Flovent (fluticasone propionate). There’s a generic fluticasone inhaler, but Flovent had been the most cost-effective, because many insurance plans said you had to have that exact one. A lot of patients were left scrambling because there wasn’t an automatic substitution or generic option automatically covered by their insurance. Limitations imposed by formularies caused our patients to have a hard time getting access to their medications when the brand name was no longer available.
Another example, although this more so involves insurers and payers than public policy, is the requirement for step therapy, which specifies that you can’t give a specific treatment until you have failed prior medications, even if those might not be the best treatments in the physician’s opinion.
Healio: Why might physicians be hesitant or afraid to get involved in the political arena? How can they overcome this hesitation?
Rathkopf: Physicians are used to being an advocate at the patient level; where it gets a little uncomfortable is going outside the one-on-one interaction with the patient and their family and having to discuss it with politicians, legislators and insurance companies. There are very few and probably not enough physicians who are politicians.
Physicians are also burned out, overworked and overburdened, especially in the last few years. There are so many nondirect care requirements being put on physicians, from the electronic medical records to documentation, forms, approvals and prior authorizations. At the end of the day, I’m not likely to block patient care so I can go talk to a legislator.
During the American College of Allergy, Asthma & Immunology House of Delegates annual training, Priya Bansal, MD, FAAAAI, FACAAI, brought up a great example concerning the prohibitive cost of epinephrine autoinjectors. In 2016, a parent criticized the cost of EpiPen (Mylan/Viatris) on a Facebook group, reaching thousands over social media in what became known as #EpiGate. The power of one is amazing.
Physicians can overcome their hesitation by picking a topic they are passionate about and comfortable discussing. Start small and local to make a big difference even in an area that is nondirect patient care.
Healio: From patient care to administrative duties, research and leadership positions, physicians are pressed for time. What would you say to someone who says they do not have time to include advocacy in their routines?
Rathkopf: I would challenge that advocacy is already in their routines. Physicians are already advocating for their patients through the payer’s insurance; finding a way to channel that advocacy into other areas may make lasting change. If they take that one little battle they fought on an individual patient level and expand it to help everyone in their area, state or nationwide, that is advocacy.
Healio: In your editorial, you recommend that physicians advocate for patients, themselves and their practices. What are some means of doing so?
Rathkopf: Patient access to the appropriate medications is one way, such as by challenging the need for step therapy and prior authorization.
Supporting the Clean Air Act and the CDC’s National Asthma Control Program are other ways of advocating for our patients. There are a lot of programs that we’re not asking physicians to create but to sign on and support. Send a letter saying, “My asthmatic patients do better when the air quality is better.” Putting a physician’s name behind these already created programs and having a physician pushing for them can really help.
As far as advocating for themselves, doing away with a lot of the restrictive tasks put forth by third-party groups such as pharmacy benefit managers and insurers can help. One example is the fees for electronic fund transfers. Insurance companies are going through a loophole by using a third-party payer to collect payment electronically with a fee. One thing the ACAAI Advocacy Council is trying to do is get Congress to close the loophole that payment vendors are using to charge us these transaction fees and prohibiting these payments.
Healio: What recommendations do you have for small practices or those in rural areas that want to get involved but may not have as many resources available to them?
Rathkopf: Every area has a political representative. Having come from Alaska where we only had one representative, it was much easier to get to know them. I’m challenged with trying to recreate some of these ties now that I’m back in Georgia.
Find out who your representatives are and build these relationships. Volunteer to be a go-to medical resource. One way to push yourself out of your comfort zone and build relationships with your representatives is by going to political fundraisers. Don’t be afraid to donate; you have to put your money where your mouth is.
I even hosted a political fundraiser for one of our candidates in Alaska, which is something I never thought I’d do. When an issue came up later, I was able to call their office and say, “Please remind the representative we met in person.” They personally called me back.
The great thing about our political system is that we all have representation no matter where we are in the country. Start local, make these connections, show up and call up. Could I fly all the way to Juneau to get testimony or a hearing? No, but I could call and get on the phone to do it.
Healio: Do you have any recent examples of how you or your colleagues have successfully advocated for change?
Rathkopf: While I was in Alaska, I testified on some issues related to Medicaid reform, and that gave me the opportunity to work on a task force for Medicaid reform for the state. Later down the road, I was invited to a small dinner that the governor put together to talk about Medicaid for the state. We successfully enacted some Medicaid reform issues that all started locally.
There’s been recent discussion around doing away with step therapy or at least making it easier to get certain medications without having to go through failure of the prior steps. We also support ongoing funding of the NIH and research.
The College has some key issues that our advocacy council is working on, including Medicare reform and reimbursement, the electronic payment fees and voluntary price caps on inhalers. I also testified through the College to our local people about including epinephrine autoinjectors in airplane medical kits.
HealioAre there any other noteworthy examples of advocacy you would like to mention?
Rathkopf: The biggest example of a grassroots movement that started locally and became a national conversation was when the U.S. Pharmacopeia was going to prohibit compounding medications following the unfortunate incident in New England when a compounding pharmacy spread a severe, life-threatening infection. This blanket decision would have affected all allergists and our allergy shot patients. By finding a legislator who was on allergy shots and understood how different their treatment would be if they had to go to a compounding pharmacy instead of their allergist office, they were able to escalate the issue and work as a network. Everyone got passionate about it and met at the national level to educate on the low risk of allergy shots to enact certain rules.
When little things like this come up, say they’re happening in rural Cheyenne, Wyoming — if it’s happening there, it could happen in other places too. Let’s start working on it locally.
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For more information:
Melinda M. Rathkopf, MD, MBA, can be reached at mrathkopf@emory.edu.