We need support in our advocacy efforts

Advocacy issues will require a bigger piece of membership dues and donations, as well as more volunteer time.

Issue: October 2005

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

Many of the long-standing national umbrella medical organizations have become increasingly involved in advocating for patients, the profession and its members. The original role for these organizations — supplying education to members — continues. And, as is the case for most professional organizations, ongoing education helps practitioners “to be the best they can be.”

In our profession, that educational effort is a continuum that begins by helping younger members meet strict board certification requirements. In later career stages, physician needs shift to recertification and a desire to keep abreast of important developments.

As is the case with many of you, most of my structured educational needs in orthopedics are met at the annual meeting of the American Academy of Orthopaedic Surgeons, the world’s premiere musculoskeletal conference, which offers a potpourri of educational opportunities. In addition, many continuing medical education courses are available to fulfill our varied educational needs, and they compete for our time and revenue. National and specialty organizations, industry, institutions, individual educators and publications offer educational opportunities. The emerging electronic educational avenues are also expanding and playing an increasing role in ongoing professional educational needs.

Advocate for whom?

Our dues and donations to those medical organizations to which we belong support many of our educational needs. However, there appears to be an increasing need to spend more of their revenue and staff time to support something in addition — advocacy. This is the result of the rapid rate of change occurring in financial and reimbursement issues affecting medical practices, patients’ access to health care, insurance coverage, funding of orthopedic research and a host of other critical issues.

Busy practitioners, with extensive clinical and educational demands, simply are unable to achieve effective advocacy for their own and their patients’ interests. It behooves us all to pay attention and support the political action and health policy arms of our organizations. These efforts are not necessarily self-serving as long as we advocate for quality health care and keep our patients’ interests as a key goal.

The standard of advocacy we need is bigger than simply sending donations to political action organizations; orthopedic surgeons need highly trained and motivated staff professionals representing them at the local, state and national levels. These professionals must continually monitor changing events and develop and prioritize well-thought-out solutions and critiques of proposed changes. It takes expertise, workforce energy and resources just to gain access to and present positive input to decision-makers.

Maintaining a private setting

“It behooves us all to pay attention and support the political action and health policy arms for our organizations.”

How does all this play out “on the ground?” Advocacy issues will require a bigger piece of our membership dues and donations, as well as more volunteer time. If we want to continue to offer our medical services in a private setting, we need continued involvement and analysis of pending political action.

There are ongoing attempts at reform. These reform efforts will continue on complex issues involving reimbursement, regulation, a single-payer system, length-of-wait lists for patients, medical liability coverage, employee health care and many more.

In discussions, some of you have said to me, “We are trained to be doctors, not businesspeople,” “let me take care of my patients,” and “let someone else take care of the business aspects for me.” This usually means working for a salary and letting someone else take another layer of profits out of your efforts.

I feel strongly that we need to be very careful about abdicating the business side of the practice of medicine. If there is no alternative, our current salaries and working conditions will change more quickly. Turn the business side over to another party and your interests will be subject to more factors out of your control.

Involving patients and others

One pessimistic, sophisticated friend, acknowledging the importance of the business side of practice, tells me that “the marketplace” is such a powerful force that it will settle these issues and our advocacy will not make a difference in the end. If our advocacy turns strictly self-serving, he will probably be right. To succeed in representing our interests, advocacy must be coupled with coalition-building efforts that include patients and other voters, as well as other organizations promoting patients’ interests.

As I get further along in my career, I feel a greater need for assistance from the medical organizations that I belong to for advocacy and less for my specific education needs. We must stand up and speak responsibly, succinctly and with well-developed positions for our profession and the patients we serve. No one else will do this for us.

We cannot leave the pursuit of our ideals and interests to others. We must be at the table where and when change is occurring. Our profession needs to be more involved in the “Big A” than we have been.