AAEM Chapter Division Updates: Medicine and Politics

Medicine and Politics

Andy Walker, MD FAAEM

“One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.” I -Plato (paraphrased from The Republic) didn’t go to medical school in the hope of becoming involved in politics. Neither did the thought ever occur to me during residency. All I ever wanted to do was take care of acutely injured and seriously ill patients in the emergency department. To that end I spent a fortune in time, effort, and money in acquiring the knowledge, skills, and judgment needed to provide the best possible emergency medical care. Once in practice I quickly learned, however, that a host of people wanted to interfere in my ability to exercise my sorely acquired professional judgment on behalf of patients. Even worse, none of those people had sworn an oath – as I had when I took the Oath of Hippocrates – to put the patient’s health above financial and other interests.

That is why I found myself involved in politics and regulatory policy: taking good care of patients required it, and I feel an ethical obligation to do my best for my patients. If you are a member of AAEM you probably feel the same ethical obligation to our patients and our profession, and I urge you to take action on that feeling. Don’t leave it up to others. How do you make a real difference in the regulatory environment in which emergency physicians work? You start by simply paying attention and staying informed. The vast majority of medical regulation takes place at the state level. Plus, AAEM’s leadership, Government & National Affairs Committee, and DC lobbying firm, Williams and Jensen, do a great job of taking care of things at the federal level. So, keep an eye on your state

“You start by simply paying attention and staying informed.”

“Always frame your argument in terms of what is best for patients.”

legislature. Every legislature has a website you can use to find your legislators, search for bills relevant to the practice of medicine, read and track those bills and their amendments, and communicate with legislators. Every February, after the deadline for filing bills passes, I go to the Tennessee General Assembly’s website and search for bills by topic using keywords like physician, medicine, tort reform, and surprise bills. If I find something important, I notify TNAAEM, AAEM’s Tennessee Chapter Division, as well as the Tennessee Medical Society (TMA). You can find your legislature’s website (and more) at govengine.com. I also strongly recommend that you join your state medical society and donate to its PAC (political action committee). Believe me - tort lawyers, the insurance industry, hospital administrators, contract management groups (CMGs), and everyone else who wants to control the practice of medicine is supporting their professional organization and its PAC. State medical societies usually do a good job of keeping members informed of important bills and proposed regulations, and are always one of the most powerful lobbies in the state. Your state society deserves your support, and you need its help. However, it needs your help too. Our specialty is unique in many ways, and your state society’s lobbyists may not understand the unique impact a law will have on emergency physicians and our patients. Surprise billing legislation is one example of that. It is up to us to explain such issues to our state medical societies, so they can go to bat for us. You can’t rely on the ACEP chapter in your state for that either. I believe ACEP and its state chapters are

too influenced by CMGs, and too willing to sacrifice the interests of individual emergency physicians and our patients to corporate business interests. A big example of that in Tennessee was the legislative battle over restrictive covenants in physician employment contracts. Because of TNAAEM’s involvement, emergency physicians are now the only physicians in Tennessee exempt from such non-compete clauses. Your state medical society needs to hear from AAEM, not just ACEP. Next, get to know your state legislators. Subscribe to their email newsletters. Offer to be an information resource for them. If you generally support their positions, donate a little money to their campaign or PAC – as little as $25-50 is enough to put you on their radar. Educate them on how relevant bills would affect emergency physicians and our patients. Be sure to thank them when they do the right thing. If they are consistently supportive of emergency medicine, let AAEM’s leadership know and suggest a donation from AAEM’s PAC. Communicating with your legislators and state medical society over the long term can pay big dividends. TNAAEM and I spent years educating the Tennessee Medical Association (TMA) and legislators on the unique position of emergency medicine in regard to EMTALA obligations and

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surprise billing legislation. Not only did we successfully fight off insurance industry attempts to cap what out-of-network physicians and hospitals could bill insurers, the TMA decided to make the issue one of its highest legislative priorities. This relieved TNAAEM of much of the lobbying work and, more importantly, moved us from defense to offense when my state senator filed surprise billing legislation that protects patients without sacrificing the medical safety net to insurance industry profits. Make a good argument – a rational and polite argument that puts patients first. In your more cynical moments you may think that whoever donates the most money to a politician will win, but that is rarely the case. While I may agree with Otto von Bismark’s aphorism that laws are like sausages, it is better not to see them being made, I have learned that in most cases whoever makes the strongest argument wins. Remember that you are almost always explaining the issue to someone who is not a physician, much less an emergency physician. Keep it simple. Always frame your argument in terms of what is best for patients. Nobody cares about how something affects you personally, if it doesn’t also affect patient care and the general public. Finally, be patient. Politics never ends. Whether you won or lost on the

issue at hand, the battle isn’t over – it is just on pause. Never let your attention lag or your guard down, and never give up. Another opportunity to get what you want will likely arise. Be open to working with anybody if your interests align. Politics does indeed make strange bedfellows. And never, ever burn any bridges – no matter how frustrating a defeat may be. As battered as physicians are “We can’t win every battle, but we are guaranteed to lose every right now – and especially emergency physicians – the battle we don’t fight.” biggest obstacle we face is our own sense of hopelessness. It is easy to forget that we are still widely respected in society and in government, and we are hard to resist when we are protecting patients and their health. The belief that there is no point in trying to achieve the right thing because we are doomed to fail is what leads to most of our defeats. We can’t win every battle, but we are guaranteed to lose every battle we don’t fight. Pay attention, support your state medical society, get to know your legislators and communicate with them occasionally, craft your argument in terms of patient welfare, never give up or lose hope, and most basic of all – when AAEM or its chapter division asks you to contact your legislators, do it! There is strength in numbers.

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