The Domino Effect of Physician Advocacy

LARRY LIGHT SENIOR EXECUTIVE OF THE PENNSYLVANIA MEDICAL SOCIETY

The domino effect of physician advocacy is somewhat nuanced. Certainly there are exceptions, for example tort reform, but in many cases the end goal of physician advocacy is to protect the clinical ability to treat patients and improve health outcomes. Holding an unrestricted license to practice medicine, physicians don’t need to advocate for an expansion of their scope of practice. Filling their waiting rooms with more patients isn’t often the priority, especially in times of well publicized physician shortages. As a result, the goals of advocacy campaigns to reform insurers’ prior authorization restrictions, reduce the cost of prescription drugs, promote the availability of telemedicine services, ban smoking in public places and a host of other policy initiatives are far more altruistic.

Particularly in health care the “domino effect” can be surprisingly impactful. An example from health care, although not related directly to physicians, would be American Association of Retired Persons (AARP) advocacy for the $35 cap on insulin prices for Medicare patients. The AARP victory resulted in a projected savings of $25 billion in out of pocket costs for seniors. In addition, a result of the 2022 prescription drug law and subsequent positive actions taken by drug companies, is that savings will be extended to the much broader community of patients through reduced drug prices. There will also be savings for taxpayers and hospitals as the lower insulin costs and broader reduction in prescription drug costs lead to improved health care for patients. The out of pocket dollar savings are dramatic but the domino effect savings are just as real. Also quickly evident will be the positive changes for physicians who are clinically helping patients to manage their care as the domino effect takes hold. AARP engaged in advocacy to achieve an important win for their members and along with other advocates accomplished much more.

The real challenge of physician advocacy is how to do it successfully, and that challenge is significant. In many cases negative consequences are self-inflicted. Physicians can be especially prone to advocate with an approach of telling policy makers what actions and changes must be undertaken. At all levels of the political universe, especially in situations with strongly divergent partisan forces, demands for change that might seem obvious to the advocate are really not politically practical. The politicians have to consider a broad spectrum of factors, including funding concerns, how the change will be interpreted and implemented and how the action might affect other interests. The aggressive advocate is often just focused on what must, in their eyes, be accomplished to solve their problem.

Another factor that makes physician advocacy challenging is the broad scope of issues that can clutter the advocates’ agenda. Clinical issues should always be a priority, but sometimes those can be pushed aside by a concentration on social issues that while appropriate have the effect of diluting the advocacy message. And from the clinical perspective, different messages and demands from the crowded field of medical specialties can make it difficult for policy makers to prioritize the viable issues. In those instances the dilution of physician advocacy messaging often leads to the relevant issues being set aside for further study.

A very important factor is that physician advocates cannot participate in health care policy discussions without bumping into the very aggressive and well funded advocacy campaigns of other stakeholders. For starters there is no requirement that the wide array of health care providers will have any level of unanimity on any and all issues. All sorts of factors come into play, including how an allied health profession may or may not be impacted by the issue and even how they want to strategically engage relative to a possible scope of practice confrontation with the physician community.

But in health care policy discussion, physicians and other providers are just some of the relevant stakeholders. Policy makers can expect to hear from disease specific interest groups, the AARP and a wide range of groups created primarily for focused but high profile advocacy activities. In addition, trial lawyers, hospitals and health systems, health insurers, nursing homes, pharmaceutical companies and a whole host of other special interests crowd into health care policy debates. Their advocacy campaigns are always well funded and always aggressive. And many competing advocates have what might seem a minor advantage in that they don’t have to juggle their advocacy work with patient appointments. Hospital leaders are paid to engage on behalf of their employer.

From a more positive perspective, within the very wide and fairly crowded spectrum of health care advocacy there is a special respect among policy makers for the potential that can be reached by physician advocates. Whether it is encouraging support for a political candidate on election day or supporting passage or defeat of legislation, physician advocacy has several positive predictors of success.

Physician advocates begin their engagement on an issue with some built in advantages. It’s a given that they are well educated, both generally and especially with respect to their profession. Sometimes a reminder is necessary, but it is accepted that their education and training outpaces any other health care provider. In many situations, physicians and physician advocacy organizations then find strong allies among other provider groups.

Successful physician advocacy highlights the sanctity and intensity of the patient-physician relationship and then promotes it as an unbreakable bond. Contemporary health care provider organizations and lobbyists have learned to follow the same tact in regard to policy issues. The patient-centric focus serves as a foundation for not only physician advocacy, but across the health care policy spectrum for the strong allies who contribute to health care policy discussion.

Policy makers are particularly responsive to the clinical focus that physicians can insert into policy debates. Many of the health care issues on the policy docket present the opportunity for consideration of a clinical aspect. The obvious advantage is that this is foreign territory for most legislators and reporters. While they can certainly obtain relevant information online or from other health care providers, the physician advocate perspective gains credibility. Like every episode of the hit television series MASH, relating the issue to a clinical procedure or diagnosis serves to enhance the policy discussion.

It is a given that physician advocates always have tremendous potential to have a significant impact in any health care policy discussion. You won’t win every vote, pass every bill or even get every amendment adopted. But everyone in the discussion will realize the importance of your engagement in the political process.