Lancaster Physician Winter 2020 - 33

WINTER 2020

Every day, local, state, and federal legislatures
make decisions affecting our patients and our
profession. Through rules, regulations and laws,
legislators control how we practice medicine,
how our patients access care, and whom they
are allowed to receive care from. Legislators
formulate and introduce bills after constituents
they know personally make what seem like
reasonable requests. Legislators often sign on
to bills after colleagues solicit them with a
simplified description of what the bills will do.
Medicine, however, is complex. Legislators
often do not have the understanding or the
time to research bills that affect patients and
the medical profession or to truly understand
their impact.
It is far too easy for a bill to rapidly move
through committee and end up on the floor
for a vote, without any significant input from
physicians. The danger in this is that the ill
effects of a particular bill may not be initially
obvious. It is at this point that organized
medicine must sometimes scramble to prevent
a disastrous bill from passing.
All areas of medicine are affected by scope
battles. Legislation on enhanced scope of
practice for non-physicians often moves
forward with little input from physicians or
the medical community. The primary reason
for this is that state legislators have no contact
with their physician constituents. Is it the
legislator's fault? No. It is the physician's fault
for not engaging their legislator. Each of us
have two legislators: a State Senator and a
State Representative. Unless we want decisions
on medicine to be made without our input,
every physician must reach out to meet their
two legislators and their staff.

even though no one on the former has any
experience in surgery. While the public assumes
that all decisions on who provides their medical
or surgical care is made by a centralized Board
of Medicine, this could not be further from the
truth. Advances in scope are typically made by
independent provider boards outside the Board
of Medicine. Usually, they are not based on
evidence but done by legislative fiat.
Through advocacy, an individual physician
can help educate their legislators. You, as a
physician, are the expert. You can provide
insight to legislators that they would otherwise
not obtain. However, if you do not actively
get to know your legislators and engage with
them, they will never have the benefit of
your expertise.
One of the easiest ways to dip your toe in
the water with respect to advocacy is to attend
an advocacy day planned by your state or local
society or your subspecialty group. Typically,
physicians will gather and discuss topics concerning patient safety, scope of practice, or
other issues concerning medicine in general
and be teamed up to meet state legislators.
In these meetings, it's important to recognize that the staff is just as important as
the legislators and must be treated with the
utmost respect. Unfortunately, legislative
days at the capital are jam-packed with
minimal time to meet with each legislator or
staff member. It's very easy for your concerns
to be lost in the shuffle of scores of other
constituents at the capitol who are meeting
with the same legislators.

For an example of what can happen when
physicians are not engaged, we need only
look at a number of states that have passed
legislation allowing optometrists to do surgery.
They have granted optometrists (who did
not go to medical school nor have a surgical
residency or surgical training) permission to
conduct surgery.

Once you've been to an advocacy event
and learned how to talk with legislators from
more seasoned colleagues, the next step is to
meet with your local legislators at their office.
This is best done during legislative recesses.
First contact your state, local, or specialty
medical group to determine what are their
important issues. They can provide you with
position papers to leave behind. Then call and
schedule a time to meet with your legislator(s)
or their staff.

Who determines what surgery the optometrist can do? Well, that would be the
Optometry Board, not the Board of Medicine,

At a meeting with a legislator, introduce
yourself, and explain where you live, where
you work, and what you do. Take the visit as

LANCASTER

33

PHYSICIAN

an opportunity to educate your legislator on
what it is like to be an anesthesiologist or a
family practitioner. Describe how it differs from
a CRNA or a CRNP, what the difference in
training is, etc. You will be surprised to find they
often really don't understand the difference.
Be prepared to talk about the issues of
importance to your medical specialty. It's always
most important to focus on what is best for
patients. Never complain about how hard your
job is or how you are underpaid. When you
are making an argument regarding what's best
for patient care, it is very hard to have your
motives questioned. Visits in the local office
are much more leisurely, far less rushed, and
ultimately more beneficial than at the capitol.
When you are done meeting, offer to have the
legislator visit your office or observe surgery.
Offer to be a resource to them when issues of
importance arise. Always send a thank you
note with your business card.
Once you've met your state legislator you
often will find that you really like them, regardless of party. You may consider stepping it up a
notch and either attend one of their fundraisers,
or better yet, organize a fundraiser for them.
Initially, this may seem to be a daunting task,
however, your state or specialty group can help
you with this. The legislator's office can also be
a helpful resource. You don't even have to be
of the same party. As a Democrat living in a
sea of Republicans, I have personally thrown
fundraisers for both my Republican state
senator and state representative. While they
both know that I'm not a Republican, they
appreciate that I can put aside party differences
to work on common goals.
In closing, each of us must ask who we
want to control the narrative of medicine.
There are far more non-physicians interested
in enhanced scope of practice than there
are physicians. If we allow our legislators
to hear only from non-physician providers,
we have only ourselves to blame for being
shut out of the decision-making process
regarding medicine.



Lancaster Physician Winter 2020

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