For better or for worse, I have always been a big proponent of the Medicaid program. Starting with some research of pediatric patients receiving Medicaid as a medical student, as well as always having an inclination to care for those in most need, I have long backed this up with advocacy at both a grassroots and legislative level. The problem with advocacy for physicians, however, is that it takes a lot of time and emotional energy, and most of us simply do not have that to give, in addition to caring for patients.
Physicians who do not actively participate in advocacy tend to complain about what is or is not done on certain issues impacting themselves and their patients. Physicians who are actively engaged in advocacy efforts tend to complain that not enough physicians are involved and so should stop complaining unless they are willing to participate.
The trick is that both are right, and therein lies the catch-22 — you’re damned if you do and you’re damned if you don’t.
As we all know, the legislative process can be as fluid as molasses — it takes forever to get anything done. Even then, it requires a lot of know-how, understanding of the intricacies of the political process; and time to foster relationships, compete with other interests that may have opposite viewpoints and often higher-paid lobbyists, and change policy that may be a low priority or extremely unpopular in certain crowds.
This may be somewhat easier on a more local and state level, but still requires all of the above.
Many physicians see this as trying to move a mountain with a shovel, and indeed it sometimes takes just as long. Some of the legislative goals that organizations have may involve a multi-year plan, trying to gain small steps along the way, which can be very frustrating to those of us who are in clinic every day and see the needs and issues that we think should change.
So the question becomes how can we engage, or even, should we?
The hard truth is that nothing changes without our involvement, or may change for the worse for us based on the efforts of other special interests. So how do we fit this in to our busy and oftentimes draining schedule?
The important thing is to not be overwhelmed by the process and instead, focus on small steps. Tell your legislator your concerns. It is true that physicians are more listened to by lawmakers than nearly any other profession. Send an e-mail, chat on the phone or in person, and offer yourself as a resource on medical issues.
Oftentimes this may lead to invitations to testify in committee meetings, though this may certainly cause conflicts with clinic time. Only do as much as you’re comfortable with, but start the process.
As we all know, there are many important issues that need to be addressed. As I mentioned above in my interest in Medicaid, I have been working hard to forward Medicaid expansion in Utah, with both community organizations and legislators. It has been a long road, three years in coming, and the plan that would cover more than 100,000 citizens that most need it recently was voted down in favor of a lesser plan that would provide reduced coverage for nearly half as many people at the same cost.
It has been little more than a political game, which is hard to watch. And yet, it never would have gotten this far without so much physician support. We likely would not even have the lesser option if we ignored the issue completely.
No matter what your issue of interest is, working with legislators, community organizations, or private organizations, even in a limited capacity that doesn’t overwhelm you, can make a large difference.