If you interviewed a dozen medical students, chances are very few would 1 day think they’d spend time lobbying their local, state, or federal legislators trying to resolve pressing issues that affect their ability to provide care.
However, sharing these challenges with elected representatives is needed today more than ever, said Jesse M. Ehrenfeld, MD, the 178th president of the American Medical Association (AMA).
“People go into medicine because they want to contribute to improving human health,” said Ehrenfeld, a practicing neurology anesthesiologist. “It’s so fulfilling knowing I can put my hand on someone’s shoulder and make a difference in their lives, but all the junk that gets in the way — the political infighting, the payment cuts, the distrust of science, and misinformation — makes it more challenging, and more and more of my colleagues are struggling to find joy in the practice of medicine.”
What’s on Doctors’ Lobbying Agenda?
Some of the most significant issues that doctors say affect them today include high rates of maternal mortality among communities of color, nonphysician providers playing a larger role in patient care, missing payments due to the May cyberattack on Ascension, the nation’s largest health system (which followed the hacking of Change Healthcare, part of UnitedHealth Group), more Medicare payment cuts, a looming physician shortage, and political influences on the very healthcare that patients need.
“No one on the Hill thinks we have a rational Medicare payment system,” said Ehrenfeld. “We’re working right now to deal with physician payment inadequacy. My oil change is not the same price I paid for it 10 years ago, and yet doctors are getting paid less through Medicare.
Legislators understand the challenge. Unfortunately, Congress hasn’t had the will to act on these critical health issues. It’s an issue around challenges in governing that’s not specific to us.”
These are just some of the topics the AMA focuses on during regular visits to the Hill as well as during twice-annual AMA conferences attended by 600 delegates from every state.
“We come together to argue, to debate, to set the best policy for the association,” he said. “We have delegates in primary care, rural, urban — and we come together to have conversations about the issues that matter. We vote and decide our policy positions, and this is a great opportunity for physicians to have their voices heard.”
Lobbying is especially important given yet another pressing issue — the physician shortage on the horizon — as 71,000 doctors have retired yearly for the past few years and only 21,000 graduates per year.
“We can’t allow individuals who have no medical expertise to make decisions impacting the physician workforce,” said Brian Stone, MD, a urologist in Jasper, Alabama. Stone recently testified on Capitol Hill about the need to address access to STEM education for Black and Brown students as well as the need to find ways to replace retiring physicians. “Those decisions have us in this predicament in the first place.”
The State of the States
On the state level, doctors are busily mobilizing for change throughout the United States.
“I would argue that, in many cases, there have been more opportunities to get legislative movement on the state level than at the federal level,” Ehrenfeld told Medscape Medical News.
Stone, who serves as president and chief of the medical staff of Walker Baptist Regional Medical Center, agreed but added that Alabama is one of the poorest states in the country and, hence, is facing an uphill battle when it comes to equitable access to care.
“A lot of the rural hospitals and clinics have closed, and most of the major health centers are concentrated in major cities,” Stone said. “There are huge areas in our state where patients don’t have access to doctors. That’s why it’s important for us to devise funding that offers incentives to new medical school graduates if they spend several years at an established facility set up by the government. This would be a great way to get patients in our state the care they need.”
Jerome Cohen, MD, president of the Medical Society of the State of New York, said on-time payment and prior authorization remain big topics he has brought to the attention of legislators in Albany, the state capital.
“When we’re taking care of patients and billing for services, we insist that the insurance companies pay us on time,” he said, referring to the cyberattack at Change Healthcare, the processor of claims for UnitedHealth Group, that led to doctors not getting paid and prescriptions being unable to be authorized. “When insurance companies don’t pay, there’s a problem there. Prompt pay laws require the insurance companies to pay doctors within 30 days.”
As physicians know too well, prior authorization, the process by which insurance companies insist that procedures or even medications be preapproved before they will reimburse the patient or cover the payment, has become more and more onerous and time-consuming.
“Some of the decisions insurance companies make are arbitrary and against patients’ interests,” Cohen said. “It’s one thing to fight directly with insurance companies; it’s another for doctors to get together as a group and go to Albany and say the law should be changed. Prior authorization interferes with patient care; that’s why we’re working hard to get legislation concerning this issue.”
These are also topics that are discussed at length at legislative brunches sponsored by the Medical Society.
“During our lobby day in March, doctors come to Albany to visit legislators in their offices,” he said. “Between that and letter writing, there are plenty of ways of engaging with politicians who are making policies that affect us.”
Ultimately, no matter the issue, doctors have just as much responsibility and the right to speak about their expertise and focus on the issues that they’re committed to, said Danielle Turnipseed, JD, who leads the Association of American Medical College’s public policy and legislative advocacy efforts.
“It’s so important for physicians to get involved and try to effect change with elected leaders,” she said. “I applaud people who deliver care, who connect with patients, and take the extra step of communicating back to their elected leaders. It’s not time to sit on the sidelines. We must hear from the people whom patients entrust for their care.”
Lambeth Hochwald is a New York City-based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.
