The advocacy efforts in the fall of 2021 to stave off pending cuts to Medicare payment were successful. Collectively, surgeons were able to prevent a 9% pay cut, sustaining instead a much smaller 2% cut. To be sure, we would have been unable to mitigate that 9% cut without so many Fellows answering the American College of Surgeons (ACS) call to action and engaging in the political process. For many surgeons, it may have been their first time participating in ACS advocacy efforts.
Subsequently, we heard from some Fellows who found the advocacy process a bit frustrating. Some members indicated those challenges might make them less apt to participate in similar activities in the future. Though I clearly understand that engaging in the political process can be daunting at times, I also believe it is important that we continue to act collectively to move the needle for our profession and, most importantly, for our patients.
The frustrations expressed by some of our colleagues were largely centered on their legislators’ offices’ response to their electronic communications. Basically, these concerns fell into two broad categories: the impersonal nature of the response received, and political messaging in the response that differed from their personal political views.
First, it is important to remember that the purpose of sending a grassroots message to a congressional office is to make sure your voice is heard and provide cause for another check mark to be placed on the tally sheet that your legislator’s staff keeps on the specific issue involved. This is why we often ask Fellows to contact their legislators multiple times, which results in marks on the scorecards on multiple days.
To this point, it is helpful to remember that a primary objective of every member of the House and Senate is reelection. Representatives and senators know that a key strategy for getting reelected is to be responsive to their constituents; receiving multiple grassroots messages on the same topic gets their attention. As legislators receive more communications on the same issue, they tend to be more receptive to the message they are hearing from their home district and, hopefully, more apt to react by taking positive steps.
Impersonal Nature of Responses Received
The electronic messages we transmit via SurgeonsVoice contain standard messaging, though it is infinitely modifiable to allow Fellows to edit as they wish. We do this to make participation easy and efficient so that the legislator clearly knows the viewpoint of our Fellows. The responses sent in reply to these messages also contain standard language generated to broadly address the concerns expressed. Stated differently, it is fair to view these responses as simply an acknowledgement that your message has been received, which is perfectly fine. Again, the goal is to ensure that our message gets through. The intended ends of the action were accomplished.
Typically, these responses will be impersonal, and it is common for them to be addressed to Mr. Smith or Ms. Smith and rarely to Dr. Smith. This salutation is not a sign of disrespect, but simply a function of the volume of responses legislative staff send in reply to constituent contacts daily. It also is important to note that sending these grassroots messages is a good first step toward building a positive relationship with your elected officials. Our hope is that Fellows can become a trusted voice and resource for their legislators on healthcare matters.
Partisan Political Content in the Response
Some Fellows objected to or were offended by the inclusion of partisan rhetoric in the responses they received. This is a dilemma that we in the ACS Washington office face daily—separating one’s professional political agenda from one’s personal political beliefs. Unfortunately, this quandary has become even more significant in this hyper-partisan era.
To be blunt, it is imperative that we separate our personal political agenda from the advocacy efforts made on behalf of our profession and our patients. We must be able to work with legislators across the political spectrum in a professional and respectful manner.
Having said that, I realize this situation can be challenging. Most of us have deep-seated, long-held political beliefs—and for good reason. Political identity often has its roots in our earliest socialization from our family. For many individuals, it is at the core of our personal identity. However, as surgeons, we must recognize that regardless of the party with which we most often identify, at times our professional agenda will require us to engage with individuals who do not share our broader political agenda or, alternatively, with a political personality that we find objectionable.
In sum, there will be times when brutal, objective pragmatism in our professional politics should supersede the subjective passion of our personal political views. To that point, we should not take offense when the response received from legislators who are outside the party with which we identify contains political rhetoric that uses the opportunity to take a shot at their political opponents. This is simply the state of politics in our country.
Building Relationships
Finally, I want to urge you to build a relationship with your elected leaders so that you are a trusted voice and resource for them on healthcare matters. Here are a couple of suggestions to foster relationships with policymakers:
- Get to know your legislators when they are back home in the district. Attend events and talk with them. Let them know what you are thinking about issues of concern to you and your patients.
- Get to know the district director, district staff, and health policy staff, who are essential advisors to your elected officials. If you have a relationship with them, they will seek out your opinion on healthcare matters and share it with the legislator.
- Build bridges with elected officials to help ensure that they know the views of trusted medical professionals like our Fellows in their communities. Hopefully, they will keep that in mind as they cast votes on matters important to us and our patients.
In the meantime, we urge members to remain optimistic about the political process. Get engaged, stay engaged, and answer the call when we need to make our voices heard on Capitol Hill. Fellows made a real difference last fall in mitigating the Medicare payment cuts, and they can make a difference on whatever issues may be next on the horizon.
