Commentary

Make a difference at every level of patient care

Anthony A. Romeo, MD
Anthony A. Romeo

Orthopedic surgeons recognize the three pillars of the highest level of patient care are excellence in clinical assessment and surgical skills, continued education and research. Our profession has resources that emphasize all aspects of the management of musculoskeletal conditions. We have opportunities to attend outstanding educational meetings and surgical skills labs. Likewise, webinars, surgical videos and maintenance of certification exams keep us at the top of our game.

An appreciation for the fourth cornerstone of patient care – political advocacy – is often not clear. In general, physicians have not realized the full potential of the democratic process. Physician apathy is seen at all levels of government and it is rare to see physicians at political meetings where the issues that affect the daily practice of medicine are decided by those who do attend – politicians and lobbyists from businesses, interest groups, health insurance and pharmaceutical companies. Conceptually, orthopedic surgeons would not choose these organizations to represent their views and influence health care public policy. However, by not participating in the democratic process, we choose to let these special interest groups determine how we provide patient care.

Democratic process

Recently, I was supported by the Orthopaedic Political Action Committee (OrthoPAC) to attend and participate in the Republican Governors Association Meeting in Chicago. Twelve of the 34 Republican governors and their staff, as well as others who wish to be governor or staff members, attended the meeting. More than 250 lobbyists also attended. Not only was I the only orthopedic surgeon, I was the only physician who was not also a politician. Every other aspect of the health care delivery system, except for patients, was represented.

During the 90-minute session on health care, seven experts — three governors, as well as executives from Aetna, Blue Cross Blue Shield, Walgreens and an insurance company that specializes in high-risk, high-cost coverage — spoke without an opportunity for questions. No physicians or patient advocate experts were included. Key issues related to orthopedics were never discussed, including workers’ compensation reform, medical liability reform and reimbursement burdens. The perspective from the physician’s side of the health care delivery system was absent.

After the session, I asked one of the governors why no physicians were on the panel. I also asked why governors do not routinely seek the advice and counsel of physicians on health care issues. His response was bold and clear. He asked me how many physicians are at the meeting and said the other people there (ie, lobbyists) invest in the democratic process by providing their advice, time and money, whereas physicians rarely get involved.

Political action

The American Academy of Orthopaedic Surgeons (AAOS) has made a focused effort to be more involved in political advocacy, especially at the federal level, with the growth and development of the OrthoPAC. In terms of funding, the OrthoPAC is second only to the American Society of Anesthesiologists. Considering orthopedic surgeons represent 3% of all physicians, we have a proportionally strong voice among medical political action committees on Capitol Hill.

The OrthoPAC is supportive of the issues that are developed and proposed by AAOS leadership and increasingly issues from subspecialty societies. The OrthoPAC helps facilitate the political process, fundraising and direct interaction with politicians. However, competition is impressive from other groups, such as the American Hospital Association and Blue Cross Blue Shield.

Many talented leaders and members of the orthopedic community remain on the sidelines. Most explanations are not well-supported. Physicians, especially surgeons, remain one of the most trusted groups of professionals by the American public. Our ability to provide the best care possible is what we should represent when we are engaged with the democratic process. No group understands musculoskeletal care better than we do. No one is better equipped to lobby for patients who need this care. More than 100 million people in the United States have arthritis and it is estimated that almost 10% of our gross national product is spent on the care related to musculoskeletal problems.

Our current administration threatened to dramatically reduce NIH funding, which includes important research dollars for musculoskeletal care. The efforts of the OrthoPAC and other lobbyists resulted in approval of the funding for 2017 without cuts and recommendations for an additional $2 billion for 2018.

Be involved, influence policy

Leadership in the form of political advocacy is clearly one of the cornerstones of delivering the best care to patients. There are many avenues to become directly involved and influence health care policy. State orthopedic societies provide an opportunity to impact your local community and state. Issues, such as tort reform, workers compensation regulation and financing, certificate of need and others are decided entirely at the state level without federal input. With the possible repeal of the Affordable Care Act displacing significant decisions regarding health care and financing back to states, working with local congressmen and the governor’s office is powerful. When you attend meetings with politicians, fundraisers or go directly to their offices, the impact is real.

Time is the most important asset to provide, however, funding is close behind. If you stay on the sidelines, then financially support the OrthoPAC and local and state organizations that represent your opinions.

Eliminate the notion that one voice won’t make a difference. Even if you cannot accept that you could be more influential than other constituents, then remember political advocacy is one of the four cornerstones of providing the best possible patient care. If you are forced to practice in a manner that distracts and interrupts your best efforts for patients, then the quality of care will suffer. Don’t forget the many examples in which our involvement in the process was a victory for patients.

The most powerful form of advocacy for orthopedic surgeons is in the form of public service. We are fortunate to have two orthopedic surgeons in national public service: Sec. Tom Price and Sen. John Barrasso. Orthopedic surgeons have served as elected officials and numerous local and state positions, too. Unfortunately, there has been little promotion or opportunity for mentorship or development of political advocacy early in an orthopedic surgeon’s career, which could potentially lead to more political representation at all levels.

Get involved. Make a difference at every level of patient care. We have work to do — for us, our patients and society.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.

Anthony A. Romeo, MD
Anthony A. Romeo

Orthopedic surgeons recognize the three pillars of the highest level of patient care are excellence in clinical assessment and surgical skills, continued education and research. Our profession has resources that emphasize all aspects of the management of musculoskeletal conditions. We have opportunities to attend outstanding educational meetings and surgical skills labs. Likewise, webinars, surgical videos and maintenance of certification exams keep us at the top of our game.

An appreciation for the fourth cornerstone of patient care – political advocacy – is often not clear. In general, physicians have not realized the full potential of the democratic process. Physician apathy is seen at all levels of government and it is rare to see physicians at political meetings where the issues that affect the daily practice of medicine are decided by those who do attend – politicians and lobbyists from businesses, interest groups, health insurance and pharmaceutical companies. Conceptually, orthopedic surgeons would not choose these organizations to represent their views and influence health care public policy. However, by not participating in the democratic process, we choose to let these special interest groups determine how we provide patient care.

Democratic process

Recently, I was supported by the Orthopaedic Political Action Committee (OrthoPAC) to attend and participate in the Republican Governors Association Meeting in Chicago. Twelve of the 34 Republican governors and their staff, as well as others who wish to be governor or staff members, attended the meeting. More than 250 lobbyists also attended. Not only was I the only orthopedic surgeon, I was the only physician who was not also a politician. Every other aspect of the health care delivery system, except for patients, was represented.

During the 90-minute session on health care, seven experts — three governors, as well as executives from Aetna, Blue Cross Blue Shield, Walgreens and an insurance company that specializes in high-risk, high-cost coverage — spoke without an opportunity for questions. No physicians or patient advocate experts were included. Key issues related to orthopedics were never discussed, including workers’ compensation reform, medical liability reform and reimbursement burdens. The perspective from the physician’s side of the health care delivery system was absent.

After the session, I asked one of the governors why no physicians were on the panel. I also asked why governors do not routinely seek the advice and counsel of physicians on health care issues. His response was bold and clear. He asked me how many physicians are at the meeting and said the other people there (ie, lobbyists) invest in the democratic process by providing their advice, time and money, whereas physicians rarely get involved.

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Political action

The American Academy of Orthopaedic Surgeons (AAOS) has made a focused effort to be more involved in political advocacy, especially at the federal level, with the growth and development of the OrthoPAC. In terms of funding, the OrthoPAC is second only to the American Society of Anesthesiologists. Considering orthopedic surgeons represent 3% of all physicians, we have a proportionally strong voice among medical political action committees on Capitol Hill.

The OrthoPAC is supportive of the issues that are developed and proposed by AAOS leadership and increasingly issues from subspecialty societies. The OrthoPAC helps facilitate the political process, fundraising and direct interaction with politicians. However, competition is impressive from other groups, such as the American Hospital Association and Blue Cross Blue Shield.

Many talented leaders and members of the orthopedic community remain on the sidelines. Most explanations are not well-supported. Physicians, especially surgeons, remain one of the most trusted groups of professionals by the American public. Our ability to provide the best care possible is what we should represent when we are engaged with the democratic process. No group understands musculoskeletal care better than we do. No one is better equipped to lobby for patients who need this care. More than 100 million people in the United States have arthritis and it is estimated that almost 10% of our gross national product is spent on the care related to musculoskeletal problems.

Our current administration threatened to dramatically reduce NIH funding, which includes important research dollars for musculoskeletal care. The efforts of the OrthoPAC and other lobbyists resulted in approval of the funding for 2017 without cuts and recommendations for an additional $2 billion for 2018.

Be involved, influence policy

Leadership in the form of political advocacy is clearly one of the cornerstones of delivering the best care to patients. There are many avenues to become directly involved and influence health care policy. State orthopedic societies provide an opportunity to impact your local community and state. Issues, such as tort reform, workers compensation regulation and financing, certificate of need and others are decided entirely at the state level without federal input. With the possible repeal of the Affordable Care Act displacing significant decisions regarding health care and financing back to states, working with local congressmen and the governor’s office is powerful. When you attend meetings with politicians, fundraisers or go directly to their offices, the impact is real.

Time is the most important asset to provide, however, funding is close behind. If you stay on the sidelines, then financially support the OrthoPAC and local and state organizations that represent your opinions.

PAGE BREAK

Eliminate the notion that one voice won’t make a difference. Even if you cannot accept that you could be more influential than other constituents, then remember political advocacy is one of the four cornerstones of providing the best possible patient care. If you are forced to practice in a manner that distracts and interrupts your best efforts for patients, then the quality of care will suffer. Don’t forget the many examples in which our involvement in the process was a victory for patients.

The most powerful form of advocacy for orthopedic surgeons is in the form of public service. We are fortunate to have two orthopedic surgeons in national public service: Sec. Tom Price and Sen. John Barrasso. Orthopedic surgeons have served as elected officials and numerous local and state positions, too. Unfortunately, there has been little promotion or opportunity for mentorship or development of political advocacy early in an orthopedic surgeon’s career, which could potentially lead to more political representation at all levels.

Get involved. Make a difference at every level of patient care. We have work to do — for us, our patients and society.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.