 January 2003 • Volume 9 • Number 1 |
 Even when the message to lawmakers is clear, says FP Rhonda Medows, M.D., there's no guarantee they'll "get it." Medows is secretary of the Florida Agency for Health Care Administration. |
Have you heard the one about the frog and the scorpion? Nick Franklin, J.D., senior vice president of public affairs for California's PacifiCare Health Systems, recently told a story about these two critters negotiating a stream crossing. The frog agrees to carry the scorpion across; in return, the scorpion agrees not to sting the frog.
Halfway across, the scorpion stings the frog. As they sink below the water, the dying frog asks, "Why?" "Because I'm a scorpion," the doomed arachnid replies.
The lesson?
Don't put your primary goal at risk by falling back on what you've always done, Franklin told FPs, health lobbyists, AAFP chapter executives and others during the Academy's State Legislative Conference here Nov. 15 16. "We've got to get beyond that," he said.
Don't dilute the message
By expending energy squabbling about whose piece of what pie stands to be nibbled on, for example, at the expense of larger issues such as quality, universal access and privacy, physicians run the risk of alienating patients and turning off legislators, said Michael Ashcraft, M.D., a health consultant to the California Senate Insurance Committee.
"We need to all get behind one issue. If we focus on turf, we've already lost," he said. The real message -- the important message -- goes ignored.
"Do you know what the single most effective lobbying group is?" Ashcraft asked. "Prison guards. There's only one message: It's about pay. How many messages do you have?"
Keep it simple and on target, Franklin advised, and utilize all the resources at your disposal. PacifiCare, in collaboration with the California AFP and the California Department of Managed Health Care, recently succeeded in helping state lawmakers draft clear, concise legislation involving timely patient access to physicians. The bill represented a working solution, Franklin noted, because all stakeholders had a say in formulating the bill.
Divide and be conquered
Still, it's difficult to ignore the spread of expanding privileges among nonphysician health professionals. But what's really important about this proliferation is for physicians to recognize their part in the process, observed Scott Gallant, government affairs director for the Oregon Medical Association.
Experiences in Oregon -- "the land where everybody can do anything they want to do" -- have revealed several major disconnects for lawmakers trying to make sense of proposed scope-of-practice changes, Gallant said.
"Legislators get mixed signals," he noted. "Physicians hire nurses; ophthalmologists hire optometrists. You say these people aren't qualified (for certain tasks), and yet you hire them."
On top of that, Gallant said, physicians know their patients aren't really behind them in scope-of-practice disputes.
"Why do patients go to alternative providers?" asked Gallant. "Because of something organized medicine hasn't been able to say for years -- easy access. Organized medicine isn't organized anymore, and it hasn't been for some years."
The key, he went on, is to focus on resolving the problem -- improving access to care -- without introducing another problem -- defending turf -- into the mix. Until physicians internalize that message and act on it in a unified manner, health care issues will be decided with limited, if any, physician input.
"You're some of the most powerful, influential people in the country," said Gallant. "But you're letting it get away from you."
 "We need to all get behind one issue," advises Michael Ashcraft, M.D., a health consultant to the California Senate Insurance Committee. Engaging in turf battles dilutes physicians' message to legislators, he told attendees at the AAFP State Legislative Conference. |
Drive your point home
Even if you're focused on a single, significant message, however, there's no guarantee that legislators will automatically "get it," said FP Rhonda Medows, M.D., of Tallahassee, Fla. You've got to drive your point home. And that can take some chutzpah.
As secretary of the Florida Agency for Health Care Administration, Medows oversees the state's Medicaid system. In all, 2.1 million people are served by the system, which employs only 600 people working out of 12 locations around the state.
"Everybody has a pretty heavy case load," she quipped to conference attendees. And she has had more than her share of dealing with lawmakers. Florida is just one of many states around the nation looking to cut Medicaid to offset budget shortfalls.
"I am probably the least political person in this room," Medows said. Initially reluctant to lobby policy-makers in the statehouse and elsewhere, she changed her ways to defend Medicaid patients. "When I got mad enough to stand up for the program, it was surprisingly easy," she said.
She told of a recent Washington hearing at which she presented testimony. One senator said providing preventive services seemed to be a waste of time and resources. Why not simply wait until illness developed, the senator said, and then, if treatment failed or was not offered, let nature take its course?
"Do you know how chilling that was?" asked Medows. "It took a lot for me not to jump out of my seat and run screaming out of the room after hearing that.
"These are patients just like any other patients, and they deserve our respect."
There are multiple ways to become involved, she said:
Make no mistake, Medows advised: "If you're not there speaking for your patients, someone else will. And I guarantee you they won't share your perspective."
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Copyright © 2003 by
American Academy of Family Physicians.