Coalition Memberships Can Amplify Family Medicine's Voice

The Texas Academy of Family Physicians has 5,500 members, but -- as a member of the Texas Primary Care Coalition, which encompasses the Texas AFP, the Texas Academy of Internal Medicine and the Texas Pediatric Society -- it is able to speak with a voice that is nearly 15,000 strong. A chorus that large tends to be heard in legislative halls, the house of medicine and the news media.

And that, according to Tom Banning, director of legislative and public affairs at the Texas AFP, has helped family physicians redefine family medicine's issues and frame solutions in terms of patient care rather than state budgets or internecine debate within the health care community.

In the legislative session set to begin in January, the Texas Primary Care Coalition will focus on ensuring the state's residents have access to health care through public and private insurance programs, as well as on guaranteeing an adequate primary care physician workforce.

Working together, coalition members expect to see progress, said Banning. He will describe the Texas Primary Care Coalition, how it was established, and how it is useful in guiding legislative and public education efforts during the AAFP State Legislative Conference, Nov. 10-11 in Austin, Texas. Texas AFP President Doug Curran, M.D., of Athens also will speak during the session.

"The primary care coalition was created for two purposes," said Banning. "The first was to bring together our collective membership power and political capital to advocate for issues of common interest related to the uninsured, Medicaid and some other managed care issues. The second was to use our collective numbers and power to push for more primary care-centered focus within the house of medicine."

Eugene Stokes, M.D., president-elect of the Texas Academy of Internal Medicine and chair of the coalition, agreed, citing a recent example. "We have now -- because of our strength in the primary care coalition -- begun to take more bold initiatives within the Texas Medical Association," or TMA, he said.

He pointed to a recent meeting of TMA's Interspecialty Society, which is composed of subspecialist groups. A family physician suggested the group "look more closely" at primary care and, as a result, the interspecialty society is discussing development of a resolution that would ask TMA to study the state of primary care in Texas.

"We feel we're having an impact on how Texas medicine represents primary care," said Stokes. "It wouldn't have happened without the primary care coalition and the empowerment we gave to each other."

The coalition is building on its increased visibility. Pooling their resources, its members have published "Fractured: The State of Health Care in Texas," (PDF file: 16 pages / 1.8 MB. More about PDFs.) a comprehensive review of conditions that are contributing to the state's faltering health care system. The 16-page publication will form the foundation for legislative and public education activities designed to increase awareness of the need for laws, policies and regulations that will resuscitate the state's health care infrastructure, according to Banning.

The coalition's unified voice brings particular weight to legislative discussions, said Carrie Kroll, director of advocacy and health at the Texas Pediatric Society. Political power, she said, comes with numbers.

"The public and, more importantly, the legislature see that we're speaking with one voice, that we can prioritize the issues," Kroll said. "In Texas, the legislators want you to come to the table and show you've talked to others about what you're doing. Our recommendations will have more weight when we speak together than if we spoke independently. Working together, we cover more ground."

Claudia Kamas, Oklahoma AFP legislative consultant, agreed. "There is strength in numbers, especially when you've got a variety of members in the coalition," she said. "That shows the issue affects a lot of different groups. When legislators see that many people are concerned about an issue, it makes the issue more real."

In addition, coalitions put more feet on the ground, Kamas continued. Each coalition member has its own grassroots network that can be summoned to action on an issue, "So you can activate thousands of phone calls and letters to legislators in support of the coalition's issue," she said.

True, said Diana Ewert, AAFP senior manager of state legislative relations. The sum of participating organizations' resources often exceeds the impact of their individual efforts, she said, adding, "You're leveraging resources and you're increasing your visibility. With a coalition, you demonstrate that you're inclusive and that you're not self-serving."

The Texas Primary Care Coalition already has seen some success. In 2002, the group published "Fading Away -- Access to Primary Care: Flirting with Disaster," (PDF file: 15 pages / 453 KB. More about PDFs.) a report that focused on medical liability insurance and slow payment policies of private insurers. The report was released before the state's biennial legislative session began. The coalition then launched comprehensive legislative educational and public relations campaigns to explain the need for reform on those two issues. At the end of the legislative session, Texas had new medical liability and insurance payment laws.

"That document, along with the support of more than 14,000 primary care doctors, we felt was instrumental in helping pass House Bill 4, which limited noneconomic damages in medical liability lawsuits," said the Texas Academy of Internal Medicine's Stokes. "And we felt that the momentum of the whole engine going down the track was responsible for getting Proposition 12 passed, which amended the Texas Constitution so the (medical liability) legislation wouldn't be held up in a legal battle."

The coalition has become a model for other AAFP constituent chapters. Among those working with such a coalition is the Oklahoma AFP, which joined 10 other physician organizations to form the PatientsFIRST Coalition, which is working to clarify for patients the respective educational, training and skills levels of various health care professionals. A focus for the state's upcoming legislative session is a bill that would define physician, said Steven Crawford, M.D., of Oklahoma City, chair of the AAFP Commission on Governmental Advocacy and Oklahoma AFP representative to the PatientsFIRST coalition.

"A coalition is important because these issues impact all physicians and all of our practices," said Crawford. "We have increased numbers to express our concern across the board in many different venues. Ours becomes a much more powerful voice.

"It's also a way to educate the public and our fellow colleagues, because many times, they don't know the issues associated with our position."