Join Grassroots Advocates in Push for Reform During Legislators' Summer Break

Health care reform is on a roll this summer, but many naysayers are trying to narrow its scope or slow the process down. Although no one can foresee the outcome of the debate, the good news is that bills drafted thus far contain many provisions favorable to family physicians and their patients.

For example, the Affordable Health Choices Act (at the THOMAS Web site, type "H.R. 3200" in the search box after selecting "Bill Number") drafted in the House offers strong support for primary care in a variety of ways, including via medical home demonstration projects, improved Medicare payment for primary care physicians, and expanded scholarship and loan programs for students who choose careers in primary care.

Likewise, a Senate committee bill would provide loans and scholarships to encourage careers in family medicine and primary care.

When you think about such favorable provisions, think also about the family physicians who have stepped forward as grassroots advocates for their specialty -- and then consider joining their ranks. Their efforts have paid dividends in rallying support for reform and getting primary care-friendly provisions in the bills, but the voices of even more family physicians are urgently needed.

How much difference can a family physician make by becoming a grassroots advocate? Consider the following two examples.

Solo family physician Heidi Foley, M.D., of Phillipston, Mass., didn't consider herself a political person -- she was just sick and tired of insurers making it impossible for her to care for her patients. To vent her frustration, she became a grassroots advocate, first in her state and then in Washington after attending the AAFP's 2008 Family Medicine Congressional Conference.

"I went to that meeting with a list of questions and fired them at the deputy staff director for health of the Health, Education, Labor and Pensions (HELP) Committee chaired by Sen. Ted Kennedy, and she must have found them compelling," Foley says. "She and I exchanged e-mails that summer. When I reached the end of my rope again with difficulties in my practice, I e-mailed her to ask what I should do."

To Foley's surprise, that congressional staff member invited her to be part of a new health reform "brain trust" -- six physicians and two practice managers -- established to advise the HELP Committee. "There I was, the lone primary care physician on a panel with some big names," Foley recalls. "At first I was shaking in my boots, but I learned I could serve as the 'No way in hell will that work -- this is what my patients really need' person. The horror stories I've shared from my practice have gone all over Capitol Hill."

Foley also reached out to other primary care doctors so she could share their opinions during advisory group discussions.

The advisory group has held weekly telephone discussions with congressional staff members and also has met in Washington three times. The group wrote a 30-page compendium of its recommendations, some of which appear in the Affordable Health Choices Act, Foley says.

She also has good relationships with her other federal legislators and their staff members. Her congressman, Rep. John Olver, senior whip of the Democratic caucus, recently spoke on the House floor about the need for health reform.

Foley hopes that health care reform will happen in spite of those trying to squelch it and that it will be based on primary care. "The AMA is not our voice -- people who think that are fooling themselves," she says. "If we let the AMA and the politicians decide for us, we won't get what we and our patients need.

"You hear politicians saying this bill or that bill will kill America -- but what's going on now is killing America!"

Dennis Salisbury, M.D., who practices in a multispecialty group in Butte, Mont., confesses that he was a noisy mosquito in the ear of Sen. Max Baucus, D-Mont., for some time before the chair of the Senate Finance Committee finally appointed him to a health care stakeholders panel. The finance committee is playing a prominent role in health care reform, although it hasn't introduced a specific bill yet.

After getting active in the Montana AFP and the AAFP, "I became convinced that doctors on the front lines need to speak to the people who are making policy," Salisbury says of his entry into grassroots advocacy. He set about establishing relationships with his federal legislators -- especially Baucus, because the senator is so involved with health care. He wrote to Baucus several times about health care issues and spoke to the senator's staff members. He also attended a benefit for Baucus.

"Finally, my persistence got me on his radar screen" and on the stakeholders panel, says Salisbury, who is the only family physician on the panel's six-member physician subgroup.

When Baucus asked whether any panel members would help moderate meetings in the state about health care reform, Salisbury volunteered. "It was a very vocal crowd," he recalls of the meeting he helped moderate. "About a third of them were loud and angry because legislators were not looking at a single-payer system!"

Salisbury played a role in getting participants to listen to one another. He says that's a good example of how the skills family physicians use every day come in handy during advocacy work.

"In our practices, we're always trying to get people to stop, listen and engage in a discussion, not just stamp their feet and insist on one thing," he says. "I think FPs are naturally gifted at lobbying because the skills we use to educate and care for patients are the same skills we need in Washington. We can get the people who are writing legislation to listen and understand the issues from our perspective."

The consequences are huge if those people don't hear a family medicine perspective, he adds. "There are a lot of loud and well-heeled specialty groups giving their opinions, and those groups outnumber us, so it's critical for family doctors to get involved."

Both Salisbury and Foley emphasize the importance of contributing to FamMedPAC, the AAFP's federal political action committee, because it helps open doors in Washington. Salisbury has twice presented FamMedPAC checks to Baucus or his staff members.

All FPs -- indeed, all primary care physicians -- owe advocates like Heidi Foley and Dennis Salisbury a debt of gratitude. And now is the perfect time to add your voice to the grassroots advocacy effort. Congress is in summer recess, and legislators are at home wanting to hear from their constituents, including you.

Visit the AAFP's Grassroots Advocacy Web page to get started. Then call your legislators' local offices to schedule face-to-face meetings. Do your part to swell the phalanx of family doctors speaking with one voice for reform based on the bedrock of primary care.