Advocacy Network Puts Rural Medicine on Congress' Radar Screen

Want to win in Congress? Build a network. Work together. Speak with one voice. Speak often.

That recipe, said Harold Johnston, M.D., of Anchorage, Alaska, has worked well for WWAMI, a partnership comprising the University of Washington School of Medicine, Seattle, and 17 residency programs in Washington, Wyoming, Alaska, Montana and Idaho. The partnership, formed 30 years ago to provide access to publicly supported medical education in the five states, initiated an advocacy network two years ago.

"We realized we need to know what's happening in legislative issues," said Johnston. "We needed to identify good legislation and bad legislation and decide what to support and take a position on."

Since launching the network, WWAMI has successfully advocated federal budget language requiring CMS to define integrated rural medical training that qualifies for Medicare funding, witnessed the introduction of legislation that specifically deals with rural medical education and sent invited representatives to U.S. Senate hearings on the physician workforce.

The effort began with a simple realization: Virtually all of WWAMI's goals required some form of government action, Johnston told participants of "Advocacy Efforts of the WAMMI Network for Family Medicine Residencies." His presentation, given during the Society of Teachers of Family Medicine, or STFM, Annual Spring Conference here, described an advocacy initiative that won STFM's Advocate Award.

The group's goals included ensuring the financial viability of WWAMI programs and enhancing collaboration with community health centers, or CHCs, in residency program opportunities. WWAMI had three priorities, said Johnston -- residency program financing, resident recruitment and an improved practice environment.

"We realized these three had a common theme," said Johnston. "Financing is done through the government decision-making process, through the states, and Medicare and Medicaid payment rates. Resident recruitment was related to the government through graduate medical education funding. Improving the practice environment was related to government. We saw the need to develop a system of legislative advocacy."

That WWAMI system represents 25 percent of the U.S. land mass and, more importantly, 10 U.S. senators, or 10 percent of the U.S. senate, said Johnston.

"As a group, we can do things that individually we cannot," he said. "Ten percent of the U.S. Senate is a bigger deal than one person in Alaska talking to one or two senators."

The WWAMI advocacy network coordinates with the University of Washington and STFM to ensure conformity with their overall legislative goals. The advocacy network's strategic plan establishes an overall legislative message, fosters member commitment, focuses on specific goals, communicates quickly and clearly about legislative activities and how members should respond, and provides flexibility for quick action.

"We identified the key areas that our 17 programs agreed on and formed a legislative committee with representation from all five states," said Johnston. The legislative committee agreed on five areas on which the network should concentrate:

Residency program directors are expected to develop a relationship with their senators and congressmen. For those who have not worked with legislators, WWAMI provides a grid that helps them measure their progress in building legislative relationships.

"At first, we thought this was an impossible dream," said Johnston. "Then we started it and discovered it's fun, it's effective, and it develops our directors and makes their programs better."

The WWAMI approach has worked. Congress inserted language in the 2008 federal budget that calls on CMS to develop regulations for implementing the Integrated Rural Training Track program, authorized by the Balanced Budget Refinement Act of 1999.

In addition, U.S. Sens. Lisa Murkowski, R-Alaska; Ted Stevens, R-Alaska; Charles Schumer, D-N.Y.; and Bernard Sanders, D-Vt., introduced the Physician Shortage Elimination Act of 2007, or S. 896, (at the Library of Congress' THOMAS Web site type "S. 896" in the search bar after selecting " Bill Number") which would authorize grants to CHCs to establish new or alternative-campus accredited residency training programs, provide grants to CHCs to increase the number of medical professionals associated with such centers, and permanently resolve the dispute with CMS regarding the use of volunteer preceptors in community-based training.

Effective public policy advocacy depends on both local and national efforts, according to Johnston. National efforts, such as those by the STFM and staff members in the AAFP's Government Relations Division, provide invaluable education and input for lawmakers. But an equally important factor is input from legislators' constituents.

Thus, the WWAMI network and advocacy by STFM and the AAFP "have a lot more potential to move legislation forward," said Johnston. "National efforts are great, and we need them. But they are not enough alone."