For Massachusetts AFP, Advocacy Takes Center Stage

Chapter Enlists Residents, Students in Lobbying Efforts

May 31, 2014 09:02 am Jessica Pupillo

In Massachusetts, the roots of political advocacy run deep. The commonwealth's halls have been the sites of some of the country's earliest political organizing, its capital’s harbor an epicenter of iconic protest, and its fields places where battles for independence were fought. Thus, it should come as no surprise that the Massachusetts AFP (MassAFP) is carrying on the state's tradition of legislative involvement and is being recognized for its growing presence in both the U.S. Capitol and the Massachusetts State House.

Massachusetts AFP President Kami Phillips, M.D. (center, in blue sweater), flanked by chapter officers and members, receives a FamMedPAC fundraising award from AAFP President-elect Robert Wergin, M.D., during the 2014 Annual Leadership Forum.

During the AAFP’s Annual Leadership Forum in early May, the MassAFP was named the top FamMedPAC donor among medium-sized chapters in 2013. Massachusetts chapter members contributed a total of $14,725, making the chapter the ninth highest contributor overall among AAFP state chapters.

FamMedPAC, which the AAFP founded in 2005, helps elect federal lawmakers who understand and support family medicine. The PAC has raised about $1 million each two-year electoral cycle, according to Hugh Taylor, M.D., of South Hamilton, FamMedPAC board member and a MassAFP past president. The MassAFP historically lands on the top 10 list of chapters that donate each year.

Taylor credits the chapter's leadership for encouraging member support — through annual meeting sessions and yearly appeals — of the AAFP’s political action committee.

Story Highlights
  • During the AAFP’s Annual Leadership Forum in early May, the Massachusetts AFP was named the top FamMedPAC donor among medium-sized chapters in 2013.
  • Chapter leaders routinely testify, comment and lobby their legislators on federal and state bills related to issues such as primary care workforce shortages, payment reform and patient safety.
  • Among the chapter’s legislative successes is passage of a measure that secure funding for four family medicine residencies' community health centers.

"I cannot overstate how important our PAC is in getting our message to our representatives in Congress: It works," he wrote in the chapter's May newsletter( "We do not 'buy' votes with PAC money, and it would be hard to prove that our contributions turned the tide in any individual race. But by giving money to Congressmen and -women who understand family medicine, and who help us by voting with us, we reward them in a way they appreciate, and most importantly, we remind them that we are worth supporting."

Creating a Consistent Presence at the State House

Supporting FamMedPAC is just one way the MassAFP is increasingly involved in federal and state advocacy for physicians and patients. The chapter participates in congressional conferences in Washington, D.C., and has historically held an advocacy day each year for the past 20 or so years, but chapter leaders and members are now involved in state and national politics year-round, said MassAFP President Kami Phillips, M.D., of Gardner. The growth is part of the chapter's strategic plan to promote patient and primary care physician advocacy, she said.

"We see this as a great time of opportunity for MassAFP because we see ourselves in a positive place — a place where we can advocate for our patients and our physicians," Phillips told AAFP News. "We can provide a voice of reason in a time when the legislators are trying to meet the needs of citizens."

Chapter leaders routinely testify, comment and lobby their legislators on federal and state bills related to issues such as primary care workforce shortages, payment reform and patient safety.

To provide a coordinated response to pending legislation, the chapter developed a legislative affairs committee with about 10 to 15 members, who, beginning about a year ago, started meeting monthly, said Joseph Gravel Jr., M.D., of Lawrence, the chapter's immediate past president and a member of the legislative committee. "We were meeting quarterly, but because there's so much legislation coming down the pike and things are moving so quickly, we made a commitment to meet monthly," Gravel explained.

MassAFP President-elect Fred Baker, M.D., of Holden, serves as chair of the committee, which includes family physicians from rural, urban and suburban communities who practice in a variety of clinical settings. "We really try to capture the sentiment of the chapter and our members," said Baker. Last year, the committee surveyed chapter members to help determine advocacy priorities.

From left, Massachusetts AFP President-elect Frederic Baker, M.D.; Flora Sadri-Azarbayejani, D.O.; Noah Rosenberg, M.D.; Rep. Jim McGovern, D-Mass.; Hugh Taylor, M.D.; and Joseph Gravel Jr., M.D., the chapter’s immediate past president, gather for a group shot during the 2014 Family Medicine Congressional Conference. The chapter delegation attended the conference in early April to encourage lawmakers to continue to fund the federal teaching health centers program and to extend the Medicaid-Medicare payment parity program.

"Eighty percent of MassAFP members said outside regulations are making it more difficult to practice," Baker said. The survey also revealed that 82 percent of respondents said payment reform would help people choose family medicine over other specialties, he said.

"A lot of our role in the legislative committee is to speak on behalf of the chapter and its members to ensure they want to stay here and serve the public in the best way possible," said Baker. That means reducing administrative burdens, which are often the unforeseen consequences of legislative policy. For example, there is legislation under consideration that, if it goes into effect in 2015, would require physicians to demonstrate the skills needed to comply with meaningful use requirements to obtain a medical license, he said.

Meaningful use was created to incentivize the adoption of electronic health records, said Baker, and requiring physicians to satisfy those requirements as a condition of licensure would place undue burdens on family physicians and hinder access to care.

Committee members are also tracking and advocating against another piece of Massachusetts legislation, this one related to scope of practice. Massachusetts Amendment 935 (formerly H.2009/S.1079) would allow all advanced practice nurses to prescribe and dispense medication, and order and interpret tests. The amendment is currently in the legislative conference committee.

"The sponsors of the bill are not hearing our message that allowing nurse practitioners to practice independently would not solve the primary care shortage," said Phillips, citing reports that nurse practitioners typically do not practice in underserved areas. "Our other big concern is patient safety. Training of nurse practitioners is not standardized, and there is no adequate oversight. We are not convinced they will provide full-spectrum family care."

Liz Quinn, M.D., a second-year resident at Lawrence Family Medicine Residency, testified against the bills during a hearing last fall. She was accompanied by Gravel, who is the program’s residency director, and a few other residents.

"Testifying at committee was eye-opening because I saw how important it was that clinical voices be there," Quinn said.

"From a resident's perspective, this bill really captures our attention because we are in the midst of training," she added. "Our jobs are really humbling. I encounter patients, and I'm not sure what the right move is, and I want to talk it over with a senior physician. We're immersed in that process right now, and to have legislation that says you don't need this process to be a full primary care practitioner, it goes against what we're doing every day."

Facts About the Massachusetts AFP

Chapter executive director: Becky Wimmer
Number of chapter members: 2,035
Year chapter was chartered: 1948
2015 Annual Meeting & Spring Refresher: March 20-21, Taj Hotel, Boston

As the bill advanced, Quinn and her fellow family medicine residents cosigned a letter to the chairs of the joint legislative committee on public health. "We worry that this bill — which purports to enhance access and quality in health care — actually puts MA residents at risk by prematurely licensing clinicians to practice independently," the residents wrote. The letter highlighted the value of advanced residency training in family medicine.

Family medicine residents and medical students joined family physicians at the Massachusetts State House on April 17 for the chapter's annual Family Doctor Day. More than 70 family physicians, family medicine residents and medical students attended to learn about the legislative process and meet their state senators and representatives. Gravel has long been a champion for encouraging students and residents to participate in advocacy.

"We're trying to mobilize students and get them excited about our specialty," Gravel said. Through legislative involvement, he added, family physicians will have an influence on the evolution of health care. "Students are, hopefully, thinking ahead to the next 30 to 40 years, and family medicine is a great route for making a difference.

Through its efforts, the chapter has seen some lobbying successes, Baker said. For example:

  • The chapter supported a bill calling for a childhood vaccination program that was signed into law this winter. The program establishes a Massachusetts immunization registry and a trust fund to pay for the distribution of all nationally recommended vaccines for children.
  • The chapter also spoke out against a bill that would have mandated that every new patient participate in a prescription monitoring program, regardless of whether that patient required narcotics.
  • The MassAFP has helped secure funding for four family medicine residencies' community health centers, and the chapter is committed to ensuring those appropriations are renewed in the future.

Advancing Family Medicine’s Agenda

"We're excited about the possibilities of being proactive, not only playing defense on well-intentioned bad ideas that come down the pike every week, but also trying to set more of our own agenda," Gravel said. One of the chapter's goals is to let legislators know that investing in and supporting family medicine can solve the primary care workforce shortage while reducing health care costs, he said.

To help, the chapter hired Rasky Baerlein Strategic Communications to serve as its lobbying representative. The firm started working with the chapter in April. In addition to helping the chapter track relevant pieces of legislation, the firm is also helping the chapter articulate its key messages to educate lawmakers and the general public and generate support for primary care, Gravel said.

The chapter hopes to increase the opportunities members have to engage with their elected officials. Currently, legislative alert emails and newsletters keep members abreast of pending legislation and opportunities to comment.

And about that PAC: Taylor said he hopes to see even more contributions from his fellow MassAFP members.

"Being one of the best is nice, relatively speaking, but it's far from ideal in an absolute sense,” he said. The goal of FamMedPAC is to get people into the habit of contributing to the PAC as a regular part of the year. It's so important to getting our message to the legislators in office."