Guest Editorial

I Made a Difference For Family Medicine; So Can You

April 18, 2012 05:00 pm Carla Kakutani, M.D.

Some people are inhibited, maybe even intimidated, when it comes to connecting with their elected officials in Washington.

They wonder, "Who will listen to me?" Or maybe they think, "I can't make a difference."

But, we can make a difference.

[Carla Kakutani, M.D.]

Carla Kakutani, M.D.

I know because I helped make a difference when Reps. Mike Thompson, D-Calif., and Cathy McMorris Rodgers, R-Wash., introduced a bill last year that would allow a portion of graduate medical education payments to go directly to community-based primary care residency programs.

Although McMorris Rodgers' support for primary care training in nonhospital settings grew out of her contact with the Washington AFP, Thompson's support came about after he visited the Santa Rosa Family Medicine Residency Program at the urging of me, the California AFP and other constituents.

My ability to influence support for the bill was an outgrowth of the relationship I have established with Thompson, who represents my district. I've met with him a few times in his office on Capitol Hill, and I've met with key members of his staff in Washington. I also keep in touch with his office here in California.

The relationship I maintain with Thompson and his staff developed, in part, because of my regular attendance at and involvement with the Family Medicine Congressional Conference (FMCC), the AAFP's annual two-day event designed to train family physicians, residents and students how to influence policy and provide them an opportunity to visit legislators or their staff members on Capitol Hill.

I first attended the FMCC in 2008 as president of the California AFP because it was important for me as a chapter leader to learn more about being an effective advocate for family medicine. I attended the next three years as a member of the AAFP's Commission on Governmental Advocacy, which helps plan the event.

The FMCC, which is scheduled this year for May 14-15, draws academic family physicians and practicing family docs, as well as students and residents. Although we all have different issues that concern us, bringing this family medicine group together allows us to see the big picture and how issues such as the FP pipeline, workforce and payment are intertwined.

The first time I attended the FMCC, I found the first day's practical instruction for those new to lobbying and tips on how to effectively deliver our message to legislators or congressional staff members to be vitally important. Speakers reviewed the key issues facing family medicine, providing critical background information and talking points. By the time I made my first Capitol Hill visit on the second day of the event, I felt comfortable with the issues and confident in myself.

The FMCC's agenda is created by Academy staff with input from the Commission on Governmental Advocacy, which includes more than a dozen practicing family physicians and academics, as well as student and resident representatives.

We communicate what topics we think will be the most interesting and valuable to our fellow FPs. For example, after the Patient Protection and Affordable Care Act was signed by President Obama in 2010, the commission expressed concerns about how HHS might implement various provisions of the act, how the regulations might be written and how we might influence that process. In response, the AAFP invited Kavita Patel, M.D., from the White House Office of Health Reform, to the next FMCC to address those critical questions.

Attending this event for the past four years and hearing from people in the trenches also has taught me where the legislative process can be influenced and how to do it. Personally, I have been able to meet with key staff members from the offices of House Minority Leader Nancy Pelosi, D-Calif.; Sen. Barbara Boxer, D-Calif.; and Sen. Dianne Feinstein, D-Calif., because of the FMCC.

Those discussions have not resulted in the kind of relatively quick action we experienced with Thompson, but lobbying requires patience. Working with Congress is somewhat like trying to help a patient stop smoking. You have to lay the groundwork with an initial conversation, bring it up again at subsequent opportunities and stay engaged. If you hang in there, good things can happen.

It's a lot of work, but we don't have to do it alone. Joining up with colleagues from the same state to make visits to legislators as a group allows rookie lobbyists to be paired with those with experience. And it provides an opportunity for legislators or their congressional staff to hear different, but related, stories on how issues are affecting their constituents.

For example, my state often sends a delegation of 10 or more physicians to the FMCC. This allows us to break into small groups and make several visits to legislators. It takes the pressure off because one person doesn't have to carry an entire conversation. We can even assign roles and practice what we're going to say ahead of time.

I sometimes agonize over meeting with these powerful elected leaders because I'm shy by nature. I recently was asked to attend an event at which my state senator was appearing. I felt a bit of dread as I made my way over to talk to her, but she recognized me, remembered me, and everything was fine. Building these ongoing relationships makes all the difference. The longer and more often you talk, the more likely lawmakers are to hear your message.

If I can do it, so can you.

Tell your story. Make a difference.

-- Carla Kakutani, M.D., of Winters, Calif., is the chair of the AAFP Commission on Governmental Advocacy, a member of the board of directors of the AAFP's federal political action committee, FamMedPAC, and past president of the California AFP.