In My Opinion
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If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising.

The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States. Fortune magazine consistently ranks the National Education Association in the top 15 of its Washington Power 25 list for influence in the nation’s capital. In the words of Terry Moe, author of Special Interest: Teachers Unions and America’s Public Schools, “the power of the unions to block change is the single most important thing that anyone needs to know about the politics of American education.”

How did a group of teachers and teamsters become so powerful? It started when a critical number decided to collectively contribute significant funds to political campaigns. If 330,000 union members in Sacramento, for example, agree to contribute $1000 per year to political campaigning, that’s $330 million a year that can be spent influencing and/or controlling California’s legislative process. With this kind of influence, nearly every piece of legislature would need union approval before it has a chance of surviving a vote. Extend this across the country and the same logic­—and influence—holds true.

Now I am not suggesting that it is good for the political process to bend to the will of a single group purely because they’ve got the most money. As a matter of fact, I find it unethical and ultimately destructive of our system of government. However, it is a stark reminder of emergency medicine’s need to engage actively in the political process. It is absolutely critical – even to our survival – that physicians take an active role in health reform at a legislative level.

In the 70s, a few of us tramped around the halls of Sacramento trying to influence legislation. Although we thought we were wearing the white hat and our cause was critical and everyone should do what we ask, we did not find ourselves to be very influential. And then along came Jim Randlett who became the Cal/ACEP legislative advocate for many years. Early in my Cal/ACEP government affairs activity, it became apparent that we needed a Political Action Committee, and EMPAC was born. About that time, upon the request of then ACEP President, John McDade, I accepted leadership of the Government Affairs Committee for ACEP and marched on Washington with our first part-time lobbyist, Terry Schmidt. In an effort to influence policy on a national level, the National Emergency Medicine Political Action Committee (NEMPAC) was born. ACEP opened and grew a substantial Washington office, all in recognition of the fact that if you want to make something happen – or prevent something from happening – you need to be influential where decisions are being made and where the money is doled out.

Emergency medicine now enjoys wide respect and influence at state levels throughout the land, and at the Federal level with very well placed and effective legislative advocates working full time on our behalf. But what we are doing is not enough when the “pie” is limited and powerful players are doing the slicing. Imagine if half of the physicians in the USA each contributed $1000 each year to political campaigning. We would match at least one union in California. Trial attorneys in California are trying to kill MICRA. Without some $2000/year that they each contribute to campaigning, they would not have a chance. Our AMA and state and county medical associations have worked hard to look out for physicians in America, but with physicians giving around $60 per year to the political process, their position is severely compromised.

We in medicine are looking at increased competition for declining dollars in the face of soaring demand for services. California is cutting MediCal payments to physicians by 10% and may even take some back that they have paid in the past. Medicare is scheduled for cuts and the legendary fight over the SGR continues. Do you think that this would be happening if physicians were spending $2000/year on the political process?

Why are physicians flocking to hospital employment? It’s not because fee for service is working well for most physicians. It is more likely because hospitals are community resources employing a lot of people who vote, supported by politicians who want their voters to have a hospital in their community.  Physicians, by drinking plenty of the water but not adequately helping to carry it, have not counted – and I submit will not be counted – for much unless they start participating in the process.

Participation in the process means joining and supporting your specialty society and, as I’ve extolled before, joining the AMA. Most physicians may not have the time nor interest in being a councillor or committee member or delegate to the AMA. That is perfectly fine. What physicians need to do is pay dues and belong to their speciality organizations and the big house of medicine represented by the American Medical Association. It might seem basic, but these organizations grow in influence and effectiveness with sheer member numbers. The next essential step is generous participation in our Political Action Committees, EMPAC in California, NEMPAC nationally and AMPAC as well. The cost might seem painful at first, but it’s a minor discomfort relative to the pain of declining reimbursement that is on the way and sure to get worse if we don’t step up to the plate.  

Emergency medicine organizations have done an outstanding job of educating EPs and they advanced the specialty from unrecognized to being a highly respected, appreciated, and critical specialty logistically and academically. But there is still much work to be done. If just 900 emergency physicians were to give $1000 each, ACEP’s PAC would eclipse both the orthopedists (who have an average annual contribution of $106 per 18,318 members) and the AMA (who average $12 per 157,000 members). ACEP currently averages $47 per eligible member (22,000). The added influx could not only make ACEP the largest PAC in the beltway, but more importantly, allow it to be a whole lot more effective in promoting, preserving and protecting our specialty.

Finally, the number of delegates and alternates that ACEP is entitled to at the AMA House of Delegates is determined by how many ACEP members there are who are also AMA members and have designated ACEP as the organization to represent them. AAEM is represented at the AMA EM Section Council, usually in the person of Joe Wood.  Based on our 3007 AMA members at the last count, ACEP has five delegates and five alternates, up from the single one when I started in the 80s. We would like to raise that number to over 4000 members and gain another delegate as we work to potentially elect the first emergency physician as the 170th President of the AMA in June 2015 in the person of Steve Stack.

Richard L. Stennes MD, MBA, is the ACEP Delegate to the AMA House of Delegates and was the president of ACEP from 1985-1986



 

Comments   

# Fred Johnson 2013-09-25 20:48
I can see why we would donate to ACEP if we want to support poor, struggling corporations like TeamHealth and EmCare - but what if we want to protect and promote INDIVIDUAL emergency physicians; equitable democratic groups; and the private practice of emergency medicine? Clearly, ACEP will not promote those causes, so where should our donations go if we believe in those things? Hmm.....is there an emergency medical society you forgot to mention? Perhaps The American Academy of Emergency Medicine - AAEM?
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# scott 2013-10-03 08:58
Can't support the AMA after its instrumental role in pushing Obamacare - I don't know how anyone could. It will take the AMA quite some time to win back my trust. As a DO, ACEP is not very interested in me. I agree, however, that we should stick together as a group and fight for what is important. AAEM seems like a good place to start.
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# Pam Bensen, MD 2013-10-09 02:35
In my 42 years in ACEP, I have NEVER worked for, voted for (BOD 6 yrs, Council >30 yrs) things to help the BIG Groups at the expense of the individual, seen ACEP not helping the INDIVIDUAL, or seen AAEM at the table. Please open my eyes, explain what AAEM will do for me that ACEP has not done, is not doing, and is not planning to do! How much per physician do AAEM members contribute to AMA, to their PAC? As a LIFE member of the AMA and ACEP, and an original AAEM member, please tell me the positive things that would sell me a membership today. Thank you.
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# Physicians do need to beome more politically activeWilliam T. Durkin, Jr., MD,MBA,FAAEM 2013-10-12 18:18
After spending the day on Capitol Hill lobbying with our Resident/Studen t Association, I read with interest Dr. Stennes' column. Though we have had our disagreements over the years, I find that, on this topic, I agree almost entirely.
It is indeed quite true that physicians are not nearly as active in the political process, either as contributors or meeting with politicians to discuss issues, as they should. When compared to what the Trial Lawyers and other groups contribute to their PAC's, physicians are always substantially behind. Unfortunately, it does require a well funded PAC to gain continued access to those who make our laws. Campaigns are expensive and Senators and Congressmen get those funds from contributions and fund raisers.
We do need to be present when the decisions are being made that affect our practices and specialty. Participating in lobbying efforts, writing letters/emails to your representatives , attending town hall meetings are all ways to let the politicians know your opinions. Donating one day's pay to the PAC of your specialty organization is another means of participation. To those so motivated, running for elected office is yet another way to be heard. There are presently two emergency physicians in Congress, Reps Heck and Ruiz. Physicians are one of the most trusted professions in the country. I have found that our representatives and their staff realize this and value our input on legislation and policy.
As President of the Academy, I have actively recruited new members while stressing the importance of being an active participant in organized medicine. I would suggest that the best organization for the practicing emergency physician is the American Academy of Emergency Medicine. We are very active on the hill and and getting our members more involved in these efforts. It is true that the AMA is still perceived by many as representing the house of medicine. I would suggest that you join the Academy and the AMA so that the Academy has better representation in the AMA. In fact, the price of combined dues for the Academy and the AMA is the best value for emergency physicians.













William T. Durkin, Jr., MD,MBA,FAAEM
President, American Academy of Emergency Medicine
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