Data, relationships, and money: Key ingredients for effective advocacy

This article is part of an ongoing series from the American Association of Clinical Urologists (AACU), based on a partnership between the AACU and Urology Times. Articles are designed to provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions about topics for future articles. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

Urologists from around the country recently gathered in Washington for the 2012 Urology Joint Advocacy Conference (JAC) to take an active role in advancing the interests of the urologic community. Physicians, public policy experts, and politicians stressed similar themes in presentations that equipped attendees with the tools to effectively advocate for their profession.

All I know is just what I read in the papers, and that’s an alibi for my ignorance.

-Will Rogers (1879–1935)

Data is just as, if not more, important as personal relationships with legislators and staff when it comes to effective advocacy, according to several speakers at the 2012 JAC. Anecdotal and emotional evidence may win the day when governments are flush with funds, but current budgetary constraints require that decisions be based on what costs less or saves more. U.S. Preventive Services Task Force Co-Vice Chair Michael LeFevre, MD, MSPH, insisted in his presentation that only concrete evidence informs the quasi-independent panel’s recommendations. Dr. LeFevre acknowledged that new data concerning the benefit of PSA-based screening for prostate cancer comes out daily, but believes the USPSTF’s recommendation against that service based on 5-year-old evidence remains sound.

Michael S. Grable, MD, immediate past president of the Florida Urological Society, asserted that data convinced Sunshine State lawmakers to reject the wholesale abolition of urologic group practices during the waning moments of that state’s 2011 legislative session. Under the leadership of Panhandle urologist Neal P. Dunn, MD, urologists countered stale and incomplete data provided by opponents with the latest and most specific statistics available. Through this effort, a historic number of senators signed on to an amendment to maintain single-specialty integrated care.

A man only learns in two ways, one by reading, and the other by association with smarter people.

-Will Rogers

In the Florida case, urologists first depended on relationships to "get in the door." The nature of these connections varied, from patient to golf partner, from sister-in-law to next-door neighbor. Physicians who engage their patients in this manner often must overcome a psychological aversion to such activity, according to U.S. Rep. Tom Price, MD (R-Ga.), who presented the AACU Russell Carson Memorial Lecture at the JAC. Indeed, the AMA Code of Medical Ethics specifically asserts that physicians’ political communications with patients is "laudable" (AMA E-9.012). Similarly, representatives of the New Jersey Patient Care and Access Coalition (NJPCAC) found that patients inside and outside the legislature appreciated the group’s activities on their behalf. "Thank you for fighting for me," reported one patient, according to NJPCAC legal counsel Howard Rubin, JD.

Politics has become so expensive that it takes a lot of money even to be defeated.

-Will Rogers

The aforementioned relationships are forged not only by personal or professional connections, but also monetary bonds. During the 2012 JAC, UROPAC Chair Gary M. Kirsh, MD, reported on the funds raised and distributed by forces that traditionally oppose the interests of urologists. Announcing a new monthly giving program, Dr. Kirsh laid out the committee’s goal: 1,000 urologists contributing $1,000. Such a level of giving would allow UROPAC to establish relationships with elected officials who influence the policies that directly impact the practice of urology.

Noted political observer and elections prognosticator Charlie Cook attempted to put this in terms every physician can understand. Cook inferred that as urologists, you have invested too much in your education to allow government officials to compromise your ability to practice medicine and serve patients. Just as you invested in that education, you must now invest in UROPAC and the professional societies that represent your interests.

Even if you’re on the right track, you’ll get run over if you just sit there.

-Will Rogers

Effective advocacy depends on data, relationships, and, for lack of a better term, money. These ingredients in the process that is lawmaking depend on personal action to stir the pot and bring the issues to the table. U.S. Rep. Mike Rogers (R-Mich.) provided inspirational advice to JAC attendees as they prepared for visits to the offices of their elected representatives: "Advocacy is honorable. The Constitution guarantees your right to petition the government. You must engage in these fights as we try to set things right."

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