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VIEWPOINT: Why I Left My Desk for Capitol Hill — And What I Learned

Goldenberg, James MD

doi: 10.1097/01.NT.0000433898.84535.9b


I can remember giving my office manager specific instructions not to pay the Political Action Committee (PAC) portion of my yearly American Academy of Neurology (AAN) dues. When it was paid “by accident,” I was furious. Sure, the benefits of AAN membership were tangible: I could read Neurology and Neurology Today, get reduced rates on meetings, log on to the website, complete continuing educational material, and much more. Still, the PAC portion of dues seemed like a waste. How would they spend my money? Who would make the decisions? Would I endorse the candidate's beliefs? I used these questions to rationalize opting out of the PAC. In other words, beyond the walls of my office and outside of my own career, I chose not to be involved with my profession.

There certainly was no time for advocacy in my workday. I had patients to see, committee meetings at the hospital, and a family to go home to. “Someone else” was advocating for me, weren't they?

As the years passed, I became even more certain that I was right to opt out of the PAC. When I queried my colleagues, I found that I was in the majority. They all depended on AAN leadership to advocate on their behalf.

I started to look at things differently when I realized that my colleagues and I were quick to criticize the AAN when we felt that legislation was undesirable. Cuts to reimbursement were implemented at the same time as requirements for paperwork and non-clinical activities increased. I began to think not only about the problems that face our profession but also about how to become part of the solution.

Neurologists solve problems every day when our patients walk through the door. We are a clever and analytical group of physicians. Many of us have been leaders at various times in our lives and careers. How could I use these skills to address the problems we face as a profession? The task seemed daunting because this debate was happening on a national level.

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That's when the advertisement for the Palatucci Advocacy Leadership Forum (PALF) caught my eye. The program is a two-day workshop designed to improve neurologists' communication and advocacy skills. When I looked through the list of graduates, I found that many of our profession's leaders have shared this training experience. Perhaps I could meet the people who work on behalf of our profession — or even become one of them.

What a meaningful experience PALF was for me. Surrounded by a youthful and enthusiastic group of 30 physicians, we learned — hands on — how to communicate and advocate effectively. The focus was on action planning, media training, and legislative training. The forum leaders challenged us to learn new skills and get out of our comfort zone. We spent time giving mock interviews to media and critiquing ourselves. We were able to replay the interviews on video and received guidance from several experts with extensive media experience. We learned how to communicate effectively with legislators. We went through mock legislative visits and mock testimony before a Congressional committee.

Through PALF, I had the opportunity to meet the passionate people who were that “someone else” doing advocacy work on my behalf. They included practicing physicians like myself as well as academic physicians, residents, and Fellows. Unlike the discussions back home, where my colleagues were convinced that nothing was being done on our behalf, a lot was being done!

Many physicians and staff members work on behalf of our profession all around the country. These physicians are actively practicing and advocating at the same time. There are many levels and opportunities for involvement.

You can easily and quickly communicate with your legislators from the computer on your desk by responding to a call to action email or by using the web-based VOCUS system. You can meet personally with your local or state legislator in your home district. You can participate in the yearly AAN-sponsored advocacy event Neurology on the Hill.

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Once a year in the spring, neurologists from all around the country gather in Washington, DC, to meet with legislators and try to solve the problems that face our profession through legislative advocacy. I had the pleasure of participating this year in the annual event, “Neurology on the Hill (NOH),” with 138 neurologists from 43 states.

We spent the first day with AAN staff and consultants learning about Capitol Hill and the pressing issues that face our profession. There were updates on current policy issues, including those that affect physician reimbursement. We were able to learn about the political process and how it affects us. We learned to deliver a cohesive, finely tuned message directly to our legislators.

On the second day, we left en masse via the Metro for Capitol Hill. It really was a thrill to walk the halls of Congress. The delegations were divided geographically by state and region. We had the opportunity to meet with several legislators and staff members from our home districts.

Legislative staff members support the legislators in various areas of interest and expertise. The health care staffers differed widely in their knowledge of neurology. Some were seasoned with years of experience. Others were assigned to greet us and meet with us even though their knowledge of healthcare and neurology was limited.

The staff members as a group were far younger than the neurologists. At first it was a bit unsettling. As the day went by it seemed more like an opportunity to educate.

Time was limited in each session to perhaps 15 or 20 minutes. The time spent practicing our message helped us stay focused. We tried to relate a personal story of patient care to support the facts. We found additional opportunities to reinforce our message with staffers that had family members in the medical profession or family members that see a neurologist.

We were treated with courtesy and respect at every turn — from the congressional police passing us through security to the secretaries, staffers, and legislators.

Our group took advantage of physicians with advocacy and NOH experience to lead our sessions. In each meeting we had three or four neurologists. Before long we learned to involve everyone in the conversation.

This year we talked about cognitive care. As the legislative dialogue continues to shift reimbursement towards primary care specialties, we asked that neurologists be recognized as principal care providers for our patients with chronic neurologic diseases.

As we wandered the halls of the Capitol it became clear that we were not alone. Many groups were visiting and lobbying at the same time we were. I realized first hand that we were competing for attention. I also realized that being absent from the legislative process was a critical mistake.

Whether introducing neurology to a staffer or advancing our agenda with a legislator, I felt that we began to influence the legislative process. Phone calls, postcards, and letters to a congressional office are tallied and reported to our legislators. Personal visits are even more influential. When a group of physicians take time away from their practice the message carries more weight.

As I traveled from home to PALF in San Diego this January, and then to NOH in Washington, DC, in April, it became clear to me that we all must recognize that it is our duty to advocate for our patients, our profession, and ourselves. This duty cannot be delegated to “someone else.” If we are not present in person, via email, or on the phone, then someone with competing interests will be.

I know now that it is essential that each of us continue to deliver our message via phone or letter or return visit. The team for NOH has grown from 50 to nearly 150 neurologists. Please consider joining the team next year when you see this opportunity discussed, via email, or on the website.

When the PAC bill comes attached to the yearly membership dues, pay it. Those funds directly affect our current and future practice. I suppose you can consider funding Brain PAC as advocacy by proxy. If you're fortunate enough to travel to NOH or attend any of the Academy's other advocacy training or events, I can guarantee that you will help fund our PAC.

It has been a personal journey for me to understand the meaning of advocacy. I'm hopeful we can all select a level of involvement that will help to promote our profession and to protect our future. Our strength as a profession comes when our voice is clear and strong.

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•. Palatucci Advocacy Leadership Forum:
    •. Neurology on the Hill:
      •. Capitol Hill Report:
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