Physician executives and the political process.

Historically, individual physicians and physician executives have had very little personal involvement with the political process. Instead, the U.S. Congress would look to large organizations like the American Medical Association for information regarding the political views of doctors.

Recently, however, as diverse health care issues topped the national political agenda, both state legislators and members of Congress realized that they need multiple opinions before deciding how to vote on the various bills.

Issues affecting physician executives debated on Capitol Hill include:

* The creation of Medicare Part D

* Use of sustainable growth rate (SGR) formula to cut Medicare payments to physicians

* Malpractice insurance and payment caps

* Stem cell research

* Pay-for-performance clinical quality measures

* The legality of physician unions

* Health savings accounts 

* Feasibility of universal health care

* Medicaid reductions

* The strain on hospital emergency departments

* The projected medical needs of the aging population

* The plight of the uninsured

Physician executives have knowledge and experience in these topics, and politicians respect and welcome the opinions of their physician executive constituency.

With so many people vying for time with members of Congress, here are some guidelines to create a productive relationship with your elected official and maximize the impact of your input.

General rules

Before contacting your representative or senator, have a specific issue and/or bill to discuss. (Go to www.Congress.org to find contact information as well as summaries of bills currently before both Houses of Congress.)

Understand all sides of the issue thoroughly and be able to explain how the issue will affect the politician and his/her constituents. Have credible data to support your side. Don't just know that something is a problem--have a proposed solution. Always identify yourself as doctor. Avoid speaking about money. Be familiar with costs of proposal if asked. Never lie. Always be respectful.

There are a number of ways physician executives can approach legislators: Make a personal visit to that official's local or Washington, D.C., office, telephone, e-mail, and/or write a letter. Each of these has a protocol.

Making a personal visit

The face-to-face meeting is the most effective way to present your side of an issue. Call or write the legislator's office to set up an appointment. Identify who you are, the purpose of your visit, and who will be attending.

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If possible, join with others who have the same point of view and meet with the legislator together. It is optimum to visit in small groups of three or four, with each person representing a different organization.

Meetings tend to last from 15 to 30 minutes. (Expect interruptions and cancellations.) Most visitors only get to speak with staff. Never underestimate the role, responsibilities, and influence of the staff.

If you have any social, business, political, or family connections to your legislators, mention them as this serves as yet another way for the legislator to identify and remember you.

Explain your position on a certain bill and what you would like your legislator to do. Identify the bill by name and number. Know who supports and opposes the legislation. Acknowledge legitimate concerns, if any, and refute any incorrect information. Explain how the bill may affect constituents by using personal anecdotes when possible.

Let the legislator know if you are working with others or if you are representing the views of the members of an organization.

Present a written statement of one page with your position on a specific bill and why your viewpoint should be supported. (Again, identify the bill by name and number.)

Be direct and firm with your views, but do not try to force the legislator to change positions.

Never get angry and make any personal attacks. Do not alienate your legislators. Even if they may not support you in this issue, you may need their support on other issues.

Know when to stop talking and follow up with a thank you note.

Telephone and e-mail

Identify yourself by name, address, and hometown within his/her legislative district. Always include "doctor" in your title.

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Ask to speak to the health aide unless you know the legislator personally.

Identify the bill by name.

Briefly state what your position is and how you would like your legislator to vote.

When e-mailing, do not send the exact same e-mail that others are sending.

Show your appreciation for his/her service on past votes. Be positive.

If your legislator requires further information, supply it as quickly as possible.

The legislative cycle moves very quickly.

Always be courteous.

Letters

Nowadays, writing letters to legislators has become an underutilized method. Because of its general rarity, it remains a very effective way to get attention.

Always type your letter on personal stationery or business letterhead. If you are writing as a representative of a group, write on the organization's stationery. Do not send a postcard. Sign your full name and address so the legislator can respond. Include a telephone number as the legislator may want to speak with you.

If you are a constituent, begin your letter by saying so. Do not use the words, "As a citizen and taxpayer...."

Make clear what your position is and exactly what you want your legislator to do. Refer to a specific bill by name and number--not just a general issue. Write about only one bill in each letter.

Avoid sending form letters.

Explain how the issue affects you, your family, your employees, your patients, your organization, your profession, your community, etc. Be reasonable; do not seek impossible things, do not threaten.

If your legislator supports you with a vote on an issue, write and tell him/her so. Be appreciative of past votes. So much mail is from displeased constituents that positive messages are remembered favorably.

Timing is important. If your letter arrives too early, it will be forgotten. If your legislator is a member of a committee to which your bill has been referred, write when the committee begins hearings. If your legislator is not a member of the committee handling the bill, write him/her just before the bill is to come to the floor for debate and vote.

Write the president (for federal legislation) or the governor (for state legislation) promptly after both Houses of Congress pass the bill.

When sending a letter to different legislators, address each letter individually, i.e., do not "cc" to different legislators at once.

By following these general rules, physician executives can be effective in providing opinions and expertise to their elected politicians. By building strong relationships with their local and national representatives, physician executives can become an integral part of the current health care debate.

Chandak Ghosh, MD, MPH, is a medical consultant for federal policy with the U.S. Department of Health and Human Services/HRSA. He can be reached at [e-mail]. Views expressed in this article do not necessarily represent the views of DHHS/HRSA or the United States.

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By Chandak Ghosh, MD, MPH