Five Ways to NOT be a Successful Legislative Advocate

Physicians are in some ways uniquely unsuited to be legislative advocates. We function in a world that acknowledges our extensive training and experience and is respectful of scientific analysis. And despite all the difficulties of practicing in the 21st century, we still get what we want in most situations. When we make a diagnosis and propose a treatment plan, our patients usually go along with it. And when we want things to do a particular way in our clinical settings, be it the office or the operating room, they usually do.

However, in the world of legislative advocacy, we are back to square one. In that arena, it is not uncommon for a group of us to meet with a legislator who has had less than a third of our formal education, patiently explain our sage analysis and thoughtful recommendation regarding a piece of legislation, and later find that the legislator voted the other way. Over the years, I have seen this kind of frustrating situation cause dozens of would-be physician advocates to just walk away from the process. Even worse, though, I have seen this frustration result in behavior that was counterproductive and even detrimental to what we were trying to accomplish.

To illustrate what can go wrong, I describe below five true scenarios involving physicians that illustrate some of the behavior that simply must be avoided if one is to be a successful advocate. All of these situations took place in the setting of a group of physicians meeting with a state legislator in their office in Sacramento or with a member of Congress in their office in Washington, DC.

1. After being told by a legislator that a particular CMA position would not be supported, one of the physicians in attendance boldly stated to the then first-term legislator that she would personally see to it that CMA’s political resources would be used to support that legislator’s opponent in the upcoming November election. (COMMENT: Hopefully this is self-explanatory. Threats from the grassroots in this kind of setting can only hurt us).
2. After being told that a legislator was unavailable to meet with us and that we would have to meet with a staff member instead, one of the physicians in the group openly protested, along the lines of “doesn’t he know that the Doctors are here?” (COMMENT: Respect elected officials and their staff. A legislator’s first priority when in Sacramento is to attend their committee meetings, which are often in conflict with when groups wish to meet with them. In addition, an opportunity to educate legislative staff on an issue is usually well worth our time).
3. In a burst of enthusiasm, when discussing CMA’s proposal to increase Medi-Cal fees, a physician in Sacramento for the first time volunteered that, in the past, CMA had never objected to Medi-Cal fee cuts when the state budget was in a bad situation, so that it was only fair that we should receive an increase when the state budget was doing well. While enthusiastic and well intentioned, that statement was patently untrue (and that particular veteran legislator knew it) - CMA has always strongly opposed any cuts to the profoundly under funded Medi-Cal program. (COMMENT: Respect the truth. Once you make an untrue statement, even with the best of intentions, your credibility with that legislator for anything else you might say drops to zero).
4. After a legislator stated to a group of physicians that he had decided to vote for a CMA-opposed bill, one physician proceeded to pepper the legislator with a series of escalating questions designed to change his mind, the last of which was “Do you want people to die?” (COMMENT: Respect elected officials. It is quite rare that a legislator actually volunteers to a visiting group that they are voting in opposition to one of their top positions. When that happens, it means that they have already given the issue significant thought and are highly unlikely to change their mind. A barrage of interrogative questions in that situation is basically saying that we believe that the legislator is being stupid - not a good idea).
5. After being told that a proposal for medical education funding reform other than the one favored by his visiting group would be what this member of Congress would support, a prominent academic physician told this Congressman that he must have been “bought off” by a particular interest group. This physician then proceeded to repeat this charge in a series of public forums back in San Diego. (COMMENT: Academic physicians are even more prone than the rest of us to believe that anyone who does not agree with them must be either unbelievably stupid or unethical. That is part of what makes many of them such poor role models in this area for medical students and residents).