Politics and Advocacy

Over the past seven years as your executive director, I've had the pleasure of meeting and learning from many exceptional physicians and physician leaders. I want to share some of these pretty good rules about politics and advocacy, and start by thanking Dr. Bob Hertzka (past CMA president), Dr. Jim Hay (future CMA president), and Joe Dunn (CMA CEO).

1) Look at politicians as either those who view physicians as part of the solution or those who view physicians as part of the problem.

In the world of political parties, we are seduced into thinking that the party affiliation drives "goodness" or "badness." Not so. We in the leadership team use a very simple litmus test: Does the decision maker trust physicians or not? If they do, it matters not whether they are a Republican or a Democrat.

2) Respect the truth ... always.

This rule can't get any easier - and more difficult to adhere to in the heat of the moment. Never, ever BS. Never, ever fudge. Your reputation, and that of your organization, can be destroyed in 30 seconds by being (even inadvertently) untruthful. And remember, few are more respected than those who say, "I don't know, but I will find out," and then actually find out and inform the legislator.

3) The most powerful spokesman for your cause is someone who has no direct stake in the outcome.

When you speak to a decision maker, and you have a clear interest in the outcome, you will be politely listened to, but your words will be assessed in the context of a special interest. When those same thoughts come from someone without a (perceived) conflict, those words become (magically) much more compelling. So, for example, when a family physician speaks to the lunacy of letting optometrists operate on the eye, that's a powerful statement - much more so than if the ophthalmologist who may in fact be making a much more fact-based argument (see rule #10).

4) Count your votes before the vote.

Don't find out you're close (or behind) during the vote. Do everything in your power to find out who is with you and who isn't, then lobby the heck out of the issue.

5) Focus on the persuadables.

While actual percentages may vary, on any given issue, about 30 percent will be in full-throated support, and roughly 30 percent are stridently opposed. Focus 90 percent of your energy on the 40 percent who are convincible.

6) No one bats 1.000 in advocacy.

If you expect to win every issue, you've chosen the wrong avocation. It's a game of percentages. Work for the long haul, and be patient.

7) It's about the relationship, not about the issue.

• Variation 1: When it's a core issue, then it is about the issue.
• Corollary 2: Choose your core issues very, very carefully.

There are a million issues. Choose the ones you're willing "to die for" very carefully. So treasure the relationship. Those you lobby may not agree with you (see rule #8 below), but the value of the relationship is that you get a fair and fast hearing. Being able to pick up the cell phone (and having the cell phone number) and calling a state legislature is incredibly useful.

8) Today's opponent is tomorrow's ally, and vice versa.

Note, I did not say enemy ... I said opponent (see rule #9 below). Alliances come and go; accept that the greater good sometimes makes for strange bedfellows. Therefore, never, ever personalize a disagreement because you may be looking for a partner someday soon!

9) Respect the elected officials, their staffs, and your adversaries.

You haven't run for office. You haven't had to fly to Sacramento or Washington, DC, every week. You haven't spent interminable hours in meetings listening to ... well, let's just say that our legislators work incredibly hard, and every move they make is scrutinized, criticized, and second-guessed. Respect them for what they do and who they are.

The staff are just as, and sometimes more, important as the elected official. Never, ever, ever treat the staff with anything but respect. They may be young, they may be underpaid, they may work under very challenging conditions, but they have the ear of the decision maker. Make them your allies, even your advocates!

Badmouthing your opponents (or worse, not respecting the truth) will invariably cause you to be ineffective. And the word gets around. Quickly!

10) It's 90 percent on the politics, only 10 percent on the merits.

• Corollary 1: You don't get to the merits until AFTER you deal with the politics.

Deal with (and understand) the politics before you speak to the merits. Those of us educated in deterministic, objective, and data-driven disciplines (engineering in my case, medicine in my spouse's) are resolutely convinced that the merits of any argument will always prevail. Sadly, in the world of politics and advocacy, that is rarely the case. In fact, many decisions are made in the absence of, or even contravention of, the facts. Decision makers have to do things, e.g., their party leadership may demand a vote, maybe they need to vote against something we like that is passing easily but they have a constituency to appease, the list goes on. Get over it! That's the world we live in.

So who cares about advocacy and politics anyway? You do. If SDCMS and CMA are not building those relationships, making the case for physicians, walking the halls of power, then a nonphysician will tell you how to practice medicine and reach into your pockets - and directly affect your ability to provide patient care. Which brings me to the last, and most important rule (with apologies to the famous line from the 1992 presidential campaign): It's the patient care, stupid. Everything we do as advocates for physicians has to focus on the ultimate goal of healing the sick. Honestly framed as a patient care issue, it's hard to lose an argument!