AAOS Bulletin - April, 2005

A Unified Advocacy Agenda for orthopaedics

Advocacy efforts extend to specialty societies

Stuart L. Weinstein, MD

The American Academy of Orthopaedic Surgeons was founded in 1933 with the primary mission of education. Education remains our number one priority. However, over the past two decades, advocacy has played an increasingly important role.

The AAOS has and will continue to play a leadership role among specialty societies in the advocacy arena. And this year we will expand our advocacy efforts to the members of the Council of Musculoskeletal Specialty Societies (COMSS).

Our advocacy efforts began in 1979 when we established our Washington office to confront issues of musculoskeletal research funding.

In 1997 the Academy established the American Association of Orthopaedic Surgeons to meet the ever-increasing advocacy needs of our members and our patients, and to make these efforts more effective. We are now in the process of developing a unified, specialty-wide advocacy agenda that will strengthen these efforts and build on the political capital developed by the Academy over the last 25 years.

Orthopaedic advocacy

All of us, regardless of specialty within orthopaedics, are under siege from outside influences such as government, third-party payers, the non-physician health-care community and industry (with direct-to-consumer marketing). Orthopaedic surgeons account for only 3 percent of all physicians, yet our advocacy influence through the AAOS is near the top of all medical specialty societies.

The AAOS advocates for appropriate access to specialty care and fair reimbursement for services provided. We advocate for increased funding for basic science and clinical musculoskeletal research. And we advocate for the primacy of patient welfare, patient autonomy and social justice in healthcare.

The AAOS has played a leadership role among medical specialty societies in establishing and leading major coalitions addressing the important global issues of the day. We founded the National Intitute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Coalition, the Practice Expense Coalition, the Alliance for Specialty Medicine, and, most recently, Doctors for Medical Liability Reform (DMLR).

The AAOS uses numerous and varied communications vehicles to keep members informed of the status of advocacy issues. These include AAOS Headline News, the bimonthly Legislative Update Newsletter, the Daily Federal Register Updates, Academic and Research updates, advocacy pages in the Bulletin and the Washington Scene on the Health Policy page of the Academy’s Web site.

In my two years of leading the medical liability reform campaign through the DMLR coalition, it has become clear to me that the AAOS enjoys the respect and admiration of the other major medical specialty societies. Our outstanding Washington staff, led by David Lovett, is relied on for their counsel, advice and leadership. Our member level of commitment, involvement and leadership in this arena — exemplified by our Health Policy Council led by David Halsey, MD; our Political Action Committee (PAC), ably led by Paul Collins, MD; and the countless number of our members lending their expertise, time and passion — are envied by all.

Political activism has not traditionally been part of the physician culture. Many of us have been reluctant to get involved in the political process directly or by contribution to the PAC. I will tell you that our PAC efforts were critically important to our success in this past election cycle in key Senate and Congressional races, and in getting the first orthopaedic surgeon (Thomas E. Price, MD, from Georgia) elected to Congress. The Orthopaedic PAC is poised to become one of the largest medical PACs in Washington, D.C.

The PAC is a non-partisan group that supports candidates in both parties who support these issues: the importance of the patient-physician relationship; the need to reduce the regulatory burden on physicians; the need to adequately fund musculoskeletal research; and the importance of fairly compensating physicians.

A Unified Advocacy Agenda

Our Unified Advocacy Agenda will include COMSS specialty societies with advocacy as part of their mission. The AAOS wants to help ensure that specialty societies who have made advocacy a goal of their strategic plan are aided in this effort.

The AAOS realizes that it is important for specialty societies to achieve their advocacy goals, yet maintain specialty society identity. We feel that the way to do this is to work with a proven advocacy leadership organization—the AAOS. The AAOS has developed the infrastructure and the expertise. We are you! Going it alone makes it very hard to achieve success.

There are many examples of positive results when we speak with one voice and use our resources on behalf of our orthopaedic specialty. Politicians love a house divided; they don’t have to do anything when there is in-fighting within the physician community. Division within our own house would be a “doomsday “scenario in the political arena. As I mentioned above, orthopaedic surgeons represent only 3 percent of all physicians, yet our advocacy influence is near the top of all medical societies.

If each specialty society tries to go it alone, initiating its own advocacy effort and its own PAC, we all lose. Years of hard work to get orthopaedics to the preeminent leadership position in the advocacy arena will quickly erode. We must operate under the premise that we are all orthopaedic surgeons and that we will advocate together on important issues of the day—medical liability reform, Medicare reimbursement, increased funding for musculoskeletal research, and others.

If individual specialty societies wish to get involved in the advocacy arena, the AAOS will provide the infrastructure and expertise to accomplish specialty society advocacy goals. We will help COMSS members define and develop a plan for implementing their own advocacy agendas. The agenda of the specialty societies is our AAOS agenda.

The Pediatric Orthopaedic Society of North America (POSNA) provides an excellent example of this working relationship. POSNA members comprise just 3 percent of the total AAOS membership, and less than one-tenth of 1 percent of all physicians. Medicaid and the uninsured are very important issues to POSNA members, and advocacy is in the POSNA mission. By devoting some resources to advocacy through the AAOS Washington Office, POSNA has helped elevate the issues of Medicaid and the uninsured.

It is our hope this year that the specialty societies who are interested in advocacy could elevate their issues by working through the AAOS and making their issues a priority for the AAOS Washington Office.

Establishing a presence

Going it alone is also expensive. The establishment of a PAC costs from $50,000 to $75,000 a year in administrative costs. PAC software to comply with the federal election commission costs another $30,000 a year. But with a small contribution, individual specialty societies can enhance their issues by advocating through the AAOS.

By contributing to the AAOS Washington Office, each specialty society has a presence in Washington. By having a presence in the Washington office, the specialty society can develop relationships with Congress and join alliances, which require a Washington, D.C., presence.

The AAOS has made a commitment to establishing a senior regulatory representative in the Washington Office as a COMSS position. Thus far, the Orthopaedic Research Society, the American Association of Hip and Knee Surgeons, the Limb Lengthening and Reconstruction Society, the Ruth Jackson Orthopaedic Society, the Orthopaedic Trauma Association, POSNA, the American Orthopaedic Foot and Ankle Society, the Scoliosis Research Society and the American Shoulder and Elbow Surgeons have contributed to the support of this position. The AAOS Presidential Line has made a total organizational commitment to help all specialty societies that have advocacy as their mission to achieve their goals.

We can make a difference — but only with the continued and expanded participation of the orthopaedic community. We need to work together. We need to advocate as a unified body.

Stuart L. Weinstein, MD

President


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