June 2002 Bulletin

Advocacy and the AAOS:
An essential part of the profession

There has long been an interest among the Academy membership for involvement in what have been called advocacy issues. To advocate, the dictionary says, is to argue for a cause. In a recent article in Annals of Internal Medicine ("Medical Professionalism in the New Millennium: A Physician Charter," 136:243-246, 2002) on medical professionalism today, it was noted that public advocacy for our patients is an essential part of medicine’s social contract. This is the way professional organizations such as AAOS can potentially influence the language in laws that are passed daily and that have an impact on our orthopaedic patients. The AAOS Board of Directors concurred and adopted this charter on medical professionalism at its meeting May 17, 2002.

There continues to be, among some of our Fellows, a sense of uneasiness about spending AAOS funds to try to influence governmental decisions, whether they are in the legislative branch or in the executive branch of our government. Today, however, there is not a viable option to avoid this political process, leaving AAOS to focus on improving our advocacy efforts to ensure they are as efficient and effective as possible. Establishing the American Association of Orthopaedic Surgeons in 1997 as our advocacy arm on behalf of patients and the orthopaedic profession was a major step in this effort.

Identifying and promoting the AAOS advocacy agenda was the subject of a recent workshop in April, when the AAOS Board of Directors spent two days discussing various aspects of advocacy. Among workshop participants, there was unanimous opinion that AAOS had to be involved in the advocacy arena, despite the fact that evaluative criteria on the effectiveness of this advocacy effort remain evasive.

Lively discussion resulted in recommendations for increasing the efficiency and effectiveness of our advocacy efforts. A more complete Board Workshop summary is found elsewhere in the Bulletin (see Board of Directors holds workshop on advocacy article), but I would like to touch on a few of the major advocacy efforts within AAOS.

There are several areas within AAOS in which advocacy efforts are important. The Council on Academic Affairs is concerned about deep cuts in graduate medical education (GME) as budget cuts loom. Major changes in this funding will put intense financial pressure on the academic medical centers where you trained.

Seeking alternate sources of funding, in addition to Medicare funding, are among the issues addressed in this advocacy effort, though this is far from the only issue that requires advocacy attention in the academic arena.

The Council on Research and Scientific Affairs is active in an annual research advocacy event in Washington, DC, during March. Orthopaedic surgeons go to Capitol Hill to speak with legislative representatives in support of increasing the funding for musculoskeletal research through federal agencies such as the National Institutes of Health (NIH) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Additional research advocacy is done throughout the year in cooperation with the AAOS Washington office.

By 2003, the NIH research budget will have doubled over a five-year period, though the portion of the NIH budget related to orthopaedic issues increased at a somewhat slower rate. Now that President Bush has proclaimed the next ten years to be the Decade of the Bone and Joint, we are hopeful that more research funding will be focused on musculoskeletal problems. We need to continue our research advocacy efforts to take full advantage of this presidential proclamation to insure this proclamation will pave the way for expanded orthopaedic research support.

Over the past several years, the Council on Health Policy and Practice and the Board of Councilors have been the most active AAOS entities in the legislative advocacy arena. These two groups have worked closely with the Washington Office and with the state orthopaedic societies to identify the legislative issues important to orthopaedic patients and the profession, both federally and on the state level, and to respond to them in a timely fashion.

The National Orthopaedic Leadership Conference (NOLC) was established by the Board of Councilors (BOC) a number of years ago as the spring meeting of the BOC in Washington, DC, and as a mechanism for allowing BOC members to visit their legislators on Capitol Hill. In recent years, participation in the NOLC has expanded to include, in addition to the BOC members and their spouses, many members of the AAOS Board of Directors, Council of Musculoskeletal Specialty Societies (COMSS) representatives, state orthopaedic society representatives, and other interested orthopaedists.

In April 2002, a record number of more than 300 participants attended the NOLC (see article on page xx). Most made personal visits to their congressional representatives during the conference. There is clearly recognition on the part of orthopaedists, including those within COMSS, of the need to become involved in the political process.

The AAOS Washington Office is headed by David Lovett, JD. He and his staff are the eyes, ears, and, to some degree, the mouth of AAOS in Washington. They are effective in lobbying efforts, in gathering background data on pending legislation that may have an impact on orthopedics, and, particularly, in coalition building with other medical specialty organizations to increase the impact of our advocacy efforts. David is available at lovett@aaos.org if you have concerns that he or his colleagues in the Washington Office can address.

Funding for advocacy efforts has continued to be a bit of a problem. While financial support for the Washington Office and its staff of six is allocated through the AAOS budget, funding for contributions to political candidates must come solely from U.S. orthopaedic surgeons’ contributions to the Political Action Committee of the American Association of Orthopaedic Surgeons (Orthopaedic PAC).

A separate letter asking for contributions to the Orthopaedic PAC was included in the recent dues statement you received. Last year only 3% of AAOS members contributed to the Orthopaedic PAC. Since 2002 is an election year, it is essential that the Orthopaedic PAC be better funded for us to support the candidacy of legislators who will most likely support the issues of importance to our orthopaedic patients and practice.

If you don’t want to give to the Orthopaedic PAC, give to your local candidates who you think are supportive of the AAOS goals. Get involved with your local candidates and inform them of the concerns you and we have about access of your patients to orthopaedic care, Medicare physician reimbursement, liability reform, and a myriad of other issues, which can and will be dealt with in the political arena.

Education remains the primary focus of the AAOS, but advocacy activities are continuing to expand. In my mind, it is essential that AAOS maintain its educational focus and not go the way of the American Medical Association (AMA), which has evolved into primarily an advocacy organization and has seen its membership drop steadily, so that now only about one in three of American physicians belong to the AMA.

But that does not diminish the importance of orthopaedists individually, and the AAOS as a whole, becoming more involved with advocating, with arguing for the causes we believe are the proper ones for orthopaedic patients and for orthopaedics. While advocacy by professional organizations like the AAOS at one time may have been optional, it is now mandatory.

Vernon T. Tolo, MD

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