Team Win: Relationships Key to Georgia Advocacy

GOS pushes for limited medical licensure exemption for out-of-state team physicians
We live in a sports-crazed society and often hear about the importance of relationships when it comes to successful teams. Well, success in advocacy is no different—it requires strong teams and positive relationships.

Out-of-state team physicians face dilemma
This notion was the primary take-home lesson I learned while "running point" on the efforts of the Georgia Orthopaedic Society (GOS) to align Georgia';s sports medicine laws with those of other states. In most of the United States, a limited medical licensure exemption applies to out-of-state team physicians.

The issue at stake is all too familiar to physicians, trainers, and other medical staff who travel across state lines in support of their athletic teams. Professional licensure always has been the purview of the states, not the federal government; therefore, no national-level medical license currently exists. Physicians who practice in multiple states must obtain and maintain multiple licenses. Such multilicensed physicians are usually found in "border towns" that straddle several states. For example, in my hometown of Rome, Ga., we serve patients from three states (Georgia, Tennessee, and Alabama).


Georgia Orthopaedic Society members and friends celebrate the signing of the Georgia Visiting Physician Protection Act by Gov. Nathan Deal.
Courtesy of Brad Bushnell, MD, MBA

This arrangement might make sense for someone who needs a license to obtain hospital privileges or open a medical office in a neighboring state. Although licenses are expensive to get and keep, they are a necessary cost of doing business for these doctors. For sports medicine physicians who spend very limited time "on assignment" for a road game or other athletic contest, the situation is vastly different. In an age in which college teams from the Big East routinely play west of the Mississippi River, team doctors face a conundrum. Licensure in the state visited on every possible road trip is simply not practical. Doctors are left hoping that the state their team plans to visit has a licensure exemption for sports medicine. If not, they could face professional risk. Alternatively, team doctors may choose to stay home and leave their athletes to whatever care may await them on the road.

Advocacy in action
Our friends and champions at the federal level have met stiff opposition in trying to achieve a national-level solution. As such, orthopaedic surgeons have led a state-by-state campaign to create laws to protect visiting team physicians.

Even at the state level and in spite of the hard work of many of my colleagues within our state orthopaedic society, prior efforts to secure passage of our "sports med bill" had stalled. The state medical board worried about precedent and a "slippery slope." The governor';s office worried about opening the door for "pill mills." The national environment made almost any healthcare-related law a significant liability for a sponsoring legislator.

Indeed, the deck seemed stacked against us. Last summer, however, the proverbial planets seemed to align.

As a participant in the Georgia Physicians Leadership Academy (an advocacy program sponsored by the Medical Association of Georgia [MAG]), I had to choose a "class project." As I weighed options involving community service, patient care, and other themes, I ultimately chose a path that seemed to me like Robert Frost';s "The Road Not Taken."

'The Road of Advocacy';
With encouragement from senior surgeon-mentors, including Todd Schmidt, MD, and Xavier Duralde, MD, I set a goal of protecting our out-of-state sports medicine colleagues when their teams visit Georgia by ensuring the passage of a bill through our state legislature in 2017.

In the beginning, all I really knew was that it was a good idea to contribute to the American Association of Orthopaedic Surgeons (AAOS) Political Action Committee and our state political action committee because they managed political aspects that I did not understand. And while money is certainly important, I quickly realized that money is irrelevant without relationships.

I met with lobbyists from the teams that work for GOS and MAG, who helped me plan the steps necessary to reach our goals. They all agreed that this was a "white hat" issue—one that held very little controversy or political risk. It was mind-blowing, however, to see how much work was still involved to get to the finish line.

First, I had to find a formal sponsor for the bill. That part was relatively easy. Our state senator, Chuck Hufstetler (R-Ga.), is a good friend and works as an anesthetist in one of our local hospitals. I met with him for coffee and he cheerfully agreed to be the "legislative champion" of the bill. I created draft language by using a template from the American Orthopaedic Society for Sports Medicine (AOSSM). Sen. Hufstetler then leveraged his legislative counsel to create a version viable for the 2017 session.

Meanwhile, I had to "get everyone on board" with the idea long before the legislature met in January. I worked with the governor';s chief advisor on health affairs to make sure that the bill fit in the governor';s agenda for the year. I worked with the State Composite Medical Board to explain the details of the bill. We reassured them, for example, that our plan would not lead to bigger issues, such as cross-state compacts.

Fortunately, I had an ally—Ronnie Wallace, a local banker and businessperson from Rome who happened to be the medical board';s lay member. Mr. Wallace understood the importance of the issue for events like NCAA bowl games and even the NFL Super Bowl and remained a staunch supporter throughout the process. Other meetings followed with leadership and key legislators in both houses, explaining to them—over cocktails, dinner parties, and late-night phone calls—why they needed to support the bill.

At each encounter with the various legislators, lobbyists, advisors, and other stakeholders, I came armed with a "white paper" in support of our bill. It contained an executive summary, model language for the Georgia bill, examples of successful bills in other states, media coverage of the stalling national-level efforts, and other critical background information. The key piece of the white paper, however, was the section with support letters. I had collected crucial letters from my friends and colleagues who worked as team physicians across the state and across the country who gladly took the time to explain the importance of the bill. Again, the power of relationships was on full display.

Once the Georgia General Assembly opened, the formal process began in earnest. It was like watching the old Schoolhouse Rock "I';m Just a Bill" video, but in real life and in slow motion.

The bill began in the Senate as "Senate Bill 47," which then had to pass out of committee. I went to Atlanta to testify at the committee hearing, expecting a small room with a handful of bored legislators. Instead, I walked into a cavernous chamber filled with lobbyists, reporters, and countless others.

I almost ran out; however, with some coaching from Sen. Hufstetler and our lobbyist team, I was able to get through the hearing. In the end, we got the bill out of committee unanimously, and it then went to a vote in the Senate. It passed unanimously out of the Senate as well—thanks in no small part to a multitude of phone calls from GOS members to their senators encouraging support for the bill. These phone calls proved most effective when members had an existing relationship with their senator.

The process repeated itself in the House of Representatives. Another trip before a committee resulted in a unanimous favorable vote. The bill then passed unanimously out of the House in its one-word altered form, but the change in wording unfortunately required another Senate vote. As the end of the session loomed, Sen. Hufstetler masterfully guided the bill through the process, and it cleared the legislature.

Signing of the bill
As Nathan Deal, our governor, signed the bill, he was flanked by many of the people whose hard work helped put the bill on his desk—members of the GOS leadership, Sen. Hufstetler, Mr. Wallace, and members of our lobbying team. I also invited my athletic trainer and the head football coach of the college that I cover because they represent the reason (to serve our athletes) that we started this process in the first place. I even brought along my wife and children, the most important relationships in my life, to reward them for their love and support during all the hours I spent on this project.

Indeed, the group picture we took at the signing ceremony seemed to capture the team spirit and relationships that drove the whole process. It reminds me that no one can succeed alone in advocacy.

Brandon D. "Brad" Bushnell, MD, MBA, is the chairman of orthopaedic surgery at the Harbin Clinic in Rome, Ga.—Georgia';s largest physician-owned, multispecialty clinic. He is a member of the AAOS Education Assessments and Evaluations Committee and the Appropriate Use Criteria Voting Committee for Surgical Management of Osteoarthritis of the Knee.