ESPR (educate, support, participate, run) is an easy pathway to advocacy involvement.
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Published 11/1/2011
Maureen Finnegan, MD

This fall, turn to ESPR

The 2012 elections are just around the corner

Like many Americans, you are concerned about the state of affairs in Washington. But without a personal contact, you may wonder what difference one lonely orthopaedic surgeon can make.

As it turns out, a single orthopaedic voice can make a lot of difference. Although you can choose from several paths to get involved, one of the easiest pathways to involvement is known as ESPR.

E = Educate
Who is more informed about the real problems of health care than those who toil in it every day? Neither the Centers for Medicare and Medicaid Services nor many legislative advisors know as much as you do. Politicians are very sensitive to voters’ opinions and concerns—and voters trust physicians significantly more than other groups when it comes to finding answers on health care.

The key is to concentrate on educating and to avoid either lobbying or preaching. Good objective data are the best source for educating and are available from your Board of Councilors and Board of Specialty Society representatives, your state orthopaedic society, the AAOS office of government relations ( or 202-548-4430), and the Orthopaedic Political Action Committee ( or 1-877-389-2267).

Although wise ancestors have suggested avoiding discussions of religion and politics with family, that is one of the best venues for honing your political education skills. Pick the toughest relative on political issues and find a way to educate him or her on the objective data available on the state of health care. Once you have fine tuned your message, you are ready to educate voters.

Although family and friends are good supporters, your secret weapon is your patient population. Objective information available in your office—whether self-published information sheets or posters available from various medical societies—will encourage questions and often conversation from your patients, who truly care about your input. Just remember, your job is to educate, not pontificate.

You’ll soon find that both your community at large and its leadership are searching for good information. Not infrequently, their education on patient care issues comes from nonphysicians such as insurance companies, hospitals, drug or implant manufacturers, and allied health providers. Look for opportunities to provide input on public health questions or offer to be a sounding board for elected officials from your local county commissioner to your federal senator.

S = Support
What if a good friend drops by to let you know that he (or she) is running for a local office? Although your first thought might be to donate money, candidates need much more than just funds. Candidates need people they can trust for advice. Because most candidates for political office have minimal healthcare expertise, they need people—preferably physicians—whom they can contact quickly for input on various proposals and problems.

Candidates also need exposure to voters and potential donors. Your network of connections can be invaluable, especially to those who are just starting out or moving up to the next level. They need volunteers in the campaign office to answer phones and organize bulk mailings.

A unique group of candidates that really need your support is physician candidates. Most physician candidates are running for positions that still allow them to practice, and they will need support with practice coverage and often some temporary relief from hospital staff rules.

But don’t forget the money issue. No one can run a campaign without funds, and the act of donating is as important as the amount contributed. Although contributing does give you some access to the candidate, hosting a fundraiser gets immediate personal access. Because fundraisers combine financial contributions and network connections, they can offer more value than an outright dollar contribution.

P = Participate
Traditionally, physicians have been dependable leaders in their local communities. Data over the past few decades, however, show decreasing voluntary involvement by physicians and a degree of isolationism. Hospitals are finding it increasingly difficult to fill slots on committees mandated either by local bylaws or by government regulation. State and local medical societies are recycling member volunteers to keep functioning.

Physicians may be concerned about the time and energy required to serve. The reality is that serving requires minimal time and energy, while giving you a voice in important local issues. Starting at this level enables you to evaluate your enthusiasm and talent for participating while noticeably contributing to your community.

Every legislative session whether state or federal, has to deal with some healthcare issues. State and national orthopaedic/medical associations need members willing to work on specific issues. Participating on a task force or providing expert opinion at a government hearing as an official representative of one of these groups enables you to volunteer short blocs of time to your issues of interest.

Volunteering for state orthopaedic societies, specialty societies, or AAOS committees allows for more input but requires more time. Finally, leadership positions at all levels—hospital, state, regional, specialty, and national—require significant time and energy; you should be sure to have the support of your partners and family.

R = Run
Physicians, including orthopaedic surgeons, are often excellent political representatives at all levels—from municipal government to Congress—but it is best to start small and locally. The most common first steps are seats on school boards or the city council or county commission. Several physicians have successfully run for office at the state and federal level after establishing their credentials in the local community.

It is critically important to fully understand the undercurrents of the local political scene when contemplating a campaign. Previous membership and active participation in the local and state political associations are obvious pluses. But do not underestimate what you have to offer.

Orthopaedic surgeons can participate in guiding the politics of health care in myriad ways. Not participating is an active decision rather than a passive excuse. Getting involved (ESPR) is the only way to make a difference.

Maureen Finnegan, MD, is a member of the AAOS Advocacy Resource Committee.