According to Mr. Porter, an effective advocate does not need to be part of a large group like the NOLC. He reminded the audience that a legislator’s success depends on his or her ability to satisfy voters. “Never underestimate the power of you,” said Mr. Porter. “Legislators won’t care about you, unless they are forced to care about you. Your mission every day should be to take an active step in one way or another.”


Published 6/1/2012
Madeleine Lovette

Taking Advocacy to the Grassroots

More than 300 AAOS members descended upon Washington, D.C., April 25–27 for the annual American Association of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC). This yearly advocacy event helps raise awareness about issues affecting the orthopaedic community, builds support for orthopaedic-related legislation, and strengthens Congressional relationships.

Although very successful, NOLC is an annual event and is largely federally focused. To keep up with the ever-changing nature of healthcare policy, year-round advocacy is required.

The critical nature of year-round advocacy—particularly in preserving access to orthopaedic care—was featured during a Grassroots and Advocacy Symposium at NOLC, moderated by Fred C. Redfern, MD, chair of the AAOS Board of Councilors (BOC) and Peter J. Mandell, MD, chair of the AAOS Council on Advocacy Chair. Symposium speakers included former U.S. Representative Jon Porter; Cindy Brown, vice president of government affairs for the American Medical Association (AMA); Stuart L. Weinstein, MD, chair of the Orthopaedic Political Action Committee (PAC), and Julie Williams, senior manager, government affairs, in the AAOS office of government relations.

The power of you
Advocacy can be expressed in a variety of ways, ranging from personal letters and phone calls to national movements around a specific policy. In today’s fast-paced political environment, new policies are constantly being proposed, and legislators depend on their constituents to communicate how these proposals will affect their communities and businesses.

Fred C. Redfern, MD

Penning your appeal
One of the most traditional ways of expressing an opinion to a local legislator or member of Congress is through a letter. According to Mr. Porter, legislative offices generally accept both handwritten and electronic letters, but due to enhanced security on Capitol Hill, he recommended that handwritten letters be sent to the local district office of a Senator or Representative to reduce delays.

Letters should be as personal as possible. “Form letters, petitions, and other impersonal methods of correspondence do not carry the same weight as a personalized letter,” he said. He also advised keeping letters brief, preferably mentioning only one issue, and including a bill number when possible.

Calls to action
When an issue is imminent or legislation is being voted on that day, it may be more effective to call a state legislator or member of Congress. The AAOS often sends out ‘calls to action’ on important national issues, but individuals can call local legislators or members of Congress at any time to express their concern about an issue.

State legislators may answer the phone themselves, while staff members usually answer for a member of Congress. No matter who answers the phone, callers should identify who they are and where they are from, specify the bill or issue for which they are lobbying, and personalize the message by stating why a specific stance is important to their community or business. Finally, callers should request the legislator’s position on the issue.

Pay a visit
According to Mr. Porter, one of the most effective advocacy techniques is a face-to-face meeting with an elected official. “The goal is to establish a personal relationship,” he said. “When I was in office, I often turned to Dr. Redfern as an expert because of the many conversations that we had and the trust that I had in him.”

Meetings with state legislators and members of Congress can and should be scheduled throughout the year. Elected officials have both local and official capitol offices. Visitors are welcome at both locations, but a local meeting has several advantages. It confirms that the visitor is a constituent, is generally more relaxed, and can be more easily and predictably scheduled.

Visits allow advocates to raise more than one issue with a legislator, but discussions should be limited to only two or three issues at a time to prevent one from being overlooked or forgotten. According to Mr. Porter, no matter what issue is being discussed, the focus should always be on the patient.

“Your message as physicians always has to be about taking better care of patients,” Mr. Porter said. “Never, ever complain about how much you make or are getting paid.”

Advocates should bring issue materials to their meetings to supplement the discussion. Materials can be obtained by contacting the AAOS office of government relations at 202-546-4430 or by downloading issue sheets from the AAOS website (

Another effective meeting place for physician advocates to express their concerns is at the practice office. This gives legislators the opportunity to see the important services orthopaedic surgeons provide and how policies and regulations affect medical practices.

A grassroots example
Sometimes a larger effort is necessary to achieve an advocacy goal. In Nevada, building a grassroots effort helped doctors achieve medical liablity reform, explained Dr. Redfern.

“The state had passed a tort reform bill that placed ‘soft’ caps on noneconomic damages at $350,000, but the law contained too many exceptions to result in a lowering of medical liability premiums for physicians,” he said. To pass medical liability reform legislation that didn’t include exceptions, physicians launched a grassroots effort, Keep Our Doctors in Nevada (KODIN).

The goal was legislation that placed a $350,000 hard cap on noneconomic damages, eliminated joint-and-several liability, and limited attorney fees. In response, the Nevada trial attorneys proposed dismantling the current medical liability reform law and making it unconstitutional to limit noneconomic damages or attorney fees in medical liability suits.

When meetings with state legislators were ineffective, KODIN members turned to their patients. With the help of an AAOS grant and aggressive fundraising, KODIN raised public awareness about the need for reform using flyers, patient handouts, buttons, and bumper stickers.

“We spent 60 seconds at the end of every visit telling our patients that if this issue was defeated, their doctors might be forced out of the state” Dr. Redfern explained. Physicians then asked patients to spread the message to their friends, families, and co-workers.

“In an effort like this, it is critical to use every contact you have,” said Dr. Redfern. “You never know who owns an advertising agency or who has close relationships with community leaders.” The KODIN initiative proved successful as voters defeated the trial lawyers’ proposals and passed exception-free medical laibility reform.

Dr. Redfern noted that the AAOS can assist physicians who are interested in initiating a grassroots movement. “There is no greater or stronger grassroots movement than the doctor-patient relationship,” he concluded. “Voters will choose saving their health care over almost any issue.”

In her comments, Ms. Brown concurred that the doctor-patient relationship is a powerful tool. The AMA has enlisted patients to assist in its efforts to repeal the Medicare sustainable growth rate (SGR) and enact private Medicare contracting.

“Patient involvement is the key to advancing an issue,” she told the audience. “We encourage physicians to educate their patients on the issues and ask them to contact their elected officials. Patients can also help educate their neighbors by submitting letters to their local papers.”

Making a contribution
Ms. Brown and Mr. Porter both emphasized the impact and stature of the Orthopaedic PAC. “You have one of the most effective PAC’s in the country,” said Mr. Porter. “A donation to the PAC is an easy way to be an active advocate for orthopaedic issues.”

In the last election, 89 percent of the candidates supported by the Orthopaedic PAC were elected to office. As members of the 112th Congress, they have helped to increase funding for orthopaedic extremity trauma research through the Department of Defense, repeal harmful provisions in the Patient Protection and Affordable Care Act, and make medical liability reform a legislative priority. Contributions to the Orthopaedic PAC enable the committee to identify candidates who support issues of importance to the orthopaedic community and to support them in their 2012 campaigns.

Madeleine Lovette is the communications specialist in the AAOS office of government relations. She can be reached at