Writing this column on the heels of the National Orthopaedic Leadership Conference (NOLC), I find myself thinking about what it means to live in a country whose Constitution begins with the words, “We, the people …” Our revolutionary forefathers (and foremothers), whose vision and commitment shaped these United States of America, knew the importance of participatory democracy.

I started studying citizenship as a Boy Scout, and even then I was impressed by the fact that we, the people, are responsible for this democracy. Throughout my life, I’ve tried to be involved, beyond just voting. Over the years, I have traveled to my state capitol more than a hundred times. I found out that legislators really do try to do the right thing most of the time. But they deal with hundreds of bills on topics that range from agriculture to zoning. They can’t possibly know everything, and they are looking for good information. And sometimes, I had that information. The problem was getting their attention.

Eventually, I discovered how to build relationships with legislators. And once they started to identify me as a friend and resource, they listened to me. Even more importantly, they started to call me for advice.

To deal with today’s realities, more orthopaedic surgeons across the country are going to have to go down that same road. We are competing for limited resources—financial and otherwise—and we have to be able to make our case to legislators and regulators, just as we do with our colleagues within our practices, departments, hospital boards, and local councils.

The American Association of Orthopaedic Surgeons (AAOS) has a great staff in Washington, D.C. Most of them have years of experience in dealing with legislators. They’re well-known and well-respected on “the Hill.” But they can’t do it alone. They’ve got to be able to show legislators that voters care about the decisions they make. And we—the members of the AAOS—and our patients are those voters. Our stories, our involvement, and our support are needed.

The impact of involvement
Policy decision makers respect our education, rigorous training, and the value of our work ethic. As physicians, we have enormous credibility. But frequently we hesitate to talk to a legislator about an issue because we think we have to know everything about it (due in part to our training and the grilling we received during grand rounds). When we speak from experience, however, we don’t have to know everything; we can simply share our perspective with our elected officials.

I heard Peter J. Mandell, MD, chair of our Council on Advocacy, address the NOLC about the impact that we can have. He pointed out that each of the 435 Congressional districts in the United States has about 700,000 people. Approximately 560,000 are eligible to vote, and about 448,000 register to do so. But only about half of registered voters actually exercise that right. Within that group, just 1 percent actively support a candidate by attending an event, making a campaign contribution, or hosting a fundraiser, for example. And only about 0.1 percent actually volunteer in a campaign (Fig. 1). Those are the people that legislators remember, listen to, and contact for information. If you’re one of those people—and it’s not hard to become one of those people—you have enormous access and influence.

We all know that orthopaedic surgery has come under fire in recent years. It’s expensive, often considered elective surgery, and frequently seen as an easy target for cost-cutting measures. The AAOS is constantly working to combat those perceptions; let me give you just two examples.

About a year ago, my predecessor, Daniel J. Berry, MD, appointed a project team to work with health economists to articulate, quantify, and even monetize the social and economic value of our work, specifically in the areas of total knee replacement, hip fracture, lumbar diskectomy, anterior cruciate ligament reconstruction, and rotator cuff repair. The results of that effort will be submitted to a nonorthopaedic, peer-reviewed journal. Preliminary data indicate that the value to society of these “expensive” procedures is worth far more than the initial medical costs. This is information our legislators—both state and federal—need.

During the NOLC, members of the Board of Councilors, the Board of Specialty Societies, and many state orthopaedic societies brought this message to their Congressional representatives in the House and Senate. Using materials developed for our new public awareness campaign, A Nation in Motion: One Patient at a Time, they extolled the virtues of our new website, anationinmotion.org, with its hundreds of patient stories. They also delivered a specially developed board game, filled with facts and figures about the impact of musculoskeletal conditions on patients and on our economy. The response was both positive and enthusiastic.

This is the biggest public relations campaign the AAOS has ever conducted. In one day, I participated in 33 different satellite media tours. It was a prime opportunity to get our message out to the public.

Let me tell you about another example of our efforts to advocate for our patients that we seldom consider. Our office of government relations, led by William R. Martin III, MD, works almost behind the scenes to make a difference. In the past 4 months as your president, I’ve reviewed and signed numerous in-depth comment letters, recommendations, and reports that the office of government relations has then delivered to Congressional committees, federal agencies such as the Food and Drug Administration and the Centers for Medicare & Medicaid Services, and individual legislators. These letters are aimed at shaping rules and regulations before they are released—and we are effective.

The recent update to the Medical Device User Fee & Modernization Act (MDUFMA), for example, included an expanded definition of custom devices, which was desperately needed, particularly by our pediatric orthopaedic surgeons.

No more free passes
I believe orthopaedic surgeons have often passed on our responsibilities as citizens, absolving ourselves of the messy process of representative democracy. But as First Vice-President Joshua J. Jacobs, MD, has pointed out, new knowledge and technologies will not be developed or accepted if we do not convince payers and policy makers of our continued efforts to promote evidence-based, cost-effective, appropriate treatments. We must replace the locker room cathartic of constant complaints with timely, consistent communication of who we are and what we do. We need a new wave of volunteerism in advocacy and politics—outside the arenas of education and research.

When I first served as a member of the AAOS Board of Directors more than a decade ago, more than a few of my fellow board members refused to make contributions to the Orthopaedic Political Action Committee (PAC). Today, we have 100 percent participation. Ours is the largest medical PAC in Washington, D.C., but we are still far behind the American Justice Association (the trial lawyers)—not only in dollars but also in participation of members.

As PAC Chair Stuart L. Weinstein, MD, often points out, the PAC gives us access to our legislators. Ours is a nonpartisan PAC, which supports individuals of either party who support our issues. Elected officials aren’t necessarily leaders; they often reflect the views of those willing to support them who present persuasive messages.

Incompetent or uninformed politicians can stay in office only if we do not engage with them or educate and we continue to elect them. We need a political discourse to hold them accountable for their words and actions. As Plato said, “Those who are too smart to engage in politics are punished by being governed by those who are dumber.”

It takes courage to run for political office. Just look at one of our own—John A. Barrasso, MD, who impresses me as a real star in the U.S. Senate, someone who’s in public life for the right reasons and is doing a good job. Don’t like your member of Congress? Get out and support someone you can be proud of. Host a coffee; invite the candidate to your home to meet your colleagues; and let our PAC know about your efforts. Colleagues “too busy” to attend can at least write a check for you to deliver.

The title of this column reflects a common definition of “lobbyist—the person you hire to protect yourself from the people you elect.” We must all become lobbyists for our patients. We enjoy the best government in the world’s history; it only asks that thoughtful citizens be informed and ready to take action. So support issues and initiatives you believe in. Take part in the political process, lest others take us apart!