Why should we donate and what can we do to improve involvement?

The Orthopaedic Political Action Committee (Orthopaedic PAC), as AAOS President David D. Teuscher, MD, explained in the June 2015 issue of AAOS Now, is a vital tool used to engage and support elected leaders to promote those issues that are most important to us as orthopaedic surgeons. The Orthopaedic PAC was formed in 1999 to help advance the legislative agenda of AAOS and is now among the largest association PACs in the United States. This is great news, but there is significant room to grow; just 31 percent of orthopaedic surgeons contributed to the Orthopaedic PAC in the 2014 cycle.

This information is important to all residents because we are orthopaedic surgeons-in-training. The goal of this article is to explain how we can make a real difference in Orthopaedic PAC participation.

Why it matters
As orthopaedic residents, we have our entire careers ahead of us. Policies established today will have a profound impact on us as we move along that path. The success and impact of the Orthopaedic PAC was seen most recently when Congress finally came together and passed legislation repealing Medicare's sustainable growth rate (SGR) formula, a reimbursement formula that has caused instability for years within physician practices.

Orthopaedic PAC funds enable the AAOS to build relationships with policymakers and gain access to them during the formation of health policy. The access gained through the Orthopaedic PAC enabled the AAOS to be closely involved in formulating the bill that ultimately replaced the SGR. Therefore, this legislation was strongly supported and influenced by organizations such as AAOS.

All of the issues that the Orthopaedic PAC supports are put forth and endorsed by the Council on Advocacy, which oversees the PAC Executive Committee. The PAC Executive Committee then makes carefully studied, well-informed decisions on whom to support, ensuring that financial support is put where it will best represent the profession. Advocacy issues can be viewed in the government relations section of the AAOS website (www.aaos.org/dc). They include priorities such as repealing the Independent Payment Advisory Board to protect senior's access to care, medical liability issues like protecting sports medicine physicians who practice across state lines when they travel with their respective teams, and physician payment policies.

As residents, the best thing we can do is take a proactive approach by engaging in professional advocacy early in our careers. (See "Easy Steps for Advocacy Involvement as a Resident," AAOS Now, June 2015.) Despite challenges, residents can make a real difference in the Orthopaedic PAC and other areas of professional advocacy.

Engaging residents
My interest in the Orthopaedic PAC and increasing PAC involvement within my residency program began earlier this year. I was first introduced to the influence the Orthopaedic PAC can have on our advocacy efforts during a Grand Rounds Academy update by AAOS First Vice President Gerald R. Williams Jr, MD. I learned about the importance of getting involved, but still did not realize the influence that residents could have.

A few weeks later, as I was preparing for the first Resident Assembly meeting, I saw that six residency programs (Columbia University, Geisinger Health System, University of Vermont, University of Connecticut, University of Hawaii, and the University of Puerto Rico) had achieved the amazing goal of obtaining 100 percent resident participation in the Orthopaedic PAC in 2014. I reached out to these programs to learn how they achieved this level of involvement, and learned not only how to do it, but also the impact that residents can have.

David A. Halsey, MD, of the University of Vermont Medical Center (UVM), knows the importance of professional advocacy through his many leadership roles in the AAOS, most recently as the chair of the Board of Specialty Societies. In 2013, his state of Vermont had 16 percent participation in the Orthopaedic PAC from practicing orthopaedists. He wanted to improve this statistic and started by encouraging the residents at his own program to join the Orthopaedic PAC with a nominal contribution.

During a lecture on practice management, Dr. Halsey explained the importance of supporting the Orthopaedic PAC to residents. Within 2 days, every resident in the program had made a contribution. Not to be outdone by residents, faculty members increased their involvement. Dr. Halsey then presented this information to the Vermont State Orthopaedic Society. In 2014, Orthopaedic PAC involvement increased to 58 percent! And it was residents who took the lead and showed their understanding of the importance of the Orthopaedic PAC.

Some faculty members have instituted an Orthopaedic PAC match campaign within their programs. According to William N. Levine, MD, of Columbia, matching donations was a large motivator in attaining high participation. Dr. Levine organized the effort like a corporate donation drive. Recognizing the importance of early involvement, he encouraged every resident to donate to the PAC, even if the dollar amount was low, and he guaranteed to match every resident donation. This strategy not only promotes resident involvement, it also increases PAC contributions.

The Health Policy Committee of the Resident Assembly—and Resident PAC Fellow Chad A. Krueger, MD—have set the following goals to improve resident participation in the Orthopaedic PAC:

• Each program with less than 50 percent participation in 2014 can try to reach 50 percent participation in 2015.
• Each program with more than 50 percent involvement in 2014 should try for 100 percent participation in 2015.

Even a minimal donation of $5 to $10 can make a difference in the future of orthopaedics. If each program achieves these goals, residents would send a message to all orthopaedic surgeons. As more residents invest in the Orthopaedic PAC, they will help it grow and enable its message to resonate louder. Furthermore, participation would set a foundation of broad Orthopaedic PAC involvement early in residents' careers making sure that we have a voice in the policies directly affecting our future practice life.

Seeing results
In the past few months, nearly half of my fellow residents at Thomas Jefferson University have joined the Orthopaedic PAC after years of minimal participation. Resident member participation in the Orthopaedic PAC in 2015 has already surpassed 2014 involvement levels with more than 130 resident PAC members representing 39 different programs.

For a complete listing of participating residency programs, download the Orthopaedic PAC Resident Toolkit at www.aaos.org/pac; To learn more about the importance of residency involvement in the Orthopaedic PAC or for resources you can use to encourage your program to become involved, contact pac@aaos.org or 202-546-4430.

Daniel E. Davis, MD, is a member of the AAOS Resident Assembly. He is a PGY-5 at Thomas Jefferson University in Philadelphia. He can be reached at daniel.e.davis@gmail.com