John J. McGraw, MD, (far right) with Rep. Roe (in pink tie) and members of Rep. Roe's staff.
Courtesy of John J. McGraw, MD


Published 9/1/2016
John J. McGraw, MD; Ann R. McGraw, MSEd

Anatomy of a Congressional Office

Knowing congressional office staff is important
The American Association of Orthopaedic Surgeons (AAOS) generally holds its annual National Orthopaedic Leadership Conference (NOLC) in early May. However, the Congressional calendar varies from year to year, and members of the House of Representatives or the Senate may be back in their districts during NOLC. As veterans of nearly 20 NOLC events, we've overheard AAOS fellows and spouses say, "What's the use of my attending if my representative is not in?" This is a complaint without merit. The work of congressional offices continues in the senator's or representative's absence.

The AAOS office of government relations key ambassador program challenges orthopaedic surgeons to form positive, meaningful relationships with their members of Congress. A good relationship with a congressional representative is more than a relationship with a single person. It must also include positive relationships with key staff members. In fact, a relationship with the appropriate staffer(s) may be as important as the relationship with the elected representative.

Developing these relationships requires an understanding of the structure and function of the congressional office. Although every office is organized in a different manner, most follow a similar pattern.

Inside the office
Our county in eastern Tennessee is split between two congressional districts. This enables us to claim two representatives, as well as our two senators, giving us perspective into the workings of several offices. Reps. Phil Roe, MD (R-TN 01), and John J. Duncan Jr, (R-TN 02) allowed us to interview their staff to get a better understanding of their respective roles and duties.

It may be a surprise to learn how much a congressional office accomplishes with just a handful of staff members. Offices in the Cannon, Longworth, or Rayburn buildings across from the Capitol are usually beehives of activity crammed into relative small spaces. Salaries of each staff member are publicly reported, and commensurate with the staffer's level of responsibility.

Virtually all congressional offices have a chief of staff, who supervises all office activities, in both Washington and district offices. As expected, some chiefs of staff readily delegate responsibilities to other experienced senior staff members. In all cases, their job is to ensure the office functions as a cohesive team. The team concept is so important that both of our representatives had lengthy staff vacancies—not because there was a lack of qualified applicants, but because finding the right person to mesh with existing staff is so vitally important.

A key member of the team is the legislative director (LD), who supervises several legislative assistants (LA). One LD or LA is tasked with healthcare legislation—and is important to know. This relationship opens an avenue of communication for making salient points concerning proposed legislation in favor of our patients. Communicating via email with the healthcare liaison is critical; in urgent cases, we pick up the phone.

It is also important that staff members understand your qualifications and expertise in advocating for patients' issues. Because most members of Congress do not come from the healthcare industry, they look to physicians and other providers as experts when choosing whether to support medical bills. LAs are often the conduits for shaping opinions.

John T. Gill, MD, chair of the AAOS Political Action Committee, starts many of his addresses by asking how many in the audience know the name of their member of Congress and whether he or she "knows your name." To be effective advocates for our patients, that concept must go a step further—to building a good relationship with the LD or LA assigned to healthcare legislation. That includes quick access to you personally should a question on musculoskeletal health arise.

Two other staff critical to each office are the communications director (CD) and the scheduler. Each AAOS key ambassador should have a relationship with these individuals.

John J. McGraw, MD, (far right) with Rep. Roe (in pink tie) and members of Rep. Roe's staff.
Courtesy of John J. McGraw, MD
Ann R. McGraw, MSEd (left) and Rep. Duncan's legislative assistant.
Courtesy of John J. McGraw, MD

Different approaches
Tiffany Haverly is the CD for Rep. Roe. She maintains his Facebook and Twitter accounts and edits his press releases. She communicates almost daily with home district press when Congress is in session. She organizes regular press conferences and works closely with scheduler Catherine Bartley to coordinate events in Washington and the home district.

Rep. Duncan attends every event possible in his home district. He places less value on social media, but accentuates personal contact with constituents. Consequently, he uses two schedulers—one for his time in Washington and one in his central home office. His long-time chief of staff Bob Griffitts (who has worked with him since 1988) accompanies him to most events in the district.

On the other hand, Rep. Roe's chief of staff Matt Meyer has a young family and usually stays in the D.C. area. Rep. Roe is most often accompanied at home by a manager from one of his district offices. Congressman Roe also tries to attend as many events in the district as possible.

In district
District offices can vary depending on the local geography. Usually, each member of Congress has one or two local offices. Urban districts with a concentration of constituents in one city generally have one large office, but more sparsely populated districts will have two or even three offices. These function to help local citizens obtain access and services from the federal government. Veterans' benefits, Social Security, appointments to the military academies, grants for local governments, and a host of other needs are handled through the district offices.

Washington-based staff occasionally visit the home district. The healthcare LA is an ideal person to invite to tour an orthopaedic practice. Visits are also opportunities to cement relationships that will affect future advocacy efforts.

Although Senate offices differ from House offices, they tend to follow an analogous structure, with a chief of staff, an LD, and several LAs as well as a CD and a scheduler. Most of the time, Senate offices have more staff than representatives have, which may enable each staff member to develop more expertise in their policy field. It is just as valuable to form meaningful relationships with the appropriate health policy staffer(s) in Senate offices.

All members of Congress want quality orthopaedic care for their constituents—who are also our patients. Their staff members share similar concerns. Access to them is sometimes possible when direct communication with the congressperson is not. Get to know the vital team members of your Congressional office. Know them personally as well as professionally. These men and women can help us be even better advocates for our patients.

If you have a meaningful relationship with your elected representative and are interested in signing up for the key ambassador program, or would like to be connected with staff in your congressional offices, the AAOS office of government relations can help; simply contact Stephanie Hazlett, AAOS government relations specialist, at

John J. McGraw, MD, is medical director of OrthoTennessee and a member of the AAOS Communications Cabinet. Ann R. McGraw, MSEd, was a spouse participant in the 2016 Advocacy Forum for Orthopaedic Advocates.

Tips for Extending Advocacy
The following tips may be helpful in extending advocacy efforts to congressional staff.

  • Find out who is responsible for healthcare policy. Get the individual's name and contact information—and make sure he or she has your name and contact information.
  • Reach out on a regular basis. Share stories of how legislation is affecting you and your patients.
  • Invite your congressional representatives to lunch when they are in district. Both Reps. Roe and Duncan have visited OrthoTennessee to discuss problems and needs specific to the practice. The invitations should come through the LD or LA.