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Published 3/24/2021
Douglas W. Lundy, MD, FAAOS

Unified Advocacy Agenda: How Do We Decide What We Are for or Against?

Editor’s note: This article is part of a yearlong series written by the Advocacy Council chair dedicated to introducing advocacy and explaining key concepts to AAOS members.

I have been actively involved in advocacy for decades, and a question I am commonly asked is, “How can you talk to a politician in that party?” Other variations on the theme are, “You talked with her/him? How were you able to set aside your personal opinions and political beliefs to discuss that topic?” The nation today is sharply divided on partisan issues, so reactions like this from individual members are not surprising. There is also a distinction between advocating for the Association’s healthcare policy positions and supporting a candidate for federal office through the Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons.

Douglas W. Lundy, MD, MBA, FAAOS

To effectively advocate the viewpoint of the orthopaedic community, one must set aside individual political ideations and personal feelings for the lawmaker who is being addressed. Surprisingly, this can be easier to do than it may seem. If you believe that the leader, regardless of how much you agree or disagree with his or her politics, is doing what’s best for musculoskeletal health, a natural degree of mutual respect can develop, and effective interaction can occur. Everyone I have met in this arena, whether I personally admire them or not, has a story to tell and their own set of trials and tribulations they had to overcome to rise to their positions. At the end of the day, they are the ones who make the laws or execute the regulations, so improving our ability to care for patients requires us to interact with and educate them about our issues.

Whenever I accompany physicians to meet with political leaders for the first time, I always remind them that our purpose is only to improve the care of our patients. There is nothing more to the interaction than that one objective. If they want to talk about social issues, the economy, or international relations, they can do that a separate time, and, most importantly, not with me! My personal politics are my personal politics, and no one on the planet knows what I believe on every subject or how I vote. When I advocate for orthopaedic surgery in Washington, D.C., it is only about patient care. It is an incredibly freeing exercise in that I am equally comfortable on both sides of the political aisle.

With that introduction, how do we know what to talk about when we meet with political leaders? How deep and wide is our advocacy agenda? Do we care only about payment reform, or are there other issues that are of importance to us? Do we just talk about whatever the member of Congress wishes to discuss, or do we arrive ready with our specific points and facts to make our case? All of these answers are generated from what is known as the Unified Advocacy Agenda (UAA). Without the UAA, orthopaedic surgeons representing AAOS would be advocating on countless, and often contradictory, issues before members of Congress. We must speak with a unified voice if we are to represent our profession and our patients.

Three of the main charges of the AAOS Advocacy Council are to:

  1. Develop a UAA that will guide the Association’s work in the legislative and regulatory arenas.
  2. Identify issues internal and external to the Association regarding access to and delivery of high-quality musculoskeletal care and address those issues as appropriate.
  3. Develop, review, and recommend to the Board position and advisory statements on health policy-related issues; set the advocacy agenda for AAOS programs such as the National Orthopaedic Leadership Conference (NOLC).

The Advocacy Council comprises the council chair as well as the chairs of the Coding, Coverage, and Reimbursement Committee; Health Care Systems Committee; PAC; and Medical Liability Committee, as well as chair of the Board of Councilors, chair-elect of the Board of Specialty Societies, AAOS first vice president, and a member-at-large. After seeking input from many stakeholders, this group distills the voluminous issues that affect our profession into the concise list of the UAA. After the AAOS Board of Directors (BoD) approves the UAA, the Office of Government Relations (OGR) has a clearer understanding of how they should spend their energy advocating for our profession. The UAA also drives the unified topics that our members take to Capitol Hill each year during what was previously known as NOLC and more recently the In-District Advocacy Event, which took place in August 2020. It should also be noted that the UAA, in combination with other factors, helps guide PAC decisions and its criteria for making political contributions to federal candidates.

The UAA further divides issues into three tiers: (1) active pursuit, (2) opportunistic action, and (3) actively tracking. Understanding that all organizations have only a certain degree of bandwidth, we know that we must focus our limited resources on the matters that have the greatest impact on our profession and patients. We must also determine how likely we are to influence the decisions being made. There are many important concerns that we could focus on, but we must prioritize issues to enable our maximal effectiveness.

The issues under active pursuit are the most important advocacy initiatives of the Association. The OGR and the Advocacy Council drive these issues with all the resources that we can muster. We seek any opportunity to express these concerns to governmental leaders, and these are the topics that receive our greatest effort. Subjects under the opportunistic action category are important advocacy issues that are worked whenever political opportunity allows. These items may not receive the extent of advocacy effort that active pursuit issues do, but they are actively worked whenever the opportunity avails. The lowest category is actively tracking. Although these topics are important, we cannot dedicate our limited resources equally and expect maximal effectiveness. Instead, we actively track these issues and may elevate them in priority as the political landscape evolves. We also work with other like-minded medical and surgical organizations to increase our voice based on how their advocacy agendas coordinate with ours.

Some examples of active pursuit agenda items include encouraging physician burden relief and maintaining surgeon-patient primacy in setting of care. Opportunistic action topics include supporting Stark law reform and both registries and population-based research based on registry data. Actively tracking subjects include drug and device safety as well as advocating for increased guidance from the FDA on novel biologics. Clearly, all of these topics are important, but the Advocacy Council is tasked with collecting input from stakeholders on the priority of each issue and appropriating resources effectively.

I hope that this article helps to explain why the UAA is so important and how it unifies the voice of orthopaedic surgery on Capitol Hill. Multiple levels of people in the organization contribute their opinions to the UAA, and the BoD ultimately approves it. Learn more at https://bit.ly/3sjxyuI.

Douglas W. Lundy, MD, FAAOS, is a trauma surgeon at Resurgens Orthopaedics in Atlanta and chair of the AAOS Advocacy Council.