President’s commentary: Inside view of MSV’s advocacy efforts

15 April 2010

My weekly visits to the General Assembly in Richmond have been a great privilege; representing the doctors of Virginia in challenging times, and also a great opportunity to gain new insights into how government and politics combine to effect, for better and for worse, the practice of medicine. Working with the MSV executive committee and with our government affairs team has indeed been an educational experience for me.

From my vantage point, I am very grateful for the process by which MSV evaluates legislation and decides what position we will take on a great volume of bills. No one could do this alone, and it truly is a team effort.

However, it wasn’t all that long ago that I didn’t know how MSV could get its collective arms around the 2000 to 3000 bills introduced into the General Assembly each year. Throughout the session, the MSV government affairs team assesses the great volume of bills submitted to the House of Delegates and Senate, and identifies the several hundred that impact the health arena and the practice of medicine. Of those, the team analyzes which are likely to go anywhere and which need to be actively followed.

At that point, the government affairs team looks at these bills of interest in the context of the MSV policy compendium as well as our political and legislative goals. These goals were the result of input from the MSV board of directors, the legislative summit and committee, the discussions in various forums at the annual meeting, and staff’s assessment of the evolving political and budgetary environment.

This analysis is then presented to the executive committee on weekly conference calls during session. During these calls, we hear perspectives from the government affairs team and the executive committee takes ownership of our positions on the various bills. We either support, oppose or continue to monitor the bills deemed appropriate for our review. Often we debate the merits of the various positions and the techniques we can use to achieve our political and legislative goals. In addition, the bills are often amended during session and we have to update our positions and lobbying activities, and we assess the effectiveness of our actions.

Building relationships
It really is all about relationships. If we are only about getting what we want and are unwilling to invest the time to form real and lasting relationships, the means for creative partnerships going forward, then we will not be successful. On the other hand, if we are sincerely committed to meeting and understanding why people hold particular positions and work with them seeking common ground, then we will be more successful. I have seen this happen with our staffs and the staffs of legislators and other officials. I have seen this happen with MSV leaders and key legislators. I have also seen this during White Coats on Call days with individual doctors and their legislators. Relationships are about trust and respect, and this is no less true in the political arena.

Other core ideas that I think have become durable lessons for me about the complex process of defending and promoting our values and needs to those with political power include the understanding that if our perspective is only about this year or right now, rather than a more extended time frame, then I think we will be disappointed, less energetic and in the end less effective. A lot of what happens during session is influenced or even determined by what happens outside of session. Meeting with legislators and executive branch members is a year-round activity and this is as true for individual MSV members as
it is for our staff and leaders.

Working with those with political and government authority is a long-term enterprise and it shows its value over the years. Yes, what happens this year is important, but it needs to be placed in the context of what came before and what we are working towards in the future. For us as an organization it is hard to have that disciplined of a perspective, but if we do I think we will achieve greater success.

Measuring success
Closely related, is the idea that our metrics of success in the political arena as an organization have to be as sophisticated as our overall campaign to increase our influence. Certainly we have to be unequivocally successful in our goal to maintain a meaningful cap on malpractice awards, for example, and for protecting the safety of patients in a number of settings. With other issues, however, like the current budget crisis and great and real challenges to the funding of all core services (health, education, public safety) like never before in most of our lifetimes, we have to develop a different notion of scoring how we performed.

Sometimes it really is about how you played the game because if you did it well — with passion, respect and professionalism — then you will be more effective down the road when the conditions and chances of success are much more favorable. We also need to understand that many of our successes this year, like those with regard to nurse practitioners, naturopaths, and Lyme disease, are preventive in nature. We stopped things that we think would have hurt the care of patients in Virginia. It is often hard to fully appreciate the complete value of our substantial efforts to stop bad or misguided efforts from going forward.

As a practicing physician it may seem unexpected that I will miss my visits to the General Assembly at the close of session, but I will. I love caring for my patients and the challenges of clinical care, but I was thoroughly energized during each visit to Richmond. I also think I have acquired a better appreciation for how we attempt to speak truth to power, and how we can better assess our successes and influence going forward.