On Advocacy and the Early Career Cardiologist

The 2015 ACC Legislative Conference provided Early Career physicians with a unique and exciting opportunity to work directly with lawmakers in order to shape important policy issues and have discussions that will impact how we provide cardiovascular care in everyday clinical practice. We had terrific representation of young eager cardiologists who got a chance to learn what happens in the government at a local and national level. Early Career Professionals had a unique opportunity to have a roundtable informal discussion on critical issues facing health care and got a chance to learn directly from the "giants" who shape health care policy, such as advocacy expert and veteran, M. Eugene Sherman, MD, FACC.

The excitement was palpable as Early Careers were meeting directly with congressional leaders to share the ways in which the cardiovascular community is providing quality, evidence-based care to millions of patients nationwide. Below, Joshua Schulman-Marcus, MD, recipient of a travel stipend from the ACC NY Chapter and first time attendee, Tom Ryan, MD, PhD, FACC, recipient of a travel stipend from the ACC Ohio Chapter and first time attendee, and Rajesh V. Swaminathan, MD, FACC, co-chair of the ACC Emerging Advocates Program, share their experience from the 2015 ACC Legislative Conference in Washington, DC:

Upon completing training, early career cardiologists rapidly recognize that the practice of medicine is as influenced by the larger political and regulatory environment as by the scientific literature. These forces largely determine the character of our employers, which patients we see, the nature of medical documentation, what tests we order and how we are paid. While trainees are often obliquely made aware of this power dynamic, early career cardiologists ignore it at their peril.

In this light, the ACC has recognized the necessity of political advocacy. It gives cardiologists (and their clinical care teams) a voice with rule-makers and politicians. This is imperative, even if our numbers are small compared to the advocacy of larger players, such as insurers and hospital systems. After all, as told to us numerous times, "if you don't have a seat at the table, you may be on the menu." It's our impression that many cardiologists feel that they've been on the menu for the past few years.

For two days this October, we had the privilege of attending the 2015 ACC Legislative Conference in Washington, DC. The conference was attended by over 400 cardiovascular professionals from across the U.S. Our attendance was facilitated by a travel stipend from our state ACC chapters and from the ACC Emerging Advocates Program.

The first day of the conference was devoted to education on some of the major policy issues relevant to cardiology. This included inspiring lectures by ACC President Kim Allan Williams Sr., MD, FACC, and Bruce Siegel, MD, MPH, chief executive officer of America's Essential Hospitals; updates on major legislation; and workshops on how to create relationships with legislators.

The second day, we visited the offices of our local representatives and senators, where we tried to advocate for several specific causes, including expanding medical research, allowing cardiac rehabilitation to be supervised by non-physician advanced practitioners, as well as the inclusion of specialists in rule-making pertaining to Medicare reimbursement and electronic health records.

There were a few pediatric cardiologists in attendance at the Legislative Conference who were able to advocate for important legislation that affects patients with complex congenital heart disease. In addition to ACC's advocacy priorities, the pediatric attendees were able to discuss H.R. 546/S.298, the Advancing Care for Exceptional (ACE) Kids Act of 2015. ACE Kids is an important piece of legislation intended to establish a nationally designated children's hospital network to reduce hospital visits and emergency room visits.

ACC's advocacy efforts need the voice of early career physicians. This is no simple feat, as many of us are busy enough trying to establish careers, fulfill family obligations, pay off debts and squeeze in a few hours of pleasure. It is too much to expect most of us to be up-to-date on political and regulatory minutiae and maintain personal connections with our legislators. And yet, we are the future face of cardiology in this country, and it is a different face than much of ACC's advocacy leadership. We are more diverse, more tech-savvy and have entered cardiology amidst a different employment landscape. Most importantly, legislative and regulatory changes will affect us much longer than physicians closer to retirement. In many ways we are analogous to young voters who can swing an election, but only if they show up. The ACC knows this, and it is our hope they will continue to facilitate our participation in setting and representing their agenda.

Advocacy doesn't have to be an all or nothing cause. Even small efforts transcending "slacktivism" matter, and these are much more achievable by the busy early career cardiologist. Several presenters at the legislative conference showed evidence that most politicians are influenced by even an occasional visit or letter. We noted this to be true when we went to legislators' offices. Given the prevalence of cardiovascular disease in the population and a higher respect for physicians than lobbyists, legislative aides and politicians are willing to listen to our perspective. It's also easier for them to relate to it, to think of a grandparent or friend with heart disease. Our message is augmented by the participation of cardiovascular team members, which sends the message that we are not just advocating for doctors but for all health care providers and trainees to improve the quality of care for our patients. The combination of these favorable elements may make even a brief encounter more politically meaningful.

At the legislative conference, the coming transformation of Medicare reimbursement towards a "value-based" system was frequently discussed. The specifics are still being finalized, but as the blanks are filled in, we will feel the implications daily in our practice. There will likely be several shifts like this over the coming decades as the baby boomer generation retires, technology advances and the limits of our overly expensive system are reached. Our careers will be molded by the political and regulatory responses to these larger trends. Busy though we might be, the ACC Legislative Conference re-enforced the importance of maintaining our voices in the halls and tables of Washington, DC. Otherwise, we (and our patients) may find ourselves on the menu.

The Emerging Advocates Program is a new initiative from the ACC which provides a unique opportunity for ACC members, particular Fellows in Training, Early Career Professionals and Cardiovascular Team members, to increase their knowledge of the College's advocacy and health policies, and to receive structured didactics and advocacy mentoring over a two-year period. To learn more, visit ACC.org.

For more information on the 2015 Legislative Conference, visit the ACC in Touch Blog.

This article was authored by Joshua Schulman-Marcus, MD; Thomas D. Ryan, MD, PhD, FACC, and Rajesh V. Swaminathan, MD, FACC, co-chair of the ACC Emerging Advocates Program, with a forward by Jeffrey Anderson MD, FACC, and Dmitriy N. Feldman MD, FACC, co-chairs of the Early Career Professionals Leadership Council Advocacy Workgroup.