Ramnik Dhaliwal, MD, JD
Chair, CMS Council on Legislation

A legislator asked me that question last fall. She was not being dismissive. She wanted to know how many physicians stood behind what I was about to say.

Before I tell you my answer, let me acknowledge the argument against renewing your Colorado Medical Society membership, because many physicians make it quietly between opening the dues notice and setting it aside.

The argument is simple: When CMS succeeds, every physician benefits, including those who never paid dues. Why pay for something others receive for free?

It is a rational argument. It is also why our collective voice is more fragile than it appears.

When physicians opt out, the work does not become less expensive. It becomes less effective. Insurance companies, hospital systems, attorneys and other well-funded interests do not decide each year whether advocacy still feels worthwhile. Their representatives are at the Capitol because the policies being debated directly affect them.

Physicians need the same consistent presence.

Membership provides the numbers behind our message. Dues provide the resources required to deliver it. We need both.

The value of what
did not happen

The challenge in explaining advocacy is that the product is often an absence.

You do not receive an email when a harmful provision is removed from a bill. There is no announcement when a regulation is changed before it reaches your practice. You may never know that someone proposed weakening your licensing protections, increasing your liability or making it harder to collect payment for care already provided.

You simply continue caring for patients.

Consider prior authorization. Colorado reforms extended many approvals from 180 days to one year and reduced repeated authorizations for many chronic medications. Carriers must offer alternatives for physicians with strong approval records and cannot deny coverage for a related procedure discovered to be necessary during an operation.

When the Colorado Medical Practice Act underwent sunset review, CMS helped preserve physician representation on the board that licenses us and opposed proposals that could have weakened due-process protections. CMS also defended the confidentiality of physician peer-assistance programs.

These are not glamorous victories. They protect your license, livelihood and ability to seek confidential help.

You do not receive a notification when a harm fails to reach you.

Not every fight ends in victory. Colorado physicians still face a Medicaid payment reduction as the state attempts to balance its budget. We should not call a cut a win. But advocacy is also measured by what was prevented, reduced or improved and whether physicians remained at the table. In a difficult year, it can mean the difference between a cut and a rout.

Colorado’s rules are
written in Colorado

National specialty societies are essential, but many decisions most directly affecting our work are made here.

Prior authorization, licensure, Medicaid rates, scope of practice, insurance regulation and professional discipline are debated at the Colorado Capitol and within state agencies and regulatory boards.

Your employer’s government-affairs team represents your employer. Your specialty society represents your specialty. CMS represents physicians: employed and independent, urban and rural, primary care physicians and specialists.

Being proactive requires relationships before a vote is needed, physician input before a bill is introduced and experts who can identify unintended consequences before they become law. That requires voices, numbers and money.

Most CMS members will never testify or attend a legislative meeting. The model still works. Your dues place a full-time team in the room while you are caring for patients.

How many of us are missing?

When that legislator asked how many physicians I represented, I answered:

6,244.

That is a meaningful number, but Colorado has roughly 18,000 licensed physicians. Only about one-third are standing behind the collective voice of CMS. Imagine the answer I could give, and the credibility it would carry, if physicians participated at the rate of Colorado attorneys.

The Colorado Bar Association is also a voluntary, dues-supported professional organization. It has approximately 16,000 members and represents a substantial share of Colorado attorneys. Its voice at the Capitol is powerful because lawmakers understand that it speaks for a large portion of the profession.

Physicians should expect and build the same influence.

I know CME funds are shrinking and physicians are questioning every professional expense. It is reasonable to ask what membership provides.

CMS membership protects the environment in which you practice. It gives physicians a voice before decisions are made, not merely after the consequences arrive.

Our influence must be rebuilt every year, one membership at a time.

Renew your membership or join us.

The next time a legislator asks how many of us there are, I want to include you in the answer. ■