by Alfred Gilchrist, CMS CEO
Featured in the November-December 2019 Colorado Medicine Colorado Medicine.
It has been my good fortune to represent the medical profession in the public affairs space almost continuously since 1978. I have been on the inside of many health policy initiatives – both good and bad – debated in the Texas Legislature, the U.S. Congress and the Colorado General Assembly that affected the practice of medicine and the care of patients. It is unknown whether the cumulative effect of long and, at times, painful experiences from a lifetime of health care advocacy is scar tissue, wisdom or both.
The lines and cracks that delineate the legitimate economic interests of medical communities have widened and complicated physician advocacy. There is less-than-zero in the complex, rigorous world of medical training that prepares physicians for the non-linear chaos of a universe where politics drives the process that sets policy. Physicians would be well served to address this deficit given that health care politics in Colorado has been elevated to almost militant levels of activism both in the consumer and stakeholder communities, driven across the board by the rising cost of care.
The economic pressures and administrative burdens that are splintering organizations and galvanizing physician views along demographics, practice types or specialty alignments weaken your collective ability to persuade and sustain a unified position, much less make a fist and throw a punch. This is a vulnerability that politicians readily exploit. They can smell these intramural differences from across the dome. The same pressures that have provoked alarming levels of work dissatisfaction and burnout also suppress physician engagement in the politics of health care. Throughout my career, bandwidth, ideology and partisan bias have also conspired to limit the reach of medicine to influence the policies that govern.
During my formative years and into adulthood, physicians played critical roles at various times of my life. Dr. Bundy came to our home when we were sick. Roderick McDonald saved my right eye. Gaines Entreken got me through two difficult hospitalizations. Uncle Doc, Robert Patton and Jack Ward were inspirations. When Larry Frederick roared up hospital hill a half block from my home, I knew he was going to the emergency room and I often wondered what he’d find. The daily, even hourly professional sacrifice and heroics of physicians have always amazed me, and they served to motivate me during my career. God bless you all.
Surely, there is still more that unites than divides your profession. We might start thinking of unity as areas of moral clarity; a space where advocacy comes into sharp focus for sustainable, meaningful consequences for patients and society as a result of organized and methodical consensus building.
We must recognize that the widening gaps between medical communities render professional advocacy more daunting and complicated than I could have ever imagined in 1978. Paul Starr warned us about these sea changes in his 1982 Pulitzer Prize winning epic “The Social Transformation of American Medicine.” Physician advocates across the country avidly read and discussed it back then, yet we continue to struggle with how to adapt medical society governance so that form anticipates function in a meaningful and unified way. While it’s more challenging than ever before to be Gretzky in today’s medical rink, I offer my bias as to what has worked and can work moving forward.
1. Medical society governance across the country has to flatten into a shareholder model. Our first-in-the-nation virtual policy forum, Central Line, is a step in the right direction. It connects across the spectrum of medicine to engage in evidence-based debates that are grown into a consensus. Horizontal engagement does not imply forgoing the fundamentals of local, face-to-face engagement. It is more a sociogram than a flow chart.
2. Medical society priorities should also target root causes of population health failures – the social determinants – as well as aligning incentives that assure care value is optimized. This implies as an organization saying “no thanks” to agendas that can’t prove value or advance the broader task of improving population health.
3. Priorities are not an annualized box to check in a board report. The art of advocacy is in the set-up – strategic considerations that should be incubated over time – in cycles that might require years to gestate. It incubates in local elections and grows into grassroots when the General Assembly convenes. This transitions the “Gretzky rule” – skate to where the puck is going – from concept to reality.
4. Pick your fights carefully and sustain them. An adversary needs to know the organization will persist, notwithstanding counterpressure and, in some cases, friendly fire.
5. Always look to accommodate. No organization has bulletproof wisdom. No matter how well developed the policy, it will need to be revised over time. There is far more to lobbying than lining up votes and running over an adversary.
6. Stare down your outliers – residing in the areas of moral clarity means not accommodating or defending the indefensible regardless of who is antagonized. This also requires acknowledging whether the outlier is actually a game-changing catalyst. Is the outlier going where the puck is headed?
7. The preservation of clinical autonomy and balance in the practice ecosystem is paramount. Assuring practice choices and legitimate competition must center on the value of care.
Thank you for what you do every day in communities across our great state and nation and, once again, for the honor and privilege of serving as your advocate.