The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States. Fortune magazine consistently ranks the National Education Association in the top 15 of its Washington Power 25 list for influence in the nation’s capital. In the words of Terry Moe, author of Special Interest: Teachers Unions and America’s Public Schools, “the power of the unions to block change is the single most important thing that anyone needs to know about the politics of American education.”
How did a group of teachers and teamsters become so powerful? It started when a critical number decided to collectively contribute significant funds to political campaigns. If 330,000 union members in Sacramento, for example, agree to contribute $1000 per year to political campaigning, that’s $330 million a year that can be spent influencing and/or controlling California’s legislative process. With this kind of influence, nearly every piece of legislature would need union approval before it has a chance of surviving a vote. Extend this across the country and the same logic—and influence—holds true.
Now I am not suggesting that it is good for the political process to bend to the will of a single group purely because they’ve got the most money. As a matter of fact, I find it unethical and ultimately destructive of our system of government. However, it is a stark reminder of emergency medicine’s need to engage actively in the political process. It is absolutely critical – even to our survival – that physicians take an active role in health reform at a legislative level.
In the 70s, a few of us tramped around the halls of Sacramento trying to influence legislation. Although we thought we were wearing the white hat and our cause was critical and everyone should do what we ask, we did not find ourselves to be very influential. And then along came Jim Randlett who became the Cal/ACEP legislative advocate for many years. Early in my Cal/ACEP government affairs activity, it became apparent that we needed a Political Action Committee, and EMPAC was born. About that time, upon the request of then ACEP President, John McDade, I accepted leadership of the Government Affairs Committee for ACEP and marched on Washington with our first part-time lobbyist, Terry Schmidt. In an effort to influence policy on a national level, the National Emergency Medicine Political Action Committee (NEMPAC) was born. ACEP opened and grew a substantial Washington office, all in recognition of the fact that if you want to make something happen – or prevent something from happening – you need to be influential where decisions are being made and where the money is doled out.
Emergency medicine now enjoys wide respect and influence at state levels throughout the land, and at the Federal level with very well placed and effective legislative advocates working full time on our behalf. But what we are doing is not enough when the “pie” is limited and powerful players are doing the slicing. Imagine if half of the physicians in the USA each contributed $1000 each year to political campaigning. We would match at least one union in California. Trial attorneys in California are trying to kill MICRA. Without some $2000/year that they each contribute to campaigning, they would not have a chance. Our AMA and state and county medical associations have worked hard to look out for physicians in America, but with physicians giving around $60 per year to the political process, their position is severely compromised.
We in medicine are looking at increased competition for declining dollars in the face of soaring demand for services. California is cutting MediCal payments to physicians by 10% and may even take some back that they have paid in the past. Medicare is scheduled for cuts and the legendary fight over the SGR continues. Do you think that this would be happening if physicians were spending $2000/year on the political process?
Why are physicians flocking to hospital employment? It’s not because fee for service is working well for most physicians. It is more likely because hospitals are community resources employing a lot of people who vote, supported by politicians who want their voters to have a hospital in their community. Physicians, by drinking plenty of the water but not adequately helping to carry it, have not counted – and I submit will not be counted – for much unless they start participating in the process.
Participation in the process means joining and supporting your specialty society and, as I’ve extolled before, joining the AMA. Most physicians may not have the time nor interest in being a councillor or committee member or delegate to the AMA. That is perfectly fine. What physicians need to do is pay dues and belong to their speciality organizations and the big house of medicine represented by the American Medical Association. It might seem basic, but these organizations grow in influence and effectiveness with sheer member numbers. The next essential step is generous participation in our Political Action Committees, EMPAC in California, NEMPAC nationally and AMPAC as well. The cost might seem painful at first, but it’s a minor discomfort relative to the pain of declining reimbursement that is on the way and sure to get worse if we don’t step up to the plate.
Emergency medicine organizations have done an outstanding job of educating EPs and they advanced the specialty from unrecognized to being a highly respected, appreciated, and critical specialty logistically and academically. But there is still much work to be done. If just 900 emergency physicians were to give $1000 each, ACEP’s PAC would eclipse both the orthopedists (who have an average annual contribution of $106 per 18,318 members) and the AMA (who average $12 per 157,000 members). ACEP currently averages $47 per eligible member (22,000). The added influx could not only make ACEP the largest PAC in the beltway, but more importantly, allow it to be a whole lot more effective in promoting, preserving and protecting our specialty.
Finally, the number of delegates and alternates that ACEP is entitled to at the AMA House of Delegates is determined by how many ACEP members there are who are also AMA members and have designated ACEP as the organization to represent them. AAEM is represented at the AMA EM Section Council, usually in the person of Joe Wood. Based on our 3007 AMA members at the last count, ACEP has five delegates and five alternates, up from the single one when I started in the 80s. We would like to raise that number to over 4000 members and gain another delegate as we work to potentially elect the first emergency physician as the 170th President of the AMA in June 2015 in the person of Steve Stack.
Richard L. Stennes MD, MBA, is the ACEP Delegate to the AMA House of Delegates and was the president of ACEP from 1985-1986