President’s Desk Column

Advocacy and professionalism

May 2002
Paul A. Raslavicus, MD

Wisdom is knowing what to do next; virtue is doing it.

-David Starr Jordan, MD,
Stanford University’s first president

One of the most important CAP strategic directions—those outlined in the strategic plan—is advocacy. While the College is committed and prepared to advocate on behalf of the profession, successful outcomes require not only the efforts of our association but of each one of us as individuals.

Since its founding the College has espoused excellence in the practice of pathology and laboratory medicine. Pathologists have insisted on consistent, quality performance in their laboratories, wherever they were located. We relentlessly pursued quality beyond reproach. As our partner in this effort, the College supported us through the Laboratory Accreditation Program and its accompanying Surveys. Through this symbiotic relationship, pathologists became the leaders in all of medicine in quality assurance and improvement.

Our strategic plan intends to bring the message that we stand—before all health care decision-makers in or out of government—first and foremost for quality in the care of patients. To do this, we again need a partnership between the College and its members. With your personal involvement, we can more than hold our own in the national arena against other interest groups. We need members to testify before Congress, visit lawmakers, take part in fundraising events, and get involved in their state medical and state pathology societies. We also need you to participate in local political campaigns and in work with state legislatures and state regulatory agencies.

Advocacy with the government is only a part of a much broader process. Medical care has become so fully integrated that any effort to represent our interests is likely to involve other physicians, non-government payers, hospital and health care system advocates, special interest groups, and others. This means, as an example, involvement with influential entities such as the National Quality Forum, which was created to develop and implement a national strategy for health care quality measurement and reporting. The College is pleased to be one of the Forum’s early members.

Winston Churchill once said politics is not a game but an earnest business. Influencing public policy requires significant investment, and a terrific way to accomplish this is for CAP members to invest in their future by joining PathPAC, the College’s political action committee. A total of 921 CAP members joined PathPAC in 2001. We can and must do better; we need to double the membership and contributions to place us among the top 10 physician PACs in the United States. With your help, as a CAPmember, we can do this and thereby double our effectiveness in influencing outcomes in many more congressional races.

I ask also that you participate in the American Medical Association. Despite its shortcomings and sometimes deserved criticism, the AMA is the place where all specialties intermingle, where we can spread the word about pathology’s needs, and where we can most readily establish relationships with colleagues that will be of future importance. It saddens me that the CAPhas lost one if its five AMA delegate seats because of a declining number of AMA member pathologists’ votes. This is not what one would call "moving ahead"; this means we have fewer opportunities to participate on committees, to seek national office in the organization, and to strengthen personal ties that increase pathology’s influence.

Personal relationships are requirements for effective representation. I recently spent two days in Washington meeting with congressional and administration leaders.

• I met with Rep. Nancy Johnson (R-Conn.), House Ways and Means health subcommittee chair. She and I had become acquainted at a fundraiser for a congressman who failed in his bid for office, and that earlier encounter helped in our discussion of the legislation she has introduced to ensure a positive update next year for Medicare physician payments.
• I met with Michael Ascher, MD, who coordinates bioterrorism preparedness in laboratories for the newly created HHS Office of Public Health Preparedness. Dr. Ascher was first exposed to SNOP, SNOMED’s predecessor, in his youth during his work in a College member’s lab in Illinois, so he already appreciated SNOMED’s usefulness in bioterrorism communication.
• I met with HHS deputy secretary Claude Allen, and we talked about the need for more CAP members on federal advisory committees and our concerns about proposed medical records privacy and "business associate" regulations under HIPAA.
• I met with Rep. Fortney "Pete" Stark (D-Calif.), who knows well our issues of lack of appropriate payment for clinical lab services, and with Rep. Mark Kirk (R-Ill.), whose district includes the College headquarters in Northfield.

This was time well spent, and it was personally satisfying. If you get involved, you too will be rewarded. The easiest way to do this is through the College’s grassroots Pathology Advocacy Network. The network, through laboratory tours for members of Congress, visits by CAP members to Capitol Hill, and telephone and letter-writing campaigns, is making pathology’s voice heard. (Call the College’s Washington office—800-392-9994—to learn more.)

Advocacy need not be—and often is not—based on an economic imperative. We may speak with our legislators and regulators about payment formulas and conversion factors, about lack of appropriate payment for Part A services, and about onerous documentation requirements, but our underlying motives are always aligned with the needs of patients. We do this so they are able to obtain medical care that is of high quality, that is delivered professionally, and that puts their needs first. Rules and regulations that are detrimental to the quality of care degrade the medical profession. Likewise, patients are often poorly served by those who view the provision of pathology services first as a business and then, if one is lucky, secondarily as a profession. When we stand together with patients as partners in the delivery of personal and quality service, we serve them and our heritage best. Patient primacy is the essence of professionalism, and professionalism is the basis of medicine and the essence of the College.