All politics is local
Donald S. Karcher, MD
April 2024—When Tip O’Neill, former speaker of the U.S. House of Representatives, said many years ago that all politics is local, he was talking about how elections, legislation, and all of politics affect people where they live. I believe the concept applies just as much to pathology advocacy. When it comes to the issues we care about for our profession and for our patients, our efforts in advocacy, lobbying, educating, and persuading all need to happen at the local level just as much as at the national level.
That’s why many of the CAP’s advocacy efforts take place at the state and local levels. Typically, we associate advocacy and lobbying with Washington, DC, but more and more issues that affect pathologists day-to-day are coming up closer to home.
Consider private payers and everything they’re doing to pay pathologists and clinical laboratories less. One of the ways private payers have reduced their costs is by creating very narrow networks. These insurance companies are increasingly offering very low in-network rates or simply not allowing pathologists to join their networks at all. And with the No Surprises Act, even out-of-network pathologists can now often collect only the in-network rate for their services. That’s frequently much less than what a pathologist would typically charge or previously collect, and it’s hindering our ability to deliver the best possible care to our patients. Addressing network adequacy and related billing practices is currently a state and local issue as these are usually regulated at the state level.
Another major issue is scope of practice, with nonphysicians trying to take on more functions traditionally performed by pathologists. This, too, is a state issue because each state sets its own requirements for the training and experience needed to perform certain clinical tasks.
These are just two examples that underscore why it’s so important to advocate for our profession, our laboratories, and our patients at the state and local levels as well as at the national level. The CAP is actively working at all of these levels to further the interests of pathologists and our patients. A key part of the CAP’s advocacy efforts is to work closely with and support state pathology societies as we together tackle important issues in the states.
By the time you read this column, the CAP’s annual Pathologists Leadership Summit will have just wrapped up. This is one of our most important advocacy activities. Pathologists come from all over the country, not only to speak with members of Congress or their staff during Hill Day but also to receive valuable coaching about how to present our positions clearly, succinctly, and with authority. That’s a skill that will help us advocate for our most important issues with any audience, at any level.
I attended my first summit in 2011 (we called it the Policy Meeting in those days), and I’ve never missed a year since. I remember that, at first, meeting with my elected representatives in Congress seemed like an intimidating or overwhelming thing to do. But by the end of the day, even that first year, I regarded it as one of the most rewarding and fun experiences I’ve had as a pathologist. It’s truly democracy in action: advocating for the things that matter most for us as pathologists to the very people who have been elected to represent us. When we go to a congressional office, we often meet with our elected representative, but we just as often meet with their key staff members. Although it’s fun to meet and be photographed with our senator or representative, I believe it’s even more productive to meet with their legislative aides because they are the ones who deeply research issues on behalf of the elected member they work for.
The skills we learn at the Pathologists Leadership Summit in the lead-up to Hill Day stay with us, giving us the confidence and policy knowledge we need to continue that advocacy back at home. While the preparation and talking points help, the most important thing to remember is that only we can speak with authority about what pathologists need to give our patients the best care. Whether we’re advocating at the national, state, or local level, our expertise matters. People will listen because we have the training, skills, and experience to know what we’re talking about.
If you’ve never attended the Pathologists Leadership Summit, I highly recommend giving it a try in the future. I also encourage all of you to become active members of your state and local pathology societies, to help address the critical issues we face every day where we live and practice. To add to Tip O’Neill’s famous statement: All politics, advocacy, lobbying, educating, and persuading is, in the end, local.
Dr. Karcher welcomes communication from CAP members. Write to him at president@cap.org.