I didn’t know there is an underground subway connecting the House of Representatives and Senate buildings to the U.S. Capitol until I was running through the halls with Representative Virginia Foxx (R-N.C.). We jumped into the “members only” elevator, sprinted to the subway, and arrived just in time for a vote on the House floor. I also didn’t know there is an orthopaedic surgeon who is also a senator until I met John Barrasso, MD, FAAOS (R-Wyo.). I also didn’t know the difference between the terms “regulatory” and “legislative” until I did the AAOS Resident Advocacy Fellowship.
Over the past year, I have spent time meeting with and learning from the AAOS Office of Government Relations (OGR), located in Washington, D.C. Truthfully, before I applied for the fellowship, I didn’t even know that the office existed. Based on a recent poll undertaken during my AAOS Instagram stories takeover, about 70 percent of respondents said they did not know that AAOS has an office in Washington, D.C.
The OGR promotes and advocates the viewpoints of the orthopaedic community before federal and state legislative, regulatory, and executive agencies. Efforts may be focused on helping government bodies like the Centers for Medicare & Medicaid Services (CMS) create and implement laws on the regulatory side. For example, the regulatory team assists CMS in determining which procedures should remain or be removed from the inpatient-only list. Other initiatives involve helping to shape legislation in Congress. You may have heard of AAOS’ efforts to support one of the numerous bills being proposed to stop surprise medical billing. Subtle differences in each of the bills can have significant consequences on our healthcare system, so the AAOS advocacy team is working tirelessly to support legislation that would include an option for arbitration and give physicians more negotiating power.
As part of the Resident Advocacy Fellowship, I had the opportunity to spend a week in Washington, D.C., meeting with representatives and senators from both sides of the aisle. We met with Representative Alma Adams (D-N.C.) and chatted about her hats—she has more than 1,900. I also had dinner with Senator Bill Cassidy (R-La.), a former gastroenterologist, and talked about Louisiana State University football. During the meetings, we also had meaningful conversations about issues affecting orthopaedic surgeons, such as burdensome prior authorization requirements and the need to lift the ban on expansion of physician-owned hospitals.
I also have learned that effecting change in government requires persistence and patience. Ironically, one of the reasons I went into orthopaedics was that the care we provide has more immediate results. If a bone is broken, it needs to be urgently fixed. But if the government is broken, then we form a committee to debate the merits of fixing it, vote on a resolution, and then have a debate on the House floor.
Change does happen though—very slowly. We are fortunate as a profession to have dedicated, passionate people in Washington, D.C., fighting battles daily on behalf of orthopaedic surgeons—battles most of us do not even know about. While you’re preparing for your first total knee arthroplasty of the day, the AAOS advocacy team is fighting to make sure that case isn’t delayed because you couldn’t get timely prior authorization from the insurance company.
Our team is relentless, and I’m glad I had the chance to work with so many of them over the past year. But I also have learned how valuable the help and support of individual orthopaedic surgeons are to the OGR. When I went to Washington, D.C., this fall, members of Congress actually sat down and listened to what I had to say. They wanted to hear the opinions of a physician. The overwhelming belief is that physicians are leaders in their communities and the best advocates for their patients. If we don’t advocate for ourselves and our patients, I’m sure other groups like insurance companies and hospitals will be happy to tell Congress what is best for patient care.
I’ve learned a tremendous amount over the past year. Prior to the AAOS Resident Advocacy Fellowship, I didn’t know that the voice of an orthopaedic surgeon in Congress is powerful, or how important it is to donate to the Orthopaedic Political Action Committee.
Incidentally, I also learned that if Representative Foxx asks whether you have read the entire Constitution, you should certainly say “yes”—or she will scold you, give you a copy, and sternly ask that you read it on your train ride home.
Matthew Conti, MD, is an AAOS 2019 Resident Advocacy Fellow and is completing postgraduate year-4 at the Hospital for Special Surgery. He can be reached at email@example.com.