Lobbying has earned a bad name in Washington these days, and for good reason. To the average citizen, politics has shown itself to be a necessary but repugnant activity, and the scandals involving the business of lobbying have become a very public embarrassment. Recent congressional scandals have led many to express skepticism about the state of the legislative process.

Clinicians typically share the attitude that involvement in political affairs, particularly lobbying, is a messy set of activities best left to others. They often feel that there is no need for them to pay attention to the political side of things. They regard politics as an activity that is a bit unsavory and that diverts attention from patient care. While perhaps convenient, this thinking is shortsighted and ignores the modern realities of medical politics. In the modern world of the health professions and health policy, politics requires our interest and involvement.

Conversing With Congress

Lobbying is the activity that brings together clinicians with their government representatives. It is usually nothing more than the act of having a brief meaningful conversation with a legislator who will listen and who has the capability to influence policy direction with his or her vote.

Historically, lobbying got its name from the practice that developed in the 1860s, when citizens would gather in the lobby of the Willard Hotel in Washington, one block from the White House. Lore has it that when persons sought to petition President Ulysses S. Grant, they would intercept Grant in the Willard lobby to make their requests. The practice of lobbying thus grew.

In modern Washington, it is virtually a necessity for health professions organizations to engage in lobbying. Representation is critical on Capitol Hill if these groups are to maintain their practice prerogatives and, importantly, to be reimbursed for their services through Medicare. Some health professions groups appear omnipresent in conducting lobbying activities. For example, the pharmaceutical industry, among the most prominent and powerful groups in Washington, employed 675 lobbyists and spent more than $91 million in 2002.¹

The PA profession, appropriately, maintains a solid presence on Capitol Hill. Through its national staff, the American Academy of Physician Assistants monitors legislation affecting the profession and advocates for PA interests. It also promotes special programs that allow members to aid in the lobbying process on behalf of the profession.

PA Lobbying Adventures

"Adventures in Lobbying," a recent meeting sponsored by the AAPA (see this issue' "Making the Rounds" section), brought together PA clinicians, academics, chapter officers, students and the leadership for two days of politically focused activities. The intent of the gathering, much like its predecessor, the Constituent Chapter Officers Workshop (later renamed the Capitol Constituent Organization Workshop), was multifold.

First, the meeting prepares attendees to engage in lobbying in an appropriate manner to raise the profile of the PA profession among members of Congress. It enables PAs to connect with their representatives and senators to discuss relevant issues. This year, the key governmental issues that were discussed with Congress were: (1) amending Medicare to allow PAs to order hospice care, (2) requesting that the Veterans Administration hire a full-time PA in the central office to represent the profession in that hospital system, (3) permitting PAs to provide care for federal employees in workers' compensation injury cases, and (4) requesting continuing support for the funding of Title VII of the Public Health Service Act, which covers the health professions education assistance that provides for funding for PA educational programs.

Another important function of this meeting was to educate and develop younger and less experienced individuals in the lobbying process and to allow them to obtain needed experience in advocating for the profession on this level.

All Politics is Local

While it is vital for the PA profession to maintain a presence in federal affairs, much of what affects PA practice on the day-to-day level is determined by the states, particularly state medical and health regulatory boards. PA practice essentially is defined by the medical practice acts and regulations promulgated in state statutes and enforced by state medical licensing boards. State boards have direct control over the specific tasks that physicians can legally delegate to PAs, including the authority to prescribe. A major legislative victory was achieved earlier this year when Ohio became the 49th state to authorize PA prescribing (see this issue's "Making the Rounds" section).

Legislative activities, including lobbying, are important for the continued and growing success of the PA profession. No doubt Indiana now will become a focus of efforts to complete the list of states authorizing PA prescribing, but those with experience in state regulatory affairs know that the job is never really finished. While enabling legislation and prescribing authority are necessary and now standard, there is a need to be vigilant on the state legislative front. The health occupations are engaged in constant struggles related to money and turf, and groups not enthusiastic about PAs often either deliberately or inadvertently seek to limit aspects of effective PA practice. The profession, particularly state chapters, cannot afford to relax efforts in monitoring new regulations and bills that may be introduced into state legislatures that would adversely impact PA roles.

James F. Cawley is director of the PA/MPH program and professor and vice chair of the Department of Prevention and Community Health, School of Public Health and Health Services at The George Washington University in Washington. He also is professor of health care sciences at the university's School of Medicine and Health Science.

Reference

1. Angell, M. The Truth About the Drug Companies: How They Deceive Us and What to Do About It. New York, NY: Random House; 2004:198.