Advocacy and Family Medicine: Where the Twain Shall Meet

By Jennifer Dailey

As I sit in room 445 of the Utah Capitol building mentally prepping for my presentation to the Interim Health and Human Services Committee on Family Medicine residency expansion in Utah, I am reflecting a bit on my three years with the Utah Academy of Family Physicians (UAFP) as its director and lobbyist.  This particular effort, to secure state funding to cover the costs of increasing Utah’s FM residency graduates from 25 to 30 graduates per year, is now in its third iteration.  The argument has always been compelling to legislators – they see the need without question, and likely even understand the benefit to our communities – but the answer twice before is predictable: we just don’t have enough money.

Yeah.  No kidding.  We in Family Medicine understand fully well the challenges that come with underfunding primary care: reimbursement rates that fall short of the value provided by Family Medicine physicians; the difficulty in funding the costs necessary to train competent, world-class physicians; the utter challenge of convincing a student with exorbitant medical school debt that they don’t need to pursue subspecialties, forgoing the gratification of being good at everything, in order to pay off loans before, say, age 50 or later.

Happily, though, we are making progress.  Just recently an attorney in the Office of Legislative Research and General Counsel (OLRGC) at the legislature asked me rather pointedly: “Where did you guys come from?  Three years ago, none of us had ever heard of Family Medicine.”  The short answer is, of course, the Academy hired a squeaky wheel.  The more comprehensive answer is that with the help and guidance of our newly invigorated Legislative Committee, member involvement and legislator engagement has never been higher.  Around Utah, family physicians and residents have become increasingly engaged and vocal about the state of primary care in Utah.  Increased numbers of legislators know some of their family physician constituents, and with appropriate communication will become more dependent on those family physicians for input and guidance on health care policy.

But this must come from family doctors.  Legislators are inundated by their constituents and do not have the bandwidth to seek you out.  It takes the conscientious and deliberate creation of a valued, professional relationship to build that trust and desire for guidance.  Luckily, building strong, respectful relationships with people is one of the many things at which family physicians excel.  Knowing this is a valuable strength in our Family Medicine community begs the question as to why we don’t take better advantage of it.  The answers are many: medical training and work, family life, personal interests, and/or aversion to politics, just to name a few.

Now, I understand that the whole “the sky is falling” rhetoric quickly becomes tiresome, and I’m here to tell you that the sky is not falling.  I’m also here to tell you that the skies and the horizon beyond could be brighter, but for a more forceful Family Medicine voice in policy decisions in our state and nation.  There is not a single more compelling message to a legislator than a well-thought out, cogent argument by a well-educated, well-spoken physician constituent.  That is an absolute truth.  The right message at the right time can have more power, even, than a big, fat check.

So, while I’m thrilled to continue to be the squeaky wheel on behalf of Family Medicine in Utah, don’t forget that the real power in my message to policy makers is the physicians and residents that I represent.  As for the money thing I mentioned earlier, I’m happy to report that our efforts to train more Family Physicians in Utah have begun to appear less and less “expensive” to our legislative body and more like a great investment for our state.  I have you, and all family physicians, to thank for that reality.  The value of your work and dedication, both in monetary and medical terms, provide the second most compelling message of all.  The most powerful message, the one that resonates and affects true change, is yours.

Jennifer Dailey is the  Executive Director and Chief Lobbyist for the Utah Academy of Family Physicians

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