Ajit Rai, MD - UCLA
Chip Snyders, Jr., MD, LT, MC, USN - Naval Medical Center San Diego
The California Society of Anesthesiologists routinely advocates on behalf of our specialty, but it is a unique opportunity when our organization also helps to serve as a champion for medical doctors from all specialties. On April 18, the CSA assembled a team to speak with legislators at the state capitol in Sacramento about a concerning bill (AB 3087) that would affect all physicians practicing in California.
We lobbied alongside more than 400 residents, medical students, and practicing physicians from across the state. The CSA advocacy team was comprised of CSA President Karen Sibert, MD, FASA, Past President Mark Zakowski, MD, FASA, Christine Doyle, MD, FASA, Puja Trivedi, DO, Executive Director David Butler, CSA Lobbyists Bryce Docherty and Vanessa Cajina, as well as the authors, Chip Snyders, CA-1, and Ajit Rai, CA-3. The Legislative Advocacy Day was organized by the California Medical Association (CMA) with the goal of urging legislators to oppose AB 3087.
In an effort to stem rising healthcare costs, AB 3087 was introduced to the Assembly Health Committee. At its core, the bill establishes a small panel of individuals empowered to set prices that commercial insurers would use to reimburse physicians and medical facilities in California. In the bill’s original form, this panel ironically lacked any physician members, however last-minute amendments provided for a single physician representative. Much has been written on the havoc that AB 3087 could wreak on healthcare in California and its implications for patient access to quality care, and we would refer interested readers to this blog post, penned by Dr. Sibert.
CSA Advocacy Training
Few residency programs provide formalized opportunities to get involved at the legislative level. However, by interfacing with the CSA, residents are provided a unique platform to become empowered. Not only has our involvement with the CSA allowed us to learn and discuss many of the pressing issues facing our field, but we also acquire tools to take action.
We received a crash-course in legislation and advocacy during the CSA’s Residency Advocacy Day in March. After a day of walking the halls of the State Capitol, meeting with a few lawmakers, and learning about the movement of bills through committees and onto the floor, members acquired a nascent sense of how the legislative process works. More importantly, we learned many ways in which individual citizens can influence this process through advocacy.
This training was ultimately put into practice when we had the opportunity to advocate for physicians regarding AB 3087. We recognized this bill as a threat to both future job stability and patient access. By centralizing pricing decisions in such a heterogeneous state as California, AB 3087 would likely strain hospital markets, leading to reduced staffing and resources and thus patient volume. It would appear to have grave implications for patient care. With these thoughts in mind, we happily participated in the CMA Legislative Advocacy Day.
CMA Legislative Advocacy Day
The morning began with a large group meeting to discuss the key problems with the bill and advocacy points. For example, despite the bill’s central premise (runaway medical costs), the rate of increase in healthcare costs in California was the lowest of all 50 states. This reflects not only successes in cost-containment but also failures—in particular, burgeoning systemic financial strains. While operating costs for physician practices have continued to rise significantly over the past decade, income from sources such as government-priced payments (i.e., Medicare) have barely budged. Thus, by threatening to further reduce reimbursements from the commercial sector, AB 3087 would undermine an already stressed system.
After the initial meeting, we gathered on the steps of the California State Capitol building and took a group picture. Family practice physicians, urologists, nephrologists, anesthesiologists, internists: all stood side-by-side in a show of opposition to AB 3087. Finally, we formed small groups and journeyed inside the Capitol to meet with lawmakers and their staff members.
Meeting with Lawmakers
Assemblymembers and Senators remain busy throughout the day and are often preoccupied with committee meetings, but they welcomed the opportunity to speak with advocates for and against this bill. If ever they were unavailable, our teams would meet with their staff members instead, who also happened to be very informed and knowledgeable.
At the start of our meetings, the senior CSA members would take the lead on making a case against AB 3087. The team would then follow with examples from our experiences as providers. We all expressed our views on AB 3087 along with the many concerns we had about what it would mean for the sustainability of a future practice in California. Lawmakers were especially intrigued by the junior team members because they acknowledge that residents and medical students are the future of medicine.
Therefore, it was reassuring to hear from legislators that there is significant value in the voice of a trainee. Residents and medical students generally are viewed as less biased, less protective, and less parochial. We haven’t yet established our practices, and many of us haven’t determined where our roots will be planted. Thus, when we express concern about job prospects or patient care, lawmakers seemed to pay much more attention.
Furthermore, there is already a physician shortage throughout the state of California. Proposing legislation that would further deter physicians from practicing here might prove to be problematic. Speaking with Assemblyman Frank Bigelow (R-O’Neals) about our concerns from the perspective as a resident, he wondered aloud to the group, “Why aren’t more young people here talking about this?” Fortunately, there was an abundance of residents at the Legislative Advocacy Day, all making their voices heard.
Physicians and Politics
Legislative Advocacy Day was a whirlwind, and as we boarded our flights back home, we reflected upon the day’s events. We left encouraged by the widespread participation from so many physicians. We are thankful that associations such as CMA and CSA exist to track important political issues that affect our profession, patients, and future and to provide resources in order to positively influence outcomes. Finally, we were grateful to have the freedom and ability to participate in the political process.
Advocacy can leverage important resources such as organizations and lobbyists, but ultimately, it’s a relatively simple act. If you want to help shape the future of medicine, the task is daunting, but participation is relatively simple and makes a difference. Thanks to organizations like CSA, it’s easier than you’d think.