American College of Physicians: Internal Medicine — Doctors for Adults ®


Washington Perspective

Getting through to legislators: a slow but worthwhile process

By Robert B. Doherty

Medical science is based on rigorous, outcome-based research. Before internists choose a particular course of treatment, they typically look at outcomes and effectiveness. They tend to look for similarly absolute proof when deciding whether writing to or meeting with legislators has any impact on public policy.

Unfortunately, political science cannot be measured against such a definitive standard. Most of what is considered to be effective in influencing lawmakers is based on experience, not research studies.

Do letters make a difference?

ACP-ASIM members often express a healthy degree of skepticism about whether writing a letter to Congress will make any difference at all. After all, almost everyone who has written to a member of Congress has found the result to be less than satisfactory.

The typical scenario goes something like this: You spend valuable time crafting a letter and when you've sent it off, you wait weeks or months to hear anything. When an answer finally arrives, it's in the form of a generic letter that reads something like this: "Thank you so much for sharing your views, which will be given careful consideration as I vote on H.R. ____." Often, there's no mention of the particular issues you raised, let alone a response to your concerns.

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So why bother to go to all that effort in the first place? The answer is that writing letters to lawmakers can make a difference, maybe not all of the time, but enough of the time to make it worthwhile.

For one, congressional offices count how many letters they get on hotly contested issues. If representatives are undecided, the number of letters they receive on each side of an issue may influence how they vote.

Even when members of Congress have already made up their minds, letter-writing is important. Sometimes the objective is to give ammunition to those who support your position, rather than changing the opinions of the opposition. When making their arguments on the floor of the House of Representatives, congressional proponents of a strong patient bill of rights, for example, frequently cite stories from their physician-constituents about how HMOs have denied needed care. Those stories often get extended life as they are retold by the media.

A personal letter from an internist can have more impact than 50 form letters or 1,000 postcards

Even if legislators have already decided to vote against your position on a particular issue, they still need to hear from you. They want to know who they've made happy or angry by a particular vote. They especially want to know if constituents who have supported them in the past with financial contributions are unhappy. Even if they don't side with you on one vote, they may be swayed to redeem themselves by voting with you on another issue.

Letters also raise the visibility of an issue that might otherwise be ignored. The goal may not be to influence a particular vote, but to show lawmakers that an issue is so important to constituents that they need to pay attention. With so many constituents demanding your legislator's attention on so many issues, the first task of political advocacy is to make sure that your issues stand out from the pack.

Organized petition drives, postcards and form letters can also exert a modest degree of influence by providing legislators with a sense of where the public stands on an issue. Knowing that someone who has simply signed one of these documents has not put forth much effort, however, legislators tend to give them much less attention than a personal letter from a constituent.

"Canned" messages also lack the personal "here is how this issue will affect care of my patients" content that is so important in effectively communicating your views. A personal letter from an internist can have more impact than 50 form letters or 1,000 postcards.

Up close and personal

Internists who schedule meetings with members of Congress in Washington or back home often end up meeting with a young congressional staff person who knows little about issues affecting internists, not the lawmaker. If they do get to meet the legislator, it may be for no more than a two-minute photo opportunity.

Don't be discouraged, though: Face-to-face meetings can have a big impact. No letter-writing campaign can compare to being able to tell your side of the story in person. But the meeting is most likely to be effective if it is part of an ongoing effort to establish a relationship with a lawmaker and his or her staff rather than just an isolated event. If the legislator already sees you as a trusted source of advice, he or she is more likely to free up time to meet with you and listen attentively to your concerns.

And like it or not, lawmakers are more likely to fit you into their schedules and listen to your views if you have contributed money to their campaign.

How ACP-ASIM can help

ACP-ASIM offers several services to help members advocate more effectively. The College's new Legislative Action Center Web site ( includes information on members of Congress, the status of key bills and legislative alerts from ACP-ASIM. It also includes sample letters and e-mails that you can personalize and send to your lawmakers with a click of the mouse. We have also established a toll-free legislative hotline (888-218-7770) that will directly connect you to your federal legislators' offices.

Members who volunteer as an ACP-ASIM "Key Contact" receive a bimonthly newsletter on legislative developments and alerts and a pocket-size congressional directory. They also receive help from the Washington office on how to establish a positive relationship with Congress. For information about ACP-ASIM's Key Contact Program, get in touch with Jenn Jenkins (, the College's Grassroots Advocacy Coordinator.

ACP-ASIM's annual Leadership Day gives ACP-ASIM Governors and Key Contacts an opportunity to meet with lawmakers in Washington and to participate in issue briefings and training sessions on how to advocate for internal medicine.

Internists know that there is seldom a "magic bullet" that can cure a chronic medical condition, that a sustained effort using multiple interventions may be needed. In many ways, the legislative process is not that different. Although a single meeting, phone call or letter will rarely change a lawmaker's mind, a sustained campaign using all three modes of communication does make a difference.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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