How the College develops its public policy agenda
By Robert B. Doherty
Internists often wonder how ACP selects the issues that appear on our public policy agenda.
Membership organizations need to show that the needs and desires of members—not a distant elite—drive their public policy agenda. The College takes this "bottom-up" philosophy to heart. We make sure decision-making flows from the dues-paying members up to the leadership and staff, rather than from the top down.
We make sure decision-making flows from the dues-paying members up to the leadership and staff, rather than from the top down.
Identifying issues and setting priorities
The College relies on several sources to determine which issues require a public policy response. Here's an overview of how members and leaders work together to develop the College's public policy agenda:
Board of Governors. Made up of elected representatives from each of the College's nearly 80 chapters, the Board of Governors introduces, debates and approves resolutions that call for the College to address members' concerns about a particular public policy. Chapter members develop resolutions at "town hall" membership forums and through chapter-level health and public policy committees. Individual Governors then bring resolutions from the chapter to the larger board.
When the Governors approve a resolution, they send it to the Board of Regents for implementation or further study. The Governors also review all draft College position papers before the papers go to the Regents for final approval.
Public policy committees. The Health and Public Policy Committee develops recommendations for the Board of Regents on issues such as access to care, health care financing and physician workforce shortages. The Medical Service Committee develops recommendations on socioeconomic issues that affect the daily lives of internists, such as payment, coding and "hassle factor" issues. (The committee receives guidance from the Third Party Relations, Coding and Payment Subcommittee, as well as the Subspecialty Advisory Group on Socioeconomic Affairs.) The Ethics and Human Rights Committee develops policies on ethical issues like physician-industry relations, end-of-life care and professionalism.
These committees can initiate policy recommendations on their own by bringing proposed position papers to the Regents for review or approval. The committees also develop recommendations on issues related to the College's strategic plan.
The relationship between committees and the Governors is a two-way street. For one, the committees develop draft position statements in response to Governors' resolutions referred to them for study or implementation. They also submit their own resolutions directly to the Governors.
Residents, students and subspecialists. The chairs of the Council of Subspecialty Societies, Council of Student Members and Council of Associates each have a seat on the Board of Regents and can bring resolutions directly to the Regents for action. This representation ensures that Associates, student members and subspecialists can directly address public policy issues that concern their constituencies.
The councils also review all draft position statements before they go to the Regents for final approval.
ACP staff. The College's public policy staff bring issues directly to the ACP's policy-making committees for review and guidance when Congress, the president or a federal agency proposes legislation that will affect physicians and the College has no clear policy on the issue. The committees can directly advise staff about what position to advocate.
If the issue is particularly controversial, the committees can bring it to the Regents for consideration. Because it is impossible to predict what issues Congress or the executive branch may raise, staff need to be able to seek guidance from College leaders on emerging issues so our advocacy efforts are both effective and timely.
Board of Regents. The Board of Regents has the final authority for approving all College public policy statements. This includes draft position papers from the policy committees, as well as resolutions from the Governors and councils.
The Regents also approve and update the College's strategic plan, which describes ACP's top "strategic objectives"—including public policy goals—for a three-year period. With input from hundreds of Governors, committee members, staff, officers and individual Regents, the Board of Regents develops these strategic objectives based on an evidence-based assessment of the threats and opportunities facing internal medicine.
The Regents also initiate the policy development process by identifying issues that it would like the College's policy-making committees to address.
ACP President. The College's top elected leader approves all major testimony and other communications to members of Congress, federal agencies and the media.
The College's agenda
ACP benefits from the views of hundreds of internists who have been elected to serve as leaders or appointed to policy-making committees because of their interest and expertise in a particular topic. These individuals, in turn, represent the views of the 115,000 internists and medical students who belong to the College.
To understand the scope and breadth of the public policy agenda that flows from ACP's "bottom-up" process, consider some position statements recently approved by the Regents.
Over the past year, the College has released position papers on medical liability reform, the nursing shortage, resident work hours, cuts in Medicare payments to doctors and hospitals, payment for e-mail consultations, prescription drug benefits and formularies, coverage for the uninsured, physician-industry relations, privacy regulations and the scope of practice of nurses and pharmacists. (For a complete, searchable listing of the College's public policy position papers, see the College's Public Policy Virtual Library.)
The College is currently developing policy papers that address racial and ethnic disparities in health care; ethical implications of time limits on office visits; payment for telephone consultations; and revitalizing internal medicine by easing both student debt and economic trends that hurt practicing internists.
The College's versatile and inclusive policy-making process does not guarantee that we will achieve all our public policy objectives. Once a policy is approved, ACP must still do the hard work of lobbying Congress and the executive branch to support our policies. When federal money is short and competing groups are lobbying for entirely different (and often conflicting) policy prescriptions, this is no easy task.
What our policy-making process does guarantee, however, is that ACP members themselves—not distant Washington staff or out-of-step elite leadership—drive our policies and priorities. When we tell policy-makers in Washington that we speak for you—the physician-members of ACP—we're fully confident that it's true.
Robert B. Doherty is ACP's Senior Vice President for Governmental Affairs and Public Policy.
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