A Seat at the Table Getting Involved in State Legislation and Advocacy

Luke Wohlford, MSIII, University of Arizona College of Medicine – Phoenix
EMRA MSC Southwest Regional Representative 2020-21

The first time I met an Arizona state representative brought me straight back to high school – the breathlessness that comes with fear of public speaking and the annoying bead of sweat that rolls down my back both served as reminders that I was out of my element. The representative was nothing but nice, and I still couldn’t seem to calm my nerves. I was reminded of the time my father took me to an event where Senator John McCain had spoken over a decade ago. Sitting 50 yards away from the recent presidential nominee, I was starstruck, but my father was somewhat unimpressed. In response to my enthusiasm he told me, “No use in getting so excited, everyone has to put their pants on one leg at a time”. Underneath the humor and cynicism was an important point: some people may seem larger than life, but at the end of the day they’re still people.

But the reason why advocacy is far less daunting than I originally thought is more than normalizing legislators as regular people. They chose positions in their government to represent people where they live, and they love getting input from their constituents! Twice I’ve had the pleasure of participating in AzCEP’s (Arizona’s ACEP Chapter) ED Doc Day at the Capitol. The day begins bright and early with a debrief on the current state of bills pertaining to emergency medicine, and how we can advocate either for or against bills. Prior experience in advocacy is not even required! Most organizations will coach their participants on how to present the information and the strategies that will or won’t work. For example, a criminal justice bill meant to decrease physical assaults on healthcare workers can become much more important in a legislator’s mind if an emergency medicine provider can paint an emotionally charged picture of the problem based on their experience. Whereas bills increasing the scope of practice for some professions that could have dangerous implications may benefit from a more logical and scientific argument.

With the help of some experience and newly calmed nerves, I was able to meet with legislators on my own in my second year at AzCEP’s event at the Arizona Capitol! The highlight was a 15-minute meeting with the senator from my own district. The first few minutes were somewhat of a presentation of the three bills that we were advocating for, but the rest of the meeting felt like a regular conversation. She asked engaging questions and was receptive to our arguments for bills regarding health insurance and mandating CPR in accredited nursing homes. She even disagreed with a bill we were advocating for regarding raising the punishment for assault on healthcare workers. She had her own perspective on the criminal justice aspect of the bill and believed that raising the punishment would not inherently decrease the incidence of assault, making the end result an increase in incarceration. Instead of just being discouraged from getting a “no”, I was able to think more critically about the problem and discuss her viewpoint with the author of the original bill later that day. I look forward to the ED Doc Day at the Capitol next year to continue building my relationships with my senators and representatives.   

If your state’s ACEP office or your state’s medical association holds state advocacy days, it is a valuable way to engage in local politics and work with physicians. But if not, have no fear! There are plenty of ways to still be involved in state politics. It is arguably much easier to have a say in state politics because there is less attention on state legislatures and legislators are more available to meet with. Each state should have a website dedicated to tracking bills where you can read the text of relevant legislation and see where bills are in the process. LegiScan is a user-friendly website that has bill tracking capabilities for all states and a robust search mechanism. State ACEP offices and other state medicine organizations may keep a list of relevant bills for each legislative session as well, so there are several ways to learn about your state’s current politics.

When you’re ready to jump in and get involved yourself, there are several avenues you can take depending on your comfort level. Letters, emails, and phone calls to your legislators may not seem like much, but most legislators value input and will appreciate any constituent reaching out. Setting up meetings with legislators can be daunting at first but building relationships is critical to having your voice heard. When you set up an initial meeting, be sure to bring a business card so that they can remember you and have your contact information. Don’t expect to change their minds about multiple hot-button issues on your first visit, but if you meet with them consistently and show your engagement over time, they may reach out for your opinion on healthcare bills that come up in the future! Perhaps requiring the most preparation, in most states you can even testify in committees for specific bills. Effective testifying usually involves one to two minutes of concise arguments in favor or against a bill. Often it is best to coordinate with organized medicine agencies to have multiple people testify for the same bill. However, be sure to each have different points to enhance your argument so as not to repeat the same information.

My favorite cliché when it comes to organized medicine and politics is “if you’re not at the table, you’re on the menu”. Given that state legislatures have massive input on the prescribing rights, scope of practice, and legal protection of physicians, this statement is all the more true for our professional lives. So read up on your state’s legislation and come to the table!