Washington Scene: What I’ve Gained From Participating in STS Advocacy

Jess L. Thompson III, MD
Assistant Professor of Surgery, Section of Congenital Heart Surgery,
University of Oklahoma
2016 STS Key Contact of the Year

STS News, Spring 2017 -- “Politicians and diapers must be changed often, and for the same reason.” - Mark Twain

In the 5th grade, my teacher asked what job I wanted when I grew up. My response – a United States Senator. When asked to provide the rationale for my choice, I replied, “Because people will think I’m important, but I don’t have to do anything.”

Whether I was displaying youthful naiveté or a precocious understanding of our political process is open to debate, but what is certain is that being engaged in the Society’s advocacy efforts has been a fulfilling professional experience. I have come to better understand and appreciate the history and machinations of the American political process.

During my cardiothoracic surgical training, I had the opportunity to attend my first STS Legislative Fly-In. Prior to meeting with our representatives on Capitol Hill, we were given a thorough briefing by the Society’s Government Relations staff. I was impressed by how the more seasoned surgeons in attendance displayed a deep understanding of the pressing issues confronting cardiothoracic surgeons. Feeling a little intimidated, I initially wondered how I could contribute. The DC staff, however, did a wonderful job preparing me so that I could advocate our positions. It also was very reassuring to make visits with other surgeons who had done it before.

When the time came to meet our legislators, I was struck by several things. First, it is much more common to meet with a legislative aide than an actual member of Congress. The aides appeared young, but were obviously very bright and inquisitive. Second, having clearly defined “asks” (the actions we were requesting members of Congress to perform on our behalf) increased our chances of success. Third, we were treated with respect, in part because of our professional status, but perhaps even more so because we were advocating not for ourselves, but for issues that would benefit our patients. Fourth, proactively steering the direction of a policy from its inception is infinitely easier than changing a policy that has already gained momentum. Ultimately, I left Washington feeling like I had made a positive contribution to the specialty and to our patients.

Proactively steering the direction of a policy from its inception is infinitely easier than changing a policy that has already gained momentum.

“If you’re not at the table, you’re on the menu” goes the saying in Washington. With our advocacy efforts giving us the proverbial seat at the table, potentially catastrophic changes to our specialty have been avoided. For example, it was only through our advocacy that the Centers for Medicare & Medicaid Services (CMS) mandated that a multidisciplinary heart team approach be used for transcatheter aortic valve replacement (TAVR). Certainly, embedding a cardiothoracic surgeon in TAVR protects the surgeon’s ability to provide this therapeutic modality, enhances patient safety, and continues patient access to optimal care (see page 1 for more on surgeon involvement in TAVR).

More recently, CMS proposed to eliminate 10- and 90-day global surgical payments. The leadership provided by STS rallied the surgical community so that we could stop this disastrous policy before it was implemented.

It has been said that the first noble truth of politics is frustration. Certainly, this emotion has been experienced by everyone who has engaged in any level of political advocacy. When I feel this way, I try to remember that most of our advocacy focuses on policies and practices that are long-term in nature. Securing meaningful change in government is more akin to turning an aircraft carrier as opposed to maneuvering a nimble speedboat. That said, once we point the aircraft carrier in the direction we want, it is difficult to move it off course.

During the most recent Fly-In, our attentive STS legislative staff made me aware that my member of Congress was having an early morning meet-and-greet for people in his district. I was able to have a long discussion with Rep. Steve Russell and invite him to visit the hospital where I work. When he toured my hospital, I pointed out the economic impact of and jobs created by the hospital. We visited the operating rooms and the ICU, and he interacted with one of our patients and her grateful parents (our best advocates!).

STS members Jess L. Thompson III and Harold M. Burkhart with Rep. Steve Russell

STS members Jess L. Thompson III, MD (left) and Harold M. Burkhart, MD (right) took Rep. Steve Russell on a tour of the operating rooms and ICU at the University of Oklahoma.

I have enjoyed a great deal of professional satisfaction by participating in STS advocacy efforts. I believe that the successes we have achieved on Capitol Hill are significant contributions to our specialty and are for the betterment of our patients. Plato is attributed with the observation that one of the penalties for refusing to participate in politics is that you end up being governed by someone worse. I would invite those STS members not currently participating in the Society’s advocacy activities to reconsider their involvement in this vital effort.