How political is your “average” hip and knee surgeon?
And, to what extent do they take advantage of opportunities to help craft governmental policies that influence their work, as well as the lives of patients?
A team from Rothman Orthopaedic Institute at Thomas Jefferson University, Maine Medical Partners, OrthoCarolina, and the American Association of Hip and Knee Surgeons (AAHKS) launched an effort to find answers to these questions.
Their research, “Health Policy Views and Political Advocacy of Arthroplasty Surgeons: A Survey of the American Association of Hip and Knee Surgeons Members,” was published in the August 2023 edition of The Journal of Arthroplasty.
The OR and the Boardroom
Co-author P. Maxwell Courtney, M.D., division chief of adult reconstruction at the Rothman Orthopaedic Institute-Thomas Jefferson University explained to OTW, “We have been facing substantial headwinds in trying to preserve access for our joint replacement patients over the past few years. Hip and knee replacements are one of the most successful operations we perform in medicine and provide great value to our patients. With many recent policy changes, we as surgeons cannot just focus on patient care anymore and need to be advocates educating the public and our elected officials on the issues we face.”
The researchers distributed a 22-question email survey on multiple occasions to all 3,638 U.S. members of AAHKS who were in practice or training in 2022, ultimately obtaining 311 responses.
The survey was divided into three parts:
- Demographics—membership level, political affiliation, surgical experience, and practice setting
- Policy views including perceptions of contemporary policy issues, mispriced procedure codes, awareness of recent changes to the fee schedule for arthroplasty procedures, and experience with bundled payment systems.
- Advocacy participation including political donations, current advocacy efforts, and barriers to participation.
The team found that 18% of respondents had begun practicing within the last 5 years and 38% had more than 20 years of practice.
Their political affiliations were:
- Republicans (40%),
- Independents (37%), and
- Democrats (21%).
The top concerns were:
- preserving physician reimbursement and equitable fee schedule representation (95%),
- the burden of prior authorization (53%),
- the impact of Center of Medicare and Medicaid Services regulations (39%), and
- medical liability and tort reform (39%).
The top benefits from participating as advocates for their profession were:
- maintaining appropriate physician reimbursement (44%) and
- advocating for patients (37%)
And what do most orthopedic surgeons want? Survey says: (81%) more time on pre-surgery optimization now than 10 years ago.
What was the most common impediment to advocacy participation? Lack of time (77%).
“This study showed that many AAHKS members are informed and actively engaged in the political process,” stated Dr. Courtney to OTW.
“Regardless of personal political party affiliation, we continue to advocate for non-partisan causes. Although inflation is up 20% in the last four years, Medicare reimbursements for total joint replacements have dropped substantially. Insurance companies often require a prior authorization process to approve a test or a procedure, burdening our clinical staff, requiring more time on the phone for the physicians, and causing frustration in the delay of care for our patients.”
“Medical liability continues to be an issue in several states, with us in Pennsylvania fighting ‘venue shopping,’ where a plaintiff’s attorney can file a lawsuit in a more litigious county anywhere in the state, not just where the surgeon practices. We hope our study can prompt other subspecialty societies to continue to engage its members to take an active role in the political process to advocate for their patients.”
Surgeons are trying to protect their private interest while advocating for a greater public good. This puts them in an intractable dilemma.
First. Private versus public interest. Public insurance (Medicare, Medicaid etc.) is a public good. Surgeon reimbursement is a private interest. This pits more public spending against the private interest of keeping taxes down. Surgeons overwhelmingly give campaign contributions to Republicans, who support their private interest, but are no friends of the public good.
Second. No professional unity. Surgeons are high up in the food chain of physician pay. This puts them at odds with other medical specialties that are not as conservative. This dilutes influence.
Third. Surgeon organizations have consistently opposed expansion of universal health proposals. Medical societies opposed Medicare, Medicaid and the Affordable Care Act (among others). This negates the surgeon argument that they are fighting for patient access.
Fourth. Washington is a one-industry town run by a duopoly. Staying in power is the primary objective of the two parties. Surgeons are like a guy trying to have a foot in two canoes.
Finally, physicians and surgeons are just not very good or effective at politics.
Students that became physicians were in the library studying while the social science students were learning to organize and protest. It’s not a fair fight.
Electoral political power rests on getting voters to the polls. There aren’t enough physicians to make a difference at the polls. So, they are left with making campaign contributions to parties and candidates. The result is a lot of lip service from party leaders who take the campaign contributions for granted.
The solution to the dilemma? Pick a side, openly and aggressively. Organize providers and patients to turn out voters at the polls. If that can’t be done? Save your time and money and just be doctors. Let society decide the public good versus private interest argument.