Bright colors and lots of ribbons

I am writing this post with tremendous gratitude for the fact that I am sitting in my kitchen in Salt Lake City while I listen to crickets in the backyard rather than busy Chicago traffic.  The College is always amazing, wonderful, maybe even sometimes a bit TOO much (so many things! so little time! so tired by today!), and being home is always amazing, wonderful, and comforting.  The fact that I have cats wandering in and out of the kitchen to check on me and a dog under my feet as I write provides even more solace.

Soviet General or Young College Leader?
Soviet General or Young College Leader?

I joked more than once about the litany of brightly colored ribbons I’ve acquired with my College engagement over the last decade- if I weren’t so committed to great shoes, I could easily have passed for a Soviet General during the days of the Politburo.  To be completely transparent, a couple of the ribbons are a product of work within the ACS, and a couple more are a product of donating early and often to the ACS Foundation. Here’s a short guide:

  • PAC Contributor- Exactly what it sounds like. I give money to SurgeonsPAC, and not just because I am on the SurgeonsPAC Board of Directors.  The ACS Advocacy and Policy Division was instrumental in finally getting SGR repealed last year. We are now being looked to for leadership on MIPS and APMs, the new alphabet soup of physician payment, and we will be looked to for leadership on GME reform.  Do not underestimate the political clout of our organization in Washington DC, and if you are a surgeon or surgical resident who donates to the PAC your financial support really does help to strengthen our voice.
  • Governor- Last year I was privileged to be selected as the ACS Governor for the state of Utah.  Within the Board of Governors, we help guide the direction of the ACS on many issues, and serve as a representative body for the members of the ACS.  The Board of Governors has recently undergone significant restructuring to have “pillars” of Advocacy, Education, and Member Services, making it a true working group within the ACS.
  • 1913 Legacy Circle- I was a donor to the ACS Foundation’s 1913 Legacy Circle campaign, which was conducted in honor of the 100th year of the ACS.
  • Mayne Heritage Society- I have the ACS Foundation named in my trust to receive a portion of my estate when I die.  Yes, you can do that- and since I don’t anticipate having any human heirs, I have named several organizations in my trust.  For me this is an important way to leave a durable legacy.
  • CPC- This gorgeous pink ribbon is a new one this year!  It stands for Chapter Philanthropic Champion, and we are a group who have agreed to represent the Foundation at Chapter events, reminding members of the tax deductible nature of Foundation donations, and sharing the many amazing missions of the ACS Foundation.  A new-to-me statistic I found out during this year’s Clinical Congress is that our dues as Fellows in the ACS are about $200 a year less than the benefits available to this.  The difference is essentially made up by programs sponsored by the Foundation, and it makes the Foundation immediately relevant to all of us who are ACS members.
  • The AWS ribbon is a nice bonus, something all of us who are Association of Women Surgeons members wear to remind people of our presence and our engagement with the American College of Surgeons, both as an organization and as individuals.  I am incredibly honored to serve as the President of the AWS this year, and thanks to a skillful question from my friend Sherry Wren, one of my upcoming posts will be on the legacy I hope to leave in that role.  Anyone who knows me well knows that I am 100% committed to leaving it better than when I got here, and it’s already in great shape.

And since I mentioned Sherry Wren, here’s a great photo of some ACS leaders yesterday evening at the Taste of Chicago event:

ACS leaders, present and future, and (most importantly) friends
ACS leaders, present and future, and (most importantly) friends

It was great to be there, and I so appreciate the myriad opportunities I am granted.  It is also great to be home, and it’s time for a dog walk.  That’s one of the things I missed most being away.


Advocacy for beginners

This week marked the LAST in-class session for our 4th year students and we focused their afternoon on health care policy related topics.  There were some definite heavy-hitters there, and I had the privilege of providing a more practical session on advocacy.  I’ll admit- I was pleasantly surprised at how many students signed up for it, and also pleasantly surprised at how many of them had previously participated in advocacy in some way.  I’m hopeful that a few more will based upon the tips I gave them (and the fact that it’s just not that hard to send an email to your Congressperson!).

Based upon our discussion on Wednesday (and some crowdsourcing on Twitter), I generated an advocacy pyramid.  As you work your way up, the level of commitment increases- and the number of those involved at that level decreases.





Advocacy Pyramid
Advocacy Pyramid

When I crowdsourced on Twitter, one of the biggest comments that I got was that people have NO idea where to start- understandably.  I’m hoping that both of these pyramids give you an idea of where to start (hint: purple!).  In terms of writing letters or calling a legislator’s office, several of our professional organizations make it very easy for you.

  • For my non-surgeon colleagues, the most ecumenical was to engage with healthcare issues is via the American Medical Association.  Their Legislative Action Center for their Physician Grassroots Network makes it quite easy.
  • For those in Academic Medicine, the AAMC has an excellent resource as well.  Note:  To use their member action center you do need a AAMC login.
  • And, dear surgeon readers, please check out the American College of Surgeons’ SurgeonsVoice resource.  It’s your roadmap for surgical advocacy.

If you want an easy way to try out contacting your Member of Congress and Senators, I recommend going to the SaveGME website.  I’m reasonably certain if you are reading my blog that you share the idea that we are about to be in big trouble with GME (residency slots) in the United States, particularly in 2016 when we will have more medical school graduates than residency slots.  The medical schools have expanded to accommodate the projected need for more physicians, but we’re stuck with the same number of residency positions we’ve had since the Balanced Budget Act went into effect- so we now have a pipeline problem.  Help us fix the pipeline!

If you’re inclined, I would also encourage you to set up an in-district meeting with your Congressperson or Senators when they are back home.  Yes, you can do this.  Tip for first timers:  Take a “wingman” (or wing woman) who has done this before.  It’s less scary that way.

And fairly, a shameless plug to the surgeons reading:  Attend the American College of Surgeons Leadership and Advocacy Summit in April.  It’s a wonderful opportunity to rub elbows with College leadership, you get spoon-fed the process for doing Hill visits, and your appointments all get made for you.  Most importantly, someone from your state will usually have done this before, so you have that wingman I alluded to above.  If you can’t go this year, I encourage you to consider it sometime for the connections and the opportunities.

An important principle to remember is that you are in this for the “long game,” so to speak, if you really want to engage. You will not get a win on one of your policy asks the first time that you walk into a Senators office.  What you can do, though, is develop long-term working relationships with staffers.  These relationships allow you to become their go-to expert when they have a question or issue that is within your area of expertise.  I’ve cultivated one of these relationships, and they’re honestly quite a bit of fun to have- and it makes office visits in those particular offices feel more like fun and less like work.

So, get involved.  Send a letter, make a call on an issue you’re passionate about.  It’s an easy thing to do, and it’s an important opportunity in our democracy.


(Note:  Lest you think I’m ignoring the money side of the equation, PAC membership and the like, I’m not…I’m saving that for another day.)


Vote early, vote often

It’s time for a bit of prosthelytizing from me, to those of you who are perhaps less politically engaged.

Many of you know that I’m a member of the SurgeonsPAC Board of Directors, a role in which I am honored to serve my profession.  The Health Policy and Advocacy team at the American College of Surgeons rolled out an exciting new program this year, Surgeons Voice; the goal of Surgeons Voice is to educate our members on how to be effective grassroots advocates for our profession and our patients.  Much like many non-profit organizations, one of the key principles is to make advocacy easy for our members- simply sign in, see what you need to act on, push a button and BAM!  Letter to your representative done.

We have also have created a tiered advocacy system, ranging from Beginner to Advanced, depending up on time, experience, and issue salience, with recommended activities for each of these levels.  While the Beginner moves are captured within the Surgeons Voice website (see my above description), what it excludes is the most basic thing that we can all do.


Yes, you read that right.  I’m reminding you to vote. I’m not telling you to donate to a candidate, or go do canvassing or literature drops for them, or anything that’s going to push you our of your comfort zone if you haven’t worked in this world before.  Vote, it’s as simple as that.

Here’s the thing.  It’s a midterm election, and even though there has been huge spending (see this Politico piece about outside spending in the Iowa race; thanks, Supreme Court, for that pesky Citizens United decision), midterm election turnout is historically 15-20% lower than in Presidential election years.  What that means to you, informed citizen, is that your vote is likely to count more- relatively speaking- in a midterm year.  In 2012, a Presidential election year, Representative Jim Matheson won by only 768 votes; in a midterm year, those results can change incredibly easily with fewer voters even heading to the polls.  And sometimes, just sometimes, surprise victories happen based upon better-than-predicted voter turnout among certain population segments- though I’ll confess that Clayton Williams did put his boot in his mouth more than once in ways that helped mobilize Ann Richards’ base.

I early voted on Friday.  I live in an electorally safe district in some weird ways- safe for the Republicans for the US legislature (Utah’s House districts give new meaning to “gerrymandered”- Matheson switched out of this district after it was drawn in 2010), safe for the Democrats for the Utah House and Senate.  It can be argued that my vote didn’t matter, and that may well be true if the renewal of the Zoo, Arts, and Parks program happens by a generous margin.  But…I voted.  It’s my responsibility as an advocate.  It’s my privilege as a citizen.  And most importantly, if I’m going to complain for the next couple of years about terrible political decisions, I best make sure I voted against those driving them.

Now, go.  Arrange your Tuesday so you can vote.  It’s the least you can do.