I have come to the conclusion that politics are too serious a matter to be left to the politicians.
– Charles de Gaulle
Few PAs choose their profession solely for the paycheck. There are plenty of ways to earn a living that don't require years of training, endless hours on your feet, and exposing yourself to a variety of contagious diseases. PAs take these and many other stresses in stride because they are fundamentally committed to improving the health of their patients and their communities. PAs want to help. Moreover, every PA knows that the determinants of patients' health extend far beyond the exam room or hospital. Patients' lifestyles, families, and the way they work and play affect their health as much as or more than the interventions of health care providers. In the drive to help, then, PAs should recognize that contributions to the health of the community can be as important as their delivery of care to individual patients.
PAs are adept at finding ways to contribute to healthy communities outside of the clinic, from volunteering to serving as hospital administrators or PA educators. But one way that is particularly effective also can seem particularly daunting to the inexperienced: politics. The word might carry an uninviting connotation to some, but PAs shouldn't think of politics as limited only to the ominous ads that seem to fill the airwaves around this time every other year. Politics encompasses all the collective action that citizens undertake to set the rules for our society. Political activity can mean anything from sitting in on your state's medical board meetings, to writing a letter to the editor, to—yes—participating in the campaigns that help determine our political leadership. And, as the French general concluded, politics are too serious to leave solely to the politicians and their TV ads. Your involvement is needed. That said, as we find ourselves in the fall of an even-numbered year, a full slate of federal and state elections approach. There's no better time to review the best reasons for PAs to become politically active and the best ways for them to do so.
Why bother?
Getting involved in electoral campaigns and lobbying legislators once they're in office might seem unrelated to improving patient care or to your day-to-day practice environment. Actually, though, politically active PAs
can have a direct impact on the delivery of care to patients—just as an unengaged PA community can allow others to make decisions that prevent PAs from providing care as they are trained to. For instance, state lawmakers might consider a law to require stricter physician supervision of unlicensed personnel, such as medical assistants. Without PA input, legislators might craft the law so that it requires the physician's presence whenever medical assistants are working. This means the medical assistant can't assist the PA unless the physician is present. This could unnecessarily restrict the way you serve patients since PAs are trained to work without physicians on the premises.
The AAPA has recognized that PAs must both acknowledge and respond to our nation's health care system, many aspects of which are determined politically. One of the core competencies for PAs is that they “must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that is of optimal value.”1 In addition to understanding funding sources and providing cost-effective treatments, responding to the larger system of health care means working to change it for the better.
Political decisions also help to determine the direction of the PA profession. Elected state legislators often have the final say on which drugs PAs may prescribe; how much on-site supervision they require; and what procedures they may perform. All these decisions influence not only your job but also the position of the PA profession relative to that of other health care providers.
So politics gives PAs a chance to support healthy communities, improve the care they deliver to patients, and aid their own profession. In fact, as highly trained health professionals, PAs have a responsibility to take advantage of the opportunity offered by political involvement to look out for their communities, their patients, and each other.
The value of the PA perspective
”Sure,” you might say. “Politicians make important decisions that affect my patients and my job, but what influence can I have with them?” In fact, ordinary citizens can have substantial political influence on key issues, especially when they are part of an organized group. PAs' characteristics, skills, and knowledge make them particularly valuable participants in the political arena.
First, there's that strong commitment to helping others. Our political debates need this above all else. The ability to see and act on what is good for others, not just in our own interests, is the key to the public-spiritedness that drives compromise and real solutions rather than political posturing. The more PAs and others committed to helping get involved, the less powerful those in politics who seek only their own interests become.
PAs' teamwork skills are also valuable in politics. Just as it takes a wide variety of people with differing skills to care for almost every patient, so nothing much gets done in politics without the buy-in of a range of constituencies. In our political system, many players have the ability to stop action, but no one center of power can accomplish very much without the support of others. PAs can help apply the lessons of team medical care to bringing about the concerted action necessary to accomplish political goals.
PAs also have access to knowledge and insight that can be particularly helpful in political contexts. Health care, of course, has been and will continue to be a hot political topic. Anyone with direct knowledge of the care that patients receive has an important perspective to contribute to the political discussions about that care. But working as a PA doesn't just train you in human ailments and their treatments. It also gives you a front row seat on the human condition. PAs see how people react when they're scared or faced with a tough choice. PAs find out which priorities really matter when it counts and how people and institutions deal with scarce resources. These insights are directly applicable to political choices, both in health care and in just about every other area.
How you can make a difference
So PAs have much to contribute to the political sphere. How should they go about doing so? Luckily, opportunities to get involved in politics abound for PAs, from the simple but fundamental act of voting to serving in elective office themselves, with a range of other activities in between.
Remember, political activity doesn't just mean working on campaigns, although that's a central part of our political process. PA political activity includes advocacy before government bodies and the public as much as it does participation in electoral campaigns. Long after they are elected, politicians need input from their constituents. Only by stepping up and getting involved can PAs achieve the political influence they need to truly add to the health of their communities.
Whatever the point in the election cycle, PAs can get involved by letting decision makers know their views on the issues most important to them. Especially on the state level, legislators often don't know how their constituents would like them to vote on all but the most high-profile bills. A handful of letters, phone calls, or e-mails from informed PAs who reside in their districts can be enough to win the support of otherwise indifferent lawmakers. PAs can reach other influential community members by submitting letters to the editor of the local newspaper or even by casual conversations with coworkers or neighbors—remember, as a PA, you've got a perspective that many others don't have access to.
Working through the state PA society is another way to get involved. Each state chapter of AAPA has a legislative coordinator, and many have government affairs committees. These dedicated PAs keep tabs on the political situation in their states, working to advocate for the health of the public and the PA profession. They know PAs can't just appear on the scene when they want a law changed and expect instant results. They work to build relationships over time, so they're always ready for new volunteers and can show them how to best use their interests and energy.
The AAPA has created similar avenues for PAs to become engaged in politics and policy development at the federal level. AAPA's online Legislative Action Center includes information on the issues affecting PAs that are currently being considered in Congress and allows you to contact your congressional representatives and senators. Further, AAPA's federal affairs staff run a Congressional Visit program, which gives PAs the chance to meet with representatives in their Washington offices. The Adventures in Lobbying conference, held every other year, educates PAs on advocacy techniques and gives attendees a chance to compare notes on lobbying activities.
Making your voice heard to office holders is an important way to become engaged in the political process, but getting involved during election season can help ensure that those office holders will be people who are receptive to your message. The most basic way to participate in an election is to vote. All citizens have a responsibility to make considered choices and vote, and PAs should be sure not to let hectic schedules get in the way of expressing this fundamental contribution to the democratic process. But there's a lot more PAs can do to influence the outcome of elections than casting a single vote. You might be surprised how easy it is to get involved with campaigns and make a real difference in an election.
From planting signs in yards, to labeling envelopes, to knocking on doors and speaking to neighbors, successful campaigns require the efforts of many volunteers, and the duties don't usually require any specialized skill or political savvy. By devoting a little time to accomplishing these tasks for a chosen candidate, PAs can help shape the composition of the school board, state legislature, or other elected body that makes decisions that affect the health of those in the community. Campaigns also require money to get their messages heard in our crowded media landscape. While few of us have the means to make four-figure pledges to multiple candidates, even small contributions will be appreciated and remembered, especially by candidates for local office.
For a few special PAs, devoting a part of their time and income to campaigns is not enough. Their drive to help their communities calls them to give politics their all and run for office themselves. PAs in California, New Hampshire, and North Carolina have been successful in winning seats in their state legislatures. The same qualities that all PAs have to offer in the political realm— teamwork skills, specialized knowledge of health issues, and insight into human behavior—have allowed these PAs to become successful lawmakers. They show by example that it is possible to combine the roles of politician and PA, but be forewarned: just like being a PA, running a successful campaign and serving in a legislature take dedication, perseverance, and a whole lot of hard work. Nonetheless, for those with the energy and motivation, it might be the best way to help their communities on a wide range of issues.
PAs help individual patients on a daily basis and, over time, can improve the health of whole communities from their clinics. But PAs also have much to offer their communities outside of the workplace. Engaging in political activity is a key way for PAs to spread their unique knowledge and their keen judgment on health care issues. By taking the time to express your support for a positive piece of legislation, plant a candidate's sign in your yard, or visit your member of Congress, you can help build the political influence of the profession and, more important, support political decisions that will improve the health of Americans. You'll find it more productive, more rewarding, and certainly more interesting than watching another of those endless political ads. JAAPA
The author is assistant director of state government affairs for the American Academy of Physician Assistants, Alexandria, Va.
REFERENCE
1. Competencies for the physician assistant profession. JAAPA. 2005;18(7):16-18.