Category Archives: Advocacy

STFM’s Top 10 Ways to Win (Policy) Friends and Influence (Government) People

by Joseph W. Gravel, Jr, MD and Hope Wittenberg, MA

Wikipedia defines advocacy as “an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions.” This blog will focus on federal legislative advocacy, but you can use the very same skills in state or local legislatures, your home institution, or advocating for patients in the course of your work.

# 1: Begin With the End in Mind

Identify what change you want, how to make it happen, and who can make it happen. For example, is the issue a federal law that needs changing? Which committees have jurisdiction over that issue? Who sits on that committee? If it’s not legislation, who holds the decision-making power? Refining the problem and the solution you want, along with knowing who can make it happen, is the first step to moving forward with an advocacy goal. When you meet with who can make it happen, come ready with viable solutions, not just problems. There’s power in providing viable solutions, as you could be essentially writing a bill’s “first draft”, even if/when your ask gets amended in the legislative process.

#2: “Friends” Wasn’t Just a 90’s Show

Are you alone in trying to create change? Who can you identify that might strengthen your position? With whom might you ally? There is strength in numbers and power in broad movements. A corollary question is who would oppose the change you want? What are their arguments and how can you address them? Can you change their minds?

#3: Tell Me a Story. I Like Stories

How do you reach people to gain their support? Data and facts are important, but not enough. With advocacy, forget what you learned in professional school about the scientific method and the problem with anecdotal evidence. You’re not writing a paper here. Anecdotes are often more powerful than data in the advocacy realm. You need to develop a good story that both portrays the problem you are trying to solve and captures one’s attention at an emotional level. What are the key reasons to support your cause that would reach someone? Use examples that come from your patients, practice, or neighborhood. Remember that your community is your legislator’s community as well, and their job is to represent you and the community. (Read the blog posts Moving Away From Data Points and Back to the Patient Story and From Journalism to Medicine: Not Such a Huge Leap After All to be prepared.)

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Moving Away From Data Points and Back to the Patient Story


Kathryn Freeman, MD

This past spring, I consciously moved away from learning clinical skills and spent time at two conferences: the National Medical Legal Partnership Conference, and the Family Medicine Advocacy Summit. There, instead of learning about medicine, I learned about stories.

When I reflect on what I learned in medical school, it was all about taking a patient story and converting it into a formal presentation. We spend years training our residents to boil down a patient’s history into discrete facts in a defined structure, using medical terminology to convey a message that only other physicians can understand. But that only allows us to communicate with each other, not with the world around us, or with the people, partners, groups, and leaders who have the potential to make a larger impact our patients’ health.

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Our Nation’s Primary Care Academic Infrastructure: What Is Needed to Protect it During Obamacare “Repeal and Replace?”



Hope Wittenberg, MA Director, Government Relations

When one thinks of the repeal of the Affordable Care Act (ACA), the major tax and coverage provisions required by insurance come to mind. Efforts by the new Trump Administration and Congress to repeal the ACA will obviously have a tremendous impact on these features of the law.

What is less known is other provisions of the law, many of which have an impact on academic family medicine–they affect workforce or primary care research, or both. These issues do not have large constituencies behind them–we may be alone or in slim company trying to maintain key portions of the law that impact our academic infrastructure.

Academic Primary Care Provisions in the Affordable Care Act

  • Establishment of payments for training provided to Teaching Health Centers, rather than hospitals
  • Reauthorization of Title VII Primary Care Training and Enhancement with an emphasis on the patient-centered medical home
  • Primary Care Extension programs to assist primary care practices regarding innovations and best practices
  • Medicare Graduate Medical Education (GME) provisions supporting community-based training within the confines of historic GME
  • Establishment of the Patient-Centered Outcomes Research Outcomes Institute (PCORI), to improve patient care and outcomes through comparative clinical effectiveness research
  • US Preventive Services Task Force (USPSTF) gained a new requirement that private insurance plans cover recommended preventive services without any patient cost-sharing

A Campaign We Must Not Lose

Assuming others will make the case for us is not an option. Working in partnership, STFM and the other CAFM organizations, along with our members, will need to actively engage on our key issues. If each of us does not get involved, we may not have the political might to support our position(s.) We do not have the luxury of large population size to assume that others will make the case for us. Members of Congress need many voices educating them about what we know–that the overall health of a population is directly linked to the strength of its primary health care system and workforce.  They need to hear why each of these provisions is important to the primary care infrastructure of the United States.

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