ACP engages in the political process because it is necessary

There is almost nothing that physicians and the larger health care system can do for patients that isn't affected by what comes down from Washington. ACP must become involved in the political process.

When ACP pursues its policy objectives with Congress, the administration, and federal agencies, we are sometimes accused by unhappy College members of being too "political." The implication is that we support or oppose the agenda of a particular Republican or Democratic administration, or that of the political party that holds the majority in Congress, because we favor or oppose one party or political ideology over the other.

For instance, I have heard from a few ACP members of late who believe ACP is being "political" in opposing President Trump's immigration travel ban or the GOP plans to "repeal and replace" the Affordable Care Act. This criticism, not surprisingly, comes from ACP members who self-identify as Trump-supporting, conservative/Republican-leaning voters. Yet over my 38 years plus of advocacy for internal medicine, I have often heard the "too political" charge from liberal ACP members who thought ACP was not doing enough to promote progressive views or oppose conservative ones as well as from conservative members who did not feel we were doing enough to promote conservative reforms or oppose liberal ones.

Basically, what I have found is that if ACP is advocating for positions that don't align with a College member's own partisan leanings, especially when that member's party controls the White House or Congress, we are labeled as being too political. Yet the same member is fine with our advocating in the political process for the positions he or she agrees with, and against the views of the political party he or she disfavors.

This of course is fully understandable. If you pay dues to a membership organization like ACP, you want that organization to advocate for the things you agree with and against the things you don't, and for the political party and politicians who share your views.

The easy answer for ACP, then, would be to stay out of politics altogether, or to hedge our bets, so as not to make any of our members unhappy. Of course, this would then mean that a substantial number of our members would be unhappy because we are not advocating for the policies they believe to be important. But more important, staying out of the political process, I would argue, would be a dereliction of duty—the duty of the medical profession to speak out for policies that are best for patients.

The fact is that patients are directly affected by what the president, federal agencies, and Congress do or don't do. The government can propose policies that make it easier for patients to access health care, or harder. These policies can make it more or less likely that patients will be subjected to medical errors, be injured by firearms, or be exposed to environmental hazards that adversely affect their health; that they can afford their medications; or that they are exposed to preventable infectious diseases like Zika. There is almost nothing that physicians and the larger health care system can do for patients that isn't affected by what comes down from Washington.

So, in the current context, when ACP advocates against rolling back coverage and consumer protections from the Affordable Care Act that have driven down the uninsured rate to record lows, it isn't because we are being political or partisan or want to score political points against President Trump and the GOP-controlled Congress. It's because we believe patients would be hurt as a result of ACA repeal. When we speak out against the administration's ban on travel from seven majority Muslim countries, it is because we believe that patients in the United States benefit from having physicians and medical students from these countries train and provide services to many underserved communities. When we speak out against discrimination based on religion, race, ethnicity, gender, gender identity, or sexual orientation, it is because medical professionalism obligates physicians to oppose discrimination against their patients and their colleagues, not only within the U.S. but globally.

When we call for government and insurers to eliminate excessive red tape and administrative documentation/paperwork requirements, it's because we believe that they take physicians' time away from patients and contribute to physician burnout; studies show that unhappy people do not make good doctors. When we call for reform of the medical liability system, it's because we believe the current system pits patients against their doctors and vice versa, denies patients fair compensation when they are harmed, and leads to unnecessary testing and defensive medicine costs. This is not only bad for doctors, it's bad for patients.

Not every ACP member will agree with the College's views on what is best for patients, and that's fine and understandable. With 148,000 members, it is not possible for every one of them to agree with everything we say. If you disagree with our views on a given issue, try to persuade your colleagues in ACP that your ideas are better for patients. Start with getting involved in chapters, communicating your views to your ACP Governors (who can submit resolutions calling for changes in policy), and maybe even serving on College committees. And of course, let us know what you think, whether you agree or disagree.

But don't expect ACP to disengage from politics. There simply is too much at stake for patients for us to be silent when politicians from either political party push ideas that could harm them, or fail to support policies that would help them.