Physician advocates can play an important role in getting legislation passed at the state level to better help patients. The ACR Bulletin recently sat down with Christopher R. McAdams, MD, chair of the Government Relations Committee of the Georgia Radiological Society (GRS), to discuss his personal experience with physician advocacy, influential mentorships and success in the 2023 legislative session. McAdams shares practical insights into the challenges faced during the legislative process and a description of political realities in the push for legislative reform related to breast health in Georgia.

How did you become interested in advocacy?

My interest in advocacy dawned on me during my residency at Wake Forest Baptist Health when I realized the profound value of relationships. I've been incredibly fortunate to benefit from strong mentorships I developed then within the North Carolina Radiological Society. 

While I excel at networking and building relationships, I initially didn't see a role for myself in the advocacy space. It was during the ACR’s annual meeting when Brian S. Kuszyk, MD, FACR, insisted, “You have go to Hill Day, absolutely have to do it. You are with me today.”

He took me on my first Capitol Hill Day in Washington, D.C., determined to illustrate its importance. Throughout that day, I observed his style of communicating with legislators, witnessed the “elevator pitch” in action and learned how to articulate the significance of our work with patients. 

I was inspired and thought to myself that advocacy could be something I would enjoy and where I could potentially make a difference for my patients, my state and my profession. Upon returning home, I applied for the Rutherford-Lavanty Fellowship in Government Relations, spending a week in Washington with the ACR’s Government Relations office. This fellowship offered me insight into the mechanics of advocacy, truly helping me develop my skills and personal toolkit. Yet, I must admit I am still learning. To be successful in advocacy efforts, one must always be unafraid to leverage existing relationships and forge new ones.

Can you provide an overview of the roles and responsibilities of a physician advocate in a state legislature? What does it take?

In Georgia, our legislative endeavors have been multi-year efforts involving various stakeholders. We are fortunate to have many dedicated physician volunteers who have made significant contributions over the years. Early educational initiatives involved numerous physicians from our chapter members and our legislative consultant, Becky Ryles, educating legislators about disparities, a unique challenge in Georgia.

I was inspired and thought to myself that advocacy could be something I would enjoy and where I could potentially make a difference for my patients, my state and my profession.

With a substantial team of advocates, we began by meeting with various leaders, including Mark O. Bernardy, MD, FACR, a longtime advocate with the GRS, and Mary S. Newell, MD, FACR, a breast radiologist from Emory. Their efforts led to cultivating relationships with key figures, such as then-State Rep. Jon Burns, now Speaker of the House, and State Sen. Ben Watson, a Savannah physician and chair of the Senate Health and Human Services Committee, and positioned the GRS and the house of radiology as subject matter experts in breast health. I have since met with many other elected leaders, including state Rep. Sharon Cooper of Georgia, chair of the Committee on Public Health.

When you say it’s a multi-year effort, how does that unfold in terms of pursuing legislative change?

The multi-year effort involves laying the foundation of education about clinical aspects, which proved invaluable when discussions about potential bills surfaced. One such bill aimed to ensure parity of coverage between diagnostic mammography and diagnostic breast workups with screening mammography. While it sailed through the Senate with a majority of votes in favor, it encountered obstacles in the House due to concerns about fiscal implications. 

This presented an opportunity to educate lawmakers about the cost-effectiveness of early-stage, treatable breast cancers compared to the emotional and financial costs of late-stage metastatic cancers. The legislative session was ending, and as the bill stalled in the House, stakeholders sought any moving vehicle. House Bill 733, a popular insurance issue in Georgia, provided a unique opportunity for collaboration. It passed both chambers and was signed into law.

I’ve heard you say, “Progress is often iterative and less often linear.” Can you elaborate, please?

Yes, this insight stems from my Rutherford fellowship, emphasizing that the legislative process is a marathon, not a sprint. While getting a bill passed is a significant milestone, the real work begins afterward. In our case, we achieved a second success with House Bill 315 in 2023, sponsored by Georgia state Rep. Darlene Taylor. Incremental change is still change, but it requires ongoing attention to regulations and opportunities for improvement. The key is to hold insurance companies accountable to the letter of the law, ensuring that diagnostic imaging is treated with parity. Advocacy is about recognizing the potential for progress in various forms and being vigilant in pursuing it.

Can you give an example of a best practice in advocacy?

A best practice in advocacy is presenting a specific ask. Every group takes an “ask” for the benefit of patients. Physician advocates, armed with their relationships and personal experiences, share their stories in the halls of Congress and in state chambers. While lobbyists may deliver messages more eloquently, I as a constituent bring the clinical stories directly from my practice. The political process may seem complex and slow, but the opportunity to tell your patient's story is invaluable. While I can't do it every day due to my time constraints in clinical practice, I can still help facilitate meaningful change, and my story has many compelling examples of women needing better access to breast cancer screening and care.

Is there something one must account for when approaching state legislators as a physician?

In Georgia, known for its diverse communities, it’s crucial to recognize the significant number of physician legislators and others in healthcare. I highly recommend identifying representatives and senators who are fellow physicians. While they may not always align on every issue, building and maintaining relationships with them is worthwhile. Georgia’s healthcare landscape is dynamic, and having allies in the form of physician legislators is invaluable.

Advocacy often involves working with a wide range of stakeholders. Can you talk a little bit about your advocacy efforts with stakeholders?

One helpful aspect was educating legislators representing rural districts versus Atlanta. Creating awareness of this issue and demonstrating its clinical impact garnered their support, a critical factor given Georgia’s vast size and the divide between urban and rural areas. Access to breast services and healthcare in Georgia is a significant challenge due to its size and demographic diversity. Geographically, Georgia is the second-largest state in the South after Texas. By illustrating how insurance coverage impacts patients in rural areas, we were able to educate legislators and make a compelling argument for the importance of follow-up diagnostic imaging. 

What advice do you have for newcomers to physician advocacy?

The best advice I’ve received about advocacy is to never be afraid to introduce yourself to others, especially those in different specialties or advocating on different issues. Initiating conversations and learning about your community dynamics is the first step in building relationships. By sharing insights and learning from each other, you can make connections with like-minded individuals who share concerns about breast health. Some of the most valuable connections I’ve made have been through introductions at events. I recently made a new connection that led me to a new opportunity to join the AMA’s Cancer Caucus.

When is the best time in your career to get started in advocacy?

I wish I had started advocacy efforts earlier in my career, perhaps during medical school or my first year of residency. Attending events like the ACR meetings provides numerous opportunities for learning, networking and gaining insights. However, I’ve also come to realize that it’s never too late to get started. 

Do you have advice for anyone from a state chapter that does not have a lobbyist?

Connect with the ACR Government Relations staff at both the federal and state legislative levels and the ACR RAN. While it may seem like you're alone, opportunities to get engaged or find common ground with others often exist. The ACR Government Relations and Economics staff members play a crucial role as the boots on the ground in Washington, handling the hard work, late meetings and early fundraisers. Seeking advice and support can be incredibly beneficial, highlighting one of the many values of ACR membership.