The Art of Physician Advocacy: 4 Questions With Thomas Eppes, MD

In this conversation with Thomas Eppes, MD, we discuss the importance of physicians advocating on behalf of physicians and identify useful tips for providers to work with — instead of against — legislators.

Physician advocacy places doctors at the helm of the healthcare “ship.” Like a ship, changing course is a slow-but-steady process, one that works when the crew collaborates consistently.
Every day, legislators pass regulations that can help or hinder healthcare’s advancement. Physician advocates help ensure laws steer healthcare in the right direction. But with doctors experiencing burnout at unprecedented rates, advocacy can seem like another time-consuming activity. In order to find a proper balance of staying involved but not burning out, check out tips from a physician advocate who has decades of experience.
Thomas Eppes, MD is the president of Central Virginia Family Physicians and practices at the multi-specialty group’s office in Forest, Virginia. He holds academic appointments at Liberty University, Virginia Commonwealth University, and the University of Virginia. He was the president of the Medical Society of Virginia from 2008–2009. Since 2009, he has been a delegate for the American Medical Association (AMA) and from 2015 to 2017 was the chair of the Association’s Integrated Physician Practice Section. This year he stepped away from the AMA’s governing council. He is the head of Privia Medical Group’s Advocacy Committee, which works to improve the practice of medicine by partnering with lobbying firms to improve medical legislation.
Dr. Eppes and I discussed advocacy over the phone while he strolled through the streets of Chicago during the Annual Meeting of the AMA’s House of Delegates.
The conversation was lightly edited for length and clarity.

Key Takeaways

• “Whatever policy you build, you want to build it on evidence.”
• “Advocacy is not in everyone’s DNA. That’s fair. However, you can at least support the people who do.”
• “Stay engaged with the issues of the day and be a resource for legislators.”

Morgan Hensley: What got you interested in advocacy?
Dr. Eppes: If you become involved in the leadership of the Medical Society of Virginia (MSV), then you become involved in advocacy; that’s an expectation of leadership. I started with MSV in the late ‘80s and had the opportunity to be a part of a task force on indigent care and several initiatives I was assigned to or volunteered for. I took a break for a period of time in the late ‘90s, then went back full-steam-ahead around 2000 when the committees I dealt with were [examining] not only access to care, but issues such as stem cell research.
I was writing white papers to educate legislators, and during that time I’d gone down to the MSV Legislative Summit, dropped into the office of my senator to say thank you for his work on a particular issue. He wasn’t busy. He looked at me, put his feet up on his desk, and said, “Tell me, what are the physicians thinking about?” We talked for half an hour, mainly focused on malpractice issues happening in the US at the time, and out of that conversation we eventually had the malpractice legislation that exists in the state of Virginia. We worked with trial lawyers to craft a solution that makes malpractice rates predictable and insured multiple carriers instead of dropping down to one or two, which was what we’d gotten to.
What you learn is that, in your lifetime and through your practice’s lifetime, there are many rules and regulations that happen in the legislature and state regulatory laws that truly affect the way you practice medicine. If you are not active in formulating these policies, they will happen to you.
MH: How do you differentiate between good and bad legislation?
Dr. Eppes: An example of bad legislation is when the assembly tries to write laws telling us how to practice medicine, like they tried to do with Lyme disease in the past. And in fact did do. Every time you see a patient and draw the Lyme test, you have to hand them a piece of paper that says this test might not be 100 percent diagnostic, et cetera. To avoid that, we do what we did when I was president of MSV and we sought to ban smoking cigarettes in public restaurants. We worked with both parties and our governor — now senator — Tim Kaine to make that happen. What you have to do is just get out there and do the best that you can from the standpoint of trying to make sure that you can get the best laws written in the best way for our patients and our professional lives.
MH: What do being a doctor and a legislative advocate have in common?
Dr. Eppes: One of the biggest things is public health. Our goal is to keep all our patients healthy. So there are a lot of public health issues — simple things like clean water, immunizations, access to affordable care — that physicians should always be on the forefront of to be advocates for their patients.
Another commonality is evidential approaches. At this year’s AMA, there’s a lot of talk about proper diets and gun legislation. But ultimately, whatever policy you build, you want to build it on evidence, and that doesn’t always happen. We all have opinions like we all have noses. One of the challenges we face is ensuring that we’re building evidence and basing our decisions off that evidence. That’s the key: to write laws not on opinions, but on sound evidence.
MH: How can doctors be active participants in advocacy and legislation without having it become another job, which could lead to burnout?
Dr. Eppes: Advocacy is not in everyone’s DNA. That’s fair. However, you can at least support the people who do whether it’s on a state or national or local level, city council, or government, taking big slices or small bites of the pie.
Not everyone can or should be president of a medical society. If public office isn’t your cup of tea, get to understanding the things that burn in your heart and that are important to care for your patients, then sit down and talk to your legislator. You can still stay engaged with the issues of the day and be a resource for legislators.
It takes a lot of time and effort to understand the ins and outs of healthcare policy and what’s going on from that standpoint. In Virginia, we’re fortunate to have three representatives, one senator, and our governor as physicians. It doesn’t matter whether you’re a Republican or Democrat; just understanding the issues from the physicians’ point of view is important.  
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