Hello and thank you so much for joining us for DO Day on Capitol Hill 2025. My name is Sean Neal and I am the Vice President of Advocacy and Political Affairs for the American Osteopathic Association and it is my honor to make sure to make sure that your voice is heard on Capitol Hill. I'm going to go ahead and turn it over to my to Dr. Ray Morrison. Hi, this is Dr. Ray Morrison. I am the Vice Chair of our Osteopathic Political Action Committee, OPAC. I'm also the Speaker of the House for the AOA and pleasure to be with you today. I'm the Founding Dean for the Edward Viack College of Osteopathic Medicine in Monroe, Louisiana. Sean. Thank you so much for that introduction, Dr. Morrison. And so Dr. Morrison and I are going to cover a very important topic today, which is strengthening rural health care through osteopathic advocacy. But before I begin and we begin, just a quick disclosure that we have no conflicts of interest or relevant financial relationships to disclose. Here are the learning objectives of this presentation. And by the end of it, you will be able to identify the AOA's federal and state legislative priorities that impact rural health care. Discuss effective advocacy strategies for engaging with policymakers on rural health care issues. And then finally, define the current challenges facing rural health care and the role osteopathic physicians play in addressing these challenges. And so with that, I'm going to go ahead and turn it over to Dr. Morrison to discuss rural health care. Dr. Morrison. Thank you, Sean. I appreciate you allowing me to do this with you today and like to welcome all of our affiliates on this track for our virtual DO Day. Let me start out and say I do have some references that are not shared on the slide. But I'll tell you, I used references from, of course, the AOA. I've used references from AACOM and I even went through CHATGPT for some of this just to help organize some of my thoughts. But one of our one of my big references also is from the NCADH, which is the National Center for Analysis of Health Care Data. So you might see that referenced on the slide here now. OK, we'll go to the next slide. And I know that I'm preaching to the choir on some of this, but I'm sure most of you recognize that there are two schools of recognized licensed positions in the United States, and those are the Osteopathic Medicine, or DOs, and the Allopathic Medicine, the MDs. We've got training throughout our course of medical school training. Of course, the osteopathic profession carries with it about 200 more hours in osteopathic medicine, and that along with giving us our credentials in licensing, as well as the similar residencies throughout in all the specialties that are represented. We've had a significant growth of osteopathic profession. If you think about from the time I graduated back in the mid-80s, we had 12 or 14 medical schools. I think we had 12 medical schools back during that time. That has grown significantly over the last 10 or 12 years and 15 years. We have a significant amount of student input in our profession, and currently one in four are now students in our osteopathic medical schools, but one in four students out of all the professions in medicine. It's very important that we recognize why we have the need for primary care and rural health care, and I'll demonstrate as we go along through this brief lecture, the shortage we actually have in the physician workforce. It's very easy to see that if you're in a large city, Chicago, Dallas, New York, San Francisco, any of these large cities, you'll typically see, well, there's no shortage there. They have plenty of physicians. Well, we understand that, but when you see the map that I'll present later, you're going to see the reduced workforce, and that's not just with physician. That's pretty much all specialties of medicine, whether that be ancillary medicine, the nurse practitioners, the allied health professionals. They're all in short percentage in the rural areas. There we go. There we go. When we looked at this, we actually looked at the HRSA report from the period of 2013 to 2025. These were a projection of shortages that we would see during this time period, and as you can see right now, there's probably 20 overall that they're expecting to have primary health care shortages. These are primary care providers, and whether that be an internal medicine, family practice, pediatrics, all of those go along to be part of this health care shortage population. Obviously, just like me, I'm part of this aging population that is showing an increasing demand for the health care. We have a larger than usual number of septogenarians, and heptogenarians, and octogenarians. We're growing, and we just simply need more docs. There's also, as I stated, a maldistribution of physicians. We have more physicians in the city areas, less in rurals, and we also have a significant underrepresentation of many of the minority groups throughout the United States. Next slide, please. I'm showing you Louisiana because I have very good knowledge of that, living here in the state, and of course, coming to the state was one of the reasons we were invited to join the state to help provide the supply to this rural physician workforce shortage. When we look at Louisiana, I think the thing to look at here, we had a 19% predicted shortage overall nationwide of physicians in Louisiana. The more graphic map on the right shows the medically underserved areas, medically underserved populations. Again, you can see at the top of the Louisiana map is Ouachita Parish. That is where Monroe is, and we have plenty of physicians in Monroe, but even in the outskirts of the parish, on either side of that parish, we have a paucity of physicians. If you go south, you'll see Baton Rouge in the East Baton Rouge Parish. As you get further south into the boot of Louisiana, you're around New Orleans, plenty of New Orleans, and then over to the western part of the state, but throughout the majority of the state, there's a significant number of parishes that are underserved. Let's go to the next slide, if we could. So, why does health care matter, especially in the rural regions? And one, the rural health care does offer significant challenges, and mainly because of just the access to care. If you think about your rural parishes or your counties that you live in, or that you may have family and friends in, it's a long way to drive anywhere. The towns are small. There's typically significant distance between the towns, and if you're far away from a larger urban area, you just don't have the ability to bring in, or to get that substantial care that you might need. Also, there's, as part of that, is the, we're having more and more of cultural changes to the different areas of the country. There are language discrepancy, and even with the recent political executive order to make English the language of the United States, we still have a lot of people that speak French and other dialects that maybe they're having a problem communicating with their local physician. There's also higher rates of chronic diseases, and I'm not sure exactly why that occurred, but the people that live in these small towns, even though they have the fresh air debris, they have all the wonderful nature of being away from the urban area, they still have a significant amount of chronic disease, and whether that leads from physical attributes that they have, or area emotional, because maybe they're feeling alone. Maybe they don't have the social interaction that would be desired, or sometimes it's just the intellectual disabilities of not being educated to a point where they can communicate that well, and that's part of their, that's part of the education that a physician provider in the rural workforce would carry out. Obviously, transportation and insurance barriers, you know that going from a small town to a large city sometimes takes a lot of gas mileage, and if you buy a lot of gas, people just don't have the affordability to buy all that gas to get to their health care provider, and so the local access of medicine in the rural areas is a big need in the workforce. Mental health care shortages, I'm not saying anything new. The entire country is lacking in mental health care shortage. This is becoming more apparent, especially following COVID. We have more and more people that were isolated, bringing in and exacerbating more health care diseases, and there's just not enough doctors. There's just not enough programs that are available to do that, and doctors are the primary health care delivery providers for health care services. There's also a risk of health outcomes. There's a high risk of complications, because a lot of people may go into the city and have significant procedures done or significant illnesses cared for. However, when they return to their home in the rural areas, they may not have physicians dear enough to be able to help with those post-operative or post-procedural or post whatever condition that was treated. They might not have the support there, so that's why rural health care is an important topic. Next slide, please. So right now, 11% of the physicians in the United States is cared for by the osteopathic profession. Now, you can say, well, there's plenty of MDs in the United States. There's plenty of DOs in the United States, making up probably over 400,000 physicians total. Yet, the DOs currently have established a large percentage of the workforce shortage in those service areas because of our mission, because of the way we were trained, because of the way our osteopathic colleges bring that. Also, as I said earlier, we're the fastest growing profession in health care. We've gone from 12 medical schools in the early 80s to now that we have almost 70 osteopathic medical schools in the nation. Now, we haven't caught up to having all those schools graduate their positions, get them out of residency, and get them in the workforce, but we think that is going to make a big difference in, again, addressing our needs in rural regions. Next slide, please. So, this is interesting. As I was saying, we've got right now 67 actual locations. I said 70 because we have three or four other schools that are in the process of getting credentialed to be accepted as a future osteopathic medical schools, and currently have 42 base colleges of which we have these extended. As I am a part of the Edward Viner College of Osteopathic Medicine Monroe, we have three of the sister schools, the original school in Blacksburg, Virginia. We have one in Spartanburg, South Carolina, one in Auburn, and then one in Louisiana. But you can see by the map, we still have a significant shortage of those schools in the mid-states or in the central portion of the region. But if you take a look at some of the statistics from U.S. News & World Report, the top 10 spots of all of this report, I add that most of our graduates are in primary care from osteopathic medical schools. Four out of the top 10 spots of osteopathic medical schools show graduates practicing in these underserved areas, and six out of 10 show actually moving to those rural areas. So, we are a small numbered profession. However, we're a large representative of producing physicians for the rural regions and underserved regions. Next slide, please. So, let's talk a little bit about our comms, our osteopathic medical schools. 50% are designated in a health profession or health shortage area. It means that we have intentionally placed our colleges in places of need, and more than half our schools have done that. Of our schools, we graduate 64% or, excuse me, of those schools that we are going to graduate, we make sure that they have an experience or an expertise in rural medicine. The majority of our schools require that they get clinical rotation in a rural setting or in an underserved community so that they can gain that experience and knowledge. And as a matter of fact, almost all of our schools, 88%, that's a high percentage, we actually prioritize and promote rural health care in our mission statements. So, if you look at any of the college mission statement line, I'm sure that you will see that that's one of our expectations. We expect our recruited physician groups or for a recruited student to come in and understand that we do have a commitment toward that care. And again, it's been identified that DOs are the ones that are most likely to enter primary medicine. That next slide shows a quote, yeah, from Fierce Healthcare. Let's go to the next slide, Sean. The, this was out of Fierce Healthcare and it talks about, Matt Kurt was an author, he brought up this quote, and I love this quote, given that, and I'm going to read it, given the doctor of osteopathic medicine's workforce, higher likelihood of practicing in rural communities and of pursuing careers in primary care, doctors of osteopathic medicine are on track to play an increasingly important role in ensuring access to national care or to care nationwide, including our most vulnerable population. So, we're known nationally as the profession that wants to put our, into those underserved, underrepresented areas, and especially in the rural regions. Next slide, please. So, now that we're going to talk a little bit, I, this briefly about what is the osteopathic medicine in total's commitment to rural health care. And so, again, as I stated, if you train in these rural areas, there's a big recent report that stated that of those people in residencies, of all residents, about 50% end up staying in the area. And it's kind of the same thing with our medical schools. If they train in the area that they're used to being in, then there's a bigger, that's why we have greater than 60% going back to these underpopulated areas. Next slide, please. So, this data was developed from the, again, from the National Center of Advancement of Health Care Data. I'm just going to say the NCHD. And this is pertinent to VCOM. And the reason I say this is because this is where I live. And this is some of the data that we specifically choose. I'll put in a plug for the NCHD and say that if your society, if your affiliate society, or if your com wants to, has been affected in your area, you can contact the NCHD and they can help lead you to providing maps and service areas and help you with some of this information. I think it's a worthwhile service that our osteopathic physicians are able to present. This is somewhat of an old map. But if you take a look, the yellow stars represent our campus. I don't have one for Louisiana. I'm sorry. But if you, if you look at that, we're in the Appalachian Ridge. So, the entire part of Appalachian into the Delta, which are very, very needed areas, very underserved areas of the United States. And this is where the majority of our students are coming from. You see how close they are. We don't recruit outside of those areas because, as we stated earlier, there's a bigger percentage we can get you to go back to that rural area if you're from that. So, let's look at the next slide. And I'll show you, it's not a secret, but one of the things we do is we recruit specifically to the smaller populations. It's very easy to go to Dallas, very easily go to New York. It's very easy to go to Chicago and look at all of the top performers. But the problem is, if they come to your school, there's a good percentage they would go back to those urban areas. That's where they came from. We typically recruit almost half of our students from communities less than 30,000. That's not very big at all. But if you can see that even going up to 100,000 or less, that's 75% of our recruitment efforts. And only 25% come from the areas of populations greater than 100,000. Again, making it suitable for those that we educate to go back to those rural areas. Sean, please, next slide. This was interesting because this originally came back. A good friend of mine, Natasha Bray, is now the Dean of the Oklahoma State University of Health Sciences in the Cherokee Nation. This was in Tahlequah. It's over in the eastern part of the state. And they have just opened up again. This is our first medical school in a tribal, recognized tribal school. They represent 31 counties totally over entire Oklahoma. Again, it's just the osteopathic approach to delivering rural medicine. The next slide, I'll show you six out of the top 10 schools that are absolutely recruiting to those rural areas, improving that by putting their students in those areas. And as you can see, the A.T. Still University, which has three campuses, has made that list. The William Carey University down in Hattiesburg, Mississippi. The Kentucky College of Osteopathic Medicine in Pikesville, Kentucky. West Virginia School of Osteopathic Medicine up in Lewisburg, Virginia. Des Moines University, which is also a fairly large city. However, even in that larger city, they are putting out students into the rural and encouraging rural practice. And then the Pacific Northwest Universities over on the western portion, Seaboard up into Oregon and Seattle and California as well. Next slide, please. So I put this slide in just to give you an example of our students when they get to the, like I said, our first two years are pretty much all the same training that we give with the exception of the addition of osteopathic medicine and the medical medicine. All of our students get the required basic science courses of medicine. But when they get to the third year, we are truly looking, how do we encourage or how do we teach those subjects that will allow our students to gain that experience? As you can see in our ambulatory based third year programs, we have a component of rural primary care. We also do practice, family practice, as well as geriatrics. And we put those actually in the nursing home. And the reason we do that, again, is of the underserved. We're not in the large multi-story hospitals throughout the United States necessarily. We have some, but for the most part, we're right in the community. You can see we have internal medicine, pediatrics, OBGYN, psychiatry, and even our hospital-based surgeries tend to be on the community setting, training our students in those rural areas. We're incorporating AI as seems to be the next big push in medicine. We're trying to figure out how to best incorporate that throughout our comms, as well as our profession, as well as our nation. And we see that ongoing all the time. Sean may have something to say about that at some point in time, or you as affiliates, we would love to have you please contact us and give us some of your input regarding that. Next slide, please. One of the other things that we support, and this is typically a governmental project of the Federal Qualified Health Care Centers, the FQHCs and the RICs. These are governmental entities that are placed in communities of underserved populations or underrepresented populations. And we've even incorporated this with something called the THC-GME, the Teaching Health Centers and the Graduate Medical Education, which are also in the smaller areas. And they're producing residents, again, where we talked about 50% of our residents staying in that area, help to provide for needs post-residency in those areas. But right now, the FQHCs are servicing some 31 million patients in over 14,000 locations. We are continually striving to increase those numbers, gaining support from our advocacy as osteopathic physicians to try to bring those into our deserving areas. And we need policies, and we are developing policies and submitting policies that help. Sean, next slide, please. This, again, going back to our data from the NCH, this is actually just looking at our graduate placement for VCOM specifically. As you can see, the majority of our graduates go into a primary care practice site, of which 2 thirds stay in the region of which they came. And 2 thirds of them are actually in medically underserved regions or in the rural regions. And again, it's a large percentage of doctors that are trained in primary care that do this. Next slide, please. What people don't realize, and I always like because that's what the community is here. When you talk about how does this really affect our community, well, I particularly looked at VCOM on this. I'm just going to use that as an example. And we look at the number of graduates. We've had almost 5,000 graduates since 2003 when the school started. And we're looking at those graduates. 2,700 have gone. What does that mean? If you take a look at the next column, it shows $47 billion of input that those physicians into these various communities where they practice. $47 billion, they've created more than 400,000 jobs for the communities they serve. They pay out $29 billion in payments to those that are working and also bringing that back into our federal tax system. If you think about local on tax revenue, $12.6 billion from just the VCOM graduates. Now, you put that over 62 medical schools over a period of the next 10 or 12 years, we're making a significant contribution to the communities we serve in the rural and underserved area. So putting a small college into a small comp to an area of need makes a big impact. And we'll talk about that at the end of the slide presentation today. We'll go over to the next slide, please. Also, looking at what our role is, when we think about this, 86,000 physicians are going to be needed in the rural areas by 2036. That's 10 years away. 2036 was a number I never imagined. I never imagined 2025. Can you imagine that, how far out that was? And we're here. And now in just 10 or just a little over 10 years, that's the number of physicians that we're going to need. That's the number of physicians we're going to need in those areas. We're going to have, again, to just reiterate, there's a decreased access to care. We don't get diagnosis as quick. There's poor outcomes, and we don't treat them quicker. It's just a totally weakened health care infrastructure. So we need to bring our physicians to the workforce. Next slide, please. So what's the role of osteopathic medicine? Again, as I say, we have a rapid, rapid growth of the DO profession. It's increased 70% over the past 10 years. We're continuing to grow osteopathic medical colleges. We're going to have graduates of osteopathic medical colleges, and we're moving into the regions that need to be served. And again, if you looked at that income database, we're strengthening this community partnership. When we do that, that also brings in a better access. So in summary, next slide, your osteopathic physician workforce are crucial in addressing our physician shortage. We're focusing in on the whole person aspect of medical care, but we're also focusing on the community aspect of medical care. That's who we serve. We serve the people of our communities. We have a need for the continued investment in rural training programs. And Sean's going to talk about how we achieve that as we get further into advocacy. And we're going to be, of those of us that are already in practice or in affiliates that are helping with your associations throughout your state and specialty societies, it's good to support those policies that promote rural health care. You can be an active participant in helping us serve our communities better. And of course, also, we go out to the recruitment to these smaller towns. But we also recruit from the colleges and the local small colleges of these smaller towns to have them consider choosing osteopathic medicine as their primary source of medical school training. So now that I'd like to go ahead and turn the lecture over to Sean, and thank you very much for your attention to this part. Thank you so much for that important overview, Dr. Morrison. And now that we have a base, I'm going to discuss how we can activate physicians and our affiliates in these areas, in these rural and underserved areas and beyond. And so I'm going to be highlighting that you don't necessarily need a big budget to make a big difference in health policy. I also wanted to start at a very basic level, and that is just to define advocacy, which in theory is pretty simple and straightforward. Advocacy is a group of citizen or a citizen attempting to influence lawmakers. And so you can engage in advocacy in many ways, such as showing support or opposition for legislation, asking for change, telling stories, sharing ideas, or providing information to your representatives. In turn, lawmakers will create laws and regulations based on the feedback that they hear from their constituents, which really why it is so important and critical to stay engaged. The osteopathic profession has the opportunity to craft health care policy and make a difference, especially in these rural and underserved areas. And so we here at the AOA engage in advocacy at all three levels, from the local level, anything from county school boards and city councils, to the state level, so state legislatures and their regulatory bodies, and then finally, the federal level as well, which is US Congress. As we kind of move up the pyramid here, legislation and policy moves slower and slower and slower. So when we engage in advocacy, we really have to be resilient in that process because it can take sometimes multiple, multiple years in order to pass a specific piece of legislation. And so the most important thing to keep in mind is that your members of Congress really want and need to hear from you. And so there's many different ways to advocate, but I will say that not all strategies are necessarily created equal. And so a recent study from a think tank here in Washington, D.C., from the Congressional Management Foundation pulled Capitol Hill staffers and asked them a really simple question. If your boss has not already arrived at a firm decision on an issue, how much influence might the following advocacy strategies directed to their office have on their decision? And as you can see, an in-person visit from a constituent is right there at the top of being most effective. So 54% of Capitol Hill staffers said that it had a lot of influence on their boss's decision. Compare this to only 19% from sending kind of individual emails or telephone town hall letters. Now, I will say that all of these forms of engagement are very important, but some play kind of a more important role in the overall process, and some have higher priority depending on where you are at in the advocacy process. And so members of Congress, they truly value staying in touch with their constituents, and osteopathic physicians are definitely the subject matter experts when it comes to healthcare-related topics. We want them, members of Congress, and state lawmakers to reach out to you when they have a question about health policy. And so while you're engaged in advocacy, it really is important to know that very few bills actually go on to become law. A small percentage of bills will go on to get a vote in Congress, and an even smaller percentage of bills will go on to become law. So again, as I mentioned earlier, you really need to be resilient in the advocacy legislative process. But at the same time, also set realistic expectations for your campaign. Even though a particular bill does not pass, it can still have significant and important implications and go on to become powerful political tools. So here is just a quick example of how rare it is to become a bill to become law. So in the 117th Congress, of the more than 16,000 bills that were introduced, less than 315 actually went on to become law, or around 3% or so. And I should say that most of these bills that did become law are just naming post offices or something like that. So in order to pass a significant piece of legislation, it's very rare. And I can say that this is something that the AOA and our affiliates work really hard to do every cycle and are able to get some of our priorities heard. So it really is kind of an elite club to be a part of to get a bill passed into law. But how do we actually pass a bill given that so few go on to become law? Part of the solution is to understanding the structure of a congressional office. So what you see here is the kind of typical structure. And the member of Congress is obviously going to be at the apex, they're the boss. Each staffer under the member of Congress has unique responsibilities. And depending on the office, each staffer will have kind of a dedicated particular issue. So if we can identify the appropriate person to connect with, we have a better chance to kind of building that relationship so you are a resource on the office for key issues. One of the thing also to keep in mind is each congressional office is like its own little independent business. So some of them may be structured a little bit differently, but overall, this is kind of what the structure looks like for the most part. So if you were able to secure a congressional meeting and you're not meeting with the members of Congress themselves, it is likely that you'll meet with the Health Legislative Aid or HLA. These are individuals that specialize in healthcare related issues. It is important to note that staffers can often be as knowledgeable or even more knowledgeable on a particular issue than the member of Congress themselves. So lawmakers will often rely on the staffers' recommendations. So when you're meeting with these individuals, just be sure to put your best foot forward and be prepared when talking to them. And don't underestimate staffers. Each staffer within a congressional office has a specific role and responsibility. Members of Congress themselves can be overscheduled, typically averaging 70 hours a week or so, and can be double or even triple booked, which means that lawmakers typically have to rush from meeting to meeting to meeting. So the chief of staff is the closest to the lawmaker, which is often delegated to speak on behalf of the member of Congress. Legislative directors, they tend to be the kind of the policy specialists and typically oversee the legislative assistants who specialize in a specific policy area. Under the legislative assistants are legislative correspondents or LCs, who are often younger. They're recent college grads for the most part, and join meetings typically to take notes or to listen to their constituents' concerns. As a reminder, kind of going back to civics 101 in middle school or maybe elementary school, the U.S. Senate is made up of 100 members, which are elected for six-year terms on rotating intervals. And the U.S. House is represented of 435 members elected to two-year terms. The total number of representatives for each state that each state has is based on population size as reported by the U.S. Census Bureau. So for example, California obviously is going to have more representatives than let's say Wyoming, simply just due to population size. So you are represented by two senators and one representative on the federal level in your state. And as for passing a law, it's, you know, in theory, a straightforward process. A lawmaker introduces a bill. If approved, it goes on to the other chamber. If passed, it goes on to the president to become law if they sign it. So it sounds pretty simple, but there are many, many steps along the way that could interrupt this process. But in a perfect world, that's kind of how it works, but a lot of different variables that are in play. As we prepare to meet with members of Congress and their staff, it's important to understand how to effectively communicate our message. And so our goal is to make a compelling case for the issue impacting osteopathic physicians and, you know, your profession and the patients that you serve. So every interaction with the congressional office is an opportunity to build relationships and influence policy. And so just want to talk through a key, some key elements here that will help structure your meeting in order to have a successful conversation with your lawmakers. And the first things first where you want to establish is your geographic connection. Dr. Morrison talked much about the rural and underserved areas. So it's important that we bring that up and why we need policy in that area to help better serve your practice and to better serve the patients that you serve. And so congressional offices prioritize hearing from their own constituents. So introducing yourself and your ties to the district or the state is really critical when you're meeting with them. Start just by thanking them on their work on healthcare and introduce yourself. So for example, like, hi, my name is Sean Neal. I'm an osteopathic advocate in your state in Virginia. And I appreciate your efforts into support patient access to care in our area, in our district. If you're a student, just emphasize your future as a physician and your commitment to serving the constituents at a later time. I'm a medical student. You know, I'm at the College of Osteopathic Medicine in your district, right? And I hope to practice in this community after completing my training. So that's kind of an example of how you could potentially utilize that as a student. And expressing appreciation can go a long way in building kind of with this rapport, right? And setting a positive tone for the conversation. Next, tie the lawmakers past work or kind of position to the issue at hand. Kind of demonstrating that you've done your homework shows really kind of a lot of credibility and helps frame the conversation quite nicely. Mention the members previous support on, you know, related issues. So for example, we know that Congressman Smith has been a strong advocate for protecting physician-led care and we appreciate that. Or if they're a member of a key committee, acknowledge that as well, right? As a member of the Energy and Commerce Committee, you play a critical role in shaping healthcare policy and then go on with your conversation. If they haven't taken a stance, let's go ahead and kind of go into that. Just, you know, introduce the issue in a way that connects to their priorities. So ensuring that access to quality healthcare is important to everyone. And we see that in your efforts to shape rural healthcare. One of the most important things is to convey why this issue matters at this moment. So congressional offices deal with thousands of issues. So making it clear why they should focus on yours is key. So tie the issue to an upcoming vote, for example, or kind of some kind of deadline or real world impact. So with the upcoming vote on, let's say the CR, for example, Congress is running out of funding on March 14th and we would really like your support to include, you know, a certain bill within that CR. If there is no immediate legislative action, kind of frame it around consequences, right? So if Congress doesn't act, more physicians will struggle to keep their doors open and patient access will suffer. And just kind of remember that urgency drives action. If there is kind of a sense of immediacy, lawmakers will likely be more engaged to act. Facts and figures are definitely helpful, but personal stories are what truly resonate with members of Congress. Congressional offices want to hear how policies impact real people. And this is especially true in rural and underserved care. Keep your story concise and relevant. So for example, in my practice, I've seen firsthand how Medicare physician payment cuts have made it harder for physician practices to stay open. Without any kind of additional payment efforts, we risk losing physicians, especially in rural areas, because they simply cannot keep their doors open anymore, due to a lot of different factors. Such as inflationary issues, such as student loans, liability insurance, you name it. There's a lot of different variables that go into maintaining a physician practice that makes it very, very expensive. Offer resources for them to review later. If you'd like more data, the AOA definitely has a lot of information that you can use. So feel free to use our department as a resource. We'd love to help. And of course, with a clear call to action. We hope that Congressman Smith will consider co-sponsoring this bill to ensure physicians can continue to serve their communities. You know, our goal here isn't just have a one-time conversation. And Dr. Morrison is so good at this by continuing to build relationships with members of Congress and lawmakers in his state and beyond. So when they do have a question, they reach out to him and ask him, how does this impact you in your area? So our goal isn't, you know, again, just to keep it one time. We want to build a long lasting relationship with the office, ensuring that the conversation with the plan is ready for future engagement. So just mention, you know, the AOA policy team is happy to follow up, you know, offer to be a resource again. And then, you know, this kind of helps turn a one-time meeting, right, into an ongoing dialogue, which is how we create real change. The most effective advocacy is about building connections and sharing real world experiences and making clear asks. So remember, congressional offices really do want to hear from you, as mentioned earlier. So if you follow kind of these key components here, you can have a successful meeting. But there are so many other influences on Congress and millions of voices expressing either support or opposition for bills. So how can we break through this noise? And getting through that information overload is one of the many reasons why our AOA public policy department exists, right, is to pass pro-physician and student legislation by navigating kind of the murky waters by building support with the right individuals. But that really can't be done without momentum. And the constant beating of the drum on Capitol Hill or I'd say tilling the soil, we need to be active on these issues continuously, not just one and done with one event. When we start a grassroots campaign, it doesn't end with an email. It is consistent and sustained engagement throughout the year. And some of that engagement is done through direct lobbying, but others just comes from engagement from our members, of course, and our affiliates can certainly take advantage of that by working with us to help bolster your message. And I know, you know, we've seen a lot of noise on TV and social media, and I know everybody has heard the quote, 90% of success is just showing up. And I think this picture illustrates that quite nicely. So this is an actual town hall with a member of Congress, a real member of Congress, and we see about seven people here at most. So imagine the impact that we can have as osteopathic physicians and students if we fill these seats talking about the issues that matter to you. And so that is exactly why the Osteopathic Advocacy Network was created to help build and foster relationships with lawmakers in order to pass legislation that not only benefits physicians, but the patients that they serve as well. So this network created by the AOA, it brings together osteopathic physicians to kind of build and foster these relationships with lawmakers. We do host a monthly public policy roundtable for OAN members. So these are kind of informal Zoom meetings where we discuss, you know, health policy and kind of what to expect in Congress. The latest and greatest is what's going on, not only on the federal level, but the state level as well. We always welcome our state affiliates and our leaders to come on these calls to present and talk about the issues that are impacting them, because that leads to a conversation where we can all discuss how to tackle these issues together. So if you'd like to join, there's a QR code on the screen there, where you can always join osteopathic.org slash grassroots. One of the things too that we do to engage in advocacy is through the OAN network is building these relationships when members of Congress are back home in district on congressional recess. So we set up a campaign. This is our August recess campaign. And with one click of a button, similar to our other grassroots campaigns, you can send a meeting request to your member of Congress to meet during a specific time of year. And we make sure to set this meeting up with, we make sure that you have all the tools that you need to ensure that this meeting is a success. So we'll provide you all the talking points. There's an advocacy toolkit for you to utilize that, again, that we want to make sure that you're comfortable with the meeting itself. And that kind of brings me to what we're all celebrating here today, which is DO Day on Capitol Hill. If you want to take it a step further and to advocate outside of your state, we encourage you to come to D.C. to lobby your members of Congress on the issues that matter the most to you. So looking forward to seeing many of you in Washington, D.C. in late March. I know we're going to make a big impact and build that momentum that I talked a little bit about earlier. Partisanship, it seems to be growing, right? There seems to be kind of a divisive line between the Republicans and the Democrats. But I will say that it's pretty much a bell curve, right? On the far left, you have a small number of individuals that are allowed and will not work with the right. And the same goes for the right end of the bell curve as well. You have some, a few individuals on the right that aren't going to work with anybody on the left. But the vast majority of members of Congress fall in the middle of that bell curve where they do want to engage in common sense health policy that advances the osteopathic profession. And that's what we do here at the AOA as well, is we make sure to advocate for bills, bipartisan bills, nonpartisan bills that impact the entire osteopathic profession in all states. And many of the bills that we advocate for do impact rural and underserved areas. Dr. Morrison mentioned one of them earlier, and that is making sure that the Teaching Health Center Graduate Medical Education Program, or THCGME, is reauthorized. This is a program that receives funding from the U.S. government for a certain amount of years, and if it does not go reauthorized, it risks the potential of shutting down. So that's why it's so important to keep advocating for these issues to avoid potential shutdowns on issues. I mentioned that we talk, and we advocate at the state and federal level, and this is what, on the state level, we have a priorities document. This priorities document is reviewed by the AOA's Bureau on Federal Health Programs, and they kind of oversee all health care-related policy for the osteopathic profession, and then it was confirmed by the AOA Board of Trustees. And through this priorities document, it allows us to stay focused on the issues that are most important to the vast majority of the osteopathic profession. And at the very top there, you can see scope of practice and new licensure types. That is the issue that we deal with most in the states, and you're going to hear a little bit about this more in other presentations. So I'm not going to go too far into depth of what that looks like, but just know that we continue to fight back against inappropriate scope of practice expansion for non-physician clinicians. This topic is something that state lawmakers typically use to solve the problem of access to care in rural areas, when in fact that we know that that is not true. If you haven't seen it, I don't have an example here on the screen, but there is a map, an overlay map, of where non-physician clinicians practice and where physicians practice, and that overlay intersects, right? So they're practicing in the same area. So again, but when we talk about patient access to care, or scope of practice, excuse me, we want to make sure to recognize that non-physician clinicians are an important role in the health care process. But at the same time, we want to make sure that patient safety is protected. So that's our number one argument. And of course, education and training is obviously a part of that, and that matters as well. So again, not going to dive too far into that, but just going down the list of our priorities, osteopathic equivalency, making sure that osteopathic physicians are recognized appropriately, truth in advertising, public health initiatives, the physician workforce, graduate medical education, Medicaid, for example, is really being under attack lately, so we're making sure that Medicaid is funded, telemedicine, and making sure that the payment parity is there between various telehealth forms. AI is a big one these days, and prescription drug use. So just an example here of some of the state priorities that we use, that we focus on, excuse me, some of the federal priorities that we focus on as well, supporting physicians and their ability to care for patients, of course, number one, strengthening the physician workforce where it is needed most, so graduate medical education funding, access and affordability, regulatory reform, right, everybody's favorite topic, prior authorization reform, nobody likes it. So we are trying to streamline that process and make it better for physician practices and for the patients that you serve as well. And of course, public health, much like the SAGE initiatives and federal funding for various initiatives. We recently launched a campaign that educates, that really kind of welcomes the 119th Congress. So if you haven't done so already, I encourage you to visit our Advocacy Action Center to send your lawmaker this welcome letter. It kind of outlines all the priorities that I mentioned earlier and really kind of sets you up for success throughout the year. One of the major issues that obviously we're advocating for is Medicare physician payment cuts and advocating against those and providing that kind of an inflationary update to Medicare physician payment. It's been a lot of years, a lot of decades now at this point that physicians have not had any kind of payment raise and that is unacceptable. We know that physician practices are closing due to financial restraints. So we want to make sure that physicians are compensated adequately for the work that they do. And so this is one of the bills that we're advocating for by providing an inflationary update to Medicare physician payment. Going to pivot now here to executive orders because I know we have been hearing a lot about them on TV. So as we advocate for policies that support osteopathic physicians and patients, it's kind of important to understand all the tools a president can use to shape health care policy, including executive orders. So executive orders or EOs are official documents signed by the president that directly, that kind of directs how government agencies enforce and implement laws. So while they don't necessarily create new laws, they do have a significant impact on how existing laws are applied in practice. So executive orders can directly influence key health care policies, things like Medicare physician payment and telehealth and workforce development programs and policies impacting physician training. And so over the past few years, we've seen EOs used to expand telehealth access. This happened during the COVID pandemic, increase health care workforce funding, adjust regulations that impact physicians reimbursement and more. So it can be used absolutely to impact the osteopathic profession. So it's important to remember that executive orders aren't unlimited in power. Courts can step in if an EO is challenged or is deemed as unconstitutional. And Congress can revoke or change an EO's impact based on them passing new legislation. So this means that advocacy from the AOA and our members really does remain critical part of our mission. So not just with the White House, but also with Congress and the courts as well. So if an EO is issued that negatively impacts physician practice or patient access to care, we need to be ready to respond. And so we have done that recently with the WHO, World Health Organization, withdrawal and also the elimination or the withdrawal of information from CDC's website. So as for the EO process, they typically start with a draft that is reviewed by the Office Management and Budget, or OMB, and the Attorney General. They kind of ensure that EOs align with federal law before it is finalized and signed by the president and published in the Federal Register. And so this slide is, as I'm presenting today, needs to be updated slightly. I believe that number is just a little bit more. But so far, Trump has signed around 47, I believe, EOs. Again, the slide is slightly dated. And 26 of those EOs came on Inauguration Day itself. So you can compare that to when he was first elected in 2016, he only signed, President Trump only signed eight. And so, believe it or not, the number of executive orders that have been signed by the president is declining by quite a rapid pace, actually. So we've seen and heard a lot of the news about EOs. This process isn't exactly new. And so when Clinton was in office, he signed a total of 364 executive orders. Compare that only to 162 of Joe Biden. Obviously, Clinton was in for two terms. But even as we look at these two-term presidents, you can still see a decline in the number of executive orders that are going out. And so what are the EOs that impact health care the most? One of the most immediate impacts we're seeing is the rescission of executive order aimed at lowering prescription drug prices for Medicare and Medicaid patients. Many EOs' intents were to kind of reassess and potentially redirect federal funding efforts in order to manage this drug pricing issue. So I know we're all familiar at this point as with DOJ, the Department of Government Efficiency. So that certainly plays a factor into why a lot of these EOs were implemented to begin with. And so a detailed plan on prescription drug pricing is not really out there yet. So don't have some concrete information for you all at this moment. There's also other executive orders such as banning federal DEI programs. That's another issue that could potentially impact our comms. And these rural and underserved areas. And then, of course, temporary funding freezes as well. Here's just a quick example of the letter that we sent that we partnered with other physician organizations that addresses our concern with the withdrawal from the WHO. We also sent one on the CDC information as well. So I'm going to quickly talk about how our advocacy efforts can be used to work with our affiliates to impact advocacy. So advocacy software is expensive. It can cost upwards of $20,000, sometimes more. And I know that a lot of our affiliates don't necessarily have that budget to buy this advocacy software. And so luckily, that's where we can come in. We can help assist you utilizing our advocacy software to engage in grassroots campaigns in your states. And so this is what it looks like here on the screen. We will prepare everything for you and send it off to your way for editing. And so what you see here on the left is a real example from the state of Michigan. We partnered with the Michigan Osteopathic Association. We sent an email on scope of practice to all physicians, both members and non-members, within their state to educate them about why this bill is inappropriate and what you need to do to take action. So similar to our other advocacy campaigns, with one click of a button, your members can send out an alert or an email to their state lawmakers on why they should oppose this bill. And we want to make sure that that email is coming from your state president so your members within that state can recognize that it's coming from one of their own. We co-brand everything, so we want to make it sure it's as simple and as easy to communicate with these individuals as possible. You can, of course, use this information in your newsletters, talk about the great work that you're doing through your advocacy engagements. We can also create infographics for you if you want to take it a step beyond and utilize it for in-person meetings, for example. And we can also do letter writing campaigns itself if we want to send it directly to your state leadership within the state legislature. Social media individuals engage. We are seeing that it's taking much less advocacy actions to get a lawmaker to move in and to engage on a specific issue through social media, just because of its public nature, right? It's out there. More people can see it. So if we want to engage in this form of advocacy, we absolutely can do so. The other great thing, too, is we can build out advocacy action centers for your websites. So if you have a website and you want to take advantage of our advocacy software, we can incorporate it into your website at no charge. And the great thing about this is it's evergreen, right? You don't have to worry about updating the content at all. It'll always stay fresh. We manage it on the back end. So again, just kind of gives you peace of mind that you don't have to keep updating this and it'll always stay relevant for you and your members to engage. If you want to have a meeting to discuss anything about advocacy, I am always there to help set up a quick meeting with you. I use this great advocacy software, and this is my, you know, March 21st. This was my time, and this is what it looked like. So you could schedule a meeting. What's great about this is it sends you a calendar invite with a Zoom link, so you don't need to do anything. And we can set up a meeting right then and there, and we can talk about all the great issues that you want to be addressed. So always happy to help. And I really want to thank you for kind of listening to how we can engage in advocacy together. I know we have a few more minutes left, so I want to turn it back over to Dr. Morrison to discuss how he went utilizing these advocacy efforts to start a College of Osteopathic Medicine in the state of Louisiana. So Dr. Morrison, I'll kick it off to you. Thank you, Sean. Great presentation. I appreciate it. I learned a lot. Every time I hear one of these advocacy presentations, I continue to learn. But Starting to Calm is basically a situation of need. In other words, when we especially, there was a significant number of, and we showed that earlier, how we needed the workforce. We actually had the college here in town contact us as a system and said, we would love to start a college down. How do we do this? Well, we came down, actually, we looked at the area, we looked at the possible we offer to the community, what could we offer in the sense of monetary income to the area? And at the same point in time, how would that best assist the state? It's interesting to know, we talked to all of the people involved at the state level, the Department of Educators, the commissioners, the governor, everybody was 100% for us. And so that made, first of all, step in the right direction says, yeah, I think we can go toward that way. And then we came down and actually had to just a personal thing, we had to go along with the Napoleonic Code, which we have French law in Louisiana. And so trying to learn how to do that was somewhat of an interesting education. But once we got that through, we were able to come down, provide space for our comp. And then the infrastructure was nothing more than deciding where and then building what was really the important part of, I would say my job when I for the campus in Monroe, is actually, I burned off the tires on my car, going all over this state, pretty much north of I-10, all the way to the top of state. So the majority of the state, going into small towns and hospitals and saying, listen, we would love to offer a connection with your hospital in bringing medical students to try it. And oddly enough, the acceptance of those people, they were very excited. They said, we would love to do that. Some doctors are going to get into this business to train, but in matter of fact, I said to them, well, you were trained by somebody, somebody trained you, this is kind of a giving back. And so when I kind of represented it that way, tug of war sometimes, but we got it through. We actually ended up in our first year having 36 rotation sites to take individual students to rural areas of that. And now that we've graduated, we're fixing to graduate our second class. And again, we've had great reception within the state. We've had excellent residency production to bring our students that are graduating into residencies. And then hopefully we'll get that 65% to come back to Louisiana again and help out with the rural workforce shortages. You know what, I pulled out one slide. I didn't see that slide, but it was the one of United States and all of the shortages in those parishes. There is plenty of opportunity throughout this nation, especially looking at to start a college of osteopathic medicine. It's not easy. What's good about it is that it strikes up a conversation with the local hospitals, the local community, and it brings about, it's actually an advocacy to your state, to your community, to your area in what osteopathic medicine actually is. And it wasn't just me doing this. We had the help of many physicians. I had plenty of staff that I had hired to help do this and going out. And so it's a labor of love to get started. A lot of work to get going. We are so proud, and the state of Louisiana is now very proud to have our college of osteopathic medicine. And if there are any of the affiliates that would like to contact me, I'm sure there will be contact information represented. So if you would like to find out more of any specifics, I'm happy to do that. Sean, I'll turn it back to you for some final addressing statements. Well, one, I just want to thank everybody for joining us for this presentation. I hope you found it useful. Dr. Morrison, I also want to thank you for taking the time out of your day to talk about this important topic. I hope you can take some of the advocacy initiatives that you learned here and take them and put them into action. So if you have any questions, feel free to contact us, and we look forward to working with you in the future. Thank you.

osteopathic advocacy

rural healthcare

physician shortages

DO graduates

Osteopathic Political Action Committee

healthcare legislation

advocacy strategies

Teaching Health Center funding

American Osteopathic Association

advocacy tools