McGlew

Caitlin Phillips, a PGY-2 ambulatory care pharmacy resident, interviews John McGlue, the Senior Director of Government Affairs for ACCP, on the ACCP Post-Grads Podcast. They discuss advocacy and lobbying in the healthcare field, with a focus on the role of pharmacists in advocating for patients and the profession. McGlue explains that advocacy is inherent in clinical practice and pharmacists are already skilled advocates. He also discusses the difference between advocacy and lobbying, highlighting that lobbyists are paid professional advocates while advocates are not paid and have a unique voice in policy-making. McGlue also mentions the ACCP's Washington, D.C. office and its role in lobbying for the profession. And Caitlin, when you are ready, you can begin. All right. Welcome to the ACCP Post-Grads Podcast, a podcast for post-grads by post-grads. My name is Caitlin Phillips, and I'm currently a PGY-2 ambulatory care pharmacy resident at the University of Tennessee Medical Center in Knoxville. On today's episode, I'm joined by the Senior Director of Government Affairs for ACCP, Mr. John McGlue. John McGlue was raised in Edinburgh, Scotland, and attended the Edinburgh Academy before completing a Master of Arts with honors at the University of Aberdeen in Scotland in political science and business management. His final dissertation was a comparative study of UK and US voting behavior. Very interesting for this year as we head into our voting season. After he graduated, he moved to Hartford, Connecticut and interned in the State Senate and eventually moved to Washington, D.C., where he worked for several associations in the healthcare field. He joined the ACCP in October of 2006 and still works with us to develop political participation and advocacy among ACCP members. He also leads our college's legislative efforts. He's a perfect guest for our topic today. He also advocates for us in lobbies on Capitol Hill and prepares comments and testimony on regulatory issues, participates in many pharmacy and interprofessional advocacy coalitions, provides training for ACCP members to become better advocates, which he will be doing for us today. He also supports the ACCP ASHP-VCU Congressional Healthcare Policy Fellow Program and manages the ACCP Political Action Committee. Today, we are delighted to have him to discuss his work in advocating for our profession and how we can also advocate for ourselves. So, Mr. Maglou, let's start with the basics. Let's assume that we don't really know much about advocacy. Can you tell us exactly what advocacy is? Well, yeah, wonderful. Thank you so much for this opportunity, Dr. Phillips. And I'll just start out by, again, thanking you for setting this up and for giving us this platform to talk about some of these really exciting issues, really important issues. I'll just say, firstly, it's such a privilege to work for ACCP to represent this great profession on Capitol Hill. I'm really passionate about the work that I do about helping ACCP members and other clinical pharmacists get more involved in the advocacy process. And I'm really, really passionate about advocating on behalf of the patients that you represent. This is all about optimizing medications and improving health outcomes on behalf of patients. And that really shows up in all of our advocacy work. It's really what I'm passionate about. And so I want to reiterate how thankful I am to get to do this for ACCP and get to represent this great profession. So with that said, one thing I really, having worked for ACCP since 2006, and I'm not a pharmacist myself, although I do have the privilege of working with many pharmacists on the team here on staff. But one thing that I've observed working with pharmacists is how much advocacy is inherent as part of clinical practice. Pharmacists, our members, clinical pharmacists work with patients, as I observe, and help them navigate very challenging, difficult situations at times when they're often feeling in a very vulnerable situation, faced with, confronted with a healthcare crisis. And so pharmacists kind of work with the patient and their family members and other members of the healthcare team, physicians and other healthcare providers, and navigating health insurance coverage and the mysteries of health system bureaucracy. There's so many barriers to achieving medication optimization and doing the work that pharmacists are trained and positioned to do. And so, I've just observed over the years, and I think it's so relevant for this conversation, that I believe that pharmacists are excellent advocates already. That is part of the work that you do. And so my job is to help folks understand the skills that you already have and communicating on behalf of patients and speaking out in difficult situations to avoid a potential catastrophic medical situation emerging. There's real crises that pharmacists are responsible for and you're advocates, both for the patient and for the profession, and helping patients navigate these difficult issues. So, you can translate those skills onto Capitol Hill and into politics and into legislation and into all the regulatory work that we do with all the different government agencies. I really believe that pharmacists are already very good at advocacy as part of the work they do. And so, we can just kind of direct that to this political landscape. I really appreciate that perspective. That's very interesting. I was advocating for patient medication access this morning in clinic. I appreciate your perspective there. I think another buzzword we hear and maybe don't quite understand all that it means is lobbying. Can you tell us maybe the difference between advocacy and lobbying and what goes into that? Sure, that's a wonderful question. And, as I say, I do this for a living. I'm a professional lobbyist. My background, I'm not a pharmacist. My background's entirely in government affairs and this kind of communications side to advocacy. So, I'm a registered lobbyist. And that means that, as part of my job, we register with the House and Senate and we declare our income, we declare conflicts of interest, and we publicly declare all the issues that we work on, what our priority issues are. That's a quarterly lobbying report that, by law, I have to, as a lobbyist, I'm entitled or responsible for delivering. And then, as a lobbyist, I also have to declare all my political contributions. So, if I make a PAC contribution, either to ACCP PAC or to a different PAC, if I wanted to support a member of Congress who I believe is the great champion for pharmacy or just somebody who I think ought to be in Congress and I chose to support that member, I have to declare that. So, that's part of this kind of public transparency process. And the idea is basically to avoid corruption and conflicts of interest, shall we say, within the political process. So, my kind of response to your excellent question is that lobbyists are essentially paid professional advocates. You know, I'm a full-time paid advocate professionally on behalf of ACCP. So, I have certain skills and expertise in this. I do this all year long, all year round. I've been doing this for over 20 years. So, you know, over time, you know, and I've had training in this over time, I like to think that I've got some expertise there. And so, I bring that expertise to the college. That's what I do as a lobbyist. And the downside to lobbyists as a professional, not maybe not the downside, but the question mark is that, you know, because I'm paid to do this work, when I go and talk to people on Capitol Hill, there is a slight question mark over my legitimacy. They think, well, you would say that, wouldn't you, John? Because, you know, that's the organization that pays your bills. So, you know, it's not to say that there's a kind of question over my integrity, but when I'm really effective is by bringing my skills as a lobbyist, but by also using my skills as a lobbyist to have the voices of all our members brought to Capitol Hill as advocates. So, you know, we have 16,000 members spread, you know, across the entire country. And so I'm one lobbyist on behalf of the college, but I represent these 16,000 advocates who aren't paid to do this. You're not paid advocates. You know, when you advocate on behalf of your professions and your patients, there's no question mark over your authenticity or your legitimacy, because no one's paying you to do this. You're doing this because it's the right thing to do on behalf of your patients and behalf of your profession. So, I mean, obviously I want to kind of, I'm a lobbyist, so I'm on team lobbyist here, but, you know, I do want to kind of clarify that subtlety that advocates, I think, as non-professionals have a certain, there's a certain power to your voice because there isn't that question mark that you're being paid to deliver this message. Now, for example, ACCP, you know, part of our organization, one of our organizational principles is that we don't accept sponsorship for pharmaceutical industry. And again, that kind of speaks to that question mark over the motivation behind doing something. And so I just kind of use that as a comparison that, you know, as a paid lobbyist, there always will be that question mark over your motivation even if, you know, I like to think I truly do this with integrity, but, you know, as kind of passionate advocates who aren't paid to do this, I believe there's a unique voice that you can bring that's heard in a different way on Capitol Hill and by policy makers. Thank you. We definitely appreciate the work you do on our behalf. Even at the state level, even putting bugs in someone's ear, we've seen some great progression in our profession and I'm sure it'll only get wider from there. So thank you genuinely for what you do for us. So the ACCP headquarters is in Lenexa, Kansas. If you've spent time with ACCP, you've probably seen that little city. Maybe all you know about it. But we do have a Washington, DC office. Can you tell us about that office? Absolutely. Well, you know, it's kind of a great segue there. You mentioned lobbying and it's a kind of an odd term for a professional advocate. You think, why are we called lobbyists? And the term comes from the Willard Hotel on Pennsylvania Avenue in Washington, DC, which was home to various presidents. President Abraham Lincoln stayed there, for example. So, you know, it's a wonderful, wonderful building in DC, steeped in Washington and American history. And so, you know, as the kind of early years of the country, people would gather in the lobby of the Willard Hotel and to meet members of Congress or presidents to meet their elected leaders who were staying in this hotel. And they would gather in the lobby and then approach them as they approach the elevators and then use that moment to advocate for certain issues. So, you know, prior to our kind of official lobbying process, like I described, where we have this registry of lobbyists, we declare all of our income and conflict of interest. It just used to be people would travel to Washington, DC. If you were passionate about an interest and you thought that your president or your member of Congress needs to know about this, you would travel to Washington, DC and hang out in the lobby of the Willard Hotel. And that's where you would find your member of Congress and you would use that moment to kind of capture them and have a moment of kind of conversation. So that's the history of that. And the reason why I'm so, I think this is such a great story as a lobbyist, is that, so, you know, the Willard Hotel is very historic. And then I think perhaps in the 1980s, there was an addition to the Willard Hotel and an office building was added to the property. And that's where ACCP has this office. So we are at 1455 Pennsylvania Avenue and as part of this kind of Willard kind of complex, which includes the old hotel and then this kind of new-ish kind of just Washington office building. So that's where we have our offices. And you kind of alluded to our historical home in the Kansas City area. And we do own this great property in Lenexa, Kansas, which is our official headquarters, our world headquarters. But we have this Washington office in kind of what is a prominent location in part just to re-emphasize our Washington presence. We historically, you know, we were based out of Kansas City. That's where we were founded. So much of clinical pharmacy goes on in these big teaching institutions. And I think that's so many of the traditions of the college are based in that. So I think there's some strong tradition around our location in the Kansas City area. But there's so much going on in Washington, D.C. that with the Congress, the White House, the federal agencies, we have the Centers for Medicare and Medicaid Services, CMS is just up the road in Baltimore. There's the FDA's in Rockville. So there's, and then all of our colleague organizations are here. We have, you know, our friends at APHA have that wonderful building on Constitution Avenue and ASHP are up in Bethesda, Maryland. And lots of our colleagues are across in Alexandria, Virginia, which is another kind of cluster of all these kind of advocacy organizations and professional associations and societies. So it's just great to have this presence in the Washington area where we can collaborate with our different colleagues and, you know, have access to host meetings and attend events. And it's just really part of a lot of the work of lobbying and advocacy does. And it's kind of location specific in a way and Washington is that location. And that said, and this is a theme I'm really passionate about at the moment is this kind of virtual opportunity. And we're having this great conversation online at the moment. And so, you know, with all this kind of excitement from my point of view, but working in Washington, D.C. and getting to be part of the tradition of the Willard lobbying history. You know, the fact that we can bring together people from around the country and participate in meetings and collaborate in these different ways, I just think it's so exciting that you don't have to come to Washington, D.C. in order to lobby anymore. We can set up Zoom meetings where we can, you know, how to set up a Zoom meeting with a member of Congress and bring in folks from that district to have a conversation with that congressional office and, you know, over Zoom or a different platform, if you will. And, you know, all of this is, you know, this is available before the pandemic, but it's become so normalized. I think we're all so used to it now. And Congress is certainly, you know, very adaptable around making these meetings happen. We have great meetings with different government agencies, you know, where, you know, you just, you can have people in different locations. It just facilitates a lot of communication. So I do think there's an importance to being in that presence in Washington, D.C., the ability to kind of collaborate with other Washington-based organizations, but just, you know, facilitating, bringing our members in and bringing your stories and your patient care stories in and using these different methods of communication. It's very exciting for me at this time. So I'm interested in learning more from, you know, from our members about how we can do a better job of communicating and using these tools. That is very interesting, the history of the word lobbyist. If you haven't seen the APHA building in Washington, D.C., I definitely recommend swinging by there. If you're ever in our nation's capital, it is pretty cool. And Pennsylvania Avenue is certainly not a bad place for us to be to advocate for ourselves. I do like what you said about it really being anywhere, though. We don't need to go to D.C. And that kind of leads into my next question. So what are some initial steps that us, you know, we're baby pharmacists, we're post-grads, what are those initial steps that we can take to start being an advocate for our profession? Well, yeah, I mean, it's a wonderful question. And, you know, firstly, I'll just say that, you know, I'm based in Washington, D.C., and, you know, I will admit that sometimes Washingtonians can be a little bit insular. And sometimes we think, you know, that everything revolves around Washington. You get this kind of beltway mindset. And, you know, I think that's an inevitability, but we have to be careful about that. And I'm kind of joking, but, you know, it's important not to lose focus. The clinical pharmacy goes on across the entire country, across the entire world. It's not a beltway issue. It's not a Washington issue at all. And, you know, politics is a local initiative. And, you know, while members of Congress come to Washington, D.C. to legislate, it's voters at home that give them that position, that authority, that power, all the perks, the nice office on Capitol Hill, and, you know, the benefits that come with being an elected official. That's all dependent on the folks back home, you know, voting and participating. And so, you know, again, my job in Washington, D.C. is to kind of connect the dots from, you know, the communities, the practices that are going on throughout the country, helping our members of Congress understand about the work that's going on in their districts, but, you know, helping tell those stories of the work that's going on and the passion that's going on across, you know, across communities throughout the country. So all that said, I just want to kind of reiterate, it's a bit of a cliche, but politics is local. It all, you know, really what motivates members of Congress, particularly on the House, on the House side where, you know, you have around half a million, each House district has approximately half a million people, so it's a relatively, you know, House district is a relatively small, you know, at least by population-wise, it's a small district, and they're hyper-focused on local issues, and I think that's where your members come, where our members become so powerful, because you know what's going on at the local level, and you can communicate in a really authentic way about, you know, issues that are important to Pennsylvanians if you're in Pennsylvania, or Ohioans, or I'll not list all states and territories, you get the message, but, you know, you can bring that in an authentic way that I can't. You know, I'm based here, I live and work in the District of Columbia, you know, because of quirks of our constitution. We don't have members of the House and Senate here, so, you know, I vote to be a mayor and a council, and we vote in presidential elections. Again, that's a bit of a tangent, but, you know, the truth is that politics goes on in the districts throughout the country, and your voices are so powerful there, so, you know, being involved in your professional organisations, clearly I'm biased for ACCP, but being involved in professional societies is really, really important. All of the pharmacy organisations, we work very collaboratively, we all do great jobs advocating for the profession, so being involved at the national level, being involved in your local chapters is really important as well. As I say, tying, you know, those local issues and having that local presence to communicate and make it relevant for members of the House and Senate I just think is so important. And then, again, I'm talking in this really kind of overly Washington-focused mindset. Don't forget about the state capitals. You know, we... I think largely for resource purposes, we are focused in Washington, DC. We want the resources to be, you know, really present in all 50 state capitals in the way that we can be in Washington, but that, you know, we don't overlook the really important work that goes on in state capitals. You know, it's important for me to remember as a lobbyist that pharmacy practice isn't regulated at the federal level, it's regulated at the state level. That's what really matters on the day-to-day business of pharmacy practice, and, you know, having relationships with local elected officials at the state level is really important. You know, attending lobby days in your state capital is really important. And just helping, you know, lobbyists or the kind of representatives at the national level, keeping us updated about what's going on in your state, you know, providing and sharing intelligence, reporting back. All of that is so useful because, you know, as I say, I just... It's not possible for me alone to do the federal work and know what's going on in all 50 states. So, you know, we really need the hands on the ground, the people on the ground, the eyes and the ears who can provide that information for us. So these are all ways that we rely on our members to kind of help us be better advocates. I agree. I think that's a great way to kind of get your... dip your toes in the water to join your state pharmacy association. I know the Tennessee Pharmacists Association, where I'm a member of, they do a day on the hill every year when we do our conference and we're celebrating a new bill that just got passed that I'm sure you know about that increases our practice here. So it's very exciting. What actions do you find are the most impactful that we do as pharmacists? From an advocacy standpoint? Yes, I'm thinking like writing letters to our local representatives or what seems to work that you've seen? Well, I mean, I don't think there's a right or a wrong answer to any of this. And certain different situations call for different responses. But to answer your question quite simply, I think the most effective thing that pharmacists can do is to try to host a practice site visit. It's probably the most labor intensive, the most challenging. There are some hoops to jump through coordinating with a member of Congress, a member of the House or Senate to host them at your facility. You've got some challenges there. Getting approval internally from your institution or your practice site to do that. Navigating your own internal bureaucracy. So these are all challenges. I want to be realistic. It's not an easy ask necessarily, but it's an incredibly effective one. The fact is that I think most elected officials, if they don't have a background in healthcare themselves and most of them don't, when they see pharmacists, they think of their friendly community pharmacy and they think of getting a prescription dispensed and that's a wonderful role. But there's so much more to the practice of pharmacy and there's so much more that our members do that leave me, I'm always in awe of the work that, as I learned from our members about the work that they do as part of teams especially. The number one most effective thing that pharmacists can do is host a practice site visit where bringing in a member of Congress or a leader from a regulatory agency, from a federal agency, from Medicare, bringing in a policy and showing them how pharmacists collaborate as part of teams to optimise medications on behalf of patients, seeing that work go on first hand is quite remarkable. But that said, there's challenges to that and we want to be respectful of that. We'll certainly support and we have lots of resources to support such initiatives, but there's lots of other things that pharmacists can do to be effective advocates. Just recently we had this wonderful peer writing campaign around PGY1 residency funding. This is a serious issue where CMS, the Medicare programme, is auditing PGY1 programmes and there's a clawback issue and there's a lack of guidance from CMS around their auditing process. But because of this lack of guidance, residency programmes are failing to stay in compliance through no fault of their own. They don't have guidance to show them how to stay in compliance. But then CMS is retroactively clawing back funding that's undermining these necessary programmes. Anyway, you're all more familiar than this with IAM. It's a really important issue affecting our members. We're really concerned about this and so we've been working more recently with Senator Klobuchar's office from the state of Minnesota who's leading an effort with what they call a dear colleague letter. She's generating support from her fellow senators who are going to publish a letter to CMS requiring the agency to both provide better guidance but also prohibiting retroactive clawbacks. We generated this letter writing campaign in support of Senator Klobuchar's initiatives and I was really, really quite overwhelmed in the response from our members. We had over 1,300 ACCT members and supporters who wrote. That's 10% of our membership. Now I'd love it if 16,000 members supported. That would be great but realistically that level of activation is just really, really impressive. Almost all members wrote to their two senators so we had 2,600 letters sent to the Senate. That's really quite remarkable. We have that all set up online. I hope that some of your members were able to participate in that but it's a really easy click-through process so you just enter your zip code or a few details and you can send a letter. We do encourage people to edit the letter, personalise it, tell your story but if you're busy you can just hit send and that letter will go up there and your voice will be heard. We're getting a lot of responses back already. We're getting letters from confirmations from Senate offices. They just say, hey, we're hearing you. They're not necessarily acting yet. You have to keep the pressure on. This is an iterative process but we know we're making some progress there so there's lots of options to get involved and we want to make it as easy and fun for people as possible. This most recent letter writing effort needed a very quick turnaround. I think we mobilised on Wednesday of last week and the deadline was Monday just a couple of days ago so there was a quick turnaround there. An email campaign was a perfect response. Other times when you have a longer lead time, if you can generate a practice visit, that would be a great way to really cement a relationship with a member of Congress. I say that once again. If someone who hasn't first-hand experienced the team-based care of a clinical pharmacist who came and saw a practice and saw the work you do, could not fail to be impressed and could not fail to walk away as a renewed supporter for the profession. I'm certain of that. I appreciate that advice. I would not have thought of that but I think that would be effective even at the state level as well, especially doing it through maybe the state's pharmacy organisations. I did see the letter writing campaign for Senator Klobuchar and I think that makes a good point too of how we can get involved. I think that came across a PRN email for me so things pop up as well that we can help with. I appreciate your efforts in getting us involved as well with that. Do you have anything else that you want to talk about during this podcast or anything else you'd like to say? I'll just say quickly again, thank you so much for this opportunity. I'll reiterate, I am really passionate about this work. I love working in Washington, D.C. I love the political process. It's what I studied at college. It makes me... I'm really excited about this work and I truly love the work the issues that I get to represent. This is a wonderful profession. I'm very proud to get the honour to represent you all on Capitol Hill and I hope my enthusiasm comes across. I truly enjoy this work. I think it's fun. I try to make it fun for other people but we need the involvement of our members. We saw that wonderful mobilisation of 1,300 letters in just a few days. It goes to show that we can do this. If we can get involved, I'm absolutely certain we can make a real impact. Change the way we deliver care for patients and change outcomes on behalf of patients and populations. That opportunity, I think, is something that we can't ignore. I just hope you all get involved in this advocacy work and think of us as a resource. Please do not hesitate to reach out to me or any of the team in our Washington office. We'd love to work with you to help you all be better advocates. Thank you so much for your work that you do on our behalf. Again, John McGlue is the Senior Director of Government Affairs for ACCP. If you'd like to connect with him, he's really easy to find on our ACCP website. I am certainly feeling very motivated and I hope you are too. If you'd like to read more on advocacy via ACCP, we do have publications. Mr. McGlue has written one called How Can I Engage in Advocacy for My Profession and Maintain a High Level of Engagement Throughout My Career. That is accessible through ACCP. We also have Can I Speak to a Representative? Advocacy for the Profession. That was presented at an ACCP meeting and those slides are available on the ACCP website. There's also ACCP reports that are published that talk about the work that our Washington office is doing that I'd highly recommend checking out. Otherwise, thank you for listening to this episode of the ACCP Post-Grad Podcast, a podcast for post-grads by post-grads. For more episodes and other resident and fellow resources, you can visit our website at www.accp.com slash resfell like resident fellowship, resfell. Thank you.