By Laura Boylan, M.D.

It was December. I got a dismaying e-mail from the American Academy of Neurology.

The AAN was conducting a membership survey to inform the Academy’s 2011 advocacy agenda. “We want to hear from you about the challenges you and your patients are facing,” the message read.

To my chagrin, I did not feel that my priorities or values were represented in the choices presented on the questionnaire. The items on the menu were all decidedly “thinking INside the box” of business-as-usual health care:

From the list below, please select up to three issues that you believe should be top legislative priorities for the AAN in 2011:

* Adoption of guidelines to minimize concussive injury during sporting activities
* Inclusion of neurology in the E/M bonus (created by the 2010 health reform law)
* Medical liability reform
* Neuroimaging practice issues
* Reimbursement for telemedicine
* Remedy for the loss of Medicare consult codes
* Right to privately contract with and balance-bill Medicare beneficiaries

I felt sure many other neurologists would feel the same way as I did about the limitations of this list. I appealed to my colleagues at Physicians for a National Health Program for help and was quickly supplied with a list of e-mail addresses of PNHP neurologists.

I e-mailed this group and suggested they send a “write-in” vote for single-payer national health insurance. I wrote to 113 members and, though I did not ask for any response, got back 14 personal replies from neurologists in eight states, all of whom “wrote in” votes for single-payer health reform to the AAN.

After this heartening response, I had a series of conference calls and e-mail exchanges with several of my colleagues, including Drs. Rachel Nardin and Deborah Leiderman, to discuss how we might put additional pressure on the AAN to take up our issue.

We did not expect the Academy to take a stance in support of single payer. We decided that a more sensible “ask” would be to request that the AAN poll its members about their views on health care reform.

Citing polling data showing robust, majority support for national health insurance, we wrote a letter to the Academy suggesting it conduct such a survey “so as to faithfully be able to represent its members’ voices in the national health care debate.”

Over 30 neurologists from 14 states signed the letter, which we sent to the president of the AAN, Dr. Bruce Sigsbee, and other key members of AAN leadership.

Dr. Sigsbee replied to our letter, saying that “AAN members have diverse views ranging across the spectrum of the government involvement in the health care system,” adding, “We recognize and respect the differing views and feel it best to focus on those issues where a majority of our members feel we can have the most impact.”

In short, he did not agree to our request.

Nonetheless, we believe efforts such as ours will keep pressure on bodies of organized medicine and keep single-payer advocacy “on the map.” Furthermore, the sign-on letter allowed a disparate group of neurologists to raise our voices together for what we believe in: health care as a human right, with everybody in and nobody out.

Laura S. Boylan, M.D., is clinical associate professor of neurology, New York University School of Medicine; attending neurologist, Department of Veterans Affairs; and board member, Physicians for a National Health Program – N.Y. Metro chapter. Dr. Boylan’s institutional affiliations are provided for identification purposes only; the views expressed are hers alone.