For years, the Society of Teachers of Family Medicine (STFM), a professional association for family physicians and other educators in family medicine, avoided responding to public policy issues of a social nature, such as gun control and climate change. We understood the connection between these issues and health, yet we believed our members wanted us to focus our advocacy efforts on programs more directly linked to family medicine education.

That philosophy changed several years ago. After receiving a series of requests from members that we make statements on such issues, our board agreed we needed a policy and improved process for determining which ones may have a significant tie to our mission. To ignore social issues without debate seemed unresponsive to members and a lost opportunity to look at advocacy through a different lens.

With the right process, organizations can engage their members in dialogue about important issues.

Certainly, there are downsides to responding to social issues:

• Your members may be divided on how your organization should respond, and your statement could be divisive.


• You may not know what the majority of your members think about an issue and may not have time to survey them to understand all sides.


• If done well, the process takes time.

We decided the pros would outweigh the cons if we could develop a good process to ensure we focused on issues most relevant to our mission. With the right process, organizations can engage their members in dialogue about important issues. And such conversations can lead to joint statements with other organizations, which bring the potential to influence social and economic conditions for large numbers of people.

Policy and Process

At STFM, we developed our policy first:

Issues of a political or social nature referred to STFM with a request to take a position will be reviewed by the executive committee for appropriateness and relevance to STFM's mission and priorities. If found within the scope of STFM's mission, the issue may be referred to the board of directors or an appropriate committee for full discussion and the development of a consensus position and statement.

Once we had this broad policy in place, we struggled to apply it to specific situations. To help us implement the policy more effectively, we created a more robust evaluation process, which included a decision tree to help us analyze an issue and an enhanced approach to communications.

Here are two examples of how our policy and process worked to respond to member requests for public statements on issues:

Request: Write a statement deploring the 2009 murder of Dr. George Tiller, a family physician from Kansas who provided abortion services to women.

• Decision: Our executive committee agreed that writing a letter of this nature was not likely to advance our mission or family medicine education. Tiller was not a member or involved in our organization, and that factored into our decision.


• Communications: We published a letter to the editor in our journal to explain our decision and our process for considering the request.

Request: Write a statement to the secretary of the U.S. Department of Health and Human Services regarding her decision to overrule a Food and Drug Administration recommendation allowing access to over-the-counter emergency contraception.

• Decision: Applying our decision tree, we agreed that the request fit our advocacy priority to apply evidence to improve medical education. The STFM board wrote a letter to the HHS secretary to advocate for teaching and applying evidence-based medicine to improve medical education, healthcare, and general health in our country. We opposed the secretary's decision because it overruled a scientifically developed FDA recommendation.


• Communications: Before making the decision, the president of STFM and I held a call with our special interest group leaders to gather information and explain our process. After the board's decision, we sent a letter to this group explaining how and why we arrived at it and shared the letter we had crafted to the HHS secretary.

Lessons Learned

The specific issues that you may be asked to speak out on will, of course, vary depending on the industry or profession you represent. But several lessons we learned in developing our process could well be applied to other associations.

Look for a nexus with your mission and consider impact. We closely examine whether requests fit directly and strongly with our strategic priorities and whether a statement would have a measurable impact. This has helped us prioritize when and where we will commit resources to a response.

Facilitate individual response. Members may use our group list servers to organize themselves to respond as individuals to social causes. They are prohibited from using the society's name in their communications to outside groups, as that would imply STFM organizational endorsement. This approach has allowed our members a mechanism to gather support for their passions without a statement from STFM.

Communicate with stakeholders. Sharing with members our process for determining which issues we'll discuss and the outcomes of those discussions has been critically important. Depending on the complexity of the issue, your response may require a call with key stakeholders to gather information or explain the decision. Email alone may not be sufficient.

Ultimately, some members may disagree with your decision, but if you've arrived at it using a thoughtful process, most will appreciate your responsiveness to their request.