Get involved in advocacy early and often

Physicians have been using their voices for decades to raise awareness about issues affecting the health of everyday Americans. But recent changes at the federal level, along with a broader understanding of social determinants of health, have been particularly galvanizing, energizing many doctors—especially those early in their career—to take on the role of advocate, according to experts.

Early career is definitely the time to start engaging in advocacy, said Allison Ruff, MD, MHPE, FACP, a clinical associate professor at the University of Michigan in Ann Arbor and member of ACP's Council of Early Career Physicians.

“Early career docs—you just graduated from residency and start your practice—you have this vision, a rather idyllic vision, of what it's going to be like,” Dr. Ruff said. This can make it easier to see what's not working as well as you might have expected, she noted: “You have that unique perspective, because you haven't been in the system that long.”

Where to start

There are myriad ways physicians can engage in advocacy, ranging from lobbying in Washington, D.C., to creating a post on social media, but deciding which cause you want to champion can be a daunting task. Reflecting on the parts of being a physician you care most about is one way to narrow down the options, explained Adriana Dhawan, MD, FACP, an internal medicine and pediatric hospitalist at the University of Minnesota in Minneapolis.

“It can sometimes feel overwhelming when you care about a lot of different things that might be changing right now, but thinking about what's going to fill your tank, being able to start small, and just recognizing that there's a lot of different ways to do it, I think is an important place to start,” Dr. Dhawan said.

Defining and playing into your individual strengths will help maximize your impact. For example, if you enjoy writing, maybe a letter to the editor of your local newspaper is the route to take. If you enjoy public speaking, maybe a school board or community meeting is the best setting for you, experts said.

Engaging with your county health department or state medical society is another option, said Ky Stoltzfus, MD, MACP, a hospice and palliative care physician at University of Kansas Health System in Kansas City. “What are some of the important issues within your community that need physician support?” is one question to consider, he said.

Physicians can engage with their elected officials and state representatives too. Remember, “physicians themselves are constituents,” said Shari M. Erickson, MPH, Chief Advocacy Officer and Senior Vice President of Governmental Affairs and Public Policy at ACP. “They can, as an individual, go and speak with their [congresspeople] … and can appeal to them directly, whether that's through an email, phone call to their office, or setting up an appointment to go visit with them.”

Lawmakers may take particular interest in the concerns of early career physicians because they recognize them as lifetime voters, said Dr. Ruff.

Local or state-level engagement helps build physicians' knowledge of how policy impacts people, helps increase their experience with the system, and helps them learn how to communicate with policymakers, explained Dr. Dhawan. From there, you're “able to then go to the higher levels and say that you understand who's involved here, you understand stakeholders, you understand the local implications of a proposed policy change. And that can be a really, really powerful place to start, as opposed to expecting that as a non-health policy expert you're going to be effective from a high- level, top-down approach,” she said.

Change on the local level can also be rewarding because, as a physician, you witness its effects firsthand when seeing patients. What's more, “the folks at the local level are going to listen to [physicians' voices] maybe a little bit more than a national audience. Because it's a much bigger pool, your influence [nationally] is going to be a bit smaller,” Dr. Stoltzfus added.

Working your way up to advocacy on a national platform has the added benefits of developing increased confidence in tackling more controversial issues and forging lasting relationships with representatives who may then turn to you for advice in the future, Ms. Erickson added.

Making the time

Finding time to incorporate advocacy into your workload can seem like an impossible feat. But “sometimes the reason that you're so darn busy is the thing you have to advocate for,” said Dr. Ruff. “Are you busy all the time because you're doing a million prior authorizations?” If issues like this impede your efficiency at work, “you owe it to yourself to advocate for that thing,” she said.

Dr. Stoltzfus suggested physicians be intentional with their advocacy by recognizing their time availability and limitations. Committing yourself to just a small chunk of time to begin with can go a long way, he said.

Small actions do add up, said Dr. Dhawan. “Getting involved with local groups, trying to understand the local politics, these are also ways to get started. Even if you aren't using this information to do something big in advocacy right now, like testify at the Capitol, it doesn't mean it won't inform future advocacy efforts.”

Importantly, she added, “for many people, finding those small ways to stay involved in your community … can certainly be protective against things like burnout.”

One quick way to engage is to enroll in ACP's Advocates for Internal Medicine (AIM) Network. Among its other functions, the network provides members with letter templates to advocate for specific policies.

“[AIM] will essentially just send you reminders—’Hey, this big issue is coming up. Email your congressperson’—and you click two buttons and then fill in the little blank about what you want to say, and it sends it,” explained Dr. Ruff. “In something that takes 30 seconds, you've made a difference.”

Even if one letter feels inconsequential, many can make a real difference. “If those members of Congress hear from 1,000 physicians in their district that they're concerned about something, you're going to pay attention to that,” Ms. Erickson said.

Additional ACP resources include webinars on advocacy, the ACP Advocate newsletter, state health policy toolkits, and a list of ACP's priorities.

“Engaging in advocacy doesn't have to be intimidating or hard or overly time-consuming,” said Ms. Erickson. “Baby steps are the way to go.”

Once a year, ACP also sends members to the nation's capital to engage with lawmakers in person. This year's Leadership Day is scheduled for April 28 and 29.

“[ACP will] not only literally walk you around the Capitol and tell you who to talk to and give you all the papers you need, but also give you a primer in how it's done so that you're prepared” to eventually do it on your own, Dr. Ruff said

Take-home tips

Implementing change in the health care system is a notoriously slow process, experts conceded.

“It can be easy to become disillusioned that things are not changing quickly and maybe not changing in a way that we hope for,” said Dr. Stoltzfus. “Know that perseverance is critical in terms of moving the needle forward.”

For those who feel disillusioned, Dr. Ruff offered the following insight: “I have to believe that our country was set up with the checks and balances and the means to make things work better for everybody. Everybody who's in leadership … is trying to do what they think is right.” She suggests capitalizing on that fact. “The more we can discuss and share information and share knowledge about what's the right thing to do, the more we can come up with a solution that works for everybody.”

Experts also offered advice for physicians who fear employer retaliation should they engage in advocacy.

“I don't think that anyone wants to lose their job over things that they're doing to try to better the health of their patients and their community,” said Dr. Stoltzfus. “We all have to live within certain bounds of what our employers say is OK and not OK.” What you can do is speak up on your own behalf and not that of the institution's, he suggested.

“Your institution's values and policies will rarely fully align with your own, but you may find an area of overlap. In some cases, you can leverage that institutional support to get investment and move the needle on an issue you care about,” said Dr. Dhawan. Engaging as part of a state association or organization may offer some protection too, said Ms. Erickson.

And for those that aren't in a position to do the work, you can always support the people who do, added Dr. Ruff.

Some may argue that physicians should stay neutral on controversial topics. But according to Ms. Erickson, “advocacy is really inherent in a physician's job day to day, even if they may not realize it.”

Dr. Stoltzfus agreed. “There are many factors that contribute to health that go beyond what we provide in the hospital or in the office. When we take that oath to become a physician, I think that part of that is to commit ourselves to doing all that we can to help our patients, help our community,” he said.

Physicians are also in a unique position because they have a specific knowledge base others don't, including firsthand experience of how policies impact patients. Because of this, their voices might be held in higher regard, experts said.

“We have this insight into all of those different aspects of our patients' lives, and we can … think about how to integrate that with different policies, with different practices that are being discussed at the larger institutional or health policy level, to say, ‘This change is going to have these downstream impacts,’” said Dr. Dhawan.

Doing so involves sharing and elevating patients' stories. “[Lawmakers] are not the ones that are actually sitting in front of the patient and experiencing the impact of the laws or regulations directly,” said Ms. Erickson.

For Dr. Ruff, the bottom line is simple. “Not being an advocate, not doing the work, will give you absolutely no benefit,” she said. “If no one is speaking to it, if no one is advocating it, it's the loudest voice that wins.”