During my recent Family Medicine rotation, I attended an informal lecture about advocacy. I’d been exposed to the concept advocacy in the past, particularly in my pediatric rotation, but those advocacy sessions primarily involved sharing information about the various community organizations and resources that were available to our patients – Woman, Infants, and Children (WIC), Child Protective Services (CPS), Department of Family Services (DFS), Supplementary Security Income (SSI), State Children’s Health Insurance Program (SCHIP), breast-feeding support groups, etc. There was also an awareness of the need for physician advocacy on other levels – within the media, as lobbyists, as community leaders.
Personally, I’d never much cared for learning history or any sort of political science. Admittedly, I’ve been trying to read up on the topic as of late, considering how overwhelming the discussions on health care reform have become and how dramatically this legislation will affect my future career. I can follow a conversation about SGR and the RUC, and understand why these things are generally bad for our current health care system. I think I have a relatively good handle on how insurance programs like Medicaid and Medicare are funded, and how changes to these programs will affect both my patients as well as physician reimbursements. I can’t cite statistics or really go into nitty-gritty detail, but I feel confident enough to take a stance on these issues and get involved.
The more unfortunate reality is that medical students and residents are rarely afforded the time to take action for or against any of these issues. This brings me back to my recent advocacy lecture.
Rather than talking about a generic need for advocacy, the speaker gave us concrete explanations about how even medical students could find, access, and lobby to a congressperson. At the simplest and most basic level, we were directed to the websites of physician organizations such as the American Medical Association (AMA) and the American Academy of Family Practice (AAFP). These sites have pages dedicated to lobbying state and national government leaders for or against the special interests of the respective organization. Topics such as SGR and Medicare are hot right now, but the sites (and the issues) are updated frequently. Simply plugging in a name and address can generate an email, letter, or script for a telephone call to one’s senator or representative.
These national and state physician interest organizations are also a resource for identifying the appropriate senator or representative regarding more specific advocacy issues. A message will be heard more clearly if it is addressed to a congressperson who sits on a committee or writes a bill that addresses the concern. That congressperson is also more likely to pay attention to the message if its author is a constituent who can offer (or refuse) support in an upcoming election; thus, it is important to reach out to local and state leaders. With that said, one should choose a direct subject heading that lets the reader know exactly `what bill, topic, or issue the letter or email relates to. The message becomes more concrete if it contains a personal story; these are the accounts that we hear about in campaign speeches and political debates. It is important to remember to add these types of anecdotes to even generic, generated letters and e-mails.
Finally, there are days set set aside “on the Hill,” where special interest groups can raise awareness for their concerns. During these times, senators and representatives (or their office staff) may be available to meet in person about specific topics. Again, it is important to address concerns to the appropriate congressperson, and also helpful to provide a hard copy of the concrete changes or topics that need to be addressed. However, one needs to recognize that nothing tangible may come out of what will probably be a very brief encounter.
I’d always pictured myself as a media-type advocate; I’d like to write news articles or Op-Ed pieces about issues that I think are important for my patients to be aware of. Even that idea has sort of a “when-I-grow-up” sort of vibe to it, considering I have no idea what type of physician I want to be, or what sort of patient population I’ll serve. However, I thought it was extremely helpful to know there are little ways that even the most politico-illiterate and time-crunched medical students can get involved. With that said, I think I know what my New Year’s Resolution will be.