Introduction by Daniel D. Klaristenfeld, MD, FACS:
For two consecutive years, the Young Fellows Association of the American College of Surgeons (ACS) has sponsored an essay contest. The winner of the competition receives a stipend and free admittance to the annual Leadership & Advocacy Summit, which will take place May 6-9, 2017, in Washington, DC.
The theme of this year’s contest—What It Takes to be Great through Advocacy—was best exemplified by A. Britton Christmas, MD, FACS, in his winning essay titled Weathering the story, which highlights the challenges of lobbying for trauma system support. In the following essay, Dr. Christmas expresses the personal experiences of a young surgeon negotiating the world of political advocacy.
“So, what you are telling me is that all emergency departments are not trauma centers?” This puzzled question came from a professional staff member of the U.S. House of Representatives Committee on Appropriations Subcommittee on Labor, Health and Human Services, and Education during my second visit to Capitol Hill to lobby on behalf of our nation’s trauma centers and the patients to whom we provide care. While we had successfully achieved reauthorization for the trauma and emergency care systems grants, no funds had been appropriated to our nation’s trauma systems since 2005. Unfortunately, that day would not be the day for change. However, our group—which was a part of the Trauma Center Association of America lobby day and included my trauma program manager and two other health care professionals from North Carolina—continued to voice our concerns in the congressional offices, appointment after appointment.
That night, a snowstorm hit the area leaving me stranded and wondering why I had even bothered to come to Washington, DC, that February in 2014. These legislators and their advisors didn’t even understand what a trauma center was. How did this happen? Why were we even here? As I walked through the snow savoring a moment of introspection, I realized that the streets were empty and that all was quiet. This would be the sound of our nation’s capital if nobody “bothered.” The stories would never be told, blissful ignorance would ensue, and all emergency departments would continue to be viewed as trauma centers.
Although surgery has produced many of the most talented physicians, researchers, and innovators, we have often failed to tell the story not only of the care we provide but also, most important, the stories of our patients. For far too long, we have focused solely on daily clinical care and our busy practices, all the while doing our patients an incredible disservice by not speaking out for them and advocating for their health care.
Applying lessons learned
Following my snowy visit to Washington, DC, I discovered a determination and passion for advocacy that I had not previously realized. I was ready to become a voice for my patients, for our trauma centers, and for our health care system. In fact, my newfound interest in advocacy was put to the test when a strong attempt to overturn North Carolina’s state helmet law arose in April 2015. We collected data, lobbied on behalf of the state, and personally contacted 34 state legislators to ensure that the respective committees would oppose passage of this legislation.
Another trip to Washington ensued later that year. This time, I was accompanied by one of my hospital administrators. She knew the numbers, and I told the stories. The trauma system grants were due for reauthorization making this a pivotal year for our advocacy efforts. We were garnering support for these grants with the realization that our advocacy efforts would be more effective with a team-based approach. We would later learn that our efforts were successful as the trauma system grants were overwhelmingly approved by the House and, in effect, another “storm” had been weathered.
At present, many uncertainties exist regarding the future of surgery and health care in general. I, however, view this as an opportunity to expand our influence and scope of care. I understand that now is the time for young surgeons to step forward and assist in redefining health care. Some of us are chosen to lead not out of our own desires, but due to our actions and the examples and standards that we set for those around us. With leadership comes responsibility, and with responsibility comes the expectation of improvement. Rather than denying the issues that arise due to a lack of personnel and financial support, we must educate the public, policymakers and the health care community. Improvement and progress does not occur through acceptance of the status quo but through advocacy to achieve meaningful change.
Recently, I was appointed to serve as Vice-Chair of the North Carolina Chapter of the ACS’ Committee on Trauma and tasked with leading our state’s advocacy efforts. While I know that this will be a challenging responsibility, I recognize that we must continue to visit lawmakers’ offices and show the numbers, and tell the stories. When we go, we march with one voice, one message, and one goal—to improve the quality of care for our patients and to speak for those who cannot speak for themselves. Another crisis will always loom on the horizon, and the young surgical leaders of tomorrow will continue to step forward to weather the storms.