Introduction by Rebecca Britt, MD, FACS:
The following essay is the winner of the Young Fellows Association Advocacy & Issues Workgroup essay contest. Surgeons were asked to submit an essay on the topic of how they are achieving their personal best as a young surgeon working within organized medicine by advocating to state and federal government officials for the safety and well-being of the surgical patient and/or for the surgeon. The winner, chosen from a number of submissions, received a stipend to attend the 2015 American College of Surgeons Leadership & Advocacy Summit, April 18–21 in Washington, DC. The essay is being posted as a Bulletin online exclusive.
“Where do we even start?” When I ask practicing surgeons how to improve patient safety and access to care, or I encourage my fellow trainees to get involved in legislative advocacy for our specialty, or I speak with patients about promoting urological health in the community, this response is the most common one I hear.
The problem is not that physicians are unaware of how to be advocates. Indeed, we are skilled in clinical advocacy, engaging our patients in shared decision making, supporting them through acute and chronic illness, and counseling them on how to achieve the best possible outcomes. We become well-versed in dissecting evidence, analyzing guidelines, and tailoring our recommendations to each individual and family.
Yet we seem to think that legislative and political advocacy requires a daunting paradigm shift. Issues at the federal level, such as Medicare payment or medical liability reform, suddenly become too important or cumbersome to tackle at the local level. In contrast, local issues seem of too little importance to warrant formal advocacy or too difficult to disentangle from the complexities of the health care system. Amid continuing debate regarding what the dynamic health care landscape may look like tomorrow, it’s no wonder that figuring out where to start feels like its own finish line.
Workforce issues: A personal point of entry
For me, the starting point has been illuminating how public policies in the headlines will affect our patients. For instance, one of the American College of Surgeons’ federal legislative priorities is to maintain a robust surgical workforce through graduate medical education (GME) system reform, such as revising funding limits. We have all read commonly cited statistics showing the increasing demand for and shrinking supply of providers across the country, which has had a tangible impact at local hospitals unable to meet the needs of their communities. At tertiary care centers like my hospital, Dartmouth-Hitchcock Medical Center, Lebanon, NH, waiting lists for new patients have in some cases stretched to months. Patients seeking our help for problems old and new are running into troubling obstacles that threaten access to and continuity of care, as well as our commitment to maintaining the highest standards of practice.
These observations prompted me to write a column for the state newspaper, the Concord Monitor, to explain why a seemingly apolitical event like medical school graduation underscores the challenges that many patients in my region now face.* I also wanted to call attention to proposed federal legislation targeting GME funding caps, not only to hold policymakers accountable but to give patients a way to make their stories known. I strongly believe that making policy issues digestible for the people they most affect is a natural extension of the work we do as advocates for patient care.
Similarly, we should confront the contemporary demands of the populations we serve. In my work at the Veterans Affairs Medical Center, I have witnessed the changing needs of returning veterans, including psychological and urological trauma. So when “urotrauma” recently gained traction in Congress, I immediately wanted to lend my voice to advocate for legislative attention to an under recognized condition. In serving as a liaison between the local and Washington-based policy staff of the members of Congress from my state, I learned firsthand that effective advocacy takes more than raising awareness about a lobbying “ask” or proposed legislation. Though we may underestimate it, the impact of consistent communication with lawmakers, particularly from physician constituents, can be substantial. This inspired me to write a Veterans Day op-ed in the New Hampshire Union Leader about the urotrauma bill, underscoring that while organizing and campaigning are indispensable, successful advocacy often begins with making a phone call or picking up a pen.†
Presenting a united front
But the most direct impact of advocating for quality health care for our communities is often the result of efforts at the local level. My hospital is a cancer referral center for many underserved regions of the state, but I have been surprised by how few colleagues in other specialties, as well as the community at large, are aware of the multidisciplinary clinical, research, and support resources of our urologic oncology programs. Partnering with the leadership of our affiliated cancer hospital, Norris Cotton Cancer Center, Lebanon, NH, I organized a “Movember” campaign—the first of its kind at our institution—to encourage collaborations supporting men’s health among providers, patients and families, and community organizations. By uniting advocates for cancer care specifically and preventive health in general, the campaign brought together diverse stakeholders as a collective voice to meet the needs of our region, which demonstrated to me the potential power of grassroots advocacy.
Achieving our best as surgeons is rooted in our dedication to advance the care of our patients and communities. In our clinical roles, we are keen observers, analytical investigators, and creative problem solvers. Advocacy, then, is not just a part of what we do, but indeed who we are. We should bring our firsthand knowledge of the barriers to surgical care and patient safety to our lawmakers, who often want to hear physicians’ perspectives but seldom do. And we should share our experiences with other ACS Fellows so that their best practices can inform our own efforts, whether at City Hall or on Capitol Hill. As the College continues “Inspiring Quality,” my goal as a young surgeon, and my hope for our specialty, is that we move our health care advocacy beyond “Where do we even start?” and instead ask ourselves, “How do we keep moving forward?”
*Koo K. My turn: Crisis looms for next generations of doctors. Concord Monitor. June 6, 2014. Available at: http://www.concordmonitor.com/home/12270577-95/my-turn-crisis-looms-for-next-generation-of-doctors. Accessed May 28, 2015.
†Koo K. Every war brings a new medical challenge for our veterans. New Hampshire Union Leader. November 9, 2013. Available at: http://www.unionleader.com/article/20131111/OPINION02/131119977. Accessed May 28, 2015.