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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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July 1, 2013 Volume 77, Number 7
Young Physician, Heal Thyself… Jerome Adams, M.D., M.P.H. Committee on Governmental Affairs

Crystal C. Wright, M.D. Committee on Governmental Affairs



Using your profession to affect lives beyond typical daily encounters is a theme taken from the best-selling book Start Something That Matters by Blake Mycoskie.1 In his book, Mycoskie describes his journey as he developed the successful yet highly charitable business of TOMS shoes. He talks primarily about the value of being good at and loving your day-to-day work while seeking to make a larger change in the world at the same time.

As physicians, we are privileged to receive daily gratification in the successful treatment of our patients, and there is no doubt they in turn value our care. Beyond those daily and direct interactions, however, anesthesiologists are uniquely positioned to be part of the larger conversation on health care delivery. According to a Harris Poll measuring trust in different professionals to give advice, doctors are trusted “completely” by the greatest number of U.S. adults.2 When we utilize this credibility and the knowledge we possess as physicians to affect larger change, we position ourselves to be a part of “something that matters.” Advocacy in medicine simply means that physicians can be a part of something greater by using their expertise to influence changes in medical care policy.

The discussions, emotions and politics regarding health care in the U.S. are at an all-time high. With a focus on the high cost and substandard quality of care that is provided for much of our country, more people than ever are taking notice. Whether we address health care issues on a local, state or national level, learning to be an effective advocate helps us protect our patients and our profession as we traverse the significant changes on the horizon. It is therefore imperative that anesthesiologists in early practice understand the importance and how-to of advocacy.

Earnest et al.3 define advocacy as “the action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being identified through professional work and expertise.” Physicians experience the value and importance of advocacy as we often go the extra mile to make sure our patients get the care they need. We can go further than the individual patient encounter and explore the impact of physician advocacy on behalf of an entire society of potential patients. Advocating on this larger level means striving to ensure that all patients get the services they need and, perhaps more important, working to address the root causes of the problems those patients face.

The complex and rapidly changing environment of health care has created gaps in care and negatively impacted both patients and providers. Young physicians are uniquely attuned to these changes, and if we fail to realize the importance of advocacy, sudden and striking transformations may occur without our input and values. Not only will this make our professional experiences less rewarding, but it could degrade the physician-patient relationship and the quality of care that our patients receive.

Beyond the aforementioned, there are numerous practical reasons for young physicians to become involved in advocacy. The perspectives and goals of a physician who has 20-plus years left to practice can be very different than those of one who is well established in his or her career or near retirement. If you are not at the table in what is commonly a zero-sum political game, your priorities may be on the menu.

Furthermore, the young physician voice is frequently sought out by legislators, as we are the bridge between the often very different worlds of medical training and day-to-day patient care. Politicians can be more responsive to the younger physicians who say they can’t afford to take a job at a hospital in their district due to a poor payer mix and substandard Medicare payment, rather than to older physicians who they may view as simply protecting their turf or representing the “old guard.”

Young physicians are also uniquely qualified to speak specifically and credibly about many of the new changes in health care delivery, such as the use of electronic medical records, the shift from smaller groups to hospital or mega-group employment, the impact of rising student loan debt, and how the lack of GME funding and residency spots can affect type and place of residency and where a person ultimately chooses to practice. Being recently out of residency, young physicians can directly compare the amount of training an anesthesiologist receives in contrast to others who wish to provide anesthesia services, as well as the advanced training many of us have received in fellowships.

Anesthesiologists often think that advocating beyond the O.R. is difficult, but it can and should be done according to the particular interests, skills and everyday opportunities of each particular physician. Earnest goes on to describe several ways physicians can advocate beyond individual patient care, including educating and getting involved in the community via career days or health fairs, institutional and local board and committee membership, writing to or calling politicians, and state and national medical society and political action committee involvement. Advanced advocacy can include being a media liaison for your group or hospital, testifying on proposed legislation at your state house, meeting one on one with politicians at home or in D.C., and even holding political fundraisers or inviting political figures to see you at work (site visits).

Fortunately, ASA provides many opportunities to help you, no matter your desired level and type of involvement. The annual Legislative and Practice Management conferences literally run the gamut from describing small changes you can advocate for locally (even within your own practice) to national campaigns focused on improving patient safety. Both conferences have been a springboard for many aspiring young (and older!) advocates. ASA offers workshops on interacting with the media and helping with political campaigns, or even running for office yourself. The ASA website is a great resource and has information you can share with the public, media and other physicians. Last but not least, becoming a member of the ASA Grassroots Network is an easy way to stay abreast of what is going on beyond the O.R. and promotes opportunities to advocate for your patients.

Advocacy is a process that can and should be practiced along a continuum. This spectrum of physician advocacy allows individual practitioners to decide the best way to develop and utilize their advocacy skills to affect greater change. The sooner young anesthesiologists get involved, the greater the impact we can have on our patients and our profession. There are a multitude of complex issues out there that will affect us both as patients and physicians if not addressed in a meaningful and informed way. Our health care delivery system is sick, and young physicians are called upon to be a part of something that matters – now is the time to answer the call and participate in healing the practice of medicine.



Jerome Adams, M.D., M.P.H. is Assistant Professor of Anesthesia, Indiana University School of Medicine, and Chair, Wishard Hospital Pharmacy and Therapeutics, Indianapolis.

Crystal C. Wright, M.D. is Assistant Professor of Anesthesiology, Baylor College of Medicine, Houston.


References:
1.  Mycoskie B. Start Something that Matters. New York: Spiegel & Grau; 2011.
2. Taylor H; Harris Interactive. Doctors, dentists and nurses most trusted professionals to give advice, according to Harris Poll of U.S. adults. The Harris Poll® #37. Rochester, N.Y.: Harris Interactive; May 10, 2006.
3. Earnest MA, Wong SL, Federico SG. Physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63–67.



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