Why did you get involved in advocacy work?
I recognized that through advocacy work my ability to help patients could expand beyond the doors of the ED. I wanted to advocate for solutions to the systems issues I saw negatively impacting my patients’ health.
Every day, I see patients in the ED with health issues that cannot be solved in the exam room. Frequently, patients delay seeking care because they are afraid they cannot afford it or have difficulty accessing specialty care. Many don’t have access to the supports that they need to be healthy, such as stable housing, healthy food, safe communities, employment, and transportation. These issues are difficult to address in the clinical environment but are often even more important than any test I can order or medication I can give.
For instance, when I started my training, people with pre-existing conditions often didn’t have access to health insurance. Today, thanks to physicians and the many others who spoke out in support of the Affordable Care Act, we have laws that have greatly improved access to health insurance. Our perspective as clinicians is unique because we understand both the statistics (that millions more are now insured) and the human impact that policy changes like this have on our own patients. Recently, I diagnosed a man in his 30s with leukemia in the ED. He was able to sign up for insurance and get a bone marrow transplant that saved his life. Seeing this human impact inspires me to pursue advocacy work.
Why are clinicians uniquely positioned to be effective health advocates?
Polling consistently shows that physicians are one of the most trusted professions, and when it comes to health care, the public trusts them more than any other group. As physicians or other clinicians, we need to be good stewards of this trust and help decision-makers make informed choices and the public understand the issues, so they can make informed choices regarding political candidates and support health-promoting public policy.
Clinicians also have the unique privilege of seeing how policy plays out in the exam room. While most of us are not policy experts, we can tell our patients’ stories and describe how policies impact real lives. This provides an invaluable perspective that most policymakers won’t have if we don’t speak out.
The combination of public trust and firsthand knowledge means that adding a clinician in a white coat to any advocacy coalition provides a unique credibility. Even a relatively small number of physicians or other clinicians engaged in an issue can have an outsized advocacy impact. In fact, because physicians’ perspectives on health-related issues are so valued, some legislative staff record physician calls separately when assessing support for proposed policies.
What are examples of public health issues that clinicians have impacted through advocacy work?
Physician advocacy efforts helped pass California Senate Bill 277, which tightened up allowable exemptions to school immunization requirements. I share this example because it’s had a tangible impact - childcare and school immunization coverage levels have increased in Los Angeles County - and because it illustrates the range of tactics clinician-advocates can consider using. Physicians signed letters of support, wrote op-ed letters, and worked with their professional associations to support the bill. At legislative hearings, they provided expert testimony and public comment. And notably, the bill’s legislative co-author is a pediatrician, Senator Richard Pan. So, from writing a letter of support to writing the bill itself, physicians were instrumental in this policy change.
Substance Use Disorder Counselors in Emergency Departments
Physicians and other clinicians can also advocate for meaningful change within their own organization. Thanks, in part, to clinician advocacy efforts, we recently placed dedicated substance use disorder (SUD) counselors in our ED at Olive View-UCLA. This has greatly improved our ability to address the needs of patients with SUDs in the ED setting.
How can clinicians integrate advocacy into their day-to-day jobs?
If you have an employer or work for an organization, it’s important to understand what actions are acceptable. Ask:
- Whether you can speak on behalf of your organization and to what degree you can associate your advocacy work with your employer. Most employers will not bar you from speaking as an individual on an issue, but you should clarify the degree to which you can associate yourself with your employer.
- What types of advocacy actions are acceptable. Often, even employers who are friendly towards clinician advocacy become sensitive when there is media coverage, whether you are publishing an op-ed or doing an interview on the local news. Identifying what type of activity your employer is comfortable with is as important as determining how much you can associate yourself with your employer.
What advocacy activities do you recommend?
There are many options, which I think of as a ladder of engagement. Consider the following ideas.