The Executive Suite: Why physicians need to be patient care advocates

Physicians have a significant impact inside the exam room, where they can educate and engage their patients to take better care of themselves.

Outside the exam room, though, physician voices are too rarely heard by the legislators and regulatory agencies that set the standards and laws for patient care and social issues that affect patient populations. Instead, those regulations are often dictated by insurance companies, lobbyists and politicians who know little about the realities of healthcare delivery.

We’ve seen plenty of ramifications already, including poorly implemented electronic health record systems, restrictions on which options a physician can present to pregnant patients and regulatory bureaucracy that leads to inflated charges and inefficient staff workflows.

“There aren’t many physicians involved at a national level in some of the agencies that make patient-care policies,” says Gary Price, MD, a surgeon and president of The Physicians Foundation. “As a result, we’ve certainly had a lot of experience with healthcare solutions that were poorly informed and haven’t worked well.”

Physicians need to raise their voices and be heard, he says. “As our nation’s frustration with our healthcare system increases, I’m hopeful that everyone will start paying more attention to the physicians who are delivering the care. (From a business standpoint,) I don’t think they’ll be left with any choice.”

In the meantime, physicians can continue to find ways to advocate for their causes - even if those in power aren’t listening yet. “All physicians impact individual patients on a day-to-day basis,” says Anders Gilberg, senior vice president of government affairs with the Medical Group Management Association. “That’s what makes the profession so rewarding. And to the extent they have the time, energy and desire to do more, they can use their day-to-day experiences to try to improve the overall delivery of healthcare in this country.”
Bring your perspectives to policy discussions

Physicians are already seen as leaders in their communities. They’re highly educated and tuned in to what’s happening in healthcare, and they bring a unique perspective on the important issues of healthcare equity and delivery. Their voices are important in finding solutions, not only to patient care challenges, but also to other issues that impact the health of their populations, such as gun violence, poverty and even climate change.

Theresa Rohr-Kirchgraber, MD, FACP, a primary care physician and executive director of the Indiana University National Center of Excellence in Women’s Health, has worked with sex trafficking and abuse victims, survivors of accidents and other traumatized patients. She, like other physicians, understands the personal burden of disease and the importance of healthcare all too well. “Physicians can use those experiences and those personal stories to influence policy discussions,” she says.

Physicians can also provide factual evidence to balance political discussions, Gilberg notes. “So often politics is based on rhetoric and opinions. Physicians can bring real-life examples that can have a real impact. They’re honest brokers, and that’s important because they can help find middle ground where issues like healthcare can be polarizing.”
Patients crave your advocacy

The overwhelming majority (96 percent) of respondents in The Physicians Foundation’s 2017 Patient Survey Report say they think physicians should advocate for their patients. In the 2019 Great American Physician survey conducted by Physicians Practice, 72 percent of respondents say more physicians should become involved in physician advocacy. However, less than 38 percent of physician respondents in the Foundation’s 2018 Survey of America’s Physicians say they felt they had much ability to influence policy.

“In terms of influencing legislation, what really talks is the money they get from lobbyists,” says William Choisser, MD, a family physician. “Unless you come with a check in hand, they’re not really going to consider what you have to say.”

The problem is bigger than that, though, says Amaryllis Sanchez Wohlever, MD, a family physician and author of the book, Recapturing Joy in Medicine. “We’ve not learned about advocacy for our profession. That’s a need in our curriculum to learn to advocate for our profession and our patients better.”

Physicians know advocacy is necessary because the system isn’t working, Price says. “We just need to make it easier for physicians’ voices to be heard.”

Between 2005 and 2018, the Foundation’s Karl M. Altenburger Leadership Academy provided leadership development to 357 participants. so that those physicians can deliver their voice and perspectives effectively. That will help them as advocates, Price says. Leadership skills also will help physicians serve as educators and mediators when discussions become polarized, which can so often stunt progress on policy discussions.
Foster relationships with policy makers

One way to participate in creating healthy policy is to build relationships with legislators and regulatory agencies at local, state and federal levels, Gilberg says. “By being a resource to those lawmakers, you often find they will then start coming to you as a physician and asking your opinion about public policy issues and how they affect the district and the patients you serve. You can take that a step farther and testify on the local, state or national level at hearings.”

For example, many states have programs where physicians meet with state lawmakers at the state capitol. Patrice Harris, MD, MA, president of the American Medical Association, began working with medical organizations after a visit to the Georgia general assembly gave her an epiphany about the importance of physician voices being heard by policy makers. Even just spending 15 minutes a week writing letters or sending emails to legislators can be effective, Sanchez Wohlever says.

Some physicians may feel compelled to go a step further and become the legislator - or at least run for office. “But you’d have to leave the practice, or put it on hold,” Choisser says. “It takes a lot of money, and you have to commit time.”

Other ways to advocate in your own community include starting a local mentoring group; feeding the hungry; helping victims of social injustice; speaking publicly to local groups; writing letters, articles or blogs for publications; or taking up the cause on social media. Choisser takes his advocacy directly to the people: He writes editorials for TheWall Street Journal and his local paper. He’s had more than 30 editorials published locally, and several published in the Journal.

Rohr-Kirchgraber suggests encouraging patients to get involved in healthcare advocacy, too. “We do not lobby for a candidate, but we can encourage patients to vote and write to their local leaders about issues and use their own stories to make a point,” she says.
Get to know healthcare advocacy organizations and academies

With long hours and demanding jobs, physicians may not be able to devote the time and energy to influencing policies by themselves. Another way to make a difference is to support healthcare associations and societies that are policy influencers, many physicians say. Medical organizations give physicians the unified voice that is more likely to be heard, Price adds. They already devote money to lobbying, and because they’re comprised of members with different political beliefs, organizations can help find middle ground that is more likely to result in viable solutions.

“One individual voice is important, but we often find in Washington when we’re working on issues - even as an association with tens of thousands of members - we seek to join and to create like-minded coalitions,” Gilberg says. “That makes our message more powerful and gets more attention to our issues.”

Price says that through 10 years of talking about the impact of social determinants of health, The Physicians Foundation has brought that topic to the forefront of policy discussions. “I think we’ve also been successful in raising our voice about the fact that electronic health records have to be redesigned around the issue of well-being,” he says.

The AMA is working with stakeholders and the federal government to refine and streamline the Medicare payment system and to ensure that as physicians report on various quality improvements, those performance reporting items are meaningful, Harris says to Physicians Practice.

Sanchez Wohlever is a past president of the Florida Association of Family Medicine Residents and has been involved in advocacy efforts with the American Academy of Family Physicians, Physicians Working Together, Physicians for Patient Protection and other organizations. This legislative session, she joined leaders from several state medical organizations in testimonies before Florida state House committees to help defeat a bill that would have allowed pharmacists to diagnose and treat certain infections and chronic conditions without medical school training or medical residency.

Each month, the Texas Medical Association hosts the First Tuesdays event, when physicians meet with state senators and representatives in their Austin offices. “If every state did something like that, that would be starting to take medicine back. It would be incredible,” says Sanchez Wohlever, who is trying to start a similar program in Florida.

“Getting involved at the state level is one of the most powerful ways physicians can advocate for their patients, their needs and the needs of the healthcare team,” she adds. “State medical organizations need our active involvement now more than ever.”
Help drive the policies, or someone else will

“If we don’t advocate, people will continue to manage the system for us, whether it’s healthcare, immigration, taxes, whatever,” says Dennis Perry, ND, a naturopathic physician. “And they’re not doing a very good job. They’re just not. People with skills, people with interests have to step up.”

Sanchez Wohlever says advocacy can help remind physicians why they love medicine. “Advocacy is empowering in itself. What we need most is to step back into who we are. We were all leaders when we arrived in medical school.

“The problem is that many of us cannot lead in the current setting because we are disempowered in various ways. When we are disempowered, we become disengaged. And for every physician who is disengaged at work, that means nonclinical voices are unopposed. It’s a tough environment, but we have more power than we sometimes exercise.”