Engagement needs to start at medical schools and residency programs
Advocacy is vital to the future of medicine as a profession. Founded by the Academy in 1997, the American Association of Orthopaedic Surgeons—together with the Office of Government Relations (OGR)—advocates on Capitol Hill throughout the year on behalf of all orthopaedic surgeons. The support of the AAOS Orthopaedic Political Action Committee (PAC), founded in 1999, further bolsters the impact of AAOS’ advocacy and legislative efforts.
During this time of rapid change in health care, however, additional advocacy efforts are needed to effect change on the myriad policies and policy proposals that will directly impact orthopaedic surgeons and their patients. During the AAOS 2017 Annual Meeting, past presidents William J Maloney, MD, and Gerald R. Williams Jr., MD, expressed the need for increasing orthopaedic surgeons’ investment in advocacy. Their goal was to grow the AAOS PAC into the largest medical PAC in Washington, D.C.
Early exposure and education are needed to foster orthopaedic surgeons’ investment in advocacy and policy efforts. Unfortunately, most medical schools lack a formal advocacy and policy education curriculum. Residency programs also fall short when it comes to training their orthopaedic residents on the importance of advocacy for the advancement of the profession. A study on residents’ attitudes on advocacy revealed that half felt it was their professional responsibility to participate in the legislative process. Although 25 percent of the respondents believed they would be able to effectively communicate their position to legislators, only 13 percent have taken an advocacy role in the past. This percentage fell to less than 10 percent when residents were asked if they believed their medical school curriculum or residency education program provided adequate training in health legislative advocacy.
Currently, no widely implemented medical schools or residency program educational curriculum incorporates advocacy. When residents complete pre-curriculum surveys, only 33 percent thought that learning about orthopaedic advocacy was important to their education. At the completion of the curriculum, which included healthcare policy and patient and specialty advocacy, 90 percent of residents stated they would be interested in getting involved in orthopaedic advocacy. The AAOS Resident Assembly, formed in 2014, has a Health Policy Committee that helps educate residents on advocacy and policy and the importance of each in their careers.
Advocacy in action
My passion and interest in advocacy and healthcare policy stem from a desire to have a more robust impact on health care than with just each patient I encounter. The realization that healthcare policy is wide reaching and affects a great number of patients prompted me to pursue a Masters of Public Health degree, with a concentration in Health Law, Policy, and Ethics.
With eight percent of the U.S. gross domestic product consisting of musculoskeletal disease and disability, it is imperative that orthopaedic surgeons are attuned to policy decisions and advocacy platforms. Given their large influence on our country’s health care and economic stability, orthopaedic surgeons must view advocacy and policy engagement as a responsibility. I believe educating orthopaedic surgeons to be a component of—and engaged in—advocacy should ideally begin in medical school, or at the very least, in residency.
Engaging medical students in advocacy efforts sets the stage for their future involvement in healthcare policy. Realizing this, the AAOS OGR organized a Medical Student Advocacy Day last year for Howard University College of Medicine’s Orthopaedic Surgery Interest Society to meet with congressional leaders on Capitol Hill. Prior to their visit, the students were provided background materials on the issues that would be discussed during the meetings. Onsite, the OGR staff briefed the students on current issues for which they were seeking congressional support. They also provided tips on how to best engage congressional members.
The students met with Sen. Dianne Feinstein (D-Calif.), Sen. Johnny Isakson (R-Ga.), Sen. Kamala Harris (D-Calif.), Rep. David Scott (D-Ga.), Rep. Robert Wittman (R-Va.), Rep. Joe Wilson (R-S.C.), Rep. Hakeem Jeffries (D-N.Y.), and Rep. John Sarbanes (D-Md.) to discuss e-prescribing of opioids, musculoskeletal research funding, and graduate medical education funding. The meetings complemented the annual advocacy activities that take place during the National Orthopaedic Leadership Conference and Research Capitol Hill Days, and provided AAOS with another way to engage Congress members.
With healthcare rapidly changing, rather than lobbying lawmakers after a policy is in place or a law has been enacted, orthopaedic surgeons should be on the forefront of crafting policy and advising legislators. Orthopaedic surgeons can be involved in advocacy in many ways: by donating to their state orthopaedic PAC or AAOS PAC, lobbying state and federal legislatures, volunteering to be a part of a political candidate’s campaign, or running for office themselves. If each orthopaedic surgeon does their part, patients, health care, and the profession of orthopaedic surgery will all benefit.
- Sethi MK, Obremskey A, Sathiyakumar V, Gill JT, Mather RC. The Evolution of Advocacy and Orthopaedic Surgery. Clinical Orthopaedics and Related Research. 2013;471(6):1873-1878. doi:10.1007/s11999-013-2900-3.
- Frick, S. L., Richards, B. S., Weinstein, S. L., Beaty, J. H., & Wattenbarger, J. M. (2010). Workforce, work, and advocacy issues in pediatric orthopaedics. Journal of Bone and Joint Surgery – Series A, 92(17). DOI: 10.2106/JBJS.J.00333, http://dx.doi.org/10.2106/JBJS.J.00333
- Theodore Long, Krisda H. Chaiyachati, Ali Khan, Trishul Siddharthan, Emily Meyer, and Rebecca Brienza (2014) Expanding Health Policy and Advocacy Education for Graduate Trainees. Journal of Graduate Medical Education: September 2014, Vol. 6, No. 3, pp. 547-550.
- Shaath M, Berberian WS. Attitudes of Orthopaedic Surgery Residents Toward Public Health Advocacy: The Affordable Care Act and Orthopaedics. http://aaos2016.conferencespot.org/61513-aaos-1.2968416/t002-1.2975366/f002-1.2975367/a024-1.2976971/paper-183-1.2976997
- Daniels AH, Bariteau JT, Grabel Z, DiGiovanni CW. Prospective analysis of a novel orthopedic residency advocacy education program. R I Med J (2013) 2014 Oct 01;97(10):43–6.
- Press VG, Fritz CDL, Vela MB. First year medical student attitudes about advocacy in medicine across multiple fields of discipline: analysis of reflective essays. Journal of racial and ethnic health disparities. 2015;2(4):556-564. doi:10.1007/s40615-015-0105-z.
- US Bone and Joint Initiative. The Burden of Musculoskeletal Diseases of the United States. Available at: http://www.boneandjointburden.org/. Accessed February 15, 2018.
William Hill, MPH, is a member of the Howard University College of Medicine’s Orthopaedic Surgery Interest Society.