Advocacy for Our Patients and Ourselves

by: Amalia Cochran, MD, MA, FACS, FCCM

How many of you have written a letter or sent an email to your member of Congress about an issue?

How many of you have called your member of Congress’ office?

How many of you have visited your member of Congress office, either in the home district or in DC?

How many of you aren’t sure this stuff matters?  Does it really make a difference when you call or write or visit to discuss the SGR or the zero-day global or ongoing support for trauma systems?

I’m here to tell you that it does matter.  Our Senators and our Representatives are listening- maybe not they themselves directly, but they are using their staff members as their eyes and ears to review those emails and letters and calls.  They are interested in what you, as a constituent, have to say.  When you are able to develop a longer-term relationship with a staffer, you can even become a content expert for them so that when issues they know are within your scope of practice come up, they’ll contact you for support and further information.  So, yes, your engagement on these things matters, and can even bring your Representative along to become a co-sponsor of meaningful legislation or to vote “Yay” or “Nay” in a way that helps our patients and helps the profession of surgery.

I recently crowdsourced on Twitter, and immediately realized that the biggest gap for most people with advocacy is that they simply have no idea where to start.    Here’s a helpful visual for you, recognizing that you want to start at the broad base of the pyramid:

The great news is that the American College of Surgeons has developed a resource in the form of Surgeonsvoice.org ; once you log in to the site using your ACS member number, it provides you with a roadmap for advocacy, especially if you go to the Action Alerts.  They set you up to seamlessly send an email to your member of Congress in two minutes or less.

If you are interested in becoming a bit more engaged, the next step would be to set up an in-district meeting with your member of Congress and/or their staff.  I strongly recommend that the first time that you do this, take someone with experience with you.  It will make it less intimidating and more fun- and it’s an opportunity to participate in some peer mentoring.  In-district meetings are easy to set up, and you can do it simply by making a phone call to their local office.

Finally, a shameless plug.  Please come to Washington, DC, in April for the ACS Leadership andAdvocacy Conference. It’s a wonderful opportunity to rub elbows with College leadership, you get trained in the process for doing Hill visits, and your appointments all get made for you.  Most importantly, someone from your state will usually have done this before, so you have that experienced peer mentor who I alluded to above.

So, get involved.  Send a letter, make a call, set up a meeting…go to DC for the leadership and advocacy.  Your voice matters.

Visiting Professor at Washington University

by: Amalia Cochran, MD, MA, FACS, FCCM

On a cold and snowy February 17 & 18, I had the privilege of visiting Washington University in St. Louis as the Ephgrave professor.  Dr. Stephanie Bonne was an amazing host, organizing a trip that provided perfect exposure of the medical students, residents, and faculty.  I had the opportunity to tour many of the surgical areas at Barnes- Jewish Hospital, including participation in their Trauma QI/M&M meeting and rounds with both the Trauma team and the Surgical ICU team.  I very much enjoyed and appreciated some dedicated time with Stephanie, who is a developing leader in the AWS, and with Kathy Raman, a vascular surgeon who shares my interest in telemedicine.  I also had some focused time with John Kirby, the medical student clerkship director, and Paul Wise, the residency program director, to compare notes on challenges our institutions face in the education of the next generation.

I delivered Grand Rounds on Tuesday evening with my talk entitled, “Bullies Throwing Tantrums:  Disruptive Surgeon Behavior in the Perioperative Environment.”  Professionalism and disruptive behavior is a particular interest of Dr. Tim Eberlein, the Department chair, and he specifically asked that I share my research in this area.  Grand Rounds was followed by a wonderful dinner at a local restaurant that included women faculty, women chief residents, and Adrienne Davis, who is a Vice Provost and member of the University’s law faculty.

My area of clinical expertise is in burn care, and Wednesday morning began with me teaching about the complexities of burn physiology for the weekly resident’s conference.  An innovative way in which the residency program at Wash U capitalizes on the experience of visiting professors is by having a “fireside chat” at the conclusion of Wednesday conference, giving residents an opportunity to discuss issues about education, academic surgery, and life as a surgeon in a more casual environment.  After the fireside chat, Elspeth Hill (a plastic surgery intern) shared her PhD dissertation about women in surgery with me; her eye-opening qualitative work was done about the system in the UK, but has some interesting implications that are also relevant in the US.  After a visit to see the weekly skills lab activities for the residents, I had lunch with the AWS Student Chapter Leadership.  Best wishes to Grace and Amelia in the upcoming match, and thanks to Lindsey and Ema for spending time with me as well.  After an interesting case presentation from the Surgical ICU team, it was time for me to head home from my great St. Louis adventure.

Special thanks to the AWS for sponsoring me as the Ephgrave visiting professor this year, to Tim Eberlein for his enthusiasm for my work, and to Stephanie Bonne for doing some “heavy lifting” to make my visit go seamlessly.  It was an honor to be your guest, and the hospitality was without parallel.

Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah.  She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah.  Her research interests lie in surgical education and in clinical outcomes in burns.  She is completing her term as Vice President for the Association of Women Surgeons. 

Engagement through Advocacy

by: Amy Liepert, MD

“Oh my! You look too young to be a surgeon!”  This was not exclaimed to me (this time) by a patient, although I have often heard that.  As I am nearly 2 years out of my fellowship training and not having taken significant time off, my age is not much of a secret.  However, instead of my response this time being an assurance that indeed I am old enough, and I am older than I look, as it might have been to a patient or family member, this time I responded differently.  “With all due respect Lieutenant Governor, YOU do not appear old enough to be Lieutenant Governor!”

With engagement in advocacy you never know what chance meeting, connection or opportunity might arise to put you in the position to influence and impact the care of your patients at a legislative level.  While participating as part of my state’s physician advocacy day, known as Doctor Day, I had the opportunity to meet one-on-one with the young and female Lieutenant Governor of my state.  Just as medicine and surgery has been undergoing a transformation with the incorporation of more female surgeons, women are making up a greater proportion in politics. 

As women have impacted and influenced the practice of surgery for the better, we also carry the responsibility to ensure equitable and quality care to our patients.  This often requires engagement in the political arena.  Engagement in these activities is not about partisan politics; it is about developing relationships with those who navigate within the political sphere.  Those relationships allow us to share the important work that we do for our patients and to ensure that the amazing care that we have been trained to provide is protected.

As I have participated in advocacy days and in-district meetings on both a national and state level, I have found myself talking less and less about specific policy agenda items and more about patients, the care I provide, and the challenges I have faced in delivering care.  As legislators learn more about these real-life example circumstances they seek out solutions.  More often than not, those inquiries lead back to the issue briefing that were meant to be the topic of discussion.

Advocacy and engagement is less of an additional burden or task to the surgeon, but instead it is an extension of the important work that each of us contributes to our patients each and every day.  Each phone call, each email, each letter, and each visit to legislators are important and vital components for the care of your patients.  Relationships developed with legislators who can rely on you, as an expert surgeon reference, is a priceless gift that a surgeon can give to her patients. 

I encourage each of you to challenge yourself to engage in the on-going care of your patients by engaging with your (and you patients’) representatives.  Share stories, successes and challenges.  You will find legislative members of government who look similar to you and many who do not.  But sharing your viewpoints, experience and expertise is a necessary extension of your role as a surgeon.  It is now easier than ever to participate.  Check out Surgeonsvoice.org, the advocacy dedicated webpage created by the American College of Surgeons.  Here you will find all kinds of information including current issues.  Log in with your ACS member ID number and last name.

Engaging in advocacy is easy once you start.  In order to make that transition look to join a Doctor Focused Advocacy Day in your state or attend the ACS Leadership and Advocacy Summit in April.  These types of events are supportive, educational and fun. Finding common ground with legislators is the method to ensure a strong on-going foundation to the future quality of care for all of our patients.