Health Care Policy What does it have to do with me? Sally Weiss, MSc Bethany Picker, MD Central Maine Medical Center FMR

Disclosures We have nothing to disclose.

Advocacy – One definition 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 that he or she identifies through his or her professional work expertise. Earnest MA, Wong SL, Federico SG. Physician Advocacy:What is it and how do we do it? Academic Med. 2010;85:63-67

Odds ratios indicate likelihood, by specialty, of a rating of very important relative to family practitioners (reference group). From: Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy. JAMA 2006; 296(20):2467-2475. doi:10.1001/jama.296.20.2467

Can we summarize the findings here in just a few sentences? From: Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy.JAMA 2006; 296(20):2467-2475. doi:10.1001/jama.296.20.2467

Direct socioeconomic influences were more often rated as very important by physicians than were access-to-care issues, followed by broad socioeconomic influences. Adapted from Gruen et al. Socioeconomic influences, including their environment, political and behavioral associations are shown as expanding domains depicting proximity to physicians’ core responsibility for individual patient care. From: Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy. JAMA 2006; 296(20):2467-2475. doi:10.1001/jama.296.20.2467

Milestones: SBP Advocate for the individual and community Level 5 achievement: role models active involvement in community education and policy change to improve the health of patients and communities

Discussion Have you been politically involved or advocated for something? If yes, how did you advocate for an issue important to you? If not, are there any barriers to engaging in health policy?

Potential Barriers Medical training Competence Time Uncomfortable Perceived or Real Risk Culture “perhaps a culture that stubbornly clings to the passive-voice-verb construction is simply averse to the proactive, declarative nature of advocacy.” Medical Training: isolating and intense. It removes the physician and students from community. Competence: Feel competent in clinical world and uncertain how to advocate. Time: Maybe just too damn busy Uncomfortable: Trained to keep opinion out of clinical setting and how this may influence ability to persuade others. Perceived or Real Risk: Opinion or feelings about issue may conflict with institutional priorities. Misaligned objectives between employer and physician. Culture: In an era of EBM. Little evidence for public policy and community based interventions. Perhaps a heavier reliance on anecdotal evidence. Earnest MA, Wong SL, Federco SG. “Physcian Advocacy: What is it and how do we do it?” Academic Medicine. 2010; 85:63-67

Online Advocacy Tools STFM Free Online Advocacy Course: Less than one hour Includes How to get started in advocacy Navigating Congress Preparing for and conducting a hill visit Continuing the relationship with political leaders.

Curricular Exercise How and when do we teach physicians about subjects related to and impacted by health policy? Trainees should have the opportunity to practice advocacy skills in the context of learning environment. This curricular exercise familiarizes the resident with the state legislative process and how a legislative hearing can be an opportunity to provide meaningful testimony in either support or opposition of a proposed policy. The exercise requires residents to write testimony and then present it in front of a mock legislative hearing comprised of health care leaders from the community and state.

Mock Legislative Hearing How does it work? Who participates? Outcomes?

Group Exercise & Discussion “The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in shadows of life, the sick, the needy and the handicapped.” – H. Humphrey What is our role?

Please evaluate this session at: stfm.org/sessionevaluation