Residency programs and medical schools must prioritize advocacy training


Any physician who firmly believes in the ethical principles of beneficence and justice will recognize the legislation recently passed by the United States Congress known as the American Healthcare Act (AHCA) as a moral travesty. The bill’s provisions to shift costs from the wealthy to the impoverished, diminish protections for individuals with pre-existing conditions, and strip away essential health benefits for patients are cruel measures that run directly counter to the goal of creating a more egalitarian health care system.

Physicians and health care providers at large railed against AHCA. Citing the troubling projection that millions of Americans would lose health care access should the AHCA bill become law, the American Medical Association and several other prominent physician organizations publicly opposed the bill, but to no avail. Despite the outcries from hospitals, nurses, citizens and physicians alike, the Senate is now trudging onwards in its attempt to pass a version of this bill.

However, as the debate on the future of the American health care system electrifies television screens and blares on radios around the country, the voices of young physicians in training are conspicuously absent from public discourse. As a resident physician, I can surmise that while other groups are marching on Washington, the vast majority of my colleagues have been shuttered away in hospitals inundated with clinical responsibilities and answering pages in the dead of night. Most resident physicians are too exhausted from their hectic schedules to engage in these issues, and many residency programs do not offer opportunities for engagement in political advocacy.

In the age of Trumpcare, the voices of young physicians on the frontline of the health care system are more important than ever. Some residency programs have already taken the initiative to create specialized tracks for physicians interested in integrating policy and advocacy into their careers.  The NYU Langone Medical Center recently started a strategy and policy track for it’s orthopedic surgery resident physicians. The Boston Combined Residency Program in Pediatrics at Boston Children’s Hospital and Boston Medical Center offers an urban health and advocacy track for some of its physicians in training.  Similarly, the Kaiser Permanente Oakland Internal Medicine Residency Program is launching a new Health Equity and Disparities track beginning this year. Medical students have led formative roles in the New York City Coalition to Dismantle Racism in the Health System, and the #ProtectOurPatients grassroots campaign is also led by medical students.

These examples are praiseworthy, but should not be exceptional. The American Medical Association Declaration of Professional Responsibility dictates physicians must “advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.” Some physicians eventually do become policy advisors, fulfill media positions, contribute to public discourse on issues relating to the social determinants of health, or run for political office — but basic levels of competency in policy and advocacy are ill-defined for medical students and resident physicians.

Every medical school should be compelled to implement a mandatory advocacy curriculum that ties topics of clinical competence to the implications of relevant state and federal policy decisions for patient outcomes. Institutes of graduate medical education must give young physicians opportunities to familiarize themselves with the political landscape of their local communities and encourage them to learn to effect change on a broader scale beyond their individual health system. The pitfalls of moral hazard in the health care system and comparisons of free-market to single payer insurance models should be discussed at length in residency grand rounds.  The intricacies of value-based care shouldn’t be left entirely to policymakers behind closed doors on Capitol Hill. Rather, these topics should be debated amongst medical students and physicians. The medical profession must embrace advocacy as an ethical imperative now more than ever before.  Doctors cannot be taught that befuddled shrugging or sincere expressions of sympathy alone are acceptable responses when a patient asks, “How will I pay for this treatment?”

I recently watched a compelling video of Neil deGrasse Tyson extolling the power of science to define emerging truths.  Physicians toil away fighting disease in the caliginous spaces where the hard truths of science and the tumultuous narratives of human suffering collide in real time. Daily, doctors apply the awesome power of scientific knowledge to mend the human body in seemingly miraculous fashion.  We perform this delicate craft in the service of our patients only to often have our efforts undermined by the toxicity of a fragmented health care system. We are poised to speak out for the most marginalized and ill patients who don’t have a lobbying firm doing it for them.

It is time our medical education system give young physicians and medical students the tools to translate their perspectives into public policy. Otherwise, the voices of our brightest young doctors and our most vulnerable patients will continue to be drowned out by the cacophony of partisan squabbling.

Christian Alexander Pean is an orthopedic surgery resident.

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