Letters to the Editor
In Reply to Premkumar et al: We agree with the points raised by Premkumar et al and appreciate the opportunity to continue this important discussion. Their proposal to empower medical students’ involvement in advocacy projects supported by faculty and resident role models early in medical education is an essential element to the success of physician advocacy. Through participation in programs like the Advocacy Training Program (ATP) at Premkumar and colleagues’ medical school, students will be more likely to develop the advocacy praxis needed to sustain their advocacy efforts in residency training and over a career. Developing evidence-based competencies in advocacy will be important to help advocacy efforts become an encouraged team-based activity as opposed to a perfunctory activity that is merely tolerated. While medical student training is a fundamental part of this effort, the inclusion of advocacy training in continuing medical education also can help create a culture of continuous improvement within modern medicine.
Physicians at all levels of training are advocates for their patients. Physician advocacy occurs in four major areas: patient-centered, clinical, administrative, and legislative. It can range from the consistent role-modeling of professionalism in patient encounters to being a part of a program such as the ATP or being involved in a legislatively active national nonprofit advocacy group like Doctors for America (DFA).1 In DFA, practicing physicians, faculty, residents, and medical students interested in legislative physician advocacy use a team-based approach to “improve the health of the nation and ensure that everyone has access to affordable, high quality health care.”1 Supported by experts in legislative advocacy, participants at all levels of training are learning by doing: organizing support for and educating fellow physicians on the Affordable Care Act, leading campaigns on important health topics including contraception and gun safety, and meeting with senators and representatives to discuss important state and national bills affecting health care. Great examples of advocacy in action like ATP and DFA have reinforced our confidence that physicians may organize and advocate effectively for the improvement of health care.
While support of experiential learning in advocacy is needed, there is more work to be done if evidence-based advocacy training is to become readily accessible to current and future physicians nationwide. All colleagues in advocacy education need to find a way to organize and compare our experiences to build a collective competency. Through this competency we can formalize a reproducible model that will help speed up the adoption and diffusion of physician advocacy training in America.
Daniel Croft, MD, MPH
Second-year resident in internal medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, and resident member, Doctors for America; email@example.com.
Stephen J. Jay, MD
Professor of medicine and public health and past founding chair, Department of Public Health, Indiana University School of Medicine, Indianapolis, Indiana.
Margaret M. Gaffney, MD
Clinical associate professor, Department of Medicine, and director, Introduction to Clinical Medicine course and Moral Reasoning and Ethical Judgment competency, Indiana University School of Medicine, Indianapolis, Indiana.