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When Policy Issues Become Stressors, Become an Advocate: Two Neurologists Share Their Way In

Article In Brief

Early on in their careers, two neurologists became involved in advocacy issues on behalf of neurology on a national, regional, and local level. And that, they said, has been one of the greatest antidotes to burnout.

For Donn D. Dexter, MD, FAAN, a neurologist and sleep medicine specialist at Mayo Clinic Health System, a weekend of advocacy training in 2012 turned out to be a new beginning for his career.

At the time, his practice was so busy, that taking time away to participate in the AAN's Palatucci Advocacy Leadership Forum, a training program for neurologists interested in learning skills—from action planning to media training and grassroots advocacy—was a tough decision. But he returned to the office with a whole new perspective.

“I came back from that much more interested in my practice and profession and my patients,” he said. “Being involved with the Academy, your medical society, or community advocacy efforts is a powerful way to transform your understanding of your role in society. It's a powerful antidote to burnout—I truly believe that.”

Dr. Dexter saw his own burnout symptoms melt away after he graduated from the AAN's Palatucci Advocacy Leadership Forum in 2012, inspiring his 2017 AAN Annual Meeting presentation on advocacy as a strategy for career satisfaction. Educating legislators and regulators who are in a position to help patients with neurologic conditions and the physicians who care for them is empowering, he told the audience.

Brad Klein, MD, MBA, FAAN, a partner in Abington Neurological Associates in Abington, PA, needed no convincing. An active advocate since his medical residency, Dr. Klein said taking action against burnout-inducing regulations, funding shortages, and injustices in modern medicine keeps them from getting the upper hand. He considers advocacy work to be a “release valve” from the pressures of everyday practice.

“We can vent and complain, but that doesn't change the situation that we're all in,” he said. “We need to take our frustration and channel it in a way that will be productive and can make a difference.”

When Congress approves funding for brain research or a state law gets tweaked in a way that helps patients maintain access to needed medications, advocates feel the satisfaction of making a positive difference in the world, he said.

“Yes, I love taking care of people at the bedside, but being able to help potentially hundreds of thousands of patients with a few specific moves is so rewarding,” Dr. Klein said. “I may never know many of the patients who were helped by my advocacy, but it has been significant for me.”

Advocacy in Action

Dr. Dexter points to significantly increased federal funding for brain research—through the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, the National Institutes of Health has invested more than $950 million to fund more than 500 projects since 2014—as an example of the rewards of advocacy.

“You can have such a big impact on your patients, although they may not know it,” he said. “I like to think that that hundreds of millions of dollars of research translates into saved lives down the road for my patients with complex neurological disease.”

Dr. Dexter has served on the AAN Governmental Relations Committee and he regularly participates in the annual Neurology on the Hill events. This year, 214 neurologists from 48 states gathered in Washington, DC, to meet face-to-face with lawmakers. They educated them about the need for more funding from the National Institutes of Health, the dangers of step therapy in certain situations, and how payment policy for evaluation-and-management codes can make it harder for neurologic patients to access care.

He is also active in local and state advocacy efforts. He helped start the Mayo Clinic Health System Wisconsin Government Relations Core Team and helped organize a health care forum in which more than 80 physicians, health care leaders, and local politicians met with two congressional leaders from Wisconsin, Ron Kind (Democrat) and Sean Duffy (Republican). He has participated in Wisconsin Medical Society's annual Doctors Day to meet legislators in Madison and the Wisconsin Hospital Association's Advocacy Day events at the state capital.

He has served as a board member and president of the Wisconsin Medical Society, as well as chief medical officer for the state society.

Indeed, he has dived so deeply into advocacy that the Palatucci forum named him Advocate of the Year in 2014. But Dr. Dexter believes, any level of commitment—for example, simply attending the meetings of a county medical society—is empowering.

“In general, this is a low-effort/high-yield opportunity,” he said. “You spend an hour or two at a dinner typically with passionate colleagues who are trying to make a positive change. If you fall in with a good group of men and women there, maybe you take on an office. There's a very low amount of hours required to do that work, but it makes a real impact in your community.”

Opportunities Abound

A state legislator inadvertently inspired Dr. Klein to make advocacy an important part of his career. The lawmaker thought he was educating Dr. Klein—then a neurology resident at Thomas Jefferson University Hospital—about the way the world works.

“He said the only way that health care is going to change is when people start dying,” Dr. Klein recalled. “That statement never left me—and I said to myself at that moment: ‘I can't let that be the way the system changes.’”

He graduated from the Palatucci forum as a neurology resident and, shortly thereafter, started the Pennsylvania Neurological Society to advocate on behalf of patients at the state level. When the Centers for Medicare & Medicaid Services slashed payment associated with electromyography codes, he joined the AAN's Medical Economics and Management (MEM) Committee, for which he now serves as chair. “Through MEM, I learned how we can successfully advocate to Medicare (staff) about issues that affect evaluation-and-management coding,” he said.

In 2007, a colleague started the Headache on the Hill event to educate Congress about the need for headache research, and Dr. Klein jumped on board. Nearly 150 neurologists and patient-advocates participate in the now-annual trek to Washington.

“We've been going to the Hill for over a decade and this advocacy has impacted NIH operations, including a significant increase in headache research dollars as well as specific funding for post-traumatic headaches,” he said.

Getting Started

How do busy neurologists find time for advocacy? By making it a priority for how they want to spend their time.

“There's no easy way around this—this work has to be done in addition to your normal work,” Dr. Dexter said. “But it's worthwhile.”

That said, some activities take almost no time. Reading an emailed “action alert” from the AAN or state medical society and following the recommended steps is advocacy, Dr. Klein pointed out.

“Click those few buttons to inform the legislators that you feel a certain way,” he said. “They tabulate how many people feel one way or another about an issue, and that can impact the decisions they make.”

Many activities, such as contacting legislators for meet-and-greets and attending local medical-society meetings, can be done on evenings and weekends. Others require a bigger a commitment that pays off over time, Dr. Klein said. Participating in Neurology on the Hill or a state legislative day, for example, can be the beginning of a relationship.

“Even if you meet with them only one day a year, legislators and their aides can get to know you by name,” he said. “The relationship builds, and your voice matters more every visit.

Tips to Become an Active Advocate

Dr. Dexter offer tips for neurologists who wish to become active in advocacy:

  • Find your right fit. Advocacy efforts differ based on the issues you want to work on, the amount of time you can allot, and the level of government you wish to engage with. Dr. Dexter encourages neurologists to apply for one of the AAN's leadership programs or to visit the experiential learning area at the annual meeting. “You can meet with the people that are doing advocacy, those that are working with BrainPAC (the AAN's political action committee) and other efforts,” he said. “There are many, many ways in to this work.”
  • Consider advocacy work as a career booster. “For people who want to advance in an academic department, this work looks great on your CV,” said Dr. Dexter, a former chair of Mayo Clinic Health System's neurology department in Eau Claire, WI. Some activities may qualify as continuing medical education credits.
  • Keep an eye on the big picture. Legislative and regulatory changes are, in many cases, hard-won after years of slow progress and setbacks. But experienced advocates never consider their efforts to be wasted. “Some people say, ‘Oh, it's thankless work,’ but it's not thankless at all,” Dr. Dexter said. “There's the benefit of having the camaraderie with your colleagues, there's the things that you learn and the things that you are doing for your community.”

Link Up for More Information

• Palatucci advocacy leadership. Accessed May 27, 2019.