In the picture is a 5000 pound granite ball which is constantly in motion. By placing your hand on it, you can move it in another direction. This is at the cancer survivors’ park in Dallas, and to me, it has always represented a problem that’s huge and movable.
Having seen patients for the last 25 years – first during medical school in Pondicherry, India, and subsequently in several academic medical centers in the US, it’s pretty frustrating to know that you can’t deliver on all the medical knowledge there is. To make matters worse, patients share with us intimate details of their lives with the hope, trust and expectation that somehow we will figure it all out and make them better.
I am now an infectious diseases physician working to prevent healthcare-associated infections in a large academic public safety-net health system. I wear multiple hats as many academic physicians do, with administration/ leadership being my largest responsibility. I also provide clinical care, teach trainees and conduct original research. Although I don’t aspire to be a quadruple threat, I like to pursue all these aspects of academic medicine as they are all professionally gratifying. Things were coming along for me until our health system (ergo my young career) was hit by a train as they say. We failed a critical regulatory survey by the Center for Medicare and Medicaid Services in 2011 and that marked my forays into public policy.
I probably spend 4-5 hours a month learning and advocating for public policy issues and I am now convinced that more academic physicians, particularly ID physicians, need to learn and inform public policy and economy. Here is my list of nine Why’s.
- We are smart and we have unique expertise and training.
- We have disproportionately high exposure to socioeconomic determinants of health. This is particularly true for those of us who serve in public academic safety-net health systems. As economists Kenneth Arrow and Apurva Sanghi say “Health and survival are basic to every individual. Health, unlike other valuable goods, cannot be supplied without deliberate social policy.” I had been complaining about having to earn research grants to conduct research until I heard from my friends in India that they frequently write grants to fund clinical care for some of their poor patients.
- We are currently redefining our ‘ID’entity. [Examples are recent studies showing that clinical outcomes are better when patients with Staphylococcus aureus bacteremia and solid organ transplantation are cared for by ID physicians, and recent publications outlining desired skills for healthcare epidemiologists and antimicrobial stewardship leaders.]
- Recruitment into ID is at an all-time low and declining. Our field will not advance without our advocacy.
- Our communities and lawmakers are (relatively) ignorant about infections.
- Academic medicine and medical education are poised for reform. There are too many practical realities around us that we can’t afford to turn away from.
- Adding advocacy (even if an hour a month) to patient care, teaching and research activities is emotionally satisfying.
- Adding advocacy increases the societal value of our work.
- We begin by informing, and eventually have an excellent chance of influencing and shaping public policy and economy, particularly if a critical number of us do so.
A key learning for me has been that the law makers and policy writers have good intentions and they may or may not have the right kind of expertise available to them. They do appreciate subject matter expertise and the ability to translate science into common practical terms while retaining accuracy is a good skill to cultivate. We academic ID people have more to offer than we think. Relationships facilitate success in public policy and advocacy.
Below is a suggested menu for advocacy and action.
- Pick a topic – e.g., Healthcare-associated infections, Antimicrobial Stewardship, HIV prevention
- Pick geographic scope – e.g., campus, city, state, national, country of choice
- Pick a specific policy issue – e.g., save a healthcare agency, better surveillance definitions, drug price control, antibiotic use in food
- Choose how much time you want to devote to this
- Educate yourself, educate others, talk to everyone about it, get on social media, become part of groups and associations that work on the policy issue of your choice
- Don’t forget to track progress!!
Some advocacy resources are the policy professionals and committees of professional societies like Infectious Diseases Society of America, Academy Health, Society for Healthcare Epidemiology of America, county and state medical associations, and the public policy and government relations professionals within health systems where we work. SHEA has a grassroots network and one can join by emailing firstname.lastname@example.org. Information on local representatives is available at http://www.house.gov/representatives/find/. So, next time you have a call from your professional organization to call your elected representative to advocate for a particular policy issue, do not ignore it. Your time spent is worth more than you think.