ChangeLike it or not, many things that determine our daily satisfaction with our work are determined by policy. QI measures, the implementation of EMRs, the availability of cigarettes, the funding of GME positions, the strength of drunk driving laws, the availability of mental health care: these are all legislative decisions, with an intimate relationship to our work. Yet, only half of the practicing physicians in the U.S. report that they are actively involved in policy change/advocacy.

What is advocacy?

According to one of the leading textbooks on policy change in public health, “An Introduction to Advocacy” by Ritu R. Sharma, advocacy is defined as:

  • Changing the policies, positions or programs of any type of institution.
  • Pleading for, defending, or recommending an idea before other people.
  • Speaking up, drawing a community’s attention to an important issue, and directing decision makers toward a solution.

Why we need to do this is because we know that we are the only ones who REALLY understand the life of patients and providers. If we don’t get involved in policy change, we’re ceding the landscape to the folks who don’t understand the real problems that our patients, and their healthcare team, face.

And the way that we can DO advocacy can take any of a 1,000 forms. We always think of advocacy as “meeting with legislators”. While this is important, it is not the sole way to become involved. It may mean becoming involved with committees on a hospital, city, or state level. It may mean writing op-eds. Or doing lectures. Or tweeting!

It may mean getting involved with a community group working on a topic you care about. Or even working on the design of the ED.  The goal is the end result– to improve the systemic factors that influence health and well-being.

Reasons I don’t get involved…. Debunked:

I don’t have enough time”

But you do. You must. You really don’t want someone else deciding on your antibiotic administration rules or the number of guns your patients can buy. You have enough time.

“I don’t know how”

But you advocate with your patients every day. You probably advocate with your department and hospital administrators. Just turn those one-on-one conversations into a bigger scale. If you’re interested in learning more definitive techniques, check out ACEP’S Leadership and Advocacy Conference.

“I don’t get any credit for it”

While this often depends on where you work, in my experience with a little advanced planning, you can turn your work into a publication, a lecture, a blog post (!), or some other form of “currency” for your group. If you’re really talented, maybe you can chair your local medical society or ACEP chapter!

“I already give money….”

This is great, and important.  But it’s not sufficient. Our voices need to be heard, too.

Interested in learning more? Check out the PDF handout from our talk at SAEM’s Annual Meeting last year, consider attending ACEP’s Leadership & Advocacy Course, or read Rita Sharmu’s guide.


Thoughts? Questions? Examples of ways that you’ve successfully created policy change?! 

Please share them with us!

Megan L. Ranney, MD MPH

Megan L. Ranney, MD MPH

ALiEM Featured Contributor
Assistant Professor of Emergency Medicine
Alpert Medical School, Brown University
Injury Prevention Center of Rhode Island Hospital
Megan L. Ranney, MD MPH

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