Physician advocacy has progressed the field of medicine to improve health equity and outcomes across populations. Successful examples span throughout time—from the relentless activism of Dr. Dana Farber to advance research for pediatric oncologic treatments, to the courage displayed by Dr. Mona Hanna-Attisha in fighting for lead exposed families in Flint, Michigan. More recently pediatricians across the United States were integral in supporting extension of the Children’s Health Insurance Program, which protected health insurance coverage for 9 million children.
Amidst a myriad of health policy changes, physician advocacy is now more relevant than ever. With the shift from fee-for-service payments towards capitation with value-based measures, preventive care, care coordination, academic-community partnerships, and integration of health and social services have transitioned from lofty goals to the norm. For example, screening for social determinants of health in both the inpatient and outpatient settings is being widely implemented. Yet without institutional support for advocacy, physicians are faced with limited resources to address positive screens. How can a physician address mold as an environmental trigger for a child with asthma if mold is not considered a violation of public housing code? How can a physician address an elevated body mass index (BMI) in a patient with food insecurity if the family lives in a food desert? Paradigm shifts in healthcare payment and delivery present opportunities for physician advocacy efforts to run in parallel with institutional goals.
As a newcomer in the established arena of physician scholarship, advocacy is largely under-recognized in the academic setting. To date, advocacy has proven to be a square peg in the round hole of academia – a world traditionally defined by peer-reviewed presentations, publications, and grants. Many physician advocates have found success by promoting their work through such traditional mechanisms. However, scientific journals rarely make their way into mainstream media or practice, as the translation from journal article to actual clinical practice is an estimated 17 years. While these scholarly products undoubtedly hold value for academic institutions, advocacy can display academic value through a scholarly approach as well. To date there has not been a standardized format through which physician advocates can promote such products.
In the novel article “The Advocacy Portfolio: A Standardized Tool for Documenting Physician Advocacy”, we, along with our coauthors, address this issue by proposing the Advocacy Portfolio (AP). Similar to the evolution of the Educator Portfolio used to document a scholarly approach to medical education, the AP allows for documentation of a scholarly approach to advocacy. Whereas advocacy can be measured through Glassick’s six standards of quality scholarship (clear goals, adequate preparation, appropriate methods, significant results, effective presentation, and reflective critique), the AP format selected serves to maintain the uniqueness of advocacy and the specific skillset that it requires. The AP also addresses the main hurdle for traditional scholarship: advocacy is capable of disseminating findings, creating momentum, and rapidly catalyzing change for the betterment of patients and populations. Based on surveys of physician advocates conducted by Dobson et al., advocacy domains utilized in the AP include advocacy engagement, knowledge dissemination, community outreach, advocacy teaching and mentoring, and advocacy leadership and administration. Whereas the product of advocacy efforts can be broad within these domains, from op-eds to legislation, the AP proposes measurement criteria across domains similar to the EP, including quantity, quality, scholarly approach, and scholarly product. This format allows for careful consideration to maximize success of advocacy efforts while offering an outlet for physicians to document and measure their advocacy efforts for promotional value. In this manner, the AP serves as the backbone for physicians’ scholarly advocacy work.
The Advocacy Portfolio is intended to bridge the gap between academic institutions and physician advocacy. The authors hope that displaying a scholarly approach to advocacy will garner institutional support for current and future activities in terms of funding, time, and philosophy. Advocacy lies at the core of physician practice while enriching careers and enhancing patient and physician quality of life. Isn’t it about time that physician advocates have an academic voice as loud as their political voice?