Patient-Centered Advocacy

By Atul Grover, MD

Originally posted May 30, 2013 in AAMC’s Second Opinion

It’s graduation season, and I had the privilege of giving a medical school commencement speech this month. New M.D.s head into their residency programs facing a changing health care system and an exploding population of patients, many of whom will be getting insurance coverage for the first time. The challenges new physicians face will be shaped significantly by lawmakers and the proposals they are putting forward to solve the nation’s fiscal crisis. All of these forces coming together make it imperative for tomorrow’s physicians to be active and engaged, not just on health care issues, but on behalf of the patients they serve.

Here are some messages I’ve shared with the Class of 2013:

I hope you’ll remember what brought you to medicine in the first place—the patients who, at their most vulnerable, let you care for them. It is a privilege of the degree and it should not be taken lightly.

For anyone who’s had to navigate the health care system, they know it can be a nightmare; but it is especially difficult for the sickest patients in our society. Physicians cannot merely wring their hands and blame a flawed system that someone else should correct. Patients need physicians to speak up for them, as well as for the medical profession.

I believe that we will come very close to attaining universal insurance coverage in the next decade, but it will be far from a smooth process. Our political system, like our health care system, leaves much to be desired—particularly for patients without a voice. But we are still better off than the rest of the world in many aspects. Democracy gives us a chance to weigh in, to be counted, and to shape the national dialogue and our country’s future.

This is particularly important as a new health care system takes shape in the coming years. I don’t believe that we will quickly abandon fee-for-service reimbursement, or that we will learn how to care for populations overnight. But these are laudable goals, and they should be influenced by clinicians who understand the consequences of public policy for patients.

One of the reasons our nation spends more on clinical care is because we have huge holes in our social safety net. When about one-third of African American, Hispanic, and Native American children in the U.S. do not graduate from high school, that is a health problem. When 1 in 5 American children live in poverty, that is a health problem. These social ills turn into physical illness by the time patients come to see a doctor. I hope that this generation of physicians will help shape all the policies which influence our nation’s health.

Physicians are greatly under-represented in the political process. They are less likely to vote in national elections when compared with similarly educated professionals; lawyers are more likely to vote than average, which may explain a lot.

Often, the messages we send as organized medicine reflect poorly on us as a profession, but more importantly, poorly reflect why we came to medicine in the first place. We spend a lot of time in Washington and in our statehouses talking about reimbursements for physician services. Today, you graduate after leading student-run clinics and attempting to improve access in your community and around the world. After you finish training and go into practice, I urge you to remember what led you to this day, and what is important to you. Policymakers need to hear from you, not only about fair payments for services, but about the change that needs to happen in today’s health care system so that patients have access to the care they need. You need to be leaders in your communities and leaders of our profession.

So new grads (and those not-so-new grads who are part of the faculty and staff here), I urge you to lend your own voice to a civic debate. Go to town halls of your local officials. Educate yourselves and your patients about what is or isn’t in “ObamaCare.” Have a discussion on the merits of the facts. And, if you choose to work through a professional organization, make sure you know just how they are speaking on your behalf. Help shape the agenda of that organization to reflect not only the professional challenges you face at that moment, but also the priorities and the passion that brought you to this auditorium on commencement day. Advocacy, too, can be “patient-centered.”

Congratulations, Class of 2013.

grover—Atul Grover, M.D., Ph.D., is Chief Public Policy Officer of the Association of American Medical Colleges.  Follow him @atulgrovermd.