Health Care Policy

Physician Advocacy

You are needed now

Advocacy: the act or process of supporting a cause or proposal (Merriam Webster Unabridged Dictionary – accessed August 2022)

In health care: pleading or representation for a desired goal or interest group (Medical Dictionary, 2009) 

BY PETER DEHNEL, MD

That has obviously changed. Starting in the late 1990’s and continuing into the 2000’s, there was a concerted effort by a number of community organizations and public health groups, supported by a small cadre of local physicians and medical organizations, that began to campaign for the removal of smoking from indoor public places. While the bulk of the effort was carried out by these other groups, active physician involvement was essential to the success of this effort. As one Edina City Council member put it in 2003, “If secondhand smoke is such a big health issue, where are the physicians?”

Thankfully, the effort was successful, and the Minnesota Clean Indoor Air Act went into effect on October 1, 2007. Indoor public places and venues are no longer permeated by secondhand smoke, which most people find as an improved experience. It is certainly a healthier environment, especially for those with risk factors such as heart disease, COPD, asthma and a number of other underlying health conditions.

Considering this example, the following questions arise. What is physician advocacy and where is its place today? Where, as physicians, are we in this whole concept of advocacy; on behalf of our patients, our community and our profession? As with most complex topics, it will be helpful to break this down into specific components that are easier to “get your mind around.” There is certainly not a “one size fits all” answer to this very important topic. That said, the greater the number of physicians who get involved in advocacy efforts at some level, the greater the results will be in terms of better outcomes for our patients, our communities and our profession.

Physicians are in a unique position of influence.

Physicians are in a unique position of influence when it comes to health-related issues. This is certainly true with our patients when you are outlining a treatment plan of care or reviewing preventive health recommendations in a clinic or hospital setting. Physician opinions and testimony on health-related issues expressed in front of a city council or the state legislature also generally carry more weight than most other speakers. The usual challenge is getting physicians engaged, even on topics that they feel are important. Public advocacy is generally something that most physicians did not learn in medical school or residency, and it is easy to feel like a “fish out of water” the first time you appear before a city council or county commissioner meeting testifying about an important community initiative.

Opportunities for Advocacy

A key first step is deciding that advocacy is in your “wheelhouse” as a physician and recognizing that this is actually an important aspect of your career and current role. In many ways you have likely been doing this with your patients since the very start of your training. What follows are some examples of how you can break this down into different levels of involvement and opportunity.

Patient Advocacy

Advocating for important treatment and preventive health recommendations with your patients during clinic and hospital interactions is standard practice for physicians. Optimal diabetes control, blood pressure management, lipid reduction, colon cancer screening and immunization recommendations are important patient advocacy opportunities carried out several times a day within patient interactions. COVID continues to present a unique and unprecedented issue for advocacy efforts within clinic settings. Enlisting the entire clinic staff–from the front desk to the medical assistants to the nurses–in these efforts will be far more effective than just individual physician effort.

Advocating on behalf of your patients takes on different sets of efforts. Working to help get patients into specialists in an accelerated manner can be critical for the best outcome of that patient. Advocating on their behalf with insurance companies to receive “second tier” treatments or medications can be essential for them to receive the truly “best option” for their particular diagnosis. Advocating on their behalf for disability benefits or workers’ compensation may be the only way for them to receive needed benefits. Again, it will be more effective and efficient to create an office environment where this can happen without excessive physician time and effort. An office-based case manager, likely a nurse, is one way to be more effective and efficient in this area.

Finally, advocating for improvements that lead to a better community is something that will benefit your patients. Safe, walkable outdoor paths and play areas, accessible community centers with exercise facilities and local stores with healthy food options will all benefit the health trajectory of your patients and their families. This particular area does blend into the next topic.

Community and Public Health Advocacy

There are likely a large number of issues within your community (and Minnesota as a whole) that will benefit from your direct involvement as a physician. Reduction of secondhand smoke in public places was compelling, definable, actionable and received the support of a broad coalition of organizations. In many ways, it can serve as a template for how additional important health initiatives can be successfully addressed.

A suggested approach is to find a topic or issue that is pertinent to you in your practice setting and affects your patients directly. You need to have a certain amount of “passion” or energy about this topic to have the staying power to get to at least an interim level of success. Do a brief information search on what can be done to address that particular topic. Find others locally who are also engaged in this topic, which will ideally include health systems, medical societies and/or public health-related entities (MDH, American Cancer Society, American Heart association and so forth). Find out what opportunities may exist to support their efforts. Then simply show up and work to create a successful outcome. This could include testifying in front of a city council or a committee of the state legislature. Easy, right?

Expect resistance, sometimes from very unexpected sources.

The answer to this last question is an unequivocal “NO”. Even health issues and public health problems that seem simple and straightforward are anything but that. To take the secondhand smoke issue again, there was a lot of resistance on many fronts opposed to reducing smoking in public and work places. This included hospitals and health systems, where the patients, staff and employees did not want their ability to smoke within their care and work environment to be limited in any way.

Expect that progress will be slow, and that is why it is important to create interim goals that you can successfully accomplish to help keep you engaged in the issue. Also expect resistance, sometimes from very unexpected sources. There is a reason why the situation is what it is, and there are likely vested interests working hard to maintain the status quo. Finally, depending on the issue, you may be personally insulted if you are publicly advocating for a topic. Within the tobacco reduction work, this was especially true, and it would not be uncommon to hear comments like, “Wow, for a physician, she/he must not be very smart”. 

There are many important issues and topics that will benefit from increased physician engagement and involvement. These include a number of direct health-related issues: obesity reduction, diabetes prevention and prediabetes awareness, hypertension, dyslipidemia, heart disease reduction, opioid awareness and reduction, depression, suicide and mental health awareness, access to needed health care services and patient safety deficiencies. More recently added to this list are all of the health equity and social determinants of health opportunities.  

Professional Advocacy

Advocacy on behalf of physicians and this profession is extremely important, but like a number of other areas, uncommonly seen. It is important to emphasize that this is not stated from a self-serving position. The amount of time, effort, persistence and financial resources that go into training physicians develops a level of expertise in treating patients, developing medical policies, influencing systems of care and providing input on approval of protocols and treatment algorithms that cannot be duplicated or replaced by alternative resources, personnel or professionals.

Teaching Physician Advocacy

University of Minnesota medical students are learning about the importance of advocacy early on in their careers through the Twin Cities Medical Society’s Dr. Pete Dehnel Public Health Advocacy Fellowship. Fall 2022 marks the program’s fifth year of teaching physician advocacy to University of Minnesota medical students on both the Twin Cities and Duluth campuses. 

Twin Cities Medical Society founded the fellowship as an experiential program for medical students to get hands-on, real-world training in advocacy. The fellowship is organized around skills training, personalized physician-mentor pairings and hands-on advocacy activities. Through small cohorts, connecting with like-minded peers and interacting with local leaders, students engage in the process of public policy, systemic change, and turning passion for a specific issue into action.

The first group of cohorts in spring of 2018 included eleven student/mentor pairs. Since then, more than 115 student/mentor pairs have taken part in the program. During the application process, students are asked to identify an area of advocacy interest. Based on their interests, TCMS staff pair each accepted student with a physician-advocate to provide personalized mentorship. Areas of advocacy cover a range of issues including healthcare access, racial health inequities, environmental justice and reproductive health.



Physician-advocates can be practicing or retired and are not exclusive to the U of M Medical School or TCMS membership. Current medical students can apply each spring to join the next cohort. Mentors are asked to connect with their student once each month and between TCMS-led activities and meetings, students typically spend three to six hours per month on fellowship activities. Learn more at: metrodoctors.com/fellowship.