All right, we'll get started, it's a little bit harder to find this room, so hopefully more people will come in shortly. So welcome, this is Advocacy 101, Getting Involved at the Local, State, and National Levels as PM&R Physicians. Just some housekeeping notes, welcome everyone, please silence your cell phones or put them off, this is being recorded, the audio is being recorded. Also you'll get an evaluation regarding this session, so please complete your evaluation, that helps us improve our sessions for future annual assemblies. And then many of you have already visited the PM&R Pavilion, but there's great resources there, so please take a look there as well. So onto our session. So there's going to be four of us speaking today. I'm Prakash J Balan, I am a Physician Scientist at the Shirley Ryan Ability Lab in Chicago and Faculty at Northwestern. I'm primarily here as the Chair of the Healthcare Policy and Legislation Committee of the AAPM&R. Next will be, it's not totally in order, but one of our other speakers is Dr. Amber Clark-Brown. She's Medical Director of the Bureau of Health Provider Standards at the Alabama Department of Public Health. Then we have Chris Stewart, who, he's the lucky one that we actually get a picture of him and his wife, but in front of the hill, in front of the Capitol. Chris is our Director of Advocacy and Government Affairs. He has a wealth of experience in this area and will be providing some insights. And then finally, Dr. Rich Chang. He's the outgoing Chair of the AAPM&R State Advocacy Committee as well. So this is our agenda today. I'll be moderating the session, though I have some slides at the beginning, then we'll have Dr. Chang to talk about state-related issues and being involved as an advocate at those levels. We'll have Dr. Amber Clark-Brown, who will be talking about empowering physician-led advocacy to advance health equity and remove barriers to care. Chris Stewart will be talking about engaging with legislators, particularly at the federal level. And then we'll have time for questions and a discussion as well. So the first question is, what is an advocate? And the definition of an advocate is to speak or write in support or defense of a person or cause. But health care advocacy actually takes it a step further. This is an action by a health care professional to promote the social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that they identify through their professional work and expertise. And I think all of us, through our clinical practices and many of the patients that we see, have potential opportunities to advocate for either our patients, our specialty, as well as our residents and other issues. So one question to ask yourself when you're trying to get involved as an advocate is, why is it important? Why do you want to be an advocate? And I would say these are some things that I've thought about over the years in different levels of advocacy is that it's allowed me to challenge myself, be on the front lines of change, make a difference for your patients, residents, the field as a whole, following my passions, understanding upcoming issues in the field. Because I'm in the position with our advocacy committee, we hear about threats to our specialty that are forthcoming. And we meet many diverse individuals from diverse backgrounds and interests, but we all have the common goal of furthering the field of PM&R. In terms of levels of engagement, there's different levels of engagement. You could have interpersonal advocacy, advocating at the organizational level, advocating at the health system level, and then advocating at the federal or health policy level. So the question you should ask yourself, if any of you are interested, particularly those of you who are residents or students interested in getting involved in health care advocacy is to ask yourself why. Why do I want to be involved as an advocate? And I think all of us come from different backgrounds, both in terms of racial, ethnic backgrounds, but also in terms of our training, the things that we've seen. And that's going to impact why you want to be an advocate. So my why is, so I'm a physician from England. This accent is not fake. Hopefully, I still got a British accent because I don't want to lose that. I sound way more intelligent when I've got a British accent as well, so that helps. But I did medical school in the UK. And I was initially an orthopedic resident in Oxford. And when I was doing my residency, I started to realize that I don't really want to be a surgeon. And I was not enjoying orthopedics. And so my residency director at Oxford basically allowed me to come to the US to do a PhD. I was planning to do it during my training anyway, and I loved research. And so he said, why don't you go and do a PhD? And I had a mentor at the University of Missouri. And at the University of Missouri, on my PhD committee was the chair of the PM&R program at the University of Missouri. His name is Greg Wershowitz, well known to our field. And he said, you should really think about PM&R as a field. And so I essentially decided that, OK, I'm going to do PM&R as a field. I did residency at Pittsburgh. And then I did fellowship at Northwestern. And then now currently, I'm a physician scientist, as I mentioned, at the Shirley Ryan Ability Lab. And I treat individuals with osteoarthritis. So then when I'm trying to think about what things am I potentially going to focus my advocacy efforts on, well, I'm an immigrant to this country. And I'm also an immigrant physician. I'm an international medical graduate. So those are areas that I am focused on and passionate about just in sort of my medical background. Secondly, and then because in England, PM&R is really not a field, and most people haven't heard about it. And we always say PM&R is the best kept secret. Well, it's not a secret anymore, as we see by the number of people applying to PM&R. But I really wanted to advocate for PM&R as a field and make sure that our field is respected but also has the resources it deserves. And then finally, I am a researcher in treating individuals with osteoarthritis. And that's one of the most leading causes of disability in the United States. So treating individuals with disabilities or advocating for individuals with disabilities has become a big passion of mine as well. So my background has really impacted my why. And so I'll ask all of you to think about that, particularly as you want to get involved in advocacy. Finding your why is also important in finding your passions. And as I mentioned, the field of PM&R, the rehab research, musculoskeletal care, those are the clinical interests I have. My patients, the residents and community that I work with locally in Chicago. And I'm also passionate about DEI-related issues as well. But the challenge for physicians is that we are not trained in being an advocate. So a survey from a few years ago actually showed that over 90% of physicians believe that healthcare advocacy is really important and it's a duty that we should have as a physician. But in our medical schools, less than 20% have actually received training in how to be an advocate. The other thing that we've also seen is that unfortunately, particularly when we think about electoral issues, that physicians actually vote less often than lawyers and the general public. And physician contributions and lobbying are more likely to relate to our financial interests rather than our patient interests. And there are studies that have actually borne that out. So why do this as a physician? Well, many of our national organizations, in particular the AAPM&R, has strongly encouraged physicians to be involved in advocacy. And the ACGME is now promoting advocacy as a milestone or something that you should be learning about in residency. And in certain specialties, particularly for example in pediatrics, in pediatrics you are actually evaluated on your end of year evaluations and how much advocacy you've been involved in in terms of your patient care. Many of our professional societies across the spectrum of rehabilitation are actually advocating for their members to be involved in healthcare advocacy as well. But one of the major issues that certainly our specialty could be at the forefront of or is at the forefront of is treating individuals with disabilities. And so advocating for those individuals certainly is important. Other issues that are also, many of you probably face in your residency programs, your medical schools or your GME offices is that medical school admission or even residency admissions kind of favor academics over service orientation such as advocacy. Medical training often sometimes can, we're sort of in our academic departments and sometimes can be a little bit isolated from the community that we're treated. And advocacy, if you say you're an advocate, it's a very ambiguous role that one could actually say. So that, and that's one of the challenges. And I think probably the biggest challenges that I see particularly with our trainees is the time constraints during residency. Residency is very short. So getting involved in advocacy is a big challenge. There's this perception that being involved in advocacy maybe isn't something that is as fruitful as being involved in say research or other activities that directly impact the program that you're at. And then there's no, for example, our institution, if I do advocacy related things, it doesn't impact my academic promotion. Maybe that should change and maybe that's something that we are, and that's certainly something we're talking about as a department, that academic promotion, this should be one of the metrics. How much advocacy have I been done? That should be something that I get extra points for as well. And then the last part is something that I hear from some of my colleagues. That's someone else's job. I'm not involved. That's fine. You don't need to be involved. But one thing that I talked about yesterday is that often there's very, very small asks that, for example, the AAPM may ask you to sort of sign up to a letter. Chris will talk about that down the line in our voter voice campaigns of a very simple ask that we may ask of you in the future that literally takes you five minutes to do to sign on to some of the advocacy stuff that the AAPMNR is doing. There's often arguments against advocacy as well. There's this thought that civic virtues are outside the professional realm. We shouldn't be involved in sort of politics. We shouldn't be involved. But if anyone tells you that politics is not involved in health care, then I don't know where they're living, particularly today. And there's this other part which I've heard, particularly in the media, which is the stay in our lane. And certainly issues like gun control, climate change, those are not things that we should be involved in. But those are issues that impact our patients to some extent. And so you can utilize your own patient experiences to use that when you go to advocate in certain areas as well. Advocacies to political. Politics should not exist in medicine. Very similar to what I said before. And there's no benefit. Yes, you're not going to get rich for being an advocate, unless you're advocating for more money in your bank account. That's great. But I don't think we're often doing that, particularly at the federal level when we visit the Hill. The other part that's really important to our specialty is this idea of burnout and physician burnout. And many of the things that your academy is working on is directly tied to physician burnout. For example, all of the prior authorization that you do, the Medicare reimbursement issues and the scope of practice issues, we know that those are really tied to much of the burnout that you're all feeling or potentially could feel when you are attendings in the future. And so much of the priorities that we are thinking about when we're developing advocacy things that we should be working on as an academy, we're sort of taking those into mind in what's impacting you. I think the key part is why to get involved is it's an opportunity to educate policymakers about the importance of our field and how we can be the solution, build support for our specialty, particularly when we do it at the federal level, and support for our patients. And then outside advocacy efforts by individuals and organizations is critical in getting any effort across the finish line. So we sort of, and I'll talk about this in a second, we sort of create coalitions with other organizations so we can all work together towards that same common goal. The other part that's sort of sad is that why should we be advocates? Well, I don't know, many of you may feel that your patients when they come to your clinic don't trust you. There's a lack of trust among physicians, but we still are quite highly respected. This was a survey study. I'm happy to say that car sales people are definitely very low on this, and we are better than car salesmen, that's very good, and we're better than lawyers as well. But we have some ways to go, there's still an element of distrust of physicians, particularly I would say from the pandemic onwards, unfortunately. And I think this is why it's important that we're front and center and go to these areas and advocate for our specialty and our patients. So how do you strategize your advocacy? Well, I would suggest, and I got asked this yesterday, particularly by students, is identify issues that you're seeing in your medical school or you're seeing in your residency or you're seeing with your patients, particularly if you're unattending. And these are some topics that potentially are really threats that we're facing. Health insurance coverage, access to healthcare for individuals, particularly individuals with disabilities, rehabilitation research, the rehab physician definition, that's something that certainly the academy was front and center in advocating for the last few years, and then GME funding as well. These are some of the things that we work on as an academy. So in our last Hill visits, we decided the things that we were actually going to focus on was based on surveys that we sent out to all of you. And these are the three most commonly, particularly the top two, sorry, were the two most commonly cited things that our membership was feeling was impacting them. And so this is fair Medicare reimbursement for physicians and prior authorization reform. And these are two issues that are certainly impacting many physicians, not just us, but our members really felt that those are things that we should focus on. And then the three-hour rule legislation, certainly happy to talk about that as well if we need to. And then the other part, we also have a future leaders program. They also went back and they advocated for those same things we advocated for them. It's no problem for these offices to hear the same thing again, but they also educated individuals on what is PM&R. I mentioned this yesterday, unfortunately, it's still something that we come up against in the federal level that people still may think you're a psychiatrist or a physical therapist. Sorry if you heard that joke yesterday as well. So where to begin? It's coming up with a strategy. And this is anything that you're advocating for in your medical school, in your residency, or in your work. And I would suggest you identify an issue of concern that you have for yourself. Gather information. So do like a literature review or background on that. Commit to action. We'll talk about that in a second. Collaborate with other stakeholders as well. You don't necessarily need to do this all on your own. Mobilize the resources that you need to be successful and sustain the effort. So I'm going to use an example that we've been doing at the Academy, which is prior authorization reform. So the Academy's done a lot of homework on this. We've created background data packages that we then provide to congressional offices. We've developed our view on this over the last few years and what we feel is helpful from listening to members such as yourselves as well. Collaborate with other stakeholders, such as the Regulatory Relief Coalition, others that are actually very interested in making, and other specialties as well, or the AMA, to make sure that we're working cohesively and talking about the same thing. And signing onto letters that other organizations are developing as well. Mobilizing resources, so working together for sure. And sustaining the effort. So it's not just one visit to the Hill. That's why the Academy has someone like Chris who's at the Hill. He's there continuing that advocacy effort and speaking for us as well. How to get involved? I think it's, and this is a key question for many of you, particularly the trainees. one thing to start at is just at the medical school level. It doesn't need to be at the federal level to be an advocate. You know, go to local committees in your medical school. The AMA is a great resource. They have a medical student council. There aren't many PM&R interested medical students, I believe, on those councils, but that would be great. There are DEI committees, National Medical Student Councils that you can also consider. At the resident level, particularly PM&R residencies, there are departmental committees, house staff associations. That's a great way to spread the word of PM&R within your wider GME offices as well. There's the FIT Council. They do a lot of advocacy. We've had FIT Council members come with us to DC to also do advocacy work as well. And then every national organization, others also have, for example, the AAP has the resident fellow council as well. And then the AMA again has a young physician section or a resident fellow section as well that you could get involved in. And then at the attending level, many of our organizations also have similar committees. So we have the HP&L committee, and I would certainly encourage any of you who are interested in being involved in healthcare advocacy to reach out to us, and we'll have the email at the end. There's the AAP, the public policy committee they have. There are subspecialty organizations that also have their own healthcare advocacy committees, the AMA, state and national organizations. And then obviously at the public level, there are issues, for example, you can apply to a local school board. My local school board does do some healthcare advocacy to an extent, and there are district offices you can apply to too. So with that, these are some of the experiences I've had in healthcare advocacy across the spectrum. And I think one of the most important things in my why is probably my kids. And I think about their future, and that's probably the biggest passion I have in advocacy. And I would say think about those whys when you're developing your passions in healthcare advocacy as well. All right. That's it. Thank you. Thanks, everyone, for joining. My name is Dr. Rich Chang. I'm a PMR sports and spine physician at Mount Sinai Medical Center in New York. I'm also the social program director. I'll be zoning in a little bit more on state advocacy and how I got involved in state advocacy. So a little bit about how I got into it in terms of what, in terms of the factors. Technically, actually, it started before med school, undergrad. For my eight-year program in New York through the SUNY University system, they asked us to do non-science majors, and I chose sociology. And kind of one of our anthropology professors, you know, pitched on a combined MD and master's public health program. And I kind of like that because in terms of making impact as physicians, we can make it on a one-to-one level. But I felt that having the public health degree would give me a greater understanding, appreciation of the healthcare system and its relevance and impact on how we deliver care to patients, you know, in terms of, you know, and other aspects like the business medicine and, you know, in terms of the different relationships between the different institutions. During med school, I was involved with, you know, not just the PMR Specialty Club, but also with our local state medical society. So a number of you, whether you're a trainee or even as an attending, generally are involved with your local medical state society. So I was involved with the local state society sort of med student interest. Again, I wasn't the most active in the beginning, but these were just the beginning sort of roots. Later on, I was also involved with our local state society, especially in New York Society PMR, and I felt that was a catalyst in being a proponent. I had fantastic mentors, Dr. Stern at Montefiore Medical Center in Chicobee, and Dr. Vanderwaal, who's a private practice physician. Both were very involved in the medical state society in New York, and it was powerful to see physiatrists at a leadership level, and, you know, and they were fantastic that they were teaching students these topics where, as Dr. Dallman mentioned, you really, well, in med school, we didn't really talk about this in the medical school curriculum, and really more in my public health degree, which was done within the first two years, I kind of had a greater appreciation of what could be done beyond what we can do on a one-to-one level with patients or with your own organization. As the years progressed, during residency level, I got to be involved with the sort of residency council and also the House of Delegates meeting, where they nominate a certain individual to usually an annual meeting, and then you can, you develop that sort of language regarding what's called resolutions, and then you can bring up also to the national level, and those resolutions can be used toward promoting issues relevant to your patients and to your discipline. And then also that brought me to APMR and also the more national organizations I'm involved with, with American Medical Society of Sports Medicine, International Pain, Interventional Society, or what used to be called SIS, and again, APMR has been a fantastic organization in terms of helping sort of flourish and mature these skills and knowledge and networking. So in terms of why, so why I advocate, part of it is I felt was a form of community service. So technically, as a physician, we understand that modern medicine, you devote your time, skill, monies to building a position, but I felt that as a community, it's a form of service, a duty, giving back to your community. In terms of impact, again, I felt that it would have a greater impact on the patients we serve and as our discipline, so again, there's so much you can do on a local level, but if you're involved even with, you know, just signing a grassroots sign and letter to a bill, but if you're involved with these committees, definitely I would say it has a greater impact in shaping policy, or it has ripple effects as well as, you know, on the other side in terms of guidelines, because it does impact how you practice and also how you get paid. And in terms of relationship between U.S. healthcare systems, the hospitals where you're trained and, you know, Congress, again, as a sociology major, I, you know, you can be with the poli-sci majors in undergrad and, you know, kind of get a greater appreciation of, you know, how, unfortunately, you have to interact with politicians in order to get the things moving in terms of the U.S. health and U.S. healthcare. So again, generally, you start your way up and to be involved, you know, start small and you gradually build up. Again, I know it's a time commitment, but if you let it, you know, it comes natural as a side hobby, so to speak. In terms of our state advocacy committee, we're a subcommittee of the Health Policy and Legislative Committee. We're a small but mighty committee. We do our best to represent, you know, the whole nation from the East Coast to West Coast. Again, a shout out to Dr. Bishop, who's in Texas, Dallas, and Dr. Fitzgerald, who's here in the audience, from Illinois, Chicago, Dr. Baker, who's pain management in Tennessee, and Dr. Cho, who's an outpatient physiatrist in Stanford. So again, we do our best to represent the different National Geographic locations as well as the practices. And again, you know, I appreciate my time as the state advocacy chair in the last four years, and we, again, the academy does its best to recruit all members. And if you have anyone that's interested, please let us know. And again, in terms of what our role is, we do our best to be proactive and identify legislative bills that will have a greater impact on the nation. So there is overlap between the local state level as well as the federal level. In terms of state advocacy goals and priorities, you know, again, we do our best to identify and try to be proactive. So one of the ways is local state members will identify a bill and bring it to our attention, and we'll review it to see if it's worthy of review by the large committee. I would say in most instances, we do review it, and we will make recommendations into the respective state. For example, if it's a bill concerning usually scope of practice is the number, usually the most popular topic. You know, given our broad and diverse field, you know, a number of other health care, affiliate health care professionals, you know, wish to overlap with what we do. For example, physical therapists, chiropractors, and more recently, naturopaths. So again, usually we make recommendations in terms of what can be done on the state level, whether it's interacting with the local medical state society, or if they have a state PMR specialty society, that we would also make a recommendation to them in terms of whether following bills that were passed in other states, or helping connect to certain congressional members as well. And usually we have key stakeholders and context for each state. Again, we're very aware that not all states have a PMR specialty society, and there are some coalitions, but again, we do our best to, you know, mobilize members. We try to, again, be as quickly as possible to respond to these. Again, a number of these bills sometimes are due to be reviewed by the local state, you know, congresses within a week, and again, we do our best to respond and review to members. Again, we're trying to create a larger coalition of stakeholders, you know, besides physicians, but also our patients, and with other organizations as well. And again, part of it is it also creates a larger network of contacts, and again, we're trying to also develop resources, and many of them are already on the academy, in terms of, you know, how do you review a bill in terms of its language, you know, how do you speak to a local congressional member, and how do you, you know, shop it around, so to speak. Again, basically, a lot of it is not done in isolation, but again, but we're always looking to try to make this bigger and better for future spying physiatrists like yourself. In terms of priority areas, somewhat, we sort of just alluded to this, again, this, a lot of it does overlap with the federal level. Scope of practice, again, there's a lot of other non-physicians groups that wish to do what we do, but again, we all play together, and again, we do our best to respond to these state bills in a collaborative fashion. Prioritization reform is also a big thing that comes up often, in terms of insurance, and you know, it does disrupt daily physician practice and flow. And then, before the COVID-19 pandemic, we were dealing with the opiate pain pandemic, and there's bills related to that, as well as some sports-related bills, like coverage and concussion. And again, we always wish to make sure that we protect our members with long-term disabilities who are vulnerable, as well as with chronic conditions. In terms of the things that have been accomplished in the last year, again, we've done our best to alert members in these various states, in New Hampshire, Missouri, Washington, Vermont, about specific relevant state legislatures, so again, generally, practically speaking, we would, you know, identify a bill, and then we'll notify the members of that state. And then, usually, again, the state society present for, if they have a PMAR special society organization, as well as the Medical State Society contact. I just wish to highlight two bills that were sort of, you know, pretty important. I mean, one of them was regarding scope of practice, actually, of orthodontists and prosthodontists. Again, we work with them on a daily basis, but in Missouri, with the House Bill 2115, early this year, one of the local orthodontists and prosthodontists wanted to create a bill, sort of what physical therapists and occupational therapists have with what's called direct access. They wanted to create a bill where, essentially, they can deliver O&P services without a physician oversight or prescription. Fortunately, that created a lot of mobilization, not just in the county, but also local state societies, and that bill didn't go through. And we did speak directly to the bill creator, and, essentially, there's further talks, but we're doing our best to optimize it. In Washington State, there was a big bill regarding naturopaths. Again, generally speaking, that specialty is sort of like an emerging, trying to be like physicians, where they use more holistic methods. But again, in the last, I would say, couple years, a decade, they're trying to incorporate more allopathic methods into their practice. So in Washington State, in this bill, this bill would have asked or incorporated ability to prescribe scheduled medications, like opiates, and that created a great response, not just on the state level, but on the federal level. And again, with feedback from members such as yourselves, especially in Washington State, we thank you for that response, and that was defeated. But again, as every year, these bills do pop up, and I would say on a monthly basis. In terms of what we also do, again, besides identifying and trying to be proactive in terms of looking at bills, reviewing them, we try to mobilize members with trying to have their local state society, PMR Specialty Society, in terms of creating their organization. Again, I'm lucky I'm coming from New York State, which is a large state, and we have bylaws, and we've been doing this for over a century now. But I would say, in other states, you may not have the same level of organization, but you can start off small with only two members. And again, we do have resources to help you create bylaws or some kind of plan if you want to create your local PMR State Specialty Society. And again, a number of these states, in Carolina, Nebraska, Arizona, and West Virginia, we either revamped or they resurrected their state specialty society. In terms, I just want to briefly touch upon this in the Medicare Contract Advisory Committee. So usually, the state PMR Specialty Society or medical state society will identify a member as a CAC member, essentially CACs or regions where Medicare gives the companies, you know, where they represent certain geographic areas for Medicare services, you know, for medication served in, you know, durable medical equipment, for example. So I'm coming from New York. It's, I think, Region K, and that, of course, is the local sort of geographic area. Again, here, this is important because then members can actually listen in to these meetings, and they do discuss policy regarding clinical guidelines and what can be approved and delivered to your region. And again, it does have national implications as well. So it's generally, you know, they have it a couple, a few months, but again, if it's a topic relevant to you, for example, if you do interventional spine, there is one reason for a facet joint procedures. And you can listen to that and then give your feedback, and again, you're essentially important in terms of the process for creating, shaping these guidelines. Again, with sort of the theme is, again, we understand your time is very precious and valuable, but again, if you just volunteer even a little bit of your time, just signing one of those grassroots bills or, again, if you have extra bandwidth to volunteer on one of our committees, it's a fantastic experience. And with that, I'm going to turn it to Dr. Clark-Brown. All right, good afternoon, everyone. We are so excited to have you here. I am Dr. Amber Clark-Brown. I am one of you. I am a physiatrist, believe it or not, but I have transitioned into the world of public health. I started in academics, you know, after I graduated from residency in 2020, I stayed on as an assistant professor, and I matriculated from there in December 2022, and I've been working for the Alabama Department of Public Health since February of 23. As you can imagine, and as you know, it is a time, you know, for medicine and science since after COVID, and just as my colleague said before, it's so important to really get a broad sense of healthcare. I will talk a little bit more about how you can do that, and you're going to see some broad stroke overlaps, but all this to say for, you know, everyone in the room, if the bug hits you and you want to pivot, you can do it, and there are so many opportunities for you to do it simply by having an MD or a DO behind your name, literally opens doors. So what is advocacy? We've already seen and talked about these definitions. Advocacy is public support for an idea, plan, or way of doing something, and is any action that speaks in favor of, recommends, argues for a cause, supports or defends, or pleads on behalf of others. So at several points in our lives, we have advocated, if for no one else, at least ourselves. I'm going to prove it to you. Remember in high school, that party that you wanted to go to, and you had to ask your parents, but you knew that you were going to have to plead your case. Because if you didn't go to this party, it was going to be detrimental to your social life. Right? If you didn't go to this party, the ramifications of everything that would happen, you know, you're going to miss what happened, everybody was going to come to school talking about what happened, that you weren't going to be in the know, and then you're going to be, you know, the outsider, advocacy. And I'm just using that as a funny example, but that's really literally what it is. If you are pleading the case on behalf of whatever you're advocating for, whether that's the party, or that that is your patient, whether it's for a policy, you're advocating. But I must say, this is not something that is cookie cutter. There's so many ways, as my predecessors on the panel here have talked about how you can advocate. It looks different for everyone. We all have different personalities. We all have different strengths. This is not necessarily to say that you have to go up to the heel and, you know, be banging on the doors of your, you know, your senators and your representatives. It's not to say that. You've heard several times already. It can be as simple as signing a letter and sending it on. It can be as simple as showing up and being the only physiatrist or physiatrist in training in the room, as I found myself being in several situations, which is why I am in the position that I am here today. It doesn't have to be as hard, I think, as sometimes we make it, or as scary as we make it sometimes, because believe it or not, you are already experts, just by your lived experiences, just by making it through medical school, making it through residency, having a practice, taking care of patients. It's not like everyone gets to do this. You know the stories that you've heard. You know the stories that you've lived and that you're living. You know what's going on in your spheres of influence. And so, it's being the voice in the room, bringing this to the forefront. How many of us in here are trainees? Ooh. Y'all, what a time to be alive and training, right? What a time, seriously. And this is a perfect time to really be thinking about how you're going to weave advocacy into your practice. It's never too late for those of us who didn't, you know, raise our hands. It's never too late to start, but it is essential. Long gone are the days that physicians get to solely just practice medicine. Long gone are the days that we can be isolated from what's going on in the political sphere and think that we are immune to what happens. This was long before this election took place. This has been going on for years and years and years. It affects the ability for the amount of what residency spots we have. Huh? It's important. If you don't remember anything else that I say today, just remember this, your voice counts. I've already alluded to it that you are an expert already. If you do the statistics, again, there are very few people that make it to where you are today. Everyone doesn't get into medical school. Everyone doesn't finish medical school. Everyone doesn't get into residency, nor do they finish residency. And the pandemic took a lot of us out. And I'm not saying, you know, yes, we did lose some people to death, but healthcare took a huge hit, a massive hit, one that we have not yet recovered from. Healthcare in all sectors, that's in hospitals, that's in nursing homes, that's in public health, we are all down. However, those of us that are still here, again, what a time to be alive because there's so much opportunity. You know, we've learned, I hope we learned, I pray we've learned, you know, a lesson from the pandemic on preparedness. We still have a ways to go, but we've learned some things. But your voice counts. This is a picture of me at the AMA in 2017. I just happened to get here because I had attended an event my intern year, a woman from the Alabama Medical Association, or the Medical Association for the State of Alabama came to speak to our intern class. You know, when I was in medical school, they would talk, I went to medical school in Rhode Island, and there were several of my classmates that were very involved in the Rhode Island Medical Society. I didn't know what it was, I just know that they were doing stuff. But somehow, some way, like this bug really bit me during my intern year. The lady remembered me, the resident delegate that was supposed to go and the alternate delegate were not able to go. So she asked me if I would be able to go. I was so blessed because the residency director let me go. And when I tell you, this was life changing. This really altered the trajectory of my professional career. And so it's from here that I became the resident representative for the State of Alabama for the Medical Society. It was from here that I became the young physician section representative for the Alabama Medical Society. It was from here, because I was so involved at NASA, that I met the state health officer who I just happened to have his cell phone, and I was sitting at my desk one day, wanting to make a shift in my career, I texted him, hey, you know, do y'all need any physicians at the Department of Public Health? Come on over. And I've had such a privileged position to be able to affect the health of the State of Alabama. So where to start? We've already talked about this a little bit before, somewhere. The answer is somewhere, okay? So just by virtue of being here, just by virtue of being a part of AAPMNR, this is a start. By coming to this Advocacy 101 talk, this is a start. You can get involved in the AAP, get involved in your professional organizations. Prakash is so, so right regarding the medical student section, the AMA, there are local chapters that you can get involved with if you're a medical student. Also the resident fellow section is also very active in the AMA. And of course, your local medical society, state medical society. So I want to spend a little time, I was about to say a lot of time, I hope it's not a lot of time, but a little time, and I've titled this AAPMNR Wins in Alabama. Just by virtue of showing up, being in the right place at the right time, you can affect change on a scale that you can't even imagine. Again, I'm a physiatrist. My specialty is physical medicine and rehabilitation. And by virtue of being a medical director at the Department of Public Health, I get to go all across the state, all across the nation, not only representing public health, but also physiatry. There are not a lot of us in public health. I'm the first physiatrist to be a medical director in the state of Alabama. Along, and I'm still pretty new, you know, I'm a toddler in public health. Along the journey, I've met one other physiatrist that is in, I would say public health or government, and she works for CMS. So needless to say, when I come across people and I tell them I'm a physiatrist, I still get the look. I still not have to explain what we do, but when I tell them, it makes sense. So I oversee three different bureaus at the department. The main one is health provider standards, and we are similar to, everyone's heard of JCO, right? Right, right, right. So we're the JCO of the state. We regulate and we certify healthcare facilities that receive CMS funding. We survey non-deemed hospitals. Skilled nursing facilities are a huge part of who we survey, dialysis centers, et cetera. So being a physiatrist, and particularly when we're talking about also home health, hospices, bringing the larger context of what we do in physiatry to this level is something that really truly kind of intersects and overlaps with what we do. So as a part of my role here, I've been able to really explain to people the difference between rehabilitation and habilitation. It was a whole thing, guys. It was, I don't want to say like kind of heads were spinning, but people really were having a hard time understanding the difference, because it is confusing, right? If you are, quote, an outsider, you see someone having PT, OT, and speech, and you're calling that habilitation, but then someone's also having PT, OT, and speech, and you're calling that rehabilitation. So bringing that clarity, and this is actually going, this was part of state regulations, and so as a part of this, being a physiatrist and being in this role, I'm affecting the regulations of the state that businesses, that healthcare facilities, that healthcare providers are able to operate and are supposed to, and we enforce how they operate. Another thing, PM&R education is SNF owners. I know everyone in this room understands the value that we bring to skilled nursing facilities. Residents and medical students, if you have not had the opportunity to rotate in a skilled nursing facility, I suggest that you do that. There is such a huge gap that PM&R physicians fill. There's a huge gap that is needed to be filled by us, but it is not the case. And so do you know the amount of skilled nursing facility owners that have never heard of PM&R? Like, I was in a meeting with one of the largest owners in the state, and I was like, hey, you know, you all should think about PM&R when you're thinking about medical directors and attendings, and I just, again, got this blank stare. They're like, you know, is that something that our APPs can learn? No. You need a physiatrist. Training on medications, I gave unnecessary medication training to our staff. You know, these are medications that we use. A lot of medications we use to treat our patients can be very sedating. Some of the patients in nursing facilities do need these, but our staff are the ones that are surveying and making sure that the residents are receiving these medications appropriately. So I was able to wield my expertise in this to help them understand what they should be looking for. As far as Alabama medical directors, I serve as a liaison between them and the state, really speaking the language of a physician, as well as breaking down what we're looking for as far as CMS regulations as well as the state regulations. Also serving IDR is independent review expert panelists. Again, if you have not had the opportunity to rotate in a skilled nursing facility, you should. There are some great things that happen. There are some not-so-great things that happen, and being able to bring the expertise of being a physiatrist forward has been really, really rewarding. I was able to advocate on behalf of a patient that unfortunately was deceased because there were certain things that were not done. This patient fell from a hoarder lift, ended up having cervical fractures, thoracic fractures. She actually had had a compression fracture that wasn't even found when she was initially admitted to the SNF. So having, you know, this expertise is really, really important, and in this way we're still advocating for patients. The last thing I'll touch on right here is being appointed to the governor's task force on dementia. So knowing that, and this is not just for dementia, but really all brain injury, there are several experts that are a part of this task force, but knowing the broad knowledge that we have as physiatrists in treating brain injuries of all types is something that is really welcomed on this task force, which is why, you know, I'm representing PM&R in Alabama on a state task force. Home and community service. Has anyone ever heard of NCHPAD? Oh my gosh. Only one hand in the room? Y'all need to look this up. This is a great resource, not just for us, but for patients. They're focused on improving physical mobility, physical health for people with disabilities. They have where they can work with remote coaches, so please look up NCHPAD. So we have partnered. We're one of the last remaining states that offer home health to patients. We serve over 90% of Medicaid patients. So we've been able to partner with them through a grant to bring exercise equipment to the patients that need it the most and get them to exercise because we know our patients with disabilities have higher unfortunate health outcomes. Please look them up, NCHPAD. Glad to educate y'all. Okay. Moving on. Lastly, the Office of Health Equity and Minority Health, another bureau I oversee. I have the opportunity. I'm talking too long, y'all. I'm coming. I have the opportunity to speak at a session and really to have a session at the Alabama Disability Conference. I talked to, it was geared towards healthcare professionals on how to interact with patients that identify as having a disability, i.e. don't be weird. You talk to patients that have disabilities like you talk to anyone else. I also was served as a panelist on the Alabama Department of Rehab Services. They had a conference. And lastly, the Learned Conference is on health equity. And my purpose in life, anytime I am invited to these things, is to really bring up and continuously bring up disability because I'm sure you guys can appreciate with the language of health equity, most people's minds go to it's a race thing. It's not. It's not just race. While race is a factor, there's so many other components when we're talking about health equity. And I just want to make sure that people with disabilities and those of us who take care of them are represented at the table and don't go unheard. There are tides of change. This is becoming, you know, my predecessors have talked about this. Medical schools, residency programs are starting to get it. This is no longer, again, something that we have the luxury of ignoring. Advocacy, policy, it affects the way that we're able to practice medicine. And we definitely have to have a voice. We need to use our voice and be at that table. So take home points. Your voice counts, period. Don't let anyone tell you that it doesn't. You are our resident experts. Build relationships. When you're at places like this, any time I go to a conference, I have three goals. Meet somebody I don't know. Do something that I wouldn't otherwise do. Now, look, I'm not talking about outside of my character. Do something new. And learn one thing. One new thing. So if you can do that and all of these networking opportunities, please take advantage of it. Again, you're already an expert, even if you believe that you aren't. Start somewhere but not everywhere, okay? Pick one thing. Get good at that really one thing, and you're going to move on. And as you continue in your advocacy journey, you're going to be able to interweave things. Just start one place. Remember, advocacy does not always mean going to the White House. But if you can go, do. Please do. Please do. And lastly, you don't have to do it all. Just do something. Thank you for your attention. Thank you. Come on down, Chris. Awesome. I love looking at big pictures of myself up on the screen like that. All right. Well, my name is Chris Stewart. I am the Director of Advocacy and Government Affairs for the Academy. I am based out of Washington, D.C., where I work for y'all in federal advocacy for the most part. I'm going to briefly touch on my why. I think at the most basic level, I am employed by you guys. You pay for me to represent your interest in Washington, D.C. Building on that, my background is that I was a health policy staffer for Congress for eight years. I worked for other health care provider membership associations for six and a half years after that before joining the Academy. I think the biggest part of the why there is that I really enjoy working for health care providers. You all are very easy to work for. You're asking for things that are going to make the health care system better. It's really enriching and fulfilling work. I am going to jump to the next slide here. Why should physicians advocate? I'm coming at this from my current role where I'm working for you, but also from my background as a congressional staffer where I was on the other side of meetings with advocates. Basically, it is an opportunity to educate policymakers. You are the expert, as many of our speakers have already pointed out. You have knowledge that policymakers need, and they desperately want to hear from you. Also, outside advocacy by individuals and organizations. As Prakash pointed out earlier, that is absolutely essential to making progress on advocacy initiatives. It's hard to get things accomplished in Washington, D.C. without a large coalition of stakeholders across different areas working together. Continuing with the why you all should advocate, legislators, when you meet with them, they pay special attention to voices that are coming from their state or district. You are their constituents. You are their boss. They want to hear from you. They want to understand what will make you happy, how they can take positions that will make you feel more favorable towards them. At the end of the day, if you're talking with somebody that you reside in their district, you are a voting member of their district, they want your vote, and they want to do things that will make you more likely to vote for them. They value your opinions. The second part is, if not you, then who? If you are not in there making those requests to policymakers, no one else is going to be doing it. There are issues where the academy works with a large coalition of, say, other physician specialty societies, you know, where we are working in concert with other groups. Those are things that maybe, you know, that advocacy is happening without us, but there are definitely a lot of issues where PM&R, if we are not making those arguments to policymakers, those arguments are not happening. And then finally, if you're not at the table, then you're on the menu. So if you're not at the table, then you're on the menu. So if you're not in the room when discussions are being had about health policy in the direction where, say, Congress or CMS or other policymakers are looking to go for health care policy, your perspective is not going to be included in those deliberations, and often that will be to your detriment. So I'm going to jump to some low-hanging fruit for you all in terms of how you can get engaged with advocacy directly through the academy. We have grassroots advocacy that is pretty simple for you all to do. It's a voter voice platform where we give you the opportunity to contact your members of Congress and basically weigh in on issues that the academy has, you know, endorsed legislation or possibly, you know, there's legislation that we want Congress to look at not moving forward on. So it is something that takes less than five minutes out of your time to go. It's on the academy website. You go there, you enter in your information, and we have campaigns for you all to, you know, just generate a very quick email that you can send to a member of Congress asking for their support on an issue. So in this current Congress, this year and last year, academy members have sent nearly 3,000 messages to members of Congress, which, as a former congressional staffer, I can tell you those messages absolutely do get read. Members of Congress care about that. They want to hear what their constituents are saying. So if somebody is reading those messages, they are reporting that up the chain of command to their boss, and then decisions are being made based on that input. So we can reach the VoterVoice grassroots advocacy platform through the academy website. So if you are on the website, click on that advocacy tab. It'll take you to the Member Action Center where you get to the VoterVoice platform. So if you look here, that is what it looks like on your computer or on your phone. You also have the option to sign up for alerts where we will be more directly reaching out to you for future advocacy campaigns. You also have probably received emails from Prakash on the VoterVoice campaigns that the academy runs. So we send those messages out to all of our members. If you see an email from the academy, I would ask that you read that, and if it's asking for you to take part in a VoterVoice grassroots advocacy campaign, please click that link and take part in it. All right. For some fruit that isn't quite as low-hanging as clicking a couple links on your phone or on your computer, we'll talk a little bit about meeting with health care policymakers. So directly engaging with your elected representatives, either in person or virtually, and obviously with the last four and a half years, we're all familiar with Zoom, Skype, whatever platform you use. Virtual meetings are more and more an option with congressional offices. Those have a significant impact on health policy. It's a great way to get in and meet with either a member of Congress or with the staff who works on health care policy issues. So we are available, AAPM&R is available to provide resources for that. We can help link you up with your member of Congress. We can provide training. We can provide the logistics for the meeting. Whatever you need, we are able to provide that. So please speak with me after this or email healthpolicy at AAPM&R.org with any questions. I'll walk you through a little bit about what those meetings might entail and what those offices are looking for. So basically, they're looking for what actions do my constituents want me to take? They're looking for why would my constituents want me to do that? What are the impacts that this action would have on my community? And what kind of personal stories, what anecdotes are you able to bring to this? So they're looking for that information to see how a position would have an impact on their community and, again, on their constituents who they do want them to vote for them. So they're looking for that support. What you bring to the table as a physiatrist for those meetings, it's your story. It's your why. So the speakers who were already up here before, they spoke about their why. That's very powerful when you're walking into a congressional meeting. You want to be able to, you know, anchor your request to, you know, why you are doing this, why it's important and impactful for your community. So it provides an instant connection. It's an emotional impact as well. Obviously data is great, but if you can have an emotional hook, that helps a lot as well. It also makes the issues local and relevant, which is very important for these congressional offices. And if you give a member of Congress a reason to become your champion, that helps differentiate your meeting from all the other meetings that they're having throughout the day. I can tell you that congressional staffers and members of Congress, they have packed calendars. They meet with maybe dozens of people every day. If you can give them something that is unique, memorable, that will make that meeting stick out and hopefully be more impactful moving forward. For the logistics, in-person meetings with legislators and staff, you can do those at home or in district. Members of Congress are frequently not in Washington, D.C. They are working in their home district or state. They will meet with people at their district office. They will travel to healthcare facilities, you know, to learn more about that facility to meet with y'all. So if that's something that you're interested in setting up, the academy can help with that. We also have, obviously, the traditional most popular version of this in, I guess, the media would be a meeting in Washington, D.C. Going to Capitol Hill and meeting with staff or legislators. That's something that the academy engages in and Prakash spoke to that earlier in the presentation. If you're ever out in Washington, D.C. and you think maybe you'd like to meet with your representatives, please give me a call and I would love to make that happen for y'all. You also have virtual meetings, as I mentioned earlier. So that's a great way to, it's easier to set those meetings up. You're more likely to be able to do that. So if you would like to go that route, we can help you with that as well. Finally, the correspondence, the voter voice campaigns that I spoke about earlier, you're also able to do that on your own. Every single member of Congress has a contact me option on their website so you can reach out through that with your own story if that's what you would like to do. So if you actually do get a meeting set up, here's a basic blueprint for a successful meeting. When you walk in, you introduce yourself and the PM&R specialty. As was alluded to a little bit earlier in the presentation, frequently people do not fully understand what PM&R is. This is your opportunity to explain the specialty and the importance of PM&R to your patients and the community that you practice in. You introduce the issue in a very simple, you know, brief way so you can make sure that they understand what you're there to ask about. You make that issue local, relevant, and personal. This is impacting constituents in your community. This is why people in your community care about this. You make a clear ask after you've laid out that issue. I want you to take this specific action, whether it's co-sponsoring legislation, whether it's not co-sponsoring legislation, or whether it's coming out to visit your facility to learn more about PM&R. You have to make the ask. Frequently, I can tell you from my experience, I've been on the other side of meetings where people will come in and tell me all about an issue, but they would not actually make a concrete ask for, this is what I think your boss should do. And if you don't make the ask, it's really hard for that office to be able to do what we're hoping, you know, what we would like them to do. And finally, wrap it up. Congressional staff and members of Congress, very busy calendars. Once you have had the meeting, once you've laid out the issue, you've made your ask, at that point, just make sure that, you know, you're not lingering and taking too long with that meeting. All right, and I'm going to end with, what's the worst that could happen for any of these meetings? If you're looking at that list right there, truly, the worst is not that bad. You're asked a question that you will not be able to answer in the moment. It's not a problem. You can just say, you know, I don't have an answer for you, but I can get back to you as soon as possible with that information. AAPM&R can be a resource for this, and it's an opportunity for further engagement. You know, you have the meeting, but then you follow up with them via email. You can be asked about what the other side's view of the issue that we're talking about is, particularly on scope of practice issues. Not a problem. The staffer is going to find that out anyway. It's better if you are an honest broker with them and tell, if we do have somebody on the other side of an issue that we're talking about, it's good for you to just give that perspective and make sure that they have that information. They will appreciate the honesty, and they definitely won't appreciate it if you try to hide that from them, because they will find out. Finally, they say no. That happens all the time. Frequently, you'll go in and meet with a member of Congress or their staff, ask them to co-sponsor legislation, and they won't do it. It's frustrating, and you're not always given a reason why for it, but that's not the end of the dialogue. Just because there are no on that particular issue or that particular day doesn't mean that they're not someone that you can work with going forward. And with that, I am done, so I'm going to hand this back over to Prakash. All right. Thank you so much. We have time, plenty of time for questions. I'm going to ask Dr. Clark Brown a question right now. So when are you running for office? You have my vote already. Seriously, though, I've been asked that question now three times in three weeks. So one day? We need a physiatrist in Congress. So that's what we're looking for. Thank you, Prakash. Yes, absolutely. Absolutely. Yes, please. Hello. Thank you so much for the talk. Really appreciate it. My name is John Mullins. I'm an assistant professor at University of California, Davis. And this topic, much has been about health care policy. And I think it was alluded to in one of the talks, we're in a transition of power in the White House. So I might be the elephant in the room, no pun intended, given this is a Republican Party. But I'm curious what your thoughts are in terms of what changes you can foresee, especially with health care being a key topic with Kennedy and Trump, and maybe what role as physiatrists we can do to continue to advocate for our patients and our clinics. Thank you. Thank you. Go ahead. I'll take that. Yeah. All right. That's a great question. Thank you for asking that. Love microphones. Sorry, y'all. Is this working? No. All right. Perfect. Sorry about that. Yeah. It's a very interesting time. I guess that's the easiest way to put that. At this point, the elections are still being settled out. We know what has happened with the presidency. We know what has happened with the Senate. We're still waiting to see what's going to happen with the House. So we have some ideas for what might be coming down the pipeline. But at this point, we're not fully ready to – we're not entirely sure of what's coming. And health care was not the issue – was not the dominant issue of this election. So there's still not a lot of clarity in terms of where the incoming administration is going to be for for a lot of the issues that are important to PM&R. I will say I would expect that there are opportunities and challenges coming down the line. I don't know if they'll be equal, but yeah, it'll be interesting and the Academy will be continuing to engage on this. Dr. Mullins, thanks for the question. I think we met as a committee today to discuss this specifically in our advocacy priorities and I think a lot of it's going to, as Chris was alluding to, is going to we're just going to have to wait and see and what are the threats. I think one thing that's clear that we as an organization, as a set of PM&R physicians, is that we're very clear that we need to be the specialty that advocates for individuals with disabilities and that's a clear sort of just general philosophy and priority that we will do. And as we've also alluded to, even if some of the things that are introduced we may not agree with, we want to make sure that we still have to advocate to those individuals that may not necessarily agree with our viewpoints always, with individuals with disabilities, and be a resource for them. So they're going to reach out to us if something comes up regarding individuals with disabilities in particular. Thank you for the question. Hi, I'm Therese. I'm a medical student applying into physiatry. I have a question on how you guys navigate the commentary that like physicians should not be political. Go ahead, Dr. Clark-Brown. If you're in academics, you're already in politics, number one, okay? You know, did you talk about this in your talk? It is buffoonery, again, at this particular point, to really stay beholden to the fact or the idea that we have the privilege of being insulated. In fact, it is really a duty now because if we don't speak, who will? And I can tell you, they can tell you, the people that are making these laws, the people that are creating policy, really don't know. And so, being in such a privileged position that you are, that we all are, to not speak on behalf of our specialty, to not speak on behalf of the patients that we serve, is a huge disservice. So I would tell people, and I'm not gonna say what I want to say, but this is my lane, right? Because my job is to advocate on behalf of my specialty, my patients, America, whatever you want to say. I would also point out, too, that I'm not really aware of many groups that are not political or are not engaged in advocacy. So you would be doing yourself a disservice if you want to be engaged and you let that stop you. The other thing I would just add is that we're physicians, we're scientists as well, so we're evidence-based. And so, if there's evidence to support our view, I would encourage you to, when you're in these situations and you're advocating, we cite those, that evidence. And that cannot be argued with. It's not a political decision. Science is not political. It is maybe made political by certain individuals, but if there's scientific studies that have shown a certain thing and we use citing that evidence, that is not a political decision. That is us being objective. So I mean, you look at it that way as well, and then you won't feel that it's as adversarial as it could be. Yeah, I mean, pretty much every speaker hit the nail on the head. I know as a student, you know, you want to make sure you succeed in your rotations, you don't want to upset any viewpoints, but unfortunately when you're in health policy and advocacy, you'll run into these situations. So again, as Dr. Prakash mentioned, if you have the evidence, for example, a lot of these issues, again, it technically crosses party lines, like prior authorization affects how you do carry your work, it disrupts your daily routine, it delays how you deliver care, and if you cite resources and studies, they would understand. I mean, I guess the differences will come if, for example, you meet with certain congressional offices, whether or not it gets funded or the cost. So different parties will see a bigger cost, but again, there's objective measures to that as well. So when you see in media, you know, stay in your lane, for example, like in gun violence, and again, you can say one part, one group says the other, but again for physiatry, it has impact on patients with consequences, with disability, their DME, you know, pain. It crosses so many paths. So you definitely have ways to make it more relevant without, I guess, going to one party per se, but again, again, because again, you're the experts, and again, at the same time, though, I would say that we try to deliver a message within a 15 to 20 minute time period. Thank you. Great question. Question that kind of builds on the last question. We had Dr. Gluckman-Flecken come in and speak with us. We're in an age of social media. A lot of people find social media as a way to advocate. We also have potential employers kind of investigating their potential new hires, and with some topics becoming politicized, what are your thoughts on the risk-benefit where maybe you can advocate, but potentially offend employers or, you know, new employers? Go ahead. Yeah, go ahead. Did you have anything? No. I guess I can start because I work at an academic institution, a large one in New York City. I mean, there are rules. We'll have to essentially run it by the media department, and I mean, I have to make disclosures that I volunteer for certain committees, and again, you have to disclose that it's not representative views of the organization you represent. It's your own personal views, and I mean, that's discussions with the department. I mean, Dr. Klonkoff, I guess, has the liberty that he roasted an insurance company, and it hasn't had any consequences. I don't think I have the same liberties of doing that when I'm like, oh, you didn't cover a ultrasound, you know. Aetna, for example, insurance doesn't allow us to ultrasound procedures without doing something landmark-based, which is crazy for a majority of procedures, but I can't quite roast them the same way. I can make a humorous, but then I have to divest myself from the, I guess, separate from the institution or make a separate convenient account, but I don't know. It's a very, yeah, it's a very touchy subject. I would say for those who work in institutions, you have to touch base with your departments. Otherwise, again, for those of you who have social media accounts, technically you're supposed to put disclaimers saying that it's your own views, and it doesn't represent the institution you represent. That's coming from a, I guess, hospital academic perspective. And I would say, just as our specialty, disability is a nonpartisan issue. 25% of the population identifies with having a disability, so I see that as there being safety in that because when you are advocating just, you know, in that sphere, who's going to be offended that you're advocating on behalf of someone or a policy that affects the patient population that we serve? Like, who really is going to take offense to that? I'm sure there's somebody, because in this day and age, it seems like we live to be offended, and that's really unfortunate. But it's definitely, I think, you know, using wisdom. If you think you shouldn't post it, you probably shouldn't. I agree with everything that he said, but again, I just think with what we're talking about, these things are nonpartisan. And I think a lot of people, if they knew more, because that's our job when we're advocating, we're actually educating. You know, if they're educated more about it, oh, I never thought about that. So those are just my thoughts. Yeah, I think to that point, I think, well, as you mentioned, if you're going to say something on social media out of anger, don't do it. You know, just always that thing, put it easy. On social media, you don't have the, you know, drafts folder as you do in your Outlook, right? So, but the second thing, and we all know that, the second thing I would say is that one thing that bringing in stories, like not obviously de-identified stories of individuals that you see on a daily basis or you've seen in your clinic, this is either on social media or your inner congressional offices. In my experience in advocacy, those are so powerful and you can tell that story and then the person on the other end has a lot of empathy because they have a family member who's gone through that similar thing. And that could be sometimes even effective on social media as long as that person cannot be identified. But I think that's also another thing that I've seen and as Dr. Clark-Brown mentioned, it's who's going to be annoyed with that if that might help. Thank you for your talk. My name is Megan. I'm a medical student also applying physiatry. And my question was, as physiatrists, could you speak to our role in advocating conjointly as a partner with disability rights groups and organizations, like what we can add uniquely to the shared mission of developing better health policy for individuals with disabilities? Thank you. Great question. Chris, did you want to speak to that? Yeah, so the Academy does engage in a lot of advocacy at the Academy level in the disability space. We partner with patient organizations. We are members of multiple coalitions that focus on these issues. PMNR is a unique specialty in that it is very patient focused. I mean all physicians are patient focused, but the specialty does, it puts a lot of resources into advocating for things that have that patient component to it. So it is something that the Academy prioritizes. I'd also add, sorry, there are a lot of these disability advocacy groups who represent people who still have never heard of physiatry, right? We know that we are a small specialty. We know that we are not as expansive as we would love to be. And so there are people that have gone their entire lives without having interacted or interfaced with a physiatrist. So again, just being present, bringing light to the specialty, and what we do is also something that's invaluable. Again, I mentioned I spoke at the Alabama Disability Conference. When I was interacting with the lady that was over it, she'd never heard about physiatry. But you're putting on a conference for the entire state of Alabama, and we have the only PM&R residency program right up the street in Birmingham, but yet you still haven't heard about physiatry. So again, opportunities galore. And to those points, I think one other thing that we've talked about as a committee, but then at the Academy advocacy level is, we're talking about one-way advocacy. We're advocating for our patients, but then also talking about our patients also spreading the word about our specialty and advocating for us. And that's something we've talked about and will be something that will continue in the future. And then collaborating with them, like working with Brain Injury Association, Spinal Cord Injury Association, etc. Because a lot of those organizations understand what we do and want to continue to facilitate making sure we are at the forefront of their health care. And so we've also looked at it that way as well, and that could be the future to make sure that PM&R is well represented. Any other questions? Hello, I'm Lena. I'm a PGY2 at Rush University. Thank you all so much for your insight. My question is just regarding how we might be able to bring more advocacy training to our residency programs, and if there's any program that has a good example of good advocacy training that we can bring to our own respective programs as an example. Personally, I don't know, unless someone in the audience has a residency that actually does health care advocacy. I know, for example, at our institutional level at Northwestern, the pediatric program actually has an option, and pediatrics is definitely a specialty that's very well represented. The AAP is developing a program. It's called the Apple program, which is specifically, you know, they have a research program, which is RMSTP. They have a leadership program, which is PAL, and then the third program is going to be advocacy. I don't believe it's available for residencies yet, but that is going to be something as you transition to being an attending that you could certainly get involved in, and it's to grow the next, and the other, the program here, which is the future leaders program, I would highly encourage you to look at that, because that, you do get a lot of training and advocacy as well. Again, at the sort of attending level, that's what that program is meant for, and then finally, if you're in any of those councils, like the FIT council or the equivalent at the AAP, those councils, you immediately get on advocacy committees in the organization, so that's also another really great way to be involved and get an advocacy, but in terms of residency programs, this is a great area of opportunity, and I think, I think all of us this week, I think advocacy is a front and center of our mind, and so I think this could be something that our specialty continues to further in training as well. I agree with Prakash. Yeah, I'm not where, I work more on the fellowship side of things, but yeah, it hasn't been recognized as a formal milestone in physiatry, but again, sort of with the current landscape, you can capture that zeitgeist or energy and mobilize. Again, I, in my personal experience, I use my local state PMR special society, or again, a lot of local medical societies in your own state will have medical student or resident, you know, committees or councils as well, so again, you know, fortunately, I would say most residency directors, I think, understand it, just again, I'm hoping that you all understand, as training trainees, that it's not so abstract. It definitely has an impact on how you practice and going forward. Sorry, I actually participated in the George Washington University resident in health fellowship policy. Excuse me, resident and residency fellowship in health policy, and I did this during my first year as an attending. This is open to you during residency. Now, they do typically take their own first, but they do allow outside residents to be a part of this, so I can talk to you about that afterwards, and it's a three-week, you get to go to Washington DC. It's a huge thing, so. Apologies, we've overstated our welcome, overstayed our welcome. Thank you so much for joining that session.

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