All right. We'll get started. I'm certain that there'll be more people coming in over the next hour because it was just a break. Thank you so much for joining this session. The impetus of this session really happened from last year's Healthcare Policy and Legislative Committee update, when there was a lot of junior, in particular, faculty that were – junior faculty, but also residents, medical students, very interested in getting involved in advocacy for PM&R at different levels. And I'm very honored, excited to have a powerhouse panel here today. I'm Prakash J. Balan. I'm the chair of the Healthcare Policy and Legislation Committee here at the AAPM&R. I'm a clinician scientist at the Shirley Reinability Lab and also at Northwestern University. I will introduce each of our four fantastic speakers right before they go up, so then if people are late, they know who they are. But rest assured, we're very lucky to have them here today, and they're doing fantastic work for our field. The agenda will start with Chris Stewart, who's going to be talking about engaging with legislators at the Hill level, but he's doing a lot of work for the academy in different levels of advocacy. Dr. Hubbell will talk about the AMA House of Delegates and the powers of the Unified Voice of Medicine. Dr. Clark Brown will be talking about empowering physician-led advocacy to advance health equity and remove barriers to care. Dr. Aguri will be talking about the role of state societies and local and state advocacy efforts. And then I'm going to be talking just briefly at the end about how to get involved, if advocacy is something you're very interested in. So the first question I ask trainees is, why do you want to be an advocate? And throughout all of these presentations upcoming, I would like you just to think, particularly those of you who have never done healthcare advocacy before, what is your why? Why is it that you want to be an advocate, and what is it that you're going to be advocating for? And there are different reasons to potentially be an advocate. It's a challenge to be an advocate. You can be on the front lines of change, specifically for PM&R and our patients. You make a difference for your patients, your residents, your field. It helps you to wait as an outlet to follow your passion. It's understanding what upcoming issues there are in the field and knowing that often early on. And then you meet many people from diverse backgrounds, other institutions, other specialties through being involved in advocacy. And I think that sometimes also makes you a better physician and clinician as well. There's different types of healthcare advocacy. I don't need to go on to that too much, and you're going to get a sense of that today when we talk about advocating for your patients, advocating for improved medical education, advocating for your staff at maybe your local hospital level, then taking that further in your sort of city-like level, then going to state level. Many of the individuals you'll meet today or hear from today are doing sort of federal and national advocacy, and obviously there's also the global level as well. So I want to begin with Chris Stewart, who is our Director of Advocacy and Government Affairs at the AAPM&R. I'm really thankful to have Chris on board because he, for the Healthcare HP&L Committee, he is my staff liaison, and I'm very excited to hear him talk today. Hello, everybody. Thank you for joining us today, and thank you for that, Prakash. So I'm going to give you a quick little background for me just to inform where I'm coming from for this presentation. So I studied political science and did not advance beyond the BA, so I am not a physician. I am somebody who has been working in politics for about almost 15 years now. So I worked for the U.S. Congress for eight years. Four years of that, I was handling the health policy portfolio for a physician member of Congress, which brought me a lot of exposure with groups like AAPM&R, AMA, and other groups like that. So I got to work on a lot of really fun or interesting health policy issues. After that, I transitioned to working in federal advocacy for healthcare provider organizations for about six and a half years and then joined AAPM&R earlier this year. So I have been on the other side of, well, I've been on both sides of Hill meetings with physician. Thanks, Prakash. So I've been on both sides of meetings for meeting with legislators. All right. So why should physicians advocate? So I have a graph up there. It's America's most and least trusted professions. So you're going to see at the top, medical doctors, very high up there. You're going to note at the bottom, members of Congress, not so trusted. So basically, you have political offices, you have politicians who would love to hear from you and would love to be making decisions that are going to make people like you happy and have you tell their constituents, their other constituents, that they're doing good things out there. So they want to, they would like to be able to work with some of the trustworthiness that you all have earned from your education and your training and your work in your communities. At the top here, you also have nurses. And I left that in there because I wanted you all to see that nurses, that is a trusted profession. And I can assure you that those organizations or professions, the non-physician providers, they are advocating for their professions. So politicians are going to be hearing from non-physician providers. So if they're hearing from them, they should also be hearing from physicians. So advocating, it's an opportunity to educate policymakers, to inform them when they're actually doing healthcare policy work, so that they're going in with a good background for what they're working on, and it's able to have physicians provide some input. It builds support for the specialty, for your patients, and for the policy priorities that AAPM&R is working on for the specialty. And outside advocacy efforts, like having physicians jump in on things like this, it's incredibly important for getting legislative initiatives over the goal line, especially in times like now where you have Congress that is incredibly polarized. From the perspective of a former staffer, former Hill staffer, I can also tell you that legislators pay special attention to voices from inside their state and district. They want to hear from their constituents, they want to know what's happening in their community, and you can give them that perspective. That leads to, if not you, then who? Well, the only people who will speak up for physiatry are physiatrists, and you all need to raise your hands to make sure that the specialty is being represented when you have policymakers making healthcare policy decisions. Leads to a probably apocryphal quote here, if you're not on the table, then you're on the menu. If you're not at the table, rather. If you're not in the room where these decisions are being made, then you have the potential to be negatively impacted by a lot of these health policy choices. So what legislators and policymakers want to know when they're meeting with you all and why you're the best person to tell them about these things, it's what actions do constituents want me to take? They want to hear what's going to make their constituents, their bosses, the people who can vote for them happy. Why do constituents want me to take that action? What are the impacts of this action on our community or our state? So how is this going to impact other people who are, you know, constituents and potential voters? And then finally, what are your personal stories? If you're a constituent resident of the community or the state for a legislator, what is your personal story or your connection to this issue? So it's one thing to explain something in a very technical, cut and dried manner. It's another thing to give someone an anecdote about how this actually impacts your practice, your business, or the patients that you're treating. So what you bring to the table as a physiatrist. So what Prakash had talked about, your why. So that informs the stories that you're going to be able to tell legislators when you meet with them. So providing those stories, it gives an instant connection. It's an emotional impact beyond just dry data. It brings health care, your practice, and your impact on your community to life. It helps illustrate an issue, make it more easy for a legislator who might not have a lot of experience as a health care, or any experience as a health care provider, or any experience with health care policy. It helps them to understand why this is an important issue. So it makes the issues local and relevant. Importantly, it also gives them reasons to become a champion for the specialty for your patients. So it differentiates your meeting from pretty much any other meeting that they're going to have that day. So if you can give them an anecdote about how something impacts your community, as opposed to just data, data is helpful. But if you can give them an anecdote about how this is going to impact the community, that's going to be something that sticks with a legislator after you meet with them. So you want them to be able to have that positive impression and walk away with a clear understanding for why you asked them to do something and what that something would actually do for the community. So for logistics, for actually meeting with your legislators, you can do in-person meetings. You can with both legislators and staff. So in district or in state, depending on who you're meeting with, a senator, a member of the House of Representatives. There are also opportunities through AAPMNR and other medical societies that you might be associated with for DC Hill visits. So those meetings are incredibly impactful. It helps to actually meet face-to-face with legislators and also their staff. We also have virtual meetings. One of the silver linings of COVID is that Zoom and Teams and other virtual meeting options have become a lot more commonplace. So a lot of Hill congressional offices will conduct meetings with constituents over Zoom, which is a great tool for being able to get more people to meet with their congressional offices. You can also do correspondence, email and physical mail. So offices pay attention to the type of communications that they get. As someone who used to tally up that mail and write a lot of the responses to that mail, they pay very close attention to what their constituents are writing them about. I'm going to circle back to one thing here. The meetings with legislators and staff, it's important to meet with your legislators, but it's also important to meet with the staff as well. Because the staff are the people who are actually going to be working on this issue and are going to need to have a deeper understanding of it than a legislator. So if you are actually able to make those connections with legislators or staff, you'll be able to present the issues that we have and hopefully get those people on your side when it comes to health care policy decisions. So the blueprint for a successful meeting. It's pretty simple. And I can assure you that most organizations, they want to keep it as simple as possible. So it's broken down into just introducing yourself and PM&R. So make sure that they know who they're meeting with. They understand that you're a constituent, you're a physician who is working in the community, you're treating people who are actually constituents for this politician, and they should be listening to you. Because essentially, as a constituent and a voter, you are their boss. You're also explaining PM&R to an office. So I can tell you that a lot of health care policy staffers on Capitol Hill, at least, they don't necessarily have a strong background in health care policy when they start. So they're looking to meet with as many different organizations as possible so they can try to broaden their understanding. So if you can come in and you can explain PM&R in a quick elevator pitch or even more if they're interested, that's really going to help them understand why the issues are impactful and why they should care about those issues. For the meetings, usually you're going to want to have a specific issue that you're talking about beyond just introducing yourself and PM&R. So it might be a bill, it might be a letter that you want them to join on, something like that, or even legislation that you want them to oppose. So you need to introduce the issue, set the table for them. When you're setting the table, you want to make it local, relevant, and personal. So that gets back to your why and how that issue will impact the community. So it's one thing for a legislator to be given an issue and told that it's going to affect the national picture for health care policy. It's another for them to be told this is going to have a direct impact on my practice in the community, on the hospital system that I work for, or patients in the district. So when they hear those things and impact on the local or their district level, that's going to make it a lot more important for them. It moves it up their priority list. So after you've set the table like that, you need to make a clear ask. You're asking them to support legislation, you're asking them to oppose legislation, you're asking them to be a champion for PM&R. You want to walk away having made an ask that is clear and understandable for them, and it's not just something that they can push off or there isn't really an action item for them afterwards. Finally, you wrap it up. Congressional staff and legislators as well, they have very busy schedules. And if you've been able to set the table, present your argument and make an ask, that's great. You've gotten plenty of time with them and you've got your issue out there. So you wrap up the meeting, you thank them for their time, and you make sure that they have your contact information and that they know that you have an interest in being a resource for them. So you can tell them that if they have any questions about health care policy or any of the issues that you talked about, you're more than happy to answer any questions that they might have. You can also offer them the opportunity to visit your practice or meet with you in district. So that's something that legislators and their staff really enjoy doing. It's an opportunity for them to see up close and personal what the impact of health policy decisions would be. And here with what's the worst that could happen from a meeting with a legislator, because I know that it can be scary if you have never done a meeting like this before. So here are basically some common things that could actually happen in a meeting with a legislator's office. You're asked a question that you can't answer in the moment. That's not a problem. It's perfectly all right to answer that with, you know, I don't have the answer to that right now, but I can get back to you. You take down their contact information, you can reach out to them. You can also reach out to AAPM&R and we'll have contact information for us at the end of this presentation. You reach out to us and you tell us that you had this meeting or you have this question, we'll make sure that we get that information to you and help you close that loop and answer that question. It's also an opportunity for organic follow-up. So we want you to be able to continue the conversation with these offices. So if they have a question that you can't answer in the moment, that's your foot in the door right there to continue the conversation. The next thing is you could be asked about the other side's view of an issue. So particularly with scope of practice issues. It's important to be honest with legislators. They're going to appreciate that from you. You can tell them that, you know, for a scope issue that maybe the nurses or other non-physician providers will have a different opinion on that. They'll understand that. They deal with those issues fairly frequently. As long as you tell them that and you're honest about it, that's great. There's no problem with that. And they're going to find out anyway. So it's better that they hear it from you as opposed to someone else. Finally, they could say no to co-sponsoring the legislation that you asked them about or they could say that they're going to end up co-sponsoring or endorsing legislation that we don't want them to support. Not ideal, but it does happen. The important thing is that that's not the end of the conversation. That's not the end of the relationship. So even if they're not with us on that issue, there's a possibility that they can come to the right side on a different issue down the road or even change their minds later on. You never know what's going to happen. But saying no does not mean that the conversation is over and that that was a waste of time meeting with that office. So on that note, I'm going to wrap it up here and I'll be available for questions afterwards. I'll hand it back to Prakash. Thanks so much, Chris. So our next speaker is Dr. Susan Hubbell. I've known Dr. Hubbell for a few years. She's the chair of the AMA PM&R delegation to the AMA and the chair of the PM&R caucus as well at the AMA. She's a private practitioner in Lima, Ohio. I almost said Lima again, but I didn't. Lima, Ohio. And she's the new incoming chair of the new committee, which is the HPPA, which is Healthcare Policy Practice and Advocacy. I look forward to hearing her talk today. So what is organized medicine? How does it work? And what are the benefits to the physiatrist of being involved with organized medicine? When we think of organized medicine, we think of what's called the federation and includes the AMA, American Medical Association, state medical societies, county medical societies, specialty societies like AAPM&R, and armed services. The AMA was founded in 1847. The first house of delegates met in 1901, and there were 150 delegates. No specialty societies represented in those sections. It was all basically state representation. That has changed markedly. In 2022, there were 692 delegates present. So it's really expanded. AMA has the greatest access to Congress, national employers and insurers, and the world medical community. It has a political action committee, AMPAC, and it has the greatest influence on education of medical students and residents, the public profession, the legislators, the world. It has influence on professional ethics, publications, and quality issues. It is the largest national organization representing physicians. And the house of delegates, which is the policymaking body of the AMA, that meets twice a year. We just met last week at National Harbor, Maryland, for the interim meeting, and the annual meeting is always in Chicago in June. There are delegates. All the delegations are based on the number of AMA members in any one area. So each state has delegates based on the number of AMA members in the state. DC, Puerto Rico, and Virgin Islands have delegates. So there's about 306 state delegates. All this kind of goes up and down just a bit. And the medical specialty societies have delegates. AAPMNR has two delegates. AANEM, which some of you are members of, has one delegate. We will soon have a delegate from the AAP. That group has just done their preliminary work to become represented in the house of delegates. There's professional interest societies. There's national societies. There are 28 medical students represented from all over the country, 33 residents and fellows. We do have a resident and fellow delegate. Now there are 11 sections. A section is a special interest group, like there's a private practice section, women's physician section, senior physician section, foreign medical graduate, IMG section. So there's different groups that get together and those groups in general have one delegate to the house of delegates. But they also represent their whole constituency. And the services all have delegates. So it's a big range of people that are there. As far as PMNR goes, we have the delegates from AAPMNR. Right now we have two based on the number of AMA members in our group. AAP will soon have one delegate after the June meeting when they'll be voted in as another society. AANEM has one. And then pain medicine has one. So we're represented. And you know, if you're a member of any of those groups, your membership and your member of AMA, your membership in AMA counts towards the number of delegates that each society gets. So it's very important to join organizations to help out with our representation. When I first went to an AMA meeting as a guest of Dr. Claire Wolf, who is a mentor of mine, their number of women in the house of delegates was small enough that we could meet in a hotel room. Now there's a huge amount of women in the AMA. The makeup has changed entirely. The sections now have votes for special interests. And we have a current president, Jesse Ehrenfeld, MD, MPH, is an openly gay individual. So you can see that we've had the first president of color was Dr. Lonnie Bristow back in 1995, first woman president, 1998. There have been six women presidents to date, including Dr. Patrice Harris, who was just president a few years ago, first woman of color. We had Dr. Wah, first of Asian descent, and Dr. Ehrenfeld, the first openly gay president. So the AMA is not what we thought of 20, 30 years ago of old white men sitting in a room smoking cigars. It's not that at all. It's a vibrant organization with lots of representation of all groups. And the goals are to get better patient health, smarter medical training, and satisfied physicians and sustainable practices. We just met last week. Medicare payment reform was top of the issues. Physician burnout was another big issue, firearms and suicide. Really, any medically related subject you can think of might be discussed at the meetings. What happens is at the House of Delegates, individuals put in items of business called resolutions that have a topic that they wanted the AMA to take a position on. We discuss those. It's a very democratic process. People get up and talk about why they like it, why they don't like it, why they want to change it. And then there's a vote of the whole group, the whole House of Delegates in the end, to whether it's going to be policy or not. There's all kinds of different AMA journals that are out there, AMA Wire. There's lots of emails you can sign up to be on a list that gives you information on hot topics. There's a code of medical ethics that many states use as a basis for their code of medical ethics for physicians. So why should a physiatrist, physiatrist, and their patients be involved in organized medicine? Well, we're few in number. And you know we don't have residency programs at every medical school. So not every physician that's trained even knows what we do. So it's important for us to be at the AMA in order to gain support of fellow physicians for our causes. Very few people, patients and physicians alike, have heard of what we do. So we need to be out there advocating for ourselves. And also, it's popular to give lip service to the disabled. We have the Americans with Disability Act. But few people are really, truly the bottom care. And discrimination is rampant against individuals with disabilities. Dr. Quach was our resident fellow delegate last year. And we asked him why he thought it was important for him to be at the AMA as a resident fellow delegate. And we thought his insights were good. So that's why I put them in the slide presentation. But it's a collective voice to make change, even though change can be very slow. It's educational. It teaches us how to engage with the legislative process and advocacy. And these are things that are not taught in medical school very often. So it's important. And the networking that you get from being at the AMA meetings or even your state medical society meetings is very important, because you engage with individuals who are not in PM&R, but are influenced by what we do. And we should be interacting with them. So in the past five years, AMA has supported us on the 75% rule, on the change in mobility device restrictions, doing away with the improvement standard to continue physical therapy. EMG is the practice of medicine. Wheelchairs on airplanes, we just put in a resolution to that, like buses and trains and other modes of public transportation, who all are required to make modifications for wheelchairs. Airplanes are the only exemption from that. Even with Americans with Disabilities Act, it was an exemption. So we put in a resolution, which was supported at the AMA, that we need to get change for that. There was also one recently on wheelchair ramps and how that should be covered. This last meeting last week, we put in a resolution about the disability questions on the census. Those are right now being discussed as changing them without any input from the disability community, any of the advocacy organizations, or any disabled individuals. We don't feel that's right, that we feel that community should be involved before a final decision is made on any change in those questions. A year ago, we had a resolution, National Strategy for Collaborative Engagement, Study, and Solutions to Reduce the Role of Illegally Possessed Firearms in Firearm-Related Injury. And AMA now has a task force on that, and we have a PM&R representative on that. We did resolutions on bundled payments and medically necessary care because we'd seen that individuals getting total hip replacements and total knee replacements were not even being referred for outpatient therapy, much less for inpatient rehab or skilled nursing care. And we felt like that, and that was basically in the Medicare Advantage plan area. We did not feel that was right for patients. And we did a resolution on modification of the Medicare Appropriate Use Criteria Program. We called for increased funding, research, and education for post-viral syndromes like COVID. And we did one on preventing Medicare Advantage plans from limiting care. All of those things are policy at AMA, which means that when AMA advocates at Capitol Hill, that those policies are advocated for. One that happened in 2019 was protecting patient access to seat elevation and standing features in power wheelchairs. So that's 2019. It's now 2023, and CMS is just coming out with new regulations that will pay for power seat elevation. So we feel really good about that, but it's not something that happens overnight. It's very important for you to get involved. Join organized medicine. Join your county society. If you haven't done anything yet, start at the county society level or the state level. We have meetings, and I'll be talking about that in a minute. Join AANEM, AAP, and get out and vote. And it's not what you know, but who you know. Get to know your state legislators, your state, your congressmen. If you can, get to know the state senators and the senators at federal level. Use your spouse or significant other. Everyone's important. Don't forget to use the media. Letters to the editor from a physician are read and listened to. Don't think you can start at the top. If you decide you want to run for office, it's not really the best idea to try to run for U.S. Senator. Start smaller. Run for something like a county commissioner or a school board or whatever. Start with that and then move your way up if you want to continue. Remember, you can't do it alone. AMA has a candidate school, which they run once a year, which helps individuals who want to help someone to run or who want to run themselves for an office in the future. So it's a good thing. If you can't or won't or don't want to give time to advocacy, please give the money. Join and pay dues because your membership tells legislators when we go to see them that this many doctors are members of our organization. We then have the finances to help advocate for you and pay those dues so that we can go ahead. We can get more representation the more members we have. Remember, it's not easy. It's not fast. It's not something that you pass something and it happens that day. So, thank you. Thank you. Thank you so much, Dr. Hubbell. Next up, we're gonna have Dr. Amber Clark-Brown. Dr. Clark-Brown has been doing some incredible stuff. She is the inaugural Medical Justice Advocacy AMA Fellow. So she was inducted into this class. She was the inaugural fellow and she completed a fellowship at the AMA in this area of medical justice and advocacy. She's also now transitioned into being the medical director in the Bureau of Health Provider Standards, Bureau of Home and Community Service, the Office of Health Equity and Minority Health in the state of Alabama. And she's an amazing representative for PMNR in that state. So, excited to hear Dr. Clark-Brown. Thank you. Thank you. And you know what I'm excited about? Is that we're having these discussions. We're having these discussions about how important it is for us as physiatrists to get involved. I feel like I've been beating a dead horse. I know I look young, right? It's good genes and all the things. You'll see my parents in a minute. But you know, it really is, for us being such a small specialty, and it's been said already before, it's up to us to really move the needle forward. No one's gonna speak for us. We see day in and day out what we go through as physiatrists, what our patients are going through. And we're in this for a reason, and that really is to be the voices and to support the voices of the people that we treat. So, we're gonna get started. So, I have a question. What is advocacy? Like, what comes to mind when you think about the word advocacy? Yeah, speaking up for someone. Promoting a cause, yes. Yeah, so all of those things. Okay, who's gonna be honest? When you think about advocacy, who thinks about going to the White House or somebody yelling on the front steps? Yeah, thank you for that one honest person in the room. I appreciate it. But yeah, so Cambridge Dictionary defines advocacy as public support for an idea, plan, or way of doing something. Another definition, any action that speaks in favor of, recommends, argues for, a cause, supports, or defends, or pleads on behalf of others. So, it's simply speaking on topics, on behalf of things that you are passionate about, what you believe in, and convincing, or at least trying to convince others that this is important and why they should care. If you celebrate Christmas, you have all had practice with this as a child. You are advocating on behalf of yourself, to your parents, as to why you need said toy, and how this is gonna improve your life, how this is gonna improve their lives, because you're not bugging them. Same thing, just on a different level. I do have a spoiler alert, however. There really is no cookie cutter approach, right? All of us on this panel have kind of arrived here in different channels, and it's already been a list. When we think about advocacy, and when we're looking at advocacy, it's not all the same. You don't always have to go to the heel. You can write in. You can advocate by being in small conversations with people, and this really is about who you know. That's why networking, and coming to these kinds of events, like AAPMNR, large organizations, is very, very important, because you never know who you're talking to. They could be somebody that is one of your worst enemies, but they could also be somebody that can really, really support you in your cause. So I just wanted to go ahead and just put that out there. When you think about advocacy, please know that it's not one specific path, okay? You can get involved at any different point in the trajectory, depending on what your interests are. So for me, and if you don't remember anything else about this particular presentation, remember this thing, your voice counts. This is a summary of my life up to this point, and Dr. Hubbell, who just went, talked a lot about the AMA. I tell you, my involvement with the AMA is the reason that I'm here and working at the Alabama Department of Public Health today. Advocacy has always been a part of my life. It was instilled in my life by my lovely parents at the top left, I think they should, whatever side, you're a side mouth, whatever side. It's on the left of my screen, and they really taught my sisters and myself. So my oldest sister is to the left. I actually, she's a judge back home, and my other sister is an internal medicine physician, to really speak up, not only for ourselves, but when we saw injustices, to speak out against that. So grew up in Monroe, Louisiana, small town, smallish town. My parents grew up, were raised there, are still there. They lived this, they continue to live this, and this was instilled again from an early age. So I went on to Tougaloo College, and there I became a Jackson Heart Study Scholar, and this is where I was first introduced to public health. And it's kind of a full circle moment, because now I'm back in public health. But outside of that, it was the concept of, you can improve people's health outside of a one-to-one doctor interaction in a room, which is lovely, and we all love that, but it's also being in the room. It is also being at the table with the people that are putting these policies and creating these policies. As we know, a lot of people that create these policies, I want to think that they mean well, but a lot of them are ill-informed. And so again, it behooves us, as people who do the work day in and day out, to be a part of those conversations, to at least, if the decision is still something that is not the best, at least they actually had accurate information. So I've had different experiences. Prakash mentioned I was a part of the inaugural cohort of the Medical Justice and Advocacy Fellowship. It was a partnership between the American Medical Association and the Satcher Leadership Institute of Health at Morehouse College. And it was such a privilege to be a part of this cohort with many, many brilliant physicians from across the nation. What the purpose of this was is, I mean, it's in the title, we're taught to and supported in using our voices to champion causes, things that we believe in, and specifically for marginalized populations, okay? So when I was a Jackson Heart Study Scholar, again, I got involved in public health, but the Jackson Heart Study, excuse me, study, for those of you who don't know, it's the largest cohort that studies why African-Americans are predisposed to chronic diseases such as hypertension, diabetes, et cetera. So I got introduced to health disparities there. Now in my interest and love of PM&R, it's a double whammy. So I got to come up with a project, and we all have to do projects, but to address that. And we had other people that were interested in LGBTQ causes, immigrant causes. So it was a wonderful, wonderful experience in this third integration. And we did get a $15,000 stipend, so that was wonderful too. But outside of that, it was just wonderful to meet people that are really doing the work and some of the powerful people. So I'm gonna move on. Again, your voice counts. This is a picture of me, and this is where it really clicked, okay? I was an intern, and this was at the 2017 annual AMA meeting. It was a serendipitous way of how I got here. The person that was supposed to go wasn't able to go. And our state representative that worked with medical students had come to speak to us during the luncheon, and I just showed some interest. And she reached out to me, and she was like, hey, this person can't go, will you be able to go? And I got clearance from the residency director. I tell you, this was the moment that changed my life. Again, because it clicked that my voice counted as a physician, and that is something, again, if you don't take anything else from this presentation, please remember that. A lot of times, and especially when we have just graduated from medical school, there is a feeling that you don't know anything, even though you spent four years grinding, you graduate and you're like, crap, I don't know anything. And we do, but I also want you to know that just by virtue of having an MD or a DO behind your name gives you instant credibility, because you have matriculated through an arduous four years. Last time I checked, nobody was just handing out MD and DO degrees, last time I checked. I don't know if things have changed, but you've proven that you, first of all, have put in that hard work, but you also have those clinical experiences, those classroom experiences, life experiences to back up what you're saying. So that was really, really important, and you can't, it's hard to see what's actually on the screen, but I'll read it to you, it's hard for me to see it. It says, shape your career. And then there are two names on here. John White, who was an MD, NPH, he was the Director of Professional Affairs and Stakeholder Engagement at the FDA. And Joseph Hutter, also an MD, he worked at the US Public Health Service at CMS. And so again, it's like, wait, physicians can really do great and big work in government, outside of the clinic? Like, this is actually a thing? So this opened my eyes to the world of, as a physician, you really can do a lot with your degree. We're trained to think critically. These are skills that are transferable. So this is why it's so, so, so important to really think about that, and to use these skills in as many avenues as you can to advocate on behalf of the patients that we have chosen to treat in our beloved specialty of physiatry. As we know, many of these patients, they fall into marginalized population just by having a physical disability. And as we know, history has often proven itself that marginalized populations really have little to no voice. And if they voice, it's often squashed, unfortunately. So I see that we not only have, we should do it, but it's really an obligation, because we are well-poised to be able to not necessarily always speak for, but again, to partner with organizations, to partner with patients, to partner with people that are able to carry these messages forward so that we can see the change that we all want, because we'd be frustrated in clinic, right? Right? How many times have you asked, what are all the things that went wrong for this person to show up in clinic like this? Seriously, right? And instead of complain about it, and complain about it some more, we have the opportunity to be effective. As Dr. Hubbell said, really like nothing in policy, nothing in government moves fast. We know that. That has been reaffirmed since I moved to the Alabama Department of Public Health. It's slow, y'all. However, it is possible. And again, we have the opportunity to do that. So where do you start? Dr. Hubbell already laid out some areas that you can start in, of course, the AAP Menorah, the AAP. Again, your local state medical society, AMA, and some states actually have a local AMA medical student chapter. And my previous institution at UAB, they had that, and this was student-led. And so it is quite, quite possible for you to get involved. I know that when we think about advocacy as a whole, it can be very daunting. Again, I know I thought about when I first was introduced, you know, lobbying and the White House. But there's so many other things that you can do that actually counts as advocacy. So we're starting to see some tides of change. Again, we're seeing it here. We're seeing it here in our groups. But also the world and the nation, I should say, is taking note. These are just some headlines of some research papers and some articles that I took. Inaugural class of 12 physician fellows to advance health equity. That was my class. Trends in medicine. Physicians as advocates for social change. We can do this. We're poised to do this. We have to do this. Because if we don't, then in 10 years, where will we be? And not just as PM&R, physicians in general. Because when we graduate, we graduate into the body of medicine. Then we diverge. but it is so so important to remember and like Dr. you know Hubble said when we're talking about organized medicine it's great for you to be a part of you know your specialty society but I'm a huge advocate of also being a part of the AMA because again we graduated into medicine first and then last with a novel disability advocacy and awareness program for training future health care professionals on care for patients with disabilities this is wonderful I want talking to you I was talking to somebody earlier in a different session and this is wonderful that people are starting to train other specialties medical students etc outside of physiatry because really unless you are in pathology everyone is going to you know encounter someone that has some type of disability and that's something that just really needs to be normalized so people aren't weird and awkward and then you know just it just kind of goes downhill from there so I see some ties to change I'm really really excited to at least be having these conversations so I just have some take-home points again your voice counts if ever you feel like it doesn't it does you have instant credibility by having an MD or do behind your name even if you just graduated yesterday your voice counts remember to build relationships networking is so important again you never know who you're going to meet it's important if you can come to these types of conferences do that even think about conferences that are not necessarily tied to your specialty but you may have different interests go because you just never know again you're already an expert even if you may believe you aren't that should be aren't start somewhere but you can't start everywhere okay it's so easy to get overwhelmed so pick a topic that you're passionate about and look for advocacy groups for that consider your local and state medical societies and consider your professional society groups remember advocacy does not have to be at the White House level but absolutely if you're for the opportunity please go don't don't don't turn it down don't turn it down they'll prep you they'll prep you you'll get to meet staffers you'll get to be in DC it's a wonderful experience I've heard I haven't been there yet where I'm going but just don't turn down an opportunity but again it doesn't always have to be at that level and again you don't have to do it all just do something write a letter many times the emails that we get if you're part of either your local medical society or you know a team in our AP they're already pre-filled so all you have to do is click and they'll have your name sign you just send it on just send it so it's not a lot of work that you have to do you can do more if you want but just do something okay and I just have a list of resources here AMA website one one website that I want to bring your attention to is that third one the stanford.edu diversity programs this is one that is specifically it's an advocacy group that is specifically dedicated to disability inclusion so it's wonderful you can get involved you can do they have virtual sessions the founder is actually a physician that had a spinal cord injury and after that time you know he was having a lot of difficulty getting back into work and so he actually started this group and then I had to put the Alabama Department of Public Health because you don't have to read but that is it again I'm available for questions afterwards but thank you for your attention all right so last up is Dr. Antigone Ajuru who's going to be talking about state society level and local state advocacy Dr. Ajuru is a private practitioner predominantly interventional spine specialist at spine medicine and surgery of Long Island she's also a member of the Medical State Society of New York as an advocacy work with them she's a proud graduate of the future leaders program of the AAPMNR which those of you more genius should definitely look into and she's currently the alternate alternate CPT advisor for the PMNR our entire field to the AMA which is a very big deal position thank you so much Dr. Ajuru. Thank you so much for that introduction and thank you to everyone for being here so there'll be some overlap with things that have already been said but that's because these things are important so we'll talk a little bit about why it's important to volunteer as a physician and then I'll tell you about my story how I got involved with advocacy and legislation and that's through my experience with the New York Society of PMNR the Medical State Society of New York AAPMNR the future leaders program in the American Medical Association I'll give you some practical advice I'm hoping it's practical and I'm hoping to inspire you about where you can start I'll provide some resources and then we'll conclude so why is it important to volunteer we sort of hit on this point before so advocacy is very very important to promote or reinforce positive changes in health policy and legislation to help ourselves our specialty our patients and our communities and physician leadership is a crucial part of advocacy and legislation as physicians we already advocate every day for our patients but many physicians don't embrace their potential to be public advocates and influence policy seems daunting and intimidating but it really isn't so hopefully we'll inspire you today to take that step forward volunteering in advocacy and legislation can be tremendously rewarding you could really make a difference you really do have a voice and as a volunteer personally I feel like I'm a catalyst for change I feel honor and pride knowing I'm truly making a difference in the lives of patients colleagues and the specialty so as we've already mentioned advocacy can occur at multiple levels there's local state and national levels so start small like we already said and then slowly work your way up which is sort of what I did so my story started locally this was back when I was a resident and I heard about the New York Society of Physical Medicine and Rehabilitation at the time and actually even currently there are CME lectures that occur monthly and at the time the attending I was working with was a former president and she encouraged the residents to attend and I didn't want to upset my attending so I went and I just sort of fell in love I met a ton of other PM&R residents it was really fun the lectures were educational there were medical students there residents even program directors and attendings from the area so following the educational lecture there would be an executive board meeting it was open to the public and so I started attending those meetings and after that we would have this networking event at a restaurant or a bar so I got to know other people and so I started attending every single month so initially I felt like a fly on the wall but eventually after attending monthly I became a familiar face and I made a lot of friends I started to make strong connections with other leaders and I started by volunteering with small tasks cleaning up after the meeting taking notes just small steps and that really makes a difference even if you think that's insignificant just volunteer even to do simple little things if you are dependable and reliable and you're there consistently there will be other responsibilities that will fall into your lap after that so the following year I decided to run for a committee position a year after that I was appointed program coordinator and a year after that I was elected president of the State Society and that was 10 years ago and so through those connections at New York Society of PM&R I was able to connect with other physician leaders who were involved in other you know policies and and in other societies including the Medical State Society of New York's or MISNY and so state medical societies are very important they provide critical legislative and advocacy resources as we've already mentioned today and so with each state having specific laws and regulations that govern the practice of medicine the Medical Society of your state is very important about your state specific issues and so I was eventually appointed to MISNY's House of Delegates I served as a voting delegate for my county and it's very very easy to get involved in this you can just find your state society sign up and there are a lot of opportunities you can attend the meetings and slowly work your way up and I have a link here on finding your state society and getting more involved and I encourage you to find colleagues that have similar interests so this here is me and Dr. Daniel Choi who's my current partner in private practice he's an orthopedic spine surgeon with a very very large interest in legislation and advocacy so he supports my work we collaborate and it's just been great to work with somebody that shares similar interests so do that you know find other colleagues that are also passionate about this and collaborate together for a greater cause and so you know as you open one door of opportunity another one presents itself and then you just sort of walk through the doors of opportunity AAPMNR is an amazing resource there's so much information on our website if you just go ahead and explore it and so all my work at the local and state level eventually connected me with AAPMNR's advocacy team after I completed my term as New York Society of PM&R president I was invited to the AAPMNR's Council of State Society Presidents attended those meetings after one year on the council I was appointed chair of that council I was able to regularly connect with presidents from other states we talked about issues that were they were dealing with in their states and we sort of collaborated and then this allowed me to participate in the Medicare Contractor Advisory Committees or the CACs so I participated as an advisor in the development of local coverage determinations and eventually I think what really catapulted my career to the next level was AAPMNR's future leaders program I am so grateful for this opportunity if you are an early career physician I encourage you to apply it was an absolute amazing experience so if you're not familiar the Academy's future leaders program selects 10 members 10 early career physicians to complete a two-year immersive leadership program it's a tremendous opportunity to learn about the Academy's governance strategic planning media skills advocacy and more and after completing the program there's an opportunity to be appointed to specific committee roles in the AAPMNR so after graduating from the program I was appointed to the AAPMNR's RPRC committee reimbursement and policy review committee and that addresses reimbursement related issues by collaborating with other bodies like CMS and the AMA I was then nominated as the alternate CPT advisor for the AMA so the CPT process is very important we monitor the CPT codes emerging technologies and make sure that the CPT codes reflect how we're practicing so that's my story as we mentioned there's there's no one size fits all everybody's story is a little bit different but start small do little things even volunteering to do things like take notes or clean up or set up these are really important just show up just show up get a sense of how everything works just keep volunteering make yourself available and then you just sorry you could just climb up that ladder if you're not sure where to start after everything I just spoke about I think the best place to start is to go to the AAPMNR website right on that home page you'll see a section for advocacy if you click that you'll see current priorities it's a list of current priorities that we're dealing with and if you click on Academy in Action there's a tab there specifically for state advocacy so you can get some more information then I also encourage you to join local and state societies so this is for New York specifically where I'm from the Medical Society of the state of New York you can find one in your own state and before I move on to this I want to mention there are multiple PM&R state societies that are not active right now and some states don't even have one you don't have to be in attending if you're a resident and you're interested look to see if there's a PM&R state society if there isn't one make one I can help you the AAPMNR can help you and if there is a society and it's not active we have ideas to help you make it active hold meetings and so I'm available to help with that there's other staff in the AAPMNR that can help so just please that's another option if you really want to take action that's something that you can do so again this is Misny's website you can join Misny and then you can click take action and it will give you several things that they're working on with that you can become a part of so again stay connected volunteer when you do sign up for these societies you'll get alerts you'll get newsletters emails updates that will keep you informed social media of course you can go ahead follow pages you'll get things on your newsfeed about different updates connect with other physicians like I said who have similar interests attend those meetings and just just show up show up and volunteer and just apply for these leadership positions with the AAPMNR there's a lot of opportunity so in conclusion advocacy and legislative work is extremely important for physicians patients and the future of medicine we need physician leadership you're all leaders so we can pave the future of medicine and ensure that we're preserving access to quality of care and medical policy and while it can be time consuming it's tremendously rewarding and gratifying and it can be as easy as just joining at a local or state level and when you don't know where to start the AAPMNR can help there are extensive opportunities and resources to get you involved right on the website thanks for listening all right before we go into questions Dr. Giroux gave some great pearls on on areas to look at but just in closing we kind of want to give you some pearls of also how you can advocate for our specialty and your patients meeting with your legislators has been mentioned today both of the local well not both this the trifecta local state and federal levels participate in some of our AAPMNR advocacy initiatives and volunteer some of our advocacy initiatives I know we all get a lot of email but you'll have you'll see sometimes your inbox these voter voice campaigns which come out and I would definitely encourage all of you to sign up to them some of them are Medicare reimbursement related scope of practice issues and your voice really does matter and makes a difference it also gives us an idea as those who are working in advocacy what is really impacting on membership if we have some of those voter voice campaigns filled out then we know which is the issues the hot-button issues that are really impacting you as physiatrists on the ground and so these are some some of the prior voter voice campaigns that have been out there so look out for these emails I know we always have email fatigue but if you see them maybe once in a while just just read them and take a look so with that we're gonna go into questions the this is audio recorded so if you have any questions please step up to the mic if anyone does if while we wait and you all are so shy that no one wants to get up and ask a question but that's okay so actually I have a question for the audience how many of you have been taught about advocacy in medical school okay like two three how about in residency okay so a few not many definitely not even 50% so my question is sort of to the panel do you do you think that advocacy should be something that we should be teaching our medical students teaching in residency it's not currently a milestone in PM&R but in for example in pediatrics it is something that is a milestone so yes 100% and not just you know advocacy of course policy and understanding policy should be rolled into that because at the end of the day policy directly affects the way we're able to practice so I think that we have to do a better job of equipping you know our medical students and residents because that's why it's such a shock when you go from being a resident to an attending because you aren't necessarily taught that unless you seek it out for yourself you're so you're so focused on just making it through making it through but this is so critically important to your ability to continue to practice medicine so I'm just going to add that early exposure will make this less intimidating as you go ahead and become a resident and an attending and so as these issues are constantly brought up throughout your career and at that point early exposure will give you opportunities let me attend this meeting you know let me let me sign up for this opportunity and then with time it becomes just less intimidating you're more likely to take action it sounds great so definitely an area of opportunity in residency programs and medical schools the other part that I also wanted to ask you some of you oh sorry yeah well I was just gonna say that it may not be a formal part of the program but you know if you're into doing advocacy yourself and you have a medical student rotating with you talk to them about what you're doing and why I know there's a couple students that I've had in Lima Ohio who one is now on the fit council here and is very involved and he came up to me and said he told me this was important and I'm doing it now so you know I was kind of proud of that but I think that we might not be formal but talking to residents and medical students who come to your office or you see on rounds isn't it's very important don't let them know about this aspect of health thank you and then and this is probably mainly for amber advocacy isn't usually something that's like works with academic promotion how has that worked for you or how is there anything that you've seen that maybe academic promotion could tie in advocacy towards that I think still that the tides are turning as in medicine is becoming more and more evident just across the board how important it is even in the administrative roles for people to be involved there was not really a route as far as academic promotion for me so I pivoted that's why I'm at the Department of Public Health now to really live out what I wanted to do but I think it's possible like I said the tides are turning and we're really seeing how important this really is and it's not just our specialty it's across the body of medicine and then this is for Chris actually so Chris you may not be aware to the audience that oh there are we get to say sorry I was gonna ask Chris you almost saved Chris I'm asking a question they say the gotcha question I'm gonna get him with right now but Chris used to be work with ENT as a specialty also worked with the PA's as a liaison for them too so you've seen good advocacy from physicians and and bad advocacy tell us tell us the bad stuff stuff what have you seen that's not effective and something that we should avoid when we when we're going to congressional advocacy let's see here talking down to the people that you're meeting with I have seen that and that never ends well and using too many acronyms I know that's tough don't talk down and then you should also try to give a layman's perspective so it's a you got to shoot for that narrow middle road there you want to make sure that you're meeting people where they're at so for a lot of legislative staffers they don't have a background in health policy so they they don't know what physiatry is they might not have any idea what an earth is until you you meet and talk with them so you want to make sure that you're you're explaining things in a friendly and conversational way thank you and I think that's a great segue to what we discussed in our committee today about the elevator pitch for PM&R and making sure that we have that down and they definitely discussed that in some of the media training that happened a couple of days ago through no worries I was just making a fantasy football trade while you're talking kidding I was not thank you Thiru Anaswamy Penn State Hershey a question about advocacy at a one-step removed level not directly where you're attempting to influence policy legislation on government action perhaps more at a community level or trying to change public opinion about a certain issue or instigate a thought or a discussion about a certain issue that you're still not sure if you have a clear stance or position that you want to take yet but you think you have a basic idea of some principles surrounding an issue are there any of you that have done something like that are there steps that you could take to for lack of a better description be a better community organizer I think that's a great idea, actually. If someone hasn't done that, I think they should. For the New York Society of PM&R, Dr. Richard Chang is here, who's the current president. So we do a lot of local work, and there are a couple of things we've done, like Walk with a Doc. So we have residents and attendings that volunteer for a cause, and then we sort of try to get public awareness out. So with Walk with a Doc, we volunteer to walk with people in the community, and they can bring up topics that they wanna ask. We can sort of provide information. And so that's one way we try to sort of engage with the community, and with each other, really. But I think that's a great idea, and I think the local and state societies are a good place to start. If you're not sure if this is a national movement, but something that's important, you can sort of communicate that and see if others agree, and I think it will grow from there. I'd add, it's the same steps, the same principles apply. Whether it's community level or federal level, it's about knowing who your stakeholders are. Those who support, or you think would be supportive of your formulative idea, and also knowing who those are that will likely oppose it. Depending on what it is, of course I'm gonna vouch for local health departments. Each state is run differently, as far as health departments are concerned. But there's a vested interest in community organizations, and health departments have a huge imprint on the community. So again, depending on what you're interested in, they could be a resource as well. And there's several community, clearly organizations throughout. So I think it's the same formula. Yeah. Thank you. Thanks for the question, Thierry. The next question I have is actually about social media, and whether you use social media for, and I think Antigone, I'm mainly looking at you, I think. Not, I actually don't know. I don't follow everyone on Instagram on the, on the, I don't know. But I know you've used social media really effectively for getting your advocacy out there, and can you speak to that? So you mean personally, or with, working with a society? Working with a society. Absolutely. So we've actually designated a couple of people with this task, and the duty to constantly post on social media, and keep people informed, send emails, make newsletters. I'm going to say I've been inspired by my partner, Dr. Daniel Choi, who you saw in my presentation, who has 18,000 followers on Instagram, and posts regularly and constantly in its professional content. He talks a lot about advocacy, and he makes really interesting videos, and provides educational content as well. And so watching him do that has been really inspiring, and it's not easy. You have to dedicate yourself to this. But I think things like you're at this conference, just take a couple of pictures and put a post. You can promote important things. It's not going to take up too much time, but I think we, as physicians, we don't always post on social media as much as we can, and it doesn't have to be your personal life. Dr. Choi, for example, this account is strictly professional. There's nothing there about his family or his personal life. And I think if we all did that, if we all sort of had these channels, or we're posting educational content, and things we're experiencing as physicians that's important, these issues and policies, I think that's a great way to get our message out. Thank you, thank you. Question. First, thank you all for your presentation. And my question revolves around one of Chris's slides, looking at what careers have more trust and least trust. So I'm wondering after COVID, how do you feel like that's changed for physicians? And how have your advocacy efforts changed after the peak of COVID? Great question. That is a really good question. I think in a lot of ways, when you're meeting with legislators at the federal level, there's a divide between COVID issues and physicians in terms of how the legislators, federal legislators who are really polarized on this look at it. So I don't think that you're gonna meet with a lot of congressional offices that are gonna look at you with a different, with maybe distrust after COVID being an issue. I can't speak for state or local issues, but it's definitely changed how we have done advocacy, definitely logistically. But in talking about issues, you have things that were not partisan before that are partisan now, and you have to modulate your message depending on which office you're talking to. So we do advocacy work in long COVID, and the way that we talk with Republican offices is different than the way that we talk to Democrat offices. So yeah, it's changed, but I don't think that you're gonna have a lot of federal legislators looking at physicians with distrust in the era of COVID. Thank you. Go ahead, go ahead. I'm sorry, I feel like I'm talking a lot, but- No, not at all. Being on this side now, I can say from the state level, and particularly in Alabama, public perception has definitely changed. And our state health officer, Scott Harris, has really taken a lot of hits. He continues to show up. I'm happy about that, but it's even kind of, COVID has allowed this to kind of creep into other legislative things that are coming forward. So not only is it just COVID vaccinations, but it's childhood vaccinations. And we've had a lot of legislation go forth about parents not wanting that. And so we have mostly conservative legislatures on that side supporting bills that are in not favor of that. Also, because of the way that the public perception of how our state health officer handled COVID in Alabama, there are bills that have come forth and they've been able to be squashed because we've been able to work with different committees, but to kind of dethrone him. And so it's really been interesting. I would say public health has lost the trust of the public. From the federal side, I will tell y'all, I went to a meeting, CMS said, particularly for the nursing home side, that they now know that they should have done things differently. So CMS is actually run by humans, believe it or not. I got to meet some of them face-to-face, but the issue is that this messaging is not getting out to the public. And so there's still this wall of distrust when if we were just transparent, I think it would be a little bit better. Thank you. Last question. Thank you so much, guys, for this presentation. My name is Samuel. I'm a fourth year medical student. I just had a question. In your experience, what would you say are some effective ways to reach out to underserved communities to let them know that physiatry exists? Because I go to school in Harlem and a lot of our health fair, when we speak to people about physical medicine, rehabilitation, they're not really aware that this field exists, what we can do. A lot of them tend to believe that we're just the opiate prescriber, which majority of the physiatrists I know don't even do. I can probably start because everyone's like, why do you keep asking? But I think one thing that certainly would be that you could try is actually thinking about local community organizations within the Harlem area. That's what we did in my hospital. We reached out when, actually more from a research standpoint, but working with local communities, in the same way that Chris was just saying, bad advocacy, you're not talking down to them because you're not just coming in, doing all this stuff and then peacing out. You've got to be an active member and create some sort of trust with them as well. There's distrust a lot in some of those underserved communities. So making sure that you develop that partnership over a period of time, and then they start to build trust. They start to think, well, I have joint pain. I need to go to PM&R. And then we actually active a clinic in West Side, Chicago, where our residents go to that. We provide free healthcare to some of those underserved populations. Many of them are from non-English speaking countries, but I think we've developed a level of trust that now some of those community organizations reach out to us. So I think working with the community and the organization, some of those are faith-based organizations as well, I think are really, really important. Anything else you guys say? I guess I would say also doesn't have to be medical. I mean, our food bank needs people to come in and help pack boxes and do things and help distribute items to people that need them. And just getting to know you as a person is helpful. And then you can branch out a little and tell them what you do. But just to see you out there helping out with those kinds of things is important too. And at the end, they'll still think you're a psychiatrist. Is that okay? All right. Thank you, guys. All right, thank you so much. All right, thank you all so much for attending. Thank you to our panel. Good, good, good. Thank you. Thank you. That was really a good presentation. I appreciate it. I enjoy speaking. I can tell. I do have a question for you, because I'm actually bi-university.

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Medical Justice Advocacy Fellowship

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