Like any large and diverse organization, the American College of Physicians has struggled to describe to its physician membership why it engages in public policy and advocacy, instead of tending only to their educational needs. Advocacy, unlike clinical education, is something that many physicians have only a vague understanding about. According to survey and focus groups, most ACP members (and nonmembers) say they think advocacy is important, yet they have trouble describing what ACP is advocating for and why.
The College understands that it needs to do a better job in educating ACP members and non-members about its advocacy. Over the past several months, ACP's advocacy, communications, membership, and marketing teams have been researching and analyzing how internists perceive our advocacy and how we can show them more clearly its relevance to their daily lives.
Based on our research, we found that one description resonates with ACP members and non-member internists alike: The American College of Physicians works for you—providing internists with education, clinical support, practice resources, and advocacy for policy changes that will make a difference in your daily work, your professional development, and your patients' health.
This description has several things going for it: It's succinct, it makes it clear whom ACP is working for—doctors (internists)—and it's about making a difference for physicians in their daily lives and in their patients' health. It's accurate: Almost every day, ACP takes a position on issues affecting patients' lives, like advocating for funding to address the opioids epidemic, and on issues affecting physicians' daily work and professional development, like reducing administrative tasks.
Two new ACP policy papers, published online by Annals of Internal Medicine in April during ACP's scientific meeting in New Orleans, illustrate how advocacy for patients, and for physicians, really are two sides of the same coin.
One paper, “Addressing Social Determinants to Improve Patient Care and Promote Health Equity,” advocated for policy changes to make a difference in patients' health; the other, “Achieving Gender Equity in Physician Compensation and Career Advancement,” advocates for policy changes to make in a difference in the daily work and professional development of female physicians. Both papers came out of ACP's Health and Public Policy Committee and were approved by the Board of Regents after extensive review, comments, and revisions by ACP's Board of Governors, Board of Regents, councils, and outside expert reviewers.
The paper on social determinants of health makes the case that where someone lives can have as much or more of a bearing on their health than the care they receive when they show up in a doctor's office, emergency department, or hospital. “Social determinants of health, which are defined as ‘the conditions in which people are born, grow, work, live, age, and the wider set of forces and systems shaping the conditions of daily life,’ are responsible for most health inequalities,” the paper's authors assert.
The paper cites extensive research showing that place of birth is more strongly associated with life expectancy than race or genetics and that “lack of economic or social mobility can also affect future generations who are born into environments that contribute to negative health outcomes. Research also suggests that investments in interventions to address social determinants of health, such as housing, income support, and care coordination, yield positive outcomes.”
To reduce the adverse impact of social determinants, ACP recommends policies to address environmental risk factors, like eliminating lead in water; to reduce income inequities; to ensure access to healthful food; to promote adequate and safe housing; and to invest in programs and social services shown to reduce health disparities or costs to the health care system. ACP also recommends that social determinants of health and the underlying individual, community, and systemic issues related to health inequities be integrated into medical education at all levels.
The paper on gender equity in medicine advocates for policies to support the professional development and daily lives of female physicians, citing research showing that despite considerable progress in recent years, women in medicine continue to be compensated less than men, are less likely to be considered for leadership positions in their workplaces, are more likely to be held back from career advancement, and face bias at all stages of their professional lives.
ACP recommends policies to ensure that physician compensation is equitable and that no physician is penalized for working less than full time; that residency programs and medical schools provide a minimum period of six weeks of family and medical leave for physicians, residents, and medical students; that six weeks of paid leave becomes a standard part of any physician's or resident's benefit package regardless of gender; and that all organizations that employ physicians take steps to increase the number of women in leadership positions.
The College recommends investing in further research on the impact of gender compensation inequity and barriers to career advancement and best practices to close these gaps across all practice settings, implementing regular implicit bias training by all organizations that employ physicians, and establishing programs in leadership development, negotiation, and career development for all physicians and physicians in training.
Two ACP papers published the same week, one that advocates for policy changes that will make a difference in patients' health, another that advocates for policy changes that will make a difference in physicians' daily work and professional development.
Aren't they really the same thing? Physicians want nothing more than for their patients to be in good health, because that's why they went into medicine in the first place. Patients want their physicians to be supported in the care they give to them. ACP advocacy is about making things better for doctors and patients alike, not one over or more than the other. Could it be any simpler than that?