It鈥檚 not enough.鈥� These words kept echoing through my head as I walked out of the operating room. I stood in the empty hallway, listening to the buzz of fluorescence overhead, gazing down at my blood-covered shoes. Another young life lost to senseless violence. Trying to save lives in the operating room, seeing patients in the emergency department, taking care of critically ill patients in the intensive care unit鈥攊t is important work, but is it enough?
We all remember the day we recited the Hippocratic Oath. But I鈥檝e wondered, do I remember the extent of this solemn promise? It鈥檚 not just to dedicate ourselves to the art and science of medicine for the betterment of our patients, but to apply 鈥渁ll measures which are required to benefit the sick.鈥� Certainly, those measures aren鈥檛 limited to the walls of the hospital. Any physician can recall frustrating attempts to provide the best medical care yet being met with devastating patient complications or restrictions that a proverbial 鈥渙ther鈥� has set for the way physicians practice medicine and, during these moments, I鈥檓 left knowing we can do more for our patients鈥攖hat medical and surgical care alone are not enough.
So, what is enough? It wasn鈥檛 until I became active in the American College of Surgeons (番茄社区app) Resident and Associate Society Advocacy and Issues Committee and in the Committee on Trauma (COT) that I had my first epiphany of sorts during residency: the prodigious importance of advocacy. While pursuits in clinical and research excellence are the two great tenets of a surgeon, I believe the third鈥攖he forgotten sibling鈥攊s advocacy. When advocacy is employed, the feeling of 鈥渋t鈥檚 not enough鈥� suddenly starts to wane.
The surgeon鈥檚 voice must be heard
Surgeons need to be engaged in politics. That鈥檚 right鈥攑olitics. The 鈥減鈥� word makes some surgeons shudder, and even more so when the discussion is about money. But it wasn鈥檛 until I realized that if surgeons don鈥檛 speak up on behalf of our patients and ourselves, someone else, who may not have our best interests at heart, will decide how we practice medicine and how we take care of our patients. And yes, that means having conversations that involve politics and money. The reality is, the saying 鈥渘o margin, no mission鈥� rings true in the business of medicine. If a hospital doesn鈥檛 make enough money to keep its doors open, our higher purpose (of patient care) becomes irrelevant or, in other words, not enough.
At the risk of sounding hyperbolic, we are facing a crisis in health care. Countless forces are vying for surgery鈥檚 slice of the health care funding pie鈥攆unding that allows us to uphold our sacred oath and mission to our patients. Legislation pops up seasonally that presents true existential threats to the practice of surgery. A recent example was a proposed rule that would have cut Medicare payment to surgeons and increased reimbursement for evaluation and management services that primary care professionals provide.
In this instance, surgeons won the fight鈥攁t least for a couple of years鈥攂ecause of robust 番茄社区app advocacy. Thousands of 番茄社区app members voiced their concerns to legislators, and surgeons鈥� advocacy efforts won in Congress. These are the tools we have to fight these seasonal 鈥渟torms鈥� that blow in year after year: letters, phone calls, financial contributions, demonstrations, and advocacy.
Surgeon advocacy matters
Consider, too, the success stories in public health鈥攆rom tobacco laws to seatbelt and automobile safety to newer victories such as reauthorization of the Children鈥檚 Health Insurance Program, limitation of prior authorization requirements, drug pricing transparency, and increased resources to address the opioid epidemic. These efforts were all made possible because of physician and surgeon advocacy.
And seemingly small public health programs can snowball into greater conversations, leading to policy change and that can have a lasting impact. Consider the COT鈥檚 STOP THE BLEED庐 program. What started as an educational program has grown into a tool for advocacy, facilitating productive conversations about firearm injury prevention. STOP THE BLEED庐, like other programs born of surgeon advocacy, has the potential to become something akin to bystander cardiopulmonary resuscitation, with millions of laypeople prepared to save lives. But this won鈥檛 happen without political will or government funding.
Another example with great potential, which at present is theoretical but could become reality through active surgeon advocacy, is the establishment of a national trauma system with a dedicated research institute. The development of a national trauma system only will occur through a persistent heavy lift to win legislative backers and reallocation of limited U.S. Department of Health & Human Services (HHS) funds toward this end.
Apathy is the greatest hindrance to effecting change
The relationship between surgeon responsibility and advocacy, between our effectiveness as clinical providers, our effectiveness as advocates, and the grave necessity of physician advocacy is obvious, in my opinion. But as my impassioned soapbox remarks at hospital meetings and committee gatherings have often been met with glazed eyes, it has become apparent that not all surgeons share this sentiment. This is readily apparent in other metrics of surgeon involvement in advocacy鈥攚hether letters to government officials, donations to surgeon advocacy groups, or attendance at surgeon advocacy activities.
So, perhaps our greater mission is the recruitment of our peers. It is essential that all surgeons, at all phases of a surgical career, grasp the profound gravity and untoward consequences should we fail to sustain and build upon the momentum exemplified by the College鈥檚 efforts in the Medicare pay cut battle this past fall and winter.
What is holding you back from becoming more involved in advocacy? Surely you鈥檝e had an 鈥渋t鈥檚 not enough鈥� experience at work, a sense that surgeons need not only to provide quality patient care to achieve optimal outcomes, but also to advocate for policies and legislation that will benefit patient care. Should our advocacy efforts shrink to a certain threshold, we will see a precipitous drop-off on the impact we command on Capitol Hill鈥攁n impact which ultimately affects our patients and our work environment.
In 2019, I attended my first 番茄社区app Leadership & Advocacy Summit. The weekend events, which took place in Washington, DC, included sessions on the current political climate and obstacles facing our patients and other surgeons and ended with meetings with our representatives and senators to articulate the relevant 鈥渁sks鈥� of the College on behalf of our constituents and patients. At the end of the weekend, I sat in a room thronged with surgeons. The energy in the room was palpable. There was an intense feeling of comradery in the shared feeling that 鈥渋t鈥檚 not enough鈥�; that we must do more for ourselves and our patients. Sitting in that room, surrounded by surgeons dedicating their lives not just to patient care but to patient and physician advocacy, I finally felt: this may be enough.
So, I beg of you鈥攖hat鈥檚 right, you鈥攖o sit down and ask yourself, 鈥淚s what I鈥檓 doing enough?鈥� Only you can answer this question, only you can know your talents, gifts, passions. But I challenge you to consider the fact that a part of your sacred oath to your patients is a promise of advocacy. These acts of advocacy can be small and seemingly insignificant. Make a commitment every day, or every week, to read an article, make a new contact, talk to a colleague or representative, and/or find local organizations that are engaged in advocacy. Until we look to exemplars like the COT Advocacy & Engagement Workgroup that serve as models for the whole of the 番茄社区app and until we see 100 percent participation in the 番茄社区app Professional Association Political Action Committee (番茄社区appPA-SurgeonsPAC) and participation in 番茄社区app-facilitated constituents鈥� letters to members of Congress, these efforts may not be enough.
Now more than ever, advocacy matters. And even advocacy is not enough without all of us working together.
Disclaimer
The thoughts and opinions expressed in this commentary are solely those of Drs. Jeng and Coleman and do not necessarily reflect those of the American College of Surgeons.
