Two years ago, Jeremy Lazarus, M.D., psychiatrist and vice speaker of the
AMA House of Delegates, gave a lively presentation at the APA annual meeting
on the importance of advocacy as a core competency. The presentation was aimed
primarily at residency directors.
Then a PGY-3 sitting on the sidelines for his presentation, I heard
residency directors puzzling over how to add advocacy to the residency
curriculum. Since hearing Dr. Lazarus's presentation, though, some thoughts
about training for advocacy have been percolating in my mind.
For three years, I've been fortunate to represent the American Academy of
Child and Adolescent Psychiatry (AACAP) in the AMA's Resident and Fellow
Section (RFS). I initially had some level of discomfort with the conservative
reputation of the AMA, but I realized that change must come from within the
organization. I was excited to see that physicians were already pointing the
House of Medicine in new directions.
As I have spent more time in the RFS and been able to see the work of
psychiatry's representatives in the AMA House of Delegates, I have come to see
the power of a unified voice representing all physicians. This power is most
dramatically brought to bear upon issues that affect the entire profession,
such as Medicare reimbursement and medical liability reform.
Over the past year, I was able to see firsthand another example of the AMA
and allied specialty societies speaking with a unified voice. As the Roper
v. Simmons case on the death penalty for adolescents approached the
Supreme Court, I developed a resolution in the RSF that asked the AMA to
oppose executing juveniles. I found co-sponsors for the resolution, including
David Huang, M.D., a psychiatry resident who was the chair of the Texas
Medical Association Resident and Fellow Section. I also found support from the
Resident Section of the American Academy of Pediatrics.
As we moved forward with the resolution, it came to light that the American
Academy of Pediatrics did not have official policy on this issue. The Resident
Section's support pushed that organization to issue an official policy
statement opposing the juvenile death penalty. In the end, the AMA signed on
to a joint amicus brief with AACAP and APA that argued against executing
juveniles. The voice of physicians in multiple specialties speaking together
weighed heavily on the decision rendered by the Supreme Court, which cited a
number of the references from the amicus brief in its majority opinion.
The AMA has also had a major impact on the training experience of
residents. The efforts of the RFS and the AMA in support of residents tilted
the tables toward work-hour reform by the Accreditation Council for Graduate
Medical Education. The 80-hour workweek was a change that almost every
physician knew made sense, but until residents found their voice as advocates,
the old system of q3 call and sleep deprivation went ahead unchecked.
Another example of the AMA's power is scope-of-practice legislation, where
the AMA works with state medical societies to educate legislatures.
The unified response of local physicians is crucial when legislators
experience a barrage of lobbying from psychologists seeking prescribing
privileges. The advocacy and presence of psychiatrists in local and state
medical societies remind our fellow physicians (and ourselves) of our place in
the House of Medicine.
The AMA has extensive outreach efforts to residents, including fellowships
that fund trips to Washington, D.C., in March for Lobby Day.
Two years ago, a resident parlayed a Lobby Day conversation into a role
drafting health care policy for Sen. Joseph Lieberman's campaign to win the
Democratic nomination for president in 2004. The RFS also has a two-day
meeting preceding each meeting of the AMA House of Delegates. The interim
meeting in November included seven psychiatry residents.
For residents, the decision to join the AMA should be an easy one. We can
join for only $40 a year if we sign up for the duration of residency. As an
added bonus, AMA resident members receive both JAMA and the
Archives of General Psychiatry. For only $40, we can learn to engage
in the issues in medicine and in psychiatry, helping to educate the public and
politicians about the issues that we see firsthand in our daily practices. We
can enjoy the fellowship of physicians of all specialties. We can assume
positions of leadership, like Michelle Nichols, M.D., a psychiatry resident at
Washington University, who is serving on the Governing Council of the AMA RFS.
We can begin to learn advocacy as a core competency. ▪