Study probes what helps and hinders physician advocacy
Whether they’re advocating for a single patient or calling for changes to the health-care system, advocacy is a key part of being a physician.
A new study led by Toronto researchers suggests that formal training and institutional culture can help support physicians in this part of their role. The paper was published in the Canadian Medical Association Journal.
“The health information ecosystem is rapidly changing and there are more complexities at play today, in part because the pandemic taught us all about the need to have skill in this area,” says the study’s senior author Blair Bigham, an assistant professor at the University of Toronto’s Dalla Lana School of Public Health and the Temerty Faculty of Medicine’s department of medicine. “The scholarly literature around how to teach and do advocacy work is much more evolved than it was then.”
The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, national bodies that oversee post-graduate medical education in this country, include ‘health advocate’ as a core competency for physicians.
National frameworks in Australia, the United Kingdom and the United States also list advocacy as a critical skill.
Bigham notes that few residency programs in Canada have structured advocacy curriculums to meet the CanMEDS standard, and that current offerings are usually didactic, rather than hands-on or practical experiences.
"Many medical educators would find single-patient, on-shift advocacy to be a sufficient example of being a health advocate,” he says. “For example, urging for a patient to receive a timelier medical test or specialist appointment.
“But an evolved and widely accepted definition of advocacy is that that is just part of a physician’s regular work. Going beyond the clinic walls and one-on-one patient-physician relationships to more public-facing advocacy requires a different skill set.”
The team spoke with 27 physician advocates from a variety of backgrounds, clinical specialties and career stages across Canada about their experiences and insights.
From those discussions, the researchers identified seven themes that influence physician advocacy, ranging from intrapersonal factors such as motivation from personal experiences to organizational variables like whether advocacy work would be considered in hiring or integrated into their work through protected time.
Physician advocates who have had training, coaching or mentoring also reported greater success advocating earlier in their careers than those who had to learn more independently and informally through ongoing experience.
Colin Whaley, the paper’s first author and an internal medicine resident at Temerty Medicine, says participants unanimously spoke about the importance of mentorship and expressed how lonely and isolating advocacy work can be.
“Despite this, we also found that people reported that doing this kind of work helped alleviate some of the moral distress they experience day in and day out,” he says. “We found that there was a lot of self-reported moral injury and burnout because physicians might now know how to fix many of the problems they see, but the unfortunate reality is that we operate in a resource-constricted environment and can’t always affect the changes we’d like to see.”
The researchers also found that when physicians had a ‘hero’ in mind to advocate for, like a family or community member or another physician advocate, provided respondents with strong motivation to advocate.
Conversely, the greatest barrier was the fear of blowback, ranging from online trolls — anonymous commenters who make inflammatory arguments in bad faith — to illegitimate complaints made to regulatory bodies, or retribution from their employers.
The study’s release comes as the Royal College works to revise its framework, which was last updated in 2015.
Doctors who advocate find it difficult but rewarding, and say the benefits almost always outweigh the risks, notes Bigham, who was also chair of the Royal College’s advocacy working group.
“Similar to performing a medical procedure, there are indications and contraindications. And sometimes, there are unintended outcomes,” he says. “But our participants found they could navigate those challenges and still have a positive impact for their patients or experience personal benefits like contributing to career progression, acting as an antidote to burnout or boosting satisfaction in one’s work.”
The team hopes the paper will help increase awareness among their peers.
“Not everyone’s path is going to lead them to a provincial legislature or Parliament Hill, and that’s okay,” Whaley says. “But it’s important for them to have a foundation so that if they want to become involved in advocacy, they’re prepared. And there are so many amazing folks in our health-care system across the country who want to support them.”
