Health Policy and Advocacy

Join us in learning from guests Dr. Zoe Tseng and Dr. Ankita Sagar about the fundamental importance and role of advocacy and policy work in healthcare. Listen in to learn practical tools and strategies for advocacy at the local, regional, state, and national level, so that you can effectively incorporate this work into your career.

Learning Objectives:
1. Describe the role of advocacy in healthcare. 
2. Describe the mission of ACP as a regional and national physician advocacy organization.
3. Identify tools to effectively advocate for public policy at local, regional, state, and federal levels.
4. Implement strategies for community and civic engagement, such as coalition building, social media engagement, and grassroots organizing. 

Episode Credits:
Guests: Dr. Zoe Tseng, Dr. Ankita Sagar
Co-Hosts: Dr. Elisa Choi, Dr. Branden Barger
Executive Producer: Dr. Tammy Lin
Co-Executive Producers: Dr. Pooja Jaeel, Dr. Tiffany Leung
Senior Producers: Dr. Maggie Kozman, Dr. DJ Gaines
Editor/Assistant Producer: Joanna Jain
Production Assistants: Alexandra Babakanian, Ann Truong, Likitha Aradhyula
Website/Art Design: Ann Truong
Music: Chris Dingman https://www.chrisdingman.com

Continuing Medical Education/Maintenance of Certification (CME/MOC) credits are available as an American College of Physicians national member benefit. To submit for CME/MOC credit for this episode, visit: https://assets.acponline.org/cgi-bin/moc-quiz?deip-20211215

Connect with us on Instagram at @thedayshift.pod and via email at thedayshifthealthcare@gmail.com

Transcript

[0:00] Branden: Welcome to the DEI Shift, a podcast focusing on shifting the way we think about and talk about diversity, equity, and inclusion in the medical field. I'm Branden Barger, a second-year medical student, and my pronouns are he, him, his.

Dr. Choi: I'm Elisa Choi, an internal medicine and infectious disease specialist and cohost of today’s DEI Shift episode. My pronouns are she, her, hers.

Branden: Today we'll be talking about health policy and advocacy for physicians and clinicians, and we think that this is a really salient topic for today and in today's day and age, because last year as the COVID-19 pandemic unfurled and sort of the sequelae of federal and state mandates rolled out, it became increasingly clear to many physicians that we have a growing and ethical responsibility to advocate not only for our patients, but for ourselves as professionals and for the policies and guidelines that inevitably impact all of us who work in the health profession. This particularly is relevant as we continue to battle health misinformation surrounding the COVID-19 pandemic, uh, clinical research, public health vaccination efforts, et cetera.

And really even in a non-pandemic setting, physicians are constantly struggling with the ever increasing pace of new research, updated therapeutic guidelines, greater public health insurance and policy concerns that really established these multilevel facets to delivering effective patient care. In addition, the ethos of clinical medicine is changing to better recognize how patients' cultural backgrounds, as well as their thoughts and hesitancies with certain types of care or how they feel, uh, engaging with certain medical staff, all may define their opinions of healthcare for years to come. Today, we're privileged to be joined by two amazing physician leaders and advocates, uh, Dr. Zoe Tseng and Ankita Sagar, who will be sharing a little bit about their professional journeys, as well as their inspiration for doing a lot of the advocacy work that they'll talk about. Hopefully they can also share with us some nifty tips and tricks with our listeners for how they too can get involved with health policy and advocacy.

[2:04] Dr. Choi: Thanks Branden. Today, we are joined by two colleagues, Dr. Tseng and Sagar. Dr. Zoe Tseng is an internal medicine specialist and primary care physician practicing in the greater Boston area of Massachusetts. She's also an instructor at Harvard Medical School, a member of the Massachusetts Chapter of the American College of Physicians Governor's Council, and co-chair of the Massachusetts ACP Chapter’s Health and Public Policy Committee. Dr. Tsenghas received state and national award recognition for her health policy advocacy efforts. She is faculty advisor and lecturer in her institution's internal medicine residency’s social justice and advocacy curriculum. She also serves as the faculty advisor for the Harvard Medical School Internal Medicine Interest Group.

Dr. Ankita Sagar is an internal medicine specialist and primary care physician practicing in Long Island, New York. She's an associate professor of medicine at Zucker School of Medicine at Hofstra Northwell Health. She is the current chair of the Early Career Physicians Committee for New York Chapter of the American College of Physicians. She serves as a member of the Council Early Career Physicians for the American College of Physicians. She is the director of Internal Medicine Health Policy at her home institution. Her efforts in the area of public policy, advocacy, amplification of women in medicine and physician well-being have been recognized regionally and nationally.

Branden: Wow. I'm so excited to have you both on. You both are so amazingly accomplished in your careers. Excited to hear what you guys have to say.

Dr. Tseng: Hi, my name is Zoe Tseng. I'm so thrilled to be here to share the space, to speak about advocacy, which I love doing. My pronouns are she, her, hers.

Dr. Sagar: Hi, this is Ankita Sagar and thank you so much for inviting me to record this episode of DEI Shift. I'm very excited to be here, big fan of everybody on this episode and my pronouns are she, her, and hers.

[4:07] Dr. Choi: Well, before we get started with today's topic, we'd like to get to know each of our guests a little better. We typically start every episode with a step in their shoes where we ask guests to share an element of their background or culture that has been important in their life and personal journey. We'll start with you, Dr. Sagar, share with us something that allows us to take a step in your shoes.

Dr. Sagar: I am a new mom to a fur baby who is 10 months old, my shih poo puppy named Mowgli and he has definitely been a joy to have in our home and somebody to come home to after a very long day. Hard days, good days, he makes them much better. Mowgli loves blueberries and watermelon, but I think what he loves the most is toilet paper. So my shoes have been busy running after him was trying to save my toilet paper during a pandemic. So, yes, it's a good time.

Dr. Choi: I love that name, Dr. Sagar, all this talk of saving toilet paper brings me back to the very start of the COVID 19 pandemic. I hope we don't go back to that level of scarcity of toilet paper.

Branden: And my question is, does Mowgli have an Instagram account?

Dr. Sagar: He’s not on Instagram, but he is on Twitter and we will happily share his handle at the end of our episode.

Branden: And what about you, uh, Dr. Tseng?

Dr. Tseng: Yeah, so it's been pretty hot and humid lately in the Northeast, and this reminds me of, my childhood, growing up, or spending the summers in Taiwan, where my family is from and we would spend every summer there with family and, enjoying our childhood summers and the yummy food that Taiwan has to offer.

Branden: I love that and what is your favorite food from this season?

Dr. Tseng: So of course it's the summer, so you gotta have something cold. So, and Taiwan is a tropical island so there are many things, foods that keep us cold, but, uh, specifically there's shaved ice, uh, of which there's many different toppings that you can pile on it. And, also bubble tea, which was originally invented in Taiwan.

[6:37] Branden: I'm so glad we got to get to know a little bit about you, both, uh, jumping into today's topic, I think it would be great to touch on sort of our mutual connections through ACP or the American College of Physicians. So for those who may be unaware and tuning in and are unfamiliar with ACP as an organization, uh, can one of you share a little bit about what ACP is, what it does as an organization, and how you got involved? Let's uh, let's start with you Dr. Tseng.

Dr. Tseng: So ACP is the American College of Physicians and we're a national organization of internal medicine specialists and subspecialists, we are the largest medical specialty organization, the second largest physician group in the United States. There are 161,000 members, including internists, sub-specialists, medical students, residents, and fellows. In terms of how I got involved in ACP, this probably goes back to my medical school years where I became the leader of our school's Internal Medicine Interest Group, which is sponsored by ACP.

And through that, I got to learn about what ACP does and the perks of the free membership includes, you know, being able to attend meetings and from there, I would attend the National Leadership Day, which is where ACP organizes a two day event in DC to train people, to go and speak with their legislators and get some background on policy issues and then have their opportunity to have meetings set up to meet with their legislators. So this, I found super exciting, and that was probably one of the formative events that got me involved in ACP and advocacy.

[8:27] Branden: You both do a fantastic amount of work in the field of health policy and, as both of you mentioned health advocacy, but those tend to be some fairly amorphous terms. So I’d love it, if you could, both kind of in your own words, describe what health advocacy means to you. And I'll, I'll throw it back to you, uh, Dr. Sagar.

Dr. Sagar: Sure, so I've been thinking about this question since you offered it to me of how do I define health advocacy? And to me it really encompasses a few things. It encompasses recognizing, promoting, as well as perhaps, defending and also sponsoring policies and thoughts and research for both clinicians, but more also patients and healthcare workers to make it so that the system is that much better for the generations to come forward. So to me, health advocacy is a pretty broad term that you can find yourself a little niche within it fairly easily.

Dr. Tseng: I agree with, uh, Dr. Sagar, advocacy is quite a large field and I don't know that there's any official definition for at least when it comes to physician advocacy, but the way I see it is it's about how I, as a physician can help the patient sort of beyond the immediate clinical encounter. So for me, that might be figuring out how to make sure their referral to a specialist is addressed in a timely way and thereby improving the system that I'm working in or the institution, or even calling or writing a letter to the patient's insurance company to get a certain medication authorized, or it could be addressing the rising costs of prescription drugs through legislative means. So I think there are different, many levels that we can advocate, and it depends on what the issue is and what we think might be the most effective way to address that issue.

[10:59] Branden: Dr. Sagar, uh, just giving kind of your work in recent, uh, COVID advocacy or just general physician wellness, in your opinion, sort of what are, what are some of the most prevalent advocacy and policy concerns that you think will start to impact physicians and patients in the foreseeable future.

Dr. Sagar: Thank you for the question. I think it's a really important question because I think we are at a time in healthcare system, both delivery, patient experience, clinician experience that advocacy is really important because some of the key concerns that we may be facing shortly ago are going to be, first and foremost, uh, public health safety, and public health advocacy for evidence-based medicine when it comes to COVID pandemic, when it comes to structural racism when it comes to even some things that we find to be very bread and butter medicine like cancer prevention or screening tests.

I do think that advocacy on behalf of a lot of these vulnerable populations is going to be very important in the coming years. The other concern that I have for our clinician and healthcare teams is going to be wellness. And I want to separate wellness from burnout because they're two separate concepts, but really to be able to ensure that our colleagues, our peers, our team members are, are feeling fulfilled and finding joy in their work, but also feeling that they are able to manage and integrate life with work, and also being able to manage the emotional toil that sometimes healthcare members and clinicians and physicians specifically maybe faced with when, especially during pandemics of varying degrees. I do think that these are very closely tied to ACP and I think that ACP has done a phenomenal job in both making sure these are legislative priorities, but also have a strong support across their health policy and advocacy committees, to be able to really find traction, to make some of these things a reality for a lot of our team members and patients.

Dr. Choi: That was very powerful. Dr. Sagar. I wanted to turn it over to Dr. Tseng and ask you if there were any additional advocacy or policy concerns from your perspective that you find would be priorities that will impact physicians and patients in the coming years.

Dr. Tseng: Yes. As Dr. Sagar mentioned, I think COVID-19 pandemic has really shown us the, shed a light on all the social determinants of health that we know really impact people's health. So, for example, housing, food insecurity, these became very apparent, during the early, early days of the pandemic, as particularly important to keep people safe and healthy and, and sort of reduce their risks of COVID. I think also at the same time with people losing their jobs or the economy taking a turn, it became also quite important to address the costs around healthcare. So for example, costs of care, out-of-pocket costs, prescription drug costs, and insurance coverage, particularly Medicaid as many individuals during the pandemic have lost their job and needed to enroll on Medicaid. At the same time, ACP has been looking at this issue of insurance coverage and has put support for universal coverage.

I do think that in the coming years, that this will be increasingly important to address. Because if we do not solve this issue of insurance coverage, we will continue to leave, you know, thousands of people, Americans not covered and in poor health as a result. I think COVID-19 has also shown us how racial disparities in the delivery of healthcare has really impacted people's health, particularly around COVID-19. How particular groups of people have been disproportionately affected by COVID-19 and this, some of this stems from, you know, years of racial disparities in healthcare. So I'm glad to say that ACP has been looking internally to ensure that it is addressing racial disparities in health and advocating for changes to improve the health of our entire community. So I believe the next few years, the most important advocacy related issues will be around these areas of social determinants of health, costs and cost of care, and racial disparities.

[16:59] Branden: Keeping some of these sort of concerns in mind... for the folks who are interested in advocacy related work, how to go about advising people anywhere, sort of on the healthcare profession timeline, how to get involved?

Dr. Tseng: So I currently serve as the co-chair of the Massachusetts Chapter Health and Public Policy Committee and I would say this is a great way for people to get involved at any level. Every ACP chapter should have a Health and Public Policy Committee. Basically, this committee meets together to address issues that are important, both to the members of the chapter, as well as to ACP’s priorities. For example, in Massachusetts, we have grown our Health and Public Policy Committee from what was maybe two handfuls of members to now two to three dozen members over the course of the last five years. Our members include medical students, residents, fellows, and attending physicians.

The reason I suggest getting involved through our Health and Public Policy Committee is because I think for many of us, it's hard to stay up to date on what's going on. And so the Health and Public Policy Committee leaders are typically informed and have ways that they are staying in touch with the most up-to-date state and national issues related to healthcare and be able to direct you more on how to help on the issues that you feel strongly about. Another way to get involved is through your state medical society. We work very closely in Massachusetts with our medical society. We meet with them regularly in order to stay on top of what's going on.

Dr. Sagar: I think having experience means to approach your professional society or an interest group within your school or your training program and finding those folks who are willing to identify an issue, a concern, something that needs rectification and then finding the right person to help you build your advocacy platform. One of the things I want to stress though, is sometimes we don't necessarily have an idea that we want to fix. And that's okay, but once we start seeing how other people are thinking about solutions or thinking about advocating on behalf of solutions and changes slowly, slowly, you develop those ideas and you develop a way in which you approach them.

One thing I'll add is, even if health policy seems like a very large umbrella to tackle, most professional societies that could speak for the New York Chapter of ACP, we have a council of early career physicians, we have a committee for residents, medical students, and fellows. So these are great ways and opportunities to get involved and kind of dabble your feet in policy and advocacy without necessarily taking on a large project.

[21:45]Branden: I'd love to sort of end our conversation on a really positive and actionable note. And it would be wonderful if you both could kind of share two tips for our listeners on how they can get involved with advocacy or be a better advocate.

Dr. Tseng: So I think the number one tip is just caring for people, your patients, an issue, and having that care for that particular issue is going to allow you to speak from the heart and with passion. I think number one is to have that passion and be able to convey it and also be able to accept that there's some discomfort with some of these advocacy skills that you may not have, or that you're learning to develop. The only way we get better at it, certainly, is practicing it. Learning how to communicate effectively, write something, talk to your legislator—these are all skills that we can learn.

The second tip I have is to learn from others. Most of us I think, are not experts in every issue and I think particularly around health care systems and the nuances of health policy, it can get very complicated. So find those around you who are passionate about your particular issue and use their expertise to help guide how to advocate most effectively. I would encourage anyone to get involved in your state’s ACP chapter.

Dr. Sagar: I agree with Dr. Tseng, I think she's given excellent tips. Practicing advocacy skills is very much like practicing your physical exam skills or interpreting labs or images, it takes a little bit of time, but you need to partner to practice it on. We want to have a very clear ask and we want to have a very clear story behind our ask. This can be true whether you're going to a legislator, or whether you're going to your boss to ask for a raise or negotiating new contracts. I use my husband all the time as my practice partner and he's not in medicine. So if he can do it, anybody can be a good partner. So tip number one, I agree with Dr. Tseng.

The other tip I would give is try to find a professional society with whom you find a similar vision, are you aligned on values? For me, it's been ACP. It's helpful to have that community near you, that you can contact. And I know you asked for two, but I'm going to give you a third one for free. And my third one is going back to what I said initially, you don'thave to have the idea to start advocating sometimes just being in a community you can find the cause that you're passionate about, and you can find the mentorship and sponsorship to really help you advocate on behalf of it.

[27:13] Branden: I love all of those tips, thank you both so much for sharing some of your unique wisdom today. And I really hope our listeners were able to get some really nice pearls from hearing from your experiences.

Dr. Choi: I also want to echo Branden's thanks to our two superb guests, Dr. Zoe Tseng and Dr. Sagar. I personally have learned so much. I will echo what Dr. Tseng and Sagar have said and encourage you to find your community. Coordinate, communicate, collaborate, and form your community. As our guests articulated, you don't need a title. You don't need a degree. You just have to care to be an advocate. Thanks to our listeners for your attention.

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