1. How did you become involved in advocacy and how can residents become involved in advocacy?
As a medical student from the United Kingdom, I never knew of the field of PM&R. I initially came to the United States to pursue a PhD during a sabbatical as an orthopaedic resident. I had realized that surgery was not for me and it was during this time living in the U.S., that I found the field of PM&R. Once I found about it, I realized the importance of care PM&R physicians provide for individuals with and with and without disabilities. So, advocacy for both our specialty and the individuals we treat became of significant importance to me both in residency and as an early-career attending. As a resident, the best way to get involved is to start locally, for example, joining your house staff association, joining volunteer organizations in your university or PM&R interest groups. These organizations give you an opportunity to learn about issues impacting the physicians at your organization, us as PM&R physicians and the communities we serve. Nationally, joining the AAPM&R’s PHiT Council Board (this was something I did as a resident) or your local AMA chapter is also another great way to increase your level of advocacy and experience. In addition, the AAPM&R also has periodic ‘Voter Voice’ campaigns, so signing on to one of those also increases the impact of PM&R in Congressional offices and makes sure your voice is heard.
2. How do you explain advocacy to your children or patients?
To my children I would say that advocacy is speaking or writing in defense of a person or cause that you believe in. For patients I would say that as a physician in healthcare advocacy, I am an advocate to promote changes to reduce healthcare threats and/or optimize the quality of life of the individuals we treat. Often this involves directly advocating for physicians, the well-being of whom is important to providing optimal care to our patients.
3. For physiatrists, what is the most important issue for which to advocate at this moment?
Currently, the biggest issue comes from the burden of prior authorization (PA). PA is a process used by health insurance plans requiring physicians to obtain approval before providing care to patients for covered services. We know that this burden is having a significant impact on the burnout many in our specialty are facing. This process is a major burden for PM&R physicians, delaying the care of our patients and potentially leading to negative health outcomes. One half of Medicare beneficiaries are covered by Medicare Advantage (MA) plans. Physicians working in inpatient rehabilitation facilities (IRFs) have reported that an inordinate number of prior authorization requests for IRF care are initially denied by MA plans, forcing acute care hospitals to send patients to less intensive, and potentially inappropriate settings of post-acute care. Data from the Medicare, Payment Advisory Commission (MedPAC) has shown that MA beneficiaries receive one third the access to IRFs that traditional Medicare beneficiaries receive. There is potentially upcoming bipartisan legislation that the AAPM&R has been highly supportive of that we hope will be re-introduced into congress soon to deal with this issue - ‘Improving Seniors’ Timely Access to Care Act.’
4. In your advocacy experience so far, what victory would you like to highlight?
There have been many highlights and rather than picking one specifically I would say the biggest victory has been our standing at Congressional offices. When I first started as a volunteer on the Health Policy and Legislation Committee (HP&L) several years ago, when we would visit Capitol Hill, there was a significant lack of knowledge as to what PM&R is. Over the last few years, I have noticed a major change, in that major governmental organizations such CMS (Centers for Medicare and Medicaid Services), the Office of the Inspector General (OIG), MedPAC as well as senior Congressional offices and staffers are calling on us as physiatrists through the AAPM&R for our opinion on topics pertaining to rehabilitation. We are often seen as important parts of the healthcare system and can now focus more on our issues during our visits rather than explaining our specialty.
5. How does advocacy play a role in the future of PM&R?
Advocacy is pivotal to our specialty's future stability and viability. We need to be advocates for ourselves and our patients in local, state and federal systems to maintain the future of our specialty and individuals’ access to care. During the pandemic, our specialty’s standing in healthcare really improved, as we were seen as integral parts of the healthcare system. Due to our training, we’re a specialty that really came forward in a massive way to help these individuals with serious illness integrate back into the community. There remain many threats that our patients and the future of healthcare face, and we as a specialty need to continue to be seen as part of the solution by advocating for ourselves. If you don’t have time to get involved in advocacy yourself, an easy way that you can support advocacy initiatives as PM&R physicians is being a member of AAPM&R. Your membership goes toward much of the advocacy AAPM&R is doing on all our behalf.