my wonderful presenters, Dr. Megan Schott, Dr. Karen Pierce, Dr. Jennifer Doerr, and of course myself. And I'll start with just giving some introductions to Advocacy, the Nuts and Bolts. I have no disclosures, but I want this to be as interactive as possible. So if you could, please scan the QRS code, scan the QRS code, and we're going to play along too. Thank you, thank you. All right, if you got it, then we will keep it moving. So what words come to mind when you think about physician advocacy? Just simple words, time phrases, just words. I see change, right, right standing, policy, legislative, parody. We'll take a couple more. Perfect, thank you. So let's start with a working definition of advocacy. So advocacy is a set of targeted actions directed at decision makers in support or opposition of a specific issue. Now when we think about physician advocacy specifically, we're talking about the public voicing of support for causes, policies, or opinions that advance patient and population health. Now, you've already been doing advocacy all this time when it comes to advocating at the bedside when patients need to be admitted or need to be up on a certain medication. So some of those same skill sets that you use there can be utilized when we're talking about advocating at the hospital level, the local level, the state, national, and even globally. So another poll. What are the strengths that you uniquely bring as a psychiatrist to advocacy? Yes, we have a wonderful knowledge base, experience, we have great assessments, we have the rapport of our folks, and we can give voice to our patients' experiences. All right, perfect. So now we will shift to what do you feel are your specific areas of interest when we talk about policy and advocacy? What is that unique thing that you feel like you should move forward? So addiction, most certainly, and I know that'll be the next main focus of APA for the presidential initiative. Access to care, always something that's important. Children's mental health, I know that all of us as panelists are child psychiatrists. Veterans' mental health, very important. Education, gun laws, so a lot of great topics. Now, we're actually going to hear from some of our orthopedic colleagues that are going to talk a little bit about the importance of physician advocacy, and I'll highlight a couple of things. So we'll start that. The specifics of health care are complicated, and no one understands that issue better than a physician. We're really the boots on the ground. We're the ones in the exam room with the patient. We're the one listening to the patient and what they're going through, both clinically in front of us, as well as all the behind the scenes in terms of administrative and financial burdens. It is critical because we know more about our field and about what benefits our patients than anyone, and we have to serve in an educational role for legislators who might not understand medicine, and they certainly won't understand orthopedics besides maybe their own orthopedic injuries. And so it's really important for us to bring that message to Capitol Hill and to allow our legislators to have a full understanding of what we do and what we do for patients most importantly. And, you know, replace orthopedics with psychiatry, and you'll get the point. You know, legislators aren't necessarily going to understand mental health in the way that we as experts might outside of their own experiences, the experiences with their family. And we have firsthand clinical experience that can be compelling, memorable, and persuasive. And also, we're rooted in evidence-based to help change systems of inequity and structural factors. And lastly, I just want to emphasize that things that affect patients and patient care is in our lane. So that includes addressing health equity and healthcare infrastructures, addressing the workforce shortage, reimagining models of care. That includes making policies and practices that affect our patients, for instance, gender care, reproductive rights. Our speakers will showcase how we can embody this across the lifespan. And before then, I want to talk about how we as psychiatrists and mental health professionals are uniquely positioned to do so. First, like I mentioned before, you put a human face to advocacy. You care about your patients every day who've been affected by the greater health and social systems. When you tell your story, you make that issue of mental health real to people in a way that fact sheets and statistics alone just do not. Credibility. By the nature of your profession, education, and training, people in your community respect and trust you. When you speak on behalf of any issue, you bring credibility to that issue. Influence. Because you instill trust and are credible, you can easily inspire others to get involved in health issues. Others in your community will be influenced by what you have to say and will want to be a part of your efforts. Your patients are depending on you. Some of the patients that you care for can't vote. Many do not have the power to advocate for themselves. They need us to tell their story through advocacy, and we can help ensure that decision makers don't just say mental health is a good issue but actually act on the issue. Passion. Advocacy allows you to dig deeper into your interests and touches on why you became a psychiatrist in the first place. Through advocacy, you can channel your passion for mental health into meaningful and lasting change. Skills. Psychiatrists already have the skill set of an advocate. The same skills, like I mentioned, that you use every day to establish trust, rapport, and develop relationships and provide solutions to your patients can be applied to advocacy work. Research is on your side. The issues you care about are backed up by research, and through advocacy, we can convey both the personal and factual importance of the issue. You aren't alone. Through advocacy, you join other psychiatrists who, through the APA, residency programs, and other mental health partnerships, have made mental health a priority, and we can demonstrate strength in numbers. And then one of the key things is it's a part of the profession. Psychiatrists of the APA, in part, founded it to ensure patient advocacy received a higher priority. Advocacy allows us to help improve the lives of our patients and also increase the strength of the profession at the same time. So, as mentioned, advocacy is in the DNA of psychiatrists. So, now I'll turn it over to Dr. Doerr. All right. Thank you so much, Dr. Newsome. We're all very excited to be here this morning. Advocacy is one of our passions, and we're very excited to help share and empower you to become advocates, which you already are doing, as Dr. Newsome had said. So, my name is Jennifer Doerr. I just finished my Child and Adolescent Psychiatry Fellowship last year, and this is my first year as an attending. I work at Children's National in D.C. and have the first position for integrative care and oncology, focused on neuro-oncology. I'm very passionate about child and adolescent psychiatry, psycho-oncology, and advocacy. I'm here to discuss the many ways you're able to become involved in advocacy during training. So, I've had quite a lot of training. I started off in pediatrics, switched to psychiatry, and then went to child and adolescent psychiatry. I would like to say I've been an advocate for my whole life, as my grandmother, if she were still alive, would say the same thing as when I was in first grade, she went to pick me up from school, and I was breaking up a fight between fifth grade boys. So, I've always had a strong sense of human rights, and it's always been very important to me. So, I'll discuss official ways I'm involved in advocacy and how I started all of that during training in the slides to come. I have no disclosures as well. So, I'd like to start off by this quote by Dr. Felusi, who is the Medical Director of Advocacy Education at the Child Health Advocacy Institute at Children's National in Washington, D.C. The pandemic highlighted what we already knew, that physicians cannot just sit on the sidelines when it comes to policymaking. We must bring our scientific expertise and patients' experiences to the table. Further, the American Medical Association, through their Declaration of Professional Responsibility, encourages all physicians to advocate for, quote, political changes that ameliorate suffering and contribute to human well-being, unquote. So, a lot of people ask, why should we be involved in advocacy? Isn't that for lobbyists? Isn't that what our organization does on a national level? Can't I just be involved in helping my patients on an individual level? Well, yes, this is advocacy, helping your patients on an individual level. There's so, so, so much more that I believe we're called to do as a profession. Policymakers want to hear from us. We're the experts in our field. If they don't hear from me and you, they'll hear from somebody else about our field. And that may be the only information they get about psychiatry, whether factual or not. So, I just want to go through this picture I thought was really interesting. It just shows some ways you can advocate. So, you can, yes, climb to the top of a mountain and yell. You can also post on social media. You can testify to legislators. You can write op-eds. There's so many ways you can become involved in committees. So, there's so many ways to become involved in advocacy. You're probably already doing a lot of this without even realizing it's called advocacy. So, the Accreditation Council for Graduate Medical Education, or the ACGME, and the American Board of Medical Specialties, the ABMS, has developed six core competency domains for physician training programs. These are patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The ACGME program requirements for pediatrics residency state that programs should include elements of child advocacy education. And that is a required element of pediatric residency education. Further, the ACGME actually requires ambulatory experiences to include elements of community pediatrics and child advocacy. However, the ACGME program requirements for psychiatry state that residents must demonstrate competence in advocating for the promotion of mental health and the prevention of mental disorders. They don't have a required rotation, however, and most residency programs don't have official advocacy training in their curriculum. Thus, advocacy is not actually a training requirement in psychiatry residencies. Specifically, including this in the curriculum, like pediatric residencies do, would allow residents and their mentors to carve out specific time in training to focus on advocating for their profession. So next, I'm going to go over advocacy curriculums. And there's several out there and ways that trainees can become involved. So many psychiatry residencies are implementing specific advocacy curriculums or offering specialized programs in advocacy for their residents to participate in. An example of an advocacy organization specifically for trainees is White Coats for Black Lives. This is a medical trainee-run organization born out of the National White Coat Die-In demonstrations that took place on December 10, 2014. Their mission is to, quote, dismantle racism and accompanying systems of oppression and health, while simultaneously cultivating means for collective liberation that center the needs, priorities, and self-determination of black people and other people of color, particularly those most marginalized in our communities, end quote. Another great example is the organization Med Out the Vote. They offer institution-specific voter registration resources through the Healthy Democracy Campaign. Thus, medical schools are able to keep track of voter registration and absentee ballot requests that they facilitate. Their website states, quote, these numbers feed into a national movement to normalize civic engagement as a dimension of health care, end quote. So what this organization does is allow health care professionals and trainees also to register to work at polls and overall become more involved in having their communities vote. So helping to get the word out, to help people register to vote, you're not pushing a position, you're not pushing a candidate. You just want people to use their right to vote and become involved. There are also many, many formats I found in which advocacy curriculums are designed in residency, in psychiatry residency. According to the 2021 academic medicine study, as of 2020, 71 percent of MD medical schools provided at least one course that covered advocacy. Further, also in 2020, the Association of American Medical Colleges, or the AAMC Curriculum Inventory, showed that almost 1,200 medical schools covered policy or advocacy versus only 696 in the year 2013. This increase demonstrates the increasing awareness and acknowledgement of the importance of starting to provide advocacy at knowledge and skills in a medical trainee's career. There are opponents of this, including advocacy in medical schools and residency, perhaps feeling that it takes away from time spent on scientific and medical knowledge. However, advocates point out that health and being a physician, and I would point out being a psychiatrist specifically, or other mental health care professional, requires that we help our patients meet their overall health goals. And this does not include just learning about diseases and medication and surgeries, but also an understanding of social equity, determinants of health, access to mental health, addressing increasing the mental health workforce, and promoting diversity and equity in the field of mental health. I was at a talk yesterday, and Dr. Ng, the president of ACAP, said that 80 percent of health outcomes are determined by the social determinants of health. So I think that it's fair to say we have to become involved in more than just illness, disease, and medication. There are ranges in ways that advocacy curricula are delivered. There are programs that offer an 80-hour, two-week elective, and programs that include monthly lectures over two years during their didactics. At Children's National and the George Washington University in D.C., there's an elective entitled the Residency Fellowship in Health Policy. This is a program that includes three weeks of hands-on training in advocacy for residents and fellows. Some residencies require this program, and some make this optional. From their website, it quotes that the program, quote, provides multi-specialty resident and fellow physicians with an understanding of U.S. health policy and its implications for medical practice and health care delivery, unquote. And this uses the combined resources of the Milken Institute of the School of Public Health at GW, the GW School of Medicine, and Children's National. I myself obtained my MPH from GW and was part of this program, and as was Dr. Newsome. And I think we both found it very, very beneficial during our second year of fellowship. So the fellowship also includes meetings with key leaders in health policy. Another example of a new advocacy curriculum established at our fellowship at Children's National is a program of approximately four didactic sessions during the first year of fellowship focused on learning health policy and advocacy, and ending in a simulation in which fellows practice advocating for a specific bill to one of their legislators. Then during the second year of fellowship, there are further didactics and then an advocacy project, which culminates with groups and fellows writing a one-pager on a specific mental health advocacy topic, and then meeting with one of their legislators or staffers to discuss specific bills related to the topic. Myself and also Dr. Newsome participated in this training created by Dr. Laura Willing when we were fellows, and now myself, I am one of the attending supervisors who helps to run this course. But again, all of this started my roots during training. All right. And there's just a link to the policy fellowship at the resident fellowship at GW. So next I am going to open this. Do you want to help me with this? Thanks. All right. So this is a document. I'll scroll to the top. Advocacy teaching in psychiatry residency training programs. I believe this document was made in 2018. I couldn't find the specific year, but I believe it was 2018. And it was put out by the APA Council on Advocacy and Government Relations. So it's really a great, great document. It shows a comparison of different residencies and training programs and how they implement an advocacy curriculum. And I will go to there we go. So here's an example. So for Yale, they initiated their program in September of 2016. They don't have a specific advocacy protected time. They may now. They coordinate with the Yale Policy Initiative and other Yale-based groups and programs to provide didactics, seminars, conferences, grand rounds, et cetera. And then their experiential learning is a group legislative project where they advocate for legislation during the Connecticut General Assembly by a public hearing testimony, media outreach, and coalition building. There's an example of Harvard where they do have protected time. That started in 2015, three-issue lecture series, and then informal resident reflection sessions, and then culminating with a community project competition, ad hoc experiential opportunities, staffing an asylum clinic, and advocacy day and development. The end of this document is specific advocacy curricula printed out. So if you're interested in starting something like this at one of your training programs, that's a really great resource. It literally lays out everything that they're doing. Thanks. Thank you. All right. So outside of specific training programs, all trainees including medical students, residents, and fellows are able to participate in advocacy networks and national organizations. These include the American Psychiatric Association, the American Medical Association, the American Association of Pediatrics, the American Association of Child and Adolescent Psychiatry, the National Alliance on Mental Illness, the American Medical Student Association, and the Substance Abuse and Mental Health Services Administration. And this is not an exhaustive list. Many of these organizations have a national advocacy day or legislative conference. I recently participated, I think everyone, a lot of us on the panel participated in the American Association of Child and Adolescent Psychiatry's legislative conference earlier this month. And this included two in-person days of discussing advocacy and mental health legislation, providing awards to legislators who have been champions in mental health, and then meetings with senators and representatives and or their staff to promote specific legislation on improving mental health care access, increasing diversity in mental health care, and increasing the mental health care workforce. I was the Maryland captain, which I also was during fellowships, so trainees, yes, you can have leadership roles, and was able to participate in all sessions that we had with both senators and several representatives. So I encourage all trainees to become a part of at least one professional organization and to inquire about their advocacy groups and initiatives, as most have specific spots for trainees. All right, moving on to the next slide. Focusing on these specific training opportunities, so during residency in New Jersey, I was able to really officially become involved in advocacy with Dr. Deborah Koss in the New Jersey Psychiatric Association Advocacy Committee. Then there were several work groups, initiatives, and I was also the vice president of the southern chapter of the New Jersey Psychiatric Association. Then during fellowship, I became highly involved in the Child and Adolescent Psychiatric Society of Greater Washington, which is the regional organization of ACAP, as the Children's National Liaison, then the Advocacy Liaison, and then I also recently became chair of the newly developed Advocacy Committee. I'm also part of the Washington Psychiatric Society, which is the regional organization of the APA, and I'm involved in the Advocacy Committee, as well as the Legislative Action Committee, which is a combined committee of advocates from both the Washington, D.C. regional organization and the Maryland regional organization. Further as a fellow, I ran for and became a part of ACAP's National Advocacy Committee, which has given me tremendous opportunities to participate in advocacy at the national level. So those are examples of regional and national organizations that you can easily become involved in as a trainee, and I really recommend that. There are also several medical student and resident groups and national organizations, and these can provide a hub to network and discuss and promote advocacy issues. There are also specific travel grant opportunities for trainees to be able to go to advocacy conferences, typically reporting back and or presenting to their regional organizations. Further, we discussed ACAP's National Advocacy Conference earlier, and last October, I had the opportunity to attend the APA's State Advocacy Conference in Minneapolis. This was a great way to focus on advocating on a state level and hearing from and reaching out to state legislators, as well. And this is a picture of a book, A Psychiatrist's Guide to Advocacy, that is very, very helpful, and we used that during our fellowship, as well. All right. On this slide, I've listed several trainee opportunities to engage in advocacy, specifically offered through the APA. So the first one is the Gene Spurlock Congressional Fellowship, which is an amazing fellowship. Two psychiatry residents are chosen, and you come down and you work for a Congress member. So your staff are in their office, and I think that's really a great opportunity, really exciting, and you're up in the front lines doing health policy and right there learning how to do it. There are several, like I said, APA resident fellow members on councils and caucuses. There's also the APA Congressional Advocacy Network, which you can sign up for, and they really help you to learn how to advocate to your specific legislators and learn about issues that are important in your area. You can receive the APA Advocacy Alerts, and the APA Political Action Committee is something that is the policy arm of the APA, where they donate money and help to lobby for promoting our profession. And there's a link right here, just in case you would like to list all the things that are on this page. There's several interests and areas for advocacy. A lot include inclusion, diversity, equity, anti-racism, legislative action, mental health parity, access to care, telepsychiatry, non-physician scope of practice, prior authorization, suicide prevention, naloxone access, gun violence, and 988 implementation. And that's a small portion of areas that we can advocate for in mental health. So you can find your niche. You can find what's important to you, like Dr. Newsom had us all list our areas of interest. Find what you're interested in and then advocate for it. All right. So trainees can make a difference in advocacy. This is a slide showing smoke-free airlines. A lot of us may not remember, but you used to be able to smoke on airlines. This initiative started with the medical student section of the American Medical Association, who first started the campaign to eliminate smoking on domestic flights. The students took this idea to the AMA House of Delegates, who then adopted a policy that then led to a national smoking ban on domestic flights. This picture is from 2020, which celebrated the 30-year anniversary of this. As a trainee, there are times when you're tired, facing burnout, thinking there are no options for change. First of all, burnout is a great area for advocacy as well. For me, advocacy reminds me of why I do what I do. I want to advocate for my patients and my profession. And becoming a part of professional advocacy organizations is open to all trainees. I started all of my roots in what I'm involved in now as a trainee. And this helped me during training, and it continues to help me to this day to avoid burnout by focusing on promoting improvements in our profession. Your voice, even and especially as a trainee, can and will make a difference. And for any specific questions about training opportunities, feel free to email me directly. Thank you. Thank you, Dr. Doerr. I'm Megan Schott. I am active in several advocacy organizations locally as well as nationally. And because of this effort, our own institution actually institutes a way to be a Child Health Advocacy Institute affiliate faculty member, where it even gives us even more opportunities to do advocacy locally and nationally, and really kind of honors what we're doing. So now that you're no longer a trainee, yay, you have so much extra time, it makes it really hard to actually feel like doing advocacy and doing all these other things can actually help you. But advocacy can actually be very much incorporated to your academic promotions, and so we're going to talk about that for a second. Now not everyone might not be in the academic track, but it's still important of how it can actually advance your career. So I have no disclosures. So what is an academic portfolio? So if you're an instructor and assistant, you probably don't know because they don't necessarily require them yet until you get to the associate and professor level in order to get academic advancement. But it's really a summary of their faculty members' educational research and service contributions to an institution and community. Not all institutions use portfolios, some of them use CVs, and so you really need to make sure you're looking at your own institutions to know if you need a CV or a portfolio and all the other things that are required in it. And they can be very specific and need something, and needs things that are actually precise in how they do it, including what text format you actually use. So the real difference between a CV and a portfolio is CV is really a list format and that tells you what you're doing. And it's always important to keep a running tabulation of what you're doing that we don't forget it later. The portfolio, which often we often neglect and wait until we're up for academic promotions, is actually a really descriptive thing about the how and why. And then they often will come in three domains. So you'll have your teaching activities, scholarship and research, and service and contributions to the institution. And then depending on if you're on the tenure track or the non-tenure track, a tenure track, you'll need significant contributions in all three. And to get to the associate level, you actually need regional recognition. And the promotions level, you need national recognition. But if you're on a non-tenure track, which is often the case for a lot of clinical people, you only need to have national recognition in two of these. I mean, not national recognition. You only need to have like severe, lots of contributions to two of these domains with some in the third. So you don't have to be all about into research, all about into everything else. So there's been a growing evidence, especially more recently, of actually adding a fourth section on advocacy as part of a career track. And a lot of organizations like the American Family Practice Organization, and this is actually coming from John Hopkins, is like telling you how to implement a plan to actually include advocacy into your CV appropriately. And so can advocacy be a part of it? Absolutely. And we look at scholarship as being the model and the mode for actually putting it into advocacy, I mean, to putting it into your CV. And so really, you have to make sure it meets these domains from Glassick's model of scholarship. It has clear goals. There's adequate preparation, adequate methods, significant results, effective presentation, and reflective critique. And oftentimes, where we kind of miss the boat, and because we don't know how to actually just demonstrate it appropriately, it's really in the last three. Significant results, effective presentation, reflective critique, because it's really hard to show dissemination and how much is actually getting out into the community and doing those things. But in fact, actually, a lot of these things are making national changes, and we were able to figure out a way to actually show how these changes are actually being demonstrated and actually creating things. We have even more power than a lot of our research presentations would actually have. And that's the biggest problem, is we just don't know how to show it appropriately. But if you're able to demonstrate these steps in actually your portfolio, you can actually show very adequately and very easily how advocacy can be incorporated. This table here, I know it's busy, actually divides up what I just told you into the pros and cons we have to think about when you're looking at adding advocacy into your portfolio. So where do you put it? And it really depends on where your track and your emphasis is. So we were talking about how you have to have three domains, or the three domains. But oftentimes, you might have an educator track, a research track, or a clinician track. So if you are an educator on the educator track for academic promotions, it's really going to be about teaching activities and your contributions. So maybe you're creating advocacy curriculum that Dr. Dorr was talking about. If you're on the research track, hey, guess what? Doing presenting like I am right now, this gets to be put into the research track a bit. And then the clinician track is going to be a lot more in how most of us as clinicians really are, are going to be really focused on our service to the community and service to the organization. Now, a lot of these can actually be intertwined, where in some ways I'm actually, we talked about teaching in our national presentations, you can kind of almost, if you're really going on the clinical educator or the educator track, you can actually put it there instead of somewhere else. So really just keep it in mind of what track do you need help in to emphasize where you want to actually make your case that you should be promoted. Most portfolios that you're going to see, although I already told you you need to look at actually each institution and how they lay it out, usually comes in this format. You have your title page, your table of contents, your personal statement, your teaching and curriculum development, scholarship and research, and your service contributions to the community. And that's generally where most people put their advocacy stuff in because it seems to fit the most nicely there. But you can put it in other sections depending on how you spin it and make it work for you. So these last few slides are really going to be talking about areas and ways you can actually incorporate it based off of what you're doing. So when we have advocacy engagement or practice, like system levels of care, it's really talking about we're making changes on federal, state, and local level, and we're really targeting a specific population. It goes beyond just the individual patient but really addressing full needs, and that's how you're going to really sell it on your academic promotions and not just like, I helped this one person. It's going to be like, look at this change, look at this value, look at this outcome. And it really actually, you can actually even tie it into why it's important by actually showing like research papers and everything else of where this is actually needed to be addressed in like maybe a community needs assessment, which many hospitals and organizations actually need to put out for the local area, or in basic literature that's kind of happening. And then the activity could be like you did a peer-reviewed publication, you were invited to present on research topics, you did a public health intervention and became a standard of care. So these are things that can be very much incorporated that we don't think about us doing advocacy and how we can be incorporated that way. Another is knowledge dissemination, and these are activities aimed at disseminating knowledge to the public and to policy makers. This is really like how are you communicating, how are you doing that? And this actually can be done through peer-reviewed literature showing that, or is also cited by policy makers. So sometimes you have to know who you're talking to, but a lot of times these will get disseminated because they're repeating back your own facts. And so this is why you actually need to build the community, you need to build a partnership with local communities and things like that, and if you're a community psychiatrist, that's essentially what you do on a daily basis by connecting and being a part of the community like with Children's Protective Services, or like schools and other kinds of systems of care, and that's how your dissemination is going to happen. Then you have community outreach. So these are actually really like ways to empower communities and population, and these are physician-coordinated activities with a community-based organization to build trust, including academic and community partnerships. And sometimes I also think of this like if you are at a parade and you're talking about something that's gay pride or LGBTQ rights, that actually can be part of community outreach and what you're doing. And so making sure like these volunteer-type things can actually be a form of advocacy and how we can actually promote that. In addition, you can actually get grant funding for some of these things, because a lot of these community outreach things, they actually want you to build and develop things. And so, hey, look, I got a grant to actually to talk to the community leaders and do qualitative analysis with this, and so you're actually creating change that actually is going to actually lead to policy change. And so making sure you actually like look at all the levels that you can actually do in community outreach and not just you went to the parade but actually did things that actually can make a difference. Then you have advocacy teaching and mentoring, which Dr. Doerr talked about quite a bit, but this could be like curriculum development, creating a lecture series, getting grant funding for advocacy and curriculum development, and participating in a workshop or a committee that addresses standardized advocacy as a skill set. So if you happen to be on a work committee that's going to actually now include advocacy more heavily in ACGME policies, we are getting into our teaching domain very easily. And then advocacy leadership and administration. So this is actually doing those things that Dr. Doerr was talking about, is like actually putting yourself on committees, getting yourself known locally, so it kind of, excuse me, helps with some of the communication aspects, but also is very much a part of organized medicine and how you create change. So making sure if you're a member of the AMA, if you are a member of advocacy committee, those kinds of things can actually get you noticed. Then elected positions, even nationally, will actually recognize you and say, hey, come talk to us about this, come talk to us about that, and that can further other things that we were already talking about. So those are a few standardized ways of actually incorporating and thinking about advocacy differently and how to add it to your portfolio, but very important. And then you could also think about advocating for a new promotions track. So one of the highlights that we actually, at GW, where I have my academic rank, is in October of 2022, they actually included an equity community and populations health track to be added as a fourth domain that we're talking about from teaching, teaching scholarship, and clinical service. And so this is what they actually have straight from their academic handbook. And really it's meant to show like, oh, yeah, we're in DC, I guess this should be an emphasis of ours. The problem is it's not necessarily one of the three standard ones. It's actually just, hey, you can go down this track, we're not really sure how to use it, so we're not saying you have to do things in this area, and I think that's where the misnomer is going to be, is because it's not one of the three clinical domains of what it is. But at least we're getting a step forward in actually being able to recognize it. And here it actually tells you a little bit what things can be included, and it's saying like publications, peer-reviewed articles, white papers. And so even being involved in white papers actually create change can actually be a big way and has a huge dissemination portion of things. Published policies, documentation of their adoption, media accomplishments. And so we often forget that media actually is a form of advocacy and talking about that. And so it's important if you are getting printed in newspapers or speaking to the local TV or national TV, it is a form of advocacy and actually promoting whatever mission or goals that you actually want. And this is actually telling you this is what GW feels actually is a way of advocacy. So before that, before October 22, when I discussed this, like where do I put my media contributions? They're like, I don't know, just kind of put it somewhere. But now we officially have a place to put it. And so please do keep track of the media stuff, because it can be very, very important for what you're doing. And then we talked at the very beginning about a portfolio, but it's also important to remember the CV. Now, a lot of places will have the CV, but most places will have a portfolio, but not every single one. It's important, again, to follow your institution's template. And then institutions that use portfolios generally expect the CV to be very distinct. You don't really need to add emphasis. But if they don't use a portfolio, you'll need even more documentation that really helps to supplement what this is. So what you're kind of looking at is like, here's what I did, and this is why it's important. Where the portfolio oftentimes will do that in a much more broader sense of the words. And these are my references. All right. Thank you so much. Now we have Dr. Karen Pierce. Good morning. Thank you guys for coming. I really do have a gift today. I'm talking about really the gift of being a late career person and somebody who's been doing advocacy probably since fifth grade when I raised money for John F. Kennedy and the investigation. I still have a letter that says, Dear Miss Pierce, thank you for raising money for the investigation. So what I did in my disclosures, I really have nothing to disclose, but if you can see, I have memberships or I have many, many, many responsibilities in many, many kinds of organizations, and that's going to be important for advocacy and coalition building. So what I'm going to talk about is the gift of experience, what I bring to it as a gray hair, what I don't bring to it as a gray hair, broadening my reach of my knowledge, what I do in organizations. Right now, there are many of them that I span, and how I advance scholarship, sitting here and watching all these people I have known in many phases of their career and watching them be the leaders is like beyond rewarding right now. And then, as Brandon said, what do you learn by keep doing this? So that's a lot. I actually learned about how to do Google Slides today. So one of the things I want to talk about is there are many phases of advocacy, and when we're talking about policy advocacy, we're talking about a bigger way of doing it. One of the ways that when I'm teaching about prior auths, I mean, how many of us hate prior auths? And my husband at one time worked for the insurance companies, and he realized that prior auths were a way that insurance companies, most physicians won't take time to do it, and they win. And every time you sit on a phone for prior auth, you are advocating for a patient and making a difference in care. And even though it's not policy advocacy, it turns out, as our panel was talking about, many institutions are measuring how many times in hours people are on prior auths, and that is going to be a way to push, and that's the scholarship we're talking about, is to do change. It's called plan, study, do, act, PDSA cycles. And so they studied how much prior authorization, and that's one of the things that are doing. So you can tell, I can take anything and make it into a policy advocacy. And we do it at many, many levels, and I always make sure, even now that I'm doing something to change, even sitting here right now, I have three new ideas about what I'm going to change for system-level interventions. And we have to really begin to talk about it, and I'll tell you as we do it. So being experienced, I've been around a long time, and I've seen a lot of different things. And when I first started advocacy was in medical school, and when I went to medical school, I was on call every third night for the entire six-week rotation, no holidays, no weekends. And I thought it was outrageous, and I'm a person who needs sleep. And one day I fall asleep in my dinner while I was out with my parents who were ready to have me arrested or have me quit school. And that's the first time I went and did advocacy. I went and started calling the AMA and saying, this is ridiculous. I mean, none of us can think, none of us can do things, and let's fast forward. We have work requirements. We don't let physicians be so tired anymore, and that's important. And so good policy really does change the way a physician works, the way there's better access to care. And being physicians, as my colleagues talked about, we can bring evidence base and science to it. We just have a physician who was elected in Illinois to our House of Representatives, and he is shocked by the way the bills are written. And we really do need our knowledge, because 30 percent of bills right now are about health policy. What's nice about being older is that I have a lot of flexibility, and the best part of the pandemic, I probably have testified or been on the phone with many people, because they'll say, we need a testimony today, and I'm there. And I have that flexibility, and it's really key to be able to show up and to be able to really say what we need. So one of the things that I was thinking about, and as I was sitting here, I think about development, because I am a child psychiatrist, and we don't talk about adult development very much. But in adult development, we have to think about generativity versus stagnation, or ego integrity versus despair. And sitting here, I was like, whoa, guys, we are generating more advocates. Because I have to tell you, as a medical student, when I was saying I'm falling asleep at dinner, I was a very lone voice. First of all, there were only 11 women in my medical school class, so not only was I a medical student asking for change, I was female. And I cannot tell you the barbs that I got and what happened in that journey. But I'm pretty much of a pit bull, so it was okay. I also think that we have a civic responsibility. But I tell my friends, Karen, you're going to a conference again? You're going to Springfield again? You're going to Washington again? I go, yes. We have knowledge as physicians. We went to school. I think it's our civic responsibility to share that with other people and make good policy. Because our patients don't speak for us. They don't know about prior loss. They don't know why they can't have medicine. They need our stories. I tell their stories to make change. And that's really what I think our responsibilities are. One of the best parts of my job is I get to teach everybody. I teach students, legislators, residents, fellows, colleagues. I'm surprised. Now these are a new generation of real advocates who've had the training. Most of medical trainees have never had any advocacy. They do not understand what we're talking about and what we're doing. And that's one of the things that I've loved to do is I've educated people in legislative conferences, both state and local and federal. And it's really a way to broaden the reach. So I'm getting to scholarship, what you guys could put on your CV. So the way we do it is we broaden the range of knowledge is really understanding federal lobbying. I'll tell you this a little bit later, but every time I approach a new subject that we want to advocate on, you have to do all the research. You have to write up the document. You have to document the research that's there. And I bet those are policy briefs should really be counted as scholarship stuff. It can take me 10 to 20 hours to get a policy brief. I go look at every state, see what states are doing, what's going on there before I'm doing those kinds of things. And those are not things that we talk about. You will see that I am not a professor because none of my institutions counted the work that I was doing in advocacy for the last 20 years. And so it was always on my own time that I did it. I'm not sorry I did because I really think, especially in Illinois, there's been some really great changes that we have. So one of the things that we do, we don't just say, okay, no prior authorizations. It's not good. It's not good for patient care. It interrupts stuff. Can't do that. You have to study it. You have to figure it out. You have to do costs. You have to figure out where your places are. And we can do media, social media. Actually, I tweet. That was one of the things that I do. The first ledge cons we did, what did Adam teach? He said we did a Twitter trend. And so he got everybody in the audience of any age to download Twitter and to trend advocating for children's mental health. And so I do think all of that's important. And I do think if you're a writer, please write. I tend to do more interviews than write. And that's tricky. You have to know how to talk in sound bites. The other thing about broadening reach, which we didn't talk about, is coalition building. None of us can do this alone. And I can tell you in Illinois, psychologists can prescribe. But in 2014, when that bill was set, we were colleagues with the nurse practitioners. Now they're about to change the law in Illinois. Now the nurse practitioners don't want to partner with us. And so our coalitions go back and forth, and we really have to do that. And the beauty of being a psychiatrist is you know how to talk to people. And so I do think those are skills we can use in order to build coalitions. So this is what I want to talk about. You can't do it alone. I often talk when I talk about hats. Today I'm talking from the APA, right? I wear a child psychiatry hat. I wear an AMA hat. I do the parallel to all my state organizations. I'm a NAMI person. I was on the board of CHAD for many years. I've done many different kinds of things because we need leadership. I'm actually involved in many advocacy projects. I just was doing long COVID. And because I was a physician, they had me go to almost 30 meetings to educate people about COVID. Because in case you didn't know, many people do not believe COVID existed. And so those hats are really important. And now I have a whole set of patient groups that when I'm trying to advocate for mental health and mental health care, I have a whole set of new coalitions. You do have to get trained. You have to get trained. Shall I say it again? You have to be trained to advocate. Because you have to speak in one voice. At any time I can go to any hill visit and talk about 30 subjects. But I'm usually there with APA or with ACAP. In this case I was with the MFCFS. I've been with the women's group. I've been with... And that's what we have to be careful. Those are the skills. And it's important to find mentors. And it's really key to do it. I remember when I fell asleep that time and I walked into my mental health services at the med school and said, what am I doing? I can't do this by myself. What's going on? And they said, oh, yes, you can. Go out there. We all support you. Medical students need to sleep. We wouldn't be busy. And I was like, wow, a mentor really early who encouraged me to do it. So I think Jen talked a little bit about all the different organizations there are. There are plenty of them. But I think you heard me talk about that I'm also involved with patient advocacy groups as well. Because let me tell you, the voice and the stories of people with lived experiences are key. And there's another scholarship idea I have. I have spent many hours training people with lived experiences how to tell their story to a legislator. And it is just not you just there is a skill in how you tell your story and ask for the ask. And there's training materials and all sorts of things that I have for training that. So we talked a little bit about what has the APA resource. And the APA has just done amazing things and has had a leadership and a government affairs department for many, many years. And in this year of mental health, we can really thank the government affairs at APA for getting a lot of the mental health bills that were spent, the increase in SAMHSA, increase in all of the bills for mental health, the increase in the Lorna Breen Act was really spirited by both patient advocacies and the APA. You can sign up for all of these things. You can be learning all of the time. I happen to be a political nerd. And so I listen to and read all of these. There's the other place of the scholarship is that I compare what I'm hearing from all these different organizations. And let me tell you, they don't all say the same things. So one of the things that I've done is advancing scholarship. And I no longer care about my CV or my portfolio. And so I just give away any talk I have, any conversation I need to have. And it's really like I sat down there because these are our leaders. And you need to find a mentor. Because there are many of us out there who will be glad to train you and have you take the baton. Because I do think the voices of youth are really important. And anybody younger than me is youth. So you have to understand that. I've said to somebody, I see a lot of kids, and they go, Karen, you don't see any kids anymore. I go, right. But I see everybody who's really growing and trying to do it. Because many, actually both at APA and at ACAP, the senior section really donates money for scholarships, for learning, for advocacy skills, because we want people to really keep this up. I mean, loan forgiveness, the expense of medical school, who could better tell the story? And who could better tell the story about what's the difference between, I'm going to talk a little bit about scope, why a physician should lead a health care team and why somebody else should not. And I think those are really important to be able to do. These are just what I did in the last, what I gave away in the last, I just let everybody write if they want to. It's a good thing I don't like to write. So any time I get an opportunity, I pass it along. So Dr. Newsome asked me to say, so why am I still doing this if I see this is happening? So I'm a lifelong learner, and it turns out in order to, we went to medical school, we like to learn. Be a lifelong learner and find your passion. So I just did a whole thing on chant GBT, because we're talking about it. I love that. I read articles. I learned things. I just was in a meeting this week about what are we going to do about it? Is it ruining the world? Is it helping the world? How are we going to advocate for it? I am not computer literate. It is not the language I know. And so even this morning, I got more tips. And what's really interesting about the way social changes and where the passion issues are, so you have to know the Democratic Convention is coming back to Chicago. And in high school, I was at the 1968 convention, and got so scared that I left before all the police came. And I never told my parents, and I came back shell shocked that day, because I took the train downtown, and they go, where were you? I go, oh, my goodness. But that's a different kind of advocacy. And that's not successful. It doesn't get things changed. The other piece that has been fascinating to me in leadership, we're in a partisan world right now. And I've talked to Second Amendment people. I've talked to people who don't believe in science. You have to make coalitions with all of them. And that's where our skills as psychiatrists happen. And I should tell you, I have a 96-year-old father who still works full time and lives independently. And he said to me this morning, what are you going to talk about? I said, about still learning new things. And he says to me, oh, right. So are you going to talk about the Dobbs decision for him has been very upsetting to him. And he says, are you going to put she, he, or they on your stuff? I said, dad, you've been reading. So yes, we keep learning and keep changing. And I think that's important. So where are you guys as leaders? Where are you going to go? One of the things I'll say about advocacy is find a passion. You've heard about when I had a passion, I went for it. I think stigma for me for psychiatric issues is what drove me when I was a resident and a fellow, that people were afraid to say. Actually, I had an Ativan death in training, was a mother, a new mother who got admitted for depression, never told the staff or anybody she was on daily Ativan. Her family didn't know. Nobody knew. She went into withdrawal on the unit. None of us knew. She had a seizure and died. And I was like, what are we doing? How do we advocate? How do we make it more transparent? I think she was on like three or five milligrams of Ativan a day. And nobody knew. Her husband didn't know. The physician who was writing it didn't have it. And now that's much less likely to happen. And that's when I decided stigma has to be changed. So each of you find your passion. There's so many great ideas out there. And one of our goals is to help you figure that out. So thanks. Perfect. Well, thank you all. Thank our great panelists, Dr. Schott, Dr. Doerr, and Dr. Pierce. So now we're going to enter the scary session, right, where we're hoping to be able to kind of sort of break out. Well, we might just make a single room, ideally a workshop of issues so we can, you know, in vivo talk about a topic and work through it. I know that a lot of folks mentioned before a host of different areas of interest, parity, addiction, education, veterans' rights. So let's all have our panelists go down. And then for the next, let's say, 15 minutes or so, we'll try to workshop some of your areas of interest. Perfect. Thank you all so much for workshopping these great ideas. And I know that we also got a chance to answer a lot of questions. So I know that we are at our time. However, we will, as panelists, will continue to be up here to support you. And thank you.

psychiatry

physician advocacy

mental health

health policy

Dr. Megan Schott

Dr. Jennifer Doerr

Dr. Karen Pierce

advocacy training

healthcare professionals

public health