PracticalDermatology

As dermatologists, we spend the better part of every day involved in advocacy. We advocate for our patients’ health. We advocate for sunscreen use and proper skincare. We advocate for individual’s access to the prescription medication we believe, based on our training and expertise, is the best treatment to meet their needs. Therefore, we and other of your peers may seem out of touch when we say that there is an urgent need for more advocacy in dermatology. The reality, though, is that our specialty is in desperate need of more advocacy. And the fact is that no one can (or will) advocate for us better than we can advocate for ourselves.

Our experience in advocacy began with our work with the Louisiana Dermatological Society, for which each of us has served presidential terms. Our involvement in the association had largely focused on education—supporting resident presenters and planning the annual society meeting. Neither of us had a particularly strong interest in advocacy. But as we got more involved in leadership, we were essentially forced into advocacy. A major issue confronting our society, which we discuss below, was the need for legislation to ban tanning by youths under age 16. What seemed like an imminently logical proposition proved to be a substantial challenge. Perhaps naively, we thought that the clear risks posed by indoor tanning and the clear health benefits of limiting its use by minors would ensure legislation would pass on its obvious merits. We didn’t fully understand the processes involved in putting forth and passing legislation, nor did we anticipate the extent to which opponents of the ban would organize and advocate against us.

Through this and subsequent experiences, we learned about the importance of finding and making connections, educating on the issues, investing in lobbyists, and being persistent. We experienced the satisfaction of knowing that we were making a difference. We prevailed after a great deal of effort and learned much along the way. Most importantly, we learned that advocacy is essential to ensure the future of our specialty and the health of our patients.

The investment in our future is priceless

Ultimately, all the advocacy under way in the field of dermatology is intended to make your life better and easier. Even if you cannot envision personal benefits or will not see immediate effects, at some point you will. Eliminating step edits will reduce costs associated with paying staff to deal with paperwork and denials. Protecting Medicare payments will directly affect your bottom line.

It is critically important to remember that anything you may advocate for has someone advocating against, or vice versa. The person on the other side might not necessarily be advocating against dermatologists; but their advocacy does not prioritize the best interests of dermatologists or our patients. That is why it is essential to advocate as much and as often as possible.

You can find the time

Advocacy doesn’t necessarily take as much time as you think it does. As with most other activities, once you get accustomed to it, it becomes less time-consuming and becomes “easier.” It also should not significantly interfere with your clinic work and livelihood, since that would be counterproductive.

The best approach to advocacy is to integrate it into other activities you already do. If you like to socialize, find opportunities to socialize with individuals who are or can be allies in your advocacy. If you like to educate, focus educational efforts to influence advocacy. If you’re in academia, focus some of your reading or research on understanding key issues.

Don’t feel defeated

Some physicians generally and dermatologists specifically are not very (or at all) involved in advocacy. Certainly, there may be some apathy among dermatologists that prevents their participation in advocacy, but more likely physicians are overwhelmed by the prospects of advocacy or feel defeated by perceived lack of success. With so many potentially important issues, it may be difficult to know how or where to get started.

There is no need to feel overwhelmed. There are multiple potential starting points for those interested in taking action (see sidebar). The best way to begin is to sign up for email alerts from the American Academy of Dermatology Association (AADA), the American Society for Dermatologic Surgery Association (ASDSA), and other organizations, including your local dermatology and medical societies. These action alerts provide background on pressing issues with calls to action. While there are likely to be several options for taking action, the most common call is for an email, telephone call, and/or letter to decision-makers, including legislators. This is typically something that takes just a few minutes, but the confluence of voices can have an impact.

As physicians and scientists, most of us don’t feel comfortable with “politics” or the notion of fighting for a cause. Don’t give in to defeatism. Don’t just delete that alert email. Don’t skip the meeting. Get to know the issues and the opportunities.

We’re all in this together, and some of our peers are great resources and role models. Reach out. The more of us that pitch in to carry the load, the easier it is for everyone; every voice makes a difference.

No one else will do it for you

The AAD advocates for us, and part of our dues goes to pay an advocacy staff, but the dues money we pay is simply not enough to subsidize getting necessary legislation passed on a national level. Passing a bill in Louisiana to ban tanning for children under age 16 required the assistance of a lobbyist, at a cost of several thousands of dollars. It wasn’t a luxury; it’s unfortunately how politics works. Imagine the costs for lobbying at a national level, especially when there could be multiple competing views on an issue.

Monetary donations beyond annual dues can go a long way toward supporting the work of the AAD and other organizations. Your local organizations will also benefit from financial donations. If you honestly believe you don’t have time to give, then consider donating money.

The tanning ban scenario also highlights the reality that advocacy occurs both at the state and the national level. National professional organizations like the AADA certainly support local efforts, but they simply cannot put boots on the ground for state efforts. That work really is up to local societies and their members.

Grassroots efforts matter

The AAD and other national organizations play a critical role in advocacy for our profession. They can develop policies and consensus statements and can lobby at the federal level. But local medical societies are a must—not only your state society, but also your county or parish or city-wide medical society. At this more intimate level, personal outreach really can be impactful. Pick up the phone and call law-makers. If you have connections or potential connections to open a dialogue, then tap into these.

Regular communication is essential, especially between local and national organizations.

One case-in-point is scope of practice. This is a state medical society and/or state law issue, and little can be done on the national level to meaningfully affect scope of practice in any given state. National organizations can observe and advise on trends and may be able to share information about what worked or did not work from state to state. But if physicians in each state do not step up, then their point of view will not be heard or represented.

Advocacy is often about education

Often the key to successful advocacy is providing information. Knowledge can be very influential, and decision-makers don’t always have all the background related to a topic. Don’t assume anything in any advocacy setting. For example, insurance companies may hire physicians and other health professionals to administrative roles, but if you’ve had to fight to get a patient’s prescription approved, then you know this doesn’t mean that person truly understands dermatologic diseases—or their impact.

Because we, as dermatologists, are so close to issues and so focused on educating our patients, we may assume that those who would pass legislation must also have all the facts at the ready. As scientists, we have a knowledge base and a way of approaching topics that may not be shared by others. When it comes to legislators and other decision-makers, their staff may not have the time or access to resources to fully research an issue. This is not to suggest incompetence or bad intentions; it is simply a reality when you consider the number and vast range of issues that these individuals may deal with. Someone else may be advocating on the very issue that matters to you—providing select background information and a specific viewpoint. Use your voice to ensure that decision-makers have a full understanding of a topic. In advocating for tanning bans, we learned that our governor was not aware of the risks posed by indoor tanning; once he was made aware, he had a better understanding of the health impact of the bans, which proponents were positioning as a small-business protection issue.

You need to think big

When it comes to legislation, ultimately you and your co-advocates must convince a law-maker to vote for or against something. But don’t set your sights on that legislator alone. This person has a staff of individuals working for them; they are often the gatekeepers. Try to cultivate relationships with these individuals, if possible and appropriate. Include them on correspondence you send to the office.

Additionally, consider opportunities to amplify your voice. National and local professional organizations may be a helpful resource for identifying and reaching out to members of the media or others who may be interested to cover the issue at hand. Recognize that these individuals rely on sources and are often open to outreach from local experts. Their reporting may bring attention to an issue, or your involvement may highlight a different perspective that may then prompt others to also advocate.

As a physician, you know the science and you know the facts. The AADA and ASDS can often assist in compiling or confirming statistics and other bits of information you may not have readily available, thus assisting you and reducing your workload.

Speaking to a reporter or providing comment doesn’t take hours. Usually, the conversations or email communications are brief and to-the-point. A full interview is likely to take less than a half-hour. As with so many things, there can be multiple benefits to this work, as you are also educating the public and building awareness of your services.

Your patients can get involved

The ability to reach out directly to decision-makers can be priceless. Network with decision-makers and their staffers so that you can reach out on important issues. Just as a personal connection between you and a lawmaker can be beneficial, any other opportunity to make an issue more personal can also be effective. To that end, consider recruiting patients who can share their story to help decision-makers understand the issue at hand. A young patient with a history of tanning bed use who has been treated for melanoma can share her story to make the issue of tanning bed risks more “real.” Statistics and data can make an impact, but a personal story is often more compelling.

Look to your existing patient base for potential connections. As noted, key decision makers have staff members to support them. If one of those individuals is a patient, then they may be more receptive to your outreach and presumably will trust your expertise and insights.

Build your team

If you’re advocating, you should always be advocating with a group—whether that is your regional, state, or national professional organization (perhaps all three). Don’t ever feel alone when you’re advocating; there’s a team of people on your side along with that team of people who are on administrative end. When you do it that way, it’s so much easier.

Think outside the box

Sometimes it is possible to achieve your intended outcomes in ways that may not be obvious. States are or have been addressing issues related to scope of practice, and many dermatologists have been involved in advocacy around scope of practice. Adjacent to scope of practice are issues of representation. In seeing an increase of billboards and other advertisements for dermatology services from non-dermatologists, our state dermatology society looked into the issue. One potential solution would have been to seek to pass legislation related to issues of medical practice and associated advertising. Research identified existing truth in advertising laws already on the books that were relevant to these promotions. It is easier to advocate for the application of existing laws than to implement new laws. So, we advocated for the enforcement of existing regulation to ensure accuracy of representation.

Interestingly, this issue led to us recognize some inconsistency in the language or our own state dermatology society bylaws that we updated to better represent and protect the scope of practice of board-certified dermatologists.

You can do it!

You spend the bulk of your days practicing dermatology. Additionally, you may have a family that relies on you or have other personal obligations. You have hobbies and interests, and you likely set aside time for health and fitness. You may even have a side business, consulting or doing other work. And you believe this means you don’t have time to advocate.

The fact is that you can and should find time to advocate. Start small. Make it part of your other routines. You and your patients will benefit. A time investment now may lead to significant time savings or revenue protection in the long run. Monetary support is helpful and welcome, but you can do more. As a specialty, we must abandon any thoughts that “someone else is going to do it” and instead focus on believing that “all of us will do it together.”

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