Medicine as a Profession and the Soros Advocacy Fellowship

1. Medicine as a Profession and the Soros Advocacy Fellowship Claudia Calhoon, MPH Open Society Institute Physicians for Reproductive Choice and Health Symposium May 9-10, 2003 Vilnius, Lithuania

2. Healthcare and Medicine in the US • Most private health care is “managed care” • For-profit, dictates amount of time spent with patients • Publicly financed programs are increasingly organized in “managed care” models • Restricted access for poor and elderly • 41.2 million people are uninsured

3. Healthcare and Medicine in the US • Increasing racial and ethnic diversity • Disparities between white and racial minorities, limited access to health services • Organized medicine is not at the forefront of the fight to address these issues • Aspects of medical training in U.S. discourage engagement in these issues

4. Soros Advocacy Fellowship • Since 1999, 28 Fellows funded in areas including: • health care access • health of racial minorities • public housing • adolescent health services • immigrant health • health care in prisons • Small, issue-focused projects add up to a larger effort to transform the health care system

5. Setting the context • What issues are you are passionate about? • On your own behalf? • On behalf of your patients? • Within your community? • What are the challenges to doing advocacy? • As a physician, what specialized expertise do you have to promote an advocacy agenda?

6. Soros Advocacy Fellowship Marji Gold, MD, Bronx, New York • Partner: National Abortion Rights Action League, NY • Goal: To integrate medical abortion into family medicine programs (6 target sites, nationwide) • Working with people from a distance is a challenge • Doctors cannot do it on their own, need advocates • Advocacy empowered her to be more assertive in her own institution • Found she has to demystify medical abortion for other doctors

7. Soros Advocacy Fellowship Katie Plax, MD, St. Louis, Missouri • Partner: Citizens for Missouri’s Children • Goal: Mobilizing church-based groups to protect health care access • Ensured that children in public assistance programs were automatically enrolled in publicly financed health insurance • Working to protect funding for outpatient primary care network that serves low-income and uninsured • Working to involve people who receive these services

8. Lessons from the Fellowship • Advocacy includes building relationships • With Medicine Residency Directors • Determining what will it take to get them to advocate for medical abortion in their own programs • With church groups: • Exploring how they feel about their health care and what it would it take to get them involved in a campaign for health care coverage

9. Lessons from the Fellowship • Making technical information accessible to colleagues and the public • How funding for health care works • What the clinical issues are in administering medical abortions • Distinguishing between political and technical obstacles • Eliciting unspoken political concerns

10. Medicine as A Profession Three Grantmaking Initiatives • Consumer Physician Alliances • Encouraging physician and consumer groups to collaborate • Service Program for Community Health • Medical students spend a summer working with a community based organization • Soros Advocacy Fellowship for Physicians

11. Physicians as Advocates • Well respected and potentially powerful • Understand health risks associated with social problems • Lend credibility and prestige • Uniquely equipped to communicate with consumers and colleagues

12. Medicine as a Profession “A civil society grappling with issues of equity and humaneness, in which health care is one of the most central concerns, desperately needs physician participation.” Rothman D, O’Toole T. Physicians and the Body Politic. Ideas for an Open Society; Open Society Institute. 2002; 2