Physician Advocacy and IUSM’s HEAL Competencies: A Comparative Analysis

Abstract

Introduction: Over the last ten years, the profession of medicine has undergone a reckoning: as our society has been shaped by the Black Lives Matter movement, climate change, and the COVID-19 pandemic, medicine has grappled with how to respond. Indiana University School of Medicine’s new Health Equity, Advocacy and Leadership competency is one such response which is designed to shape, at the institutional level, the attitudes and behaviors of trainees through affirming the importance of advocacy and the role of physicians in making healthcare more equitable. However, the nature of physician advocacy—including both its obligations and limits—remains poorly understood, both in medicine writ large and in the context of medical education. Study Objective: Our goal, here, is to offer a comparative analysis of the skills and knowledge which students are expected to develop in accordance with IUSM’s new HEAL competency, and those which are reflected in the guiding documents of the broader medical profession. Methods: We utilize a qualitative, philosophical approach to accomplish our objective, utilizing the guiding documents of the American Medical Association and the American Board of Internal Medicine (particularly the AMA Code of Ethics Opinions 1.2.10 and 11.2.1 and the ABIM Physician Charter) to represent larger consensus surrounding physician advocacy in organized medicine. We compare the skills, knowledge, and behaviors reflected in these documents with those represented in IUSM’s HEAL competency. Results: The HEAL competency highlights two important points: first, that patients should be treated holistically, and second, that leadership is an important role of the physician in society. However, when we compared the HEAL competency to guiding documents of professional societies, some notable differences were found. While professional societies heavily emphasize the importance of public advocacy and working to change institutions, the HEAL competencies do not address the public arena. Instead, the competencies focus on the physician’s role in demonstrating advocacy through identifying and supporting specific patient needs. In addition, the HEAL competencies emphasize understanding how the social determinants of health impact health equity in patients, as opposed to developing and taking actionable steps to ameliorate those health issues. Conclusion: Physician advocacy will, and should, be a central focus of both organized medicine and medical education in the coming years. However, attempts to integrate education regarding advocacy into the medical curriculum have been hampered by a broader lack of clarity in the obligations and limits of physician advocacy. We have argued here that IUSM’s new HEAL competency is inadequate in emphasizing advocacy as a skill students should develop, especially when compared to the guiding documents of professional societies, which emphasize public advocacy as integral to a physician’s responsibilities.