Advocacy Day 2019: Two residents share their experiences and why they attend this annual event

By Laura Dover, MD, MSPH, and Chelain Goodman, MD, PhD

This past April, radiation oncologists from across the nation converged on Capitol Hill to discuss with policy makers the challenges facing the field of radiation oncology, a day known as ASTRO Advocacy Day. On nearly a daily basis — on some level — every radiation oncologist is an advocate for his or her patients and colleagues. All take the time to ensure their patients receive coverage for the best possible treatment, and staff work tirelessly to improve and refine the efficiency of workflows to maximize physician-patient interaction and minimize “busy work.” So, what exactly is so special about this one day, ASTRO’s Advocacy Day?

Laura Dover: That was the exact question on my mind as I traveled to my first Advocacy Day last year, in 2018, as a resident physician awarded an ASTRO travel grant (Residents take note — all current residents should explore this opportunity at least once during their training.) It didn’t take long to realize how little I understood about the in-depth political process underpinning much of our daily workflows in medicine. I brought home with me the general overview, and it often played in the background of my mind during my daily routine and patient interactions over the past year. My eyes were opened to the heavy hand of health policy influencing patient presentations and referral patterns. With this prior knowledge, I approached this year’s Advocacy Day with a bit more excitement and a tad less uncertainty.

Chelain Goodman: I’m just going to say it: My favorite radiation oncology conference is ASTRO Advocacy Day. It’s a relatively intimate conference with a large number of attendees who return annually. The Association of Residents in Radiation Oncology and the Society of Chairs of Academic Radiation Oncology Programs executive committees both have meetings prior to the Advocacy Day events, so there is always a cohort of residents and chairs attending. In addition, members of the ASTRO Board of Directors as well as private and academic radiation oncologists from across the country attend.

Day One: Laying the Foundation

The 2019 Advocacy Day events began with an educational forum kick-started with a state roll call.

LD: It is always invigorating to be in a room surrounded by collegial radiation oncology advocates spanning coast to coast (Roll Tide!). The chair’s address by Paul Harari, MD, FASTRO, followed the roll call, and he outlined this year’s prioritized congressional asks that are formulated throughout the year by the ASTRO Government Relations and Health Policy councils.

CG: As a result, attendees learn about the behind-the-scenes work ASTRO does that is critical to the success of our specialty. In addition, attendees get a crash course in the current status of health care in the United States. Each year, I leave Washington overwhelmed by all that I don’t understand about billing, insurance coverage and the multitude of issues relevant to health policy and legislation that impact our field in a highly relevant way. These level-setting sessions help alleviate much of the unknown and prep attendees for the visits on Capitol Hill.

LD: This year’s primary focus was streamlining the efficiency and effectiveness of what many view as an overly-burdensome prior authorization process. We all have stories of how this process has delayed the cancer care of a patient, often with little to no added quality-assurance (e.g., how many times has your “peer” on a peer-to-peer call been unfamiliar with the radiation techniques in question?). To add credence to anecdote, ASTRO conducted a survey to demonstrate the costly impact on physician resources and time and, most importantly, on potentially life-threatening treatment delays.

Next up was a Centers for Medicare and Medicaid Services (CMS) representative, Kimberly Brandt, who updated the room on pertinent CMS policy change proposals, including a halt on punitive retrospective audits on IMRT billing practices during what is now recognized as a time of uncertainty. This was an uplifting reminder of the power of unified advocacy. Following that, Representative Paul Tonko from New York addressed participants, and reminded us that utilizing our unique expertise and experiences as physicians to advance health policy is a crucial component of any career built on service to our patients and our field.

A panel then discussed ways to harness the power of social media to educate and engage policy makers about the daily struggles of delivering high-quality cancer care across diverse populations. Finally, there was a briefing about federal health care issues, with an engaging question and answer session, circling back to brainstorming logical solutions to a more effective prior authorization process. Prepped with that knowledge, we were ready to tackle a day of one-on-one meetings with our local representatives and their staff.

Day Two: Visits on the Hill

CG: On the second day, attendees split into their state “teams” and visited their state’s congressional representatives. Sometimes these meetings were with the representative’s staff, while occasionally we had the opportunity to speak directly with the congressional representative. Given that meetings with constituents are not unique occurrences for these representatives or their staff members, I was impressed by the sophistication of these conversations and the genuine interest that was conveyed regarding our opinions as physicians. Although the few conversations I participated in may seem negligible, the net effect when considering all the radiation oncologists participating in Advocacy Day has the potential to be quite significant.

LD: My co-resident, Sam Marcrom, and I teamed up as the two radiation oncology advocates representing our home state of Alabama. Having a strong connection to the state and an understanding of the specific problems faced by Alabamians deeply influenced our conversations and helped us form more impactful connections with our representatives. We introduced ourselves as patient advocates and shared our patients’ stories; everyone with whom we spoke was familiar with the fear and anxiety that surrounds a loved one’s cancer diagnosis. There was a mutual understanding of the end goals of prior authorization and a genuine interest to hear oncologists’ ideas for maximizing the efficiency and effectiveness of the process. They, in turn, shared with us some of the challenges of legislating the practices of private insurers. At the end of the day, relationships were formed and ongoing lines of communications opened — the overarching goal of every Advocacy Day.

Key Takeaways

CG: Perhaps most importantly, I’ve found Advocacy Day to be a great opportunity to spend time with good friends as well as make contacts with people I otherwise might not have met. There is sufficient free time to mingle, and the number of attendees is just small enough that you are able to bump into the same people at least a few times. After telling my co-resident, Laura Ashack, how much I enjoyed Advocacy Day in 2018, she applied for and was awarded an ASTRO Travel Grant for 2019. ASTRO has a strong interest in having more residents attend, so if you harbor even a small interest in attending in 2020, keep your eyes open for next year’s call for applications!

LD: A highlight of Advocacy Day 2019 was regrouping for lunch on the Hill with some words from Representative Kim Schrier of Maryland, the only female physician currently serving in Congress. She shared her own frustrations as a pediatrician with the inadequacies of health care delivery, which were so overwhelming they ultimately served as the impetus to transition careers from physician to legislator. She aptly noted that the nation’s representatives should “represent” the nation, and that includes female physicians who bring unique views to the table.

While we may not all be called to serve as a U.S. representative, we are, each of us at our core, called daily to serve our patients by ensuring every individual under our care receives the best possible cancer care. ASTRO Advocacy Day has left me with an understanding that this simply cannot happen without physician-informed constructive health policy.

Laura Dover, MD, MSPH, is beginning her career as an attending radiation oncologist at Memorial Sloan Kettering Cancer Center. She has a long interest in health policy and received her MSPH while completing her radiation oncology residency at the University of Alabama at Birmingham.

Chelain Goodman, MD, PhD, is a PGY-5 and chief resident in radiation oncology at Northwestern University, and also serves as the Chair of the Executive Committee for the Association of Residents in Radiation Oncology (ARRO).