Medical professionalism is one of many traits that residency training programs strive to foster in trainees. Many authors have grappled with what behavior constitutes professionalism; their answers range from ethical duties laid out by Hippocrates to the domains included within the ACGME Core Competencies list. Recently, there has been a growing call for broader advocacy training within medicine as an element of medical professionalism.
Advocacy within medicine is not a new concept, and many national, specialty, and local organizations encourage their physicians to engage in it. Though a slightly nebulous term, advocacy broadly refers to any strategic action to drive social, organizational, or policy change. A widely accepted definition of physician advocacy in particular, supported by the American Medical Association (AMA) and AAMC, is “action by a physician to promote social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.” Under this framework, engagement in public advocacy serves as an extension of a physician’s clinical mission to promote the health of patients — be it through individual educational efforts or local/national legislative efforts.
Accordingly, numerous specialty societies and the AMA have highlighted the importance of advocacy within the physician workforce. The American Academy of Pediatrics, American Board of Internal Medicine, and American College of Physicians have all affirmed the role of advocacy as a component of physician professionalism.
When polled, 86% of physicians agreed that physicians should advocate for “legislation to assure that all people in the United States have health care insurance coverage” as a core aspect of professionalism. Trainees, despite the many competing responsibilities within residency, also felt that education in advocacy should be incorporated into training. And a 2021 national survey of medical students found that the majority of students felt advocacy was an important responsibility for practicing physicians.
Echoing the opinions of specialty societies, practicing physicians, and trainees, the ACGME has listed physician advocacy as a core competency to be taught during residency. In response, numerous medical schools and residency programs have begun to incorporate advocacy curricula for trainees. A 2023 systematic review of advocacy curricula in GME found 31 unique advocacy curricula within the U.S. and Canada, involving internal medicine, pediatrics, psychiatry, as well as surgical training programs.
Despite this, the incorporation of advocacy as a professional responsibility of physicians is not without controversy. Some believe that promoting the engagement of advocacy redirects resources from core medical professional roles, and does not account for the plurality of ways doctors may contribute professionally to society. Others have argued that advocacy, though important as a civic virtue, goes beyond the professional norms of physician practice. In encouraging physicians to engage in advocacy, an intrinsically political endeavor according to one physician, societies demand a particular political stance of their members. The decision to engage in political advocacy, detractors believe, should be left up to the individual rather than be considered a professional obligation.
In terms of the inclusion of advocacy curricula in medical school and residency, some feel that the topic is not worthy of training in these settings. One physician detractor opines that “advocacy must remain an occasional and optional avocation in academic medicine, not a universal and mandatory commitment.” Others believe that while advocacy can “enable the pursuit of excellence and recognition, provide a setting for displaying who [participants] are, and function as an area for ethical self-formation,” many other options may serve similar purposes, and so caution should be exercised in endorsing advocacy as a requirement of all physicians.
Rebuttals to the above arguments have questioned this characterization of advocacy, highlighting the need for systemic strategies to address individual and collective patient concerns. Additionally, they take issue with the stance that advocacy is necessarily a partisan endeavor. While engagement in advocacy is a political endeavor in the sense that it is involved in public affairs, advocacy efforts promoting patient well-being need not fall neatly along party lines. In fact, common ground can often be found through advocacy, as evidenced by the multiple bipartisan bills currently proposed.
In regard to the incorporation of advocacy training within medical school and residency programs, proponents describe this knowledge as one of the many things that shape the practice of medicine and patient care and that physicians should have some familiarity with, similar to bioethics or clinical research. By providing trainees exposure to advocacy, medical school and residency programs provide another tool and skillset for physicians to care for their patients, and interested trainees may make the decision to engage at a deeper level if compelled to do so.
Though there is disagreement as to whether advocacy ought to be a core part of professional medical codes, there is no doubt that understanding the tools of advocacy and the impact of policy on patient outcomes is an important aspect of modern medicine. Further, engaging in advocacy in some capacity is beneficial for physicians and physicians in training. Research has suggested that significant engagement in advocacy can reconnect clinicians to their original motivations for pursuing medicine, improve professional solidarity, sense of community, and professional identity, and help prevent burnout. If that’s not something worth treating as part of medical professionalism, I don’t know what is.
Do you think advocacy should be considered a form of medical professionalism? Share in the comments!
Marc Drake is a fifth-year resident in the Department of Otolaryngology and Communication Sciences at the Medical College of Wisconsin. His clinical interests include facial reconstruction, violence prevention, and the interplay between urban design and health care. Dr. Drake was a 2024–2025 Doximity Op-Med Fellow.
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