Background/Purpose: Healthcare delivery and health policies in the United States are evolving rapidly. Rheumatology fellowship programs lack formal curricular content to educate trainees about legislative and regulatory healthcare policies that will have a profound impact on the future of academic and community practices.

Methods: A web-based survey was sent via the American College of Rheumatology (ACR) Fellows in Training (FIT) listserve in June and July 2015. The survey queried fellows enrolled in U.S. rheumatology training programs about their knowledge of and participation in health policy and advocacy. Survey results guided the design of an educational session called Advocacy 101 for fellows and program directors in October 2015 in conjunction with the ACR Advocates for Arthritis fly-in. Curriculum included introduction to state and federal legislative and regulatory policies as well as education on how to be an effective advocate. Participants were asked to take educational content from the event and hold a teaching session at their home institution. Participants also shared their experiences at the 2015 ACR Annual Meeting FIT roundtable sessions and the 2016 ACR State of the Art meeting Advocacy Workshop. A second survey was sent to fellows in April 2016.

Results: Survey response rates increased from 19% to 39% between 2015 and 2016. The majority of respondents were in adult training programs with nearly half (46% in 2015, 47% in 2016) reporting plans for a career in academics. Forty percent (up from 35% in 2015) reported that they were aware of advocacy efforts through the ACR. The top reason (64%) for non-participation in health policy and advocacy efforts in 2015 was lack of knowledge on how to get involved. This decreased to 39% of respondents reporting the same barrier in 2016. Other barriers to participation in 2016 included lack of time and familiarity with the issues. Only 7% felt their participation would have no effect, down from 16% the previous year. The health policy issues that 2016 participants identified as most important were patient access to medication (83%), patient access to insurance (68%) and physician reimbursement (58%). Fellows preferred in-person teaching sessions and online modules to email correspondence for education on these topics. The percentage of individuals who were familiar with and contributed to RheumPAC increased.

Conclusion: Engagement in health policy and advocacy efforts is critical to continued recruitment of trainees into the field of rheumatology, support for education and research, and advancement of clinical practice. Current training program curricula do not prepare fellows for the new challenges of our changing health care system. Advocacy 101 is the first program designed to educate and engage rheumatology fellows in health policy and advocacy endeavors. Fellows express an interest in becoming involved but view their lack of time and knowledge of the issues as their biggest barriers. Fellows indicate that ACR-sponsored events and formal curricula would be an effective way to gain knowledge on health policy and advocacy. Advocacy 101 is the first step in addressing this need.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/advocacy-101-engaging-rheumatology-fellows-in-health-policy-and-advocacy/