Surgical advocacy as an academic career path: A guide for promotion discussions.

Public policy and health care are demonstrably interconnected. Medical and surgical outcomes are inseparableable from the political processes and laws that govern our nation. Health care delivery and public health are shaped by public discourse in city councils, county commissions, and state/national legislatures and agencies. Health inequities including barriers to access are the subject of ongoing political debate related to health care reform, practice management guidelines, firearm violence prevention, physician compensation, and Medicaid/Medicare policy. Effective surgical advocacy is perhaps more needed now than ever. Surgeons are among the best positioned to collaborate with policymakers and to engage with their communities to address many of these issues. However, for the university-based surgeon, time is limited; much of the time spent outside of the operating room is focused on building a portfolio worthy of promotion. The academic surgeon seeking advancement may be discouraged from advocacy work if it is seen as distracting from traditional scholarly efforts required for promotion. Historically, academic promotion tracks have emphasized original research, clinical expertise, education, and institutional service. Achievements in surgical advocacy do not fit neatly within the typical criteria used to assess readiness for promotion. Metrics that define excellence in advocacy have been lacking, yet many of the activities and achievements of surgeon-advocates can be quantified by time, effort, and impact similar to efforts in traditional domains. The impact of surgeons advising policymakers, initiating legislative ideas, researching projects that inform policy solutions and public health interventions, engaging in social/news media, and providing service to the community through local organizing or presiding on city/state government task forces all contribute to improvements in health care analogous to other promotional metrics. Rewarding surgeons for their achievements in advocacy acknowledges the value of advocacy while simultaneously incentivizing such work. A framework is proposed to assess the impact of advocacy work and to incorporate it within the academic portfolio.