Getting Involved in Grassroots Advocacy

• Pathologists Leadership Summit

Alec Bose:

It is one thing to talk about the advocacy pathologists engage in, but it's another to get started, especially in a time where getting in contact with your local official can be more difficult than ever. Dr. Bekra Yorke of Houston Methodist invited three residents to participate in a virtual fly-in with their representative to advocate for the mitigation of Medicare cuts. Dr. Chiraag Gangahar, Dr. Amanda Holloman and Dr. Lukas Cara all participated in their first virtual fly-in and in some ways their first venture into advocacy as pathologists. We sat down with the four of them to talk about their experience, how they worked with the CAP to lobby their congressmen effectively, and how other pathologists can begin their advocacy journey.

I want to thank you all for joining me, Dr. Yorke, Dr. Cara, Dr. Holloman, and Dr. Gangahar. Thank you so much. It's a pleasure having you all here. We're really lucky to have you. We're going to start this off with Dr. Yorke. Dr. Yorke, can you talk about how you got into advocacy and what your first experiences were like?

Dr. Bekra Yorke:

The big influence was the fact that I had faculty when I was a resident and fellow who were involved in organized pathology and in advocacy as part of their professional life. They were involved in promoting, helping the profession through organized pathology, including advocacy. And actually we as residents and fellows were pretty well funded to attend meetings. So they put their money where their mouth was and led by example.

So for me, when I got out of training, it was just a couple of years into private practice out in suburban Houston, an opportunity arose to play a little part with the local pathology society, the Houston Society of Clinical Pathologists. It was helping to get sponsors for the meetings, like companies to come in and exhibit. So, I figured I could do that and sort of to my surprise, it meant that I got to attend the board meetings prior to the general meeting, and here I was all of a sudden sitting with these senior pathologists who were in leadership and I didn't know anything about how organizations worked.

I was a little intimidated, but I had promised to do a job, so I showed up. Then life rolls on and it's really about showing up. So over time, I became an officer of the Houston Society of Clinical Pathologists and the Texas Society of Pathologists needed somebody to fill a last minute vacancy for the young pathologist section. They gave me a call and I said, sure, I'll help. So along with that has come advocacy. These aren't issues that necessarily you know about as a resident, although it's good to learn when you have the opportunity, but basically it's just a matter of stepping up and occasionally getting a little outside of your comfort zone.

I think we all know that we're a small profession and we're the only ones who know what pathologists do, and if we don't let the world know, let the legislators and decision makers know, nobody will. So it's actually very interesting and broadens your horizons and you meet great people along the way.

Alec Bose:

So that leads me into how you sort of brought the residents that we have here today involved in this and this virtual fly-in that we just had the few weeks ago. Can you talk a little bit about what inspired you to get them involved and how you were able to even just sort of coordinate that?

Dr. Bekra Yorke:

It's a silver lining and of Covid, I guess, a very slim silver lining, but since these were virtual meetings and became aware at sort of the last minute that we could have other folks or colleagues on the call with us, we signed up to do these Hill visits. So I just sent out an email to via the chief residents to all of the residents and fellows asking for folks who wanted to participate. It's a great opportunity.

Alec Bose:

So I want to open this next one up to everyone, but Dr. Gangahar, let's start with you. What was your involvement in advocacy before this fly-in and just sort of talk about your experience and how that was.

Dr. Chiraag Gangahar:

So I'm a Surge Path fellow at Methodist, so I'm new to this institution. I participated in the 2021 Leadership Summit that was virtual, but it was a good opportunity for me to learn how the more experienced pathologists like Dr. Yorke, Dr. Valdez down in Victoria, Texas, how they communicate with legislators. So I sat in on the session with the representative from District 27 from Victoria, Texas, and then also Al Green, the rep from the Texas Medical Center, and me being a more junior, I basically listened and then at the end there were some questions, so I chimed in.

But it was fairly straightforward and I think the fortunate thing of being involved with CAP, as a resident and as a fellow, you get a free membership and all you do is sign up for the Path Pack Alerts and Path Net Alerts, and they give you a sheet that just explains to you what you need to know that's relevant for the discussion, and you just read it before the call or the day before the call, jot down some notes and when you're on the call, you just personalize.

Just be yourself. Talk about what you do in your day-to-day job as a resident or as a fellow, and that's really what they need to hear, the technical aspects of it, like the specifics of whatever bill that's on the ticket. Usually the more senior people are going to be more well-versed. They've had more reps in this arena. So I would really encourage, and I applaud Lukas and Ashley for stepping up this time, and hopefully this sparks a chain of residents being more involved moving forward. So, that's how I got involved. I'll turn it over to my colleagues to express their stories.

Alec Bose:

Dr. Holloman, would you like to go next?

Dr. Ashley Holloman:

Sure. So prior to the fly-in, I really had very limited experience and advocacy at all. I signed up for the Action Alerts, so I would get those and then I would press the send button to go to my congressman, but I didn't really pay too much attention to it. I've always been more passionate about education, and I've always sort of viewed advocacy as something that the attendee or taking care of and their handling it. So, didn't really feel like I had a role there, but I'm graduating next summer, and so I'll be the attending. And because of that, I have more interest now in getting involved and seeing what the issues are.

So, while I've only been doing the Action Alerts, the opportunity that presented itself to participate in the virtual fly-in seemed like the perfect opportunity for me to get an idea of how I can be involved and what more it is that I could do. So, after partaking in the meeting at Dr. Yorke and the representative from Dan Crenshaw's office, it sort of made me feel like this is something that I definitely quite could do. It was not threatening or scary at all. So, I'm sort of looking forward almost to being more involved in advocacy

Alec Bose:

And then Dr. Cara.

Dr. Lukas Cara:

Yeah, so I have not had any experiences with advocacy of any kind. So, when the chief's emailed and Dr. Yorke invited me to be part of this, I was actually really excited because I kind of was interested in how advocacy would work in a practical standpoint. Dr. Yorke was great. She walked us through like what the process was going to be like, and the big takeaway I took from it is that it really is education.

What really impressed me, especially with Dan Crenshaw's office, is the spokesperson had a working knowledge of what pathologists do, especially during Covid. She knew already that you were integral to getting the testing ramped up here at Houston Methodist, and she pinpointed that to her meeting with Dr. Yorke previously, which I found very encouraging. So yeah, it was a very positive experience overall.

Alec Bose:

Dr. Cara, you said they had a better working knowledge of what pathologists did. Was there anything else that made them more accessible that you didn't anticipate?

Dr. Lukas Cara:

Yeah. Well, like I said, the main thing was she understood exactly what pathologists did. I guess she saw us as part of our constituency and an integral part of medicine, which I think is really important, because I think as pathologists sometimes you like to hide in the black box, which is the lab. It's difficult because legislators, they're people too, and if they don't hear about us, they're not going to know about us. So, she was very interested in pathology as a profession, which I found very encouraging. It was very approachable, and she did ask some interesting questions about what we do on a day-to-day basis.

Dr. Ashley Holloman:

I agree with everything that Lukas has said, and then just also I think I was just surprised at how, easy it seemed to be able to talk to the representative and how conversational it was. I think going in, I was just thinking politics, politics, politics, and I'm thinking the strike stern face politician who I have to convince on something too, and it was just not like that at all. She was just very nice said, easy to talk to. She was knowledgeable about pathology, and it just made the whole process seem a lot less intimidating than what I sort of worked up in my head, which was really encouraging to, I guess want to be more involved in advocacy.

Also, I imagine that while, this one representative she was knowledgeable about pathology, I'm sure that there are other representatives who are not, and Lukas sort of brought up an educational component, and earlier I said that I've been more interested in education and that's where I'd focus.

But, I thought about advocacy is sort of looking at it as just sort of a different audience. So there's also this educational component, but instead of it being mentored undergraduate students or medical students or the residents, well, I have my representatives and my congressmen, who I need to educate about what I do and what the issues are and why they're important for patient care.

Dr. Bekra Yorke:

That's an excellent point, and people don't realize that so much of it is simply a matter of educating the legislators and their staff about our perspective and what we do and why the decisions that they're making, which they typically understand the bill or the issue from a generic perspective, but it's making them understand from a personal perspective.

Dr. Chiraag Gangahar:

I think the question was how did you feel during the visit with legislators? I mean, I felt fine. I was happy to meet other pathologists who are like-minded. If you foresee yourself being on the job market in the next few years, it's not a bad idea to participate in such these type of events because it's a great way to just meet people, build friendships. These are people that introduced me to partners in private practices all over Texas, and it made my transition into getting interviews very smooth, and it also opened up possibilities to other projects to make things better for our profession. It's probably a subject for another podcast, but it was a very positive experience. I would echo my colleagues on that.

Alec Bose:

Dr. Gangahar, let's stick with you for a second. You were actually at your first virtual Hill Day in the spring. Can you talk a little bit about that and how this most recent one compared to that,

Dr. Chiraag Gangahar:

The Hill Day that happened virtually with through several pathologists around Texas. That is something that, I mean, I had been salivating over this since the prior year when the PLS was canceled. And so I mean, in residency, we didn't have much leeway to take PTO for these types of things. So finally my fourth year, I had some free time and we had done some resident fellow stand downs at my prior institution. It was like little 15, 20 minute talks to talk about what Path Pack is, what they do and why you should care about it. But then that year, the Covid, the first wave was hitting, and so it was canceled. So by the time I had the chance to participate, I was pretty excited about it, and I tried to share that avenue with everyone here because we're very, I mean, there's not a lot of platforms like this where everything is just set up for you, so you just have to show up and it's a layup.

So, our membership fees pay a highly professional staff in DC that curates relevant information, so it doesn't take up too much time. You don't have to dig too deep into these bills. It's all curated for you. And so I think if there's one takeaway point from this podcast among others, it would just be that it's not that much extra work. All you have to do is open your emails, jot down some notes and show up.

Dr. Bekra Yorke:

I will plan to let our residents and fellows also know as we get closer to the Pathologist Leadership Summit, because I think that the College of American Pathologists does a terrific job with this. It's yet another opportunity to be educated about and experience aspects of our profession and actually our life as citizens in the United States that you don't have often, and it is so well curated. First, you learn about general issues facing pathology, everything from maybe the upcoming potential wave of artificial intelligence to funding for graduate medical education, a wide spectrum of things.

And then they will hone down and educate you deeply on the issue of the ask. And this is over the course of two days, and then the third day you go as groups to meet with your legislators and folks who are new at it. We'll be paired with more senior people. And so it's an opportunity to get involved in a way that you will be very well-prepared for. And it won't be intimidating. It won't feel like you're just thrown in over your head.

Alec Bose:

But I think that leads sort of into the final question of what takeaways or what sort of advice would you give to your fellow residents if they wanted to get involved in advocacy or they wanted to do this sort of work. What would you say to them if they are feeling intimidated or found it daunting?

Dr. Lukas Cara:

I'm going with what Dr. Gangahar said. I would say the most important thing is to show up. Just being there is a big part of the starting experience. You have to just get your feet in the pond, so to speak. And, it's easy to set up, and as Dr. Holloman was saying, they're very approachable, the representatives and congressmen and senators. So it's a very easy experience and very rewarding. But the first step is to show up.

Dr. Ashley Holloman:

So I would say look out for emails like Dr. Yorke's, and if there's an opportunity that presents itself to just sort of sit in on a meeting, then there's no harm from doing that. So you can at least see what it's like. I think it will remain to be a mystery or scary or foreign to you if you never just sort of give it a shot. So I think that's one option. And then the Action Alerts, if you want to do something very, very simple, very easy, that won't take up any of your time at all, just sign up for the Action Alerts and participate that way.

Again, as I said earlier, I'm very new to advocacy, but so I have a lot to learn, but doing the Action Alerts, participating the virtual fly-in, I think that those are just easy things that you can do to sort of jump in and get started, and then who knows where it will take you, because I'm already excited about the next Hill Day, and I've done one virtual fly-in.

Dr. Lukas Cara:

I mean, if you need to know why, I mean, if you're going to engage with something, the why is just remember why you went into medicine in the first place. You wanted to help people, and you can't help people if you're not at the table where business decisions are being made and policy decisions are being made that affect your autonomy and the viability of your practice.

Dr. Ashley Holloman:

I'd also just say, I sort of put it off saying, oh, I'm a resident. It doesn't matter for me right now. I don't need to get involved. Well, I think that you can involve, and it's a perfect time for you to get involved.

Alec Bose:

If you are a pathology resident or a CAP fellow teaching residents and would like to experience teachable moments like this, make sure you register for the Pathologist Leadership Summit, which culminates with the CAP's Hill Day on May 3rd. This Year's Hill Day is taking place virtually so you can participate alongside colleagues from the convenience of your home or office.

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