Cite as: Shih-Shien Chou R. The imperative of physician advocacy: a call for ASRA’s strategic action. ASRA Pain Medicine News 2025;50. https://doi.org/10.52211/asra020125.007.

Advocacy

Introduction

Physicians are dedicated to alleviating suffering and improving community health. Historically, this commitment has been rooted in the stability of the profession and focused on patient care. However, today’s rapidly evolving landscape presents physicians with new and complex challenges that demand a shift in approach. Over the past 30 years, healthcare has seen a significant transformation. The shift from independent practices to large corporate entities has changed the dynamics of medical practice. What once sufficed for individual patient care now seems inadequate in a system marked by complexity and regulation. Modern medical practice requires a deeper understanding of physician advocacy and its vital role in shaping practice and reimbursement structures. In this context, ASRA Pain Medicine stands at a crucial juncture.

This advocacy series is designed to provide insight into the current healthcare landscape, the policies shaping it, and their direct impact on patient care and reimbursement through quarterly articles exploring various facets of modern healthcare and their effects on ASRA Pain Medicine. The series will highlight the importance of physician advocacy, ASRA Pain Medicine’s role, and how individuals can get involved. We will begin with an overview of medicine and healthcare finance and a call to action, offering steps for members to engage in advocacy. The discussion will then focus on the significance of ASRA Pain Medicine’s involvement in advocacy through the American Medical Association (AMA), illustrating how even a small sub-specialty society like ASRA Pain Medicine can influence the larger AMA House of Delegates.

Physician Advocacy: Beyond the Exam Room

Physician advocacy extends far beyond clinical expertise and patient representation. As noted by Columbia University’s social medicine program it addresses systemic inequities, institutional biases, and structural injustices within healthcare. Advocacy bridges the gap between patient care and broader social determinants of health, leveraging the physician’s role to drive meaningful change. Physician advocacy seeks to improve population health by addressing broad and specific healthcare policies.¹ Advocacy is one of the three core pillars of ASRA Pain Medicine’s mission, playing a central role in supporting its members and their patients. Focused on regulatory initiatives, ASRA Pain Medicine uses its expertise in pain management to influence policies that enhance patient care. It is important to note that ASRA Pain Medicine does not engage in political lobbying or political advocacy.² ASRA aims to leverage our knowledge and experience in the diverse fields of acute pain, chronic pain, and perioperative medicine to help advocate for the best outcome for our patients. Our clinical practices focus on individual patients. However, the big picture of medicine and the effects of funding decisions influence how we practice medicine for each patient. Advocacy is that opportunity to help elicit change on the macro scale of medicine to improve medicine at the micro/individual level.

Engaging in Advocacy: How to Get Involved

For those interested in advocacy, there are several ways to contribute:

1. Engage with the ASRA Pain Medicine advocacy page. Stay updated on current issues and ASRA Pain Medicine’s positions. ASRA Pain Medicine President Dr. David Provenzano wrote an excellent overview of the society’s current advocacy efforts at the AMA in the August 2024 newsletter.³
2. Subscribe to ASRA Pain Medicine News. Receive regular updates on advocacy efforts within ASRA Pain Medicine. Also, subscribe to other newsletters, such as those of the American Society of Anesthesiologists, state anesthesiology societies, and medical associations, to become cognizant of the bigger picture of medicine—it all affects our patients and the practice of medicine.
3. Volunteer and contribute. Every fall, ASRA Pain Medicine opens a call for committee positions. Leverage your strengths and focus on them to bring value to these roles. Be persistent as you may not secure your desired position on the first attempt. Additionally, challenge yourself by stepping out of your comfort zone and embracing new opportunities.
4. Embrace lifelong learning. All physicians are perpetual learners. This topic is familiar territory for them; with time, your knowledge will deepen and expand.
   1. The AMA has a website on how to be involved in advocacy.
   2. The California Medical Association (CMA) also has a page⁴ on how to be a physician advocate.
5. Seek mentorship or offer to mentor. You never know who you’ll meet; everyone has something valuable to contribute.
6. Get involved locally. Many states have county medical societies that serve as the grassroots foundation for advocacy and are eager to develop future leaders. These societies bring together professionals from various specialties. Membership in your local or county medical society is typically included with state society membership. Additionally, there is often a shortage of specialists in leadership roles within these local and state organizations.
7. Collaborate with healthcare professionals. Healthcare executives and other professionals are invaluable assets, each bringing unique perspectives and challenges. By sharing knowledge about our specific issues and difficulties, we can collaborate effectively to develop better solutions for our patients.
8. Join the AMA. Contrary to popular belief, AMA revenue comes from the licensure of royalties and credentialing products such as the Current Procedural Technology (CPT) codes. CPT codes are used for physician reimbursement and are the sole source of reimbursement for Medicare and Medicaid.⁵ CPT codes are updated annually. ASRA Pain Management is involved in the CPT/Relative Value Update Committee (RUC) process. Increasing our voice within the AMA allows ASRA Pain Management to influence reimbursements for the work we do. More importantly, the AMA fights for issues important to all physicians, such as Medicare reform, fixing prior authorization, promoting physician-led care, reducing physician burnout, and making technology work for physicians.⁶

The Evolution of Medical Practice: A Shift in Focus and Role of AMA

The medical field has undergone profound changes since the expansion of managed care in the 1990s. Physicians, once primarily in independent or small private practices, now often work in large groups or under corporate ownership. This shift has reduced the individual physician’s voice, making collective advocacy essential to navigating the complex regulatory and financial landscape.

Established in 1847, the AMA embodies this collective advocacy. Representing more than 190 state and specialty medical societies, the organization speaks with a unified voice in legislative and judicial matters, advancing the art and science of medicine and promoting public health.⁷ “As the physicians’ powerful ally in patient care, AMA delivers on this mission by representing physicians with a unified voice in courts and legislative bodies across the nation, removing obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises, and driving the future of medicine to tackle the biggest challenges in health care and training the leaders of tomorrow.”⁷ The AMA House of Delegates (HOD) is primarily divided into two main sections: state societies and specialty societies, each comprising 312 delegates. In state societies, each delegate represents about 1,000 AMA members, while in specialty societies, each delegate represents approximately 2,000 members.⁸ Consequently, every AMA member is represented by multiple entities, including a state society and potentially several specialty societies. This structure ensures a broad representation of AMA members within the larger physician community.

Physician advocacy seeks to improve population health by addressing broad and specific healthcare policies. Advocacy is one of the three core pillars of ASRA Pain Medicine’s mission, playing a central role in supporting its members and their patients.

According to the latest 2023 Demographic Report of the HOD and AMA membership (B of T Report 34-A-24 of the AMA), there are 282,952 AMA members out of a total of 1,514,092 physicians and medical students, meaning approximately 18.7% of all physicians and medical students⁹ are AMA members. The AMA HOD consists of 1,091 total delegates and alternates with 391 positions currently vacant.⁹ This includes medical students and residents endorsed by their states for delegate and alternate delegate roles. Notably, the average age of an AMA member is 46.7 years compared to 52.8 years for all physicians and medical students. Medical students comprise 18.2% of AMA members despite representing only 7.7% of the physician and student population. Residents account for 29% of AMA members, comprising 11.5% of all physicians and students⁹. For more details on AMA membership and representation, review the full report.

The AMA HOD convenes twice a year: at the Annual Meeting in June in Chicago and Interim Meetings held in November at different locations. During the Annual Meeting, the HOD reviews and hears testimony on resolutions submitted by specialty or state societies. Before this meeting, the ASRA Pain Medicine practice management committee holds virtual discussions to review resolutions relevant to ASRA Pain Medicine, providing guidance for the delegate’s vote or modifications. This process mirrors the legislative procedure for advancing a bill in the United States Congress. Reference committees categorize resolutions based on their relevance, such as legislative advocacy or advocacy related to medical services and practice. These committees, composed of delegates, oversee the testimony and resolution discussions. The delegate’s role involves attending reference committee sessions for society-related resolutions, taking notes, and potentially testifying on these resolutions before the HOD vote. These committees meet simultaneously, and after hearing testimony from delegates, they spend the following day compiling all in-person and online testimonies into a summary report for the HOD. During the HOD session, which lasts 4-5 days, delegates vote on the proposals with additional testimony on contested resolutions often heard before the final vote. Once approved, a resolution becomes AMA policy, representing the organization’s official stance on various issues. Recent issues the AMA addressed include its 2023 position on single-payer healthcare, efforts to fix Medicare cuts, RUC/CPT code reform, and scope creep by non-physician providers.

ASRA’s Strategic Position in Representation

Despite a strong membership of approximately 5,000, ASRA Pain Medicine’s representation within the AMA HOD is relatively small and relatively new. Among its members, 87% specialize in anesthesiology, 4% in physical medicine and rehabilitation, 1% in emergency medicine, and 8% identify as other specialties. After a multi-year effort, ASRA Pain Medicine secured representation in the AMA HOD in 2022. As of the latest AMA membership assessment, 27% of ASRA’s eligible members are also AMA members.

Based on the apportionment for 2024, Resident and Fellow Section delegates are allocated at a rate of one delegate per 2,000 members according to year-end 2022 figures. Consequently, ASRA Pain Medicine holds two delegate positions, an alternate delegate and one resident/fellow representative who does not have voting rights. ASRA Pain Medicine is one of 54 specialty societies with more than one delegate, giving it a stronger voice within the AMA. Currently, ASRA Pain Medicine represents approximately 0.33% of all physicians and medical students but holds a 0.64% representation among AMA specialty societies. Increasing membership to 6,000 could elevate its representation to nearly 1% in the AMA HOD, enhancing advocacy efforts with an additional delegate. Currently, based on 2022 numbers, ASRAPM has 955 AMA members and we need to  increase AMA membership within ASRAPM to 1500 to gain an extra delegate seat.

ASRA Pain Medicine is notable for its diverse membership, which includes specialists in acute pain medicine, regional anesthesia, and chronic pain treatment. The society supports fellowship-trained and non-fellowship-trained members, providing a cost-effective educational platform to help physicians enhance their skills in a competitive medical landscape.

Within the AMA, ASRA Pain Medicine participates in several councils. The largest is the Specialty and Services Council, which includes all specialty societies and meets virtually twice yearly to discuss key resolutions and vote. ASRA Pain Medicine is also part of the Pain & Palliative Medicine Specialty Section Council, consisting of 10 member organizations that meet multiple times during the HOD. Additionally, it belongs to the Anesthesiology Section Council, which comprises American Society of Anesthesiologists delegates and other anesthesia-based pain societies, to discuss anesthesia-related resolutions.

Significantly, ASRA Pain Medicine is a member of the Mobility Caucus, which includes many influential societies within the AMA, such as major surgical societies. This provides an excellent networking opportunity for ASRA Pain Medicine to engage with larger societies and discuss resolutions and other AMA matters. In 2024, ASRA Pain Medicine became a member of the Surgical Caucus to expand its influence at the AMA.

Conclusion

This series will explore healthcare finance and its impact on medical practice and policy. The next article will provide historical and current perspectives on healthcare finance, offering a framework for understanding its effects on the medical profession.

In today’s era of change, physician advocacy is crucial for driving meaningful reform. Through collective action and informed participation, we can navigate the complexities of healthcare and advocate for our profession and the patients we serve.

References

1. Physician advocacy. Columbia University Department of Medical Humanities and Ethics. https://www.mhe.cuimc.columbia.edu/our-divisions/social-medicine-and-professionalism/physician-advocacy.Published 2024. Accessed July 27, 2024.
2. Advocacy. ASRA Pain Medicine. https://www.asra.com/news-publications/asra-updates/advocacy. Published 2024. Accessed July 27, 2024.
3. Provenzano D. President's message: ASRA Pain Medicine advocacy and the development of future physician leaders. ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra080124.001.
4. 12 ways to be a physician advocate. California Medical Association. https://www.cmadocs.org/newsroom/news/view/ArticleId/50110/12-ways-to-be-a-physician-advocate-2. Published April 7, 2023. Accessed July 27, 2024.
5. American Medical Association. Influence Watch. https://www.influencewatch.org/non-profit/american-medical-association. Published July 2023. Accessed July 27, 2024.
6. AMA Advocacy Impact Report. American Medical Association. https://www.ama-assn.org/system/files/ama-advocacy-efforts.pdf. Published November 2024. Accessed July 27, 2024.
7. About the AMA. American Medical Association. https://www.ama-assn.org/about. Published 2025. Accessed July 27, 2024.
8. Madera JL. Constituent society delegate apportionment. American Medical Association. https://www.ama-assn.org/system/files/delegate-apportionment-memos.pdf. Published February 5, 2024. Accessed July 27, 2024.
9. Underwood W. Demographic report of the house of delegates and AMA membership. AMA board of trustees report 34-A-24. American Medical Association. https://www.ama-assn.org/system/files/a24-bot34.pdf. Published 2024. Accessed July 27, 2024.