If you ask an anesthesiology resident if they know what it means to be an “advocate,” you might be met with a puzzled look. While residents manage to acquire a wide range of clinical and technical knowledge, there is often a void when it comes to governmental affairs or health care policy. On an everyday basis, state and national legislatures and regulatory agencies are creating health care policy that impacts all physicians and our patients. Yet, when most anesthesiology residents graduate and enter clinical practice, the vast majority do not have the skills to be “change leaders” and advocates on behalf of our specialty and patients.

In an effort to bridge the knowledge gap and to educate, train, and develop anesthesiology residents as health care advocates, the California Society of Anesthesiologists (CSA) developed an annual Resident Advocacy Workshop. The purpose is to educate and orient anesthesiologists on what is happening in state politics, why they should care, and how they can engage effectively in grassroots advocacy efforts. CSA leaders invite one to two residents from each of the anesthesiology residency training programs across California to come to our state capital in Sacramento. They participate in a full-day workshop that lays the foundation in advocacy and educates them on the nuances of complex state health care politics.

The CSA Resident Advocacy Workshop agenda includes the following components:

  • Welcome – CSA president

  • Personal Storytelling About Advocacy – Resident director/chair of CSA's Committee on Resident Representation

  • Perspectives From a Health Care Lobbyist – CSA lobbyist

  • CSA's Guiding Policy Principles and Look at Current CSA Legislative Priorities and Strategies – CSA chair of Legislative & Practice Affairs Division

  • The Importance of Resident Involvement – CSA past president

  • Basics of Practice Management and Regulatory Oversight – Chair, Legislative Affairs Committee

  • Public Relations as Part of an Effective Communications and Grassroots Advocacy Program – CSA public relations firm

  • Meet Your State Assemblymembers and Senators – Four legislative panelists

  • Tour of the State Capitol

  • Networking and Debrief Reception.

One of the tenets of the Resident Advocacy Workshop is exposing the residents to a wide variety of stakeholders who are involved in health care governmental affairs and advocacy. Residents learn about the basic types of advocacy – direct lobbying, coalition engagement, and grassroots outreach in legislative districts. Additionally, they are taught about key principles for effective advocacy, which include having a clear message, knowing how to relate your issue to the legislator's interests and current state policy priorities, determining the right strategic “ask,” and building relationships. CSA leaders also explain the grassroots advocacy structure that we utilize via the intentional design of eight California geographic districts for CSA members that are aligned with 10 assemblymembers and five senators.

State Assemblymember Akilah Weber, MD (D-79th District), fifth from left, with California anesthesiology residents.

State Assemblymember Akilah Weber, MD (D-79th District), fifth from left, with California anesthesiology residents.

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“While residents manage to acquire a wide range of clinical and technical knowledge, there is often a void when it comes to governmental affairs or health care policy.”

At the 2022 workshop, residents heard about how CSA leaders must determine legislative priorities each year, including both proactive and reactive positions. This year, CSA is managing engagement on more than a dozen health care bills being introduced in the state legislature. Additionally, one of the most controversial and headline-grabbing topics discussed was the Fairness for Injured Patients Act (FIPA) California ballot initiative that would alter the existing Medical Injury Compensation Reform Act (MICRA) – a law designed to limit liability for malpractice claims. In 1975, the California Legislature passed a law that capped non-economic damages in malpractice awards to $250,000, and that was considered the gold standard for medical liability insurance. MICRA has been in place for 50 years, and residents learned about the continual attempts to change MICRA limits. After hearing about MICRA, the residents, CSA leaders, lobbyist, and staff members then discussed malpractice insurance, issues related to practice management, and the importance of being involved in state referendums and health policy initiatives that can significantly impact all physicians, not just anesthesiologists.

Due to restrictions imposed by the COVID pandemic, instead of having the residents go from office to office visiting with state legislators in the capitol, we brought the legislators to meet offsite with the residents and CSA physician anesthesiologist leaders. This year, Assemblymember Dr. Akilah Weber, representative of California's 79th District (D-San Diego), was one of the speakers. She is a board-certified obstetrician/gynecologist, and she is the founder and past director of the Pediatric & Adolescent Gynecology Division at Rady Children's Hospital-San Diego. She also served as an Assistant Clinical Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at UC San Diego. She motivated the residents to get involved now and to be active members of their society. The anesthesiology residents were captivated by hearing the perspective of a physician who entered the political arena, and all agreed Dr. Weber's presence in the California State Assembly is critical to having a “physician voice” in the legislative chambers.

California anesthesiology residents with CSA leaders.

California anesthesiology residents with CSA leaders.

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The Resident Advocacy Workshop ended with a networking session where residents connected with CSA physician anesthesiologist leaders, our CSA staff, and our CSA lobbyists over a “Happy Hour.” After the workshop, CA-1 Stanford resident Dr. Franklin Canady, said, “It was an extremely informative session. I'm really glad we were able to meet with state senators and hear about MICRA and how it can affect insurance rates and future anesthesiology physicians.” He praised the CSA staff and CSA physician anesthesiology leaders: “I can tell the physicians representing us at CSA and ASA are invested in residents and getting us involved. The CSA administrative staff are stellar and invested in my career.”

The future goal for CSA is to create a CSA Resident Policy Research Rotation that is modeled after the ASA Anesthesiology Policy Research Rotation in Political Affairs (asamonitor.pub/3R7PODM). The ASA rotation will open its applications in December 2022 and is an effective way for residents to receive exposure and training in advocating for our specialty and patients.

Next year, CSA plans on integrating the CSA Resident Advocacy Workshop with the California Medical Association Legislative Advocacy Day so the event will really allow residents to place their knowledge into action and be part of organized medicine.

The CSA Resident Advocacy Workshop is a robust and dynamic training model and certainly can be adapted for use by other state component societies. The future of health care is dependent on educating tomorrow's physicians, and it is imperative for all of us as physician anesthesiology leaders to empower our anesthesiology residents today.

Felipe D. Perez, MD, FAAP, Chair, Legislative Affairs Committee, California Society of Anesthesiologists, and Clinical Assistant Professor, Stanford University School of Medicine, Stanford, California.

Felipe D. Perez, MD, FAAP, Chair, Legislative Affairs Committee, California Society of Anesthesiologists, and Clinical Assistant Professor, Stanford University School of Medicine, Stanford, California.

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Antonio Hernandez Conte, MD, MBA, FASA, ASA Committee on Governmental Affairs; President-Elect, California Society of Anesthesiologists, and Partner, Southern California Permanente Medical Groups, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

Antonio Hernandez Conte, MD, MBA, FASA, ASA Committee on Governmental Affairs; President-Elect, California Society of Anesthesiologists, and Partner, Southern California Permanente Medical Groups, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

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