Advocacy Internship Reflections by Dr. Shruti Varadarajan

Shruti Varadarajan, MD

PGY 2
Internal Medicine
Northwell Health Northshore LIJ

Entering the Program

Advocacy has always been an integral part of the medical profession. In our medical training, we are taught to advocate for our patients, whether it’s to their insurance company for a treatment that can really alter their trajectory, or to our colleagues in the hospital to make sure patients are getting the care they require in a system that is already overburdened. As a result, many of us in this profession are familiar with the ideals and value of advocacy as a concept; however, we lack the tools and expertise to navigate the rooms where high-impact, far-reaching decisions are made at the legislative level. Furthermore, as a collective, physicians and trainees are woefully behind the times when it comes to unionizing and labor laws, and I do believe that is partly because we are naïve to our legal rights and representation.  

In a broader sense, this is also a polarizing and dynamic moment for our nation politically, and therefore legislatively. Currently we are expecting major funding cuts to be made to Medicaid/Medicare; not only are these going to affect millions of patients, these are also the funding source for medical education and trainees in schools and academic centers throughout the country. In addition, we are seeing a rise in mistrust of the scientific enterprise. A not-so-recent development in our national politics that has concerned me greatly as a woman and a physician is the overturning of Roe v. Wade in 2022, thus removing the federal right to abortion and allowing individual states and legislative bodies to create their own rules regarding a pregnant person’s autonomy. 

Although physicians are traditionally encouraged to be apolitical, I believe there is a way to continue serving our patients with a nonjudgmental approach while also advocating for the institution of medicine in a sustainable and effective manner. To this end, I am looking forward to learning tools and strategies from the ACP to thread advocacy into my career. I am hoping to learn more about policymaking and lobbying for legislation from the experience of seasoned professionals. From a medical perspective, it often feels like a lot of these decisions are made in a vacuum, but already from my first week I am able to appreciate that health care policy is a complicated, multifaceted endeavor with several stakeholders.

While I initially started out with an interest specifically in reproductive rights, I think there are several areas to target that I will need to reflect on to spend my time on an issue that is both relevant and important to me and my colleagues. My hope is that the final paper that I complete  as a result of this rotation will be worthy of discussion with a policymaker in any capacity, and perhaps will contribute to the ACP’s ongoing advocacy in some small way. I am looking forward to engaging with our community and its representatives in a productive and significant manner.

Program Experience

I chose this ACP advocacy elective because of my interest and curiosity in health policy. I do not have prior experience in legislative contexts and I felt it was important, especially as a physician, to understand the system as it relates to medical matters and community health. At the beginning of the elective, I reflected on how this is a polarizing and dynamic moment for our nation politically, and therefore legislatively, and that continues to be true. However, now I can confidently say after having had a glimpse of the infrastructure of local government that there do exist tangible avenues and opportunities to contribute to the legislative dialog as a physician, and especially as a collective.

While doing my research on my chosen topic of reproductive policy, I learned about the historical context surrounding abortion legislation and what I discovered was quite surprising: anti-abortion views that center fetal well-being over maternal health were actually influenced in large part by extremely successful lobbying in the mid-nineteenth century by the then-nascent American Medical Association. In fact, the AMA released a “Report on Criminal Abortion” that framed abortion as an immoral act of “murder” and disseminated the opinion that life began not at “quickening” as was earlier believed, but at conception. Of course, almost two hundred years later, the opinion of the majority of the medical profession has changed quite a bit. As endorsed by the ACP in 2023, physicians as a whole support equitable access to reproductive health care services including abortion; however, the early misconceptions perpetuated by the medical society ignited much of the anti-abortion rhetoric we hear today. This story speaks to the impact that medical professionals have on the cultural and political narratives and how imperative it is that we use this power responsibly and ethically.

            Over these past four weeks, I have had the opportunity to watch State Legislative sessions in real time, participate in discussions with ACP members discuss lobbying for current bills such as the primary health care investment, conduct a focused and thorough review of reproductive health policy at the federal and state level, and engage in thoughtful discussion with my peers on the importance of advocacy on NY ACP’s podcast.

            I wanted to learn how to thread advocacy into my career as a physician and I certainly think this experience gave me an insight and preliminary understanding of a process that I have no familiarity with. I am interested in joining the Health and Public Policy Committee to continue being engaged in the ACP’s work. I would also like to spend more time reflecting on the medical system and communities that I am a part of and focus on areas of legislation where I can be impactful as a resident physician.

             I am very grateful to have had this opportunity to work with the NY ACP chapter over the past month. I hope to attend future events such as ACP leadership day to engage at the federal level.