The consequences of society’s most far-reaching decisions often arrive first at the doors of our hospitals and clinics. Infectious disease outbreaks, widening health inequities, a polarized political environment, and shifts away from policies grounded in science have underscored the importance of surgeons’ voices. Health and public policy are closely linked, yet surgeons are not always prepared to engage in advocacy early in their careers.1,2
Many surgeons have responded to this need with little preparation beyond a desire to address morbidity and mortality.3 However, effective surgical advocacy requires skills and experience not widely included in medical education or postgraduate surgical training. Traditional promotion pathways in academic surgery also have not consistently recognized advocacy work.4 More recently, frameworks have been proposed for measuring the impact of surgeon advocates.5
Advocacy is a growing priority for the ACS, with opportunities for engagement through initiatives such as the Leadership & Advocacy Summit and SurgeonsPAC. While avenues for participation exist, there remains a need for structured approaches to prepare surgeons to engage in advocacy early in their careers and address societal issues that influence patient outcomes.
The question is how surgeons can be equipped to participate effectively within the structure of surgical training.
The University of Chicago Medical Center piloted a surgical advocacy fellowship that was later replicated at Emory University.1 These two non-Accreditation Council for Graduate Medical Education-accredited, institutionally recognized graduate medical education fellowship programs were designed to provide aspiring surgeon advocates in their professional development years with skills to engage at the community, state, and national levels.
The experiences begin after the first 2 to 3 years of surgical training, when residents have substantial exposure to patient care and to factors that affect community health, access to surgical care, and outcomes. The framework has three pillars: (1) knowledge and skill building, (2) evidence-based advocacy projects, and (3) community engagement.1
Knowledge and Skill Building
Effective surgical advocacy requires an understanding of population health, public health research, the political process, and the US healthcare system. Formal graduate education, such as a master of public health or master of public policy degree program, or structured didactics can help build that foundation.
Externships with institutional government affairs personnel also can provide practical experience. These professionals engage with policymakers and advocate on behalf of medical institutions at the local, state, and federal levels. Shadowing them can give trainees opportunities to observe advocacy in practice and understand how policy issues may affect surgical care.
Communicating effectively with lawmakers and the public is a skill developed through experience and practice. Faculty development programs also may offer training in executive communication, media interactions, and editorial writing. The annual ACS Leadership & Advocacy Summit provides this type of training as well as opportunities to meet with lawmakers on Capitol Hill.
Evidence-Based Advocacy Projects
The framework pairs knowledge and skill development with practical application. Residents and mentors identify issues affecting community health that may benefit from surgical advocacy, such as screening access, prescription affordability, rural surgical access, or organ allocation.
Guided by existing data or resident-initiated public health research, trainees develop or participate in local, state, or national policy interventions. For example, a resident might develop a local literacy intervention informed by research linking childhood educational outcomes with later community violence, or collaborate with civic organizations on existing policy proposals.
Community Engagement
As residents learn the tenets of surgical advocacy, relationships and partnerships with the community become essential. The people and communities affected by these issues often have substantial experience and investment in potential solutions.
Surgeon advocates therefore should build social capital and trust with community members and organizations as partners rather than approaching them solely as experts. In practice, this may include participating in community health fairs and panels, joining health-related community organizations, and speaking publicly about relevant health issues.
Community engagement can extend the impact of surgical care beyond the operating room and into the environments where recovery and prevention occur.6
Amber Hannah, MD (PGY-3), Emory University in Atlanta, Georgia
Dr. Hannah’s advocacy has centered on interrupting the cycle of violence through community- and hospital-based approaches. Through her work with the Interrupting Violence in Youth and Young Adults program in Atlanta, Georgia, she partnered with frontline violence intervention workers to understand the social and structural drivers of violent injury and identify opportunities to prevent recurrent harm and advance advocacy efforts.6
She also contributed to regional violence prevention initiatives across the southeastern US. Her work included testifying on firearm injury legislation and helping develop a community resilience learning program for urban high school students. These experiences demonstrate how surgeons can engage with community partners and medical students outside the clinical setting.
Anthony Douglas II, MD, MPH (PGY-3), The University of Chicago in Illinois
During his surgical advocacy experience, Dr. Douglas co-developed a proposal introduced in the Illinois General Assembly that would require firearm manufacturers to contribute to the public costs associated with firearm injuries based on their products’ involvement in shootings.7
Supporters describe the proposal as a public health approach intended to create financial incentives for manufacturers to invest in safety, distribution practices, and violence prevention. The proposal has drawn attention in Illinois and from advocates interested in similar approaches elsewhere.7
Preparing Surgeons for Advocacy
Preparing surgeons to engage in advocacy requires more than clinical expertise. Trainees need an understanding of the US healthcare system, the relationship between policy and health, and the political process. They also need opportunities to use data and research to inform interventions or public policy and to build relationships with the communities they serve.
The surgical advocacy programs at The University of Chicago and Emory University offer one model for providing motivated residents with structured training and experience in this work.
Acknowledgements
The authors gratefully acknowledge Grady Memorial Hospital and Morehouse School of Medicine for their contributions to the development and advancement of the Emory Trauma and Surgery Advocacy Fellowship.
Disclaimer
The thoughts and opinions expressed in this article are solely those of the authors and do not necessarily reflect those of the ACS.
Dr. Anthony Douglas is a clinical PGY-3 at The University of Chicago in Illinois. He is a co-founder of UChicago’s Surgical Advocacy Fellowship and plans to pursue a career in trauma and acute care surgery.
Dr. Amber Hannah is a clinical PGY-3 at Emory University School of Medicine in Atlanta, Georgia, and co-founder of the Trauma and Surgery Advocacy Fellowship in partnership with Grady Health System and Morehouse School of Medicine in Atlanta. Dr. Hannah is an aspiring trauma/surgical critical care surgeon.
References
- Douglas AD, Dorsey C, Benjamin A, et al. Preparing surgeons for advocacy: A framework for trainees. Surgery. 2025;188:109675.
- Dorsey C, Ogunnowo S, Douglas A, et al. Surgeon as advocate: A widening lane. Surgery. 2025;185:109515.
- Smith RN, Ward C, Hink A, et al. Violence prevention advocacy in surgery: Strategies across the socioecological spectrum. Surgery. 2026 Feb;190:109842.
- Douglas AD, Benjamin A, Donington J, et al. Surgical advocacy as an academic career path: A guide for promotion discussions. Surgery. 2025;187:109650.
- Castater C, Hart L, Metchik A, et al. Characteristics of a three-pronged continuum of care model for hospital-based violence intervention. Trauma Surg Acute Care Open. 2025 Nov 27;10(4):e001869.
- Hannah A, Russo K, Ward C, et al. Coalition building for regional violence prevention advocacy: Unique perspectives from the Southeast. Surgery. 2026 Feb;190:109826.
- Brownlee C. A Chicago trauma doctor has a plan to shift the cost of gun violence. The Trace. Published September 16, 2025. Available at: https://www.thetrace.org/2025/09/gun-industry-victims-fund-rifl-illinois/. Accessed October 1, 2026.
