Q&A with John Melvin, MD
Professor Emeritus and Chair Emeritus at Thomas Jefferson University and Member of the AAP’s Public Policy Committee
How did you get started in your advocacy efforts?
I have focused my advocacy efforts towards achieving recognition of and support for the essential contributions of medical rehabilitation and physician specialists in PM&R. I began these activities in the 1960s when rehabilitation was relatively unknown and unrecognized as a critical part of healthcare. We called ourselves proselytizers as we advocated for the general acceptance of rehabilitation.
My first advocacy efforts involved giving lectures to varied audiences on the roles of medical rehabilitation and PM&R specialists. These included groups of nurses, nursing students, lawyers, medical students, physicians and county medical societies. I began these lectures while I was still a resident. Next, I served as the PM&R Representative to the quality programs of my state medical society. This was during my second year as a faculty member. I was recommended by the Section of PM&R, which I joined just after my residency. This position provided me the opportunity to advocate for PM&R within the state medical society. More significant advocacy began in 1971 when AAPM&R appointed me Chair of its Ad Hoc Committee for Peer Review. This committee developed the core criteria for admission of patients to rehabilitation hospital/units that later with additions was implemented by the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services).
What skills learned during your medical training have helped you in your advocacy efforts? What new skills did you have to develop?
During my residency, I learned how to communicate regarding functioning and rehabilitation, first with patients and team members, later with those outside of rehabilitation. I was fortunate to work with Saad Nagi, PhD, who was the first to describe the conceptual framework of disability. This provided me with a clear understanding of disability, which made it easier to communicate regarding it. As a faculty member, I had to learn how to be effective as an advocate with members of Congress and the administrators of government agencies.
What challenges have you encountered?
I think we still have the challenge of how to describe rehabilitation and the role of PM&R specialists in terms that those outside our discipline can easily understand. What we do is highly complex and overlaps with the roles of others.
Another challenge is to understand that advocacy must be sustained over long periods of time, whether seemingly successful or unsuccessful. Success is often vulnerable, and lack of success may only be temporary.
Why do you serve on the AAP's Public Policy Committee?
Serving on the AAP’s Public Policy Committee gives me an opportunity to participate in efforts to expand the acceptance of and support for the academic aspects of physiatry, which has been one of my long-time interests.
How have you seen advocacy change over your career?
Our professional societies have developed over time more extensive and sophisticated advocacy programs, something unavailable at the beginning of my career.
There is also less a need to explain the basics of rehabilitation now as compared to the 1970s. The issues now are more what level of rehabilitation complexity patients need or will need.
Should all physicians be active advocates? Why?
Yes, all physicians should consciously see themselves as advocates for what they believe is important. This is especially true of those who are PM&R specialists, as the population they care for has such significant needs. Advocacy is along a continuum from daily performance to dedicated seeking of legislative support. Physiatrists should realize that various stakeholders assess their day-to-day performance and use it to judge their specialty. Performing well within the healthcare system is in itself advocacy. Physiatric practice presents multiple opportunities to advocate for patients, such as influencing payers to provide appropriate services and equipment or providing supportive legal testimony. Medical staff meetings can present opportunities for advocacy of the specialty.
Participating in advocacy helps physiatrists appreciate what they do for patients by forcing them to articulate the benefits they provide. It provides insights into a complex political world and the opportunity to interact with many interesting people.
What advice would you give to someone just starting out?
The first step would be to decide where on the continuum of advocacy you wish to be, both short term and long term. If the interest is to participate in national advocacy, seek volunteer positions in our PM&R professional associations. They have innumerable projects designed to improve physiatry and to position it for recognition and support. The earlier in one’s career, the better.