Q&A with Michael Boninger, MD
Professor and Vice Chair for Research at the University of Pittsburgh Medical Center and Co-Director of the AAP’s Rehabilitation Medicine Scientist Training Program (RMSTP)
What does advocacy mean to you?
Advocacy means doing work outside of research and normal faculty activities that positively impacts the field and the individuals with disabilities that we work with.
How did you get started in your advocacy efforts?
When you do research that shows policy needs to change, how can you not take the next step and try to change that policy? This was what happened to me in my wheelchair research. We found that higher quality manual wheelchairs broke down less often and likely prevented shoulder injuries. Unfortunately, reimbursement policy defaults to the least expensive chairs. My advocacy in that area extended to advocacy for the field of PM&R as I moved into more leadership positions.
What skills learned during your medical training have helped you in your advocacy efforts? What new skills did you have to develop?
Unlike research, where you can see results, it is not always clear what progress you are making in your advocacy efforts. Having said that, I would say that two important qualities learned during medical training are active listening and being direct. It is really important to listen to others’ concerns or their reactions to your specific requests. Also important is being direct in what one is asking for and the reasons for the request. Transparency serves well in all aspects of an academic career.
What challenges have you encountered?
Resistance to change and inertia are very potent challenges when advocating. Governments are large structures that are hard to get to move.
How have you seen advocacy change over your career?
For me, I have gone from advocating for better coverage of a specific type of wheelchair, to advocating for the field and pushing for legislation that can help the people we serve. For the field in general, I think that all of our organizations, including the AAP, have realized the importance of make advocacy one of our important activities.
What have you learned in your role as Co-Director of RMSTP and serving on national councils?
Simply put, advocacy is hard and requires persistence. It requires difficult conversations and can involve making people uncomfortable. We all try to avoid that, but in certain circumstances, like calling out inequities, it is essential. For example, the National Center for Medical Rehabilitation Research (NCMRR) is in the National Institutes of Health’s (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Being a small center in a large institute means that the AAP, and specifically AAP members who serve on council, have to advocate for people with disabilities and full representation in NICHD. As an example, funding physician researchers is thought to speed translation of science into clinical practice. Because NIH recognizes this need, there are many programs that specifically address building physician research capacity, including millions of dollars’ worth at NICHD. However, the only grant specific to physician researchers in rehabilitation is the relatively small RMSTP. Clearly, ongoing advocacy is necessary.
Should all physicians be active advocates? Why?
Yes, in our DNA is caring about the patients we serve. We must advocate for research funding, policies and laws that help this group.
What advice would you give to someone just starting out?
Because advocacy is hard, you need to focus on what you are passionate about. Figure that out first, then find mentors and allies who can help and be your partners as you work to cause change.