Two of the most influential courses I took in college — “Economics of Social Policy” and “Economics of Medical Care” — continue to shape how I view the intersection of policy and medicine. They revealed how legislation can profoundly affect patient outcomes and emphasized the value of quantifying policy impacts to drive evidence-based investment. I was particularly struck by the work of Almond et al., who showed that proximity to a neonatal intensive care unit (NICU) significantly reduced infant mortality among low birth weight newborns, providing a compelling economic case for expanding NICU access [1]. Yet, as my professors often reminded us, research alone rarely drives change without advocacy and storytelling.

As a medical student, I’ve seen firsthand how policies influence clinical realities. Many physicians struggle daily to provide optimal care within systems shaped by decisions far upstream. Still, the connection between day-to-day dissatisfaction with the healthcare system and the actual policies that have resulted in present circumstances may not always be understood or acknowledged. Although physicians are uniquely positioned to advocate for patients, our voices are underrepresented in health policy debates dominated by other powerful interests.

Public policy has reshaped nearly every aspect of orthopedic surgery — from the ban on physician-owned hospitals and the expansion of Medicaid to private equity consolidation and declining Medicare reimbursements — all with measurable effects on access to orthopedic care for vulnerable populations [2–6]. The scale of these issues can be daunting at every level of training, and I often question whether my efforts are meaningful, if I am learning and contributing enough, and what the role of the medical student should be in advancing health policy research and advocacy.

Fortunately, I had the pleasure of interviewing Dr. Christopher Dy, MD, MPH, FACS, Associate Professor of Orthopaedic Surgery at Washington University in St. Louis. Dr. Dy is a previous AAOS Health Policy Fellow, has been involved with regional and national advocacy efforts through both the AAOS and American Society for Surgery of the Hand, and has published extensively on the impact of health policy on orthopedic care. He is also the co-host of The Upper Hand Podcast. In the following conversation, he sheds light on how health policy shaped his path from trainee to orthopedic surgeon and his advice to students looking to get involved with health policy and advocacy efforts.

--

Annika: We’ve talked about this briefly before, but tell me more about how you first developed an interest in health policy.

Dr. Dy: Difficulties with access to care. There were a lot of underserved communities in South Florida at the time and I believe still to this day, so the medical school was really into doing health fairs. The medical school there has a big legacy of community service. So, I got the bug there and then, seeing not only how I wanted to provide health care in that manner but then trying to think about what can we do from a systems and policy perspective to mitigate some of the impact of these disparities as well. I also did some international work when I came out of the school there. That’s clearly a very different entity but all of that got me thinking about delivery of care and then policy goes hand in hand with that.

Annika: You completed the AAOS Health Policy Fellowship during training. How did having this experience as a trainee shape your career?

Dr. Dy: It’s a shame that fellowship no longer exists. I think it was a great opportunity to learn a lot about how policy is made. To that point, I had done more research on health services and health delivery but always wanted to know how those findings might actually influence what happens in terms of policy. So, one of the best parts about that fellowship was getting the opportunity to learn how things are done on The Hill – which I think on the smaller level is done at every city, regional, and state government but especially at the level of being on The Hill – learning how the AAOS approaches advocacy issues, getting to actually do some lobbying, meeting members of Congress as well as their staffers. Their staff always has a huge influence on what informs [the member of Congress] and shapes their views. You realize how much of the country is run by people that are staff, and so it was an interesting insight. I learned a lot in that process, and it gives you perspective on what we potentially as clinicians could do to shape policy down the line. There are a lot of things that happen between the research you do and the care you give patients and how it may actually influence things on The Hill.

Annika: Going off of that, you mentioned prior to the fellowship, you had primarily focused on health disparities research. As a medical student, a lot of times the education we get on health systems could use some more work and it is harder to stay in touch with those issues. What advice would you have to medical students who are interested in this work and want to stay engaged?

Dr. Dy: For health services research, it’s a lot of the things you yourself have done. It’s reaching out to people who are in the public service area, asking how they got started, looking at questions that are important to you and how they may impact the faculty that you work with at the time. If you’ve identified a really engaged faculty member, ask them what kind of the pain points they have in practice in terms of delivering the care that they want to deliver. That will lead you to the whole plethora of questions that you could potentially ask and then it’s figuring out how to address those questions. Health services is hard because you can never answer a question to the level of granularity and definitiveness that you would get if you were to design a really nice clinical trial. Oftentimes, health services research will invite more questions than it answers, but part of the fun is trying to figure out what you need to understand and what questions you need to ask to actually get to a different type of study design.

In terms of policy, I think that as a medical student getting involved with your state orthopedic association is probably the easiest point of entry because they’re always looking for energetic and engaged people to help with lobbying at the state level. So that’s probably the easiest to get started.

Annika: That definitely makes sense! One of our residents just went to the National Orthopaedic Leadership Conference (NOLC) so there’s definitely a lot of involvement at the state level.

Dr. Dy: I think so! If you get involved with the state level, then you could get invited to something like the NOLC which is the Academy’s big effort to lobby The Hill. The Hill is always exciting, and I imagine it’s a very different place now but equally exciting if not as treacherous.

Annika: I’m sure I’ll have to ask him about that. You touched on this earlier that advocacy efforts on The Hill mirror what you do at the local, state, and institutional levels. As you career has gone on – I know now you’re in St. Louis, Missouri – how have you gotten involved at more of the local or institutional level?

Dr. Dy: You know, I haven’t been as involved as I have been in the past. Life has happened where things are quite busy right now with career and family, but there are lots of opportunities to be involved with the state and federal level. I think just keeping abreast of what’s going on and thinking about the issues that affect you and your daily practice and passing that on to the people that are more involved.

You know, one of the biggest things about lobbying at the state or federal level is about being able to tell a story. People love stories and that’s how you actually change their minds. Data are not going to change people’s minds as much as you think. It’s linking the data to a story that is compelling. That’s a theme throughout research too, say if you’re trying to write a grant, you want to be able to tell a story to convince somebody to change policy or get behind it and you need to convince them why this is important for them and that’s storytelling. I think the biggest thing that I’d say if I was a student right now is trying to you look at people who tell engaging stories to try to figure out a way to do that. Again, it’s talking to your faculty, talking to your attendings about the pain points they have, the victories they have. How do you weave all of that together to engage somebody in a conversation and convince them why they need to change their viewpoint or continue to support you.

Annika: I used to write in undergrad, and this is something we talked about often. Stories are the way people’s hearts but also just the way our brains are wired.

The last thing I wanted to touch was as students and trainees, a lot of our time goes towards our education. There’s a lot to learn from the orthopedics and medical side of things. What advice would you have – whether it be health policy, advocacy, whatever someone’s interests are – in terms of growing those interests as you grow in your career?

Dr. Dy: You know I think that finding a mentor or role model, somebody who has done this before is super helpful. There’s typically always a playbook for what you want to do. There may be some variations on the theme, but there’s no need for you to reinvent the wheel whether you want to become a stellar clinician, the best teacher, a federally funded researcher, or somebody who’s heavily involved and influential on The Hill. Somebody’s already done that in some capacity, so figure out who those people are, try to meet them if you can or look up what they’ve done in their path and try to emulate that the best you can with your own take on it. Do your homework and see who’s done what you want to do and try your best to to follow their lead.

--

I hope you all enjoyed this interview with Dr. Dy on health policy and advocacy. At the

end of this blog, you will find linked resources to continue to explore health policy

advocacy and how to get involved. Stay tuned for more MSOS blog posts on paths in

orthopedic surgery!