Can you tell us about a time when your work reached the public or impacted population health and/or policy?
When you can bring people together and create little wavelets, that can have real impact.
Michael Potter MD
Director of the San Francisco Bay Collaborative Research Network (SFBayCRN)
Hunter Holt knew he was making an impact when his geriatrician colleagues began quoting a New York Times article about his work to help support decision-making on cervical cancer screening in older populations.
Anjana Sharma's impact became apparent when she saw her pilot of patient advisors being involved in residency interviews unexpectedly lead to the rate of matched residents who identify as underrepresented in medicine almost doubling from the historical average. This result demonstrates the program's potential to advance health equity by giving patients a voice in deciding who will eventually care for their community.
Michael Potter had several examples of impact, including how his work in cancer screening research has changed practice and is being used nationally and internationally. He feels gratitude when he learns about patients whose colorectal cancer was detected early clinics that have used his team's Flu-FIT approach. Family physicians who become successful researchers can often influence public health and policy through their leadership and advocacy roles. He described organizing conferences and working on the board of advocacy organizations for which his research is relevant. "I think those types of opportunities when you can bring people together and create little wavelets can have real impact.”
Kevin Grumbach's research and scholarship on the primary care workforce, innovations in the delivery of primary care, racial and ethnic diversity in the health professions, and community health improvement have widely influenced policy and practice, including increased attention to health policy payment systems reform. “The challenge is that when you're dealing with the broader policy environment, where so much is ideologically driven...there are people who are just anti-affirmative action, they're just dug in on that, there are people who are anti-abortion, there are people who are protecting the special interest status quo in the for profit-oriented health system," said Dr. Grumbach. " when you're doing this kind of work, no one study or one thing is going to do [change policy]. You're in it for the long haul."
Christine Dehlendorf added that although the wins aren't always quick, they are well worth the struggle. Dr. Dehlendorf reflected on her own trajectory around person-centered contraceptive counseling (PCCC) and pushing back against a movement towards directive counseling promoting use “Long-Acting Reversible Contraception” or “LARC,” a practice that impinged on reproductive autonomy. While PCCC had no traction when she started in 2008, Dr. Dehlendorf persisted and led the pushback against directive counseling and LARC promotion through research, developing quality metrics, and producing systematic reviews and commentaries to promote PCCC. These efforts over a 16 year-period, along with work by other researchers, scholars, and the reproductive justice community, resulted in the shift in practice described in the 2022 ACOG guidelines towards intentional application of a patient-centered reproductive justice framework and use of a shared decision making model.
"And I just think that it was, it's a reminder for me when I'm feeling disheartened in some of my current work that it may be 14 years, 16 years, 20 years, or not in our lifetime," said Dr. Dehlendorf. "But, if we don't ask the questions that family medicine has the insight into health equity, community engagement, and all of the various ways that we touch our patients and our communities, then other people aren't going to ask them. And then the evidence base won't be there when the time is right.”