A necessary paradigm shift: recognizing the surgeon-advocate in academic surgery

Health equity and the social determinants of health are increasingly prioritized in health care delivery across North America and globally, yet academic medicine remains ill equipped to support equity-focused advocacy. We argue that this stems mainly from a gap in recognizing advocacy as an academic pillar alongside research, education, and administration. Advocacy is undervalued in academic medicine, as reflected in teaching, hiring, and promotion criteria and what is published in academic journals. Health equity is essential for the health of populations, and the current structure of academic medicine should be redesigned to recognize, value, and support equity-based advocacy efforts. Advocacy can be integrated in 2 key areas: medical education and faculty roles and promotion pathways. A new academic role, the surgeon-advocate - whose work focuses on the engagement, knowledge dissemination, and administration of advocacy-based work to affect system change - is vital for a paradigm shift that accepts advocacy into the essential work of academic medicine. The concept of a surgeon-advocate is not new and is vital to our identities as physicians. However, formally embracing advocacy within academic institutions represents the paradigm shift needed to move closer to health equity goals. This analysis proposes a critical revision to academic surgery and, more broadly, academic medicine. We provide practical steps to intentionally weave advocacy and health equity into the fabric of academic medical institutions to improve how we practise and serve our patients.