The surgeon advocate's role in shaping state and federal policy

Although most surgeons dedicate their careers to clinical excellence, education, and research, many overlook a critical fourth pillar of the profession, advocacy. Surgeons already advocate daily, whether guiding patients through care plans, performing technically complex operations, or navigating insurance barriers. However, few recognize their potential to influence broader health policies that directly affect their surgical practices. This article emphasizes the urgent need for surgeons to engage in both legislative and regulatory processes. Policy decisions, ranging from scope of practice laws to Medicare reimbursement rates, have profound and often immediate impacts on how surgeons deliver care. Although surgeons may be familiar with legislative processes, many underestimate the influence of regulatory bodies such as the Centers for Medicare & Medicaid Services, Food and Drug Administration, and state health departments. These agencies interpret and implement laws, often through unilateral decisions, without direct votes and with minimal physician input. Surgeons are often absent from critical discussions at both state and federal levels, allowing other stakeholders such as the insurers, hospitals, and device manufacturers to shape the narrative and outcome. To counteract this, surgeons must proactively engage with legislators, build long-term relationships, support political action efforts, and participate in organized medicine. These steps do not require holding office or mastering policy intricacies but just consistent, informed involvement. Advocacy is a professional responsibility, an extension of surgical leadership that goes beyond the operating room. By becoming more engaged, surgeons can protect the integrity of their practice, ensure patients maintain access to high-quality surgical care, and shape a health care system that values expertise and evidence-based care. The call to action is clear; if surgeons want a seat at the decision-making table, they must claim it. The scalpel may heal patients, but the pen shapes the system, and both are needed to lead the future of surgery.