Good morning. My name is Colleen Murray-Payton and I will be your virtual emcee over the next two days. Be sure to watch my daily welcome video on the daily updates page for tips on navigating within the platform and other program highlights. You'll find the daily updates option on the main conference page. Thank you for joining us as we kick off the virtual DO Day 2025 conference. The educational sessions offered this weekend have been developed to support your leadership skills and raise your voice to educate members of Congress on the issues that matter most to you and your patients. Now it's my distinct pleasure to introduce the president of the American Osteopathic Association, Teresa Hupka, DO. Dr. Hupka is a fellow of the American College of Osteopathic Obstetricians and Gynecologists and an inductee in the American Osteopathic Association's Mentor Hall of Fame. She is the founder and medical director of Comprehensive Wellness Care, LLC, a practice specializing in obstetrics and gynecology and reproductive health, providing complete health services to women of all ages. Thank you for your service, and all you DO, for the AOA and the osteopathic profession, Dr. Hupka. So I'd like to now introduce our incredible DO Day keynote speaker, Dr. Lina Nguyen, MD. In addition to being a practicing emergency medicine physician and healthcare executive, Dr. Nguyen is one of America's leading public health executives. She is a CNN medical analyst and Washington Post contributing columnist and a guest contributor for NPR, PBS, and BBC. When not advocating on the front lines of public health, Dr. Nguyen serves as clinical associate professor at George Washington University. As the Baltimore Health Commissioner from 2014 to 2018, she led the nation's oldest continuous operating health department in the United States to fight the opioid epidemic, address healthcare disparities, and improve maternal and child health. She's written two critically acclaimed books, When Doctors Don't Listen, How to Avoid Misdiagnoses, and the second, Unnecessary Tests and Lifelines, a doctor's journey in the fight for public health. During the course of her career, Dr. Nguyen has been honored as one of modern healthcare's top 50 physician executives and Time Magazine's 100 most influential people. We're fortunate to have Dr. Nguyen with us today to discuss the challenges and opportunities of navigating the current health policy landscape. I know you'll enjoy me in extending a warm welcome to Dr. Lina Nguyen. Dr. Nguyen, thank you so much for joining us today. Good morning, everyone, and thank you very much for that very kind introduction, Dr. Hapcom. I would also like to thank the other leadership of AOA, Kathleen Creason, your CEO, Don Amaskin, the Vice President of Governance and Meetings, Sean Neal, Vice President of Advocacy and Political Affairs, and also our moderator, who I will have the chance to speak to later, Colleen Murray-Payton, for inviting me to be with you all today. So I wanted to start today by sharing why it's so meaningful for me to be invited to speak with osteopathic physicians and physicians-in-training who are advocating on behalf of their profession and patients by sharing my story. So I'm someone who has known since I was very little that I wanted to be in medicine because I had severe asthma as a child and visited the doctor's office, the emergency department a lot as a child. In addition, I'm an immigrant. My parents and I came to the U.S. just before I turned eight, and though my parents worked multiple jobs, we often had trouble making ends meet, and we depended on Medicaid. When my mother was pregnant with my little sister, she was on WIC. And I saw for myself the social determinants of health. Of course, I didn't know what that meant at the time, but the idea that so much of health is not influenced by the health care that you receive, but by the other aspects in our lives. Well, I thought that it was a dream when I finally got into medical school. But then I saw a lot that made me question my choice of the profession, frankly, when I started medical school. I remember seeing a young man who had come in in status epilepticus. He was having a prolonged seizure, and when I talked to his wife, she said that he had a seizure disorder, but these were the days before the Affordable Care Act, and he couldn't afford his seizure medications because he had a preexisting condition and he couldn't get health insurance. I remember another patient of mine who was a child with asthma, a disease that I knew well because I had it growing up, who kept on coming to the emergency department because his mother had trouble getting refills of his medication because it required prior authorization. They weren't able to get it, and so he often ended up with asthma exacerbations. I remember seeing also patients with diabetes, with heart disease, and I knew that a good diet and exercise were important to them managing their conditions, but if they were then telling me that they lived in a food desert where they had to take two buses and then walk 10 blocks in order to get healthy foods because otherwise they're going to their corner store, and in their corner store they can't find fruits and vegetables, then what am I doing telling them that they need to eat healthier foods? So I say all of this because I realized, I think, early on that it wasn't just the care that we were providing in our hospitals that was determining the quality of their health, but there was something else as well, and that's what prompted me to want to advocate. And so in medical school, I went to my first conference, which was of the American Medical Student Association. I got really inspired at that conference. I ended up running for office. Eventually, I became the president of AMSIM and worked in DC for a year. I took a year off from medical school to lead the organization to speak on behalf of physicians and training and patients. And I learned a lot from that experience and later on as the president of another medical association of the American Academy of Emergency Medicine, Residents and Students Association. And I then went on, as you heard in Dr. Hubbika's kind introduction, to work as Baltimore's health commissioner to change the policies around the issues that I saw for myself as a problem as a clinician, issues, for example, around food deserts. We worked on a program to partner with our local supermarkets to increase food access for our vulnerable residents. We got to work on a program for asthma to reduce asthma readmissions in children. We worked on medication access. And in that role, I had a formal role as well doing advocacy, advocacy for funding on the local level, advocating for policies on local, state, and national levels. And so today, I wanted to share with you some of the things that I've learned along the way as we go into DO Day on effective advocacy. And specifically, I want to share eight things that I learned myself and through the mentors and people that I admire. So eight things, and then I welcome your comments and questions as we engage in a discussion around these points. All right. So the first point is something that the mayor that I worked for here in Baltimore, Mayor Stephanie Rawlings-Blake, used to say. And she said that if everything is a priority, nothing is a priority. Look, I understand in medicine and public health where everything is interconnected, right? I very much believe that housing is healthier, very much believe that we have to care about social determinants of food and food is medicine and all these issues. But at the same time, you also have to narrow your advocacy focus on any given day. You could be outraged by a lot of things, but you can't be outraged equally about everything all at once or else you're not going to be heard. And so I appreciate that for DO Day, you have very clear priorities. You want to be protecting physician practices and Medicare access. You want to address barriers to care, in particular Medicare funding. That's a lifeline for our most vulnerable individuals. You want to invest in the future of the physician workforce. You want to preserve teaching health centers. You want to make sure that there are jobs to train residents so that there will be opportunities to care for patients later. And when I look at your priorities for DO Day, I think they really center on a key unifying value, which is that of protecting patient access. You want to keep practices open, physicians to be trained so that you can continue serving patients, especially in underserved areas. And to me, all of that is a clear North Star. And I think when it comes to priorities, it never hurts to say it over and over again. Maybe the person was not listening the first time, maybe they didn't quite grasp it the first time. Maybe you can say it in a different way the second time. But I think it's really important to have examples of what you're advocating for and then to come back to that and to your central guiding values. So remember, if everything is a priority, nothing is a priority. Keep very clear about what those priorities are on your advocacy day. Number two is the power of the group. For legislators, it really means something when you stand together as an organization. There is the power of the alliance. It really means something when you say that you are representing an organization that has X many members. And also, if you are able to say on some issues that there are dozens of other organizations — I'm making up these numbers here — but let's say 70 other organizations representing 10,000 clinicians who have also signed on to something. Politicians know, as well as anyone, how challenging it could be to build and sustain alliances. And so they'll really appreciate it when you can say, we have built this alliance and look how many people stand behind us in this effort. By the way, something else about the power of the group is that it helps to shield you. If you as an individual are speaking on behalf of Lena Nguyen, the person, or John Smith, the person, then in a way you're more vulnerable to attacks than if you say, I'm here standing with other physicians and physicians in training on this issue. And these are challenging political times that we're in. And again, I think it's better to say, I'm among a group of peers and we're standing together on this particular issue on behalf of our patients. Number three is something that may sound trite because it is something that's often said, but I believe is very true, which is that all politics are local. And what I mean specifically on this is, it's really important to start connecting on a personal level. And I would mention anything that you have in common. I understand that you all have received your preliminary schedules for your lobby day. Well, think about if there's the possibility to do research on the individuals that you're meeting with, certainly if on the member, but also if you're meeting with the staff, do research on that staff as well. Find all the things that you have that you have in common. If you live in the same neighborhood, if you went to the same school, if your kids are in the same school, if you support the same sports team, if you play the same sport, if you have the same activity, it's just human nature to listen most to people with whom you have a relationship. If you have individuals that you know in common, definitely mention those. But if you don't, and it's something that you share, an interest, a school, et cetera, begin with that. And that's a good way of finding that connection. Along these lines with all politics is local is probably you're going to be meeting with someone that you have something in common with geographically. Probably the person is representing the area that you're from or that you're practicing in. And it's good to show that you really understand their constituents who are your patients. You have the same goal. You're serving the same people. They're serving their constituents. You're serving your patients. They are actually the same people. And so emphasizing that, showing how much you understand the needs of that area will be important in your advocacy too. All right, number four is to tell a story. Again, this is human nature. It's how people remember. It also personalizes why this is so important to you. And so what I would say here is you can, as physicians, as physicians in training, you have many of these stories. You have seen what happens when patients don't have access to care, when they wait too long to get care. And instead of treating their blood pressure early, now they're coming in with extremely high blood pressure that's led to a subarachnoid hemorrhage that's led to brain bleed. You know what happens when people do not get treatment for their kidney disease and they end up on dialysis. You know what happens when people have to travel really far for care. I know that you're also lobbying about keeping telemedicine in place. And you can talk about your own experiences delivering virtual care and how that augments care, especially for people who live in faraway areas or have difficulties with mobility and transportation. You know what happens. You know what the consequences are when people have to wait for care. You know why this should be different. You can illustrate all of these points with stories. I believe that that's important, again, for helping people to engage in the subject matter, to connect with people. It also gives you credibility. I think we cannot underestimate the credibility that we naturally are afforded by virtue of being providers. And I think we should lean into that physician-provider voice also when we're speaking with our legislators because we are the ones on the front lines who are engaging with patients, their constituents on a daily basis. And so sharing those stories is important. And given that not everyone that you're meeting with may know previously about osteopathic medicine, I believe this is also the opportunity to illustrate what you do, not just by explaining what osteopathic medicine is, but by showing them what it is through your examples. All right, so tell the story, number four. But then number five, you should also marry the story and the emotional appeal of that narrative with data. I think it's good to start with a story because, again, it gets people's attention. It connects people on an emotional level. But then you follow up with the data. So for example, maybe you start by talking about somebody who went without access to care. And then you can mention cuts to Medicaid threatened access for 66 million patients. You can talk about someone you've seen, a child who has Medicaid, whose family depends on Medicaid and Children's Health Insurance Program and what that means for them. And then you can follow up with a data point that there are 72 million people on Medicaid, more than 7 million children who depend on Children's Health Insurance Program. Then you can also give key data points that further illustrate the importance of why you're there. For example, that physician payment has not kept up with inflation. When adjusted for inflation, Medicare payment to physician practices has dropped 33% since 2001. It's not fair, says other providers of automatic yearly updates. And this is going to force practices to close, which means that your patients will not have access to care. If you have local data points, even better. If you can talk about a local hospital or local practice that has had to close, again, that connects people even better. But I would say here, statistics, I know all of us are very data-driven. We're scientists. This is how we got to where we are. But also, don't get stuck in the numbers. Remember that numbers provide context, but it's stories that compel action. You have to marry both because, again, numbers provide context, but it's stories, that narrative, that compel action. To that point, let me go on to number six, which is that you need to make the person that you're speaking to care about the issue. It's very possible that the issue that you're there speaking to them about is something they haven't thought about before. That's okay. That doesn't mean that they aren't informed or don't care about your issue or are against you. It actually just means that, as a legislator, they have to know all the issues across all these subject areas, and it's possible that they've never thought about Medicare payment to physicians or teaching health centers before. That's okay, and that's why you are there. You are there to help to provide education to them, which, frankly, is what you all do every day. For those of you who maybe it's your first time doing advocacy, know that it's what you do with your patients every day. You're providing education to your patients every day on subjects that they may not have thought about before, and that's no different than when you're speaking to a legislator about something that they may not know about. You are the expert when it comes to that particular issue. What I would encourage you to do is to connect with the issues that they care about. If you don't know what those are, again, very natural. You may not know about all the issues that a legislator particularly cares about, but what you should do is to do your research in advance. Look up old speeches. Look at the issues. Look at their websites. Look at their social media feed. What are the issues that they are emphasizing over and over again? If it's workforce, education, public safety, immigration, whatever the issue is, connect to that issue back to health, and then access to health back to their issue. I believe that it's really important for us. One of the key tenets of public health is to meet people where they are, and that's no different for when it comes to advocacy. Make it local. Again, if there are closure of local hospitals or local providers not being able to take patients because of payment cuts, mention those things. Again, if they're not automatically connecting with the issue, see it as your job to make that happen. Number seven is to find common ground. I strongly believe that we all have more in common than we have differences. We are going to have disagreements. I think it's very unlikely, it's possible, but I think very unlikely that you're going to be speaking with someone with whom you are in 100 percent agreement with on every single issue. It's okay to have these disagreements. That's important in a civil society. I believe that there are ways to find areas of agreement on some areas even as you disagree on others. I'm going to give you a very specific example of what we did in Baltimore on this. When I was the health commissioner in the city, the city was being sued by the Catholic Church over something related to reproductive health access. Specifically, we had implemented a legislation in the city that required that pregnancy resource centers advertise that they did not provide the full spectrum of reproductive health care, and the Catholic Church was suing us over that. At the same time that this lawsuit was going on, we were also partners with the Catholic Church and with Catholic charities and a number of other associations funded by the Catholic Church on other priorities. For example, one of our very successful programs was a public-private partnership called Be More for Healthy Babies that aimed at reducing infant mortality and maternal mortality. We were partners with them on that. Catholic charities, while the Catholic Church was suing us, became one of our key collaborators for a violence prevention program in our city called Safe Streets. I give you this example because there are ways to talk to people, even with whom you have some disagreements on other areas of common ground. I would also add that in these divisive times, I believe that it's not pragmatic to reflexively oppose everything. Not everything is a five-alarm fire. It's important to try to find common ground on issues that you can move forward, including protecting patient access. I'm going to give you one more piece of advice, number one through eight, and I know that not everybody is going to agree with these pieces of advice. I look forward to engaging in a conversation around it, but I just want to add number eight, which is something that Congressman Elijah Cummings, one of my dear mentors who has since passed away, used to say. Congressman Cummings talked about pain, passion, and purpose. What he meant by this is that for so many people, including me, and I'm certain including many of you, it's something painful in our experience that becomes our passion, that then drives us and becomes our purpose. I think in your advocacy, it's important to show the person that you're speaking to why you care. Lead into your voice as a physician. Talk about the patients that you've seen and why is it that you're there? All of you, you have many other things that you could be doing this Saturday. There are many other things that engage your time, but you are choosing to be here because of how much you care about that issue. Appeal to the person's why that you're speaking to by showing them your why and why it is that you care and what it is that your passion that you're turning into or your pain that you're turning into your passion and your purpose. Well, I'd like to end these remarks today with a quote from civil rights activist and scholar Benjamin Mays. He said, I only have a minute, 60 seconds in it. Forced upon me, I did not choose it, but I know that I must use it. Suffer if I lose it. Give account if I abuse it. Only a tiny little minute, but eternity is in it. So osteopathic physicians, physicians in training, let's take the minutes that we have. Let's take action. Let's turn your passion into purpose, your purpose into action, and continue your mission to provide the best care for your patients, and then advocating to ensure that we can secure a better healthcare future for all, in particular, protecting the most vulnerable among us, and always hold true to our values and keep our North Star as the patients and the communities that we serve. Thank you all for doing the work that you do every single day, and I look forward to your questions. Well, good morning, Dr. Nguyen. Thank you so much for that wonderful presentation, for sharing your story, and for those important advocacy tips. I know our audience is very excited to chat in their questions, so please do that now. Please open up your chat, submit your questions to Dr. Nguyen, and let's hear your voice in this conversation. So before we get to the Q&A with the audience, Dr. Nguyen, I'd love to kick it off with some of my favorite and my own questions, if that's okay with you. Of course. Great. So can you give us a landscape of what you see as the major health policy challenges facing the U.S. in 2025? I think that there are a lot, and I think in terms of numbers of things, and so I'm going to give you five things, and let me see if I can come up with all five. But the five things that come to mind in a particular order, although I will say the first is certainly top of mind, is around funding cuts and the uncertainty of the environment that we're in. We are seeing in various budget proposals cuts to Medicare, maybe cuts to Medicaid. We're seeing universities dealing with funding cuts coming their way through research, through caps on NIH funding, through grants that may not be coming through. This might be influencing training for PhD programs, for graduate programs, for scientists, and for other fields. And so I think the uncertainty in what these funding cuts mean has to be top of mind, although it's difficult to see how this is going to be dealt with. And I think we're going to have a lot of uncertainty around what this means going forward, but certainly I see this as when the question is, what are the major health policy challenges, funding cuts is going to be a big one. Number two is prescription drug reform. This is a bipartisan issue. Thankfully, I'm glad that we see this as a big problem that our patients cannot afford the medications that we're providing them, even if we provide it. Again, this is the theme of even if we're providing great medical care, what happens if our patients are not able to receive them? So under the Biden administration, it was started to have Medicare negotiations around the most costly, most used medications. It remains to be seen if that's going to continue. PBMs, the middlemen, I think there's a lot of discussion going on around what's going to happen around pharmacy benefit managers and prescription drug reform in that sense. So I would say that's another big category. Number three related to this is obesity treatment. The rise of GLP-1, semaglutide, terzapatide, it's really revolutionized how we think about obesity. There is a movement to have to treat obesity first. I think many people are very excited about the possibility of these medications and finally treating obesity as a disease and preventing problems for occurring later. But there are many issues, including how are we going to pay for these medications, how long these medications need to be used for, that need to be dealt with as well. The fourth issue is around technology. I know that's something that you all are thinking about as you're advocating for telehealth flexibilities. I would add AI in this category as well of something that's an emerging technology already that is being rolled out quite rapidly that have a lot of promise, but also we need to be careful around this. But I think how we meaningfully integrate technology into our brick and mortar healthcare so that we're able to right-size healthcare, we're delivering the right care for people while expanding access, is another major area. Which leads me to number five. I was able to think of five after all. The fifth is around workforce. I think a lot of hospitals, health systems are facing substantial challenges with workforce. And at the same time, it's something top of mind for trainees, especially in light of funding cuts. And we have to talk about burnout. I saw a recent survey done that found that 80% of physicians reported some form of burnout on a regular basis. And I have been doing research also on this issue of moral injury. This idea that physicians and other clinicians want to do the right thing for our patients, but sometimes we run across system barriers that prevent us from doing that. And then that leads to the sense of, like we're failing our patients, but we want to do the right thing. And so I think how we struggle with this issue of moral injury is going to be very important going forward. Well, thank you so much for that great description of the landscape, which is really robust and dynamic. Talk to us a little bit more about workforce challenges and the role of technology, including AI, and how that might help to bridge gaps. Yeah, so I'm a columnist with Washington Post, as you heard, and I've been doing a series over the course of a couple of years on technology, and in particular, AI in healthcare. And actually, I've been quite amazed by what I found. There have already been many studies looking at the use of specific AI algorithms in diagnosis. For example, in essentially being a second operator to read mammograms or to flag polyps that could be concerning in colonoscopies. And I think the use of AI in diagnosis is really promising. And if that's something that has promise in making care safer, improving the diagnosis, great. Research and development for new drugs, streamlining processes for approval of drugs, I think that's something else that I'm quite excited about, the use of AI in that. There have been some interesting studies looking at how AI could be used in hospitalized patients to flag individuals at risk for sepsis or at risk of deterioration and needing ICU care. And if AI, certain AI algorithms can predict those patients who are at risk, that again is something that I see as in line with helping to make care safer that I think we should be doing more of. And I'll mention one more use of AI that I think some of you may have experienced, which is using ambient AI scribes in your medical documentation. I have not used this myself, but I've spoken to many physicians who have. I'm doing a column on this actually next week on this issue. And I think this really has a lot of promise in reducing inefficiencies and helping to, if it's integrated appropriately into the workflow, could reduce the burden of documentation and allow physicians to do what we are here to do, what we entered training to do, which is to spend time focusing on our patients. At the same time, I think it's important for us to not lose the low-tech, high-touch aspect of medicine. And I think that's why I'm especially excited about things like ambient AI that can, in theory, allow us to focus more on the patient in front of us and actually allow more high-tech while we're using, or more high-touch while we're using high-tech, maybe somewhat ironically, to get there. Yes, thank you. That makes a lot of sense to leverage it to be more efficient and hopefully safer. You mentioned your time serving as Baltimore's health commissioner. I'd love to hear what are some of the programs you're most proud of leading, and what can other cities and communities learn from Baltimore's innovations? Yeah, well, I describe my time as Baltimore's health commissioner as my dream job. It was an opportunity to work on policy, to change the service delivery, because you can have a great policy, but if there are no services, that's not going to do much good. And also to work on education. You can have the best services, but if people don't know about your services, what is that going to do? And so to me, it felt like the perfect trifecta, the policy, education, and services. And I'll give you a couple of specific examples of that. One of my major focus areas was around the opioid epidemic. At that time, and now this is back in 2014 when I was first appointed the health commissioner, naloxone, the opioid antidote, was not yet in common use. We got legislation changed on the state level so that I was able to issue a blanket prescription for every resident of our city to carry naloxone with them. We also worked with state Medicaid so that patients were able to get naloxone for a dollar if they were on Medicaid, or to get it free of charge if they could not pay. And then we went to local pharmacies to make sure that they had naloxone in stock. We worked with local organizations that provided services for individuals experiencing homelessness or individuals at high risk for overdose to get naloxone into their hands. And to me, again, that to me illustrated the policy side. We changed policy to make it happen. Then we made sure that there were services, and then we also provided education accordingly. And within a matter of three years, everyday residents used naloxone to save over 3,000 lives in our city. Along the way, we also started a 24-7 center for individuals who are frequent visitors to the emergency department, needing care for behavioral health services. We expanded buprenorphine and other treatment, and I was very proud of our work around opioids. Another example that I'll give that I had mentioned earlier is around our Be More for Healthy Babies program. That's our program where we worked with over 150 public and private partners, including Catholic charities, but also including all of our local hospitals, our insurers, our religious organizations, our neighborhood associations, to provide education on the ABCs of safe sleep, alone on the back in a crib, and don't smoke, no exceptions. We also delivered free cribs for families. We provided home visits for postpartum women and so forth. And I give this example because I think that you can have partnerships, again, with diverse partners who otherwise have a lot of different goals, but if you are very clear about your North Star and you're able to get people to focus on that common goal, you're able to not focus on those differences. I don't want to say you're overlooking those differences because you're still able to do things on those differences too, but at least you're able to collaborate on these shared goals to advance something important forward. And in seven years, we reduced infant mortality in our city by over 30%, and I think that is something that's important to keep in mind, that, again, it's fine and possible to work on common ground with organizations and individuals with whom you may have other differences. Kudos to you for all of that hard work and those accomplishments. What are some other examples you have seen of hospitals and providers addressing social determinants of health? Yeah, so I love my job now as well, working as a clinician, part-time, but also part-time working as a columnist for the Washington Post because I get to find out what are these innovations that people are piloting, pioneering around the country. So I'll give you three examples that come to mind and that I've written about. I profiled Northwell Hospital in New York that started a program to screen every single patient on their risk of gun violence. So every patient coming into the emergency department, and I believe to many of their clinics, are asked, just as a matter of screening, if they own a gun. And if they do, they will then go further into questions about is the gun secured, firearm training, and so forth. And for people who do not have firearms that are secured, they will actually provide a gun safe or a gun lock right from the emergency department. They will also screen individuals who are at risk for community gun violence, for example, involvement in gangs or past experiences in that sense, and they'll provide social support for these individuals. And I appreciated how Northwell Health has made this part of routine care. It's nonpartisan. It's apolitical. They're talking about gun violence as a safety issue, a health issue, which is the lens that we as healthcare professionals are approaching it as. My second example is of Boston Medical Center. I had the opportunity to visit them and see what they're doing as part of their food as medicine initiative. Boston Medical Center has long had a prescription food pantry where individuals with food insecurity are flagged by their providers. They can then go into a food pantry that's in their hospital. And as long as they're enrolled in the program or as long as they need to, they can be enrolled in the program. They can get a full package of food that feeds their entire family for three weeks and then go back when they need it free of charge. They're also able to select the kinds of food that they need. Boston Medical Center makes that food, the food selection, tailored to the individuals that they're serving. For example, they have a significant Haitian community, and they're able to provide food that people in the community would want to choose. They also have a rooftop garden on the roof of their hospital that supplies patients who are part of this food pantry program and also supplies patients in the hospital. And so they actually tell patients who are inpatient at the hospital, hey, you know that lettuce that you're eating came from right above where you are now. And what I love about this initiative as well is apparently by having this rooftop garden on top, it also makes the hospital greener, as in it helps to save the hospital energy. So they're able to save money from that, from heating and cooling costs. Also, they're able to save costs from the food that then further supplies this food as medicine initiative. One more example I'll give here is that here in Maryland, the Medicaid program has allowed certain flexibilities to allow pilot funding to help individuals experiencing homelessness. There is an economic case to be made as well that if individuals who have chronic medical conditions are frequent visitors to the emergency department who otherwise need to be hospitalized, if they're able to be provided housing, that would reduce their ED visits and readmissions. And so I'm excited about programs like this. I hope that they'll be able to continue, that people around the country will be able to learn from them so that we're able to do, again, what we know is the right thing for our patients from a health perspective. Thank you for sharing those really interesting, innovative examples of programs that are moving things forward. Dr. Nguyen, earlier you mentioned connecting with legislators. So I want to ask a question about that. What are some ways people can identify those areas of possible commonalities with their legislator, especially thinking about going into yoga? Yeah, I'd say the most important thing you can do is to do your research in advance. These legislators all have done a lot of speeches. They all have a website. They're all active on social media. There's a lot of material to choose from. I would watch their speeches. I would go through the social media feeds. I would go through their websites. If they've written op-eds, read their op-eds. You will very quickly, and I'm saying you all are very skilled at going through materials very quickly because that's what we have to do with our patients. We have to go through their medical records very quickly, their histories very quickly. And so you can find out very quickly what are the issues that legislators care about and then find your way to that issue. So for example, if what they care about is education, that's their number one issue. You can very easily see how health ties to that issue. You can talk about school health programs, for example. You can talk about if kids are not healthy, if they're not able to focus in class, if what they care about is a healthy workforce or if it's a workforce development, you can talk about why a healthy workforce is important. Behavioral health, many legislators care about behavioral health. Many of them have talked before about telemedicine. There is a way to get back to that issue that they care the most about. I want to mention one more thing here, which is perhaps a bit controversial but maybe necessary in these days, is to understand language. When you watch their speeches, when you go through their social media feeds, when you read their op-eds, you will see key words that they use that they have found to be important over the time of their research that connects with their audience. I would try to use those same key words when you do your advocacy and that will then get their attention to connect with them. If, for example, what they talk about a lot is underserved residents or families or fairness, whatever those key words are, find a way to use those key words in an organic and not strange way. You don't want to be searching and making it just dropping a random word in, but rather what is the issue that you're going to be talking about? Find a way back to that issue using the words that the legislator has found to be effective in their work. Great advice. Really find that way and connect with what's important to them. I think that's excellent. You know, there's a lot of changes happening on the federal level, from cuts to government agencies to gaps in research funding. So how can physicians and physicians in training keep abreast of these changes and the effects of these changes on their patients? Yeah, it's really hard. You know, as part of my work with the Washington Post, I write a newsletter where my readers will write in and share with me their comments. And last week, I had someone write in with a comment that I decided to feature this week. And essentially, it was about how right now there's so much news. And if you look at the news, it's overwhelming. And the person specifically said, don't share something with us unless there's something we could do about it. And I understand where this is coming from. But I also don't know if I fully agree with that. Because on the one hand, of course, you need to do what's good for your mental health. If you're following so much news, and you're doom scrolling social media that you now can't sleep, and it's interfering with your work, and you're stressed out all the time, I would say, please take a step back and at least take a step back from social media and things that, you know, just aren't that are whatever it is that's detrimental to your mental health, don't do that. But I also think that knowing is important. And how are we going to know the issues affecting our patients and what where we should be advocating unless we follow the news in some way. And so perhaps limit your news readership to once a day or a couple days, there's some good aggregators for the types of things that have been done that impact health specifically. And so perhaps you could look at things like walks or New York Times or the Post or Stat, or there are a number of places that have aggregators of things that have happened. So you don't have to follow the news all the time, every single moment. But I think that, you know, there is, it's, I think, very real, this idea of moral injury, this idea that if you hear a lot of things on which you feel powerless, that makes you feel helpless. And I really understand that. And so that's also why I want to come back to DO Day and why it's so great for you to be here, because you're advocating on issues where your voice really matters, where your voice is really needed, where your voice will really make a difference, something that you understand a lot about. I think that's exactly in your Venn diagram, right? You can think about the Venn diagram of things that you care about, but you can't do much about that are a bit outside your realm of expertise. And then there are those things that you actually know a lot about, that impact you every day, where your voice matters. And I think that's the right confluence of the issues that are chosen for DO Day and why you all are here today. That's great advice to find that Venn diagram and to use your voice. And speaking of your voice, we really do want to hear from the audience. So I'd love for you all to chat in your questions, and we'll float those up to Dr. Nguyen in just a moment. I have one more question for you, and then we'll turn to the audience Q&A, Dr. Nguyen. A lot of people in medicine and science are concerned about the rise in misinformation and vaccines. What advice do you have for physicians and trainees on addressing vaccine misinformation? Oh, this is so hard. And I'm very upset, as I think that many of you are, about the rise of misinformation around vaccines, including childhood immunization that we have been using for decades. You know, I also did my training at a time and practice medicine at a time where I have not seen many of these diseases that we have vaccines for. I've never treated a patient who is in the midst of having polio. I've treated patients who had polio when they were children, but not people who are actively having polio or measles now. And I think in a way, vaccines are a victim of their own success. Because vaccines have been so successful, many of us of our generation have not seen the impact of vaccine-preventable diseases. And so I think part of this, to address vaccine information, is to emphasize this point that we know the data around this. We know the data around measles vaccine, around polio vaccine. We know why these vaccines have been so effective in the past in terms of having widespread immunization of the population. And that's the reason why we have not seen outbreaks of this. We can emphasize those points. But I would add one more. And I'll give you this example. You know, I think this took place in maybe 2022. So this was well after the COVID vaccine was very widely available. This was also after vaccine misinformation had already been quite widespread around the COVID vaccine. I was seeing a person in a clinic. I work in a clinic for urgent care and primary care here in Baltimore as well. And I saw an individual, a man, who I think was in his late 50s, early 60s, who had just been discharged from the hospital after having a stroke. He had high blood pressure, diabetes, heart disease, all kinds of medical issues. And it was marked on the chart that he refused to have the COVID vaccine. And so I knew that this was an issue that I wanted to talk to him about because we were in the middle of Omicron, right? It was everywhere. I definitely did not want this individual who had just been hospitalized with all these medical conditions to get COVID at that point. And so I thought, oh, my goodness, I'm going to have this long conversation about misinformation around COVID vaccines and so forth. And we're going to have this drawn out thing. So I addressed the COVID vaccine with him. And I went into my spiel of why it was important for him at that particular time. And he said to me, thank you. I've never heard anyone talk to me about the COVID vaccine before. I was like, what? No one's talked to you about the COVID vaccine? And he said, yeah, I haven't gotten the vaccine because no one's talked to me about it. And I just thought for myself at that moment, it's a good reminder of how we may make assumptions about people and why they have not done certain things. We may think that there's someone who has certain views about vaccines or other issues. But we really need to ask. We need to listen. We need to not assume. And I also think that we as clinicians, that is what we do on every issue. We do this in our daily work. If somebody has hesitations about a medication, if they don't understand their diagnosis, we talk to them through it. We listen to their concerns. We don't say that this is a conspiracy theory. If it's a concern to that person, it's a concern to them, and it's our job to address it. And I think that it's through those one-on-one conversations that we are going to be able to make the most difference. Now, do I think, of course, that there is misinformation out there, that there are actors perpetuating misinformation? Of course. But what can we do as clinicians with the patient in front of us, with our colleagues, with our neighbors, with our friends? We can have those one-on-one deep conversations. Terrific insight. Meet people where they're at. That's excellent. It would be great now if we could turn to the audience Q&A, and I'd love to kick it off with this question, Dr. Nguyen. Can you speak more about framing? How do you connect policymakers to issues we care about while also avoiding controversial areas and words? That is really difficult, and I just want to acknowledge the challenging times that I'm in. Obviously, this is a nonpartisan talk on my end, but I think you all understand what I mean, that it is just very challenging. It's challenging even to know what language we can use because some people might find some words to be upsetting or might think that it has a certain connotation that we don't mean. And so I'll say two things. And, again, I think that some of you will disagree, and that's okay, and I would love to engage with you on this. But the first thing is, again, I would mirror their language whenever possible. If there are two ways of describing something and they choose one way, just use their way. It's not that big of a deal. Tie whatever you want to talk about back to their issue. So, for example, if in their conversation they say underserved communities and not diverse communities, if we're talking about the same thing, just say underserved communities. If they are talking about vulnerable families, that's also, I'm sure, what you care about, too. So talk about vulnerable families. Mirror their language as long as it's something that you are comfortable using. That's the first thing. The second thing, and I think this is the point that maybe some of you will disagree. And, again, my own view here, but I'm a pragmatist. Working in local public health, you have to be a pragmatist because you have to work with people with whom you disagree. If you know that there are certain words that are going to be triggering to somebody else, just avoid it. I think that nowadays you all know what words that maybe some individuals choose not to talk about. And I think that as long as, again, it feels natural to you, use alternate words. Because you do not, the last thing that you want is for the person that you are talking to to hear a certain word and then just refuse to hear anything else that you're saying. That could happen with any of us, right? If we hear certain things, maybe that just makes us think, hey, this person will not understand anything else that I'm saying. I give up. Just try to not, you know, think about your end goal here. Think about the North Star. If you want your North Star to go forward, maybe avoiding certain language. If that's what it takes, that may, I think that's something that it's a tradeoff that many people, not everyone, but many people would be willing to accept. Remember your North Star. That is great. Well, we've got a lot of questions coming in, Dr. Nguyen. So I'd like to ask you this one. This is from Lena Sayam. She says, thank you, Dr. Nguyen, for this talk. As a first-year osteopathic medical student without many stories to tell yet, how do you have, how do you talk to folks? Do you have any advice for making an impact as an advocate? That's a great question, and I think it's so terrific that you're there doing DO Day as a first-year student. That's really terrific, and I fully applaud that. Again, as somebody who was very involved in medical student advocacy, in my early days, I have to tell you this. I started medical school in 2001, so it really was quite a while ago that I was exactly in your shoes. But I can still remember those days and the excitement also of being, of doing advocacy as a medical student. You know, I think, so several things. One is I think you do have stories. If you are, you got into medical school in part because of your stories. You have shadowed. You have done clinical work. You've done some volunteer work. Maybe you worked in a medical student clinic. Maybe you did something as an undergraduate. Maybe you did something between undergraduate and medical school. You have stories. It doesn't have to be exactly something that happened yesterday. It could be something that you experienced before. It could even be something from your childhood. Again, I would come back to your why. Why is it that you're here? Maybe you experienced illness as a child. Maybe you, as I did, needed to be on Medicaid. Whatever the case is, I think there's something from your background, something in your training, something that drove you to go into medicine that you're able to share. Again, I would really lean into that connection. You could even say, if you really can't think of anything else, but you're talking, for example, about graduate medical education, you can say, look, I came into medicine for this reason because I really want to help patients, but I'm concerned that there aren't going to be places for me to train, and I want to work in underserved communities. I want to go back to where I'm from in Iowa and work there or wherever, but I want to be able to get training to do that. I think there are definitely things that you can bring back to you that are authentic to you, but also tell a story too. Great, great. That's excellent. Everybody has a why. Another question coming in from Dr. Emily Hurst. Dr. Hurst says, excellent presentation, Dr. Nguyen. Thank you for all of your advocacy. What recommendations do you have for when we have to connect to someone with whom we don't really have or see any common ground? That's a good question. I will wager, though, that there is going to be something you have in common with them. And maybe what I mean here is maybe you need to dig one level deeper, as in if you perhaps look at their website and you look at their priorities, it's possible that you might not agree with how they're getting to where they want to go, as in they're advocating for a policy. They support policies that you generally don't agree with. That's possible. But why are they advocating for those policies? To that level, you probably will agree with them. I would wager that the vast, vast, vast, vast number of people in this country want safety for our families. We want our children to have a better future. We want education for kids. We want people, when they get ill, to be able to receive high-quality medical care. I think there is enough that you'll be able to get back to, again, on the what is it that they value that you're able to connect to. So even if how they want safer communities may be different from how you would want safer communities, if you focus on safer communities or better future for our families, maybe you're able to come back to, hey, this is why Medicaid funding for children is so important, or this is why we need to ensure that physician practices stay open so that we're able to care for families. This may take a little bit of mental acrobatics, but, again, I think looking at that one level deeper at what their values may be, not just at the policies that they support, may be one way of getting there. That's very helpful. Thank you. Another question coming in from Jason Jackson. Jason says, Dr. Nguyen, in your Washington Post column, you speak frequently about the need for physicians to address their own mental health. As you speak to these challenges and uncertainties, what tips can you provide for combating physician advocate burnout or a sense of defeat as we try to identify which issues we should elevate to five alarm fires? Thank you for that. And I think this is going to be different depending on the person, and I would encourage you to find what works for you and identify the strategies that work for you right now, understanding that it could also change over time and that maybe you want to try something and see if it works or not. Look, I have colleagues who are saying, I just don't even want to know. As in, I don't want to read the news. If it's something important for me to know, I'm going to find out because somebody is going to tell me I don't even want to engage right now. That's, I mean, I work in the news, so probably not the strategy that I could take, but I really, really respect that. I respect people who say, I want to focus on the things that I can change. My priorities now, I'm already working a full-time job. I have young children. I need to care for them. That's what I need to focus on. I really respect that. I also respect those who say, I want to be involved as much as I can. I want to be involved in my medical association. I want to be involved in my specialty association, advocating on those issues, but I also want to work in my community. I want to help with, you know, on immigrant issues, or I want to work on whatever other issues that they really care about that maybe their medical associations cannot focus on, but they want to focus on outside of their work. I really respect that, too. I think that that's also a very reasonable way of saying, here's the way that I am bringing my authentic self to this work and to the times that we're in. I think that those who are focusing on there, who are saying, I need an outlet for my mental health. I need to focus. I need to also have my own interests where that'll take me away from the constant youth cycle. I think that that is really reasonable, too. For me, I'm a triathlete. I really enjoy my training. I enjoy cycling and running and swimming. When I'm with the folks that I cycle with, we don't talk politics, and that's important to me, to have that kind of outlet as well. But to each their own, I think it's important to find the strategies that work for you. Understanding, too, that the moment may also change. There may be right now, maybe it all feels way too overwhelming. There are too many issues. You can't deal with any of them, and that may be okay. But maybe there's one issue that you really care about, that you want to be engaged in, or that you say, okay, maybe the issues have not risen to the question or to the level of a five-alarm fire for me personally. But maybe there's going to be a threshold at which that is met, and then I'm going to be involved. Essentially, I'm saying you need to find a strategy that works for you, and be okay with that, and not feel guilt that you should be doing more, because you should be doing what's right for you. Thank you. That's a great explanation of how to find that strategy, what works for you. We have another question for Dr. Ronnie Martin, from Dr. Ronnie Martin. If you know that you or your legislator or their staff feel strongly but differently about Issue A, but have general agreement on Issues B, C, and D, do you invest time in A, or first take the low-hanging fruit and reach for success with the remaining issues if your time is limited? Yeah, I would definitely do the latter. I think if you start with an area where you disagree, they're not going to hear you on the other stuff, so what's the point? I, again, fully admit that I'm a pragmatist. I'm, again, working on the local level, working in advocacy on a whole variety of issues. You know that you're not going to win them all. If you're not going to win them all, do you want to lose everything, or do you want to win the majority? For me, when my job was advocating for my residents in the city on services, I don't want to have zero services to show them. I would rather that I have 80%. Yeah, I'm very upset that we didn't get the rest of the 20%, but I don't want to lose all 100%. I think that's one way of thinking about it, is you want to get what you are able to in this common ground. The other way to think about it is using human psychology. If you start with that part that you find the most controversial, you are already engaged in this kind of combative relationship. You're not starting with a point of agreement, and so I don't think you're able to reach the other areas of commonalities if you start with an area that you know you disagree with. And so I would begin with the areas that you agree with, and look, you also need to thank your legislators. They are, for many of these issues, they're going out on a limb. They don't have to choose this issue. Legislators have many, many, many, many issues that they could possibly be advocating for. If they're advocating for you on that issue, please thank them. Thank them for sponsoring or co-sponsoring a bill on teaching health centers. Thank them for signing on to legislation that promotes telehealth flexibilities. Thank them for supporting Medicare payments to physicians. But whatever it is that they've done, please thank them for it. I probably should have put that as tip number nine. Be very grateful. Mention the issues that they have already signed on to, and thank them for everything they've done for that. Start with a place of, I appreciate what you've done. Thank you for supporting us here. This is why this issue remains so important. Continue advocacy, please. And then if there's time at the end, or make time at the end and say, I also want to mention to you, because you've been such a wonderful supporter of us on all these other issues, I also want to mention to you this other issue that's very important to preserving our patient access. That's also very important for supporting our families. That's also very important for preserving access for vulnerable populations. I know this is also your goal. And let me explain why this is also an issue that I hope that you can support, too. Excellent. Well, we have about five minutes left. So here comes another question from Angelique Nazira. In this environment, what are the best sources for accurate data and the background information needed to understand all the factors involved in decision making? I think that really depends on what the issue is. But I think that there are multiple sources of information. I mean, if we're speaking about something like vaccines or something that's very science-based, you all know how to do research on that. There are reputable journals that you can go to. You can look up articles in those journals. You can also find, I think there's good information that's given by health systems, that's given by specialty societies that you can cite, and that also carries weight. If you can say, for example, the American Academy of Pediatrics says this, or the American College of Obstetricians and Gynecologists say that, I think that also helps to carry weight behind some of the scientific recommendations that we give to our patients. When it comes to policy factors, there are also a number of very reputable organizations that do research on policy. For example, I'm associated with the Brookings Institution, so I want to mention them as well. Many other academic institutions do research on policy issues that you can also cite. Fabulous. Thank you for that. Well, we really just have time for one more question, Dr. Nguyen. This has been amazing. This question is coming from Adam Alpers. In your opinion, what seems to be the hesitation toward making telehealth a permanent addition to medical care and not just a conversation that kicks it down the road to the next budget meeting? How do we get the narrative to be a priority? Yeah, I think I can tell you what the issue is. It's a payment. I think that people are concerned that telehealth is not just replacing in-person medical visits, but it's adding to medical visits and therefore is making healthcare more expensive. And I think that the concern also is that if everybody ends up switching to telehealth services, then people who have brick-and-mortar care services will see, I don't need to have brick-and-mortar. I don't need the overhead of hiring people and renting an office and renting space if I can just do everything from telehealth, and that's going to make it harder for patients to actually access brick-and-mortar care. I actually think that both of these are reasonable concerns. And I think that the way to address this is to say that is to look at data that telehealth has actually not been adding to the total number of medical visits. That for many individuals, it's been replacing their existing visits with primary care physicians. For people who live in rural areas who cannot access specialists, it's giving them a new access line. For individuals who are seeking mental health services, before they were not able to get mental health services, now they are able to. That's not adding to healthcare. That's actually making healthcare better and maybe even reducing readmissions later. If somebody has an undiagnosed mental health issue that's contributing to their physical health issues, maybe treating their mental health may help them and help the bottom line later. I think when it comes to not having to somehow replacing brick-and-mortar care, for some people, it may replace the brick-and-mortar care. But it's certainly not going to make – it's not going to drive hospitals out of business because of all the unmet medical need that's out there. That is where I would focus. I would focus on unmet medical need based on what you have seen. If you work in a rural area, that unmet medical need may be people having to travel long distances. If you work in an area where there aren't many specialists, child psychiatrists as an example, you could talk about telehealth helping to fill that particular goal. If you interact with patients who have barriers to mental health care because of stigma, because of access, you can talk about that element. I think focusing on unmet medical need and inciting the data around telehealth will help to make that point very clear that the concerns that are legitimate are actually not borne out in reality. In fact, that telehealth is adding to the care that is needed in order to meet that unmet medical need. Well, thank you so much for answering that question and for answering all of these questions. We're out of time. I feel like the audience was so engaged and we had so many more questions for you, but Dr. Nguyen, thank you so much for sharing all your knowledge, your story, and all these tips for advocacy. I know everyone watching really benefited from hearing from you today, so thank you so very much. Thank you very much, Colleen, for your questions also. Thank you everyone who submitted questions. Thank you again to AOA for inviting me, and I hope that you all have a really terrific Lobby Day. Thank you for the work that you do every day, again, to care for your patients and keep our focus on the North Star of the patients that we serve. Thank you. Wow, thank you, Dr. Nguyen. What an informative session. Next on the program will be the learning tracks for physicians, early career, and affiliate leaders. The learning tracks will take place today at 10.15 a.m., 11.30 a.m., and 12.45 p.m. Eastern Time. Enjoy the program, and we'll see you tomorrow.

virtual DO Day 2025

Colleen Murray-Payton

leadership skills

healthcare advocacy

Teresa Hupka

Dr. Lina Nguyen

social determinants of health

advocacy tips

health policy challenges

healthcare outcomes