'Occupy AMSA': Medical Students Encouraged to Be Activists and Advocates

An Expert Interview With AMSA Executive Director Carol Williams-Nickelson

Nancy A. Melville

March 29, 2012

March 29, 2012 (Houston, Texas) — Editor's Note: Carol Williams-Nickelson, PsyD, has been at the helm of the American Medical Student Association (AMSA) and the AMSA Foundation since 2008. She is the author of more than 100 scholarly publications and best-selling books in psychology. Dr. Williams-Nickelson has led legislative advocacy initiatives, particularly in health-related areas, including long-term activities in support of mental health parity. She holds master's and doctoral degrees in psychology from Our Lady of the Lake University in San Antonio, Texas, and completed her doctoral internship at the University of Notre Dame Counseling Center.

Dr. Williams-Nickelson has spent time in clinical practice, held academic positions, and consulted health-related businesses in organizational development. As demonstrated in her ongoing leadership at AMSA, she is committed to student advocacy and professional development. She was instrumental in organizing the AMSA 62nd Annual Convention held here and spoke with Medscape Medical News.

Medscape: How long have you been executive director of AMSA, and what has been the most rewarding aspect of your position?

Dr. Williams-Nickelson: I took the helm as AMSA and the AMSA Foundation's executive director in 2008. Every single day is different, and I actually enjoy being pulled in a variety of directions — from supervising staff, to consulting with our fellows, to setting strategy and vision with the AMSA president, to planning aspects of educational events to ensure the content is high quality, to guiding board members and other leaders, to interacting with leaders from other organizations…it's all incredibly exciting and exhausting.

What I enjoy the absolute most, however, is the opportunity to develop and mentor future physician leaders. My entire graduate and postgraduate career has focused on different aspects of developing leaders and mentoring students, so my work at AMSA gives me the chance to gain fulfilment by working within a complex system to make it run smoothly, coupled with coaching talented students in achieving their leadership goals.

Medscape: At times, this year's meeting felt almost like an orderly Occupy movement gathering of its own, with attendees encouraged to become activists and advocates for a host of causes at every turn, and particularly with the lively welcome for physician activist Arthur Chen, MD, himself involved in Occupy protests in California. Does this reflect a heightened sense of activism that is unique to this generation of physicians-in-training? What issues or influences do you think have played the biggest roles in energizing medical students?

Dr. Williams-Nickelson: Wasn't it fabulous and energizing? There's nothing like the feeling of empowerment — when others tell you that you can make a difference and create the kind of healthcare system and world that you want to live in. AMSA has a 62-year history of physician activism. One of the characteristics of our members is their idealism and refusal to accept the status quo if they believe there's a better way to help and heal. Advocacy is core to AMSA's identity and we teach and encourage advocacy in its many forms.

We've given students the tools they need to implement change in their medical school and to influence curricular reform. We've taught students how to speak with their members of Congress and local legislators about the importance for all Americans to have equal access to quality affordable health care. We've encouraged residents to work with hospital administration and their attending physicians to limit resident work hours so they can provide safe care to their patients. We've taught students how to support and help each other through the rigors of medical school. All of these activities, and more, demonstrate that one of AMSA's core values is advocacy, which is evident in all that we do.

I think all graduate and professional students have a propensity for activism. It's a rite of passage of sorts, but our members tend to be attracted to AMSA because it's here where they can focus on the ways they want to promote change that will benefit their patients. Perhaps this generation sees that there are more possibilities than there have been in a very long time, and this might contribute to the sense that this generation of physicians-in-training is different.

They've also seen their efforts pay off in activities like AMSA's PharmFree Scorecard and our Scholars programs. Success breeds enthusiasm and a sense of community and empowerment. In the end, students want a voice in their training, the medical environments they will practice in, and above all else, they want to be able to provide the best care possible for their patients. They see many barriers to achieving these issues, and they understand that they can control their future if they work together to advocate for the changes they want to see.

Medscape: The success of AMSA's PharmFree Scorecard program in driving academic medical institutions to implement conflict of interest policies is really remarkable — Dr. Howard Brody, who spoke at the meeting on ethics, policy, and single-payer healthcare, told Medscape he found the scorecard effort to be "one of the most brilliant campaigns I have ever seen." Has AMSA been surprised by this success, and has the accomplishment been an impetus in planning additional campaigns?

Dr. Williams-Nickelson: This is one of the many other reasons why I love what I do. Indeed, I do get to work with brilliant young people. The PharmFree campaign grew out of our members' great discomfort with how industry was influencing their education. Our students want to be taught by expert faculty, not well-trained marketers who are skilled in influencing behavior. We are all human and all susceptible to good advertising. Students are particularly vulnerable, however, because they are cash-strapped and hungry. When a particular pharmaceutical representative feeds them, gives them branded pens and other goodies, it can shape the beliefs of even the most manipulative-savvy individual. I'm a clinical psychologist and it works on me in shopping centers — and I know a good amount about the tactics of influence!

I wouldn't say that AMSA has been surprised by the success of our scorecard, though I will say that we have celebrated it because it has brought attention to an issue that is an important value for our members. If doctors are influenced to prescribe because of an effective marketing campaign and not the scientific evidence, they are not providing the best care for their patients. And quality of care is of upmost importance to our members.

We are indeed expanding the AMSA PharmFree Scorecard. Not only do we want programs and training hospitals to have strong conflict of interest policies in place, we want them to consistently and effectively implement those policies. Over the next 3 years, beginning this May, AMSA will employ a full-time PharmFree fellow who will work with our staff and several members to build and execute the next iteration of the campaign to measure compliance and effectiveness of policies. We are really excited to continue the momentum of positive change that the PharmFree Scorecard set out to accomplish at its inception.

Medscape: The idea of single-payer healthcare was alive and well at this year's meeting. Can you elaborate on AMSA's stand on the issue and its plans regarding the issue moving ahead?

Dr. Williams-Nickelson: AMSA has long been in support of a single-payer healthcare system but recognizes that incremental steps toward achieving that system are important wins. It took many years and many bad decisions to get to the complicated and bad place we are now, where profits are put above the needs of patients and human beings are unable to access basic health care. AMSA will not be satisfied until all people have quality affordable healthcare, beginning in our own backyard — America.

There are hundreds of confounding factors, such as the cost of a medical education, physician pay disparities based on specialty, lack of access to a medical education for individuals from diverse backgrounds, training environments that don't always keep pace with the changing technology and healthcare environment, poor quality of life for physicians in certain specialties, endless paperwork and exchanges with insurance companies just to cover basic office visits and procedures, a lack of recognition by insurance companies of the importance of preventative care and integrated care, inequities in treatment for so-called mental health versus physical health issues, and the list goes on.

AMSA is committed to addressing the problem on all levels and as long as it takes to see a much different health care system. Our members have a lot of stamina. They're persistent and their beliefs are firm, so AMSA will continue to support efforts that move us closer to the ideal of a single payer health care system.

Dr. Williams-Nickelson has disclosed no relevant financial relationships.

American Medical Student Association (AMSA) 62nd Annual Convention. Presented March 8, 2012.

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