Caring for Patients Beyond the Exam Room
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By John Gallagher
In 2024, while tracking health data, Bindu Nayak, MD, could see that during a wildfire smoke episode, there was a huge increase in emergency room visits for children with asthma, with a disproportionate number of the visits among Latino children, the vast majority of whom were on Medicaid. “We knew that using indoor air purifiers is one of the few things that could help children with asthma during a wildfire smoke episode to improve indoor air quality,” she says. However, Medicaid does not cover air purifiers to help with asthma.
“I could see that there was this need, and there hadn’t been any solution to the problem,” Dr. Nayak, an endocrinologist with Confluence Health in Wenatchee, recalls. “Historically, Central and Eastern Washington have more wildfire exposure, so the need felt disproportionate. I thought this was something important to advocate for.”
The problem was where to do so. “I didn’t see many avenues,” Dr. Nayak admits. “But in July 2024, I realized that this was a perfect resolution in the [WSMA] House of Delegates. It’s one of the only ways to advocate for solutions to problems we discover.”
Dr. Nayak serves on the WSMA’s board of trustees as an officer of the association’s executive committee and serves as a delegate on the House of Delegates representing the board of trustees. She says working on the resolution went smoothly. “The ability to write a resolution was the best way to advocate for this. I did ask for help from other members of WSMA, and it was great to get input on the best way to write it,” she says. “The process was a lot easier than I thought it would be. I learned a lot from it.”
The WSMA House of Delegates adopted the resolution at its annual meeting in October 2024. Since then, with the new policy on its books, the WSMA successfully advocated for the air filter coverage policy to be included in Robert J. Bree Collaborative’s guidelines around heat and wildfire smoke and has shared the policy with the state Health Care Authority.
Patients first
Helping patients is the heart of physician practice. It’s why physicians chose their career in the first place, and it’s why the profession holds a unique place in society. But improving health doesn’t happen just in the exam room. Organized medicine has a long history of advocacy for better health for large populations, successfully campaigning for everything from adding vitamin D to milk to prevent rickets to lobbying to end smoking on airplanes. That’s why physicians, including young physicians, are turning to advocacy in organizations like the WSMA to effect change far beyond their practice walls.
“I want to be able to make a difference in patients’ and communities’ lives,” says Daniel Low, MD, a family physician with HealthPoint in Renton. “While that can happen individually in the clinic and the hospital, both at which I work, to make change more broadly requires institutional change, which is inherently tied to policy. Therefore, advocacy work is incumbent upon me and the physician community.”
Dr. Nayak concurs. Because of her work on health equity, she sees large- scale patterns affecting many people. “I’m looking at population health data,” she points out. “It’s not just a few patients who are affected, but whole groups of patients who are affected. When you see that trend, it made me realize that there needs to be a bigger solution.”
Advocacy is an integral part of the WSMA’s mission. In recent years, the WSMA has helped effect major improvements to public health policy in Washington state. These include raising the age of sale of tobacco and vapor products in Washington state from 18 to 21, eliminating personal and philosophical vaccine exemptions for school, child care, and preschool, passing protections for reproductive health and gender-affirming care services, and banning the sale of semiautomatic “assault weapons.”
The seeds of public policy advocacy
Dr. Low began his advocacy work while he was still in medical school at the University of Washington, when he saw how friends who were undocumented struggled to enter medical school. Dr. Low first successfully advocated for a change to the medical school’s matriculation criteria to allow for admissions of undocumented students. Even then, these students faced barriers accessing student loans. Undaunted, Dr. Low helped draft and pass legislation in the Washington State Legislature that allowed access to loans for students, including undocumented students, willing to work in underserved areas.
“It’s been a decade of doing this work,” he says. “It’s been really meaningful.”
Dr. Low, who serves as a delegate on the WSMA House of Delegates representing the King County Medical Society, co-authored three resolutions at the 2024 WSMA Annual Meeting, all related to the health care industry’s contributions to climate change: reducing single-use plastics in health care, reducing anesthesia gases in health care, and encouraging health care industry adoption of the National Academy of Medicine’s Sustainability Journey Map (see this issue’s cover story). “It’s an acknowledgment of the role that health care plays in climate change,” he says. “If health care was an individual country, we would be the fifth largest contributor to greenhouse gases in the world.”
Dr. Low admits that advocating for systemic change can be frustrating because of how long it can take. “Compared to clinical care, it has a much more glacial pace to it,” he says. “It’s important to have other folks who are passionate about this work to buoy you when there are the frustrations and setbacks, which are inevitable.”
But the seeds of advocacy can unexpectedly take root. In medical school and his residency, Dr. Low spent a lot of time with people who were experiencing homelessness. “I was thinking of how we could frame this as a public health issue,” he said. Eventually, he successfully brought a resolution to the WSMA House of Delegates identifying homelessness as a public health crisis and compelling WSMA’s advocacy for policies that support the construction and management of supportive housing.
After the policy was adopted, the homeless crisis in Seattle and the state dramatically expanded. Suddenly, the Legislature took up a measure mirroring the WSMA resolution, coordinating how clinics and health care facilities could collaborate with housing groups to create better outcomes for people. Legislative staff directly reached out to Dr. Low for help in drafting the bill. With the new House of Delegates policy providing guidance to WSMA’s legislative advocacy, the association threw its weight behind the measure, which passed the Legislature and led to major investments in the program.
“It was a rewarding opportunity to see this work come full circle, to see the patients in front of you who are suffering, address the broader context of what that means, and then take it to an institution and argue for the value of this type of policy,” says Dr. Low. “Even if it took a few years, it was manifested in the state Legislature and influenced how that law was written.”
Getting started
Dr. Nayak says that she can see the need for another resolution around continued glucose monitoring. “There’s a huge need for better coverage of CGM,” she says. “A lot of the time, patients can’t afford a CGM and Medicaid doesn’t cover it for most patients, which makes it harder to monitor their glucose levels, and as a physician, it’s hard for me to help them help them without this information.” However, she notes, “the first step to solve the problem is to change the system.” And that means advocating with a resolution.
“It seems such a difficult thing to do, but for physicians, going through the House of Delegates with a resolution seems like the way to do it,” says Dr. Nayak. “I’m very appreciative that there is this option. There aren’t many other ways for physicians to advocate for policy. This is a unique and very special opportunity.”
The ability to make meaningful change is one of the benefits of working at the state level, says Dr. Low.
“One of the reasons that I find working with WSMA so important is that it is significant enough with budget and influence to make dynamic changes and have an impact, but also small enough to have meaningful relationships and meetings with legislators,” says Dr. Low. By contrast, the dynamics at the federal level are far more complex.
Dr. Low encourages other physicians not to be put off by a lack of advocacy experience. “I would say jump in and get your feet wet,” he advises. “Advocacy is a skill set. None of us is going to be an expert when we start. Just as it took hundreds of hours to hone a clinical skill set, the same is true of advocacy. That doesn’t mean you can’t make a difference here and now.”
Dr. Low says that advocacy work is an important counterbalance to the pressures of practicing medicine. “It absolutely helps with some of the day- to-day stresses and potential moral injuries in our field,” he says. “Part of that is simply because it’s a constant reminder of why we are doing this work and what has brought us into the field of medicine in the first place.”
For Dr. Low, advocacy is also an opportunity to take advantage of the privilege that the profession affords him to work on his patients’ behalf. “For me personally it’s been in relation to the issue of health equity, and how I can leverage my expertise and position to make a difference for those who often have been excluded in policymaking and have not received the same benefits of medical advances,” he says. “In doing this work, I’m able to see how I can use my voice and position in that space, and that’s extremely motivating and powerful.”
John Gallagher is a freelance writer specializing in health care.
This article was featured in the May/June 2025 issue of WSMA Reports, WSMA’s print magazine.