Portal de Periódicos da CAPES

Academic Advocacy and Promotion: How to Climb a Ladder Not Yet Built

2019; Elsevier BV; Volume: 213; Linguagem: Inglês

10.1016/j.jpeds.2019.07.051

1097-6833

Shetal Shah, Heather L. Brumberg, Alice A. Kuo, Vivek Balasubramaniam, Shale Wong, Valerie P. Opipari,

Childhood Cancer Survivors' Quality of Life

Recent federal challenges to children's healthcare suggest an increased need for pediatric advocacy efforts to articulate a medical perspective on child health policy issues.1Luft L.M. The essential role of physician as advocate: how and why we pass it on.CMEJ. 2017; 8: e109-e116Crossref Google Scholar, 2Flores G. An Urgent call to action: building a better America and world by prioritizing children's health, health care and well-being.Acad Pediatr. 2018; 18: 493-495Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Attempts to change the funding structure of Medicaid via block grants, reductions in funding for teen pregnancy prevention, delays in reauthorizing the Children's Health Insurance Program, and actions to undermine the Affordable Care Act threaten the pediatric population's access to care.3Rivkees S.A. Opipari V. Denne S. Commentary from the pediatric policy council 2018: they year of living dizzyingly.Pediatric Research. 2019; 85: 115-117Crossref PubMed Scopus (2) Google Scholar, 4Plax K. Donnelly J. Frederico S.G. Brock L. Kaczorowski J.M. An essential role for pediatricians: becoming child poverty change agents for a lifetime.Acad Pediatr. 2016; 16: S147-S154Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 5Frederico S.G. Cull W. Olson L. Garg A. Racine A.D. Fisher A. Dreyer B. United States pediatricians' attitudes regarding public policies for low income children and their profession's advocacy priorities.Acad Pediatr. 2018; 18: 783-788Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Academic pediatricians, whose research and clinical work often closely relates to healthcare disparities and social determinants of health, are ideally poised to help inform public policy for children's health issues. However, there is considerable uncertainty as to how to obtain institutional/program support for pediatricians who seek to incorporate advocacy efforts into their academic activities.6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar In addition, pediatric department chairs may be similarly unsure of how to support faculty's advocacy efforts and integrate these activities into the standard triad of clinical care, teaching, and research. To help clarify these issues and provide guidance to academic advocates, the Society for Pediatric Research (SPR) Advocacy Committee presented a 2018 Pediatric Academic Societies' Invited Science Session entitled "Strengthening the Academic Advocacy Pipeline: Getting Promoted as an Academic Advocate," featuring representation from the SPR, the Association of Medical School Pediatric Department Chairs (AMSPDC), the Academic Pediatric Association (APA), Pediatric Policy Council (PPC), and the American Academy of Pediatrics (AAP). Attendees focused on frequently encountered obstacles in applying current academic and promotion standards to policy activities. These obstacles include the need to (1) accept advocacy as an essential academic mission of pediatrics in all academic divisions; (2) emphasize and determine ways to give credit for the unique work products which result from advocacy work; (3) highlight the advocate's role as a mentor for residents as a potential promotion vehicle; (4) articulate opportunities within pediatric organizations for leadership in advocacy activities; and (5) describe strategies to avoid potential conflicts within large academic medical centers resulting from child policy work. Broadly defined, advocacy includes actions on behalf of others (children) that support, defend, recommend, or argue for a specific undertaking.7Paulson J.A. Pediatric advocacy.Pediatr Clin North Am. 2001; 24: 1307-1318Abstract Full Text Full Text PDF Scopus (14) Google Scholar Scientists and physicians, particularly pediatricians, are ideally suited to the task of advocacy, as their daily work requires making complicated medical issues more readily accessible.8American Academy of PediatricsPediatricians are Natural Advocates.https://www.aap.org/en-us/advocacy-and-policy/state-advocacy/Documents/Pediatricians%20are%20Natural%20Advocates.pdfDate: 2009Date accessed: December 24, 2018Google Scholar Confidence and trust in the scientific community has remained steadily high for decades, and 70% of Americans support our nation's scientific investment in federally funded research, believing these commitments "pay off" in the long run.9Kennedy B. Americans broadly favor government funding for medical and science research. PEW Charitable Trust, 2018http://www.pewresearch.org/fact-tank/2018/07/03/americans-broadly-favor-government-funding-for-medical-and-science-research/Date accessed: December 24, 2018Google Scholar However, in the absence of strong medical and scientific advocacy voices, this public interest may not translate to annual robust increases in funding. In current dollars, the budget for the National Institutes of Health is still approximately one-half of its 1995 value, closing the doors to promising research careers and reducing funding for federal projects, in which children are suffering from a disproportionate decrease in funding commitments.10Federation of American Societies for Experimental BiologyFederal Funding Recommendations and Related Life Sciences Research, FY.http://www.faseb.org/Portals/2/PDFs/opa/2018/Federal%20Funding%20Brochure%20FY2019.pdfDate: 2019Date accessed: December 24, 2018Google Scholar Pediatricians and scientists are needed, for example, to explain to policymakers how changes in funding directly impact child health, pediatric science, the pipeline of future trainees, and the finances of academic pediatric departments. As this example illustrates, promoting the role of science and evidenced-based medicine in the creation of health and social policy is of tremendous institutional and societal benefit and wholly consistent with any medical institution's broad mission. Traditional measures of academic achievement are reflected in grants and peer-reviewed publications. However, promotion committees now recognize other scholastic projects as work products. For those promoted along an "Educator Track," these include curriculum development, academic portfolios, mentor advising, and learner assessments. Though health science advocacy can lead to scholarly activities and publications, this broadened view of scholarship is essential. Symbolically, is demonstrates the importance of advocacy in the ecosystem of pediatric health and, practically, it concedes that this work utilizes professional time and may impact productivity related to more traditional scientific publications, teaching, relative value units, or other standard metrics of academic success. Failing to provide scientific expertise to legislators who create policy results in a policy-implementation gap, delaying or preventing creation of established evidenced-based policies for the betterment of public health.11Javier J. Brumberg H.L. Sanders L. Hannon T.S. Shah S. How gaps in policy implementation create public health malpractice.Lancet. 2018; 319: 2414Abstract Full Text Full Text PDF Scopus (2) Google Scholar In pediatrics, the stakes are exceedingly high, as improvements in child health have an effect throughout the life-course.12Genel M. McCaffree M.A. Hendricks K. Dennery P.A. Hay Jr., W.W. Stanton B. et al.A National Agenda for America's Children and Adolescents in 2008: recommendations from the 15th Annual Public Policy Plenary Symposium, annual meeting of the Pediatric Academic Societies, May 3, 2008.Pediatrics. 2008; 122: 843-849Crossref PubMed Scopus (11) Google Scholar Given these issues, recognition of advocacy as a scholastic endeavor, rewarded with the traditional benefits of academic promotion, is crucial to supporting these efforts on behalf of children and to ensure the pipeline of future pediatrician-advocates. Though academic institutions such as the University of Oregon have now specifically included Health Policy, Advocacy, and Community Service into criteria for promotion, this perspective exists in a minority of academic medical centers.13Hoffman B. Finding the Path: the Challenge of Advocacy in Academics.2019Google Scholar Advocates seeking promotion must often shoehorn their activity into existing academic templates. Counsel on how fitting the "square peg" of policy work into the "round hole" of conventional academic deliverables is briefly outlined in this article. Acknowledgement of administration and leadership at the institutional, regional, and national level is a standard evaluation criterion for appointment and promotion. Regional and national recognition are often essential to the promotion process, particularly in the rise from Associate to Full Professor (Tenured or Clinical). For advocates, this domain of scholarship may include a proactive role in community-based, issue-oriented nonprofit organizations. Nationally, pediatric organizations provide a framework upon which to build advocacy skills and bolster credentials. Serving on these organizational committees and graduating to a leadership role can be an effective method of strengthening a promotion package, while simultaneously providing the collaborations that translate to legislative change. Given that significant pediatric work can occur in "silos," an orientation to advocacy activities by major pediatric organizations may serve to initiate early-career pediatricians toward increased participation and eventual leadership within the advocacy sphere. All major pediatric organizations have influential advocacy committees aligned with their missions. The SPR advocacy committee pushes for increased federal research funding, fights against politicization of science, and has organized Congressional Briefings. The APA sponsors a pediatric advocacy special interest group and a national public policy and advocacy committee, which informs membership of the legislative landscape and provides updates on how policies impact children.14Academic Pediatric Association Task Force on Childhood Poverty.https://www.academicpeds.org/taskforces/pdfs/StrategicRoadMap_ver3.pdfDate: 2013Date accessed: December 24, 2018Google Scholar Working through 10 different regions, APA efforts can also be more regionally focused. These groups, as well as the AAP, provide leadership positions. In AMSPDC and the APS, representatives comprise the PPC, a policy think tank representing a unified voice for academic pediatrics. The PPC communicates with key legislators on issues such as healthcare access, research funding, and pediatric workforce issues, and it comments on legislation impacting academic practice. The PPC is also responsible for providing monthly policy commentaries for Pediatric Research, which represents a peer-reviewed publishing opportunity.15Shah S.I. Brumberg H.L. Bearer C.F. Toward development of evidenced-based quality parameters: what gets counted and who gets paid?.Pediatr Res. 2016; 80: 170-171Crossref PubMed Scopus (2) Google Scholar The largest advocacy group within pediatric medicine is the AAP, representing 68 000 members. The AAP, in coordination with an appointed Committee on Federal Government Affairs, Subcommittee on Access, and Committee on State Government Affairs directs the academy's national advocacy efforts. For advocates interested in state or local issues, AAP Chapters work on child health issues as granular as creating a local park, and thus, it is an ideal organization to build credentials toward a national position. For most aspiring advocates, chapters are accessible means for academic pediatricians to create meaningful work products and influence local child health policy. Legislative offices monitor social media to assess constituent opinions on specific issues and provide information on public appearances, legislative drafting, and co-sponsorship. This makes social media platforms ideal venues for "virtual advocacy." In a data-driven environment, quantification of work products provides context to the importance of scholarly work and is often part of a promotion package. For publications, this may include the impact factor of journals, the total number of publications, and year-over-year publication rate. As an analogy to these established metrics, advocates utilizing social media can support their promotion package by using the impact analytics of social media postings to quantify the influence of their work. Specifically, this could mean information on number of tweets, impressions, engagements with content, page views, profile visits, mentions, and followers that would be included in promotion materials as readily as citation indices for peer-reviewed articles. Though multiple platforms exist, Twitter, Facebook, Instagram, and blogs have emerged to host a large share of advocacy via social media.16Peek H.S. Richards M. Muir O. Chan S.R. Caton M. MacMillan C. Blogging and social media for mental health education and advocacy: a review for psychiatrists.Curr Psychiatry Rep. 2015; 17: 88Crossref PubMed Scopus (23) Google Scholar These platforms provide analytic data that tracks clicks, impressions, and engagements with content, which have been described as a means to assess impact for the purposes of academic promotion.6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar Twitter and Instagram are ideal for sharing short pieces of information, such as an important fact related to policy (eg, the number of children in a legislative district who receive Medicaid, or school lunch, or visit the local emergency department with a specific injury). The AAP also offers a useful resource on beginning to use Twitter for advocacy.17Ameenduddin N. Consider using Twitter to take meaningful action beyond office walls.2016http://www.aappublications.org/news/2016/11/22/MasteringMedia112216Date accessed: December 24, 2018Google Scholar Facebook posts and blogs lend themselves to longer discussions of child health issues. Multiple examples of these blogs exist, covering local AAP Chapter actions to neonatal research.18Shah S. Brumberg H.L. This is How Your Vote Affects Child Health.2018https://www.kevinmd.com/blog/2018/11/this-is-how-your-vote-affects-childrens-health.htmlDate accessed: December 24, 2018Google Scholar, 19Raphael J. Is Medicaid on the Block (Grant)? Center for Child Health Policy and Advocacy. Texas Children's Hospital Blog.https://www.texaschildrens.org/departments/center-child-health-policy-and-advocacy/blog/medicaid-block-grantDate accessed: December 24, 2018Google Scholar Social media can also amplify one's message and drive users to content (eg, op-ed, blog post, video, or podcast), which in turn may educate and subsequently inform public opinion. As academic medicine evolves and the definition of scholarly work is potentially expanded to include all forums, it is imperative that promotion committees understand this new environment and are fluent in the language and tools of social media.6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar Failing to do so risks dismissing the time, effort, and impact that the development of social media content entails. However, in the current pediatric academic climate, the speed and ever-present nature of social media require the aspiring advocate and larger medical institution to work cooperatively. As social media use carries potential risks, institutions now have policies and compliance offices to serve as resources. Offices of public relations and/or legislative affairs should also be notified of advocacy-oriented social media postings. Several general themes should guide advocates in their use of social media. Pediatricians should refrain from identifying their specific institution unless authorized or endorsing an advocacy position consistent with the hospital's mission. Physicians should understand that any virtual presence, irrespective of hospital affiliation, should be consistent with the standards of medical professionalism, even if the messages convey personal content. Similar to a statement made in a journal article, comments related to health policy in social media postings should be factual and referenced. Information should not violate Health Insurance Portability and Accountability Act standards, and messages on behalf of a professional organization should be indicated. Mentoring and advising may be crucial elements for promotion. Personal/career advising, teaching effectiveness and performance of trainees are considered quality indicators within academic educator tracks.20Gusic M.E. Baldwin C.D. Chandran L. Rose S. Simplson D. Strobel H.W. et al.Evaluating educators using a novel toolbox: applying rigorous criteria flexibly across institutions.Acad Med. 2014; 89: 1006-1011Crossref PubMed Scopus (31) Google Scholar These roles have increased in importance given current Accreditation Committee of Graduate Medical Education standards in pediatrics require ambulatory pediatric clinical experiences include aspects of child advocacy.21Accreditation Council for Graduate Medical Education Program Requirements for Graduate Medical Education in Pediatrics.2017https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07-01.pdfDate accessed: December 24, 2018Google Scholar To meet this Accreditation Committee of Graduate Medical Education stipulation, residency programs should provide trainees with physicians experienced in advocacy, giving aspiring advocates an ideal "niche" within the department upon which to advance their career.22Earnest M.A. Wong S.L. Federico S.G. Perspective: physician advocacy: what is it and how do we do it?.Acad Med. 2010; 85: 63-67Crossref PubMed Scopus (140) Google Scholar, 23Dharamsi S. Ho A. Spadafora S.M. Woollard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice.Acad Med. 2011; 86: 1108-1113Crossref PubMed Scopus (92) Google Scholar Department Chairs and Promotion Committees should recognize and value mentoring for advocacy work given that experienced physician-advocates are relatively rare compared with clinical/research mentors. Sustained involvement in mentoring over time also serves a larger societal role by ensuring the pipeline of physician advocates remains robust.6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar Receipt of advocacy mentorship early in training is associated with an increase with in community involvement throughout one's career.24Minkovitz C.S. Grason H. Solomon B.S. Kuo A.A. O'Connor K.G. Pediatricians' involvement in community child health from 2004 to 2010.Pediatrics. 2013; 132: 997-1005Crossref PubMed Scopus (13) Google Scholar, 25Solomon B.S. Minkovitz C.S. Grason H.A. Carraccio C. Community pediatrics: a consistent focus in residency training from 2002-2005.Ambulatory Pediatr. 2007; 7: 321-324Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar However, unlike evaluation of mentoring within promotional tracks for research professorships, in which grant success, publications, and presentations can indirectly gauge the quality of mentoring by a promotion candidate, it may be unclear what constitutes advocacy mentoring and how to assess its effectiveness. Examples of mentoring in advocacy may include coaching and supervision in the context of a local advocacy project that benefits community health (eg, improving education related to nutrition)26American Academy of PediatricsCommunity Access to Child Health (CATCH) Grant 2011: Teaching Teens to Conquer the Corner Bodega.https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/commpeds/funded-projects/Pages/GrantsListItemDisplay.aspx?LIID=22Date accessed: May 1, 2019Google Scholar; coaching or co-authoring a pediatric health-focused policy brief on the benefits of a social program widely recognized among pediatric scientists as improving child health27Shah S. Balasubramaniam V. Brumberg H.L. Sanders L. Policy priorities for child health: results from a membership survey of the society for pediatric research.Pediatr Res. 2018; 84: 6-9Crossref PubMed Scopus (2) Google Scholar; editing an opinion-editorial column outlining support for specific legislation; organizing and providing testimony to a local, state, or federal legislative body; grassroots organization of a Day of Action related to a timely issue28Markowitz M. Nash R. Channeling the Collective Voice of Future Pediatricians to #KeepKidsCovered.https://www.aap.org/en-us/aap-voices/Pages/Channeling-the-Collective-Voice-of-Future-Pediatricians-to-KeepKidsCovered.aspxDate: 2017Date accessed: December 24, 2018Google Scholar; health services research or co-authoring a policy-based commentary for an academic journal; or performing several in-person legislative visits with a researched 1-page summary related to a specific policy issue. Mentoring of such activities could be listed within the promotion packet as part of a comprehensive advocacy dossier.29Nerlinger A.L. Shah A.N. Beck A.F. Beers L.S. Wong S.L. Chamberlain L.J. et al.The advocacy portfolio: a standardized tool for documenting physician advocacy.Acad Med. 2018; 93: 860-868Crossref PubMed Scopus (9) Google Scholar As with advising trainees on any project, successful mentoring of trainees in advocacy entails unique challenges. Trainees often have limited time to devote to a project in the context of work hours limitations. Further, trainees may feel intimidated by the policy aspects involved in care, as few have health policy expertise.30Agrawal J.R. Huebner J. Hedgecock J. Sehgal A.R. Jung P. Simon S.R. Medical students' knowledge of the US Health care system and their preferences for current change: a national survey.Acad Med. 2005; 80: 484-488Crossref PubMed Scopus (41) Google Scholar Trainees also come to advocacy with different motivations; some seek inspiration and respite from residency activities, and others want to lay the foundation for a future career interest. Matching a project's scope with appropriate mentee goals, objectives, and expectations is therefore crucial. In advising the early-career physician intent on a career in advocacy, mentors should note advocacy is often fueled by political romanticism in trainees. Advisors should nurture this idealism but must still remain realistic about challenges that advocates face in having their work legitimized in a slowly changing academic environment. These obstacles include the increased focus nationally on clinical productivity. When aspiring advocates seek their first appointment, they should negotiate a clear outline of responsibilities associated with policy work, including mentoring. "Deliverables" and measures of productivity should be delineated. Dedicated time for advocacy, with protected time as mutually agreed goals are met should be outlined contractually. The clinical adage of "If it's not documented, it didn't happen" also applies to advocacy work as well. All avenues by which advocates add value to a department's mission must be documented for promotion. Though activities are often not formally quantifiable, documentation highlights the diverse array and breadth of work, which can easily be digested by members of promotion committees. Several authors have proposed the use of "Advocacy Portfolios."6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar, 28Markowitz M. Nash R. Channeling the Collective Voice of Future Pediatricians to #KeepKidsCovered.https://www.aap.org/en-us/aap-voices/Pages/Channeling-the-Collective-Voice-of-Future-Pediatricians-to-KeepKidsCovered.aspxDate: 2017Date accessed: December 24, 2018Google Scholar, 31Kuo A.A. Thomas P.A. Chilton L.A. Mascola L. AAP Council On Community Pediatrics, AAP Section on Epidemiology, Public Health, And EvidencePediatricians and Public Health: optimizing the health and well-being of the nation's children.Pediatrics. 2018; 141: e20173848Crossref PubMed Scopus (10) Google Scholar Nerlinger et al illustrate a model advocacy portfolio including domains of engagement, knowledge, dissemination, community outreach, teaching and mentoring, and leadership.29Nerlinger A.L. Shah A.N. Beck A.F. Beers L.S. Wong S.L. Chamberlain L.J. et al.The advocacy portfolio: a standardized tool for documenting physician advocacy.Acad Med. 2018; 93: 860-868Crossref PubMed Scopus (9) Google Scholar Each domain can be cross-referenced with quality, quantity, approach, and scholarship. This system presents a framework for standardizing advocacy. As advocacy continues to become a greater part of the academic pediatric mission, the need to create a clinical-advocate promotion track should be considered.5Frederico S.G. Cull W. Olson L. Garg A. Racine A.D. Fisher A. Dreyer B. United States pediatricians' attitudes regarding public policies for low income children and their profession's advocacy priorities.Acad Pediatr. 2018; 18: 783-788Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 6Shah S.I. Brumberg H.L. Advocating for advocacy in pediatrics: supporting lifelong career trajectories.Pediatrics. 2014; 134: e1523-e1527Crossref PubMed Scopus (7) Google Scholar, 29Nerlinger A.L. Shah A.N. Beck A.F. Beers L.S. Wong S.L. Chamberlain L.J. et al.The advocacy portfolio: a standardized tool for documenting physician advocacy.Acad Med. 2018; 93: 860-868Crossref PubMed Scopus (9) Google Scholar Overall, pediatric department chairs are supportive of advocacy work and should incorporate advocacy within all branches of a diverse department. The recent AMSPDC Strategic Plan specifically calls for facilitating advocacy among member departments, with an emphasis on promoting child health policies at the state and federal level.32Association of Medical School Pediatric Department ChairsStrategic Plan 2015-2020.http://www.amspdc.org/about_us/strategic_plan/index.cfmDate: 2015Date accessed: December 24, 2018Google Scholar However, at the departmental-leadership level, more work should be done to assist faculty seeking to build an advocacy career. Given the significant role a department chair's recommendation for promotion carries, this may include taking an active mentorship role for the first physician seeking promotion along this pathway. Department chairs should also work with committees to legitimize a new generation of "deliverables" as scholarship and promote the use of Advocacy Portfolios as a repository of independent academic work. Department chairs can also play a strong role in identifying advocacy as an independent academic activity instead of as a supplement to a physician's or scientist's focused, academic interest. Historically, this has been the domain of established, tenure-track scientists. Examples of this work may include recruitment as an expert on a state or federal advisory panel based on a physician's peer-reviewed publication record.332017-2018 New York State Expert Panel for Perinatal Redesignation. New York State Department of Health Perinatal Regionalization, 2017https://www.health.ny.gov/community/pregnancy/health_care/perinatal/docs/expert_panel_members.pdfDate accessed: December 24, 2018Google Scholar, 34California Legislature 2017-2018 Regular Session.https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB328Date: 2017Date accessed: December 24, 2018Google Scholar Researchers may also use advocacy to extend the public health impact of their academic work. A pediatric obesity investigator may, for example, advocate for calorie listing, sugar-sweetened beverage taxes or neighborhood changes (such as bicycle lanes) conducive to child exercise, using their publications to directly inform a government debate. In these situations, the advocacy work is not primary, but supplements the investigator's publication and grant record. New advocates may not fit well into this paradigm, instead choosing to focus on legislative policies, which are well endorsed in the pediatric world, but have not been readily adopted such as the need for increased rates of human papilloma virus vaccination. Here the policy need or legislative fix for the problem of low vaccination rates is primary, and the research work involved requires becoming a subject-matter expert on vaccination. This may not require independently undertaken research studies, but instead a thorough review of published papers written by other physicians to garner expertise and render it digestible to policy-makers. Department chairs should recognize this role and help to incorporate programmatic support in the form of protected advocacy time or potential departmental underwriting of policy activities such as legislative visits and travel to the state capital for provision of expert testimony. Within the confines of promotion requirements, chairs should seek to promote advocates along the "Educator/Clinical Track." Though peer-reviewed research is not expected, these faculty should be guided toward publication opportunities in-and-out of the peer-reviewed arena. Promotion, vigorously supported by the chair, allows for ascension of the academic ladder while recognizing the paramount roles advocates can have within the institution. Programs upon which children rely continue to be threatened at all levels of government, yet these systems play a major role in contributing to the health outcomes of children. Hence, the need to recruit, train, and support advocacy within pediatric departments. However, sustaining a pediatric and professional responsibility to continually elevate child health cannot be achieved without institutional support, reinforced, and validated by academic promotion, for those whose policy work helps engineer the changes children need for optimal health.