ELEVATING V O I C E S
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advocacy pulls attention from the repetitions clinical excellence requires. You will acknowledge, honestly, that boards are harder when you are doing this, because they are. Internally you will carry that weight alone.
Your peers will recalibrate too. The ones already close will draw closer. The ones who weren’ t will quietly widen the distance. Many will conclude that anyone who voluntarily takes this on must be crazy. You will simply have to decide whether their skepticism changes your calculation. For me, it didn’ t.
Why I Kept Going Back
Part of it was the genuine belief that resident silence is not neutral. When people with the most current, ground-level understanding of healthcare delivery stay quiet, decisions get made without that vital information. The structures shaping your daily clinical life will be written by someone. The only question is whether any of those people recently finished a 28-hour call, navigated today’ s EMR or understand what burnout feels like under all of our student loan conditions. That information is perishable; you are holding it right now. When you don’ t use it, the system doesn’ t just fail residents, it fails patients.
But I also went back for reasons entirely my own. Advocacy builds something durable: relationships, institutional standing, a record of having done something with the access you were given. As AI reshapes medicine and careers evolve unpredictably, that foundation matters. I went back partly because I believed in the work, and partly because the work was building something I would eventually need. I am not ashamed of either reason. I don’ t think you should be either.
What the return felt like: in San Antonio, at the American Society of Anesthesiologists Resident House of Delegates, I stood at a podium in front of a packed House of Delegates who didn’ t know me, competing for the most contested seat on the resident governing council. Walking up I felt every awkward early meeting, every evening spent on policy instead of board prep. I won the support of people who had never heard my name, earning their confidence to represent them at the highest advocacy level in our specialty. The night that followed on the San Antonio River Walk, sharing that win with colleagues from my program, is something I will carry the rest of my life. current training. Be precise about what you don’ t know, and equally precise about what you do. When you speak from genuine front-line experience, the room listens.
Learn to write a resolution. Frustration without architecture gives a room nothing to act on. A resolution forces you to define the problem precisely, research existing policy, engage opposing perspectives and build an argument that withstands scrutiny. That process clarifies whether your frustration reflects a genuine systemic gap, versus a problem that already has a solution you haven’ t found.
For Whoever Comes Next
I am starting my final year of residency having traveled a considerable distance from that chair by the exit. The parliamentary procedure that baffled me is now a tool I use deliberately. The microphones I avoided are ones I seek out. I am not writing this to recruit you. I am writing it because whoever eventually finds this deserves an honest account more than an inspirational one. The microscope is real. The isolation is real. The boards don’ t get easier because your schedule didn’ t either.
But I also want you to know what a night on the San Antonio River Walk feels like after you’ ve done something that has never been done before in your program. What it feels like when every awkward early meeting, every moment of parliamentary confusion, every evening spent on policy, suddenly makes complete sense as the thing that built you into someone capable of standing in that room. That feeling is real too. And it’ s worth more than I knew how to anticipate.
The cost is real. So is the return. What you do with that calculation is yours to decide. If you find yourself drawn to these rooms: trust that instinct. Find your mentors. Learn the language. Get near the microphones. The chair closest to the exit will always be there if you need it. But you probably won’ t.
Dr. Andrew Ray is an anesthesiology resident at the University of Louisville School of Medicine.
Three Things I Wish Someone Had Told Me
Find those already doing the work. Systemic change is not a solo project. In that first KMA boardroom, I wasn’ t ready to lead, but I was willing to be useful. My mentors introduced me to advocates actively looking for residents to carry work forward. Your first move is not to draft a manifesto. It’ s to find who is already doing what you care about and ask how you can help.
Your inexperience is the point. Senior leaders don’ t need residents to match them in policy expertise; they need the front-line texture of
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