title: The evolution of advocacy and orthopaedic surgery.
abstract: BACKGROUND
  The future direction of American health care has become increasingly controversial during the last decade. As healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as "advocates" for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in health care and can work together to influence major health policy decisions.
  
  
  OBJECTIVE
  We (1) define the role of advocacy in medicine, specifically within orthopaedic surgery; (2) explore the history of physician advocacy and its evolution; (3) examine the various avenues of involvement for orthopaedic surgeons interested in advocacy; and (4) reflect on the impact of such activities on the future of orthopaedic surgery as it relates to hospital-physician alignment.
  
  
  METHODS
  We performed a comprehensive review of the literature through a bibliographic search of MEDLINE(®) and Google Scholar databases from January 2000 to December 2010 to identify articles related to advocacy and orthopaedic surgery.
  
  
  RESULTS
  Advocacy among orthopaedic surgeons is critical in guiding the future of the American healthcare system. In today's world, advocacy necessitates a wider effort to improve healthcare access, quality, and delivery for patients on a larger scale. The nature of physician advocacy among orthopaedic surgeons is grounded in the desire to serve patients and alleviate their suffering. Participation in medical societies and political campaigns are two avenues of involvement.
  
  
  CONCLUSIONS
  The increasing role of government in American health care will require a renewed commitment to advocacy efforts from orthopaedic surgeons. The role of advocacy is rapidly redefining the continuum of care to a trinity of clinical excellence, innovative research, and effective advocacy. Failure to recognize this growing role of advocacy limits the impact we can have for our patients.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN 37221, USA. Manish.K.Sethi@Vanderbilt.edu
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
authors.forename: Allie
authors.initials: A
authors.lastname: Obremskey
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.forename: John T
authors.initials: JT
authors.lastname: Gill
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
mesh_terms: D003254:Consumer Advocacy / Q000191:economics / Q000639:trends*; D003363:Cost Control; D019033:Delivery of Health Care, Integrated; D018578:Hospital-Physician Relations; D006801:Humans; D016239:MEDLINE; D009985:Orthopedics / Q000191:economics / Q000639:trends*; D010344:Patient Advocacy / Q000191:economics / Q000639:trends*; D010817:Physician-Patient Relations; D011640:Public Policy