This past year, I have had the privilege of serving as the AUA’s 2023–2024 H. Logan Holtgrewe Legislative Fellow. This experience has been a highlight of my urologic training and enabled me to participate in numerous unique opportunities that I would not otherwise have had access and exposure to, including working with legislators and staffers on Capitol Hill, engaging in major AUA advocacy strategic planning initiatives and committees, and participating in the AUA Annual Advocacy Summit and Alliance of Specialty Medicine Fly-In Conference in Washington, DC (Figures 1 and 2).

One of the main goals of the Holtgrewe Fellowship is to educate urologists on the legislative aspects of health policy. As such, opportunities to be involved in policymaking at the AUA and in our federal government were at the forefront of my year-long experience. I was invited to attend the AUA’s Health Policy Weekend, during which the State Advocacy and Legislative Affairs Committees meet to review the results of AUA membership surveys and vote on legislative priorities for the upcoming year (Figure 3). This weekend culminates in a meeting of the Public Policy Council, where I was also able to report on the achievements of the Policy and Advocacy Recruitment Work Group. This is the principal AUA work group for medical students and urology trainees interested in policy and advocacy and I was overjoyed to share with the Public Policy Council how this group of enthusiastic young physicians has grown exponentially over the past year. Getting a behind-the-scenes look into the AUA’s legislative priority-setting process emphasized for me how much collaboration and thoughtfulness goes into determining how the AUA will best represent and advocate for urologists and patients each year.

For nearly 2 months, I also had the honor of working as a congressional fellow on Capitol Hill in the office of Congressman Darren Soto (D-FL-09; Figures 4, 5, and 6). I served as a member of the congressman’s legislative team and was responsible for the office’s health care portfolio, which encompassed any topics related to health care issues that came across the congressman’s desk. This involved covering legislation related to Medicare and private health insurance coverage and reimbursement, health care infrastructure, biomedical industry regulations, prescription drug programs, mental health access, health information technology systems, opioid harm reduction initiatives, medical provider licensing laws, and rare disease research and development, among many other topics.

Since Congressman Soto is a member of the House Energy and Commerce Committee, the home to the House Subcommittee on Health, my days as his health staffer were often busy and dynamic as I conducted meetings with stakeholders and constituents, attended health care hearings, reviewed proposed legislation, wrote talking points, filed bills and amendments, and briefed the congressman on local and national health care issues. Additionally, my congressional fellowship happened to coincide with integral moments in the legislative calendar, such as the fiscal year 2025 appropriations process, in which proposals for allocating trillions of dollars to state and federal health care programs are submitted. As the only urologist at the table, I was able to underscore the importance of providing funding for certain programs, such as prostate cancer research, spina bifida comprehensive care, graduate medical education residency expansion funding, and improving access for rural and underserved populations. During my time in the office, Congressman Soto signed on to cosponsor over 50 bills on a variety of health topics, the majority of which had bipartisan support.

One of the most eye-opening experiences that I had in the US Congress was sitting on the other side of the table during meetings with medical societies, patient advocacy groups, hospital administrators, biopharmaceutical companies, state legislators, and other constituents. Prior to this time on the Hill, I had only attended these meetings as part of a group of physicians coming to congressional offices to state the case for legislative support, just as we do during the annual AUA Advocacy Summit. While I was able to gain an insider understanding of what data and information a congressional office most values in these meetings, I was struck by how often it was an emotional connection, more so than hard facts, that resonated most with the team when discussing certain policy positions with the congressman. This is not to say that evidence-based arguments are unimportant, but rather I found it reassuring that groups coming to the Hill to advocate for their causes were able to make a real difference without knowing the intricacies of specific bills and the legislative process, but instead by speaking passionately about their lived experiences.

Overall, I could not have asked for a better experience this past year as the Holtgrewe Fellow. There is a concept in public policy known as the Three Ps of Advocacy. These are policy, or the legislating that occurs at the local and national levels; politics, or engaging with lawmakers who can support your causes; and process, or the realities of public persuasion that both influence and are influenced by policy decisions. During my year as the Holtgrewe Fellow, I was able to interface with the three Ps in a variety of different settings that broadened my perspective and taught me many valuable lessons that I will carry with me.

Ultimately, one of my most important takeaways from the Holtgrewe Fellowship is my renewed conviction in the power that we have as physicians to make a difference. As physicians we are uniquely positioned with intimate insight into the issues that are most important in our patients’ lives and I was able to see firsthand that sharing these stories and our medical expertise is an effective way to provide input to elected representatives and make tangible changes to our health care system. I am extremely appreciative of the AUA leadership, AUA legislative team, and Congressman Soto’s office for their support, and I have no doubt that the experience that I have gained as the Holtgrewe Fellow will serve me throughout my career as a urologist engaged in health policy and advocacy.