Here, the Column’s editorial team continues our interview series highlighting urologists with unique accomplishments outside of the clinical sphere. Dr Kara Michel is a resident at the University of Pennsylvania and currently serves as the vice chair of the AUA’s Policy & Advocacy Resident (PAR) Workgroup. The authors had the privilege to work closely with Dr Michel at the 2024 AUA Summit, where urologists, trainees, and patient advocates converge on Washington, DC, to meet with congressional staff and discuss key issues facing our profession. Below, Dr Michel discusses her passion for health care policy and leadership, key takeaways from this year’s AUA Summit, and her vision for the future of this work in urology.

How Did You Get Involved in Health Policy and Advocacy With AUA?

I’m someone who has always had an eye on the “bigger picture.” I was struck pretty immediately on my clinical rotations in medical school by the dysfunction of the health care system and felt compelled to learn more about it. I took an extra year in medical school to get a master of science in health policy research, and that was my window into the policy and advocacy world. I loved the policy research I did during that year, and I was then very lucky to find some mentors in my co-residents, who helped me transition my research efforts into more actionable work. Dr Ruchika Talwar dragged me to the AUA Summit a few years ago when I was an overwhelmed junior resident, where I got to feel what it was like to voice my opinions to the people who can really make a change. It was a breath of fresh air from my busy clinical life. I’ve been coming ever since.

What Does Your Leadership Role With the PAR Entail?

This year, I am serving as vice chair of the PAR, which only became an official group last year. It’s growing exponentially, very much in a “bottom-up” way, due to increasing interest and applications from trainees. I’d say one of my biggest roles is defining the PAR’s role within AUA policy operations. It’s an exciting place to be because I get to shape the priorities and reach of our group in a way that will influence how residents and students interact with AUA advocacy for many years to come. One of our priorities is mentorship, so we organize virtual fireside chats with attendings who engage in advocacy in addition to clinical practice. A second role of mine is to make the PAR function as a representative body for the trainee perspective on policy issues. We’re working on a survey for all urology residents to identify their current priorities so we can better represent future urologists.

Why Should Urologists Care About Policy and Advocacy?

Policy and advocacy is the final step along the path of caring for patients. It’s often the most forgotten about by practicing physicians, but I would argue it’s essential! Research allows doctors to define the right care plan. Clinical practice is the process of actually delivering that care. But we need to create the right practice structure that incentivizes and rewards this proper care. That’s advocacy. If we don’t become advocates and take ownership of the health care system, someone else will; I believe that we as doctors have the most insight into the way to structure health care delivery, and we should play an essential role in leading it.

What Was Your Biggest Takeaway From the Presentations at the AUA Summit?

This year at the summit, I noticed that the themes of provider burnout and workforce stability were much more pronounced than I felt they were in prior years. In the setting of an aging US population and consolidation of care in urban areas, we spent time advocating for continued telehealth and for an increase in the number of practicing urologists so that there is adequate access to urologic care and urologists are not overwhelmed by the demand. We also argued against cuts to Medicare reimbursements to physicians, especially in light of increases in reimbursements to hospitals and other health care institutions. It feels empowering to stand up for ourselves as physicians and argue that since we play a critical role in care delivery we deserve payment parity. But what struck me this year was how all these “asks” were frequently presented through the lens of ensuring stability and longevity for physician careers, about setting up a health care system where physicians are not too burnt out to take good care of their patients. Ultimately, we must ensure we are taking care of our practice structure so that we are able to provide quality patient care.

What Issues Do You Think Will Become More Pressing in Future Years for Urologists and/or Urology Patients?

I think we will be facing some pressing issues regarding the future of undergraduate and graduate medical education, including urology. There’s a lot of issues I see converging in that area, including student debt, decreasing resident autonomy, increasing medicolegal action against training, decreasing physician incomes, and scope-of-practice creep, to name a few. I think there will be people questioning if physicians are receiving adequate training in residency, and at the same time, potential physicians questioning if becoming a doctor is still worth all the years and financial costs to practice in the evolving system.

How Can Medical Students Get Involved in This Space?

Research is one really good way for students to get involved. My advice is to look for physicians who are already doing research that could have policy implications. Look for buzzwords like “health care systems,” “access,” “costs,” or “quality.” Once you’re involved in the project, see if you can figure out how to take the research a step further than just publication. Try to find an actionable takeaway from the research and pursue it, like maybe writing an op-ed. Research is a great way for students to get involved because it serves the dual purpose of building your curriculum vitae. And, of course, another great way is to join the PAR!