Key points are not available for this paper at this time.
As hospitalists, we must step outside of the hospital to engage in community, legislative, and public awareness advocacy. An “Op-Ed,” short for “opposite the editorial page,” serves as an accessible form of advocacy that can and should be used by hospitalists to reach out beyond the hospital to assist our patients and improve our communities.1, 2 Hospitalists see some of the worst outcomes of health inequity, ranging from a child struggling to survive an act of gun violence to the undocumented migrant worker returning to the hospital repeatedly for “compassionate” dialysis because they are not eligible for kidney transplantation. Despite this knowing, we may feel limited in our ability to affect these circumstances. The Op-Ed gives us the power and the voice to enact change. Collectively, we have published dozens of Op-Eds using a streamlined format that pulls from persuasive speech strategies such as Monroe's Motivated Sequence,3 a structured motivational appeal (often used by advertisers) intended to prime your audience to make change. There are five sequential steps: (1) grab the attention of your audience; (2) identify a need (i.e., problem); (3) satisfy that need (i.e., solution); (4) visualize a future with (or without) the solution; and (5) call to action (i.e., what the audience can do right now). We also used training and resources from The OpEd Project Public Voices Fellowship4 and our own trial and error. We have refined our approach through workshops at our own institution, regionally, and nationally.5 Our published Op-Eds have sparked invitations for speaking events, legislative testimony, and institutional advocacy leadership positions. We have first-hand experience seeing how Op-Eds build the author's network, credibility, and promote academic advancement, all while multiplying one's advocacy efforts. In this perspective, we walk through the steps of writing and submitting an Op-Ed, while providing practical guidance on generating ideas, beginning the writing process, managing the vulnerability of advocacy, and making the pitch. Op-Eds, written commentaries published in the lay press, communicate evidence directly to the public. An Op-Ed outlines a problem, illustrates it with stories and facts, and provides a clear solution and action. This action can take various forms, including legislative action (e.g., vote yes on AB 816 a California bill that would allow minors ages 16–18 with opioid use disorder to consent to treatment with buprenorphine), a policy or administrative ask (e.g., GME should increase paid resident maternity leave to 12 weeks), and a behavioral ask (e.g., readers with young children should keep them rear facing in their car seats until 3 years). Op-Eds follow the news cycle, which can move quickly. The news cycle speed can be daunting for the busy clinician; however, an Op-Ed draft can be completed in as little as an hour. Additionally, some physicians providers may complete an Op-Ed as a group writing exercise at a faculty development workshop or division retreat. Most physicians have never been trained in this style of writing, which differs from academic writing. An Op-Ed should highlight the humanistic side of your issue with emotion or humor; you can address the audience directly while being steadfast in your argument and expertise. Once learned, the process of Op-Ed writing can be replicated and taught easily. While an Op-Ed is not a rant, some of the best Op-Eds start with anger. You may encounter an injustice in your hospital or wrangle with an insurance company over coverage for a life-saving treatment for one of your patients. Channel that energy into action by putting your thoughts onto paper. Head: Do you have an intellectual case to be made? Heart: Do you have an emotional case to be made? Action: Is there something you want people to do? What are you arguing for? A good Op-Ed argues for one thing. If you have more than one argument, you have more than one Op-Ed. Why do people need to read about it right now? The most successful Op-Ed authors tie their idea to current events or make a case for the timeliness of action. What is your unique perspective or authority? Own your expertise as a physician! You are an expert! What change do you want to see? Be as specific as possible. Who is your audience? Defining your audience informs how you frame your Op-Ed, what stories you might share, and what data might be most compelling. The more specific your audience, the better. Op-Eds are typically short, ranging from 500 to 800 words, and have a standard structure (Figure 1). The five-section framework outlined is one we have had success with when teaching Op-Ed writing. The opening paragraph, or lede, highlights your issue with a story or compelling statistic. If you choose a patient story, be mindful of patient privacy and confidentiality. Without explicit permission, a patient should never be able to recognize themselves in your piece. The second paragraph highlights your main argument. You may want to include one or two statistics to elevate your point, but do not let your message get lost in the numbers. The third paragraph addresses the opposing argument. Do not spend too much time here. Acknowledge one of the opponent's main arguments and discuss why it is less relevant than the solutions you are proposing. The fourth paragraph proposes solutions. Illustrate what needs to be done and what will happen if it is not implemented. Finally, close your Op-Ed with your call to action in your last paragraph. Highlight what you want your reader to take away from the piece and describe the action you want them to take. Make sure to also tie back to your patient story to remind the reader why you are asking them to take this action. This five-section framework is best used as a starting point and tailored to highlight your message most effectively. We recommend drafting each paragraph to be roughly the same length initially and then adjusting based on your topic. For some Op-Eds, the patient story effectively highlights the issue, and so, more time should be spent here. For others, your argument or solution would be the bulk of the text and may even need to be split into more than one paragraph. Staring with these five sections though will ensure that you cover all of the critical areas needed for an effective Op-Ed within a limited word count. There is vulnerability in using your voice. You may be worried that you don't know what you don't know, that you might speak out of turn, or accidentally write something culturally insensitive. You may be concerned about pushback from your own institution. You may receive responses from people with very reasonable counterarguments or even trolls. While these are certainly considerations, The OpEd Project reminds us that, “If you say things of consequence, there may be consequences. The alternative is to be inconsequential.”4 If everyone agreed with what you're arguing for, you would not need to write about it. Your voice is powerful and influential in shaping public opinion. There are some important ways to protect yourself. First, write what you know. Support your arguments with evidence or guidance from professional organizations and ground them in your lived experience. This approach makes your work difficult to contest, even if a reader is not happy with what you have to say. Second, discuss your Op-Ed with your institutional government relations and public relations departments. This serves multiple purposes. These departments can help provide context to political nuance that may not be accessible to you as an individual. These departments may also help you field feedback from individuals who may not agree with your messaging. Also, depending on the message and institutional considerations, your place of employment may support your work by allowing you to use your affiliations in your piece. This approach provides you institutional credibility, which can amplify your voice; however, always obtain explicit permission before using your institutional affiliation. Third, find and utilize honest and knowledgeable editors. These editors may include colleagues with an interest or expertise in the topic and should also include individuals outside of medicine, as they may be more representative of your audience. Readers may not always interpret your words in the way that you intend. The more people that lay eyes on your work and confirm that your intentions align with their interpretation before publication, the less likely that your words will be misinterpreted once published. Finally, only submit your writing to quality outlets. While you should not expect significant editing or fact checking, the higher the quality of the publication, the more likely the editor will pick up on any detail that might be misunderstood or incorrectly presented. Pitching your completed Op-Ed is an art form in and of itself. The first step is deciding where to submit. For this, you will need to revisit the audience you hope to reach. For example, if you are writing about a statewide policy, the primary newspaper for the state capital city may be a great place to start. The OpEd Project has curated a list of quality news outlets and is a good place to look for ideas.6 If you are writing for other physicians, you may consider a blog like KevinMD,7 Doximity,8 or Johns Hopkins Closler.9 Reading Op-Eds from a few outlets will give you a sense of the tone of the publication and allow for you to choose a match that aligns with your own. Once you determine your preferred outlet, review their Op-Ed submission guidelines and follow them exactly. If you have collaborated on a piece with multiple authors, be aware many outlets will have a maximum of two authors on Op-Eds. In addition, outlets often have specific word count limits. Writing more words than an outlet allows is a quick way to have your submission ignored. Your pitch email should be short, 200 words or fewer. In the email, you should state your opinion and explain why this issue is important for an outlet's readers to know about now. Make sure to highlight a relevant news hook (Box 1). Do not submit to multiple publications at once. But do check in with the editor 24–48 h after you submit (excluding weekends and holidays). Do not expect (or demand) to hear back the same day. If you have not heard back for another 24–48 h after your first check in, it is OK to email and let them know you are assuming they cannot use your piece and that you will be submitting elsewhere (Box 2). Your Op-Ed may be rejected. There are countless reasons why an outlet may not be able to publish your piece. It does not mean that what you have to say is not important or will never be published. Have a list of several potential outlets so that if you are rejected, or pull your piece because you have not heard back, you can quickly submit to the next outlet on your list. Physicians have important things to say. We see how policy plays out in real people's lives. We have the right and responsibility to shape the future with our knowledge and experience. And now, each of you has one more tool in your toolbox to do this work. Now go write. Grant funding from the American Academy of Pediatrics Community Pediatrics Training Initiative was used by two authors (Lena C. van der List and Lauren K. Gambill) in the original creation of the discussed workshop. Drs. Gambill and Altillo both completed the OpEd Project Public Voices Fellowship sponsored by the University of Texas at Austin. The authors declare no conflict of interest. The opinions expressed in this article are those of the authors and do not necessarily reflect the official views of the institutions with which they are affiliated. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Gambill et al. (Sat,) studied this question.