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Abstract

Background: Physicians are increasingly acknowledged as key stakeholders in shaping health policy due to their clinical experience and system-level insights. However, their participation in formal policy advocacy remains inadequately quantified, and the enabling or limiting factors influencing their engagement are poorly understood. Addressing this knowledge gap is essential to strengthen physician-led public health reform, especially in an era marked by complex health challenges and persistent health inequities.
Objective: To assess the extent of physician involvement in health policy advocacy, evaluate the impact of leadership training on their advocacy engagement, and identify major facilitators and barriers to participation.
Methods: A cross-sectional survey was administered between January and March 2025 to a purposive and snowball sample of 210 licensed physicians working in clinical leadership, academic, public health, or policy-based roles. The questionnaire integrated validated tools from the Medical Leadership Competency Framework and PATH Advocacy Evaluation Framework. Responses were recorded using 5-point Likert scales. Data were analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression to determine associations and predictors of high advocacy engagement.
Results: Among 210 participants, 124 (59.0%) were male and 86 (41.0%) were aged 40–49 years. A majority (80%) had over 10 years of experience, with 62% serving in academic or hospital leadership. The highest leadership competency scores were in personal qualities (Mean = 4.21, SD = 0.61) and working with others (Mean = 4.15, SD = 0.57), while improving services scored lowest (Mean = 3.88, SD = 0.75). Frequent advocacy activities included public speaking (46.7%) and contacting policymakers (40.0%). Legislative testimony (20.0%) and international advocacy (≤21.5%) were less common. Leadership training (OR = 2.45, p = 0.002) and high policy leadership competency (OR = 3.21, p < 0.001) significantly predicted high advocacy engagement. Institutional support remained moderate (Mean = 3.52, SD = 0.85).
Conclusion: Physicians with formal leadership training and high policy leadership competency are more actively involved in advocacy, particularly in academic and policy-driven roles. Institutional constraints, however, may limit sustained engagement. Integrating leadership development and structured advocacy training into medical education and organizational policy is critical for advancing physician-led health reforms.