Medical Leadership and Health Policy Advocacy: Physicians as Change Agents in Public Health Reform

Background: Physicians are increasingly recognized as key stakeholders in health policy reform due to their clinical insight and system-level experience. However, empirical evidence quantifying their advocacy involvement and evaluating determinants such as leadership training remains limited. Understanding these dynamics is essential for guiding professional development and institutional strategies aimed at enhancing physician-led policy engagement. Objective: To quantify the level of physician involvement in health policy advocacy, assess the impact of formal leadership training on advocacy engagement, and identify barriers and facilitators to such involvement across various healthcare settings. Methods: A cross-sectional survey was conducted between January and March 2025 among 210 licensed physicians engaged in leadership, academic, public health, or policy roles across Pakistan. Participants were recruited through purposive and snowball sampling methods. A structured, self-administered online questionnaire was developed using the Medical Leadership Competency Framework and PATH Advocacy Evaluation Framework. Data on leadership competencies, advocacy behaviors, and perceived policy impact were collected using 5-point Likert scales. Descriptive statistics, chi-square tests, independent t-tests, and multivariate logistic regression were used for data analysis. Results: Among 210 participants, 59.0% were male, and 79.0% had over 10 years of professional experience. The most represented work settings were hospital leadership (34.3%) and academia (27.6%). High leadership scores were observed in personal qualities (Mean = 4.21) and working with others (Mean = 4.15), while improving services scored lowest (Mean = 3.88). Frequently reported advocacy activities included public speaking (46.7%) and contacting policymakers (40.0%), while legislative testimony (20.0%) and international engagement (8.7%) were less common. Leadership training (OR = 2.45, p = 0.002) and high policy competency (OR = 3.21, p < 0.001) significantly predicted advocacy engagement. Institutional support remained low (Mean = 3.52), despite high confidence in policy influence (Mean = 4.01). Conclusion: Leadership training and strong policy competencies significantly enhance physician engagement in health policy advocacy. However, limited institutional support may hinder sustained advocacy efforts. Strengthening advocacy curricula and supportive organizational environments is critical to empowering physicians as leaders in health reform.