One of my favorite quotes is, “If you’re not at the table, you’re on the menu.” I did not fully understand the meaning of that statement until I became involved in advocacy and organized medicine during medical school.

Like many medical students, I entered training focused almost entirely on becoming the best physician I could be. My priorities were studying for exams, earning strong grades, learning pharmacology and anatomy, and developing the clinical skills necessary to diagnose and treat patients. I believed that if I worked hard enough academically and clinically, I would be fully prepared to care for patients.

However, as I progressed through my clinical rotations and assumed greater responsibilities, I began to realize that practicing medicine requires far more than medical knowledge alone. I saw firsthand how health care delivery was often shaped not only by physicians and patient needs, but also by administrative decisions, insurance requirements, health care regulations, and policy. Prior authorizations delayed care. Staffing shortages strained health care teams. Bureaucratic obstacles interfered with efficiency and sometimes affected patient experiences directly.

As a student, it was frustrating to witness how many aspects of patient care were influenced by systems outside of the physician’s control. That frustration ultimately became the reason I became interested in advocacy.

I realized that many of the issues physicians encounter daily are not problems that can be solved solely within the hospital or clinic. They require physicians to engage in larger conversations about health care policy, legislation, and the future of medicine itself. I began to understand that advocating for patients also means advocating for the systems and policies that allow physicians to provide safe, effective, and accessible care.

My perspective changed even further the first time I went to the Missouri State Capitol in Jefferson City for the Missouri Society of Anesthesiologists’ annual advocacy day. Walking through the Capitol, meeting legislators, and listening to health care policy discussions was eye-opening. For the first time, I saw how many major decisions affecting physicians and patients were being made by individuals, most without any formal medical training or firsthand experience caring for patients.

That realization was not discouraging. It was motivating. It reinforced the importance of physicians and medical students being present in these conversations. If health care practitioners are absent from discussions surrounding patient care, physician workforce issues, scope of practice, and health care access, then critical decisions may be made without sufficient medical perspective.

As an aspiring anesthesiologist, advocacy became especially meaningful to me because advocacy in anesthesiology is fundamentally tied to patient safety. Conversations about the importance of physician-led care, adequate operating room staffing, and access to perioperative services are not simply political discussions; they directly affect patient outcomes. Before becoming involved in organized medicine, I did not fully appreciate the extent to which legislation and health policy shape the practice of medicine. Through advocacy, I learned that protecting patients also means safeguarding the highest standards of care.

One of the biggest lessons I learned through advocacy is the importance of simply showing up. Many students hesitate to get involved because they feel inexperienced or intimidated. I remember walking into advocacy meetings unsure whether I belonged there. I assumed everyone else was more knowledgeable, more connected, or more qualified to contribute. Over time, I realized that organized medicine is not looking for perfection. It is looking for participation.

Showing up matters. Showing up to medical society meetings matters. Showing up to your state capitol matters. Showing up to conversations about the future of health care matters.

You do not need to be an expert in health policy to deserve a seat at the table. Sometimes the most important step is simply being present and willing to learn. Students often underestimate the value of their own perspectives. We are living through the realities of modern medical training and witnessing the strengths and weaknesses of the health care system firsthand. Those experiences are valuable and deserve to be heard.

My experiences in advocacy eventually extended beyond Missouri to Washington, D.C., where I had the opportunity to see health care advocacy on a national scale. Walking through congressional offices and participating in discussions with lawmakers reinforced how interconnected medicine and policy truly are. The conversations happening in Washington, D.C., directly affect physicians, trainees, and patients across the country.

Seeing advocacy at both the state and national levels made me realize that meaningful change often begins with people who are willing to consistently engage. The individuals who make the greatest impact are not necessarily the loudest voices in the room. They are the people who continue to show up, build relationships, and advocate for patients even when the process feels slow or imperfect.

Organized medicine also provided opportunities I never expected. Through advocacy, I found mentors who were passionate about leadership, policy, and patient care. I met physicians who demonstrated that being a doctor also means being an advocate for your patients, colleagues, and profession. I developed communication and leadership skills that are difficult to learn in a classroom alone.

Most importantly, advocacy gave me a sense of empowerment. Medicine can sometimes feel overwhelming, especially as students navigating health care systems that seem impossible to change. Advocacy reminds us that physicians and trainees still have the ability to shape the future of health care. Progress starts when people choose to engage rather than remain on the sidelines.

Medical students belong in organized medicine because we are not just the future of health care. We are already part of it. Our voices matter now, not years from now after training is complete.

The future of medicine is being shaped every day by the people willing to show up, speak up, and stay engaged. If we want a seat at the table, we must be willing to take it.

Michelle Wu, MD, is a recent graduate of the University of Missouri-Kansas City School of Medicine and is soon to begin her anesthesiology residency at the University of California, Los Angeles. She is a member of the American Society of Anesthesiologists’ Committee on Residents and Medical Students.

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research, and scientific society with more than 60,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit ASA online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. ASA publishes Anesthesiology, Anesthesiology Open, and ASA Monitor, and stays connected with members and the public on Facebook, X, Instagram, Bluesky, and LinkedIn.