When arriving at Reagan International Airport in Washington, DC, for ACC's 2022 Legislative Conference in October, we didn't have the clearest sense of what to expect, even though the three-day itinerary was spelled-out in advance. On reflection, we also didn't fully appreciate the impact this conference would have on us, our careers, our profession and our patients.

Unlike a typical annual cardiovascular meeting featuring data from late-breaking clinical trials, the Legislative Conference presents staggering statistics regarding the trajectory of health care in the U.S. Instead of comparing outcomes of various medications and interventions, the discussion is focused on how health policies will impact the future of cardiology and patient access to care.

Legislative Conference brought together physicians, CV Team members and trainees at various stages of their careers who were all focused on learning how to advocate and how to develop relationships with their legislators to effect meaningful changes. As Fellows in Training (FITs), we gained a sense of the importance of learning these skills and getting involved with advocacy this early in our careers.

"I think fellowship is the most appropriate time to become engaged in advocacy," said Nicole Lohr, MD, PhD, FACC, chair-elect of ACC's Board of Governors during the conference. "We spend so much effort learning about how to become good doctors, but we don't understand that to be excellent doctors we need to know how to navigate the system and to be able to advocate for our profession and our patients."

Before the Legislative Conference we did not feel qualified to have discussions surrounding advocacy, but over the course of three days the educational sessions and meetings with lawmakers helped us understand the external threats to cardiology and discover the strength of our own voices.

In short, we learned our voices matter. At nearly every meeting on Capitol Hill, the legislators wanted to hear from us as FITs, about how the issues we were raising affected our patients and our careers. It was surprising to see that our unique anecdotes and experiences providing patient care were important; it felt like they were really listening.

"The best part of going to the Hill is to go with FITs because they get to see it in action. It is a unique experience," said Lohr. "I think that you really realize how legislation is constructed, lobbied for, revised, and refined. If you don't see this process and don't talk to the people who are making these decisions, then you're really at the mercy of the system. It's a much better position to be in as a physician helping your patients by making sure that you have a seat at the table."

The good news is that there is much hope for our health care system and our profession. There is a growing interest in advocacy among FITs. There were 55 FITs and Early Career professionals who attended the conference and advocated on the Hill, comprising 15% of all attendees. Additionally, 10% of all 2022 contributors to ACC's HeartPAC are FIT members, with the ACC FIT Section winning an award for the most new contributors.

But to ensure the brightest future for our patients and ourselves, FITs must continue to be more involved in advocacy at both the state and federal level. If we don't speak to our senators and representatives, who else will advocate for our patients and us?

As we reflect back on our Legislative Conference experience and how much we learned about advocacy and its importance as part of our profession, we look forward to taking these new lessons and skills and applying them year round. We'll definitely be returning to this conference and hope to inspire many FITs and other CV Team members to join us as well.

This article was authored by Aaron A. H. Smith, MD; Mohamad Khattab, DO; and Carson Keck, MD, all FITs and members of ACC's FIT Section Leadership Council.