Inspired by Healthcare Disparities to Advocate for Change

When Amanda Schnell moved from Kansas to the Southeast in 2017 for a rheumatology fellowship at the University of Alabama at Birmingham (UAB) Hospital, she quickly noticed an unfamiliar challenge: Rural patients in the South seemed to have much less access to medical care compared with rural patients in the Midwest. Surprised and concerned about these disparities, she saw an opportunity to help in an email from the ACR seeking fellows to advocate on behalf of patients. She took the chance and hasn’t looked back.

Dr. Schnell

Dr. Schnell is now an assistant professor in the UAB Division of Clinical Immunology and Rheumatology, associate program director of the Rheumatology Fellowship Program at UAB and a member of the ACR’s Government Affairs Committee. This year, she is managing the Advocacy 101 program held in conjunction with Advocates for Arthritis. She spoke with The Rheumatologist about what led her to push for change and how advocacy has become an integral and valuable part of her life today.

The Rheumatologist (TR): How did you become interested in rheumatology, and what was your path from the Midwest to the Southeast?

Dr. Schnell: I became interested in rheumatology during medical school at the University of Nebraska, where I got to learn from excellent rheumatologists who had a passion for patient care and research and really ensuring that their patients did their best. I continued to be interested during my residency at the University of Kansas Medical Center, and then I moved to UAB for my rheumatology fellowship. I’m still in Alabama, now as a clinician-educator and I see patients at the Kirklin Clinic of UAB Hospital and at the Birmingham VA Medical Center.

TR: Your first experience with advocacy came once you moved to Alabama. What led you to get involved?

Dr. Schnell: I’m from a rural town of about 7,000 people in Nebraska, but when I made the move to the South, the rural communities seemed a little bit different. I don’t know if it was the time in my life that made me more aware or if it was the move to unfamiliar surroundings, but I really noticed a disparity in access to treatment for rheumatologic conditions and in access to care overall. It seemed to me that there were fewer medical centers and hospitals and less availability of specialty care in the South. And maybe it was because I was prescribing more expensive medications, but the patients seemed much less able to afford them, so their diseases were progressing. It was frustrating for the patients and also for me, as the prescriber, to figure out how to help these patients who had limited resources.