| doctors-making-a-difference-craig-riley-md | Doctors Making a Difference: Craig Riley, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-craig-riley-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/dmd-website-image-riley-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Craig Riley, MD logo" /></div>
<h5>November 7, 2023</h5>
<h2>Doctors Making a Difference: Craig Riley, MD</h2>
<p>
For Craig Riley, MD, changing the way primary care is delivered and tackling the ever-increasing problem of burnout among primary care physicians go hand in hand. As a physician leader-Dr. Riley is medical director of population health and medical education at Vancouver Clinic and program director for the Legacy Salmon Creek internal medicine residency-he's working to push his organizations beyond simple solutions to burnout by urging them to both change how they do business and work to foster purpose and meaning for primary care physicians. He talks to WSMA Reports about the sea change that's needed to address burnout at its root.
</p>
<p>
<strong><em>WSMA Reports:</em> In your view, why is burnout so prevalent in primary care? </strong>
</p>
<p>
<em>Dr. Riley:</em> Quite simply, the Medicare physician fee schedule does not prioritize primary care and leaves primary care clinicians feeling undervalued. This is the most important job in America from a health and cost perspective (with a growing projected shortage), but a tiny fraction of our brightest medical school graduates is even considering it. Even as a program director of a primary care-focused internal medicine residency, incentivizing graduates to enter primary care is a constantly evolving exercise in creative problem-solving.
</p>
<p>
All of the well-documented post- pandemic drivers of burnout are only magnified in primary care. Emotional exhaustion and depersonalization naturally deepen where vaccines are administered and patients' anti-science attitudes are openly expressed. Short-staffing affects primary care medical assistants and nurses first, as they often choose less burdensome or better-compensated roles instead. Career satisfaction lessens as primary care physicians are expected to take on more value-based care box- checking and electronic medical record landscaping, often using more family and personal time to do so. Work-life integration is sacrificed, and professional fulfilment becomes career resentment.
</p>
<p>
<strong>Are there ways you're working in your position at Vancouver Clinic to address burnout and well-being among primary care physicians?</strong>
</p>
<p>
Given the expectation that health care continues to achieve improved outcomes with fewer resources year over year, the only way to solve this problem is for organizations to take on more financial risk and move aggressively away from fee-for- service reimbursement. At the least, this aligns patient complexity with resources and encourages innovative delivery models. At Vancouver Clinic, we have incorporated Lean-based thinking and experimentation to innovate low-, medium-, and high- throughput primary care delivery models, engaging clinician brilliance to most effectively approximate the Quadruple Aim. We have also incorporated advanced practice clinicians in creative ways and tackled the in basket from all angles. The result is principle-aligned workflows, improved EMR integration, better compensation, collaborative team-based care, and hope that there is a better way.
</p>
<p>
<strong>What solutions have you found the most impactful for physicians to stave off burnout?</strong>
</p>
<p>
Purpose is key, and one size does not fit all. Many of my colleagues and I find deep, meaningful purpose primarily in education. I have also found work diversity (education, leadership, quality improvement, and multiple clinical domains) can keep work engaging and fresh. Others thrive in an all-clinical environment but feel most fulfilled with more procedural work, certain disease categories, or care for specific populations. And interprofessional team-based care models that thoughtfully incorporate advanced practice clinicians to grow, thrive, and work at the top of their degrees promote a communal purpose. Work opportunities, clinical and otherwise, tailored to a clinician's sense of purpose will always improve professional fulfilment.
</p>
<p>
<strong>For other health care leaders, what are some ways they can begin to address burnout among the physicians they lead?</strong>
</p>
<p>
There are no simple solutions; short-term strategies consistently fail. Investments in value-based care, quality improvement, and education are costly. However, the consequences of continuing unabated on the fee-for-service treadmill, with rising clinician burnout in the post-pandemic age, can be measured by staff turnover, clinician turnover, reduced clinical quality, more wasteful costly care, and reduced work effort. Health care leaders must prioritize not just minor adjustments in staffing ratios, time off, or the occasional free lunch, but invest in the wholesale transformation of primary care.
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/7/2023 12:30:06 PM | 11/7/2023 12:23:32 PM | 11/7/2023 12:00:00 AM |
| preventing-the-great-resignation | Preventing the Great Resignation | WSMA_Reports | Shared_Content/News/Latest_News/2023/preventing-the-great-resignation | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/cover-wsma-reports-novdec-2023-645x425px.jpg" class="pull-right" alt="cover of November/December 2023 issue of WSMA Reports" /></div>
<h5>November 7, 2023</h5>
<h2>Preventing the Great Resignation</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Soon after Garrett Jeffery, DO, took over as section chief of two of PeaceHealth's Bellingham family medicine clinics in early 2020, the COVID-19 pandemic would push his health care workforce to the breaking point. "We just saw a lot of resignations over the course of those three years. Some left for different jobs. Some left health care entirely. And it just didn't seem to let up," says Dr. Jeffery.
</p>
<p>
Even before the pandemic, burnout plagued medicine. In 2018, the National Academy of Medicine proclaimed it an epidemic. In May 2022, U.S. Surgeon General Dr. Vivek Murthy issued an advisory highlighting the urgent need to address the health worker burnout crisis across the country, pointing to the record numbers of health workers who are quitting or reporting that they intend to quit.
</p>
<p>
Since that advisory, the American Medical Association, the Medical Group Management Association, the Commonwealth Fund, and KFF Health News, among others, have reported more recent data on burnout prompting physicians and clinicians to leave the workforce. According to the Physicians Foundation's 2023 Survey of America's Current and Future Physicians, for the third year in a row, 60% of physicians report often having feelings of burnout. That's compared to 40% prior to the pandemic.</p>
<p>
Ensuring a strong physician workforce has always been a priority for the WSMA and other health care workforce advocacy organizations. While evidence doesn't yet show that a "great resignation" has taken place, the potential looms large if health care employers-systems, hospitals, large groups, and clinics-don't address burnout and its impact on retention, says Sue Skillman, senior deputy director of the Center for Health Workforce Studies at the University of Washington.
</p>
<h3>A shift to workforce retention</h3>
<p>
When it comes to building a strong health care workforce, retention has been underrecognized and undervalued for far too long, says Skillman. She also hesitates to use the term workforce shortage. "That implies that you can solve the problem by just producing more in the education system. And as many before me have said, we can't educate ourselves out of the workforce issues that we're dealing with," she says. "While education is important in keeping the supply growing, we have to incentivize those already in the field to want to work in the settings where we want them to work."
</p>
<p>
Yet, unlike requesting more government funding for medical training, retention solutions don't come with an easy legislative ask, says Skillman. "But we need to start talking about these things. We need the collective will and creativity to do that."
</p>
<p>
While the drivers of burnout are multifaceted, organized medicine is united in its belief that the conversation must move away from individual resilience to focus on systemic issues that drive burnout and on adopting best practices to ensure physicians and clinicians are supported appropriately.
</p>
<p>
To bolster physician wellness, the WSMA and the WSMA Foundation have been awarded a grant from the Physicians Foundation for a physician wellness initiative that will look at systemic solutions to physician and physician assistant burnout, including getting health systems and large groups together to come up with best practices and to pledge their commitment to meet those best practices.
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<p>
In addition, the WSMA has convened a small work group with members from the Washington State Medical Group Management Association and Washington state's large group leaders to create a package of workforce policy solutions in advance of the 2024 legislative session.
</p>
<p>
Failing to address worker burnout and the workforce retention crisis, says Dr. Jeffery, who participates in WSMA's workforce work group, will make it harder for patients to get care when they need it, cause health costs to rise, hinder our ability to prepare for the next public health emergency, and worsen health disparities.
</p>
<h3>Starting at the top</h3>
<p>
The Physicians Foundation report found that prioritizing physician well-being is critical to addressing burnout. Yet only 31% of physicians agree that their workplace culture prioritizes physician well-being, down from 36% a year ago.
</p>
<p>
Tackling burnout means addressing mental health head on, says Mark Mantei, CEO of Vancouver Clinic and a member of WSMA's workforce work group. Vancouver Clinic provides employees with up to six visits with a licensed counselor free of charge and often accessible within two days. "It's sometimes very helpful to be able to talk to a neutral party about this before your burnout reaches a height where you're just not able to function," says Mantei. "Calling out that it exists and then offering some resources around it is a step all of us in the industry need to take. Nobody's beyond a need for that."
</p>
<p>
At PeaceHealth, Dr. Jeffery has made physician well-being central to workforce recruitment and retention. Strong physician leadership, he says, is a component of broader workforce team retention.
</p>
<p>
"The things that cause people to be engaged in their work, the three pillars, have been referred to as value, reimbursement, and growth. Do they feel heard? Are they being compensated well? And are they able to learn and grow?" says Dr. Jeffery. At PeaceHealth, he's created a culture change based on those three pillars from lessons he learned from one of his mentors, Dr. Trish Wooden, as well as during WSMA's Leadership Development Conference in 2021.
</p>
<p>
"People really want to feel valued. To feel that their roles are fulfilling, that they're part of a team that makes a difference. And there's study after study that shows that," says Skillman.
</p>
<h3>Reducing documentation overload</h3>
<p>
Reducing barriers that prevent physicians and other clinicians from working at their highest licensure is critical to physicians feeling valued, reducing burnout, and increasing retention, says Mantei.
</p>
<p>
Spending time on unpaid work, such as prior authorizations, are common frustrations expressed by physicians and clinicians in WSMA's workforce work group, says Dr. Jeffery. These frustrations are echoed in the Physicians Foundation report, which found that at least half of physicians reported documentation protocols, insurance requirements, regulatory policies, and mandatory training requirements were a hindrance to their autonomy and to their ability to deliver high-quality, cost- efficient care.
</p>
<p>
And some 80% of survey respondents said they found reducing administrative burdens helpful to their overall well- being. So, it's no wonder many health care organizations have made reducing physician documentation overload central to their retention efforts.
</p>
<p>
Vancouver Clinic has seen a moderate uptick in turnover, increasing since the end of the pandemic rather than during it, says Mantei. That's because the shutdown of nonessential patient care during the pandemic created backed up demand for patient care now. Other health care systems are seeing similar trends.
</p>
<p>
"Primary care folk are experiencing a larger patient panel because of high demand and the workforce shortages in general. So, what we've seen is acuity go up, and then available primary care go down," says Mantei. Health care organizations also haven't put the necessary systems in place to manage the increased use of telehealth that was fast-tracked during the pandemic.
</p>
<p>
A major stress point for physicians and health care professionals is what Mantei calls managing digital medicine-patient medical records and the clinician's inbox. "So many patients got used to corresponding via clinician inbox during the pandemic, and it's continued. It's a good thing. But we haven't adapted all of our systems to really cope with it very well."
</p>
<p>
To help physicians get a handle on data entry, PeaceHealth has shifted the responsibility of updating medical history and other information to patients through their electronic medical record. "That's been a tremendous help with our workflow. Physicians are spending less time on data entry and more time seeing the patient," says Dr. Jeffery. "And patients are in more granular control, which we know improves the accuracy of the data entry. It's just a commonsense move."
</p>
<p>
Physicians at PeaceHealth and Vancouver Clinic also have begun using medical AI scribes, a tool that automatically transforms conversations during patient medical exams into medical documentation. "Doctors are able to spend less time documenting and more time face to face with their patient," says Dr. Jeffery. "It's part of a global effort to try to decrease work at the computer and improve efficiencies in documenting."
</p>
<p>
Providence, PeaceHealth, and Vancouver Clinic also rely on medical assistants, often through on-the-job apprenticeship programs, to alleviate the documentation burden on physicians. But apprenticeship alone cannot meet all MA demand, says Skillman, as MA positions have among the highest vacancies among health care occupations.
</p>
<h3>Providing a work-life balance</h3>
<p>
Dr. Jeffery says his first order of business in his clinics was advocating for culture change, including focusing on work-life balance, better internal communication, and reframing the workforce experience. "As we drove culture change, and really engaged with our workforce, we emerged from a period of staffing turnover to a place where now we're celebrating consistent staff retention. And we're onboarding new physicians now," says Dr. Jeffery. "We're really pleased with where we are today. But there's still more to do."
</p>
<p>
During the pandemic, flexible work schedules and remote work options became critical to work-life balance, solutions that continue to play an important role in long-term workforce retention, says Amber Pedersen, RN, immediate past president of the Washington State Medical Group Management Association and member of WSMA's workforce work group.
</p>
<p>
In her role as director of clinical service at Providence Medical Group in Spokane, Pedersen promotes flexible work schedules as a way for staff to achieve a work-life balance. "We look at each position and ask, 'What is its ability to be remote? Or could it be hybrid? Can they work four 10s? Can some of this work be done in the off hours?' We have dedicated resources looking at all of those issues in each position," she says.
</p>
<p>
Moving to value-based care has also added to physician stress. To manage the related complexities, PeaceHealth broadly reevaluated the panel sizes and metrics for their physicians and advanced practitioners. "Using published methodology to examine panel sizes gave us a good way to look at where we were going as an organization and remove some of the variability across the organization. In many cases, it also gave us a practical way to calculate a number of patients assigned to each physician or clinician based on what they historically have been able to do," says Dr. Jeffery.
</p>
<p>
Feedback on PeaceHealth's numerous retention initiatives has been positive. One supervisor highlighted that some staff are opting for career advancement from within the PeaceHealth system, rather than leaving the organization altogether. "That's a huge shift," says Dr. Jeffery. "This shows that because our focus is on work-life balance-and you can't find that everywhere-people are choosing to advance rather than quit."
</p>
<h3>Tackling external issues</h3>
<p>
Child care, elder care, and housing aren't typically things one thinks about when it comes to physician retention. But lack of access to these and their high costs are major barriers to work-life balance and critical drivers of physicians moving out of state, says Dr. Jeffery.
</p>
<p>
These issues go beyond the scope of what health care organizations can solely control, says Skillman. "We can't solve them alone, but we can't ignore them."
</p>
<p>
In his role as president of the Northwest Washington Medical Society, Dr. Jeffery has tried partnering with community organizations to increase available child care for health care workers only to be told there are not enough child care providers. "That's something that is big picture. It's not all in our control. But that's something that we need to also be talking with our legislatures about," he says.
</p>
<p>
Some systemic organizational changes, such as flexible work schedules and telehealth, however, can indirectly address these larger societal issues, says Pedersen. "In one of my clinics, someone doing four 10s saved their household quite a bit of money. Because they don't need to drive that extra day, they save on gas. And so that was a retainer for this employee who worked a long distance from our facility," says Pedersen.
</p>
<h3>The cost of doing nothing</h3>
<p>
Failing to make changes that address burnout and workforce retention comes at a steep price. A study published in Mayo Clinic Proceedings estimated that primary care physician turnover, fueled partially by burnout, leads to nearly $1 billion in excess health care spending each year.
</p>
<p>
Each physician turnover costs organizations anywhere from $500,000 to more than $1 million on average, according to AMA. "There's lost productivity as well as the cost of recruiting and signing on a new physician with decreased productivity, in comparison, in their first year," says Dr. Jeffery.
</p>
<p>
Workforce gaps and inconsistent staffing also mean health care systems will struggle to embrace new technologies or more efficient delivery models, says Skillman. "It just slows you down and may prevent adoption of new innovations and things that are going to ultimately help the practice and hopefully help the health care outcomes you're trying to deliver." Skillman recently heard from one rural health clinic that couldn't implement several initiatives because a key staff person had left.
</p>
<p>
Not putting effective systems in place will only lead to higher burnout and even more difficulty recruiting a skilled workforce, says Pedersen. "Your workforce isn't only looking for opportunities in the local area. With advances in technology, they are now looking globally. And so, if you're not on top of it and not meeting the needs or understanding the needs of your workforce, you won't have one."
</p>
<p>
Thanks to PeaceHealth's systemic changes to address physician wellness and retention, its Bellingham location is now functioning at full capacity. "I have staff now that call us their second home," says Dr. Jeffery. "That goes back to the culture changes we fostered. We're now having to share our staff out with the other clinics because they haven't done the same work on culture. And they're continuing to see the physician exodus and turnover."
</p>
<h3>The work ahead</h3>
<p>
Systemic efforts at increasing retention fall short if policymakers aren't involved, says Skillman. "When we talk to legislators, the conversation typically moves to medical school loan repayment or putting more seats in medical schools. And those are easily identifiable solutions to workforce problems, especially when people use the word shortage a lot. But those are long-term solutions. If we could retain the skilled workforce longer in their work settings, it just seems like a much simpler solution," says Skillman. "Maybe I'm naïve. I'm not a clinician; I don't run a clinic or hospital. But I really would like to see more emphasis on those solutions for which we have a lot of evidence."
</p>
<p>
Skillman encourages health care employers to make their voices heard on workforce issues through the Washington State Health Workforce Sentinel Network, a collaborative effort funded by the state Legislature to provide an objective filter of information to planners and policymakers. "Every six months, it's an open call for input. Anyone who identifies as a health care employer can respond," says Skillman. "It's a tool to take those voices, take input from health care employers and health care settings, and get those issues to the foreground. So, it's actionable."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/7/2023 12:30:06 PM | 11/7/2023 12:24:10 PM | 11/7/2023 12:00:00 AM |
| if-there-is-a-will-there-is-a-way | If There is a Will, There is a Way | WSMA_Reports | Shared_Content/News/Latest_News/2023/if-there-is-a-will-there-is-a-way | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/heartbeat-website-image-ellingson-645x425px.png" class="pull-right" alt="Heartbeat column logo with Amy Ellingson, MD" /></div>
<h5>November 6, 2023</h5>
<h2>If There is a Will, There is a Way</h2>
<p>
By Amy Ellingson, MD
</p>
<p>
I want to share this good news, but at the same time, I am a bit afraid to let the word get out. Our rural health clinic in Brewster has found a way to keep family medicine alive.
</p>
<p>
My generation of doctors has experienced incredible changes. The internet revolution is one of them. When I went to medical school in 1995, the internet was slow and clunky and limited in its practicality. We studied at libraries with shelves of books and periodicals all around us. Nowadays, I have reference websites on my phone and laptop for diagnostic protocols, the latest treatment guidelines, and medication dosages. This same revolution that gives me real-time evidence-based practices also brought along the electronic medical record, which has been both a blessing and a curse. I am of the class of doctors who initially learned how to handwrite office and hospital notes. I recall some of my internal medicine notes being several pages long. It seems old-fashioned now, but that wasn't that long ago.
</p>
<p>
In that same time period, the American primary care system in our country also changed radically. One of these changes has been the transition away from physician-owned clinics. This trend started in the late 1990s and has continued to grow. A <a href="https://www.medicaleconomics.com/view/number-of-doctors-in-private-practice-continues-to-slide">recent study</a> found that as of January 2021, 69% of U.S. physicians were working for entities not controlled by physicians, with 49.3% of those owners being hospitals or health care systems and 20% being either private equity or publicly traded insurance companies. This change in practice ownership continues to grow due to financial, administrative, and other regulatory changes that are not going away. One of the most palpable differences that affects primary care the most is management by nonclinical administration.
</p>
<p>
When I came to North Central Washington in 2002, I bought into a physician-owned practice. We had an office manager, but the decisions were made by the physician owners. The people seeing the patients decided how best to run the practice. We decided the days we worked, how many patient slots we had each day, and how much vacation time we would take in a year. I was the first partner to take maternity leave and we worked through that together. At the time, taking eight weeks off seemed a bit revolutionary.
</p>
<p>
Due to the ownership model now being nonclinical, the model of how practices are managed has almost totally been replaced by administrators who are making the decisions and then telling the physicians how they need to structure their days. This has been problematic in many systems, and some say it was a major player in higher rates of clinician burnout that we were seeing even before the COVID-19 pandemic. Already, there was a sense of physicians and advanced practitioners being pushed harder with more administrative demands, as well as being asked to see more patients each day in shorter time slots. Along with these changes, there is also a loss of agency when clinicians are not involved in the decision-making. Even when working conditions are nearly the same, being an employed physician can lead to more dissatisfaction. <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2791439">One 2022 study</a> found that "physician-owned practices are more likely to be satisfied with the EHR" and "to have positive perceptions of time spent on documentation." We can learn something from this.
</p>
<p>
Of course, the pandemic added an accelerant to this already burning bush of increasing physician pressures and burnout. This led to the "great resignation" where many physicians and advanced practitioners left medicine at a younger age than they had planned. In family medicine alone, 117,000 physicians left practice in 2021. Since then, many thousands more have left practice along with nurses and other health care workers. This has led to significant staffing shortages in both clinics and hospital settings. <a href="https://jamanetwork.com/journals/jama/fullarticle/2790791">One national study</a> showed only one out of five primary care clinics were fully staffed and that 40% of primary care clinics had to take on new patients because other practices had closed. Unfortunately, this trend looks like it is going to continue. Based on 2021 Association of American Medical Colleges data, only 33% of physicians in practice in our country are in primary care (family medicine, internal medicine, and pediatrics). Even when you add in nurse practitioners and physician assistants, it is still not enough to provide primary care to our country.
</p>
<p>
The response to all of this has led many organizations to push their physicians and staff to see more and more patients. This is not only to keep afloat financially but also to accommodate patient demand. I know many practices that are only allowed to have 15-20-minute appointments no matter what is going on with the patient. The physicians and advanced practitioners at these clinics feel strapped for time and are concerned they are not able to listen well and provide optimal care. This same model does not feel good to patients as they get rushed through their visits and often cannot see the physician or clinician with whom they have the strongest connection.
</p>
<p>
Here's the good news. I know we can't go back to the handwritten note with five lines written in cursive diagnosing acute otitis media, but family medicine doesn't have to die. I know this because where I work, we practice in a way that feels good to this family doctor who trained over 20 years ago. We found a way to balance these competing forces and create a sort of harmony. We put our commitment to our community first. This includes our staff community and our patient community. We created a standard that says we create a supportive environment for our staff and patients. We listen to each other and try to figure out how to make things work so we provide the optimal patient experience plus the optimal staff experience. We believe that a happy and healthy medical team provides the best medical care.
</p>
<p>
We believe that providing optimal care may take more time. This means that I still have 40-minute appointments to meet new patients. I just saw a new 67-year-old patient who had not seen a doctor in close to 10 years. He brought me three Honeycrisp apples from his orchard. It was the first time a new patient brought me a gift, and I was so pleased that I had the time to listen to him and provide full-scope family medicine. As I go through my day seeing patients, I am listening to their stories. As physician author Abraham Verghese said, "When I see a patient, I take a history, and what is a history but a story?" Being heard is what people want and that requires keen listening and a collaborative approach to address the issues that are ailing them.
What allows us to do this? I asked our CEO this question and here is his reply "I know that for a member of our team to bring their best every day, we must have a positive, enriching culture. What that really means is that we have to embrace being balanced in all we do. Yes, the financial pressures are always there, along with the need for improved quality and meeting the demands of regulation. But we can never afford to lose sight of the fact that we are human beings taking care of other human beings and for that to go well, we must always attend to maintaining our humanity first and all the rest is secondary to that."
</p>
<p>
It is possible to have a primary care clinic that has clear commitments and then lives up to them. If we can do it, then I would assert the same can exist nationwide. As a recent Kaiser Health News article points out, having a relationship with a "doctor who knows your health history and has the time to figure out whether the pain in your shoulder is from your basketball game, an aneurysm, or a clogged artery in your heart" is what we need and what we can create. We need to prioritize primary care in our country before it is too late to salvage. The life expectancy in the U.S. is declining while we have a higher number of specialists per capita in the world and spend more on health care than any other high-income country. Being a primary care doctor is not a sexy profession that plays well in medical dramas. But I have had countless patients tell me I saved their life. I have had countless patients tell me their story and say it is the first time they have shared it with anyone. I want to continue to practice medicine in a way where I am healthy and well in order to keep my patients healthy and well. So, just look to rural Washington to know that when there is the will, a way can be found.
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/6/2023 3:37:18 PM | 11/6/2023 3:35:45 PM | 11/6/2023 12:00:00 AM |
| letting-the-healer-heal | Letting the Healer Heal | WSMA_Reports | Shared_Content/News/Latest_News/2023/letting-the-healer-heal | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/cover-wsma-reports-novdec-2023-645x425px.jpg" class="pull-right" alt="cover of November/December 2023 issue of WSMA Reports" /></div>
<h5>November 6, 2023</h5>
<h2>Letting the Healer Heal </h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
The emotional toll that comes with working in medicine has never been higher. The pandemic has strained the entire health care system to the breaking point and many physicians with it.
</p>
<p>
"Everyone is so overworked," says Judith Kimelman, MD, OB-GYN with Seattle Obstetrics &amp; Gynecology Group and chair of the north and western states region for the American College of Obstetricians and Gynecologists. "Burnout is just rampant among physicians, and it can lead to depression and suicides."
</p>
<p>
Indeed, according to the American Medical Association, recent studies place the national burnout rate for doctors in practice at more than 40%. An even more frightening statistic is the suicide rate for physicians, which is twice as high as it is for the general population.
</p>
<p>
Faced with patients experiencing such turmoil, physicians would readily recommend counseling. Indeed, wellness programs for physicians are not new and exist in a wide variety, from employee assistance programs to peer counseling sessions.
</p>
<p>
Yet many doctors are reluctant to seek the same help for themselves. A primary reason is the worry that talking to someone about their problems will end up being used against them. More than 40% of physicians do not seek help for burnout or depression for fear of disclosure to a state licensing board.
</p>
<p>
"There are too many reasons why physicians choose not to get the help they need," says Jesse Ehrenfeld, MD, president of the AMA. "Concerns around confidentiality are one of them. I work in a health system with a terrific employee assistance program, but too many of my colleagues are afraid to use it. Anything we can do to strengthen their trust and not impact licenses in a negative way is important."
</p>
<p>
Dr. Ehrenfeld knows firsthand how fear can cause a doctor to hesitate about getting much-needed help. "I had an experience of having a physician colleague walk into my office in crisis, having an acute psychotic episode at the hospital," he recalls. "I walked that physician to the employee assistance program, and the very first question they asked was, 'What does this mean to my license?' "
</p>
<p>
Sadly, says Dr. Ehrenfeld, that fear is widely shared. "That is not uncommon," he says. "That is the very first question that people ask."
</p>
<p>
Confidentiality concerns aren't the only barrier to physicians accessing wellness programs.
</p>
<p>
"One of the big issues is that we have a culture that you're tough, you don't let people know you have a weakness, you don't reach out to people, you don't show vulnerability," says Dr. Kimelman. "When you have that culture of not talking about it and denying your emotions, it's really bad for people."
</p>
<p>
While the culture of never showing weakness may be fading, confidentiality concerns remain strong. In a litigious environment, virtually everything becomes discoverable during in a lawsuit, making physicians rightfully cautious about sharing anything for fear of the impact their frank conversations may have.
</p>
<p>
"In obstetrics and gynecology, there's such a concern for potential litigation, that there's a fear of talking to anyone," says Dr. Kimelman. If a problem arises, "you're told right away, 'Don't talk to anyone,' " she notes.
</p>
<p>
Litigation isn't the only factor, Dr. Ehrenfeld points out. "There's concern about the impact on their career in medicine," he says. "Doctors may not seek help for suicidal thoughts because of fear of disclosure to the state medical board."
</p>
<p>
Yet physician wellness programs can be incredibly helpful. John Chuck, MD, chief wellness officer at California Northstate University, testifies to their value. "I'm of the strong opinion that the king of all health is mental health," he says. "It really determines how one thinks about one's self and one's place in the world."
</p>
<p>
In his previous position as the regional chair of the Physician Health and Wellness Leaders Group in The Permanente Medical Group, Dr. Chuck participated in a pilot program where he saw a therapist for six months. "I loved it so much that I continued to do it well after the pilot was over," he says. He is currently seeing a life coach through a program offered through his local medical society.
</p>
<p>
"I personally have benefited from counseling and coaching," says Dr. Chuck. "It keeps me right in the head."
</p>
<p>
So much so, that he has become an evangelist for physicians seeking help from mental health professionals. "I talk about it publicly," he says. "We need to emerge from the outdated belief that physicians don't need help to be emotionally well. We probably need such help more than anybody given the tremendous responsibilities and burdens we carry every day."
</p>
<p>
"At the very least, good counseling has two great effects," he adds. "You feel deeply heard and you begin to understand that you are not alone in your suffering."
</p>
<p>
Dr. Kimelman believes that peer- to-peer programs can be particularly helpful for physicians. These sessions are an opportunity for physicians to talk to someone who can provide context for the difficult patches that physicians sometimes experience.
</p>
<p>
Peer support programs rely on physicians from any type of practice who undergo training. They are not mental health counselors and the program is not meant to be long term. "It's just a chance for people to get that first touch that somebody cares," says Dr. Kimelman. If additional resources are necessary, the peer counselor would be able to provide them. The programs are available in multiple health care systems in Washington state.
</p>
<p>
"Let's train people in the field to have those open conversations with a peer, to help people reframe what they've been through," she says. "It's not so much the specifics, but how they perceive the problem. They can help physicians with coping mechanisms and normalize their feelings, letting them know they are not alone. It helps them get perspective."
</p>
<p>
In addition, physicians and physician assistants in Washington also have the Washington Physicians Health Program, which provides help for health professionals who may not be able to practice safely due to an impairing or potentially impairing health condition.
</p>
<p>
"Washington is very lucky to have the program," says Dr. Ehrenfeld. "I'm really pleased for my colleagues in Washington, but there's obviously an opportunity to strengthen what's happening through confidentiality protections."
</p>
<p>
The AMA has been spearheading policy changes to allow physicians to get much- needed care without unnecessary fear of career repercussions. The association has been promoting legislative and regulatory changes to create a "safe haven" through which physicians and other health care professionals can seek and obtain confidential care.
</p>
<p>
Several states have already passed legislation to offer such protections. Virginia was the first, passing a measure in 2020. Indiana, South Dakota, and Arizona have all followed suit. The laws further the goal of supporting physicians and health care professionals to seek professional support to address career fatigue, burnout, and behavioral health concerns with broad confidentiality and civil immunity protections, with a focus on "career fatigue and wellness" rather than "burnout." The AMA has proposed draft legislation and regulatory language in the hopes of promoting adoption in other states.
</p>
<p>
For peer-to-peer counseling, confidentiality protections may not be an absolute necessity. "Nobody is taking notes or listening as an expert," says Dr. Kimelman. "They're just dealing with the emotions from a harmful event and helping people cope." However, the protections would remove the barrier that prevents physicians from accessing the programs out of fear.
</p>
<p>
The WSMA and the Washington chapter of ACOG are working together to consider seeking confidentiality protections for physician wellness programs next year. "It's the perfect partnership to work on this together," says Dr. Kimelman.
</p>
<p>
In the meantime, she says, it's important for physicians to know that asking for help isn't a sign of weakness.
</p>
<p>
"We're all human," says Dr. Kimelman. "Things happens, and we're going to have emotions about them. It's important to work thought those emotions. We're caring physicians."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/6/2023 3:16:11 PM | 11/6/2023 3:13:23 PM | 11/6/2023 12:00:00 AM |
| member-profile-penny-reck-md | Member Profile: Penny Reck, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/member-profile-penny-reck-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/member-profile-website-image-reck-645x425px.png" class="pull-right" alt="Member Profile: Penny Reck, MD logo" /></div>
<h5>November 6, 2023</h5>
<h2>Member Profile: Penny Reck, MD</h2>
<p>
<strong>Works at:</strong> Clarus Eye Centre (The Retina Service) in Lacey.
</p>
<p>
<strong>How long in practice:</strong> Since 2008.
</p>
<p>
<strong>Specialty: </strong>Retina.
</p>
<p>
<strong>Why WSMA:</strong> I joined for the opportunity to connect with other physicians and to have access to WSMA resources. The WSMA is active with health care policy and legislative advocacy with knowledgeable staff who support physicians all over the state, and they play a vital role in supporting physicians to be active and effective advocates. The WSMA's House of Delegates generates a positive vibe of mentorship combined with insightful and respectful collaboration, and inspires me to try to do more.
</p>
<p>
<strong>Proud moment in medicine:</strong> My mom, a pediatrician for more than 30 years, was diagnosed with breast cancer in late 2015. Despite being married to a doctor, she asked me to help with overseeing her care, which was provided by a female plastic surgeon and a female surgical oncologist. Mom's successful 8-1/2-hour surgery (bilateral mastectomies with immediate reconstruction) took place under the deft surgical skills of these working mom surgeons on Feb. 3, 2016, which also just happened to be the first National Women Physicians Day. On that day-167 years after Elizabeth Blackwell, MD, became the first woman to earn a medical degree from an American medical school-lifesaving medical care was delivered to a female physician by female physicians. That moment gave me mindful pause to appreciate and celebrate the successful journey of women in medicine.
</p>
<p> <strong>Top concerns in medicine:</strong> Loss of quality and efficiency due to problems like reimbursement cuts despite rising costs of care delivery; growing financial disparity despite calls for equity and improved access; work-life balance, burnout, and a resulting lack of civic engagement. We need more representation and visible action to ensure we have a health care system created by the people who deliver that care.</p>
<p>
<strong>Spare time:</strong> Besides being a transportation service for my kids, I attend school district board meetings, provide public comment, and help keep families informed because I believe that high-quality public education is society's best chance to break down equity barriers. I also enjoy stealing a moment to play the piano, especially when the kids join in to sing or add other instruments or percussion. Some moments are just a little better with "more cowbell."
</p>
<p>
<strong>What people might not know about me: </strong>I had 13 years of formal dance training and dreamed of dancing on Broadway or in Los Angeles for music videos. I choreographed student productions in college and medical school, and one of my life's passions still is to dance.
</p>
<p>
<strong>Best advice: </strong>In a debrief when I was a competitive swimmer, my coach said: "At some point, you just need to let go, go for it, and push through. Even when it gets painful. Because it'll be okay. You're ready." It was ambiguous feedback, as post-swim critiques are typically specific and technical. But with that counsel, she captured the idea that preparedness, action, confidence, and perseverance are fundamental tools to achieve a goal. If you have all that, even when the challenge feels overwhelming, "hit go."
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/6/2023 3:19:50 PM | 11/6/2023 3:18:11 PM | 11/6/2023 12:00:00 AM |
| member-profile-greg-may-md | Member Profile: Greg May, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/member-profile-greg-may-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/member-spotlight-greg-may-website-image-645x425px.png" class="pull-right" alt="Member Profile: Greg May, MD graphic" /></div>
<h5>Sept. 19, 2023</h5>
<h2>Member Profile: Greg May, MD</h2>
<p>
<strong>Works at:</strong> Harbor Regional Health Orthopedics in Aberdeen.
</p>
<p>
<strong>How long in practice:</strong> 28 years. Specialty: Orthopedics and hand surgery.
</p>
<p>
<strong>Why WSMA: </strong>I'm active in the WSMA because the politics of health care demand unity, and the WSMA supports physicians and physician leadership. I've been more active over time and have particularly enjoyed the WSMA Leadership Development Conference, which I try to attend annually.
</p>
<p>
<strong>Top concerns:</strong> One of my top concerns in medicine, which affects all specialties, is the onerous requirements of prior authorization. It is an additional burden the insurance industry has placed on us. My academy [the American Academy of Orthopaedic Surgeons] and the WSMA are actively working on changing this unnecessary delay tactic.
</p>
<p>
<strong>Why my specialty: </strong>I'm drawn to my specialty because I'm a happy tinkerer. I've always been mechanically inclined and enjoyed discovering how things work. My specialty is mechanically oriented, particularly regarding the intricacies of hand anatomy. Orthopedics also treats all musculoskeletal conditions and patients of all ages. I enjoy this variety that my patients bring to the clinic.
</p>
<p>
<strong>Proud moment in medicine:</strong> I'm proud that three of my four daughters have chosen medicine as their profession. My wife (WSMA member Anne Marie Wong, MD) is also a physician, and the fact that my children feel this is a worthy profession to pursue after living with their medical parents makes me feel like I've done something right. Unrelated to medicine, I am proud of my daughter who is in engineering and also a happy tinkerer.
</p>
<p>
<strong>Challenges in profession:</strong> The shortage of physicians and attempts to replace them with advanced practice practitioners is a major change challenging our profession. This lack of physicians, particularly in rural areas, contributes to the already exorbitant cost of care and affects those most vulnerable due to social determinants of health.
</p>
<p>
<strong>What people may not know:</strong> I have kept bees for the last three years. I have two hives in my backyard, and I enjoy them and their honey. Bees are wonderful and an important part of our ecosystem.
</p>
<p>
<strong>Spare time:</strong> When I'm not at work, I spend my time enjoying craft beer, going to yoga class, downhill skiing, and spending time with my grandchildren.
</p>
<p>
<strong>Favorite quote:</strong> "Always laugh when you can, it is cheap medicine." -English poet Lord Byron.
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/19/2023 10:05:51 AM | 9/19/2023 10:02:25 AM | 9/19/2023 12:00:00 AM |
| ya-es-tiempo-its-time | Ya Es Tiempo (It's Time) | WSMA_Reports | Shared_Content/News/Latest_News/2023/ya-es-tiempo-its-time | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/heartbeat-meljen-website-image-645x425px.png" class="pull-right" alt="Heartbeat: Vivienne Melvin MD logo" /></div>
<h5>Sept. 15, 2023</h5>
<h2>Ya Es Tiempo (It's Time)</h2>
<p>By Vivienne Meljen, MD</p>
<p>
Most of my patients have a look of surprise on their face when they first see me stepping into the exam or hospital room clad in casual scrubs, sneakers, a mask, and with my short wavy hair. Yet, so often I watch this common reaction melt away as it sets in that I'm speaking Spanish with them and I am their doctor. Just as my entrance often elicits surprise, my exit will end with some variation of them saying "Gracias, que Dios te bendiga doctora" (Thank you, God bless you, doctor). At the end of my day, these are the patients who fill my soul. Yet my heart hurts for them when I see how their struggles with the health care system affect their lives.
</p>
<p>
When I first started my OB-GYN practice, I felt patient questions about my age, life, and background were distractions from the care I was giving. I would try to address their questions honestly but briefly to maximize my time with them. That was, until I later recognized that for most of my patients, I am the first Latina physician and surgeon they are meeting. When I reflect on this, I realize that even at the diverse academic institutions where I trained, I hadn't met someone who was "like me" until I was a resident.
</p>
<p>
Patients are genuinely curious about how a young Latina, not unlike them, came to be in a position to care for them. They are hungry for culturally competent health care. They want someone to understand. I've never been more certain that maternal care in this country is not in a good place right now, and this is especially true for the ethnic minorities who make up much of Washington's medically underserved.
</p>
<p>
We know that diversity in the health care workforce improves the provision of care and patient experience. We also know that the few patients who can access health care in a culturally competent way are more likely to do so and thus have better outcomes. In this context, the closing of hospital maternity units across Washington and gaps in clinics accepting pregnant patients with Medicaid are creating wounds to our most sensitive communities that can only be fixed by taking the exact opposite actions and increasing access and care.
</p>
<p>
When compared to other gender-matched specialties, obstetric and gynecologic care is beyond disproportionally reimbursed. Health systems will say higher reimbursements are "not sustainable," but neither is providing high-risk services to the medically underserved on shoestring budgets and burning out the clinicians who are choosing to serve them.
</p>
<p>
I recognize each day that as the daughter of Cuban immigrants, my path could have been very different. As a teenager I interpreted for my Abuela (grandmother), who died unnecessarily from a preventable cervical cancer. I received Pell grants and went to medical school with not only student loans, but also medical debt. I've been a Medicaid patient. When patients tell me their struggles, I am looking at my own reflection. It's why I sought to work for an organization where I could have the greatest impact on the Latino community.
</p>
<p>
It will take deliberate work, but if we are going to support every woman in Washington there are no other options in my mind:
</p>
<ul>
<li>We need to bolster community-building around health care centers, so patients feel welcome and comfortable seeking care and the physicians and practitioners who are looking to serve these communities can be validated.</li>
<li>We need to support the education and pipeline programs of our youth in a meaningful way, much like the efforts of WSU's homegrown physician mission. I am an National Health Service Corps and Truman scholar-it is possible. These initiatives work.</li>
<li>We need to improve reimbursement for obstetric and gynecologic care so our clinicians and organizations can sustain care models that allow for the actual time it takes to counsel patients in their native tongue or with interpreters in a meaningful way. Not be rushed to meet the system's bottom line.</li>
<li>We need to maintain the caring clinicians we have and listen to the frontline voices.</li>
<li>We need to support women and diverse candidates to fill true leadership positions across all facets of this industry so they can be change agents.</li>
</ul>
<p>
Policy makers, insurers, leaders, and health care conglomerates may say they are "caring for mothers and infants," but their actions speak louder than words. Maternal services in Washington will continue to be plagued by staffing shortages and physician, midwife, and nurse burnout if we don't see radical change. Ya es tiempo. (It's time)
</p>
<p>
<em>Vivienne Meljen, MD, is an OB-GYN at SeaMar Vancouver Women's Health Center and an assistant professor at Elson S. Floyd College of Medicine, Washington State University.</em>
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/28/2023 10:05:08 AM | 11/28/2023 10:04:43 AM | 9/15/2023 12:00:00 AM |
| a_family_tradition | A Family Tradition | WSMA_Reports | Shared_Content/News/Latest_News/2023/a_family_tradition | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div>
<h5>Sept. 14, 2023</h5>
<h2>A Family Tradition</h2>
<p>By Milana McLead</p>
<p>
Nariman Heshmati, MD, is a problem solver; the more difficult the issue, the better it suits him. Whether it's automating his house so the lights are motion activated, programming the fireplace to function with a remote, operating on a patient in a life- threatening situation, or perhaps even more daunting, fixing what's broken in health care, he's up for the challenge.
</p>
<p>
"We are designing a system that we will all need," he says. "Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We've got the ability to design that system."
</p>
<p>
His passion for doing just that is more than a mantra, it's personal. His efforts to that end literally made a difference to his own family's life. "My kids were born at Providence, where I was division chief for women's and children's services at the time," he says. It was then the second- busiest labor and delivery unit in the state. As division chief and an OB-GYN, Dr. Heshmati and his team worked to improve the neonatal intensive care unit, striving for process and quality improvements.
</p>
<p>
"When my wife came in [for delivery], I knew it was too early," he says. As their newborn son, Robert, spent his first 10 days in the NICU, Dr. Heshmati understandably wanted him to have the best care and the best chance of surviving. "Then the irony hit me: All those things I'd worked on, that my team worked on ... my family was actually experiencing the result of those efforts," he says. "To me, it's not just a job. We are developing a system not only to take care of patients, but to take care of ourselves and our families."
</p>
<div class="col-sm-12" style="text-align: center;">
<blockquote style="text-align: center;"><strong>
<em><span style="font-size: 18px;">
Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We’ve got the ability to design that system</span>.</em></strong>
</blockquote>
</div>
<p>
Working to fix that system also drives his involvement in the WSMA, advocacy, and organized medicine. During his earliest days in medical school at Florida State University, getting involved was heavily encouraged. He served on the political action committee of the Florida Medical Association, even spending a month embedded with the association's lobbying team at the Capitol in Tallahassee at the height of Florida's medical malpractice reform. The "sea of white coats on the steps of the Capitol demanding action" launched him into advocacy efforts that continue today.
</p>
<p>
"One of the hardest challenges being a physician is that we are in such a regulated industry, it's easy to feel that you lose autonomy and control. The system around you is deciding how you can provide care and all you want to do is provide that care," he says. "Being involved in the WSMA gave me visibility to how decisions are made, how to improve the system, and how to give voice to the physician perspective.
</p>
<p>
"When you're part of the WSMA, instead of feeling like the health care system is crumbling and patients can't get the care they need, you can feel like you're in the driver's seat to speak up to say, 'This system is not OK, and here is what we need to take care of the community.' "
</p>
<div class="col-sm-5 pull-right newsbody" style="text-align: center;">
<p><img alt="Dr. Heshmati" src="/images/Newsletters/Reports/2023/september-october/Nariman_Heshmati_0051_425x650.jpg
" class="pull-right" width="425" height="650" /></p>
</div>
<p>
Taking care of the community is a thread that's woven into most, if not all, of what Dr. Heshmati thinks about in terms of leadership, advocacy, and impact. While he's done the clinical 80-hour week, been on call around the clock, developed departments, argued legislation, and testified in front of elected officials, he is now focused on where he can make the greatest impact: physician leadership. "In my leadership roles, I might be able to help 10 people, or 100 people, or maybe 1,000 people. That ability to make a broader impact is what drives me," he says. "I feel strongly that medical organizations need physician leaders. To take care of patients, we need to have the right ingredients, the right rules, the right system around us. If we're not at the table helping guide that process, that's when we see regulations we don't need, policies that don't make sense, and interference in the patient-physician relationship."
</p>
<p>
Early in his life, he saw firsthand the value and importance of the patient- physician relationship. As a child, he watched his parents taking care of patients. It was practically destiny that Dr. Heshmati would become a physician, considering that his father, two uncles, and older brother are physicians, and his mother and older sister are psychologists. Growing up near Florida's Cape Canaveral, instead of dreaming about space adventures, he hung out at his parents' primary care medical offices while they worked. "While my dad was seeing patients, my mom ran the office," he says, "and I was there too, playing with toys."
</p>
<p>
That childhood may sound idyllic, but his family's journey to that point was anything but. Dr. Heshmati was born in Iran on New Year's Day 1980. As he entered the world, revolution had upended his country; it was day 59 of the seizure of the American Embassy in Tehran and the Iran-Iraq war was raging. His father was an orthopedic surgeon and head of surgery at the major army hospital in Tehran, so though his work was deemed necessary, it wasn't necessarily safe for him or his family to remain in Iran. After months of covert planning, the elder Dr. Heshmati and family left everything behind, fleeing their homeland, first to Europe and ultimately to Florida's Satellite Beach.
</p>
<p>
His father reestablished his credentials and served the community in primary care, then as Brevard County's public health director, and ultimately as a revered public health advocate: When he retired, the building he worked in was renamed in his honor. He was widely known for innovative programs he created to ensure access to care, maternity care, vaccines, and more.
</p>
<p>
"My dad was a huge influence," Dr. Heshmati says. His father modeled, well before it was popular, that everyone should have access to health care. "Everyone knew my dad and would tell me 'My child was sick and was able to use this program [your dad created].' That had an impact on me. I realized if I go into medicine, the positive impact I can make on a community can be significant."
</p>
<p>
His parents shaped and inspired his life, from making a positive impact in everything you do ("keep your community healthy") to having a strong work ethic ("work hard to get results"). Their journey of leaving everything behind and rebuilding-new land, new language- also inspired a sense of optimism for the younger Dr. Heshmati. "They had a sense of no matter what the challenge is, we have the ability to get things done here," he says.
</p>
<p>
As incoming president of the WSMA, he's optimistic about getting things done, together. "What speaks to me is the power we have when our voices are unified," he says. "When we come together, we have significant power to implement change. Some of the brightest and most dedicated people I've ever seen are in health care. If you had to pick a team to improve health care, this is the team. Our members are that team. We can make this the best place to practice medicine and receive care."
</p>
<p>
<em>Milana McLead is WSMA's senior director of strategic communications and membership.</em>
</p>
<h3>Snapshot </h3>
<p><strong>Family:</strong> Met his wife, Kathryne, during his undergraduate studies at the University of Florida. Their son, Robert, is 10; their daughter, Sirena, is 7.</p>
<p><strong>First language: </strong>Farsi. He still understands it but must work at speaking it. </p>
<p><strong>Day job:</strong> Senior regional medical director for surgery and specialty for Optum’s Washington market. Oversees more than 40 departments and multiple ambulatory surgical centers between The Polyclinic and The Everett Clinic and has accountability for more than $400 million in revenue.&nbsp;</p>
<p><strong>Office décor</strong>: Drawings by his kids: “I love having these reminders of my family in my office. Why do we do what we do? It’s for our kids.†</p>
<p><strong>Social media:</strong> Includes his “DrNari†YouTube channel and an endless stream of selfies on Twitter. “The first thing patients do when they have concerns is go to Google. Better to put the right information out there because they’re going to look there anyway.â€</p>
<p> <strong>Starting the day: </strong>A 4 a.m. wake-up alarm, a work out, then a 10-mile e-bike ride to his office in a nondescript, highly secure building in Everett. “Every day we have an opportunity to make an impact. When I wake up, I look forward to that.†</p>
<p><strong>Favorite quote:</strong> “Coming together is a beginning, staying together is progress, working together is success.â€</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/28/2023 10:05:49 AM | 11/28/2023 10:05:21 AM | 9/14/2023 12:00:00 AM |
| a-growing-maternity-care-crisis-in-washington | A Growing Maternity Care Crisis in Washington | WSMA_Reports | Shared_Content/News/Latest_News/2023/a-growing-maternity-care-crisis-in-washington | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div>
<h5>Sept. 14, 2023</h5>
<h2>A Growing Maternity Care Crisis in Washington</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Imagine if cardiac care was only spottily available. Hospitals were shutting down their cardiac care units, with patients needing immediate treatment traveling significant distances. Physicians who offered the care were overwhelmed with huge patient panels. Access to care was particularly difficult for patients in rural areas, disproportionately impacting communities already suffering disparities in care.
</p>
<p>
If that sounds far-fetched, just replace "cardiac care" with "maternity care." Because that's the current reality in Washington.
</p>
<p>
When it comes to maternity care, many parts of Washington are in a state of crisis. While the large population centers still offer the full spectrum of care, many counties are seeing maternity services reduced or disappear altogether. The result is worrying physicians faced with fewer resources to help their patients.
</p>
<p>
"I get a lot of calls from my colleagues who are struggling, asking, 'Where can I send patients? What can I do?' " says Nariman Heshmati, MD, an OB-GYN and WSMA's incoming president for 2023-2024. "Historically, if you were in a rural area, you had access to maternity care but not access for the small minority of care for the highest risk. Now we're seeing lack of access to basic maternity services."
</p>
<p>
The crisis comes at a time when the nation as a whole is experiencing a rise in maternal mortality. Between 2018 and 2019, the rate increased from 17.4 maternal deaths per 100,000 live births to 20.1. It then continued to rise to 23.8 in 2020 and to 32.9 in 2021. While Washington's pregnancy-related death rate is lower than the national average, with 15.9 pregnancy- related deaths per 100,000 live births from 2014-2020, preliminary state Department of Health data indicate an increase in the rate of pregnancy-associated deaths in 2021 compared to the previous year, and Washington's rate is higher than those of wealthy countries outside of the U.S., according to the World Health Organization.
</p>
<p>
As a whole, the state looks no worse than the rest of the nation in terms of access. Indeed, in some ways the state is much better at offering maternity care to women than others. The problem is delivering it.
</p>
<p>
"The state of Washington does a really good job compared to many other states," says Rita Hsu, MD, an OB-GYN with Confluence Health in Wenatchee and chair of the Washington State Perinatal Collaborative. "It's relatively easy to qualify for Apple Health. In many counties, you can get access in the first trimester, which is a good predictor of outcomes. The challenge is when you get into these geographically big counties, which tend to be lower resourced."
</p>
<p>
Indeed, portions of the Evergreen State are maternity care deserts. As of 2020, one-fifth of the counties in the state didn't have a hospital or birthing center offering obstetric care and don't have any practitioners whose licensures allow practice of obstetrics (OB-GYNs, family practice physicians practicing obstetrics, certified nurse midwives, or licensed midwives). Things have only gotten worse since then. Since 2022, labor and delivery units have closed in Covington, Forks, Bremerton, and Toppenish.
</p>
<p>
Of the 39 critical access hospitals in the state, 24 do not offer obstetric care, according to the state Department of Health. Eight counties have no maternity services, while five others have limited access to services. In maternity care deserts, women have to drive on average more than 30 miles to the nearest labor and delivery service.
</p>
<p>
Moreover, in rural areas, patients frequently present with more complex issues. "Patients in general are higher acuity," says Dr. Hsu. "We see more pregnant persons with hypertension, diabetes, or a higher BMI. If you look at the most recent year for which we have complete birthing data, which is 2021, the maternal age group of 21-29 is shrinking while 30 and above is growing, which means more risk."
</p>
<h3>A hospital closing devastates a poor community</h3>
<p>
The closure of the labor and delivery unit at Astria Toppenish Hospital, located on the Yakama Reservation, last December highlights how devastating the impact can be on both physicians and patients. Citing a loss of $3.2 million for the unit over the previous 12 months, the hospital said it could no longer afford to provide the services. While the hospital had announced it planned to close the unit in mid-January, it shut it down suddenly before Christmas.
</p>
<p>
"We worked hard," says Jordann Loehr, MD, an OB-GYN who worked at Astria Toppenish. "We treated people with dignity and respect. The nurses were here for 20 years. Now it's all over. People down here have no place to go."
</p>
<p>
Dr. Loehr's patients had few resources, so losing access to maternity care presents an agonizing dilemma for them.
</p>
<p>
"I have more than one patient who walks to clinic," says Dr. Loehr. "One patient's plan is to walk to the Toppenish hospital in labor and hope that they will call an ambulance and transport her to Yakima Memorial. I don't have a solution for these women."
</p>
<p>
The closure has turned Dr. Loehr's life upside down, as well, since she is no longer working at Astria Toppenish. "Now I have nowhere to deliver," says Dr. Loehr. "I have to leave. It's breaking my heart. I haven't delivered a baby in six months."
</p>
<p>
Still, says Dr. Loehr, "I am the least victim of the victims here. I can get another job. All of the options are better than what's happening to the women in Toppenish. I will be fine with a broken heart."
</p>
<p>
Dr. Loehr has been advocating for the creation of a public hospital district to fill the gap caused by the closure at Astria Toppenish. "I feel wholeheartedly that a public hospital district in the Lower Valley would thrive," she says. While a recent vote on a proposition to consider a public hospital district in the Lower Valley received support, it did not pass due to not meeting the voter turnout threshold. Supporters say they will work to get the proposition back on the ballot.
</p>
<p>
Such closures are only exacerbating existing disparities in care. In rural areas of the state, maternal mortality is 40% higher than the state average. According to a study released in JAMA last July, the maternal mortality ratio in the state increased a staggering 71% for American Indian and Alaska Native women from the period 1999-2009 to 2010-2019. For Black women, the increase was 20%. For Hispanic women, the increase was 22%.
</p>
<p>
"Maternal mortality persists as a source of worsening disparities in many U.S. states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis," the authors of the study concluded.
</p>
<h3>High cost, low payment</h3>
<p>
Low Medicaid reimbursement rates are a major reason why labor and delivery units are closing. The overhead for keeping the units operating is high. They require specialized nurses and specialized services such as neonatal care. But Medicaid reimbursement rates fall far short of matching the costs to physicians and hospitals, even though Medicaid pays for nearly half the births in Washington. In some rural communities, that figure approaches 80%.
</p>
<p>
"I get paid $2,000 for a delivery," says Kathy Hebard, MD, an OB-GYN at Kitsap OBGYN. "That's for all prenatal visits, hospital care, the delivery, and postpartum care. For an uncomplicated pregnancy, it's somewhere between $50 and $75 an hour. And these situations aren't always uncomplicated. It doesn't matter how risky. You get paid roughly $2,000. It's demoralizing."
</p>
<p>
Dr. Hebard says that her global reimbursement hasn't changed since 2005. "I don't know any other industry where you don't see a cost increase every few years, let alone over two decades." She says that the failure to value the work OB-GYNs are doing sends a clear message.
</p>
<p>
"What you pay somebody for a job is how you value it, and clearly they don't value us or the women we care for," she says.
</p>
<p>
Given all these problems, it's unsurprising that fewer medical students are pursuing OB-GYN as a specialty. The average age of OB-GYNs in the state is 50. As more physicians retire, the odds of finding replacements are shrinking.
</p>
<p>
"It's not a very appealing job to sign up for when you have to work long hours, pay a huge amount for malpractice, and probably get sued once or twice in your career no matter how good you are," says Dr. Hebard.
</p>
<h3>A case study in Kitsap County</h3>
<p>
Dr. Hebard's experience is illustrative of how changes over time have brought the state to this crisis. A graduate of the University of Washington School of Medicine, she chose to work on the Kitsap Peninsula because it was an attractive place to start her career.
</p>
<p>
"I joined a private practice," she recalls. "Initially there was another group in town, plus a smattering of family practice clinicians. Of course, there was also the Naval Medical Center, which was a full-time source of care for Navy members and their families." (Bremerton has the third-largest naval installation in the country.)
</p>
<p>
Over time, says Dr. Hebard, "the community kept growing, but the numbers of physicians and advanced practitioners did not. The volume was steadily increasing over the past 20 years, but we had the same number of physicians and practitioners." That changed in the past five years.
</p>
<p>
First, family practice physicians stopped offering maternity services. "It didn't make sense for them to pay the malpractice insurance, so they quit doing the job," says Dr. Hebard. Then there were a series of retirements. While a few physicians came to replace those who retired, eventually they left, as well.
</p>
<p>
The most devastating blow in Kitsap County came in the spring of 2022, when the Naval Hospital in Bremerton closed its labor and delivery services, citing staffing and cost issues. A few months later, Peninsula Community Health Services, also in Bremerton, followed suit. That left a single hospital on the Kitsap Peninsula-St. Michael's- providing birth services.
</p>
<p>
As a result, Kitsap County went from having eight OB-GYNs per 100,000 people to just three per 100,000 people. Washington has an average of 15 OB-GYNs per 100,000, well below the 27 per 100,000 recommended as the optimal number in a 2011 study published in Surgical Science, but about average for the U.S.
</p>
<p>
Dr. Hebard says that the impact has been overwhelming. "I look at the number of babies we delivered in our practice last year, and it was well over a thousand," she says. "That's 200 babies a physician or nurse. It's exhausting. We're delivering babies all the time, and taking on the risk. How much can you take on and still provide good care? It's just a hard scenario."
</p>
<p>
To handle the volume, patients often have to wait to see their physician until the second trimester. Initial lab and ultrasound results are handled over the phone without an initial physician interaction, for example.
</p>
<p>
"We have to prioritize the urgency," Dr. Hebard says. "We're routinely double-booked, seeing more patients than the time allotted. I'm routinely an hour late. A lot of patients understand we're strapped, but it's still frustrating for both myself and them."
</p>
<h3>Advocating for changes</h3>
<p>
Some help is on the way, at least for hospitals. Washington has finished its Medicaid safety net assessment. As a result, Medicaid reimbursement rates will be increasing, but not until next year.
</p>
<p>
Jennifer Hanscom, the chief executive officer of the WSMA, notes that the state has a statutory requirement to intervene in "maternity care distressed areas." The statute directs local officials to develop a report recommending remedial action, which the state Health Care Authority will review and use "to the extent possible, in developing strategies to improve maternity care access in the distressed area."
</p>
<p>
In a written appeal to the Health Care Authority, the WSMA has urged the agency to respond to the crisis in maternal care in the state. "As more pregnant individuals begin to experience the worsening impact of these closures, the WSMA strongly urges the HCA to consider available resources and engage in the statutorily required remedial work to ensure safe and appropriate access to maternity services no matter where a person lives in the state."
</p>
<p>
"Our work is focused on drawing attention to the obligation that policymakers have," says Hanscom. "People need to have safe places and skilled individuals to deliver their babies. If policymakers are going to commit to expand access to Medicaid, they have to make sure that the second set of that equation is fulfilled, which is there are people available to meet patients' needs."
</p>
<p>
Ultimately, Hanscom acknowledges, "It's going to be related to money, and state policymakers need to fulfill their promise of offering medical services to people covered by Medicaid. They have to stop overpromising and underdelivering on these services. By extending access to Medicaid coverage, the state has an obligation to provide those services and make it a priority to address those communities having to go without them."
</p>
<p>
In the long run, argues Dr. Heshmati, the lack of care is only adding more cost to an already overburdened system.
</p>
<p>
"The irony is that the health care system is having to table these patients' needs because of economic issues, but when patients don't have access, they have more complications and more downstream costs that end up costing us more as a society."
</p>
<p>
Dr. Hsu says that everyone recognizes the problem, but developing a comprehensive response will be difficult. "I talk to people on both sides, and we share the same goals, but sometimes it's really hard to find a place where we overlap," she says.
</p>
<p>
In the meantime, alternatives are at least being explored. An expert panel convened by the state Department of Health has endorsed more out-of- hospital birthing care. Dr. Hsu believes it's worth exploring whether the state could use Accountable Communities of Health to develop a kind of hub-and- spoke model, which would allow rural hospitals to continue to provide access to maternal services while directing more complicated or risky cases to a referral hospital.
</p>
<p>
Despite all the challenges, Dr. Hsu says that being an OB-GYN remains a fulfilling career. "It's the most joyful experience you can have and call it work."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/28/2023 10:06:26 AM | 11/28/2023 10:06:01 AM | 9/14/2023 12:00:00 AM |
| doctors-making-a-difference-sara-mazzoni-md | Doctors Making a Difference: Sara Mazzoni, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-sara-mazzoni-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/dmd-mazzoni-website-image-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo: Sara Mazzoni, MD" /></div>
<h5>Sept. 14, 2023</h5>
<h2>Doctors Making a Difference: Sara Mazzoni, MD</h2>
<p>
For Sara Mazzoni, MD, MPH, division chief of OB-GYN at Harborview Medical Center in Seattle, quality maternal health care goes hand in hand with the professional well-being of the physicians providing it. At the OB-GYN clinic at Harborview, she's focusing on both fighting burnout among physicians and the issues that can lead to inequitable care for patients often left behind in health care. She talked with WSMA Reports about the landscape of maternal and reproductive care.
</p>
<p>
<strong><em>WSMA Reports:</em> What are the most challenging issues in maternal care and reproductive care right now?</strong>
</p>
<p>
<em>Dr. Mazzoni:</em> The issues at the top of my mind are the attacks on reproductive health care inclusive of the Dobbs [v. Jackson Women's Health Care] decision and its aftermath, our nation's abysmal maternal mortality rate, and the disparities in all reproductive health outcomes.
</p>
<p>
<strong>As a medical director at Harborview, are there aspects of improving maternal and reproductive care that you're focusing on? </strong>
</p>
<p>
I'm constantly focused on two things: centering our most marginalized patients and improving the well-being of our physicians and clinicians. At Harborview, we care for the full spectrum of our community. If we can focus on the patient experience and outcomes of our most underserved patients, then all patients will benefit. We are continuously striving to improve our delivery of equitable and inclusive care for all patients, but especially those often left behind in our health care system.
</p>
<p>
With the second issue, our group of physicians and clinicians are all women. We know following the pandemic that female physicians are facing a level of burnout higher than their male peers. Every day I do what I can to fight burnout and increase professional satisfaction for our physicians, knowing that if they have improved well-being, our patients will have better outcomes.
</p>
<p>
<strong>What are the biggest factors you see in your practice that influence maternal and reproductive health outside of the care they receive in clinic, such as social factors?</strong>
</p>
<p>
So many! Prenatal care is such a small piece of a pregnant person's experience, and often doesn't have a huge impact on overall maternal health. The places we live, work, and play impact our health to a large degree, and this is no different for reproductive health. Stress plays a role in pregnancy in a way we don't yet understand. Social factors that increase a person's stress, such as unstable housing and food insecurity, clearly impact maternal health in a way greater than medical care.
</p>
<p>
<strong>Are there things that physicians and physician assistants from other specialties can do to support good maternal and reproductive care for patients?</strong>
</p>
<p>
Other clinicians can put contraception on their radar. We frequently see people who are interacting with the health care system due to serious health problems who then have an unintended pregnancy. If a physician is treating a reproductive- aged person for poorly controlled diabetes, for example, add contraception to the checklist!
</p>
<p>
<strong>What system-level changes in the greater health care ecosystem need to be made to ensure all women and pregnant people receive the highest-quality care? </strong>
</p>
<p>
There are seismic changes needed in the entire system for all people to receive highest-quality care. Following the pandemic, it is abundantly clear the system is broken. Clinicians are burned out and disillusioned. Patients don't trust the system. We are largely functioning in an insurance system rather than a health care system. These are overarching issues, however, and don't answer the question.
</p>
<p>
Administrative bloat in the entire system needs to be addressed; there are layers upon layers of administrators, all of whom may not be improving the quality of care. The administrative burden on clinicians needs to be decreased so that we can spend more time focused on patient care and less drowning in the electronic medical record. We need more mental health professionals and social workers trained and integrated into all aspects of health care. Finally, we need to address systemic racism throughout our health care system so that Black women aren't terrified to give birth in our hospitals and all people have equitable health outcomes.
</p>
<p>
<em><em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em></em>
</p>
</div> | 9/14/2023 11:33:33 AM | 9/14/2023 10:57:51 AM | 9/14/2023 12:00:00 AM |
| responding-to-dobbs | Responding to Dobbs | WSMA_Reports | Shared_Content/News/Latest_News/2023/responding-to-dobbs | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div>
<h5>Sept. 5, 2023</h5>
<h2>Responding to Dobbs</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Like many OB-GYNs around the country, Sarah Prager, MD, learned of the U.S. Supreme Court's decision to overturn Roe v. Wade and leave abortion policies up to individual states while she was at work. For Dr. Prager, division chief of complex family planning for UW Medicine in Seattle, the news of the Dobbs v. Jackson Women's Health Organization decision came during a team huddle before a full day of scheduled abortions.
</p>
<p>
"I felt an immediate sense of doom, also tearful," says Dr. Prager. "We had colleagues coming into our OR all day to commiserate." Their sadness quickly turned to anger and an invigorated sense of purpose, says Dr. Prager, who talked to reporters in between cases that day and drafted a statement reinforcing her department's commitment to the full spectrum of reproductive health care.
</p>
<p>
That commitment to abortion and evidence-based care between a doctor and patient has long been the foundation of reproductive health care in the Evergreen State. Washington first legalized abortion in 1970-the first state to do so by referendum and three years prior to the Supreme Court's landmark Roe decision making abortion a constitutional right nationwide. It's a commitment Washington and the WSMA have rededicated themselves to as the rights of patients and doctors come under attack in ways never imagined.
</p>
<h3>Legal repercussions from and in response to Dobbs</h3>
<p>
The fallout from the Dobbs decision was immediate and wide-ranging, affecting reproductive health beyond abortion care. Numerous conservative states have passed laws not only to severely restrict or ban abortion within their own borders (14 states to date have a full ban in effect), but also to penalize those seeking and providing abortion care out of state.
</p>
<p>
"There's a lot of uncertainty and confusion-that's the point of these abortion restrictions. They're intended not only to make it harder to seek out these services and perform these services, but also to create chaos, which in itself diminishes the ability to access care," says Alex Wehinger, WSMA's associate director of legislative advocacy.
</p>
<p>
To counter these efforts, 20 Democrat- controlled states, including Washington, have put new and additional laws in place to expand access to care within their borders and to protect those seeking or providing care from laws in other states. On April 27, Washington Gov. Jay Inslee signed a package of laws protecting reproductive care (see sidebar on facing page).
</p>
<p>
"We are doing what we can in Washington state to insulate both the patients and the physician community here to the extent possible under Washington state law," says Wehinger.
</p>
<p>
In addition, Washington is leading 17 states and the District of Columbia in a lawsuit to preserve and expand access to mifepristone, a safe and effective drug prescribed for medication abortions. On April 13, Judge Thomas O. Rice of the U.S. District Court for the Eastern District of Washington issued an order affirming that mifepristone access remains protected in Washington and in the other states involved in the lawsuit. This means any certified health care professional can prescribe mifepristone for up to 10 weeks gestation. Patients can get it through the mail and via telehealth appointments.
</p>
<p>
"This past year was a very successful year in Washington for reproductive rights. I was honored to be at that signing," says Nariman Heshmati, MD, WSMA's incoming president for 2023-2024 and legislative chair for the American College of Obstetricians and Gynecologists Washington section, who attended the reproductive health legislation package signing ceremony presided over by Gov. Inslee. The WSMA worked with WA- ACOG and other advocacy groups to fight for these necessary protections.
</p>
<p>
Medical record privacy issues remain a big concern for both out-of-state and Washington patients, says Dr. Prager. She's had Washington residents ask her not to document abortion care in their electronic records for fear of someone accessing them in states with onerous abortion laws.
</p>
<p>
To protect patient and physician and physician assistant privacy regarding reproductive health care, the WSMA supports the U.S. Department of Health and Human Services' proposed modifications to the HIPAA Privacy Rule (see sidebar on following page).
</p>
<p>
Nationwide, 42% of OB-GYNs report that after Dobbs they are very or somewhat concerned about their own legal risk when making decisions about patient care and abortions, according to a survey by the Kaiser Family Foundation.
</p>
<p>
To this end, last year WSMA's endorsed liability insurer, Physicians Insurance A Mutual Company, developed criminal defense reimbursement coverage. It provides up to $250,000 in legal defense costs incurred in response to criminal allegations arising in connection to patient care.
</p>
<p>
"Historically, medical professional liability policies only provide coverage for civil suits and do not include coverage for any criminal defense costs. This means that in the absence of this coverage, a physician facing criminal charges related to the provision of abortion would be responsible for payment of any legal defenses related to those charges. This coverage provides physicians with the financial ability to seek a vigorous criminal defense," says Melissa Cunningham, general counsel and senior vice president for Physicians Insurance.
</p>
<p>
As new challenges unfold, the WSMA will continue working with advocates and legislators to identify opportunities to ensure access and protection for patients and the physician community, says Wehinger. There are already new bills in development for the next legislative session.
</p>
<h3>The impact on the ground in Washington</h3>
<p>
Since the Supreme Court's June 2022 decision, the number of monthly abortions in Washington has increased by an average of 166, according to data from the Society of Family Planning.
</p>
<p>
As expected, Washington has seen an increase in the number of out-of-state abortion patients. Since Dobbs, the number of such patients coming to Washington has risen by 36%, according to Planned Parenthood of Greater Washington and North Idaho. The bulk come from Idaho, which bans abortion at all stages of pregnancy with few exceptions- Washington has seen an increase of 56% coming from that state for abortion care.
</p>
<p>
An out-of-state patient population is nothing new for Washington OB-GYNs. "Even prior to Dobbs, there weren't many or any [abortion care] professionals past the first trimester in Wyoming, Alaska, Montana, and Idaho. So, we have taken care of patients in the region, particularly with more complicated pregnancies, for a long time," says Dr. Prager. Recently, she's also seen patients from further away, including from Oklahoma, Texas, and Louisiana.
</p>
<p>
With the specter of prosecution from their home state hanging over them, Dr. Prager does her best to reassure these patients. "What we can say to them is that the care you are getting is safe and legal here. And you have no obligation to share this information with anybody. And your records are as secure as we can make them."
</p>
<p>
Another concern for OB-GYNs here is that lack of access to care elsewhere means that by the time patients come to Washington for reproductive care, physicians are seeing them in later stages of gestation or with serious complications, says Dr. Prager.
</p>
<p>
Across the country, the uncertainty caused by restrictive abortion laws has prompted both individuals and families to make preemptive decisions about their reproductive health. Dr. Prager has seen a 10- fold increase in patients seeking sterilization procedures or permanent contraception.
</p>
<p>
"I'm not just inferring this. Patients were very blatantly saying, 'I don't want any chance that I will have a pregnancy that I can't manage. And I don't want to be pregnant in this context,' " she says. "People are concerned that they may not always live in Washington state or that their job might take them elsewhere, to a state where they can't access abortion care."
</p>
<p>
Worried that contraception is next on the conservative chopping block, patients are also asking for their IUD or long-acting contraception to be replaced early. "They want to have the longest time possible for the device to remain effective," says Dr. Prager.
</p>
<h3>Far-reaching consequences</h3>
<p>
Dr. Heshmati has heard from colleagues around the country regarding the Dobbs decision and how it impacts them. Beyond concerns over losing their right to make evidence-based patient care decisions, Dobbs has already begun to change the medical landscape in other negative ways, says Dr. Heshmati. "Many doctors who are in restrictive states have chosen to relocate. In some cases, physicians looking for OB-GYN training programs are avoiding states that do not offer the full complement of reproductive health."
</p>
<p>
A study by the Association of American Medical Colleges found that medical students starting residency programs, regardless of specialty, were far less interested in matching in states with abortion bans or gestational limits than in states without those restrictions.
</p>
<p>
"There's a concern for practicing abortion care, but also of having access to the full spectrum of evidence-based reproductive health care for themselves or their partners," says Dr. Prager, who was not involved in the study. "There is going to be difficulty recruiting physicians to states where abortion is illegal because of these reasons. And that's going to lead to huge problems around the country for general medical care."
</p>
<p>
All physicians and physician assistants, not just OB-GYNs, must play a vital role in advocating for abortion care, say Dr. Prager and Dr. Heshmati.
</p>
<p>
"We all have a moral obligation to still take care of our patients as much as we can in the state in which we live," says Dr. Prager. "But every specialty needs to fight for access to abortion to be safe and legal across the country. And not to be this piecemeal patchwork of different legislation that is not tested and not understandable."
</p>
<p>
"As WSMA president, I will continue the legacy of physicians standing together regardless of specialty to ensure patients have access to quality care and make our state the best place to practice medicine and receive care-and that includes ensuring access to the full scope of reproductive care because reproductive care is health care," says Dr. Heshmati.
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/5/2023 4:23:08 PM | 9/5/2023 4:21:11 PM | 9/5/2023 12:00:00 AM |
| doctors-making-a-difference-clint-hauxwell-md | Doctors Making a Difference: Clint Hauxwell, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-clint-hauxwell-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" alt="WSMA Reports cover July/August 2023" /></div>
<h5>August 9, 2023</h5>
<h2>Doctors Making a Difference: Clint Hauxwell, MD</h2>
<p>
As an assistant professor teaching clinical medicine at the University of Washington School of Medicine in Spokane and faculty advisor for UW's Family Medicine Interest Group, Clint Hauxwell, MD, is working to encourage medical students to get involved in shaping the future of medicine through legislative advocacy. Dr. Hauxwell talked with <em>WSMA Reports</em> about his work with medical students and their unique perspective on the policymaking process.
</p>
<p>
<strong><em>WSMA Reports:</em> Tell our readers a little about your work with medical students around the importance of advocacy and organized medicine.</strong>
</p>
<p>
<em>Dr. Hauxwell:</em> In my roles with the UW, I have had the privilege of observing medical students as they serve the community-for example, by treating patients at the local homeless shelter or by meeting with high school students who are interested in pursuing a career in health care. I work with students who entered medical school with a desire to make a difference in the lives of their patients, but few of them understand the concept of organized medicine and how institutions such as the WSMA and Washington Academy of Family Physicians can act as conduits for positive change.
</p>
<p>
I have been inspired by the advocacy opportunities afforded by membership in the WSMA and wanted to challenge local medical students to take advantage of those opportunities as well. At UWSOM Spokane we have coordinated an annual workshop where representatives from the WSMA and WAFP discuss advocacy from the perspectives of their organizations. This year, [2022-23 WSMA President] Katina Rue, DO, and [WSMA CEO] Jennifer Hanscom did an excellent job of introducing the resolution process and its impact on WSMA's policy and legislative agendas.
</p>
<p>
<strong>What motivated you to get involved with that work?</strong>
</p>
<p>
I saw a desire on the part of medical students to effect change on the local and state levels, and I recognized that both the WSMA and WAFP eagerly encourage student and early-career physician involvement. I distinctly remember being at the WSMA Leadership Development Conference in Chelan when a medical student stood up to make comments during one of the workshops. His input was received with enthusiastic applause from the other participants, and really highlighted the fact the students and residents are valued members of the WSMA.
</p>
<p>
<strong>What advocacy or policy issues in health care have you found that medical students are most passionate about?</strong>
</p>
<p>
Students are consistently interested in issues that directly impact patient health and are less concerned about policies that are aimed specifically at improving the lives of physicians. At the WSMA House of Delegates, student resolutions often focus on improving health care for the underprivileged. In a sense, students serve as the conscience of an organization such as the WSMA, reminding us that our focus should always be patient-centered. Over the past several years, students have proposed resolutions at the HOD focusing on prediabetes care, transgender health, and migrant worker safety.
</p>
<p>
<strong>How do you connect the dots between advocacy and how its outcomes can have a tangible impact on students' daily practice once they become physicians?</strong>
</p>
<p>
I think it is important to provide concrete examples of how advocacy, through the resolution process, has impacted WSMA lobbying efforts and has resulted in new legislation. We try to walk the students through the process: "Here is the issue, here is the successful [House of Delegates] resolution that addressed the issue, and, finally, here is the legislation that was eventually passed, with the support of the WSMA." Fortunately, we have many examples of successful student resolutions that have directed WSMA's policy or legislative agenda.
</p>
<p>
<strong>What advice would you give to students as the first step to getting involved with advocacy?</strong>
</p>
<p>
The first thing that I recommend is that they join an organization! This could be their county medical society, a specialty society, or the WSMA. Students are encouraged to identify an issue that they are passionate about and that needs to be addressed in Washington state. Historically we have held a resolution writing workshop and have directed them to the tutorial on the WSMA website. I find that medical students need minimal encouragement to get involved!
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 8/10/2023 12:01:54 PM | 8/10/2023 12:01:30 PM | 8/9/2023 12:00:00 AM |
| the-reluctant-leader | The Reluctant Leader | WSMA_Reports | Shared_Content/News/Latest_News/2023/the-reluctant-leader | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/july-august/heartbeat-website-image-walker-645x425px.png" class="pull-right" alt="Heartbeat column logo with Ed Walker MD" /></div>
<h5>July 25, 2023</h5>
<h2>The Reluctant Leader</h2>
<p>
Edward Walker, MD
</p>
<p>
I couldn't answer. I had no idea. The awkward silence felt embarrassing.
</p>
<p>
The physician sitting across from me had come for leadership coaching. I always enjoyed interacting with rising physician leaders, especially in the early stages of their development when they are first realizing their true potential. Her question was harmless, but it stopped me in my tracks: "When did you first decide to become a physician leader?"
</p>
<p>
Honestly, I didn't know. I still don't. It wasn't a single decision at a specific point in time, more of a slow realization that I was doing things that were consistent with being a leader, the formal roles I was slowly adopting evolving naturally rather than from ambition.
</p>
<p>
Having reflected on that moment, I've realized that many of the major decisions we make over the course of our lives are not simple transitions. I decided today at 11:30 a.m. to go out to lunch, but I don't recall the exact moment I decided to marry the woman I love. Some decisions are lightning strikes, but the really important ones often resemble the imperceptibly slow dawning of a new day.
</p>
<p>
To be honest, I don't think I ever aspired toward any of the many leadership positions I've held. Each chapter started out with a desire to be the best doctor I could be at that phase of my career. In the process of making care more safe, efficient, patient-centered, satisfying, and cost-effective, I ran into resistance and obstacles that could only be surmounted by assuming responsibility and authority. I recall several moments when I reluctantly concluded that the person to whom I reported was less interested or able to raise the bar in these areas, so I couldn't move forward without moving up.
</p>
<p>
Each time, something remarkable happened. As I assumed the responsibility and accountability of the role, a vision of what could happen beyond my initial plans would slowly materialize. To make things happen, I needed to inspire people to be different, to share in the transformation of our work together, and to involve everyone in a team effort to realize change. Yes, there were often colleagues with competing, sometimes self-interested visions, but the key was always to build the coalition around best practices in quality and fiscally responsible, patient-centered care.
</p>
<p>
Several times a year I stand in front of a group of future physician leaders in my WSMA Physician Leadership Course and we own up to why we're there. For some, it's the realization that they have already accepted the responsibilities of being a clinic medical director and they need the skills. For a small number of others, they've seen a path to being a chief medical officer, and they like what they see. But for many, maybe half the class, there are looming questions: "Should I be a leader?" "Can I make a difference?" "Do I have the right stuff?" By the end of the course, most have answered these questions for themselves.
</p>
<p>
They know what they need to do. They have been reluctant leaders all along. Now they have the path.
</p>
<p>
<em>Edward Walker, MD, MHA, is a professor emeritus in the departments of psychiatry and behavioral sciences and health services at the University of Washington in Seattle and senior physician advisor for the <a href="[@]wsma/physician_leadership/center-for-leadership-development.aspx">WSMA Center for Leadership Development</a>.</em>
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/1/2023 5:01:39 PM | 9/1/2023 5:01:12 PM | 7/25/2023 12:00:00 AM |
| raising-our-voices | Raising Our Voices | WSMA_Reports | Shared_Content/News/Latest_News/2023/raising-our-voices | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="cover of July-August 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>July 18, 2023</h5>
<h2>Raising Our Voices</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
Health care consolidations have been part of her medical career since Joanne Roberts, MD, former senior vice president and chief value officer at Providence, entered medicine in 1985. By the time the palliative medicine specialist retired in 2021, she had been through eight consolidations- an economic trend that has accelerated in recent years. Today, several major corporations dominate in Washington state, with the locus of control often moving from local hospital or practice administrations to corporate offices. Virginia Mason Health System and CHI Franciscan forming a joint operating company is the most recent local merger.
</p>
<p>
The economic sea change is due, in part, to the cost of doing business today and in response to similar consolidations nationwide. Many WSMA physicians work within these consolidated systems or soon will. A 2021 analysis by the Physicians Advocacy Institute found nearly seven in 10 doctors are either employed by a hospital or a corporation.
</p>
<p>
Consolidation isn't the only economic trend creating turbulence in health care today-that list would include escalating prescription drug costs, medical debt, staggering corporate profits, and an influx of profit-driven private equity into health care, among others. But the phenomenon certainly tops the list, and, together with those other trends, helps to form what physicians sometimes feel is the broken umbrella under which they must work today.
</p>
<h3>Navigating the new normal</h3>
<p>
The concern many physicians often express, either publicly or privately: Consolidation minimizes the patient and physician experience at the expense of maximizing margins. The newly created systems point to greater fiscal efficiencies, better coordinated patient care, and increased ability to move toward the value-based care models that many organizations, including the WSMA and the Washington State Department of Health, embrace as the future of medicine.
</p>
<p>
"The toothpaste is out of the tube, and we can't shove it back in," says Jennifer Hanscom, CEO of the WSMA. "As physicians navigate this consolidated practice environment, we must ensure that the physician- patient relationship and physicians' professional and independent judgment remain protected, even in our quest to have a healthy bottom line. What's essential is that physicians don't shy away from this conversation but instead lean in. Their ability to see the delivery system through a physician-patient lens is a unique perspective that they bring to the table."
</p>
<p>
Market pressures have often been blamed for increasing physician demoralization. It's a serious concern, says Hanscom, as health care systems face a growing physician shortage.
</p>
<p>
"We often hear the term 'no margin, no mission.' And yes, finances matter. But on a basic level, if you want to be financially successful, you have to deliver good care. And to deliver good care, you need to attract a workforce that is committed and able to do their best work," says Hanscom. "We need physicians who have that lived experience to be at those decision- making tables. That's crucial not only to good patient care, but also to having a good care delivery system."
</p>
<p>
During and after consolidations, Dr. Roberts has noticed a sense of helplessness among front-line physicians and middle-level managers who often respond, she says, with a "just-keep-my-head-down-and-take- care-of-my-patients" approach.
</p>
<p>
But there are things physicians can and should do to navigate what can feel like an economic tsunami, say experts. It starts with remembering the unique and necessaryroletheyoccupy,saysDr.Roberts, who now serves as a leadership development coach based in St. Paul, Minnesota.
</p>
<p>
"Physicians are the most key people in making these consolidations and mergers successful," she says. "The finances are in service to caring for patients. It's on physicians to keep reminding leaders that is the way the systems are set up to operate."
</p>
<h3>Leading through change</h3>
<p>
To better advocate for their patients and themselves, Dr. Roberts recommends all physicians-both those aspiring to leadership roles and front-line physicians-learn basic leadership skills, something not traditionally taught in medical school.
</p>
<p>
"If you are part of a large system, it's not your clinical skills that are going to make you feel like you are having an effect on the system. It's your leadership skills," says Dr. Roberts. "If I understand the basics of finances, I understand why certain decisions are made. If I understand and learn negotiation skills, then I can work with my colleagues across the new organization and we can agree on the way we're going to work together. But if you don't step up and develop those leadership skills, then I imagine you feel like a cog in a big system."
</p>
<p>
Hanscom encourages all WSMA members to take comprehensive leadership training through WSMA's Center for Leadership Development. During WSMA's first-ever Physician Leadership Course, the basic leadership "boot camp" that anchors the center's curriculum, Hanscom recalls physician leaders admitting to not understanding several common business acronyms. "It was this 'Aha!' moment for them," says Hanscom. "By learning the language of leadership, they learned to be more effective in bringing their perspective to the table, to do what's best for their patients and community."
</p>
<p>
Effective communication is bidirectional, says Jamie Park, MD, who recently became the new chief medical officer at Providence Swedish North Puget Sound. A family physician by craft, Dr. Park previously served as CMO for Valley Medical Center, a system which has a strategic alliance with UW Medicine. He's also gone through several consolidations during his 25-year career.
</p>
<p>
"It's also important for physicians to be able to listen and understand what organizations are trying to accomplish, because it doesn't work when you say, 'This is what I need,' when you don't understand what the other side is trying to accomplish," says Dr. Park. "Leadership training and understanding for even front-line positions can really open people's eyes as to what makes an organization tick, how process improvement works, all those kinds of things. So even though physicians may not be planning those things, they can interact with people who are doing those things in a more successful way."
</p>
<h3>Understanding market economics</h3>
<p>
Jeff Collins, MD, who retired from his last leadership role as regional chief physician executive for Providence's Washington and Montana region in December 2019, says physicians need to understand the economics of health care to effect meaningful change.
</p>
<p>
"When I started out in private practice in the late 80s, about 80% of doctors were in one- or two-doctor offices. We were criticized for being inefficient and old-fashioned," Dr. Collins recalls. Starting in the 1990s, Dr. Collins, like many other private- practice physicians, joined progressively larger physician groups, spurred in large part, he says, by the burden of ever- changing Medicare rules and growing administrative complexities.
</p>
<p>
"I can remember myself in an interview at the time saying, 'Physicians didn't invent this market, we're just trying to learn how to be successful in the marketplace,' " says Dr. Collins, who served as WSMA president from 2004- 2005. Even back then, one of WSMA's goals was helping physicians deal with the rise of health care consolidations.
</p>
<p>
In 2006, Dr. Collins became chief medical officer for Sacred Heart Medical Center in Spokane, the biggest hospital in the Providence system at the time. Like Dr. Roberts, he went through several consolidations with Providence.
</p>
<p>
Now on the outside looking in, Dr. Collins echoes a general criticism often leveled at consolidations. "[Consolidations] are not really delivering on the promises of scale that are supposed to happen when you consolidate," he says. "It's really part of a larger dynamic in the whole country of market fundamentalism, where the whole business community has decided that the market is going to solve all our problems."
</p>
<p>
Rather than alleviating economic burdens, consolidations can add new financial pressures on physicians, says Dr. Collins. "Physicians are often given data on their cost efficiency. And the data are incorporated into their compensation formula ... So, their patients' needs are put into direct conflict with the physicians' financial and career well-being, which contributes to burnout."
</p>
<p>
But Dr. Collins emphasizes that physicians shouldn't fall into the victimhood mindset, something he says he still sees all too often. "It's important when consolidations happen to understand what the value structure is at the core of the merged corporation and how they're going to incentivize behavior going forward," he says. Once physicians understand the system's value framework, they can bring their insights and experiences to the table to make it better, says Dr. Collins.
</p>
<p>
Although Dr. Collins says physicians are inherently conflict avoidant, he encourages them to embrace conflict when it matters. He recalls times when he challenged data or data analysis used to drive health care decisions. "I was able to engage the folks I worked with in a productive way by saying, 'You know, that is really not very patient-centric. It's pretty hospital-centric. If you were a patient, how would you deal with that situation?' " he says.
</p>
<h3>Protecting autonomy</h3>
<p>
Physicians often worry that consolidation will further erode their autonomy, a component often cited as critical to physician motivation and job satisfaction. Assuming the worst will happen can become a self-fulfilling prophecy, says Dr. Park.
</p>
<p>
"It's very easy to develop assumptions about what the new partnership either means or doesn't mean," says Dr. Park. "And if two people are acting on assumptions, if they're acting from two different playbooks, it just makes things more complicated."
</p>
<p>
Mentoring from someone who has gone through the consolidation process can help override some of those knee-jerk reactions, says Dr. Park, who counts Edward Walker, MD, MHA, who developed and teaches WSMA's Center for Leadership Development basic and advanced course curriculum, which now includes the Physician Leadership Course, the Dyad Leadership Course, and the Leadership Masterclass, as his mentor. "The benefit of that is not necessarily that you're going to know exactly how it's going to go for you or your group. But you're going to know better what questions to ask, what things to look for. It's an opportunity to turn an unknown into a known."
</p>
<h3>Rethinking "patient first"</h3>
<p>
Every consolidation is different. What physicians can do to ensure that any health care system doesn't shortchange patient care or physician autonomy will vary depending on the system structure.
</p>
<p>
"There is no perfectly green grass in the world of health care. Everywhere I have been does some things well and has opportunities in other areas," says Andrew Jones, MD, who became CEO of Confluence Health in July 2022. Prior to joining Confluence, Dr. Jones was the chief medical officer and vice president of medical affairs for St. Mary's Medical Center in Grand Junction, Colorado, and served in medical leadership for nearly 25 years for various organizations.
</p>
<p>
C-suite leaders, including Dr. Jones and Dr. Park, increasingly believe a patient-first care model is insufficient for integrated systems.
</p>
<p>
"I often see physicians want to focus only on 'quality care' or 'patients first' as a way to avoid the messiness of health care today and the questions about cost, workforce, community, diversity, and a host of other [issues]," says Dr. Jones. "That is shortsighted. To be a leader in health care is to take on the whole work of not only making our system better, but also to have it work better for our patients, which is so much more than simple slogans like 'patients first' or 'high-quality care.'"
</p>
<p>
Rather than a patient-first mindset, both Dr. Jones and Dr. Park say effective consolidations and organizations focus on the Quadruple Aim medical model: improving population health; enhancing the patient experience; reducing the cost of care; and improving caregiver satisfaction and well-being.
</p>
<p>
"If physicians want to be leaders in health care, they can't avoid any of these areas," says Dr. Jones. "Physician leaders can add amazing value with their knowledge of the system and their commitment to patients. Physicians can also struggle when they don't respect areas of health care that they either don't understand or don't like."
</p>
<p>
"It's better to say that we put the patient at the center of our decisions. But those things surround it and affect all of our decisions," says Dr. Park.
</p>
<p>
Though Dr. Park never worked as a private-practice physician, he understands the fear some may feel at the prospect of consolidation. "It's human nature to think about all the bad things that may happen," says Dr. Park. "But these types of moves can be beneficial for all involved. There are financial benefits to consolidation. We can leverage organizational capabilities to deliver even better care for patients. But, again, to do that it's key to understand what's the same, what's different, and then have a good plan for moving forward, for developing some shared values. And everyone has to be part of that conversation."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/25/2023 10:03:17 AM | 7/18/2023 8:57:13 AM | 7/18/2023 12:00:00 AM |
| leading-in-a-changing-landscape | Leading in a Changing Landscape | WSMA_Reports | Shared_Content/News/Latest_News/2023/leading-in-a-changing-landscape | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="cover of July-August 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>July 17, 2023</h5>
<h2>Leading in a Changing Landscape</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Medicine has always been a business, but business has never driven the profession as much as it does today. Consolidation, financial pressures, hiring shortages, administrative burdens-a series of business issues ostensibly unrelated to the delivery of care but having a tremendous impact on it-have converged to create a crisis situation for physician leaders in Washington state and across the nation.
</p>
<p>
Unfortunately, physicians starting their careers are frequently unprepared for that side of the profession. "Physicians spend significant time learning about the human body and how to effectively manage disease processes," says Vanessa Carroll, MD, chief medical officer of Mary Bridge Children's Hospital in Tacoma. "But health care is a team sport, and being able to interact with people having different perspectives is important not just in patient care but in operations. How do you keep a hospital open? How do you communicate effectively with people? Some of these skills are not taught in medical school or residency."
</p>
<p>
Having the skills necessary to navigate through a rapidly changing landscape is critical for physicians moving into leadership roles. Some skills are practical, like understanding budgets and strategic planning, while others are soft skills, like how to build teams and communicate effectively.
</p>
<p>
Barbara Thompson, MD, who was appointed chief medical officer of Mary Bridge Children's Hospital's health network earlier this year, agrees. "All physicians are leaders, but they are never really taught to lead in school," she notes. "Since COVID, we really see how important leadership is, not just leadership through the pandemic, but to keep physicians inspired and provide direction back to the 'why' of medicine."
</p>
<p>
This combination of skills-a firm understanding of the business side of medicine along with the tools to coach toward a desired outcome-come at a particularly fraught time for the profession. Finding the training that provides that set of skills is an important part of ensuring successful leadership.
</p>
<p>
Unsurprisingly, physicians are turning to business programs to prepare them for the new landscape that they are facing. Indeed, the number of medical school graduates who have also earned an MBA has been steadily rising. According to the American Association of Medical Colleges, a total of 85 MDs had earned both degrees in 2003-2004. By 2021-2022, that number had more than tripled, to 237.
</p>
<p>
However, the challenge facing today's leaders isn't just a matter of grappling with financial pressures and staffing issues. It's how to address a system that is, in many ways, fundamentally broken when it comes to addressing the needs of physicians and advanced practice clinicians. Chief among these challenges is addressing the underlying causes of burnout.
</p>
<p>
"We're not burning out, we're being burned out," says Edward Walker, MD, MHA, a professor emeritus in the departments of psychiatry and behavioral sciences and health services at the University of Washington in Seattle and senior physician advisor for the WSMA Center for Leadership Development. "Burnout is a feature, not a bug. COVID just drove that home."
</p>
<p>
"Even before COVID, physicians and advanced practice clinicians felt the job was getting too hard to do," Dr. Walker says. "As the amount and complexity of our daily work started piling up, it felt like the administrative burden was disproportionate to direct patient care." Previously, the focus was on physicians taking care of themselves, but Dr. Walker believes that now only changing the system itself will help restore physicians' well-being.
</p>
<p>
"I think the sine qua non for the next decade for physician leaders is training up to help redesign the system," Dr. Walker says. "The key insight now is how do you join with an administrative partner to redesign the system to reduce burnout."
</p>
<p>
Physicians and advanced practice clinicians with the right skills are uniquely positioned to help move the system toward a more sustainable place. "If we're partnering effectively and speaking a common language, that's where the creative solutions can develop," says Dr. Carroll. "It's about being informed and understanding the 'why' in decision-making to understand what's mission critical and then being able to communicate that to our colleagues in order for them to understand the rationale."
</p>
<p>
Some of that communication begins with leaders knowing how to encourage their colleagues to remember why they became physicians to begin with.
</p>
<p>
"I don't think we're going to get past burnout just by paying people better or giving someone a course on resilience," says Dr. Thompson. "I'm not saying those things can't help. Ultimately, what we have to do is connect people back to the 'why,' that everyone ends your day feeling that you made a difference. We still need to be reminded that we're doing good things and we're keeping the humanity in corporate medicine."
</p>
<p>
Being able to speak the language of business is great, but it needs to be combined with the ability to coach others toward agreeing on a course of action. "Reading the spreadsheet and talking about planning are important to establish our operational credibility," says Dr. Thompson. "But it's not enough to have the info if you don't have the skills to bring people along with you."
</p>
<p>
While many of these skills are taught in an MBA curriculum, a formal degree is not necessarily essential for all physician leaders, says Dr. Walker. "You don't need to be able to formulate the strategic plan, but you need to implement it," he points out. "You don't have to construct a budget, but you have to understand it and explain it to your doctors."
</p>
<p>
WSMA's Center for Leadership Development offers a curriculum that allows physicians to gain that understanding, along with other leadership skills, for their career journey.
</p>
<p>
The Physician Leadership Course is essentially a "boot camp" for physicians and physician assistants who want to know more about health care leadership or who would like to brush up on their leadership competencies. The Dyad Leadership Course allows physicians and their administrative dyad partners the opportunity to improve team function and achieve greater operational success within their clinical system. For those seeking to develop their skills even further, the intensive three-day Leadership Masterclass examines the complex challenges facing leaders and provides the tools necessary to solve them.
</p>
<p>
Both Dr. Carroll and Dr. Thompson have MBA degrees and also attended the WSMA Physician Leadership Course.
</p>
<p>
"I was actually in the process of getting my MBA while I had the chance to take this course," says Dr. Carroll. "It was fascinating to see just how well it aligned with the MBA curriculum. It doesn't go into the detail, but it hits the pearls of business and operation."
</p>
<p>
"One of the great things about the program was learning from each other," says Dr. Thompson, who took both the Physician Leadership Course and the Dyad Leadership Course. "It was wonderful to spend time with other physician leaders, because going into leadership can be a little bit lonely."
</p>
<p>
As the Dyad Leadership Course underscores, many administrators are interested in partnering with physician leaders committed to improving the system.
</p>
<p>
"The notion now is to acquire the skills you need that will help you be valuable to an administrator also interested in redesign," he says. "What I have found over the past decade is that administrators respect physicians who are broadly trained and can understand what the administrator is doing." At the same time, says Dr. Walker, "Physicians look to a physician leader and will be more likely to believe you if you say, 'I have a strong partner here in this administrator.' "
</p>
<p>
Ultimately, as the profession undergoes sometimes wrenching changes, it will take the combined efforts of everyone in the system to effect the changes needed to fix it. Physicians and advanced practice clinicians will have to play pivotal roles for that effort to succeed.
</p>
<p>
"We're seeing organizations and health care systems really struggle," says Dr. Carroll. "Just imagine if we could leverage the strengths of the people working with us to find the solutions encompassing all of our roles."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/25/2023 10:02:19 AM | 7/17/2023 3:03:20 PM | 7/17/2023 12:00:00 AM |
| better-prescribing-better-treatment | Better Prescribing, Better Treatment | WSMA_Reports | Shared_Content/News/Latest_News/2023/better-prescribing-better-treatment | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>Better Prescribing, Better Treatment</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
As the ravages of the opioid epidemic became increasingly apparent a decade ago, lawmakers began to look for ways to stop the escalating toll from addiction. Unfortunately, the options they frequently came up with were ham-fisted and likely to cause more harm to clinical practice than help to patients. In Washington state, the suggestions being considered were prior authorization for any opioid prescription and a seven-day pill limit.
</p>
<p>
Still early in her role as chief executive officer of the WSMA, Jennifer Hanscom knew that prior authorization was an inefficient approach that was unlikely to get to the heart of the problem. Instead, she realized that all sides needed to collaborate to find a solution that would work for everyone.
</p>
<p>
"I still remember the moment in the conference room when we decided to tackle this," Hanscom recalls. "I was really focused on how do we get away from this contentious situation. We don't want opioids to be misused and overprescribed and the state doesn't either. Let's get everyone around the table. Put the stick away and focus on the carrot."
</p>
<p>
Working with the state Health Care Authority and the Washington State Hospital Association, the WSMA worked to develop a program that would provide meaningful data and change long-term behavior. The result was the Better Prescribing, Better Treatment program, which celebrates its sixth anniversary this year.
</p>
<p>
The program has multiple components. It encourages compliance with Health Care Authority opioid prescribing guidelines that establish pill limits
for all prescriptions for acute pain while allowing prescriber discretion to override those limits if they feel it is in the best interest of their patients.
</p>
<p>
Importantly, physicians and physician assistants can see data to understand how they compare to the guidelines, if their system opts in. Each quarter, the WSMA sends prescribers in the state an opioid prescribing feedback report. Using data from the state prescription monitoring program, the report shows how their opioid prescribing practices compare to others in their hospital, health system, or medical group, as well as within their specialty.
</p>
<p>
The program also provides coaching on opioid management. The coaching is done in partnership with the Six Building Blocks program, developed by the University of Washington Department of Family Medicine and Kaiser Permanente Washington Health Research Institute, which provides an evidence-based quality improvement roadmap to help primary care teams implement effective guideline-driven care for their chronic pain and long-term opioid therapy patients.
</p>
<p>
By any standard, Better Prescribing, Better Treatment has seen tremendous success in a relatively short period of time. The initiative now encompasses more than 20,000 clinicians with 62 hospitals, health systems, and medical groups in the state. Nearly 11,000 prescribers receive regular peer-to-peer comparative data reports and accompanying guidelines. These guidelines serve as educational interventions to help ensure clinicians maintain quality care and better control how opioids are prescribed. Collectively, thanks to Better Prescribing, Better Treatment, opioid prescriptions above the prescribing guidelines have been reduced by an impressive 46% since 2018.
</p>
<p>
Those numbers have a two-fold effect, says Nathan Schlicher, MD, JD, WSMA's lead on Better Prescribing, Better Treatment. For one, fewer people are being exposed to the possibility of getting opioids longer than the three days considered optimal in most cases of acute pain. "The longer the initial prescription, the more likely you are to develop tolerance and conversion to addiction down the road," he says.
</p>
<p>
At the same time, as a result of the drop in prescriptions, says Dr. Schlicher, "the number of excess pills or opioids in the community is less, which helps prevents kids from getting access." Data show that teenagers and young adults often misuse drugs for the first time by stealing or borrowing them from friends or family.
</p>
<p>
"These two things together-fewer prescriptions and fewer opioids in the community-are hopefully helping reduce the creation of chronic use and the risk of addiction," says Dr. Schlicher.
</p>
<h3>Implementing in a system or networked setting</h3>
<p>
There's no question that undertaking any kind of organizational change is challenging, and a topic as sensitive as opioid prescribing could seem especially fraught. However, many systems embraced the opportunity to understand not just their prescribing patterns but their entire approach to pain treatment. The result could be unexpectedly exhilarating.
</p>
<p>
"It was exciting to engage a cross- continuum multidisciplinary team and patients in this effort," says Donna Smith, MD, president of Franciscan Medical Group and Virginia Mason Franciscan Health and senior vice president of the PNW Division of CommonSpirit Health, recalling the work to implement Better Prescribing, Better Treatment systemwide. "We engaged team members and changed practices. We surfaced the myths and fears and helped create safety on the team about what was not known or did not feel right. People really cared about the work."
</p>
<p>
Virginia Mason brought together a cross-disciplinary team that included physicians, nurses, pharmacists, social workers, and even front-desk workers. Just as important as this multidisciplinary approach was the individual experience that each person brought to the group, making the work as much personal as professional.
</p>
<p>
"People on the team had family members who had died from overdoses," says Dr. Smith. The team also brought in family members of people who suffered or died from opioid use to hear their perspectives. "Team members would talk about the assumptions they were making about not sharing the risks and family members were saying, 'Are you kidding me? Tell us! I need to know if I should get off pain medications by a certain day or my risks increase,' " Dr. Smith recalls.
</p>
<p>
The work was an opportunity to, in Dr. Smith's words, "connect the dots and connect our care."
</p>
<p>
"We were coming together to establish organizational standards and help everyone realize that the care we provide to a patient in the ED or hospital post- operative period impacts the care we provide for that same patient in primary care, and vice versa," she says. "For example, if someone dealing with an opioid addiction had it under control and then needed surgery, the surgeon needed to be aware of the patient's history to optimize pain control and long-term outcomes for that person."
</p>
<p>
"We worked to get this in the frame of a chronic disease," said Dr. Smith. "You don't opt out of treating diabetes, so you wouldn't opt out of treating this either."
</p>
<p>
At the same time, physicians and PAs needed to understand their own biases. "We had a team of amazing educators-pain doctors, social workers, pain psychologists, an ethicist-so people could start to understand a patient's experience and how medication could be influencing patient communication," says Dr. Smith. Physicians and PAs learned how to listen and talk compassionately to patients while setting limits. "We developed a curriculum to build these skills that helped the team feel that they could make a difference," says Dr. Smith.
</p>
<p>
That experience is duplicated in other systems, as well. Christine Hancock, MD, is the medical director for Sea Mar Bellingham Medical Clinic, one of 32 community health centers under the Sea Mar umbrella located along the I-5 corridor stretching from Vancouver to Bellingham.
</p>
<p>
"We started with the Six Building Blocks program in 2017 with improvements to the process for opioid prescribing that ran the gamut from fixing the patient agreement to changing the language we use with patients," says Dr. Hancock. "We worked with WSMA to get prescribing data from different sites across our system."
</p>
<p>
That wasn't always simple. "There are certain things you can pull out of the health record easily and other things you have to build complex and time- consuming reports to try and figure out," says Dr. Hancock. However, the work has paid off.
</p>
<p>
"In the last year, we've gotten all of the processes in place to look at acute prescribing and present that to the medical directors group," says Dr. Hancock. "WSMA gives us individual-level reports, and physicians can sign up for those voluntarily. In addition, they give us data on our practice as a whole. At a system level, it's good to get a bird's-eye view." The data is divided by practice types, which allows Sea Mar to understand if a prescribing practice is out of line with a whole group. "It's a powerful suite to have at our fingertips," says Dr. Hancock.
</p>
<p>
Physicians have been receptive to seeing the data. "Sometimes someone will write back to me and say, 'Thanks, I totally missed that,' " says Dr. Hancock. "That level of intentional intervention is where people will retain the learning and change their behavior going forward."
</p>
<p>
One of the key elements of the state's opioid prescribing rules is that they provide physicians and PAs with flexibility in making clinical decisions. "It's important that you prescribe appropriately, but it's also important that you treat patients with chronic pain," says Dr. Hancock. "We're trying to walk the fine line where we're accountable to the standard of care and not shutting the door completely." In addition to creating barriers of care to the largely Latino population that Sea Mar serves, suddenly cutting off a patient's access to pain medications increases their risk for suicide and use of street drugs.
</p>
<h3>Safer communities</h3>
<p>
One of the specialties that was contributing to excess opioids in the community, despite the best of intentions, was hospice care. Thomas Schaaf, MD, who was involved with Better Prescribing, Better Treatment at the beginning, was also increasingly responsible for Providence's hospice services in Washington and realized that the way pain medications were being prescribed was excessive.
</p>
<p>
"Many of our patients would have pain crises in the middle of the night or on weekends, so depending on their locations, we sent them an emergency kit, or e-kit, to put in the back of the closet," he says. "If they suddenly became symptomatic at 3 a.m., rather than try to find a pharmacy that was open, they could get the e-kit out."
</p>
<p>
The problem was that the e-kits contained a lot of medication. "We were using liquid medications for ease of administration," says Dr. Schaaf. "Those tend to come in largish quantities. We were putting a lot of morphine, oxycodone, and lorazepam into the community that might not ever get used. The patient dies, the family pulls the e-kit out of the closet, and my gosh, here are these very large doses."
</p>
<p>
To reduce the risk of having the drugs misused, physicians revamped the nature of the e-kits. "We changed to pills and substantially lowered the number of doses," says Dr. Schaaf. "They didn't need a month of stuff, just enough to get them through until they could use a regular pharmacy for a new dosing strategy."
</p>
<p>
The change resulted in a "staggering" decrease in the volume of opioids being prescribed. "It was a remarkable quantity," says Dr. Schaaf. "At the same time, it wasn't just cutting the amount of medications. We also changed the protocols around how we would think about a patient's baseline symptom management regimen. In the end, we believed patients were getting better symptom management and less probability that these leftover meds were ending up in the hands of people other than the patient. It accomplished both the goal of better treatment for patients and a safer community."
</p>
<h3>Growing the success, short-term and long-term</h3>
<p>
The Washington State Department of Health recently awarded the WSMA a $425,000, nine-month grant to expand Better Prescribing, Better Treatment. The money will help create reports focused on prescriptions for chronic opioid use and co-prescribing of opioids; previously, reports have concentrated on prescribing for treatment of acute pain. As with the earlier reports, the new reports will be an opportunity to identify outliers who are high prescribers to engage them in discussion about their prescribing practices.
</p>
<p>
Providing data on opioid prescriptions beyond treatment for acute conditions is an important next step, says Dr. Schlicher. "The prescribing of opioids with sedatives like Ambien can increase the risk of respiratory depression and death," he notes. "We want to provide feedback on that danger and how often that's happening. Getting at that challenge would be a next step."
</p>
<p>
The grant is just one step in the effort to expand the safe-prescribing initiative in the coming months and years. The program is looking to continue to expand its reach.
</p>
<p>
"Over the next five years, we want to reach as many prescribers as possible with the initiative on acute prescribing," says Dr. Schlicher. "We're looking at our own membership that hasn't been able to participate through their own clinics." The idea is to create an enrollment category for member physicians and PAs who are not in enrolled health systems and clinics but who wish to participate in the program, with the option to opt out.
</p>
<p>
The program's sights for growth extend beyond physicians and PAs. "We also want to reach out to other professional societies, like dentists, nurse practitioners, and podiatrists, to expand the program to everyone," says Dr. Schlicher. Dr. Schlicher is also planning an education series to add to the existing library of resources for physicians and PAs.
</p>
<p>
Still, the spine of the program remains the data, which shows physicians and PAs how they compare to others. "Data management is not an easy job," says Dr. Hancock. "You have to work really hard to provide valid, good quality data that are meaningful. I have to give a shout out to the folks at WSMA. I appreciate all their efforts to get that info into an accessible place."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 12:22:48 PM | 5/8/2023 11:26:00 AM | 5/8/2023 12:00:00 AM |
| so-long-x-waiver | So Long, X-Waiver! | WSMA_Reports | Shared_Content/News/Latest_News/2023/so-long-x-waiver | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>So Long, X-Waiver!&nbsp;</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
In her 11 years treating those struggling with substance abuse, Lucinda Grande, MD, a family practice and addiction medicine specialist in Lacey, has seen firsthand the benefits of initiating buprenorphine to treat opioid use disorder. People who were once unhoused now have a job and a place to live. Estranged families are reunited. Someone caught in a cravings- usage-overdose-withdrawal cycle now has hope of managing their disorder so they don't end up a statistic. And the stats from the Centers for Disease Control and Prevention are startling: Nearly 75% of overdose deaths nationwide in 2020 involved an opioid. Here in Washington state, provisional data show 1,831 opioid-related deaths in the most recent 12-month period ending in October 2022.
</p>
<p>
In the U.S., some 7 million people are currently living with opioid use disorder. For them, buprenorphine is life-changing, says Dr. Grande. "Buprenorphine reduces mortality rates. It relieves cravings and withdrawal without causing respiratory depression, so overdose is nearly impossible."
</p>
<p>
Despite the safety and efficacy of buprenorphine, until recently Dr. Grande was among only 5% of physicians and medical professionals licensed by the Drug Enforcement Administration to prescribe the drug for opioid use disorder, a result of onerous training requirements to get a DATA-Waiver, or "X-waiver," added to their DEA registration. The X-waiver requirement was eliminated, effective immediately, with the passage of the bipartisan Mainstreaming Addiction Treatment Act of 2023, included in the Consolidated Appropriations Act of 2023 signed into law by President Joe Biden on Dec. 29, 2022.
</p>
<p>
The X-waiver removal represents a watershed moment in the fight against the opioid epidemic, says Dr. Grande. "The most important thing about passage of the MAT Act is the opportunity to galvanize the medical community into engaging in treatment of opioid use disorder."
</p>
<h3>Removing legislative barriers to treatment</h3>
<p>
The WSMA hopes to partner with the Washington State Department of Health, the Washington State Health Care Authority, and other state agencies to get the word out and develop workflow guidance, says Jeb Shepard, WSMA's director of policy. "Ideally, we'd like to connect our members with a start- to-finish overview on how they can incorporate buprenorphine, including pharmacological education and how to bill public and private payers," says Shepard. It's part of WSMA's ongoing efforts to remove barriers to medications for opioid use disorder, or MOUD.
</p>
<p>
Buprenorphine is one of three Food and Drug Administration-approved medicines, including methadone and naltrexone, proven to benefit those with opioid use disorder. Use of these medications decreases the duration people use opioids, reduces hospitalization, prevents deaths, and reduces drug-seeking behavior. Yet in the U.S., only 27% of people who qualify for these life-changing drugs currently receives them.
</p>
<p>
The WSMA supported a provision in Senate Bill 5380, opioid omnibus legislation passed by the Legislature in 2019, that prohibits prior authorization for MOUD. That law, which requires insurance carriers to cover at least one FDA-approved MOUD drug, became effective in January 2021. "We didn't want people who would benefit from these treatments and perhaps are in a fleeting moment where they were willing to move their life in a different direction have to wait to get started because insurance carriers needed to approve it first," says Shepard. "But we could only do so much at the state level when that DEA waiver was in place."
</p>
<p>
In 2019, the WSMA also joined the fight to remove the federal buprenorphine X-waiver, spearheaded by a resolution put forth by Dr. Grande, then serving as a member of the WSMA House of Delegates, which called on the WSMA to support American Medical Association advocacy on the issue. "There were joint letters that we signed on to and we also reached out to our congressional delegation, who were pivotal in getting the MAT Act passed. Sen. Patty Murray and Rep. Cathy McMorris Rodgers were key votes," says Shepard.
</p>
<h3>Removing the stigma</h3>
<p>
Removal of the X-waiver alone won't change the trajectory of the opioid epidemic unless other system-level changes take place, says Richard Waters, MD, a family physician with Neighborcare Health in Seattle and an advocate for low- barrier buprenorphine access. "We have all created this divide where addiction medicine for a long time, and to a certain extent continuing now, was set apart from the rest of health care."
</p>
<p>
In the U.S., removal of the X-waiver was long overdue, says Dr. Waters. France, for example, has allowed doctors to prescribe buprenorphine without special education or licensing since 1995. As a result, within three years deaths from opioid overdoses there fell 79%. Research found X-waiver removal in the U.S. would translate to more than 30,000 fewer opioid overdose deaths in the U.S. each year.
</p>
<p>
Dr. Waters hopes the U.S. will continue being proactive in removing other barriers to MOUD, such as those surrounding methadone therapy. "There is also a continued imperative, given the overdose crisis, to look at what has been effective elsewhere and how we can move toward these evidence-based practices," he says.
</p>
<p>
A safe and effective treatment for chronic pain, buprenorphine can also help prevent opioid use disorder by replacing addictive narcotics, says Dr. Grande. Even before the MAT Act, physicians and physician assistants could legally prescribe it for chronic pain, but confusion caused by the X-waiver kept doctors from using it, she says.
</p>
<p>
Removal of the X-waiver comes amidst a growing fentanyl crisis nationwide. From 2019 to 2021, Washington state saw a 66% rise in overdose deaths, more than half due to fentanyl.
</p>
<p>
Despite this increasingly urgent backdrop, many physicians and PAs may still be hesitant to prescribe buprenorphine, in part because of the impression created by the X-waiver that buprenorphine is a riskier, scarier, and more complicated medicine than it is, says Dr. Waters. "The jarring contradiction was that any [physician] could prescribe as much fentanyl, oxycodone, and hydromorphone as they wanted, without necessarily any training, but could not prescribe buprenorphine, which is a far safer medication than all of those."
</p>
<p>
As more medical schools and residency programs embrace teaching addiction medicine, Dr. Waters remains hopeful for the future. "The X-waiver going away was a symptom of an ongoing cultural shift in modern medicine that is starting to embrace the care of people with substance use disorders as people worthy of care for whom we have a variety of effective tools that can help improve their lives."
</p>
<h3>How you can get started</h3>
<p>
While the MAT Act eliminates the X-waiver, it doesn't remove the need for buprenorphine education. The appropriations bill also included the Medication Access to Training Expansion Act of 2023, supported by the American Society of Addiction Medicine, which calls for new training requirements for all prescribers scheduled to go into effect on June 21, 2023. According to the DEA, these requirements don't impact the specific changes related to the X-waiver elimination. The WSMA and the AMA did not support the MATE Act, concerned that eight hours of mandated training requirements would add additional burden to already overwhelmed physicians, says Shepard.
</p>
<p>
Some education is still needed before prescribing buprenorphine, says Greg Rudolf, MD, immediate past president of the Washington Society of Addiction Medicine. But the society wants to ensure that training doesn't create additional obstacles for physicians. "We're hoping for something modest, in the one- to three-hour range of educational commitment ... understanding a little bit more about how to start somebody, how to dose appropriately, how to keep them engaged and in treatment," he says.
</p>
<p>
One immediate way physicians and PAs can get comfortable prescribing buprenorphine is assuming management of patients already stable on the medication, says Dr. Rudolf. "Some of my patients come from great distances to see me. If primary care physicians in their local area can take over their prescriptions, they don't have to worry about transitioning the patient from an unstable situation to stability ... This can help take the burden off specialists, who, at this point, are having a hard time meeting demand."
</p>
<p>
X-waiver elimination also benefits underserved populations who have historically struggled with access to buprenorphine because there were few or no X-waivered prescribers nearby. In rural communities, even if just one additional physician now provides care with buprenorphine that can make a real difference, says Shawn Andrews, MD, senior medical director for ambulatory care services at Summit Pacific Medical Center in Elma. Rural patients often don't have the money, time, or means to travel for MOUD elsewhere, she says.
</p>
<p>
"Geographic barriers are very significant in rural areas," says Dr. Andrews. "The MAT Act will make it much easier to staff our low-barrier MAT clinic. It also decreases the administrative burden of tracking how many waivers each [physician] has available."
</p>
<p>
Addiction medicine professionals <em>WSMA Reports</em> interviewed emphasized the need for mentorship in prescribing buprenorphine. "Physicians should not feel helpless. If they see someone who's a good candidate for it, they should not delay when there are resources to help physicians initiate buprenorphine. They shouldn't let that patient get away without treatment," says Dr. Grande.
</p>
<p>
Dr. Grande especially encourages emergency department professionals- often on the front lines of the opioid epidemic-to consider initiating buprenorphine. She cites a 2015 study showing that those who were started on buprenorphine in the ED were twice as likely to be engaged in formal addiction treatment at 30 days compared to people given a referral to treatment alone, even with a brief psychosocial intervention.
</p>
<p>
"They don't come back to the ED because their life is better. Their habits are healthier," she says. But ED physicians can't do it alone, says Dr. Grande. "Hospitals and health care systems need to be motivated and incentivized to make changes to how they treat those with opioid use disorder."
</p>
<p>
At minimum, physicians and PAs can play a vital role in educating patients about MOUD, says Dr. Waters. "Learning how to talk about the benefits of methadone, buprenorphine, and extended-release naltrexone is the kind of thing all of us should be able to do."
</p>
<p>
Whenever she can, Dr. Andrews appears on local radio stations to promote MOUD. It's a required part of the curriculum at Summit Pacific's family medicine residency, where Dr. Andrews serves as program director. "Physicians and other [prescribers] need to see what is at stake. And I think they are seeing it with the explosion of fentanyl deaths. They need to know that they are likely to save lives," she says.
</p>
<p>
Dr. Rudolf encourages all doctors to reflect on what prescribing buprenorphine means for their community. "To literally change someone's life with the right care intervention at the right time, it's a thrill," he says. "Any doctor who shies away from it is really missing a great opportunity to provide the kind of impactful care that I think most of us went into medicine to try to do."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 12:23:08 PM | 5/8/2023 11:59:25 AM | 5/8/2023 12:00:00 AM |
| doctors-making-a-difference-raj-sundar-md | Doctors Making a Difference: Raj Sundar, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-raj-sundar-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Doctor Making a Difference: Raj Sundar, MD logo" src="/images/Newsletters/Reports/2023/may-june/dmd-website-image-rsundar-645x425px.png" class="pull-right" /></div>
<h5>April 26, 2023</h5>
<h2>Doctors Making a Difference: Raj Sundar, MD</h2>
<p>
Through its first 15 episodes, guests on the podcast "Healthcare for Humans" cover topics ranging from the concept of food as medicine to the model minority myth to the meaning of "aloha." In the series, creator and host Raj Sundar, MD, a family physician at Kaiser Permanente's Burien Medical Center and community organizer, speaks with physicians and others from a wide range of backgrounds about how physicians can weave patients' cultural values into the care they provide. Dr. Sundar talks to <em>WSMA Reports</em> about the genesis of the podcast what he hopes physicians take away from these conversations.
</p>
<p>
<strong><em>WSMA Reports:</em> Where did the idea for the "Healthcare for Humans" podcast come from?</strong>
</p>
<p>
<em>Dr. Sundar:</em> The idea was born out of my personal experience of feeling stuck in caring for culturally diverse communities. This was particularly noticeable in immigrant and refugee communities, where there was a vast difference between my worldview and that of my patients. I tried to find ways to be a better caregiver but found that existing resources were focused on cultural competence, which was stereotypical and "othering." It conveyed the belief that my way of life was normal, while the patient's way was abnormal and needed to be studied.
</p>
<p>
As I have two kids (a 2 1/2-year-old and a 12-month-old), I listen to a lot of podcasts while doing chores. I found that the podcast was an excellent medium to capture voices and stories better and convey the nuances of culture by elevating community voices. After realizing this, I started the "Healthcare for Humans" podcast to give community members a voice and answer the question, "What does it mean to care for your community?" The podcast focuses on highlighting the diversity of cultures and values in the community and bridging the gap between caregivers and patients.
</p>
<p>
<strong>In the podcast intro, you say one of the goals is to help physicians learn to "care for the person in front of you, not just a body system." What does that mean to you?</strong>
</p>
<p>
Caring for the person, not just their body system, means treating patients like individuals with unique needs rather than just a collection of organs and symptoms. It's about recognizing that health care is more than treating diseases and conditions. It involves healing the person in front of you. Although the [biomedical] model is effective in many situations, we all witness daily how this can be inadequate in healing our patients and communities. We can lose sight of the person behind the illness, their needs, values, and preferences. To be healers, we need to be well versed in the history and culture of our communities as we are about diagnosis and treatment plans.
</p>
<p>
<strong>Why is it important to include that historical context?</strong>
</p>
<p>
Understanding the historical context of a patient's community can provide insight into the cultural, social, and economic factors that may impact their health outcomes. Historical events such as immigration patterns, discriminatory policies, and social movements can shape a community's experiences and contribute to current health inequities.
</p>
<p>
One important point is that cultural competence, the idea that health care professionals should learn about and master cultural practices and beliefs, is not the most effective paradigm for promoting health equity. Instead, we need to focus on cultural safety. Cultural safety is about creating an environment where patients feel safe, respected, and understood, regardless of their background or cultural identity. It's not just about learning specific cultural practices but also recognizing the historical and social contexts that have shaped a patient's experiences and tailoring care accordingly.
</p>
<p>
Lastly, understanding the historical context of a patient's community can help clinicians identify systemic issues and advocate for policy changes that address health disparities. This is critical to creating more equitable and just health care systems that better serve all communities.
</p>
<p>
<strong>What are some of the most surprising or meaningful things you've learned from guests on the podcast?</strong>
</p>
<p>
Each episode has many learnings I have not learned about in my medical education. Let's take the Pacific Islander community, for example. The foundation of our health care system is on one-on-one consultations. This traditional approach of educating individuals with diabetes may not work in Pacific Islander families where someone else prepares the food. Making dietary changes must involve the entire family to be effective. The respect and togetherness of the family are essential in making these changes. This value is not exclusive to Pacific Islander communities, but it's amplified in a culture that values family and community over individuality. How often do we see health systems make "family" visits a priority?
</p>
<p>
Another example is from the Native Hawaiian episode. We often focus on morbidity and mortality to "motivate" individuals and patients. "Hey, you should do this so you can live longer and healthier." But this idea of living longer as a selling point for health care doesn't resonate with families who face hardship and poverty. However, passing down knowledge and legacy to younger family members is a value that is important to many. Again, what does it mean to focus our care on families and how we care for each other because we have generational knowledge that we want to pass on and a legacy that we want to create? Do we talk about that at all in our conversations?
</p>
<p>
Lastly, in almost all episodes, there is a focus on bringing back practices that ancestors had to integrate into daily lives, shifting away from the toxic stress of capitalism to nurture relationships and recreate the village or town of health.
</p>
<p>
<strong>What do you hope physicians, or other listeners, take away from the podcast?</strong>
</p>
<p>
I want listeners to contemplate these questions: What does it take to build a healing relationship? What do you need to know about the person to care for them? What does it mean for you to learn about them and their community so you don't place the burden on the patient to educate you? I hope the podcast is one resource to help clinicians on this journey.
</p>
<p>
<strong>What topics would you like to cover that you haven't, yet? </strong>
</p>
<p>
I am currently working on a series of interviews that aim to amplify the voices of underrepresented communities, particularly the Latinx community, and their intersectional experiences. This series includes interviews with the Afro-Latinx community and DACA recipients. Additionally, I am collaborating with Safe Place International to shed light on the often-overlooked experiences of LGBTQ individuals in refugee populations. Lots more ideas and I'm happy to hear more from listeners at <a href="https://www.healthcareforhumans.org">healthcareforhumans.org</a>.
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 4/26/2023 10:37:31 AM | 4/26/2023 12:00:00 AM |
| a-call-to-climate-action | A Call to Climate Action | WSMA_Reports | Shared_Content/News/Latest_News/2023/a-call-to-climate-action | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/heartbeat-website-image-mzfy-badger-do-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat logo with Mary Badger, DO's name on it" /></div>
<h5>April 25, 2023</h5>
<h2>A Call to Climate Action</h2>
<p>
By Mary Badger, DO
</p>
<p>
My interest in the outdoors and sustainability started as far back as my time in the Girl Scouts, with its emphasis on community betterment, and those many days and weekends spent with friends or on my own hiking and backpacking, carefully and thoughtfully following the "leave no trace" ethic of good wilderness stewardship. These interests only grew as I became an adult, then a practicing (and now retired) physician, and rapidly expanded to include health as I saw firsthand the increased vulnerability of my older patients and my patients with chronic diseases to climate change.
</p>
<p>
The 2022 Intergovernmental Panel on Climate Change impacts report states that climate and health care are inseparable, that addressing climate change is the greatest public health opportunity of the 21st century, and that failure to adequately address it could undo most of the progress in global health over the past century. Climate change is putting increased pressure on vulnerable systems, populations, and regions, compounding existing medical conditions and health disparities. A host of medical societies, including the WSMA, the American Medical Association, the American College of Physicians, the American Osteopathic Association, and the American College of Osteopathic Internists, have position papers on climate and health (ACOI, AMA, and ACP are members of the Medical Consortium on Climate and Health).
</p>
<p>
But what can we do as individual physicians?
</p>
<p>
Educate ourselves: Sixty percent of physicians cite lack of knowledge about climate as a reason they don't address climate-related health concerns with patients. There are free webinars available from the <a href="https://medsocietiesforclimatehealth.org/educate">Medical Consortium on Climate and Health</a>, <a href="https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-care-sector-pledge/webinar-series/index.html">Office of Climate Health Equity</a>, and <a href="https://www.publichealth.columbia.edu/research/centers/global-consortium-climate-health-education">Global Consortium on Health</a>. "Global Climate Change and Human Health, from Science to Practice," second edition by Lemery and Sorrenson, is a great resource. Several institutions now offer fellowships in climate and health.
</p>
<p>
Educate our trainees: Medical schools are implementing either required or voluntary lectures on climate and health, and residencies are including patient-specific climate discussions during rotations. According to colleagues in several climate groups, rumors are that the Accreditation Council for Graduate Medical Education may be considering adding climate to competencies in the future.
</p>
<p>
Educate our patients: Even though patients trust their physicians more than anyone else, when it comes to discussions on climate change, 40% of physicians report lack of time as a reason they don't do this. You can briefly review their individual risks as part of disease prevention strategies. To save time, give them printed information, available from the <a href="https://mygreendoctor.org/waiting-room-brochures/">My Green Doctor website</a>, which can be set up with your practice information and emailed or printed for patients in English or Spanish; from the <a href="https://climatehealthconnect.org/resources/posters/">Public Health Institute</a>; and from websites such as <a href="https://www.ready.gov/kit">ready.gov/kit</a>, for emergency preparedness, and <a href="https://www.airnow.gov/">airnow.gov</a>, for air quality.
</p>
<p>
Serve as an example: Use the Native American "seventh generation" principle, which says that in every decision, be it personal, governmental, or corporate, we must consider how it will affect our descendants seven generations into the future.
</p>
<p>
Reject, reuse, and recycle: The health care sector is responsible for about 10% of U.S. greenhouse gas emissions. We need to address this in our places of work. The U.S. government has provisions to help with this.
</p>
<p>
Finally, be sure that vulnerable populations are specifically included-visit the <a href="https://www.epa.gov/cira/social-vulnerability-report">U.S. Environmental Protection Agency website</a> for a social vulnerability report.
</p>
<p>
It's said that weather is what is happening where you are at a given moment and that climate is how you got there over time. I would add that climate change is adversely affecting that journey. Addressing climate change will help our patients' and our own health and the health of our planet. We must all do our part to "leave no trace." Please start now!
</p>
<p>
<em><strong>Mary Schaefer Badger, DO, FACOI, FAWM</strong>, is an emeritus member in Spokane and chair of the American College of Osteopathic Internists Committee on Climate and Health.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/11/2023 9:34:20 AM | 4/26/2023 10:36:40 AM | 4/25/2023 12:00:00 AM |
| death-comes-to-us-all-prepare-now | Death Comes to Us All: Prepare Now | WSMA_Reports | Shared_Content/News/Latest_News/2023/death-comes-to-us-all-prepare-now | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/cover-wsma-marapr-2023-645x425px.jpeg" class="pull-right" alt="cover of March/April 2023 issue of WSMA Reports" /></div>
<h5>March 17, 2023</h5>
<h2>Death Comes to Us All: Prepare Now</h2>
<p>
By Joanne Roberts, MD</p>
<p>
Having practiced palliative medicine most of my career before I retired in mid-2021, I have been involved in thousands of deaths and sat vigil with hundreds of families. I know a thing or two about the end of life. Or so I thought.
</p>
<p>In October 2021, I had a routine exam that included basic blood work. A few hours after the draw, the results dropped into MyChart: neutrophils 700; hemoglobin 9.2; platelets 108,000. A week later, a bone marrow biopsy showed 14% myeloblasts.</p>
<p>
"What do you think of the biopsy results?" asked Brian, my hematologist, letting me take the lead in recognizing this as a high-risk myelodysplastic syndrome. "I think I would have liked to have lived to be at least 80," I replied. He wisely let silence fill in the next few moments.
</p>
<p>
We know that from the moment we're born, we are dying. But as another patient with a terminal diagnosis said: "We all see the exit sign, but I see it more clearly than you do." Indeed, little in my life has focused my brain more than being within sight of my death.
</p>
<p>
Once I got through the first month of shock, every day of the last 17 months has been among the best of my life. I've intensified my meditation alone and in groups, reflected on my life, spent more time talking with friends and daughters, ridden my bike more than 7,000 miles, and, generally "gotten my affairs in order."
</p>
<p>
My biggest worry was for my young adult daughters. Both live far from me, so I set up a Zoom call to share the news of diagnosis, chemotherapy plan, and prognosis. When my older daughter, a nurse and my health care agent, blurted out, "Does this mean we'll get a bigger inheritance?" we all wept with laughter, and I breathed easier. I know from my practice that when families laugh together, grief is easier to bear.
</p>
<p>
For my friends, CaringBridge is a lifeline to scores of people I know and love around the world, and I've hired a doula to help me build a support team for my daughters, my friends, and me.
</p>
<p>
Working in palliative medicine for decades, I failed to appreciate the intensity and richness of life that exists between diagnosis and hospice. Part of that richness is the accomplishment of the "logistics" of the end of our lives. As we come up to the annual Healthcare Decisions Day this April, my plea to you is to focus on yourself-and your own mortality. Don't put it off. As they say on every flight, "Put your own mask on first." This year, tend to yourself first and your patients second.
</p>
<ul>
<li>Havetheconversationwithyourfamilyabout your values and the care you hope to have when you are struck by disease, frailty, or another cause of death that is daily closer.</li>
<li>Designate a health care agent, and make sure everyone in your family knows who that is.</li>
<li>Complete your will so your family won't suffer over your "stuff."</li>
<li>Decide what you want done with your body. It will help you all acknowledge that death comes to us all.</li>
<li>Write your obituary. It will help you clarify what is most important to you in the life you have.</li>
</ul>
<p>
Death is the most natural thing in the world, particularly among those of us over 50 or 60. It is the one event that we all share. Imagine yourself as having a year to live, and then live as if you do. I suspect you'll be surprised at what you and your loved ones-and your patients-will discover.
</p>
<p>
<em>Joanne Roberts, MD, MHA, is an emeritus member now retired and living in Minnesota.</em>
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:32 AM | 3/10/2023 2:12:23 PM | 3/17/2023 12:00:00 AM |