| the_whole_person | The Whole Person | WSMA_Reports | Shared_Content/News/Latest_News/2022/the_whole_person | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 26, 2022</h5>
<h2>The Whole Person</h2>
<p>
<em>Osteopathic principles inform incoming WSMA president Katina Rue's life philosophy.</em>
</p>
<p>
By Milana McLead
</p>
<p>Nestled on the desk amid numerous photos of Katina Rue's daughter, Valeria, and a sign that says "Mom: A title just above queen," rests a heart-shaped red glass paperweight. It's a shiny reminder of an experience that exemplifies Dr. Rue's approach to life, medicine, and community. It was her first year practicing medicine in Yakima, when a patient presented with gout at the after-hours clinic where she worked. Dr. Rue, an osteopathic family physician, listened to his heart, realizing that he had a "whopping loud heart murmur." She recommended an echocardiogram, which revealed a ruptured leaflet. Thanks to her attentive observation, his valve was repaired. Later, his wife brought her the glass heart, noting, "He was here for his toe. I don't even know why you listened to his heart. But if you hadn't, who knows where my husband would be now."</p>
<p>"That heart reminds me that it only takes a few moments to impact patients' lives," says Dr. Rue, "and that the time we spend with patients is a precious opportunity and privilege we have as physicians. It also grounds me in the need to be present with each and every patient."</p>
<p>It's an ethos that's integrated into everything she does, whether it's tending patients, teaching medical students and residents, caring for her family and community, or minding her five-acre farm.</p>
<p>Her colleagues see this in action. Nicole Austin is a program coordinator at Trios Health Family Medicine Residency in the Tri-Cities, where Dr. Rue serves as residency program director. "She is passionate about her role as an educator and community building," says Austin. "She's made a concerted effort to increase the collaboration between training programs and departments within the hospital. Although that can be challenging and at times frustrating, she has not backed down, realizing that the results will benefit not only our programs and organization, but ultimately and most importantly, the patients we serve."</p>
<p>Community, connectedness, and collaboration all played a role in Dr. Rue's journey. In middle school, she thought about heading into marine biology. High school prompted an interest in physical therapy. While shadowing physical therapists during her pre-PT studies at Western Washington University and later at Montana State University, she took note of the education and training they offered in biomechanics, physiology, and more, but felt their scope of practice was limited. After learning about osteopathic medicine, she switched to pre-med and applied to osteopathic medical school at Kansas City University in Missouri.</p>
<p>"What spoke to me about osteopathic medicine was the interconnectedness of&nbsp;the patient, the human condition of the mind, the heart, the body, the spirit, and&nbsp;that we are made in a way that structure&nbsp;and function are related," she says. "It's&nbsp;hard to be well when one aspect isn't—it's not only the physical aspect, it's the&nbsp;whole person."</p>
<p>While she enjoyed surgery, having grown up around the OR with her mom, as well as psychiatry, it was family medicine that felt like the best fit. "Seeing patients over time in multiple settings, getting to make connections with families, being there for the birth of a child and the passing of grandparents—holding that community and space to be together as a family was really amazing," she says. "When you have those relationships and you understand the different aspects of people's lives, it just made sense to me."</p>
<p>Getting involved in organized medicine was another aspect of community in her journey. In medical school, she saw her mentors modeling involvement in state and county medical associations. She stepped up, as well, serving as a student liaison between the Missouri Association of Osteopathic Physicians and the Missouri State Medical Association, and as a student and resident member of the Johnson County Osteopathic Medical Society. When she moved to Washington state, it was a natural progression to join the WSMA and participate in its House of Delegates.</p>
<p>"It was naturally what I did when I got here, because I believe it's what you're supposed to do as a doctor," she says. "I wanted to continue to be part of the passion and commitment to communities, patients, and medicine that I saw modeled by my mentors." Once part of the WSMA, she was all in, helping to launch the early career governing councils and sections with Past-President Ray Hsiao, MD, and others, and later stepping into leadership. "For me, it's what you do to support your profession and to represent it in the best way in the eyes of the public. If you're not involved, if you're not at the table, then, as they say, you're on the menu."</p>
<div class="col-sm-5 pull-right newsbody" style="text-align: center;">
<p><img alt="Katina Rue DO" src="/images/newsletters/Reports/2022/september-october/Rue.Katina_2022.SeptOct-small.jpg" class="pull-right" /></p>
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<em>
Would you want your pilot to be the same as your flight attendant?
"Good morning, I'm airline worker Carl and I'll be flying your plane
today." Would you want your trial attorney to say, "I'm Sarah, your
legal worker, and will be defending you today"? I am a physician, yet
somehow it has become OK to refer to me as anything but physician.</em></strong>
</blockquote>
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<p>Dr. Rue continues to be passionate about engaging younger physicians in the WSMA. As she looks to the year ahead, other interests include prior authorization, scope creep, social determinants of health, physician burnout, and physician workforce diversity. She is the co-chair of WSMA's newly formed Diversity, Equity, and Inclusion Committee and is an active participant in WSMA's Latinx Advisory Council. "WSMA's vision and mission can be bolstered by the development of a strong, diverse physician workforce that looks like, sounds like, and understands the patients they serve," she says. "For me, WSMA has been an open and accepting place to grow and be a voice for those who are less represented."</p>
<p>As she embraces her role as president of the WSMA, how will she lead? Her colleague Russell Maier, MD, offers a glimpse. "Dr. Rue is confident, a good listener, looks to the future, and is committed to the house of medicine," he says. "She is committed to community, learners, and improving patients' health." Just as she did for that patient with gout.</p>
<p>
<em>Milana McLead is WSMA’s senior director of strategic communications and membership.</em>
</p>
<h3>Snapshot: Katina Rue, DO</h3>
<p><strong>FAMILY</strong></p>
<p>Husband of 11 years, Aureliano, 10-year-old daughter, Valeria, and "unofficially adopted" 22-year-old Nataliya Frick and her 25-year-old brother, Anthony.</p>
<p><strong>GROWING UP</strong></p>
<p>Lived in Pueblo, Colorado until her family moved to Washington when she was 11. Her mom is a retired operating room nurse and ran the OR in Port Townsend for almost 30 years. Her father was the director of pharmacy at Olympic Memorial Hospital in Port Angeles.</p>
<p><strong>HERITAGE</strong></p>
<p>While Dr. Rue's adoptive mom is of Latino and Navajo heritage, her birth parents were also Latino (and Norwegian!). Dr. Rue's husband, Aureliano, is Mexican, although was born in Yakima, and has family in Mexico that they regularly visit.</p>
<p><strong>AT HOME</strong></p>
<p>Lives on five acres of farmland populated with five cows (Charlotte, Dixie Mae, Lia, Estrella, and Luna), five chickens, three beehives, a Yorkie named Storm, and 30 fruit trees (cherry, apricot, peach, pear, plum, walnut, and quince). Note: Blueberry the bull (who features in Dr. Rue's virtual Zoom background) recently moved to a ranch nearby.</p>
<p><strong>WORDS TO LIVE BY</strong></p>
<p>"Live like someone left the gate open!"</p>
<p><strong>WHAT GETS HER UP IN THE MORNING</strong></p>
<p>"Opportunities! I haven't always been the positive person. But now, in the face of daunting challenges, I see opportunities sprinkled like wildflowers."</p>
<p><strong>PET PEEVE</strong></p>
<p>Hearing people complain about things. "If you are a member, showed up, participated, and taken action—then maybe I'll listen to you complain." She wants to hear feedback, input, and solutions.</p>
<p><strong>FIRSTS</strong></p>
<p>She'll be the first DO and the first Latina to serve as WSMA president.</p>
<p><strong>SPARE TIME</strong></p>
<p>Soccer mom, dance mom, farm wrangler, WSMA leader, Washington Osteopathic Medical Association leader, Washington Academy of Family Physicians alternate delegate to American Academy of Family Physicians, and past president of Northwest Osteopathic Medical Foundation.</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/30/2022 10:20:58 AM | 9/16/2022 2:06:54 PM | 9/26/2022 12:00:00 AM |
| why-not-her | Why Not Her? | WSMA_Reports | Shared_Content/News/Latest_News/2022/why-not-her | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/heartbeat-website-image-strasik-645x425px.png" class="pull-right" alt="Astrid Strasik Heartbeat column graphic" /></div>
<h5>
September 15, 2022
</h5>
<h2>
Why Not Her?
</h2>
<p>
By Astrid Strasik
</p>
<p>
Growing up in rural Arizona, my knowledge of medicine was limited to the home remedies of my mother when treating everyday ailments: aloe vera for a burn, a warmed towel with Vicks VapoRub for a cold, or a freshly brewed cup of yerba buena ("good herb") for a stomachache.
</p>
<p>
My earliest memories of the clinical setting are limited to the momentary misery of childhood vaccinations, later expanded upon by the too-frequent 70-mile trips to the "city hospital" to visit extended family who had the misfortune of suffering a heart attack, stroke, or GI bleed. But this was our "normal"; health insurance was a utopian fantasy. A trip to the doctor often meant the difference between buying groceries for the week or not. I can still picture the hospital bills covered in coffee ring stains sitting on the kitchen counter-their ever-presence reminding us to endure the pangs and twinges until absolutely necessary.
</p>
<p>
So naturally, as my own symptoms arose, we reasoned with them in the only way we knew how: The rash was simply from the Arizona heat, joint aches were just "growing pains," and the relentless fatigue was a sign I needed more sleep. It would take another 20-some years for me to put a name to the underlying condition that had been there all along.
</p>
<p>
It is well known that the incidence, morbidity, and mortality of many rheumatologic conditions are much higher among people of color, especially in the case of systemic lupus erythematosus. Research has shown, however, that patients of color have longer times to diagnosis, less access to specialty care, and that disparities exist even in the types of therapies offered to patients of color with these conditions. Research also has shown that patients of color are less likely to see a doctor who looks like them, and that doctors feel less confident in evaluating rashes on patients with melanated skin. Despite our greatest strides forward in medicine, these are just a few examples of how racial and health disparities continue to plague our progress.
</p>
<p>
I often wonder how to best utilize my position of relative power and privilege as a future physician to shed light on the experiences of patients from marginalized communities. As a Latina walking into a space historically occupied by predominantly white male faces, I am frequently overwrought by feelings of inadequacy. I await the moment I am "outed" as an imposter, even as I stand in my white coat in the hallways of the hospital. And yet, I find myself filled with joy in those moments of sincere connection, as when caring for a Spanish-speaking patient whose face lights up in a smile when they learn they can speak with their physician in their native tongue. It is in these moments that I am reminded of my purpose.
</p>
<p>
It wasn't until the age of 23 that I was able to establish care with a primary care physician who came to elucidate my SLE diagnosis. With this, I felt I was closer to taking control of my own health. My only hope is that I may one day do the same for my own patients.
</p>
<p>
It is with these lived experiences that I have come to believe that each clinical encounter can only be strengthened by a physician's ability to see the world through their patients' eyes. Maybe then will we start to uncover and dismantle the underlying racial, sociocultural, and economic disparities that affect the health outcomes of our patients.
</p>
<p>
Maybe then another young girl with a little more melanin in her skin can not only get the care she needs, but also see herself in her physician.
</p>
<p>
<em>Astrid Strasik is a fourth-year medical student at the University of Washington School of Medicine in Seattle.</em>
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/15/2022 4:28:53 PM | 9/15/2022 4:26:29 PM | 9/15/2022 12:00:00 AM |
| doctors-making-a-difference-elizabeth-peterson-md | Doctors Making a Difference: Elizabeth Peterson, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors-making-a-difference-elizabeth-peterson-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/dmd-website-image-peterson-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Elizabeth Peterson MD " /></div>
<h5>September 14, 2022</h5>
<h2>Doctors Making a Difference: Elizabeth Peterson, MD</h2>
<p>
As a board member of both AMPAC and WSMA's political action committee, WAMPAC, Elizabeth Peterson, MD, is no stranger to health care advocacy. Throughout her years as a physician advocate, the issues have shifted, but the end goal remains the same: making sure the physician voice shapes the future of our health care system. Dr. Peterson, a pediatric plastic surgeon at Mary Bridge Children's Health Center in Tacoma, talked with WSMA Reports about her history with advocacy work and why physicians should get involved.
</p>
<p>
<strong>WSMA Reports: What does health care advocacy mean to you?</strong>
</p>
<p>
Dr. Peterson: Advocacy simply means to ask for something on behalf of or in support of another person or thing. Health care advocacy, to me, is the intersection of medical education and evidence-based information with organized groups of physicians who have recognized patient or physician issues. Much of the time, these challenges require the creation of solutions through public policy. The advocacy, the driving force, is the art of how to get there.
</p>
<p>
<strong>How did you first get involved with health care advocacy?</strong>
</p>
<p>
I was in my first two years of practice when the local county medical society president asked if I would become involved on their board of trustees. I found that through this involvement I developed insights into the broader view of how medicine in our community was practiced and how we could serve our patients the best. It became clear that collectively we could educate ourselves about the many challenges that we faced and that changed how we practiced.
</p>
<p>
Back in those days, we had to learn about and share with our physician communities information on restricted physician health plan panels, how to implement new HIPAA rules, information about EMTALA, how to work collectively yet avoid monopoly rule violations, and how to navigate many other regulatory actions that have come and gone involving insurance and payments.
</p>
<p>
But organized medicine is not limited to regulatory or financial issues at all. It helps develop and communicate a consensus around disease management, public health practices, and now, more deeply, how social determinants of health are pervasive.&nbsp;</p>
<p>
<strong>Are there issues you've become especially passionate about during your years of advocacy?</strong>
</p>
<p>
Universal access to health care for patients. Fair and enhanced reimbursements for physicians. No, I do not think these are mutually exclusive.
</p>
<p>
<strong>What advocacy successes are you most proud of?</strong>
</p>
<p>
Years ago, I was but a small voice in the larger plastic and reconstructive surgery community advocating that breast cancer reconstruction be covered by health insurance. We were very gratified when Congress passed the Women's Health and Cancer Rights Act and President Bill Clinton signed it into law in 1998.
</p>
<p>
One small secret of advocacy work is that a great deal of what we accomplish is not limited to laws we support that are passed, but that we also keep uninformed, unworkable, and patientor physician-harming legislation from being passed (or even getting out of committee) on a regular basis.
</p>
<p>
<strong>What's the best way for WSMA members to get involved with advocacy?</strong>
</p>
<p>
Show up at organized medicine events like the WSMA House of Delegates. Join political action committees of medical organizations (including WAMPAC and AMPAC). Participate in county and specialty society committees and leadership positions. A single act of participation leads to opportunities to become involved and eventually become an advocate.
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/14/2022 4:17:49 PM | 9/2/2022 1:19:07 PM | 9/14/2022 12:00:00 AM |
| generational-change | Generational Change | WSMA_Reports | Shared_Content/News/Latest_News/2022/generational-change | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 12, 2022</h5>
<h2>Generational Change</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
When Nancy Auer, MD, entered The University of Tennessee Health Science Center College of Medicine in Memphis, Tennessee in the mid1970s, there were 13 women in her class of more than 100. And that was a record number.
</p>
<p>
"I absolutely thought we were affirmative action," recalls Dr. Auer, a past president of the WSMA (2000-2001) and one of the first women to lead an integrated medical system as chief medical officer at Swedish. "In the past, there were maybe five women in a class if you were lucky."
</p>
<p>
As rapidly as the practice of medicine has changed over the past several decades, so too has the status of women in medicine. In 1976, women made up only about 20% of the enrollment in medical schools. During the 2021-2022 application cycle, 56.8% of applications to MD-granting medical schools came from women, who made up 52.7% of matriculating students.
</p>
<p>
By contrast, Bridget Bush, MD, began her career 30 years later. "I feel my experience in my career has been much more a traditional male experience," says Dr. Bush. "I was in the Navy as a flight surgeon. I have always been the breadwinner in both of my marriages."
</p>
<p>
The similarities-and differencesbetween the two doctors provide a useful illustration about what has changed over time, as well as the barriers that still remain. While the most blatant forms of discrimination have for the most part faded, some remnants still linger. Perhaps more interestingly, the discussion of gender parity is shifting in recognition that parity can be as much a challenge among the sexes as between them.
</p>
<h3>A pioneer in the doctors' lounge </h3>
<p>
Dr. Auer began her career on the path common to many women of her generation: secretary and teacher. Taking a break from college, she worked at a dental school in Kentucky for two years for the chair of orthodontics. "I was hired as 'secretary,' but I got to do a lot of things," Dr. Auer recalls. Her boss encouraged her to consider a career in medicine. "He used to say to me, 'Wouldn't you like to hear them say one day, 'Paging Dr. Auer'?'"
</p>
<p>
After the dental school, Dr. Auer went on to become a teacher, and in hopes of teaching at the college level, she decided to seek a master's in biology. But when the funding for the program she was accepted to fell through, she looked at other options.
</p>
<p>
"Several of my colleagues were going to medical school, and I thought, I'm as smart as they are, so I applied and got accepted," she said.
</p>
<p>
Dr. Auer quickly discovered a love of surgery, but also ran up against systemic discrimination. She was recruited for a neurosurgical residency, but she says, "Once they took me, they didn't know what to do with a woman." A lot of teaching took place in the doctors' lounge, which was men only.
</p>
<p>
Dr. Auer eventually switched her specialty to emergency medicine, moving to Swedish in 1980 just as it was establishing its presence in the field. Her skill led to a series of promotions: chief of emergency medicine, chief of staff, vice president for medical affairs, and finally chief medical officer. In addition to serving as president of the WSMA, Dr. Auer also served as the first female president of the American College of Emergency Physicians.
</p>
<h3>A matter of respect</h3>
<p>
Yet even with her success, Dr. Auer observed inequities in pay. She also noticed that other women physicians weren't granted the same respect. "I can remember when the first woman neurosurgeon came to work at Swedish," says Dr. Auer. "The talk in the doctors' lounge was, 'Who would go to her?'"
</p>
<p>
Dr. Bush believes that that kind of egotistical attitude has changed, in part because of the presence of women physicians.
</p>
<p>
"I think one of the fields that has had the greatest change is surgery," she says. "It used to be a typical female surgeon was an uber-competitive woman who has put her career first and has to be the best of the best of the best to play with the boys on the boys' field. Nowadays, there's less tolerance for the typical male surgeon who was king. It's become much more of a team sport. I'd like to think it's the female physicians who helped change the culture."
</p>
<p>
One thing that hasn't changed is casual sexism. Dr. Auer remembers a thoracic surgeon putting his hands on her sexually. "I stepped on his instep with clogs as hard as I could," she says.
</p>
<p>
For Dr. Bush, it was a patient in a Veterans Affairs hospital who began catcalling and making rude comments. "It was the first time I felt uncomfortable about my body," she says. The incident left a lasting mark. "I never wore a skirt again at the VA or in the rest of my medical career. I've had to overcome the feeling that my femininity is something to be ashamed of in the workplace and that is something I struggle with."
</p>
<p>
While there has been tremendous progress over time, it has produced new challenges. As more women physicians balance family and children with their professional lives, it can create a tension with those, like Dr. Bush, who chose not to have children. "It's had [an] unfortunate side effect of not helping me understand my female colleagues' struggles," she says.
</p>
<p>
Indeed, says Dr. Bush, the struggle for gender equity is as much within genders as between them. "I feel unequal to my female counterparts because I'm not like them," she admits. "Gender-equity-wise, I have never felt unequal to my male counterparts."
</p>
<p>
While that focus has helped her thrive in her career, it has also sometimes created a challenge in relating to other women physicians. When an anesthesiologist colleague needed additional time for breastfeeding after giving birth, Dr. Bush said she was initially upset.
</p>
<p>
"I was kind of put out that we had to rearrange how I was going to do breaks," she recalls. "And then I was also feeling really [upset] about that feeling. How am I supposed to be a champion for my fellow female physicians when I don't have the basic experiences that a lot of them do?"
</p>
<p>
What helped Dr. Bush was going to an all-female dance studio with one of her attendings. "Every class was a celebration of the women around you," she says. "The easier it was to cheer on these women, the easier it was to cheer on yourself and be easier on yourself. I brought that into the workplace. I could cheer these women and boost them up. It took nothing from me because there's not a finite amount of generosity."
</p>
<p>
What Dr. Auer and Dr. Bush have in common is a firm belief in ignoring limits based on gender. "I just never recognized barriers," says Dr. Auer. "A lot of the women who were my contemporaries saw barriers where there didn't have to be any. It was kind of like a cattle guard. Cattle can get across the cattle guard without a problem, but they think they can't. I never saw the cattle guard."
</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 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/12/2022 1:03:23 PM | 9/1/2022 1:04:34 PM | 9/12/2022 12:00:00 AM |
| setting-their-sights-on-leadership | Setting Their Sights on Leadership | WSMA_Reports | Shared_Content/News/Latest_News/2022/setting-their-sights-on-leadership | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 1, 2022</h5>
<h2>Setting Their Sights on Leadership</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
Lola Oluyitan-Okeze, MD, MHMS, experienced pandemic child care stress firsthand when the daycare her toddler attends shut down for a week. Fortunately, she says, her husband rearranged his schedule and stayed home. But she heard from other women physicians who had to take time off when child care fell through. "Their supervisors were upset. And it's not their first choice."
</p>
<p>
While the COVID-19 pandemic placed significant stress on all physicians, workforce studies have found women physicians, especially those with children, were disproportionately affected. Among some specialists, women were significantly more likely than men to report salary cuts and reduced or discontinued work, citing the burden of child care responsibilities. They also continued to shoulder more child care responsibilities overall.
</p>
<p>
For women physicians eyeing greater leadership responsibilities, time will tell whether the pandemic affects their advancement. For Dr. Oluyitan-Okeze, the burden of her lived experience is evident when she recounts her colleagues' stories. "These decisions are sometimes levied against women when it comes time to hire or promote."
</p>
<h3>More, yet not enough</h3>
<p>
Dr. Oluyitan-Okeze is one of several physician leaders WSMA Reports spoke with for this article, who, in many ways embody the successes, struggles, and setbacks of women physicians everywhere aspiring to a seat at the decision table.
</p>
<p>
Women continue to enter medical school in groundbreaking numbers. Data from the Association of American Medical Colleges show that for the past three years, women have comprised the majority of MD-granting medical school applicants, matriculants, and enrollees, representing 56.8%, 55.5%, and 52.7%, respectively, in 2021-2022. For the past four years, women have also been the majority of applicants to DO-granting medicals schools, representing 57.9% of applicants in 2021-2022, according to the American Association of Colleges of Osteopathic Medicine. The most recent DOmatriculant data puts women at 51.9%.
</p>
<p>
Whether these numbers translate into the workforce remains to be seen. The percentage of women in the physician workforce increased from 34% in 2015 to 36.3% in 2019, according to the AAMC's Physician Specialty Data Reports. Women also made up 45.8% of residents and fellows, up from 45% in 2016.
</p>
<p>
Despite these advancements, nationwide women continue to be underrepresented in the highest levels of medical leadership, holding only 17.5% of board chair positions and 15.3% of CEO roles, according to a November 2021 research letter in JAMA Network Open. It's not a clear apples-to-apples analysis, but women may have lost ground among CEO slots: In 2018, they accounted for 18% of CEOs, according to a <em>Harvard Business Review</em> report.
</p>
<p>
Even when women reach the C-suite, gender discrimination persists. A 2019 study found female CEOs at not-for-profit hospitals earned 22.6% less than their male counterparts-an annual gender wage gap of $132,652.
</p>
<h3>A change in the conversation</h3>
<p>
Despite the glacial pace toward medical leadership representation, there's been a marked increase in cultural awareness of issues hindering gender and racial equity, both in health care and in society, says Donna Smith, MD, senior vice president at Virginia Mason Franciscan Health and president of the Franciscan Medical Group.
</p>
<p>
"In so many ways, we're not as far as we thought we were in terms of respect for women and other people," says Dr. Smith. "Social justice issues are relevant to the health of the people we serve, whether it's gun safety or freedom to choose. These are basic issues of public health and human rights that women do need to be involved in and help inform."
</p>
<p>
Dr. Oluyitan-Okeze, who joined Swedish Health Services in February as regional medical director for primary care in Snoqualmie, says that awareness has translated into positive steps for women in medicine and particularly for women of color who aspire to leadership roles.
</p>
<p>
"With the social and racial reckoning that this country is going through, I do think more organizations are looking at their leadership and asking, 'What is missing?'" she says. "As a Black woman, I check off two boxes, and it's an easy choice to peg me for leadership if I meet the qualifications. I will say more and more people are interested in what I have to say and offer in the leadership room. But it doesn't make it any easier, because I still walk into a room and I'm maybe the only African American, or there are only one or two other women there."
</p>
<p>
Representation at the top matters for promoting women down ladder; it sets the tone for the organization and for health policy.
</p>
<p>
The 2021 JAMA research letter found health systems with women CEOs had higher proportions of women serving on either the board of directors or in senior executive positions. Overall, women hold approximately 20% to 50% of positions on boards of directors and senior executive teams.
</p>
<h3>Hitting the 'maternal wall'</h3>
<p>
One disadvantage many women in medicine face that impacts leadership ascendency is balancing the desire to have a career with the desire to have a family. The struggle is both personal and systemic. According to a 2018 University of Michigan study, within six years of finishing their residencies, 40% of women physicians either quit or go part time, citing family as the primary reason. In the general workforce, pregnant women and mothers are often viewed as less competent and less committed to their jobs, a concept known as the "maternal wall bias," first coined in 2004 by feminist legal scholar Joan C. Williams.
</p>
<p>
"When you're a young female physician, there's no good time to have your baby," says Dr. Oluyitan-Okeze. "As a physician who wants to be a mom, that's one of the hardest things we have to maneuver."
</p>
<p>
Last year, when Dr. Oluyitan-Okeze interviewed for her new role at Swedish Medical Group, she was six weeks pregnant with her second child. Her intention had always been to work in medical leadership, so she jumped at the chance for her first full-time leadership position. She now has oversight of some 40 medical staff across five clinics.
</p>
<p>
While Dr. Oluyitan-Okeze wasn't legally obligated to disclose her pregnancy, she did so. She felt guilty knowing she would need to take maternal leave within a few months of starting. "It's a tug on your emotions.
</p>
<p>
If you're doing what you're doing well, you want to give your organization some legroom and let them know what your situation is. But the other side of the coin is, why is this a situation at all? " she says.
</p>
<p>
She also worried how her pregnancy would be perceived. "When you're up for a leadership position, they look at you as a young woman with young children. And you look at your competition, and they're all men.
</p>
<p>
It's possible these men will not take paternity leave and they will probably not need to take a sick day because of child care issues. Their wives may need to, but men will not. It's just an unsaid thing," says Dr. Oluyitan-Okeze.
</p>
<p>
She says she's been fortunate that her current and previous employers have supported her with what she needed to succeed in her job and as a mom.
</p>
<p>
"These things just aren't in place for women physicians, let alone women in leadership," says Dr. Oluyitan-Okeze. "If you have a boardroom full of all men, no one's thinking about maternity leave, breast milk pumping breaks, milk storage, and all those things that you would think of if you're a woman in that same boardroom helping shape policies for your organization."
</p>
<p>
In her own leadership role, Dr. Oluyitan-Okeze takes a proactive approach for physicians going on maternity leave. "I want them to know we have those systems in place," she says.
</p>
<h3>Women and burnout </h3>
<p>
For women in medicine, the COVID-19 pandemic amplified the disproportionate burnout they were already experiencing, says Tamara Chang, MD, medical director of clinician wellness at MultiCare.
</p>
<p>
"Female physicians are at significantly higher risk of burnout, depression, and suicide than male physicians. Women in medicine also have higher deaths by suicide than women in the general population, like 400% higher, which is pretty dramatic," says Dr. Chang.
</p>
<p>
Five years ago, Dr. Chang took an emergency leave of absence. She was only five years into being an attending pediatric hematology oncologist. "I was one of those physicians who hit rock bottom-severe burnout, severe depression, suicidal," she says.
</p>
<p>
Women aspiring to medical leadership face other barriers besides pregnancy and child care issues. "I'm one of the lucky few in medicine who has a supportive spouse who does everything at home for me. And I don't have children," says Dr. Chang. "And yet, I still was one of those with severe burnout."
</p>
<p>
Women often take on what they think are promising work tasks, but they ultimately contribute to burnout, says Dr. Chang. Taking a physician leadership course through the WSMA or another organization can help women identify potential blind spots and common pitfalls that hold women back, she says.
</p>
<p>
Burnout also hit WSMA's incoming president, Katina Rue, DO. In February 2021, Dr. Rue quit her full-time job to work part time and refocus her career. "I took the whole summer off, and it was an amazing thing for my life," she says. Allowing herself the chance to reenergize made the difference climbing up the leadership ladder, says Dr. Rue, who, after consulting for Trios Health Family Medicine Residency Program in Kennewick, in January 2022 became its program director.
</p>
<p>
The key to helping herself and other women, Dr. Chang realized, was changing things from the inside. "That was the catalyst for everything I do. My deepest passion now is how do we get women into leadership, especially women in medicine," she says.
</p>
<p>
To that end, about a year ago, Dr. Chang helped found and now serves as the director of ELEVATE, a leadership development program for women physicians at the American Medical Women's Association. She is also co-founder of Pink Coat, MD, a digital platform exclusively for women physicians, and co-author of "How to Thrive as a Woman Physician."
</p>
<p>
Dr. Rue also has made it her mission to promote women in medicine through the various boards she serves on, including the nominating committee of the Washington Academy of Family Physicians. "At WAFP, we've been pretty intentional in the nominating committee to look at representation," she says, adding that she hopes to bring that same focus to the WSMA.
</p>
<h3>The push forward </h3>
<p>
While there are now more resources than ever to help women attain leadership roles, in many ways, the more things change, the more they stay the same. A common sentiment echoed by the women leaders WSMA Reports spoke to: Women in medicine still need to overcome implicit bias.
</p>
<p>
"Women get treated differently for the same behaviors and characteristics that men exhibit and get applauded for," says Dr. Rue.
</p>
<p>
Over her 25-year career, Sheila Rege, MD, a radiation oncologist in the TriCities and a WSMA board member, dealt with the some of the same issues facing her younger counterparts today. "Confident, professionally assertive women will succeed faster if they show their empathetic side and elevate others," she says.
</p>
<p>
Mentors and friends played an important role in her own career, Dr. Rege notes. "Many women go through a zigzag path in their careers, and I am passionate about supporting formal and informal career development opportunities for women and students," she says.
</p>
<p>
Another common sentiment: Women can't advance without allies, both women and men. "It's so much more powerful, unfortunately still, when a man is the ally, rather than another woman," says Dr. Chang.
</p>
<p>
That's been Dr. Rege's experience, too. "I find that requests for women to advance are seen in a more positive light when male physician colleagues or department chairs speak up in support," she says.
</p>
<p>
Dr. Oluyitan-Okeze urges women who aspire to medical leadership to voice their intention early and often. "When I was at my former organization, they were looking for a department chair for family practice. They remembered I had expressed interest in leadership. I don't know if my name would have ever come up for that role otherwise," she says.
</p>
<p>
Dr. Smith, who served as WSMA president from 2017-2018, encourages women to join community and organizational boards. "Put yourself in situations where you get exposed to healthy dialogue around a boardroom table of really smart people who care about what they're doing."
</p>
<p>
However, Dr. Smith cautions, power dynamics still exist.
</p>
<p>
"The typical male/female kind of dynamics can still happen at a table when the majority of the people around the table are female," she says. "You still need to make sure people are heard and people's opinions are respected. You still need to be curious about what people are saying and encourage debate and open dialogue if you want to make the best decisions for an organization."
</p>
<p>
There's no quick fix to help women overcome the myriad obstacles to advancing in health care leadership, according to a 2021 systematic review published in The Lancet's eClinical Medicine. It outlines dozens of specific evidence-based organizational interventions in four broad categories, including organizational process; awareness and engagement; mentoring and networking; and leadership development.
</p>
<p>
Dr. Chang takes the long view, too. "These are discussions that need to happen on every leadership level in an organization, from the top to the lowest levels," she says. "We are just trying to reach equality. We haven't even started talking about equity. So, we have a long way to go, but I'm hopeful. I hope over the next several generations that we can do it."
</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 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/1/2022 1:03:53 PM | 9/1/2022 12:15:49 PM | 9/1/2022 12:00:00 AM |
| member_profile_jennifer_maxwell_MD | Member Profile: Jennifer Maxwell, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/member_profile_jennifer_maxwell_MD | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;">
<img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" />
</div>
<h5>July 13, 2022</h5>
<h2>Member Profile: Jennifer Maxwell, MD</h2>
<p><strong>Works at:</strong> Yakima Valley Farm Workers Clinic.</p>
<p><strong>In practice:</strong> Five years.</p>
<p><strong>Specialty:</strong> Family medicine.</p>
<p><strong>Why WSMA:</strong> I joined the WSMA because I wanted to be more active in advocacy and I wasn't sure the best way to start. I knew from working at a federally qualified health clinic in Eastern Washington that my patients' struggles are different from those on the other side of the mountains. I wanted to make their voices heard.&nbsp;</p>
<p><strong>My top concerns in medicine: </strong>I worry about the instability of the health care workforce. In Yakima, we only have one hospital and depending on the month, some specialties are not available. There has been a nursing shortage for way too long. It feels like we’re just one step away from disaster. As medical director, I see many of our physicians and health care professionals struggling with work-life balance and I worry about the long-term stability of primary care.&nbsp;</p>
<p><strong>What inspires me: </strong>People who overcome adversity and being part of that journey. I’m humbled that people sometimes wait weeks to see me about their concerns. I reflect on this every day before I step into the clinic.&nbsp;I only hope that I can make good decisions and say what needs to be said to help them on the right path.</p>
<p><strong>Why my specialty: </strong>Family medicine is the specialty of long-term wins. It values the therapeutic relationship and focuses on the patient as a part of their family and their community. When I have a child whose BMI is at the 99th percentile, their mom and grandmother are my patients too. If I can help them set goals around changing those habits, it improves the health of the whole family.&nbsp;</p>
<p><strong>If I weren’t a doctor:</strong> Hands down, I’d be a stay-at-home mom. Any physician-mom will tell you that being a parent is often more challenging than medicine.&nbsp;</p>
<p><strong>Best advice:</strong> When I was an intern on the Harborview medicine wards, three months postpartum after my first child, my attending sat down with me. She told me to think of her as a coach, that we all start in different places with different gaps in our knowledge, and that this is OK. She made it clear that the important thing was not my struggles or deficits at that moment but that I continually grow. That growth mindset changed my trajectory and outlook. I share this with learners now when they rotate with me.&nbsp;<img alt="" src="/images/News/Maxwell.Jennifer_2022.JulyAug.v9-forweb.jpg" style="float: right; margin-top: 15px; margin-bottom: 15px; margin-left: 25px;" /></p>
<p><strong>Spare time: </strong>I have three kids, ages 3, 5, and 8. I’ve been coaching my daughter’s Little League team and watching the other two play soccer and T-ball. We love hiking, rock hounding, or playing board games. I’ve probably played too much Wordle this past year.&nbsp;</p>
<p><strong>Goals: </strong>I’d like to finish an obesity fellowship, learn how to swim or rock climb, and thrive during our clinic renovation.&nbsp;</p>
<p><strong>People might not know about me:</strong> My mother is Cuban, and my father is Chinese. I am the first generation in my family to graduate from high school.&nbsp;</p>
<p><strong>Pet peeve:</strong> Negativity.</p>
<p><strong>Recommended reading: </strong>For the past two years, I had a Zoom book club with my two sisters-in-law and our mothers. The six of us met monthly across the West Coast.&nbsp;The first book we read was “Where the Wind Leads†by Dr. Vinh Chung. It helped us understand and discuss with our mothers about their struggles and immigrant&nbsp;journeys.&nbsp;</p>
<p><em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine. Image courtesy of Dr. Maxwell.</em></p>
</div> | 7/14/2022 1:05:50 PM | 7/13/2022 10:28:12 AM | 7/13/2022 12:00:00 AM |
| making_the_post_pandemic_transition | Making the Post-Pandemic Transition | WSMA_Reports | Shared_Content/News/Latest_News/2022/making_the_post_pandemic_transition | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div>
<h5>July 12, 2022</h5>
<h2>Making the Post-Pandemic Transition</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
On May 17, the U.S. Department of Health and Human Services signaled it would extend the federal COVID-19 public health emergency declaration set to expire in mid-July for another 90 days, until mid-October. First implemented in January 2020, the declaration allowed for much-needed health care flexibilities to mitigate the spread of the novel coronavirus and care for those sickened while maintaining virtual access to routine health services. This included reducing telehealth regulations, expanding Medicaid enrollment, expediting licensing processes, and providing access to COVID-19 vaccines, tests, and treatment with no cost to individuals, regardless of insurance status.
</p>
<p>
The medical community, bracing itself to lose these flexibilities, breathed a collective sigh of relief at the new timeline. But there are mounting pressures on the Biden administration to end the public health emergency, despite ongoing surges and other pandemic pressures. Unfortunately, the reprieve may be short-lived, potentially to the detriment of patient care.
</p>
<h3>
What's at stake?</h3>
<p>
"Both state and federal waivers have resulted in diminishing several administrative burdens during a time of crisis. However, we are not out of the woods yet," says Jennifer Hanscom, CEO of the WSMA. "We need to, at the very least, continue these flexibilities until we are sure we have a handle on COVID and have addressed all pent-up demand still in our communities."
</p>
<p>
For now, HHS has agreed to provide states with 60-days' notice prior to terminating the COVID-19 public health emergency. The WSMA and other parts of organized medicine are carefully tracking the public health emergency and its implications for practices.
</p>
<p>
"We want to make sure federal and state governments unwind these flexibilities in a way that is predictable and manageable, while also considering keeping those policies that have led to improvements in health care delivery and access," says Jeb Shepard, director of policy for the WSMA.
</p>
<p>
Hanscom agrees. "Ideally, we need to garner support to make permanent some of the most beneficial waivers. This will require new laws and regulations passed at both the state and federal level."
</p>
<p>
Wholesale ending of funding and regulatory flexibilities would put additional strain on health care systems already struggling to play catch-up with a stretched and stressed workforce, says Mika Sinanan, MD, PhD, WSMA president. "We're in a new phase of the COVID experience where patients who delayed or deferred care are now filling our hospitals. And there are huge staffing and inflation issues. As those benefits go away, it only adds to this very difficult transition period."
</p>
<p>
The post-pandemic transition has begun, as many state and local governments have already rescinded their emergency orders. Of the 89 COVID-19-related proclamations Gov. Jay Inslee signed, only 29 remain in effect in whole or in part, including the requirement that those working in health care settings be vaccinated unless they have a religious exemption or precluding disability. The health care vaccine mandate is a measure the WSMA continues to support, says Dr. Sinanan. "Our leadership position has always been that this is a safety issue," he says.
</p>
<h3>Impacts on telehealth </h3>
<p>
The expansion of telehealth services removed one of the pandemic's biggest health care hurdles-access to care-especially during public lockdowns when office visits and elective procedures were discouraged or prohibited. It's a pandemic flexibility the WSMA and its members would like to become permanent.
</p>
<p>
Under the public health emergency, physicians seeing Medicare patients don't need to establish an in-office patient relationship before providing services via telehealth. Waivers allow for some audio-only care and the use of certain social media platforms to see patients, which previously violated HIPAA privacy rules. The Centers for Medicaid and Medicare Services also began covering 100 new telemedicine services at in-person reimbursement rates. Waivers also allowed for the extension of medical care across state lines to support outpatients who livedor were located in other states.
</p>
<p>
"It was really a message of just step up and take care of patients. That was an enormous relief during such a highstress time," says Marcia Sparling, MD, chief medical information officer and medical director for surgical specialties at Vancouver Clinic.
</p>
<p>
Dr. Sparling's concern is that once the health emergency ends, CMS will tighten how it reimburses for telehealth visits and prohibit telehealth visits across state lines. "I would hope that Medicare modernizes aggressively and accepts that this is the way the world works now," she says. "For example, we have patients who might live in Vancouver, but they do a video visit across the river in Portland [Oregon], because that's where they work. And this occurs all over the country where people move back and forth across state boundaries."
</p>
<p>
For mental health practitioners, relaxed telehealth rules and payment parity have been particularly critical to patient care, says Donna Lohmann, MD, a private-practice psychiatrist in Seattle. "I didn't have to skip a beat. My practice pivoted and it pivoted quickly," she says.
</p>
<p>
While Dr. Lohmann didn't take on new patients during the pandemic, two former patients whom she hadn't seen in a few years returned. Because of relaxed telehealth rules, she could schedule telehealth visits without needing to see them in her office first.
</p>
<p>
Most of the time, Dr. Lohmann's telehealth portal worked well for her tech-savvy patients. But glitches can and did sometimes happen, so they used FaceTime as a backup. Losing that option, says Dr. Lohmann, could make it more difficult to care for patients. "It's a real issue because technology is certainly never 100%," she says.
</p>
<p>
For continuity of care, Dr. Lohmann, Dr. Sparling, and others would like to see federal licensing across state lines. "Right now, if somebody leaves the state for a few weeks and they have a crisis, I'm not allowed to treat them. It's not particularly pandemic-related but it became a much bigger issue during the pandemic. You have to choose between breaking the law and abandoning a patient. And that's not a choice anyone should have to make," says Dr. Lohmann.
</p>
<p>
Medical licensure still rests with the states, and federal involvement in licensure remains a thorny issue. But the WSMA has recently made progress, working with both Oregon and Alaska to update their telemedicine policies to permit Washington-licensed physicians and physician assistants to provide followup care to established patients without obtaining licensure in those states. The WSMA is working with other states to update policies, including Wyoming, Montana, and Idaho, says Shepard.
</p>
<h3>The impact on Medicaid</h3>
<p>
As businesses closed shop and Americans lost their jobs, many found themselves without health insurance or unable to pay. The public health emergency allowed for continuous Medicaid enrollment, suspending the need for yearly Medicaid redetermination. Nationwide, continuous enrollment contributed to a Medicaid enrollment growth of 20.5% between February 2020 and November 2021.
</p>
<p>
When the health emergency ends, millions of people could lose Medicaid coverage or potentially face higher costs for insurance coverage. The WSMA supports continued federal funding increases for Medicaid and congressional reauthorization of funds to support the uninsured.
</p>
<p>
In Washington state, about 361,400 people have joined Apple Health, the state's Medicaid program, since the start of the pandemic, according to the Washington State Health Care Authority. Once the public health emergency ends, enrollees will need to verify their Medicaid eligibility once they hit the month their one-year anniversary would have normally occurred. It's unknown how many enrollees will still be eligible for Apple Health once the health emergency ends.
</p>
<p>
The redetermination process will take place over 12 months, says Charissa Fotinos, MD, the HCA's state Medicaid director and behavioral health medical director. "We will need to reach out to all those folks by whatever means we can and check to see if they're still eligible for Medicaid. If they are, we re-enroll them. If they are not, we will refer them to the health insurance exchange so they may look at other insurance products. There are some plans with subsidies for income levels that exceed Medicaid but aren't high enough to warrant people managing insurance on their own."
</p>
<p>
Physicians, physician assistants, and nonphysician providers can play a vital role in making sure these vulnerable patients continue to receive the services they need, says Dr. Fotinos. While they won't directly be involved in determining Medicaid eligibility, she asks physicians and PAs to encourage their patients to read any notices they receive from the HCA or CMS. "Physicians can be good partners with us," says Dr. Fotinos. "And if they have questions, they can certainly reach out to us."
</p>
<p>
In April, the HCA released an external guide on what happens to Apple Health eligibility during and after the expiration of the COVID-19 public health emergency, which physicians and health care systems can download from its website.
</p>
<h3>Impacts on COVID-19 testing, treatment, and vaccine coverage</h3>
<p>
To fight the pandemic, the U.S. Food and Drug Administration issued emergency use authorizations for three vaccines and hundreds of COVID-19 tests and treatments. According to the FDA, an emergency use authorization declaration is distinct from, and is not dependent on, the federal public health emergency declaration related to COVID-19. An emergency use authorization may remain in effect beyond the duration of the health emergency if other statutory conditions are met.
</p>
<p>
While some vaccines and therapeutics have received full FDA approval, the concern is that ending the public health emergency may trigger the FDA to terminate emergency use authorization for products that haven't obtained full approval. There's also concern over federal funding for vaccination, testing, and treatment.
</p>
<p>
"We know that timely access to vaccines and boosters as well as timely access to antiviral medications like Paxlovid and to monoclonal antibodies given to people at high risk of hospitalization or death reduces the risk of severe disease. So, we really need to remove any barriers that we can to vaccination, testing, and treatment. Our hope is that federal funding and support continue to be really strong," says Tao Sheng Kwan-Gett, MD, chief science officer for the Washington State Department of Health.
</p>
<p>
It's hard to predict what impact ending the health emergency will have on funding. "It's not an automatic given that funding for testing, treatment, or vaccination would be reduced. But it's certainly a possibility," says Dr. Kwan-Gett.
</p>
<p>
Through the FEMA Stafford Act, the federal government has reimbursed physicians and health care systems 100% for COVID-19 testing. While there is no set date to end Stafford Act funding, as of July 1, the cost-sharing formula will shift, with the federal government now covering 90% and state and local agencies each paying 5%, signaling the first change in funding, says Dr. Kwan-Gett.
</p>
<p>
"The funding change won't affect what physicians and health care providers do. It just means the Department of Health will make up 10% of the cost," he says. "Ending the public health emergency certainly wouldn't change anything about the vitally important role of physicians in vaccinating people and in testing them and getting them access to treatment for those at high risk."
</p>
<p>
For now, Washington state has several funding mechanisms that support the COVID-19 response, says Dr. Kwan-Gett. The state's COVID programmatic grant awards-like Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases and vaccine dollars-are not impacted by the end of federal reimbursement for coronavirus vaccine administration, testing, or treatment. These grants have already been awarded, and the funding continues with expiration dates ranging from July 2023 to June 2024.
</p>
<p>
In May, the WSMA surveyed its members to better understand which flexibilities physician practices are relying on, what factors should be considered in deciding to end or retain them, and what preparation is needed at the practice level to end a waiver. As the next public health emergency end date looms, the WSMA hopes members will add their voices to the need to keep pandemic-era flexibilities in place, says Dr. Sinanan. "Their stories of how the benefits of the public health emergency impacted their practices will go a long way toward advocacy and moving health care forward."
</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 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/13/2022 10:58:37 AM | 7/12/2022 3:43:56 PM | 7/12/2022 12:00:00 AM |
| the_fix_that_wasnt | The Fix That Wasn't | WSMA_Reports | Shared_Content/News/Latest_News/2022/the_fix_that_wasnt | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div>
<h5>July 12, 2022</h5>
<h2>The Fix That Wasn't</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
When Congress overhauled the Medicare payment system for physicians in 2015, the reforms put an end to a model that was plainly broken. At the time, physicians were facing a 21% cut in Medicare fees, the latest in an endless line of "cliffs" created by a formula designed to tie spending to overall economic growth. The new system held the promise of removing the perennial threat of impending fee cuts while also creating payment models that rewarded high-value care.
</p>
<p>
"It became so overwhelming that Congress finally had enough," says Jason Marino, director of congressional affairs at the American Medical Association. "We were happy at the time" with the new system and the incentives for valuebased care.
</p>
<p>
As it turns out, that optimism was short-lived. Just seven years after that overhaul, the Medicare payment system is again stuck in a cycle of statutory payment cuts that require Herculean effort to avoid every year. At the same time, the alternative payment models originally envisioned as encouraging greater innovation and value in care have proven harder to implement due to inadequate incentives and unrealistic requirements.
</p>
<h3>A need for change </h3>
<p>
"We're still in the same situation where every year we have to fight back the cuts we don't want to have happen," says Jennifer Hanscom, CEO of the WSMA. "It's frustrating to be on that hamster wheel."
</p>
<p>
The need for change is evident. Physicians are facing a continuing statutory freeze in annual Medicare physician payments that is scheduled to last until 2026. After that, payment updates will resume, but only at a rate of 0.25% a year indefinitely.
</p>
<p>
Medicare physician payment has fallen 20%, adjusted for inflation, since 2001. At the same time, the cost of running a medical practice increased 39% since 2001. In the meantime, Medicare payment updates to physicians have been far outpaced by increases for others. While Medicare physician pay rose 11% since 2001, payment updates increased roughly 60% for inpatient and outpatient hospital services and for skilled nursing facility services.
</p>
<p>
Compounding the problem of low and eroding reimbursement is the fact that insurers increasingly use Medicare as their baseline for payment standards. "The rates for much of commercial insurance, which in the past had cross-subsidized Medicare and Medicaid, are trending toward Medicare," notes Mika Sinanan, MD, PhD, a surgeon at the University of Washington and current president of WSMA. "They say you have to live and work at a Medicare level."
</p>
<p>
It's no surprise that as a result of this combination of factors, the Medicare payment system is exacting a high toll on practices and on patient care across the state and the country.
</p>
<p>
"The impact on practices is uncertainty about the sustainability of taking Medicare patients," Dr. Sinanan says. "It's impacting the sustainability of physicians to offer services to Medicare patients. There's going to be an access problem in parts of the country and parts of the state."
</p>
<p>
Easy in theory, difficult in practice An improved payment system was one fix promised seven years ago. The other was a pathway toward rewarding valuebased care models. It too has proven to fall far short of expectations.
</p>
<p>
The congressional legislation created several new alternatives to traditional fee-for-service payment. The Medicare Merit-Based Incentive Payment System based payments on the Medicare Part B physician fee schedule, but those payments can be adjusted either up or down depending on scores from four performance categories. The scoring is complex and the administrative burden for participating in MIPS is onerous. A 2021 study published in JAMA Health Forum found that it costs an estimated $12,811 and takes more than 200 hours per physician annually to comply.
</p>
<p>
Medicare's attempt to encourage practices to embrace advanced alternative payment models has proven equally complicated. Practices can earn a 5% bonus, but setting up such an innovative model is something only the largest practices are able to consider.
</p>
<p>
"Medicare wants to pay physician practices based on the risk scores of their patients. However, in small private practices, there are no additional resources to help physicians be successful in capturing the true risk scores," says Katina Rue, DO, Trios Health Family Medicine Residency Program Director and president-elect of WSMA. "I question how practices doing that can accurately capture this information.
</p>
<p>
It's often on the backs or fingertips of the physicians without organizational resources or support such as coders."
</p>
<p>
The bottom line is that a practice will need to hire staff, which, as Dr. Rue says, "do pay for themselves eventually, but there is an 18-month turnaround for reimbursement." The model can drive small practices toward consolidation, which isn't always good for physicians, patients, or their communities, she says.
</p>
<p>
Measuring value has also been a challenge, especially for specialty practices. "The value-based concept makes sense theoretically but has proven to be very difficult to implement, in large part because the goal is to reward outcomes, but there's no easy mechanism to track outcomes and measure them objectively," says Dr. Sinanan. Instead, surgeons find themselves dealing with unrelated process measures, such as blood pressure control for patients with diabetes.
</p>
<p>
Amid this confusion, the rules are changing regarding the alternative payment models. The 5% bonus is slated to go away at the end of this year, and practices will need to increase the number of participating patients from 50% of their practice to 75%. That will essentially set those practices that willingly embraced innovation on a path to failure.
</p>
<p>
"I believe that even most big systems will not qualify" under the new requirements, says Marino. "All the other investments in APMs will just go belly up."
</p>
<h3>Not if, but when </h3>
<p>
Given the myriad problems facing Medicare, the need for a major overhaul seems obvious. However, an election year isn't the right time for such an attempt. Instead, organized medicine is laying the groundwork for a twopronged approach: Address some of the most immediate problems in the short term and build the foundation for a bigger fix in the not-too-distant future.
</p>
<p>
"Where we want to focus at this point in time is on those short-term fixes," says Hanscom.
</p>
<p>
Foremost among those fixes is stopping any proposed payment cuts. Indeed, one of the issues that the AMA would like to see addressed is having payments adjusted for inflation, a particularly timely issue right now. "That would go a long way, right there," says Marino.
</p>
<p>
Extending the 5% bonus for APMs is another priority, as is keeping the current patient standard for participation at 50%. Extending a $500 million pool for exceptional performance in MIPS is also important.
</p>
<p>
Longer term, the time is approaching to revisit the entire payment model.
</p>
<p>
"In the end, the goal is to have a strong Medicare program that physicians want to participate in," says Hanscom. "We need to create a rational Medicare payment system that encourages fiscal responsibility and embraces innovation. We've been straddling the canoe and the dock for years. If we're ever going to get into the value-based care boat, we need a program like Medicare to set the parameters for it."
</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 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/13/2022 10:59:11 AM | 7/12/2022 3:02:33 PM | 7/12/2022 12:00:00 AM |
| please_stop_saying_provider | Please Stop Saying 'Provider'! | WSMA_Reports | Shared_Content/News/Latest_News/2022/please_stop_saying_provider | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;">
<img alt="Susan Baumgaertel,MD" src="/images/newsletters/Reports/2022/july-august/heartbeat-website-image-645x425px.png" class="pull-right" width="645" height="425" />
</div>
<h5>July 11, 2022</h5>
<h2>Please Stop Saying 'Provider'!</h2>
<p>By Susan J. Baumgaertel, MD, FACP</p>
<p>
When I presented Resolution B-8 at the WSMA House of Delegates 2021 annual
meeting, it was with a sense of urgency that patients and the general
public deserve to know who is caring for them. Not so easily done,
unfortunately.
</p>
<p>
When I started my internal medicine practice in 1996, the medical arena
was vastly different than it is today. Back then, having an MD after my
name actually meant something. A letter from me to an insurance company
would get a needed medication covered for a patient-a time before
preauthorization existed. Dr. Google was not yet born. "Provider"
exclusively belonged to the insurance industry.
</p>
<p>
My patients called me doctor and referred to me as their physician. Well,
most of them. I still chuckle fondly when I recall the World War II vets
at the Veteran's Affairs Hospital calling me nurse, no matter how I
introduced myself. That's okay-I knew who I was and didn't need to prove
it. I actually think they did too and just wanted to get my goat!
</p>
<!--
<div class="col-sm-5 pull-left" style="text-align: center;">
<img alt="Baumgaertel pullout quote" src="/images/newsletters/Reports/2022/july-august/baumgaertel-pullout-quote.png" class="pull-left" width="569" height="312" />
</div> -->
<p>
Fast forward to modern times: Professional appropriation runs rampant. I
cringe, along with many of my physician colleagues, when I am wished
"Happy Providers' Day" instead of "Happy Doctors' Day." And I was stunned
when someone recently addressed me as "Provider Susan" in an email-that
was a new one. The word "provider" has become ubiquitous.
</p>
<p>
Would you want your pilot to be the same as your flight attendant? "Good
morning, I'm airline worker Carl and I'll be flying your plane today."
Would you want your trial attorney to say, "I'm Sarah, your legal worker,
and will be defending you today"? I am a physician, yet somehow it has
become OK to refer to me as anything but physician.
</p>
<p>
In an era where burnout is akin to another pandemic, it is further
demeaning and demoralizing to all in medicine to be lumped together as if
we are the same. This is just not sustainable. This is also not about ego.
It is about patient safety and transparency. Substitute words only serve
to confuse the public and take away transparency by implying all training
and experience is equivalent, which is simply untrue.
</p>
<p>
I haven't worn a white coat in decades. Nowadays, a white coat means
nothing-the beauty counter makeover folks wear them. Everyone wears
scrubs. ID badges are now issued with "medical staff" instead of actual
titles. Badges also are notorious for flipping over and not actually being
visible to patients. All too frequently patients get seen by a "provider"
never actually knowing their credentials.
</p>
<!--
<div class="col-sm-5 pull-right newsbody" style="text-align: center;">
<img alt="parrot" src="/images/newsletters/Reports/2022/july-august/parrot.png" class="pull-right" width="480" height="262" />
</div> -->
<div class="col-sm-5 pull-right" style="text-align: center;">
<blockquote style="text-align: left;"><strong>
<em>
Would you want your pilot to be the same as your flight attendant?
"Good morning, I'm airline worker Carl and I'll be flying your plane
today." Would you want your trial attorney to say, "I'm Sarah, your
legal worker, and will be defending you today"? I am a physician, yet
somehow it has become OK to refer to me as anything but physician.</em></strong>
</blockquote>
</div>
<p>
How can we fix this? Patients and the public should be completely
comfortable with asking who is taking care of them and what are their
credentials. Staff need to be trained not to ask, "Which provider are you
calling for?" We need to refrain from grouping all physicians,
nonphysicians, and health care professionals together using one word.
Words matter-at meetings, in emails, on nursing home forms, in the news,
on websites, and so on.
</p>
<p>
Let's bring back respect for physicians and respect for nonphysicians.
Respect our differences in training and medical experience. We are not all
the same. Use our titles individually. With this will come transparency to
patients and the public. And with transparency will come improved safety.
</p>
<p>
Washington state has the opportunity to set a decades-overdue example for
the rest of the country, not just by making another strong recommendation,
but by publicly educating everyone that use of the term "provider" or any
other replacement term is unacceptable.
</p>
<p>Let's reshape modern medicine. It is time.</p>
<p>
<em>Susan J. Baumgaertel, MD, FACP, is the founder of
<a href="https://myMDadvocate.com">myMDadvocate.com</a> and is a
physician advocate, guide, partner, coach, resource, navigator, and
educator. She is the author of Resolution B-8, sponsored by the King
County Medical Society and adopted by the WSMA House of Delegates in
2021, which called for the WSMA to support education to highlight
concerns related to inappropriately using one title to group all medical
professionals together (e.g., "provider").</em>
</p>
<p>
<em>
Are you passionate about this or another topic? Send us your story (less
than 500 words) at
<a href="mailto:editors@wsma.org">editors@wsma.org</a>.</em>
</p>
<p><em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em></p>
</div> | 7/13/2022 10:59:33 AM | 7/11/2022 11:21:27 AM | 7/11/2022 12:00:00 AM |
| hub_and_spoke_model_five_years_later | Hub-and-Spoke Model: Five Years Later | WSMA_Reports | Shared_Content/News/Latest_News/2022/hub_and_spoke_model_five_years_later | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 3, 2022</h5>
<h2>Hub-and-Spoke Model: Five Years Later</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
When Lora Jasman, MD, an addiction medicine specialist with the Healthy Behavior and Function Clinic at MultiCare Rockwood Clinic in Spokane, learned a long-time patient with opioid use disorder was thinking about starting community college, she cheered. Dr. Jasman had first treated him in her internal medicine practice, but the limited services she could provide weren't enough. As happens for many with the disorder, he returned to use.
</p>
<p>
"He had a period of time where he was very unstable, using a lot of methamphetamines, in and out of the hospital, and in and out of urgent care," she recalls. So, what changed to get him on this new path?
</p>
<p>
Dr. Jasman credits the patient's efforts, but also the comprehensive services her team has been able to provide since becoming a "hub" in August 2018 under Washington state's hub-and-spoke care model for treating opioid use disorder.
</p>
<p>
Hub-and-spoke networks in Washington state were launched as part of the federal 21st Century Cures Act to address the opioid epidemic. Modeled on a program in Vermont, it's a coordinated care approach to prevent return to use, overdose, and death by removing barriers to accessing medication. The 2021-2022 Washington State Opioid and Overdose Response Plan considers the networks an integral part of expanding capacity to provide medication for opioid use disorder, or MOUD (also referred to as medication-assisted treatment).
</p>
<p>
Many of the networks are now in their fifth year of operation. While the model has proven successful in helping patients with opioid use disorder, it also has challenges related to care coordination across the network and funding.
</p>
<p>
"Hubs" are designated primary care physicians and clinicians, behavioral health clinics, health professionals who offer office-based MOUD, or federally qualified health centers in a region that coordinate care for adults with opioid use disorder. To provide integrated MOUD, each hub subcontracts with organizations or "spokes," including emergency departments, residential treatment facilities, therapist's offices, drug courts, correctional facilities, needle exchanges, and tribal medical facilities.
</p>
<p>
Within each network, nurse care managers or spoke care navigators help reduce the burden on prescribing physicians by providing screening, care planning, and services and referrals needed to stabilize patients.
</p>
<h3>Meeting patient needs</h3>
<p>
When it comes to increasing capacity, the model has exceeded benchmarks. An analysis by the Institute for Behavioral Health at Brandeis University published in January 2020 found that in the first 18 months of operation, these networks added nearly 5,000 new people with opioid use disorder onto MOUD, double the projected goal.
</p>
<p>
"It's allowed us to individualize our approach to each patient and help provide them with the wrap-around care that they need in their recovery," says Dr. Jasman. "Before, I didn't have a coordinated team. So, if I wanted a patient to go into inpatient treatment, I would basically say, you need inpatient treatment, here's a list of places that do that."
</p>
<p>
While her internal medicine clinic served few patients with opioid use disorder, since becoming a hub, MultiCare's Rockwood Clinic has served over 2,000 such patients, says Dr. Jasman. Her team now includes two physician assistants, two medical assistants, a nurse care manager, hub care coordinator, and a receptionist.
</p>
<p>
Wrap-around services provided by these networks are crucial in helping patients navigate what life throws at them, says Shawn Andrews, MD, program director of family medicine residency and senior medical director of ambulatory care services for Summit Pacific Medical Center, a hub in Elma. Shortly after one patient went through several tough years and challenges to stop using, his brother was killed, recalls Dr. Andrews. "People will often return to use when something horrible like this happens." But even though he was distraught, he was able to remain stable.
</p>
<p>
"He came back to the MOUD clinic for a point of contact and some direction on how to protect his sobriety through this difficult time," she says. "He knew that people cared about him personally and he felt safe there."
</p>
<p>
The model also helps relieve pressure on emergency departments, says Dr. Andrews. "It's strengthened the alliance between ED, primary care, and MOUD clinics," she notes.
</p>
<p>
For Capital Recovery Center, a hub in Olympia, the hub-and-spoke model has increased access to treatment, says Malika Lamont, co-founder and director of harm reduction practices of Capital Recovery Center's Olympia Buprenorphine Clinic, a spoke. Since it opened in 2019, Capital Recovery Center has seen over 1,500 patients. Because of its high volume, the peer-led behavioral health facility has a nurse navigator and 10 physician prescribers.
</p>
<p>
"I remember the days when we did not have meaningful access to medication for opioid use disorder in a six-county area. It has helped us grow our capacity to provide treatment to folks, and to better engage with them," says Lamont. Olympia Buprenorphine Clinic clients know they can drop in anytime during operating hours and get their medications dispensed free of charge at the time of visit, says Lamont.
</p>
<h3>Persistent challenges</h3>
<p>
Hub-and-spoke networks are intended to help transition patients seamlessly between health professionals and organizations, depending on their level of stability and what else they need to remain stable, such as mental health and social services.
</p>
<p>
But coordinated care has been easier said than done. The Brandeis report found very little movement of patients across hubs and spokes.
</p>
<p>
"I know the state says we're a hub, but we don't get a lot of referrals. We mostly see people coming in literally right off the street," says Ryan Herrington, MD, medical director of Capital Recovery Center's Olympia Buprenorphine Clinic.
</p>
<p>
Financial challenges are also a problem. Hub-and-spoke models are funded through multiple federal and state grants to ensure low-barrier access to those on Medicaid and low-income populations. But the low payment structure can be a struggle for physicians and health professionals who participate in hub-and-spoke. "The vast majority of these patients are on Medicaid," says Dr. Jasman. "So, it's just difficult to make the budget work out well. That's a barrier [to participation] that the state of Washington is well aware of and trying to do something about."
</p>
<p>
Another issue with the state's model is that it leaves care design up to each network. While that provides flexibility, it also creates some confusion, as there is no agreed-upon standard for what constitutes patient stability and outcomes.
</p>
<p>
"A big challenge with the hub-and-spoke model is that you have different physicians and practitioners with different levels of expertise and different treatment philosophies," says Dr. Herrington. "It's not like blood pressure management, where everyone knows that the goal of treatment is 120 over 80 or better."
</p>
<p>
Defining patient stability and what dosage is needed to maintain stability remains a challenge, says Dr. Herrington. "Somebody who might be stable to me might be unstable to another physician."
</p>
<p>
Once patients are stable, the long-term goal is to get patients in with a primary care physician or practitioner to continue their care. But because of previous negative experiences, many patients are reluctant to change physicians. "We're finding that they are really attached to the people who help them enter recovery," says Dr. Andrews.
</p>
<p>
Still, despite all the challenges, the hub-and-spoke system has given people with opioid use disorder an option to lead stable lives that they might not have otherwise had.
</p>
<p>
"There's still just a lot of barriers [to treatment]," says Dr. Jasman. "But this is a start. And it's not perfect, but we are serving a lot of people in a way that they are getting a lot of benefit."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/3/2022 10:44:19 AM | 5/3/2022 10:43:15 AM | 5/3/2022 12:00:00 AM |
| embracing_empathy_in_complexity | Embracing Empathy in Complexity | WSMA_Reports | Shared_Content/News/Latest_News/2022/embracing_empathy_in_complexity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Embracing Empathy in Complexity</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
One of the consequences of the COVID-19 pandemic was its impact on another epidemic: drug overdoses. According to the Centers for Disease Control and Prevention's National Center for Health Statistics, there were more than 100,000 drug overdose deaths in the U.S. during the 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before.
</p>
<p>
The bulk of opioid-related deaths are attributable to synthetic opioids like illicit fentanyl, with 75,673 total opioid-related deaths in the 12-month period ending in April 2021, up from 56,064 the year before. About six people in Washington state die every day from an overdose. The rising numbers put new pressure on physicians and policymakers to develop fresh approaches to address the tide of addiction.
</p>
<p>
But the tragic toll also contains a success that underscores the confounding nature of the epidemic. A recent report from the American Medical Association shows that opioid prescribing nationwide has dropped 44% in the past decade and fell nearly 7% from 2019 to 2020. Even as physicians in Washington and other states have made tremendous strides addressing the overprescribing of opioids, the epidemic continues to shift its form, creating a new set of challenges.
</p>
<p>
"Deaths from prescription opioids continue to slowly decrease, yet a lot more work needs to be done," says Steven Stanos, DO, medical director of Swedish Pain Services in Seattle. "Prescription overdose deaths are now far overshadowed by the increase in deaths due to illicit fentanyl, a far more accessible, potent, and lethal opioid. Methamphetamine, heroin, and cocaine-related deaths also are rising."
</p>
<p>
There's no question that the COVID-19 pandemic contributed to the rising toll of drug overdoses. "The opposite of addiction is connection," says Lucinda Grande, MD, a physician at Pioneer Family Practice in Lacey, citing author Johann Hari. "The pandemic really increased isolation, boredom, and stress." Yet the picture is not entirely bleak. There have been successes. Moreover, the understanding of how to address the epidemic has deepened with time, with a more nuanced understanding of the clinical approaches that will work and a commitment of resources to help those in need of treatment.
</p>
<h3>Tackling opioid overprescribing</h3>
<p>
One of the major changes over the past several years has been the success in reducing overprescribing of opioids for acute pain conditions, including dental and hospital-based elective procedures. "Physicians and prescribers didn't appreciate the significant impact their unnecessary prescribing was contributing to a large supply of unused pain medication in our communities," says Dr. Stanos.
</p>
<p>
A typical example was seen with elective surgery. "Patients were commonly prescribed a one-month supply of pills out of convenience for an acute pain condition that normally needed only a few days of therapy at best," says Dr. Stanos. "This led to a significant number of unused pain medications finding their way into the hands of vulnerable individuals, including recreational users and people struggling with addiction."
</p>
<p>
Washington helped set a standard for other states with the Better Prescribing, Better Treatment program, launched in 2017 as part of the state's opioid response plan. The program, a joint effort of the WSMA and the Washington State Hospital Association, has three components: encouraging compliance with a prescribing policy that establishes pill limits for all prescriptions for acute pain, giving physicians discretion to override pill limits if they feel it is in the best interest of their patients, and allowing physicians to compare how their opioid prescribing practices compare to others in their specialty and health system.
</p>
<p>
Pill limits were an attempt to get at what seemed at the time the heart of the opioid problem. "Our goal in going upstream was to cut off the supply to those at risk for addiction," says Nathan Schlicher, MD, JD, an emergency room physician at St. Joseph's Medical Center in Gig Harbor and WSMA's lead on Better Prescribing, Better Treatment.
</p>
<p>
At the same time, providing physicians with clinical flexibility and data on how they compared to their peers were also important. "We recognized that no guideline is applicable to every patient," says Dr. Schlicher. "We said, let us give people feedback on performance compared to how their peers perform. If you are the only one performing with those guidelines compared to your peers, that should give you pause."
</p>
<p>
Overall, the results have been positive. "There have been a lot of improvements in addressing the opioid epidemic within the house of medicine," Dr. Schlicher says.
</p>
<h3>A changed landscape</h3>
<p>
As the epidemic has continued, the focus has shifted, bringing with it new challenges. "We handled what was a really bad prescription opioid problem, and now it's evolved into a synthetic street opioid problem," says Jeb Shepard, WSMA's director of policy.
</p>
<p>
Indeed, the bulk of the deaths reported by the CDC were attributable not to prescription opioids but to street drugs, and in particular fentanyl. Fentanyl and other synthetic opioids now account for about two-thirds of all drug overdose deaths.
</p>
<p>
One of the most immediate needs has been to stop overdose deaths. Starting in 2019, anyone in Washington was able to obtain naloxone, a medication which reverses opioid overdoses, simply by walking into a pharmacy.
</p>
<p>
"Unfortunately, the people who need it the most aren't compelled to go to a pharmacy," Shepard says. "Their lives are chaotic and complicated. There's been a lot of success with it but it's not the magic solution everyone had been hoping for."
</p>
<p>
Still, notes Dr. Stanos, naloxone prescriptions by physicians are rising. "Prescribers can do our part by getting more naloxone in our communities and in patients' homes, whether it will be needed by the individual patient, or a friend or family member." Naloxone can easily reverse an overdose and save a life, he says. "Some have likened community goals of increasing naloxone availability to having a fire extinguisher in every house."
</p>
<h3>Moving forward: More access, more nuance</h3>
<p>
Not surprisingly given the death toll, the state has focused increasingly on creating more opportunities for access to treatment for substance use disorders.
</p>
<p>
"The Legislature is making a generational investment in treating this problem and a whole other raft of behavioral issues," says Shepard. "If there's ever been a problem where money would help, this is one, because treatment has long been underfunded."
</p>
<p>
At the same time, the original zero-tolerance policy of opioids is giving way to a more nuanced perspective, even among pain specialists.
</p>
<p>
"I went through a phase where I believed that chronic opioid prescriptions were absolutely evil and harmful," says Dr. Grande. "Over time, I realized I was wrong because a lot of people benefit from it, and when you take it away from them it can be an absolute tragedy." Instead, Dr. Grande says, people will take matters into their own hands, seeking illicit opioids or even committing suicide.
</p>
<p>
The CDC issued guidelines on opioid prescribing in 2016 that were frequently interpreted as being proscriptive and rigid. "A lot of people in their haste to respond to the problem took the guidelines as gospel that needed to be adhered to strictly," says Shepard. The result was often harm to patients, who had their opioid treatments discontinued without any alternative.
</p>
<p>
The agency released a new draft guideline in February that is more patient-focused and that provides greater flexibility for physicians and prescribing clinicians. "Controversial and confusing dose thresholds are removed in the draft guideline," says Dr. Stanos. "There is more emphasis on how to integrate non-opioid therapies for pain, and to more safely select and manage patients that may benefit from opioids, better instruction on how to taper patients, more clarity in prescribing short-term for acute and subacute pain, and an overall emphasis on patient-centered care that appreciates the unique complexities of each patient."
</p>
<p>
Both the Trump and Biden administrations have loosened some regulations related to opioid treatments. In particular, it is now easier to prescribe buprenorphine, which is used to treat people with opioid use disorders.
</p>
<p>
"Increased use of buprenorphine is more effective and safer management of chronic pain for patients with or without an addiction," says Dr. Grande.
</p>
<p>
Properly managing chronic pain patients in the first place can help prevent the cycle of addiction and overdose that's exacting such a high toll currently. However, the financial realities don't always currently align with those goals.
</p>
<p>
"Greater improvements in insurance coverage and patient access for non-opioid therapies, like behavioral health, physical therapy, and many interventional therapies, have been slow to come by," says Dr. Stanos. "Even if an 'approved benefit,' reimbursement many times is so low it's an ongoing challenge to incentivize clinics and systems to keep offering services."
</p>
<p>
For many patients, coverage can be nonexistent or limited, with significant out-of-pocket expenses. In Swedish's pain clinic, patients participating in a structured four-hour therapy session that includes individual and group physical and occupational therapy, behavioral health, and patient education, can incur multiple out-of-pocket copay charges in a single day.
</p>
<p>
"If we're going to improve care, payers have to truly incentivize and support comprehensive pain management," says Dr. Stanos.
</p>
<p>
The fact remains that the opioid epidemic is just one part of a larger problem fraying the fabric of society. While drug overdoses have been among the fastest rising death rates among Americans in the past two decades, so too have suicide and alcohol liver disease.
</p>
<p>
A recent study published in the Journal of the American Medical Association found that more than 99,000 people died in 2020 of alcohol-related causes. Addressing those societal problems and "deaths of despair" go well beyond the range of medicine.
</p>
<p>
But there are things that physicians can do, starting with how they approach their pain patients, says Dr. Grande.
</p>
<p>
"Physicians need to increase their awareness and empathy," she says. "They need to treat them with kindness."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/2/2022 11:45:47 AM | 5/2/2022 11:40:22 AM | 5/2/2022 12:00:00 AM |
| pre_visit_planning_is_increasing_efficiency | Pre-Visit Planning Is Increasing Efficiency | WSMA_Reports | | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2022/may/thrive-cover-image-wsma-may-june-2022-thrive-645x425.jpg" class="pull-right" alt="Thrive cover, May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Pre-Visit Planning Is Increasing Efficiency</h2>
<p>
"Addressing burnout at the clinic and organization level is the primary way to increase well-being and professional satisfaction for physicians," says Pratima Sharma, MD, executive medical director at EvergreenHealth Primary Care.
</p>
<p>
EvergreenHealth is one of the Washington health care organizations that took part in the American Medical Association's Wellness Practice Transformation Initiative, which tasks participants with implementing and examining the impact of workflow redesign interventions. The initiative is funded by a grant from The Physicians Foundation.
</p>
<p>
After implementing pre-visit planning at the EvergreenHealth Redmond Primary Care Clinic, there was a measurable increase in care team efficiency. In fact, 92.8% of physicians in the intervention group reported that the degree to which "my care team works efficiently together" was "optimal" or "good" compared to their baseline of 77% and compared to the control groups' steady average of 62% pre- and post-survey results. Notably, the proportion of physicians in the intervention group that reported a high degree of care team efficiency was nearly 30% higher than the AMA national benchmark.
</p>
<p>
Physicians in the intervention group also saw an increase in time spent on direct patient care and a decrease in time spent on indirect patient care as compared to the control group. Time spent on indirect patient care in the intervention group was less than that of the AMA national benchmark.
</p>
<p>
The results also showed that burnout was less severe in the intervention group, although the proportion of people experiencing burnout had risen.
</p>
<p>
"What this meant for the physicians is that there was an increased level of engagement, which positively impacted our staff and patient experience," says Besty Hail, executive director of primary care at EvergreenHealth Primary Care Administration.
</p>
<p>
"Participating in the wellness PTI was one of several ways that EvergreenHealth demonstrated its commitment to improving wellness," says Dr. Sharma. The organization sought feedback from its physicians and advanced practice providers through monthly town-hall style meetings as well as their regularly scheduled meetings. "Common themes were the need for increased administrative support for prescription refills and inbox management," Dr. Sharma says. "We are launching new pilots to address these concerns."
</p>
<p>
The WSMA Foundation and the AMA continue to work on several fronts to address the physician burnout crisis, which has only been exacerbated by the pandemic. Through research, collaboration, advocacy, and leadership, we are working to center the patient-physician relationship and to make physician burnout a thing of the past.
</p>
</div> | 5/2/2022 12:11:14 PM | 5/2/2022 12:08:27 PM | 5/2/2022 12:00:00 AM |
| improving_care_for_underserved_patients | Improving Care for Underserved Patients | WSMA_Reports | Shared_Content/News/Latest_News/2022/improving_care_for_underserved_patients | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/march-april-2022-reports-cover-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports March/April 2022" /></div>
<h5>March 8, 2022</h5>
<h2>Improving Care for Underserved Patients</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
By any measure, the Puget Sound region would be considered one of the friendliest places in the U.S. for members of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community. Yet when Amish Dave, MD, MPH, moved here from Boston after training in Chicago and the Bay Area, he was surprised at what he found.
</p>
<p>
"This is a super progressive place, but medical care for LGBTQIA patients is still lacking compared to other places in the country," says Dr. Dave, a rheumatologist at Virginia Mason Franciscan Health. "When I first moved here, not every primary care physician knew how to prescribe PrEP. That's not an issue I had seen in the Bay Area or Boston. Something that has such great efficacy was not regularly being discussed."
</p>
<p>
Pre-exposure prophylaxis, or PrEP, is a drug regimen that has been proven to reduce the risk of HIV transmission from sex by 99%. As such, PrEP has become a cornerstone for primary care for many in the LGBTQIA community.
</p>
<p>
Dr. Dave's experience underscores one of the ongoing challenges in medical care: addressing the needs of underserved patients. Despite the progress made so far, race, ethnicity language, and sexual identity can all still serve as barriers to care, no matter how inadvertently.
</p>
<h3>Unnecessary barriers</h3>
<p>
For some patients at Virginia Mason, getting PrEP was a cumbersome process. "People were being referred to the infectious disease department," says Dr. Dave. "It was unfair to them to pay two copays and wait a long time to get their prescription."
</p>
<p>
Dr. Dave embarked on a campaign more than five years ago to help educate his colleagues about PrEP and more generally the importance of understanding their patients' sexual history. "We formed a task force and did a road show across the campuses," he recalls. What conversations with physicians and clinicians revealed was that many didn't feel comfortable taking a patient's sexual history. As a result, "they were missing opportunities to do appropriate screenings for things that the queer community might be at higher risk for, such as certain cancers or depression."
</p>
<p>
"We talked about the importance of taking a sexual history, the importance of PrEP, the importance of templates," says Dr. Dave. The upshot was a process that eliminated the barriers that were sometimes in place before for LGBTQIA patients.
</p>
<p>
Unfortunately, such barriers are hardly uncommon for patients in underserved populations. Sometimes they are actually part and parcel of standard treatment regimens.
</p>
<h3>Outdated race-based standards of care</h3>
<p>
For several years, Mabel Bodell, MD, a nephrologist at Confluence Health in Wenatchee, regularly treated a patient who identified as African American. "She's very savvy about her numbers," Dr. Bodell says. "She always looks at her creatinine levels and her GFR."
</p>
<p>
The patient regularly asked Dr. Bodell why test results were interpreted differently for white patients and African American patients. "I would always answer, 'Because there were differences in the original study'" upon which the treatment standards were based.
</p>
<p>
The test in question, which measures estimated glomerular filtration rate, or eGFR, has been widely used to determine whether a patient is a candidate for a kidney transplant. A healthy patient has an eGFR of 60. Patients with an eGFR of 20 or lower are transplant candidates.
</p>
<p>
But for years, that was true only if they were white. The original study in 1999 misinterpreted higher creatinine levels in Black patients as a sign that they had a higher muscle mass. As a result, the test multiplied Black patients' eGFR numbers by 1.2. That meant Black patients had to wait longer for a kidney transplant, even though they were far more likely to suffer from serious kidney disease.
</p>
<p>
About a year ago, Dr. Bodell's patient came to back to her office with a surprise. She had taken a DNA test and learned that she was more than 50% white. Suddenly, the patient qualified for a kidney transplant after years of being told she did not, solely on the basis of the race-based standard.
</p>
<p>
"It was really hard for me to explain," said Dr. Bodell. "Maybe this race-based stuff should not be in our calculations. Examples like that make you think about all of those formulas that include race. Maybe they are harming more patients than helping them."
</p>
<p>
The conversation with her patient crystalized a conversation that was happening within Confluence. "There were a lot of people internally already asking questions, knowing that African Americans are more likely than white Americans to have kidney failure and higher rates of end-stage kidney disease but less likely to get a kidney transplant," said Dr. Bodell, who is a member of the Health Equity, Diversity and Inclusion Council at Confluence. "We took our time to reassure ourselves it was the right thing to do." The review process included a wide range of internal partners, from risk management to the laboratory medical directory.
</p>
<p>
Ultimately, Confluence eliminated the race-based standard in July of 2021. The American Society of Nephrology recommended eliminating the standard last September.
</p>
<h3>The role of physician champions</h3>
<p>
There are plenty of other examples of disparities affecting care. Endometrial cancer is one of the most common gynecological cancers, with a high survival rate. But the rate of survival for Black women is much lower. While a series of issues contribute to the reduced survival rate, one of them is the diagnostic test used to determine whether a biopsy is needed.
</p>
<p>
According to a study led by Kemi Doll, MD, a gynecologic oncologist with the University of Washington School of Medicine, the use of transvaginal ultrasound to determine whether a biopsy was warranted was four times more likely to miss endometrial cancer in Black women than in white women. That's because Black women are more likely to have fibroids and other non-endometrial growths, which lead to false negative results.
</p>
<p>
Dr. Doll's analysis of her research was published in the August 2021 issue of JAMA Oncology, and the study has widely been hailed as groundbreaking advancement in addressing endometrial cancer disparities.
</p>
<p>
While change is difficult, it can be accomplished. What it takes is leadership from physicians to advocate for improvement. "Having a champion or a series of champions is important," says Dr. Dave. "Dedicating time for people to teach people about it is very important, and that lies at the system level."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
</p>
<p>
<em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/8/2022 10:56:01 AM | 3/3/2022 1:10:29 PM | 3/8/2022 12:00:00 AM |
| doctors_making_a_difference_mary_beth_bennett_md | Doctors Making a Difference: Mary Beth Bennett, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors_making_a_difference_mary_beth_bennett_md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/dmd-website-image-bennett-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Mary Beth Bennett, MD" /></div>
<h5>March 4, 2022</h5>
<h2>Doctors Making a Difference: Mary Beth Bennett, MD</h2>
<p>
Mary Beth Bennett, MD, a first-year pediatric resident in Seattle, says it was opposite extremes of weathera widely reported severe winter storm that left her family and thousands of others without power and enduring freezing temperatures for days in Texas, followed by last summer's record-setting heat wave after relocating to Seattlethat inspired her to sound the alarm on the connection between climate change and public health. As a member of the Washington Physicians for Social Responsibility's Climate and Health Task Force, Dr. Bennett is helping to advocate for policies such as building electrification and more funding for climate change mitigation and public transportation. Here, she talks with <em>WSMA Reports</em> about these efforts and how physicians can help patients connect the dots between climate change and their personal health.
</p>
<p>
<strong><em>WSMA Reports:</em> Last summer you wrote a guest column in the Seattle publication <em>The Stranger</em> urging everyone to treat climate change as a public health emergency. You advocate for transitioning away from the use of natural gas for cooking and heating in homes; why is that such an important component of how climate change and public health intersect?</strong>
</p>
<p>
<em>Dr. Bennett:</em> Kids who grow up in homes with gas stoves are more likely to develop asthma and experience wheezing related to asthma, which can mean a trip to the emergency room or even worse. And we see from new data that our gas-powered homes and buildings are a major source of air pollution in cities. I can't think of a clearer example of a policy win-win than this: Reduced pollution from gas-powered appliances will lead to healthier cities and families, while also addressing global warming through reduced fracking.
</p>
<p>
<strong>The extreme heat we saw last summer in the Pacific Northwest is a tangible effect of climate change. What are some other less-obvious public health effects that physicians should be aware of? </strong>
</p>
<p>
Vector-borne illnesses are increasing, so diseases that were previously seen almost exclusively in tropical climates are now hitting communities thousands of miles away. We're also seeing increased rates of depression caused by fears about the climate. Related to this is the fact that the U.S. birth rate has declined six years in a row: A quarter of childless adults cite worries about the climate as a key factor in their decision not to have children (Morning Consult, 2020).
</p>
<p>
<strong>What is the Washington Physicians for Social Responsibility's Climate and Health Task Force working on in terms of policy or public health messaging?</strong>
</p>
<p>
WPSR's Climate and Health Task Force is currently advocating for policies related to building electrification, increased investment in public transportation, enhanced funding for climate change mitigation, and adaptation efforts in low-income communities. We approach this advocacy with a specific focus on health equity, since we know the people most likely to suffer the harmful effects of climate change include historically marginalized groups.
</p>
<p>
<strong>How can physicians talk with their patients about climate change and how it relates to their personal/family health?</strong>
</p>
<p>
It's a great question because doctors already have too much to cover in too little time during primary care visits. Step one is for doctors to educate themselves better on how climate issues affect healththere's so much data out there that experienced and newer doctors didn't learn in medical school.
</p>
<p>
Step two is to look for opportunities to link climate issues to health situations that patients are currently facing. For example, when I'm talking with a family whose child has asthma, I'm careful to mention all the potential irritants and exposures that could trigger wheezing, including smoke from cigarettes and fumes from a cooking with a gas stove.
</p>
<p>
Outside of patient visits, I think we should use our platform as medical professionals to advocate for better climate policies to improve health for entire communities. Patients rely on us to tell them how to be healthier and we're not doing our jobs if we're unaware of how the climate affects health.
</p>
<p>
</p>
<p>
<strong>Are there ways health care organizations and practices can support climate change goals?</strong>
</p>
<p>Yes, we should be leaders in reducing energy waste, in incentivizing employees to use public transit, and in composting and recycling. It's important for every organization with a public health mission to be adopting practices that reduce emissions. "Do no harm" is an ethos that we should apply not only to patients but to the larger ecosystem in which our health
care organizations exist.</p>
<p><em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em></p>
</div> | 3/4/2022 11:43:43 AM | 3/3/2022 12:35:43 PM | 3/4/2022 12:00:00 AM |
| increasing_physician_diversity | Increasing Physician Diversity | WSMA_Reports | Shared_Content/News/Latest_News/2022/increasing_physician_diversity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/march-april-2022-reports-cover-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports March/April 2022" /></div>
<h5>March 3, 2022</h5>
<h2>Increasing Physician Diversity</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
As a Black female physician, Nwando Anyaoku, MD, the first chief health equity officer for Swedish Health Services in Seattle, knows all too well how lack of physician diversity affects health outcomes for patients from marginalized communities.
</p>
<p>
On the day Dr. Anyaoku spoke with WSMA Reports, another Black woman had shared how five white male gynecologists had once each recommended a hysterectomy for treating her uterine fibroids. It wasn't until the young woman saw a Black female doctor that she was given other options, thus preserving her fertility. "That doctor gave her different care and that completely changed the course of her life," says Dr. Anyaoku.
</p>
<p>
Changing the course of people's health care experience is a critical reason for increasing physician diversity. Studies have shown that having racial, ethnic, gender, and socioeconomic diversity in the physician workforce has powerful benefits for the health care system. Diversity leads to better access, better quality of care, and therefore, better outcomes for patients.
</p>
<p>
Diversifying the workforce requires addressing both the immediate shortfall and long-term needs of physician diversity. That's important not only in the Puget Sound region among the most rapidly diversifying areas of the countrybut throughout the state, as population growth accelerates diversity statewide.
</p>
<h3>Addressing the immediate shortfall</h3>
<p>
Over the last decade, health organizations throughout Washington state have prioritized health equity, galvanized in part by the 2012 national call to action
to eliminate health care disparities by the American Hospital Association, the Association of American Medical Colleges, and other organizations.
</p>
<p>
The events of 2020, including significant COVID-19-related health disparities, the murder of George Floyd, and the Black Lives Matter movement, spurred organizations to redouble their efforts. During a special meeting in June 2021, the American Medical Association adopted a policy to increase diversity among physicians to further its "commitment to racial justice and equity within the medical profession."
</p>
<p>
In 2021, Swedish Health Services launched a new office of health equity, diversity, and inclusion to tackle health equity from all angles. Since March 2021, Dr. Anyaoku has directed the organization's programs to measure and improve equity in care delivery and outcomes. To address workforce development and workplace culture, Swedish also named a diversity, equity, and inclusion officer. Mardia Shands, who previously served as the chief diversity officer at TriHealth in Greater Cincinnati, started in that inaugural role in April 2021.
</p>
<p>
Shands says Swedish takes an intentional two-pronged approach to increasing physician diversity. The first prong is tapping their residency pipeline, particularly those residents who've already gone through Swedish's cultural competency training, to fill vacant physician positions. "We're home growing our underrepresented minority physician staff... And that's how we're being intentional about building the clinic [physician] staff," says Shands.
</p>
<p>
To attract Black physicians to the Pacific Northwest, Swedish recently partnered with Meharry Medical School, a historically Black college in Nashville, Tennessee. The first cohort of third-year residents arrived for surgical rotations at Swedish in January. The program provides them with housing and living expenses. Eventually other specialties will be added. "When it's time for them to do their residency matching, then they've had that visibility, and they've had experience with us. And that helps to build that pipeline going forward," says Dr. Anyaoku.
</p>
<p>
Recruiting diverse physicians in pairs is the second prong. "It lessens the burden on you being the only one. Then you have a support mechanism that's kind of built in," says Shands.
</p>
<h3>Focusing on retention</h3>
<p>
Recruiting diverse talent isn't enough if those physicians don't feel they belong once they get there, says Dr. Anyaoku. "One of the challenges that health systems have is that they go out and recruit diverse candidates, but they don't work on having a welcoming community and an organization that values their diversity," says Dr. Anyaoku. "Then they're pressured to conform. And if they conform, then you lose the value of their diversity."
</p>
<p>
To ensure retention, Swedish focuses on creating an environment where diversity is respected and accepted, says Shands. It does so by training all new and existing residents and medical staff on cultural competency. "It orients them to the fact that this is the environment we are creating for our physician staff ... the behavioral expectations in terms of being accepting of people from other cultures, backgrounds, and ethnicities, and so forth," says Shands. "They feel as though this is a place where I belong. And that helps to retain people."
</p>
<p>
To foster a workplace culture where diversity thrives, Swedish is also developing a mentorship program for minority physicians and an online learning platform to introduce medical staff to concepts around cultural competencies, DEI, and health equity.
</p>
<p>
But focusing on overall physician diversity can be a "false equivalence," says Shands, if some marginalized groups continue to be underrepresented. Even when physician diversity matches the community diversity, that doesn't mean those patients will see a doctor who represents them.
</p>
<p>
"Representation may not necessarily equate to the health outcomes that we're looking for," says Shands. "What we try to do is to augment the fact that we may not always get one-for-one with building cultural competence of the majority population, so that if we have a white [physician] who has passed cultural competence in dealing with minority patients, that suffices as well."
</p>
<h3>Taking the long view</h3>
<p>
Barriers to workplace diversity often begin in childhood. For many Black and other marginalized youth, medicine doesn't seem like a possible career choice because they don't see themselves reflected among physicians. And many often lack access to educational programs that put them on a path to a career in medicine.
</p>
<p>
The University of Washington School of Medicine's "Doctor for a Day" program has been filling those gaps since 2014. The program provides middle and high school students of color in the greater Seattle area with hands-on learning in health care fields taught by health care professionals from similarly diverse backgrounds. The all-day events take place about 10 times a year at Harborview Medical Center, UW Medical Center, and other locations around Seattle. Since it first began, more than 2,500 students have participated in Doctor for a Day, now run by the medical school's Center for Health Equity, Diversity and Inclusion.
</p>
<p>
Estell Williams, MD, the program's executive director, credits her own childhood experience in Oakland, California, through the Stanford Medical Youth Science Program, with laying the foundation for her own success. "They were helpful to me being able to see the profession and really have that direct mentorship that was so integral in my growth and development along my educational path," says Dr. Williams.
</p>
<p>
While UW encourages physicians of color to lead the programs, it welcomes participation from all physicians interested in inspiring the next generation. For physicians, participating has positive effects, as well. "This really does affect physician wellness and burnout," says Dr. Williams. "Seeing what that excitement about medicine and learning medicine looks like, being able to have an impact on what those future physicians will look likeI think all of that is a huge takeaway for those physicians, residents, and fellows to volunteer."
</p>
<p>
Johnnie Orozco, MD, a UW hematologist and oncologist had that first-hand experience after he led a Doctor for a Day event.
</p>
<p>
"The most important thing for a lot of these Black and brown faces is for them to say, 'You mean, I could do this, too?' which is a big hurdle in these communities that we don't really appreciate unless you're in it. The idea is that if you don't see it, you can't be it," says Dr. Orozco, who shares his experiences as a first-generation Mexican American. "For me it was exciting to lead a session, and a moment of hope... to have people who are living that kind of marginalized health care experience to now all of a sudden realize, 'I can potentially find my way to this medical field and take care of my community.'"
</p>
<p>
When it comes to the next generation, the Doctor for a Day program takes the long view, says Dr. Williams. "When you start that investment at the third-grade level, you have a 15-year investment at least before you're going to know if students actually matriculate into health professions," she says. Her office hopes to publish data later this year on the program's impact.
</p>
<p>
To reach high school students, often the last chance to impact career choice, UW is relaunching its U-DOC summer enrichment program, which ended in 2012 due to a funding shortage. Targeted to rising juniors and seniors from disadvantaged communities throughout Washington state, this intensive learning experience mimics college life and includes peer-to- peer mentoring, science classes, and shadowing in a clinical setting. Students selected for the U-DOC program receive a full scholarship, which covers on-campus costs and reimbursement for a round trip to Seattle. Several U-DOC graduates are now in medical school or residency.
</p>
<p>
Whether it's now or in the future, better patient and community outcomes are the end goal for increasing workforce and workplace diversity, says Shands. "We're not doing this work for PR purposes, or to, you know, right the wrongs of racism, discrimination, and whatnot. From a clinician perspective, this is all about creating equitable health outcomes for every patient that comes through our doors."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
<p>
<em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/3/2022 12:22:49 PM | 3/3/2022 12:20:30 PM | 3/3/2022 12:00:00 AM |
| teaching_the_skills_of_leadership | Teaching the Skills of Leadership | WSMA_Reports | Shared_Content/News/Latest_News/2022/teaching_the_skills_of_leadership | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/jan-feb-2022-reports-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports January/February 2022" /></div>
<h5>January 12, 2022</h5>
<h2>Teaching the Skills of Leadership</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
A roomful of students sit together composing haiku as an exercise in putting their thoughts into words. Each of the three stanzas reveals a range of emotions, from excitement to apprehension. "I have much to learn," one composition begins. It's a thought widely echoed by others.
</p>
<p>
The class isn't in literature or any of the liberal arts. It's a class in leadership. And the students aren't your normal collection of pupils. Most of them are physicians, and all of them are health care professionals with years of experience.
</p>
<p>
The exercise is part of the WSMA Physician Leadership Course. The course is taught by Ed Walker, MD, MHA, the driving force behind WSMA's Center for Leadership Development, the home of WSMA's expanded leadership education curriculum whose beginnings can be traced to the launch of the course in 2010.
</p>
<p>
For physicians taking on new leadership roles, whether as the head of a physician-led team or in an administrative capacity, the course provides skills that aren't taught in medical school.
</p>
<p>
"Medicine has always looked for people who have the ability to stay disciplined and push themselves to their limits. But while that works in the emergency room, so that people will stay on task, it doesn't bode well for teams. Because in a team-oriented environment, you want to use the strength of the team, not your individual skills," says Dr. Walker. "The idea of this course is to tell people what's important, so that they can learn what they need to learn to lead."
</p>
<h3>Driving force</h3>
<p>
Along with Dr. Walker's original physician leadership course, or PLC for short, WSMA's leadership development catalog now includes the Dyad Leadership Course, a by-invitation Leadership Masterclass, Leadership Seminars, and the Effective Board Governance Course. Complementing the Center for Leadership Development's curriculum is WSMA's annual Leadership Development Conference.
</p>
<p>
WSMA's physician training focuses on making physicians feel safe in learning to lead-admitting they don't have all the answers, says Dr. Walker. Team building exercises like haiku writing break down defensive reflexes and foster a sense of camaraderie. "Physicians have to feel comfortable in front of each other, making mistakes and saying, 'Hey, I don't know how to do this'-that's a very important part of the course," he says.
</p>
<p>
Kristi Lineberry, MD, medical director of the department of imaging for St. Michael's Medical Center in Silverdale, is a graduate of the course. Along with technical expertise gained, Dr. Lineberry says the PLC helped her recognize her leadership style and, more importantly, how that style relates to other members of her team.
</p>
<p>
"I was able to apply that immediately," says Dr. Lineberry. "It's realizing that maybe you yourself have some weaknesses, and that you need to surround yourself with people who can complement not only your strengths, but your weaknesses. For instance, I'm not a good numbers person. I'm better at other aspects of leadership, so I need to have on my team people who understand numbers and finances."
</p>
<p>
Part behavior-modification course, part competency-based learning, the PLC- what Dr. Walker calls a 101 course-is an amalgam of everything he brings to the table. Dr. Walker's 40-year background in medical education and executive coaching includes being the founding director of the University of Washington Healthcare Leadership Development Alliance, working as a trained psychiatrist, and serving as medical director at the UW Medical Center.
</p>
<p>
Dr. Walker's reputation is an important factor in why many health care systems choose the WSMA for their leadership training. "His reach is pretty remarkable. It wouldn't be a stretch to say that either the physician has been to an Ed Walker course or has had mentoring or support from somebody who has," says Jamie Park, MD, chief medical officer at UW Medicine Valley Medical Center in Renton.
</p>
<h3>Partnering opportunities</h3>
<p>
Along with offering open-enrollment courses, WSMA's Center for Leadership Development actively partners with health care systems to create targeted programs for them.
</p>
<p>
MultiCare has partnered with the WSMA since 2017, bringing both the PLC and dyad course in house. Each year the program trains 25 to 30 physician leaders and advanced practice providers. Some 125 MultiCare providers, and 40 to 50 dyad partnerships have already completed the training.
</p>
<p>
"It truly is a partnership. We'll do a briefing ahead of time with them on what the organization is going through. Ed comes in knowing the dynamics and the big things eating up our time and our emotional energy," says Karen DeLorenzo, director of provider leadership and organizational development and wellness for MultiCare Health System in Tacoma.
</p>
<p>
All of MultiCare's CMOs have been through the partnered program, says DeLorenzo, including some front-line medical directors, part-time medical directors, and even some informal leaders who have been identified by their CMOs as influential.
</p>
<p>
"That's been a huge relationship builder for them and helps them have the same language to look at things and understand each other... and have each other's backs," says DeLorenzo.
</p>
<p>
The pandemic added a new urgency to the need for leadership development. Seattle Cancer Care Alliance, which had its own medical leadership development program since 2007, began its partnership with the WSMA during the pandemic.
</p>
<p>
The WSMA modified the dyad course to create a team-based leadership course specific to SCCA. Anyone the physician leader deems critical, such as service line managers, operational managers, intake scheduling leads, nurse leads, or advanced practice providers, can participate.
</p>
<p>
"We did that because very often our [physician] leaders have to work not just with a single operational dyad partner, but also other team members that are critical to success," says Brittany McCreery, MD, director of medical staff practice for SCCA. SCCA launched the WSMA-led program in spring 2021, with six clinical teams going through it. Another six to eight teams will participate in spring 2022.
</p>
<p>
"Our physician leaders appreciated some dedicated time to stop and slow down from all that was happening around them in the pandemic, and actually work on their team building and communication," says Dr. McCreery. "Oftentimes we just assume that by putting a physician in a leadership role with an operational leader that they're just going to get together on their own and make a partnership happen. And, in reality, a lot of things get in the way of that."
</p>
<h3>Creating a wellness system</h3>
<p>
The goal of physician training is creating a health care system that's designed for wellness both for patients and physicians, says Dr. Park. "Physicians have to be involved in change. And to be involved in change, you have to be trained in the concepts that allow you to help organizations change."
</p>
<p>
For the last decade, each year Valley Medical Center has sent a group of physician leaders to WSMA's physician leadership course. Last year, Valley Medical Center partnered with the WSMA to do a system-wide training in house.
</p>
<p>
Over the years, the investment in WSMA leadership courses has paid off both for the physicians and for Valley Medical Center. "We were lucky enough to partner with Ed when he was developing the first dyad course. In the first two courses, we had something like 14 dyads... and many of them still work here," says Dr. Park. "The training that WSMA offers, I don't think there's a better one out there. There's no scenario in which this would not be a good usage of a physician leader's time."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
</div> | 2/9/2022 1:11:41 PM | 1/5/2022 3:54:21 PM | 1/12/2022 12:00:00 AM |
| doctors_making_a_difference_tiffany_spanier_md | Doctors Making a Difference: Tiffany Spanier, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors_making_a_difference_tiffany_spanier_md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/dmd-website-image-dr-spanier-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Tiffany Spanier MD" /></div>
<h5>January 11, 2022</h5>
<h2>Doctors Making a Difference: Tiffany Spanier, MD</h2>
<p>
Burnout is a well-documented problem affecting the physician community-one that has been
exacerbated by the stresses and traumas of the COVID-19 pandemic. For the past decade, pediatrician Tiffany Spanier, MD, who practices at Allegro Pediatrics in Bellevue, has been motivated to
help other physicians combat burnout through physician coaching. While the roots of and solutions for burnout need to be addressed on a systemic level, coaching can help physicians build a foundation for well-being in their daily lives and practices.
</p>
<p>
<strong>WSMA Reports: What is physician coaching?</strong>
</p>
<p>
Dr. Spanier: Physician coaching is a process that allows physicians to better understand their present circumstances and empowers them to be who they want to be and create the future they desire. Physicians partner with a coach in a safe space that allows deep reflection to increase self-awareness. Coaching assists physicians in clarifying goals and values, identifying obstacles that are holding them back, and developing strength-based strategies. How can coaching help physicians in their day-to-day practice? Similarly, how can it help outside of practice? Doctors participate in coaching for a variety of issues, including work-life balance, career fulfillment, burnout prevention, personal well-being, leadership, and effective interpersonal communication. Through coaching, physicians can better understand their beliefs, mindsets, and blind spots. Understanding these foundational elements supports physicians in seeing more clearly where they are stuck, what needs to change, and finding that first step forward, both personally and professionally.
</p>
<p>
<strong>How did you get involved with coaching and how have you incorporated it into your practice as a physician?</strong>
</p>
<p>
I have been passionate about addressing physician burnout and supporting well- being for the past decade. After my own pursuit to improve my well-being and find greater satisfaction in my career, I obtained certification as a mindfulness teacher, and I also completed training in self-compassion for health care communities. After learning about physician coaching in a 2019 study by Liselotte Dyrbye, MD, I decided to become a master certified physician coach. I find that coaching fosters a presence of openness and curiosity that has enabled me to be more present with my work, patients, and colleagues.
</p>
<p>
<strong>Among physicians you see for coaching, what are some of the most common challenges they're facing?</strong>
</p>
<p>
Stress, dissatisfaction, a lack of fulfillment, and the desire to grow personally and professionally. Many physicians are looking for a way to practice with integrity and authenticity, while seeking more work-life balance and passion for their work. They want to foster a sense of agency, the feeling of control over actions and their consequences, that allows them to make a difference and serve from a place of excellence.
</p>
<p>
<strong>Have you seen an increase in physicians with pandemic-related burnout?</strong>
</p>
<p>
According to a survey by Medscape, about two-thirds of physicians surveyed say their burnout has become more intense during the pandemic. This is consistent with the increased levels of stress, burnout, and exhaustion that I have seen in physicians I have coached.
</p>
<p>
<strong>Are there a few simple coaching tricks physicians struggling with COVID-19 burnout can start to incorporate into their daily lives?</strong>
</p>
<p>
One of my favorite concepts is "intention plus attention equals manifestation." Being intentional helps us recognize how we want to be, how we want to show up, and how we can purposefully align with our values and vision. It is the compass that influences us in the moment.
</p>
<p>
Philosopher William James states, "At the end of your days, your life will have been what you paid attention to." When we keep bringing our attention back to our intention, we develop focus, clarity, and the creativity needed to transform intention into action. Our manifestation then becomes a life well lived, one step at a time.
</p>
<p>
<em>This article was featured in the January/February 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/11/2022 12:47:29 PM | 1/10/2022 4:48:58 PM | 1/11/2022 12:00:00 AM |
| health_care_as_a_team_sport | Health Care as a Team Sport | WSMA_Reports | Shared_Content/News/Latest_News/2022/health_care_as_a_team_sport | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/jan-feb-2022-reports-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports January/February 2022" /></div>
<h5>January 10, 2022</h5>
<h2>Health Care as a Team Sport</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
As the state Legislature convenes for its working session this January, scope of practice issues will be a topic for potential action yet again. The legislative debate is likely to center around two separate approaches.
</p>
<p>
The first involves addressing the problem of the shortage of health care practitioners. "Washington state, like many other states, has a shortage with its health care workforce," says Sean Graham, WSMA's director of government affairs. "Those shortages have been exacerbated for a number of reasons by the pandemic."
</p>
<p>
Solving that issue will require a long- term investment. In the meantime, however, there continues to be pressure to expand scope of practice for existing practitioners, something unrelated to the pandemic. Supporters of expanding scope often argue that changes are needed to ensure patient access to practitioners.
</p>
<p>
"A lot of those proposals have been kicking around for years, if not decades," says Graham. "There's nothing novel about them other than the time in which they are manifesting. They are perennial proposals that have a COVID racing stripe on them."
</p>
<p>
Scope of practice has long been a thorny issue. "It's a complex dynamic for which there are many inputs and changes occurring in society, at the legislative level, in training, and in the expectations of different groups," says Mika Sinanan, MD, PhD, president of the WSMA and a professor of surgery at the University of Washington.
</p>
<p>
Exactly what the legislative proposals may be remains to be seen as the Legislature returns to session (for several proposals we do expect, see sidebar on p. 12). But one solution to the impetus behind such proposals has already been successfully adopted without legislative intervention. That solution is increased use of physician-led teams. The teams allow practitioners to perform at the top of their license under the leadership of a physician, which eases workforce shortages while also protecting patient safety and access.
</p>
<p>
"Expanding the scope of practice is just one possible solution," says Dr. Sinanan. "Until we are assured that the quality and safety and level of collaboration is clear- and it often is not clear-then we're taking a risk by going that route. Developing the communication ties that are present within high-function clinical teams led by physicians is a better approach."
</p>
<h3>The value of physician-led teams</h3>
<p>
In some ways, physician-led teams are already built into the health care system. With their extensive training, physicians are naturally expected to lead, even though they may need to learn the skills to do so. On medical teams, roles are clear.
</p>
<p>
"As an OB-GYN, I don't enter the OR with the thought of who is in charge of this or that," says Nariman Heshmati, MD, WSMA's vice president. "We all have a part to play based on our experience."
</p>
<p>
The real issue, says Dr. Heshmati, is having each team member perform at the top of their license.
</p>
<p>
"I push people to consider talking less about scope of practice and more about acknowledging that everyone on the team has a critical role to play," he says. "We have to reduce the variability of training at all levels in order to ensure the level of care."
</p>
<p>
At the same time, the team is not about a strictly hierarchical approach to care. "A team means you are working closely with somebody," says Dr. Sinanan. "Someone who is available to bounce things off of, to test hypothesis and challenge assumptions. That makes the quality of care better."
</p>
<p>
This collaborative attitude acknowledges that every member of the team has strengths-and gaps. "Even as physicians, we're continually looking up things," says Dr. Sinanan, who says a team's success depends upon "all members of the health care team having the same openness to what they know or don't know."
</p>
<p>
Teams in certain specialties, such as palliative care, involve a wide range of health care practitioners and others, such as social workers and chaplains. Yet the team approach actually enhances the importance that each team member brings to the group.
</p>
<p>
"There's an exultation of various roles for the people involved," says John Bramhall, MD, PhD. "That's not to diminish the value of non-physicians. If anything, the value of non-physicians is amplified by being coordinated."
</p>
<h3>Improving outcomes by working together</h3>
<p>
Physicians who have led teams readily testify to the benefit such a structure provides. By bringing together all members of a patient's care team, each member gets a fuller picture of the issues to be addressed, offering the potential for better care and outcomes. It also helps to ease the problem of too few health care practitioners, particularly outside of western Washington.
</p>
<p>
"We're in a position here that it's necessary because there aren't enough physicians to go around," says Katina Rue, DO, a family medicine physician in Yakima. She notes that necessity may be a culture shock for older physicians, who weren't taught to work in teams.
</p>
<p>
But her own experience has taught her the value of teams. "When teams work together, it brings about better patient care with better outcomes," says Dr. Rue. "Medicine can continue to improve by getting the disciplines together, with physicians in a place where they can lead the groups collaboratively."
</p>
<p>
When she worked with a homeless population in her clinic, Dr. Rue led a team that included a nurse care coordinator, a pharmacist, and a behavioral health consultant, among others. "Everyone has a piece to play," she notes. "It's really much bigger than the physician piece. But the physician piece is important. The physician needs to have a pulse on what's going on with the rest of the team."
</p>
<p>
The team approach also offers physicians a broader perspective than they can get just from time in the exam room. "It's part of our responsibility to our patients to really understand what their needs are, but also the needs of their families and community," Dr. Rue notes. "If we are not listening to the other members of the team- actively communicating with them and reviewing their notes, seeking their input-we're going to miss the boat on what patients and the community need."
</p>
<p>
As the conversation about scope of practice heats up in the Legislature, the focus should remain on what's best for patient care. "We have strongly believed that physician-led teams, based on physicians' training, background, and experience, is the best approach," says Dr. Sinanan. "Until such time as the training, background, and experience of other groups is equal to that, we don't believe that they are able to handle the same standardized level of quality care." Meanwhile, the problem that prompts the Legislature's interest will require longer-term investment to create more opportunities for training to solve the shortage of workers.
</p>
<p>
Having a physician-led team won't solve all those workforce issues, but it can make a difference. It can also build on the structures already in place to ensure better care and outcomes.
</p>
<p>
"Health care is a team sport," says Dr. Heshmati. "We've got to do it together, but we've got to ensure that we're doing it the right way. How do we all bring the best of what we have to the table to improve outcomes?"
</p>
<p>
When that succeeds, as it can on a physician-led team, the results can tran- scend the debate about scope of practice.
</p>
<p>
"When everyone is focused, it's not about you or me," says Dr. Heshmati. "It's about the patient. They always come first."
</p>
<p>
<em>John Gallagher is WSMA Reports senior editor.</em>
</p>
<p>
<em>This article was featured in the January/February 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/10/2022 11:58:01 AM | 1/5/2022 3:28:56 PM | 1/10/2022 12:00:00 AM |
| moving_the_needle | Moving the Needle | WSMA_Reports | Shared_Content/News/Latest_News/2021/moving_the_needle | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports cover November-December 2021" src="/images/Newsletters/Reports/2021/nov-dec-2021-reports-cover-645x425px.jpg" class="pull-right" /></div>
<h5>November 8, 2021</h5>
<h2>Moving the Needle</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
For nearly 20 years, Geoff Jones, MD, has practiced family medicine in Newport, the largest city in Northeast Washington's Pend Oreille County. Sharing borders with Idaho and Canada, Pend Oreille (pop. 13,000) is known for its wilderness beauty and pioneer spirit. Timber and mining have long been the region's largest employers. The Washington Academy of Family Physicians' 2016 family physician of the year, Dr. Jones spends his spare time enjoying fly fishing, hiking, and camping. He loves the people in this rural community.
</p>
<p>
Every time he is in the exam room at the Newport Health Center talking to a long-time patient, he asks a question he has asked many, many times: 'What are your thoughts on the COVID vaccine?'
</p>
<p>
"From there the conversation can proceed however they want to take it," he says. "The key has been the open- ended question and having the vaccine in the clinic to give them a shot right then and there."
</p>
<p>
By most standards, Washington state has done a great job with COVID-19 vaccinations. The state has consistently ranked in the top 10 states with the highest vaccination rates and is outpacing the United States as a whole. But the big picture veils a more nuanced reality. While vaccination rates are extremely high in the heavily populated western part of the state, figures in eastern rural areas tell a far different story.
</p>
<p>
In counties such as Pend Oreille, Ferry, and Stevens, vaccination rates are less than half of those in urban areas. By early fall, little more than a third of people in those counties have been fully vaccinated. By contrast, about 80% of the population in King County was fully vaccinated.
</p>
<h3>Rural doctors speak out</h3>
<p>
For physicians in the region, the hope is that they can use their trusted role in their communities to allay patient concerns and lead to a better vaccination rate.
</p>
<p>
"People want to sit down and talk about specific questions they have about the vaccines," says Samuel Artzis, MD, health officer for the Northeast Tri County Health District, which encompasses Ferry, Pend Oreille, and Stevens counties. "About the only person with whom they can have an educated conversation and get accurate information is going to be a private physician."
</p>
<p>
Dr. Artzis and Dr. Jones are two of the physicians participating in WSMA's "Talk to Your Doctor" campaign, a partnership with the Washington State Department of Health to improve confidence in COVID-19 vaccination in Artzis' health district. The campaign, featuring videos with local doctors, will be promoted across popular web platforms and supplemented with traditional media outreach and print resources to try to increase vaccination rates in the region.
</p>
<p>
Physicians engaged in the effort believe that the campaign will be effective.
</p>
<p>
"A good percentage of people here are in a category where they're highly unlikely to ever receive a vaccination," says Dr. Jones, citing the current polarization around the COVID-19 vaccine. "But we do have a good chunk of people who I think are amenable to having a conversation with their local physician about getting a vaccination. We've really been targeting that population, and it's been a surprising success. ... I made a commitment to myself that I was going to talk to every single patient who hasn't had a shot about COVID vaccination."
</p>
<h3>A host of challenges</h3>
<p>
Trying to convince one patient at a time won't be easy. For one thing, the pandemic may have exacerbated the impact of vaccine resistance, but it didn't invent it. Childhood vaccination rates in the state's rural counties are significantly lower than the state average.
</p>
<p>
"Stevens County has an issue of not addressing vaccine hesitancy previously with our under-two population and new moms," says Caleb Holtzer, MD, a family physician at Providence Northeast Washington Medical Group in Chewelah. "It's certainly amplified by the current political rhetoric, but even before that, we had significant health disparities around preventive medicine and vaccinations for children."
</p>
<p>
Such challenges take place in the context of months of mixed messages, even if they were understandably so. Because the virus is of such recent origin, knowledge about how to fight it changed rapidly. Unfortunately, pronouncements about it didn't always reflect the shifting understanding of the virus.
</p>
<p>
"Every time the government comes out with a recommendation, it's an absolute," said Edward Johnson, MD, a family physician at Providence Northeast Washington Medical Group in Colville. "They say, 'You have to do this and it will do that.' Then three weeks later, it didn't do that."
</p>
<p>
Underpinning all of these issues is a culture that is generally more conservative and opposed to government interventions. Add in a polarized political environment and a seemingly endless stream of misinformation, and you have what Dr. Holtzer calls "a militant anti- vaccination campaign that is a whole different level than run-of-the-mill resistance." Instead of just refusing to get vaccinated themselves, some people are actively advocating against vaccination.
</p>
<h3>A delicate balance</h3>
<p>
Still, conversations between physicians and patients can succeed in moving the needle-literally-if done properly.
</p>
<p>
"The best strategy is to listen to people's concerns, even if they seem far-fetched," Dr. Holtzer says. "Give them an open, honest listening and then provide them with information about safety and the effect the disease is having on our community."
</p>
<p>
Dr. Johnson says that the impact of COVID-19 on the community has resonated with patients, but perhaps not in the way most people would expect. Rather than talk about the suffering the disease itself causes, patients respond to how it might affect people who don't have COVID-19.
</p>
<p>
"I get more buy-in with a message that by getting this vaccine, you can save your loved one's life," he says. "If they come in to the hospital with a motor vehicle accident, there are no beds. That's a more effective message."
</p>
<p>
That sobering statement is far from theoretical. Critical-access hospitals in rural areas are so overwhelmed that there is no room for accident victims or heart attack patients.
</p>
<p>
"We are trying to send people to Spokane or elsewhere in the state," says Ramon Canto, MD, a pulmonologist at Providence in Colville. "We even have feelers (out) to Montana and Idaho."
</p>
<p>
No matter the message the physician uses, the conversation needs to strike a delicate balance.
</p>
<p>
"As physicians, we have to walk a fine line between confronting people on vaccination while maintaining our credibility to treat them for other conditions," says Dr. Holtzer. "We have to respect what people want to focus on."
</p>
<p>
As it does with other medical conditions, it may take multiple conversations before a patient agrees to be vaccinated. "Sometimes they don't quit smoking the first time you bring it up, but they do after the third or fourth time," says Dr. Johnson. "It may be the same for vaccinations, too."
</p>
<p>
Despite the misinformation that patients have, they often respect their physician's position, even if they choose not to be vaccinated.
</p>
<p>
"To a certain extent, that trust seems to stay intact," Dr. Canto says. "Some of them are almost ashamed to tell me and avoid the topic. They trust me as a doctor and don't want to offend me."
</p>
<h3>Physicians face frustration</h3>
<p>
The failure to convince people to be vaccinated does take a toll on physicians.
</p>
<p>
"I don't handle this as well as I do people with other self-injurious behaviors, like smoking, drinking, or IV drug use," says Dr. Jones. "I honestly don't know why, but it's harder from a personal, emotional level."
</p>
<p>
It's especially hard for physicians to hear anti-vaccination misinformation from within the ranks of health care workers, including other physicians. Dr. Canto notes that some nurses even counsel patients not to get vaccinated.
</p>
<p>
"It's almost like they have two different lives," he says. "They are really good nurses, compassionate. Then they take off their nurse's uniform and they say they would never put that 'poison' in their body. If you can't convince the people who know the science, how much more difficult is it to deal with the general public?"
</p>
<p>
Unfortunately, the same is true of COVID-19 survivors. People who themselves refused to be vaccinated and then got seriously ill from the virus would seem a natural source to talk to the vaccine hesitant. Yet, survivors are unlikely to take that step, despite having first-hand experience of the toll the virus takes.
</p>
<p>
"The interesting thing is that they won't talk to others in the community," says Dr. Artzis. "There's some stigma attached to it. It would be better than a doctor talking to have a friend say, 'I thought I was going to die, please get vaccinated.'"
</p>
<p>
Ultimately, as more people are vaccinated, physicians will have more availability to treat patients' other health issues.
</p>
<p>
"If one person gets vaccinated, that takes me less time sitting in the clinic talking to folks [about vaccination]," says Kal Kelley, MD, a physician with Ferry County Public Health District. "I'm very frustrated with the investment of time to talk to patients."
</p>
<p>
Still, says Holtzer, there is nothing like the feeling a physician gets when a patient finally agrees to be vaccinated.
</p>
<p>
"It's one of the most satisfying experiences to move people along the spectrum toward getting vaccinated," he says.
</p>
<p>
<em>John Gallagher is a freelance journalist in Washington state who specializes in covering health care. He is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the November/December 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 11/8/2021 9:32:34 AM | 11/8/2021 9:29:08 AM | 11/8/2021 12:00:00 AM |
| no_jab_no_job | No Jab, No Job | WSMA_Reports | Shared_Content/News/Latest_News/2021/no_jab_no_job | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports cover November-December 2021" src="/images/Newsletters/Reports/2021/nov-dec-2021-reports-cover-645x425px.jpg" class="pull-right" /></div>
<h5>November 8, 2021</h5>
<h2>No Jab, No Job</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
On Aug. 31, the chief physician executive at PeaceHealth in Vancouver, Doug Koekkoek, MD, braced for protests by employees against its COVID-19 vaccine mandate. It was their last day to comply or face the consequences, including regular COVID-19 testing, additional masking, and removal from patient care settings or from the work schedule entirely.
</p>
<p>
Dr. Koekkoek had reason to worry: There had already been several vocal protests outside PeaceHealth's locations statewide since the mandate's announcement on Aug. 3. Encountering significant resistance to COVID-19 vaccinations from medical professionals is not something Dr. Koekkoek anticipated when he joined PeaceHealth at the end of March, a time when health care systems were still euphoric about a vaccine roll out.
</p>
<p>
Since the beginning of the pandemic, vaccines have been the best hope in getting the country through COVID-19. But as WSMA Reports goes to press-a timeframe many had hoped would be the homestretch for containing the pandemic- health care systems in Washington state and nationwide find themselves spinning in reverse, with surging cases and hospitalizations fueled by the virus' delta variant. And the unvaccinated.
</p>
<p>
Some of the PeaceHealth protests were organized by fringe online groups, such as Waking Up Washington, that dismissed that a delta variant crisis even existed.
</p>
<p>
When PeaceHealth decided to mandate COVID-19 vaccines, 80% of its workforce was vaccinated. Through educational initiatives and open dialogue, administrators had spent months trying to convince the remaining 20% to get vaccinated. With the delta variant at its doors, PeaceHealth decided to require the vaccine, says Dr. Koekkoek. "We were watching outbreaks in hospitals and in our community, and we thought we can do better in terms of protecting our staff and patients if we had a workforce that was fully vaccinated."
</p>
<h3>Mandate is needed</h3>
<p>
Outbreaks in hospitals throughout Washington state since the pandemic began, including as late as August, highlight the need for mandatory vaccinations in health care settings, says Nathan Schlicher, MD, JD, MBA, WSMA's immediate past president and an emergency physician at Virginia Mason Franciscan Health. "We're still on the front lines of the explosive delta wave," he says.
</p>
<p>
Virginia Mason Franciscan Health and Providence Hospital issued their vaccine mandates on Aug. 6, following in the steps of PeaceHealth, Kaiser Permanente, and MultiCare. UW Medicine was the state's first large health care system to announce a COVID-19 vaccine mandate- on July 19-effective Sept. 10.
</p>
<p>
Shortly after these systems put their facility-specific mandates in place, Gov. Jay Inslee issued an emergency order requiring that employees of most health care and long-term care organizations statewide, as well as K-12 and higher education employees, state employees, and childcare employees, be fully vaccinated by Oct. 18-or risk losing their jobs. Gov. Kate Brown of Oregon issued a similar mandate and deadline for health care organizations for her state. On Sept. 9, President Joe Biden ordered sweeping new federal vaccine requirements for private-sector companies with more than 100 employees, as well as health care workers and federal contractors.
</p>
<p>
With the addition of these mandates, more than 90% of PeaceHealth employees were fully vaccinated and another 4% were partially vaccinated by mid-September, says Dr. Koekkoek. By the state's mid-October deadline, PeaceHealth expects over 94% of employees to be fully vaccinated. "There are clearly nurses and physicians who don't want to be vaccinated. Some of them have more sound reasons than others; some are just fearful. But they're a vocal few," says Dr. Koekkoek.
</p>
<h3>Physicians struggle with implementation</h3>
<p>
In the days after Gov. Inslee's announcement, the WSMA was flooded with messages from members worried about how they should handle compliance. Outpatient practices, many small-staffed and already overworked, were particularly feeling the impact of employees who refuse to get vaccinated.
</p>
<p>
WSMA Reports spoke with a physician in a small primary care practice who tried unsuccessfully-even offering $100 bonus incentives-to convince staff to follow her lead to get vaccinated. "The people who weren't going to get a shot still wouldn't get a shot. The bonus didn't help," says the physician, who asked to remain anonymous.
</p>
<p>
The physician's practice was already having difficulty recruiting an advance practice provider after one announced he was moving. "It's the general problem of finding workers right now, and has nothing to do with the mandate," she says.
</p>
<p>
The state mandate, plus the risk of office closure, finally convinced another partner in the practice to get vaccinated. "I don't know whether one pressure alone would've done it," says the small practice doctor. Sadly, she says the other two providers are adamant they won't get vaccinated.
</p>
<p>
She worries her practice may need to close for good if unvaccinated clinical staff aren't allowed to work even remotely. "The practice has existed for 50 years. It's small, but until now there was no reason to think it wasn't going to continue to be here for a long time," she says. "And if we suddenly have to close, that's 5,000 patients who have to find a new provider."
</p>
<p>
Prior to the pandemic, health care was already grappling with a looming workforce crisis-a shortage of 122,000 physicians by 2032 and 200,000 nurses needed each year to keep up with demand, according to the American Hospital Association.
</p>
<p>
The physical and emotional toll of COVID-19 has made many health care workers re-evaluate their careers. In a 2021 Washington Post-Kaiser Family Foundation survey, nearly 30% of health care workers said they are considering leaving their profession entirely. How COVID-19 vaccine mandates will further impact health care systems remains to be seen.
</p>
<p>
As of this writing, the state mandate hasn't created the hoped-for impetus for some vaccine-resistant employees to get vaccinated. "When the state mandate came out, my first thought was, 'Wonderful. This is going to make people get it.' But, in fact, it's not going to make people in my office get it. What it's going to do is just add turmoil," the small practice physician says.
</p>
<h3>WSMA pushes for clarity</h3>
<p>
For PeaceHealth and other health care organizations with facility mandates, the state mandate was a welcome endorsement of their decision, says Dr. Koekkoek. "The vast majority of our nurses and physicians are vaccinated and feel like [the state mandates] are a validation around the positions they've taken. It's made it easier in their various practices and hospitals to get the rest of the staff on board."
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Like other employers, PeaceHealth now faces an additional workforce gap left by those who refuse to comply. "People who are still vaccine-hesitant are going to either drop out of the workforce entirely, do something different, or move to a state with fewer requirements to practice there," says Dr. Koekkoek.
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Unlike smaller physician practices, PeaceHealth is able to pivot by rearranging schedules and filling that void using agencies to staff their workforce, says Dr. Koekkoek.
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To address member concerns surrounding the state mandate, the WSMA continues to work with the governor's office and the Washington State Department of Health for clarity on implementation. "While WSMA strongly supports the governor's mandate, it recognizes the administrative burden it puts on physician practices," says Jeb Shepard, director of policy at WSMA. "We are seeking guidance from the state based on WSMA member feedback, have conducted several webinars with legal counsel who have expertise in health care labor law, and have provided templated practice policies and accommodation documents."
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Despite an entrenched group of hold- outs, Dr. Schlicher remains confident that health care workers will continue to do the right thing. "I'm hopeful that we'll get folks to line up and get vaccinated, and for those already vaccinated, to get their booster soon," he says. "At the end of the day, it's the best way that we both keep all our patients and workers healthy-our physicians, nurses, techs, custodial staff, administrators ... but it's also a way that we keep our own families and community safe."
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<em>Rita Colorito is a freelance journalist who specializes in covering medicine and health care. She is a regular contributor to WSMA Reports.</em>
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<em>This article was featured in the November/December 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
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</div> | 11/8/2021 9:34:14 AM | 11/8/2021 9:32:51 AM | 11/8/2021 12:00:00 AM |