| understanding-contribution-claims-in-medical-practice | Understanding Contribution Claims in Medical Practice | WSMA_Reports | Shared_Content/News/Latest_News/2025/understanding-contribution-claims-in-medical-practice | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/march-april/cover-wsma-marapr-2025-final-645x425px.jpg" class="pull-right" alt="March/April 2025 cover of WSMA Reports" /></div>
<h5>March 19, 2025</h5>
<h2>Understanding Contribution Claims in Medical Practice</h2>
<p>
By Melissa Cunningham, JD
</p>
<p>
Health care is a high-stakes world and medical malpractice claims are a cost of practice. Adding to existing liabilities is a growing but not well-understood risk for medical practitioners: contribution claims.
</p>
<p>
Unlike usual malpractice claims, which are the result of disagreements between patients and health professionals, contribution claims come into play after a settlement or verdict against a hospital or other facility that uses contracted physicians, such as an ambulatory surgical center. They occur when a hospital seeks financial contributions to help pay their settlement or courtroom loss- with that money often coming from physicians. Physicians, especially those in contracted roles, need an understanding of contribution claims to protect their practice and finances.
</p>
<h3>What is a contribution claim?</h3>
<p>
Think of a contribution claim as a claim triangle. It's a legal action in which a party pays a legal settlement, then seeks to have its costs entirely or partially covered by the party that played a role in the underlying incident. In health care, these claims arise when a hospital facing a malpractice lawsuit pays a settlement or is ordered to compensate the patient and then seeks to have other parties-such as physicians-share in the financial pain.
</p>
<p>
In typical malpractice cases, the patient/plaintiff must prove three things to prevail: that a duty of care existed, that this duty was not met, and that the breach caused injury to the plaintiff. This direct approach focuses on whether a physician or hospital acted negligently or carelessly, harming the plaintiff.
</p>
<p>
In contribution claims, that dynamic changes. In these cases, a plaintiff may sue only the hospital without the physician's knowledge. If the hospital chooses to settle or loses a case in court, it may then decide to seek a financial contribution from the physician or physicians involved, claiming that because the physicians provided part of the care that led to the settlement, they should share the economic burden.
</p>
<h3>How contribution claims unfold in medical malpractice</h3>
<p>
Picture a case in which a heart patient suffers post- surgery complications. The patient sues the hospital, alleging negligence, but does not specifically sue the physician who performed the actual surgery. After settling the claim against it, the hospital then goes to the contracted physician and demands that they pay a share of the settlement payout. This may occur even though the physician has not had a chance to defend themselves in court with capable legal counsel.
</p>
<p>
This scenario does indeed occur, and in most cases comes as a surprise to physicians who assume that they won't face financial liability unless they're sued directly. In contribution actions, however, a hospital will argue that it should not carry the financial burden alone, especially if it was sued based on the principle of "vicarious liability." Under this principle, the hospital is held accountable for the actions of contracted agents-such as physicians-who deliver care within it.
</p>
<h3>Legal standards and the shift in focus</h3>
<p>
Legal standards for contribution cases differ from those in conventional malpractice suits. In malpractice claims, plaintiffs must establish that a health professional's breach of the standard of care caused a patient's injuries. In contribution claims, the focus shifts to whether the hospital's settlement was "reasonable" under the circumstances. Determining this involves a distinct set of factors, including:
</p>
<ul>
<li>The hospital's defense, including how strong or weak it may have been.</li>
<li>The relative fault of each party involved in the patient's care.</li>
<li>The hospital's risk if the case goes to trial.</li>
<li>The financial ability of each party to pay.</li>
<li>The extent of harm to the patient.</li>
</ul>
<p>
This "reasonableness standard" emphasizes the financial and practical implications of the settlement, rather than the clinical details. This focus shift can frustrate physicians, as the hospital's decision to settle and then file a contribution claim may occur without any assessment of the physician's direct role or the quality of care provided.
</p>
<h3>Why are physicians at risk?</h3>
<p>
Contribution claims pose special risks to physicians due to two factors. The first derives from the complexity of modern health care settings and the financial pressures hospitals face. In scenarios in which multiple physicians and health professionals are involved, such as in obstetrics or emergency medicine, hospitals may decide to settle quickly and then decide to see if they can spread the financial burden.
</p>
<p>
The second factor to be considered is that contribution claims occur without giving the physician a chance to defend his or her actions. Once a hospital settles, the physician's ability to protect their reputation or contest their involvement is limited. To make matters worse, these settlements-even if they're related to contribution claims-are recorded in the National Practitioner Data Bank, which means they can follow a physician's career indefinitely, potentially affecting their credentialing, hiring, and malpractice insurance rates.
</p>
<h3>The practical implications of contribution claims</h3>
<p>
Contribution claims are most common in specialties involving risky medical conditions and multiple health professionals in the hospital setting, such as obstetrics, emergency medicine, anesthesiology, and radiology. Meanwhile, the financial pressures that hospitals face, plus the growing number of "nuclear verdicts"-jury awards that greatly exceed typical settlements-have driven hospitals to seek shared monetary responsibility.
</p>
<p>
These trends are exacerbated by "social inflation," which drives up verdict amounts in keeping with factors such as distrust of institutions and sympathy toward patients. When hospital settlements reach $10 million or even $20 million, the pressure to find ways to share these crushing amounts increases.
</p>
<h3>How to protect yourself and your practice</h3>
<p>
Contribution claims in health care can be particularly tricky to defend due to several factors, including the potential complexity of liability and statutory or regulatory nuances. Still, there are practical steps that physicians can take to protect themselves:
</p>
<ol>
<li>Engage in contract negotiation. When physicians sign agreements with hospitals or health care systems, these contracts often define the level of liability they may assume. Physicians should look for provisions that limit liability to their insurance-policy limits and negotiate for language that gives them control over settlement decisions affecting their cases. Hospitals may resist these efforts, but they're an effective way to forestall financial shocks.</li>
<li>Conduct legal and insurance review. Working with legal and insurance experts to ensure proper insurance coverage is critical. Malpractice insurance policies differ in their approach to contribution claims, so physicians should work with an insurance expert to confirm adequate protection.</li>
<li>Stay informed. Laws governing contribution claims vary by state, with Washington, for instance, having specific guidelines on "joint and several liability." This principle allows a plaintiff to seek full recovery from one party even if multiple parties share responsibility, thereby heightening the risk of contribution claims. Physicians should be aware of any changes to these laws and work proactively with legal and insurance professionals to keep ahead of them.</li>
</ol>
<p>
Though it is important to note that not all hospitals employ this strategy, it is equally important for physicians to understand how these claims work and take steps to address potential liability to safeguard their practice and reputation. Physicians Insurance also believes in coordinated defenses that uphold the standard of care, protecting the assets of hospitals and physicians alike.
</p>
<p>
Although the legal landscape surrounding contribution claims may continue to evolve, being proactive regarding contract negotiation, insurance coverage, and legal awareness can help physicians better manage these challenges with confidence.
</p>
<p>
<em>Melissa Cunningham, JD is a senior vice president and general counsel with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the March/April 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 3/19/2025 2:55:21 PM | 3/19/2025 2:50:16 PM | 3/19/2025 12:00:00 AM |
| a-q-and-a-with-washingtons-new-governor | A Q&A with Washington's New Governor | WSMA_Reports | Shared_Content/News/Latest_News/2025/a-q-and-a-with-washingtons-new-governor | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/march-april/cover-wsma-marapr-2025-final-645x425px.jpg" class="pull-right" alt="March/April 2025 cover of WSMA Reports" /></div>
<h5>Feb. 25, 2025</h5>
<h2>A Q&amp;A with Washington's New Governor </h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
On Jan. 15, Bob Ferguson was sworn in as Washington state's 24th governor, taking over from fellow Democrat Gov. Jay Inslee. In his inaugural address, Gov. Ferguson positioned himself as someone intent on reforming government, not defending it. "Our mission must be to speed up government, improve customer service, and center the people in every decision we make," he said.
</p>
<p>
As for specific health challenges and priorities facing Washington state, Gov. Ferguson called out the ongoing behavioral health crisis and threats to reproductive freedom. The latter he called a "core freedom" with vows to protect it for all Washingtonians. Gov. Ferguson said his administration "will work with President Trump where we can. We will stand up to him when we must."
</p>
<p>
During his time as Washington state attorney general, Gov. Ferguson defended the Affordable Care Act from the legal attack from the Trump administration and Republican attorneys general, preserving health care for 825,000 Washingtonians. He then wrote and passed legislation guaranteeing access to free and reduced-cost hospital care for 4 million Washingtonians.
</p>
<p>
After his speech, Gov. Ferguson signed an executive order directing the Washington State Department of Health to convene a roundtable of medical professionals, reproductive health experts, and policymakers to recommend strategies for protecting reproductive freedom, including strengthening health data privacy laws.
</p>
<p>
When it comes to rising health care costs, Gov. Ferguson is keenly familiar with the economic pressures facing Washingtonians and the physician community that cares for them. The state Legislature had tasked his attorney general's office and the Office of the Insurance Commissioner with analyzing policy options and making recommendations that could impact affordability. The directive came after a report showing consumers and businesses in Washington state have faced double- digit increases in health insurance rates over the last decade-nearly double the rate of inflation. The trend continues in 2025, with an average 10.7% increase for health plans purchased on Washington's health insurance marketplace.
</p>
<p>
Gov. Ferguson invited the WSMA and other health care organizations to participate on a health committee as part of his transition team. As a follow- up, <em>WSMA Reports</em> asked Gov. Ferguson how he intends to build on his work as attorney general and what the physician community can expect when it comes to other health care priorities. We asked these questions prior to President Trump taking office and the slew of directives affecting health care policy and information access that have since followed. -RITA COLORITO
</p>
<p>
<strong><em>WSMA Reports:</em> The WSMA represents physicians and physician assistants working in all specialties and practice settings across the state. What is your connection to the physician community?</strong>
</p>
<p>
<em>Gov. Ferguson:</em> Because health care touches each and every Washingtonian, my family and I have had our own personal experiences with the physician community, which helps inform and guide my policies on access and affordability of health care. I am grateful for the care that nurses, physicians, and other health care professionals have provided my family. I understand that not every Washingtonian has had access to good health care as I have over my time in public service. This is why I repeatedly fought to preserve access to health insurance under the ACA and will continue to do so if the Trump administration seeks to remove subsidies or change our public insurance system in ways that will hurt Washingtonians.
</p>
<p>
As attorney general, my team and I took a hard look at consolidation of health care entities to try and retain access to independent physician practices as much as possible. We are concerned about noncompete agreements and other effects of ownership changes on doctors, not only from the point of view of their professional and business challenges, but also on the morale toll that the corporatization of health care has taken on so many who have gone into the profession to take care of the rest of us.
</p>
<p>
<strong>The WSMA was grateful to have the opportunity to participate in the health committee of your transition team. Looking at the big picture, what's front of mind for you in terms of health policy priorities for our state?</strong>
</p>
<p>
Thank you for participating in the health committee of our transition team. We needed our valuable health care experts to guide my administration on the immediate health priorities facing the state. We heard loud and clear that youth behavioral health needs to be bolstered so that our young people can thrive in supportive environments. There is coordination to be done between agencies to ensure we get new behavioral health providers licensed and registered with Medicaid in a timely manner. My team has already begun meeting with Department of Health and Health Care Authority on these issues. We're also exploring how to expand Medicaid coverage to effective youth interventions, both in school, community, and medical settings.
</p>
<p>
Given what we're facing with the new federal administration, maintaining the coverage gains Washington has made over the last decade is also vitally important. While we know that our state is facing a difficult budget crisis, preserving funding for coverage to current benefits is one of our top priorities as we review options for spending efficiencies and cuts.
</p>
<p>
Lastly, almost every Washingtonian is feeling an affordability crunch and health care costs are a major factor in what families across the state are faced with day-to-day. We are aware of several pieces of legislation that the Legislature is considering in order to address health care cost containment and transparency of health care ownership and expenditures. All of these proposals are important to evaluate to help alleviate the health care cost pressures our communities are facing.
</p>
<p>
<strong>Are there policy options you will be proposing to promote health care affordability?</strong>
</p>
<p>
One of my top priorities is bringing down the cost of living for Washingtonians. As attorney general, I fought for affordable health care to help Washingtonians, and as governor, I will continue working to improve access to excellent, affordable care. As you know, there is lots of work to be done. My team is already exploring what we can work on with the Legislature and in the interim to address the underlying costs for actually delivering care, how to make care delivery as effective as possible while maintaining a level of efficiency, and how we streamline our goals for oversight and management of health care expenditures across our state agencies so the health care community knows the exact direction we're headed in.
</p>
<p>
<strong>Our state has become very consolidated, in terms of where care is offered, and some would argue this has driven up cost and limited choice. Do you think we can get back to helping practices operate independent from a hospital health system or private equity?</strong>
</p>
<p>
What I want to see in our health care ecosystem is the availability for physicians to have a choice in how they want to practice. We know some physicians like to be a part of a health system and they should have an opportunity to do so. However, we need to help support the option for other physicians to operate independent practices or join independent physician groups without the fear of closure or affiliation.
</p>
<p>
We must adopt good policies that prohibit mergers and acquisitions that create unlawful monopolies and those that cut off care to essential services. Additionally, we must look at ways to ease the administrative burden physicians and providers face as independent practitioners. Managing multiple health plan contracts and their associated policies and procedures has become untenable. We hear that, and are committed to finding regulatory or legislative solutions to ease this burden and make the choice between health system and independent practice more available statewide.
</p>
<p>
I'm also aware of the impact prior authorization requests have on administrative burden and the level of justification that can be required to get a referral for your patients or prescribe the appropriate medication treatment to meet your patients' health needs. Medical necessity guidelines, turnaround times, and policies need to be better streamlined across our health plans. I am committed to working with the Health Care Authority and the insurance commissioner to determine how we can do that with or without legislative intervention.
</p>
<p>
<strong>The state is facing a difficult budget dynamic, with hard choices ahead on spending and revenue. Even as we want to avoid cuts to critical health care programs that would adversely impact access to care for patients, many WSMA members are wary of the possibility of a business and occupation (B&amp;O) tax increase or the establishment of a statewide payroll tax that may threaten their ability to keep their practice doors open. How will you approach closing the budget gap?</strong>
</p>
<p>
Washingtonians expect that we will increase revenue as a last resort. I will not contemplate additional revenue options until we have exhausted efforts to improve efficiency.
</p>
<p>
I am prioritizing budget savings and efficiencies. As a first step, I propose reducing state agency spending by at least $4 billion. These reductions will be challenging, but, ultimately, I believe they will improve our capacity to serve the people. I hired agency directors who share this vision, and I know our dedicated state employees will rise to meet the challenge.
</p>
<p>
<strong>One of your first actions as governor was to sign an executive order related to protecting reproductive freedom. What are your thoughts on how our state can further protect patients and the physicians who are providing abortions and other reproductive health care services?</strong>
</p>
<p>
Protecting reproductive freedom remains one of my top priorities. In light of the Dobbs decision and what has been outlined in Project 2025, we know we need to work immediately to identify any additional policies and funding strategies that are necessary to protect access to services.
</p>
<p>
As one of my very first official acts as governor, I signed an executive order directing the Department of Health to convene a roundtable of medical professionals, reproductive health experts, and policymakers to recommend strategies for protecting reproductive freedom. Not only will we be focusing on access to abortion and miscarriage services but also on access to gender-affirming care and pregnancy prevention. We also want to focus on the safety and security of reproductive and gender-affirming care. This means ensuring the physical security of our patients and clinics but also developing policy options to ensure our data systems are as secure as possible to protect patient health information.
</p>
<p>
<strong>Washington state was ground zero for the COVID-19 pandemic. The Trump administration has nominated Robert F. Kennedy Jr., a vocal skeptic of vaccine safety and efficacy, to head the Department of Health and Human Services. What are your concerns regarding public health? How do you intend to safeguard public health vis a vis vaccine requirements and availability?</strong>
</p>
<p>
Combating misinformation about the effectiveness and side effects of vaccines is where we need to focus in the coming years. This means ensuring state and local public health officials aren't restricted from educating the public in any way about the importance of vaccines in preventing and containing the spread of communicable diseases. Part of what we're analyzing during our state budget exercise is how to maintain foundational public health funding to ensure community education programs are not eliminated. It's no guarantee but we recognize the importance of having accurate, evidence-based information available for the public to easily access.
</p>
<p>
<strong>You've been a leader in helping address the fentanyl and opioid crisis, and you campaigned on combating the opioid epidemic. What policies will you propose (or seek to change) and what public health initiatives are needed to manage and reverse the epidemic in Washington state? And are you concerned with the possibility of the opioid settlement funds getting diverted to uses other than what they were intended for, given the state budget gap?</strong>
</p>
<p>
As attorney general, my legal team and I recovered more than $1 billion from opioid lawsuits. I refused to settle with opioid manufacturers and distributors without legally enforceable agreements in place ensuring that the recoveries must be used to address the opioid and fentanyl epidemic.
</p>
<p>
Addressing the fentanyl crisis will take all stakeholders to be bold and innovative in preventing and treating patients. We welcome the expertise of WSMA members to provide us with emerging clinical solutions to help communities across the state address this urgent crisis.
</p>
<p>
<em>This article was featured in the March/April 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 2/26/2025 10:05:03 AM | 2/25/2025 10:53:56 AM | 2/25/2025 12:00:00 AM |
| doctors-making-a-difference-amy-ellingson-md | Doctors Making a Difference: Amy Ellingson, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-amy-ellingson-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/march-april/dmd-website-image-ellingson-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Amy Ellingson, MD" /></div>
<h5>Feb. 25, 2025</h5>
<h2>Doctors Making a Difference: Amy Ellingson, MD</h2>
<p>
After watching a documentary about the AIDS epidemic in 2003, family medicine physician in North Central Washington Amy Ellingson, MD, was inspired to take action. She, along with a group of others in her home city of Chelan, decided to focus their efforts on children in Africa, one of the most vulnerable groups affected by HIV and AIDS. Her search for a way to get involved led her to the Tiny Lives Foundation, an organization serving children in the town of Mokhotlong, which sits at 8,000 feet in the mountains of Lesotho. Dr. Ellingson talks with WSMA Reports about what the foundation does and her experience in the country.
</p>
<p>
<strong>Q: What is the Tiny Lives Foundation and how did you get involved? </strong>
</p>
<p>
In 2003, while attending a CME event in Seattle, I watched the documentary "A Closer Walk" about the AIDS epidemic. At the end, there was a simple but powerful message: "Just do something." The enormity of the crisis felt overwhelming, but I was determined to act.
</p>
<p>
Back in Chelan, I gathered a group of people who also wanted to help and decided to focus on children in Africa, one of the most vulnerable groups affected by HIV/AIDS. During our search, I received an alumni magazine from Notre Dame featuring the founders of The Tiny Lives Foundation, a nonprofit based in Lesotho, where HIV/AIDS was devastating families, especially women and children.
</p>
<p>
The Tiny Lives Foundation was founded by a couple working with the Peace Corps in 2004, after they began caring for critically ill infants in the remote mountain town of Mokhotlong. In an area with little medical infrastructure, these children would have otherwise died without care. With the help of local volunteers, TTL established a safehouse for children under 5, offering food, medical treatment, and support before they return to their families.
TTL's motto, "One child at a time," has guided the organization's work ever since. Over the years, TTL expanded to include programs in education, microfinance, and outreach, growing into a lifeline for over 5,200 children and their families. Despite Lesotho's HIV rate-around 25% of the population-and other challenges like food insecurity and malnutrition, TTL continues to make a profound impact.
</p>
<p>
We fell in love with the work and people at TTL and started up Chelan to Africa, where we hosted fundraisers for the next 15 years to help support the work of TTL. Over that time, many of us in the Chelan area visited TTL in Mokhotlong to witness the excellent work they are doing.
</p>
<p>
I feel fortunate to have been part of TTL's journey, helping bring attention to the needs of these children and the people of Lesotho. The work is ongoing, but TTL continues to make a difference, one child at a time, and that is something.
</p>
<p>
<strong>Q: What do your roles as a board member and medical director entail? </strong>
</p>
<p>
As a board member of TTL, I have the privilege of meeting throughout the year, both in person and virtually, to help guide the direction of the foundation. One of our key responsibilities is selecting the annual "fellow," a young adult from the UK, Canada, or the US, who stays on the TTL campus to assist the director, maintain reports to the board, and help manage social media updates. We also oversee the foundation's finances, actively seek passionate donors, explore fundraising opportunities, and ensure sound management of our investments.
</p>
<p>
Collaboration with our incredible director, Nthabeleng Lephoto, is essential. We work closely to ensure she has the resources and support needed to continue TTL's impactful work.
</p>
<p>
For the past several years, I've also served as the medical director alongside another doctor. In this role, I've assisted in determining the best treatments for children needing less common medical treatments, managed outbreaks of infectious diseases like measles in the safehouse and advised on various medical issues affecting both the children and staff.
</p>
<p>
<strong>Q: What is a typical trip to Lesotho like for you? </strong>
</p>
<p>
Each time I have gone I have felt privileged, connected, exhausted, and concerned that our work is a mere drop in the bucket. The physical journey to TTL is long-halfway across the globe! A team is typically made up of 4-6 people, both medical professionals and lay people. Once we land in Maseru, the capital, we embark on a six-hour drive into the mountains to reach Mokhotlong. As we ascend into the highlands, we begin to see shepherds with their flocks, the classic stone rondavels, a small ski resort and a large diamond mine. By the time we reach 8,000 feet, we arrive at the safehouse in Mokhotlong. The scenery is reminiscent of North Central Washington, with its sweeping hills and rugged beauty.
</p>
<p>
There is additional lodging on the TTL campus for the team, along with a communal kitchen we share with the "fellow" staying there for the year. The favorite activity for many of us is spending time in the safehouse with the caregivers-holding, feeding, and playing with the babies and children. It's a joyful, playful environment, and it's incredible to see the transformation in the children's health. Hearing stories and seeing photos of the children from when they first arrived, compared to weeks and months later, is so moving.
</p>
<p>
TTL also goes on outreach trips five days a week, traveling along rural, rugged roads to deliver medicine and food and assess children in nearby villages. There is a state hospital in Mokhotlong, and during some of my trips, I've had the chance to attend to patients in the "walk-in" section of the hospital, as well as round on patients in the inpatient pediatric wing.
</p>
<p>
On my most recent trip, I was on campus when a staff member asked me to look at a boy who had arrived unannounced with his mother. She had carried him on her back for many miles, hoping to get help. She was mostly seeking more baby formula, as her son wasn't eating solids. Though she looked tired, she was determined to find support for her child. Teboho was over two years old but was nonverbal, non-ambulatory, and severely malnourished. After a brief assessment, it was clear he had cerebral palsy, a diagnosis that was unknown to mother, a common situation in this rural area with limited access to healthcare.
</p>
<p>
The mother was caring for her child alone, both her husband and mother-in-law were working in South Africa. Culturally, there is often a stigma attached to having a child with a disability in this rural community, and she was shouldering the entire burden on her own. Thanks to TTL, we were able to walk her to the local hospital, where he was admitted for malnutrition. TTL covered the hospital bill and brought him back to the safehouse for more nutritional and physical support. He gained many pounds and his spasticity was improving. The real turning point, though, was when TTL organized a nurse-led course for mothers with children who have cerebral palsy that was held before he went home.
</p>
<p>
Teboho's life was saved, and his mother was given the tools, education, and support she needed to help them thrive. It was a powerful example of how TTL's work not only addresses immediate needs but also empowers families to care for their children long-term.
</p>
<p>
<strong>Q: What are some of the biggest barriers to providing care to the children the foundation serves? </strong>
</p>
<p>
The first is limited access to medical care. Lesotho is about the size of the state of Maryland and has only one specialty hospital for the entire nation. While not a big country, one specialty hospital six hours away for our clients is not enough. If a child needs to see a specialist or have a procedure, it often just does not happen. One other thing contributing to this challenge is that Lesotho does not have a medical school and relies on doctors from other countries in Africa to come and work there, leaving them vulnerable to a lot of turnover.
</p>
<p>
Second is the high prevalence of HIV/AIDS, 1 in 4 adults, which ranks them 2nd in worldwide HIV prevalence. The epidemic has devastated Lesotho's most productive age group, leaving children vulnerable and often orphaned. Children are often left to be cared for by family members with very few means, which contributes to why one in every nine children dies before reaching their fifth birthday in Lesotho. The problem is much more manageable compared to when I first traveled there in 2010 because HIV testing and treatment is readily available. Unfortunately, infection rates are still high.
</p>
<p>
Food insecurity is another issue that has plagued Lesotho for many years. Land degradation and climate change, particularly persistent drought, flooding, and early frost, have caused low agricultural productivity in Lesotho, exacerbating food insecurity and extreme poverty. In the area that TTL serves, most families try and grow their own food because just going to "town" requires multiple hours of walking.
</p>
<p>
<strong>Q: Have you taken any lessons away from your work with the foundation into your practice as a family medicine physician? </strong>
</p>
<p>
The lessons I have learned from my work at TTL have not specifically applied to my family medicine practice. My biggest lessons have been personal, in the realm of just being a better human.
</p>
<p>
Whenever I travel and experience other cultures, a big takeaway for me is that no matter where we may live on the planet, we are all the same. Some of us are born into poverty in rural Lesotho and some of us are not. We all deserve to be cared for with dignity. All our lives matter. The parents of the children that sleep at the TTL safehouse do not worry any less just because malnutrition and infant death is common in their country. The young adults in Mokhotlong do not dream any less just because the unemployment rate is 25%. We are a global family and each time I travel to Lesotho my experience of that strengthens.
</p>
<p>
<em>This article was featured in the March/April 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 2/25/2025 9:52:44 AM | 2/25/2025 9:48:30 AM | 2/25/2025 12:00:00 AM |
| bringing-it-back-to-the-patient-always | Bringing It Back to the Patient, Always | WSMA_Reports | Shared_Content/News/Latest_News/2025/bringing-it-back-to-the-patient-always | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/heartbeat-website-image-bramhall-645x425px.png" class="pull-right" alt="Heartbeat: John Bramhall, MD, PhD" /></div>
<h5>Jan. 16, 2025</h5>
<h2>Bringing It Back to the Patient, Always </h2>
<p>
By John Bramhall, MD PhD
</p>
<p>
At last September's Annual Meeting<strong> </strong>of the WSMA House of Delegates, as I wandered in and out of the reference committee hearings, I marveled at the energy and focus WSMA delegates and members brought to a range of issues facing us: public health structure, AED distribution, access metrics, nanoplastic pollution, diaper access, air purification, firearm education, and more. It added up to a long list of issues that reflect our interconnectedness with, and concerns for, the well-being of Washingtonians.
</p>
<p>
I was also taken aback by the frustrations so clearly felt and expressed by meeting attendees. We heard story after story of treatment plans delayed or denied altogether by misjudged or badly implemented prior authorization requirements, of patients unable access or afford needed care in their communities due to practice closures, discontinued service lines or cost of coverage, or of practices struggling to make ends meet burdened with reimbursements that fail to cover the costs of core services.
</p>
<p>
In each story is a physician who is stuck between a desire to connect with patients and the need navigate seemingly endless red tape or a fragmented or failed system. Added to those struggles are the growing challenges ignited by battles over the COVID-19 pandemic, prevalence of mis- and dis-information, and the politicization of health care. Together, these factors have created an unnecessary crack in patient-physician relationship that we at the WSMA intend to mend, to restore that interconnectedness that's fundamental to the care we provide.
</p>
<p>
Recent survey data from the American Medical Association bears out what we've known to be true over the years: A vast majority of patients believe that the patient-doctor relationship is central to health care, that physicians should be central to treatment decisions and care, and that red tape bureaucracy makes it harder for physicians to provide the best care to patients.
</p>
<p>
Over the last several years, decisions made by third parties like insurance companies and others in health care have dramatically limited the time physicians can spend with their patients. From insurer prior authorizations that deny needed care to access issues resulting from reimbursements that don't cover the cost of care, physicians are spending more and more of their time and energy fighting to ensure their patients can access the care they need. Adding to their frustration, physicians then find they often are blamed for these third-party intrusions into the patient-physician relationship.
</p>
<p>
Physicians understand that time spent listening to, responding to, and treating patients is essential to providing the quality care patients deserve. Health care can be an especially vulnerable space for patients, and establishing a meaningful relationship is necessary to build trust and provide the most effective care and treatment.
</p>
<p>
Physicians enter the practice of medicine because they are caring, compassionate, and genuinely want to help others. They are protective of the time they spend with their patients—time to have questions answered, time for a second look, time to make the best choices together to provide the best quality care. Time spent arguing with insurers over care denials or fighting for reimbursements just to cover the basic costs of the care being provided is time stolen from their patients. Physicians are patients' best advocates, and it's past time for us to push back together against artificial barriers that prevent patients from accessing timely, needed care and that keep physicians trapped in a cycle of frustration and burnout.
</p>
<p>
Physicians advocate for their patients each and every day. The WSMA, with support from the AMA, is amplifying these efforts through our Your Care Is at Our Core campaign. We hope you will follow along with us at <a href="https://wsma.org/your-care-is-at-our-core">wsma.org/your-care-is-at-our-core</a>. Do you have a story of a time when you advocated for a patient? Tell us—we may feature it in the campaign. Write to <a href="mailto:gfs@wsma.org">gfs@wsma.org</a>.
</p>
<p>
<em>John Bramhall, MD, PhD<strong> </strong> is president of the WSMA.</em>
</p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/16/2025 9:58:33 AM | 1/15/2025 12:11:52 PM | 1/16/2025 12:00:00 AM |
| communication-and-the-use-of-interpreter-services | Communication and the Use of Interpreter Services | WSMA_Reports | Shared_Content/News/Latest_News/2025/communication-and-the-use-of-interpreter-services | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/cover-wsma-reports-1-janfeb-2025-645x425px.jpg" class="pull-right" alt="January/February 2025 cover of WSMA Reports" /></div>
<h5>Jan. 16, 2025</h5>
<h2>Risk Management Considerations With Today's Telemedicine </h2>
<p>
By Jessica Sofie
</p>
<p>
Telemedicine is one of the fastest growing means<strong> </strong>
of delivering patient care, and its technologies and policies are evolving rapidly. Physicians Insurance, WSMA's exclusively endorsed professional liability carrier, last provided risk-management telemedicine guidance to <em> WSMA Reports</em> readers in 2020. We thought the time was ripe to bring our guidance up to date—and to answer some of your frequently asked questions. As this area of health care is evolving rapidly, we advise you to continue to stay current on federal and state regulatory changes.</p>
<p>
<strong>What organizational policies should be in place before providing telemedicine services to patients? </strong></p>
<p>
The standard of care for telemedicine is the same standard as for in-person visits, so the same policies for patient care will apply. In addition, your policies and procedures should address common topics impacted by telemedicine. These could include the following: </p>
<ul>
<li>Provisions for obtaining informed consent for telemedicine services. </li>
<li>Which patient visits are eligible for telemedicine. </li>
<li>How the physician will verify and authenticate the patient's identity and location at each virtual encounter. </li>
<li>How the physician will determine patient readiness in a private environment. </li>
<li>How preventive maintenance for equipment will be handled. </li>
<li>Which quality data will be monitored and how improvement will be implemented. </li>
<li>How to handle a patient medical emergency that develops during a telemedicine visit. </li>
<li>Any documentation differences. </li>
<li>Changes to billing procedures. </li>
<li>Backup plans or downtime procedures for telemedicine interruption. </li>
</ul>
<p>
<strong>Are there license or geographic restrictions to providing patient care via telemedicine? </strong>
</p>
<p>
Each state regulates the scope of practice and requirements for licensure regarding the provision of telemedicine in their jurisdiction. Most require licensure in the state where the patient is located. For instance, if a Washington state-licensed physician is seeing a patient in Oregon, that professional is obligated to be licensed in Oregon, as well, and adhere to its scope of practice. There are exceptions where a rare appointment may be provided, such as if a patient is temporarily traveling out of state and has a follow-up question post procedure or needs a medication refill. Check with your professional regulating bodies, state regulations, and federal agencies for up-to-date practice acts and licensure laws including those that pertain to telemedicine.
</p>
<p>
<strong>Should I notify my professional liability carrier about new or expanded telemedicine services? </strong>
</p>
<p>
You are required to notify your professional liability carrier of changes in services to ensure you have adequate insurance coverage.
</p>
<p>
<strong>What are the credentialing considerations for providing telemedicine services? </strong>
</p>
<p>
All physicians and practitioners should be credentialed through their organization to include telemedicine privileges, if indicated. In addition, organizations should also check with their accreditation agencies for any telemedicine credentialing requirements. If telemedicine services are provided from a distant-site hospital, an agreement should state that the distant-site hospital is responsible for credentialing requirements.
</p>
<p>
<strong>Is written informed consent necessary when holding telemedicine visits? </strong>
</p>
<p>
Since state requirements vary, it is important to know the regulatory requirements for your state(s) of practice as well as for the patient's state of residency. While it is standard practice to obtain written patient consent for medical care, informed consent for telemedicine should include patient education about telemedicine and how it differs from an in-person visit.
</p>
<p>
A single consent form may be used for multiple visits as long as the same physician is treating the patient. When that changes, the patient should sign a new form. Even when the same physician continues to treat the same patient, it is recommended that a new form be signed annually.
</p>
<p>
Patient communication should include information on the unique characteristics of telemedicine services, such as:
</p>
<ul>
<li>Technologies used, capabilities and limitations of each. </li>
<li>Potential technical problems that may occur and what to do if an issue arises. </li>
<li>Agreement that telemedicine is appropriate for care. </li>
<li>Available alternatives to telemedicine. </li>
<li>Credentials of the physicians or practitioners involved. </li>
</ul>
<p>
Be sure to set realistic expectations with the patient regarding the scope of service, who will be present during the appointment, billing, prescribing policies, and follow-up communications.
</p>
<p>
<strong>How can I obtain written informed consent for telemedicine? </strong>
</p>
<p>
Prior to the telemedicine visit—and if indicated, the informed-consent document translated into commonly used languages—forms may be exchanged through the patient portal, electronically (either secure email or facsimile), or by standard USPS mail. Ensure receipt of the signed form. The completed documentation should be included in the patient's medical record. If a patient is unable to return electronic confirmation of signed informed consent, then document the following: consent has been reviewed with the patient, the patient is unable to respond electronically, and verbal consent has been obtained. If possible, a second staff member should listen in and attest as a witness.
</p>
<p>
<strong>Is international telemedicine allowed? </strong>
</p>
<p>
Many state medical boards have dictated that medical licenses are for the practice of health care within their specifc state or within U.S. borders. Since telemedicine rules apply where the patient is located, if a patient is a permanent resident of a foreign country, a physician would typically need to be licensed in that country for international care. An additional factor involves privacy rules and HIPAA compliance for telemedicine platforms.
</p>
<p>
Physicians traveling internationally who wish to deliver telemedicine services while abroad to U.S. residents may do so, provided the physician is licensed in the state where the patient receiving care is located and the platform used for telemedicine is HIPAA compliant (see the question after next).
</p>
<p>
<strong>If an established patient has left the state to attend college, can I continue treatment by using telemedicine visits? </strong>
</p>
<p>
Our recommendation is to check your licensing state's rules, as most states require the physician to be licensed where the patient is physically located.
</p>
<p>
<strong>Can I provide telemedicine services from my home or other location that is not my office? </strong>
</p>
<p>
The physician's obligation for patient privacy extends to any setting where care is provided. With proper privacy safeguards and consideration given to a professional presentation, it is possible to use the home setting. Keep in mind that public-facing communication resources, such as Facebook, Instagram, and others, are not appropriate for electronic health visits because the software or platform used for telemedicine must be HIPAA compliant.
</p>
<p>
<strong>Am I required to provide interpretation services on a telemedicine visit? </strong>
</p>
<p>
During a telemedicine visit, patients in need of interpretation services should have access to a certified health care interpreter. Physicians or their staff should be competent concerning how to bring the certified interpreter into the conference, and they should document this service. Check with Physicians Insurance or your professional liability carrier for more guidance on the use of certified health care interpreters.
</p>
<p>
<strong>Am I allowed to prescribe medications via telemedicine visits? </strong>
</p>
<p>
When deemed appropriate for the patient, a telemedicine physician may prescribe, as long as it is done within the scope of their licensure. Special caution must be used hen prescribing controlled substances. Currently, the DEA mandates how to prescribe for controlled substances via telemedicine. Please review their website and reach out to your pharmacy and medical board to verify state rules.
</p>
<p>
If you are a Physicians Insurance-insured member and have questions that are not covered here, visit <a href="https://phyins.com/resources">phyins.com/resources</a> or reach out to our risk management or underwriting departments. We also encourage you to seek input from your general counsel or attorney to maintain regulatory and legal compliance.
</p>
<p> <em>Jessica Sofe, CPHRM,<strong> </strong> is a senior risk consultant with Physicians Insurance.</em> </p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/16/2025 9:54:41 AM | 1/14/2025 12:00:53 PM | 1/16/2025 12:00:00 AM |
| navigating-a-changed-political-landscape | Navigating a Changed Political Landscape | WSMA_Reports | Shared_Content/News/Latest_News/2025/navigating-a-changed-political-landscape | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/cover-wsma-reports-1-janfeb-2025-645x425px.jpg" class="pull-right" alt="January/February 2025 cover of WSMA Reports" /></div>
<h5>Jan. 16, 2025</h5>
<h2>Navigating a Changed Political Landscape </h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
As the Washington State Legislature begins its new session on Jan. 13, it will have a lot of work ahead of it. During its 105-day session, it will have to create a new biennial budget while navigating a post-election political landscape that has dramatically changed. How those changes will play out will have an impact on a wide range of issues, including the health care issues that are WSMA's top priorities in the upcoming session.
</p>
<p>
Chief among the changes will be the stark differences between the parties controlling the state Legislature in Olympia and Congress and the White House. "What we saw in Washington state was what we've seen in the last several years: Democrats maintain control of the Legislature and the governor's office," says Alex Wehinger, associate director for legislative advocacy at the WSMA. "Washington remains pretty steadily blue." (Despite their hopes, Democrats did not achieve a two-thirds supermajority in the Legislature.)
</p>
<p>
By contrast, Republicans in Washington, D.C. now control both houses of Congress as well as the White House. That portends some tension between the two Washingtons in the months ahead.
</p>
<p>
"You're going to have some oil-vinegar dynamic happening at the state and federal level," says Sean Graham, WSMA's director of government affairs. "What it means for our members is that it's foreseeable that some challenges could be imposed at the federal level in terms of access to health care services, most notably reproductive and gender-affirming care, as well as challenges for the public health systems, vaccines most prominently."
</p>
<p>
Even before the election, the WSMA had been preparing for a change among some of the key players in the Legislature. "We spent a lot of time with candidates so that we wouldn't have to start at ground zero," says WSMA CEO Jennifer Hanscom. "We were not going to take anything for granted. We met with people in advance of the session to make sure they know what WSMA is, what our priorities are, and how we can be a resource for them."
</p>
<p>
WSMA's top priority is improving access to care for Medicaid enrollees by improving reimbursement rates through passage of the Medicaid Access Program. Many physicians in Washington are reeling from a reimbursement system that has remained unchanged for decades, even though the number of Medicaid patients in the state has nearly doubled. The low rates effectively penalize them financially for treating Medicaid patients. The result is that access to care for Medicaid patients is increasingly hard to come by. Moreover, the low rates, which are among the worst in the nation, are exacerbating other disturbing trends affecting the profession in Washington state, including problems in recruiting and the financial stability of practices.
</p>
<p>
The Medicaid Access Program would allow Washington to access an approximately 2:1 federal funding match. Some $400 million a year would go toward Medicaid primary and specialty care. The program would be primarily funded by the state through its Medicaid managed care system, where the need is greatest.
</p>
<p>
Graham is optimistic about the prospects for help in fixing the problem in the upcoming legislative session. "We're hopeful that this is something that can be advanced in the legislative session this year," he says. "This has been a long-standing priority of WSMA, and we feel strongly that this is something the Legislature needs to address now."
</p>
<p>
"Passing the Medicaid Access Program would address a health care need in this state," says Hanscom. "We hope the Legislature will take advantage of this opportunity get this passed at the statewide level."
</p>
<p>
There are hurdles to overcome, however. After years of Washington state having a favorable budget climate, 2025 promises to be tougher. Due to declining tax revenues, the state is projecting a budget shortfall of at least $10 billion over the next four years. "After years of a largely positive state budget landscape, the financial picture is darkening," notes Graham.
</p>
<p>
Fortunately, the WSMA Medicaid proposal takes advantage of federal dollars. "One element of the program that we're grateful for is that it largely relies upon funding from the federal government, so we won't be competing for other state resources," says Graham.
</p>
<p>
However, just how the incoming Trump administration will view Medicaid funding is an open question. If the administration follows through on its campaign promises to reduce federal spending, Medicaid is widely considered to be one of the most vulnerable programs.
</p>
<p>
"It will be another area where there will be interplay with the federal administration, and the dynamic between the state and federal government could present a challenge," says Graham.
</p>
<p>
While legislators may look upon the Medicaid Access Program favorably because of federal funding, they will be looking to save money in other areas. Some of those have potentially negative consequences for physicians.
</p>
<p>
"An issue that will take on increasing prominence in 2025 is around health care affordability," says Graham. "Legislators of all stripes, but particularly Democrats, are increasingly concerned about the cost of health care." While rising health care costs are a concern for everyone, some of the ideas to address the problem could squeeze struggling physician practices even further.
</p>
<p>
"We know health care is expensive, and we're always interested in exploring solutions for improving affordability," Graham says. "But we have some concerns about legislative proposals that we will likely see in the 2025 session. Many would seek to use a blunt instrument, like limiting reimbursement for physicians for the services that physicians are providing."
</p>
<p>
Hanscom says that such efforts are misguided at best, because they don't connect all the issues that are driving up cost. "We are going to have to be masterful at explaining how everything is connected," she says. "We can't solve problems in a vacuum. We still have a workforce problem, people not going to the right place to receive the right care, administrative burdens like prior authorizations that are getting in the way of people getting timely care. There is no one silver bullet. The foundation starts with medicine leaning into the things that we believe will drive down costs and improve care."
</p>
<p>
In addition to looking to trim costs, legislators will be looking to raise revenue. The prospect of tax increases looms large in the 2025 session.
</p>
<p>
"Given the state's budget picture, we expect Democrats to advance a number of tax proposals this year," says Graham. "We've been told everything is on the table, and that could include an increase to the state B&amp;O (business and occupation) tax. There are discussions for a high-earner payroll tax that could be levied statewide, and that would be extremely impactful for physician groups."
</p>
<p>
At a time hen physician practices are struggling financially, the taxes could be yet an additional burden to bear.
</p>
<p>
"We know that physicians want to provide care for everyone in their community, but to do that they have to be able to keep their doors open," says Graham. "As we're engaging in issues like the Medicaid Access Program that are intended to improve access to care, we will also be defending against tax increases that jeopardize the financial viability of practices."
</p>
<p>
Separate from financial issues, the Legislature is likely to consider scope of practice proposals. "Every session, we encounter a number of scope of practice proposals that would seek to increase scope for nonphysician practitioners," says Wehinger. "We engage in those proposals pursuant to WSMA policy, which looks for comprehensive education and training requirements."
</p>
<p>
However, this year's engagement will be complicated by the number of new faces in the Legislature, including a new chair of the House Health Care and Wellness Committee. "The rub for this session is that there are going to be so many new members, many of whom who don't have a background in health care," says Wehinger. "It's going to take a lot of relationship building and education to make sure folks understand the patient-safety ramifications that arise from increased scope of practice with little to no guardrails."
</p>
<p>
Of course, it's possible that any number of other issues could pop up during the 105-day legislative session, particularly as the Trump administration begins to issue policy decisions. Whatever additional issues arise in the coming months because of decisions in Washington, D.C., the WSMA stands ready to respond. "We expect Washington state to prioritize continued access to care and support for the public health system, and we know WSMA will be a prominent voice in the conversations to come," says Hanscom.
</p>
<p>
<em>John Gallagher<strong> </strong> is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/16/2025 10:01:58 AM | 1/15/2025 12:23:38 PM | 1/16/2025 12:00:00 AM |
| keeping-patients central-to-our-care | Keeping Patients Central to Our Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/keeping-patients central-to-our-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/cover-wsma-reports-1-janfeb-2025-645x425px.jpg" class="pull-right" alt="January/February 2025 cover of WSMA Reports" /></div>
<h5>Jan. 15, 2025</h5>
<h2>
Keeping Patients Central to Our Care
</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
As health care braces for some seismic changes that may or may not come to pass, the WSMA remains steadfast in its mission to improve the lives of its members and the patients they serve. Just as any organization needs new energy to succeed and advance, so, too, does the WSMA.
</p>
<strong>
</strong>
<p>
Seven physicians joined WSMA's board WSMA board of trustees after elections held during the 2024 Annual Meeting of the WSMA House of Delegates last fall. These new board members joined with the understanding that they'll be dedicated to advocating for changes that make a real difference in health care delivery and workforce.
</p>
<p>
In 2025, much of that advocacy will be communicated publicly through a new WSMA campaign called Your Care Is at Our Core Our Core, conducted in partnership with the American Medical Association and informed by enthusiastic input from the WSMA board of trustees. Your Care Is at Our Core seeks to position physicians, through social media, traditional media, public service announcements, and more, as patients' No. 1 advocate. Further, the campaign aims to "seed the ground" for WSMA's policy advocacy through public messaging about our efforts to restore the patient-physician relationship.
</p>
<p>
The three prongs that make up the WSMA Your Care Is at Our Core campaign should be familiar to all WSMA members, as they're very much priorities that the WSMA has been invested in recent years:
</p>
<ul>
<li><strong>Access to care: </strong>Passing the 2025 Medicaid Access Program, WSMA's top budget priority.</li>
<li>
<strong>Administrative burden: </strong>Reforming prior authorization, WSMA's top administrative reform priority.
</li>
<li>
<strong>Health care work force: </strong>Supporting physician-led team-based care by ensuring physician expertise is guiding care decisions; by ensuring each clinician is able to work to the top of their respective license; and by guarding against those scope of practice expansions that endanger patient safety.
</li>
</ul>
<p>
Those may be the most publicly visible advocacy efforts in the year ahead, but the WSMA's menu of priorities for the profession is far more encompassing: practice sustainability (Medicare reform, advancing value-based care, primary care reform, influencing cost-of-care debates), workforce sustainability (reducing burnout, cultivating new, and supporting existing, physicians), health equity (reducing health inequities and supporting a more diverse physician workforce), social and technological issues (climate impacts on health, social determinants of health, artificial intelligence), and more. You could say the board of trustees has its work cut out for it.
</p>
<p>
<em>WSMA Reports</em> asked four of our new board members what motivated them to join the board and what they hope to accomplish, and we asked them to share a few words with our readers on what the new Your Care Is at Our Core campaign means to them.
</p>
<h3>
Meet Anukrati Shukla, MD
</h3>
<p>
An internal medicine and obesity medicine physician at Providence Internal Medicine Monroe, Dr. Shukla joined the WSMA in 2021, first contributing through her work with the association's Young Physician Section. She was elected by the 2024 House of Delegates to serve as young physician trustee on the WSMA board. She also recently submitted a letter to the editor, published in The Seattle Times, in support of the Medicaid Access Program.
</p>
<p>
"I saw the kind of work the staff does and what WSMA does, and I wanted to contribute more," she says of joining the board.
</p>
<p>
As an international medical school graduate, Dr. Shukla brings a unique lens to WSMA's advocacy. Her experience managing patients as a physician in India some 10 years ago stands in contrast to the paper work-fueled burnout she and many other physicians face in the U.S. It's why Dr. Shukla welcomes the opportunity to fight against prior authorization requirements.
</p>
<p>
In India, says Dr. Shukla, her patient-physician relationships were "pure connection." "You practice medicine. You make a diagnosis. You give the treatment, and there's no intermediary," she recalls. "And then I came here, and I see the hurdles, the repetitiveness and the redundancy of the work that has nothing to do with the actual medical care ... I was working more hours there, but I was somehow very satisfied. And here those barriers [to care] really, really drain you."
</p>
<p>
Getting to the heart of physician burnout is why Dr. Shukla also champions the WSMA's workforce initiatives. "We have to be innovative in solving workforce challenges. Physicians need to have a voice at the table," she says. "They have the knowledge and expertise to contribute to these solutions. And WSMA is a platform that provides the right voice for the right reasons."
</p>
<p>
As both a foreign-born physician and a woman of color, Dr. Shukla relishes the opportunity to help expand diversity in the workforce. "Diversity is the best thing that can happen to humankind. As a scientist, I see that in the microbiome. As a process improvement person, I see that diversity of thought is so important. You've got to have people with different experiences and different backgrounds to bring something creative [to solutions]," she says.
</p>
<p>
To that end, Dr. Shukla wants all WSMA members to speak up, to be active in some way to help change health care for the better. "If you don't have a seat at the table, then you're on the table," she says. "Whenever I hear somebody being helpless and being frustrated with the state of affairs that are today, I do remind them there is a right place and avenue where their concerns will be better heard."
</p>
<h3>
Meet Trace Julsen, MD
</h3>
<p>
The division chief of primary care at Providence Medical Group Spokane, Dr. Julsen was elected by the 2024 House of Delegates to serve as a trustee. He's been a WSMA member on and off throughout his 15-year career, rejoining last year to get more involved in political advocacy. Dr. Julsen's mentor, a strong supporter of the WSMA, encouraged him to join the board. "I think he saw that I had a lot of interest in doing things that aligned with the WSMA board," he says.
</p>
<p>
The board position also appealed to his current leadership role and long-standing commitment to health care reform. "I'm really passionate about reform and trying to make a change in primary care for our patients and for our care teams," says Dr. Julsen, who hopes to bring his experience as both a clinician and administrator to the board's decision-making.
</p>
<p>
As a primary care physician, Dr. Julsen's focus is on workforce wellness. "I'm worried about not being able to retain physicians or bring in new physicians to primary care. I'm worried about cuts to our training programs throughout Washington," he says. "So, a lot of the advocacy I would like to see or to work on is how we can support bringing in new physicians. How can we effect change so that our physicians don't feel burnt out with the insurance burdens that are placed on us? How can we make our work-life balance better, and at the same time, per the mission and vision and values of WSMA, how can we provide the best care to our patients at the maximum level that we can?"
</p>
<p>
Workforce wellness starts in making the medical profession attractive again. "When I'm recruiting a new grad out of residency, it is very different—the conversations—now than it was 10 years ago, of what they're hoping to have [in terms of work-life balance]," says Dr. Julsen.
</p>
<p>
From his leadership vantage point, Dr. Julsen feels there's less interest among college students today in becoming a physician, in large part because of the current health care system. "It's going to be really important for us to make sure we're bringing strong influence to future doctors, so supporting our medical schools and our residency programs and really trying to engage people," he says.
</p>
<p>
Ensuring a well workforce requires everyone's input. "It's really important for physicians to not just put their head down at work, but to actually speak up, join organizations where they can voice their concerns, their opinions, because that's the only way we're going to truly know what to do and how to fix things. Otherwise, we're just going to continue down the same pathway that we've been on," says Dr. Julsen.
</p>
<h3>
Meet Vivienne Meljen, MD
</h3>
<p>
An OB-GYN with SeaMarCommunity Health Center in Vancouver, Dr. Meljen was elected by the 2024 House of Delegates to serve as an American Medical Association alternate delegate.
</p>
<p>
"As an early career physician, I feel strongly that we need to be engaged in advocacy and in organized medicine. It's the only way to have the young physician voice help shape the system of service in the future," says Dr. Meljen, who graduated residency in 2021. "At the same time, we need to have the institutional knowledge from our more senior clinicians and work together as intergenerational teams to develop innovative solutions to today's challenges."
</p>
<p>
As an OB-GYN, Dr. Meljen is hyper aware of the challenges facing her profession and access to patient care. "It is no surprise to anyone that the world feels like it's a little bit on fire in health care. Right now, we've got physician shortages and physician career longevity decreasing for a lot of reasons. So, I feel like now more than ever, we need physician advocacy so that we can try to make changes in a system that's currently eroding our profession," she says.
</p>
<p>
In her work with the WSMA, Dr. Meljen is also focused on care for the underserved as well as health equity issues in general: She's been supportive of the Medicaid Access Program and the WSMA Foundation's Scholarship and Diversity Advancement Fund.
</p>
<p>
For her board role, Dr. Meljen wants to focus on increasing Medicaid reimbursement. In her work, she takes care of many patients with Medicaid who have difficulty accessing care because of their coverage or lack of meaningful coverage.
</p>
<p>
"A lot of organizations in our country and state are having to make the tough decision to not serve Medicaid patients because of the poor reimbursement," says Dr. Meljen. "Improving that reimbursement will help organizations, clinicians, and patients across the board. Doctors want to take care of these patients, the patients need us, and the system is getting in the way because it's incentivizing practices to see other patients with private insurance or financial means and steering doctors away from taking care of patients with Medicaid."
</p>
<h3>
Meet Stephanie Hansen, DO
</h3>
<p>
An internal medicine physician with the Yakima Valley Farm Workers Clinic, Dr. Hansen is joining the board as a first-time trustee. In another first, this year she celebrates 20 years as a practicing physician. Over the years, she's served in both clinician and leadership roles. As a current physician leader with a federally qualified health center in rural Central Washington, she brings her commitment and compassion to caring for an underserved population.
</p>
<p>
After joining the WSMA three years ago, Dr. Hansen wanted to find away to advocate for the patients and doctors she represents in her community. The Medicaid Access Program is essential to patients in rural communities like hers.
</p>
<p>
In her current and previous roles, Dr. Hansen has also seen firsthand how often prior authorizations can stymie care. "All of the initiatives are important, but my focus is really on prior authorization—how we can make a system that is better for both sides, both the payer side and us as practicing physicians, and improve that system for everyone," says Dr. Hansen.
</p>
<p>
Prior authorization often hits those in her community who can least afford it and doctors already stretched for time caring for them, says Dr. Hansen. "For those with managed Medicaid, many of the things we want to order for them require prior authorization. Having to go through these processes to try to get, whether it's medications covered or things such as imaging studies ... it definitely could be a more efficient process, especially with everything else primary care has to cover," she says.
</p>
<p>
Dr. Hansen encourages WSMA members to add their voice to the fight for a better health care landscape for all. "Everyone's voice matters," she says. And you don't have to serve on the board to help further WSMA's legislative priorities. "A lot of times it feels like there's not enough time, or that maybe someone else will do it instead, causing one not to be involved," says Dr. Hansen. "There are so many ways you can help, whether it's an email, a county society meeting, or by being a mentor to a new physician or colleague. Any of those things can help our profession stabilize, grow, and be ready for the future."
</p>
<p>
<em><strong>Rita Colorito </strong>is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/15/2025 11:57:40 AM | 1/14/2025 12:01:18 PM | 1/15/2025 12:00:00 AM |
| doctors-making-a-difference-mark-vossler-md | Doctors Making a Difference: Mark Vossler, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-mark-vossler-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/dmd-website-image-vossler-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Mark Vossler, MD" /></div>
<h5>Jan. 14, 2025</h5>
<h2>Doctors Making a Difference: Mark Vossler, MD</h2>
<p>
For Mark Vossler, MD, a trip to Japan as a medical student set in motion a decades-long effort to create a healthy population through social change. As a past president and current treasurer of Washington Physicians for Social Responsibility, and winner of a 2024 Grassroots Advocacy Apple Award from the WSMA, Dr. Vossler is working to make a difference through policies focused on climate change. He talked with <em>WSMA Reports</em> about the upcoming legislative session, what physicians can do to promote climate and economic equity in their practices, and more.
</p>
<h3>
</h3>
<p><em><strong>WSMA Reports:</strong></em><strong> How did you get involved with Washington Physicians for Social Responsibility? </strong></p>
<p>
<em>Dr. Vossler: </em>I had the privilege of doing a research fellowship at the Radiations Effects Foundation in Hiroshima, Japan as a medical student. The science was focused on cell signaling in carcinogenesis in response to radiation, but the experience was much more than that. Being in Hiroshima, studying the impacts of nuclear war, and visiting the Hiroshima Peace Memorial Park had a profound impact on me. When I returned to the U.S., I joined Physicians for Social Responsibility to speak out against nuclear weapons and to prevent what we cannot cure.</p>
<p>
<strong>Are there certain advocacy issues that are most important to you personally?</strong> </p>
<p>
Right now, I'm pretty focused on the health impacts of using gas for home heating and cooking. It turns out that there is limited awareness of the scope of the risk, even among physicians. I'm proud of the work that I did along with other concerned health professionals to help get state building codes passed that encouraged a transition off gas and to electric heating and cooking. Unfortunately, those gains are being set back by an initiative that just passed in the November election.</p>
<p>
<strong>Do you think physicians can play a unique role in advocating for policies that address climate change and its effects?</strong> </p>
<p>
Physicians have a unique role to play in advocacy, especially on issues that affect health. We are trusted by both the public and by elected officials. So long as we focus on being credible, truthful, and focused on human impacts, our input is taken very seriously. I feel it is an obligation of the physician to use their privilege to speak up on matters of public health. I am super grateful that the WSMA House of Delegates has passed resolutions calling for a reduction in emissions, acknowledging the health impacts of burning gas in the home, and for reducing climate impacts of the health care sector. This sends a very strong message to our electeds.</p>
<p><strong>What are your advocacy priorities for the upcoming legislative session?</strong> </p>
<p>
We are looking to pass a bill that would help hospitals and surgical centers reduce the greenhouse gas impacts of anesthesia. We have the backing of both the WSMA and the Washington State Society of Anesthesiologists on this. We are also eager to pass the CURB Pollution Act. This would require state agencies to take cumulative community pollution burden into account in the permitting process.</p>
<p>
<strong>Are there any ways that physicians can take action in their daily practice on climate or economic inequity issues?</strong> </p>
<p>We need to be in the habit of understanding our patients' vulnerabilities to social determinants of health. Economic factors are a big deal. Inability to buy healthy foods, fill prescriptions, or afford housing has a tremendous impact on our patients' health. We need to also ask about preparedness for things like extreme heat and wildfire smoke. Making air filtration and cooling available to low-income households in our state will make a big difference on the health impacts of climate change.</p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/15/2025 11:02:17 AM | 1/14/2025 11:35:09 AM | 1/14/2025 12:00:00 AM |
| member-spotlight-sung-won-kim-md | Member Spotlight: Sung-Won Kim, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-sung-won-kim-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/january-february/member-spotlight-website-image-kim-645x425px.png" class="pull-right" alt="Member Spotlight: Sung-Won Kim, MD" /></div>
<h5>Jan. 14, 2025</h5>
<h2> Member Spotlight: Sung-Won Kim, MD </h2>
<p>
<strong>Works at: </strong>ENT Associates, Olympia.</p>
<p><strong>In practice: </strong>13+ years.</p>
<p><strong>Specialty:</strong> Otolaryngology.</p>
<p><strong>Why WSMA:</strong> Three words: Advocacy, advocacy, advocacy. The WSMA works tirelessly to ensure that we have a voice in legislative matters that affect our practice. The WSMA lobbies for fair reimbursement rates and improved working conditions so I can focus on providing patient care. I can sip my tea in peace, secure in the knowledge the WSMA is fighting for our ability to practice medicine without constraints imposed by inadequate funding or bureaucratic burdens.
</p>
<p>
I love that the WSMA is trying to increase Medicaid reimbursement rates to Medicare levels. Every legislative session, the WSMA works to oppose inappropriate scope-of-practice legislation, including expanding prescriptive powers of naturopaths to involve schedule II-IV controlled substances.
</p>
<p>
The WSMA also provides CME accreditation, which my subspecialty organization, Northwest Academy of Otolaryngology, uses for our annual meetings.
</p>
<p>
<strong>Proud moment in medicine:</strong> I love my job and feel proud about the difference we make in our patients' lives and the lives of those who love and care for them. But I also hate my job when I encounter systems that actively or passively restrict my ability to care for our patients. These systems can be modified. The WSMA is the organization to influence policy to protect our patients and our practice.
</p>
<p>
<strong>Top concerns in medicine: </strong> I worry about our ability to provide quality care to everyone when reimbursements are decreasing and the cost of providing high-quality health care is increasing. I am concerned more practices will stop seeing Medicaid patients and, at some point, Medicare patients. Health inequity is already a tremendous problem for vulnerable populations. Cuts to Medicare and the ridiculously low payments for services by Medicaid exacerbate the situation.
</p>
<p>
<strong>Why my specialty: </strong> I wanted to be a primary care physician in medical school. I was super interested in the idea that we can prevent disease and reduce morbidity with chronic care of disease. I started my clerkship rotations with primary care, and I absolutely hated it. It did not suit my personality and temperament. Getting excited about a 0.4 drop in A1C is something I could not muster. I was despondent. I was so confident I would be a primary care physician and now my world was upside down. Worse, my next rotation was in surgery, and surgeons have a bad reputation. But when I started my rotation, I knew I belonged. Not all surgeons deserve that bad reputation. Surgery was for me. In an otolaryngology clerkship in my fourth year of medical school, I realized that was the perfect combination of medical and behavioral management of chronic disease with surgery. Perfect for me.
</p>
<p>
<strong>Spare time: </strong>Spending time with my family. I have two boys, aged 15 and 12. They are fully engaged in sporting activities such that any free minute I have, I spend it with the logistics of sports: lacrosse, sailing, basketball, cross country, etc. Winter weekends are reserved for freezing on top of a mountain at White Pass, fearing for my life as I descend a mountain at unsafe speeds. Skiing: uncomfortable, frightening, and dangerous. But my wife and kids love it. So, I go.
</p>
<p>
<strong>What people might not know about me: </strong> While there are some secrets that must not be shared, one of mine is that if you recognize me in public and start to talk to me, I will probably not remember who you are, but I will pretend I do. </p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/15/2025 11:02:17 AM | 1/14/2025 11:35:31 AM | 1/14/2025 12:00:00 AM |
| doctors-making-a-difference-michael-brush-md | Doctors Making a Difference: Michael Brush, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-michael-brush-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Doctors Making a Difference: Michael Brush MD graphic" src="/images/Newsletters/Reports/2024/november-december/dmd-website-image-brush-645x425px.png" class="pull-right" /></div>
<h5>Dec. 16, 2024</h5>
<h2>
Doctors Making a Difference: Michael Brush, MD
</h2>
<p>
Through his volunteer work<strong>, </strong> Michael Brush, MD, an ophthalmologist at Kaiser Permanente, is working to provide free vision care to those without access through typical means. His work stretches around the globe from Ghana, where he provides surgical eye care, local training, and more through Cure Blindness Project, to the free Seattle King County Clinic here in his own backyard, where he serves as vision director. Dr. Brush talked with <em>WSMA Reports</em> about how he got involved in both organizations and how they provide care to the underserved.
</p>
<p>
<strong><em>WSMA Reports:</em> What prompted your interest in volunteering your medical services?</strong>
</p>
<p>
<em>Dr. Brush:</em> I began working with Cure Blindness Project due to a fellow resident from UW who has been involved with the organization for 20-plus years. I was always interested in the work that he was doing and when I reached a stable point in my career, I asked to be a part of one of the outreaches that was occurring in Ethiopia in 2015. From there, I have tried to spend 1-2 weeks a year volunteering; initially this was in Ethiopia, but since 2020 I have been working in Ghana.
</p>
<p>
My involvement with the Seattle King County Clinic came about from an email from a colleague at Kaiser Permanente asking me if I would be interested in helping run a volunteer vision clinic. I didn't quite know what I stepped into when I said yes, but the reward of clinic has been well worth the initial leap into the unknown.
</p>
<p>
<strong>Why did you choose those two organizations?</strong>
</p>
<p>
Both represent an aspect of global ophthalmology. Despite all the advances in eye care that can improve, restore, and save vision, not everyone has access to it. There are too many people in our country who lack access to insurance, and vision care is often not considered part of the medical side of health care. With the free clinic we can offer care to anyone who comes in the door and provide them with a full eye exam and a free pair of glasses during the annual four-day event.
</p>
<p>
<strong>Can you tell our readers a little about what the Cure Blindness Project does and who it serves? </strong>
</p>
<p>
There are an estimated 43 million people worldwide who suffer from blindness, but 80% of this burden is treatable or preventable. The majority of this occurs in developing countries in sub-Saharan Africa and Southeast Asia. The mission of Cure Blindness Project is to help people retain or regain sight by enabling underserved communities to cure avoidable blindness by developing high-quality, cost-effective, sustainable eye care.
</p>
<p>
This is done through multiple approaches: Building local capacity with local training; supplying and building equipment and infrastructure; direct patient care through surgical outreaches; and prevention through education of community health workers regarding primary eye care.
</p>
<p>
<strong>What is the biggest challenge when providing medical care in Africa and the other countries where the program operates? </strong>
</p>
<p>
Each location has its challenges. Sometimes we work in very remote locations that have limited health care and during outreaches all the supplies to perform surgeries are brought in by bus, boat, horse, or on foot. Power may be sporadic; I've operated under a cell phone flashlight when power cut out. Specific to cataract surgery, the cataracts that we address are significantly worse that what we typically will see in the U.S., so how you approach the surgery is different.
</p>
<p>
In larger cities with training programs, working to improve education standards is important for making sure that residents, nurses, and technicians are able to receive both the knowledge as well as the hands-on training needed to provide the full range of ophthalmic care.
</p>
<p>
<strong>Has your volunteer work taught you anything about changes you think need to be made in the health care system as a whole? </strong>
</p>
<p>
I'm an advocate for the U.S. implementing a universal health care system that includes the full range of eye care glasses included. I believe that health care is a human right and no one should be deprived of it in a country as wealthy as ours.
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 12/16/2024 4:09:33 PM | 12/16/2024 4:03:42 PM | 12/16/2024 12:00:00 AM |
| understanding-policy-limits-settlement-demands-in-medical-malpractice-claims | Understanding Policy Limits Settlement Demands in Medical Malpractice Claims | WSMA_Reports | Shared_Content/News/Latest_News/2024/understanding-policy-limits-settlement-demands-in-medical-malpractice-claims | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" alt="WSMA Reports July/August 2024 cover" /></div>
<h5>Dec.&nbsp;16, 2024</h5>
<h2>Understanding Policy Limits Settlement Demands in Medical Malpractice Claims</h2>
<p>
By Shauna Martin Ehlert
</p>
<p>
In the complex field of medical malpractice litigation<strong>,</strong> one common tactic used by plaintiffs' attorneys is the quick demand for settlement for the insurance policy limits. This approach can be stressful and intimidating for physicians and their insurers, as it aims to force a rapid settlement without a thorough investigation. Understanding this tactic and its implications is crucial for both physicians and attorneys.
</p>
<h3>Understanding the tactic</h3>
<p>
Attorneys often initiate this strategy by sending a demand letter in connection with the filing of a lawsuit. The letter typically insists that the physician's insurer settle the claim for the available policy limit within a specified period, typically 30 days. These letters may contain threats to seek amounts exceeding the policy limits and target the physician's personal assets, warn of time-consuming and stressful litigation, and raise the possibility of public embarrassment.
</p>
<p>
For example, a demand letter may take this approach: "Please inform Dr. X that this will be their only chance to gain protection from excess liability and pursuit of personal assets." Or, even more aggressively: "I will put my client in contact with the reality show 'Botched'. We'll see how that plays out." The obvious goal here is to instill fear, uncertainty, and doubt to push the physician and insurer into a quick and potentially unfavorable settlement.
</p>
<h3>What's behind early settlement demands</h3>
<p>
The main objective of early settlement demands is to use fear of the unknown to convince the defendant and their insurer to offer the policy limit as soon as possible. The early settlement demand is also designed to create risk to the insurer. In states such as Washington, if an insurer declines to make an early offer of the policy limit, the plaintiff's attorney may later argue that the insurer missed its chance and acted in bad faith. The goal is to create an argument that the insurer acted in bad faith by failing to settle early, and that therefore the insurer should be liable for amounts in excess of the policy limits. The practice is so common that some plaintiffs' lawyers have stated that it would be malpractice on their part if they did not attempt to set up the insurer for bad-faith exposure beyond the policy limits.
</p>
<h3>What happens if you settle early</h3>
<p>
There are several risks in meeting early settlement demands:
</p>
<ol>
<li>
<strong>Insufficient time to evaluate merits.</strong> A quick settlement does not allow adequate time to evaluate a case's merits. Malpractice cases are inherently complex and require thorough investigation. This can take 12 to 24 months to ensure that relevant information is discovered.
</li>
<li>
<strong>Questionable justification.</strong> Settling quickly may not be justified by the case's facts. Without a thorough review, it can be challenging to determine whether a claim is meritorious.
</li>
<li>
<strong>Reputation and reporting.</strong> For physicians, a malpractice settlement leads to a report to the National Practitioner Data Bank and the state Department of Health. This can damage a physician's reputation and career.
</li>
<li>
<strong>Encouragement of repeat claims.</strong> Early settlements can make a physician and insurer look like an easy mark, encouraging repeat claims.
</li>
<li>
<strong>Increased insurance costs.</strong> Settlements can lead to increased costs for professional liability insurance, both for the physician and the broader industry.
</li>
</ol>
<h3>Financial implications for plaintiffs' attorneys</h3>
<p>
Most plaintiffs' attorneys work on a contingency basis, typically receiving 30ñ50% of the settlement amount. For a $1 million policy limits settlement, the attorney's fee could range from $300,000 to $500,000, plus out-of-pocket costs. This leaves the patient/client with a fraction of the settlement amount. Quick settlements also mean less work for plaintiffs' attorneys, giving them a powerful financial incentive to demand an early resolution.
</p>
<h3>The importance of complete investigations</h3>
<p>
Medical malpractice cases are inevitably complex. Because of that, a complete investigation is essential. Demand letters often come as a surprise to both the physician and their insurer. The insurer needs time to digest the allegations, review medical records, and talk to its own experts. A thorough investigation helps in understanding whether the claim is valid and determining the extent of any potential liability.
</p>
<p>
Many medical malpractice policies require the insurer to obtain the physician's consent before settling. This provision helps ensure open communication and partnership between the insurer and the physician, protecting the physician's interests. Early settlement demands seek to undermine this partnership by creating a sense of urgency and fear.
</p>
<h3>Coping with high-pressure settlement demands</h3>
<p>
It is crucial for physicians and their attorneys to understand early settlement demands, and to respond appropriately.
</p>
<p>
This means staying informed and understanding that early settlement demands are a common tactic. Moreover, at times like this it is important to rely on your insurer, defense counsel, and retained experts, who are experienced in evaluating claims. They will work to evaluate your case and determine the appropriate course of action. For example, if potential liability exists, a defense counsel and the insurer may recommend early mediation. This allows a thorough discussion of the facts and can lead to a fairer and more informed settlement.
</p>
<p>
While the pressure to settle quickly can be intense, it is often in the best interest of physicians to allow time to fully evaluate early settlement demands. An investigation and a measured response can lead to a more favorable outcome, protecting both the physician's professional reputation and their monetary interests. By understanding and navigating these tactics, physicians can ensure they are making the right decision when faced with medical malpractice claims.
</p>
<p>
<em>Shauna Martin Ehlert</em><em> is an attorney at Cozen O'Connor in Seattle specializing in professional liability claims and insurance coverage disputes.</em></p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 12/16/2024 4:43:35 PM | 12/16/2024 4:23:17 PM | 12/16/2024 12:00:00 AM |
| choice-competence-and-community | Choice, Competence, and Community | WSMA_Reports | Shared_Content/News/Latest_News/2024/choice-competence-and-community | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/november-december/cover-wsma-reports-novdec-2024-645x425px.jpg" class="pull-right" alt="November/December 2024 cover of WSMA Reports" /></div>
<h5>December 10, 2024</h5>
<h2>Choice, Competence, and Community</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
It goes without saying that physician and practitioner well-being can directly impact patient care. Yet, research continues to show that more work needs to be done to adapt and implement real change across clinical areas.
</p>
<p>
According to The Physicians Foundation's 2024 Survey of America's Current and Future Physicians, 60% of physicians and residents report often feeling burnout. What’s worse, more than half of physicians surveyed say they know physicians who have considered, attempted, or died by suicide.
</p>
<p>
It’s clear that health care systems can no longer continue operating in triage mode when it comes to physician wellness. What’s critically needed are sound, evidence-based preventive measures that address the core risk factors and drive real change.
</p>
<p>
</p>
<h3>Commitment to driving change</h3>
<p>
Improving physician wellness through sound practices was the mission of the WSMA Foundation Wellness Action Committee. The 17-member committee of front-line physicians and physician assistants began its work in October 2023, funded by a Physicians Foundation grant to develop a best-practices playbook to promote physician and practitioner well-being.
</p>
<p>
“We understand the problem. Now the question is, ‘What do we do about the problem?’†says committee chair Alka Atal-Barrio, MD, national senior medical director for Optum Health.
</p>
<p>
To develop the best-practices playbook, the committee surveyed large organizations on their programs and activities to improve engagement and wellness. It also surveyed front-line clinicians on what mattered to them.
</p>
<p>
“Every institution is different, and no single solution applies to everybody’s circumstances. So there was a lot of talk about, really, how we can provide resources and a toolkit that’s adaptable to the situation on the ground, not just at a particular institution,†says committee member Chris Bundy, MD, MPH, executive medical director of the Washington Physicians Health Program.
</p>
<p>
The committee focused on wellness interventions that demonstrated a good return on investment, something historically difficult to understand but essential to convincing leadership to get on board.
</p>
<p>
“There’s this idea that in order to make employees happy, it’s going to cost money; it’s going to affect our bottom line. Self-determination theory is really rooted in the idea that, when you take care of the workers, the bottom line works itself out; that productivity and worker wellness are naturally tied to well-being and that those things aren’t in opposition. They’re actually in perfect alignment,†says Dr. Bundy.
</p>
<p>
</p>
<h3>New plan forward</h3>
<p>
From these discussions, the committee developed comprehensive and actionable criteria for medical groups and health systems that help address physician and practitioner workplace wellness. Titled Thriving in Medicine: Cultivating Choice, Competence, and Community, this new report and member resource uses self-determination theory as the psychological framework for addressing workplace wellness.
</p>
<p>
The report focuses on the ABCs of self-determination theory (autonomy, belonging, and competence) to improve physician and physician assistant workplace wellness. It provides evidence-based examples of what works for developing leadership support, empowering choices, providing skill enhancement, and fostering community.
</p>
<p>
“We also wanted a model that we could sell to the chief financial officers and the people who are trying to make these health care organizations work on diminishing returns to say, ‘Look, this doesn’t have to cost a lot of money. And, in fact, if we do this, we could probably improve productivity in our bottom line, not take away from it,’†says Dr. Bundy.
</p>
<p>
The report also contains a list of resources with point people to connect with to help members get started in that work.
</p>
<p>
Members can access the document through the WSMA website (under Foundation, then Physician and Practitioner Wellness). “They can engage in the actions and resources that are most meaningful to their practice, because it’s not a one size fits all,†says Dr. Atal-Barrio.
</p>
<p>
“We wanted something relatively simple, relatively practical, that people could use without feeling like it required some massive organizational overhaul to implement,†says Dr. Bundy.
</p>
<p>
Adapting the self-determination framework to improve physician wellness can also prove critical in addressing physician and practitioner shortages. “We’re not getting much traction on this sustainability issue. There are lots of data telling us that people are looking elsewhere who are qualified to do this work, but they’re just not finding the meaning and purpose and satisfaction in it that they would like,†says Dr. Bundy.
</p>
<p>
</p>
<h3>Next steps</h3>
<p>
The Wellness Action Committee encourages all physicians, physician assistants, and advanced practitioners to read the report and use it as a resource, regardless of their leadership position. Physicians who are not in leadership positions and want to effect change can take the document to their leadership team, says Dr. Atal-Barrio. “Physicians can’t do a lot until their leadership says, ‘Yes, this is important, we want to have change to support physician well-being.’â€
</p>
<p>
The committee also developed a framework to engage CEOs and CMOs of health care organizations across Washington state to commit to doing something. “We learned that when leadership prioritizes well-being—which is a major call to action—that’s how we’re going to move forward,†says Dr. Atal-Barrio.
</p>
<p>
To galvanize health leadership, the Wellness Action Committee presented the report during the WSMA Medical Officer Collaborative’s October meeting, renamed the CMO Collaborative and Wellness Summit. They also invited all CMOs and CEOs across Washington state to attend. The committee will reconvene with the collaborative every six months to follow up on progress.
</p>
<p>
“We want to make sure we’ve got traction to be able to retain and hire great physicians and physician assistants for Washington state,†says Dr. Atal-Barrio.
</p>
<p>
“That’s the Achilles’ heel of all of this—getting leadership buy-in and true leadership support, not just token support,†says Dr. Bundy. “The process is going to require patience, because these things are long-term investments in the health of the organization. They’re not things that can be realized on the next quarter or next year’s balance sheet.â€
</p>
<p>
The report is just the start, says Dr. Atal-Barrio. “The WSMA Foundation for Health Care Improvement and the WSMA have made physician and physician assistant well-being a top priority,†she says. “Our front-line physicians and physician assistants need to know that we take this seriously. We are putting our resources into this work.â€</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 12/10/2024 4:40:24 PM | 12/10/2024 11:08:28 AM | 12/10/2024 12:00:00 AM |
| how-do-we-fix-primary-care | How do we fix primary care? | WSMA_Reports | Shared_Content/News/Latest_News/2024/how-do-we-fix-primary-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/Reports/2024/november-december/heartbeat-website-image-berman-645x425px.png" class="pull-right" /></div>
<h5>October 25, 2024</h5>
<h2>How Do We Fix Primary Care?</h2>
<p>
By Jake Berman, MD, MPH</p>
<p>
Consider the plight of today's primary care physicians and practitioners.
</p>
<p>
First, clinical guidelines for screening, preventive health, and chronic disease management continue to grow in number and nuance, yet the time and resources needed to address them remain stubbornly fixed and insufficient. By some estimates, PCPs would need 26.7 hours per day to render guideline-concordant care for a typical panel of 2,500 adult patients <sup>1</sup>. It has been observed (with biting wit) that progress could be made if "<a href="https://www.bmj.com/content/363/bmj.k4983">general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don't like them much anyway</a>." For PCPs, the supply-demand mismatch is real, painful, and unsustainable, a common source of stress, burnout, and moral injury.
</p>
<p>
Second, in the face of these impossible demands, the PCP often remains a lone warrior, expected to address an enormous range and volume of tasks, many of which do not require the PCP's clinical expertise and many of which would be better addressed by the expertise of other health care professionals or community partners. Team-based care to support primary care patients is far from a novel concept, yet its implementation has often come in fits and starts, and many practices struggle to achieve sustainable, integrated team-based care models.
</p>
<p>
Third, such challenges in establishing and scaling effective team-based care arise in no small part because spending on primary care remains woefully inadequate. According to current estimates, in Washington state, only 4.4-5.6% of health care dollars are spent on primary care, far short of the state's goal of 12%. This yawning gap is acutely and chronically palpable for the PCP.
</p>
<p>
Finally, the pain points of primary care practice are driven not only by investing too little in primary care but also by the way in which we generally pay for primary care. Despite some forays into and some successes with value-based models, billable encounters with PCPs, which do not incentive quality and constrain the variety of ways in which primary might be rendered, largely remain the coin of the realm for many primary care practices. As the National Academies of Science, Engineering, and Medicine recommended in its landmark 2021 report Implementing High-Quality Primary Care, "<a href="https://nap.nationalacademies.org/read/25983/chapter/2">Pay for primary care teams to care for people, not doctors to deliver services</a>." Paying for teams to take care of people not only better aligns the incentives for high-value, patient-centered care but also opens the way for innovative, multimodal primary care models that can more flexibly meet diverse patient needs. The tension between primary care's business model and its clinical paradigm creates dissonance for PCPs, care teams, and patients alike. The Work Relative Value Unit simply does not describe primary care's value or lend itself to meaningfully assessing PCP performance.
</p>
<p>
Fortunately, there is hope, not only on the horizon but in the waters in which we currently swim.
</p>
<p>
In June 2023, the Centers for Medicare and Medicaid Innovation announced a new primary care model called Making Care Primary. MCP seeks to support primary care through a combination of upfront capacity-building payments and a gradual transition from fee-for-service to prospective population-based payments for primary care services, with a host of resources and incentives to advance quality, equity, efficiency, and patient experience. Washington state was selected as one of eight states to participate in MCP, in no small part because the Washington State Health Care Authority was looking to integrate the program with its Primary Care Transformation Initiative, which includes an ongoing effort to advance a multi-payer primary care model increasingly built on value-based payments. In Washington, 21 clinical practices have enrolled and 11 payers have signed a letter of intent to align with the model.
</p>
<p>
MCP is not a panacea. Nor is it the only way forward. Yet, the model is engineered to foster—and invest in—team-based care, care integration, and, ultimately, an approach that pays for the value of primary care relationships rather than billable encounters. For PCPs, this could mean a reimagined clinical workday, with investments and a payment model that enable more time and flexibility for patient care through whichever channel works best—a brick and mortar visit, a digital visit, the electronic inbox, remote patient monitoring, the community—and support for a care team that is better-suited to addressing the scale and variety of patient needs. With an effective care team, the estimate of PCP time needed to provide guideline-concordant care dropped from 26.7 hours per day to 9.3 hours per day-still too much, but a marked improvement <sup>2</sup>.
</p>
<p>
How else could a program like MCP truly impact the everyday life and work of PCPs? Among other things, the model seeks to support better integration of care between PCPs and specialists, including through a new e-consult code that pays specifically for the work the PCP does to place and follow up on a virtual consult. MCP also supports investment in building desperately needed behavioral health capacity, such that PCPs could have better access for their patients to counselors, social workers, and psychiatrists. Significantly, MCP also seeks to better integrate medical services with community resources by incentivizing the collection of data on health-related social needs and providing resources that can be invested in roles like community health workers, who may be best positioned to support and engage patients in their everyday lives. Have a patient whose diabetes is nearly impossible to manage given food insecurity? The MCP care team could include a community health worker able to assist the patient in troubleshooting root causes and pursuing nutritional resources. At its core, the model looks to enhance the primary care medical home while situating this medical home in a more cohesive medical neighborhood, empowering PCPs with more and better-integrated resources to support their patients.
</p>
<p>
MCP will be what we make of it, and the types of organizational, cultural, and practice change required for success can be complex. But with the resources provided by the program and with thoughtful execution, PCPs could chart their way out of the current predicament to a future where they are set up successfully to do what so many of us originally signed up for: make care primary.
</p>
<p>
<em>Jacob Berman, MD, MPH, is the medical director for population health integration at UW Medicine and a clinical associate professor in the department of medicine at the University of Washington. This essay reflects Dr. Berman's own views and not those of UW Medicine.</em>
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
<p><span style="font-size: 10px;">
1. J GenIntern Med 38(1):147–55 DOI: 10.1007/s11606-022-07707
</span></p>
<p><span style="font-size: 10px;">
2. J GenIntern Med 38(1):147–55 DOI: 10.1007/s11606-022-07707
</span></p>
</div> | 10/31/2024 1:44:53 AM | 10/25/2024 12:58:41 PM | 10/25/2024 12:00:00 AM |
| member-spotlight-sheree-sharpe-md | Member Spotlight: Sheree Sharpe, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/member-spotlight-sheree-sharpe-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/november-december/member-spotlight-website-image-sharpe-645x425px.png" class="pull-right" alt="Member Spotlight: Sheree Sharpe, MD graphic" /></div>
<h5>October 25, 2024</h5>
<h2>Member Spotlight: Sheree Sharpe, MD</h2>
<p>
<strong>About you:</strong> Sheree Sharpe, MD</p>
<p>
<strong>Works at:</strong> Community Health Care, Tacoma.
</p>
<p>
<strong>How long in practice:</strong> 17 years.
</p>
<p>
<strong>Specialty:</strong> Family medicine.
</p>
<p>
<strong>Why WSMA: </strong>The WSMA represents and advocates for the physician community in Washington state. For me, this means I have a powerful voice through the WSMA that supports and defends the interests and well-being of physicians, ensuring we have the resources and support to deliver high-quality care to our patients. Through the WSMA, I have shared values in advocacy, representation, and leadership, aligning with my own passion for advancing health care and advocating for others.
</p>
<p>
<strong>Proud moment in medicine:</strong> I will never forget the opportunity I had to assist my patient navigate a challenging diagnosis. After weeks of uncertainty, I worked closely with her to ensure she understood her options and felt supported throughout the process. Witnessing her relief and gratitude after we developed a clear path forward was incredibly rewarding. It reinforced my belief in the importance of compassionate care and effective communication, reminding me of the profound impact we can have on our patients' lives during their most vulnerable times.
</p>
<p>
<strong>Top concerns in medicine:</strong> My concerns revolve around three critical areas. First, ensuring equitable access to high-quality health care for all, regardless of socioeconomic status, is paramount. Disparities in health care access create barriers that prevent many from receiving the care they need, which can have long-term impacts on community health and well-being.
</p>
<p>
Second, the issue of burnout among physicians and health care professionals is increasingly alarming. Burnout not only affects the mental and emotional health of clinicians but also directly impacts patient care. Addressing this challenge is crucial to maintaining a healthy and effective health care workforce.
</p>
<p>
Lastly, I am deeply concerned about the current focus on reactive treatment over preventive medicine. By emphasizing prevention, we can improve long-term health outcomes and significantly reduce health care costs. This shift is necessary to build a more sustainable and patient-centered health care system.
</p>
<p>
<strong>Inspired by:</strong> I am inspired daily by the opportunity to make a meaningful difference in people's lives through individual patient interactions—promoting health, preventing illness, and offering compassionate care during their most vulnerable moments.
</p>
<p>
<strong>Challenges to our profession: </strong>The health care profession is facing several significant changes that are reshaping the way care is delivered. One of the most impactful is workforce shortages. Many organizations are grappling with a lack of health care professionals, which leads to heavier workloads and increases the risk of burnout among existing staff. This issue not only affects the well-being of health care workers but can result in compromised quality patient care and the overall efficiency of health care systems.
</p>
<p>
Another major challenge is the rapid adoption of telemedicine. As telehealth becomes more widespread, it has transformed patient interactions, offering greater accessibility but requiring health care organizations to adjust to new technology and adapt traditional care models to fit virtual platforms. This shift demands a reevaluation of how we maintain quality, continuity, and personal connection in patient care. Technological advancements also pose both opportunities and challenges. The rapid development of innovations such as electronic health records and artificial intelligence has the potential to enhance patient care and streamline operations. However, keeping up with these advancements requires ongoing education, training, and careful integration to ensure they support, rather than hinder, the clinical process.
</p>
<p>
<strong>When I knew I wanted to be a physician:</strong> From an early age, I was captivated by the intricacies of the human body and driven by a deep curiosity to understand how it works. As a 6-year-old, when asked why I wanted to become a doctor, my simple answer was, "to help people." That childhood desire, combined with my passion for science and medicine, inspired me to pursue the path of becoming a physician. It's a calling that allows me to merge my fascination with the human body with my genuine commitment to improving the lives of others.
</p>
<p>
<strong>Why my specialty: </strong>I am drawn to family medicine because it aligns with one of my core beliefs that "prevention is better than cure." As a family medicine physician, I have the privilege of focusing on preventive care, guiding patients toward healthier choices that promote long-term well-being. Family medicine allows me to build long-term relationships with my patients and empower them to take control of their health and well-being, which is both fulfilling and deeply meaningful to me.
</p>
<p>
<strong>If I weren't a doctor:</strong> l'd be a lawyer, because I believe in strong advocacy for oneself and others.
</p>
<p>
<strong>Leadership lessons:</strong> Throughout my journey in leadership, I have learned three crucial lessons that have significantly shaped my approach.
</p>
<p>
First, <strong>be kind to yourself</strong>. Leadership can be incredibly demanding, and I have found that self-compassion is essential for long-term success. By practicing kindness toward myself, I have discovered that resilience stems from maintaining balance, taking time to rest, and prioritizing my well-being. When I take care of myself, I am better equipped to lead and support others effectively.
</p>
<p>
Second, <strong>be your authentic self</strong>. Authenticity is vital for building trust and credibility. By staying true to myself in my leadership role, I have realized that genuine connections form the foundation of effective teams. It becomes much easier to inspire and lead others when they know I am honest and consistent in my actions and words.
</p>
<p>
Lastly, <strong>be vulnerable</strong>. Embracing vulnerability fosters deeper relationships and trust within a team. I have learned that being open about challenges, uncertainties, and mistakes not only humanizes leadership but also encourages a collaborative and solution-oriented environment. When I model vulnerability, it inspires others to share their own struggles, creating a culture of support and teamwork.
</p>
<p>
Together, these lessons have profoundly influenced my leadership style, allowing me to cultivate a more compassionate, authentic, and collaborative environment.
</p>
<p>
<strong>Best advice:</strong> The best advice I ever received came from my dad, who encouraged me to stay focused and dedicated to my goal of becoming a physician. When I was contemplating psychology as an alternative career path, his unwavering support and guidance helped me reaffirm my commitment to medicine. His belief in my potential motivated me to pursue my true calling, ultimately shaping the course of my professional journey in medicine.
</p>
<p>
<strong>Spare time: </strong>I love to travel and explore new places. I enjoy immersing myself in different cultures and learning new languages, as it enriches my understanding of the world and connects me with diverse communities. Each adventure offers a unique opportunity for growth and discovery, fueling my passion for exploration.
</p>
<p>
<strong>Hobbies: </strong>I love swimming and cooking gourmet meals. Swimming allows me to relax and stay active, while cooking gourmet meals lets me express my creativity and passion for food. Both activities bring me joy and balance in my life.
</p>
<p>
<strong>Goals for the year ahead:</strong> One of my key goals this year is successfully launch a new medical clinic. This endeavor represents a significant opportunity to positively impact my community by providing high-quality health care services.
</p>
<p>
In addition to my professional aspirations, I am committed to personal growth through language acquisition. Learning conversational Spanish is another important goal of mine. I believe that this skill will enhance my ability to communicate with a broader range of patients, fostering better connections and understanding.
</p>
<p>
Finally, I am eager to experience a new culture in a different country. Traveling to a new destination will allow me to immerse myself in diverse traditions and perspectives, enriching my worldview and inspiring my work.
</p>
<p>
<strong>What people might not know about me: </strong>Something that most people might not know about me is that I am a descendant of Samuel Sharpe, a Jamaican national hero and a prominent slave abolitionist. His legacy of courage and advocacy for freedom is a source of inspiration for me, and it deepens my commitment to justice and equality in my own work and life.
</p>
<p>
<strong>Pet peeves:</strong> One of my biggest pet peeves is cell phone use during conversations. I find it extremely frustrating when people are distracted by their devices instead of engaging fully in the moment. It undermines the connection and communication that is so important in our interactions.
</p>
<p>
<strong>Favorite books:</strong> My favorite book is the Bible because it offers inspiration and timeless relevance across the ages. Its teachings and stories resonate deeply with me, providing guidance, wisdom, and a sense of connection to something greater than myself. The lessons found within its pages continue to influence my perspective and actions in everyday life.
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/1/2024 9:51:49 AM | 10/25/2024 12:54:00 PM | 10/25/2024 12:00:00 AM |
| doctors-making-a-difference-carrie-horwitch-md | Doctors Making a Difference: Carrie Horwitch, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-carrie-horwitch-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/september-october/dmd-website-image-horwitch-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Carrie Horwitch, MD, MPH" /></div>
<h5>Sept. 24, 20224</h5>
<h2>Doctors Making a Difference: Carrie Horwitch, MD</h2>
<p>
For Carrie Horwitch, MD, MPH, her work across a 30-year career in medicine to improve both patient health and the well-being of physicians and practitioners takes many forms: As an internal medicine physician specializing in transgender health and HIV care; as a Certified Laughter Leader using laughter techniques to improve health through her business Laugh Doctor LLC; and as a volunteer for the MAVEN Project, which connects physicians and clinicians at safety-net clinics with expert physician volunteers for medical advice, mentorship, and education. She talked with <em>WSMA Reports</em> about her volunteer work at the MAVEN Project and how the extra support for primary care physicians and practitioners can help reduce burnout and improve care for patients in underserved communities.
</p>
<p>
<strong><em>WSMA Reports:</em> How long have you been volunteering with the MAVEN Project, and can you tell readers about what your work entails?</strong>
</p>
<p>
<em>Dr. Horwitch:</em> I started volunteering with MAVEN Project in June 2022. The MAVEN Project supports safety-net clinics and their patients by connecting their physicians and practitioners with specialists in medicine, including adult and pediatric specialties. Most of this work is done virtually on their HIPAA- compliant telehealth platform. They have several areas of support for the clinics and practitioners including email and video consults, 1:1 clinical mentoring and leadership coaching, and free CME through lectures given by MAVEN Project volunteers. There are currently 63 sites across Washington state partnering with the MAVEN Project.
</p>
<p>
<strong>What was it about the project's model that drew you to it as an avenue for volunteering?</strong>
</p>
<p>
Some of the main attractions for me to work with the MAVEN Project were the diversity of volunteer opportunities, including consulting, mentoring, and giving didactic presentations. I also loved the idea that I was helping clinicians in resource-limited areas and clinics to serve their patients better. I have always been a believer that when doing volunteer work, I would like it to be a sustainable model. I feel the MAVEN Project is able to accomplish this as we focus on building knowledge and skills of the clinicians in these community clinics.
</p>
<p>
<strong>What are some of the most significant challenges that the primary care physicians you consult with face in their practices, and how does access to MAVEN's volunteer physicians help them to provide better patient care?</strong>
</p>
<p>
There are several challenges these clinicians and clinics encounter on a daily basis. One is there are not enough practitioners in primary care, especially in under-resourced safety-net clinics. Another is that many of the patients have complex conditions and do not have access in their communities to specialty care (including general internal medicine and pediatrics). The MAVEN Project provides specialty expertise to the clinicians on specific cases or a general approach to different conditions patients may have (such as HIV or diabetes). Offering continuing education and support for the clinicians positively impacts the care their patients receive.
</p>
<p>
In addition, some of the mentoring can focus on the well-being of the clinician, an important component of reducing burnout. It can also help develop an approach to quality improvement projects for their clinics.
</p>
<p>
<strong>Has your volunteer experience changed the way you provide care to your own patients?</strong>
</p>
<p>
The volunteer experience reminds me that there are a large number of people in our country facing many barriers to accessing primary and comprehensive care. Working with mentees on the challenges they face with their patients and the resource limitations helps me to consider my patients' struggles. It also energizes me to continue advocacy work to better our health care system for patients and caregivers.
</p>
<p>
<strong>What has been the most fulfilling aspect of your work with the MAVEN Project? </strong>
</p>
<p>
As a "later" career physician, I am so grateful that I am volunteering with MAVEN Project. It allows me to continue to give back to diverse communities using my knowledge and skills from over 30 years as an internal medicine physician. Working with my mentees and seeing their growth and confidence build over time is very rewarding.
</p>
<p>
If you want to refer a community health center partner or inquire about select volunteer opportunities go to <a href="https://mavenproject.org">mavenproject.org</a>.
</p>
<p>
<em>This article was featured in the September/October 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/24/2024 2:40:22 PM | 9/24/2024 2:34:29 PM | 9/24/2024 12:00:00 AM |
| men-we-need-you-to-go-to-the-doctor-and-to-become-doctors | Men: We Need You to Go to the Doctor, and to Become Doctors | WSMA_Reports | Shared_Content/News/Latest_News/2024/men-we-need-you-to-go-to-the-doctor-and-to-become-doctors | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/september-october/heartbeat-website-image-low-645x425px.png" class="pull-right" alt="Heartbeat: Daniel Low MD graphic" /></div>
<h5>
Sept. 19, 2024
</h5>
<h2>
Men: We Need You to Go to the Doctor, and to Become Doctors
</h2>
<p>
By Daniel Low, MD
</p>
<p>
When June ended, so did Men's Health month. The rare June article highlighting men's health typically focused on prostate cancer or heart disease. These are serious issues jeopardizing men's health, but as a physician whose panel is predominantly made of boys and men, what worries me most about men's health is the generalized male withdrawal from the health sector. Lonely, apathetic, or disinterested men are not seeking care. Men are half as<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fintegrishealth.org%2Fresources%2Fon-your-health%2F2019%2Fjune%2Fwhy-dont-men-see-doctors%23%3A~%3Atext%3DThe%2520CDC%2520reports%2520that%2520women%2Cmaintaining%2520screening%2520and%2520preventive%2520care.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369047634%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=2w9ApQvyMYXhgyE6l5pjcy1fjdp4I%2FdMp6vkMs2PBVM%3D&amp;reserved=0"> likely as women to maintain routine health screenings, and 33% less likely</a> to visit the doctor at all.
</p>
<p>
And it's not just disengaging from health care; men are also disengaging from social life. <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.latimes.com%2Flifestyle%2Fnewsletter%2F2023-10-10%2Fmore-than-1-in-7-men-have-no-close-friends-the-way-we-socialize-boys-is-to-blame-group-therapy&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369055278%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=qGZQA1pNmf%2BYr%2FxcqhM9r8GvRRlb0aXygkXVuSG4fNs%3D&amp;reserved=0">Fifteen percent of men now report having no close friends,</a> which is <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fnap.nationalacademies.org%2Fcatalog%2F25663%2Fsocial-isolation-and-loneliness-in-older-adults-opportunities-for-the&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369062482%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=X2UvguHfp0zvujjaG%2Fo1mlAxwUPVUjap0vIKIvgCDpY%3D&amp;reserved=0">worse for one's health than smoking</a>. Men are similarly disengaging from school. In 1972, when Title IX passed, men were graduating from college 13% more often than women; today, women graduate from college <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nytimes.com%2F2023%2F03%2F10%2Fpodcasts%2Fezra-klein-podcast-transcript-richard-reeves.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369069682%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=bV8ZQJ%2BDVZ%2BSMpNwCHKKjpjYj1iW0iQc7FpEQp%2BNpDA%3D&amp;reserved=0"> 15% more often than men</a>. Similar graduation rate disparities pervade <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Flearningenglish.voanews.com%2Fa%2Fus-boys-graduate-high-school-at-lower-rates-than-girls%2F7346617.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369076762%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=wG2%2B2KnPulW2uACwH3ENlaRj7zvFaU9IyE1LDMDqXR0%3D&amp;reserved=0">high school, too</a>.
</p>
<p>
While social and educational engagement may seem unrelated to health, research repeatedly demonstrates their association with wellness. When boys and men aren't with friends and aren't in school, they disproportionately face worse health outcomes, including <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwaboysandmen.org%2Fwp-content%2Fuploads%2F2024%2F06%2FWhy-Washington-Needs-a-Commission-on-Boys-and-Men_2024_06_16.pdf&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369083829%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=GjJxzSyI77SwsoBo5TOMWXmsP2N9XWCl3mMrXdiAr98%3D&amp;reserved=0">increased rates of homelessness, drug addiction, incarceration, and death</a>.
</p>
<p>
I feel awkward writing about this. Focusing on men's struggles in the context of gender equality feels misplaced, a narrative violation, particularly given men have always occupied the dominant space in society. It's especially grating knowing that <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC9811825%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369090990%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=kcoQknTWkL3y32UMeoZQD209u%2FCJXyRvl2Jk%2FSmRPxY%3D&amp;reserved=0">women's health research has been consistently underfunded</a>, <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.pewresearch.org%2Ffact-tank%2F2023%2F03%2F01%2Fgender-pay-gap-facts%2F%23%3A~%3Atext%3DThe%2520gender%2520gap%2520in%2520pay%2C-%2520and%2520part-time%2520workers.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369097960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=yYixIx9iXD4iU3HXF4fJfN%2BrAt7yyVldJH%2Fn%2FOABhKs%3D&amp;reserved=0">gender pay gaps persist, </a> and women and gender-diverse people are frequently and <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.weforum.org%2Freports%2Fglobal-gender-gap-report-2022%2Fin-full%2F2-4-gender-gaps-in-leadership-by-industry-and-cohort%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369105205%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=43ZLwZ86G5MaW9EC%2BJc0I622DnsiKwJH8JIQN0B5fEM%3D&amp;reserved=0">unfairly overlooked for executive-level positions</a>, particularly within medicine.
</p>
<p>
It's why when I originally drafted this piece two years ago, I decided against publication; in highlighting the challenges of the privileged, I felt I'd also be unintentionally directing attention away from more marginalized groups. But I believe we can hold two truths at once. We can champion equality for women and gender-diverse people, <em>and</em> recognize that men are struggling.
</p>
<p>
Men's structural power is not translating into health advantages. In fact, men are dying, on average, five years earlier than women, while simultaneously <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.populationmedicine.eu%2FGender-differences-in-global-Disability-Adjusted-Life-Years-DALYs-a-descriptive-Analysis%2C163644%2C0%2C2.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369112343%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=EGWoN7zl8ovH1nEBlBNpNllfog7yoLzQzvDIZE2TC8w%3D&amp;reserved=0">suffering from significantly worse mental, neurological, and musculoskeletal disorders</a>.
</p>
<p>
Despite many theories, it's ultimately unclear why this is happening, which is why we should support the growing coalition pushing Washington to create a <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwaboysandmen.org%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369121696%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=6iRf5vQbH5K9zaClEgcMucWkJqOgOdL2M7PMcwWvLKA%3D&amp;reserved=0">commission on men and boys</a>; we need to study the root causes of this public health crisis.
</p>
<p>
We also need representation. When young boys are most impressionable, they rarely see themselves in their doctors, <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffamilymedicine.uw.edu%2Fchws%2Fpublications%2Fwashington-states-physician-workforce-in-2021%2F%23%3A~%3Atext%3DWomen%2520comprised%252041%2525%2520of%2520the%2Cphysicians%2520age%252055%2520or%2520older.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369129176%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=G7W%2B9KRRfwatsV6q%2BUE0qxOTWHWBxkgTJtMsPKoWaqU%3D&amp;reserved=0">as less than one-third of pediatricians in Washington are men</a>. For those with mental illness seeking care with a therapist or social worker, it is <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.zippia.com%2Ftherapist-jobs%2Fdemographics%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369136749%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=TnntGPL8MqDiGSpt4UekamJREwgssutscnGcjyaiK88%3D&amp;reserved=0">even less likely to find a male practitioner</a> in Washington, which is particularly worrisome given the increasing rates of anxiety and depression in boys and men. To be clear, evidence shows <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.forbes.com%2Fsites%2Froberthart%2F2024%2F04%2F22%2Fpatients-fare-better-with-women-doctors-study-finds%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369143733%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=n2tEObA46oY8TI4xdIFUfzB9zShMKwOKXU5QCPkRvt4%3D&amp;reserved=0">female physicians offer equal or better care</a> than male physicians. But if boys and men don't engage in care, the quality of care offered becomes a moot point.
</p>
<p>
And without intentional efforts, change will not arrive soon. Male medical student matriculants have decreased for eight consecutive years. The view is similar further up the pipeline. I lead a <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.healthpointchc.org%2Fjoin-our-team%2Fstudent-training-programs%2Fhealthpoint-health-scholars&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369150828%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=zT2hLczw6TPiEP1WvTQ%2BhkK1tItv4b1srnX9mQfOiKk%3D&amp;reserved=0">mentorship program</a> for racially and economically underrepresented high school students interested in careers in health care, and since our program's inception in 2021, we've only had one young man graduate.
</p>
<p>
We need proactive, targeted recruitment of men for patient-centered, healing professions like pediatrics, nursing, psychology, and social work. This requires incentivizing professionals to mentor; institutions should include mentoring activities as criteria for promotions.
</p>
<p>
Simultaneously, we need to cultivate a new masculinity in our young men that embraces the tenderness and sociability of excellent caregivers. We want our sons, brothers, and fathers to be compassionate, active listeners who practice grace. Let's start by modeling this behavior and acknowledging the real struggles boys and men are experiencing.
</p>
<p>
<em>Daniel Low, MD, </em><em>is a family medicine physician in Renton.&nbsp;</em></p>
<p>
<em>This article was featured in the September/October 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/19/2024 12:44:41 PM | 9/19/2024 12:27:20 PM | 9/19/2024 12:00:00 AM |
| cant-get-into-your-doctors-office-youre-not-alone | Can't Get Into Your Doctor's Office? You're Not Alone | WSMA_Reports | Shared_Content/News/Latest_News/2024/cant-get-into-your-doctors-office-youre-not-alone | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Heartbeat column logo with Nariman Heshmati MD &amp; Jennifer Hanscom" src="/images/Newsletters/Reports/2024/july-august/heartbeat-website-image-heshmati-hanscom-645x425px.png" class="pull-right" /></div>
<h5>July 17, 2024</h5>
<h2>Can't Get Into Your Doctor's Office? You're Not Alone</h2>
<p>
By Nariman Heshmati, MD, and Jennifer Hanscom
</p>
<p>
As The Seattle Times and other media outlets have reported, hospitals in our state - places Washingtonians depend upon for surgeries, births, inpatient, and emergency care - face ongoing financial instability from the pandemic, difficult-to-discharge patients, low reimbursements, and inflation.
</p>
<p>
But there's another story that doesn't get much attention in the press: The loss of the outpatient services every Washingtonian relies on for routine and preventive care.
</p>
<p>
The lack of access to care in the outpatient community, aka the physician's office, should be as concerning to every Washingtonian as our struggling hospitals. It is in these outpatient settings that your diabetes or other chronic condition is managed, where you receive wellness and prevention screening and care, and where your personal physician manages your health. Research shows that a consistent relationship with a doctor or other primary care clinician is associated with improved overall health and fewer emergency room visits.
</p>
<p>
Outpatient medical groups suffer from many of the same challenges hospitals do: thin margins, increased costs, low reimbursements (including underpayments from Medicare and Medicaid), and staffing issues. In the past few years, payment for physician services has dropped nearly 10% in Medicare, causing a ripple effect of reimbursement decline as Medicare is used as a benchmark for both Medicaid and commercial payments.
</p>
<p>
Patients and communities across Washington feel the effects of declining reimbursements and rising costs. As reported last November, Seattle OBGYN closed after 73 years, impacting more than 16,000 patients, more than 300 of whom are pregnant. Multispecialty clinic Palouse Medical in Pullman has decided to merge with a local hospital to keep its clinic open. Ear Nose &amp; Throat Associates SW in Olympia, having already dropped one Medicaid plan in 2023, reports that it will limit the remaining Medicaid patients over age 18 to just one per day to stay financially viable. Carol Milgard Breast Center in Tacoma reports booking crucial cancer screenings and exams six or more months out. Kitsap OBGYN reports routinely being double-booked and pregnant patients having to wait to see their physician until the second trimester.
</p>
<p>
Even nationally, Walmart, with 51 health centers across five states, noted they can't make the numbers work and are closing down all of their health centers, citing "the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time."
</p>
<p>
Care should be about the patients, not profitability. But when revenue is less than expenses, you can't pay your staff's salaries, you can't pay the lease on your office space, and you can't keep your lights on. It is not uncommon to talk to a group of physicians who own their practices who have cut their salaries or stopped taking a paycheck to care for their patients and pay their staff.
</p>
<p>
To have a healthy health care system, where patients can access care at the right place, right time, and in the right setting, we must not ignore the impact of these outpatient clinics. To help our struggling medical groups and patients, in 2024, the WSMA worked with legislators to introduce legislation to implement a "covered lives assessment" in our state, a funding mechanism that helps the state access federal funds to increase investments in Medicaid.
</p>
<p>
We will be pursuing this in next year's legislative session and will work with lawmakers to strengthen the proposal. The additional $400 million from the covered lives assessment and the federal matching funds will be a lifeline for these medical groups, will help physicians see more Medicaid patients- both primary care physicians and specialty care such as dermatology, immunology, neonatology, anesthesiology, and more-and help preserve the balance of care delivery in our state so routine community care and hospital care both are valued and available for Washingtonians.
</p>
<p>
<em>Nariman Heshmati, MD, is an OB-GYN in Everett and president of the WSMA. Jennifer Hanscom is CEO of the WSMA.</em>
</p>
<p>
<em>*Note: A version of this article ran in The Seattle Times on May 20, 2024.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 10/23/2024 9:09:22 AM | 7/17/2024 2:01:47 PM | 7/17/2024 12:00:00 AM |
| committing-the-resources-for-equitable-care | Committing the Resources for Equitable Care | WSMA_Reports | Shared_Content/News/Latest_News/2024/committing-the-resources-for-equitable-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" alt="cover of July-August 2024 issue of WSMA Reports" /></div>
<h5>July 17, 2024</h5>
<h2>Committing the Resources for Equitable Care</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
For years, data have shown the heavy toll that health inequities take on historically marginalized communities. Whether it's poorer outcomes for Black patients with chronic diseases like diabetes, low birth weights for Hispanic infants, or higher rates of behavioral health issues among LGBTQ+ youth, studies have shown a consistent gap among how patients access and fare in the health care system depending upon their identity.
</p>
<p>
But data alone is insufficient to address the problem of health inequities. Helping physicians understand the root causes, including their own contributions to them, no matter how unconscious, is essential to ensure all patients receive the highest-quality care.
</p>
<p>
"We've gone into medicine to help people," says Sonja Maddox, MD, a family medicine physician with Pacific Medical Centers in Renton. "As a society, we're not going to get there if we don't learn how people are taken care of. Unless people are willing to recognize the inequities and learn about them, we'll only perpetuate them."
</p>
<p>
To help physicians understand the problem and share solutions, the WSMA Foundation, which directs WSMA's health equity efforts, has teamed with Edwin Lindo, JD, assistant dean for social and health justice at the University of Washington School of Medicine, on a series of Health Equity M&amp;M Webinars (think "morbidity and mortality," but with a focus on health equity) and a four-part Health Equity in Medicine podcast to help train Washington's health care professionals to provide culturally sensitive care.
</p>
<p>
The podcast and webinars were a natural outgrowth of the increased focus on equity across society with the growth of the Black Lives Matter movement in 2020. "It's part of those larger social changes," says Alexander Hamling, MD, a pediatrician with Pacific Medical Centers in Bothell and chair of WSMA's CME program committee. "We saw a lot of other private institutions ask these questions about equity, so the programs naturally evolved from that."
</p>
<p>
Still, the challenge was not to make health equity seem like just another requirement. "We didn't want this to come out as one more task due and not be meaningful," says Dr. Hamling. "How could we wrap this up in a way that physicians would be excited about it, with high-quality education rounds, high-quality speakers, case studies, and physicians bringing their own real-world experiences into play."
</p>
<p>
The podcast and webinars rise to that challenge. They combine a background in the history that continues to feed health inequities with practical ideas on how to incorporate improvements in practice. Lindo says they take "theory and bring it into action."
</p>
<p>
The sessions acknowledge the importance of health disparity data but don't stop there. " 'Disparities' doesn't encapsulate the true weight of what's happening," says Lindo. "It merely says there's a delta between one member and another. The term I use is health inequities, meaning there is a factor or factors that causes the delta, or else we're obfuscating what's causing the disparity."
</p>
<p>
The podcast series, the newest of the health equity tools offered by the WSMA, provides listeners with the background on the history of racism in medicine and its impact on the medical profession. Importantly, rather than just a recitation of history, Lindo shares how some physicians have tackled these thorny issues, structurally and individually, and gives physicians ideas on how to incorporate equity principles into practice. The podcast is free for WSMA members and fulfills a new state requirement for health equity continuing education that applies to physicians and nonphysician clinicians.
</p>
<p>
The advantage of the podcasts is that they are available whenever a listener has time. "The luxury of being able to sit down and read without distraction isn't always there," says Lindo. "But the ability to put in headphones while you're working in the yard or going on a walk is."
</p>
<p>
While the podcasts are new, the WSMA and WSMA Foundation have been offering the Health Equity M&amp;M Webinars for three years. The webinars take the familiar format of "morbidity and mortality" and apply it to health equity. The webinars are free to WSMA members and offer CME credit.
</p>
<p>
"Physicians understand M&amp;Ms, and the webinar model is very similar to the traditional M&amp;M," says Lindo, who facilitates the webinars. "We're not talking about whether this specific exam or procedure is the right one, although sometimes that comes up. It's about how we are treating patients fundamentally differently because of their identity. At the core, we're talking about preventable harms to our patients."
</p>
<p>
Each webinar is protected under WSMA's CQIP, providing confidentiality for case discussions. As a result, physicians are able to talk frankly about how their own biases affected patient care.
</p>
<p>
"It may be where they are thinking maybe they would have done something differently or they didn't have the right language," says Lindo. "To me it's just phenomenal to see folks dig in and wrestle with it. I have had people say, 'I don't know if I believe in the DEI stuff, but I really appreciate these conversations.' "
</p>
<p>
"Edwin does a really good job of explaining not only the importance of health equity, but giving doctors real evidence, which we like," Dr. Maddox. "He does a very good job of providing historical information to help other people who may not experience racism in health care understand what it feels like to be a person of color and not feel well cared for."
</p>
<p>
"Seminars like Mr. Lindo's help us to understand the 'why' of our health system producing inequality whether or not any individual actually intends that outcome or not," agrees David Cundiff, MD, a public health physician at Discover Recovery in the small rural community of Long Beach. "One of the aspects of privilege is that people who have it don't even have to notice it exists. A forum in which we can all look at systems of privilege, power, and equity is a really important part of every physician's professional and personal growth."
</p>
<p>
Indeed, improving health equity isn't only good for patients, says Lindo. It's good for physicians, as well. Health inequities take a toll on their commitment to healing. Recognizing the challenges their patients face not only helps doctors find better outcomes, but reminds them of the humanity that is unique to their profession.
</p>
<p>
"We become numb to the harm that other people face," says Lindo. "It eats at our ability to have the empathy to make the change. When something wrong happens, we're so accustomed to things being not good, that we don't see it as severe. It's just another thing we'll get to at some point. That's the dehumanizing thing about all of this."
</p>
<p>
Ultimately, doctors recognize the need to make sure every patient receives the right care. But removing the biases that make that care impossible to deliver is the real challenge. It can't fall to just a handful of physicians who represent the marginalized communities.
</p>
<p>
"I can't tell you the number of new Black patients who have come to my practice since 2020," says Dr. Maddox. "If you have a doctor who looks like you, you live longer. Studies show this and patients know this." But as a Black female physician, Dr. Maddox represents just 2% of the profession.
</p>
<p>
"Not everybody can have a Black doctor," she notes. "We need to make sure everyone understands how to take care of everybody."
</p>
<p>
The webinars and podcasts can move Washington closer to that goal. It's the reason why Lindo signed onto the WSMA's health equity work to begin with.
</p>
<p>
"At its core, the rationale for joining WSMA as resident consultant was that the amount of impact WSMA has in the region is unmatched," says Lindo. "It has a true commitment to equity."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/17/2024 2:27:38 PM | 7/17/2024 2:23:16 PM | 7/17/2024 12:00:00 AM |
| member-spotlight-anukrati-anu-shukla-md | Member Spotlight: Anukrati 'Anu' Shukla, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/member-spotlight-anukrati-anu-shukla-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/member-spotlight-website-image-shukla-645x425px.png" class="pull-right" alt="WSMA Member Spotlight: Anukrati Shukla, MD graphic" /></div>
<h5>July 17, 2024</h5>
<h2>Member Spotlight: Anukrati 'Anu' Shukla, MD</h2>
<p>
<strong>Works at:</strong> Providence Medical Group, Monroe.
</p>
<p>
<strong>How long in practice: </strong>Four years.
</p>
<p>
<strong>Specialty:</strong> Internal medicine, obesity medicine.
</p>
<p>
<strong>Why WSMA:</strong> The WSMA offers wonderful opportunities to early career physicians for their global development. Working with the WSMA in various roles has not only strengthened my core identity and values as a physician, but also has given me a consistent and stable professional standing. I particularly felt the need for a sense of belonging during a recent transition between two jobs. The WSMA was my landing pad providing the cushion of stable connections, purpose, and roles. Suffice it to say, I derive a great sense of purpose from being a part of the WSMA. The WSMA is my one hope for a better future for physicians.
</p>
<p>
<strong>Proud moment in medicine:</strong> During the pre-vaccine era of the COVID pandemic, I was fortunate to work as a medicine resident at a community hospital in rural upstate New York. Despite the ever-looming fear and uncertainty of those times, the local community stepped up and partnered with their only local hospital system to help with anything and everything. The local brewery transitioned to manufacturing sanitizers, local restaurants kept the food coming for the hospital staff, retired doctors in the community came out of retirement to help, a local moms group sewed masks for visitors, and the list goes on. The hospital and its community becoming one with each other and their solidarity restored my faith in humanity. This time in that lovely small baseball village called Cooperstown strengthened my resolve to serve the community I work in and to acknowledge the roles of every member of the community we serve.
</p>
<p>
<strong>What inspires me in medicine: </strong>It is alluring to me how medicine can be so much science and yet so much an art of human connection. I love how my physician colleagues balance this confluence of art and science while walking the tight rope of ever-increasing demands of the regulatory landscape.
</p>
<p>
<strong>Major changes challenging our profession:</strong> The dilution of physician expertise with conflicting regulatory responsibilities in everyday life. The many "damned if you do, damned if you don't" scenarios that add to the sense of helplessness that many physicians are facing today. An example of a systems problem being blamed on individuals would be the interventions that came out of the opioid epidemic. With the majority of fault attributed to doctors, for us it became a matter of walking a thin line between maintaining DEA compliance to not overprescribe, patient satisfaction to control pain, and patient safety to mitigate risk of suicide from imposed inflexible taper plans, all while navigating psychosocial issues of the population during a "quick" office visit.
</p>
<p>
<strong>If I weren't a doctor, I'd be: </strong>A dance artist or yoga teacher.
</p>
<strong></strong>
<p><strong>
Best advice received:</strong> My ICU attending, Dr. Travis Hodgdon, advised us residents to always ask patients about what a good day looks like in their life when you see them on their worst day because it gives you the perspective you need to serve their need.
</p>
<p>
<strong>Spare time: </strong>Yoga, dancing, swimming, hiking, and snuggling up
with my son and dog.
</p>
<p>
<strong>What people might not know about me:</strong> I am a southpaw.
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/17/2024 2:47:20 PM | 7/17/2024 2:46:55 PM | 7/17/2024 12:00:00 AM |
| communication-and-the-use-of-interpreter-services | Communication and the Use of Interpreter Services | WSMA_Reports | Shared_Content/News/Latest_News/2024/communication-and-the-use-of-interpreter-services | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" alt="WSMA Reports July/August 2024 cover" /></div>
<h5>July 16, 2024</h5>
<h2>Communication and the Use of Interpreter Services</h2>
<p>
By Shari L. Hendrickson
</p>
<p>
Communication is key to providing quality health care services to patients, including those who have limited English proficiency. For patients needing language interpretation and translation services, we recommend the use of a certified interpreter when communicating. This includes patient education, care planning, and obtaining informed consent, as it is vital to ensure improved clarity of the information being presented. The use of an interpreter may reduce health care disparities among different cultures while increasing trust and confidence in the health care team. Compliance is advised regarding federal and state laws (e.g., Title VI of the Civil Rights Act of 1964) that mandate the use of interpretive services in health care.
</p>
<h3>Why certified?</h3>
<p>
Communication between patient and physician or advanced practitioner is often made more complex by the lack of knowledge regarding each other's culture. We recommend the use of certified interpreters due to the training their certification requires, which should include knowledge of medical terminology, health care systems, accuracy of the language being interpreted, and training in the obligation of confidentiality.
</p>
<p>
We recommend exclusive use of certified interpreters and translators and advise against the use of staff, minor children, or other family members as routine interpreters. This is to prevent the risk of inaccurate translation, commissions, and potential conflicts of interests that may arise from personal or emotional connections. In a health care emergency, such use may be justified until a certified interpreter can be secured-and all measures to secure a certified interpreter should be exhausted. The emergent need and actions taken to secure a certified interpreter should be detailed and documented in the medical record.
</p>
<h3>Patient refusal</h3>
<p>
If the patient refuses the use of a trained medical interpreter, the physician should document the patient's decision. One way to document the decision is with a waiver that explains the risk of refusing a medical interpreter. With a trained medical interpreter present, the physician should review the waiver with the patient and have the patient sign the waiver once the contents are understood. The signed waiver should be kept in the patient's medical record.
</p>
<h3>Practice makes perfect</h3>
<p>
It is important for physicians to recognize and address potential cross-cultural communication barriers with their patients. Medical interpreters help improve patient-physician communication and may provide insight into common communication barriers that may lead to poor quality or life- threatening medical errors.
</p>
<p>
To increase competence in the use of interpreter services, consider simulation as a training tool. Simulation may provide an opportunity to identify ways to improve style, health literacy, and medical terminology, as well as how to gauge the pace of communication.
</p>
<h3>Medical records</h3>
<p>
Certified medical translators can provide the translation of a patient's medical records. To ensure that all information is correct, such individuals are required to be proficient in the technical and medical terms for the language they are translating. These individuals should be certified to perform such services. Staff, minor children, or other family members should not translate medical records. Mistakes during translation may lead to medical errors.
</p>
<h3>Interpreter services and telehealth</h3>
<p>
The recent increase in telehealth services presents unique challenges to the delivery of care. Access to interpreter services must be reviewed prior to confirming a patient's candidacy for telehealth care. Criterion must be developed, and patients should be evaluated for their ability to access required technology, for their appreciation for both the benefits and challenges of telehealth services, and for their consent for service. Criteria must also be in place regarding the physician's ability to obtain timely interpretive language services for all aspects of the telehealth visit.
</p>
<h3>Use of a certified language interpreter</h3>
<p>
Below are procedures to consider when communicating through a certified language interpreter:
</p>
<ol>
<li>
During the interaction, look at and speak directly to the
patient, not the interpreter.
</li>
<li>
Provide guidelines for the interpreter to keep
communication open and facilitate an understanding
of the goals and purposes of the interview or counseling
session. When possible, meet with the interpreter or
familiarize yourself with interpretative companies'
processes before meeting with the patient.
</li>
<li>
To increase competence in the use of interpreter
services, consider simulation as a training tool.
</li>
<li>
Encourage the interpreter to meet with the patient
before the interview to discover the patient's language
literacy and attitudes toward health care. This
information can aid the interpreter when explaining
process and setting expectations and can aid in gaining
insight into the patient's overall communication needs.
</li>
<li>
Speak in short units of speech. Avoid long, complex
discussions of several topics in a single visit
or interview.
</li>
<li>
Avoid technical terminology, abbreviations, and
medical jargon.
</li>
<li>
Avoid abstractions, idiomatic expressions, slang,
similes, and metaphors.
</li>
<li>
Encourage the interpreter to translate in the
patient's own words as much as possible rather than
paraphrasing.
</li>
<li>
Encourage the interpreter to refrain from omitting
information or from inserting his or her own ideas
or interpretations.
</li>
<li>
To check on the patient's understanding and the
accuracy of the translation, ask the patient to repeat
instructions, or whatever has been communicated, in
his or her own words, with the interpreter facilitating.
</li>
<li>
To facilitate timely access to all health care and services,
offer language assistance to individuals who have
limited English proficiency or other communication
needs, at no cost to them.
</li>
<li>
Inform all individuals of the availability of language
assistance services. Do this clearly and in their
preferred language, verbally and in writing.
</li>
<li>
Ensure the competence of individuals providing
language assistance, recognizing the importance of
certification, and acknowledge that the use of untrained
individuals or minors as interpreters should be avoided.
</li>
<li>
Provide health literate appropriate print resources,
multimedia materials, and postings on social media,
websites, and elsewhere.
</li>
<li>
Listen to the patient and watch his or her nonverbal
communication. Often, much can be learned regarding
the patient's response by observing facial expressions,
voice intonations, and body movements.
</li>
<li>
Exercise patience. An interpreted interview takes
longer. Careful interpretation often requires the use of
long explanatory phrases.
</li>
<li>
If using telehealth care for patients who require a
certified interpreter, ensure that patients meet the
criterion for telehealth care.
</li>
</ol>
<p>
For more information and guidance on the use of interpreters in your practice, including a sample waiver you can adapt for your setting, visit <a href="https://phyins.com">phyins.com</a>.
</p>
<p>
<em>Shari L. Hendrickson is a senior clinical risk consultant with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 12/2/2024 12:17:18 PM | 7/16/2024 10:41:56 AM | 7/16/2024 12:00:00 AM |