| a-tough-road-ahead-wsma-2026-budget-priorities | A Tough Road Ahead: WSMA 2026 Budget Priorities | WSMA_Reports | Shared_Content/News/Latest_News/2026/a-tough-road-ahead-wsma-2026-budget-priorities | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/Reports/2026/january-february/cover-wsma-janfeb-2026-final-645x425px.jpg" class="pull-right" /></div>
<h5>Jan. 5, 2026</h5>
<h2>A Tough Road Ahead: WSMA 2026 Budget Priorities</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
As the truncated 2026 legislative season gets underway this month, Washington state faces an ever-increasing and severe budget deficit, fueled by sluggish tax revenue and looming massive federal cuts to the state's Medicaid program, known as Apple Health. How the Washington State Legislature has responded, or plans to respond, creates serious repercussions for patients and physicians.
</p>
<p>
Despite the fiscal mountain ahead, the WSMA remains committed to advancing and addressing several key budget priorities for the 2026 legislative session:
</p>
<ul>
<li>Business and occupation tax mitigation.</li>
<li>Medicaid reimbursement rates.</li>
<li>H.R. 1 federal cuts and policies (the 2025 One Big Beautiful Bill Act).</li>
</ul>
<p>
"Access to care remains at the core of the WSMA's legislative agenda," says Bridget Bush, MD, FASA, WSMA president for 2025-2026.
</p>
<p>
"The overall fiscal priority for the WSMA is financial stability for physician practices," says Jennifer Hanscom, WSMA CEO.
</p>
<h3>Mitigate the B&amp;O tax increase</h3>
<p>
Tax increases are one of the ways the Legislature has tried to mitigate the state's projected budget deficit (at least $903 million through 2029). The billions in tax increases Gov. Bob Ferguson has already signed into law are the largest in state history, according to the National Federation of Independent Businesses.
</p>
<p>
For physicians, tax increases, so far, have come primarily in the form of additional B&amp;O tax rate hikes. In the last six years, most physician practices have seen their B&amp;O tax rates increase by 40%: In 2019, the Legislature imposed an approximately 20% increase via House Bill 2158; with HB 2081 in 2025, it imposed an additional 20% increase.
</p>
<p>
"Mitigating the B&amp;O tax increase is a huge priority," says Hanscom. "If we're not immediately able to get more revenue in the door, we have to lessen the revenue that's going out the door."
</p>
<p>
Physicians may feel the impact more acutely and sooner than other professions. What legislators often don't realize is that physicians do not set their own reimbursement rates. They're set by the state and federal government or subject to contracting with commercial insurance carriers.
</p>
<p>
"There's no way for a physician organization to offset the impact of a B&amp;O tax increase in the way that businesses in other industries do, which is by increasing their prices," says Sean Graham, WSMA senior director of government affairs and policy.
</p>
<p>
Meanwhile, other sectors charge physician practices more to offset their own costs. "Everything is increasing, as far as business expenses," says Anna McKeone, MD, who heads an emergency medicine practice in Olympia. "It's just very hard as an independent medical practice to stay in business."
</p>
<p>
The WSMA is hoping to get a health care carve-out from the B&amp;O tax increase to mitigate the impact on physicians. "We'll also look specifically at where other taxes will hurt physicians and advocate private carve-outs, or against them entirely, to protect physicians against further tax increases," says Dr. Bush.
</p>
<p>
"The B&amp;O tax particularly hits physicians hard, especially in light of decreasing reimbursements," says Dr. Bush. "We're getting pinched on both sides."
</p>
<h3>Increase Medicaid reimbursement rates</h3>
<p>
Over the last few years, the WSMA and physician community have prioritized increasing Medicaid reimbursement rates. During the 2025 legislative session, the WSMA scored a major victory through passage of the Medicaid Access Program, WSMA-priority legislation that reflected years of hard work by the association and its partners in the physician community.
</p>
<p>
The core of this bill included the enactment of a new "provider tax," a covered lives assessment, to increase reimbursement. Recent developments through federal H.R. 1 make it unlikely that the program will be implemented as authorized.
</p>
<p>
"H.R. 1 effectively blocks the implementation of the law by prohibiting the imposition of new provider taxes," says Jeb Shepard, WSMA's director of policy. It also ramps down existing provider taxes, of which there are several already in Washington state, from 6% to 3.5% of net revenue by 0.5% per year beginning in 2028, according to the Washington State Health Care Authority.
</p>
<p>
"Before any future cuts on these state- directed payments take effect, we need to find a solution to further our goal of making sure that Medicaid payments are at the same level as those in Medicare," says Hanscom.
</p>
<p>
Washington is already one of the lowest-reimbursed Medicaid states in the nation, with rates often well below the cost of providing care. H.R. 1 puts added financial pressure on physicians, says Hanscom. "Our priority this year is to try to find a way to work around the federal prohibition in order to secure dollars to help with Medicaid payments."
</p>
<p>
"Emergency medicine is likely to first feel the brunt of the perfect storm of tax increases and cuts to Medicaid reimbursement. It's the canary in the coal mine," says Graham. While most physician groups can contract with insurance plans with adequate reimbursement rates, under federal law, emergency departments must assess and stabilize anyone who walks in the door, regardless of their ability to pay.
</p>
<p>
Emergency physicians already have little margin to absorb financial shock. A recent Rand report found Medicare and Medicaid payments to emergency department physicians fell 3.8% from 2018 to 2022. Reductions for commercially insured patient visits were much steeper, dropping 10.9% for in-network and 48% for out-of-network visits.
</p>
<p>
"Our patients already suffer from lack of primary care and specialty availability," says Dr. McKeone, who also serves as the legislative advocacy lead for the Washington Chapter of the American College of Emergency Physicians. "If Medicaid was reasonably reimbursed and we could get these people access to primary care and specialty care through the appropriate channels, they would have less morbidity and less mortality. And it would actually end up costing the system quite a bit less."
</p>
<p>
The WSMA is considering multiple strategies to address Medicaid funding levels. One approach is to move away from state-directed payments and create a new source of funding that the federal government can't regulate. "As long as the state is able to generate state dollars dedicated to Medicaid reimbursement, we can get the two-for-one match at the federal level," says Hanscom.
</p>
<p>
The WSMA will also continue to pursue the Medicaid Access Program as passed. "We're not taking MAP totally off the table, in case Congress reverses their decision or the Centers for Medicare and Medicaid Services changes their rulemaking," says Hanscom. "Should there be an opening in the future to revisit that, we want the flexibility to bring it forward."
</p>
<p>
There's still a silver lining to all this. "Passage of the Medicaid Access Program reflected a shared commitment by physicians and legislators to increase Medicaid reimbursement," says Graham. "We need to maintain the momentum that we have on this issue."
</p>
<h3>Respond to H.R. 1's sweeping cuts and policies</h3>
<p>
H.R. 1, the budget reconciliation bill signed into law by President Donald Trump on July 4, spans numerous federal budget and policy considerations that impact health care. Of immediate fiscal and financial concern are draconian cuts and limitations to Medicaid, known as Apple Health in Washington state.
</p>
<p>
The Congressional Budget Office estimates that the reconciliation package would reduce federal Medicaid spending by $911 billion over a decade. Some states, such as North Carolina, have already cut physician reimbursement in response to federal cuts. But those states already reimbursed physicians at a higher rate, so they have more wiggle room to make cuts.
</p>
<p>
"We have a lot less space to work with," says Shepard. "Washington state has struggled with Medicaid rates that don't cover the cost of delivering care and H.R. 1 will make that gap even harder to close. All of this will put significant pressure on our state budget as the demand for care grows."
</p>
<p>
The state's 2025-27 operating budget directs the Health Care Authority to reduce managed care organization rates by 1% (approximately $90 million) in calendar year 2026, in accordance with federal rules. In October, the agency released guidance on how the cuts would be implemented, which target reimbursement for health care practitioners.
</p>
<p>
The Health Care Authority anticipates "significant administrative changes and new state costs associated with implementation" of Apple Health. It estimates 620,000 Washingtonians are at risk of losing or delaying coverage because of new work requirements and changes to Medicaid redeterminations (to now take place every six months instead of every 12). (Note: Undocumented immigrants in Washington have never been eligible for Medicaid.)
</p>
<p>
Some 217,000 Washingtonians also rely on the federal enhanced premium tax credits to afford health coverage through the insurance marketplace, according to the Washington Health Benefit Exchange. The credits are critical for older and rural residents, small business owners, and self- employed people. With subsidies set to expire at the end of 2025 (at press time no compromise had yet to be reached in Congress), the Health Benefit Exchange estimates 80,000 people will face such steep price increases they may drop coverage altogether.
</p>
<p>
"Cutting patients' access to primary care and specialty care is not the answer because it drives up the costs for everyone when they're utilizing the emergency department for those needs," says Dr. McKeone. "This is going to really cause catastrophe for patients."
</p>
<p>
All of these onerous fiscal policies are putting the viability of independent health practices at risk.
</p>
<p>
"The hourly rate that we can offer employees or partnership-track people is much lower than a lot of the rest of the nation. So, it's hard for us to stay competitive and recruit quality candidates," says Dr. McKeone. "We're also being very careful about hiring, because we don't want to get in a position where we can't pay someone that we hire. It's putting a huge strain on us."
</p>
<p>
Approximately 28% of Washington state's budget consists of federal investments, according to the governor's office. The governor's office predicts the state's 4.8% uninsured rate, once the lowest in the country, could double as a result of federal cuts.
</p>
<p>
As Washington state eyes spending cuts to address its budget shortfall, there's also real concern that health care could be on the chopping block. "What's tricky is that health care spending in Washington state is discretionary," says Shepard. "When policymakers in Washington need to make budget cuts, health care is one of those areas where they're permitted to do it."
</p>
<p>
Most of the federal cuts and provisions related to Medicaid aren't slated to take effect until after the midterm elections. Overall, the Health Care Authority projects a reduction in billions in federal funding from 2025-2034. "It's like a slow-moving train wreck that we're watching," says Shepard.
</p>
<h3>Playing offense and defense</h3>
<p>
As states brace for the impact, the WSMA is working with coalitions statewide to help all residents retain access to essential health care services and to support the health care system broadly against these draconian federal cuts, says Graham.
</p>
<p>
As always, the WSMA will engage with other stakeholders, including the Washington State Hospital Association, to advocate on behalf of patients and physicians. "We recognize the health of our hospitals is crucial for the health of our workforce and physicians in the state," says Dr. Bush.
</p>
<p>
The WSMA is also participating in the Health Defense Unity Table. This forum for information sharing and strategizing on advocacy across interest groups was first convened as H.R. 1 was being considered in Congress. It includes groups representing health care organizations, patients, and other entities that advocate for patients' access to care.
</p>
<p>
For now, the WSMA is doing what it can to secure any federal health care funding available. To that end, the WSMA has been working with the governor's office and the Health Care Authority on their application for the Rural Health Transformation Program-a last-minute addition by Republicans to garner support from GOP holdouts to pass H.R. 1. It sets aside $50 billion over the next five fiscal years to be distributed among eligible states to support patient access to care and rural health care systems across the country.
</p>
<p>
In early November, Washington state submitted its application for the fund, requesting the maximum state allotment of $200 million per year to support investments across the rural health care continuum. The WSMA engaged extensively in the development of the application, meeting with state policymakers, submitting feedback on where funding should be directed, and lending formal support to the state's application. The WSMA will have representation on the advisory committee that will help implement the program.
</p>
<p>
"It's not as rosy as it's being made out by proponents," says Shepard. "The money that the program gets that needs to be divided up among the states is a drop in the bucket compared to what's being cut. But right now, it's the only thing we can work on. And so we are."
</p>
<p>
At press time, H.R. 1 provisions had not yet been fully defined through federal rulemaking. "Our role is to make sure that Washington's physician community and patients are heard throughout the process," says Shepard. "We will do our best to make sure that implementation decisions don't further destabilize our fragile health care system."
</p>
<p>
The WSMA will stay engaged every step of the way with its federal and state partners. "It's not only playing defense but also engaging in creative thinking that we need to bring to these discussions in order for us to have success-meaning that patients have access to care in Washington state and physicians can afford to see them," says Hanscom.
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/5/2026 11:16:57 AM | 12/22/2025 11:01:51 AM | 1/5/2026 12:00:00 AM |
| degrees-of-transparency | Degrees of Transparency | WSMA_Reports | Shared_Content/News/Latest_News/2026/degrees-of-transparency | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2026/january-february/cover-wsma-janfeb-2026-final-645x425px.jpg" class="pull-right" alt="WSMA Reports cover: January-February 2026" /></div>
<h5>Jan. 5, 2026</h5>
<h2>Degrees of Transparency</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
When Bridget Bush, MD, an anesthesiologist at Optum Care Washington (formerly The Everett Clinic), meets with patients, they know at a glance that she has a medical degree. "Right now, my badge says my last name, and it does say 'MD' underneath in a not-similar font," says Dr. Bush, who is also president of the WSMA.
</p>
<p>
But for many patients meeting credentialed and noncredentialed health care professionals, that kind of transparency is lacking since not all facilities require badges that show degrees. As team care becomes increasingly the norm, patients are seeing an array of health care professionals for their treatment. Some of them are physicians, and some are not. But how is a patient to tell the difference? In fact, it's not always simple. Allied health professionals often provide care that was formerly primarily provided by physicians.
</p>
<p>
"Patients deserve to have an appropriate understanding of who is taking care of them," says Dr. Bush. "Surveys show people are confused about the credentials of the people providing their care."
</p>
<p>
Indeed, surveys by the American Medical Association conducted over the past 10 years underscore just how confused patients are. Among the findings in a 2024 survey:
</p>
<ul>
<li>24% of respondents misidentified nurse practitioners as medical doctors, while only 71% correctly indicated that they were not medical doctors.</li>
<li>48% of respondents misidentified those with a doctor of nursing practice as a medical doctor, while only 39% correctly indicated that they were not a medical doctor, and 13% said they did not know.</li>
<li>22% of respondents misidentified physician assistants as a medical doctor, while only 70% correctly indicated that they were not a medical doctor.</li>
</ul>
<p>
Despite this confusion, AMA surveys show patients consistently express that when their health or the health of their loved ones is at stake, they want transparency and physicians to be involved in their care.
</p>
<p>
Thanks to a grant from the AMA Scope of Practice Partnership, the WSMA is working on a creative solution to respond to patient concerns. For the state legislative session that kicked off this month, the WSMA has prepared a measure that would require health care professionals to disclose their health care credential or provider type on their name badge if they are providing care in a clinical setting. The measure would also require health care professionals to list their credentials and titles in advertising.
</p>
<p>
"Similar laws in other states have helped improve transparency and ensure that health care professionals clearly identify their qualifications, giving patients accurate information about who is providing their care and empowering them to make informed decisions," says AMA Board Chair David H. Aizuss, MD. "Addressing issues like this is central to the mission of the AMA's Scope of Practice Partnership, and this grant represents an important investment in advancing WSMA's advocacy."
</p>
<p>
"Title transparency means different things to different physicians," says Alex Wehinger, associate director of legislative advocacy for the WSMA. "We tried to find an avenue that is positive for transparency. The bill language does not take a prohibitive approach, but is focused more on disclosure of credentials, because there are more health care professions and license types in the health care system."
</p>
<p>
Wehinger notes that this is not a new issue. A transparency bill was unsuccessful in the Legislature in 2013. "This has been on the minds of our physician members for many years," she says.
</p>
<p>
Indeed, the AMA has been conducting a "truth in advertising" campaign for more than a dozen years. The campaign's goals are to ensure truth and transparency in health care, including requiring all health care professionals to clearly identify their education, training, and licensure to patients, among other provisions. To date, all or part of the model bill has been adopted by 25 states.
</p>
<p>
With the continued expansion of team-based care, the issue has become even more urgent. The current problem is the result of the changing nature of health care delivery. To address the problem of the shortage of physicians, nonphysician professionals began to take on nonspecialized treatment of patients. Their numbers have grown substantially over time.
</p>
<p>
"Twenty years ago, you knew when you were going to see your primary care professional that it was an MD," says Dr. Bush. "Now, my primary care provider is a nurse practitioner. That's the case for thousands of people."
</p>
<p>
In fact, the numbers confirm the dramatic change in the makeup of credentialed health care professionals. According to the National Center for Health Workforce Analysis, in 2022 there were 279,194 primary care physicians in the U.S. That same year, there were an estimated 270,660 nurse practitioners delivering primary care. Yet, in one AMA survey, which covered a period up until 2018, 88% of patients thought a primary care provider was an MD.
</p>
<p>
As important as the growth of health professionals to supplement the work of physicians has been, it has also created a problem around medical title transparency. In the rush of treatment, patients may not know the credentials of the people treating them and what those credentials allow.
</p>
<p>
Some specialties have been grappling with the issue for years. For example, while ophthalmologists have a medical degree and are either MDs or DOs, many people commonly refer to optometrists as "eye doctors." Rather than medical degrees, optometrists hold doctor of optometry degrees. The American Society of Anesthesiologists has objected to an effort by nurse anesthetists to use the title "nurse anesthesiologist," even though the word "anesthesiologist" refers to someone with a license to practice medicine.
</p>
<p>
WSMA's proposed legislation is intended to prevent patient confusion in a rapidly changing health care landscape. Wehinger stresses that the goal of legislation is not directed at any group of health care professionals. "This is a patient transparency focus," she says.
</p>
<p>
Indeed, says Dr. Bush, the main purpose of the legislation is to make it clear in the clinical setting what each health care professional's credentials are. "The number one piece of this legislation is badging in health care settings," she says. "Normally, that's taken on a case- by-case basis in each institution, but this would make it a more uniform standard so that patients could go into any health care setting and know who is taking care of them."
</p>
<p>
Dr. Bush emphasizes that the legislation wouldn't affect how health care professionals refer to themselves. "It's not about who can call themselves what," she says. "It's about transparency in licensing and training."
</p>
<p>
As with badges, the advertising component of the legislation will help patients understand who is providing care so that they can make informed decisions. "There are a lot of different clinics that are providing various types of health care, for depression, chronic pain, or lifestyle modifications," Dr. Bush points out. "It's important for transparency in that advertising so that patients know the education and licensing of those providing the service."
</p>
<p>
While transparency is the focus of the proposed legislation, Dr. Bush notes that safety is also an important consideration. "It is important on a safety level, especially for the less-regulated areas of health care," she points out. "Knowing levels of education and training can help patients ensure their own safety."
</p>
<p>
Ultimately, says Dr. Bush, the legislation should be an opportunity for professionals to show their patients the hard work and dedication that went into their training. "It should be a matter of pride for every level of care," she says. "Everyone has different licensure and training. We should celebrate those differences and what we bring together as a team to take care of patients."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/5/2026 11:17:47 AM | 12/22/2025 11:00:54 AM | 1/5/2026 12:00:00 AM |
| doctors-making-a-difference-jens-metzger-md | Doctors Making a Difference: Jens Metzger, MD | WSMA_Reports | Shared_Content/News/Latest_News/2026/doctors-making-a-difference-jens-metzger-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports Doctors Making a Difference: Jens Metzger, MD graphic" src="/images/Newsletters/Reports/2026/january-february/dmd-website-image-metzger-645x425px.png" class="pull-right" /></div>
<h5>Jan. 5, 2026</h5>
<h2>Doctors Making a Difference: Jens Metzger, MD</h2>
<p>
For patients without access to preventive care or regular care for chronic diseases, that often means they turn to the emergency room-the most expensive option. Battle Ground Health Care, serving patients in Clark County, is aiming to provide a no-cost detour for medically underserved patients to manage chronic conditions and avoid ending up in the emergency room. Clinic medical director Jens Metzger, MD, talked with WSMA Reports about the community-supported organization's mission and what makes volunteer work enriching for him.
</p>
<p>
<strong><em>WSMA Reports: </em>Can you share with our readers a bit about what Battle Ground Health Care does and its mission?</strong>
</p>
<p>
<em>Dr. Metzger: </em>Since 2011, our emphasis at Battle Ground Health Care has been to be a medical home for chronic disease management in the underserved Clark County community. Our team provides dental, medical, dietary, and rehabilitation therapies along with insurance and resource navigation and pastoral care services.
</p>
<p>
<strong>How did you get involved with the clinic and what does your role as medical director entail?</strong>
</p>
<p>
I answered an ad in the newspaper to get involved in expanding medical care to all members of our local community. My role is to help with oversight of our multiple medical services while supervising medical care by our internal medicine residents and medical students.
</p>
<p>
<strong>Is the care team made up of all volunteers? Where else does the clinic get support from?</strong>
</p>
<p>
Our team of 200 volunteers provided an equivalent of $1 million dollars of resources to our clients in 2024 supported through a combination of grants, private donors, and volunteer medical clinicians. We are so grateful to our nucleus of paid office staff that are like family for the patients. The support from our community health care systems Vancouver Clinic, Peace Health, and Legacy Health in providing lab, imaging, and preventative care services is invaluable to keep services available and affordable.
</p>
<p>
<strong>Why do you think this type of community-supported care is so important?</strong>
</p>
<p>
There is a lot of real, daily fear in our underserved community. This fear can marginalize individuals from keeping up with their own health care. These resources provide vital support, making it possible for community members to prioritize their emotional and physical health.
</p>
<p>
<strong>Are there certain areas of preventive care that you think are most impactful for keeping patients from having to go to the emergency room for care?</strong>
</p>
<p>
It is a paradoxical health care system that readily provides expensive emergent and inpatient services to patients acutely yet has them face the challenge of inadequate primary care resources for affordable medications and lifestyle management to educate and enrich their health care journey.
</p>
<p>
<strong>Is there an aspect of providing volunteer care that is most fulfilling for you?</strong>
</p>
<p>
It is a greater gift to receive than give working with people who by comparison have so little yet are so appreciative of the time and attention spent addressing their needs. It is so enlightening that a small act of compassion can create a sense of belonging and importance for someone who really needs it.
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/5/2026 11:18:10 AM | 12/22/2025 10:57:10 AM | 1/5/2026 12:00:00 AM |
| ending-the-silence-on-firearm-safety | Ending the Silence on Firearm Safety | WSMA_Reports | Shared_Content/News/Latest_News/2026/ending-the-silence-on-firearm-safety | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2026/january-february/heartbeat-website-image-engel-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat logo featuring Gregory Engel MD, MPH" /></div>
<h5>Jan. 5, 2026</h5>
<h2>Ending the Silence on Firearm Safety</h2>
<p>
By Gregory Engel, MD, MPH
</p>
<p>
By the time the average American student turns 18, they have seen roughly 200,000 violent acts on television alone, not counting movies, social media, or video games. Many of these scenes glorify firearms, portraying them as symbols of power, masculinity, and personal safety in a dangerous world. The message is clear: Owning or carrying a gun makes you safer.
</p>
<p>
The data tell a very different story. Firearms in the home are associated with dramatically higher rates of suicide and homicide and carrying a gun is linked to an increased risk of death, not protection. Yet, despite this reality, our schools rarely address firearm injury or prevention. Students are surrounded by powerful myths about guns, but almost never hear the facts. It is time to end the silence.
</p>
<p>
For years, I worried that discussing firearms in schools would be seen as controversial or political. I was wrong. Over the past decade, I have taught more than 12,000 students about firearm injury prevention. In all that time, I have received zero complaints from parents, teachers, or administrators. Quite the opposite, students and families welcome the conversation. They understand that this is about health and safety, not politics.
</p>
<p>
As a physician and epidemiologist, I have cared for gunshot victims in the emergency room, supported grieving families in clinic, and studied the data behind firearm injury. In Washington state, firearm deaths have doubled over the past decade, even as the Legislature has passed more than a dozen gun laws. Clearly, legislation alone is not enough. Firearm ownership, concealed carry, and firearm deaths have all increased, underscoring the urgent need for education alongside policy.
</p>
<p>
Our team brings public health-informed, nonpartisan education to high school classrooms, giving students practical tools to stay safe. We share evidence showing that most firearm deaths are suicides, not mass shootings; that guns kept in the home are far more likely to be used in a suicide or domestic homicide than in self-defense; and that millions of children live in homes with unsecured firearms. We also teach students to recognize warning signs of suicide, practice safe storage, and access resources such as Washington's Extreme Risk Protection Order.
</p>
<p>
The second decade of life is when students are forming their attitudes toward firearms and firearm violence. The information they receive now, whether from social media, entertainment, or the classroom, shapes how they will approach these issues as adults. We see this education as a first step toward building communities of informed citizens who place safety, not politics or rhetoric, at the center of the conversation.
</p>
<p>
This work is expanding. In partnership with the Office of Superintendent of Public Instruction and the Edmonds School District, we developed a two- day curriculum building on our one-day program. It is now being delivered district-wide this fall. The curriculum is evidence-based, pedagogically sound, and engaging for students.
</p>
<p>
Physicians can help. You can volunteer to teach in classrooms, advocate for firearm injury prevention education in your local schools and districts, raise the issue with community leaders, or bring it into the media and public forums where firearm injury is discussed. We need your energy, your expertise, and your creativity to expand this effort. To learn how you can contribute, contact me at <a href="mailto:ga_engel@yahoo.com">ga_engel@yahoo.com</a>.
</p>
<p>
When we equip young people with facts and practical skills, we empower them to make safer choices for themselves and for others. Students deserve to know. It is time to end the silence.
</p>
<p>
<em>Gregory Engel, MD, MPH, is a physician and epidemiologist based on the Key Peninsula. He is vice president for education with Ceasefire Northwest, a nonprofit organization that partners with schools across Washington to provide evidence-based education on firearm injury prevention.</em>
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/5/2026 11:18:34 AM | 12/22/2025 10:59:54 AM | 1/5/2026 12:00:00 AM |
| meet-physicians-insurances-first-physician-president-ceo | Meet Physicians Insurance's First Physician President/CEO | WSMA_Reports | Shared_Content/News/Latest_News/2026/meet-physicians-insurances-first-physician-president-ceo | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2026/january-february/cover-wsma-janfeb-2026-final-645x425px.jpg" class="pull-right" alt="WSMA Reports cover: January-February 2026" /></div>
<h5>Jan. 5, 2026</h5>
<h2>Meet Physicians Insurance's First Physician President/CEO</h2>
<p>
From Physicians Insurance
</p>
<p>
On Nov. 1, Physicians Insurance A Mutual Company welcomed David Carlson, DO, as president and chief executive officer, as Bill Cotter stepped down to begin his retirement. Dr. Carlson has served on PI's board of directors since 2018 and as chair from 2019 to 2023. As the first physician to sit at the head of PI's executive table, he comes to his new role with a unique dual perspective, informed by decades of clinical and business experience.
</p>
<p>
A board-certified family practice physician, Dr. Carlson has held several senior executive roles at major health systems, including MultiCare Health System in Washington, Hospital Sisters Health System in Illinois, and Conemaugh Health System in Pennsylvania, roles in which he also oversaw those health systems' captive insurer organizations. He was most recently vice president of medical operations-King County at Virginia Mason Franciscan Health.
</p>
<p>
Here, Dr. Carlson introduces himself to WSMA members and sheds light upon the perspectives he will bring to his new role with Physicians Insurance.
</p>
<p>
<strong><em>WSMA Reports:</em> You will be the first physician CEO of Physicians Insurance, a company that was formed by physicians for physicians. What's one takeaway from your experience as a practicing physician that you think will inform your leadership?</strong>
</p>
<p>
<em>Dr. Carlson:</em> Having cared for patients, I'm accustomed to absorbing as much information as possible in short amounts of time to quickly make important decisions. At the same time, I am comfortable making decisions when we don't have all the answers at once, because we rarely do. Early in my career, a mentor said, "If you don't have the answer yet, listen harder." So, I listen a lot and I focus on continually taking in new information. Given the quickly shifting dynamics we face in medicine, I think this is important.
</p>
<p>
In addition, while in leadership and overseeing captive organizations, I gained experience in efforts to improve the day-to-day landscape of care delivery and in prioritizing patient safety to improve outcomes. There are a lot of moving parts to care delivery today, but with the right support in place, both internally and externally, I'm optimistic about the quality and safety of care. I'm excited to bring my experience as a health care insider to a medical professional liability insurer that cares so much about supporting its members' needs during both the good days and the bad days.
</p>
<p>
<strong>Are there any unique trends impacting the medical professional liability insurance industry today that Washington physicians should be aware of?</strong>
</p>
<p>
Probably the most powerful trend is the pending updates to damages caps. Related to this is the dramatic impact of social inflation, which has jurors deciding on incredibly high damage awards, in turn raising expenses across the board for health care. It's not financially sustainable or good for patient care in the long run. It's imperative for PI to continue participating in the dialogue of damage caps, seeking solutions that contribute to a stable marketplace and that support overall care quality in cities and rural areas. The ~$250,000 caps from decades ago are certainly due for an update, and PI advocates for reasonable caps.
</p>
<p>
Early settlement demands from plaintiff attorneys are another rising trend. This is where a claimant receives an early, aggressive letter from a plaintiff attorney intended to create fear and division regarding the defense approach while demanding an outsized settlement before the medical facts have even been reviewed. In such instances, PI recommends that a defendant works closely with their claims team to navigate the demand with an appropriate legal response that is in their best interest.
</p>
<p>
<strong>With medical professional liability rates going up, many of our members are advocating for tort reform. For years, that goal has remained elusive due to the political makeup of Washington state. What type of reforms do you see on the horizon to improve the cost of coverage?</strong>
</p>
<p>
PI participates in advocacy work across the legislative, judicial, and regulatory environments to protect physicians, hospitals, and their patients. By advocating for reasonableness in all aspects of reforms, whether that's updating damage caps or statutes of limitations, for instance, we work to create a sustainable health care landscape that is affordable for patients and where quality care persists in cities and rural areas alike. Our best chance at success in our desired reforms, especially in political environments like Washington's, is to maintain a broad- based approach that benefits all parties through the support of an accessible and quality health care system. We will continue with advocacy strategies that benefit the whole of health care so that liability expenses, and corresponding medical professional liability rates, can remain reasonable.
</p>
<p>
<strong>Coming out of a health system, you know how overwhelmed many physicians are feeling. How can Physicians Insurance help today's practicing physicians and their insureds?</strong>
</p>
<p>
Physicians Insurance has kept the physician's perspective at the center of its work since its formation almost 45 years ago. A lot has changed in health care over those decades, but attentive support and a commitment to excellence in claims management are still among the best ways we can help physicians. The organization is continually looking out for rising trends and meeting the needs those trends create. PI exists to create peace of mind for physicians by being the experts they need in their corner, with unwavering financial resources, guidance, and claims expertise.
</p>
<p>
<strong>Looking forward, what does the future hold for Physicians Insurance?</strong>
</p>
<p>
PI will continue doing what it does very well in protecting its members, first and foremost. We will continue to look at our growth and healthy diversification options that support our ongoing strength and relevance. We are here to be the best medical professional liability insurer in Washington, in our region, and in the country. How we grow and support our members is critical.
</p>
<p>
I'm an optimist-the glass is nearly always full. We have rough waters to sail with all the challenging trends in the medical community, but the good news is that PI has the strategies to deal with the threats we're facing, including the purpose-driven mentality to keep our members at the center of our work. That is our job every day.
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.
</em></p>
</div> | 1/5/2026 11:19:23 AM | 12/22/2025 10:57:27 AM | 1/5/2026 12:00:00 AM |
| member-spotlight-john-scott-md-msc-fidsa | Member Spotlight: John Scott, MD, MSc, FIDSA | WSMA_Reports | Shared_Content/News/Latest_News/2026/member-spotlight-john-scott-md-msc-fidsa | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2026/january-february/member-spotlight-website-image-scott-645x425px.png" class="pull-right" alt="WSMA Reports Member Spotlight: John Scott, MD, MsC, FIDSA" /></div>
<h5>Jan. 5, 2026</h5>
<h2>Member Spotlight: John Scott, MD, MSc, FIDSA</h2>
<p>
<strong>Works at:</strong> Harborview Medical Center, UW Medicine.
</p>
<p>
<strong>How long in practice:</strong> 27 years.
</p>
<p>
<strong>Specialty:</strong> Infectious diseases.
</p>
<p>
<strong>Why WSMA:</strong> WSMA’s motto resonates with me: physician driven, patient focused. I first became acquainted with the WSMA through their advocacy on behalf of telemedicine legislation and saw how smart and respected they were. The WSMA staff is top notch! I’ve enjoyed their leadership courses, annual leadership conference, and efforts to promote physician wellness. The WSMA has my back and is doing what’s best for patients.
</p>
<p>
<strong>Proud moment in medicine:</strong> I started a program called Project ECHO in 2008. This telementoring program is going strong 17 years later, reaching all parts of the state and active in more than 20 different clinical areas. I was honored to receive the Warren Reed Award from the Washington State Department of Health in 2015 for this program.
</p>
<p>
<strong>Top concerns in medicine:</strong> I am concerned by the impact of Medicaid cuts and what that’s going to mean for my patients. Also, as an infectious disease physician, I am concerned by the denial of strong science behind vaccines.
</p>
<p>
<strong>Challenges ahead:</strong> AI is going to lead to some major changes in health care. As physicians, we need to be engaged in those changes, making sure that our patients are at the center of our care: protecting privacy, being transparent about AI uses, and moving toward more relational and collaborative care with our patients.
</p>
<p>
<strong>Why I wanted to be a physician:</strong> I had a wonderful pediatrician named Dr. James I. Ball (I used to ask if we were going to see Dr. Eyeball!). He was a real Marcus Welby, MD, type of doctor. I remember him being such a kind and smart physician; I wanted to be like him.
</p>
<p>
<strong>Why my specialty:</strong> I grew up in the San Francisco Bay Area in the 1980s, when HIV/AIDS was ravaging young men in the area. That devastation had a profound effect on me, leading me into research on HIV after college. I was drawn to the field of virology because of the advances in science and how you can help not just an individual but a whole population. I was fortunate to work in the NIH Laboratory of Cellular Oncology during medical school. My mentors performed the basic science that led to the development of the HPV vaccine; they were later given the Lasker Prize for Medicine. Their discovery has saved thousands of women’s lives. I also like the detective work involved in the specialty.
</p>
<p>
<strong>Leadership lessons:</strong> 1) Go to the balcony for perspective; 2) “Service leadership†– always be the first to do the grunt work and support your team; 3) Give the work away (How’s that, Ed?).
</p>
<p>
<strong>Spare time:</strong> I love to swim! My wife and I swim with the Mercer Island Redwoods masters swim team early in the morning. One of my favorite things in the summer is swimming in Lake Washington. I grew up as a competitive swimmer and have gotten back into it in the last few years. I swam at the U.S. Masters Nationals last August and placed in the top 10 in four events! I volunteer on the AV team at my church and I like to cook with my wife and listen to music.
</p>
<p>
<strong>People might not know:</strong> I was born in Kansas and own a farm there. I once had Thanksgiving dinner with Julia Child.
</p>
<p>
<strong>Pet peeves:</strong> Not saying please and thank you, honking unnecessarily while driving, lack of accountability.
</p>
<p>
<em>This article was featured in the January/February 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/5/2026 11:19:23 AM | 12/22/2025 11:47:55 AM | 1/5/2026 12:00:00 AM |
| advocates-for-health-and-humanity | Advocates for Health and Humanity | WSMA_Reports | Shared_Content/News/Latest_News/2025/advocates-for-health-and-humanity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/heartbeat-website-image-davis-bush-645x425px.png" class="pull-right" alt="Heartbeat column graphic, with Toren Davis, DO and Bridget Bush, MD" /></div>
<h5>Nov. 12, 2025</h5>
<h2>Advocates for Health and Humanity</h2>
<p>
By Toren S. Davis, DO, And Bridget Bush, MD
</p>
<p>
<em>From the Editors:</em> It's not often that you have a poem to publish in a physician general interest magazine and it's that much rarer to have two. But in this issue, we thought that Heartbeat- our regular column featuring the passionate perspectives of individual members-would be the appropriate place to publish two such poems that found their way across our desks. Each is timely and beautiful, and we hope you agree.
</p>
<p> First, from WSMA member Toren Davis, DO, who says, "I wanted to share my poem that was published earlier this year about our duty to advocate for our patients and health. Please share to anyone you would like." </p>
<p>
<em>Through the ancient words of Hippocrates<br />
we took an oath to fight disease.<br />
To see each patient's entire person<br />
and the many ways their health may worsen.<br />
So what happens when it comes to be,<br />
that disease is born from policy?<br />
When the greatest threats to a person's health<br />
are politics, power, and prospect of wealth?<br />
As these disorders show their intent,<br />
the treatment plan includes dissent.<br />
To refute what brings a person harm,<br />
and project our voice to sound alarm.<br />
If we neglect or fail to act,<br />
our oath does not survive intact.<br />
And the human lives that are at stake,<br />
will lose their shield of staff and snake.</em>
</p>
<p>
Next, from WSMA's new president for 2025-2026, Bridget Bush, MD, come these moving lines, which she included in her inaugural speech before the WSMA House of Delegates. She says, "I've struggled with depression and feeling disconnected, and I've learned that it's healthy to have a mask-literally and figuratively-at work to stay safe. Sometimes it's vital to help you to compartmentalize so you don't fall apart when everything around you is falling apart. I've also learned, however, that you have to have people and places where you're safe without the mask."
</p>
<p>
<em>I wear a mask at work<br />
I wear a mask to work<br />
I hide behind professionalism<br />
I tell myself-my mask keeps me safe<br />
I tell myself-my mask keeps you safe<br />
The less you know of my pain<br />
The less I show of what's inside<br />
The safer we are<br />
From questions<br />
From looks<br />
From fear that I'm not enough<br />
Well enough<br />
Keep it together<br />
Keep it hidden<br />
Keep it to yourself<br />
They tell me wellness is putting my own mask on first<br />
Perhaps I should turn on the oxygen too<br />
</em>
</p>
<p>
To watch Dr. Bush deliver her inaugural address, visit <a href="https://wsma.org/annual-meeting">wsma.org/annual-meeting</a>.
</p>
<p>
<em><strong>Toren Davis, DO</strong>, is a family physician affiliated with PeaceHealth Southwest Medical Center in Vancouver. <strong>Bridget Bush, MD</strong>, is an anesthesiologist in Everett with Optum Care Washington and serves as president of the WSMA.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/12/2025 3:32:12 PM | 11/10/2025 4:50:48 PM | 11/12/2025 12:00:00 AM |
| a-safer-smarter-approach-to-peer-review-and-patient-care | A Safer, Smarter Approach to Peer Review and Patient Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/a-safer-smarter-approach-to-peer-review-and-patient-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from November-December 2025 issue of WSMA Reports" /></div>
<h5>Nov. 11, 2025</h5>
<h2>A Safer, Smarter Approach to Peer Review and Patient Care</h2>
<p>
By Brock Bordelon, MD And Sara Cameron
</p>
<p>
In today's rapidly evolving health care environment, peer review is no longer simply an administrative requirement. It has become a strategic necessity to ensure patient safety and clinical excellence. Whether it's deployed properly in hospitals or outpatient facilities, peer review plays a pivotal role in elevating care quality, reducing risk, and strengthening trust across clinical teams.
</p>
<h3>From punitive to proactive</h3>
<p>
In the past, peer review was often viewed as a punitive process, focused on finding fault in individual clinicians after an adverse event. Today's best practices emphasize a vastly different approach: continuous quality monitoring. Instead of looking at isolated complications in hindsight, modern peer review focuses on real-time trends and system-level concerns.
</p>
<p>
This shift encourages timely, unbiased feedback and helps organizations intervene before problems escalate. Well-designed peer review should no longer be about catching mistakes. It should be about learning from them and ensuring they don't recur. Caring for patients is the bottom line of any setting, and it's the responsibility of the medical staff to ensure that patients are receiving quality care.
</p>
<h3>A foundation of patient safety</h3>
<p>
Peer review is more than a compliance box to check. It's a frontline defense for patient safety. By evaluating care delivery through structured, objective criteria, peer review helps identify both individual and systemic issues that might otherwise go unnoticed.
</p>
<p>
This is particularly crucial in outpatient settings, where the clinical infrastructure can vary widely. Whether reviewing clinical notes, follow-up protocols, or procedural outcomes, peer review provides an opportunity to catch small concerns before they become larger risks. That goes for patients, physicians, and organizations alike.
</p>
<h3>Powered by clinical quality data</h3>
<p>
One of the most important developments in peer review is its integration with clinical quality data. Rather than relying on subjective case reviews, modern peer-review efforts draw on outcome metrics, documentation audits, and data trends. This enables reviewers to make evidence-based decisions that reflect real patterns of care.
</p>
<p>
These insights are especially powerful when combined with other quality tools like incident reports, root cause analyses, and patient satisfaction data. When seen together, they paint a more accurate, and actionable, picture of clinical performance.
</p>
<p>
Such data integration also enables comparative benchmarking, allowing clinics to evaluate how their processes stack up against peers or national standards. This can drive targeted improvement efforts and reduce unwarranted variations in care.
</p>
<h3>Credentialing, privileging, and professional practice evaluation</h3>
<p>
Another essential function of peer review is its role in credentialing and privileging. Today, regulatory bodies and accrediting organizations increasingly expect health care settings to move beyond one- time verifications and engage in continuous assessment of professional practice.
</p>
<p>
Peer review is often the cornerstone of ongoing professional practice evaluation and focused professional practice evaluation. These processes ensure that clinicians are consistently performing within the scope of their training and privileges, and that any emerging issues are addressed proactively.
</p>
<p>
Peer review helps credentialing committees make informed, fair decisions based on data and peer insight rather than hearsay or incomplete records.
</p>
<h3>Building a culture of safety and trust</h3>
<p>
Effective peer review supports both patient outcomes and clinician well- being and organizational culture. A collaborative approach to peer review can strengthen trust among the health care team, reduce burnout, and create a shared sense of accountability.
</p>
<p>
To get there, organizations must invest in reviewer training, clear processes, and psychological safety. This ensures that clinicians can give and receive feedback without fear of reprisal. Peer review should be collegial, consistent, and constructive, not a tool for turf battles or punitive actions.
</p>
<h3>Getting started</h3>
<p>
For organizations looking to implement
or improve a peer-review program, we
recommend:
</p>
<ul>
<li>Start with structure: Define clear criteria, workflows, and timelines for reviews.</li>
<li>Use multidisciplinary reviewers: Engage peers from similar specialties who understand the nuances of the clinical scenarios being evaluated.</li>
<li>Leverage quality data: Integrate peer review with clinical dashboards, risk reports, and quality initiatives.</li>
<li>Link to professional development: Use insights to guide mentoring, education, and privileging decisions.</li>
</ul>
<h3>A smarter path to safer care</h3>
<p>
In the end, peer review is more than a regulatory checkbox. It's a practical, data-informed way to make care better. As health care organizations face increasing complexity, regulatory pressure, and patient expectations, a well-run peer-review process can help clinics and other outpatient settings stay ahead of risk, strengthen clinical teams, and keep patients safer. By embracing peer review as a tool for learning, health care organizations can lead with transparency, improve outcomes, and create a culture where quality is everyone's responsibility.
</p>
<p>
<em><strong>Brock Bordelon, MD, FACS</strong>, is a surgery medical director and <strong>Sara Cameron</strong> a director of professional services with MDReview - A Hardenbergh Company.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/11/2025 9:33:21 AM | 11/10/2025 4:46:14 PM | 11/11/2025 12:00:00 AM |
| doctors-making-a-difference-patricia-egwuatu-do | Doctors Making a Difference: Patricia Egwuatu, DO | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-patricia-egwuatu-do | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/dmd-website-image-egwuatu-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Patricia Egwuatu, DO" /></div>
<h5>Nov. 10, 2025</h5>
<h2>Doctors Making a Difference: Patricia Egwuatu, DO</h2>
<p>
For Patricia Egwuatu, DO, a family physician at Kaiser Permanente's Capitol Hill clinic in Seattle, having conversations about evidence-based health information through her Instagram and TikTok accounts came as a natural extension of her commitment to advocacy and education. Her reach on social media has led to an even bigger platform: As a regular contributor on Fox 13's "Healthy Living" television segment, she's aiming to start conversations about topics that often don't make it out of the exam room and help the public make informed decisions about their health. She talked with <em>WSMA Reports</em> about what led her to the role and why physicians continue to be the best messengers for fact-based health care information.
</p>
<p>
<strong><em>WSMA Reports:</em> How did your role as a contributor to Fox 13's "Healthy Living" segment come about and why did you decide to do it?</strong>
</p>
<p>
<em>Dr. Egwuatu: </em>My interest in becoming a medical media correspondent started during residency. At the time, my sister was in medical school, and we often had conversations about our journeys and how we could encourage others to pursue careers in medicine. As Black female physicians, who represent only about 2% of the workforce, and as daughters of immigrants, we felt inspired to share our upbringing and experiences. That led us to start an Instagram account, which gained traction, opened doors to interviews, and gave us a platform to highlight our voices.
</p>
<p>
At the same time, I was deeply engaged in health equity work through my role as associate program director of equity, inclusion, and diversity. I began using social media, including Instagram and TikTok, to share evidence-based health information and connect with the community. That growing engagement in medical media, along with my work at Kaiser Permanente, ultimately led to the opportunity with Fox 13's "Healthy Living" segment.
</p>
<p>
I chose to do the segment because it allows me to extend my passion for advocacy and education beyond the clinic. It's a meaningful way to engage with the broader community while providing accessible, evidence-based health information that empowers people to make informed decisions about their health.
</p>
<p>
<strong>What topics do you feel are most important to be talking about in this context?</strong>
</p>
<p>
I think some of the most important topics to highlight are the conversations that often happen in the doctor's office but don't always make it into broader community discussions. Many people are looking for reliable information yet don't always know where to turn. For example, breast cancer screening or discussions around hormone testing and hormone replacement therapy are questions I frequently encounter. Segments like these are a valuable way to bring that information to the public in an accessible, evidence-based format so individuals feel empowered when making decisions about their health.
</p>
<p>
<strong>With limited time on air, how do you get the information across in a way that will be impactful for a broad audience?</strong>
</p>
<p>
I'm fortunate to have a great team at Kaiser Permanente that helps guide, research, and provide evidence-based information for each topic, which I then tailor with my own expertise. To make sure the message is impactful for a broad audience, I draw on my media training to present the information in a clear and digestible way. I also practice with my partner and my sister, who remind me to communicate as if I'm speaking directly to them making the conversation relatable and accessible.
</p>
<p>
<strong>Why do you think it's important to have a physician be the messenger for these types of public health topics?</strong>
</p>
<p>
Physicians are often viewed as a trusted source of information. We have the knowledge and expertise to provide evidence-based guidance, and that credibility helps ensure people feel confident in the information they're receiving, especially when it comes to making decisions about their health.
</p>
<p>
<strong>What are some challenges you see in reaching people with evidence-based public health information?</strong>
</p>
<p>
One of the biggest challenges is the sheer amount of information available today. People are constantly exposed to health messages from so many different sources, and not all of them are accurate. That can make it difficult to cut through the noise and highlight reliable, evidence-based information in a way that resonates with the public.
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/10/2025 3:31:09 PM | 11/10/2025 3:03:45 PM | 11/10/2025 12:00:00 AM |
| the-intersection-of-wall-street-and-the-exam-room | The Intersection of Wall Street and the Exam Room | WSMA_Reports | Shared_Content/News/Latest_News/2025/the-intersection-of-wall-street-and-the-exam-room | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from July-August 2025 issue of WSMA Reportscover image from July-August 2025 issue of WSMA Reports" /></div>
<h5>Nov. 10, 2025</h5>
<h2>The Intersection of Wall Street and the Exam Room</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
In an era of increased financial pressures, practices struggle to remain independent. The result has been a huge upswing in consolidation, as some practices conclude that it is no longer feasible to remain a solo operation. "We saw hospitals get into the outpatient space in the 2010s. Then retailers came in, and then insurers," says WSMA CEO Jennifer Hanscom. "Now it's private equity."
</p>
<p>
The growing presence of private equity in medicine has sparked a debate about the corporate practice of medicine, or CPOM for short. CPOM is the legal concept that prohibits corporations, unless they are owned and controlled by physicians, from practicing medicine or dictating what physicians can do. Prompted by publicity about the negative effects of some private equity investments in health care, CPOM has become the focus of interest among legislators and physicians. A bill introduced in the Washington state Legislature last session would have placed stringent restrictions on the structure of corporate investment in practices in some instances. While the bill did not pass, it will be reintroduced in next year's session. (A bill with similar restrictions on CPOM was successfully passed by the Oregon state Legislature this year.)
</p>
<p>
Two resolutions introduced at the 2025 Annual Meeting of the WSMA House of Delegates in September also address the issue. One resolution called for "increased transparency, oversight, and regulatory safeguards for corporate and private equity acquisitions in health care." One of the sponsors of that resolution, Jose Flores-Rodarte, MD, a family physician who works in a federally qualified health center, says that private equity represents a unique threat to health care.
</p>
<p>
"I find it very concerning where Wall Street has reached out to acquire physician practices," says Dr. Flores- Rodarte. "The whole point is to turn the practice over and strip it for profits. If that's effective for a jewelry store, so what? While it's not a great practice, that's the economy we work in. Health care is different. It's a right."
</p>
<p>
At the same time, financial stresses are leaving practices with few options. "Some practices feel private equity investment is important for maintaining the viability of their organizations," says Sean Graham, WSMA's senior director of government affairs and policy. "It's a huge challenge for independent physician groups to maintain their viability in the face of all the pressures we know about."
</p>
<h3>CPOM: the law and the structures</h3>
<p>
As of 2024, 33 states have some form of CPOM law. Washington state's CPOM doctrine is based on case law and not legislation-yet is still generally considered to be one of the nation's strongest legal prohibitions. The fact that legislation was introduced last year to address CPOM indicates that, for some legislators and proponents, moving beyond case law to codifying in legislation is needed to strengthen the law further.
</p>
<p>
"This is a judge-made law," says attorney Luke Campbell, a member of the Health Law Section of the Washington State Bar Association. That said, there have been only a limited number of cases testing it. "It seems only to be infrequently applied right now by private litigants trying to avoid obligations, or by the Department of Health when there are threats to patient care," Campbell says.
</p>
<p>
Even so, says Campbell, the case law imposes limits. "There are only a handful of cases, but the courts have clearly stated that the CPOM doctrine exists and applies in Washington-this isn't some theoretical concept," he says. "What we don't have is published case law in Washington applying it to these modern private equity arrangements."
</p>
<p>
"Under Washington case law, courts look at the substance of the transaction and the reality of the business relationship to see what's really going on," Campbell says. If there is a question that the management company is too closely involved with the entity providing professional services or maintains a beneficial ownership interest in the practice, courts can-and have-intervened. In one example, a dentist and nondentist bought a building together that housed the dental practice. They structured the arrangement as a lease, with the dentist paying the nondentist "rent" equal to 50% of the practice's net profits-an amount that far exceeded the market rate for the building. When the dentist stopped paying, the case ended up in court. The court ruled that the percentage-based rent was really disguised profit sharing that gave the nondentist an illegal ownership interest in the dental practice itself, violating Washington's prohibition on nondentists owning or operating dental practices.
</p>
<p>
The existing case law would also suggest that the courts would closely scrutinize "friendly doctor" structures. Campbell has written that the structures "present material risks in Washington because, as described above, the courts have shown a willingness to look beyond formalities and into the essential nature of the relationship. For example, if the payments from the practice to the management company do not reflect fair market value for services but instead appear to reflect a return on an ownership interest, a Washington court may find that the relationship violates the CPOM doctrine."
</p>
<p>
The structures in place for CPOM are supposed to address the issues raised by the law.
</p>
<p>
The most common structure used by private equity investors gives physicians practice ownership while effectively transferring some functions and control of the practice to the management company through contractual relationships. Under this arrangement, the professional practice remains solely owned by licensed health care professionals, while the management company-which may include unlicensed investors-takes over some business operations. The practice transfers tangible assets and contracts to the management company, including real estate and equipment leases, while the management company provides administrative services such as billing, contracting, and strategic planning.
</p>
<h3>When private equity investment works</h3>
<p>
That common structure of private equity investment in a practice can be attractive in a market where there are limited financial options available. Moreover, practices sometimes feel the other available option is worse.
</p>
<p>
"When I have talked to physician practices, they went to private equity because they didn't want to sell to the local hospital system," says Hanscom. "A lot of times, the only option to stay independent is private equity. If you want a competitive marketplace and can't afford to make a go of it on your own, you need a funder."
</p>
<p>
The right partnership can work well, supporters of private equity investment say. Jarrod Durkee, MD, is medical director at RAYUS Radiology in Washington state, a subspecialty provider for advanced diagnostic and interventional radiology services with locations in more than 15 states. A separate entity, CDI Management Corp., is responsible for the nonclinical side of RAYUS.
</p>
<p>
The arrangement has been in place for almost 20 years. "They never tell us what to do clinically," says Dr. Durkee. "We make those decisions, we make those protocols. They never say to us, you need to see more patients, you need to perform more imaging. There's none of that going on."
</p>
<p>
What the management company does is handle the business side of the practice, including regulatory changes, infrastructure upgrades, and contracts. "I'm trained as a physician," says Dr. Durkee. "I'm not trained in building patient portals to see images and reports online. I don't know how to make those things happen. The same with talking to payers. That is their expertise." Because of the combined influence of RAYUS, Dr. Durkee says that his practice is able to get better deals than would otherwise have been the case.
</p>
<p>
Those savings can help patients. "As an independent physician group, we are at a minimum 30% to 40% less in what it costs patients than if they were to go to a hospital or closed system," says Dr. Durkee. "If you take away independent practices, patient access is going to be way more expensive."
</p>
<h3>The devil in the details</h3>
<p>
As in the RAYUS example, these structures have been in place in Washington state for years, typically involving individual arrangements between parties. But private equity is raising a whole new set of issues as its presence in health care increases rapidly, and, as investment in medical practices grows, private equity systematizes these arrangements and implements them broadly across multiple practices. An analysis earlier this year by the American Medical Association found that 6.5% of physicians said that their practice was private equity-owned, a jump from 4.5% since 2022. While the overall number is small, some specialties, such as orthopedics and ophthalmology, have seen substantial growth in private- equity investment over the past several years. By contrast, more than a third of physicians report working in hospital- owned practices.
</p>
<p>
For many observers, the devil can lie in the details of the management agreement. In some arrangements, particularly those using a "friendly doctor" structure, the management company gains substantial control through stock transfer restriction agreements or succession agreements. These provisions can restrict the physician from taking certain actions without the management company's consent, including hiring and firing employees-or even selling their ownership interest. In some cases, the agreements allow the management company to effectively remove and replace the physician owner if they don't comply with business directives. (This structure would have been barred under the proposed Washington state legislation.) Not all arrangements go this far. Some relationships maintain clearer boundaries between clinical autonomy and business management. The result is a sliding scale of control, with some physicians retaining meaningful independence while others may find themselves with ownership in name only.
</p>
<p>
While the law in Washington may be strong on its face, it is largely untested. For one thing, cases so far have largely involved disputes between two parties in an agreement. The potential pressure from a management company on a practice presents a more complicated scenario. "The reality is that the DOH [Department of Health] only responds to claims and is most concerned about harm to patients," says Campbell. "Unless it receives a complaint involving actual or potential patient harm, it doesn't seem that the DOH is interested in investigating these management company relationships."
</p>
<p>
Private equity has attracted a lot of attention primarily since much of the industry is so focused on profits. Some private equity investments in health care, particularly in hospitals, have resulted in widespread negative media coverage chronicling staffing shortages and bankruptcies at facilities that were bought out. Moreover, a study in the Journal of the American Medical Association in 2023 found that adverse events, including surgical infections, central line infections, and bed sores, skyrocketed among Medicare patients in the three years after a private equity fund bought a hospital. Another study showed significant price increases in 8 out of 10 practices acquired by private equity.
</p>
<p>
Such stories prompt worries among some physicians that CPOM has gotten out of control. Kim Ha Wadsworth, DO, a family physician who has a direct family care practice in Olympia, introduced a resolution at the September WSMA House of Delegates calling on the WSMA to support policy and legislation to strengthen CPOM restrictions in the state.
</p>
<p>
"Do we want lay people to have majority ownership of medical clinics?" she says. "If you have majority ownership, you make the decisions. That's really the crux of this policy question."
</p>
<p>
Dr. Wadsworth consciously chose a direct practice model so that she could focus on patients. "I want more of my colleagues to be able to enjoy medicine as it was meant to be before CPOM," she says. "We talk about the physician- patient relationship. When you are able to restore that connection, it brings back the joy of medicine. I'm looking at my colleagues who are suffering, and I know that there is a better way. We've done CPOM for 30 or 40 years, and how is that working for us? Physicians are burning out and talking about moral injury."
</p>
<p>
Dr. Flores-Rodarte echoes that sentiment that patients are suffering as a result. "These are questions about the quality of care that are at odds with what we do, which is our relationship with our patients," he says. "We're trying to do things in the best interest of the patient, when we're also trying to maximize profits for a private company. We've all had a favorite brand taken over by new owners, they extract the profit from it, and they destroy it. I don't want that to happen to our health care system."
</p>
<h3>Navigating the changing landscape</h3>
<p>
Dr. Durkee is sympathetic to physicians worried about corporate influence. "I understand and I agree that we don't want corporations telling us what to do as physicians, because that's not their area," he says. At the same time, he worries that too broad a crackdown on private equity will harm practices that actually do benefit from it.
</p>
<p>
"Are there bad actors out there? I'm sure there are. But don't throw everything out because they're under a certain label. That would cause more damage. Don't bring a shotgun when you need a surgical scalpel."
</p>
<p>
In point of fact, says Campbell, CPOM is now so embedded in the business of medicine that rolling back by the regulators may be impossible. "That ship seems to have sailed," he says. "Is the DOH going to suddenly take an aggressive enforcement position against these management-type service agreements? It seems unlikely that DOH will be the party to draw a line in the sand."
</p>
<p>
The main issue is how to maintain physician control over clinical decisions as the business of medicine continues to transform. "We all want clinical autonomy, first and foremost," says Hanscom. "But we also want to protect the workforce we have so that patients have access to the care they need. There's a lot of corporatization of health care. We need a comprehensive approach to it, something nuanced to the practice environment now, so as not aggravate problems and cause practice closures."
</p>
<p>
The likelihood of another CPOM bill being introduced in the Legislature next year will keep the issue front and center. "It's a new and complex issue," says Graham. "In my experience, what WSMA members are thinking about is that physicians should be in control of delivering care to patients."
</p>
<p>
The question is whether legislation can address physician concerns without creating new problems. "We don't want to make it more difficult for people to make the business decisions they want to make," says Hanscom. "We don't want to create a problem for physician owners who are already in relationships with private equity that they like."
</p>
<p>
No matter what happens in the next legislative session, the debate is unlikely to end. "We're all trying to struggle with how do we approach this," says Dr. Flores-Rodarte. "I don't think we have the answer, but we should be thinking about it."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/11/2025 9:40:27 AM | 11/10/2025 4:40:19 PM | 11/10/2025 12:00:00 AM |
| member-spotlight-lucinda-grande-md | Member Spotlight: Lucinda Grande, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-lucinda-grande-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/Member-Spotlight-Website-Image-Grande-645x425px.png" class="pull-right" alt="Member Spotlight: Lucinda Grande, MD" /></div>
<h5>November 6, 2025</h5>
<h2> Member Spotlight: Lucinda (Cindy) Grande, MD, FASAM</h2>
<p><strong>Works at:</strong> Pioneer Family Practice in Lacey.</p>
<p><strong>How long in practice:</strong> 14 years.</p>
<p><strong>Specialties:</strong> Family medicine and addiction medicine.</p>
<p><strong>Additional roles:</strong> Clinical associate professor in the department of family medicine, UW School of Medicine; current president of the Washington Society of Addiction Medicine.</p>
<p><strong>Why WSMA:</strong> The WSMA is a powerful voice for physicians in our state. I learned how influential it could be in 2017 after I presented my first resolution to the House of Delegates. I had hoped to draw attention to an injustice with societal implications, one that had been experienced by my own patients. Denial of life-saving medications to treat opioid use disorder in jails and prisons creates an extremely high risk of overdose death after release. With help from veteran resolution writers at my county medical society, I crafted a proposal to advocate for legislation, standards, policies, and funding to make buprenorphine and methadone available to inmates. The resolution was adopted as a new policy by the WSMA and ultimately by the American Medical Association. WSMA and AMA advocacy helped to catalyze a growing awareness of the problem and led to real changes statewide and nationally.</p>
<p>I have since shepherded about a dozen resolutions through the process, often in collaboration with WSMA staff, family physicians, addiction specialists, and public health groups. Through my participation in the WSMA, I have learned that teamwork is essential to the power of organized medicine. Teamwork requires persistence and compromise, but results in much more attention from policymakers than any of us could hope for alone.</p>
<p><strong>What inspires me about medicine:</strong> I love to find solutions for whatever health problems patients bring to me. Often, I can use widely available treatments to address common problems. For example, for the petite white-haired lady who brought in a chart showing wild swings in blood pressure, I tinkered with the doses and timing of losartan and amlodipine. She returned at the next visit with a bright smile because her numbers were now perfectly steady.</p>
<div class="col-md-4 col-xs-12 pull-left">
<p><img alt="Dr. Grande at home" src="/images/Newsletters/Reports/2025/november-december/Grande_profile_secondary.jpg
" class="pull-left" /></p>
</div>
<p>But sometimes unconventional solutions are needed. A 38-year-old man, struggling to drop some of his 400-pound heft, yearned to try a GLP-1 agonist. Unfortunately, his insurance wouldn’t pay for it because he didn’t have diabetes. Compounding pharmacies are avoided by many physicians, but I was happy to use one to obtain generic semaglutide for him—enriched with Vitamin B12 for the inevitable fatigue of the overweight—for $200 per month. That man lost 15 pounds in the first 6 weeks. You bet he had a bright smile at the next visit.</p>
<p>A more adventurous area of my work is with patients who—like many millions of Americans—suffer from both chronic pain and psychiatric disorders. A favorite opportunity is to take a depressed and irritable middle-aged man with arthritis who has limped along for years on oxycodone, and initiate buprenorphine for his pain. There is art in luring that man into making the change, and in selecting a suitable starting dose and titration plan. But how thrilling to see the clouds lift and a new brightness in his step!</p>
<blockquote class="Quote">
<p>
Through my participation in the WSMA, I have learned that teamwork is essential to the power of organized medicine."
</p>
</blockquote>
<p><strong>What people may not know about me:</strong> My true passion is unlocking the secrets of daily sub-dissociative dose (or “microdoseâ€) ketamine. I have delighted in the frequently favorable and sometimes breathtaking outcomes among 600+ patients with common debilitating conditions from chronic pain, depression, and suicidal ideation to addiction, dementia, and existential distress at end of life. I have several research projects underway with the goal of bringing the rich potential of this treatment strategy into mainstream clinical practice.</p>
<p><strong>Recommended reading:</strong> I am immersing myself in the many wonderful books by the cognitive psychologist and psycholinguist Steven Pinker. My favorite is “The Sense of Style: The Thinking Person’s Guide to Writing in the 21st Century.†Next on my list is “The Better Angels of Our Nature,†based on the surprising premise that violence has declined over the course of human history. I am hoping for a refreshing break from the gloom and barbarism of today’s news.</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/10/2025 2:25:25 PM | 11/6/2025 2:21:17 PM | 11/6/2025 12:00:00 AM |
| healthy-food-resources-better-health | Healthy Food Resources, Better Health | WSMA_Reports | Shared_Content/News/Latest_News/2025/healthy-food-resources-better-health | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from November-December 2025 issue of WSMA Reports" /></div>
<h5>
October 21, 2025
</h5>
<h2>Healthy Food Resources, Better Health </h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Jennifer Maxwell, MD, a family medicine doctor at Yakima Valley Farm Workers Clinic, often sees patients struggling with both food insecurity and making dietary changes to manage their diabetes. To address both, Dr. Maxwell doesn't just prescribe medication and tell them to "eat better." She provides these patients the means to do so through the clinic's partnership with the Washington State Department of Health's Fruit and Vegetable Prescription Program, or FVRx. It's one of 24 such health care partners participating statewide since the program started in 2016. FVRx serves people who have or are at risk for a diet-related illness and have food insecurity.
</p>
<p>
Produce prescription programs like FVRx fall under "food is medicine," a growing movement of science- and evidence-based initiatives that recognize the critical role of nutrition in preventing, managing, and even treating chronic disease. The Food Is Medicine Institute at Tufts University defines the movement as interventions that "reflect the critical link between nutrition and health, integrated into health care delivery."
</p>
<p>
Medically tailored meals and medically tailored groceries are the other disease treatment and management interventions. Prevention interventions include population-level health food policies and programs and nutrition security programs, such as the Supplemental Nutrition Assistance Program; Women, Infants, and Children Nutrition Program; and school meals.
</p>
<h3>Washington's FVRx program</h3>
<p>
In Washington state, depending on partner parameters, patients can receive between $250 to $500 in FVRx vouchers (and soon prefunded ecards) over six months. They are redeemable at certain grocers, food cooperatives, and farmer's markets statewide for fresh, frozen, or canned produce without added salt, sugar, or fat. At Yakima Valley Farm Workers Clinic, food insecure patients with an A1C blood test of 8% or higher receive $40-$80 in monthly vouchers for six months. The program is so popular, there's a waiting list.
</p>
<p>
"In this last cohort, patients on average had a decrease of a half of a percentage point for their A1C. Some patients had as significant a decrease of 8.3 percentage points, which is huge in terms of health improvement," says Gabrielle Frank, RDN, primary care nutrition services manager at Yakima Valley Farm Workers Clinic.
</p>
<p>
While robust research is scarce, <a href="https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009520">one study</a> published in the August 2023 Journal of the American Heart found produce prescription programs associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children. Adults with poor cardiometabolic health also had clinically relevant improvements in A1C, blood pressure, and body mass index.
</p>
<p>
Many of Dr. Maxwell's patients work long hours, without paid time off, making it hard to convince them to schedule medical visits when they don't see immediate benefits. The FVRx program has incentivized patients to make and keep follow-up appointments, says Dr. Maxwell. "With this program, they see a direct benefit today, and then it translates into long-term benefits."
</p>
<h3>Medically tailored meals and groceries</h3>
<p>
Medically tailored meals, or MTMs, began in the 1980s in response to the HIV/AIDS pandemic. MTMs and medically tailored groceries support patients with severe, complex, or chronic conditions. They are typically provided by nonprofits and other community organizations and delivered to patients' homes. Upon referral from a physician or practitioner, registered dietitians assess each patient to develop meals and groceries tailored to their nutritional needs and condition.
</p>
<p>
Not all MTM programs are created equal. As food is medicine has gained traction, some traditional food and meal delivery companies have tried to rebrand themselves. "Most don't appear to meet voluntary accreditation standards crafted by medically tailored meal providers," found a STAT News investigation: Some provided patients with fried food or meals that were high in fat or sodium.
</p>
<p>
To develop quality standards, in 2023, the Food is Medicine Coalition, a leading national coalition of nonprofit organizations that provide medically tailored meals, created an accreditation program for medically tailored meal providers. Lifelong, a Seattle-based nonprofit, is the first in Washington state to receive FIMC accreditation. (FISH Community Food Bank in Ellensburg is a FIMC member, a precursor to accreditation, providing MTMs to clients in Kittitas County.)
</p>
<p>
Each year, Lifelong provides MTMs and MTGs to some 2,000 low-income clients in King, Island, and Snohomish counties. A significant portion are homebound and have challenges either accessing food or preparing their own food. "One of the things medically tailored meals, or even groceries, can do is reduce the stress around food access," says Emily Hanning, Lifelong's vice president of food and nutrition. The home delivery model can even help address the loneliness epidemic, she says.
</p>
<p>
"Bringing meals to clients fosters a sense of connection and community. Oftentimes we're one of the only people interacting with a client that week," says Hanning. "We're also able to do an informal mini wellness check. Then if there's any follow up needed, we'll reach out and make sure that we're getting clients the other support they need."
</p>
<p>
Along with providing condition-specific nutrition, MTMs also address dental or swallowing issues, barriers for many patients, says Hanning. "We're able to mechanically soften food to provide adequate nutrition."
</p>
<p>
Poor diets not only impact a patient's health, they also impact their wallet: 85% of all health care spending is related to the management of diet-related chronic diseases, according to Tufts' Food Is Medicine Institute.
</p>
<p>
In Lifelong's annual survey, 88% of responding clients reported improvements in their health. A <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.01307">recent Health Affairs analysis</a> estimated the one-year impact of MTMs (based on 10 weekly meals for eight months) would result in more than $3,000 net annual cost savings per person in Washington state and nationally $23.7 billion overall, after accounting for intervention costs. Nationally, this level would also avert over 2.6 million hospitalizations.
</p>
<p>
In recent years, the need has increased so much that Lifelong now has a waitlist. Hanning is hopeful that Apple Health will soon cover MTMs via Washington's Section 1115 Medicaid waiver, the federal mechanism that provides flexibilities for states to try new approaches with their Medicaid programs.
</p>
<p>
In February, the state Health Care Authority submitted a rate methodology under its Medicaid Transformation Project (its name for the Medicaid waiver) for reimbursable nutrition support services aimed at removing barriers to healthy nutrition. They include nutrition counseling and education, MTMs, meals or pantry stocking, fruit and vegetable prescriptions, and short-term grocery provisions. These <a href="https:/www.hca.wa.gov/assets/program/mtp-nutrition-supports-fee-schedule.pdf" target="_blank" rel="noreferrer">nutrition support services</a> are expected to increase the annual aggregate expenditures for nutrition service providers by approximately $50 million.
</p>
<p>
"We know that there are going to be reductions to food assistance and SNAP that people depend on coming up. So, the waiver, we hope, will provide an opportunity to help support our community members with healthy food," says Hanning.
</p>
<p>
In 2023, the Centers for Medicare and Medicaid approved an additional five years of payment for health-related social needs services under Washington state's Medicaid Transformation Project. The Trump administration has since rescinded CMS guidance that promoted these Section 1115 waivers for health-related social needs services addressing social determinants of health. While the new policy does not nullify existing approvals granted under the Biden administration, new requests will now be considered on a case-by-case basis.
</p>
<h3>Food insecurity and social determinants of health</h3>
<p>
Many food is medicine interventions are tied to food insecurity, a social determinant of health; not surprising, as poor diets and food insecurity are strongly linked, with both increasing the risk of early death, disability, and poor health. The U.S. Department of Agriculture defines food insecurity as "a household-level economic and social condition of limited or uncertain access to adequate food." The USDA's 2023 Household Food Report found 9.5% of Washingtonians are food insecure.
</p>
<p>
"We can't discuss food as medicine without addressing food insecurity. If people don't have reliable access to nutritious food, the idea of using food to prevent or manage disease isn't realistic. Things like affordability, transportation, food deserts, and lack of nutrition education all play a role in whether someone can consistently access healthy, culturally appropriate meals," says Chelsey Lindahl, RDN, CD, manager for health promotion and wellness at MultiCare Center for Health Equity and Wellness in Tacoma. The center and MultiCare Yakima Memorial Hospital are also FVRx health partners.
</p>
<p>
In recent months, patients have also told Dr. Maxwell they don't want to go out as frequently into the community out of fear. "Less frequent shopping trips means you can't buy as many fresh fruits and vegetables because they will expire," she says.
</p>
<p>
Food insecurity is often hidden in plain sight. Screening for insecurity is often something many physicians miss, says Dr. Maxwell. Yakima Valley Farm Workers Clinic uses the Hunger Vital Signs screening tool for all patients at intake and once yearly. Food cost is a big reason most don't eat healthier.
</p>
<p>
"Our patients are living in the margins, and sometimes food is not the most high priority for them in terms of what their needs are, or what they see as the vehicle to support health improvement three or six months from now," says Frank.
</p>
<p>
Over 22% of Yakima households receive benefits through SNAP, double the state average. Nearly 1 million Washingtonians use SNAP benefits each month. Statewide, nearly half of all babies, one third of pregnant women, and one quarter of children under age 5 rely on the WIC Program.
</p>
<p>
The Trump administration's budget bill cut SNAP by $186 billion over the next decade. In Washington state, the average household under the Thrifty Food Plan is expected to receive $56 less per month. The maximum allotment for a family of four would drop from $975 to $848. The cuts come at a time when food costs continue to outpace wage growth for many Americans.
</p>
<p>
Community health workers at Yakima Valley Farm Workers Clinics also help connect patients to local food banks and apply for SNAP benefits. The majority of their clinic locations in Washington and Oregon also contain embedded offices for WIC, the federal Special Supplemental Nutrition Program for Women, Infants and Children.
</p>
<p>
"As health care providers we really need to reserve judgment about eating choices, or what is behind why families feed their kids the way they do," says Frank. She recommends "How the Other Half Eats," by Priya Fielding-Singh, PhD, to better understand food insecurity and what informs food choices. "Most people do want to feel healthy and know when foods are healthy, but there are just so many complex barriers that get in the way of that being their day-to-day reality," she says.
</p>
<h3>Culinary medicine and whole-person care</h3>
<p>
Food is medicine interventions often include nutritional counseling, the educational, and sometimes emotional, support patients need to make lasting dietary changes. "Registered dietitians are trained in motivational interviewing and are able to take a broad concept like 'eat more vegetables,' and make it applicable to the context of their life," says Frank.
</p>
<p>
One FVRx client recently shared that after six months, she has regular meal patterns, stopped drinking soda, and takes her medication as prescribed. Her A1C dropped from 13.7 to 6.3. "She was struggling with depression and her dietitian connected her with a mental health counselor. The dietitian she worked with provided this older adult with whole-person care," says Frank.
</p>
<p>
Patients often share that changing their diet feels daunting and confusing, says Emma Dotson, DNP, ARNP, who specializes in cognitive neurology at the Swedish Center for Healthy Aging in Seattle. That's where culinary medicine comes in: a growing evidence-based field that blends the art of food and cooking with the science of medicine. The center includes culinary medicine in its shared medical appointments, an innovative program where a patient cohort meets for eight months to learn lifestyle interventions for disease prevention and management.
</p>
<p>
Once a month on Zoom, Dina Piatt, RDN, provides a virtual cooking demonstration of brain-healthy recipes and education around nutrition. "A lot of patients don't know the effect food has particularly on brain health," says Piatt. The center's plant-based recipes, such as blender banana bread, are intentionally simple and affordable, with easy prep and cleanup, so patients are more likely to make them.
</p>
<p>
In the past, generous funding allowed the center to deliver the ingredients to patients so they could follow along. Patients report feeling better and having lower A1C and blood pressure, from changing their diet, says Dotson. "Even those with early stages of dementia can participate with their care partner." The feeling of self-efficacy, she says, creates a domino effect to keep up with other needed lifestyle changes.
</p>
<p>
Yakima Valley Farm Workers Clinic's Toppenish Medical-Dental Clinic also offers all patients both in-person and virtual cooking classes around specific topics, such as heart health, diabetes management, and pediatric nutrition.
</p>
<p>
While the federal government's nascent Make America Healthy Again movement focuses on ultra-processed foods, Dr. Maxwell says cooking meals from scratch isn't an issue for her patients. "Most of my patients actually prepare their own food. It's the cost-and taking a risk in buying something that they don't know whether their family will actually eat it when they have a limited budget," she says.
</p>
<p>
"It's really not controversial that good nutrition is important. But how to actually make that work for our patients is key. And a lot of it is the health equity perspective," says Dr. Maxwell. "It's a reasonable question when patients are not eating fruits and vegetables to ask if they are afraid that they will run out of food before they have money to buy more. These are good questions before we continue to write more prescriptions and think that the patients just can't or won't."
</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 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 10/31/2025 1:42:26 PM | 10/21/2025 10:42:10 AM | 10/21/2025 12:00:00 AM |
| an_open_door_and_a_clear_path | An Open Door and a Clear Path | WSMA_Reports | Shared_Content/News/Latest_News/2025/an_open_door_and_a_clear_path | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 16, 2025</h5>
<h2>An Open Door and a Clear Path</h2>
<p>
By Milana McLead
</p>
<p><em>For WSMA 2025-2026 President Bridget Bush, MD, connections and stories empower her leadership journey and point to the future.</em></p>
<p>One might wonder what a piano teacher, the fictional Dr. Kay Scarpetta, the dinosaurs of Jurassic Park, and the book "Starship Troopers" have in common. The answer is that each was a throughline across Bridget Bush's journey into medicine. Like intersecting avenues on a map, the path is clear now, even if it wasn’t then.</p>
<p>An aunt who taught Dr. Bush piano lessons suggested biogenetics engineering as a cool career, igniting a fifth grader's imagination and dream of helping people have healthier babies. Patricia Cornwell's crime novels featuring the forensic pathologist and medical examiner Dr. Kay Scarpetta planted early thoughts of medicine combined with law (notably, both of Dr. Bush's parents are lawyers). In high school, Jurassic Park’s genetic scientists prompted the future Dr. Bush, who loved being outside digging and solving puzzles, to think: "Oh my God, I can do both! I can do dinosaurs and genetics!"</p>
<div class="col-md-4 col-xs-12 pull-right">
<p><img alt="Women in Medicine graphic" src="/images/Newsletters/Reports/2025/september-october/women-in-medicine-graphic.jpg" class="pull-right" /></p>
</div>
<p>Those interests led to a biochemistry degree from the University of Nevada in Reno, as the dream for medical school solidified. Then 9/11 happened during a time when she was rereading “Starship Troopers,†a favorite book of hers and her father’s. “The movie is campy and hilarious, but the book is phenomenal,†she says. “I remember its message hitting me so hard—the concept that if you’re willing to give your life for the country, then you get to vote for how it’s run. That made sense in my core, that if you’re willing to put yourself at risk, then you get a say. And the little voice in my head said, ‘Maybe you should serve.’ â€</p>
<p>As she was deliberating how best to pay for medical school, she’d heard of the Health Profession Scholarship Program through the military. The program made sense for her, especially since her grandfather had served in the U.S. Navy in World War II.</p>
<blockquote class="Quote">
<p>
One of my goals in life is to create connections with people and to say ‘yes.’ The more you say ‘yes,’ the more doors open and things change. I want to create positive change.†— Bridget Bush, MD
</p>
</blockquote>
<p>After medical school at Tulane School of Medicine in New Orleans, she served out her commitment in the Navy as a flight surgeon. “I had the chance to do a lot of things that most people will never experience,†she says. “I’ve been deployed to Afghanistan and Iraq, I’ve seen K2 from the air when we flew close to Pakistan, I’ve seen slopes on the Hindu Kush that I’d love to ski down. I’ve fast-roped out of a helicopter, did combat casualty care training, and made it through survival, evasion, resistance, and escape training. Would I go through SERE training again? Absolutely not! Am I happy I went through it? Yes. Those are important skills.â€</p>
<p>Besides those critical survival skills, Dr. Bush notes other skills that serve her well in her field of anesthesia. “One of my superpowers is as a ‘calmer,’ †she says. “It’s part of what drew me to anesthesia because I get to speak to people when they are most scared, and my calming influence helps them with their experience, mentally and physically, because they can go into it less stressed.â€</p>
<p>In clinical rotations, she loved nearly all the specialties except for emergency medicine, but that was because she never had a chance to get the patient stories. For Dr. Bush, the story, the puzzle pieces, and the detective work all add up to the care she wants to provide. “I was sold on anesthesia,†she says. “As anesthesiologists, we take the patient as a whole, looking at all the puzzle pieces to see where the cracks are, where the failing points are going to be and try to improve or circumvent or treat as needed. That’s what we’re doing the whole time, before, during, and after.â€</p>
<p>One of her first patients on third-year clinical rotations crystalized that care approach for her. The patient was a veteran, ill potentially with tuberculosis (common at the time in New Orleans) and was thus in isolation. “We were all in there wearing N95s, it’s super loud and he wouldn’t talk to anyone,†she says. “He had a lot of tattoos, and I’m fascinated by them, so I asked, ‘What kind of bike do you ride?’ He started talking to me. He opened up about having lung and prostate cancer and said that instead of more tests for something that couldn’t be fixed, he just wanted to go home. That molded how I saw care. Making the diagnosis, doing the tests, it was all puzzle work. It was being a detective but also talking to the patient to understand their story.â€</p>
<div class="col-md-4 col-xs-12 pull-left">
<p><img alt="Bridget Bush, MD" src="/images/Newsletters/Reports/2025/september-october/bridget-bush-md-photo.jpg" class="pull-left" /></p>
</div>
<blockquote class="Quote">
<p>
The WSMA is where you meet people.†— Dr. Bush</p>
</blockquote>
<p>People, their stories, making connections—all are woven through Dr. Bush’s approach to work, life, leadership, and her engagement with the WSMA. “One of my goals in life is to create connections with people and to say ‘yes,’ †she says. “The more you say ‘yes,’ the more doors open and things change. I want to create positive change.â€</p>
<p>Saying yes is exactly how Dr. Bush deepened her engagement with the WSMA. Her journey began when she was invited to serve as part of the WSMA Young Physician Section Governing Council, and from there on, she kept saying yes and found connections along the way. “One hundred percent, making connections is a WSMA resource anyone can tap into,†says Dr. Bush. “You’ll meet physicians in all different fields, you’re going to meet your mentor or your next boss or next best friend, and you’ll get to know what medicine is really like across the state. The WSMA is where you meet people.â€</p>
<p>It’s also how a physician in Washington state gains access to educational opportunities, knowledge, advocacy, and networking. “The WSMA is the path to making change—by standing with us, we provide that path and can help change and make things better,†she says. “And if it’s not in our power, maybe we can help you figure out a way. Joining the WSMA allows everyone to have a voice, to make change, and to take action,†she says.</p>
<p>As she steps up to lead the WSMA, her leadership approach will surely be inclusive, open, and engaging. “I believe the best leaders are the ones who bring up everyone around them and give voice to those who may not feel able to speak up,†she says. “I want to hear other people’s voices and to empower them to know that what they’re experiencing matters.â€&nbsp;</p>
<p><em>Milana McLead is WSMA’s senior director of strategic communications and membership.</em></p>
<h3>Snapshot</h3>
<h4>Family</h4>
<p>“It’s more of a family vine than a family tree!†Husband, Phil; dog, “mostly poodle,†named Ludo for the scary monster in Labyrinth who is kind and makes friends with rocks.</p>
<h4>Odd jobs</h4>
<p>Intern at the Yucca Mountain Project in Las Vegas greeting media and visitors; Department of Energy intern in Washington, D.C., where she managed $40 billion in taxes related to nuclear site decommissioning.</p>
<h4>Passions</h4>
<p>Mental health and well-being, women’s health.</p>
<h4>What keeps her up at night</h4>
<p>“Not a lot, unless it’s something my body is trying to figure out in dance.â€</p>
<h4>Meaningful quotes</h4>
<p>“I will survive†and “Walk into the room as though God sent you as a punishment!â€</p>
<h4>Wishful playlist for making an entrance</h4>
<p>Carmina Burana!</p>
<h4>Spare time</h4>
<p>Self-described movie nerd; Duolingo enthusiast (French, Spanish); pole dancing and instructing; gardening and tree planting (850 during the pandemic!).</p>
<h4>Movie references during interview</h4>
<p>PCU (Port Chester University), Star Trek, American Gods, Labyrinth, What Dreams May Come.</p>
</div> | 9/16/2025 2:35:43 PM | 9/16/2025 11:19:45 AM | 9/16/2025 2:35:43 PM |
| member-spotlight-charles-liu-md | Member Spotlight: Charles Liu, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-charles-liu-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/member-spotlight-website-image-liu-645x425px.png" class="pull-right" alt="WSMA Reports Member Spotlight: Charles Liu, MD graphic" /></div>
<h5>Sept.&nbsp;12, 2025</h5>
<h2>Member Spotlight: Charles Liu, MD</h2>
<p>
<strong>Works at: </strong>University of Washington Medical Center Montlake.
</p>
<p>
<strong>How long in practice: </strong>First year in practice.
</p>
<p>
<strong>Specialty: </strong>Colon and rectal surgery.
</p>
<p>
<strong>Why WSMA: </strong>As a physician in my first year in practice and new to Washington, I was excited to join the WSMA both for the professional networking opportunities and to get involved in the WSMA's work in state legislative advocacy. One of the first WSMA initiatives I heard about was its effort to pass the Medicaid Access Program through the state Legislature and get it signed by Gov. Bob Ferguson. Low Medicaid reimbursement creates huge access to care issues for many of our low-income patients statewide, and the program-if and when it is hopefully approved in the future by the Centers for Medicare and Medicaid Services- would leverage federal funds to increase Medicaid reimbursement rates to Medicare levels. I'm excited to get involved in future efforts by the WSMA to support public policy that expands our patients' access to timely care.
</p>
<p>
<strong>Top concerns in medicine:</strong> My patients' ability to afford their medical care is one of my top concerns as a colorectal surgeon. In my specialty, this can manifest as patients with inflammatory bowel disease stopping or skipping doses of their medication, which can lead to worsening disease, complications, and emergency surgery, or patients delaying or deferring colorectal cancer screening, leading to late diagnoses of colorectal cancer. This problem is only becoming greater as expensive new biologic medications become standard of care, and as high-deductible health insurance plans become more common. In addition to stress around paying high medical bills, cost transparency is a huge challenge. So many patients ask me if their surgery will be covered by insurance, or how much it will cost, and I have very limited tools available to help them answer those very valid questions.
</p>
<p>
<strong>Challenges in medical profession:</strong> A major challenge our profession faces is the fallout of the recently passed cuts to Medicaid and the Affordable Care Act. Through these cuts, millions of patients nationwide and hundreds of thousands here in Washington will lose their health insurance, likely leading to more delayed disease presentation. I work at an urban referral hospital, but many of my patients travel from rural parts of the state and region to get care, and I am particularly worried about the closure of rural hospitals and emergency rooms as a result of these cuts.
</p>
<p>
<strong>Why my specialty:</strong> I love that I get to take care of patients ranging from young adults with inflammatory bowel disease, to older adults with cancer, to folks of all ages with diverticulitis and anorectal conditions. On the procedural side, colorectal surgery also allows me to use open, laparoscopic, robotic, and endoscopic techniques to treat disease, and my surgical cases range from short 20-minute procedures to all- day multidisciplinary operations. Finally, I really enjoy getting to work with and teach residents and medical students as a daily part of my job.
</p>
<p>
<strong>Spare time:</strong> I enjoy running, watching soccer, and all things aviation-related (I'm not a pilot but maybe someday). Over the past couple of years, I have been dabbling in mixology. More recently, my wife and I have our hands full with our three-month old son, who is currently learning how to hold his head up and that his hands belong to his body!
</p>
<p>
<strong>Recommended reading:</strong> Trevor Noah's "Born a Crime" is amazing, both personal and educational about apartheid South Africa. I loved listening to it on audio because he narrates the accents and languages so well. "How Democracies Die" by Steven Levitsky and Daniel Ziblatt is a bit too real but eye-opening. We have to learn about history to avoid repeating it. Lastly, "How to Avoid a Climate Disaster" by Bill Gates was really enjoyable. He is, of course, not a climate scientist himself but has clearly educated himself deeply on the topic, and as a result I think he explains climate change solutions in a really approachable and clear way.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 3:37:17 PM | 11/19/2025 12:24:53 PM | 9/12/2025 12:00:00 AM |
| how-we-pay-for-medical-care | How We Pay for Medical Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/how-we-pay-for-medical-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/heartbeat-website-image-rotchford-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat: James Rotchford, MD graphic" /></div>
<h5>Sept. 11, 2025</h5>
<h2>How We Pay for Medical Care</h2>
<p>
By James K. Rotchford, MD
</p>
<p>
In the May/June 2025 issue of WSMA Reports, Amarita Stark, MD, discusses the threats to children's access to medical care due to potential Medicaid cuts. I heartily concur with her concerns and have concerns about access barriers for the vast majority of Americans.
</p>
<p>
Social determinants account for approximately 80% of health outcomes. Hence, significant societal changes are necessary to achieve substantial progress in American health outcomes. Meanwhile, what are the policies that hinder the provision of cost-effective medical care and, consequently, limit access to it?
</p>
<p>
Let's start with changing how we pay for medical care. Practitioner time and expertise would be the primary determinant for reimbursements, as they generally are for non-medical professional services. Coverage eligibility can determine the amount of health care coupons one receives, similar to food stamps. Let patients play a larger role in deciding what is most valuable and most helpful. Licensed professionals would remain accountable for ensuring that medical care options are reviewed and offered in accordance with established standards of care. Patient outcomes and satisfaction would become the driving forces for medical care. This contrasts with our current policies, in which CPT codes and their documentation commonly determine care.
</p>
<p>
</p>
Serious illnesses requiring hospitalization or significant procedural interventions could be covered by "large deductibles" as seen in the private sector. Prevention and early care could be incentivized by providing coupons for specified services, such as annual exams, breast exams, and others. Some contexts would have reimbursements based similarly to what is now done with CPT codes and their documentation. Professional time and expertise could still, however, be the primary determinants for most payments.
<p>&nbsp;</p>
<p>
Costs would be reduced by excluding third parties in decision processes. Third parties currently define available care and have limited accountability, especially regarding individual outcomes. As an example, Medicaid providers incur inordinate expenses that impact cost-effective outcomes. Administrative costs disproportionately drive expenses, along with documentation liabilities, disputes over necessity, and costs associated with managing legal and regulatory liabilities.
</p>
<p>
This approach would introduce competitive pricing based on the principles of supply and demand. Note supply might increase because practitioners would have more time to focus on patients rather than third-party concerns. Competitive pricing, combined with lower administrative overhead, would lead to predictable price reductions. Current incentives regarding the provision of relatively unproductive procedures would be reduced, and costs and outcomes would align with those of other advanced countries. Patients would recognize that care was being individualized as well as possible, rather than based primarily on what third parties cover and incentivize. Trust in physicians and advanced care providers would improve, with all the corresponding benefits.
</p>
<p>
In summary, cost-effective outcomes are compromised in large part by how we pay for medical care. If we do not address how we pay for medical care, our ability to ensure adequate and universal medical care remains compromised.
</p>
<p>
<em><em>James K. Rotchford, MD, MPH</em>, is an addiction medicine physician with Olympas Medical Services in Port Townsend.</em>
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 3:37:17 PM | 11/19/2025 12:11:18 PM | 9/11/2025 12:00:00 AM |
| doctors-making-a-difference-wayne-larrabee-md | Doctors Making a Difference: Wayne Larrabee, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-wayne-larrabee-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/dmd-website-image-larrabee-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Wayne Larrabee, MD graphic" /></div>
<h5>Sept. 10, 2025</h5>
<h2>Doctors Making a Difference: Wayne Larrabee, MD</h2>
<p>
Even before he started medical school, Wayne Larrabee, MD, knew he wanted to make a difference on a global scale. After working in public health as an epidemiologist in Central and South America, his experience in Panama observing children suffering from congenital abnormalities including cleft lip and palate led him to the second phase of his career in plastic surgery. Dr. Larrabee talked with WSMA Reports about his nonprofit organization, Global Surgical Outreach, which is providing volunteer-led cleft lip and palate surgeries to children in Africa and investing in infrastructure and training support.
</p>
<p>
<strong><em>WSMA Reports:</em> How did you first get involved with volunteer surgical work?</strong>
</p>
<p>
<em>Dr. Larrabee:</em> I went into medicine with the dream of working in global health. I chose Tulane Medical School because it had a strong school of public health and tropical medicine, and I graduated with an MD and a master's degree in epidemiology. After my internship in the U.S. Army at Letterman General Hospital in San Francisco, I was assigned as the director of civic action and public health for the Southern Command and was stationed in the Panama Canal Zone. A highlight was my work with the Kuna people of the San Blas Islands off the Caribbean coast of Panama. They were a small but charismatic group that lived off the Atlantic coast. Because of their size and culture, they married only amongst themselves and there were many babies with congenital deformities including cleft lips and palates. I was fortunate to encounter Daniel Gruver, a missionary who did surgery to repair these children's clefts. I immediately fell in love with plastic surgery and decided to become a surgeon.
</p>
<p>
After my surgical training I moved to Seattle and worked first at Virginia Mason Medical Center and later launched my own practice, The Larrabee Center for Facial Plastic Surgery. From the beginning, I participated in cleft missions to Latin America, Asia, and, later, Africa. I decided to start Global Surgical Outreach to provide not only surgery but needed education and infrastructure.
</p>
<p>
<strong>You went to Ethiopia in 2024; can you tell readers a little bit about that trip and the patients you served?</strong>
</p>
<p>
We have been to Ethiopia many times before. We love the country and its people. The surgeons there are excellent but lack certain equipment for more complex cases. In terms of clefts, they requested education in cleft lip noses specifically. On this mission we focused on treating cleft lip and palate patients who also needed nose repairs. I was fortunate to have Susan Kurian, MD, from the Larrabee Center along to assist me with operating and teaching. She did an excellent job. Cristal Flores from our surgical center also came to assist and teach her peers in Ethiopia.
</p>
<p>
<strong>Why did the organization decide to build a hospital in Accra, Ghana, and who will it serve?</strong>
</p>
<p>
We are working with Kofi Boahene, MD, from Johns Hopkins to support building a teaching hospital in Ghana. The basic concept is that we can more effectively train surgeons in Africa with an African center. The hospital will be partially staffed with volunteer plastic surgeons from around the globe. I hope to work there myself. We will also of course repair clefts and more for African children, but training the African surgeons can eventually help many more.
</p>
<p>
<strong>Is there an aspect of your volunteer missions that is particularly fulfilling for you?</strong>
</p>
<p>
There are so many, including the lifelong friendships you develop. By far the most fulfilling, however, is watching the faces of the parents when they first see their child after a cleft lip repair. It is truly magical to share their joy.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 10:55:13 AM | 11/19/2025 10:52:10 AM | 9/10/2025 12:00:00 AM |
| its-not-what-you-say-its-what-the-patient-hears | It's Not What You Say, It's What the Patient Hears | WSMA_Reports | Shared_Content/News/Latest_News/2025/its-not-what-you-say-its-what-the-patient-hears | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>It's Not What You Say, It's What the Patient Hears</h2>
<p>
From Physicians Insurance
</p>
<p>
Communication is a core clinical competency. Communication competencies are necessary to build and sustain relationships with our patients, enable patient engagement and to optimize patient adherence to treatment plans and recommendations. Communication is complex and often changing, therefore developing a general understanding of these core competencies can be applied in multiple situations.
</p>
<h3>Developing communication competencies </h3>
<p>
Once words are spoken you have no control over how those words are understood. This is particularly challenging in difficult conversations, when there is a natural reaction to become defensive. This means is that the physician or practitioner will have to be deliberate in setting aside defensive mannerisms by engaging in active listening, ensuring the patient is understanding, and using appropriate vocal elements.
</p>
<p>
Difficult conversations may be met with unintentional meaning and therefore engaging the patient through the following active listening techniques may foster empathy by demonstrating that you are reflecting on the patient's thoughts and feelings. The patient's thoughts and feelings are believed, supported, and respected, instead of diminished or challenged. The patient will remember how they felt during the conversation.
</p>
<ul>
<li><strong>Paraphrasing:</strong> Restate the information you received in your own words. For example, "You understood that the medication was going to take two weeks to fully work."</li>
<li><strong>Verbalize emotions: </strong>Reflect on the patient's feeling and emotions in words. For example, "This made you feel unsure that the treatment was working."</li>
<li><strong>Ask questions: </strong>For example, "How are you feeling today?"</li>
<li><strong>Summarizing: </strong>Restating the patient's ideas, including the feelings they expressed. "You are concerned the medication isn't working and your symptoms are making you feel uncomfortable."</li>
<li><strong>Clarifying:</strong> Ask questions to clarify vague statements or restate your interpretation to acquire further clarification. "Was this on the same day?"</li>
<li><strong>Encouraging:</strong> Give space for the patient to keep talking. For example, "This appointment is yours, so we can talk about whatever you'd like."</li>
<li><strong>Balancing:</strong> Help the patient evaluate their own feelings by asking questions. For example, "How does that make you feel?"</li>
</ul>
<p>
Patient understanding is a huge piece of communication. Medical jargon should be avoided or explained in lay terms. Your words should be simple so if there is a complex issue, consider using visual aids to help explain. Check in with your patients understanding by using frequent pauses and asking questions, especially if explaining a complex process. A patient repeating back their understanding of what you said can also identify areas of needed improvement in communication.
</p>
<p>
Vocal elements include pitch, inflection, tone, rhythm, tempo, and pronunciation. There are some types of conversations that can be emotional and can impact tone which may result in an unintended consequence where the patient deciphers the message differently than how it was intended to be conveyed. There are strategies that can be used to alleviate fear and facilitate the physician or practitioner's ability to authentically convey emotions such as caring, empathy, and sincerity. These strategies include engaging in deep breathing exercises picturing talking to a loved one about the incident and having appropriate eye contact.
</p>
<p>
Body language is equally important in communicating with your patients. Some elements of body language to consider your use of are:
</p>
<ul>
<li>Blank facial expression (not having an expression deters a physician's efforts to create rapport and empathy).</li>
<li>Crossing your arms or legs (can come across to patients as if you are closed off, uninterested).</li>
<li>Sitting versus standing (standing over the patient while they are seated can be seen as intimidating).</li>
</ul>
<h3>Navigating multigenerational communication</h3>
<p>
Physicians and patients span generations, and it is imperative that communication preferences are understood for barriers to be removed. While there is no formula for effective and successful multigenerational communication, improved multigenerational communication requires an understanding of what shaped the generation, generational values and communication preferences and expectations. The following are generally recognized characteristics of four generations:
</p>
<p>
<strong>Baby boomers (1945-1964)</strong> grew up and were shaped during dramatic social change. They relate to public recognition and respect titles. Their focus is on process.
</p>
<p>
<strong>Generation Xers (1964-1980)</strong> grew up and were shaped during political and institutional instability. They relate fairness and define themselves by their broader life responsibilities. They respect ideas more than titles. Their focus is on results.
</p>
<p>
<strong>Millennials (1980-2000)</strong> grew up and were shaped by technology and instant gratification. They relate to ways that they can make a difference. They respect skills more than titles or ideas. Their focus is on involvement. Millennials outnumber Boomers. They are high-touch and consumer-centric. They are confident, have high expectations and aspire to make a difference. They appreciate partnerships and open communication.
</p>
<p>
<strong>Generation Z (approximately 1995 - 2010)</strong> are digital natives. They grew up and were shaped by access to technology from a young age. They communicate via instant messaging, texts, and social media. Generation Z values ethics, individuality, and independence. Gen Z forgoes labels for self-expression. They are focused on health, the environment, and social justice. They make their decisions in analytical and pragmatic ways. They are the most ethnically and racially diverse.
</p>
<p>
Understanding intergenerational communication can be rewarding. Here are some ways to bridge the generation gap:
</p>
<ul>
<li><strong>Active listening: </strong>Utilize nonverbal body language to convey listening and understanding.</li>
<li><strong>Empathy:</strong> Try to understand the perspectives and experiences of the patient's generation.</li>
<li><strong>Clear language:</strong> Slang may not be understood by another generation. Using straightforward language that is clear and simple to understand by any age is best practice.</li>
<li><strong>Technology: </strong>Ask questions and learn your patient's threshold for technology and preferred use.</li>
<li><strong>Ask questions:</strong> Show interest and appreciation in your patient's experiences and opinions to reach a meaningful relationship.</li>
<li><strong>Seek training:</strong> Improve your skills in providing intergenerational care through training.</li>
</ul>
<h3>Sex and gender identity in communication</h3>
<p>
Historically, health care focused on a patient's sex, their biology. In today's world, the inclusion of a patient's gender, which reflects the psychological orientation of a person, matters. As this area grows, we encourage attention to be given to a patient's preferred gender when communicating. Adding this can benefit your patient's mental health as well as lead to positive patient outcomes. A patient can feel respected and "seen" or "heard" when you honor their preferred gender while treating their biological needs.
</p>
<h3>Incorporating cultural sensitivity</h3>
<p>
While a very complex area, the significant barriers related to cross- cultural communication can be patient safety risks and ethical matters. Culture includes traditions, customs, norms, beliefs, values, and thought patterns that are often passed down throughout generations. Incorporating cultural sensitivity into your medical practice allows you to better understand and meet your patient's clinical needs. This can aid in positive health outcomes and greater patient safety. A patient's culture can influence their attitudes and even willingness to disclose information or consent to a treatment. Being culturally sensitive can enhance your trust with patients. In case of a language barrier a medical interpreter should be offered and used and documented in the medical record.
</p>
<p>
Focusing on the below principles can help improve cultural sensitivity when communicating with your patients.
</p>
<ul>
<li>Recognize your own ethnocentrism (believing that the customs and practices of your culture are superior to those of other cultures).</li>
<li>Develop a higher tolerance for ambiguity.</li>
<li>Reduce the level of evaluation in your messages.</li>
<li>Prepare your message. The roles and rules of the patient's culture should drive the communication. Physicians and practitioners should prepare their message by adapting to the patient's culture.</li>
<li>Remove assumption. Do not assume that nonverbal communication such as eye contact, gestures, posturing, touch, and physical distance are common to all cultures.</li>
<li>Seek training and education on diversity, equity, and inclusion to improve skills in providing culturally competent care.</li>
</ul>
<p>
None of us are perfect at communication. Practicing with colleagues, friends, and family to strengthen our skillset and application is recommended. Being aware of our shortcomings in communication is half the battle.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/3/2025 12:23:24 PM | 9/3/2025 11:21:22 AM | 9/3/2025 12:00:00 AM |
| leveraging-trust-for-public-good | Leveraging Trust for Public Good | WSMA_Reports | Shared_Content/News/Latest_News/2025/leveraging-trust-for-public-good | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>Leveraging Trust for Public Good</h2>
<p>
By Rita Colorito
</p>
<p>
When a Longview city council member put forth a plan to remove fluoride from the town's water supply, Erin Harnish, MD, a longtime community pediatrician, sprung into action. The year-long advocacy campaign she led successfully defeated the plan (see p. 7 in the May/June 2025 <em>WSMA Reports</em> for more on the story). It's an example of how doctors can leverage the trust of their patients and community to ensure that public health initiatives remain based on medically and scientifically sound evidence.
</p>
<p>
Throughout Washington state, long-standing, evidence-based public health initiatives, such as fluoride in water or needle exchange programs, have come under attack in recent years. Dr. Harnish offers this step-by-step guide to push back and win:
</p>
<ul>
<li><strong>Stay informed.</strong> Dr. Harnish wouldn't have known about the plan to de-flouridate Longview's water if it wasn't for someone she knows who pays attention to city council meetings.
</li>
<li>
<strong>Build a coalition of community experts and concerned citizens.</strong> Dr. Harnish's coalition included working and retired dentists and pediatricians, teachers, parents and water treatment specialists. They quickly mobilized to send emails and letters to the community. They knocked door to door getting petition signatures. Some dentists didn't even know about the council's plan, says Dr. Harnish.</li>
<li><strong>Fill the room.</strong> Mobilize as many people as possible to attend public hearings. Dr. Harnish spoke to several community groups, like the Rotary, who were interested in the topic.</li>
<li><strong>Slow down the process.</strong>When speaking at the public portion of hearings, ask for time to study the topic. Dr. Harnish's coalition asked to convene a community workshop.</li>
<li><strong>Hold regular strategy meetings.</strong> Dr. Harnish's coalition held about five one-hour strategy sessions. They invited key experts to those meetings to discuss effective messaging, the timeline, opposition concerns, their strengths, and what information they still needed to know.</li>
<li><strong>Evaluate and address community concerns.</strong> The coalition's workshop included five expert speakers, each explaining a different part of the safety and health necessity of fluoride in water. They took a scientific approach to why removing fluoride would harm the community, especially children. It gathered evidence-based information and reviewed articles people were highlighting about their concerns. Speakers also had relevant studies at the ready to share.</li>
<li><strong>Focus on community health, not politics.</strong> Most people believe physicians have their family's health in mind. "We didn't take it as a political issue. We took it as a health issue, and I think that gave us the credibility to speak to it," says Dr. Harnish. People who lined up to speak and offer support asked council members to listen to the health experts.</li>
</ul>
<p>
<em><strong>Rita Colorito</strong> is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/3/2025 12:05:26 PM | 9/3/2025 11:21:29 AM | 9/3/2025 12:00:00 AM |
| truth-noise-and-nonsense-in-medicine | Truth, Noise, and Nonsense in Medicine | WSMA_Reports | Shared_Content/News/Latest_News/2025/truth-noise-and-nonsense-in-medicine | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>Truth, Noise, and Nonsense in Medicine</h2>
<p>
By Rita Colorito
</p>
<p>
Unqualified influencers, pseudoscience blogs, and posts with anecdotal cures: There's much dubious and downright dangerous health information online that can erode trust between patients and their physicians.
</p>
<p>
A 2024 report from The Lancet Digital Health underscores the danger, noting that overwhelming amounts of health information, increased social and political divisions, and poor health literacy has led to a sharp decline in public trust in physicians and hospitals from 72% in 2020 to 40% in 2024. Medical misinformation further exacerbates this decline in trust.
</p>
<h3>From problem to progress</h3>
<p>
While misinformation and disinformation have long existed, the proliferation of social media and the COVID-19 pandemic fueled the flames of fake health news. It's hard to quantify the universe of false information, but one study in Bulletin of the World Health Organization found the proportion of health-related misinformation on social media as high as nearly 29%.
</p>
<p>
Given an estimated 70% of adults use the internet to research health information, it's no wonder patients struggle to distinguish good from bad health information found online. This faulty "research" often makes its way to medical appointments, causing friction and frustration for patients and physicians alike.
</p>
<p>
There's hope here, though. Despite declining trust, research during the pandemic found people's personal physicians are still their number one most trusted source of information.
</p>
<p>
"One of the advantages that physicians have is the one-on-one context. You're already starting from a better place than a lot of public health communication campaigns that are just communicating into the void, out to millions of people," says Julia Minson, PhD, professor of public policy at the Harvard Kennedy School of Government. Her research focuses on the "psychology of disagreement" and scalable solutions for disagreement on hot-button topics like health decision-making.</p>
<p>Physicians, in turn, can feel pressure to
convert these sometimes confrontational
conversations into a collaborative
encounter, says John Wynn, MD, a
professor of clinical psychiatry at the
University of Washington School of
Medicine, a physician coach who often
cares for physicians facing mental health
challenges. “One of the reasons why
physicians get burned out dealing with
these patients is they feel like it’s their
job to overcome this misinformation and
convince this person to do the right thing.â€</p>
<p>
To keep the lines of communication open, it's better to view yourself as another source of information, says Dr. Wynn, instead of the "I'm-the-trained-expert" approach some physicians take. But how do you become the trusted source?
</p>
<h3>Steps to build or rebuild patient trust</h3>
<p>
Building or rebuilding trust when you don't see eye to eye can feel like a gargantuan task. Behavioral psychology, say Dr. Wynn and Dr. Minson, offers ways physicians and clinicians can engage patients with different beliefs to foster goodwill and good medicine.
</p>
<p>
Both nonverbal and verbal cues can affect patient trust and willingness to follow a care plan. Sitting down, making eye contact, and listening are the basic tenets of building patient trust, says Dr. Wynn.
</p>
<p>
"The best way to foster collaboration in any context-and by the way the best way to change people's minds-is to make sure they really feel like you're listening to them," says Dr. Wynn. But the listening part is where many physicians need help. He recommends these steps during patient interactions, but especially for potentially tense encounters:
</p>
<ul>
<li><strong>View all patient interaction as an effort at collaboration.</strong> "Say to yourself, whatever it is this patient's doing, no matter how confusing or frustrating it is, this is their effort to get through this. This is their way of joining the team," says Dr. Wynn.</li>
<li><strong>Give people time to speak.</strong> The average physician interrupts patients after 18 seconds. More surprising, the average patient will only talk for about 90 seconds if given the chance. While that can feel like a lifetime to physicians with crammed schedules, it's time worth taking. "There's social psychology research that goes back to at least the 1950s demonstrating that people are much more likely to listen to what you have to say, if, before you talk, they feel listened to," says Dr. Wynn. Time spent listening now saves time later in dealing with consequences of patients not following your clinical advice or pursuing dubious or dangerous alternative treatments.</li>
<li><strong>Ask questions about their research.</strong> Understand why the patient is investing trust in other resources. Questions to ask include: What's your sense of why this may help? How do you think this treatment might work? Why do you trust this source? Have you used it before and how did it help you?</li>
<li><strong>Speak so they'll understand.</strong> Avoid medical jargon and use metaphors to relay information. "One of the advantages of listening to the patient first is to understand their level of education and the type of language that's most likely to make sense to them," says Dr. Wynn.</li>
<li><strong>Praise their effort before offering your advice.&nbsp;</strong>Patients often complain that physicians sound dismissive or condescending of their online information. Instead acknowledge the work they did to learn about their health. Dr. Wynn suggests: "Wow, it looks like you've done a lot of research on this. I know you've got some strong ideas about this. Let me tell you how I see it and see what you think." Praising what they're already doing right, like getting regular sleep and exercise, also helps build rapport.</li>
<li><strong>Critique the information, not the source.&nbsp;</strong>Focus on the treatment that the resource is offering versus the one you understand as effective. Don't offer your opinion on the source unless asked. Even then, tread lightly. You might say: "I'm concerned that the person who might guide you in doing this is not well-trained. I don't know about their credentials; they don't make sense to me."</li>
<li><strong>Couch skepticism in humility.</strong> For example: "You know, I've read a lot about this problem, and I have not come across this explanation. I appreciate you telling me about it. It doesn't really make sense to me. Let me tell you how I think about it and then let's compare what you've read with what I've read."</li>
<li><strong>Steer them to credible online sources.</strong> Dr. Wynn suggests <a href="https://medlineplus.gov">MedlinePlus.gov</a> as a curated source for patients to do their own trustworthy medical research.</li>
</ul>
<h3>Engage minds: Now HEAR this</h3>
<p>
Resist the urge to correct patients, says Dr. Minson, which is a surefire way to end any conversation or hope of collaboration fast. "It's dangerous to get into persuasion land, where what you immediately want to do is change their mind," she says. "The worst-case scenario is when you fail to persuade and the patient feels like they can't talk to you anymore. Burning that bridge is really the biggest risk."
</p>
<p>
For confrontational interactions, Dr. Minson's research finds a technique called "conversational receptiveness" helps engage people with whom we disagree. The acronym HEAR describes the framework:
</p>
<ul>
<li><strong>H stands for hedging.&nbsp;</strong>In medicine, there's an exception for every rule-something social media is good at exploiting. Hedging helps address that. For example, instead of saying COVID-19 vaccines are safe and effective, you might say most physicians tend to believe that COVID-19 vaccines are largely safe and effective. "The point is still the same. But I make a little bit of space for your perspective," says Dr. Minson.</li>
<li><strong>E stands for empathizing agreement.&nbsp;</strong>You don't have to fake agreement with things on which you don't agree. Instead, find areas of common ground. For example, agreeing that you both want the patient and their family to be safe and healthy.</li>
<li><strong>A stands for acknowledgement.&nbsp;</strong>This step is one most physicians execute badly, especially when they're in a hurry, says Dr. Minson. "What people often do is something like, 'I hear that you've had a bad experience, but here's a reason why you should do this anyway.' That doesn't demonstrate that you really heard the person," says Dr. Minson. Acknowledgement reflects back what the patient tells you. For example: "I understand that a couple years ago, you had a vaccine that you thought gave you these side effects. You are really uncomfortable with the idea of getting vaccinated again because you had this experience."</li>
<li><strong>R stands for reframing the positive.&nbsp;</strong>Infuse your clinical advice with positive emotion and tone. Avoid contradictory or negative terms, such as no, can't, won't, or don't. For example, getting vaccinated helps prevent certain illnesses and make them less severe if you do get them. Not, if you don't get vaccinated you may get sick, hospitalized, or die.</li>
</ul>
<p>
"The key idea is that you're using language to communicate to your counterpart that you are truly engaged with their perspective," says Dr. Minson. "In the domain of COVID-19 vaccines, we found that following that framework does, in fact, make people trust you more, and does make them want to come back for your opinions on other topics again."
</p>
<h3>Embrace digital solutions</h3>
<p>
Speaking of credible sources, physicians may lament social media's hold on America's psyche. But social media can and should serve as a tool to disseminate legitimate health information. Some 65% of physicians already use some form of social media for professional purposes, according to a 2022 study published in The American Journal of Medicine.
</p>
<p>To help support physicians' online presence, in July, the WSMA broadened its <a href="https://wsma.org/your-care-is-at-our-core">Your Care Is at Our Core public awareness campaign</a> to include effective social media and public awareness health messaging. The goal is to help patients navigate health care information and bolster the evidence- based decision-making at the heart of the physician-patient relationship.</p>
<p>
"It is information that you can use directly to improve your quality of outreach," says WSMA President John Bramhall, MD, PhD. "It's information to help restore and maintain the confidence that people have when they go to see a doctor."
</p>
<h3>Make a human connection</h3>
<p>
While physicians' default mode is to present data and let patients make their own decisions, Dr. Minon's research also finds people view stories as being more trustworthy than evidence or data. Of course, personal stories are a large part of what draws people to social media influencers.
</p>
<p>
"To the extent that your goal is to get them to take a specific action, it's helpful to mix the science with personal experience," says Dr. Minson. That could include a personal or patient anecdote, such as your own bout with COVID-19, or a heart attack patient who had refused taking blood pressure medication and had another heart attack.
</p>
<p>
"It doesn't necessarily need to be scary, but it's helpful if it's a little bit vulnerable. Those stories tend to be more vivid than the data," says Dr. Minson. "As much as we want to rely on data, that's just not how humans are wired."
</p>
<h3>Redefine your end goal: replace correction with connection</h3>
<p>
Even with the best tips, one conversation is unlikely to change anyone's beliefs. Instead, focus on building a bridge to the next conversation and the long-term patient-physician relationship, say Dr. Minson and Dr. Wynn.
</p>
<p>
When you replace correction with connection, patients are more likely to come back. "Whatever it is you're talking about right now is one medical decision in a lifetime of medical decisions," says Dr. Minson. "The goal is, will this person come back and talk to me again? Not, can I make them do this specific action right now, or change a particular negative behavior?"
</p>
<p>
Building that human connection first can help steer patients through all the social media noise and nonsense, says Dr. Wynn. "Even the most troublesome patients offer us an opportunity to fulfill the role that is most important to us, the role of being a healer. Because of the interaction, because of the relationship you develop, that person's suffering stops … It's the privilege of being a doctor."
</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 September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/9/2025 11:23:01 AM | 9/3/2025 11:13:17 AM | 9/3/2025 12:00:00 AM |
| safeguarding-sexual-health | Safeguarding Sexual Health | WSMA_Reports | Shared_Content/News/Latest_News/2025/safeguarding-sexual-health | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/reports-julaug-2025-cover-645x425px.jpg" class="pull-right" alt="cover image from July-August 2025 issue of WSMA Reports" /></div>
<h5>July 22, 2025</h5>
<h2>Safeguarding Sexual Health</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
In March, the Washington state medical and research communities mourned the passing of University of Washington Distinguished Professor Emeritus King Holmes, MD, recognized worldwide as the "father of STI research." Dr. Holmes' foray into sexually transmitted infection care started in the 1960s, with his use of doxycycline as a post- exposure prophylaxis for gonorrhea that was spreading among U.S. sailors in the Pacific. Today, the Centers for Disease Control and Prevention and the World Health Organization both endorse doxy PEP for bacterial STI prevention. Dr. Holmes and his students also developed treatments and preventions for numerous STIs, including syphilis, chlamydia, trichomoniasis, human papillomaviruses, genital herpes, Mycoplasma genitalium, hepatitis B, and bacterial vaginosis.
</p>
<p>
A giant in the field of STI clinical treatment, research, and public health, Dr. Holmes helped build the world in which today's public health and sexual health leaders live, as the fight against STIs continues into a new era.
</p>
<p>
Like much of the country, Washington state remains in an STI epidemic and syndemic. Nationwide, there were over 2.4 million STIs reported in 2023-a 1.8% decrease overall from 2022, but a more than 37% increase since 2013. Washington State Department of Health data from 2023 shows 43,019 diagnosed and reported STIs-a nearly 43% increase since 2013.
</p>
<p>
While Washington state has overall STI rates lower than the national average, more can be done to safeguard the sexual health of Washingtonians, say experts, especially when it comes to syphilis. While both state chlamydia and gonorrhea cases decreased from 2022, overall syphilis cases increased about 1% (2024 data was not available at time of printing).
</p>
<p>
Though any STI can cause serious complications, syphilis during pregnancy can cause congenital syphilis, which can result in prematurity, stillbirth, neonatal death, and birth defects. Syphilis cases nationwide, including congenital syphilis, are up over 1,000% from 2013.
</p>
<p>
Washington ranks 13th in the nation for primary and secondary syphilis and 25th for congenital syphilis. In May 2022, the Department of Health and Public Health Seattle and King County issued a congenital syphilis warning letter and updated syphilis screening guidelines after 51 reported cases of congenital syphilis statewide, 11 of those in King County. In 2023, there were 57 cases.
</p>
<h3>Check your risk bias</h3>
<p>
STI prevention starts with checking bias on who is at risk, says Colin Fields, MD, quality program director for the HIV/PrEP program at Kaiser Permanente Capitol Hill Medical Center. "I particularly want to dispel the presumption that syphilis just occurs in urban men who have sex with men," he says. Over the last decade, rates of syphilis have risen sharply, including among cisgender women, men who have sex with women, and men who have sex with men, according to the Department of Health.
</p>
<p>
It's also not just a big city problem. "Syphilis is something that is a risk for any sexually active person in urban and rural settings," says Dr. Fields.
</p>
<p>
Yakima family physician Jennifer Maxwell, MD, says the federally qualified health center where she works has seen STI infections in people of all ages who are sexually active. "We're seeing infections regardless of patient risk factors. I can think of one case where the patient was married and in a monogamous relationship and their testing came back positive," she says. "We're also seeing later stages of these diseases and the complications of those diseases."
</p>
<p>
Women with a prior history of HIV, chlamydia, and gonorrhea are at an increased risk of getting syphilis. In pregnancy-capable people, syphilis cases in Washington increased by 17% from 2022 to 2023. Among pregnant people, cases increased by 9%. Over 77% of people diagnosed with primary and secondary syphilis lived in five counties: King, Pierce, Spokane, Yakima, and Clark.
</p>
<p>
Prevention of HIV-a risk factor for syphilis-also remains an issue, says Larry Corey, MD, past president and director of the Fred Hutchinson Cancer Research Center and co-principal investigator of the HIV Vaccine Trials Network. "Forty percent of people who have HIV, both in state and nationwide, don't self-identify as being at high risk," he says. "We need to seek them out to provide prevention therapy and teach them how to reduce their risk."
</p>
<h3>From policy to practice</h3>
<p>
To help curb syphilis and other STIs, the WSMA House of Delegates shared three new policies with the Department of Health and the state Health Care Authority. Dr. Fields, a member of the WSMA board of trustees, co-authored the policies. The WSMA:
</p>
<ul>
<li>Endorses universal screening for syphilis in pregnant persons during their first trimester, third trimester, and at the time of presentation for delivery. (This aligns with American College of Obstetrics and Gynecology recommendations.)</li>
<li>Supports legislation to modify state law requiring submission of test specimens for rapid plasma reagin confirmation at the state level, enabling commercial labs to conduct confirmatory testing and share results with public health agencies. "Right now, state confirmatory testing sometimes has quite a lag period," says Dr. Fields. "People who are sexually active may end up having partners from the time they have a syphilis test to the time they find out about the result. We just want to reduce that window of time to treatment."</li>
<li>Supports public health jurisdictions having appropriate access to health system electronic health records to ease result integration, reduce burden on physician reporting, and expedite efficient treatment of patients and their partners.</li>
</ul>
<h3>Let's talk about sex</h3>
<p>
Sexual health should be discussed and normalized during wellness visits, says Dr. Fields.
</p>
<p>
These conversations can feel awkward for physicians and patients alike, but they don't need to be. "It's putting yourself in the health care professional role, rather than feeling like you're having a personal discussion about sexuality," says Dr. Corey.
</p>
<p>
Before asking sexual health-related questions, Dr. Fields asks, "Can we talk about your sex life?" "I want patients to feel invited into the conversation," he says. "Most people are really happy to talk. They also view it as an important aspect of their health."
</p>
<p>
To "de-pathologize" sex, clinicians should keep an open mind when discussing patient sexual health, says Dr. Fields. Reiterate that you are not there to pass judgement but to protect them by offering screening and treatment, if needed. For those at potential risk, discussions should include preventive medications, such as PrEP for HIV and doxy PEP, and making sure patients are current on vaccines for HPV, hepatitis A and B, meningitis, and mpox.
</p>
<p>
With any sexually active patients, STIs should stay front of mind in differential diagnosis, says Dr. Fields. "If there are any symptoms that could be suggestive of an STI, it's important to continue asking questions about people's behavior," he says. "Syphilis is sort of tricky to diagnose sometimes because it can mimic other diseases. So, it's just good to rule it out as a possibility."
</p>
<p>
STI prevention should be everyone's concern, says Dr. Maxwell. "It doesn't always need to happen in a primary care setting."
</p>
<p>
When someone is diagnosed with STIs, it can feel overwhelming. "Most of the time it is a very hard conversation," says Dr. Maxwell, who takes extra time explaining how it affects their care now and in the future. "We always let them know that we are reporting the case to the Department of Health, so [it] can help with partner notification."
</p>
<h3>Access to testing and prevention</h3>
<p> Timely testing and treatment make a difference. Washington state's Sexual and Reproductive Health Network includes 95 clinics statewide, run by 14 different partner organizations, including some geared to teens, that provide STI testing and treatment. As a reminder, teens aged 14 to 17 do not need parental consent to screen for HIV and other STIs.</p>
<p>
Access to care, however, remains a challenge for many people at high risk of STIs, especially those who are unhoused or more transient, says Dr. Maxwell. "The main issue is the ongoing shortage of primary care doctors," she says. "Even if they do establish care [with a primary care doctor], there is not good point-of-care testing."
</p>
<p>
Because STIs are largely asymptomatic infections, the true scope of the problem is bigger than the data suggests, says Dr. Corey. "Sexually transmitted infections, as well as HIV, are underdiagnosed diseases. Genital herpes is very prevalent and terribly underdiagnosed and undertreated," he says.
</p>
<p>
All-site exposure testing is critical to get the right diagnosis, says Dr. Maxwell. "Oftentimes people only think about urine testing or vaginal testing, but gonorrhea and chlamydia can live in the throat, can live in the rectal area. It's important to test in all of those areas."
</p>
<p>
Some patients are also reluctant to get the testing they need, says Dr. Maxwell. Self-collection of samples is one solution. During the COVID-19 pandemic, Department of Health guidance said physicians and physician assistants could offer self-collection of non-blood specimens for chlamydia and gonorrhea testing. Evidence finds self-collection can increase STI testing. To help patients, clinics can request free printable self- testing visual aids from the University of Washington STD Prevention Training Center, available in 21 languages.
</p>
<p>
Dr. Maxwell encourages all clinicians to understand STI current best practices. "Testing is more updated and more sensitive. There are also newer, easier treatments for HIV and for hepatitis that are much more tolerable," she says.
</p>
<p>
In July 2024, the Department of Health urged clinicians to familiarize themselves with doxy PEP treatment guidelines and use it to prevent bacterial STIs. The medication needs to be taken as soon as possible within 72 hours after vaginal, oral, or anal sex.
</p>
<p>
A new law signed by Gov. Bob Ferguson, House Bill 1186, may help reduce time to treatment. It expands situations in which hospitals and health care entities can dispense or distribute certain prepackaged emergency medications, including anti-infectives and HIV postexposure prophylaxis drugs. This includes instances where community or hospital outpatient pharmacy services will not be available within 48 hours.
</p>
<h3>Safeguarding wraparound care</h3>
<p>
Safeguarding sexual health also means safeguarding other programs that help reduce STI risk-some that routinely come under scrutiny. Take Washington's Syringe Service Program. In 1988, Washington became the first state to have a needle exchange program to prevent blood-borne diseases, including STIs, HIV, and hepatitis. Since starting its exchange program in 1993, the Yakima Health District has served more than 3,000 people a year countywide.
</p>
<p>
Syringe service programs operate in 26 counties. Many provide other preventive care, such as naloxone, vaccinations, and mental health counseling. In recent years, several local jurisdictions, including the Yakima City Council last fall, have debated the need for these exchange programs, concerned with enabling drug use despite decades of research to the contrary.
</p>
<p>
State statute authorizes syringe service programs, so local jurisdictions can't ban them outright, but they can regulate them. The Grays Harbor County Council voted to end the county-run needle exchange program. A nonprofit came in to fill the gap. In April, Lewis County became the first Washington county to officially restrict syringe service programs, including mandating they not be located near residential zones or within 750 feet of schools, libraries, and public parks. Dr. Maxwell says she's thankful the Yakima City Council decided to keep its exchange program for now.
</p>
<p>
Snohomish County serves as a prime example of the importance of continued funding at the state level. For 14 years, the county lacked a free clinic, after budget cuts forced closure in 2009. In that time, the county's case rate of gonorrhea more than quadrupled.
</p>
<p>
In 2022, then-Gov. Jay Inslee approved funding for a new STI clinic in Snohomish County. Since opening in late 2023, the Snohomish County STI Clinic has ranked among the top five clinics in the county for diagnosing new cases of chlamydia, gonorrhea, and syphilis. What's more, syphilis cases diagnosed there were treated three days sooner than those diagnosed elsewhere.
</p>
<p>
For the 2025-2027 biennial budget, the STI Workgroup recommended $5 million in STI services funding. The Washington State Legislature approved a one-time fund of nearly $1.4 million for the Snohomish County Health Department for field-based syphilis treatment and to maintain its public health STI clinic.
</p>
<p>
Federal budgetary cuts also loom large in the fight against STIs. Progress on an HIV vaccine depends on whether the current level of National Institutes of Health funding continues, says Dr. Corey. Overall, NIH funding for STIs was $388 million in 2024. For HIV/AIDS it was nearly $3.3 billion. Washington state received $1.5 billion overall in NIH funding in 2024. "We pull way above our weight … It's a huge concern for us," says Dr. Corey.
</p>
<p>
The concern is both professional and personal. Dr. Corey's work in the HIV immunology space was cultivated under the tutelage of Dr. Holmes, who served as Dr. Corey's postdoctoral advisor. Together, the two men co-founded the UW Center for AIDS Research. "He single-handedly changed the field from venereology to sexually transmitted infections," says Dr. Corey.
</p>
<p>
Dr. Holmes' passion lives on in the work of his colleagues, as Dr. Corey encourages the medical community to explain the importance of NIH funding to all their patients. "Government funding for research needs to continue if we're going to develop new therapies," he says. "Miracles start in the lab."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/22/2025 10:32:27 AM | 7/22/2025 10:21:28 AM | 7/22/2025 12:00:00 AM |