| doctors-making-a-difference-abigail-plawman-md | Doctors Making a Difference: Abigail Plawman, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-abigail-plawman-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Doctors Making a Difference: Abigail Plowman, MD logo" src="/images/Newsletters/Reports/2023/january-february/dmd-website-image-plawman-645x425px.png" class="pull-right" /></div>
<h5>January 24, 2023</h5>
<h2>Doctors Making a Difference: Abigail Plawman, MD</h2>
<p>
Abigail Plawman, MD, an addiction medicine fellowship director at MultiCare's East Pierce Family Medicine Residency program, is working to bring the many facets of substance use disorder treatment and obstetric care together. Part of the Substance Treatment and Recovery Training program, the inpatient START unit at Good Samaritan Hospital in Puyallup opened this July and is providing much- needed care to a uniquely underserved population. Dr. Plawman talks about the efforts behind opening the new unit.
</p>
<p>
<strong><em>WSMA Reports:</em> Tell our readers about the START program and unit.</strong>
</p>
<p>
<em>Dr. Plawman:</em> The START program has two parts: a hospital unit and an outpatient clinic. The START Clinic is a walk-in multidisciplinary clinic based at the East Pierce Family Medicine Residency, where pregnant people can seek prenatal care, medication management for substance use disorders, social work support, and referral to community programs. The START Unit is an 18-bed voluntary treatment program at Good Samaritan Hospital where pregnant people of any gestational age can obtain medical stabilization of their use disorder or withdrawal, group treatment with trained counselors, education around both obstetrics and substance use disorder recovery, obstetric care including delivery if indicated, and connection to community resources after discharge.
</p>
<p>
<strong>Where did the idea come from for the unit at Good Samaritan?</strong>
</p>
<p>
In 2014, I had a pregnant woman come to my office with a printout of her medical records in her hand. She had been doing exceptionally well in sustained recovery on Suboxone for five years, and after revealing her pregnancy to her physician she had been abruptly cut off from that practice due to the physician's discomfort with treating pregnant women. Around the same time, another pregnant woman I was treating had been turned away from obstetric care when she revealed that she was in treatment at a methadone program. Both women were doing everything in their power to stay healthy and care for their pregnancies, and the medical system was not capable of meeting their needs.
</p>
<p>
I approached the East Pierce Family Medicine Residency with the goal of partnering to serve this unique population, and the program enthusiastically embraced providing these essential services. The walk-in clinic opened thereafter, and the groundwork was started to create the inpatient hospital program at Good Samaritan.
</p>
<p>
<strong>What kind of response have you gotten from patients? </strong>
</p>
<p>
The demand for our services was instantaneous. By far, the most common reason pregnant people seek care from us is difficulty stopping fentanyl use and challenges getting onto appropriate medication in the outpatient setting. More than half of our participants are also seeking help to stop using methamphetamine and have struggled to obtain consistent prenatal care.
</p>
<p>
We have received heartwarming feedback from many patients, including one woman requesting to bring her baby back to visit us because she is doing so well! I am grateful that we have already had more than one client referred to us from another prior participant-I consider this type of referral among the most powerful ways we receive feedback. Treatment is challenging, and it takes a lot of bravery to seek care during pregnancy, so we are all in awe of how hard our clients work to make changes in their lives.
</p>
<p>
<strong>Have any aspects of running the unit surprised you in good or bad ways? </strong>
</p>
<p>
Seeking recovery in pregnancy involves systems of care that historically have operated within their own silos: behavioral health, substance use treatment programs, obstetric care, pediatric and newborn care, and even primary care. It has been both delightful and challenging to balance the needs of these different programs
and departments in bringing together the right resources for our clients. We learned quickly, for example, that we needed to be aware of our neonatal intensive care census in the hospital as part of planning for high- risk treatment admissions to be prepared for unexpected needs from other services if an abrupt delivery was to take place.
</p>
<p>
<strong>What has been the biggest challenge in getting the unit up and running?</strong>
</p>
<p> One, of course, is financial and staff shortages-no surprise to anyone working in health care today. The other challenge has been straddling multiple regulatory and care domains in everything from certification to care delivery to staffing. Continuously balancing the urgency of pregnancy with the need to provide not only medical but also psychiatric and social support makes me profoundly grateful for the compassionate and skilled team we have assembled.</p>
<p>
<em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/25/2023 3:16:14 PM | 1/25/2023 3:15:41 PM | 1/24/2023 12:00:00 AM |
| member-profile-michael-mike-brigoli-md | Member Profile: Michael 'Mike' Brigoli, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/member-profile-michael-mike-brigoli-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/january-february/member-profile-website-image-brigoli-645x425px.png" class="pull-right" alt="Mike Brigoli, MD photo" /></div>
<h5>January 6, 2023</h5>
<h2>Member Profile: Michael 'Mike' Brigoli, MD</h2>
<p>
<strong>Works at:</strong> University of Washington Palliative Medicine
</p>
<p>
<strong>How long in practice: </strong>Since July 2022
</p>
<p>
<strong>Specialty:</strong> Hospice and palliative medicine fellow
</p>
<p>
<strong>Why WSMA:</strong> The WSMA represents the opportunity to have a voice. Before becoming a physician, I was an Army medic and a firefighter and paramedic. As a first responder, I saw heartbreaking situations due to lack of access to care and lack of resources. The WSMA enables me to advocate for policies that make a difference for the most vulnerable members of our community.
</p>
<p>
<strong>Proud moment in medicine:</strong> I come from humble beginnings, having spent part of my childhood homeless and in foster care. I am the oldest of 11 children in a blended family. I went to 12 different public schools from kindergarten to high school. I am from Hawaii, where indigenous Hawaiians make up 24% of the population, but only 4% of the physician workforce. As a native Hawaiian, I didn't think I could be successful with higher education. That is why getting into medical school at the age of 40 was an important milestone for me and my family. To do so, I left a career as a firefighter and paramedic. I didn't even have an undergraduate degree. Heading back to school meant the pressure of being a single-income family fell on my wife. I felt like matriculating meant her sacrifice was paying off and, even though it would take a while, there was light at the end of the tunnel.
</p>
<p>
<strong>Top concerns in medicine: </strong>According to a pre-pandemic study from the Association of American Medical Colleges, we are facing a severe shortage of physicians across the country, as much as 124,000 by 2034. I worry that the pandemic has worsened those numbers exponentially. While medical school enrollment is up, our GME positions have been limited by federal budget legislation. It is time for a change.
</p>
<p>
I am intimately familiar with the consequences of a physician shortage. My home in Hawaii had a physician deficit of 30% compared to what was needed to care for the community. As a result, the local emergency departments became much busier and so did our EMS agencies. When I picked up patients by ambulance, I would ask who their primary care physician was. They would give me the name of an emergency department physician. I would clarify by asking who wrote their prescriptions for their chronic conditions. Their answer did not change.
</p>
<p>
The conditions that I saw then are getting worse. The most vulnerable in our communities will suffer the worst as a result.
</p>
<p>
<strong>What inspires me in medicine:</strong> While we have made tremendous strides in our ability to provide medical interventions in the lives of our patients, I am inspired by the little things that the physicians around me do to make the lives of their patients better: The call to family at the end of the day to update them regarding a patient's condition; holding a patient's hand during a difficult conversation; taking extra time to ensure that all the patient's questions are answered and explained in a way that they understand. These acts of kindness are often done despite the pressure of having to see a full panel of patients, attend scheduled faculty meetings, and participate in teaching sessions for learners.
</p>
<p>
<strong>Challenges to our profession: </strong>I am concerned that we have a public confidence issue. We have gone from a respect for the education and training that are required to practice medicine to a "I've done my own research" culture. I think there has been an erosion of trust for physicians and that will continue to be a challenge in the care of our patients.
</p>
<p>
<strong>Why I wanted to become a physician: </strong>While working as a firefighter and paramedic, my district was so busy that in a 24-hour shift I would often be on the road for more than 14 hours. One day while taking a basic life support call, another 911 call came in for chest pain from my uncle's address. Since I was already on a call, the ambulance from the next town was dispatched, an additional 15-minute response time. My uncle had a myocardial infarction that day and did not survive.
</p>
<p>
Because of our community's physician shortage, our emergency department was busier, and emergency medical services were inundated with patients who felt that ambulance transport might expedite their care in the ED. It was not a good situation.
</p>
<p>
I often would visit high school health career pathway classes to discuss how I became a paramedic. While there, I would ask how many of them wanted to become physicians; knowing the need was severe. There were times that, in a class of 60 high school students who self-identified as wanting to pursue a health career, none would raise their hands.
</p>
<p>
I began to feel guilty about asking teenagers to make a sacrifice that I had not made. I also felt challenged by not being able to help them achieve the goal of becoming a physician. That's when I realized that I had a passion to pursue medicine myself. That my passion was greater than the fear of leaving the fire department or the fear of not being smart enough to accomplish my goal. I didn't know any physicians who were former foster children and knew very little who were Native Hawaiian. What I did know, however, was the consequence of a physician shortage and that I wanted to be a part of the solution for my community.
</p>
<p>
<strong>Why my specialty:</strong> My life experience with childhood homelessness, foster care, service in the Army, and time as a firefighter and paramedic allows me to understand how patients with serious life-limiting illnesses may feel they don't have many options for care. I love being able to explore who they are. Sometimes this leads to a revelation for patients about goals for their life. Based on these conversations, some patients opt not to limit the scope of their care and continue with aggressive care for the hope of a longer life. Others may opt to pursue comfort and time at home with their family, even if it means a shorter life. In either situation, the decision is made based on the values and life experience of the patient.
</p>
<p>
I also spent two decades taking patients to the hospital, seeing the ravages of acute injury, and exacerbations of chronic illnesses. I love the opportunity to give patients the option and opportunity to avoid ED visits and hospital admissions.
</p>
<p>
We are a specialty of "wonder." I wonder if there is more we can do to manage a patient's symptoms. I wonder what is most important for the patient and their family in light of their illness. I wonder what they are hoping for; what they are worried or concerned about. I sit in wonder of the amazing life stories that I get to hear about in the process of exploring the patient's narrative.
</p>
<p>
<strong>If I weren't a doctor, I'd be: </strong>A firefighter and paramedic. It was amazing to be on the front lines for any major incident in a community. You meet people where they live and help them with what may be the worst day of their life. It was incredible to go from a motor vehicle accident directly to an out-of-hospital baby delivery.
</p>
<p>
<strong>Top three leadership lessons: </strong>
</p>
<ol>
<li>Get to know your team. There are so many opportunities for miscommunication that can cause friction between team members. Learning about who they are helps us to see their perspectives.</li>
<li>Surround yourself with people who are good at what they do, then let them do it.</li>
<li>Start by sharing the objective or mission and see what ideas the team has on how to accomplish it. This can be the best way to find solutions that we haven't thought about before.</li>
</ol>
<p>
<strong>Best advice I ever got: </strong>
The best advice I ever got was to find an activity that refreshed me and do that as often as life would allow. Something that I could do for hours on end with more energy than when I started. For me this was coaching my sons' club soccer team. This allowed me to spend time with my family and serve my community. We did travel tournaments and combined that with educational experiences. My oldest son eventually ended up attending a college that we toured while at an out-of-state tournament.
</p>
<p>
Following this advice made interviews for residency, fellowship, and physician jobs so much easier, as well. It was simple to answer the "tell me about yourself" question. I knew what gave me energy and could talk about my family and community at length. It gave me a chance to show what I could do when motivated by something I was passionate about.
</p>
<p>
The biggest benefit was that I knew what activities filled me and could schedule that activity when times get tough. My sons are older now and no longer play club soccer. I know that time with them and my wife fills me, though, and we make time to get together and do activities as much as we can.
</p>
<p>
<strong>Spare time: </strong>My wife and I love to drive around the state and visit new locations. It's all about the food and scenery of the Pacific Northwest. We will sometimes pull up the reviews of restaurants, bakeries, or coffee shops for a town and plan a trip for the day. It's a great way to explore our new home.
</p>
<p>
<strong>Hobbies:</strong> I love running and biking. I have done 10 marathons, three half-marathons, and a half Ironman triathlon. I have learned a lot about the ability to persevere toward a goal during my training and in races. No two races are the same and each offers its own challenges.
</p>
<p>
<strong>Three goals for the year ahead:</strong>
</p>
<ol>
<li>Find a post-fellowship job in palliative medicine.</li>
<li>Spend as much of my free time as possible showing my appreciation to my family for the sacrifices they have made for this journey we are on.</li>
<li>Schedule and complete another half-marathon.</li>
</ol>
<p>
<strong>Something most people might not know about me:</strong> I attended and graduated from medical school with the son of a high school classmate. I am literally old enough to be the parent of my medical school classmates. It was during our orientation that I recognized my classmate's last name. We began talking and eventually I found out that his father graduated from the same high school I did.
</p>
<p>
<strong>Pet peeves:</strong> Palliative medicine is not a destination. We are a specialty involved in the care of any patient with a serious life-limiting illness. I have often heard, "I don't think the patient is ready to be palliative." If they have a complex symptom management issue, could benefit from a goals-of-care discussion to align the multiple care teams with their goal, or have limited options for their care, we are here to help. For example, I wouldn't say "I don't think the patient is ready to be nephrology or cardiology."
</p>
<p>
<strong>Recommended reading:</strong> "When Breath Becomes Air," by Paul Kalanithi. I have read and go back to passages in this book frequently because it helps me to remember the vulnerability we have in life as physicians and providers. Paul does an amazing job sharing his story.
</p>
<p>
<em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/12/2023 4:44:10 PM | 1/6/2023 3:39:51 PM | 1/6/2023 12:00:00 AM |
| a-tale-of-two-ceos | A Tale of Two CEOs | WSMA_Reports | Shared_Content/News/Latest_News/2022/a-tale-of-two-ceos | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/november-december/nov-dec-2022-reports-cover-645x425px.jpeg" class="pull-right" alt="cover illustration for WSMA Reports November/December 2022" /></div>
<h5>November 17, 2022</h5>
<h2>A Tale of Two CEOs</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
As one of the country's leading integrated health systems, UW Medicine stands at the nexus of medical research, clinical care, teaching, and community service in Washington state and the Pacific Northwest. The UW Medicine footprint in the region is broad and deep, incorporating the University of Washington School of Medicine, the five-state WWAMI physician training program, clinically integrated components such as UW Physicians, UW Medical Center, Harborview Medical Center, and Fred Hutchison Cancer Center, to name a few, and an extensive list of affiliations and partnerships.
</p>
<p>
This year, Paul Ramsey, MD, stepped down as the CEO of UW Medicine after 25 years of leading the health system giant, passing the mantle to UW Medicine Chief Medical Officer Tim Dellit, MD, who stepped up to serve as interim CEO for two years. As a tremendous legacy and responsibility is passed from one experienced leader to another, the two physicians sat with WSMA Reports to share their thoughts and some wisdom with our readers.
</p>
<p>
For a quarter of a century, Paul Ramsey, MD, had the ideal seat to observe the rapid changes in medicine. As CEO of UW Medicine and dean of the University of Washington School of Medicine, both in Seattle, Dr. Ramsey was able not just to watch how the profession was changing in Washington and nationally but also to help shape those changes.
</p>
<p>
During his tenure, UW Medicine emerged as a powerhouse in medical research, earning about $1 billion in federal research grant funding in 2020, the second highest of any medical school in the nation. At the same time, its clinical practice grew. In 2010, UW Medicine had 18,300 employees; by the time of Dr. Ramsey's retirement in 2022, that number had grown by 10,000. The combination allowed UW a unique opportunity to advance research to clinical applications that few other systems could rival.
</p>
<p>
Yet, at this stage of his career, Dr. Ramsey prefers to focus on the future, not reflect upon the past.
</p>
<p>
"I'd rather look forward at this point than look back," he says. "When one retires, the tendency is to look back, but I think we are at a really critical point in the history of medicine. We have substantial challenges, but we also have the most important opportunities in the history of medicine in my 50-year career."
</p>
<p>
Dr. Ramsey lists three opportunities that the Washington physician community can take advantage of in the coming years. One is to advance health care equity.
</p>
<p>
"We've recognized for many years the need to make progress with health care equity," Dr. Ramsey says. "Now that we have the ability to measure care and outcomes of care, we can develop specific solutions while advancing health care equity overall."
</p>
<p>
The second opportunity that Dr. Ramsey cites builds on advances that he has seen accelerate over his career. "I don't think anyone would disagree that research in medicine is at its best, more so than at any time in history," he says. "The technology, including computational technology, is moving faster than ever before. During the pandemic, we showed that we can accelerate that directly to clinical care. No one would have predicted that we would have had fundamental changes so quickly."
</p>
<p>
While the introduction of mRNA vaccines is one example of the huge leaps in medical research, it is hardly the only one. Dr. Ramsey notes that cancer research has also been accelerating the pace of treatment. "There are basically opportunities all over medicine to take advantage of these truly extraordinary breakthroughs in basic science and apply those to treatment and prevention," he says.
</p>
<p>
Finally, there are the opportunities happening due to the rapid changes in care delivery, also spurred by technological advances. While the COVID-19 pandemic opened the profession's eyes to the widespread utility of telemedicine, that's not the only improvement in the delivery of care that holds promise.
</p>
<p>
"It's also using the functionality of electronic health records and electronic connections to improve care by providing more accessible care at a more affordable price and at a more convenient location," says Dr. Ramsey. "I'm optimistic about what digital health can mean going forward."
</p>
<p>
Dr. Ramsey doesn't downplay the challenges that the profession faces. "The challenges are very real, and the challenges are among the most significant that I've seen in my career." He lists the rapidity with which change is happening, physician burnout, the ongoing toll from the pandemic, and the financial burdens facing systems and physicians.
</p>
<p>
Yet even in the face of these challenges, Dr. Ramsey is convinced that Washington state, and especially UW Medicine, will be able to capitalize on the advances that he has described.
</p>
<p>
"I believe that UW Medicine is extremely well-positioned to lead with taking advantage of the opportunities, and I believe that the state is in that position," he says. "We have been building to these opportunities for a number of years." He notes that more than 20 years ago, the board of UW Medicine developed a single mission to improve the health of all people, setting it on a path to become one the nation's leading integrated clinical, research, and learning health systems.
</p>
<p>
As for Dr. Ramsey, if he had it to do over again, he just wishes he could be doing it now. "The bottom line for me is that this is such a time for opportunity and exciting change that I wish I was starting over again."
</p>
<p>
In his recent roles as chief medical officer at UW Medicine and president of UW Physicians, Tim Dellit, MD, was well acquainted with the problem of the health care worker shortage. Physician burnout, nursing shortages, and difficulties in filling positions, compounded by the need for greater workforce diversity, had been part and parcel of medicine for some timeonly to be exacerbated by the COVID-19 pandemic.
</p>
<p>
"It's a period of time within our state and nationally of significant staffing challenges not just of physicians, but nursing and other members of the health care team," says Dr. Dellit. "Hospitals and physician practices are experiencing significant financial challenges and rising labor costs."
</p>
<p>
Now, as the interim CEO of UW Medicine after taking the reins from Paul Ramsey, MD, Dr. Dellit will have the opportunity to work even more closely to address the vexing problems facing the physician workforce and the pathways to the profession.
</p>
<p>
Fortunately, UW Medicine has a unique vehicle for addressing physician training. Roughly 50 years ago, the University of Washington School of Medicine formed a multi-state medical education program with Washington, Alaska, Montana, and Idaho (Wyoming would join in 1996). The program, known by its acronym WWAMI, offers a communitybased medical education program.
</p>
<p>
"The primary goal is to increase access to care in rural and underserved regions and increase the physician workforce, especially primary care physicians, in each of those states," says Dr. Dellit. "If students are trained locally through community-based education, they are more likely to practice locally and be part of that community. That is very unique compared to any other medical school in the country."
</p>
<p>
WWAMI has been successful in helping fill the shortage of physicians in rural areas. "Practicing in a rural environment can be very different," Dr. Dellit acknowledges. "This is an opportunity for our students to have a number of tracks that give them an immersion experience to understand the practice of medicine in those environments and build relationships with the local community."
</p>
<p>
The program also allows residents to receive training in underserved areas, including through partnerships with local health care systems, again with the hope that they will remain to practice there once they complete their residency.</p>
<p>One measure of the value of the program in meeting a workforce need is the number of students who choose primary care: more than 50%. "That's a testimony to the focus we put on primary care and the relationships students develop with the local communities," says Dr. Dellit.</p>
<p>
Dr. Dellit says that WWAMI is constantly reviewing how it can address the changes that are occurring in each of the states it serves.</p>
<p>"We partner with the organizations within each of the states to look at the ways to meet the needs of the local community," he says. "As the health care landscape in each of those states evolve, we continue to look at how to meet the needs."</p>
<p>
For example, increasing needs in some states have led to discussions about increasing the class size at some WWAMI sites. Dr. Dellit stresses that any changes are done in partnership with local state organizations and are dependent on having enough clinical training sites for the students to meet the accreditation standards.
</p>
<p>
"This isn't something that we can do alone," he says. "We work in partnership with the local institutions, medical associations, and physicians to support what is best for each state."
</p>
<p>
Dr. Dellit is also grateful for the preceptors, including WSMA members, who participate in the program. "We appreciate all the individuals who have been willing to supervise and support students across the state," he says. "We can't do it alone. We rely upon our physician preceptors across the WWAMI region."
</p>
<p>
Yet Dr. Dellit also recognizes that increasing medical training and professional pathways to meet workforce needs is a long-term project and that WWAMI alone can't solve these challenges without strong partnerships.
</p>
<p>
"One of the unfortunate impacts of the pandemic is that some health care systems have decreased their ability to train students given the current financial challenges," he says. "How do hospitals continue their mission and support training the next generation of professionals? That's going to be an issue that will need to be addressed right now."
</p>
<p>
Still, WWAMI at least provides hope in a challenging environment.
</p>
<p>
"The positive is that we continue to see broad community support for the partnership in each of our training sites," Dr. Dellit says. "We're always learning about the unique needs of each of the different locations across the Northwest and working in partnership to address them. Despite the challenges we're facing, we are working collectively to decrease health care inequities, increase the workforce, and make sure the workforce reflects the community that it serves."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/17/2022 3:16:27 PM | 11/17/2022 3:15:40 PM | 11/17/2022 12:00:00 AM |
| solving-the-workforce-puzzle | Solving the Workforce Puzzle | WSMA_Reports | Shared_Content/News/Latest_News/2022/solving-the-workforce-puzzle | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="cover illustration for WSMA Reports November/December 2022" src="/images/Newsletters/Reports/2022/november-december/nov-dec-2022-reports-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>November 17, 2022</h5>
<h2>Solving the Workforce Puzzle</h2>
<p>
By Garrett Jeffery, DO
</p>
<p>
The patient had suffered a setback toward the beginning of the COVID-19 pandemic. Then, to my dismay, the setback became a full-blown acute crisis as the pandemic wore on. What made this case particularly vexing for me was that, for this patient, my medical training was useless. The patient was my clinic.
</p>
<p>
That acute crisis was the departure of 13 of our 20 total physician and clinician positions across two primary care clinics over the course of three years. Exit interviews highlighted many different motivations, such as lateral moves to outside organizations, semi-retirement, career advancements, etc.
</p>
<p>
We have been anticipating physician shortages in the U.S. for decades. The global pandemic and the great many additional stressors facing our populace were understandably not a part of those initial forecasts. Yet, the resulting "great resignation" and all the supposed factors contributing to the phenomenon have not spared our health care sector.
</p>
<p>
My clinics are not unique to this seeming trend in resignations across Washington. Responses to address the widening gaps in workforce have been varied. One strategy explored locally was to begin partnering with local technical colleges. Unfortunately, they have experienced a decline in applicants that has resulted in vacancies in their training programs for medical assistants. Without identifying and addressing the driving factors for these shortages, we may be in for a long struggle.
</p>
<p>
Temporary hires are not the answer. The dramatic escalation of the costs for obtaining nursing staff would be difficult to imagine a decade ago and it is telling of the situation we are in. This is not a sustainable model. This catabolic state, so to speak, of our finite health care dollars cannot support our state's long-term need for nurses, medical assistants, behavioral health professionals, and other technical staff.
</p>
<p>
We have seen legislation such as Senate Bill 5751 and House Bill 1868 advanced earlier this year in an effort by unions to advocate for workforce shortages. These short-sighted proposals would directly reduce access when it is needed most and do nothing to address what is needed most: increased training opportunities to increase the number of graduates.
</p>
<p>
While a good portion of graduates from Washington's three medial schools are retained at local training sites, opportunity exists to expand the number of training sites. Opportunity also exists to retain physicians after completion of residency and fellowship training.
</p>
<p>
How does Washington state further establish itself as the destination to practice medicine? Ideas abound, including investment in postgraduate education, tort reform, and reducing prior authorization burden on practicing clinicians. Student loan reimbursement may be an important deciding factor for these new graduates. Investing in loan repayment programs in Washington state would expand the practice options for this cohort.
</p>
<p>
To address the staffing crisis at my clinic, I stepped into the role of section chief of the two clinics. We hired new management staff with an emphasis on promoting a supportive culture to improve physician and caregiver engagement. With recruiting incentives and an apprenticeship program, our staffing levels and retention have improved, yet we continue to feel the attrition and lag time for new applicants.
</p>
<p>
If we compare this to a quality improvement initiative, then we need to better understand the key drivers before we can develop our interventions. This may include funding a study of resigned staff and physicians to learn what impacts their decisions. In the interim, we will need to rely on prioritizing legislation to broadly invest in a highly educated and trained physician and health professional workforce to facilitate the delivery of high-quality and efficient care for all our communities-i.e., more time spent caring for patients, and less time on our ailing practices.
</p>
<p>
<em>Garrett Jeffery, DO, FAAFP, is section chief of PeaceHealth Medical Group Family Medicine, NW Network.</em>
</p>
<p>
<em>This article was featured in the November/December 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/17/2022 3:14:25 PM | 11/17/2022 3:11:59 PM | 11/17/2022 12:00:00 AM |
| member-profile-tamara-tammie-chang-md | Member Profile: Tamara 'Tammie' Chang, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/member-profile-tamara-tammie-chang-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/november-december/member-profile-website-image-chang-645x425px.png" class="pull-right" alt="Member Profile: Tamara Chang, MD graphic" /></div>
<h5>November 8, 2022</h5>
<h2>Member Profile: Tamara 'Tammie' Chang, MD</h2>
<p>
<strong>Works at:</strong> Mary Bridge Children's Hospital and MultiCare Health System
</p>
<p>
<strong>How long in practice: </strong>10 years
</p>
<p>
<strong>Specialty:</strong> Pediatric hematology oncology
</p>
<p>
<strong>Why WSMA: </strong>I didn't discover the WSMA until my boss and I were invited to present our MultiCare physician and advanced practitioner wellness work at the WSMA Leadership Development Conference at Lake Chelan in May. Right away, I could sense that these were my people: Physicians who care deeply about our profession, about our communities, about advocating not only for the health of the people we serve, but also for the well-being of physicians as a medical profession.
</p>
<p>
<strong>Proud moment in medicine:</strong> What drives me today came out of the darkest time in my life and career, only three years ago. I was severely burned out, severely depressed and suicidal, and nearly tried to drive my car off a cliff coming home from work after a long and difficult end-of-life discussion with a young patient's family. That moment-while not my proudest in medicine-became the catalyst for everything I do and who I am today. It propelled me into a life of service and vulnerability, dedicated to transforming the culture of medicine and improving the well-being of my fellow physicians. I'm committed to changing the stigma of mental illness and our silent struggle in medicine, and to improving the practice of medicine for my peers, colleagues, and future generations of people in medicine. I am especially driven to improve the practice of medicine for women, who disproportionately experience burnout and depression and are quitting medicine at record rates.
</p>
<p>
<strong>Top concerns in medicine:</strong> I am worried about the longevity and the future of our medical profession. Health care has changed so dramatically over the last 30 years and continues to change rapidly. We are experiencing the highest rates of burnout, mental illness and distress among physicians and health care workers in history. I believe we are at a tipping point in U.S. health care today. The issues of burnout and mental illness have existed for physicians for decades, but I believe that one silver lining of the pandemic was that it exacerbated these issues and brought them front and center. The worker shortages and financial crises we are experiencing universally in health care will force change to happen. I am hopeful that this will create a change that that enables a practice and delivery of medicine that will be in the greatest service of the well-being of our patients and those caring for patients.
</p>
<p>
<strong>What inspires me about being in medicine:</strong> Nowhere else have I been surrounded by such dedicated, giving, and compassionate human beings. Our work is humbling, and when I have a chance to sit down and talk with colleagues about what it is that inspires them about being in medicine, a common theme emerges: We are driven-almost without exception-by a calling to serve others, our communities, and each other. I continue to care for pediatric hematology oncology patients half-time, while I dedicate the rest of my time to serving in my roles as the medical director of the wellness program for MultiCare, co-founder of Pink Coat, MD, founder and director of the American Medical Women's Association's ELEVATE Leadership Development Program, working with physicians as a leadership coach, writing books, creating podcasts, and speaking-because I care so deeply about my colleagues, my friends, my peers, and our profession.
</p>
<p>
<strong>Why my specialty:</strong> Many of us have pivotal moments during our education when it becomes clear what we must do. Discovering pediatric hematology/oncology was just that for me. As a fourth-year medical student, I thought I wanted to become an adult oncologist. I remember the moment when it sunk in for me that, yes, pediatric hematology/oncology was what I had to do. It was an encounter with a kind and giving pediatric neuro-oncologist at Brown University, where I went to medical school. I still remember the conversation as we sat in a hospital room with a young mother holding her baby girl who had a brain tumor. There was something precious and spiritual about that moment. I will never forget the compassion of the physician, or the preciousness of that encounter. I live for moments like these. I know that I am at my best as a physician, and as a human being, when I am with parents and their children, having some of the most difficult discussions and navigating the scariest times of lives. I live to create a safe, compassionate space for others.
</p>
<p>
<strong>If I weren't a doctor, I'd be:</strong> As a kid and teenager, I thought I wanted to become a pianist. I still deeply love music, the creativity and expression through music that is not possible through words. So, maybe I'd be a pianist. I'd only play Rachmaninoff, Brahms, Busoni, Chopin, and Beethoven. And maybe I'd also be a writer.
</p>
<p>
<strong>Spare time: </strong>The happiest moments in my day are when I'm with my husband, Matthew, and our two golden retrievers, Gus and Toby, hiking outdoors. We also have a cat, Mimi, who loves to cuddle up by us on the couch.
</p>
<p>
<strong>My three goals for the year ahead:</strong> A personal goal has been to give a TEDx talk to raise public awareness and provide solutions for the silent struggle of women doctors. That goal came true in November. Goals for the year ahead? To create a large-scale documentary on the silent struggle of women doctors, to continue to live in alignment and integrity with my "why" and my purpose of transforming the culture of medicine for all of us, and to remain true to taking the long view with this work. The work we are collectively doing together now will take years, decades, and generations. It is worthy of a lifetime of commitment.
</p>
<p>
<strong>Something people might not know about me: </strong>I was a competitive open rhythm ballroom dancer in college, but don't ask me to try to dance now! I was a Brown Outdoor Leadership Training participant, leader, and leader trainer in college. My deep desire to lead from a place of love, acceptance, compassion, partnership, collaboration, and teamwork is thanks to BOLT.
</p>
<p>
<strong>Pet peeves: </strong>Victim mentality, because we have a choice to choose our mindset and approach to life, regardless of our personal history.
</p>
<p>
<strong>Recommended reading: </strong>Favorite leadership book: "Dare to Lead," by Brene Brown. This book sparked a deep desire to empower others to lead with courage, vulnerability, and integrity. Favorite book to recommend to women and girls, regardless of age or profession? "Playing Big: Practical Wisdom for Women Who Want to Speak Up, Create, and Lead," by Tara Mohr. This book changed my life and inspired me to become a coach. I share this book with all my friends, mentees, and coaching clients. If only I could have read this book 25 years ago!
</p>
<p>
<em>This article was featured in the November/December 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/8/2022 9:43:34 AM | 11/8/2022 9:34:52 AM | 11/8/2022 12:00:00 AM |
| problems-on-the-pathway | Problems on the Pathway | WSMA_Reports | Shared_Content/News/Latest_News/2022/problems-on-the-pathway | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/november-december/nov-dec-2022-reports-cover-645x425px.jpeg" class="pull-right" alt="cover illustration for WSMA Reports November/December 2022" /></div>
<h5>November 7, 2022</h5>
<h2>Problems on the Pathway</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
Prior to COVID-19, applications to the University of Washington's Summer Health Professions Education Program hovered in the low 800s, healthily exceeding the program's 80-student mandated minimum. Then COVID-19 hit, forcing the program to go virtual in the summer of 2020. By 2022, despite moving to a hybrid approach, the number of program applicants dropped nearly 50% to 433.
</p>
<p>
UW is one of 12 locations nationwide that offers the free Robert Wood Johnson Foundation program for college students aimed at increasing diversity in the health professions. Of 3,282 students participating in the Summer Health Professions Education Program from 1989 to 2020, 30% have matriculated to medical schools as of March 19, 2021. It's one of several pathway programs in Washington state that encourage understanding of and participation in health care professions by focusing on pre-college students from underrepresented communities.
</p>
<p>
Estell Williams, MD, executive director of UW's Center for Workforce Inclusion and Healthcare System Equity, worries the sharp decline in applicants isn't only a function of the pandemic, but another sign that the pathway to medical professions, particularly for underrepresented people, is in trouble and will get worse without focused intervention. "There's a one-to-one correlation between the decrease in college enrollment and what we're starting to see in supplemental programs that feed off of college enrollment," says Dr. Williams.
</p>
<p>
In her role as a WSMA Foundation board member, Dr. Williams helped to sound the alarm, knowing that workforce and health equity issues are WSMA priorities. During the coming legislative session, the WSMA is supporting increased funding for residencies to attract more young physicians to train in Washington. "Whether through financial support for local residency programs or loan repayment to draw physicians into underrepresented areas, the WSMA is advocating federally and at the state level for growing our workforce," says Jennifer Hanscom, CEO of the WSMA. "That advocacy has expanded in recent years to include being intentional about building a physician population that mirrors our patient community as a step toward addressing racial inequities in health care."
</p>
<h3>What the data shows</h3>
<p>
Dr. Williams' concern is based on startling national and local data. The big picture: By 2034, the American Association of Medical Colleges estimates the U.S. could see a shortage of between 37,800 and 124,000 physicians, in both primary and specialty care. The backdrop: The pandemic accelerated a decade-long decline of 13% in student enrollment at the undergraduate level. As of spring 2022, there were nearly 1.4 million fewer undergraduate students, a drop of 9.4% from spring 2020, according to the National Student Clearinghouse Research Center. In Washington state, overall enrollment in post- secondary institutions dropped 11% from spring 2020 to spring 2022.
</p>
<p>
How declining undergraduate enrollment will impact enrollment in medical school, and the number of physicians in the workforce, remains to be seen. Because the pathway to becoming a physician is long, now is the time to address the challenges, says Suzanne Allen, MD, MPH, UW's vice dean for academic, rural, and regional affairs. "When we see these downward trends early on, we need to address them in some fashion before they completely play out."
</p>
<p>
When it comes to achieving health equity and representation among physicians, the NSCRC reports some troubling trends. Community colleges, often an on-ramp toward a four-year degree for underrepresented and lower-income students, experienced the biggest enrollment drop, losing more than 827,000 students since spring 2020. And while spring 2022 saw a return to pre-pandemic freshman undergraduate enrollment overall, not all demographic groups experienced upswings.
</p>
<p>
Black freshman enrollment continued to see declines, with an overall decrease of 18.5% from spring 2020 to spring 2022. For Hispanics, spring 2022 freshman enrollment increased by 4.2% over spring 2021, but overall freshman enrollment is down by 3.8% since the start of the pandemic, threatening progress made. Hispanics, a population with the lowest degree attainment of any racial or ethnic group in the U.S., according to the Chronicle of Higher Education, had been the fastest-growing demographic enrolling in college over the last two decades.
</p>
<p>
"Whenever we see any sort of economic recession or educational strike within our overall society, we know that is going to have a compound impact on our communities of color," says Dr. Williams. "We know from all of this data that it's going to further widen our inequities and getting these students into professional schools."
</p>
<h3>The challenge for medical schools</h3>
<p>
The boost from the "Fauci effect"-the record-setting 18% increase in medical school applicants for the 2021-2022 school year inspired by Anthony Fauci, MD, the then-director of the National Institute of Allergy and Infectious Diseases-also appears short-lived. It's also not clear whether the dramatic increase among Black and Hispanic applicants, each accounting for nearly 12% of that surge, will be repeated.
</p>
<p>
Nationwide, medical school applications for the 2022-23 school year are coming in closer to pre-pandemic levels, according to AAMC. The return to prior levels is true for recent applicants to the UW School of Medicine, based in Seattle, and to Washington State University's Elson S. Floyd College of Medicine, based in Spokane, both of which experienced increases during the pandemic.
</p>
<p>
One thing is certain: The pandemic further worsened disparities in underrepresented communities, says Dr. Allen. "Even those students who were in college during the pandemic, if they were from underrepresented communities, it was harder for them to continue in a virtual format. Maybe they struggled with internet access. Or they had to take care of a family member who got sick," she says. "So, are we going to see a decrease in applications from individuals who are underrepresented in medicine? Maybe, because they struggled to get through college." How this affects progress on health equity goals throughout the state of Washington remains to be seen, says Dr. Allen.
</p>
<p>
For now, medical school enrollment has yet to see a negative impact from the long-term decline in college enrollment, says Leila Harrison, PhD, senior associate dean for admissions and student affairs for the Elson S. Floyd College of Medicine. She credits the college's unique admissions model with buffering it from potential applicant downturn and for promoting a diverse student body.
</p>
<p>
That model focuses on students who are from or reside in Washington state, with an emphasis on those who either come from or have served rural and underserved communities. "Our admissions [policy] is directly linked back to our mission-to serve all the communities in Washington and help solve challenging health care problems that exist within rural and underserved communities," says Harrison, who advocates at the national level for a holistic review of medical school applicants. "Even given those restrictions, we still receive around 1,400 applications for 80 seats ... so, we have more than enough that we're considering every year."
</p>
<p>
Despite a state law that prohibits public colleges from considering race or ethnicity in admissions, 17.5% of the WSU medical school's fall 2022 class are underrepresented in medicine by race or ethnicity. "I think for future applicants for medical school, when they see that we're enrolling such a diverse student body, they begin to see themselves here, as a place where they belong," says Harrison.
</p>
<p>
Unlike traditional admission models which rely heavily on direct-from- college applicants, the Elson S. Floyd College of Medicine tends to enroll older students. Its average starting age for fall 2022 is 27. Where applicants completed their undergraduate studies also doesn't factor into the admissions equation, says Harrison. "We need to move medical education away from this traditional idea that only a certain group of people can aspire or have access to medical education."
</p>
<h3>Making inroads</h3>
<p>
Addressing underrepresentation in medicine needs to start at the earliest ages, says Mirna Ramos-Diaz, MD, chief diversity and inclusion officer for Pacific Northwest University of Health Sciences in Yakima. "For our Latinx students, by the time they're in fourth grade, they've already learned that science is not for them, because the message is never spoken to them," she says.
</p>
<p>
PNWU's Roots to Wings Transformative Co-Mentoring Program is trying to change the experience of youth in the Yakima Valley who feel the medical profession is outside their reach. The program, which began in 2014, pairs sixth through 12th graders with health care students from PNWU. The medical school also offers an intensive summer research program for rising high school juniors and seniors.
</p>
<p>
PNWU has only begun tracking long-term results for the co-mentoring program, but some 98% of summer research program graduates are now in college. And at least one graduate from the inaugural co-mentoring program is now a first-year medical student, says Dr. Ramos-Diaz.
</p>
<p>
Like the drop seen by UW's pathway program, the Roots to Wings program, which takes place during the school year, also saw a steep decline in enrollment as a result of the pandemic, says Dr. Ramos-Diaz, the program's director. "They were tired of being on Zoom. They wanted to be in person, because they felt good about themselves here ... COVID was heartbreaking for our students," she says. The program returned to in-person learning this October at pre-pandemic levels. To date, more than 450 students have completed the Roots to Wings program.
</p>
<p>
Like Dr. Williams, Dr. Ramos-Diaz is also concerned about the drop off in college enrollment, especially among underrepresented communities. "What we are trying to do is support that earlier entry in medical professions with these programs," she says. "Our youth are our future. We have to support them. We have to welcome them and let them know they belong, that they are capable."
</p>
<p>
The Elson S. Floyd College of Medicine has developed several formal pathway programs for high school and college students who have an interest in medicine. "What we're doing with our pathways programs and our mission is aligned with our admissions process," says David Garcia, assistant dean for health equity and inclusion for the college.
</p>
<p>
Most of these programs continue to have increases in applications and enrollment, including during the pandemic, says Garcia. The one exception was the Dare to Dream Health Science Academy, which focuses on migrant youth. "We saw a little bit of a decline there, but much of that had to do with transitioning to online," says Garcia. "Many of our migrant scholars live in the most rural areas and even in 2022 we still struggle to get a strong internet connection. Without internet it can be difficult to participate."
</p>
<p>
Learning experiences are centered on the participants, says Garcia, reinforcing the concept of "If we can see it, we can be it." To further resonate with students, the programs engage them in critical work focused on improving conditions in their own communities, says Garcia. "A lot of the youth we work with have a passion for wanting to see social change."
</p>
<p>
The pathway to medical professions needs more than stand-alone programs, says Garcia. "We'd like to think that our one- or two-week programs make a difference, and they do make a difference. However, it is the collective ecosystem that strengthens and supports students who are pursuing post-secondary education in the health sciences," says Garcia, who is currently in conversations with national medical educational groups to create pathways on a national scale. He's also involved in the Washington State BIPOC Health Careers Ecosystem, a volunteer-driven group of professionals dedicated to increasing the number of Indigenous, Black, Latinx, and Pacific Islander health professionals in the state.
</p>
<h3>What you can do to create pathways</h3>
<p>
"We should all be encouraging young people to look at health professions in the future. And then helping them know what they need to do to get there," says Dr. Allen. "WSMA members don't need to know all the steps. But they should be aware of the places that can help students find that information. And they should reach out to any of the three medical schools in Washington for help."
</p>
<p>
Other ways to help include reaching out to local high schools, volunteering to talk to health classes about the medical profession, or participating in career days.
</p>
<p>
"We know physicians already have a lot going on and they're burned out. So, I think that it's also extremely important for them to know that they're not alone," says Garcia. "We are here to partner with them. Many hands make for lighter lifting."
</p>
<p>
Dr. Williams welcomes physicians to volunteer for the UW Summer Health Professions Education Program. "I'm scrambling trying to find people to provide shadowing or mentorships," she says. "If we truly want people to come into this profession to be here to take care of us, we have to be willing to open our doors and engage with students."
</p>
<p>
For pediatricians and family physicians, encouraging the next generation can start with a simple conversation during yearly checkups, says Dr. Ramos-Diaz, who is also an associate professor of pediatrics at PNWU. "Keep on asking them, 'Where do you want to go to college?' Keep on believing in them and supporting their journey," says Dr. Ramos-Diaz, who often asked that of her young patients when she was in clinical practice.
</p>
<p>
"If it wasn't for my family physician when I was younger telling me I could be a doctor, I wouldn't be where I am. So, I think that's super important," says Dr. Allen.
</p>
<p>
To reach underrepresented communities, language matters. Both Garcia and Dr. Ramos-Diaz stress avoiding using the term "pipeline" to medical professions in favor of "pathways." "That resonates so much more with indigenous values and traditions, and life as a journey," says Dr. Ramos-Diaz.
</p>
<p>
When talking to students interested in medicine, Garcia warns against using medical speak-a hidden barrier for many students. "The idea that all of this jargon that permeates academia and medical disciplines is common sense is extremely problematic. It's only common sense if you already know the answer," he says. "Physicians have the social and cultural capital to be bridge builders, not gatekeepers, in this space."
</p>
<p>
How deep and sustained the decline in college enrollment and looming physician shortage will be depends on many factors. The worst outcome isn't inevitable, says Dr. Williams, who encourages WSMA members to become mentors.
</p>
<p>
"As a profession, we're only as strong as those students who connect with us and can see themselves," says Dr. Williams. "The physician shortage is directly tied to how we invest in that next generation."
</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 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/7/2022 11:59:27 AM | 11/7/2022 11:59:02 AM | 11/7/2022 12:00:00 AM |
| the_whole_person | The Whole Person | WSMA_Reports | Shared_Content/News/Latest_News/2022/the_whole_person | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 26, 2022</h5>
<h2>The Whole Person</h2>
<p>
<em>Osteopathic principles inform incoming WSMA president Katina Rue's life philosophy.</em>
</p>
<p>
By Milana McLead
</p>
<p>Nestled on the desk amid numerous photos of Katina Rue's daughter, Valeria, and a sign that says "Mom: A title just above queen," rests a heart-shaped red glass paperweight. It's a shiny reminder of an experience that exemplifies Dr. Rue's approach to life, medicine, and community. It was her first year practicing medicine in Yakima, when a patient presented with gout at the after-hours clinic where she worked. Dr. Rue, an osteopathic family physician, listened to his heart, realizing that he had a "whopping loud heart murmur." She recommended an echocardiogram, which revealed a ruptured leaflet. Thanks to her attentive observation, his valve was repaired. Later, his wife brought her the glass heart, noting, "He was here for his toe. I don't even know why you listened to his heart. But if you hadn't, who knows where my husband would be now."</p>
<p>"That heart reminds me that it only takes a few moments to impact patients' lives," says Dr. Rue, "and that the time we spend with patients is a precious opportunity and privilege we have as physicians. It also grounds me in the need to be present with each and every patient."</p>
<p>It's an ethos that's integrated into everything she does, whether it's tending patients, teaching medical students and residents, caring for her family and community, or minding her five-acre farm.</p>
<p>Her colleagues see this in action. Nicole Austin is a program coordinator at Trios Health Family Medicine Residency in the Tri-Cities, where Dr. Rue serves as residency program director. "She is passionate about her role as an educator and community building," says Austin. "She's made a concerted effort to increase the collaboration between training programs and departments within the hospital. Although that can be challenging and at times frustrating, she has not backed down, realizing that the results will benefit not only our programs and organization, but ultimately and most importantly, the patients we serve."</p>
<p>Community, connectedness, and collaboration all played a role in Dr. Rue's journey. In middle school, she thought about heading into marine biology. High school prompted an interest in physical therapy. While shadowing physical therapists during her pre-PT studies at Western Washington University and later at Montana State University, she took note of the education and training they offered in biomechanics, physiology, and more, but felt their scope of practice was limited. After learning about osteopathic medicine, she switched to pre-med and applied to osteopathic medical school at Kansas City University in Missouri.</p>
<p>"What spoke to me about osteopathic medicine was the interconnectedness of&nbsp;the patient, the human condition of the mind, the heart, the body, the spirit, and&nbsp;that we are made in a way that structure&nbsp;and function are related," she says. "It's&nbsp;hard to be well when one aspect isn't—it's not only the physical aspect, it's the&nbsp;whole person."</p>
<p>While she enjoyed surgery, having grown up around the OR with her mom, as well as psychiatry, it was family medicine that felt like the best fit. "Seeing patients over time in multiple settings, getting to make connections with families, being there for the birth of a child and the passing of grandparents—holding that community and space to be together as a family was really amazing," she says. "When you have those relationships and you understand the different aspects of people's lives, it just made sense to me."</p>
<p>Getting involved in organized medicine was another aspect of community in her journey. In medical school, she saw her mentors modeling involvement in state and county medical associations. She stepped up, as well, serving as a student liaison between the Missouri Association of Osteopathic Physicians and the Missouri State Medical Association, and as a student and resident member of the Johnson County Osteopathic Medical Society. When she moved to Washington state, it was a natural progression to join the WSMA and participate in its House of Delegates.</p>
<p>"It was naturally what I did when I got here, because I believe it's what you're supposed to do as a doctor," she says. "I wanted to continue to be part of the passion and commitment to communities, patients, and medicine that I saw modeled by my mentors." Once part of the WSMA, she was all in, helping to launch the early career governing councils and sections with Past-President Ray Hsiao, MD, and others, and later stepping into leadership. "For me, it's what you do to support your profession and to represent it in the best way in the eyes of the public. If you're not involved, if you're not at the table, then, as they say, you're on the menu."</p>
<div class="col-sm-5 pull-right newsbody" style="text-align: center;">
<p><img alt="Katina Rue DO" src="/images/newsletters/Reports/2022/september-october/Rue.Katina_2022.SeptOct-small.jpg" class="pull-right" /></p>
</div>
<!--<div class="col-sm-5 pull-right" style="text-align: center;">
<blockquote style="text-align: left;"><strong>
<em>
Would you want your pilot to be the same as your flight attendant?
"Good morning, I'm airline worker Carl and I'll be flying your plane
today." Would you want your trial attorney to say, "I'm Sarah, your
legal worker, and will be defending you today"? I am a physician, yet
somehow it has become OK to refer to me as anything but physician.</em></strong>
</blockquote>
</div>-->
<p>Dr. Rue continues to be passionate about engaging younger physicians in the WSMA. As she looks to the year ahead, other interests include prior authorization, scope creep, social determinants of health, physician burnout, and physician workforce diversity. She is the co-chair of WSMA's newly formed Diversity, Equity, and Inclusion Committee and is an active participant in WSMA's Latinx Advisory Council. "WSMA's vision and mission can be bolstered by the development of a strong, diverse physician workforce that looks like, sounds like, and understands the patients they serve," she says. "For me, WSMA has been an open and accepting place to grow and be a voice for those who are less represented."</p>
<p>As she embraces her role as president of the WSMA, how will she lead? Her colleague Russell Maier, MD, offers a glimpse. "Dr. Rue is confident, a good listener, looks to the future, and is committed to the house of medicine," he says. "She is committed to community, learners, and improving patients' health." Just as she did for that patient with gout.</p>
<p>
<em>Milana McLead is WSMA’s senior director of strategic communications and membership.</em>
</p>
<h3>Snapshot: Katina Rue, DO</h3>
<p><strong>FAMILY</strong></p>
<p>Husband of 11 years, Aureliano, 10-year-old daughter, Valeria, and "unofficially adopted" 22-year-old Nataliya Frick and her 25-year-old brother, Anthony.</p>
<p><strong>GROWING UP</strong></p>
<p>Lived in Pueblo, Colorado until her family moved to Washington when she was 11. Her mom is a retired operating room nurse and ran the OR in Port Townsend for almost 30 years. Her father was the director of pharmacy at Olympic Memorial Hospital in Port Angeles.</p>
<p><strong>HERITAGE</strong></p>
<p>While Dr. Rue's adoptive mom is of Latino and Navajo heritage, her birth parents were also Latino (and Norwegian!). Dr. Rue's husband, Aureliano, is Mexican, although was born in Yakima, and has family in Mexico that they regularly visit.</p>
<p><strong>AT HOME</strong></p>
<p>Lives on five acres of farmland populated with five cows (Charlotte, Dixie Mae, Lia, Estrella, and Luna), five chickens, three beehives, a Yorkie named Storm, and 30 fruit trees (cherry, apricot, peach, pear, plum, walnut, and quince). Note: Blueberry the bull (who features in Dr. Rue's virtual Zoom background) recently moved to a ranch nearby.</p>
<p><strong>WORDS TO LIVE BY</strong></p>
<p>"Live like someone left the gate open!"</p>
<p><strong>WHAT GETS HER UP IN THE MORNING</strong></p>
<p>"Opportunities! I haven't always been the positive person. But now, in the face of daunting challenges, I see opportunities sprinkled like wildflowers."</p>
<p><strong>PET PEEVE</strong></p>
<p>Hearing people complain about things. "If you are a member, showed up, participated, and taken action—then maybe I'll listen to you complain." She wants to hear feedback, input, and solutions.</p>
<p><strong>FIRSTS</strong></p>
<p>She'll be the first DO and the first Latina to serve as WSMA president.</p>
<p><strong>SPARE TIME</strong></p>
<p>Soccer mom, dance mom, farm wrangler, WSMA leader, Washington Osteopathic Medical Association leader, Washington Academy of Family Physicians alternate delegate to American Academy of Family Physicians, and past president of Northwest Osteopathic Medical Foundation.</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/30/2022 10:20:58 AM | 9/16/2022 2:06:54 PM | 9/26/2022 12:00:00 AM |
| why-not-her | Why Not Her? | WSMA_Reports | Shared_Content/News/Latest_News/2022/why-not-her | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/heartbeat-website-image-strasik-645x425px.png" class="pull-right" alt="Astrid Strasik Heartbeat column graphic" /></div>
<h5>
September 15, 2022
</h5>
<h2>
Why Not Her?
</h2>
<p>
By Astrid Strasik
</p>
<p>
Growing up in rural Arizona, my knowledge of medicine was limited to the home remedies of my mother when treating everyday ailments: aloe vera for a burn, a warmed towel with Vicks VapoRub for a cold, or a freshly brewed cup of yerba buena ("good herb") for a stomachache.
</p>
<p>
My earliest memories of the clinical setting are limited to the momentary misery of childhood vaccinations, later expanded upon by the too-frequent 70-mile trips to the "city hospital" to visit extended family who had the misfortune of suffering a heart attack, stroke, or GI bleed. But this was our "normal"; health insurance was a utopian fantasy. A trip to the doctor often meant the difference between buying groceries for the week or not. I can still picture the hospital bills covered in coffee ring stains sitting on the kitchen counter-their ever-presence reminding us to endure the pangs and twinges until absolutely necessary.
</p>
<p>
So naturally, as my own symptoms arose, we reasoned with them in the only way we knew how: The rash was simply from the Arizona heat, joint aches were just "growing pains," and the relentless fatigue was a sign I needed more sleep. It would take another 20-some years for me to put a name to the underlying condition that had been there all along.
</p>
<p>
It is well known that the incidence, morbidity, and mortality of many rheumatologic conditions are much higher among people of color, especially in the case of systemic lupus erythematosus. Research has shown, however, that patients of color have longer times to diagnosis, less access to specialty care, and that disparities exist even in the types of therapies offered to patients of color with these conditions. Research also has shown that patients of color are less likely to see a doctor who looks like them, and that doctors feel less confident in evaluating rashes on patients with melanated skin. Despite our greatest strides forward in medicine, these are just a few examples of how racial and health disparities continue to plague our progress.
</p>
<p>
I often wonder how to best utilize my position of relative power and privilege as a future physician to shed light on the experiences of patients from marginalized communities. As a Latina walking into a space historically occupied by predominantly white male faces, I am frequently overwrought by feelings of inadequacy. I await the moment I am "outed" as an imposter, even as I stand in my white coat in the hallways of the hospital. And yet, I find myself filled with joy in those moments of sincere connection, as when caring for a Spanish-speaking patient whose face lights up in a smile when they learn they can speak with their physician in their native tongue. It is in these moments that I am reminded of my purpose.
</p>
<p>
It wasn't until the age of 23 that I was able to establish care with a primary care physician who came to elucidate my SLE diagnosis. With this, I felt I was closer to taking control of my own health. My only hope is that I may one day do the same for my own patients.
</p>
<p>
It is with these lived experiences that I have come to believe that each clinical encounter can only be strengthened by a physician's ability to see the world through their patients' eyes. Maybe then will we start to uncover and dismantle the underlying racial, sociocultural, and economic disparities that affect the health outcomes of our patients.
</p>
<p>
Maybe then another young girl with a little more melanin in her skin can not only get the care she needs, but also see herself in her physician.
</p>
<p>
<em>Astrid Strasik is a fourth-year medical student at the University of Washington School of Medicine in Seattle.</em>
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/15/2022 4:28:53 PM | 9/15/2022 4:26:29 PM | 9/15/2022 12:00:00 AM |
| doctors-making-a-difference-elizabeth-peterson-md | Doctors Making a Difference: Elizabeth Peterson, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors-making-a-difference-elizabeth-peterson-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/dmd-website-image-peterson-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Elizabeth Peterson MD " /></div>
<h5>September 14, 2022</h5>
<h2>Doctors Making a Difference: Elizabeth Peterson, MD</h2>
<p>
As a board member of both AMPAC and WSMA's political action committee, WAMPAC, Elizabeth Peterson, MD, is no stranger to health care advocacy. Throughout her years as a physician advocate, the issues have shifted, but the end goal remains the same: making sure the physician voice shapes the future of our health care system. Dr. Peterson, a pediatric plastic surgeon at Mary Bridge Children's Health Center in Tacoma, talked with WSMA Reports about her history with advocacy work and why physicians should get involved.
</p>
<p>
<strong>WSMA Reports: What does health care advocacy mean to you?</strong>
</p>
<p>
Dr. Peterson: Advocacy simply means to ask for something on behalf of or in support of another person or thing. Health care advocacy, to me, is the intersection of medical education and evidence-based information with organized groups of physicians who have recognized patient or physician issues. Much of the time, these challenges require the creation of solutions through public policy. The advocacy, the driving force, is the art of how to get there.
</p>
<p>
<strong>How did you first get involved with health care advocacy?</strong>
</p>
<p>
I was in my first two years of practice when the local county medical society president asked if I would become involved on their board of trustees. I found that through this involvement I developed insights into the broader view of how medicine in our community was practiced and how we could serve our patients the best. It became clear that collectively we could educate ourselves about the many challenges that we faced and that changed how we practiced.
</p>
<p>
Back in those days, we had to learn about and share with our physician communities information on restricted physician health plan panels, how to implement new HIPAA rules, information about EMTALA, how to work collectively yet avoid monopoly rule violations, and how to navigate many other regulatory actions that have come and gone involving insurance and payments.
</p>
<p>
But organized medicine is not limited to regulatory or financial issues at all. It helps develop and communicate a consensus around disease management, public health practices, and now, more deeply, how social determinants of health are pervasive.&nbsp;</p>
<p>
<strong>Are there issues you've become especially passionate about during your years of advocacy?</strong>
</p>
<p>
Universal access to health care for patients. Fair and enhanced reimbursements for physicians. No, I do not think these are mutually exclusive.
</p>
<p>
<strong>What advocacy successes are you most proud of?</strong>
</p>
<p>
Years ago, I was but a small voice in the larger plastic and reconstructive surgery community advocating that breast cancer reconstruction be covered by health insurance. We were very gratified when Congress passed the Women's Health and Cancer Rights Act and President Bill Clinton signed it into law in 1998.
</p>
<p>
One small secret of advocacy work is that a great deal of what we accomplish is not limited to laws we support that are passed, but that we also keep uninformed, unworkable, and patientor physician-harming legislation from being passed (or even getting out of committee) on a regular basis.
</p>
<p>
<strong>What's the best way for WSMA members to get involved with advocacy?</strong>
</p>
<p>
Show up at organized medicine events like the WSMA House of Delegates. Join political action committees of medical organizations (including WAMPAC and AMPAC). Participate in county and specialty society committees and leadership positions. A single act of participation leads to opportunities to become involved and eventually become an advocate.
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/14/2022 4:17:49 PM | 9/2/2022 1:19:07 PM | 9/14/2022 12:00:00 AM |
| generational-change | Generational Change | WSMA_Reports | Shared_Content/News/Latest_News/2022/generational-change | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 12, 2022</h5>
<h2>Generational Change</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
When Nancy Auer, MD, entered The University of Tennessee Health Science Center College of Medicine in Memphis, Tennessee in the mid1970s, there were 13 women in her class of more than 100. And that was a record number.
</p>
<p>
"I absolutely thought we were affirmative action," recalls Dr. Auer, a past president of the WSMA (2000-2001) and one of the first women to lead an integrated medical system as chief medical officer at Swedish. "In the past, there were maybe five women in a class if you were lucky."
</p>
<p>
As rapidly as the practice of medicine has changed over the past several decades, so too has the status of women in medicine. In 1976, women made up only about 20% of the enrollment in medical schools. During the 2021-2022 application cycle, 56.8% of applications to MD-granting medical schools came from women, who made up 52.7% of matriculating students.
</p>
<p>
By contrast, Bridget Bush, MD, began her career 30 years later. "I feel my experience in my career has been much more a traditional male experience," says Dr. Bush. "I was in the Navy as a flight surgeon. I have always been the breadwinner in both of my marriages."
</p>
<p>
The similarities-and differencesbetween the two doctors provide a useful illustration about what has changed over time, as well as the barriers that still remain. While the most blatant forms of discrimination have for the most part faded, some remnants still linger. Perhaps more interestingly, the discussion of gender parity is shifting in recognition that parity can be as much a challenge among the sexes as between them.
</p>
<h3>A pioneer in the doctors' lounge </h3>
<p>
Dr. Auer began her career on the path common to many women of her generation: secretary and teacher. Taking a break from college, she worked at a dental school in Kentucky for two years for the chair of orthodontics. "I was hired as 'secretary,' but I got to do a lot of things," Dr. Auer recalls. Her boss encouraged her to consider a career in medicine. "He used to say to me, 'Wouldn't you like to hear them say one day, 'Paging Dr. Auer'?'"
</p>
<p>
After the dental school, Dr. Auer went on to become a teacher, and in hopes of teaching at the college level, she decided to seek a master's in biology. But when the funding for the program she was accepted to fell through, she looked at other options.
</p>
<p>
"Several of my colleagues were going to medical school, and I thought, I'm as smart as they are, so I applied and got accepted," she said.
</p>
<p>
Dr. Auer quickly discovered a love of surgery, but also ran up against systemic discrimination. She was recruited for a neurosurgical residency, but she says, "Once they took me, they didn't know what to do with a woman." A lot of teaching took place in the doctors' lounge, which was men only.
</p>
<p>
Dr. Auer eventually switched her specialty to emergency medicine, moving to Swedish in 1980 just as it was establishing its presence in the field. Her skill led to a series of promotions: chief of emergency medicine, chief of staff, vice president for medical affairs, and finally chief medical officer. In addition to serving as president of the WSMA, Dr. Auer also served as the first female president of the American College of Emergency Physicians.
</p>
<h3>A matter of respect</h3>
<p>
Yet even with her success, Dr. Auer observed inequities in pay. She also noticed that other women physicians weren't granted the same respect. "I can remember when the first woman neurosurgeon came to work at Swedish," says Dr. Auer. "The talk in the doctors' lounge was, 'Who would go to her?'"
</p>
<p>
Dr. Bush believes that that kind of egotistical attitude has changed, in part because of the presence of women physicians.
</p>
<p>
"I think one of the fields that has had the greatest change is surgery," she says. "It used to be a typical female surgeon was an uber-competitive woman who has put her career first and has to be the best of the best of the best to play with the boys on the boys' field. Nowadays, there's less tolerance for the typical male surgeon who was king. It's become much more of a team sport. I'd like to think it's the female physicians who helped change the culture."
</p>
<p>
One thing that hasn't changed is casual sexism. Dr. Auer remembers a thoracic surgeon putting his hands on her sexually. "I stepped on his instep with clogs as hard as I could," she says.
</p>
<p>
For Dr. Bush, it was a patient in a Veterans Affairs hospital who began catcalling and making rude comments. "It was the first time I felt uncomfortable about my body," she says. The incident left a lasting mark. "I never wore a skirt again at the VA or in the rest of my medical career. I've had to overcome the feeling that my femininity is something to be ashamed of in the workplace and that is something I struggle with."
</p>
<p>
While there has been tremendous progress over time, it has produced new challenges. As more women physicians balance family and children with their professional lives, it can create a tension with those, like Dr. Bush, who chose not to have children. "It's had [an] unfortunate side effect of not helping me understand my female colleagues' struggles," she says.
</p>
<p>
Indeed, says Dr. Bush, the struggle for gender equity is as much within genders as between them. "I feel unequal to my female counterparts because I'm not like them," she admits. "Gender-equity-wise, I have never felt unequal to my male counterparts."
</p>
<p>
While that focus has helped her thrive in her career, it has also sometimes created a challenge in relating to other women physicians. When an anesthesiologist colleague needed additional time for breastfeeding after giving birth, Dr. Bush said she was initially upset.
</p>
<p>
"I was kind of put out that we had to rearrange how I was going to do breaks," she recalls. "And then I was also feeling really [upset] about that feeling. How am I supposed to be a champion for my fellow female physicians when I don't have the basic experiences that a lot of them do?"
</p>
<p>
What helped Dr. Bush was going to an all-female dance studio with one of her attendings. "Every class was a celebration of the women around you," she says. "The easier it was to cheer on these women, the easier it was to cheer on yourself and be easier on yourself. I brought that into the workplace. I could cheer these women and boost them up. It took nothing from me because there's not a finite amount of generosity."
</p>
<p>
What Dr. Auer and Dr. Bush have in common is a firm belief in ignoring limits based on gender. "I just never recognized barriers," says Dr. Auer. "A lot of the women who were my contemporaries saw barriers where there didn't have to be any. It was kind of like a cattle guard. Cattle can get across the cattle guard without a problem, but they think they can't. I never saw the cattle guard."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/12/2022 1:03:23 PM | 9/1/2022 1:04:34 PM | 9/12/2022 12:00:00 AM |
| setting-their-sights-on-leadership | Setting Their Sights on Leadership | WSMA_Reports | Shared_Content/News/Latest_News/2022/setting-their-sights-on-leadership | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/september-october/reports-sept-oct-2022-cover-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports September/October 2022" /></div>
<h5>September 1, 2022</h5>
<h2>Setting Their Sights on Leadership</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
Lola Oluyitan-Okeze, MD, MHMS, experienced pandemic child care stress firsthand when the daycare her toddler attends shut down for a week. Fortunately, she says, her husband rearranged his schedule and stayed home. But she heard from other women physicians who had to take time off when child care fell through. "Their supervisors were upset. And it's not their first choice."
</p>
<p>
While the COVID-19 pandemic placed significant stress on all physicians, workforce studies have found women physicians, especially those with children, were disproportionately affected. Among some specialists, women were significantly more likely than men to report salary cuts and reduced or discontinued work, citing the burden of child care responsibilities. They also continued to shoulder more child care responsibilities overall.
</p>
<p>
For women physicians eyeing greater leadership responsibilities, time will tell whether the pandemic affects their advancement. For Dr. Oluyitan-Okeze, the burden of her lived experience is evident when she recounts her colleagues' stories. "These decisions are sometimes levied against women when it comes time to hire or promote."
</p>
<h3>More, yet not enough</h3>
<p>
Dr. Oluyitan-Okeze is one of several physician leaders WSMA Reports spoke with for this article, who, in many ways embody the successes, struggles, and setbacks of women physicians everywhere aspiring to a seat at the decision table.
</p>
<p>
Women continue to enter medical school in groundbreaking numbers. Data from the Association of American Medical Colleges show that for the past three years, women have comprised the majority of MD-granting medical school applicants, matriculants, and enrollees, representing 56.8%, 55.5%, and 52.7%, respectively, in 2021-2022. For the past four years, women have also been the majority of applicants to DO-granting medicals schools, representing 57.9% of applicants in 2021-2022, according to the American Association of Colleges of Osteopathic Medicine. The most recent DOmatriculant data puts women at 51.9%.
</p>
<p>
Whether these numbers translate into the workforce remains to be seen. The percentage of women in the physician workforce increased from 34% in 2015 to 36.3% in 2019, according to the AAMC's Physician Specialty Data Reports. Women also made up 45.8% of residents and fellows, up from 45% in 2016.
</p>
<p>
Despite these advancements, nationwide women continue to be underrepresented in the highest levels of medical leadership, holding only 17.5% of board chair positions and 15.3% of CEO roles, according to a November 2021 research letter in JAMA Network Open. It's not a clear apples-to-apples analysis, but women may have lost ground among CEO slots: In 2018, they accounted for 18% of CEOs, according to a <em>Harvard Business Review</em> report.
</p>
<p>
Even when women reach the C-suite, gender discrimination persists. A 2019 study found female CEOs at not-for-profit hospitals earned 22.6% less than their male counterparts-an annual gender wage gap of $132,652.
</p>
<h3>A change in the conversation</h3>
<p>
Despite the glacial pace toward medical leadership representation, there's been a marked increase in cultural awareness of issues hindering gender and racial equity, both in health care and in society, says Donna Smith, MD, senior vice president at Virginia Mason Franciscan Health and president of the Franciscan Medical Group.
</p>
<p>
"In so many ways, we're not as far as we thought we were in terms of respect for women and other people," says Dr. Smith. "Social justice issues are relevant to the health of the people we serve, whether it's gun safety or freedom to choose. These are basic issues of public health and human rights that women do need to be involved in and help inform."
</p>
<p>
Dr. Oluyitan-Okeze, who joined Swedish Health Services in February as regional medical director for primary care in Snoqualmie, says that awareness has translated into positive steps for women in medicine and particularly for women of color who aspire to leadership roles.
</p>
<p>
"With the social and racial reckoning that this country is going through, I do think more organizations are looking at their leadership and asking, 'What is missing?'" she says. "As a Black woman, I check off two boxes, and it's an easy choice to peg me for leadership if I meet the qualifications. I will say more and more people are interested in what I have to say and offer in the leadership room. But it doesn't make it any easier, because I still walk into a room and I'm maybe the only African American, or there are only one or two other women there."
</p>
<p>
Representation at the top matters for promoting women down ladder; it sets the tone for the organization and for health policy.
</p>
<p>
The 2021 JAMA research letter found health systems with women CEOs had higher proportions of women serving on either the board of directors or in senior executive positions. Overall, women hold approximately 20% to 50% of positions on boards of directors and senior executive teams.
</p>
<h3>Hitting the 'maternal wall'</h3>
<p>
One disadvantage many women in medicine face that impacts leadership ascendency is balancing the desire to have a career with the desire to have a family. The struggle is both personal and systemic. According to a 2018 University of Michigan study, within six years of finishing their residencies, 40% of women physicians either quit or go part time, citing family as the primary reason. In the general workforce, pregnant women and mothers are often viewed as less competent and less committed to their jobs, a concept known as the "maternal wall bias," first coined in 2004 by feminist legal scholar Joan C. Williams.
</p>
<p>
"When you're a young female physician, there's no good time to have your baby," says Dr. Oluyitan-Okeze. "As a physician who wants to be a mom, that's one of the hardest things we have to maneuver."
</p>
<p>
Last year, when Dr. Oluyitan-Okeze interviewed for her new role at Swedish Medical Group, she was six weeks pregnant with her second child. Her intention had always been to work in medical leadership, so she jumped at the chance for her first full-time leadership position. She now has oversight of some 40 medical staff across five clinics.
</p>
<p>
While Dr. Oluyitan-Okeze wasn't legally obligated to disclose her pregnancy, she did so. She felt guilty knowing she would need to take maternal leave within a few months of starting. "It's a tug on your emotions.
</p>
<p>
If you're doing what you're doing well, you want to give your organization some legroom and let them know what your situation is. But the other side of the coin is, why is this a situation at all? " she says.
</p>
<p>
She also worried how her pregnancy would be perceived. "When you're up for a leadership position, they look at you as a young woman with young children. And you look at your competition, and they're all men.
</p>
<p>
It's possible these men will not take paternity leave and they will probably not need to take a sick day because of child care issues. Their wives may need to, but men will not. It's just an unsaid thing," says Dr. Oluyitan-Okeze.
</p>
<p>
She says she's been fortunate that her current and previous employers have supported her with what she needed to succeed in her job and as a mom.
</p>
<p>
"These things just aren't in place for women physicians, let alone women in leadership," says Dr. Oluyitan-Okeze. "If you have a boardroom full of all men, no one's thinking about maternity leave, breast milk pumping breaks, milk storage, and all those things that you would think of if you're a woman in that same boardroom helping shape policies for your organization."
</p>
<p>
In her own leadership role, Dr. Oluyitan-Okeze takes a proactive approach for physicians going on maternity leave. "I want them to know we have those systems in place," she says.
</p>
<h3>Women and burnout </h3>
<p>
For women in medicine, the COVID-19 pandemic amplified the disproportionate burnout they were already experiencing, says Tamara Chang, MD, medical director of clinician wellness at MultiCare.
</p>
<p>
"Female physicians are at significantly higher risk of burnout, depression, and suicide than male physicians. Women in medicine also have higher deaths by suicide than women in the general population, like 400% higher, which is pretty dramatic," says Dr. Chang.
</p>
<p>
Five years ago, Dr. Chang took an emergency leave of absence. She was only five years into being an attending pediatric hematology oncologist. "I was one of those physicians who hit rock bottom-severe burnout, severe depression, suicidal," she says.
</p>
<p>
Women aspiring to medical leadership face other barriers besides pregnancy and child care issues. "I'm one of the lucky few in medicine who has a supportive spouse who does everything at home for me. And I don't have children," says Dr. Chang. "And yet, I still was one of those with severe burnout."
</p>
<p>
Women often take on what they think are promising work tasks, but they ultimately contribute to burnout, says Dr. Chang. Taking a physician leadership course through the WSMA or another organization can help women identify potential blind spots and common pitfalls that hold women back, she says.
</p>
<p>
Burnout also hit WSMA's incoming president, Katina Rue, DO. In February 2021, Dr. Rue quit her full-time job to work part time and refocus her career. "I took the whole summer off, and it was an amazing thing for my life," she says. Allowing herself the chance to reenergize made the difference climbing up the leadership ladder, says Dr. Rue, who, after consulting for Trios Health Family Medicine Residency Program in Kennewick, in January 2022 became its program director.
</p>
<p>
The key to helping herself and other women, Dr. Chang realized, was changing things from the inside. "That was the catalyst for everything I do. My deepest passion now is how do we get women into leadership, especially women in medicine," she says.
</p>
<p>
To that end, about a year ago, Dr. Chang helped found and now serves as the director of ELEVATE, a leadership development program for women physicians at the American Medical Women's Association. She is also co-founder of Pink Coat, MD, a digital platform exclusively for women physicians, and co-author of "How to Thrive as a Woman Physician."
</p>
<p>
Dr. Rue also has made it her mission to promote women in medicine through the various boards she serves on, including the nominating committee of the Washington Academy of Family Physicians. "At WAFP, we've been pretty intentional in the nominating committee to look at representation," she says, adding that she hopes to bring that same focus to the WSMA.
</p>
<h3>The push forward </h3>
<p>
While there are now more resources than ever to help women attain leadership roles, in many ways, the more things change, the more they stay the same. A common sentiment echoed by the women leaders WSMA Reports spoke to: Women in medicine still need to overcome implicit bias.
</p>
<p>
"Women get treated differently for the same behaviors and characteristics that men exhibit and get applauded for," says Dr. Rue.
</p>
<p>
Over her 25-year career, Sheila Rege, MD, a radiation oncologist in the TriCities and a WSMA board member, dealt with the some of the same issues facing her younger counterparts today. "Confident, professionally assertive women will succeed faster if they show their empathetic side and elevate others," she says.
</p>
<p>
Mentors and friends played an important role in her own career, Dr. Rege notes. "Many women go through a zigzag path in their careers, and I am passionate about supporting formal and informal career development opportunities for women and students," she says.
</p>
<p>
Another common sentiment: Women can't advance without allies, both women and men. "It's so much more powerful, unfortunately still, when a man is the ally, rather than another woman," says Dr. Chang.
</p>
<p>
That's been Dr. Rege's experience, too. "I find that requests for women to advance are seen in a more positive light when male physician colleagues or department chairs speak up in support," she says.
</p>
<p>
Dr. Oluyitan-Okeze urges women who aspire to medical leadership to voice their intention early and often. "When I was at my former organization, they were looking for a department chair for family practice. They remembered I had expressed interest in leadership. I don't know if my name would have ever come up for that role otherwise," she says.
</p>
<p>
Dr. Smith, who served as WSMA president from 2017-2018, encourages women to join community and organizational boards. "Put yourself in situations where you get exposed to healthy dialogue around a boardroom table of really smart people who care about what they're doing."
</p>
<p>
However, Dr. Smith cautions, power dynamics still exist.
</p>
<p>
"The typical male/female kind of dynamics can still happen at a table when the majority of the people around the table are female," she says. "You still need to make sure people are heard and people's opinions are respected. You still need to be curious about what people are saying and encourage debate and open dialogue if you want to make the best decisions for an organization."
</p>
<p>
There's no quick fix to help women overcome the myriad obstacles to advancing in health care leadership, according to a 2021 systematic review published in The Lancet's eClinical Medicine. It outlines dozens of specific evidence-based organizational interventions in four broad categories, including organizational process; awareness and engagement; mentoring and networking; and leadership development.
</p>
<p>
Dr. Chang takes the long view, too. "These are discussions that need to happen on every leadership level in an organization, from the top to the lowest levels," she says. "We are just trying to reach equality. We haven't even started talking about equity. So, we have a long way to go, but I'm hopeful. I hope over the next several generations that we can do it."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/1/2022 1:03:53 PM | 9/1/2022 12:15:49 PM | 9/1/2022 12:00:00 AM |
| member_profile_jennifer_maxwell_MD | Member Profile: Jennifer Maxwell, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/member_profile_jennifer_maxwell_MD | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;">
<img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" />
</div>
<h5>July 13, 2022</h5>
<h2>Member Profile: Jennifer Maxwell, MD</h2>
<p><strong>Works at:</strong> Yakima Valley Farm Workers Clinic.</p>
<p><strong>In practice:</strong> Five years.</p>
<p><strong>Specialty:</strong> Family medicine.</p>
<p><strong>Why WSMA:</strong> I joined the WSMA because I wanted to be more active in advocacy and I wasn't sure the best way to start. I knew from working at a federally qualified health clinic in Eastern Washington that my patients' struggles are different from those on the other side of the mountains. I wanted to make their voices heard.&nbsp;</p>
<p><strong>My top concerns in medicine: </strong>I worry about the instability of the health care workforce. In Yakima, we only have one hospital and depending on the month, some specialties are not available. There has been a nursing shortage for way too long. It feels like we’re just one step away from disaster. As medical director, I see many of our physicians and health care professionals struggling with work-life balance and I worry about the long-term stability of primary care.&nbsp;</p>
<p><strong>What inspires me: </strong>People who overcome adversity and being part of that journey. I’m humbled that people sometimes wait weeks to see me about their concerns. I reflect on this every day before I step into the clinic.&nbsp;I only hope that I can make good decisions and say what needs to be said to help them on the right path.</p>
<p><strong>Why my specialty: </strong>Family medicine is the specialty of long-term wins. It values the therapeutic relationship and focuses on the patient as a part of their family and their community. When I have a child whose BMI is at the 99th percentile, their mom and grandmother are my patients too. If I can help them set goals around changing those habits, it improves the health of the whole family.&nbsp;</p>
<p><strong>If I weren’t a doctor:</strong> Hands down, I’d be a stay-at-home mom. Any physician-mom will tell you that being a parent is often more challenging than medicine.&nbsp;</p>
<p><strong>Best advice:</strong> When I was an intern on the Harborview medicine wards, three months postpartum after my first child, my attending sat down with me. She told me to think of her as a coach, that we all start in different places with different gaps in our knowledge, and that this is OK. She made it clear that the important thing was not my struggles or deficits at that moment but that I continually grow. That growth mindset changed my trajectory and outlook. I share this with learners now when they rotate with me.&nbsp;<img alt="" src="/images/News/Maxwell.Jennifer_2022.JulyAug.v9-forweb.jpg" style="float: right; margin-top: 15px; margin-bottom: 15px; margin-left: 25px;" /></p>
<p><strong>Spare time: </strong>I have three kids, ages 3, 5, and 8. I’ve been coaching my daughter’s Little League team and watching the other two play soccer and T-ball. We love hiking, rock hounding, or playing board games. I’ve probably played too much Wordle this past year.&nbsp;</p>
<p><strong>Goals: </strong>I’d like to finish an obesity fellowship, learn how to swim or rock climb, and thrive during our clinic renovation.&nbsp;</p>
<p><strong>People might not know about me:</strong> My mother is Cuban, and my father is Chinese. I am the first generation in my family to graduate from high school.&nbsp;</p>
<p><strong>Pet peeve:</strong> Negativity.</p>
<p><strong>Recommended reading: </strong>For the past two years, I had a Zoom book club with my two sisters-in-law and our mothers. The six of us met monthly across the West Coast.&nbsp;The first book we read was “Where the Wind Leads†by Dr. Vinh Chung. It helped us understand and discuss with our mothers about their struggles and immigrant&nbsp;journeys.&nbsp;</p>
<p><em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine. Image courtesy of Dr. Maxwell.</em></p>
</div> | 7/14/2022 1:05:50 PM | 7/13/2022 10:28:12 AM | 7/13/2022 12:00:00 AM |
| making_the_post_pandemic_transition | Making the Post-Pandemic Transition | WSMA_Reports | Shared_Content/News/Latest_News/2022/making_the_post_pandemic_transition | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div>
<h5>July 12, 2022</h5>
<h2>Making the Post-Pandemic Transition</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
On May 17, the U.S. Department of Health and Human Services signaled it would extend the federal COVID-19 public health emergency declaration set to expire in mid-July for another 90 days, until mid-October. First implemented in January 2020, the declaration allowed for much-needed health care flexibilities to mitigate the spread of the novel coronavirus and care for those sickened while maintaining virtual access to routine health services. This included reducing telehealth regulations, expanding Medicaid enrollment, expediting licensing processes, and providing access to COVID-19 vaccines, tests, and treatment with no cost to individuals, regardless of insurance status.
</p>
<p>
The medical community, bracing itself to lose these flexibilities, breathed a collective sigh of relief at the new timeline. But there are mounting pressures on the Biden administration to end the public health emergency, despite ongoing surges and other pandemic pressures. Unfortunately, the reprieve may be short-lived, potentially to the detriment of patient care.
</p>
<h3>
What's at stake?</h3>
<p>
"Both state and federal waivers have resulted in diminishing several administrative burdens during a time of crisis. However, we are not out of the woods yet," says Jennifer Hanscom, CEO of the WSMA. "We need to, at the very least, continue these flexibilities until we are sure we have a handle on COVID and have addressed all pent-up demand still in our communities."
</p>
<p>
For now, HHS has agreed to provide states with 60-days' notice prior to terminating the COVID-19 public health emergency. The WSMA and other parts of organized medicine are carefully tracking the public health emergency and its implications for practices.
</p>
<p>
"We want to make sure federal and state governments unwind these flexibilities in a way that is predictable and manageable, while also considering keeping those policies that have led to improvements in health care delivery and access," says Jeb Shepard, director of policy for the WSMA.
</p>
<p>
Hanscom agrees. "Ideally, we need to garner support to make permanent some of the most beneficial waivers. This will require new laws and regulations passed at both the state and federal level."
</p>
<p>
Wholesale ending of funding and regulatory flexibilities would put additional strain on health care systems already struggling to play catch-up with a stretched and stressed workforce, says Mika Sinanan, MD, PhD, WSMA president. "We're in a new phase of the COVID experience where patients who delayed or deferred care are now filling our hospitals. And there are huge staffing and inflation issues. As those benefits go away, it only adds to this very difficult transition period."
</p>
<p>
The post-pandemic transition has begun, as many state and local governments have already rescinded their emergency orders. Of the 89 COVID-19-related proclamations Gov. Jay Inslee signed, only 29 remain in effect in whole or in part, including the requirement that those working in health care settings be vaccinated unless they have a religious exemption or precluding disability. The health care vaccine mandate is a measure the WSMA continues to support, says Dr. Sinanan. "Our leadership position has always been that this is a safety issue," he says.
</p>
<h3>Impacts on telehealth </h3>
<p>
The expansion of telehealth services removed one of the pandemic's biggest health care hurdles-access to care-especially during public lockdowns when office visits and elective procedures were discouraged or prohibited. It's a pandemic flexibility the WSMA and its members would like to become permanent.
</p>
<p>
Under the public health emergency, physicians seeing Medicare patients don't need to establish an in-office patient relationship before providing services via telehealth. Waivers allow for some audio-only care and the use of certain social media platforms to see patients, which previously violated HIPAA privacy rules. The Centers for Medicaid and Medicare Services also began covering 100 new telemedicine services at in-person reimbursement rates. Waivers also allowed for the extension of medical care across state lines to support outpatients who livedor were located in other states.
</p>
<p>
"It was really a message of just step up and take care of patients. That was an enormous relief during such a highstress time," says Marcia Sparling, MD, chief medical information officer and medical director for surgical specialties at Vancouver Clinic.
</p>
<p>
Dr. Sparling's concern is that once the health emergency ends, CMS will tighten how it reimburses for telehealth visits and prohibit telehealth visits across state lines. "I would hope that Medicare modernizes aggressively and accepts that this is the way the world works now," she says. "For example, we have patients who might live in Vancouver, but they do a video visit across the river in Portland [Oregon], because that's where they work. And this occurs all over the country where people move back and forth across state boundaries."
</p>
<p>
For mental health practitioners, relaxed telehealth rules and payment parity have been particularly critical to patient care, says Donna Lohmann, MD, a private-practice psychiatrist in Seattle. "I didn't have to skip a beat. My practice pivoted and it pivoted quickly," she says.
</p>
<p>
While Dr. Lohmann didn't take on new patients during the pandemic, two former patients whom she hadn't seen in a few years returned. Because of relaxed telehealth rules, she could schedule telehealth visits without needing to see them in her office first.
</p>
<p>
Most of the time, Dr. Lohmann's telehealth portal worked well for her tech-savvy patients. But glitches can and did sometimes happen, so they used FaceTime as a backup. Losing that option, says Dr. Lohmann, could make it more difficult to care for patients. "It's a real issue because technology is certainly never 100%," she says.
</p>
<p>
For continuity of care, Dr. Lohmann, Dr. Sparling, and others would like to see federal licensing across state lines. "Right now, if somebody leaves the state for a few weeks and they have a crisis, I'm not allowed to treat them. It's not particularly pandemic-related but it became a much bigger issue during the pandemic. You have to choose between breaking the law and abandoning a patient. And that's not a choice anyone should have to make," says Dr. Lohmann.
</p>
<p>
Medical licensure still rests with the states, and federal involvement in licensure remains a thorny issue. But the WSMA has recently made progress, working with both Oregon and Alaska to update their telemedicine policies to permit Washington-licensed physicians and physician assistants to provide followup care to established patients without obtaining licensure in those states. The WSMA is working with other states to update policies, including Wyoming, Montana, and Idaho, says Shepard.
</p>
<h3>The impact on Medicaid</h3>
<p>
As businesses closed shop and Americans lost their jobs, many found themselves without health insurance or unable to pay. The public health emergency allowed for continuous Medicaid enrollment, suspending the need for yearly Medicaid redetermination. Nationwide, continuous enrollment contributed to a Medicaid enrollment growth of 20.5% between February 2020 and November 2021.
</p>
<p>
When the health emergency ends, millions of people could lose Medicaid coverage or potentially face higher costs for insurance coverage. The WSMA supports continued federal funding increases for Medicaid and congressional reauthorization of funds to support the uninsured.
</p>
<p>
In Washington state, about 361,400 people have joined Apple Health, the state's Medicaid program, since the start of the pandemic, according to the Washington State Health Care Authority. Once the public health emergency ends, enrollees will need to verify their Medicaid eligibility once they hit the month their one-year anniversary would have normally occurred. It's unknown how many enrollees will still be eligible for Apple Health once the health emergency ends.
</p>
<p>
The redetermination process will take place over 12 months, says Charissa Fotinos, MD, the HCA's state Medicaid director and behavioral health medical director. "We will need to reach out to all those folks by whatever means we can and check to see if they're still eligible for Medicaid. If they are, we re-enroll them. If they are not, we will refer them to the health insurance exchange so they may look at other insurance products. There are some plans with subsidies for income levels that exceed Medicaid but aren't high enough to warrant people managing insurance on their own."
</p>
<p>
Physicians, physician assistants, and nonphysician providers can play a vital role in making sure these vulnerable patients continue to receive the services they need, says Dr. Fotinos. While they won't directly be involved in determining Medicaid eligibility, she asks physicians and PAs to encourage their patients to read any notices they receive from the HCA or CMS. "Physicians can be good partners with us," says Dr. Fotinos. "And if they have questions, they can certainly reach out to us."
</p>
<p>
In April, the HCA released an external guide on what happens to Apple Health eligibility during and after the expiration of the COVID-19 public health emergency, which physicians and health care systems can download from its website.
</p>
<h3>Impacts on COVID-19 testing, treatment, and vaccine coverage</h3>
<p>
To fight the pandemic, the U.S. Food and Drug Administration issued emergency use authorizations for three vaccines and hundreds of COVID-19 tests and treatments. According to the FDA, an emergency use authorization declaration is distinct from, and is not dependent on, the federal public health emergency declaration related to COVID-19. An emergency use authorization may remain in effect beyond the duration of the health emergency if other statutory conditions are met.
</p>
<p>
While some vaccines and therapeutics have received full FDA approval, the concern is that ending the public health emergency may trigger the FDA to terminate emergency use authorization for products that haven't obtained full approval. There's also concern over federal funding for vaccination, testing, and treatment.
</p>
<p>
"We know that timely access to vaccines and boosters as well as timely access to antiviral medications like Paxlovid and to monoclonal antibodies given to people at high risk of hospitalization or death reduces the risk of severe disease. So, we really need to remove any barriers that we can to vaccination, testing, and treatment. Our hope is that federal funding and support continue to be really strong," says Tao Sheng Kwan-Gett, MD, chief science officer for the Washington State Department of Health.
</p>
<p>
It's hard to predict what impact ending the health emergency will have on funding. "It's not an automatic given that funding for testing, treatment, or vaccination would be reduced. But it's certainly a possibility," says Dr. Kwan-Gett.
</p>
<p>
Through the FEMA Stafford Act, the federal government has reimbursed physicians and health care systems 100% for COVID-19 testing. While there is no set date to end Stafford Act funding, as of July 1, the cost-sharing formula will shift, with the federal government now covering 90% and state and local agencies each paying 5%, signaling the first change in funding, says Dr. Kwan-Gett.
</p>
<p>
"The funding change won't affect what physicians and health care providers do. It just means the Department of Health will make up 10% of the cost," he says. "Ending the public health emergency certainly wouldn't change anything about the vitally important role of physicians in vaccinating people and in testing them and getting them access to treatment for those at high risk."
</p>
<p>
For now, Washington state has several funding mechanisms that support the COVID-19 response, says Dr. Kwan-Gett. The state's COVID programmatic grant awards-like Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases and vaccine dollars-are not impacted by the end of federal reimbursement for coronavirus vaccine administration, testing, or treatment. These grants have already been awarded, and the funding continues with expiration dates ranging from July 2023 to June 2024.
</p>
<p>
In May, the WSMA surveyed its members to better understand which flexibilities physician practices are relying on, what factors should be considered in deciding to end or retain them, and what preparation is needed at the practice level to end a waiver. As the next public health emergency end date looms, the WSMA hopes members will add their voices to the need to keep pandemic-era flexibilities in place, says Dr. Sinanan. "Their stories of how the benefits of the public health emergency impacted their practices will go a long way toward advocacy and moving health care forward."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/13/2022 10:58:37 AM | 7/12/2022 3:43:56 PM | 7/12/2022 12:00:00 AM |
| the_fix_that_wasnt | The Fix That Wasn't | WSMA_Reports | Shared_Content/News/Latest_News/2022/the_fix_that_wasnt | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div>
<h5>July 12, 2022</h5>
<h2>The Fix That Wasn't</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
When Congress overhauled the Medicare payment system for physicians in 2015, the reforms put an end to a model that was plainly broken. At the time, physicians were facing a 21% cut in Medicare fees, the latest in an endless line of "cliffs" created by a formula designed to tie spending to overall economic growth. The new system held the promise of removing the perennial threat of impending fee cuts while also creating payment models that rewarded high-value care.
</p>
<p>
"It became so overwhelming that Congress finally had enough," says Jason Marino, director of congressional affairs at the American Medical Association. "We were happy at the time" with the new system and the incentives for valuebased care.
</p>
<p>
As it turns out, that optimism was short-lived. Just seven years after that overhaul, the Medicare payment system is again stuck in a cycle of statutory payment cuts that require Herculean effort to avoid every year. At the same time, the alternative payment models originally envisioned as encouraging greater innovation and value in care have proven harder to implement due to inadequate incentives and unrealistic requirements.
</p>
<h3>A need for change </h3>
<p>
"We're still in the same situation where every year we have to fight back the cuts we don't want to have happen," says Jennifer Hanscom, CEO of the WSMA. "It's frustrating to be on that hamster wheel."
</p>
<p>
The need for change is evident. Physicians are facing a continuing statutory freeze in annual Medicare physician payments that is scheduled to last until 2026. After that, payment updates will resume, but only at a rate of 0.25% a year indefinitely.
</p>
<p>
Medicare physician payment has fallen 20%, adjusted for inflation, since 2001. At the same time, the cost of running a medical practice increased 39% since 2001. In the meantime, Medicare payment updates to physicians have been far outpaced by increases for others. While Medicare physician pay rose 11% since 2001, payment updates increased roughly 60% for inpatient and outpatient hospital services and for skilled nursing facility services.
</p>
<p>
Compounding the problem of low and eroding reimbursement is the fact that insurers increasingly use Medicare as their baseline for payment standards. "The rates for much of commercial insurance, which in the past had cross-subsidized Medicare and Medicaid, are trending toward Medicare," notes Mika Sinanan, MD, PhD, a surgeon at the University of Washington and current president of WSMA. "They say you have to live and work at a Medicare level."
</p>
<p>
It's no surprise that as a result of this combination of factors, the Medicare payment system is exacting a high toll on practices and on patient care across the state and the country.
</p>
<p>
"The impact on practices is uncertainty about the sustainability of taking Medicare patients," Dr. Sinanan says. "It's impacting the sustainability of physicians to offer services to Medicare patients. There's going to be an access problem in parts of the country and parts of the state."
</p>
<p>
Easy in theory, difficult in practice An improved payment system was one fix promised seven years ago. The other was a pathway toward rewarding valuebased care models. It too has proven to fall far short of expectations.
</p>
<p>
The congressional legislation created several new alternatives to traditional fee-for-service payment. The Medicare Merit-Based Incentive Payment System based payments on the Medicare Part B physician fee schedule, but those payments can be adjusted either up or down depending on scores from four performance categories. The scoring is complex and the administrative burden for participating in MIPS is onerous. A 2021 study published in JAMA Health Forum found that it costs an estimated $12,811 and takes more than 200 hours per physician annually to comply.
</p>
<p>
Medicare's attempt to encourage practices to embrace advanced alternative payment models has proven equally complicated. Practices can earn a 5% bonus, but setting up such an innovative model is something only the largest practices are able to consider.
</p>
<p>
"Medicare wants to pay physician practices based on the risk scores of their patients. However, in small private practices, there are no additional resources to help physicians be successful in capturing the true risk scores," says Katina Rue, DO, Trios Health Family Medicine Residency Program Director and president-elect of WSMA. "I question how practices doing that can accurately capture this information.
</p>
<p>
It's often on the backs or fingertips of the physicians without organizational resources or support such as coders."
</p>
<p>
The bottom line is that a practice will need to hire staff, which, as Dr. Rue says, "do pay for themselves eventually, but there is an 18-month turnaround for reimbursement." The model can drive small practices toward consolidation, which isn't always good for physicians, patients, or their communities, she says.
</p>
<p>
Measuring value has also been a challenge, especially for specialty practices. "The value-based concept makes sense theoretically but has proven to be very difficult to implement, in large part because the goal is to reward outcomes, but there's no easy mechanism to track outcomes and measure them objectively," says Dr. Sinanan. Instead, surgeons find themselves dealing with unrelated process measures, such as blood pressure control for patients with diabetes.
</p>
<p>
Amid this confusion, the rules are changing regarding the alternative payment models. The 5% bonus is slated to go away at the end of this year, and practices will need to increase the number of participating patients from 50% of their practice to 75%. That will essentially set those practices that willingly embraced innovation on a path to failure.
</p>
<p>
"I believe that even most big systems will not qualify" under the new requirements, says Marino. "All the other investments in APMs will just go belly up."
</p>
<h3>Not if, but when </h3>
<p>
Given the myriad problems facing Medicare, the need for a major overhaul seems obvious. However, an election year isn't the right time for such an attempt. Instead, organized medicine is laying the groundwork for a twopronged approach: Address some of the most immediate problems in the short term and build the foundation for a bigger fix in the not-too-distant future.
</p>
<p>
"Where we want to focus at this point in time is on those short-term fixes," says Hanscom.
</p>
<p>
Foremost among those fixes is stopping any proposed payment cuts. Indeed, one of the issues that the AMA would like to see addressed is having payments adjusted for inflation, a particularly timely issue right now. "That would go a long way, right there," says Marino.
</p>
<p>
Extending the 5% bonus for APMs is another priority, as is keeping the current patient standard for participation at 50%. Extending a $500 million pool for exceptional performance in MIPS is also important.
</p>
<p>
Longer term, the time is approaching to revisit the entire payment model.
</p>
<p>
"In the end, the goal is to have a strong Medicare program that physicians want to participate in," says Hanscom. "We need to create a rational Medicare payment system that encourages fiscal responsibility and embraces innovation. We've been straddling the canoe and the dock for years. If we're ever going to get into the value-based care boat, we need a program like Medicare to set the parameters for it."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/13/2022 10:59:11 AM | 7/12/2022 3:02:33 PM | 7/12/2022 12:00:00 AM |
| please_stop_saying_provider | Please Stop Saying 'Provider'! | WSMA_Reports | Shared_Content/News/Latest_News/2022/please_stop_saying_provider | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;">
<img alt="Susan Baumgaertel,MD" src="/images/newsletters/Reports/2022/july-august/heartbeat-website-image-645x425px.png" class="pull-right" width="645" height="425" />
</div>
<h5>July 11, 2022</h5>
<h2>Please Stop Saying 'Provider'!</h2>
<p>By Susan J. Baumgaertel, MD, FACP</p>
<p>
When I presented Resolution B-8 at the WSMA House of Delegates 2021 annual
meeting, it was with a sense of urgency that patients and the general
public deserve to know who is caring for them. Not so easily done,
unfortunately.
</p>
<p>
When I started my internal medicine practice in 1996, the medical arena
was vastly different than it is today. Back then, having an MD after my
name actually meant something. A letter from me to an insurance company
would get a needed medication covered for a patient-a time before
preauthorization existed. Dr. Google was not yet born. "Provider"
exclusively belonged to the insurance industry.
</p>
<p>
My patients called me doctor and referred to me as their physician. Well,
most of them. I still chuckle fondly when I recall the World War II vets
at the Veteran's Affairs Hospital calling me nurse, no matter how I
introduced myself. That's okay-I knew who I was and didn't need to prove
it. I actually think they did too and just wanted to get my goat!
</p>
<!--
<div class="col-sm-5 pull-left" style="text-align: center;">
<img alt="Baumgaertel pullout quote" src="/images/newsletters/Reports/2022/july-august/baumgaertel-pullout-quote.png" class="pull-left" width="569" height="312" />
</div> -->
<p>
Fast forward to modern times: Professional appropriation runs rampant. I
cringe, along with many of my physician colleagues, when I am wished
"Happy Providers' Day" instead of "Happy Doctors' Day." And I was stunned
when someone recently addressed me as "Provider Susan" in an email-that
was a new one. The word "provider" has become ubiquitous.
</p>
<p>
Would you want your pilot to be the same as your flight attendant? "Good
morning, I'm airline worker Carl and I'll be flying your plane today."
Would you want your trial attorney to say, "I'm Sarah, your legal worker,
and will be defending you today"? I am a physician, yet somehow it has
become OK to refer to me as anything but physician.
</p>
<p>
In an era where burnout is akin to another pandemic, it is further
demeaning and demoralizing to all in medicine to be lumped together as if
we are the same. This is just not sustainable. This is also not about ego.
It is about patient safety and transparency. Substitute words only serve
to confuse the public and take away transparency by implying all training
and experience is equivalent, which is simply untrue.
</p>
<p>
I haven't worn a white coat in decades. Nowadays, a white coat means
nothing-the beauty counter makeover folks wear them. Everyone wears
scrubs. ID badges are now issued with "medical staff" instead of actual
titles. Badges also are notorious for flipping over and not actually being
visible to patients. All too frequently patients get seen by a "provider"
never actually knowing their credentials.
</p>
<!--
<div class="col-sm-5 pull-right newsbody" style="text-align: center;">
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<div class="col-sm-5 pull-right" style="text-align: center;">
<blockquote style="text-align: left;"><strong>
<em>
Would you want your pilot to be the same as your flight attendant?
"Good morning, I'm airline worker Carl and I'll be flying your plane
today." Would you want your trial attorney to say, "I'm Sarah, your
legal worker, and will be defending you today"? I am a physician, yet
somehow it has become OK to refer to me as anything but physician.</em></strong>
</blockquote>
</div>
<p>
How can we fix this? Patients and the public should be completely
comfortable with asking who is taking care of them and what are their
credentials. Staff need to be trained not to ask, "Which provider are you
calling for?" We need to refrain from grouping all physicians,
nonphysicians, and health care professionals together using one word.
Words matter-at meetings, in emails, on nursing home forms, in the news,
on websites, and so on.
</p>
<p>
Let's bring back respect for physicians and respect for nonphysicians.
Respect our differences in training and medical experience. We are not all
the same. Use our titles individually. With this will come transparency to
patients and the public. And with transparency will come improved safety.
</p>
<p>
Washington state has the opportunity to set a decades-overdue example for
the rest of the country, not just by making another strong recommendation,
but by publicly educating everyone that use of the term "provider" or any
other replacement term is unacceptable.
</p>
<p>Let's reshape modern medicine. It is time.</p>
<p>
<em>Susan J. Baumgaertel, MD, FACP, is the founder of
<a href="https://myMDadvocate.com">myMDadvocate.com</a> and is a
physician advocate, guide, partner, coach, resource, navigator, and
educator. She is the author of Resolution B-8, sponsored by the King
County Medical Society and adopted by the WSMA House of Delegates in
2021, which called for the WSMA to support education to highlight
concerns related to inappropriately using one title to group all medical
professionals together (e.g., "provider").</em>
</p>
<p>
<em>
Are you passionate about this or another topic? Send us your story (less
than 500 words) at
<a href="mailto:editors@wsma.org">editors@wsma.org</a>.</em>
</p>
<p><em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em></p>
</div> | 7/13/2022 10:59:33 AM | 7/11/2022 11:21:27 AM | 7/11/2022 12:00:00 AM |
| hub_and_spoke_model_five_years_later | Hub-and-Spoke Model: Five Years Later | WSMA_Reports | Shared_Content/News/Latest_News/2022/hub_and_spoke_model_five_years_later | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 3, 2022</h5>
<h2>Hub-and-Spoke Model: Five Years Later</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
When Lora Jasman, MD, an addiction medicine specialist with the Healthy Behavior and Function Clinic at MultiCare Rockwood Clinic in Spokane, learned a long-time patient with opioid use disorder was thinking about starting community college, she cheered. Dr. Jasman had first treated him in her internal medicine practice, but the limited services she could provide weren't enough. As happens for many with the disorder, he returned to use.
</p>
<p>
"He had a period of time where he was very unstable, using a lot of methamphetamines, in and out of the hospital, and in and out of urgent care," she recalls. So, what changed to get him on this new path?
</p>
<p>
Dr. Jasman credits the patient's efforts, but also the comprehensive services her team has been able to provide since becoming a "hub" in August 2018 under Washington state's hub-and-spoke care model for treating opioid use disorder.
</p>
<p>
Hub-and-spoke networks in Washington state were launched as part of the federal 21st Century Cures Act to address the opioid epidemic. Modeled on a program in Vermont, it's a coordinated care approach to prevent return to use, overdose, and death by removing barriers to accessing medication. The 2021-2022 Washington State Opioid and Overdose Response Plan considers the networks an integral part of expanding capacity to provide medication for opioid use disorder, or MOUD (also referred to as medication-assisted treatment).
</p>
<p>
Many of the networks are now in their fifth year of operation. While the model has proven successful in helping patients with opioid use disorder, it also has challenges related to care coordination across the network and funding.
</p>
<p>
"Hubs" are designated primary care physicians and clinicians, behavioral health clinics, health professionals who offer office-based MOUD, or federally qualified health centers in a region that coordinate care for adults with opioid use disorder. To provide integrated MOUD, each hub subcontracts with organizations or "spokes," including emergency departments, residential treatment facilities, therapist's offices, drug courts, correctional facilities, needle exchanges, and tribal medical facilities.
</p>
<p>
Within each network, nurse care managers or spoke care navigators help reduce the burden on prescribing physicians by providing screening, care planning, and services and referrals needed to stabilize patients.
</p>
<h3>Meeting patient needs</h3>
<p>
When it comes to increasing capacity, the model has exceeded benchmarks. An analysis by the Institute for Behavioral Health at Brandeis University published in January 2020 found that in the first 18 months of operation, these networks added nearly 5,000 new people with opioid use disorder onto MOUD, double the projected goal.
</p>
<p>
"It's allowed us to individualize our approach to each patient and help provide them with the wrap-around care that they need in their recovery," says Dr. Jasman. "Before, I didn't have a coordinated team. So, if I wanted a patient to go into inpatient treatment, I would basically say, you need inpatient treatment, here's a list of places that do that."
</p>
<p>
While her internal medicine clinic served few patients with opioid use disorder, since becoming a hub, MultiCare's Rockwood Clinic has served over 2,000 such patients, says Dr. Jasman. Her team now includes two physician assistants, two medical assistants, a nurse care manager, hub care coordinator, and a receptionist.
</p>
<p>
Wrap-around services provided by these networks are crucial in helping patients navigate what life throws at them, says Shawn Andrews, MD, program director of family medicine residency and senior medical director of ambulatory care services for Summit Pacific Medical Center, a hub in Elma. Shortly after one patient went through several tough years and challenges to stop using, his brother was killed, recalls Dr. Andrews. "People will often return to use when something horrible like this happens." But even though he was distraught, he was able to remain stable.
</p>
<p>
"He came back to the MOUD clinic for a point of contact and some direction on how to protect his sobriety through this difficult time," she says. "He knew that people cared about him personally and he felt safe there."
</p>
<p>
The model also helps relieve pressure on emergency departments, says Dr. Andrews. "It's strengthened the alliance between ED, primary care, and MOUD clinics," she notes.
</p>
<p>
For Capital Recovery Center, a hub in Olympia, the hub-and-spoke model has increased access to treatment, says Malika Lamont, co-founder and director of harm reduction practices of Capital Recovery Center's Olympia Buprenorphine Clinic, a spoke. Since it opened in 2019, Capital Recovery Center has seen over 1,500 patients. Because of its high volume, the peer-led behavioral health facility has a nurse navigator and 10 physician prescribers.
</p>
<p>
"I remember the days when we did not have meaningful access to medication for opioid use disorder in a six-county area. It has helped us grow our capacity to provide treatment to folks, and to better engage with them," says Lamont. Olympia Buprenorphine Clinic clients know they can drop in anytime during operating hours and get their medications dispensed free of charge at the time of visit, says Lamont.
</p>
<h3>Persistent challenges</h3>
<p>
Hub-and-spoke networks are intended to help transition patients seamlessly between health professionals and organizations, depending on their level of stability and what else they need to remain stable, such as mental health and social services.
</p>
<p>
But coordinated care has been easier said than done. The Brandeis report found very little movement of patients across hubs and spokes.
</p>
<p>
"I know the state says we're a hub, but we don't get a lot of referrals. We mostly see people coming in literally right off the street," says Ryan Herrington, MD, medical director of Capital Recovery Center's Olympia Buprenorphine Clinic.
</p>
<p>
Financial challenges are also a problem. Hub-and-spoke models are funded through multiple federal and state grants to ensure low-barrier access to those on Medicaid and low-income populations. But the low payment structure can be a struggle for physicians and health professionals who participate in hub-and-spoke. "The vast majority of these patients are on Medicaid," says Dr. Jasman. "So, it's just difficult to make the budget work out well. That's a barrier [to participation] that the state of Washington is well aware of and trying to do something about."
</p>
<p>
Another issue with the state's model is that it leaves care design up to each network. While that provides flexibility, it also creates some confusion, as there is no agreed-upon standard for what constitutes patient stability and outcomes.
</p>
<p>
"A big challenge with the hub-and-spoke model is that you have different physicians and practitioners with different levels of expertise and different treatment philosophies," says Dr. Herrington. "It's not like blood pressure management, where everyone knows that the goal of treatment is 120 over 80 or better."
</p>
<p>
Defining patient stability and what dosage is needed to maintain stability remains a challenge, says Dr. Herrington. "Somebody who might be stable to me might be unstable to another physician."
</p>
<p>
Once patients are stable, the long-term goal is to get patients in with a primary care physician or practitioner to continue their care. But because of previous negative experiences, many patients are reluctant to change physicians. "We're finding that they are really attached to the people who help them enter recovery," says Dr. Andrews.
</p>
<p>
Still, despite all the challenges, the hub-and-spoke system has given people with opioid use disorder an option to lead stable lives that they might not have otherwise had.
</p>
<p>
"There's still just a lot of barriers [to treatment]," says Dr. Jasman. "But this is a start. And it's not perfect, but we are serving a lot of people in a way that they are getting a lot of benefit."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/3/2022 10:44:19 AM | 5/3/2022 10:43:15 AM | 5/3/2022 12:00:00 AM |
| embracing_empathy_in_complexity | Embracing Empathy in Complexity | WSMA_Reports | Shared_Content/News/Latest_News/2022/embracing_empathy_in_complexity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Embracing Empathy in Complexity</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
One of the consequences of the COVID-19 pandemic was its impact on another epidemic: drug overdoses. According to the Centers for Disease Control and Prevention's National Center for Health Statistics, there were more than 100,000 drug overdose deaths in the U.S. during the 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before.
</p>
<p>
The bulk of opioid-related deaths are attributable to synthetic opioids like illicit fentanyl, with 75,673 total opioid-related deaths in the 12-month period ending in April 2021, up from 56,064 the year before. About six people in Washington state die every day from an overdose. The rising numbers put new pressure on physicians and policymakers to develop fresh approaches to address the tide of addiction.
</p>
<p>
But the tragic toll also contains a success that underscores the confounding nature of the epidemic. A recent report from the American Medical Association shows that opioid prescribing nationwide has dropped 44% in the past decade and fell nearly 7% from 2019 to 2020. Even as physicians in Washington and other states have made tremendous strides addressing the overprescribing of opioids, the epidemic continues to shift its form, creating a new set of challenges.
</p>
<p>
"Deaths from prescription opioids continue to slowly decrease, yet a lot more work needs to be done," says Steven Stanos, DO, medical director of Swedish Pain Services in Seattle. "Prescription overdose deaths are now far overshadowed by the increase in deaths due to illicit fentanyl, a far more accessible, potent, and lethal opioid. Methamphetamine, heroin, and cocaine-related deaths also are rising."
</p>
<p>
There's no question that the COVID-19 pandemic contributed to the rising toll of drug overdoses. "The opposite of addiction is connection," says Lucinda Grande, MD, a physician at Pioneer Family Practice in Lacey, citing author Johann Hari. "The pandemic really increased isolation, boredom, and stress." Yet the picture is not entirely bleak. There have been successes. Moreover, the understanding of how to address the epidemic has deepened with time, with a more nuanced understanding of the clinical approaches that will work and a commitment of resources to help those in need of treatment.
</p>
<h3>Tackling opioid overprescribing</h3>
<p>
One of the major changes over the past several years has been the success in reducing overprescribing of opioids for acute pain conditions, including dental and hospital-based elective procedures. "Physicians and prescribers didn't appreciate the significant impact their unnecessary prescribing was contributing to a large supply of unused pain medication in our communities," says Dr. Stanos.
</p>
<p>
A typical example was seen with elective surgery. "Patients were commonly prescribed a one-month supply of pills out of convenience for an acute pain condition that normally needed only a few days of therapy at best," says Dr. Stanos. "This led to a significant number of unused pain medications finding their way into the hands of vulnerable individuals, including recreational users and people struggling with addiction."
</p>
<p>
Washington helped set a standard for other states with the Better Prescribing, Better Treatment program, launched in 2017 as part of the state's opioid response plan. The program, a joint effort of the WSMA and the Washington State Hospital Association, has three components: encouraging compliance with a prescribing policy that establishes pill limits for all prescriptions for acute pain, giving physicians discretion to override pill limits if they feel it is in the best interest of their patients, and allowing physicians to compare how their opioid prescribing practices compare to others in their specialty and health system.
</p>
<p>
Pill limits were an attempt to get at what seemed at the time the heart of the opioid problem. "Our goal in going upstream was to cut off the supply to those at risk for addiction," says Nathan Schlicher, MD, JD, an emergency room physician at St. Joseph's Medical Center in Gig Harbor and WSMA's lead on Better Prescribing, Better Treatment.
</p>
<p>
At the same time, providing physicians with clinical flexibility and data on how they compared to their peers were also important. "We recognized that no guideline is applicable to every patient," says Dr. Schlicher. "We said, let us give people feedback on performance compared to how their peers perform. If you are the only one performing with those guidelines compared to your peers, that should give you pause."
</p>
<p>
Overall, the results have been positive. "There have been a lot of improvements in addressing the opioid epidemic within the house of medicine," Dr. Schlicher says.
</p>
<h3>A changed landscape</h3>
<p>
As the epidemic has continued, the focus has shifted, bringing with it new challenges. "We handled what was a really bad prescription opioid problem, and now it's evolved into a synthetic street opioid problem," says Jeb Shepard, WSMA's director of policy.
</p>
<p>
Indeed, the bulk of the deaths reported by the CDC were attributable not to prescription opioids but to street drugs, and in particular fentanyl. Fentanyl and other synthetic opioids now account for about two-thirds of all drug overdose deaths.
</p>
<p>
One of the most immediate needs has been to stop overdose deaths. Starting in 2019, anyone in Washington was able to obtain naloxone, a medication which reverses opioid overdoses, simply by walking into a pharmacy.
</p>
<p>
"Unfortunately, the people who need it the most aren't compelled to go to a pharmacy," Shepard says. "Their lives are chaotic and complicated. There's been a lot of success with it but it's not the magic solution everyone had been hoping for."
</p>
<p>
Still, notes Dr. Stanos, naloxone prescriptions by physicians are rising. "Prescribers can do our part by getting more naloxone in our communities and in patients' homes, whether it will be needed by the individual patient, or a friend or family member." Naloxone can easily reverse an overdose and save a life, he says. "Some have likened community goals of increasing naloxone availability to having a fire extinguisher in every house."
</p>
<h3>Moving forward: More access, more nuance</h3>
<p>
Not surprisingly given the death toll, the state has focused increasingly on creating more opportunities for access to treatment for substance use disorders.
</p>
<p>
"The Legislature is making a generational investment in treating this problem and a whole other raft of behavioral issues," says Shepard. "If there's ever been a problem where money would help, this is one, because treatment has long been underfunded."
</p>
<p>
At the same time, the original zero-tolerance policy of opioids is giving way to a more nuanced perspective, even among pain specialists.
</p>
<p>
"I went through a phase where I believed that chronic opioid prescriptions were absolutely evil and harmful," says Dr. Grande. "Over time, I realized I was wrong because a lot of people benefit from it, and when you take it away from them it can be an absolute tragedy." Instead, Dr. Grande says, people will take matters into their own hands, seeking illicit opioids or even committing suicide.
</p>
<p>
The CDC issued guidelines on opioid prescribing in 2016 that were frequently interpreted as being proscriptive and rigid. "A lot of people in their haste to respond to the problem took the guidelines as gospel that needed to be adhered to strictly," says Shepard. The result was often harm to patients, who had their opioid treatments discontinued without any alternative.
</p>
<p>
The agency released a new draft guideline in February that is more patient-focused and that provides greater flexibility for physicians and prescribing clinicians. "Controversial and confusing dose thresholds are removed in the draft guideline," says Dr. Stanos. "There is more emphasis on how to integrate non-opioid therapies for pain, and to more safely select and manage patients that may benefit from opioids, better instruction on how to taper patients, more clarity in prescribing short-term for acute and subacute pain, and an overall emphasis on patient-centered care that appreciates the unique complexities of each patient."
</p>
<p>
Both the Trump and Biden administrations have loosened some regulations related to opioid treatments. In particular, it is now easier to prescribe buprenorphine, which is used to treat people with opioid use disorders.
</p>
<p>
"Increased use of buprenorphine is more effective and safer management of chronic pain for patients with or without an addiction," says Dr. Grande.
</p>
<p>
Properly managing chronic pain patients in the first place can help prevent the cycle of addiction and overdose that's exacting such a high toll currently. However, the financial realities don't always currently align with those goals.
</p>
<p>
"Greater improvements in insurance coverage and patient access for non-opioid therapies, like behavioral health, physical therapy, and many interventional therapies, have been slow to come by," says Dr. Stanos. "Even if an 'approved benefit,' reimbursement many times is so low it's an ongoing challenge to incentivize clinics and systems to keep offering services."
</p>
<p>
For many patients, coverage can be nonexistent or limited, with significant out-of-pocket expenses. In Swedish's pain clinic, patients participating in a structured four-hour therapy session that includes individual and group physical and occupational therapy, behavioral health, and patient education, can incur multiple out-of-pocket copay charges in a single day.
</p>
<p>
"If we're going to improve care, payers have to truly incentivize and support comprehensive pain management," says Dr. Stanos.
</p>
<p>
The fact remains that the opioid epidemic is just one part of a larger problem fraying the fabric of society. While drug overdoses have been among the fastest rising death rates among Americans in the past two decades, so too have suicide and alcohol liver disease.
</p>
<p>
A recent study published in the Journal of the American Medical Association found that more than 99,000 people died in 2020 of alcohol-related causes. Addressing those societal problems and "deaths of despair" go well beyond the range of medicine.
</p>
<p>
But there are things that physicians can do, starting with how they approach their pain patients, says Dr. Grande.
</p>
<p>
"Physicians need to increase their awareness and empathy," she says. "They need to treat them with kindness."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/2/2022 11:45:47 AM | 5/2/2022 11:40:22 AM | 5/2/2022 12:00:00 AM |
| pre_visit_planning_is_increasing_efficiency | Pre-Visit Planning Is Increasing Efficiency | WSMA_Reports | Shared_Content/News/Latest_News/2022/pre_visit_planning_is_increasing_efficiency | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2022/may/thrive-cover-image-wsma-may-june-2022-thrive-645x425.jpg" class="pull-right" alt="Thrive cover, May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Pre-Visit Planning Is Increasing Efficiency</h2>
<p>
"Addressing burnout at the clinic and organization level is the primary way to increase well-being and professional satisfaction for physicians," says Pratima Sharma, MD, executive medical director at EvergreenHealth Primary Care.
</p>
<p>
EvergreenHealth is one of the Washington health care organizations that took part in the American Medical Association's Wellness Practice Transformation Initiative, which tasks participants with implementing and examining the impact of workflow redesign interventions. The initiative is funded by a grant from The Physicians Foundation.
</p>
<p>
After implementing pre-visit planning at the EvergreenHealth Redmond Primary Care Clinic, there was a measurable increase in care team efficiency. In fact, 92.8% of physicians in the intervention group reported that the degree to which "my care team works efficiently together" was "optimal" or "good" compared to their baseline of 77% and compared to the control groups' steady average of 62% pre- and post-survey results. Notably, the proportion of physicians in the intervention group that reported a high degree of care team efficiency was nearly 30% higher than the AMA national benchmark.
</p>
<p>
Physicians in the intervention group also saw an increase in time spent on direct patient care and a decrease in time spent on indirect patient care as compared to the control group. Time spent on indirect patient care in the intervention group was less than that of the AMA national benchmark.
</p>
<p>
The results also showed that burnout was less severe in the intervention group, although the proportion of people experiencing burnout had risen.
</p>
<p>
"What this meant for the physicians is that there was an increased level of engagement, which positively impacted our staff and patient experience," says Besty Hail, executive director of primary care at EvergreenHealth Primary Care Administration.
</p>
<p>
"Participating in the wellness PTI was one of several ways that EvergreenHealth demonstrated its commitment to improving wellness," says Dr. Sharma. The organization sought feedback from its physicians and advanced practice providers through monthly town-hall style meetings as well as their regularly scheduled meetings. "Common themes were the need for increased administrative support for prescription refills and inbox management," Dr. Sharma says. "We are launching new pilots to address these concerns."
</p>
<p>
The WSMA Foundation and the AMA continue to work on several fronts to address the physician burnout crisis, which has only been exacerbated by the pandemic. Through research, collaboration, advocacy, and leadership, we are working to center the patient-physician relationship and to make physician burnout a thing of the past.
</p>
</div> | 5/2/2022 12:11:14 PM | 5/2/2022 12:08:27 PM | 5/2/2022 12:00:00 AM |
| improving_care_for_underserved_patients | Improving Care for Underserved Patients | WSMA_Reports | Shared_Content/News/Latest_News/2022/improving_care_for_underserved_patients | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/march-april-2022-reports-cover-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports March/April 2022" /></div>
<h5>March 8, 2022</h5>
<h2>Improving Care for Underserved Patients</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
By any measure, the Puget Sound region would be considered one of the friendliest places in the U.S. for members of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community. Yet when Amish Dave, MD, MPH, moved here from Boston after training in Chicago and the Bay Area, he was surprised at what he found.
</p>
<p>
"This is a super progressive place, but medical care for LGBTQIA patients is still lacking compared to other places in the country," says Dr. Dave, a rheumatologist at Virginia Mason Franciscan Health. "When I first moved here, not every primary care physician knew how to prescribe PrEP. That's not an issue I had seen in the Bay Area or Boston. Something that has such great efficacy was not regularly being discussed."
</p>
<p>
Pre-exposure prophylaxis, or PrEP, is a drug regimen that has been proven to reduce the risk of HIV transmission from sex by 99%. As such, PrEP has become a cornerstone for primary care for many in the LGBTQIA community.
</p>
<p>
Dr. Dave's experience underscores one of the ongoing challenges in medical care: addressing the needs of underserved patients. Despite the progress made so far, race, ethnicity language, and sexual identity can all still serve as barriers to care, no matter how inadvertently.
</p>
<h3>Unnecessary barriers</h3>
<p>
For some patients at Virginia Mason, getting PrEP was a cumbersome process. "People were being referred to the infectious disease department," says Dr. Dave. "It was unfair to them to pay two copays and wait a long time to get their prescription."
</p>
<p>
Dr. Dave embarked on a campaign more than five years ago to help educate his colleagues about PrEP and more generally the importance of understanding their patients' sexual history. "We formed a task force and did a road show across the campuses," he recalls. What conversations with physicians and clinicians revealed was that many didn't feel comfortable taking a patient's sexual history. As a result, "they were missing opportunities to do appropriate screenings for things that the queer community might be at higher risk for, such as certain cancers or depression."
</p>
<p>
"We talked about the importance of taking a sexual history, the importance of PrEP, the importance of templates," says Dr. Dave. The upshot was a process that eliminated the barriers that were sometimes in place before for LGBTQIA patients.
</p>
<p>
Unfortunately, such barriers are hardly uncommon for patients in underserved populations. Sometimes they are actually part and parcel of standard treatment regimens.
</p>
<h3>Outdated race-based standards of care</h3>
<p>
For several years, Mabel Bodell, MD, a nephrologist at Confluence Health in Wenatchee, regularly treated a patient who identified as African American. "She's very savvy about her numbers," Dr. Bodell says. "She always looks at her creatinine levels and her GFR."
</p>
<p>
The patient regularly asked Dr. Bodell why test results were interpreted differently for white patients and African American patients. "I would always answer, 'Because there were differences in the original study'" upon which the treatment standards were based.
</p>
<p>
The test in question, which measures estimated glomerular filtration rate, or eGFR, has been widely used to determine whether a patient is a candidate for a kidney transplant. A healthy patient has an eGFR of 60. Patients with an eGFR of 20 or lower are transplant candidates.
</p>
<p>
But for years, that was true only if they were white. The original study in 1999 misinterpreted higher creatinine levels in Black patients as a sign that they had a higher muscle mass. As a result, the test multiplied Black patients' eGFR numbers by 1.2. That meant Black patients had to wait longer for a kidney transplant, even though they were far more likely to suffer from serious kidney disease.
</p>
<p>
About a year ago, Dr. Bodell's patient came to back to her office with a surprise. She had taken a DNA test and learned that she was more than 50% white. Suddenly, the patient qualified for a kidney transplant after years of being told she did not, solely on the basis of the race-based standard.
</p>
<p>
"It was really hard for me to explain," said Dr. Bodell. "Maybe this race-based stuff should not be in our calculations. Examples like that make you think about all of those formulas that include race. Maybe they are harming more patients than helping them."
</p>
<p>
The conversation with her patient crystalized a conversation that was happening within Confluence. "There were a lot of people internally already asking questions, knowing that African Americans are more likely than white Americans to have kidney failure and higher rates of end-stage kidney disease but less likely to get a kidney transplant," said Dr. Bodell, who is a member of the Health Equity, Diversity and Inclusion Council at Confluence. "We took our time to reassure ourselves it was the right thing to do." The review process included a wide range of internal partners, from risk management to the laboratory medical directory.
</p>
<p>
Ultimately, Confluence eliminated the race-based standard in July of 2021. The American Society of Nephrology recommended eliminating the standard last September.
</p>
<h3>The role of physician champions</h3>
<p>
There are plenty of other examples of disparities affecting care. Endometrial cancer is one of the most common gynecological cancers, with a high survival rate. But the rate of survival for Black women is much lower. While a series of issues contribute to the reduced survival rate, one of them is the diagnostic test used to determine whether a biopsy is needed.
</p>
<p>
According to a study led by Kemi Doll, MD, a gynecologic oncologist with the University of Washington School of Medicine, the use of transvaginal ultrasound to determine whether a biopsy was warranted was four times more likely to miss endometrial cancer in Black women than in white women. That's because Black women are more likely to have fibroids and other non-endometrial growths, which lead to false negative results.
</p>
<p>
Dr. Doll's analysis of her research was published in the August 2021 issue of JAMA Oncology, and the study has widely been hailed as groundbreaking advancement in addressing endometrial cancer disparities.
</p>
<p>
While change is difficult, it can be accomplished. What it takes is leadership from physicians to advocate for improvement. "Having a champion or a series of champions is important," says Dr. Dave. "Dedicating time for people to teach people about it is very important, and that lies at the system level."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
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<em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
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</div> | 3/8/2022 10:56:01 AM | 3/3/2022 1:10:29 PM | 3/8/2022 12:00:00 AM |
| doctors_making_a_difference_mary_beth_bennett_md | Doctors Making a Difference: Mary Beth Bennett, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors_making_a_difference_mary_beth_bennett_md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/dmd-website-image-bennett-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Mary Beth Bennett, MD" /></div>
<h5>March 4, 2022</h5>
<h2>Doctors Making a Difference: Mary Beth Bennett, MD</h2>
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Mary Beth Bennett, MD, a first-year pediatric resident in Seattle, says it was opposite extremes of weathera widely reported severe winter storm that left her family and thousands of others without power and enduring freezing temperatures for days in Texas, followed by last summer's record-setting heat wave after relocating to Seattlethat inspired her to sound the alarm on the connection between climate change and public health. As a member of the Washington Physicians for Social Responsibility's Climate and Health Task Force, Dr. Bennett is helping to advocate for policies such as building electrification and more funding for climate change mitigation and public transportation. Here, she talks with <em>WSMA Reports</em> about these efforts and how physicians can help patients connect the dots between climate change and their personal health.
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<strong><em>WSMA Reports:</em> Last summer you wrote a guest column in the Seattle publication <em>The Stranger</em> urging everyone to treat climate change as a public health emergency. You advocate for transitioning away from the use of natural gas for cooking and heating in homes; why is that such an important component of how climate change and public health intersect?</strong>
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<em>Dr. Bennett:</em> Kids who grow up in homes with gas stoves are more likely to develop asthma and experience wheezing related to asthma, which can mean a trip to the emergency room or even worse. And we see from new data that our gas-powered homes and buildings are a major source of air pollution in cities. I can't think of a clearer example of a policy win-win than this: Reduced pollution from gas-powered appliances will lead to healthier cities and families, while also addressing global warming through reduced fracking.
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<strong>The extreme heat we saw last summer in the Pacific Northwest is a tangible effect of climate change. What are some other less-obvious public health effects that physicians should be aware of? </strong>
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Vector-borne illnesses are increasing, so diseases that were previously seen almost exclusively in tropical climates are now hitting communities thousands of miles away. We're also seeing increased rates of depression caused by fears about the climate. Related to this is the fact that the U.S. birth rate has declined six years in a row: A quarter of childless adults cite worries about the climate as a key factor in their decision not to have children (Morning Consult, 2020).
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<strong>What is the Washington Physicians for Social Responsibility's Climate and Health Task Force working on in terms of policy or public health messaging?</strong>
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WPSR's Climate and Health Task Force is currently advocating for policies related to building electrification, increased investment in public transportation, enhanced funding for climate change mitigation, and adaptation efforts in low-income communities. We approach this advocacy with a specific focus on health equity, since we know the people most likely to suffer the harmful effects of climate change include historically marginalized groups.
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<strong>How can physicians talk with their patients about climate change and how it relates to their personal/family health?</strong>
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It's a great question because doctors already have too much to cover in too little time during primary care visits. Step one is for doctors to educate themselves better on how climate issues affect healththere's so much data out there that experienced and newer doctors didn't learn in medical school.
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Step two is to look for opportunities to link climate issues to health situations that patients are currently facing. For example, when I'm talking with a family whose child has asthma, I'm careful to mention all the potential irritants and exposures that could trigger wheezing, including smoke from cigarettes and fumes from a cooking with a gas stove.
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Outside of patient visits, I think we should use our platform as medical professionals to advocate for better climate policies to improve health for entire communities. Patients rely on us to tell them how to be healthier and we're not doing our jobs if we're unaware of how the climate affects health.
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<strong>Are there ways health care organizations and practices can support climate change goals?</strong>
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<p>Yes, we should be leaders in reducing energy waste, in incentivizing employees to use public transit, and in composting and recycling. It's important for every organization with a public health mission to be adopting practices that reduce emissions. "Do no harm" is an ethos that we should apply not only to patients but to the larger ecosystem in which our health
care organizations exist.</p>
<p><em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em></p>
</div> | 3/4/2022 11:43:43 AM | 3/3/2022 12:35:43 PM | 3/4/2022 12:00:00 AM |