Medical News: Looking back on the past year, how has the healthcare system changed and what is the physician community doing to adapt to the changing environment?
LaTonia Sweet, MD: The cost of practicing medicine is becoming more and more expensive. Administrative costs to provide services and get reimbursed appear to be ever growing. Physicians are experts in clinical care but the increasing administrative role is not something that comes naturally to most. More and more physicians are seeking out employed positions rather than private practices.
Our traditional ways of doing things are not as effective as they once were. Physicians are learning to adapt to the new environment and to make the clinical voice heard. A physician’s voice is an important piece needed in the design, implementation and evaluation of healthcare policies. Physician voices ensure the best care is provided for individual patients as we as the population. The Kentucky Medical Association (KMA) is helping physicians be heard. I completed the KMA Kentucky Physicians Leadership Institute (KPLI) over the summer, which was a great experience. It gives physicians the tools to be more informed, improve their skills and be more effective at influencing healthcare policy.
MN: As a behavioral health specialist, what is the impact of the opioid epidemic on the practice of medicine?
LS: Many of us in Kentucky have been battling this problem since the 1990s. We have seen many children dealing with the aftermath of losing one or both parents, with grandparents becoming primary caregivers again. It has been a heart-breaking problem to watch. Medicaid did not have a substance use disorder benefit until a few years ago. Now, with it being a covered benefit, we are seeing patients get into care sooner but there is still much work to be done. We continue to have limited access to appropriate levels of care, as well as reimbursement issues.
In general medicine, we see many more medical complications at a younger age. Kentucky has the highest rate of Hepatitis C. Infective endocarditis is resulting in a large number of young people with heart problems. Another area people don’t think about is brain injuries, either traumatic or hypoxic, after overdose. These issues are burdening an already overwhelmed system.
Bringing attention to the issue is making healthcare systems and the public aware of the importance of behavioral health screening and interventions. Healthcare systems are beginning to understand the importance of behavioral health interventions. When implemented within any medical practice, they can improve patient health and outcomes. They can not only improve outcomes for those patients with substance use disorders but those with other health conditions as well.
MN: How is the physician community working to address the opioid epidemic?
LS: Many physicians are looking at potentially addictive medication in a different way. Most physicians always had the best of intentions and want to decrease suffering. We are now looking at who may be at increased risk of addiction with medications. Physician are beginning to screen patients for being at risk of substance use just like they do for diabetes. Physicians are starting to embed substance use treatment within their practices and treat it like any other chronic health condition. We have a long way to go but physicians care about people and are willing to change their practices to meet patient needs.
We are also educating ourselves, our patients and our lawmakers. There is a great deal of education on this subject happening through the KMA, both physician education and public education. For instance, at the KMA’s annual conference, physicians and policy makers had an open discussion about this issue. Policy makers were listening to physicians and physicians were supporting each other in an effort to tackle this problem. They are also educating the public by launching a public education initiative called “Know Your Meds” that highlights what individuals should do to help prevent opioid diversion.
MN: How has the practice of medicine changed over your career? How would you like to see it continue to change?
LS: Over the course of my career, there has been many changes. Two of the major factors are technology and care integration. Many specialists and primary care doctors would often treat patients in silos focusing on their areas of expertise, sometimes with very little information exchanged. That is finally changing. Efforts are being made to ensure care is improved by integrating all a patient’s information and care together. As a result, we are treating the whole patient and know how all the other providers are treating them as well. Being able to coordinate with other providers and make more informed decisions along with the patients themselves is improving their care.
Technology has improved to allow us to provide care quickly and efficiently to underserved areas through advances in telemedicine and electronic health records (EHRs). I am excited about the future and the benefits EHRs will bring in care. At this time, the technology is at an awkward stage. As physicians we can input data and use clinical decision supports but it is time consuming and the real benefit of entering all the data isn’t clearly being seen. As technology advances, I am hopeful they will become more intuitive, less burdensome and more physician and patient friendly. The systems will bring benefits of being able to focus specific resources/interventions to specific patients by identifying them with all this data BEFORE they actually get sick. They will help us keep people well not just treat disease. Once we see those benefits, all these years of growing pains and difficulty will be worth it.
MN: What are the biggest challenges to practicing medicine in Kentucky? What are the benefits?
LS: The lack of tort reform is a huge issue when trying to recruit physicians. Most all of our surrounding states have some sort of tort reform. In relation to that, Kentucky does not provide protections from discovery in legal cases for peer review. We are the ONLY state that does not have this basic patient safety protection. And, of course, Kentuckians tend to have a lot of medical issues. Unfortunately, we rank high in areas of cancer, smoking, hepatitis C, coronary artery disease, substance use and many other conditions. The continuing burdens placed on us to treat a host of conditions, including chronic conditions, is a national problem, but certainly intensified in a state like Kentucky where our population has a lot of chronic conditions.
The benefits? One word “Kentuckians.” In Kentucky there is a real sense of family in every aspect of life. People work hard and try to be helpful to one another. Communities come together to tackle problems. I am privileged to be part of a local home-grown initiative in Clark County to tackle the substance use epidemic. Many agencies are involved and people from all walks of life volunteer time to work on this problem within the community.
The physician community is also very close. Despite different specialties and types of work, colleagues come together to work on issues and provide support to one another here in Kentucky. Having a sense of community and knowing you have the support of others is absolutely the best benefit of practicing in Kentucky.
MN: What can Kentucky do to create a better environment for physicians?
LS: Tort reform is a big issue and Kentucky does lose a lot of very good physicians to other states that have this type of reform. This puts more strain on the existing physicians to care for those who need it most.
The other huge area is helping our patients become well, not just disease free. We know that healthcare is a small part of health with health behaviors, genetics and social/environmental factors making up the rest. There needs to be more emphasis on the social determinants of health in Kentucky. These include education, economic stability, access to food and social supports. It is difficult to attend to your health if you have inadequate housing or unemployed. Chronic stress related to unsafe environments and economic instability affects health especially children. Without transportation, patients cannot get to doctor appointments. And if you have to choose between feeding your children and picking up your medications, medications don’t get picked up. We need to start looking at these areas as a way to help decrease the healthcare spend in Kentucky and nationally. If these areas are actively addressed then people will be healthier and physicians will be happier.