Molly Rutherford, MD, MPH
Owner, Bluegrass Family Wellness
President, Kentucky Academy of Family Physicians
Mentors: For direct primary care, it is Dr. Josh Umbehr of Atlas MD. For addiction treatment I have many mentors, and at Kentucky Academy of Family Physicians (KAFP), Dr. Lisa Corum has been very helpful in guiding me and encouraging me to speak up among many people who do not understand my practice model.
Dream job as a child: I wanted to be a veterinarian when I was a kid, but as a teenager I realized my true calling was medicine.
Book on nightstand: I just finished “A Common Struggle” by Patrick Kennedy (Blue Rider Press) and I’m about to start “Big Brother in the Exam Room” by Twila Brase (Beaver’s Pond Press).
Hobbies: Hanging out with family, Crossfit and yoga are my regular hobbies. I love hiking and try to plan a trip to a national park every couple of years for my family.
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?
Molly Rutherford, MD: There have been many changes in the healthcare system in the past year. There is no longer a penalty for individuals who choose not to have health insurance coverage, which has opened the market for some innovative catastrophic care options including Sedera health, which is like a Christian Health Sharing Ministry without the religious requirement.
Short term catastrophic plans are legal again also, and they last 12 to 36 months, providing another affordable, more tailored coverage option for individuals and families.
Association plans, for small businesses to band together and leverage with insurance companies, also became legal to provide employers with a more affordable way to offer healthcare coverage for employees.
The Affordable Care Act did not allow these options, and unfortunately led to limited, cost prohibitive options on the exchanges for individuals.
These changes, along with growing concern around the rising premiums and deductibles of available insurance plans, have led overall to more cost consciousness by individuals, which will lead to pressure on providers of healthcare services to increase price transparency.
More physicians are leaving the traditional system and starting direct care practices, which offer affordable, accessible care for individuals, families and employers.
“Healthcare Unmasked,” a film available on Amazon, highlights some affordable options for people who are struggling with the cost of their medical care and coverage.
MN: How has the practice of medicine changed over your career? How would you like to see it continue to change?
MR: The practice of medicine has become more about coding/billing and meeting government requirements than about caring for patients. The Affordable Care Act unintentionally worsened administrative burden for physicians.
As a result, more independent physicians have sold out to big health systems and hospitals, all which has a negative impact on patient care. We know that outcomes are better in small, independent practices.
After working as an employed physician for eight years and being frustrated with limited time with patients due to increased billing/coding and reporting tasks, I started my own direct primary care (DPC) practice where I’m able to spend as much time as needed with my patients.
DPC is affordable, accessible care that pairs perfectly with high deductible insurance, health sharing ministries, and short-term catastrophic plans. Many of my Medicare patients save enough money on medications dispensed in my office to pay for their monthly membership.
MN: What are the biggest challenges to practicing medicine in Kentucky?
MR: Kentucky is not generally considered a physician friendly state. Kentucky physicians have been blamed for the opioid epidemic, leading to many physicians to fear prescribing of various controlled substances.
Well-meaning legislation has had unintended consequences. Chronic pain patients are needlessly suffering because of fear, and frankly the legislative efforts, including House Bill 1, have not reduced overdose deaths.
During an opioid overdose epidemic, states should make every effort to expand access to effective treatments for substance use disorders, but Kentucky has instead made treating addiction more challenging. Kentucky passed legislation regulating prescribing of buprenorphine, which has discouraged many primary care physicians from treating addiction. No other chronic disease is regulated in this manner.
Finally, the previous governor passed an emergency regulation in 2014 that prohibits Medicaid patients from benefiting from affordable, accessible care such as direct primary care, and I’m not sure why this has not yet been reversed.
MN: What was the biggest success or accomplishment for the Kentucky Academy of Family Physicians (KAFP) this past year?
MR: KAFP’s biggest accomplishment recently, in my (slightly biased) opinion, was our work in drafting direct primary care legislation which was signed by Governor Matt Bevin in 2017. In 2018, KAFP received a grant to offer free training to physicians to learn more about addiction through a live course offered twice and an online course on Screening, Brief Intervention and Referral to Treatment (SBIRT).
MN: What is your top priority for the Kentucky Academy of Family Physicians in 2019?
MR: My top priority for KAFP in 2019 is to educate practicing physicians, students and residents on direct primary care. During a time of record burnout and even increased physician suicide, there is hope for primary care physicians who want to own and operate a practice. I will continue to encourage family physicians to treat addiction as well.
Here’s what I wrote for American Society of Addiction Medicine (ASAM) contest “Why I Treat Addiction:” http://bit.ly/2Fvuyri