Ledes from the Land of Enchantment

Readers and Tweeters See Ways to Shore Up Primary Care

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Empowering PAs

The article “Primary Care Disrupted: Will the Doctor See You Now? The Health System’s Changing Landscape” (June 28) devalues a key solution critical to meeting our nation’s health care needs: PAs (physician associates/physician assistants).

Our country’s more than 168,300 PAs provide critical care to patients in all communities, including those where physicians are unable to meet patient demand. In fact, a recent survey conducted by the Harris Poll found that most adults (68%) have seen a PA and nearly 6 in 10 have seen the same PA more than once. Of those surveyed, 93% of adults agree that PAs add value to health care teams, and 90% said PAs increase their access to care and make it easier to get an appointment when they need it. These findings are consistent with the PA approach to health care: to transform health through patient-centered, team-based practice in order to help achieve greater health equity in underserved communities.

As the physician shortage worsens, it is critical that lawmakers in states and the federal government enact policies that ensure PAs are able to practice and provide care to the fullest extent of their education and training. The future of our nation’s health care system depends upon the PA workforce being fully empowered to be a part of the patient-focused solution.

— Lisa M. Gables, CEO of the American Academy of Physician Associates, Alexandria, Virginia

On Twitter, Ellen Andrews, the executive director of the Connecticut Health Policy Project, had this to say:

Primary care needs to change, embrace new ways of connecting to patients, to expand capacity and reach patients who want a new, more convenient model — Will the Doctor See You Now? The Health System’s Changing Landscape https://t.co/JesousYv7R via @kffhealthnews

— Ellen Andrews (@cthealthnotes) June 28, 2023

— Ellen Andrews, Hamden, Connecticut

Osteopathic Physicians to the Rescue

I applaud the recent article “As Fewer MDs Practice Rural Primary Care, a Different Type of Doctor Helps Take Up the Slack” (June 6), which clearly illustrates how rural communities are facing a crisis in primary care coverage. Even before the covid-19 crisis, an additional 14,100 to 17,600 physicians were needed in nonmetropolitan areas for underserved populations to have the same access to care as their more urban counterparts.

This health care access disparity has real-world health implications. A study from the Centers for Disease Control and Prevention showed rates for the 10 leading causes of death were higher in rural areas than in urban areas, with the greatest difference in rates for deaths due to heart disease, cancer, and chronic lower respiratory disease.

Fortunately, osteopathic medical education is poised and prepared to play a major role in meeting this challenge. As we celebrate its 125th anniversary this week, the American Association of Colleges of Osteopathic Medicine is proud to represent 40 colleges of osteopathic medicine (COMs) at 64 teaching locations in 35 states. In fact, the number of colleges has doubled since 2000, and today, more than 35,000 future physicians — 25% of all U.S. medical students — are being educated at our COMs. That number is projected to rise to 1 in 3 medical students by 2030.

Moreover, we are training our future physicians where patients need them the most. Sixty percent of our COMs are located in a federally designated Health Professional Shortage Area, and 64% require clinical rotations in rural and underserved communities. The historical connection between the osteopathic philosophy of holistic care and prevention and primary care is making a real difference, especially in states where COMs have been training physicians for decades.

For example, according to a recent study by the National Center for the Analysis of Healthcare Data, just since 1985 the Michigan State University College of Osteopathic Medicine has graduated 6,580 DOs who are still in active practice, and 73% of these alumni (4,776) currently practice in Michigan — more than any other medical school in the state can boast. Similarly, the West Virginia School of Osteopathic Medicine has more graduates practicing in the state and more graduates practicing in rural areas than the state’s other two medical schools combined.

And there are more COMs opening in underserved rural areas like Montana, Kansas, and Tennessee.

Osteopathic medicine is now firmly embedded in the American medical system and more sought out than ever before by both patients and prospective students. Just as we have done for 125 years, AACOM and the osteopathic medical education community stand ready to work with our peers to overcome the health care challenges our country does and will face.

— Robert Cain, president and CEO of AACOM, Bethesda, Maryland

Elsa Pearson Sites, who serves as policy director for the Partnered Evidence-based Policy Resource Center for the Department of Veterans Affairs at the VA Boston Healthcare System, weighed in with this tweet:

I love that DOs are getting the spotlight but how @KFFHealthNews is framing them as so different or novel is concerning. They don’t need any disclaimers: they’re physicians. (Dr. de Regnier sounds like a gold standard doc!) https://t.co/S9fIeLrpfw

— Elsa Pearson Sites (@epearsonbusph) June 7, 2023

— Elsa Pearson Sites, Boston

Who’s Really in Charge of Steering Opioid Settlement Cash?

In the article “Payback: Tracking Opioid Cash: Meet the People Deciding How to Spend $50 Billion in Opioid Settlement Cash” (July 10), Colorado’s settlement line states that the statewide council controls 80% of the state’s settlement. While this may be technically true, it is not so in practice.

In practice, the regional boards have complete autonomy in how their money is spent within a menu of virtually all possible opioid-related spending choices. Developing this menu was part of the Colorado Opioid Abatement Council’s mandate, but it is too broad to actually limit regional spending. Thus, the COAC oversees 10% of the state’s money and the attorney general’s office and board oversee 10% of the state’s money, but the other 60% is regional, and most of the remaining 20% actually ends up in regional hands because many municipalities hand their funds over to the regional board. So these regional boards actually oversee more than 70% of the state’s funding.

It seems like, for our state, the article significantly overstates the role of the statewide boards. While they are very important, they do not actually make decisions on anywhere near 80% of our state’s settlement money. I wonder whether there are similar situations in other states?

— JK Costello, Steadman Group, Denver

A patient advocate in Washington and a podcaster in Illinois tweeted their reactions:

📣 READ! Where is the lived experience and representative populations making decisions where the $$ will go- ‘Meet the People Deciding How to Spend $50 Billion in Opioid Settlement Cash’ https://t.co/YjENe8EM5l via @kffhealthnews

— Janice Tufte (@Hassanah2017) July 11, 2023

— Janice Tufte, Seattle

Meet the People Deciding How to Spend $50 Billion in Opioid Settlement CashVery cool interactive article. In Illinois the advisory council has 12% representing lived or shared experience, 31% representing public health and human serviceshttps://t.co/f7VL0ibcpn

— Jonathan Singer 🎙️ (@socworkpodcast) July 11, 2023

— Jonathan Singer, Evanston, Illinois

A Handwritten Appeal to Keep Writing

I am writing to you in regard to a past article in the Senior Scene paper (“Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges,” Nov. 21) about Medicare audits by Fred Schulte and Holly K. Hacker.

More articles and audits need to be done to protect and secure traditional Medicare. Medicare Advantage is very aggressive and costly to Medicare.

Your article was well-written and we need more coverage on this topic. Please keep writing.

— Rosemarie Hughes, Hazleton, Pennsylvania

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