Decades of job loss, the opioid crisis, and the current pandemic have all shaken the already tenuous health care system of rural America. This is happening in the wealthiest nation on Earth, with a GDP of over 20 trillion dollars. Why is this happening? And how can the medical education system better prepare future physicians to meet rural patients’ needs?
Despite our country’s …
The rural health care crisis and medical education
In the past year, the United States has faced compounding challenges as it struggled to control the COVID-19 pandemic and grappled with significant civil unrest. The American pandemic response has been primarily determined by the guidance—or lack thereof—of elected officials and enacted policies at the local, state, and federal levels. Now, with the development of vaccines to combat COVID-19, the interconnectedness of civic health and public health is increasingly clear. …
Voting and vaccination are 2 sides of the same coin
There is a strong push for health care to move towards greater value-based care (VBC) arrangements. The prospect of VBC holds the opportunity to re-create partnerships designed to increase health care sustainability by strategically improving processes, care delivery, and patient outcomes to achieve higher quality output at a decreased cost. Furthermore, the held potential will not be optimized until providers, payers, patients, and communities are connected in this common goal …
Why health care fails to deliver better value in patient care
As a foreign medical graduate and a multiple-time career changer — from being a doctor to a hospital process improvement and leadership coach to a business professor to a transformational career coach for female physicians — I have closely examined the U.S. health care industry from various lenses.
The one thing that stands out for me is the us vs. them attitude. Us being physicians and them being administrators.
I have seen …
Stop the us vs. them mentality in medicine
The initial wave of vaccinations is underway, but let’s not forget that the COVID-19 pandemic has exacerbated the epidemic of precarious access to health care, an issue that the U.S. uniquely faces in the developed world. In 2018, a survey found that 44% would skip a doctor’s visit because they could not afford it. 33% reported delaying care for them …
Confronting the financial barriers to health care has to be a centerpiece of any COVID-19 strategy
The health care circumstances of President Biden’s ascent to the Oval Office are unprecedented. He is inheriting responsibility for the American response to a pandemic that has taken more than 400,000 American lives and will take office just months after the Supreme Court heard a case challenging the constitutionality of the Affordable Care Act, which if repealed will threaten the insurance status of tens of …
How President Biden’s quest for a public option mirrors LBJ’s passage of Medicare and Medicaid
To get to my primary care clinic in Richmond, VA, my patients and I must walk past the Confederacy’s White House. Our emergency room sits in its shadow. Each day, I walk past the three-story white building surrounded by my hospital on three sides. Renamed the American Civil War Museum, it is now repurposed to sterilize hospital staff masks. The faded letters of a long-removed sign on the front read …
Medicine in the shadow of the Confederacy
The Wall Street Journal’s decision to publish an attack on Dr. Jill Biden’s right to be called “doctor” has appropriately unleashed a firestorm. According to Joseph Epstein, the editorial’s author, Biden should drop the title because she isn’t what people often think of when they hear the word “doctor,” namely a physician. For Epstein, ‘Dr. Jill Biden’ sounds and feels fraudulent, not to …
There’s a doctor in the house, and maybe also a physician: a view from osteopathic medicine
My first clinical rotation as a third-year medical student was in orthopedics. I remember the excitement of being scrubbed into the OR, with the gloried task of suctioning while the fellows did the real work. About 30 minutes into the surgery, when things were getting underway, a male physician scrubbed in and took the tool away from me — I grabbed it back, letting him know I had the …
As both patients and physicians, women face discrimination
This week at work, I had a patient in the hospital who had been through a pretty challenging illness, and he was going to have to be discharged to a skilled nursing facility (SNF) to rehab for a few weeks. Sadly, SNFs in my area do not currently allow any visitors due to the pandemic. The patient is very close to his daughter, who lives out of state, and she …
A real-life example of irrational health care spending
I am at a loss. While trying to explain the events to my children since January 6, I feel profound sadness and fear. Our country is built on freedom, yet the latest in a parade of crisis’ is being used by those in power to remove our freedoms at an alarming pace and divide our country further.
Less than one percent of the people who went to Washington, DC for a …
The answer to hate speech or false speech is not censorship
Sometimes structural racism surfaces in a way that even those of us who would like to be “color-blind” cannot help but see.
In the spring of 2020, the video-recorded death of George Floyd (who was Black) at the hands of a law enforcement officer (who was white) brought millions of witnesses to the kind of hostility that is all-too-familiar to individuals of color. Individuals, many non-white, took to our nation’s capital …
It is not enough to say we are anti-racist. We must address glaring disparities in treatment.
Disparities in rural health care have been well established with respect to socioeconomic status, race, and geography. COVID-19 brought these disparities to the surface within most rural communities in the United States, highlighting the limited access to health care specialists and subspecialists.
As an otolaryngologist, I have had the privilege and unique opportunity of serving two different communities: Chicago’s city dwellers and …
Why states need to develop rural health outreach programs
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That hospitals in South Carolina (SC) began COVID-19 vaccinations in mid-December of 2020 is a marvel of human ingenuity, resilience, and courage. Tragically, however, more than 5,000 confirmed South Carolinian lives have now been lost due to COVID-19. Although SC is above the national average for vaccination, many say the pace is too slow. …
Maximizing COVID-19 vaccine equity and minimizing death in South Carolina and beyond
In recent years, the divide between rural and urban areas of the United States has become more pronounced, with sharply divergent views on both social and economic policies. The results of this latest election show starkly that the divide persists, and indicate that the institutions that shape our nation are not successfully representing all portions of society.
One of those institutions appears to be medicine. A sign of this is how the public …
Medicine is failing rural Americans
As communities of color continue to be disproportionately decimated by COVID-19 and the brutal impact of racism and other longstanding systemic inequalities, academic medicine finds itself at a critical inflection point in defining its role in addressing social injustices not only for its patients but also for its academic workforce. In the aftermath of George Floyd’s killing, many medical schools and teaching hospitals released statements condemning racial injustice and vowed …
The COVID-19 vaccine has failed.
I don’t mean that the vaccine itself doesn’t work—far from it. I mean the ineffective way such an important lifesaving, pandemic-ending vaccine is being rolled out. The slovenly effort is putting the lives of millions of Americans at risk. At the vaccine’s current injection rates, or even if they got it to 1 million a day, it’ll still take a year before all Americans are fully …
The failure of COVID-19 vaccine distribution confirms government incompetence
The new American Medical Association policy recognizing racism as a public health threat and providing an anti-racist approach to equitable care will have no effectiveness unless health care organizations get their own houses in order and actively do anti-racism work in their own institutions.
Although I’m not a health care provider, as a health care communicator whose role is dedicated to diversity, equity, and inclusion, I sit in …
Health care organizations: Clean up your house first, then you can tackle racism in patient care
Though pushed to the back-burner by the never-ending orange election drama, the Supreme Court, with its significant conservative majority earned against the run of play, (to borrow a metaphor from sport) is one decision away from potential political irrelevance. Is there a way forward for the Supreme Court? Conservative hypocrisy and liberal outrage at the recent Republican machinations to pack the court with conservative jurists out of step with …
A call schedule to fix the Supreme Court
In his seminal 1977 Science magazine article, “The Need for a New Medical Model: A Challenge for Biomedicine,” Dr. George Engel outlined the biomedical model’s limitations and proposed a new model, which he termed the biopsychosocial model. The biopsychosocial approach systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and healthcare delivery. In many ways, this approach sounds so intuitive …
Health care is making progress on the “social” in the biopsychosocial model
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