Health Care Reform and Medical School: A Disconnect?

In many previous posts, I’ve written about the need to increase the number of primary care providers if we are to increase access and create a medical home for as many people as possible.

The recent passage of health care reform which intends to provide health insurance for millions of previously uninsured Americans has only accelerated the need to rapidly increase the primary provider pool. And as the Massachusetts reform project proved, if we do not, our Emergency Departments, already over-crowded, will see a two-fold increase in their volumes.

In a recent newspaper article, the significance of this change was highlighted by a recent study ranking medical schools on their “social mission.” Under the study’s definition, each medical school was measured for its ability to turn out an “adequate number” of primary care doctors, including family practitioners and general pediatricians. The study also looked at the number of graduates who worked in underserved areas of the country, including rural clinics and inner-city hospitals. And finally, the study considered the percentage of graduates who were minorities, including African-American, Hispanic, or American Indian.

Using these factors, the 141 physician training medical schools were ranked and overall demonstrated that primary care graduates are not the focus of many of the schools at present. Unfortunately, some of the best medical schools ranked by U.S. News and World Reportannually rank in the 20 schools with the lowest social mission scores.

Hopefully, this study, which undoubtedly will result in some pushback, will stimulate a robust dialogue among the U.S. medical schools, resulting in strategies which will accelerate the number of graduates pursuing primary care careers.

Until this occurs, we will need to support or increase the training and use of nurse practitioners, physician assistants and midwives. Some physicians see these providers as “intruders” on their practices, but this is not the case. Hopefully the combination of more primary care physicians with the other primary care providers I mentioned will minimize the provider shortage that may result from health care reform, making the Massachusetts experience from becoming the national experience.

The Repetitious Cry: Don’t Wait for the Cavalry

Recently, I heard a local business owner who had been affected by the BP oil spill in the Gulf repeatedly state on a national TV interview that the government’s intervention to address this disaster has been minimal, disorganized and ineffective, often hampering the positive actions of the local inhabitants and volunteers. In essence, he was giving the same advice not only CHRISTUS Health, but others have given when facing disastrous events: Do not wait for the cavalry.

We first heard this cry when we visited New Orleans in 2007 on one of our learning journeys as part of Futures Task Force II. We heard over and over again from the leaders of a local hospital system that they got little helpful assistance in facing the significant negative results of the storm, including the large number of critically ill patients who needed to be evacuated. They, appropriately so, decided they needed to take control of the recovery plan and implement it themselves.

CHRISTUS Health had a similar experience in the Houston flood in 2004, Hurricane Rita in 2006 and Hurricanes Gustav and Ike in 2009. Our plans for evacuating patients, obtaining generators and garnering emergency supplies worked well because we had plans, teams and strategic relationships in place in the affected areas. Local systems that are efficient and effective appear to be easier for us to implement than the government, so we first and foremost rely on our resources and planning.

And unfortunately—but not unexpectedly—we experienced the same in Haiti. To overcome the lack of governmental plans, scores of volunteers have, and continue, to provide the most needed medical care and recovery efforts for those in need.

So what does this tell us as leaders in health care? First, it is imperative to have a well thought out and documented recovery plan in place. Second, these plans should be reviewed and drilled annually. Third, when disasters occur, get as much of the plan implemented as possible before the government intervenes. And fourth, don’t ever forget the leadership imperative: do not wait for the cavalry!

A Call for Help for those Affected by Hurricane Alex

Over the Fourth of July weekend, the remnants of Hurricane Alex struck Northern Mexico, dropping torrents of rain in what President Felipe Calderón called the worst storm “in recent memory” in the region. The storms left thousands of residents in the Monterrey area homeless and without water, electricity and in need of massive assistance.

Multiple CHRISTUS facilities, including hospitals and Adelaida Lafon clinics in the CHRISTUS Muguerza region, located in Northern Mexico, were directly in the storm’s path. Luckily, these facilities sustained no major damage, but CHRISTUS Associates there confirm the reports of destruction and the need for emergency supplies and recovery assistance for many who suffered losses in the region.

In addition to the destruction of homes, major highways were washed away and utility lines, bridges and most anything that stood in the flood’s path were destroyed. There are critical shortages of potable water, medical supplies and funds to meet the growing needs of those in the storm’s path.

While it is difficult for people of compassion to hear about the suffering of others, we know that many will be moved to act in the face of such great tragedy. That is why the CHRISTUS family is working directly with our colleagues in Monterrey to assess their relief and recovery needs, solicit financial support on their behalf and transfer supplies to them. Time is of the essence, because we are well into Hurricane season, and fear that if other weather systems continue to develop, the needs of our colleagues will increase.

If you would like to make a financial contribution to support our family and friends in Monterrey, you can contribute to the CHRISTUS Health Foundation (with the request to use your donation for CHRISTUS Mexican relief efforts) by sending a check to P.O. Box 840973, Dallas, Texas 75284-0973. Donations made by check to the CHRISTUS Health Foundation are tax deductible.

CHRISTUS Muguerza operates six Adelaida Lafón clinics in Mexico which are located in desperately poor and underserved areas. They provide high-quality medical care to those whose health is at risk due to social, cultural and economic conditions, and charge very small fees for their services.

There are more than 350 families (1,400 individuals, many of whom are children), who are served by our two Adelaida Lafón clinics in Monterrey in need of the most basic health and safety necessities. We have received reports that although it is hard to estimate structural damages because these families lived in tin and cardboard houses, they clearly lost everything but the clothes on their backs.

To assist them as quickly as possible, we are asking for donations of needed items to be gathered. The materials management department in each hospital/facility of CHRISTUS will be gathering the supply donations at sites designated at each facility and coordinating their shipments to Mexico. The items needed to help the families include:
o Folding beds, mattresses or camps mattresses
o Sheets
o Light blankets
o Pillows
o Towels
o Basic underwear – kids and adults, both sex
o Shoes, all sizes
o Basic toiletry – Personal Hygiene Products
o Toothpaste
o Toothbrushes
o Soap and shampoo
o Anti- bacterial gel
o Disposable cups, plates and plastic cutlery
o Bottle water
o Diapers (infant, child and adult)
o Non-perishable food items
o Canned goods
o Powdered milk
o Baby Formula or adult nutrition drinks (Ensure)

Thank you for considering how you might help those we serve in Mexico. For photos of our relief efforts, please visit our Facebook page, and please keep our colleagues and those affected by the storms in your thoughts and prayers.

What’s Next in Health Care Reform?

Although many articles have been written on the implications of the health care reform legislation, I thought a recent brief summary by Bill Jessee, the president and CEO of the Medical Group Management Association, in the May/June issue of MGMA Connexion journal was most informative. (To read the article, you must subscribe to the journal.)

A good deal of the value of Dr. Jessee’s commentary lies in the fact that it is based on a presentation at the MGMA’s fall board meeting by Lynn Nicholas, president and CEO of the Massachusetts Hospital Association and Alice Coombs, MD, president-elect of the Massachusetts Medical Society. Because the health care reform implemented in Massachusetts was often cited as a template for the federal plan, Dr. Jessee felt that examining what happened in Massachusetts after their 2006 reform bill passed could be instructive.

In the article, five key learning and potential implications of the national reform package were articulated. In summary, it appears that the following occurred thus far in Massachusetts:
1. Costs have not been controlled
2. The individual mandate worked
3. Cooperation between hospital leaders and physicians has been enhanced.
4. Consolidation and integration of practices is accelerating
5. Primary care entry access points were limited
6. Emergency Room visits increased

Hopefully, the Obama Administration will continue to observe and learn from the Massachusetts experience and incorporate these learnings into positive implementation strategies and tactics.

Perhaps the most important role of leaders

Although CEOs of organizations, including health care, have a myriad of important roles and responsibilities, none might be more important for the stability and growth of the company than succession.

With that in mind, I have been working with my senior leadership team and our board of directors to plan a smooth and effective transition process. This has been officially announced and will culminate for me after 12 years of service on June 30, 2011, one year from now.

The drivers for this decision and the timing of such are multiple. These include, first and foremost, the strength of the senior leadership team, none of whom are planning to transition with me. In addition, the CHRISTUS system is extremely stable, good progress has been made in all four directions to excellence, and the five key strategies for the next decade have been formulated. And finally, our office has had strong focus for the last eleven years on leadership training and succession planning, all of which has been successful.

With regard to the latter, and after a nine-month search process, the CHRISTUS Health Board of Directors recently named Ernie Sadau, the current senior vice president and chief operating officer for CHRISTUS, as my successor.

As I journey through my “final” and exciting year, I will be, with the support of my wife and family, exploring other career opportunities since I am extremely healthy and energetic. Regardless of what doors might open, when I leave I will be filled with much peace knowing CHRISTUS Health is in the best of hands. This is what every great leader should be able to say when the door closes.