Joshua Freeman – Designing a Fair & Equitable Healthcare System

Play

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer.  He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions.

This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered.

Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS.

Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

This interview was lightly edited for clarity.

How to Prevent Burnout with Diane Shannon & Paul DeChant

Play

This week, in the second of our series about physician burnout, our guests focus on solutions. Diane Shannon and Paul DeChant, both physicians, join us to talk about their recent book Preventing Physician Burnout, Curing the Chaos and Returning Joy to the Practice of Medicine.

Diane and Paul talk about their experiences with burnout and how they came to work on this project together, how they contend that organizational and structural factors are more important than individual factors in driving burnout, how compensation and intangible rewards can reduce burnout, how leadership in healthcare can address the epidemic of burnout. We also talk about how they have come to believe that the LEAN principles, most especially the pillar of respect for people, is key in transforming healthcare organizations into places where primary care physicians can thrive, why change is so difficult, and some other resources that can help.

Diane Shannon is a general internist who left clinical medicine due to burnout and turned to a career in medical writing and public health. Paul DeChant is a family physician and experienced healthcare executive who has previously worked in organizations such as The Paulo Alto Medical Foundation, Sutter Gould Medical Foundation, and is now a senior advisor with Simpler Healthcare.

If you’ve missed it, have a listen to the first in our burnout series with Colin West, researcher at Mayo Clinic who has done foundational research on burnout and physician well-being. Please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Colin West – The Evidence Behind Burnout

Play

This week, we are joined by Colin West, professor of Medicine, Biostatistics and Medical Education at Mayo Clinic. Colin’s research focuses primarily on physician well-being, evidence based medicine and medical education. We talk today about his extensive research in the area of physician well-being and burnout.

We talk about what researchers mean precisely by burnout and how it is measured, what the implications are for patient care and quality of care that the primary care workforce is increasingly burdened with burnout, and his findings in an important 2016 study that physicians with significant burnout scores cut back on patient care over time. We also talk about the EMR, and what specific features of EMR most correlate with user dissatisfaction. Lastly, we talk about what questions he most wants to answer in his field. This is part 1 of a 2-part series on burnout. Today we focus on the evidence behind burnout, and in part 2 we will talk about what can be done to alleviate the problem.

If you like the show, please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

David Himmelstein – Blending Research & Advocacy

Play

Our guest this week is David Himmelstein. He is a distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School. He has served as chief of the division of social and community medicine at Cambridge Hospital.

David has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice. He is also a co-founder of Physicians for a National Health Program and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler.

We talk about how he got his start in research by looking at patient dumping practices as a trainee, and how he views advocacy as a natural outgrowth of his research findings. We also talk about his work as a leader in advocacy for a national health insurance program and talk about a few common arguments against such policy changes. Lastly, he gives some advice for folks early in their career who would like to follow his model of research blended with advocacy.

If you like the show, please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Reprise – David Buck, Caring for High-Need, High-Cost Patients

Play

This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.

You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Lauren A Taylor – Integration of Healthcare and Social Services

Play

Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society.

We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US.  We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right.

Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School.

If you like the show, please subscribe on our website www.rospod.org, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Journal Club – How do Pregnant Women Use Quality Measures when Choosing Their Obstetric Provider?

Play

Today we’re discussing a paper published in the January 2017 issue of Birth titled: How do pregnant women use quality measures when choosing their obstetric provider? by Rebecca A. Gourevitch MS, Ateev Mehrotra MD, MPH, Grace Galvin MPH, Melinda Karp MBA, Avery Plough BA, Neel T. Shah MD, MPP.

The researchers utilized an online forum for pregnant women, Ovia Pregnancy to survey women about how and why they chose their obstetric provider. Interestingly, they found that most women did not utilize quality measures such as c-section rate or obstetric infection rates when choosing a provider. These fascinating findings were widely covered in the media and led to a great discussion. Please have a listen!

Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in journal clubs and who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening!