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?

Mamata Majmundar, MD: Healthcare systems across the nation have redefined their approach providing care in order to sustain themselves financially, while taking advantage of the growing demand for healthcare services within their communities. Kentucky has embraced this trend.

Industry players had to rapidly pool resources to innovate and explore new care delivery models, while reevaluating existing relationships. All of this effort was taken in order to better meet the organizational need to optimize outcomes, at the same time balancing value and consumer convenience. However, an environment of change can bring about feelings of uncertainty at the individual and organizational level, thereby reducing effectiveness.

One consequence of the changing environment, physicians recognize success requires reframing their current role in the healthcare delivery model. This process will improve connection and personal significance in medicine, engendering a mindset of curiosity and creativity. The resulting innovation will enhance physician engagement and their ability to influence through leadership and advocacy.

MN: What is the role of the Lexington Fayette County Health Department in the healthcare system? How does the Health Department approach the delivery of healthcare?

MM: We focus on prevention through population-based health initiatives, providing services and interventions which protect entire populations from illness, disease and injury. To facilitate our goals and support the community, we utilize a variety of programs, resources and classes to improve the overall health character of Lexington Fayette County. The primary mission is to help Lexington be well, striving to make Lexington one of the healthiest communities in the nation.

The Health Department is more than a brick and mortar public health clinic for a single demographic group. There are outreach programs dealing with environmental health and health education, targeting the entire community. Using both on site and community venues, the Health Department presents a variety of healthcare classes, including topics on smoking cessation, child care, nutrition, diabetes, breastfeeding and improving physical activity.

Collaboration with the private and public sector enhances care coordination and services through shared expertise, identifying community wide health priorities and fostering changes in public health policy.

Using a team approach, the Health Department is continually focused on understanding the needs of our community and rethinking ways to improve our delivery of care. One example is the needle exchange program, started in 2015. The exchange program has expanded to include education and training on naloxone, and offers referral services for addiction treatment and testing for sexually transmitted infections.

MN: How does the Health Department address the social determinants of health with the patients served? How would you like to see the community address these issues?

MM: Studies have shown certain populations are at higher risk of poor health outcomes. Ninety percent of outcomes are based on social determinants of health and ten percent on healthcare delivery systems. The Health Department is continuously looking at practical ways to improve implementation of healthcare initiatives in order to enhance health potential, not just for the patient population regularly served, but also on a community wide platform.

Assessing the needs of the specific patient population requires routinely surveying our community, engaging with neighbors and expanding education. Outreach is critical and that is why the Health Department utilizes various locations and media outlets to disseminate information in order to enhance education for the patient population. Education is critical in addressing many of the healthcare concerns endemic with the patients regularly served.

Sometimes, the simplest measures will provide amazing results in community wide health markers. An example is the farmer’s market at both the Newtown Pike and Regency Road locations. These resources dramatically improve access to fresh fruits and vegetables for a wide segment of the community that might otherwise miss out on this opportunity. The Health Department is an active supporter for these activities.

The opportunity exists to build and strengthen community partnerships, education and engagement to ensure collaboration in promoting and protecting the community. It is easy to imagine more sidewalks and trails, improvement in air quality, healthy vending options, school gardens and 20-30 minutes of dedicated activity breaks for employees and students. Our community can drive policy changes to make Lexington one of the healthiest cities in the nation and the Health Department actively supports and motivates this initiative.

MN: How has the practice of medicine changed over your career? How would you like to see it continue to change?

MM: Some of the most profound changes are the result of technological advancements. These have rapidly evolved and been implemented in the practice of medicine. Physician white coat pockets now contain a smartphone with room to spare. Technology has improved the sharing of information, data collection for direct population interventions, dissemination of educational information within seconds to large groups of individuals, incorporation of algorithms to streamline processes and a move toward an evidence based approach to care.

There are many opportunities for continuing advancements of current modalities, such as improving our electronic medical records, incorporation of wearable devices to provide real time information, tailored motivational therapies for specific groups, widespread use of telemedicine, processes built into systems to decrease medical errors, as well as incorporating artificial and virtual intelligence. This is an exciting time in medicine. Our goal should be to proactively focus on the entire well-being of our patient through an integrative team based approach harnessing technology, innovation and data to provide coordinated care, while reducing cost and improving health outcomes as the primary objective.

MN: What are the biggest challenges to practicing medicine in Kentucky? What are the benefits?

MM: Kentucky is ranked number one in the nation for incidence of cancer and ranks higher than the nation in the rates of obesity, lack of physical activity and smoking. While daunting statistically, the Commonwealth can wisely invest in a variety of long term initiatives that will significantly improve these markers. It can be done. Focusing on improving modifiable behavioral risk factors such as tobacco use, poor diet and physical inactivity will increase the overall health of our community and enhance our economy.

Physicians are uniquely situated to influence and contribute to the development of policies to promote, protect and improve public health. We can promote availability of adequate resources to perform essential services using community partnerships, education and engagement, with the goal to promote, enhance, and protect the statewide health of our citizens. We can support identifiable policy initiatives that achieve measurable beneficial outcomes. Last but not least, as an informed citizen, knowledgeable in the field, doctors are the best resource to advocate before local and state organizations to support policy changes designed to improve the health of our citizens.

MN: What can Kentucky do to create a better environment for physicians?

MM: We need to support a social movement of change, focusing on reducing the incidence of burnout, especially among younger physicians. Over 50 percent of our US physician workforce is suffering. Think about that, one in two physicians. Burnout is associated with higher rates of turnover, increase in medical errors, diminished patient satisfaction and an inherent increase in healthcare costs. Burnout results from the current work paradigm and healthcare delivery system which does not promote a healthy environment for the healthcare professional. This is a public health issue which is hurting half of our patients.

It is important to acknowledge and focus on making practical, sustainable changes to regulations, an antiquated physician culture, a clinical environment which consumes its participants and a hierarchical healthcare system resistant to positive change. These factors directly influence the increasing incidence in burnout. Physicians went into medicine to take care of patients and we need policy changes to eliminate any barriers to providing quality direct patient care, without sacrificing the well-being of the doctor.