2020 in hindsight: What we can learn

With 2020 behind us and the pandemic still raging, it is incumbent upon us to take a close look in the rear-view mirror. While the vaccines’ approval gives us all hope, the vaccination initiative’s slow rollout should worry us. Physicians, health care providers, nurses, and essential workers, and patients and family members have borne the brunt of the pandemic. On the last count, about 3,000 health care workers had lost their lives due to COVID-19. The toll that the pandemic is wrecking on the health care community’s emotional and mental health is only starting to become apparent. Health care systems, local, state, and federal governments have responded in different ways to ease the pandemic burden. While we can debate the level and adequacy of the response, we may have a larger problem on our hands if we fail to learn lessons and make the necessary changes going forward. I want to offer my perspective on the changes that physicians and health care providers should pursue that would allow us to emerge stronger.

Telehealth services have been a blessing to patients and health care providers during the ongoing pandemic. They have allowed patients to receive adequate and timely care. In the spring of 2020, led by the federal government, health care systems and insurance companies responded to ensure coverage for telehealth services. It would be unwise to regress to anything less than full and comprehensive telehealth coverage once the pandemic is under control. Also, telehealth services should continue to be paid for at par with in-person office visits. To improve the care of our patients, the barriers that impede telehealth services across state lines should be removed permanently. This would require an amendment to the malpractice policies and coverage in place.

State medical licensure boards have rightly amended the licensing requirements for retired physicians and waived fees for license renewals during the ongoing pandemic.  Medical professionals should ask for state medical boards to be reformed with a comprehensive overhaul of their rules. There is no reason why medical licenses, which cost thousands of dollars to maintain, should be renewed every two years. Licensure requirements ought to be refined so that licenses are valid for three to five years. In addition, state boards should be mandated to have a reciprocity agreement with other state boards, obviating providers’ need to maintain licensure in multiple states. This would go a long way in improving access to medical services across state lines. Lastly, the licensure fees should be examined closely, and every attempt should be made to decrease them, especially for license renewals.

Physicians and other health care providers were thrown in the line of fire with little guidance or support from organizations such as the Joint Commission or the Occupational Safety and Health Administration (OSHA).   The failure of these organizations to respond adequately in time of crisis should make us question the leadership or lack thereof. I believe many of these organizations are run like corporate identities, more interested in safeguarding their own interests rather than watching out for patients, physicians, and health care providers. The time is opportune to evaluate the structure, function, and role of various organizations such as the Joint Commission and OSHA, to name a few. I would propose that a national working group be established to look into the working, role, and makeup of such organizations. I would suggest that any organization dealing with physicians or health care should be led by providers who continue to spend at least 50 percent of their time in direct patient care activity. In addition, the structural makeup of these organizations should include direct representation and move away from the current “members only” club model. This will help bring much-needed perspective and improve the functioning and decision-making capacity of these organizations.

We must fundamentally ask ourselves whether health care is a national resource that needs to be shared, held accountable, and protected just like the army or navy, or rather is a business model that is too big to fail. Either way, we need to evaluate our performance and make the necessary change in regulatory and licensing agencies, hospitals, and health systems so that they become more receptive, nimble, and effective.  Health care in our country is far too complex for physicians to enact the changes themselves, and a good starting point would be to identify the things we should try to accomplish. We should take the opportunity in the midst of an unprecedented challenge and take steps to make the changes we wish to see.  If we fail to act now, we would be found struggling again when the next crisis emerges.

Manish Thapar is a gastroenterologist.

Image credit: Shutterstock.com

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