First Federally Qualified Health Clinic residency program opens in Kentucky, with hopes of bringing more rural doctors to state

Update, Aug. 8, 2024: Dr. Jerry Eddis has since resigned from the program. 

By Melissa Patrick
Kentucky Health News

Kentucky's first residency program operated by a Federally Qualified Health Center opened July 1 in Northeast Kentucky, with hopes that the resident doctors will set up practice in rural Kentucky after they complete their training. 

The PrimaryPlus Family Medicine Residency Program will be headquartered in Maysville, Ky.  The primary focus of the residency program will be family medicine with plans to use specialty services such as obstetrics and gynecology and pediatrics to provide residents with a well-rounded experience.

Dr. Tyler Elam

Dr. Tyler Elam, director of the residency program, said FQHCs can play an important role in training physicians because of the populations they serve, who are largely indigent, uninsured or underinsured.  

"I think there is a greater . . . mutual benefit for having the learners present in an FQHC," he said. "It helps us close care gaps for the indigent, while also being able to train new physicians."  

Kentucky's program is one of 81 Teaching Health Center Graduate Medical Education programs that operate in 24 states and Washington, D.C., said Elam. 

Research shows that medical students who trained in rural areas are almost twice as likely to practice in rural areas whether or not they grew up in a small town, a topic explored in a blog post from the National Rural Health Association. Further, studies shows that physicians from rural backgrounds were more than twice as likely to practice in a small town, compared to urban counterparts.

And that is the goal of the PrimaryPlus residency program. "That really is part of our mission, is to train them here and keep them here," Elam said. 

There is a great need for rural primary care physicians in Kentucky, according to the 2022 Kentucky Physician Report from the University of Kentucky Center of Excellence in Rural Health. The report says 43 of 120 Kentucky counties meet the criteria for a primary care physician Health Provider Shortage Area. Nearly 73% of of Kentucky's 2,741 primary care physicians practice in urban counties despite the majority of the population living in rural counties.  

PrimaryPlus's residency program will bring four new primary care residents into the state each year.

The first class of residents are Dr. Devaki Dravid and Dr. Jerry Eddis, both from Pennsylvania. Devaki received her medical degree from Philadelphia College of Osteopathic Medicine and Long received his from American University of the Caribbean School of Medicine. Dr. Brion Long is from Breckinridge County, Ky. and Dr. Sara Roberts is from Bath County, Ky. Both Long and Roberts attended the Kentucky College of Osteopathic Medicine at the University of Pikeville. 

Elam said the new residency slots will help to meet the ongoing demand for more primary care physicians, especially as baby boomers continue to need more care.  

"There's not necessarily enough residency spots to keep up with the increasing medical school class sizes. And so, you know, there's like a supply and demand mismatch as a result," he said. "So the more residency spots we can open up, it definitely closes that care gap downstream."

Already, Elam said the resident doctors have been able to close some of the care gaps in the community and have contributed to the wellness of the medical community, who often work short-staffed. 

"The residents are thriving and loving it here," he said. "They'll come to my office and be like, 'Man, this is so great. I didn't know that learning could be like this. I feel like I'm part of the team. I feel like I'm making a difference. And I feel like I'm learning simultaneously.'"

Doctor-journalist says pain doesn't fit on a scale of zero to 10

Illustration of the pain scale by iStock/Getty Images Plus, via KFF Health News

OPINION by Elisabeth Rosenthal
KFF Health News

Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”

I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.

Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?

The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.

About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the Food and Drug Administration approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.

To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.

After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health-care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)

But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.

Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.

A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.

In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.

Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.

The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.

Surgeon general declares gun violence a public-health crisis; new AMA president, a Louisville physician, calls it 'evidence-based'

Surgeon General Vivek Murthy (AP file photo, 2023)

This story has been updated.

By Amanda Seitz

Associated Press

The U.S. surgeon general on Tuesday declared gun violence a public-health crisis, driven by the fast-growing number of injuries and deaths involving firearms in the country.

The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.

“People want to be able to walk through their neighborhoods and be safe,” Murthy told The Associated Press in a phone interview. “America should be a place where all of us can go to school, go to work, go to the supermarket, go to our house of worship, without having to worry that that’s going to put our life at risk.”

To drive down gun deaths, Murthy calls on the U.S. to ban automatic rifles, introduce universal background checks for purchasing guns, regulate the industry, pass laws that would restrict their use in public spaces and penalize people who fail to safely store their weapons.

Murthy said there is “broad agreement” that gun violence is a problem, citing a poll last year that found most Americans worry at least sometimes that a loved one might be injured by a firearm. More than 48,000 Americans died from gun injuries in 2022.

His advisory promises to be controversial and will certainly incense Republican lawmakers, most of whom opposed Murthy’s confirmation — twice — to the job over his statements on gun violence.

Dr. Bruce Scott

Dr. Bruce Scott of Louisville, new president of the American Medical Association, called Murthy’s advisory an “evidence-based public-health approach to addressing firearm violence” in a statement. “Firearm violence is indeed a public health crisis,” he said, adding, “The data now show it touches the majority of U.S. adults.”

 

Murthy has published warnings about troubling health trends in American life, including social media use and loneliness. He’s stayed away from issuing a similar advisory about gun violence since his 2014 confirmation as surgeon general was stalled and nearly derailed by the firearm lobby and Republicans who opposed his past statements about firearms.

Murthy ended up promising the Senate that he did “not intend to use my office as surgeon general as a bully pulpit on gun control.”

Then-President Donald Trump dismissed Murthy in 2017, but President Joe Biden nominated Murthy again to the position in 2021. At his second confirmation hearing, he told senators that declaring guns a public-health crisis would not be his focus during a new term.

But he has faced mounting pressure from some doctors and Democratic advocacy groups to speak out more. A group of four former surgeon generals asked the Biden administration to produce a report on the problem in 2022.

“It is now time for us to take this issue out of the realm of politics and put it in the realm of public health, the way we did with smoking more than a half century ago,” Murthy told the AP.

A 1964 report from the surgeon general that raised awareness about the dangers of smoking is largely credited with snubbing out tobacco use and precipitating regulations on the industry.

Children and younger Americans, in particular, are suffering from gun violence, Murthy notes in his advisory, called “Firearm Violence: A Public Health Crisis in America.” Suicide by gun rates have increased significantly in recent years for Americans under the age of 35. Children in the U.S. are far more likely to die from gun wounds than children in other countries, the research he gathered shows.

In addition to new regulations, Murthy calls for an increase on gun violence research and for the health system — which is likely to be more amenable to his advisory — to promote gun-safety education during doctor visits.

UPDATE, June 26: New research highlights the need for a public-health approach in news reporting of gun violence, reports Journalist's Resource at Harvard University.

Dr. Bruce Scott, Louisville otolaryngoloist, becomes president of American Medical Association, says he's 'ready to fight' for docs

AMA President Bruce Scott, M.D.

Kentucky Health News

Dr. Bruce A. Scott, an ear, nose and throat specialist from Louisville, was sworn in Tuesday, June 11, as the 179th president of the American Medical Association, the nation’s largest organization of physicians.

“I became a physician to care for patients, and we all know that’s getting tougher every day,” Scott said in his inaugural address. “Our health-care system should help physicians provide good care, not get in the way!” He said “The AMA does for physicians and our patients what we as individual physicians cannot do.”

Scott said “two decades of spiraling Medicare payment cuts and ever-increasing administrative burdens” have increased burnout among doctors to the point that “almost two-thirds of physicians show signs of burnout. One-third plan to reduce their hours. One in five physicians are hoping to stop practicing or retire in the next two years.

“We can’t afford to lose even one more doctor! As a physician in an independent practice, I live these issues every day. I see my colleagues struggling. I feel the urgency of the moment. I will bring that urgency to my presidency. You better believe I’m ready to fight.” 

Scott has been president of his state and county medical associations and remains on their boards. "As a leader of these associations, he has fought for access to care for vulnerable populations, improvement in public health and reduction of administrative burdens in health care," an AMA news release said. He joined the AMA Board of Trustees in 2015 and was speaker of the AMA House of Delegates starting in 2019.

Board-certified in both otolaryngology and facial plastic surgery, Scott is president of Kentuckiana Ear, Nose & Throat, a six-physician independent private practice group, medical director of Premier Ambulatory Surgery Center, and holds a clinical appointment at the University of Louisville medical school.

Scott is a director of Health2047, the AMA’s Silicon Valley-based subsidiary that finds and funds tech-enabled commercial health-care enterprises. "In this role he is helping shape the future of medicine to empower patients and healthcare providers with meaningful and measurable impact," the release said.

He has written many articles for medical journals, as well as chapters in otolaryngology textbooks, He earned his undergraduate degree at Vanderbilt University, completed his education and residency at the University of Texas.

In his inaugural address, Scott told how he suffered a penetrating hand injury when he was 12 and a surgeon told his parents "that I was unlikely to ever regain normal use of my hand, and I would probably lose at least two fingers," but Dr. Joseph Kutz, Louisville's world-renowned hand surgeon, "saved my hand and spared my fingers, forever changing the course of my life -- and, although I didn’t know it at the time, putting me on the path that led to tonight. To this stage, to this incredible moment. I am a surgeon, using this very hand, because of a doctor."

Scott and his wife Christy have three adult children. He is the second Kentuckian in recent years to be AMA president; Dr. Steven Stack, the state public-health commissioner sicne January 2020, was president in 2016-17.

National Institutes of Health boss, at UK, says U.S. is better set for next pandemic but needs more 'really snappy real-time data'

National Institutes of Health Director Dr. Monica Bertagnolli spoke at UK. (WUKY photo by Josh James)

Kentucky Health News

The new director of the National Institutes of Health said at the University of Kentucky on June 10 that the U.S. hasn’t fully recovered from the Covid-19 pandemic, and long Covid remains a problem, but the nation is readier for the next pandemic than it was for the last one.

"We're better prepared, but we're not at all complacent about how awful pandemics are and the great suffering that comes from this, and the need to be constantly ready to spring into action," Dr. Monica Bertagnolli told Josh James of WUKY.

"We really hadn't before had a good, real-time feedback link with really snappy real-time data," she said, noting that she is starting a new reporting network for doctors to share such information.

"That data – both its reliability and collection – was one of the themes of Bertagnolli’s talk at UK," James reports. "She said the pandemic showed medical officials the necessity of creating a more responsive data ecosystem running all of the time, not just during major health emergencies."

Asked about efforts to combat distrust toward medical authorities, Bertagnolli said part of the solution is delivering tangible results for patients. She pointed to recent polling from the Pew Research Center about who people trust the most when it comes to medical information.

"The very highest trust was with their primary-care providers," she said, "which is why we're launching this new primary-care research network, because we want to put the research into the hands of people who are trusted, so that everybody can have the benefit."

Dr. Wendell Kingsolver, a doctor for more than half a century and an advocate for family medicine and rural health, dies at 96

Wendell Kingsolver, M.D.

Dr. Wendell Roy Kingsolver, a longtime physician and advocate for family medicine and public health, especially in rural Kentucky, died Thursday, May 30. He was 96 and lived in Nicholasville.

After graduation from the University of Kentucky and an internship and residency, Kingsolver set up a family practice at Carlisle in his home Nicholas County. He was one of the few physicians in the area and served patients of all ages at all hours in emergency, operating, and delivery rooms, He was among the first physicians certified by the American Board of Family Practice, and trained UK medical students in rural family practice as they lived in his home and learned what a diverse rural medical career was like. In the 1960s he was a medical volunteer in the Republic of Congo, and later on the Caribbean island of St. Lucia and the Newfoundland coast town of St. Anthony. After retiring from five decades of full-time private practice, he was a public-health doctor for the Wedco District Health Department in in Nicholas, Harrison, Bourbon and Scott counties.

Kingsolver was an early adopter of organic farming, and he and his first wife Virginia were founding members of the Sierra Club chapter in Kentucky, the group that built Lake Carnico in Nicholas County, and the First Christian Church in Carlisle, where he was an elder and sang in the choir. He was a board member of the Cane Ridge Meeting House, where the Disciples of Christ denomination began. He enjoyed birdwatching and served a term as president of the Kentucky Ornithological Society. He and Ginny, who predeceased him, established a KOS scholarship for young people interested in the study of birds, and worked to preserve natural land in Nicholas County, some of it donated to the Blue Licks Battlefield State Resort Park.

Kingsolver's survivors include his wife, Eva Lee (Lynam Kanatzar) Kingsolver; son Robert (Paula) Kingsolver; daughter and noted author Barbara Kingsolver (Steven Hopp); and Ann Kingsolver, former director of the Appalachian Center at UK. A viewing will be held Tuesday, June 4, at 2 p.m., followed by the funeral at 4 p.m., at Milward Funeral Home, 391 Southland Drive in Lexington.

Information for this article was taken from the obituary.

15% fewer med-school grads applied for residencies in Kentucky this year; med-school association attributes that to abortion ban

Photo by Phallin Ooi, Creative Commons

By Sylvia Goodman
Kentucky Public Radio

The Association of American Medical Schools says 15 percent fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, part of a trend related to states' strong anti-abortion laws enacted after the federal right to abortion was abolished. The decline was even greater in programs for obstetricians and gynecologists.
 
The study found that U.S. medical students were less likely to put in an application in states with abortion bans in place. The state's near-total abortion ban only allows exceptions if the mother is in imminent risk of death or permanent injury to a life-sustaining organ.

Dr. Atul Grover, executive director of the AAMS Research and Action Institute, found that 15% fewer U.S. medical students applied to residency programs in Kentucky during the last academic year compared to the 2022-23 school year. That’s 1,050 fewer applicants across specialties.

In OB-GYN programs, there was an even sharper 23% decline, Grover said. “We do see these trends across specialties, though,” he said. “People get a little jittery around the idea that the state government is going to come in and tell you what is not appropriate care for a patient when you know otherwise.”

Grover noted that medical students overall applied to fewer schools, meaning students got pickier in where they applied. That accounts for some of the decrease in applications across states, but the remaining deficit, he said, is cause for concern — particularly to states with abortion bans.

“Health-care shortages, across specialties, across a lot of states, are already being felt by patients,” Grover said. “If I think about Kentucky, Alabama, Mississippi, these are states that already have trouble attracting and recruiting, retaining physicians.”

Kentucky hospitals are already dealing with an “acute shortage” of health care workers, with nearly 13,000 job vacancies in hospitals at the end of 2022, says the Kentucky Hospital Association.

Grover said medical-residency application numbers are one of the fastest ways to measure where doctors are moving or interested in moving. Other metrics are harder and take longer to track. Residents have a tendency to stay in the state where they train.

Grover said lawmakers should understand the full implications of abortion bans, especially in a state that already suffers from several physician shortages, including in women and reproductive health fields. According to the U.S. Health Resources and Services Administration, more than half of Kentucky’s 120 counties didn’t have a single OB-GYN specialist in 2022-23.

Louisville pediatrician Dr. Michelle Elisburg said many doctors entering residency are in their mid-to-late 20s, and may be considering having children themselves. The bans may keep those women or their partners from considering moving to the state either.

“You wouldn't come if you're a young woman and know that if something happens to you, you might die because they aren't gonna let you get the health care you need,” Elisburg said. “That's where you are going to lose the doctors.”

Elisburg was part of the lobbying effort by Kentucky Physicians for Reproductive Freedom to end the state’s abortion bans this year.

She said the bans keep students from receiving all the training they need to provide abortion care or require them travel out of state to get it. “If there's such a ban, that restricts the kind of training that people are able to do,” she said. “They're not going to want to come to a state where they can't be completely trained in all the techniques in their field.”

Blair Wooten, who attended the University of Louisville medical school, said the state’s abortion ban was one of the reasons she decided to leave the state. She ended up going to a program in Ohio for the last year. She said abortion medical training “is paramount to me. It's something I want to be in my practice.”

Wooten is moving to a residency program in Indiana, which has its own abortion ban, but that program gives students the opportunity to receive abortion training in a Detroit-based program, which eased some of her fears — and clinics in Ohio are just a few hours drive away.

Wooten said she’s not sure if she’d consider setting up a practice in a state without abortion access. She said the inability to immediately provide the care she believes is necessary would be painful, but she also wants to provide services in health care deserts.

“Family planning is something I want to be a big part of my practice, so I usually say, ‘No’,” Wooten said. “But I'm also keenly aware that people need resources in every place, especially places that are maybe a little more hostile. And they need providers who care and can help them even with limited resources.”

AMA president-elect, from Louisville, lays out his ideas for getting more physicians in rural areas, reforming prior authorization

By Melissa Patrick
Kentucky Health News

With about 46 million people in the U.S. living in rural areas and new research showing they are more likely to die early from the five leading causes of death than their urban counterparts, the American Medical Association is sounding the alarm. 

AMA President-elect Bruce Scott (AMA photo)

"Rural health is America's health," Dr. Bruce Scott of Louisville, AMA president-elect, told reporters in a May 9 press conference in conjunction with the National Rural Health Association annual conference in New Orleans. "We need policymakers to understand that the American Medical Association is deeply concerned about the ever-widening health disparities between urban and rural communities. disparities that are at the root of why rural Americans suffered disproportionately high rates of heart disease, cancer, stroke, respiratory illness, diabetes, and unintentional injuries." 

Scott, who is board-certified in both otolaryngology and facial plastic surgery, served as the Kentucky Medical Association's president in 2018-19. He will become AMA president in June. 

Scott pointed to several environmental, economic and social factors factors that put people who live in rural communities at a higher risk of death from these often preventable conditions. But the AMA's focus, he said, is on the health-care worker and the physician shortage and how this affects rural people's health. 

He added that these shortages are hitting rural areas the largest and are "creating health-care trends that are simply unacceptable. We need to reverse these trends for all individuals to live a long, healthy and active life."

Scott said rural areas have about 30 physician specialists for every 100,000 residents, compared to 236 per 100,000 in urban communities, and he noted that more than 130 rural hospitals closed from 2010 to 2021, with many more on the verge of closing today. 

Also, he said that in 2023, 65% of rural communities had insufficient access to primary-care physicians, including pediatricians. And, he said there are not enough residency spots to train doctors in rural areas. 

"History has shown us that residents, 80% of the time, tend to wind up practicing within 80 miles of where they've done the residency," Scott said. "So residency location becomes very important. In addition, medical schools are receiving fewer and fewer applicants from individuals from rural areas."

Call for Medicare reform

Scott said the AMA is working to build a stronger physician workforce, which he said starts with supporting physicians who are already in practice, to keep them practicing.

"AMA is focused on fixing the systemic issues of our health-care system that are known to be driving physician burnout, and contributing to early retirement and physicians leaving practice altogether," he said. "Highest among these problems are the broken Medicare physician payment system and the administrative burdens." 

The problem, said Scott, is that Medicare payments to doctors are not keeping up with inflation. He said that when adjusted for inflation, the payment rate to physicians has dropped 29% since 2001, and private payers and other insurers have linked their payments to the Medicare structure. 

"We need a system that is sustainable, predictable, and provides at least an annual inflation update that encourages patients choice rather than consolidation," he said. "We need Congress to act." 

Administrative burdens

Scott said physicians spend two hours on administrative work for every one hour with patients, contributing to burnout and hindering patient care. 

A key contributor to this is "prior authorization," which requires a physician to get approval from a third-party payer for care that the physician and patient have agreed on before it can be implemented.  

"On average, physicians complete 45 prior authorizations per week and it's even worse in primary care," Scott said. "The prior authorization process is overused, overly burdensome and wastes physicians' time. But I'm even more concerned about the fact that prior authorization hurts patients." 

He added, "We need Congress and payers and the administration to respond, because the result is that physicians are getting burned out and they're leaving practice, not because they don't want to practice medical care anymore, but because the system is making it more and more difficult for them to care for their patients." 

During the 2024 legislative session, Rep. Kim Moser, R-Taylor Mill, again filed a bill to address the prior authorization issue in Kentucky, but health insurers blocked it. It would have exempted from the process health-care providers who have had 90% or more of their claims approved. 

Scott said the AMA is "fighting for legislation fixes" to increase incentives for physicians to work in rural areas, to expand the number of residency spots, particularly in primary care and in rural areas, to make the pandemic's telehealth flexibilities permanent, and to allow qualified international medical graduates to keep practicing in America. 

Asked about the role of advanced-practice registered nurses and physician assistants to help increase access to care in rural areas, Scott said that "there is absolutely" a role for these "physician extenders" in a physician-led team model. 

"The AMA believes strongly in the concept of a physician-led medical team, where every component of the team is working to the highest level of their knowledge base and their experience," he said. "Now, we're not in favor of independent practice for nurse practitioners or PAs. We think that patients, no matter what ZIP code they happen to live in, deserve care by a physician." 

Legislative lobbying reports for last session rank pharmacy-benefit managers fifth, hospitals sixth, Altria 11th, Anthem 17th, docs 18th

The legislature meets in the Kentucky State Capitol.

By Al Cross

Kentucky Health News

The trade association for pharmacy benefit managers, which act as middlemen between drug and health-insurance companies, was the fifth largest reported spender on lobbying the state legislature in the first three months of the year, according to a compilation by the Kentucky Legislative Ethics Commission. 

The Pharmaceutical Care Management Association reported spending $94,694 on lobbying the General Assembly from January through March. The session began Jan. 2 and was over for most purposes by the end of March.

On March 28, the legislature gave final passage to Senate Bill 188, which is intended to keep the state's independent pharmacies from closing. It sets dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own. The PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Several other major lobbying interests dealt with health-care issues. The biggest spender was the Kentucky Chamber of Commerce, at $151,010, followed by the American Civil Liberties Union of Kentucky, at $139,599. Among many other things, the ACLU wants the legislature to enact exceptions to the state's near-total abortion ban.

Ranking sixth, just behind the PBM lobby, was the Kentucky Hospital Association, at $85,835. In 11th place was Altria Client Services, a cigarette company, at $73,309; it supported the successful bill to limit legal sales of vaping products to those approved by the U.S. Food and Drug Administration.

Ranking 17th was Elevance Health and Affiliates doing business as Anthem Inc., at $59,946. The health-insurance firm was followed by the Kentucky Medical Association, the main lobby for physicians, at $54,051, and the Kentucky Primary Care Association, a trade group for health clinics, at $49,416.

Overall, spending on legislative lobbying for the first three months of 2024 was a record of $9.719 million, the Ethics Commission reported Tuesday: "The previous record for the same period was $9.343 million, set last year; 933 businesses and organizations registered to lobby in Kentucky, spending $9.427 million; 727 lobbyists were paid $8.289 million in compensation, and also reported $291,942 in expenses."

Health insurers again win lobbying battle with doctors and hospitals over prior authorization of procedures, treatments

By Melissa Patrick
Kentucky Health News

A bill to exempt health-care providers who have 90% or more of their claims approved from health-insurance companies' requirements for prior authorization of ceratin treatments has failed again. 

"Unfortunately House Bill 317 looks like it's dead," said its sponsor, state Rep. Kim Moser. "We tried in good faith to work out a compromise and we did not have the same reciprocation. And so, you know,  I'm not exactly sure why it didn't get a hearing." 

HB 317 was placed in House Banking and Insurance Committee and had two of its three required readings to be heard on the House floor, but it was never called up for a hearing. The last regular day for final passage of a bill is Thursday, March 28.

Moser said her bill is important because it would ensure timely treatment and care that has been prescribed by a person's health care provider. 

Rep. Kim Moser

"It's really about making sure that patients get the care that they need when they need it," she said. "I think that there is a way to find a process that expedites the care that patients can get – and this is it." 

Asked what concessions she had made with the insurance companies, Moser said, "We removed Medicaid, which was huge." 

That only left the 450,000 patients on the state-regulated plans, which would have provided a snapshot of whether the change would work, she said. 

"We weren't calling it a pilot, but you know, it would allow us to really look at how this helped, or if it didn't help at all," she said. " And, you know, that's all we wanted was to be able to see how it works and see if this is a process that, like I said, (would) expedite the care that patients can receive." 

Physicians say the system undermines their medical judgement, and increases their administrative costs. 

“The current prior authorization process leads to delays for patients, administrative burdens for physicians, and increased costs,” KMA President Dr. Michael Kuduk said in a Feb. 21 news release.  “It’s time for us to pass a common-sense solution that doesn’t harm our patients or overburden our healthcare system.”

Allowing exemptions based on past performance has been dubbed a "gold carding program." KFF Health News reported Feb. 12 that five states have passed some form of it: Louisiana, Michigan, Texas, Vermont and West Virginia, and the American Medical Association is tracing active gold-carding bills in 13 states. 

Kentucky won't be one of them, at least this year, despite the strong lobbying efforts of the Kentucky Hospital Association and the Kentucky Medical Association. Moser said this is the third year she has worked on this effort. 

Asked about the bill's failure, Cory Meadows, KMA's deputy executive vice-president and director of advocacy, issued a statement saying the groiup "is extremely disappointed by HB 317's failure to pass during the 2024 legislative session. KMA members expressed the need for changing the prior-authorization process used by insurers that limits, and in some cases prevents necessary health care to Kentuckians. Throughout these past several months, citizens from around the commonwealth also shared their own stories of how the prior-authorization system impacted their lives, clearly showing that nearly everyone except insurance companies see the need to change this system.

"We're encouraged by the overwhelming bipartisan support the measure received and remain extremely optimistic that with continued advocacy from our members and the public, as well as collaboration with lawmakers, this critical legislation, which proposes to streamline the prior authorization process and ensure patients have timely access to care will soon be enacted. Otherwise, insurers will continue to pocket the money that could make Kentuckians healthier."

The hospital association also expressed its disappointment. 

"Prior authorization is a huge burden on physicians and nurses at our hospitals. And you know, it's contributing to burnout. And so we definitely support legislation that would minimize that burden, as many as has been passed in other states, and we would love to see a pass here," KHA President and CEO Nancy Galvagni told Kentucky Health News. 

Health insurers say prior authorization prevents unnecessary care and ensures that the care meets the standards of best practice. 

The Kentucky Association of Health Plans, the trade group for companies selling health insurance in Kentucky, issued a one-pager in opposition to HB 317 that said, "Prior authorization stops inappropriate care and procedures and heads off dangerous drug interactions and duplicative or inconsistent care, providing a whole-person approach to each plan member’s care needs. Plans help protect against predatory behavior."

Asked about the bill's demise, Tyler Glick, KAHP spokesman, issued this statement: "The health mandate statement generated by the Department of Insurance says the bill would cost up to an additional $11.29 in health-insurance premiums per member per month. That means a family of four would pay an additional $541.92 a year. How is saddling taxpayers (Medicaid), state employees and teachers (Kentucky Employees Health Plan), and everyone else in the commercial insurance market with these costs sound policy? Kentuckians deserve better."

Glick added, "KAHP will continue working with all members of the General Assembly to promote affordability, expose waste and fraud, and provide safeguards to patients."

Moser said she's not giving up on this effort and will likely work on it during the interim.

"The burdens of prior authorization are not going away anytime soon," said Galvagni. "And I'm sure the issue will be back. And, you know, we look forward to continuing to work on that."

As doctors plead for end to state abortion ban, legislators file bills to protect in vitro fertilization from court rulings like Alabama's

Dr. Virginia Stokes, an obstetrician-gynecologist, said she’s treated many conditions that required abortion to prevent sepsis and preserve patients’ fertility. (Kentucky Lantern photo by Sarah Ladd)

By Sarah Ladd

Kentucky Lantern

In response to a ruling from the Alabama Supreme Court stating that frozen embryos are children, Kentucky state senators from both parties have filed bills aimed at protecting access to in vitro fertilization in Kentucky.

Meanwhile, nearly 300 Kentucky health-care providers and medical students signed a letter asking legislators to restore access to abortion in the state, saying its ban on abortion handicaps their ability to provide comprehensive care.

Republican Sen. Whitney Westerfield of Christian County, a staunch opponent of abortion, filed a bill Wednesday saying that any facility or “procedure related to in vitro fertilization shall not be liable” for damages “to a patient or patient’s surviving spouse or partner resulting from the loss of a human embryo, except in cases of negligence or wanton, willful, malicious or intentional misconduct.”

It also protects health care providers “performing any procedure” related to IVF from criminal charges. The day before, Sen. Cassie Chambers Armstrong, a Louisville Democrat, filed a similar bill. The Alabama Legislature passed similar legislation Thursday.

Alabama, Kentucky and at least eight other states have laws saying human life begins at conception, with the fertilization of an egg by a sperm cell; Kentucky's law speaks of the "unborn human being."

IVF is used to treat infertility, and can help other people trying to get pregnant to do so, according to the Mayo Clinic. About 2 percent of U.S. births are results of the procedure. It sometimes involves freezing embryos for future attempts at insemination; damage to frozen embryos at a fertility clinic prompted the lawsuit that led to the Alabana ruling.

Westerfield’s filing comes as he and his wife are expecting triplets, which he announced in January. He said at that time in a Senate floor speech that they adopted and transferred embryos for the pregnancy. His 6-year-old son is an “embryo adoption” baby, he said.

At a Thursday news conference, Democratic Gov. Andy Beshear said the Alabama ruling “is what happens . . . when you embrace extremism.”

He cited Kentucky’s near-total abortion ban as another example: “Women that have non-viable pregnancies still have to oftentimes carry that pregnancy to term knowing they’re going to hear their child die moments afterwards if it hasn’t already happened.”  

Kentucky bans abortion except in cases of threat to the woman's life or of serious, permanent damage to a life-sustaining organ, under a law triggered by the U.S. Supreme Court's 2022 overturn of Roe v. Wade, the 1973 decision that created a constitutional right to abortion. 

The ban causes “devastating consequences” for patients, Louisville’s Dr. Marjorie Fitzgerald said at the health-care providers' event. “We are losing obstetricians who will not practice in our state,” a nd because of the restrictions, “Doctors are violating their Hippocratic oath to do no harm.”

Fitzgerald was joined in the Capitol Annex by Democratic lawmakers, other medical providers and a second-year medical student in Frankfort to discuss the letter written by the Kentucky Physicians for Reproductive Freedom and signed by 280 providers.

They detailed the complex nature of medical decisions that lead to abortions and slammed lawmakers for restricting their ability to provide that care.

Dr. Nancy Newman, a board-certified obstetrician, said she would not now come to the state because of a “culture of fear that our legislature has created” in which providers have to decide between jail time and what their patients need. “How do you practice medicine in a culture of fear? I don’t think you can.”

Dr. Michelle Elisburg, a Louisville pediatrician, told the story of a 14-year-old patient who was raped by a 60-year-old landlord and got pregnant.

“She had the baby and then dropped out of high school to get a job” to support herself and her child, Elisburg said. “Now both mother and child have multiple risk factors for poor health, educational and vocational outcomes, requiring more financial assistance from the state.”

Elisburg said that as a Jewish physician, she’s governed not only by the Hippocratic oath to do no harm, but also a faith-based oath to act in the best interest of her patients: “As a physician in Kentucky, I am now being forced to make impossible choices that put my professional ethics and my faith in direct conflict with the law.”

Urooj Nasim, who attends the University of Louisville medical school and said she spoke only for herself, said abortion bans may keep her and her classmates from getting the hands-on training they need to become obstetrician-gyneciogists and tackle Kentucky’s high rates of maternal mortality.

“In order to make the best calls for the patients of my future, I need to receive high quality training and all of the tools and procedures available,” Nasim said. “And in a state where physicians live in fear of being prosecuted for delivering standard care, that is just not possible.”

The American College of Obstetricians and Gynecologists says “In states with abortion bans, medical students and residents are not able to receive the hands-on training they need in order to provide patients with comprehensive care.”

Nasim, who was born in St. Louis and lived in Somerset until she was 8, told the Lantern she is “undecided” on her specialty path but was “moved by that patient population” when she worked with an obstetrician previously.

“I’m a very … mission-driven medical student,” she said. “I really want to help patients with a lot of the social factors that affect their health. And OB is a really great specialty to do that in.”

Latest in a line of protests

The Thursday letter is the latest in a long line of efforts to protest Kentucky’s tight abortion bans.

In 2022, Kentucky voters defeated a constitutional amendment that would have keptt courts from finding a right to an abortion in the state constitution.

In late 2023, a Kentucky woman sued for the right to access abortion and end an unwanted pregnancy, but dropped the lawsuit when the fetus lost cardiac activity.

Republicans and Democrats have filed bills seeking to loosen or undo Kentucky’s abortion bans, to no avail.

Several anti-abortion lawmakers have focused their efforts during the 2024 session on making Kentucky a safer place to give birth and codifying support for expectant parents.

This week state Rep. Ken Fleming, R-Louisville, filed a bill seeking rape and incest exceptions to Kentucky’s abortion bans — but only in the fist six weeks of pregnancy

Newman, an obstetrician, said “Most women don’t even know that they’re pregnant by six weeks,”  an in case of assault, “The victim likely may not even tell anyone before six weeks.”

Dr. Virginia Stokes, a board-certified obstetrician-gynecologist, said she’s treated many conditions in her tenure as a physician that required abortion — placenta previa, first and second trimester ectopic pregnancies, preterm rupture of membranes, cancer, sepsis and more.

A lack of early interventions, she said, can cause “total body sepsis and death due to the sepsis. And if death is avoided, there is a frequent loss of fertility due to disruption of the uterus.”

“The fetus will not survive if the mother doesn’t survive,” Stokes said.

In such cases she’s treated, she said, these are “gut wrenching decisions with no choice to be made” involving “very much wanted and cherished pregnancies.”

“There are lots of really bad things that can happen between six and 12 weeks,” Stokes added. “and we need to have permission to take care of those patients.”

“I am pro-life,” Stokes said. “I am for saving the life of these women who have these early pregnancy complications that require, unfortunately, a cessation of the pregnancy …. As an OB-GYN, my first priority is the life of my female patient. Please don’t tie my hands.”

Artificial intelligence may have already been used to diagnose you

A doctor looks at an X-ray on a screen helped by artificial
intelligence. (Photo by Damien Meyer/AFP via Getty Images)

Kentucky Health News

As Congress and federal regulators begin to take steps to monitor and control the use of artificial intelligence, "The technology has already been put to use in unseen and unregulated ways in health care," Ben Leonard and Chelsea Cirruzzo report for Politico Pulse, drawing on a Politico story by Daniel Payne and Ruth Reader on how A.I. is affecting Americans. Here are some ways:

Medical imaging: A.I. is is commonly used in radiology, to help "decipher medical images like X-rays — and some systems work on par with humans, according to recent studies," Politico reports. "The algorithms also measure and improve radiologists' performance."

Cancer: The progression of a cancer can be hard to evaluate, and A.I. can help, especially with prostate cancer, in which "tumors grow in multiple locations and extend in ways that might not get picked up on imaging," Politico reports.

Recordkeeping: "A.I. systems help doctors make better sense of their notes. Many health-tech companies target 'low-risk, high-reward projects' that can summarize information and act more like a secretary than a co-pilot.

Billing and coverage: "Firms are toying with technology that can change how bills are generated and processed. . . . A.I. can scrutinize bills more quickly than humans, leading to potential labor and time savings." Advocates say it will make claims move faster, "but skeptics worry AI could reduce transparency and accountability in decision-making" by health-care providers and insurers."

The Food and Drug Administration "has taken an experimental approach to regulating A.I. in medical devices, mostly issuing strategic plans and policy guidance," Politico reports. "The biggest challenge is that A.I. evolves over time, and companies don’t want to re-apply for FDA clearance to market their technology." The Department for Health and Human Services finalized a rule in December that would require more transparency about A.I. in clinical settings.

Ky. health-care providers lobby for bill that would ease health insurers' required prior authorization for medical procedures

OPINION by health-care provider groups listed below

It’s a situation all of us will find ourselves in at some point. You’re sick, or get diagnosed with a chronic condition, or need to have surgery. Thankfully, your physician diagnosed the issue quickly and a treatment plan was made, and you have health insurance to cover it. You should be on your way to health and healing, right?

Unfortunately, thanks to something called a “prior authorization,” there’s a good chance your care is about to get delayed or denied by your insurance company.

Prior authorization is a complicated, time-consuming, “cost-control process” utilized by health-insurance companies that requires physicians to obtain advanced approval from them before a specific service or medication is delivered. That’s right: your health plan can delay or deny the care that your physician prescribes in an effort to sway them towards a less effective treatment or service. There is no question that this negatively impacts patients and providers by leading to care delays for patients, administrative burdens for you and your physician, and increased overall costs to the health-care system.

Photo illustration from MedicalAlgorithms.com

Recent surveys and reports support the need to reform this system. A 2022 Kentucky Medical Association survey found that 82% of physicians said that issues related to the prior authorization process sometimes, often, or always lead to patients’ delays or changes to patients’ recommended course of treatment. Another national survey found that physicians spend a median of four hours per week on drug utilization management, while nurses spend 15 hours and other staff spend between 3.6 and 10 hours per physician per week. That is time that medical practices and professionals could surely put to better use on patient care.

However, the biggest impact is, of course, on the health of patients. 81% of those surveyed by KMA said the prior-authorization process delays access to necessary care for patients sometimes, often or always. One physician told of an oncology patient denied anti-nausea medication because of a required prior authorization. In the approximately three-day interval it took to get the authorization from the insurer, the patient was readmitted to the hospital with nausea, vomiting, dehydration, renal failure and electrolyte abnormalities. Another physician described a diabetic patient who did not receive their insulin as prescribed due to need for a prior authorization and had to go to the emergency department for care.

Of course, hospital admissions and visits to emergency rooms don’t save money, as prior authorizations are “intended” to do. Delaying necessary care can lead to complications and worsen the health of patients. And in the end, the vast majority of prior authorizations are approved, either initially or on appeal. This process is, therefore, unnecessary.

That’s why our organizations and thousands of our physician members across the state are calling for reform. During last year’s legislative session, KMA advocated for the passage of a bill which would have streamlined this process. The new program would ensure patients have timely access to the care they need, reduce administrative burdens for physicians, and lower healthcare costs. Together, we will be advocating for the passage of this legislation in the 2024 session.

Kentucky patients who are already suffering from chronic conditions and illnesses don’t need their care delayed by an insurance company. Let’s reform the prior authorization process to improve the health of our commonwealth.

This was written by the Kentucky Medical Association; Falls City Medical Society; Kentucky Association of Indian Physicians; Kentucky Chapter of the American College of Physicians; Kentucky Academy of Family Physicians; Kentucky Society of Anesthesiologists; Kentucky Dermatological Association; Kentucky Chapter of the American College of Cardiology; Kentucky Psychiatric Medical Association; and Kentucky Society of Addiction Medicine, via Ashley Bitters at ashley@runswitchpr.com. For a health care journalist’s guide to prior authorization, from Journalists' Resource at Harvard University, click here. The legislation, House Bill 317, was filed Thursday by Republican Reps. Kim Moser of Taylor Mill and Robert Duvall of Bowling Green. 

UK's largest academic building will be the Michael D. Rankin M.D. Health Education Building, named for an alumnus from Danville

A rendering of the building, to be built on University Drive between the main library and Cooper Drive

By Kristi Willett
University of Kentucky

The University of Kentucky Board of Trustees approved Tuesday the naming of the university's new building for health education as the Michael D. Rankin M.D. Health Education Building.

As an alumnus, Rankin has devoted himself to the UK College of Medicine, its success and the success of its students. He has been an invaluable member of the UK Medical Alumni Association, its past president, chair of the Dean's Advisory Council and volunteer faculty in the Department of Family and Community Medicine. In addition, he has served many years on the College of Medicine scholarship and admissions committees.

The Board of Trustees previously accepted a gift commitment of $22 million from Rankin for scholarships in the college and to support the construction of the building — which, when completed, will be the largest academic building in the history of UK.

“Dr. Rankin has left an indelible mark of healing and hope, not just on this university, but on the state of Kentucky,” said UK President Eli Capilouto. “His influence will be felt by generations of students and the patients they later serve.”

At over 500,000 square feet, the new Health Education Building will house programs in the colleges of Medicine, Public Health, Health Sciences and Nursing as well as the Center for Interprofessional and Community Health Education. The new facility will become a prominent campus landmark at the intersection of Huguelet and University drives when it opens in 2026.

Rankin when his gift was revealed in 2021 (UK photo)

Rankin, of Danville, received his bachelor’s degree in electrical engineering from UK in 1971 and his medical degree from the College of Medicine in 1980. He completed his residency in family medicine in 1983 at UK HealthCare and pursued a successful practice in primary care and family medicine in Atlanta before retiring and returning to Boyle County on a farm 10 miles from where he grew up.

“One of the greatest challenges facing the commonwealth is the current and growing shortage of health care providers, including physicians, nurses, physician assistants, physical therapists, athletic trainers, medical laboratory scientists, speech language pathologists, audiologists, public health officials and other health care professionals,” Capilouto said. “With this new facility, we will be addressing this health care workforce shortage head-on and, but it couldn’t be done without our partners like Dr. Michael Rankin, who share with us a vision for a healthier Kentucky.”

UK's latest federal grant to increase number of primary-care doctors in rural Kentucky includes new scholarship opportunities

Medical students Katelin Maggard and Anna Cox on the College of Medicine-Bowling Green Campus, a partnership of UK, Western Kentucky University and Med Center Health. (Photo by Clinton Lewis)

By Allison Perry

University of Kentucky

The University of Kentucky College of Medicine has received a four-year, nearly $16 million grant from the federal Health Resources and Services Administration. UK will get $3.97 million a year over the next four years to support efforts to increase the number and diversity of primary-care physicians in Kentucky, with the ultimate goal of improving health-care access in underserved areas of the state.

The physician shortage is not unique to Kentucky, nor is it limited to primary care. A2021 report from the Association of American Medical Colleges estimated that national demand for all physicians will exceed the existing supply by 37,800 to as many as 124,000 by the year 2034.

In Kentucky, 61% of the greatest physician needs are in rural areas. In rural and under-served areas, primary-care physicians are often the residents’ only exposure to any health-care professional, highlighting the need to improve access to these physicians.

UK's Rural Physician Leadership Program trains students

at Morehead who are interested in practicing rural medicine.

(UK photo by Jorge Castorena)

The UK College of Medicine has worked with academic and clinical partners to meet this growing need through four regional campuses in Lexington, Morehead, Bowling Green and Northern Kentucky, and graduated the largest-ever class this past spring.

These partnerships were a key to getting the new grant, which will focus on expanding pathways to support students who are interested in medical school and providing scholarship opportunities for medical students who choose primary care as a career path.

The goal is not just to increase the number of primary care physicians in the state, but to encourage new physicians to practice in underserved communities upon graduation, said Charles “Chipper” Griffith III, M.D., dean of the College of Medicine.

“As a physician who has provided primary-care services for patients of all ages, I can tell you firsthand how important it is for people to have access to these providers,” Griffith said. “An established relationship with a primary care physician is a first line of defense against acute and chronic illness and injuries. We not only provide treatment for illness, but we actively work to help our patients prevent it by identifying risk factors and screening for disease. In a state that suffers from high rates for many chronic, preventable diseases, increasing access to primary care is a critical step in improving the health of our citizens.”

Path to primary care can start in middle school 

UK already had several programs to provide educational experiences as students navigate the pre-med journey. With help from the new grant, these programs will place a greater focus on primary care, which includes family medicine, general internal medicine, general pediatrics, or the combination of internal medicine/pediatrics commonly known as Med/Peds.

The pathway to a medical career begins years before students reach college. Educational opportunities need to begin early — ideally, by the eighth grade, says James Ballard, director of UK's Center for Interprofessional and Community Health Education.

Promising students are identified with teh help of UK’s Area Health Education Center program, a collaborative effort between UK, the University of Louisville Health Science Centers, and eight regional centers. They provide support to help students meet their goals, including assistance in planning which classes to take in high school, help with applying for college, and encouragement from health-care role models.

At the high-school level, AHEC offers two free residential summer camps at UK that will be revised and funded through the new grant. The Summer Enrichment Program, for rising high school juniors, is a residential camp that allows students to gain some early college experience by spending three weeks learning, observing, and working hands-on with UK faculty, health professionals and health professions students. The program will add more mentoring specifically from primary-care physicians to provide more specific education on what a primary-care physician can do for patients, and understand how primary-care physicians function in a collaborative system.

The Health Researchers Youth Academy takes a similar approach, but is more tailored to the research side of a medical career. The residential programs connect high-school students with researchers, teach them research methods, and give them experience working in a laboratory. At the end of the camp, students will present their findings through poster presentations. In terms of primary care, the camp will educate students more on a primary care physician’s role in translational research — in other words, how basic science at the bench ultimately becomes a part of everyday patient care.

Though the Center for Intreprofessional and Community Health Education aims to create more health professionals across all spectrums, it will extol the benefits of choosing primary care, Ballard said.

“We’ve always exposed students to a variety of professions in the past, but we want to get more specific when it comes to primary care. We want them to understand ‘This is what a primary care physician does, this is why it’s important, this is why it’s valuable to you’,” Ballard said. “It’s amazing what primary care physicians can do, especially in rural and underserved areas. We want to show them what a difference they can make in their community by choosing this as a career.”

New initiatives funded by this grant will include two post-baccalaureate programs for students who have graduated from college, to provide opportunities for students to complete prerequisites for medical school and/or receive additional support and training to improve their chances of being accepted into medical school; a pre-matriculation program to prepare incoming medical students for the rigors of the curriculum and to highlight the benefits of choosing primary care as a career path; and a primary-care scholarly concentration, which will include targeted coursework and an enhanced community clinical rotation at a rural teaching health center.

Reducing debt for future primary care physicians

Research shows that students with large college debt are less likely to choose primary-care specialties because they have lower compensation in comparison to specialty and sub-specialty practices. Also, these graduates are less likely to practice in underserved communities.

The new grant will also allow the College of Medicine to provide up to $2.88 million a year in scholarships to students with demonstrated interest in primary care.

The new scholarships are positioned to decrease the debt burden by half for 80 students, and by a quarter for an additional 32 students. By reducing this burden, the team anticipates that more students will be likely to follow their passion for rural medicine and making a difference in underserved communities.

“Investing in the education of medical students through scholarships is not just an act of philanthropy, it’s an investment in the future of health care in Kentucky,” said Dr. Stephanie White, senior associate dean in the College of Medicine. “This award will be life-changing for our students who wish to pursue a career in primary care and have the desire to make a difference in underserved communities. These scholarships won’t just alleviate financial burden — they will empower dreams and nurture the talents of our next generation of primary-care physicians.”