Week 10: Making a Commitment to Health Equity
Although, I enjoy the longer evenings during daylight savings time, losing that hour of sleep last night was not enjoyable. I hope that no one reading this forgot to put your clocks forward by one hour, especially if your clinic started at 8:00 am this morning.
As many of you know, I gave the “State of the DMPG” address last Friday and I have received feedback from many of you. For those who did not see it, the link with the recording will be made available this week. Your feedback covered broad territory but was valuable and I very much appreciate the compliments and enthusiasm for the future of the department as we work together to ascend to new heights. Some expressed a new-found recognition of the breadth of activities and broad diversity of faculty within our department. Sometimes, when your activity is focused on a specific area of activity, be it clinical, research, education, or administration, it is easy to not see or recognize everything that is happening around us in the department. We are working to fix that, by boosting our communications resources and infrastructure to ensure that you can keep in touch with all that is happening in our department. We intend to provide a forum and channels by which to promote your achievements (including DOM_news@mednet.UCLA.edu, @DOM_UCLA on Twitter and more to come). I also intend to use these channels to increase the conversations about our strategic future and to discuss challenging topics.
A theme that permeated my talk, based in part on my request for information from department and division leaders highlighting one area that they were most proud of and one area for opportunity in the next year, is the strong desire by many in the department to improve health equity. For example, our hospitalist service was proud of the critical contributions that our team provided to the Martin Luther King Hospital, when it was at risk of being crushed during the peak of the COVID19 pandemic. Our Med-Peds faculty played a leadership role in providing COVID care and prevention services to undocumented and unaccompanied immigrant children and played an influential role in shaping the COVID 19 responses and services in the LA school district. Our Cardiology Division celebrated increased access to veterans to advanced cardiac care at UCLA and our community cardiologists powerfully articulated that there are several areas in Los Angeles that remain underserved in cardiac and overall medical care. “The clinical cardiology section recognizes that bringing state-of-the-art care to such areas aligns with the UCLA mission.” Thank you for commitment to this mission!
Our Pulmonary Division colleagues mobilized during the pandemic to support expanded ICU teams at the Ronald Reagan Medical Center, Santa Monica Hospital, Olive View Hospital, the Greater Los Angeles VA, in addition to 4 community hospitals within LA. They oversaw, more than 4,000 COVID-19 hospitalizations and through telemedicine and other services managed more than 32,000 patients. All I could say is “WOW!” However, despite these examples of our commitment to going the extra mile to provide the best care for all who come here, there was a very strong sense that this work is not enough, and we need to work tirelessly to address barriers to care of those who are underserved. The current architecture of Medi-Cal contracting creates nightmare scenarios for our faculty as exemplified by some powerful anecdotes from the frontlines. They exemplify the challenges that our faculty face and the moral injury that they often experience as they try to do the right thing. The eloquence of these examples speaks for themselves.
“Young Hispanic woman with end stage pulmonary hypertension managed by UCLA physicians was near-death. The standard approach was ECMO and transplantation. However, she had Medi-Cal, which does not cover lung transplant at UCLA. Our faculty spent numerous hours advocating for her. She eventually went on ECMO here, the appropriate clinical indication, prior to transfer elsewhere (a major logistical challenge). She was successfully transplanted but our lung transplant colleagues, who run one of the best programs in the country have indicated that they have no choice but to turn down dozens of outside hospital transfers of potentially transplantable post-COVID patients, because of barriers like this.“
“Young Hispanic woman with COVID on ECMO at UCLA but with concurrent renal failure. Straightforward solution: combined lung/renal transplant at UCLA. Unfortunately, the hospital with the contract does not offer lung/renal transplants. 3-months on ECMO (which is a long time) until kidneys improved enough for transfer for lung transplant.”
“Cystic fibrosis patient with Medi-Cal coming to our liver transplant ICU this week for liver failure but also has concurrent respiratory failure. He has Medi-Cal and can only get a liver transplant here but not a lung transplant. No other center in LA will do a combination liver/lung so we are debating if we can actually help this patient given his insurance.”
I share these examples not to point fingers, as the long-term solution will require renegotiation of contracts, with much inherent complexity. But we should not stop trying. I share this with you, our community, so we can all understand the challenges that our faculty deal with daily and the ongoing need for advocacy.
These challenges are not limited to the most advanced care that we provide, but also impact our ability to provide primary care to many who need it.
Access to quality health care unexpectedly entered my Sunday morning run in the Santa Monica foothills. I ran by a lady walking her dog, who said a friendly hello as I passed her. It could have been just that, but she wanted to talk. First about how nice the weather was, but ultimately asked if I ran every day. I said, mainly on weekends because of my early start to work most weekdays. She was curious where I worked, so I said UCLA. “Where?” she asked, “At UCLA Health and the Medical School”, I said. She proceeded to share with me the story of her son, now in his 20’s who struggles with multiple medical issues. Here’s the rub, they are not insured, and she is an immigrant to this country. I honestly did not expect that someone walking their dog in the Santa Monica hills would not have health insurance. In the end we talked about potential options for primary care for her son, including reaching out to Venice Family Clinic, where some of my colleagues work. I was not fully satisfied with the current state of affairs as I said goodbye and wished her well. But hope that the next time I run into her or someone else, I might be able to provide a better answer.
Our faculty continued to log a record number of patient visits despite the pandemic, and it is essential that I acknowledge the sacrifices made by everyone during the very challenging past 2 -years and to openly recognize that this has taken a toll on many. I suspect that some the issues related to burnout pre-dated the pandemic. This is why there is an ongoing focus on physician and trainee wellness, and you will hear shortly about several initiatives that the department is working on and will be rolling out in the near future. In the meantime, we need more data and Dr. Sun Yoo, asked me to use this space to encourage all faculty who see patients, whether in primary care or in specialties, to complete a survey that was released last week during the DMPG retreat. We have 115 responses so far. I will send the survey link out to all clinical faculty later today. Please spend the 5 minutes to complete this survey. Your response will help shape our strategy and response.
Last week, I touched on contributions made by emeritus and senior faculty. This week I will add another…
Dr. Vay Liang Go who was the Executive Chairman of UCLA’s Department of Medicine from 1988-1992. recently pledged $300,000 to The UCLA Foundation to establish the Vay Liang W. (Bill) Go MD Endowed Lectureship in Nutrition and Pancreatic Diseases in the UCLA Center for Human Nutrition and in the UCLA Agi Hirshberg Center for Pancreatic Diseases. This is in memory of his late wife, Dr. Frisca Yan Go, who was a professor of Neurology and founder and Director emerita, UCLA Center for Sleep Disorder.
Dr. Go is a distinguished professor and co-director of the UCLA Agi Hirshberg Center for Pancreatic Diseases at the David Geffen School of Medicine at UCLA. He received his internal medicine and gastroenterology training and subsequently became a professor of medicine at the Mayo Clinic. From 1985 to 1988, Dr. Go served in three related capacities at the National Institutes of Health, all involving digestive diseases and nutrition. In 1994, he co-founded the UCLA Center for Human Nutrition with Dr. David Heber. Over a five-decade academic career, his research has focused on the regulation of the human exocrine and endocrine pancreas and gut-brain axis in health and disease. Thank you, Dr. Go for your gift and continued service to UCLA.
It’s here! We go to the DMV tomorrow. I have been doing mock tests this weekend and cramming the California distances between vehicles driving through smoke and fog. Wish me luck.