A Presidential Visit

Last week, our university's President came for a visit to our office. So far as I know, this was the first time that any of our university's Presidents have been to the office, at least since the opening ceremony 20 years ago. The President was accompanied by a number of high-level officials from our health system.

Our office is located in South Richmond, Virginia. The neighborhood that surrounds us was, when the practice opened, mostly made up of low-income African-American residents. Starting in 2000, Richmond's Latino community started to grow, and this growth has been largely centered in South Richmond. Richmond's largest single housing community is just about 1/2-1 mile from our office: about 1,000 townhomes, now estimated at 80-85% Latino. This change in the demographics of Richmond has been sudden (from about 5,000 Hispanic residents in the city to over 20,000 in 15 years), and I believe that this is going to be a permanent shift for the city.

The Latino community is a young community, composed of young and growing families. In our office, 25-30% of our patient visits are for pediatric patients (under 18), and 70% of our these patients are Spanish-speaking. Meanwhile, the low-income African-American community has not left--many of our adults are uninsured (between 50-60% of our adult visits 18-64 are uninsured--recall that Virginia has opted not to expand Medicaid). The office also has a high mental health comorbidity among our patients: in one survey, 44% of our patients had moderate/severe ratings of anxiety and/or depression, and only one-half were receiving active care. We also have a high proportion of patients who are dealing with chronic pain and/or substance abuse.

Many of these patients have little access to needed healthcare services. We are able to provide much of their healthcare, but we lack the capacity and contacts to allow for full-service behavioral health care (e.g. including counseling, not just medications). Our adult uninsured patients lack access to dental care. Our Spanish-speaking children and families face a landscape in Richmond nearly devoid of Spanish-speaking behavioral health providers: an increasing problem given the fact that increasing numbers of Latino kids are now entering school...and running into learning problems and facing behavioral issues.

I shared with our President how exciting it is, then, for us to be working to fill these gaps in care. We have physicians who are in the office, and working with this sometimes challenging patient population, by choice. We have been awarded two grants--one from the Richmond Memorial Health Foundation and another from the Virginia Health Care Foundation--to provide in-office behavioral health services in collaboration with our Department of Psychology. Even better: the RMHF grant specifically targets services to the Latino families. The VHCF will provide us with one-day-a-week coverage from a psychiatric nurse practitioner to better help adults with chronic or severe mental illness. Now that the office renovations are completed, we can also look to resume our tele-psychiatry collaboration with our system's Child and Adolescent Psychiatry service.

I am very glad that we were able to discuss and share these initiatives with our President and with our healthcare leadership. Admittedly, these may be small steps in the greater healthcare landscape in Richmond, but they are important steps, and it is important to have supportive leadership helping push this forward.

Taking stock: where does the time go?

Looking at the blog, it is hard to believe that it has been nearly one and one-half years since I updated or posted anything here. Frankly, even as I write this, I am not even sure what will follow this post: blogging does not come easily for me, and other time commitments do not easily allow me to focus on the blog.

It is also interesting to think about where we are since the blog started. When I first started blogging regularly, I was working as a full-time clinician at a safety net clinic here in Richmond, Virginia. I was pushing for healthcare reform, and advocating for the legislation that eventually became the ACA. I was also a board member of the Virginia Academy of Family Physicians and had learned about the National Physicians Alliance.

From 2009 to 2014, we saw the ACA become law and now survive two Supreme Court challenges while its reforms became increasingly ingrained in Americans' daily life. We have experienced a paradigm shift in that the presumption is now that all Americans will have access to health insurance, and through health insurance access to health care. Though it is clear that there is still work to be done--and perhaps more significant reforms to come--the truth is that most Americans will no longer be excluded from the system...at least in states that have chosen to expand Medicaid.

I have seen increasingly frequent discussions on the importance of primary care and family medicine, and have become a more-active member of the Society of Teachers of Family Medicine, including serving on STFM's Communications Committee as we work to train future generations of family physicians and family medicine educators. I have also seen that a flawed approach to paying for medical care and primary care is still in place, despite the evident need for change.

I have joined the leadership of NPA as the Vice-President of Communications, and have worked with the organization's leadership to continue to encourage the implementation of the ACA while increasingly focusing on other areas of importance: bringing attention to the issues around gun violence and promoting a focus on gun violence as a public health issue, addressing the influence of big PhRMA and the medical industry device on medical practice, and encouraging physicians and patients to work together together to make good decisions that benefit patients and that conserve valuable resources and prevent harm and over-treatment.

I have moved into a leadership role teaching medical students both in a specialized honors program for medical students focused on working with medically underserved communities after completing their training, and leading a curriculum focused on the humanistic, ethical and holistic care.

I finally authored an article that was published. The article focuses on the benefit of an interprofessional service learning activity focused on providing care to Richmond's Latino community.

Finally, I became medical director at the office I joined in 2007. I took on this role in December, and have spent the past 8 months working through the challenges that have presented themselves and looking to enhance care for our patients.

So: I am going to try and pick this up again, but I am not sure where it is headed. It will probably still be an advocacy blog--as there is still much work to be done related to the ACA, and I am still committed to the work NPA is doing--but I will admit that my focus is much closer these days. Being in a leadership role in a safety net clinic has provided the opportunity for me to help make our healthcare system more responsive and accessible for everyone, and to provide holistic care for patients who have serious needs. I hope that I will be able to use the blog to describe what we have been doing in the office, what impact it has, and how we are looking to continue enhance and improve our patients' health.

I will try to be less of a stranger heading forward, and appreciate those who might come along.