Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Randall M. Clark, M.D., FASA, President of the American Society of Anesthesiologists, and Karen Fisher, Chief Public Policy Officer of the Association of American Medical Colleges, about how the American health care system responded to the pandemic and what it faces going forward. They discuss how the pandemic impacted physicians and health care providers, some of the successes and failures of the health care system, the renewed focus on health equity, the impact of the mental health crisis, and issues to watch in the future.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Randall M. Clark, M.D., FASA, President of the American Society of Anesthesiologists, and Karen Fisher, Chief Public Policy Officer of the Association of American Medical Colleges, about how the American health care system responded to the pandemic and what it faces going forward. They discuss how the pandemic impacted physicians and health care providers, some of the successes and failures of the health care system, the renewed focus on health equity, the impact of the mental health crisis, and issues to watch in the future.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
This episode of HL, a speaking of health law is brought to you by HLA members and donors like you. For more information, visit American health law.org.
Speaker 2:Welcome everybody to today's podcast. We're gonna be talking today about health policy. I have two amazing guests with me. My name's Sarah SW from the law firm of mixing Peabody out of the Washington DC office. I have, uh, with me today, Dr. Randy, uh, Clark, uh, Dr. Clark, can you introduce yourself to the audio?
Speaker 3:Thank you so much, Sarah. Um, I'm Randy Clark, I'm the president of the American society of anesthesiologist. It's an organization, a professional association representing about 55,000 anesthesiologist in the United States. Um, I'm also a, of anesthesiology at the university of Colorado, uh, but to say, wear and tear on the Dean, I need to make clear that I don't speak for the university. Um, actually a pediatric cardiac anesthesiologist working at children's hospital here in Denver.
Speaker 2:Great, thank you, Dr. Clark and Karen, um, can you introduce yourself to the audience?
Speaker 4:Sure. I'm Karen Fisher. I'm the chief public policy officer of the association of American medical colleges, the AAMC, uh, we represent all of the MD granting medical schools in the country, as well as over 400 major teaching hospitals and, uh, over nearly a hundred, uh, faculty and academic societies. Basically we represent all the large academic medical centers in the country. I oversee our public policy and government relations work. I've been here at the WMC for about six years and prior to coming to the WMC, I was spent four and a half years as senior health council at the Senate finance committee. Uh, I worked on healthcare issues, Medicare, Medicaid, CMMI, et cetera.
Speaker 2:Great, thank you both for joining me today. We're gonna have a really interesting conversation and even in prepping for this podcast, I mean, the world keeps changing each day, doesn't it. And, uh, um, the answers to some of these questions will, I think we'll stay the same. I mean, from my vantage point, some of the issues that are happening for, for physicians and healthcare providers have been the same for a while and, and the pandemic highlighted some of those issues, um, you know, even just the interaction with other health, like other systems that we have, um, the interaction and highlighting the strengths and weaknesses of our healthcare system. Um, I think this is probably like the easiest question. Any of the hardest question I'm gonna ask on this podcast? How did I'll start with you, Dr. Clark? How did the pandemic impact physicians and healthcare providers?
Speaker 3:Well, thank you for that. Um, before I answer, I have to point out that this pandemic has caused nearly 1 million deaths in this country alone. Uh, that's a stagger staggering number, um, uh, proportionally. It's still about half what this country saw in the 1918 Spanish flu pandemic, but in light of a hundred years of medical progress, it's still an astounding number. Uh, as of last week, we were still seeing nearly a thousand deaths per day. Uh, now there is a lot of controversy around dying from COVID versus dying with COVID, but even then a thousand deaths per day is an UN absolutely unbelievable number. So I hope we never get numb to, uh, these kinds of, uh, figures because frankly, um, we've never seen anything like it and hopefully we'll never see anything like it, uh, again, um, but in terms of the impact, I, I am proud of physicians and the response that we've had during the pandemic. I think our healthcare delivery system has stood up, uh, and, uh, uh, met the challenges that we face. And I know we'll be going into that in a little bit more detail, uh, in the following questions.
Speaker 2:Thanks. I mean, I think that's a great point. Um, you know, we, we hear a lot about like statistics and boxes and graphs and there's real people behind those numbers. So I appreciate that Dr. Clark, Karen, how do you, how did you see the pandemic impacting, uh, healthcare providers, physicians, teaching hospitals? What was something that you, that really stuck with you?
Speaker 4:Well, I think we're gonna talk a lot about this, Sarah, but Dr. Clark said, uh, I'm proud out as well as how the healthcare system and the public healthcare system really, uh, stood up during, uh, the pandemic. Certainly academic medical centers were, uh, a lot on the forefront taking many of the CRI most critically ill patients being of the forefront on the research going forward. Uh, so there are, are lessons learned certainly, uh, and forward, and we certainly saw cracks in our healthcare system. And as you mentioned, issues that were around, but that were highlighted, I am sure we'll talk a little bit more about health disparities and, and health inequities. And I, I think at some point we'll also wanna talk about physician burnout and clinician wellbeing, and I'm sure Dr. Clark will have something to be said on that because this has taken a tool, uh, on our healthcare provider, uh, system. Uh, but I, I will say on both the, uh, provider side in terms of, uh, standing up and, and, and being there for patients, our healthcare systems, uh, were there, our public healthcare, uh, systems were there. And if you think about our research, uh, the fact that a vaccine was able to be produced, what, within nine months, and it's normally five years, uh, that says a lot about our, our research enterprise and the research that the national institutes of health have done. Um, so there's still a lot that we're going to learn from, from this, but there certainly are a lot of heroes out there and that we saw on the front lines every day.
Speaker 2:Great. Yeah, I think it's interesting as a, an attorney, like some of my successes are so piggybacked off of other people's amazing work. So like some of the, some of the AI and genome and vaccine research, you know, and supporting that, or, or watching the expansion of telehealth, or even on one of these podcasts, having three amazing women physicians from Johns Hopkins, talk about launching the long COVID, um, clinic there when they weren't sure about the research yet and trying to support positions. So it, so my, my successes are really other people's successes that I've supported. Um, Karen, what are some of the successes that you you've seen, um, from your organization that you, you said and say, wow, that was really a moment that we could be proud of during this time?
Speaker 4:Well, I certainly the, the vaccine, uh, research and the development of the vaccine, I think is a critical success. I also think that, uh, the expansion of telehealth and you, uh, alluded to that, Sarah, certainly I think many providers, uh, wanted to expand their health telehealth practices. It's a, it's a wonderful opportunity for patients. Uh, it's a wonderful flexibility to provided the system. And it was amazing to me how quickly when COVID came on board, how quickly, uh, academic medical centers and teaching hospitals and physicians and Dr. Clarks how quickly they stood up telehealth, uh, practices, and were able to continue to provide care to patient through a telehealth system. And as we talk about what we wanted to see continue, uh, obviously those telehealth opportunities, uh, are something that we just can't have go away. Uh, they're too valuable, uh, to patients and they really are improving access, uh, to healthcare. But certainly I think that telehealth access was a, uh, a very big success during this.
Speaker 2:Yeah. I just saw the, the press release from HHS about trying to see if these telehealth reimbursement can stick after, after the pandemic and the emergency, uh, is over, um, I could air over, um, and we're in more of a, less to a pandemic and more into, I guess, living with the virus, whatever that is defined as, uh, Dr. Clark, what were some of your successes either as, as an organization or, or personally during the pandemic?
Speaker 3:I want to, uh, echo what Karen said about the vaccine development. It was truly an amazing accomplishment while messenger RNA technology has been around for several, several years. There had never really been a, um, application of it yet. There were many promising ideas being, uh, investigated, but to move from a, uh, new technology to having a proven and safe vaccine, uh, in a relatively short period of time is absolutely amazing. I can't, uh, uh, I can't praise enough. Those researchers that we're able to bring this about as well, I, as the several hundred thousand patients that volunteered for the, uh, early clinical trials. And I, I look forward for continued development in this area. I'm just a huge believer in the vaccines and the promise they offer, uh, to helping to, uh, both prevent and reduce the severity of disease for my organization. I'm very proud of our ability to help, uh, address the challenges we saw in healthcare, uh, to my knowledge, nowhere in this country, did we approach crisis standards of care where patients would have to be triaged between those who had received care and those who did not that, uh, fortunately to my knowledge, did not happen in the United States, but we came close in a few places early on in the pandemic. It appeared that we would, uh, overwhelm the number of ventilators that we have in critical care units, uh, across the United States. And I'm very proud of my organization getting the word to the, uh, white house and others that we have 78 to 80,000 ventilators on our anesthesia machines, uh, that could be used in these situations, uh, to help get patients through, uh, for those times when ventilation was required. Uh, the ASA president at that time, Dr. Marydale Peterson did an amazing job in getting this information to where it was needed. And she was actually even recognized by the white house for those efforts. So that was very gratifying to me, uh, to be able to see our ability to step up with this technology and to make anesthesiologist of available to support critical care needs of patients across the country.
Speaker 2:Yeah, I think Dr. Clark, one of the things that was amazing to me talking to clients or others or friends or physicians that I know was, you know, people who were, um, you know, in one specialty and were there to help in an ICU, even if that wasn't, you know, they hadn't been in that training in a long time, just, just being on hand and ready to, to support whatever, whatever needs were gonna be in that organization at the time. And I know there were some that had some really, they were real close to having some hard issues, right? Dr. Clark.
Speaker 3:Absolutely. And, and there's some even, uh, things that probably, uh, uh, nons don't even know about. So, um, we found, we knew that in severe viral respiratory infections, proning patients turning them face down, improves ventilation, improves oxygenation anesthesiologists, do this all the time when we are positioning patients for surgery on the back. And so anesthesiologists became leaders of teams that assisted in pro patients making sure that they were protected, uh, in hospitals, uh, to a improve, especially those with very marginal oxygenation, uh, and to help them get through the acute phases of the disease.
Speaker 2:Thanks, Dr. Clark, that's an amazing example. Um, so, so Karen, how, how about you, is there anything you'd like to, to add to what Dr. Clark's talking about? Um,
Speaker 4:No, no. I think, uh, you know, we talked about the successes telehealth and the vaccine, you know, but we can't, we can't, uh, diminish that there were certainly challenges that evolved, uh, and that, uh, appeared during the pandemic or reappeared. And that is, uh, the health disparities and the health inequities that had existed before the pandemic. But that really, uh, rose up when we looked at the number of COVID and the individuals impacted, um, I would also say we saw the, uh, provider burnout and wellbeing, and I think that's an issue that's going to continue, uh, to, that we have to deal with, uh, terms of clinician wellbeing, uh, going forward. Now what's wonderful is that I think, and we've seen also though, a renewed interest in, uh, younger people wanting to be healthcare providers. We saw an increase at our association and the number of applicants to medical schools during COVID. And, uh, that's a wonderful thing, but there was currently a clinician burnout that, uh, occurred during the issue. And then I think we also saw that we just have not historically invested enough in public health and that we can't constantly wait until a pandemic occurs to say, oh my gosh, we need to invest in public health. It needs to be foundational. It needs to be consistent. And, um, there certainly is activity in Congress, in the administration to bolster, uh, support for public health, but that's something we have to do on an ongoing basis and not just wait for a pandemic to appear because when it happens, uh, it's too late. So I do think there are lessons that, that we need to learn from, from the pan pandemic, uh, Sarah and not be too quick, uh, to move on and say, it's over. We all want it to be over. Uh, but without taking some lessons learned, so that we're ready for the, for the next item, and it may not be a pandemic. It could be again, the natural disaster, public health we need in so many areas. And it's critical that we have a strong public health system. And what we have found during the pandemic is the, the relationship and the collaboration between academic medicine, public health, healthcare providers, is that critical trifecta to be able to really wage, uh, uh, a successful war against these types of pandemics.
Speaker 2:It's interesting. The FDA just announced that they're gonna meet again to talk about boosters. And at the same time, you know, where we're talking about, I don't know if it's a downgrade to an epidemic. And then the first place I go with public health law is the opiate crisis is an epidemic. And I don't walk around trying to say that that's going to be solved tomorrow, right? I mean, that's a real epidemic. Um, violence in healthcare is an epidemic. Karen, what do you think about that?
Speaker 4:Well, and we, we, and I'm sure Dr. Clark and his organization did too. We, you know, the, the, the substance use disorder and the opioid epidemic was raging before COVID, if only increased, uh, during the pandemic. I would also say that what we also identify during the pandemic is we need more physicians. We probably need more clinicians overall. We certainly see that with nurses, but we know in our organization that we need more physicians that we, uh, forecast this every year and that we are going to have over a hundred thousand, uh, physician shortage by 2034. Uh, and we need to start working on that now, because it took Dr. Clark a number of years to get to his position. So this is not something that we can produce physicians very quickly, but I think that's, uh, another area. And we certainly have seen policymakers Congress recognize that we need to boost our physician workforce across all specialties, primary care of course, but other specialties as well.
Speaker 2:Yeah. It's um, it's interesting cuz we know there's like the great resignation. We know that people are leaving their jobs just generally we know they're leaving healthcare and we know that they're leaving certain environments in healthcare hospitals right now. Um, at the same time we do have some people that have this, like you said, Karen, this call to action to like go into medicine at the same time. So, um, so, but I think for me like Dr. Clark, one of the most powerful moments that I had during the pandemic was talking to a doctor, um, about trying to off to a family, like during an ethics consult around COVID treatments and just, just, and not having the resources and just really how, like I hear that academically people don't have the resources they need, they don't have, but what that must feel like as a physician or a clinician who they're they're calling was to go and do that, to help people and didn't, and we haven't always, you don't always have every resource you need, but not in this way. And how that just was adding to the burnout is, is how it's described to me. How, I mean, what do you think about this idea of burnout or compassion fatigue or all these terms and what does that really mean in medicine?
Speaker 3:So it's a, a definite issue. Um, I, I do want to comment on one thing you said about some of the stresses on the delivery system. I think all of us in healthcare were very surprised by the short of, uh, personal protective equipment early in the pandemic. Um, for those that follow, uh, the way manufacturing takes place and supply chains take place. The idea of having lean, uh, uh, uh, concepts applied to our distribution system for this kind of equipment absolutely failed early in the pandemic. And we know we had strategic, uh, stockpiles of some of this, uh, but it was, uh, old and not adequate for, uh, the challenge. So I think one of the biggest lessons we saw early on was that these, uh, lean supply chain, um, cannot, uh, persist in the future. And we're going to have to have adequate stockpiles to deal with anything like this. Again, on the question of physician burnout, I'm very proud of my colleagues. Um, I think that there's been an increasing stress on physicians and others over the last several years, the, there been some economic and other changes in, uh, healthcare delivery, uh, with consolidation that I think, uh, create a little bit more of an, uh, concept of not being totally in control of your environment. I'm not sure any of us were ever totally in control of our environment. Uh, but I think some of those stresses, um, have increased, uh, more recently both in private practice and in the, uh, academic arena. We've seen some of our academic medical centers expand dramatically over the last 10, 12 years. And the all of that takes a toll over time. But I think when, when they were needed for physicians and nurses and others really stepped up to the challenge and I was very, uh, very pleased by that. I do think we're starting to see now, uh, with a lessening of at least the, um, uh, massive numbers that we saw, uh, in different phases of the pandemic. Some, uh, beginning to think about stepping away from medicine. Um, and we're seeing, uh, uh, physicians that are later in their career looking at whether they wanted to continue, uh, under the, uh, present conditions or not. But I don't think we saw any of that during the most severe phases. And so for that, uh, I'm very grateful.
Speaker 2:Thank you for that. And, um, one thing I, I wanna touch back on that you talked about Karen is health equity. Uh, we're seeing under this administration, um, uh, I would call a focus or maybe it's a renewed focus on, on health equity. Uh, and, and we're using that word. I mean, I've had people ask me, Sarah, are you a health equity lawyer? And I was like, I, there, that word didn't exist before we talked about, you know, not have losing patients and care gaps. And we talked about navigating and cultural competency, but we're seeing things in a different way. And for, for example, for the audience, the, the ACO reach program that, uh, is, you know, ha was announced as a focus on health equity, which we didn't see previously. Um, so that the idea that we're, we're looking at payment reform in that way, um, what are some other ways, you know, is it through med schools or other ways, what are other ways Karen, that we're looking at health equity in a different way?
Speaker 4:Yeah, I, I, I do wanna talk about that. I wanna follow up on something, Dr. Clark said that that, uh, should have some means. And I think Dr. Clark may have some, uh, experiences too on the health equity front, Sarah, but, uh, Dr. Clark mentioned about the need that hospitals had been in before. COVID about being lean and only having the supplies on case. And certainly we all agree that there needs to be a focus on the rise in healthcare costs. And I think that keeping just the amount of, uh, supplies that you needed in, in, in stock was a way to help and dress controlling healthcare costs. And we saw what happened though during the pandemic. And so we need to start to find solutions that recognize healthcare costs, but also recognize are we ready when a pandemic hits? And as Dr. Clark mentioned, whether that's supplies and are, um, in many of our members, the issue, is there a way to be able to have regular hospital beds, to be able to be converted to an ICU bed when needed, when we need a surge of ICU beds, but that they can be regular hospital beds in other cases, so that you don't have ICU beds going with sitting unused, but we've gotta think about those types of issues so that we're thinking about healthcare costs, but we're also ready when a pandemic, uh, issue arises. So I, I really appreciate Dr. Clark raising that issue in terms of health equity. You're right. This is an issue that many people had focused on before the pandemic, but the voice just wasn't loud enough, uh, given the Coco of other voices and issues, uh, around, uh, healthcare. And so I think it's been critically important that it's been raised, um, during this issue, uh, during this period. And I think it's important that we don't lose momentum. And I think we were pleased that this has been a bipartisan issue and lots of hearings have been held on, uh, Capitol hill by both parties, by both the Senate and the house to talk about what those issues are. And some of it is just dealing with the data and understanding, do we have the right data to be able to really understand what's going on? And I think we just haven't had enough of the data, uh, to be able to understand what's going on. And also what we've learned is to really listen to communities and work within communities and work with trusted stakeholders and communities, uh, to be able to understand what are the needs, uh, regarding health equity. We are that the administration had a COVID health equity task force that put out a report. Uh, recently we are appreciative that the administration is looking, uh, at these issues, uh, but we need to keep that focus, uh, going as we go past the pandemic. And, and I think, uh, one of our key issues has been to make sure we're adequately collecting the data so that can, we can see what the needs are. So,
Speaker 2:Yeah, so there's codes out there. Everyone that's been around for a while, the Z codes and, um, you know, I, I have the, I don't know, intellectual cur curiosity to actually dig into some of them and how you would capture them just to understand, like, how would you collect data and what, what would be there are, um, you know, they're optional and, and, and are they the right codes or not when they capture the right data, even those codes. So you're right. There's, um, data helps drive policy, um, uh, Dr. Clark, how about you, uh, any thoughts on health equity and, and in all its components from patients to physicians, to caregivers. And
Speaker 3:So, uh, absolutely. Um, health equity is just an absolute huge, uh, societal challenge. And it's not just confined to health equity, uh, depending on how you define equity. I think that it's clear that we have disparities in not just healthcare, but in housing, in education, in, uh, food, in, uh, any number of areas. And so being able to address those, I think really is gonna take us, uh, require all of us, take a step back to try and understand what creates those disparities in out outcomes and accessibility. A lot of it has to come down. A lot of it comes down to the, uh, disparate, uh, distribution of economic benefits. And how do you fix that? Uh, in this society, we've, we've had social welfare programs, uh, for a very long time, and yet most of the disparities continue to exist. So I think we have, to, my personal opinion is that we have to rethink, uh, that approach. One thing I wanted to mention that we, uh, were talking about briefly on some of the challenges that we're facing as a result of the pandemic, I would be Remis if I did not comment on the significant amount of delayed care that exists in this country right now, and a lot of cancer screening and other, uh, normal procedures were postponed or delayed because of the pandemic. And I'm, I think we're now starting to see some increases in cancer and other diseases, uh, that we thought we had a good handle on previously, uh, but are now, uh, uh, increasing because that early diagnosis, uh, opportunity was just missed. And then finally, on, on the, one of the challenges, this sort of nebulous and, um, hard to get your arms around, but one that I'm very sad to see is that over the last year and a half, we've seen a lot of, uh, political, uh, thinking, be injected into healthcare and healthcare, uh, decision making, uh, to a degree I don't think of us ever anticipated before. So some of the questions about what we can do to protect the most, uh, members of society during the pandemic, um, really had an unfortunate degree of other, uh, framework injected into it. And I'm not sure yet how we recover from some of the challenges.
Speaker 2:Yeah. I think even, even in our, what we use the language we use, and I've talked, a lot of us have talked about this, which is like even using like disparities or food insecurities and all, and, and, um, some of the like kind of academic words around this, which is not necessarily political and understand what you're saying, Dr. Talked about political, but just even just at its base level, from an academic standpoint, like a food insecurity means there's a child starving somewhere. And we kind of, don't always say it. I think there might be, this is my personal opinion, uh, more power in it. If we talked about it, like somebody's dying because of their race or somebody didn't get the care that wanted or needed at the time because of a gender pronoun. Uh, and that is a different way to speak about it. Um, and maybe, maybe even just stripping some of that out and really being able to talk about, uh, it, because I think, I think people are really, uh, are more open to it when they understand really what it is. Um, and we're not so academic about it. Um, I also wanted to talk about one thing that you said Dr. Uh, Clark, which was, um, you know, you said something about supply chain and how that kind of burnout together. But one thing that really hit me and we just did a podcast with three chief legal officers at children's hospitals. And I, I asked them to about a mental health pandemic, basically what they're calling it like this twin pandemic that's happening. And it was really, um, I asked them to get concrete about it so that people really understood what that meant. And one of the things they talked about were like children, like in like, like they had to decide between putting kids in hallways that were Spacely or were suicidal or, or, and also having floors where people where children had mental health issues or were suicidal, but also had like a medical issue at the same time and, and being on the same floor and how to staff that. And do they, even if they can't staff to the right level to be, do they even take, how do they do they take that patient? Like, what do they do? And one of the chief legal officers was talking about, you know, they're building a mental health hospital for children because it's that impactful right now. And I think those are the kind of things that I think, you know, makes change when people really hear like, it's that it's that bad? Like, what does that look like? What, from you, from your perspective, what does a mental health crisis look like? What is like, what, what does it look like and how does it impact healthcare, whether it's delayed care or people with comorbidities, or, you know, how is it impacting the healthcare system?
Speaker 3:Um, so, uh, I work in one of the largest children's hospitals in the country, and yes, we, uh, did declare a mental health emergency about a year ago. Um, children have been relatively spared from the, uh, uh, physical, uh, challenges created by COVID 19. Uh, but the mental health health challenges have been, uh, tremendous. And, uh, that's been imposed on a system that was already marginal at best. Um, we have an inadequate number of caregivers, uh, in the mental health arena, especially for children. Uh, some of the payment issues related to, uh, mental health care for children are substantial. And the number of inpatient beds that we have available are just absolutely, uh, shockingly low, all of those, um, uh, contributed at really the worst possible time to this surge and stress on, uh, children that, uh, the pandemic caused,
Speaker 4:I will say I'm, uh, pleased to see that the Senate finance committee has been holding hearings on what they could be doing in the mental health and wellbeing space. And they've been focusing on children. And so there's been some good hearings and some good on the ground testimony there. And I think that's important for policy makers to hear what's going on, but I'm really glad that, uh, Dr. Dr. Clark Ray is that issue.
Speaker 2:Yeah. And I know Colorado, the governor was the first to, to raise their hand and say, there's, this is some something really bad is here. Um, you
Speaker 4:Know, well, Sarah, can I come back? It almost relates to the children when we talk about health inequities and disparities and so much we learned from COVID. But, uh, the other issue is Dr. Clark alluded to it is the impact of racial injustice on healthcare and, and, and, um, health of our fellow citizens. But, uh, another area that has received a lot of attention, uh, appropriately, so has been maternal mortality, particularly in populations of color. And it is, uh, gratifying to see that there has been some legislation out there. Some that has been passed, some that is impending legislation to focus on the issues surrounding maternal mortality. That's another issue when we talk about, you know, that's, that's, uh, babies dying, that's mothers dying. When you talk about being very specific about the wording, and those are issues we must take on, um, take on directly. And I do think over the last year or two, we have, uh, shed more light on that issue that had been around and that, that, uh, there is progress being made on that more, more progress it's to be made.
Speaker 2:Great. No, I think that's great. It's like when you know what it is, and even the words, I think people are intentionally trying to make it sound academic or smooth it over. It's just the words we use. And then when people go, wait, the statistic is what<laugh> and, and you just, it, it just sits there. It is so powerful. And like you said, Karen, the data on that, it, it can create change. And also just talking about it. Um, cuz if, if the people who have the data or know about it, um, either they're not, maybe they're, they aren't out talking about it or they're, they don't have somebody out like a Karen or, or Dr. Clark out talking about it that are persuasive. It's hard to change policy without people hearing the real stories behind it. And so I appreciate that. That's a great example of, of change that happened because we talked about it. Um, one thing that I think also has been a theme is this idea of like resilience. And I know that's like a strange health policy question, but it isn't, in some ways, all of this is like as a country, we've had to be resilient together. Um, and I think one of the things and the theme I heard you talk about Karen too, which is, and, and you Dr. Clark, which is like, we can't do this again. Like this is what I've had when I, when I have the closed door conversations with my colleagues and they say, Sarah, like, you have like keep going out and speaking because we can't do this again. We cannot have buy on the back of our hospital. We cannot have kids, um, that are suicidal and we don't have enough space for them. We can't not have masks for people that need them and people, and we understand healthcare is complicated, but then it's not either. Right. Um, so part of that's just staying we're. So, and staying focused on those issues, like how do we do that as a country, Karen?
Speaker 4:Well, you know, I, I tend to say, and I I've worked in policy for over 25 years and, and, and unfortunately, sometimes, uh, because of all the issues facing the country and fairness, we do have this whackamole mentality, I call it. And as you know, when the mow, when you see this mow was there, you try to hit it and get it down, but you don't, we're not preventing the MOS for coming up. And, uh, we have to figure out a way, uh, to do that in a way that's responsible. Uh, but that in a way is prepared and, and we tend to move from one crisis to another. And I know we all say, let's not let a good prices go to waste, but, but we really need to have meaning to that. And again, the Senate help committee, the house energy and commerce committee, there are, you know, there's lots of discussions. There's legislation coming out, talking about pandemic preparedness for the future, how to reinvigorate the CDC, provide additional funding, and we've gotta make sure that type of legislation passes and gets enacted, uh, to be able to get away from the WMO mentality, particularly in areas. Whereas Dr. Clark started out the conversation when you have a million, uh, Americans who die from a, from an issue like this.
Speaker 2:Thank you, Dr. Clark, what do you think? What are some of the, like, what is the future? Like, what are the challenges like and how do we stay resilient during these?
Speaker 3:So I think, um, physicians by and large are pretty sturdy folk, uh, to get through, uh, medical, uh, college and then medical school. And then residency, uh, sort of requires that the group that I'm probably most proud of during these last two and a half years, uh, two years have been the, the nurses and the non-physician, uh, techs and others that work in the hospital. Uh, they are really at the front line at the patient interface and have been under the most pressure and the they've stepped up and, uh, met those challenges. It it's taken its toll. Uh, we're seeing some, uh, increased burnout and losses from, uh, nurses and techs and others in the hospital environment. But, um, it's probably not as bad as it could be. I think all of us in healthcare certainly, uh, goal directed and the fact that, uh, we wouldn't be here if we didn't like what we do and see the benefits of what we do, uh, frequently on even a daily basis. So I think that's kept everyone focused and, um, uh, resilient as much as possible. I will say that our, our departments and our, our employers and our institutions have, uh, been cognizant of the challenge. ASA certainly has been as well early in the pandemic. We had a national town hall, uh, specifically, um, uh, devoted to burnout and resilience, uh, just to be able to convey to everyone that, yes, we know this is taking place and, uh, providing some opportunities for, uh, any help people might need. But, um, I think it's been a, a very successful collaborative effort, um, built on top of the fact that our healthcare people I think are somewhat naturally resilient.
Speaker 2:Great. Thank you, Dr. Clark. And yeah, it's a everybody, isn't it, it's not, it's our, it's our emergency responders. It's, it's the, um, environmental health workers. There's a, I mean, it's the phlebotomist, it's the people that had to stand out in the snow and the rain and testing centers. Um, it's really was a lot of people. And like, I appreciate that comment as we're like, kind of looking into the future and thinking what's next for healthcare? Like, do you wanna leave the audience with like what you wish for what you hope for, or, um, something that you think would be helpful for them, Dr. Clark?
Speaker 3:So I'm going to go from some specific things to, uh, general things. Um, I think, uh, anyone that's worked in healthcare and that would especially include the attorneys, know a lot of the challenges we've had around the electronic health record. Um, and there's still so much unmet promise the electronic health record for aggregating data in a way that we can improve care in the future. My organization has a subsidiary called the anesthesia quality Institute and the national anesthesia clinical outcomes registry. We just underwent a strategic planning process where we can a new future where we do better data collection from EHR, uh, to be able to make significant provable changes in the quality of care that we provide. And so that's a, a very expensive, very long term process, but I do think that, um, there is, uh, a great deal of promise are that really we have to be able to, um, achieve, to be able to make improvements in care and then somewhat more related, uh, to that would be the idea of artificial intelligence. So I come from a little bit of a, uh, tech background. My actual undergraduate degree was in, uh, aerospace engineering. I think AI has tremendous opportunity, but it's gonna be really, really hard. It's gonna be harder than say a space project, the landing on the moon. Um, we talk at ASA all the time to the companies that provide equipment for our, uh, anesthesiologists needs. Um, but we know that beyond them who are already, uh, investing substantially in AI, they're really big companies like Google, Amazon, and Microsoft are looking at it for healthcare as well. So I think there's some promise there. I think it will help with some of the, uh, staffing and other challenges that we're looking at. But, um, it's gonna take some smart people, uh, to be able to pull this off.
Speaker 2:Yeah. Thank you, Dr. Clark. I I've heard, um, the data scientists call our EHRs like jungles, cuz there's mines and all this junk, but it's really rich with data and wildlife and there's a lot of opportunity for AI in it. And also of course, a lot of opportunity for it bias and other things to, to go wrong. And, um, obviously a big area of potential regulation and health policy in the future. Um, Karen, I wanna ask you what you wanna leave the audience with, but I also wanna let the audience know that this is a little, you said a little bit of your Swan song and you have so much experience, so much depth and so much can about the subject on, on health policy and, and kinda where we go from here.
Speaker 4:Yeah. Thanks Sarah. I'm gonna say, I think in the short term, we have to figure out a way to make these telehealth waivers permanent. And I also say what we learned a little bit during the pandemic is we'd probably ought to be look looking at, uh, state licensure, particularly for physicians and how much does that make sense as we have, uh, more healthcare being national and global? I think in the longer term, we, we really, uh, have also exposed the critical nature of having access to healthcare and coverage. And then sadly, I would say, you know, Dr. Clark and I talked about the, the fantastic, uh, results around the vaccine being developed so soon. And yet science has taken a little bit of a hit during COVID and rather than being lauded, which I think all of us would've said if we heard the vaccine was published in nine months, that people would be saying, my gosh, this is great. We need to invest more into research in science and, uh, what a wonderful thing. And instead we have some people questioning it. And I think, uh, we, and as a country, as an Asian communities and patients are gonna be really hurt if we don't, uh, continue to focus on science, being our, our bell weather, um, moving forward so that we can really find ways. And, and Dr. Clark mentioned AI to be able to improve healthcare. And as I look, uh, forward on this issue, we have to address all these issues. And yet we also know that the growth and health healthcare costs is something that's gonna have to be addressed. Uh, but I'm also very hopeful and optimistic. I think there's a lot of young people, a lot of young thinking out there, the technology is increasing that, uh, people, uh, if we can take care of inequities, we can improve health deal with some of these underlying issues. We are seeing people live longer and in high, high quality, uh, lives. And so, uh, for anyone out there who is a little bit younger, I think going into healthcare policies, certainly like Dr. Clark going in and being a physician and a clinician, I don't think there can be a better space to be in. I think it's exciting. It's meaningful. Uh, and I really look forward to what the next 20 or 30 years can agree.
Speaker 2:Thank you, Karen. And I, you know, I agree with that and you two are very inspiring and I hope that people in the audience hear that and hear the in, you know, the inspiration in it. And also the, the hope in it that there are things that are wrong and challenges, but that they're getting they're, they're being addressed. And, and we're seeing some change because I think that will, that will we energize people and be resilient. So I really appreciate you both joining us today. Um, thank you so much, everyone in the audience for joining us today.
Speaker 3:Thank you so much for having us.
Speaker 4:Thank you.
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