The 2016 presidential election confirmed what many had seen happening on a global scale. Beginning with Brexit in the U.K., the rise of populism has swept around the world, and, in the United States, we witnessed an example of it in an election result few saw coming. The heartland and Midwest carried the victory for President Trump and demonstrated the stark ideological differences among people living in different geographic areas and settings. The lives and issues that matter to people can be vastly dependent on where they live. And, unfortunately, as this country continues to further divide along ideological and political lines, the desire to understand our differences and reach a common ground has often been cast aside for name calling and political hijinks. I would like to think we are different in medicine but, from my viewpoint, I see considerable disparities in healthcare based on where a patient resides.
I live in Kansas City and work at the sole academic center for the state of Kansas. As such, we receive transfers from all corners of a state that is the 15th largest by area but 34th in population in the country. Many of these patients live up to six hours away, and, treating patients from rural Kansas, it is impossible not to recognize the significant obstacles these patients face in receiving good healthcare. Many of these patients are farmers who literally can’t afford to be away from their farms for more than a day. There are currently two otolaryngologists nearing retirement age who cover the entire geographic area of western Kansas. They have been looking for a partner for 20+ years but have been unsuccessful in recruiting to their small town. Patients need to drive hours for routine otolaryngology care to have their tonsils removed, and even longer distances if they are diagnosed with tertiary problems. Rural areas have poorer dental coverage, greater childhood obesity and infant mortality, and greater delays in cancer treatment that can lead to poorer outcomes. Statistics are getting worse, and there needs to be a renewed focus on what we can do to optimize the outcomes for all of our patients, regardless of where they live.
Our cover story in this month’s issue is on population health. Initially popularized by CMS as part of the triple aim (improving patient experience, treating populations of patients, and decreasing cost), population health concerns the outcomes of a group of individuals with a disease state, and the delivery mechanisms, barriers to care, and interventions used to improve their outcomes. The article is an eye-opener in that it points out how few population health studies are in otolaryngology. Much of that comes from us being a surgical subspecialty, while much of population health is based on prevention. But based on what you have just read, I think otolaryngology would be wise to think about population health in a broader context.
Rural health in otolaryngology will improve if we address physician workforce issues. We are blessed with attracting the best and brightest medical students. The problem is, the vast majority of these go on to fellowship and jobs in urban centers, and very few go on to rural areas to practice. What can we do as a specialty to recruit and/or incentivize individuals to practice in underserved areas? For patients with routine otolaryngology problems but no otolaryngologist to see, what can we do to better arm their primary care providers? Outside of the VA system, telemedicine has not really taken off in otolaryngology. But what about artificial intelligence? Can research into otolaryngology-specific AI help primary care physicians and physician extenders make better treatment decisions when they can’t refer out? Can we better utilize digital health and technology to make sure our cancer patients are getting the proper follow-up and timely ancillary treatments? How do we maintain our chronic disease patients who suffer from sinusitis or Meniere’s disease without having them drive five hours to come see us once a month?
These issues are not just Kansas issues. They are applicable to every state in this great country. Let’s keep this conversation going and remember our mission of providing excellent patient care for everyone. Thanks for reading, and I look forward to visiting with you next month.