Speaker 1 00:00:00 The medical community, our public health structure. We need to get more serious about addressing this in new ways.

Speaker 2 00:00:16 Welcome to Off the Chart, A Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor over at Medical Economics, and I'd like to thank you for joining us today. And on behalf of the entire teams over at Medical Economics and Physicians Practice, I hope you're having or had a chance to relax and enjoy the long Labor Day weekend. This week, we're turning our attention to the physician workforce and the state of medical practice in America. Medical Economics Senior Editor Richard Payerchin sat down with Dr. Gary Price, the president of the Physicians Foundation, to talk about the pressures facing doctors today and what's at stake for the future of medicine. They're talking about findings from the foundation's latest research, the drivers of physician burnout, how economic and policy shifts are reshaping medical practice, and what solutions might help sustain the physician workforce in the years ahead.

Speaker 2 00:01:08 So thank you again to Dr. Price for joining us this week. And let's dive into the episode.

Speaker 3 00:01:21 I'm Richard Payerchin reporting for medical economics. With me today is Dr. Gary Price, president of the Physicians Foundation. Doctor price, thank you for joining us today.

Speaker 1 00:01:33 Thank you Richard. My pleasure.

Speaker 3 00:01:35 By now, I think most of our readers and audience are familiar with the Physicians Foundation. Just in case there are a few who are not. Can you give a brief introduction to the organization?

Speaker 1 00:01:45 Sure. The Physicians Foundation is now a more than 20 year old charitable foundation that sees their purpose to empower all physicians to provide high quality care to maintain the sanctity of the physician patient relationship. And to take an active leadership role in shaping the future of our health care system.

Speaker 3 00:02:06 And there's some exciting news, because the Physicians Foundation has two open periods for grant applications right now. Can you explain what those are?

Speaker 1 00:02:15 We do we have open grant applications, particularly in the area of drivers of health. that is, upstream factors that influence patients health.

Speaker 1 00:02:27 And we also have an open grant request for proposal in our wellbeing space.

Speaker 3 00:02:37 And another topic hopefully not to retread too much ground, but just in case there may be some new physicians out there or really haven't encountered it. Can you briefly explain what are some of those drivers of health and why those are so important to health care?

Speaker 1 00:02:52 Certainly, when we look at drivers of health as what I might also call upstream foundations of health. There are factors in a patient's lifestyle, where they live, who they are. Financial background. Access, particularly to nutritious, healthy food, all these things, access to transportation. Things which, don't normally get addressed in an office setting, but which can have an enormous impact on health outcomes. It's been estimated, actually, that 60% of our health care spending is a direct result of those upstream drivers of health, rather than the medications or even advice we dispense in our offices.

Speaker 3 00:03:39 And to continue along that line. One of the grants and an award is named after Doctor Richard Buzz Cooper.

Speaker 3 00:03:46 He's the author of poverty and the Myths of Health Care Reform, which documented the effects of social drivers of health on health care costs.

Speaker 1 00:03:56 Yes, indeed. In fact, the Physician's Foundation financially supported the publication of that first book over a decade ago. Doctor Cooper looked at data that had been established by a very large study called the The Dartmouth Atlas, that tried to parse out why the cost of health care was so different in different parts of the country. They broke that data into parcels that were allocated by what are called hospital catchment areas, which is just the area of service for a hospital, basically. And based on that analysis, they came to the conclusion that the driving factor in the differences in costs were simply the amount of physicians present in any given area. The foundation was in its early period then, and our board was looking at all the things that seemed to be changing medicine. And this study, which has been widely used for the subsequent 20 years in health care planning and policy, just didn't make sense to us, and we began to look for other explanations and ran across Doctor Cooper's work.

Speaker 1 00:05:10 His books really an inflection point in our attitudes towards the impact of drivers of health. But he very conclusively, in a very simple, readable way, showed how actually that if you looked at patient's zip codes that the explanation for these differences in cost actually broke down quite dramatically on the basis of poverty and some of the side effects of that, that in fact, it was our poorest neighborhoods where the costs of health care were actually the highest.

Speaker 3 00:05:44 Did you get a chance to work with Doctor Cooper yourself?

Speaker 1 00:05:48 I indeed had that privilege. one of our board members acted as an associate editor with him, and I had the privilege of editing several of the chapters myself in cooperation with several other people.

Speaker 3 00:06:03 I guess as he was conducting this research, can you describe maybe his reactions or responses to some of those findings? I don't know. Sort of. Did he go in with an idea that that might be the case, or was it a total surprise when he began to delineate those, those different costs along different areas with different poverty levels?

Speaker 1 00:06:25 Well, Doctor Cooper was already a noted scholar when he turned to this area of study.

Speaker 1 00:06:31 He had been dean of the medical school in Wisconsin and then went to Wharton, the Wharton School of Business, as a health care economist. And much like us, he wasn't satisfied with the results of the analysis that the Dartmouth group arrived at and decided to look at the data in a different way. And when he did parse out that data that way, the results were quite dramatic. His his books an interesting read. One of the most dramatic chapters is called take the A train. And for your listeners who are familiar with New York City and the A train, he goes on an imaginary ride from Harlem to the uptown and downtown Manhattan, and shows that with each change in zip code, how the cost of healthcare go up. And it's quite dramatic. The difference between the most expensive zip code to live in with, which actually has the lowest cost per capita of health care, and the most impoverished zip code in New York City, which turns out to have the highest cost per capita for health care.

Speaker 1 00:07:49 And in that very simple example, he really lays out the fact that we've not paid attention to these factors as part of taking care of our nation's health, and lays out a very compelling case for the economic benefits of making investments in these things upstream before they cause chronic health, disease, delayed diagnosis, that sort of thing.

Speaker 3 00:08:12 You know what? And that's a great segue to the connection. I wanted to make sure that we touched on, because it sounds like those different zip codes that have the greater poverty levels, it's not necessarily just a matter of a higher price tag, so to speak, of a certain service. It sounds like the residents, and I don't want to assume, but it sounds like the residents in those zip codes may be needing many more services due to those health effects of the social drivers of health.

Speaker 1 00:08:41 Exactly. If you compared the average expense, what's actually paid for, say, an office visit in those poorer areas because they're often government funded and supported health care plans. The actual reimbursement to physicians is very low compared to the average reimbursement.

Speaker 1 00:09:03 If you were to go, for instance, to the Upper East Side. So it's not that the individual costs are greater per visit, it's that the people who are being treated require more visits, present with more complicated problems, and have difficulty in complying with medical treatment for a variety of reasons. Things like not being able to get to follow up appointments, not being able to afford the medication, perhaps not even having access to refrigeration for some medications which require it, and making choices between food for the family and medications or medical treatment.

Speaker 3 00:09:43 A question I wanted to make sure we get to because this was something that, you know, Doctor Cooper left a legacy of research clearly, and in an award that is named after him and physicians still are dealing with some of those same drivers of health. Definitely wanted to ask about Doctor Gabriel. Oyeyemi was honored with the Foundation's Doctor Buzz Cooper Award for addressing drivers of health at his practice in new Jersey. How would you describe him and his work?

Speaker 1 00:10:15 Well, doctor Oyeyemi is a remarkable example of what a physician with great intentions, great energy and also great skill can do.

Speaker 1 00:10:28 He founded the Cherry Hill Free Clinic but went far beyond that. He has organized that clinic so that a really diverse patient population, most of whom don't have health insurance, can not only get access to care, including specialty care, but also he's made sure that his clinic can bring that care to them and meet them where they are culturally, as well as begin to include the concept of drivers of health such as healthy, nutritious food, and really begin to address these things. In his effort to decrease the burden of disease, keep his population of patients healthier, and make sure that they live healthier lives as a result.

Speaker 3 00:11:15 What do you hope other physicians might take away from his example?

Speaker 1 00:11:20 Well, I think he's a tremendous example, number one, not only of how important these upstream drivers of health are, but how practical interventions can be structured, created to help address them in a system which up until now has largely not done a great job of doing that. I think he's a great example of how creativity and persistence can really pay off.

Speaker 1 00:11:47 All physicians want their patients to be healthier, and they all want to help them do that. And he's shown one way of bringing the tools that are available to address that issue. The Foundation very much wants to see more investigation, creativity, research into other ways that we can accomplish that goal.

Speaker 3 00:12:14 A great segue into another question that I had, because the Foundation does sponsor and even has the open application period right now for the Drivers of Health grant program not to give away any unfair hints about, you know, possible application, but what are some of the areas of research that you would like to see regarding physicians and practice and in data collection involving social drivers of health?

Speaker 1 00:12:38 Well, we're particularly interested in physicians and the societies or associations that they belong to. We're interested in them looking at creative ways that in practicality, these upstream drivers of health can be addressed, and they can intervene in a way that we can improve the environment that these patients are coming from in a way that facilitates their health not only tomorrow, but in the months and years ahead.

Speaker 1 00:13:11 So we're really looking for creative, locally based solutions because our country is certainly not, like every community is not like every other community. And we think these have to be addressed locally to be really effective, but we think they're really in a unique position to explore different ways to address these drivers of health within the health care system and within the culture of the patients they're serving.

Speaker 4 00:13:46 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Speaker 5 00:13:51 Oh, then they want to check out our sister site, Patient Care online.com. The leading clinical resource for primary care physicians. Again that's patient care online. Com.

Speaker 3 00:14:04 I like that local approach. I think you probably know I made a long career as a community journalist. And you know in that approach of course we are hyper local in the reporting of news and getting to know a community. And clearly, doctors also get to know their community in a way that probably few people ever do.

Speaker 1 00:14:23 I think that's certainly true.

Speaker 1 00:14:24 And of course they have to carry it down yet another level to really get to know each individual patient if they're really going to help them navigate their own health and our health care system. But the community in which they have exposure to these drivers of health is also critically important.

Speaker 3 00:14:43 And since we've spoken last, in recent months, of course, there has been, you know, the change in administration with President Trump. And there has been a new effort to make America healthy again. And there are elements involving, you know, regulations and policy, kind of public health policy, individual choice and personal ownership of health care. And really the need for parents, I think, government, regulators and society to safeguard the health of children. Of course, that is paramount as well.

Speaker 6 00:15:16 Where do you where do you see social.

Speaker 3 00:15:18 Drivers of health fitting in with the Make America Healthy Again movement?

Speaker 1 00:15:22 I think they fit in well, Richard. You know, one of the cornerstones, as you mentioned, is to make sure that our citizens, particularly children, have access to healthy and nutritious food.

Speaker 1 00:15:34 And that's one of the key drivers of health that we feel has a very dramatic impact on health. Chronic disease burden, life span, just about anything you can think of. So in that way, our interest in drivers of health is very well aligned with the goals of the Make America Healthy Again movement.

Speaker 3 00:16:00 And to follow up on that. We know that food choices and availability, just as you mentioned, is one of those social drivers of health and the Make America Healthy Again report that came out earlier this year really placed an emphasis on potential health effects from ultra processed foods. And since then, there's even been additional kind of research and study about that.

Speaker 6 00:16:22 Do you anticipate more doctors.

Speaker 3 00:16:24 Will pursue training to guide patients about healthier food choices and food as medicine?

Speaker 1 00:16:31 I think yes, I do, because I think as this becomes more a topic of conversation, both at the level of the federal government and within our communities, our patients will be more open to learning about it, and our physicians will be more interested in something they know their communities are receptive to.

Speaker 1 00:16:52 So I. Yes, I do think that will happen. I also think that we need more research. there is some evidence that's not the ultra processing itself. It's the high, high caloric intake of many of those foods. And the ease with which they can be consumed may be a way bigger factor than some of the other things that have been, blamed for that. But I think we really need good hard data, and we need it presented to our patients in an understandable way that they trust. And I think, both our government and our, our regulators, as well as physicians in our scientific community need to work on communicating that well.

Speaker 3 00:17:42 You know what? A few moments ago, you had touched on the grant program and the physicians opportunity to really locally work on potential solutions that involve their patient panel. Bigger picture. At the national level, what policies would you like to see the white House and Congress take up to improve the health of Americans, especially regarding social drivers of health now?

Speaker 1 00:18:08 Well, I think they've already done something very important in recognizing the role that drivers of health play in our nation's health.

Speaker 1 00:18:17 we have been, providing information based on our previous research, some of which we funded, some of which we didn't. But we think there's some very specific things that can be done simply within the regulatory environment. You know, right now, under the Medicare Medicaid system, access to healthy food is not considered something labeled as as a health benefit. Interestingly, Early access to a gym to work out, though, is, we think there's some very specific regulatory things that can be done specifically, within that regulatory framework, making access to healthy food, a health related intervention. our foundation was responsible for the first two quality measures within the Medicare system that involved looking at drivers of health. We thought that was a critical step. although I think those measures and surveying that factor are very well aligned with the Make America Healthy Again philosophy. Unfortunately, in the regulations, they were just announced in a final rule that they're being taken out of Medicare. it's it's our hope that the administration's open to new measures specifically looking at nutrition.

Speaker 1 00:19:46 And, we think that if physicians are not only given an incentive to survey for needs in this area, as well as the fact that the government recognizes by regulation that these are important, we think that it will be a huge step towards introducing these as part of what's called health care. you know, physicians can't take care of the nutritional needs of their patients in their office, but they can identify those needs. And there's no reason in 2025 where why we can't develop a really good system in real time to be able to connect our patients with sources of healthy, nutritious food in their communities.

Speaker 3 00:20:36 Doctor price, it's been a great conversation regarding social drivers of health, kind of writ large, as well as the foundation's efforts and those grant opportunities that are coming up. What did I not ask about that? You want our audience to know about those grants specifically, or about drivers of health in general?

Speaker 1 00:20:54 Well, specifically for any physician or representative of a medical society or association, regardless of whether it's specialty or some other group.

Speaker 1 00:21:08 The way to find out about applying for such a grant is to go to the Physicians Foundation website, and you can easily find out about applying for those grants. The grants do involve, support in the financial way of $75,000 for a year's work on the project.

Speaker 3 00:21:32 Fantastic. And I hope there are going to be some physicians out there who want to take advantage of that. So wish the best.

Speaker 7 00:21:38 Program.

Speaker 1 00:21:38 Our our last call for a similar project, over a year ago resulted in a remarkable number of truly superb research proposals. So we're very excited about being able to offer that support again.

Speaker 8 00:22:01 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60s, we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom.

Speaker 8 00:22:23 They come from you got a clever workflow hack, an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at Kay reynolds@lifesciences.com with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers and nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next PTO management minute.

Speaker 3 00:22:53 Hopefully some of those applicants may come back. It sounds like there's never enough resources to be able to fund everything we would like, you know? so yeah, I'm excited to learn more when that when that time comes. Absolutely.

Speaker 1 00:23:08 We'll make sure that you're kept abreast of that. Richard.

Speaker 3 00:23:10 Yeah. Thank you.

Speaker 6 00:23:12 And you know what?

Speaker 3 00:23:13 Definitely wanted to talk about also because earlier today, the the survey results had come out regarding the physician survey on medical misinformation and disinformation.

Speaker 7 00:23:23 Yes.

Speaker 3 00:23:25 can we go into some questions about that?

Speaker 1 00:23:27 Absolutely. I would love to discuss a very interesting survey.

Speaker 3 00:23:31 It is indeed and is very, very timely. the Foundation published that latest survey, those latest survey results, just earlier today.

Speaker 6 00:23:42 What was the most.

Speaker 3 00:23:43 Surprising finding to you?

Speaker 1 00:23:46 Well, let me lay the background for that. You know, the survey revealed that, more than half of physicians feel that misinformation and disinformation make it difficult for them to deliver high quality care and that it's a significant issue. interestingly, rural physicians see it as a significantly bigger problem than urban and suburban physicians. We don't know why, but even suburban physicians, over 20% of them feel that it's it's often a problem in helping their patients end up with good care. I don't I don't really think, except for the rural versus urban part. I don't think that's surprising. And we all know that misinformation has become a bigger issue in all of our lives over the last five years. A lot has happened then. We've had Covid. We've had, Political use of misinformation and disinformation. We've seen foreign governments attempt to use it to influence our politics.

Speaker 1 00:24:53 we've seen people exploiting it seemingly just to get more followers on their podcasts. Except for where that disinformation is coming from. which now social media appears to be playing a huge role. You know, it's been around forever. governments have used it forever. every war in recorded history. the opponents have tried to use it against their foes. so that part isn't new. But what is new is the stream of information that patients are getting and the trust that they develop in that and that that leads me to to answering your question, which what was most surprising, most surprising to me was that the majority of physicians clearly feel that this is a huge problem for them and taking care of their patients, they're frustrated by it. It contributes to burnout. over 50%, no matter how you ask the question. Interestingly, when we asked physicians if they felt they were equipped and able to deal with it with their patients, 97% said, absolutely, yes, we are. I found that very surprising. If you take a look at what's happened with one of the leading indicators of how well we're doing with public health vaccination rates over the last five years, we clearly have not been able to cope with that.

Speaker 1 00:26:33 Misinformation and disinformation. We've let our patients down on that. And it's striking to me that almost everyone thinks that they're able to do a great job. This is a little bit the mirror image. When you ask patients about their trust in different professions. Their trust in physicians in general has been slowly eroded a little over the last decade. But when you ask them about their own physician, they rank their own physician, if not the highest, very high in people they trust. I think physicians are doing a little bit of the opposite with their confidence. They're supremely confident in their ability to talk with their patients almost to a one. But yet they recognize that for at least half the patients, it's a real issue. I think this reflects a disconnect. And it's a it's a call to action for the scientific community, the medical community in particular, but especially for physicians and the organizations that try to help represent them. I think we've fallen behind in understanding how many of our patients are getting their information and what leads them to trust a source.

Speaker 1 00:28:00 And we can't just deliver them the results of studies anymore. We have to learn to communicate and meet our patients where they're getting their information, where they're placing their trust. And that's something new for the medical profession. It's something we have to learn about. I think it's something our society has to do more research into and get some evidence based answers to how we do that. I really think that we need to look at the way we communicate with patients with just as much intensity and rigor as we do when we're trying to figure out how to make an operation better, or how to develop a better treatment for a disease.

Speaker 3 00:28:44 You know, doctor wanted to ask, just on a personal note, if there was an example you remember from your own career that would illustrate why medical misinformation and disinformation can become so frustrating for a doctor attempting to care for a patient.

Speaker 1 00:28:59 Well, I think if you asked any physician they could give you a hundred anecdotes, but the one that I found most personally disturbing occurred during the Covid epidemic.

Speaker 1 00:29:09 And I had a patient who, needed an operation. It wasn't an emergency. it it was elective. and it was a long standing patient of mine who I knew very well and had a very good relationship. One that I thought involved mutual trust between the two of us. Something that's critical to any physician patient relationship. And, we got to the part about my secretary scheduling a Covid test for him. Preoperative. This was a point in the Covid epidemic when we had reliable tests, and we knew that a patient with undiagnosed Covid under anesthesia was actually a threat, not just to himself. We could make a respiratory infection with Covid much worse by doing an operation, but also to all the caregivers around them the anesthesiologist, the nurse, myself, you know, we in scheduling surgery, we were planning on being very close to this patient for an hour or two. And we tried very hard to avoid unnecessary exposure of our health care team to these patients by getting a Covid test. this patient got, visibly agitated, was yelling and screaming at my office staff to the point where I think they were definitely intimidated.

Speaker 1 00:30:40 And some of them I think were probably afraid. And when I intervened, I got dressed down with the fact that not only was Covid not dangerous to anyone, but the test was dangerous. You know, a stream of misinformation from a very intelligent patient who I had a long relationship with. He ended up storming out of the office. Didn't even give me a chance to explain why. But that's something I won't forget for a long time.

Speaker 3 00:31:09 I certainly hope that patient, one way or other was able to come to a positive outcome if he needed treatment.

Speaker 7 00:31:16 of course I.

Speaker 1 00:31:18 Share your hope, but I have no idea.

Speaker 7 00:31:22 Gosh. Wow. Wow.

Speaker 3 00:31:25 That's that's that's really telling. And not only, you know, that personal experience, but you had mentioned a moment ago that that every doctor probably has 100 examples, maybe not to that extreme. but clearly they're there. It sounds like there is a heck of a lot of both misinformation and disinformation. And just like you had mentioned a few moments ago as well, the need to improve communications.

Speaker 3 00:31:51 this is something that sounds like it's going to be an emerging issue in medicine now.

Speaker 1 00:31:56 Yeah, I would counter that. It's emerged. It's definitely here and with us. And the only question is, when we're sort of going to take our blinders off and admit that we, we don't need to do what we're already doing better, we're going to have to to look at new ways that meet this new challenge.

Speaker 3 00:32:22 You know, doctor, we're coming down to the two minute warning here, and I could I I'm not a physician, obviously, but with the whole processing and presentation of information as a journalist, frankly, that's one of my, you know, stocks in trade. I could talk to you about this all day. just on a closing note.

Speaker 6 00:32:38 What what what points about.

Speaker 3 00:32:40 Those survey results? You had already touched on a number of great factors. Anything else you want our audience to know?

Speaker 1 00:32:46 Well, we've talked. We've talked about a lot. I, I think it's important to underscore, as far as the survey goes, that physicians recognize that this is a huge problem for their patients.

Speaker 1 00:32:59 It seems to be a bigger problem in rural areas, and we really don't know exactly why. And more research needs to be done on that. But clearly the medical community, our public health structure, we need to get more serious about addressing this in new ways.

Speaker 3 00:33:20 I'm Richard Payerchin reporting for medical economics. My guest this afternoon has been Dr. Gary Price, president of the Physicians Foundation. It's been a great conversation. Dr. Price, thank you for joining us again.

Speaker 1 00:33:31 Thank you, Richard.

Speaker 2 00:33:44 Once again, that was a conversation between medical Economics senior editor Richard Payerchin and Dr. Gary Price, the president of the Physicians Foundation. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show. And as you please, subscribe so you don't miss the next episode. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that Medical Economics and Physicians Practice published delivered straight to your email.

Speaker 2 00:34:09 Six days of the week. Subscribe to our newsletters at Medical Economics and Physicians Practice. Com. Off the chart A Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds, and produced by Austin Littrell Medical Economics. Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.