Wednesday, August 10, 2016

My new job to innovate in primary care

I finished residency this year in June. After 7 years in training, I finally get to do what I set out to do: make my patients healthier. One tiny problem, I'm not exactly sure how to do that. 

It isn't just me though, as a healthcare system, we haven't figured out how to improve overall health outcomes of our patients. This is despite being the most expensive health care system in the world spending an estimated $9,451.30 per capita or 16.9% of our GDP in 2015 according to OECD. In comparison, the country with the next highest expenditure would be Switzerland, which spends 11.5% of its GDP on health care, and then Japan at 11.1% of its GDP. At least Switzerland and Japan have more to show for their expenditures though, according to CIA's estimated rankings for 2015. For example, in terms of life expectancy, Japan is ranked 2nd highest at 84.74 years and Switzerland ranked 9th at 82.5 years. Similarly, Japan ranks 3rd lowest for infant mortality in 2015 with 2.08 deaths per 1000 live birth, and though significantly lower, Switzerland still ranked better than the US at 26th lowest with 3.67 deaths per 1000 live birth. Comparatively, the US is ranked 43rd in life expectancy at 79.68 years (right under Turks and Caicos Islands and Virgin Islands) and 58th lowest in infant mortality with 5.87 deaths per 1000 live births lagging right behind Croatia, as well as Bosnia and Herzegovina. 

So when I say I don't know how to make my patients healthier, I'm only partially exaggerating. It isn't as easy as just going to medical school and doing residency, after all, if that were the case, wouldn't our system be performing much better than it is already? So what can we be doing better and differently to improve our overall health? I'm not sure, but that's what I finally have the opportunity to try to figure out.

This month I joined The Wonderful Company's Health and Wellness Initiative as the Associate Director, Clinical Innovation. The Wonderful Company is dedicated to improve the health and wellness of its employees and families, many of whom are agricultural workers in more rural areas of Central California, and believes that the answer includes better primary care. Given I decided to specialize in Family Medicine, I obviously agree. 

However, the answer isn't in the primary care as we know it now, which often time is the 15 minute per patient visit, see as many patients as you can to become financially sustainable type of primary care we've become so used to in our system. Instead, can we re-imagine what primary care could look like to improve our country's overall health outcomes to a state better than it is today? Could we partner more with patients for their health? Could we more effectively teach and inspire better health habits? Could we coordinate care better? Could we bring in other healthcare workers to function as a team? Could we do more in the community? Could we address social factors that impact health? Could we use data better? I personally believe the answer is yes to all of the above, but I guess we have to prove it, and I'm thankful for the opportunity and flexibility to try new things and do exactly that. So my mind now is constantly churning with one question: How can it be better? Because, I know it can be better. It is actually just like when I was the senior resident on our hospital team and one of the junior residents was confronted with a road block, and I always gave the same advice: the question shouldn't be if, but how.
One of the company's sites in Lost Hills, CA