I’d like to thank the White house for the opportunity of being a regional finalist for the 2023-2024 fellowship. While I didn’t advance to the final selection the people I met and interacted with as a part of this process will stay with me forever.
Founded in 1964 by Lyndon B. Johnson, the White House Fellows program is one of America’s most prestigious programs for leadership and public service. White House Fellowships offer exceptional emerging leaders first-hand experience working at the highest levels of the Federal government.
Selected individuals typically spend a year working as a full-time, paid Fellow to senior White House Staff, Cabinet Secretaries, and other top-ranking government officials. Fellows also participate in an education program consisting of roundtable discussions with leaders from the private and public sectors, and potential trips to study U.S. policy in action both domestically and internationally. Fellowships are awarded on a strictly non-partisan basis.
Named a Healthcare Thought Steward by the Healthcare Hoagie
We laymen (and women) would hardly know what a pangolin is (hint: not a pokemon) without the presence of physicians in our learning spaces. Whether in traditional or on social media, these physicians are expanding our understanding of the care we receive by democratizing access to health education and technology.
There are obviously intersections. You can switch around, we won’t hold it against you. Most of these physicians end up participating in the dissemination of healthcare literacy. And, in a world where misinformation and disinformation are turning public spaces into asymmetrical dullards, this is all the more important.
I’m pleased to announce I’ve joined the medical advisory board of Clinics IV Life, an important charity that is helping to bring access to healthcare to those without it.
In a world filled with wonderous technologies and immense wealth, there is perhaps no greater indictment of our modern society than the plight of the poor. Healthcare is particularly notable in its failures, both in first world and developing nations, to address the imbalances poverty produces.
In a modern developed country like America, millions struggle to access even basic care. Add to this the still persistent bias in healthcare towards women and you begin to understand why our societies are plagued with the horrific statistics shown above. One thing has become abundantly clear over the past decade. The commercialized heart of healthcare beats cold to the needs of the disadvantaged.
Too long have we, as individuals within the healthcare sphere, stood by idly and accepted the injustices visited on the poor. We pontificate on health, we blog, we broadcast hour upon hour of sanctimonious indignation and we criticize, all to what end? None of these paths affect any level of meaningful change. They never will.
It was this realization that drove the creation of Clinics IV Life. Rather than sit by idly and wait, we have chosen to forge ahead on our own, and while our solutions will only make a difference to a few lives in this global tragedy, those lives matter. It is our sincere hope that our efforts, and those of others, will spur on the many, and that cumulatively, small victories will turn the tide of the war.
Finally, we bear a responsibility to our fellow man and woman and to ourselves to eradicate the imbalances in healthcare. We have the technology, the medicines, the budgets and the mechanisms to deliver this care. What is now required is action, tangible efforts and solutions that offer immediate relief, even to the few. There is no price that can be placed on the value of one human life.
You can read more on this from our founder, Robert Turner, who shares his thoughts on the healthcare system and how we need to address the inadequacies that lead to poor levels of care.
Dear Senators Sanders and Cassidy and other members of the HELP Committee –
As you know, the American Association of Medical Colleges (AAMC) 2021 published data includes estimates of a physician shortage (37,800-124,000) and a surgeon shortage (15,800-30,200)7 in the United States (U.S.) by 2034. With growing numbers of medical schools and training programs in the U.S., we must ask ourselves: why is there an impending workforce shortage? Rather than just turn towards increasing medical schools and training programs, we urge the Senate to consider the retention of physicians in training and practice.
We write this invited response to your March 2nd, 2023 letter as stakeholders and Physician Just Equity (PJE), a collective of 40 physician and surgeons who have organized to support colleagues suffering from workplace injustices, that have either disrupted or prematurely ended their careers. Physician Just Equity (PJE) is a 501(c)3 organization founded in October 2020 with the pillars of support, advocacy, education, and research. Workplace injustices, are being defined as gaslighting, harassment, discrimination, and/or retaliation in the medical workplace and are commonly experienced in aggregate by those Under-Represented in Medicine (URiM) and/or by whistleblowers.5
Being the target of workplace injustice leaves clinicians at very high risk of attrition from the workforce, and this attrition is usually not the result of PTSD from experiencing these harms but rather from workplace traumatic stress, unethical, corrupt and often illegal actions (but sanctioned under HCQIA) executed by the leadership of Academic Medical Centers, health systems, hospitals and/or medical groups resulting in restraint of trade/practice – now being referred to as the Corporate Medical Playbook.14
In response to this epidemic of attrition,8,9,15,19,20, PJE implemented an innovative individualized and independent peer-support service for colleagues experiencing Workplace injustice to help mitigate the harms, by Championing a Balanced Resolution to conflict in the workplace. This support service commenced in February 2021 and was established in response to the 6th of 15 recommendations outlined in the 2018 NASEM report on the Sexual Harassment of Women, Climate, Culture and Consequences in Academic Sciences, Engineering, and Medicine.15 After 24 months providing peer-support and more than 75 cases, our knowledge about the causes, demographics, processes, and outcomes of Workplace injustice has informed the basis of this letter. Workplace injustices exist as a driver of attrition and hence contribute to the tragic and unacceptable loss of diverse talent from the U.S. healthcare workforce and will exacerbate the projected workforce shortage.
The 6th recommendation in the National Academies Of Sciences, Engineering, and Medicine (NASEM) report15 is Support for the Target because it has been proven that academic medical centers are failing to support reporters of Workplace injustice by making them the targets of retaliation (e.g. OHSU Covington Report7). Our pilot study entitled Peer Support Helps Physicians Navigate Workplace Conflict was just published online in the Journal of General Internal Medicine2 and captures a snapshot of experiences by targets of Workplace injustice. Retaliation was disclosed by 78% of our pilot study participants and is prevalent in the literature in the setting of reporting unlawful behavior. The current lack of accountability (aided by the lawful use of non-disclosure agreementss) allows these behaviors to continue with impunity. Much like Lloyd Austin has ordered an Independent Review Commission to take bold action to address sexual assault and harassment in the military by taking prosecution out of the hands of commanders10the U.S. Senate must order that investigation of Workplace injustice be conducted by an independent body. Healthcare institutions have proven time and again that they are not capable of fairly policing themselves nor embracing restorative justice principles to facilitate healing, reduce long term harm, and promote the retention of valued clinicians in the workforce.
The failure of ethical and lawful governance over undergraduate medical education, graduate medical education, and medical staff disciplinary processes undermines the integrity and just practices within the medical profession, moral leadership, and our calling to do no harm. Talented, ethical physicians and surgeons are unduly harmed by the weaponization of processes that were originally designed to protect patients. This harm is legally sanctioned as healthcare entities are afforded significant protections under the Health Care Quality Improvement Act of 1986 (HCQIA).19 These unchecked institutional practices include physician improvement plans (PIPs), physician health programs (PHPs), sham peer review, and reporting to the national practitioner data bank. Subjecting competent ethical medical professionals to these punitive retaliatory processes for reporting and/or speaking up against an injustice leads to moral injury, mental anguish, burn out, and in too many cases, death by suicide.
The lack of safety in reporting Workplace injustice, the absence of due process rights, and the failure to hold perpetrators of injustices and those complicit in injustice accountable for their actions is a significant driver of attrition and will prevent intelligent learners and talented clinicians from choosing and staying engaged in a medical career respectively. The opportunity and financial cost of failing to intervene and protect diverse clinicians is insurmountable and would be tragic especially in the context of a workforce shortage.
Although only 5% of practicing clinicians identify as Black or African American1, justifying the use of the phrase URiM (U.S. population 14%)16 the pervasive occurrence of constructive discharges, dismissals/terminations, reputational harm, and being “Black Balled” from the profession, is a driver of attrition at the learner and attending level that cannot be ignored and therefore is addressed specifically in this letter about workforce shortage. Links to a number of the cases that have made it into the media are included in Appendix 1. Apart from racial discrimination impacting the workforce shortage, the U.S. will never realize healthcare equity and racial justice without supporting the URiM.
A short list of potential solutions are suggested below:
1) Revision of HCQIA to prevent the abusive use of immunity clauses that harm and sometimes end the careers of talented clinicians through the use of sham peer review process
2) Legislation that offers protection to clinicians from the abuse of power wielded by leadership within Academic medical centers and Healthcare Systems.
3) Additional protection under the 2022 Lorna Breen Healthcare Provider Protection Act to support and protect providers from harm at the hands of hospital and medical group administration and Medical Licensing Board who “punish” learners and practicing clinicians who seek mental health support.
4) An external independent agency resource comprised of peers educated and skilled in conflict resolution to review all cases of peer review as a result of known bias and discrimination that leads to sham peer review, referral to Physician Health Programs sanctions by Medical Licensing Boards and reporting to the national physician data bank
5) Mandate that the national physician data bank no longer enter subjects into the database until a period of appeal that employs independent vetting of a reporting entities claims of unprofessionalism
6) Mandate that the national physician data bank maintain demographic data that reflects protected class identities to track the breakdown and proportion of subjects who are URiM and claim protected class identities
7) Independently fund and staff external support programs that provide help to the targets of workplace injustice
8) Legally mandate healthcare institutions complete public national score cards that reflect their annual success at promotion, retention, and metrics of physician well-being and satisfaction with their workplace environment, culture, and leadership
9) Require reporting of annual promotion and graduation of every CMS funded trainee to track progression and entrance into the workforce
10) Mandate that WI’s that result in an adverse action as defined by the clinician be investigated by an independent body
11) Eliminate termination without cause, non-compete, and non-disclosure agreement clauses in clinician employment and separation contract and separation agreements respectively
We welcome the opportunity to meet with and work with Congress, or it’s designee, to facilitate this joint venture of resolving and ameliorating the anticipated health care shortage.
Pringl Miller MD, FACS Kellie Lease Stecher, MD
Sandra B. Cadichon MD, MMI, FAAP Melissa Blaker, DO
OBGYN, Author, President and Co-Founder Patient Care Heroes
Physician, M.D., OBGYN, Author, Educator, Policy Consultant, Passionate, Determined, Persistent. Dr. Stecher is an advocate for justice, and a leader in the fight against institutional sexism. Her memoir, titled “Delivering” was released in October 2021. Patient Care Heroes was started as a simple social media post to tell the story of a physician hero who ultimately died as a result of caring for her patients with COVID-19, ultimately launching a national conversation about all those in healthcare who risk their lives going to work and providing care for their neighbors.
Kellie is its co-founder and president. Dr. Stecher is an advocate for reproductive rights, healthcare access, mental healthcare access, and gender and racial equity. She continues to work as an OBGYN.
Connecticut woman delivers baby on flight to Dominican Republic: What pregnant travelers should know
A woman from Connecticut who gave birth on a flight to the Dominican Republic in September has returned to U.S. earlier this month after getting an emergency passport for her newborn.
Kendria Rhoden of Hartford delivered her son Skylen on an American Airlines flight, according to a series of viral TikTok videos her sister, Kendalee Rhoden, posted, which have garnered millions of views.
Kendria Rhoden and her child were able to board a return flight home in early October, according to the TikTok videos posted.
“On Sept. 8, American Airlines flight 2443 from New York (JFK) to Punta Cana (PUJ) declared an emergency before landing due to a medical emergency on board,” an American Airlines representative wrote to Fox News Digital in an email.
“First responders met the flight upon landing and the customer was taken to a local hospital for further evaluation. We thank our team members and medical professionals on board for their professionalism and quick action,” the airline rep continued.
Rhoden and her sister shared TikTok videos of Skylen’s red emergency passport and both videos have drawn questions from curious social media users who want to know what it’s like to give birth while traveling internationally.
Fox News Digital reached out to Rhoden for comment. It’s unclear as to how far along she was in her pregnancy.
Here’s what pregnant women should know before making long-distance travel plans and what needs to be done if, by chance, they give birth in the sky, in international waters or in a foreign country.
What to know about emergency passports and other documents?
Passports are an important travel document that are usually required for international trips. (iStock)
New mothers who give birth on a plane or boat while traveling internationally have to report the birth to the U.S. embassy or consulate in the country of their arrival, according to Dr. Jessica Madden, medical director at Aeroflow Breastpumps, a breast pump distributor based in Asheville, North Carolina.
Embassies and consulates will issue a Consular Record of Birth Abroad (CRBA) form, which will need to be filled out to prove a newborn’s citizenship status.
“As long as you are a U.S. citizen, your baby will also be a U.S. citizen, no matter where he or she is born,” Madden said. “Certain countries will offer dual citizenship if the plane was flying over their country when you gave birth, but others will not.”
CBRAs take approximately 15 business days to process, according to the U.S. Embassy & Consulate government website.
Passports are required for international travel and reentering the country.
The U.S. Department of State’s Bureau of Consular Affairs handles emergency passport processing, including life-or-death emergency appointments that require international travel within three days and urgent travel appointments that require international travel within 14 days.
“Newborns who are born abroad do need to have an emergency U.S. passport issued to be able to enter the U.S., unless they are born on a cruise that both leaves from and returns to the U.S. [in a] closed loop,” Madden said.
CBRAs and emergency passport applications for newborns are usually processed at the same time, according to Madden.
She noted that newborns must be present during these document appointments, which is a requirement that could delay the process if a baby isn’t quickly discharged from a hospital.
Doctors and airlines advise women who are in the late stages of pregnancy to avoid air travel. (iStock)
“There is a potential that your stay might need to be extended by several weeks,” Madden warned.
Madden noted that expecting mothers who need to travel internationally during their third trimester should check obstetric care terms with their health insurer to see if a birth abroad will be covered.
PREGNANCY COMPLICATIONS ASSOCIATED WITH PRETERM BIRTH
“I recommend having a copy of your pregnancy medical record readily available. This is important information to have with you if you give birth in a foreign country,” Madden said. “You should try to plan ahead of time where you will seek medical treatment if you go into labor or develop an unforeseen pregnancy complication.”
Women who have pregnancy complications that are associated with a higher risk of preterm birth should avoid traveling internationally during the entire third trimester, according to Madden.
What are the logistics of traveling while pregnant?
Some pregnant women choose to go on a “babymoon” vacation before they give birth. (iStock)
Airlines and cruise lines have a “no-travel deadline for pregnant passengers,” according to Sandra McLemore, a travel industry expert and television host with 22 years of experience, who currently contributes to Travel Marketing and Media, a California-based travel business firm.
“Within the airline industry, it can vary between domestic airlines and international airlines,” McLemore told Fox News Digital.
“If, for example, you were flying to Europe for your babymoon, you’d need to check each airline. Getting across the pond and then being denied boarding to your next destination would be terrible,” she continued.
Cruise lines, on the other hand, are known to adjust their own rules depending on the itinerary, according to McLemore.
“The risks are higher when a ship has a significant number of sea days away from land,” she said. “Typically, you’ll see earlier pregnancy deadlines on transatlantic or transpacific routes.”
“Most travel insurance policies do not cover any form of pregnancy complications, which means that if you require medical treatment or repatriation, you could be hundreds of thousands of dollars out of pocket,” McLemore warned.
What do doctors want pregnant women to know about travel?
Medical experts all agree that pregnant women should consult their obstetrician before they make long-distance travel plans. (iStock)
The “best time to travel during pregnancy” is between 14 and 28 weeks, according to the American College of Obstetricians and Gynecologists (ACOG), a Washington, D.C.-based professional association of obstetric physicians.
The group notes that “mid-pregnancy” is the best time for expecting mothers to travel because morning sickness and energy levels generally improve.
“You are still able to get around easily,” the group wrote in a travel information guide. “After 28 weeks, it may be harder to move around or sit for a long time.”
The ACOG urges pregnant women to consult their obstetrician before travel and to be wary of travel if they’re experiencing pregnancy complications.
Why are air and sea travel a concern?
Dr. Kellie Lease Stecher, an obstetrician at Minnesota Women’s Care, a healthcare center in Maplewood, Minnesota, said each pregnancy is unique and therefore recommendations can vary when it comes down to travel.
“If an individual is in their first trimester, but [they’re] having bleeding concerns, it would be best to stay home. However, patients can travel internationally until 32 weeks,” Stecher told Fox News Digital.
Having the information ready can help to make a backup or emergency birthing plan.
What are the risks of traveling while pregnant?
Dr. Wendy Goodall McDonald, an obstetrician-gynecologist at Women’s Health Consulting, a healthcare center in Chicago, said she advises “low-risk” patients to avoid international travel in their third trimester and “high-risk” patients to stop traveling earlier than that.
“If there is a complication, not only is the pregnant person subject to whatever health system is present where they are, but if the baby were to be born early, they now have a preterm newborn who has to remain in that health system until they are old enough to be discharged, which could be months,” Goodall McDonald told Fox News Digital.
Traveling during the early gestational period is generally viewed as safe, but there are still some risks. (iStock)
“The same is true earlier than the third trimester, but statistically, complications are less likely to occur in the second trimester or earlier,” she added.
Traveling for extended periods – four hours or more – with restricted movement while pregnant also puts women at risk of developing a blood clot, or deep vein thrombosis (DVT), which can be life-threatening, according to Goodall McDonald.
She said expecting mothers should “get up and move every two to four hours” to lower their chance of developing blood clots.
Pregnant women should consider all their options before they plan travel by air or sea. (iStock)
“Cruises often have medical personnel present, but there may be limitations to where further care will occur if needed,” Goodall McDonald said. “Air travel will allow a person to get to a destination faster than a car or bus in the event that acute care is needed, but if driving or riding a train or bus is the only option, the pregnant person should be aware of what hospitals or health systems are along their route if needed.”
One of the phrases I tell myself came directly from a Maternal Fetal Medicine (MFM) attending, and anyone who trained at MSU has heard this. “It’s better to have a living patient without a uterus than to bury them with it.” I remember my intern year and the first time I heard this phrase. It seemed so obvious to me. Of course, I would do a hysterectomy to save someone’s life. Read my newest article over at Medika Life
Really interesting interview I did with Health Tech World discussing technology in remote healthcare and some other great topics! Link #nursing #health #healthtech #doctors #remotejobs #remoteworking #obgyn