President’s Message

A Message from the President

by Clifford Wang, MD

SCCMA President

Public Health and Summer to Fall Action

This issue of The Bulletin highlights the tremendous work our local public health department has undertaken and its role in a healthy society. We are fortunate to have an outstanding public health department in Santa Clara County led by Dr. Sara Cody, Health Officer and Public Health Director, and her staff which navigated us through the uncertain waters and waves of COVID-19, MPOX, and now possibly polio.1 We have had one of the lowest death rates for COVID-19 as a county in the U.S. that is associated with a high population vaccination rate. We applaud their Herculean efforts.

At the same time, the pandemic showed us that our public health system is a patchwork with significant variability among local and state public health departments that is underappreciated, underorganized, and underfunded.2 The governance and alignment of federal, state, and local agencies is not consistent or standardized and the activities performed vary. The CDC does not have authority to compel states to act and only about 3% of our healthcare expenditures goes to funding public health which has led to a workforce crisis and lack of a modern database system. Our public health department is nationally accredited but many in the U.S. are not. The Commonwealth Fund Commission issued a report in June this year called “Meeting America’s Public Health Challenge” that recommended an overhaul of the U.S. public health system.3

It recommends establishing an undersecretary for public health at the U.S. Department of Health and Human Services to oversee and coordinate a national public health system, develop a modern information technology system, and provide adequate funding paired with standardized outcomes. In addition, there should be greater connections between health care systems and public health as well as more engagement with community partners in decision-making. If we are to improve overall health in the U.S and respond to the next crisis, we need a more coordinated and integrated public health network that is adequately funded.

The Santa Clara County Medical Association (SCCMA) has been busy this summer planning

We had over 100 students apply from 13 high schools and were able to accept 50 for the program this September.

and beginning our Stanford-SCCMA (SSTEM) transformative experience in medicine program for underserved high school students in the County. This work is in line with our effort to improve diversity in the healthcare workforce by reaching out earlier in the pipeline and inspiring young students to consider a career in medicine or health care. We had over 100 students apply from 13 high schools and were able to accept 50 for the program this September. We will have another opportunity with students in the Spring next year. The students had the opportunity to learn from different specialists about their career and participate in interactive sessions from dissections of a sheep’s brain or heart, suturing, and delivering a baby with a simulation model. I want to thank Angelica Cerano, our physician engagement associate, for organizing this program, the Stanford Medical Student Association including Wasan Kumar, and the SCCMA physicians who donated their time to meet and teach the students including Dr. Cindy Russell, Dr. Anh Nguyen, Dr. Anlin Xu, Dr. Sam Wald, and Dr. Gloria Wu. SCCMA has been quite active on the legislative advocacy side this Summer. Physicians are facing more than 8.42% in payment cuts in 2023 and the cost of operating physician practices has gone up with the cost of rent and staffing in the Bay Area, and Medicare payments lag nearly 40% behind inflation.4 We know this impacts timely access to primary and specialist care for patients. In addition, a 2021 AMA survey found that 93% of physicians reported care delays due to unnecessary prior authorization requirements and 90% said it had a negative impact on patient clinical outcomes.5 We met with Congresswomen Zoe Lofgren’s staff and Congresswoman Anna Eshoo to advocate for stopping the Medicare payment cuts through the HR 8800 bill, “Supporting Medicare Providers Act of 2022” and prior authorization reform through the HR8487/S 3018 bill “Improving Seniors Timely Access to Care Act”. We also supported the Inflation Reduction Act which helps reduce unsustainable high drug costs for our patients. At the state level, we wrote a letter of opposition to California state senators for AB 2236 that would allow optometrists to be certified to perform various surgical procedures without the appropriate level of training and spoke to Governor Newsom directly. We were also in attendance with the Governor when he signed SB1338, the “CARE court Act” that creates a civil court which allows adults with severe mental illness and substance use disorders who do not have

decision making capacity to get medical treatment and housing and empowers loved ones and front-line responders to help. Finally, we wrote a letter to Dr. Miguel Cardona, U.S. Secretary of Education, to consider allowing the Federal Public Student Loan Forgiveness program to apply to California and Texas physicians who meet Physicians are facing more than 8.42% the requirements and would otherwise qualify in payment cuts in 2023 and the cost of if it were not for state laws that prohibit private operating physician practices has gone non-profit hospitals from directly employing up with the cost of rent and staffing in physicians. the Bay Area, and Medicare payments We also welcomed two newly appointed SCCMA lag nearly 40% behind inflation. Council members – Dr. Patricia Salmon and Dr. Fahd Kahn. Dr. Salmon will be the representative for Santa Clara Valley Medical Center (SCVMC). She is currently chief of the division of endocrinology and president-elect of the medical staff at SCVMC. Dr. Fahd Kahn is a neurosurgeon who started the California NeuroInstitute and will be representing El Camino Hospital on the Council. I want to thank Dr. Hal Morrison from SCVMC for his service on the Council. In October, the CMA

Dr. Donaldo Hernandez House of Delegates was held in person in Los from our District VII was inaugurated Angeles and the major topics for discussion as the new CMA President. included Physician Workforce, Health Care Policy Reform, and Mental Health (informational) along with a special panel discussion on “Understanding the Climate Health Crisis and How California Physicians Can Make an Impact.” Dr. Donaldo Hernandez from our District VII was inaugurated as the new CMA President. We also enjoyed our SCCMA Annual Awards Gala on Friday, December 9th at the Westin in San Jose. It was great to celebrate with so many of you who attended. Warm regards and be well, Clifford Wang, MD President, Santa Clara County Medical Association References: 1. Ledford H, Spate of Polio Outbreaks Worldwide Puts Scientists on Alert, Nature, August 22, 2022, 609, 20-21, doi: https://doi.org/10.1038/d41586-022-02233-6 2. Wallace M, Sharfstein JM, The Patchwork U.S. Public Health System, January 6, 2022, N Engl J Med, 386:1-4, DOI: 10.1056/NEJMp2104881 3. Commonwealth Fund Commission on a National Public Health System, Meeting America’s Public Health Challenge: Recommendations for Building a National Public Health System That Addresses Ongoing and Future Health Crises, Advances Equity, and Earns Trust (Commonwealth Fund, June 2022). https://doi. org/10.26099/snjc-bb40 4. CMA Medicare Physician Payment and Access to Care Survey, August 29, 2022, https://www.cmadocs.org/Portals/CMA/files/public/CMA%20Medicare%20 Physician%20Survey%20-%20final%20(2022).pdf 5. 2021 AMA Prior Authorization Physician Survey, https://www.ama-assn.org/system/ files/prior-authorization-survey.pdf