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Transcript: A Look Ahead: AAMC 2021 Advocacy and Policy Priorities

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David Skorton, MD: Welcome to today's podcast. I'm David Skorton, president and CEO of the Association of American Medical Colleges — the AAMC. When I look back on the first season of “Beyond the White Coat,” back in early 2020, it almost feels like a different world. The pandemic was new, and academic medical institutions were in the midst of making rapid changes to how they operate and keep patients and their staff safe, adapting in real time to some harsh and unpredictable realities. The academic medicine community responded to these massive changes with great resilience. In fact, I heard from some institutions that they were able to make changes in just three weeks that otherwise would have taken three years.

Telehealth is just one example of the way our health system changed so quickly. Since then, new policies have emerged related to these rapid changes. The United States Congress and White House have already advanced legislation to address the effects of COVID-19 on our nation, and we expect more changes will be forthcoming. Well, many challenges remain, particularly when it comes to health equity. In some ways, our country's health care is the envy of the world, but in others, it's failing. Too many people living in America aren't as healthy as they could be because the system simply isn't working for them.

To talk more about how AAMC member institutions are working with policymakers to address these challenges and others, I'm joined today by some experienced government relations experts, including Jim Leary, the vice president of government relations at University of Massachusetts Memorial Health Care, and Maurice Rigsby, the vice chancellor for institutional relations at the University of Arkansas for Medical Sciences. Also joining us from the AAMC is my colleague, Karen Fisher, the AAMC's chief public policy officer. Well, thank you all for joining today on “Beyond the White Coat.”

Let's dive right in and talk about how Washington can help set our nation on a path toward creating a healthier future for people everywhere, even as we're still battling a global pandemic. As the new Congress and new administration develop laws and policies to address COVID-19 and other health care challenges, let's focus on how the academic medicine community can communicate our objectives most effectively in support of improving health for all living in America. First, I'll ask Karen Fisher to review recent key federal activity and the association's agenda moving forward — and then hear from Jim and Maurice. What are your institution's priorities this year, and how are you engaging with your congressional delegations and other policymakers?

Karen Fisher, JD: Well, thank you, David. I'm pleased to be here with Jim and Maurice to talk about the important issues. I think we all know — as organizations and as individuals who've worked with academic medicine — how our colleagues worked on the front lines and defined the front lines. I would say that many of our members and policymakers also stepped up during this past year, providing key relief — financial relief, key policies — that helped also to address the COVID package beginning as early as in March, where Congress passed a number of packages. Starting, of course, with funding and policies to help enhance the research that was needed to address COVID, as well as funding for testing and other issues. Then, took on the issue of patients and individuals, as we knew so many people, particularly early in COVID, were losing their jobs — and, as a result, losing their health insurance. And providing support for Medicaid program, providing support for COBRA packages to allow people to maintain their health care coverage that they had under their employer, etc.

Then, through COVID, there was also help to providers to be able to not allow our colleagues to be able to continue to provide care, whether that was financial relief, because of all the issues that were sustained by virtue of shutting down clinical activities to be able to focus on COVID, or to enhance issues, as you mentioned. Policymakers in Congress and the administration passed regulatory and legislative efforts to help, for example, to be able to enhance the ability of providers to do telehealth, which enabled those activities happen. I'm sure Maurice and Jim can talk about that even more.

But even, I would say, as the year progressed and we continued to see COVID and other activities that needed to be happening, the most recent package included funding for state and local entities. There were also issues concerning physician well-being, which was a very big issue throughout this past year in health care providers, and the role of health care providers. Then, we were very pleased to see, as you looked at the workforce and the need for additional health care workers including physicians, recognizing that our organization estimates that there will be shortages of physicians.

That, at the end of the year, Congress passed some additional funding support for graduate medical education, which was an important first step in us going forward. Certainly going forward, where there was more work to do in the health equity space, the racial justice space, continuing with dealing with COVID, and looking at our health care infrastructure. But I'll stop there for now and let Maurice and Jim talk about their priorities.

David Skorton, MD: Thanks so much, Karen. Maurice, love to hear your thoughts.

Maurice Rigsby, JD: Thank you, Dr. Skorton. I really appreciate your vision and leadership. It is an honor, for me and Jim both, to participate in this important conversation. Thanks to Karen Fisher for her leadership and her great team; we would be clueless without her. But also, first, I want to really thank the front-line workers at UAMS and around the country for the sacrifice and the commitment that they have made. It's an honor and a privilege for me to represent them.

During the last year, as an academic medical center, UAMS has been on the front line. Our chancellor, Dr. Cam Patterson, has worked closely with Governor Hutchinson, our governor here in Arkansas, and all state leaders and health care leaders to be on the front lines — and work with Senator Boozman and our congressional delegation as well. Everything that was accomplished in Washington helped us to provide front-line care for our workers and our patients.

Whether that's testing, vaccine distribution, provider well-being, broadband, support for telemedicine, supporting rural health care in rural communities — those things were so critical for us. Most importantly, for GME, working with Senator Boozman to make sure we move the needle on providing graduate medical education, not only for the — Arkansas, but for the country, has really been a game changer. So we look forward to continuing all those priorities in the future.

David Skorton, MD: Thanks so much, Maurice. I had the great honor of working with Senator Boozman when I was at the Smithsonian and he was on the board. Yeah, I appreciate you giving him credit for this very, very important progress. Thank you so much for all you do. Jim, love to hear your perspective on this question.

Jim Leary, JD: Well, thank you, Dr. Skorton, and I'd like to reiterate what Maurice said. Your staff — and I'm sure you know it — are just absolutely spectacular, and Karen has been a tremendous leader. Without the AAMC, and without national associations like the AAMC, it would have been incredibly difficult for us to get our message across. I think that's especially the case for people like Maurice and me, who are based back in our states, not based in D.C.

We have, typically, in our menu of responsibilities — it's federal relations, state relations, community relations, you name it — and that support was critical. I talked about it last week in our government relations meeting. I'm just thinking about a year ago, the fear that we all had of what was about to come. Here in Massachusetts, we had seen what happened in Italy, we were watching what happened in New York, and we realized, that is — we're right next to New York. That's on the way.

With that fear was, “Are we going to be able to have enough PPE? Are we going to be able to have enough beds and to really make the strides we need to do to take care of the population?” It took a tremendous amount of work which included — just like with everyone — changing units, closing down units, expanding capacity — we opened a field hospital at a convention center. All of that costs a lot of money. The Provider Relief Funding that came through was instrumental to us. Our leader — who used to work with you at the University of Iowa, Dr. Eric Dickson — made clear, “We are not furloughing anyone, we are not laying anybody off, we're dealing with the problem, and then we're going to try to deal with the fiscal aftermath.”

The Provider Relief Funding, we could not have done without. Increases in FMAP, in the federal match on Medicaid funding for a safety net system like us, was also critical. I think, in terms of moving forward, we still see the Provider Relief Funding as critical for future expenses, but this pandemic just laid clear every crack in our health care system and in our society. Social determinants of health, and being involved in legislation that may not be seen squarely as health care but really relates to it from housing to food insecurity, really is something that's a renewed focus of ours. Moving forward, we plan on being very active on that.

David Skorton, MD: Well, thanks to all of you. These are very, very important points — just a couple of things to pick up. Karen, I'm so glad you mentioned research. When we think about all the things that happen at academic medical centers, maybe not as visible to the public and maybe not as visible to our policymakers, is that research that — that lonely endeavor that's happening all hours of the day and night. I think about the tremendous rapidity with which we were able to develop vaccines in our great industrial labs within a year based, in part, on over a decade of fundamental research at our institutions, such as the ones we are with today.

But Jim, I'm so appreciative that you mentioned about disparities and inequities in our country. The COVID pandemic, as we all know, has taken quite a bit more than 500,000 American lives since it was first identified in this country just over a year ago. Now, with effective vaccines available, getting those doses to people everywhere in America remains a big, big problem and a big challenge that we just have to meet. These rampant health inequities were a challenge — as you mentioned, Jim — long before the pandemic.

Now, we're seeing racial disparities both in how the virus has affected minority populations and unfortunately, in the rate at which vaccinations have been given. What are your institutions doing to address this problem, and what can Congress and the overall academic medicine community do to help? If we don't get this job done, then none of us are going to be safe, and the country will not move forward, healthwise or economicwise. Jim, you would like to start off with that one?

Jim Leary, JD: Sure, I'd be happy to. We've been partnering with our local communities, literally, since day one on this. We have a care mobile van that normally goes out into some of our low-income neighborhoods and provides care on-site to people who may not otherwise be able to access it. Unfortunately, that had to shut down for protocol — for safety protocol reasons. You, obviously, can't bring people into this small little atmosphere. But our team went out into the community and partnered with a variety of community partners, including in the Latino community and in the Black community, to try to get the word early on about safety protocols to provide masks, to provide hand sanitizer and education and the like.

They then ramped that up to mobile testing. We track data by census tract throughout the city of Worcester as well as other areas that we serve, and we're able to do clinics based upon where we were seeing the highest rates to try to bring the testing right to the people. Now, with vaccines, we're trying to launch the same thing. It's a challenge with vaccines because of supply.

But we're working with the city of Worcester's Department of Public Health, we're working with various community providers — from churches to the Boys & Girls Club to YMCAs and organizations like that — and doing it in a data-driven approach where we can still identify, “Which census tracts have the highest number of cases? How do we get out to them and make sure that it's not just us as the hospital saying, ‘Get vaccinated,’ it's their peers, it's people that they trust from within their community and from community organizations that they work with?”

David Skorton, MD: It's such an important point, Jim, thank you. The voices of communities are just incredibly important. In fact, without them, we're just not going to make progress. Maurice, your thoughts and your experience, in this regard, it's one of the most important things we're facing.

Maurice Rigsby, JD: Yes. Early in the pandemic last year, that was one of our first goals, like Jim said. We developed a Mobile Triage Unit that was able to travel around the state. One of the first places we did go to was in Helena, Arkansas, which is in the Arkansas, Mississippi Delta — probably 80% African American population. Also, a place like Forrest City — 70% — which is on the highway interstate between Little Rock and Memphis, Tennessee. At that time, Forrest City was having a outbreak at a federal prison, so we got on the road and went to these communities to make sure that their needs were addressed, and we've continued that all throughout the pandemic.

Actually, this week started out — I gave a presentation before the Arkansas Legislative Black Caucus about vaccine equity distribution, along with the Arkansas Secretary of Health. Then, yesterday, with the Arkansas Health Department, there was a statewide call for equity. Not only has it been a priority for Dr. Patterson and the institution since he started, the entire state — Governor Hutchinson — is committed to providing equity and making sure that, especially, those suffering with comorbidities are able to get the access and the care that they need.

So, whether it's the African American community, the Latinx, or the Marshallese community — which we have a large population of Pacific Islanders — our entire team is focused on making sure we meet the needs of all of those citizens around the state. We have a — definitely — commitment. A part of that is working with religious leaders, HBCUs, consular generals, and others to make sure that we're working with the partners to bring the care in an effective way.

David Skorton, MD: Yeah, thanks. Those are such great examples. I so much appreciate, Maurice, that you brought up the issue of different places to live — urban, rural, and also the incarcerated population. These are all issues that we just have to face if we're going to be successful. So I thank you and congratulate you for the great, great work you're doing. Karen, turning to you: In December, Congress passed this historic increase to the Medicare graduate medical education program that had been frozen since 1997.

This recent legislation includes 1,000 new Medicare-supported graduate medical education positions — GME positions — and then the distribution of these new residency positions — the slots will be prioritized to teaching hospitals in rural areas, hospitals training residents over their cap, hospitals in states with new medical schools, and hospitals that care for underserved communities as we've just been discussing. My thanks to you, Karen, and your institutions, Jim and Maurice, for their work, helping to ensure this important provision became law. Karen, how does this change the game for academic medicine, and what needs to happen next to address physician shortages?

Karen Fisher, JD: Well, thanks, David. This was an important issue that happened. If you don't mind, I'd like to go back for a second to a little bit on the previous question and just mention, as you know, that the AAMC received a $2 million grant from the CDC to work with our medical schools and teaching hospitals on trying to increase vaccine distribution and working with communities. I think — as Maurice and Jim talked about — the role of academic medical centers across the country and the role of the AAMC to help coordinate to be able to increase vaccinations, dispel myths within vulnerable communities.

Then, I would also mention — as Maurice and Jim had both mentioned — the role of public health in all of these areas in terms of vaccine distribution and increasing vaccines. The AAMC has been very, very supportive of recognizing that we must invest more into public health, and that over the past year, the collaboration between academic medicine and public health has really helped advance our response to the COVID epidemic. The more can be done — more needs to be done as we think about the future.

But I did want to raise the importance of the role of public health as we look about COVID and the health equity in the vaccine distributions. Turning to the issue about the workforce, this is an issue that has been something that the AAMC and our academic medical center partners have realized in their own communities and nationwide — that we are facing a shortage of physicians, largely because the population is growing, and it's aging, and people are living longer, and we just aren't going to have enough physicians to deal with that.

As you mentioned, Medicare is an important partner in helping to offset the costs associated with educating future physicians, particularly in the clinical settings. Medicare doesn't pay all of the costs, but they pay for some of them. The support that Medicare provides is critical to be able to provide the high-quality physician workforce that this country has been so lucky to have. A freeze was put on that in 1997 for myriad reasons that I won't go into, but we were very pleased that — as Maurice mentioned — Senators Menendez and Boozman, and Leader Schumer, and others led the way with a legislation to increase those Medicare caps and that we received 1,000.

More needs to be done. We're pleased that, just yesterday in the Senate, Senators Menendez, Boozman, and Schumer released and reintroduced a bill to further increase and provide more additional support — federal support for graduate medical education. We're also very appreciative to Representative Sewell, and Katko in the House, who also are leading the bill to provide for additional cap slots. That bill, we expect to be released very shortly.

But as you mentioned, it's critical as we look at the workforce moving forward. Increasing physicians is not just the only answer. We're supportive, and as you have led us so well in looking at multifaceted answers to, “How do we improve access to health care?” It involves other types of providers, it involves technology like telehealth, it involves re-looking at how we provide care, but we do need more physicians as part of that as well.

David Skorton, MD: Thanks so much, Karen, for all your work on this really, really critical issue. I'd like to change gears a little bit — switch gears and talk about something that I was really surprised about at the beginning of the pandemic, and many people I run into — both in and out of the profession of health care — were surprised: the challenges that were identified early in the pandemic response related to the fragility of the nation's supply chain. I mean, it was a surprise to me, I'll tell you, about a year ago, to find out that we had shortages of everything from testing supplies and reagents to personal protective equipment for the health care workforce.

These supply chain issues really affected the country from coast to coast and from north to south. Jim and Maurice, how are the supply chain issues affecting your specific communities and institutions, and what actions at the national level could help us to address the issue? Not only in the short term, but to make sure that we're ready when the next pandemic comes. We don't know when it's going to come, we don't know what it's going to be, but we know there will be more challenges like COVID. Jim, if you could start this one off, that would be great.

Jim Leary, JD: All right. Thank you, Dr. Skorton. This brings back another one of those early memories. I remember, literally, sitting at a desk in my bedroom thinking, "We have a shortage of PPE supplies. Where are we going to get them from?" Massachusetts — it has an old industrial history, which included textile manufacturing in cities like Fall River and Lowell. I actually was reaching out to contacts in Lowell and in Fall River, a state senator down in Fall River saying, "Guys, I know this sounds crazy, but is there anybody left that's doing this manufacturing that can help us?" At the same time, thinking in the back of my mind, "I can't believe this is the United States."

The government relations guy in Worcester is reaching out to contacts to try to manufacture something, and some of that actually worked out. There was a company in Fall River that got into it. We were really fortunate at UMass Memorial to have a lot of support from the community. There's a lot of manufacturers locally that use N95 masks, as they're doing their manufacturing, who donated a lot to us and our supply chain team. I have to call out by name, Henry Lopez, who leads the team, was absolutely spectacular, but it was touch and go for months.

I think, in terms of policy, I was really encouraged. There was a good article the other day in the Boston Globe that talked about a separate company in Massachusetts that is now in N95 manufacturing and they plan on staying there permanently. I think whatever incentives we can create on a national level... It's this whole issue of producing supply that we may not need tomorrow, but we might need five years from now. Nobody wants to pay for that, but I think we need to have that capacity.

I mean, the analogy I was thinking of before this is, it's almost like — imagine a fire department that we have hoses that are 50 feet long, we have one tall building in town. What are the chances the top floor is going to catch fire? Right? Well, if it does, you're in a lot of trouble. That hose might sit around for a long time, but when you need it, you better have it. I’m encouraged the Biden administration's approach to studying the pandemic and coming up with a preparedness response. But I think supplies is going to be absolutely critical as part of that.

David Skorton, MD: Yeah, that's a great, great example with the hose and the tall building. You got to be ready for things, you can't start getting ready for them when they're right in your face. Maurice, your thoughts on this one, please?

Maurice Rigsby, JD: I'll echo the comments that Jim made. Actually, sometimes I wake up in a cold sweat thinking about what happened during the early days of the pandemic. Because we're in Arkansas, and so we were competing against New York and other states on the coast for PPE, and ventilators, and other things. It was very difficult for us. As a state, and so our state leaders, the governor, and state legislators made the decision to come to UAMS and our supply chain team, and they gave us a little over $73 million. As an academic medical center, we were put in a position to secure PPE for the entire state for all health care providers, for the emergency management department. We had a very tall order and we were up for the challenge.

This was an opportunity for us to shine as an academic medical center and prove our worth and value to the state. I even deployed my team because we were getting leads from all over the state, all over the country, and internationally. Our supply chain team committed countless hours throughout the night. I deployed my team so they can run down these leads. We were trying to weed out counterfeit, fraudulent products. We were able to work to book time, internationally, for production and other things, but it was a challenge. I echo the comments — we definitely need to invest in a domestic program to make sure we have adequate PPE, supplies, ventilators for the future, no matter what the next pandemic is or what the next public health emergency is for our country. We owe that to our citizens and to our health care workers who were actually put in the vulnerable position.

David Skorton, MD: I sure couldn't agree with you more. That's such a beautiful way to put it. I'm struck by you talking about cold sweat and Jim talking about sitting in his bedroom thinking about things. It seems to me like fear and unpredictability during this period had been big, big problems we've had to overcome. This is really, again, for Maurice and Jim: How's the morale at your institutions now? I mean, we've been through a wild year. A year where people were at risk, a year where the front-line workers had to face death after death after death without all the tools in their disposal - long before a vaccine. How's the morale right now in your two institutions? Are people seeing the light at the end of the tunnel? What is the mood like?

Maurice Rigsby, JD: I'll go first, Jim. I think our morale is great. Our workers are committed — they're champions. I will go back even to early in the spring of the pandemic. Our workers, nurses, and respiratory therapists — because they are so committed, they actually went up to New York and they participated on the front lines. These are professionals. They've had to endure a lot, they had to have questions about PPE and if they were protected. We've had deaths, of course. Of course, there've been mental health issues that we've all experienced, but they are troopers — they're champions.

I think because of the commitment that our leaders have made — our institutional leaders have made — I think they have been able to weather the storm and make sure that they were taking care of their patients. I think they definitely see the light at the end of the tunnel. That makes my job even more important because we feed off of their energy and — energy in their commitment.

David Skorton, MD: Yeah, sounds great. Jim, how about at your place?

Jim Leary, JD: I think it's exactly as Maurice described. I mean, it's one of those things where people are exhausted, it takes a toll, and there's a mental health toll on people. They're looking forward, and they're optimistic with the vaccines here, but at the same time, the morale is actually really high. It's like the sports team that has won every major challenge, and they're looking at it, having gone through this challenge and applied their skills, and applied their dedication, and have come out on the other side. As difficult as it was, they know they've had a huge impact for the community.

I mean, twice, we opened a field hospital at a convention center in Worcester, and it was just amazing to see. It was one of those processes where a lot of people, who had never worked with each other before from different departments, all were involved. It was like, everything that everybody had done — excuse me — up to that point in their careers had prepared them for that moment, and now it was their time to get out on the playing field and they delivered. It's ironic. In spite of them being exhausted, their morale is incredibly high. Now, we're trying to figure out: Moving forward, how do we use that as a platform to keep things going? Anticipate the future problems we have, and make sure we keep that momentum going while still giving them a chance to rest because they need it.

David Skorton, MD: Yeah, it's so uplifting to hear this from both of you. Well, Karen, I'm going to throw the ball over to you in a second since — I'm sticking with Jim's sports analogy here — it is March Madness in 2021. In response to the COVID-19 pandemic, there have been such significant changes in how health care is delivered. One area of note is the considerable growth of telehealth over the last year, which led to various proposals in Congress, including those from leaders of key committees to permanently increase access to telehealth. Karen, could you remind us about some of the regulatory reliefs, some of the regulatory changes that occurred related to telehealth during the pandemic? Then, I'll be curious what you think, Karen, about what policy changes will help enable new ways of doing things on a more permanent basis. Karen, over to you.

Karen Fisher, JD: Thanks, David. Yes, I think telehealth was one of the big surprises that we saw coming out of COVID — how quickly our institutions moved to provide care through telehealth. The government acted really quite quickly because the requirements on telehealth were quite stringent before COVID: only allowing it to happen if it was occurring in a rural area, not allowing it to happen if it was audio- only, through the phone, etcetera. I'm very appreciative to the government and the policymakers who saw that and quickly reacted to be able to loosen those requirements.

I would say, going forward, there's still the issue in certain areas of broadband not having the ability to do that. Jim, and probably Maurice, can talk about that in the rural areas of Arkansas, as well as the need to continue to be able to allow some of these visits to happen audio-only. Not everyone has a computer or can have the video capacity that the four of us are looking at each other now, but they're able to talk on a telephone and be able to reach their clinician that way. There are things to be worked out. We know there's bipartisan support — and issues by the current administration, by policymakers — and there's been hearings on this area in the telehealth front. I think we're not going backwards. It's — how do we go forward and continue to build on that front?

David Skorton, MD: That's great, that's great. Well, I want to throw a very broad question to all three of you, and I'd love to hear each of your thoughts on this one. Reflecting, again, in a broad sense on the past year of your work advocating on behalf of academic medicine — actually, advocating for everything from regulatory relief to funding and everything in between — what were the biggest negative and positive impacts of the pandemic on your day-to-day work?

We talk a lot about the health care workers, and researchers, and learners constituting the front line of this pandemic. They do, and they deserve all of our praise and support. But I would say you three deserve a lot of praise and support as well because you were in there representing this work and trying to make sure that you gave these front-line workers the tools that they needed to get their jobs done.

What are the biggest negative and positive impacts? Did you gain new partners? Did you gain new stakeholders? Were there new arguments, were there talking points that didn't really occur to you before the pandemic? And how can we, in academic medicine broadly across this country, change our approach to advocacy based on what you three learned this year? Maurice, let's start off with you, if you don't mind.

Maurice Rigsby, JD: Again, I consider it an honor and a privilege to serve as an advocate for medical professionals on the front line. The only negative for me has been the lack of personal engagement with policymakers and with the workers on campus. I can't interact with either one of those in the way I did previously. That's been a negative. But what we do as advocacy leaders is, we turn lemons into lemonade. We've been able to transform, like we're doing right now, our jobs into virtual engagements. We've worked with campus leaders — we've still been able to communicate with them and policymakers to deliver our message, whether it's at the state level or in Washington.

We turned a negative into a positive, and we've worked with our state leaders to enhance broadband and telemedicine. Actually, the state charged UAMS with working on a rural broadband program to deliver access across the state with CARES Act relief money that came down. We have been on the front lines helping to make sure that our advocacy message is still on the forefront. This, obviously, is an opportunity for academic medicine to shine. I think our job is to make sure we are shining brighter than ever before, and we're not going backwards. We're going to enhance this, and this is our moment in the sun to prove our value. I think all policymakers recognize that. This has been an opportunity for us to develop so many other strategic partners, and we're going to take advantage of that in the future as well.

David Skorton, MD: Thank you so much, Maurice. Jim, what are your thoughts about this?

Jim Leary, JD: I'm amazed — people may think of Arkansas and Massachusetts as two very different states, and it's almost the exact same answer. Same issues on the ground and the same challenges. But I guess, on the negative, I think the biggest negative for me was the disinformation — and the fact that we actually had to fight against disinformation. Science is science. I get questions, but when you're dealing with having to combat conspiracy theories, that makes it difficult.

But on the positive side, it was the level of collaboration, both internally within the organization and then, I think, across with other hospital systems. But what stood out to me is collaboration in the community. It was a year ago this week — Congressman McGovern, the mayor of Worcester, and the city councilor of Worcester convened a group of stakeholders when we could actually get together and stay six feet apart until a few days later saying, "We got to do something to work on this together," and we created a group called Worcester Together.

We have been meeting at least once a week — oftentimes twice a week — with a whole bunch of committees since then. This involves social service providers, it involves schools, it involves senior organizations, youth organizations, ethnic organizations, ministers — you name it — where we've been able to look at the needs of the community throughout COVID. A low-income family tests positive and they can't afford food… How do we get hot food to them? We coordinated with restaurants. There was the opening of a new women's shelter on top of one that already existed because there was discomfort among some of the women with being in a shelter that was predominantly men.

There's a whole bunch of outcomes that we've been able to have. That group also was able to raise a lot of money that went out into community programs to address social determinants of health. After the George Floyd murder, then this week after what happened in Atlanta — a meeting yesterday morning of that group, we immediately see a need to respond to that, and actually, have all created — what are our strategies, anti-racism strategies within our organization, and how do we coordinate with one another? It's been a great way of helping to address social determinants of health in real time throughout the pandemic. But now, it's really created a platform that all of us want to continue moving forward, even post-pandemic, to make sure that we're collaborating on these issues. For me, personally, that's been the most positive aspect of this.

David Skorton, MD: Just wonderful examples, thank you so much. Karen, your thoughts, please?

Karen Fisher, JD: Well, thanks, David. Thanks for the question. Building a little bit on what Jim said, I think the negative — which was a little bit of a double-edged sword — was, as we say, COVID laid bare the health disparities and inequities in our country in a very, very obvious and distressing way. At the same time, as we know from our colleagues and across the country, these are inequities and disparities that existed before COVID. I think what COVID did is really brought this to the forefront in a way that, I think, we hope — as academic medicine, the AAMC — that we are going to continue to keep on the forefront to address the disparities and inequities going forward, even beyond COVID.

But I'm so glad that, over the past year, there've been a number of hearings in congressional committees to also raise this issue up. There's been some starts of legislation to address that. That was distressing to see that, but I do think there's a little bit of a silver lining of the opportunity to make progress. I would say, the other issue — that there are so many front-line workers who were doing things.

But for someone who lives in Washington D.C., and works with Washington, D.C., policymakers, the amount of work that was done by congressional staff and members in very distressing times... They also were being isolated, having to deal with educating their children at home, making those changes. Yet, at the same time, they were working around the clock to develop and build policies and pass legislation to help the front-line workers. I think, sometimes, those public servants don't get enough credit for all the efforts that they put into this and continue to do that. I extend that to being — our government relations colleagues who are at our academic medical centers, like Maurice and Jim — they worked around the clock to talk with federal policymakers. As they both mentioned, they worked closely with their states while at the same time communicating with our colleagues. In some cases, rolling up their own sleeves and playing administrative roles to do — help on COVID-related issues or help with the paperwork associated with vaccines.

I've seen the stress by our colleagues at the government relations folks in this front. It's been a tough year for them as well, but I've been very pleased how we've all come together through weekly calls — sometimes twice-a-week calls — to come together to figure out how we can help each other and help get the right policies in place. I couldn't be more proud of how academic medicine stood up through all this, through how our government relations colleagues represented their institutions and represented academic medicine as well.

I would say, a little bit dotting on what Maurice said, saying — looking at the role academic medicine has played, I've always said sometimes that our academic medicine colleagues and front-line workers, they spend so much time just doing good work, doing good research, being there, and not talking about it. We continue to have to do a good job of explaining to policymakers and the public exactly what's happening. I'm reminded of, just recently — it's COVID, but it's during hurricanes, it's during major fires. When we look at what happened in Texas recently with the weather, and what our Texas academic medical center members did as they were addressing a spike in COVID and at the same time dealing with weather challenges. It's a wonderful community to work with — and to see the impact that they have on patients on their surrounding communities and, really, the nation as a whole.

I think there's a positive that comes out of this. I think, as Maurice mentioned, it's a building block for us to continue to do what we're doing. I think all of us — Jim, Maurice, I, others who work in policy and advocacy — feel even more committed to moving forward to making the health care in this country better, making the research better, producing better physicians as we move forward. I think, in that sense, it's invigorated, David. I know, as the leader of the AAMC, I think you have felt the same way over this past year.

David Skorton, MD: I sure have, Karen. It's such a really, really great way to wrap up our discussion this morning. Just permit me — you three are thanking everybody else throughout this whole podcast. Permit me, on all of our behalves, to thank you because you all are highly trained professionals, and I'd like to think about you as interpreters and translators. You're translating the work and the language of academic medicine to our policymakers, and then you're interpreting and translating the work of policy to those folks on the front line.

Please, on all of our behalves, please accept our great, great, and deeply felt gratitude to all of you. I also want to thank you for joining us today on “Beyond the White Coat” and working to bring us closer to this vision of achieving a healthier future for people everywhere. There's so much we have to watch in Washington and across the country as we see how the rest of this wild year unfolds. I hope the three of you will stay in touch. We'll be glad to have you back as guests down the line as the policies continue to evolve. Thank you, Karen. Thank you, Jim. Thank you, Maurice. It's been great to have you here today.

Jim Leary, JD: Thank you.

Maurice Rigsby, JD: Thank you.

[End of Audio]

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