Justice in Politics
We are charged with advocating for our patients through informed participation in political and democratic processes affecting the policies and systems that enable a more just delivery of healthcare. The U.S. Patient Protection and Affordable Care Act of 2010 was designed, in part, to improve healthcare access for many patients. By allowing for the potential expansion of access to Medicaid insurance and establishing a Community Health Center Fund, systems are in place to provide for the healthcare needs of the least advantaged. Continued development and optimization of these systems requires physician engagement to the benefit of our patients.
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Explore This IssueOctober 2019
Fourteen states continue to refuse the federal funding that allows for Medicaid expansion, and current reimbursement policies prevent adequate participation by physician specialists.5 This demands our participation and contribution to the public forum.
Justice in Academic & Clinical Service
There are insufficient data to reveal the impact that limitations on rheumatology access have on Medicaid patients with rheumatic disease. Studies do suggest that declining physician participation in the Medicaid program contributes significantly to limited specialty care access.6,7 Research detailing the impact this limited rheumatologist participation has on health outcomes is necessary.
It is concerning that 86% of community health center primary care providers would not start disease-modifying anti-rheumatic drugs in a patient with rheumatoid arthritis and 94% would not start a patient with SLE on immunosuppression.7 Identifying and comparing the barriers to rheumatology access within community and academic settings are necessary steps.
Although patient choice may contribute to academic medical centers seeing more Medicaid patients with rheumatic disease, researchers at UCSF suggest the limited number of community rheumatologists accepting Medicaid is a major factor.2
Fostering the passion to care for others, which drove so many of us into medicine, can enhance our joy and fulfillment in its practice, especially in relation to the care of those least advantaged. Jonathan Haidt, PhD, a social psychologist at New York University, writes in The Happiness Hypothesis, “It is worth striving to get the right relationships between yourself and others, between yourself and your work, and between yourself and something larger than yourself. If you get these relationships right, a sense of purpose and meaning will emerge.”8
In rheumatology practice, we have ample opportunity to work this out in the care of patients with least advantage suffering with rheumatic diseases. This may include advocating and voting for just policies; researching the impact of disease in underserved, uninsured and underinsured patients; or actively participating in Medicaid programs to provide excellent care for patients with rheumatic disease, whether for duty or delight.
Editor’s note: Do you have an ethical dilemma you’d like to see discussed in this forum? Contact us via email at email@example.com.