January 19, 2023
President's Message: Dr. Jitendra Barmecha
Last week, Governor Hochul gave her State of the State address setting the framework for her legislative agenda for 2023, indicating items that may be included in the Executive Budget for FY 2023-24 (likely to be released later this month). There are few that physicians are likely to support. However, there are a handful of items which are concerning, particularly as it relates to scope of practice. Below is a general list of noteworthy items – which the Chapter will continue to monitor:
NYACP has submitted a Chapter Advocacy Internship Program poster for ACP’s Mary Bieter Evergreen All-Stars Award on “A LEGISLATIVE AND HEALTH POLICY EDUCATIONAL OPPORTUNITY FOR INTERNAL MEDICINE RESIDENTS AND MEDICAL STUDENTS” that was developed in memory of Steven Walerstein, MD, MACP. The Mary Bieter Evergreen All-Stars Award recognizes exceptional and sustained chapter-initiated programs that support and adapt to the Internal Medicine landscape in the United States and around the world. Voting is now open and will close on January 31. VOTE NOW!
New York hospitals received approximately 38 new GME residency positions effective July 1. By 2034, the US is projected to have a shortage of 124,000 physicians. The recently passed federal omnibus-spending bill will add another 200 residency positions in 2026, with 100 slots dedicated specifically to psychiatry and psychiatry subspecialties. Direct Graduate Medical Education (DGME) | CMS
Another positive report shows continued decreases in overall cancer mortality, approximately 33% since 1991, and an estimated 3.8 million lives saved from cancer. On the contrary, the annual Cancer Statistics are being projected to be over 1.95 million people diagnosed with cancer and nearly 610,000 will die of cancer in 2023, an uptick from 2022 projections. Among the major findings: lung and colorectal cancers cause the most deaths, prostate cancer is rising among men, and cervical cancer rates have seen an ‘astounding’ drop among young women, possibly due to early prevention and HPV vaccines.
Lastly, Generative Pre-trained Transformer (ChatGPT), which is a type of machine-learning or next gen AI model, is trained on large amounts of data to produce human-like text. These models use technologies like Natural Language Processing (NLP) and Natural Language Generation (NLG) to better understand and reproduce human language. The latest version, ChatGPT v4.0, will be able to translate into other languages, summarize and generate text and answer questions, and include a chatbot.
(Note: this progress has been drafted without using ChatGPT tool).
Stay safe and warm,
NYACP Advocacy Intern Corner
Governor Hochul's State of the State - January 10, 2023:
The theme of Governor Hochul’s State of the State address was “Achieving the New York Dream” - a dream that she hopes to realize through keeping New York safe, more affordable, and allowing New Yorkers more opportunities. This includes New Yorkers that have historically been marginalized, such as those struggling with mental health concerns. Her pledge to commit one billion dollars to critical policy changes to meet the mental health needs of the people was met with roaring applause and a standing ovation. The aim is to reduce the number of those with unmet mental health needs by half over the next five years. Critical changes proposed included:
In addition, she touched upon efforts to staunch the addiction and opioid crisis and the growing threat of additives such as Xylazine and Fentanyl through local and federal partners. Other prominent topics in the address included gun and bail reform, affordable housing, investment in infrastructure, combating inflation, decreasing carbon emissions.
State of the State Address: A Win for New Yorkers and Scope of Practice Creep
Governor Kathy Hochul's State of the State Address has laudable goals for the healthcare of New Yorkers. She highlighted segments of her written strategy in her speech, and the most emphasized part of her plan was the pivot toward addressing the mental health crisis that is going on in our State. However, hidden within her written plan was concerning language surrounding a permanent expansion of Advanced Practice Providers' (AAP) scope of practice. Below, we will summarize and address those aspects of her blueprint that are important to us as internists.
Money for Mental Health:
To address the growing number of untreated and decompensated mental health problems among New Yorkers, Governor Hochul outlined a $1 billion investment plan that will go towards:
Even as many of us may not treat behavioral health issues, the focus and investment in treating mental health problems will undoubtedly benefit all within the internal medicine community.
Many of us have seen the clinic patient with poorly controlled mental illness, an A1C >10, and a systolic blood pressure >160. It's not that they do not want to exercise or check their blood sugar; it is that they cannot. We have seen our fair share of hospital ward patients with a poorly controlled mental health disorder that has led to decompensation of their physical illnesses, who then fall under our care for their infected diabetic foot ulcer.
This investment in stabilizing New Yorkers' mental health issues will make us more effective internists as New York State moves towards addressing social determinants of health that make psychiatric diseases hard to control. Managing the medications for a chronic illness is much easier with safe housing and a stable place to store medicines. Investing in wrap-around services will provide these patients with the support structure they need to make their "q3month" appointments for diabetes management. Ultimately, if we can find, maintain, and fund the staff required to support the plan, I am hopeful for this policy pivot as it relates to our specialty.
Healthcare Reform: The Good and the Ugly.
While she did not discuss it in her address, Governor Hochul outlines a three-part plan to address healthcare reform in New York. For the most part, the plan is sensible. To describe it very broadly, it acknowledges that New York spends a lot of money and does not get much return. She describes her efforts to lean into the recent shift in medicine that embraces a change in the delivery of care to telehealth, home-based care, and outpatient services, and that New York will invest in those technologies that will make our system safer and more efficient. The Governor acknowledges that there is a healthcare worker crisis, and the cost of the Agency Nurses has become untenable for our healthcare system. She wants to prepare for future emergencies, make Medicaid more accessible, place a stronger emphasis on preventative care, end tobacco and drug use, make primary care more accessible, and reinvigorate our Emergency Medical Services. Many of us would agree that these are essential issues to invest in and address.
The sheep in wolf's clothing within her plan is that the Governor has doubled down on her Executive Order from September 2021, which allows AAPs to work without the supervision of a physician. What is more concerning is that her State of the State address would like to expand their scope further. The ACP has previously released a statement and toolkit regarding "Scope of Practice" issues.
As internists, this is a disconcerting decision, as it is transforming what was a desperate contingency plan for a deadly global pandemic into a permanent policy solution that equates the care of a physician with that of an AAP. Governor Hochul purports that this will help alleviate our shortage and allow our healthcare system to provide more care, but the expansion does not equate to more care of the same quality. On the contrary, this shift will enable those practitioners with less education and significantly fewer clinical hours to make more decisions autonomously. The net effect of this will be a healthcare system that will see more inappropriate antibiotic use, higher opioid prescription rates, and more radiology ordering, as seen in the AAP community compared to physicians.
Ultimately, I am hopeful that our State has begun to invest in a fundamental concept taught in medical school: the biopsychosocial model of care. It is an acknowledgment that we cannot treat a patient's hypertension unless we help them treat their depression and address their unstable housing. I am concerned, however, that there is an a priori belief that a Nurse Practitioner or a Physician Associate can autonomously deliver the same degree of care without physician oversight. As we enter the new year, we need to advocate for ourselves and our patients by discussing with our elected officials that AAPs enrich a physician-led team, however, they should not supplant it.
A Summary of the Recent ACP/Annals Firearm Injury Forum
I Raise the Rates Adult Immunization Program
The New York Chapter is proud to once again partner with the American College of Physicians' Center for Quality in supporting the “I Raise the Rates Adult Immunization Program.” The program's monthly newsletter, I Raise the Rates (IRtR), will include a variety of resources from various public health partners, unique educational opportunities, and media articles related to immunization. The monthly IRtR Newsletter can be found under the “What’s New” section on the homepage of the Chapter Website. ACP's I Raise the Rates program is currently supported through funding from CDC and Sanofi Pasteur, Inc.
New NYACP Staff Member
NYACP would like to welcome Izaiah Wright as a new member of the Chapter staff. Izaiah’s title is NYACP Districts Liaison and Meetings Specialist. Izaiah will be working directly with NYACP’s District President's, Councilors, Councilors-at-Large and other Chapter leaders. He looks forward to revitalizing educational programs and events at the local level, as well as staffing committee and task force meetings, and fulfilling other programs and projects as needed. Welcome aboard!
Members in the News!
Congratulations to Parag Mehta, MD, MACP for being named on the 2023 City & State Health Care Power 100 List!
City & State’s Health Care Power 100 sheds light on these decision-makers in the medical world in New York, including prominent public officials, influential hospital and health care executives, heads of other nonprofit providers, union leaders, academics and an array of advocates and activists who take their case to Albany and City Hall.
ACP's Advanced Quality Coach Program
ACP Quality Coaches work with physician-led teams to co-create and implement initiatives designed to achieve their quality goals. Coaches are practicing physicians who receive specialized training on validated coaching techniques to engage clinical teams to build their QI expertise and capacity.
Doctors Across New York (DANY) Cycle IX is now open!
Doctors Across New York is a state-funded initiative enacted in 2008 to help train and place physicians in underserved communities in a variety of settings and specialties to care for New York´s diverse population.
The grant is being offered as a Solicitation of Interest (SOI), and it is posted on both of the following websites:
New York State Contract Reporter
There is also an important change: Applicants no longer have to be “new” to an underserved area. Any doctor that will be working in an identified underserved area during the DANY obligation period of July 1, 2023 to June 30, 2026 is eligible to apply.
NYACP Leadership Academy
Applications are now being accepted for the NYACP Leadership Academy. This course is a six-part CME accredited certificate program beginning in May 2023, ending with an in-person final session at the NYACP Annual Meeting on Saturday, Oct. 28, 2023 in Rochester, NY.
Course schedule: 6:30 - 8:00 pm
Final session in-person at NYACP Annual Meeting
The Health Equity Leadership Institute
The Health Equity Clinical Leadership Institute is a 12-month virtual learning collaborative for physicians, advanced practice nurses and health facility administrators.