Dear School of Medicine community:

In March, shortly after federal health care reform was passed, OHSU was asked to comment on the new legislation. We stated that it was an “important first step toward creating a better health care future for all Americans.” We also made clear that more steps are needed before we arrive at the desired destination of a “highly efficient health care system of the highest quality possible accessible to all.”
 
Rules and regulations associated with the federal Patient Protection and Affordable Care Act are working their way through the system now. We are all eager to see the frontline outcomes of this specific piece of legislation, as well as to understand how it interacts with and complements long-standing reform efforts in Oregon. There’s a lot of activity and planning going on as individuals, institutions and health systems gear up for implementation.
 
However, I have also noted an unexpected silence about the additional steps needed. It’s not hard to see how the bruising national debate combined with continuing concerns about our economy and unemployment would push aside conversations about reform. It seems we’re breathing a sigh of relief, checking reform off our collective “to do” list, and moving on to other pressing topics.

However, the interdependence of human health and economic stability, job growth, educational access and environmental quality means that when health care reform moves to the back burner, we won’t address other pressing issues comprehensively, including economic recovery. 
 
Consider this example. Oregon’s rural areas face health care workforce shortages, especially physicians. On the face of it, this is an access issue that should be considered as an aspect of health care reform. That’s a narrow view.
 
A hospital is nearly always one of the top employers in rural areas. And while estimates vary, an individual physician adds at least $1 million in direct and indirect economic value to a community because, in part, health care dollars are generally pre-spent and captured directly in communities when services are provided there. Physician workforce shortages, thus, are a jobs issue. Further, if we address workforce shortages by regionalizing health care education – bringing new health education programs into rural areas – we open up job opportunities in these communities. 
 
Now is the time to broaden the conversation about reform to include other social and economic determinants of health, including job creation, not to shy away from it. Not only can those of us in academic medicine engage in this bigger conversation, but we do so with our colleagues in the business community as well as our state and national leaders.

Best regards,




Mark Richardson, MD, MBA
Dean, OHSU School of Medicine
President, Faculty Practice Plan