First Opinion is STAT’s platform for attention-grabbing, illuminating, and perhaps even provocative articles concerning the life sciences writ massive, written by biotech insiders, well being care employees, researchers, and others.
To encourage sturdy, good-faith dialogue about points raised in First Opinion essays, STAT publishes chosen Letters to the Editor obtained in response to them. You’ll be able to submit a Letter to the Editor right here, or discover the submission type on the finish of any First Opinion essay.
“Psychiatrists aren’t fulfilling the social contract that backed their coaching,” by Richard G. Frank
Whereas I admire the sentiment, this text is incomplete at finest, and oversimplifies a fancy calculus. Doctor coaching is, after all, backed by the Medicare and Medicaid techniques; most residency positions are, and never simply in psychiatry. Nevertheless, are we leveling this on the different specialty physicians who usually are not accepting Medicare and Medicaid sufferers? Moreover, the reimbursement in psychiatry just isn’t degree — it’s way more restricted and never equitable in comparison with different specialties, notably surgical/procedural specialties. This makes it tougher for psychiatrists to pay the payments when accepting a decrease charge of reimbursement than different physicians although the scholar mortgage payments are nonetheless there.
I agree that the social-ethical contract is compelling for psychiatrists to just accept all of those sufferers. Nevertheless, substantial deficits and inequities within the well being care techniques shouldn’t be positioned on psychiatrists to take sole accountability for.
On the identical time that we should always encourage psychiatrists to just accept a wider vary of sufferers, we must also be calling out the inequities within the cost system, psychological well being “parity” legal guidelines which are largely unenforced (and thus meaningless) rendering an unfair system for sufferers in search of care and psychiatrists in search of reimbursement for care supplied.
As with most points in well being care, it’s sophisticated.
— Michael J. Peterson, Division of Psychiatry, College of Wisconsin Faculty of Drugs and Public Well being
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Thanks for reminding me of my “social contract.” I would like a favor: evaluate the again door conferences of the Medicare Act of 1965 that resulted in non-procedure primarily based care being reimbursed (and regarded much less necessary) than procedure-based care. Give us the demographics of those decision-makers (I’m assuming all cisgendered heterosexual white guys). Share with us how extrapolating this built-in monetary discrimination has resulted in psychiatrists not taking insurance coverage. In different phrases: do actual analysis earlier than throwing stones in glass homes.
— Brian Dixon
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This text ignores the very apparent elephant within the room. It implies that the cash paid by Medicaid/Medicare to help psychiatry residents truly interprets into some type of honest compensation for his or her work throughout residency. Residents work 60-80 hours per week throughout residency. In return we’re paid someplace between $40,000 and $60,000 a 12 months in the beginning of our coaching, which grows to someplace between $50,000 to $70,000 by the tip. In brief, we’re paid about $19 per hour for a few of the most extremely expert work within the nation. I believe that fulfills our social contract fairly properly.
— Karen Abdool
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Whereas Richard G. Frank’s current First Opinion piece calls consideration to the issue of lack of entry to psychological well being companies, it inappropriately lays blame for that downside on the ft of psychiatrists. On the contrary, psychiatrists are working inside complicated techniques and advocating fiercely to make sure the widespread provision of high quality care.
For many who are selecting to not take insurance coverage, the straightforward reality is that the funds don’t add up. Psychiatrists depart coaching with medical faculty debt, are paid much less per hour than major care physicians and even doctor assistants, and must spend time or {dollars} on employees to assist cope with administrative complexities like prior authorization. As Frank factors out, insurers, in an effort to chop their very own prices, have restricted networks, established insufficient charge schedules, and created administrative boundaries to psychological well being companies. This leaves psychiatrists in a bind when making an attempt to serve sufferers with out going into the pink: and nonetheless, solely 7.7% of psychiatrists have opted out of Medicare. Lots of our members and colleagues clearly wish to take insurance coverage, together with Medicare and Medicaid, however on this actuality, generally we will’t.
We wish this case to vary and we’re working onerous on options. Advocacy for psychological well being parity is crucial. Parity gained’t be achieved with out sufficient reimbursement, and we’re working with the Middle for Medicare and Medicaid companies and private and non-private payors to attain it.
In the meantime, demand for psychiatric companies has grown exponentially, and we can’t improve the variety of psychiatrists quick sufficient to satisfy this want. Whereas extra graduate medical examination slots have been created lately and the sphere is extra widespread than ever, our doctor members advocate to make sure we preserve a powerful pipeline to herald extra certified psychiatrists.
Psychiatrists are additionally on the forefront of advocating for transformative care supply fashions and modalities that can permit for higher entry, together with telepsychiatry, and team-based care to develop entry for all people. Whether or not via built-in care choices like Collaborative Care or engaged on groups in different fashions, we’re innovating to succeed in sufferers like by no means earlier than.
The failure just isn’t one in all particular person decisions, however somewhat a systemic failure to fund and help entry to psychiatric care. Because it stands at present, the sphere is compelled to leverage its scarce assets to serve the wants of a rustic dealing with a psychological well being disaster.
— Marketa Wills, M.D., CEO and medical director of the American Psychiatric Affiliation
“Medicare ought to wait on approving protection for Wegovy,” by Alissa S. Chen
Though by a considerate physician, this text is heavy on emotions and quick on empirical arguments. You could really feel like it’s not a good suggestion, and that may be your private perception, however that doesn’t warrant its getting used as proof in opposition to a therapy that has been clinically demonstrated to have advantages past weight reduction. Analysis on older sufferers is scarce however the place isn’t that the case aside from medicine meant to ameliorate dementia? How lengthy will we wait earlier than making an attempt this apparently efficacious therapy?
— Steven Struhl, Converge Analytic
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Please don’t decrease semaglutide by equating it as merely affecting urge for food to counteract “late evening snacking.” The SELECT trial demonstrated that in individuals with BMI of 27 or greater and with out diabetes who had prior coronary heart assault, stroke or peripheral artery illness, taking semaglutide versus placebo was related to 20% discount in subsequent coronary heart assault, stroke and cardiovascular demise! (Disclosure: I co-chaired the Steering Committee for SELECT and have obtained compensation for consulting from Novo Nordisk and plenty of different makers of weight problems medicines and gadgets.)
This landmark research is necessary information for each doctor, and particularly these in weight problems drugs. The SELECT trial studied 17,706 sufferers and greater than 6,000 had been age 65 or older. It used essentially the most rigorous methodology and was executed with precision. The FDA gave Wegovy a sign for secondary prevention of heart problems after rigorous evaluate.
Let’s be critical about providing this treatment to individuals who want it. It isn’t a life-style treatment. Medicare made the suitable choice in offering reimbursement for secondary prevention of heart problems.
— Donna Ryan, Pennington Biomedical Analysis Middle
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As a affected person, I’m disillusioned we now have consultants encouraging Medicare NOT to pay for semaglutide and tirzepatide. I’m 69 years outdated and I’m going to my PCP’s workplace weekly to get my injection administered. Your complete price is $350 for semaglutide for 4 weeks, and $450 for the tirzepatide for 4 weeks. I’ve been doing this for 14 months, had no opposed unwanted effects in any way and have misplaced 50+ kilos to this point. Whereas that is doable for me, I understand many others usually are not as lucky. I wish to see Medicare comply with the lead of personal insurers and begin masking half or the entire price.
— Penny Ogden
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I’m 66 and began on prescription Zepbound in February of 2024. I’ve misplaced weight, blood stress is down, unsure about ldl cholesterol although. Not solely does Medicare not pay for it however additionally they don’t permit us to get the massive low cost coupon from the producer. Probably not certain if I’ll be capable to afford this treatment for much longer, which is kind of unhappy.
— Tracey Black
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As a 68-year-old feminine who has taken Ozempic for 17 months and had it ripped away with Medicare deciding to not cowl it for these with pre-diabetes, I’ve to say I really feel a lot worse now that the burden has come again, together with incessant starvation. In 4 months my A1C, blood stress, and ldl cholesterol went up. My life is once more centered round what I can and shouldn’t eat and it’s a fixed battle that may be gained quick time period, however not long run.
Ozempic helped my weight keep fixed. I liked the as soon as every week shot after which might neglect about it. I drank a number of water and received loads of train. Garments felt good. Now it’s miserable. Can’t transfer as properly, nothing suits and simply can’t get my weight to cease climbing irrespective of how a lot I train. Medicare ought to approve this therapy for older folks. Let every physician determine by affected person if it needs to be used, not the federal government!
— S R Bratton
“Congress known as for an ALS moonshot. The plan for it doesn’t depart Earth,” by Bernie Zipprich
That is an excerpt of my testimony to the Nationwide Academies of Sciences, Engineering, and Drugs on my plan to make ALS a livable illness in 10 years:
With veterans 60% extra prone to develop ALS, it’s crucial that we serve those that’ve served within the armed forces. Nonprofit organizations like Paralyzed Veterans of America (PVA) are uniquely staffed with nationwide service officers who’re ALS advantages consultants. In partnership with the Veterans Administration, PVA’s Medical Providers crew conducts web site visits throughout the nation, partaking with ALS specialists.
It was on such a go to that I met Dr. Richard Reimer, medical director of the ALS Clinic on the Palo Alto VA. Collaborating with the Lawrence Livermore Nationwide Lab, Dr. Reimer is utilizing its world-class supercomputer, investigating medicine to repurpose for ALS.
One other research, facilitated by The Nationwide ALS Registry, assesses “Navy exposures and ALS in a big Veteran inhabitants.” Information from the Division of Protection and VA will seize army elements equivalent to department of service, occupation, deployment, demographic, and de-identified well being knowledge.
In accordance with a Mission MinE research, 15% of individuals with Sporadic ALS have a genetic element whereas regional fine-mapping has recognized an extra 690 new ALS-risk genes. This helps the opinion that ALS has multifactorial causes and that genetic testing needs to be routinely supplied as a regular of care.
In conclusion, I wish to echo the feelings of Retired Marine Corps infantry officer, Chris Mulholland, who has been battling ALS since November 2020. In a Navy Instances article titled, “ALS is Killing Veterans,” Chris wrote, “If you understand of a Veteran who has – or had ALS, we’d like you on this battle. Too usually ALS exists within the shadows, and people move so shortly they’ll’t communicate for themselves. Be their voice!”
— Juliet Pierce, Paralyzed Veterans of America
