On a state-by-state basis, legislatures and healthcare organizations are grappling with emerging social issues around pain management, including the use of medical marijuana and the tragic consequences of addiction to opioid medications. In Georgia alone, there were 1,462 overdose deaths in 2016, of which 67% were due to opioid overdoses.[iii]
Michael Byman, Director of Jackson Physician Search, led a discussion with members of the John’s Creek Medical Association about how healthcare leaders can support their medical staff as they comply with Georgia’s recently enacted regulations related to medical marijuana and prescription painkillers.
A Snapshot of Recent New Rules
Georgia recently expanded the law that protects patients from criminal prosecution for possessing low THC oil for medicinal purposes for specific conditions. However, the law does not authorize physicians to prescribe marijuana for medical use or authorize retail stores to sell products made from the marijuana plant.
In the case of opioids, the Georgia Attorney General’s office reports that 531 million opioid doses were prescribed to Georgia patients in just one year, equal to approximately 54 doses for every man, woman, and child in the state.[iv]
To address the problem of opioid abuse, the Governor’s office launched the Statewide Opioid Task Force, providing an infrastructure of communication between organizations in the public, private and non-profit sectors. The legislature has also enacted new laws including regulations that compel physicians to do more thorough research on their patient’s prescription history.[v]
Georgia’s response has earned recognition from the National Safety Council for being one of 13 states receiving the highest mark for taking comprehensive actions to eliminate opioid overdoses, improving from a “failing” designation in 2016.[vi]
Impact on Providers
Interdisciplinary teamwork among physicians, advanced practice providers, therapists, administrators and others is required to address pain management and other therapies intended to relieve debilitating symptoms. They must follow medical protocols and comply with the web of changing and conflicting regulations, all while keeping the patient at the center of their focus.
The result is a growing burden of education, communication, compliance, and reporting, requiring new skills that are in short supply and more time that is not reimbursable. The challenge is compounded by the worsening shortage and urgent demand for physicians caring for patients for whom controlled substances should be used – but may be tragically abused.
Byman painted a clear picture showing that active job postings in Georgia far outnumber the available candidate pool in specialties such as primary care, psychiatry, physical medicine and rehabilitation, and pain medicine.
Long-term solutions to expand residency and fellowship programs are not fast-acting enough to relieve the current strain on the system.
Inside the statistics, are the stories of doctors struggling to stay positive and motivated to help their patients manage pain and overcome debilitating symptoms while abiding by Georgia law and the Hippocratic Oath.
One physician recently wrote about the first time he ever “hated a patient.” She had “weaponized [her addiction] and would expertly wield it against everyone standing between her and her pain medication.” For him “true empathy, perhaps especially in the current healthcare environment, is a tool that requires constant sharpening.”
Beyond Compliance, What Can We Do?
Working within the realities of this environment, Byman offered practical and effective strategies that are helping many healthcare executives and physicians address the shortage of physicians and answer the question: “Beyond compliance, what can we do?”
Add Advanced Practitioners to your Team: The advanced training of physician assistants and nurse practitioners – many with specialty certifications – can make a significant difference. When you make them an integral part of the team, they are well-suited to assist with the additional patient communication, prescription history and necessary follow-up required by today’s regulations.
Embrace Telemedicine: There is an acute shortage of physicians willing to relocate to small towns and remote communities, or to spend time on the road to staff clinics there. At the same time, studies show that patients and families are rapidly accepting telemedicine and report high satisfaction with it when used effectively. Physicians at all stages of their careers are becoming very comfortable with technology and deliver significant value when diagnosing and treating patients even when not at the bedside.
Hire for Fit: The times are changing, and so must your criteria when recruiting new physicians. Carefully assess the motivations and values of your candidates build (and keep) a team of mission-driven physicians and advanced practice providers who will fit your culture and make a difference for your patients.
Educate and Engage the Community: From the top of the organization through the front lines, organizations are accepting their role as leaders in delivering authoritative information about how to benefit from therapies using controlled substances – while identifying and avoiding the danger of abuse. An outreach program to specialists, health centers, patients, and schools gives everyone some ownership in the solution – an essential step in solving the problem.
For help in building your team in key specialties to address this growing health problem, please contact us.
[i] Henry J Kaiser Family Foundation, Opioid Overdose Deaths, https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-gender/
[ii] STAT forecast: “Opioids could kill nearly 500,000 Americans in the next decade,” https://www.statnews.com/2017/06/27/opioid-deaths-forecast/
[iii] Georgia Department of Public Health, https://www.moveforwardpt.com/Resources/Detail/opioid-abuse-statistics-of-50-states-2
[iv] Georgia Office of Attorney General, “Opioid Abuse,” https://law.georgia.gov/opioid-abuse
[v] Georgia Office of Attorney General, “Op-Ed: Carr Continues Efforts to Strengthen State’s Response to the Opioid Epidemic, April 17, 2018, https://law.georgia.gov
[vi] National Safety Council, “Just 13 States and D.C. Are Adequately Addressing the Opioid Crisis,” April 10, 2018, https://www.nsc.org/