Mass. Medical Society president says pandemic ‘ripped the Band-Aid off’ health care inequities
New leader of physician group talks COVID, costs, and access
SINCE MASSACHUSETTS MEDICAL SOCIETY president Ted Calianos took the helm of the organization in May, he has been developing priorities that range from restoring trust in medicine to addressing workforce issues.
A plastic and reconstructive surgeon who practices on Cape Cod, Calianos was born in Worcester and grew up in the Manomet village of Plymouth. He will spend one year as the medical society’s president.
Here is an edited version of our conversation about the challenges facing heath care in Massachusetts.
COMMONWEALTH: What are your immediate priorities as Mass. Medical Society president?
It’s really the ongoing issues in medicine [that I’m focused on]. Some have come out of issues with COVID – things like restoring trust in medicine and science, making sure practice is sustainable, making sure there’s equitable spending within health care. The pandemic ripped the Band-Aid off a lot of inequities in the health care system, and a lot of things the Massachusetts Medical Society has worked feverishly for over the years became more acute, when you look at things like behavioral health access and emergency room boarding.
I’m looking at things we didn’t have three years ago like telehealth in terms of the impact and sustainability of that. Things like access to appropriate reproductive health care with [the US Supreme Court ruling in] Dobbs and the reversal of Roe.
I’m looking at diversity, equity, and inclusion in having a workforce that’s more representative of the patients that we reach. Other things that are top of mind issues are substance use and opioid misuse. How do we continue to combat that in a way that makes sense?
A silver lining in COVID is it has given us many opportunities to look at what we’re doing as a health care system and look at ways of improving, utilizing the lessons we learned from COVID, things that were uncovered as we lived through COVID, to improve the next generation of medicine for physicians and patients.
CW: With COVID, are we now in the endemic stage, and what does that mean?
CALIANOS: The endemic phase is where it’s almost like the flu. I don’t know if we’re there. I’m not a COVID expert. I’ve termed it living in a clinical trial. We have, all of us, lived in a clinical trial as we worked hard to understand the science, understand how COVID impacted us. The real question mark remains what happens with the variants? Do we have the adequate protection against variants with the new generation of vaccinations? That’s when we make the transition from pandemic to endemic, when the level of variants decreases. The thing you worry about is will a variant emerge with higher rates of morbidity and mortality, taking us back to the earlier days of COVID when there were higher rates of hospitalization? We have to see how things happen the next few winters.
CW: Since COVID, there’s been a growing distrust of science, like the anti-vaccine movement. How do you counter that?
CALIANOS: That’s one of the things that’s extremely important and tugs at the primacy of the physician-patient relationship, which is really built on trust. Over COVID, we’ve seen that trust in medicine and science erode. That’s one of the things we have to work extremely hard at.
It’s done through education. It’s done through being honest with patients, saying we really don’t know what this is, we may not have the full understanding of it. It’s really understanding the scientific process. We knew very little about COVID when it happened. We tried to use the best tools and tactics we could to combat the virus, reduce morbidity and mortality. As the science evolved, the tools evolved. Sometimes communication wasn’t as clear as it could have been. People said, “Wait a minute, they said to do X last week, Y the next week, they don’t know what they’re doing.” The truth is, we were responding to the scientific process, taking the data we had at that time, which early in the pandemic was quite limited. We lived through a time where medicine changed so rapidly.
There was a loss of trust in medicine, science, the governmental structures around that. It’s important to restore that, and it will take education and understanding.
CW: Is Massachusetts prepared for the next pandemic, whether monkeypox or something else? If not, how do we change that?
CALIANOS: As we lived through the clinical trial of COVID, we learned a lot, we saw where our inadequacies existed, where our difficulties in the public health realm were found. In many ways COVID ripped the bandage off what was going on. We were able to see where the failings in the system were. We should take those and learn from that. I personally believe we’ll be in a stronger position to handle any pandemic or public health crisis moving forward, if we maintain momentum and improvement and we don’t settle for the next status quo. I hope the next pandemic is 200, 300 years down the road, but we need to be prepared for a pandemic that may occur in our lifetimes. The approach to monkeypox is completely unlike COVID. The approach has been tempered by our experience with COVID. That, to me, is uplifting because it means we’ve learned from our experience from COVID, and we’ll continue to get better.
CW: Massachusetts has long had some of the country’s highest health care costs. The Legislature has yet to agree on how to address them. What will the Medical Society be advocating for?
CALIANOS: It goes beyond the Commonwealth. We spend more per capita for health care in this country, and we don’t have the best outcomes. The real question is to ask why. Why are these costs so high and, more importantly, why do we not have the best outcomes, what do we need to do to correct that? That’s going to put us on the road to providing health care that is cost effective, efficient, and high quality.
I don’t think there’s a singular solution. I wish I had a magic wand to say this is the solution to fix it. It goes beyond what you pay for an x-ray or bottle of anti-hypertensives. It takes looking at it in its entirety. This is not going to be an easy thing to do. It’s more than the cost of something, it’s how you got there.
We have a health care system that historically has tended to be more reactive. You’re ill, you come in and get taken care of. I’ve witnessed the last 15-20 years a shift in our mantra, our health care thinking, to being more proactive, integrating preventative medicine, things like nutrition and healthy living so from the day you’re born, you’re educated on how to live healthy and how to make healthy life choices. Not everyone will do that, but I’m a strong proponent of education. If we were able to educate, whether it be in school, through interactions with physicians, or anywhere people touch the health care system to live healthier lives, we’d become less reactive and more proactive. By leading healthier lives, we’ll reduce health care expenditures.
One of the things we have to look at is how do we as a society make that pivot, say we value leading healthy lives, how do we do it, how do we fund it, how do we structure it so when people are going to their doctors they’re getting appropriate advice and are able to make choices that will set them up for healthy living throughout their lives. Someone who spent their whole life smoking cigarettes, eating high fat foods, drinking alcohol, we know what the outcome will be.
CW: The need for mental health care has grown during the pandemic, and access is a problem. Is the state doing enough to address emergency room boarding?
CALIANOS: The state has done a lot of great things. The ABC legislation [a mental health bill titled Addressing Barriers to Care] that passed recently poured more funds into the system to assist with issues around mental health care and emergency room boarding. The other important thing it did was help to strengthen the workforce by putting money into programs that increase the pipeline of mental health care workers into the workforce to help us care for patients. At one point, everyone thought it was a crisis of beds. It really wasn’t a crisis of beds, it was a crisis of having adequate health care workers to staff those beds. You have to ask why is that, what can we do to correct that?
CW: Hospitals today are understaffed, which seems to be due to a mix of factors including burnout, people leaving the field due to health risks and working conditions, vaccine mandates, etc. How can the system better recruit and retain medical staff?
CALIANOS: There’s no simple answer. What we watched through the COVID pandemic resulted in a lot of burnout in health care workers in every level of the health care workforce. People were just tired. People were working hard. It was a very difficult time.
It goes back into getting people interested in careers in health care. It starts in school with direct outreach to encourage people to consider careers in health care. There’s no quick fix. It takes time. Especially in physician practices, it’s been tough to recruit and retain workforce.
One other thing that underlies it is we need stability and sustainability in payment mechanisms. It’s hard to run a practice or hospital and not have sustainability in modes of payment so you can plan to hire people, recruit people, educate people.
CW: There’s been a debate about how to pay for telehealth – whether virtual visits should be reimbursed equally to in-person visits. Where does the Medical Society stand?
CALIANOS: Three years ago, the utility of telehealth was not as well-understood as it was subsequent to the pandemic. In a matter of a week or two, the practices that I know of were able to pivot from an in-person world to a telehealth world. Across the spectrum, telehealth will remain and should remain part of what’s available. I think the value of telehealth has been proven over and over again. It does increase access, it does decrease rates of cancellations, it does improve the delivery of health care. As we emerged from the height of COVID, telehealth is settling into a nice niche where it has served as an adjunct in practices to allow for equitable and sustainable delivery of care. In that regard, it should have parity in payment. It goes back to having sustainability and stability in payment.
Many use telehealth as part of their daily practice. Although the level decreased, I think there will be a certain baseline level that will remain. We have a physician shortage, and it will allow us to leverage the limited workforce we have in some specialties to provide care. So the patient doesn’t have to pack up and go to someone. They can be in their office or on their device and interact and deliver high quality care through telehealth.
CW: Do you think Massachusetts will become a haven for women seeking abortion and is there more to be done to protect abortion rights?
CALIANOS: I’d thank the governor and Legislature for what they did in assuring the rights and access to reproductive health care in the Commonwealth. Whether we become a haven or not depends now on what happens in states around us. We’ll always be a place where access to reproductive health care will be assured. The Commonwealth has done a very, very good job in that regard in assuring access to reproductive health care. I can only hope other states will see and learn from our successes and follow suit.CW: Is there anything else you want to add?
CALIANOS: One of the first statements I had to put out was on [the school shooting in] Uvalde. I will work on continuing to curb gun violence. We have pretty good statistics in Massachusetts. We need to continue to educate and see how we can make things even better, provide a model for other states to use our methods and methodology and learn from us to have better outcomes in their state as well.