This is an amazing and complicated time in American healthcare. Where do you see the most hope or opportunity? What’s your greatest concern? Shameem Abbasy and Jonathan Lind wrote together in response to these questions. They are proud to work at Swedish Covenant Hospital, an independent community hospital in Chicago. Shameem is a urogynecologist and serves as medical group director and department chair of obstetrics and gynecology. Jonathan is the health system’s chief operating officer. They never knew each other at Dartmouth, although Jonathan may have delivered EBAs to Shameem a time or two. They wrote, “We have seen the new insurance co-ops fold due to inadequate funding and a riskier patient population than expected. The state’s inability to pass a budget has held up state Medicaid payments, expanded under the ACA in Illinois. Declining reimbursement makes for little cushion in the budget. Repealing the ACA could result in large numbers of uninsured or underinsured patients again. It’s a challenging time, and that’s an understatement.”

Shameem wrote, “I don’t see as many patients with neglected medical problems since the ACA was implemented. I really do not want to go back to practicing medicine in that era. Patients are also nervous. There’s been a surge of women coming in to get intrauterine devices for long-acting contraception or the Pap test done early because they don’t know what the future holds. The rising cost of care remains a problem, especially for those who gained access to care through the ACA. I see patients making the decision not to proceed with medically indicated, elective surgery due to the high cost of their deductibles.”

They went on to write, “We think our focus should be on fixing what is wrong with the current system, rather than repealing the ACA. There is much to lose by starting from scratch and it’s unconscionable to abandon the vulnerable on the margins of our communities without an alternative. Short-term political ‘gains’ are of no value when they come at the expense of quality care for the sick, prevention and wellness for communities, and the long-term stability of any community.”

Andrew Resnick, now the chief medical officer at Froedtert and the Medical College of Wisconsin and formerly chief quality officer at Penn State, writes: “There was certainly ‘enough’ going on up until the 2016 election. Ratcheting up of the at-risk reimbursement and transitioning Medicare to a new system, pushing for large-population health models, all while increasing the number of mandatory bundles (rather than fee-for-service) resulted in tremendous activity and anxiety everywhere. Just when everyone was maxed out, the election happened and the current administration has moved in the opposite direction, getting rid of mandatory bundles and dismantling the ACA however it can. Without getting political, the direction changes have created even more uncertainty and anxiety in healthcare. Certainly, there aren’t any healthcare organizations that want to see millions more uninsured Americans again.

“Increased regulatory compliance, decreased reimbursement rates, loss of autonomy and uncertainty has created a huge physician burnout problem. Despite so many positive advances in healthcare (wonder drugs for cancer, robots for surgery, etc.), burnout outweighs all of this. No other profession has lost so much control and so much financial reward over the past few decades. The problem of physician burnout, including the fact that the equivalent of an entire medical school worth of physicians commits suicide each year, is an issue that needs much more attention nationally.”

More on healthcare from these and other medical professionals in our class in our next newsletter and future columns. What’s your take? Join the conversation and keep your news coming!

—Kaja (Schuppert) Fickes, 2 Bishops Lane, Hingham, MA 02043; kaja.k.fickes.95@dartmouth.edu