Ryan Palmer is head of clinical education partnerships at AMOpportunities, a Chicago-based firm that partners with hospitals, schools and businesses to connect health care trainees with clinical experiences to make medical education accessible and help solve physician shortages. A resident of Hudson, Ohio, Palmer previously served as a principal with Kennedy & Company Education Strategies and as an associate dean of medical education for Northeast Ohio Medical University. He has held faculty and leadership positions at Oregon Health & Science University and American University of the Caribbean.
Interact for Health: Historically, your academic and professional work has focused on finding ways to solve the primary care clinician workforce shortage. How are you continuing that work at AMOpportunities?
Palmer: We make it very easy for clinical systems—hospitals, clinician groups, clinics, etc.—to host more clinical learners by providing the administrative infrastructure to do so through our process and technology platform. Many clinical systems, especially acute care and community-based hospitals that serve our rural and underserved communities, lack the administrative infrastructure to host more, or sometimes any, learners. Yet these are wonderful locations for future clinicians to learn as they often get to do more … and become more involved with the communities … than they would at urban tertiary care hospitals. Much of my work at AMO is about helping to bring or expand clinical teaching at many of these sites, as those learners can potentially become their future workforce.
Interact for Health: How can telehealth improve care equity in rural and under-resourced communities?
Palmer: Through improved access. People in these communities often have to travel great distances for their health care. This leads to deferred preventive and even acute care issues. Telehealth brings the care to these community members, helping them receive care that they potentially wouldn’t have received otherwise. Issues that might have been neglected due to travel issues can now be addressed from their own homes, and so they know if they do need to travel for an in-person visit, it is necessary.
Interact for Health: What barriers need to be overcome?
Palmer: The same barriers that exist for in-person care in these communities, and those are persistent issues of access, lack of insurance, scarce resources, etc. The promise of telehealth is to more equitably bring care to those who otherwise might not have received it, but you largely still need access to insurance to access telehealth. I’ve seen some data indicating that the huge adoption of telehealth during COVID was mainly with affluent, insured populations who utilized telehealth as replacement for the in-person care they were used to receiving. We need to make sure this same access is extended to our most in-need populations. I don’t think we’re there yet.
Interact for Health: What role can school-based health centers play in addressing the primary care clinician shortage and improving care for rural and under-resourced communities?
Palmer: Some of these clinics are the only health care many of the children in these communities get. And I’ve heard that these clinics will often help the adult family members of these children access care by helping them get signed up for Medicaid and other programs that they qualify for. As for primary care, just like in rural medicine, primary care clinicians are critical because they can do so much. In rural Oregon where I sent med students for years to do clinical rotations, the primary care clinician was often the only provider in the entire county. We would send students to rotate with these clinicians to learn about health care in these communities and, hopefully, to get some of them interested in going back to practice there. It often worked, making huge impacts on those communities when one of those students would choose to practice there. I think the same can happen with these school-based health centers that host clinical leaners. I’m actually in talks right now with some of these organizations to help place learners through AMO.
Interact for Health: What has COVID-19 taught us about the strengths and weaknesses of telehealth?
Palmer: COVID finally helped show that telehealth can do a lot more than people think in terms of caring for patients. I think both providers and patients saw that telehealth could address much of what you can do in a physical setting. There will always be the need for in-person health care, but maybe not all health care always has to be delivered in-person. Patients also saw how much they liked it, myself included. My son had a skin rash and I did a telehealth visit. I was seen within minutes, the rash was diagnosed by a physician who had excellent “webside” manner, and my son’s prescription was sent to my pharmacy before the session ended. It was fantastic.
In terms of weakness, I think there still needs to be a lot more work done on health disparities in terms of getting telehealth into the hands of the uninsured or underinsured. This can’t be something that only works for affluent, insured populations. I also think a weakness is that we’re not doing enough to train the next generation of providers on how to deliver patient-centered care using telehealth. … Clinical training programs need to embrace this new reality and quickly integrate curriculum that produces competent in-person and telehealth care providers for their future patient populations.
Interact for Health: Looking forward, what makes you optimistic?
Palmer: One thing is it seems (the Centers for Medicare and Medicaid Services) is not going to walk back the increased reimbursement for telehealth it implemented during COVID. ... If providers and systems can be reimbursed comparably for telehealth as they do for in-person care, they will continue to provide telehealth. I think it’s a safe bet now that this is the new reality. I’m most optimistic at the incredible innovation happening in the telehealth space right now. So many companies are finding new ways to help people using telehealth. I was just speaking to someone who told me about a telehealth company that focuses on helping support women going through menopause. I also recently spoke with a physician who started a telehealth company that helps geriatric patients go through recovery therapy in their homes after having a heart attack. He said the compliance of the patients using his company’s telehealth solution was above 90%! There are just so many opportunities to help makes patients’ lives better through telehealth, the sky is truly the limit.
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