Discussions with Decision Makers: Rep. Susan DuBose

Representative Susan DuBose (R -Hoover) is the newly elected representative of district 45. Rep. DuBose worked as a residential, commercial and construction loan officer and business development officer for Compass Bank for over 12 years before becoming a stay-at-home mom to raise her two children in 1997.

She is president of the Republican Women of North Shelby County, is on the Governmental Affairs Committee and Women’s Business Council for the Shelby County Chamber of Commerce and is a member of the Shelby County Republican Party Executive Committee. Rep. DuBose will serve as committee member on the House Health Committee.

What First prompted you to consider running for office?

I felt my District 45 was not adequately represented by someone who was active and engaged in the community. We are a diverse district that stretches from Irondale to Chelsea and includes three counties- Jefferson, Shelby and St. Clair. We are also an area experiencing considerable growth, especially Chelsea and surrounding areas of North Shelby County. We also have a very politically informed electorate that deserves a representative that will be involved and available.

How does your background help serve you in the Legislature?

For about the last 12 years I have been very involved in a support role in the Republican Party. I was President of the Republican Women of North Shelby County when I decided to run for office. I was also a member of the Shelby County Republican executive committee. As a member of those groups, I was often asked to be a conservative female voice in Montgomery at committee meetings and press briefings. The transition to running for office was easy for me because I had spent so much time in the political arena. I also consider myself a policy nerd. I love studying bills, current policy issues and comparing model legislation with other states. My degree is in finance, and I started my career in real estate and construction lending with Compass Bank. Years of analyzing financial statements should be an asset when navigating our state budgets.

What are some of your legislative priorities next term?

School choice, Women’s Bill of Rights, Womens’ Sports Bill (HigherEd), Workforce Participation Rate- (Only 57%!), Mental Health, Fentanyl Crisis, ESG.

What are some health-related issues important to your district and your constituents?

By far the most heart wrenching stories I have heard from constituents involve overdoses from Fentanyl/opioids. Usually, the story involves losing a child and the parents are pleading for help to stop this crisis. Secondly, mental health is the issue I heard most about. Law enforcement has been the most vocal, more patient facilities are needed. Teachers and principals want more help for students. Mental Health of students is becoming a larger and larger concern in today’s culture. My third concern is the impact of marijuana dispensaries opening all over the state. Even though this is supposed to be “medical marijuana” the conditions that qualify for a marijuana card are vast and most people will be able to obtain a card if they want one. The industry will continue to push until recreation marijuana is legalized. I am very concerned about the detrimental health and safety impact this will have on our state.

What do you think people understand the least about our health care system?

I should be asking you guys this question. I have a lot to learn about our health care system myself.

If you could change anything about our health care system, what would it be?

Take out the bureaucracy and make it more about relationships with doctors and their patients. I’m always about less regulation and less interference from the government. When the government is involved, more controls are placed on physicians, and patients suffer. I believe doctors should have the freedom to make medical decisions they feel are best for the patients without undo mandates from our government.

How can the Medical Association- and physicians statewide- help you address Alabama’s health
challenges?

Open and honest communication will help me. I am not a health expert; I’m not trained in any health field, but I care about the people in the State of Alabama. We all need to work together to address vital issues in our state. I asked to be on the Health Committee because I believe the most pressing issues facing our state are tied to our health.

What is the one thing you would like to say to physicians in your district?

I have the upmost respect and admiration for physicians. I know the sacrifices you made for many years to obtain the advanced education and training it takes to be a physician. Medicine is a true calling, and you are a public servant to your communities. Thank you all for your continued service and your dedication to your fields. May God be with each of you.

Discussions with Decision Makers: Rep. David Cole

Rep. David Cole – a member of the Medical Association and supported by the Alabama Medical PAC (ALAPAC) – is a newly elected republican legislator from Alabama House District 10 in the Huntsville/Madison area. Rep. Cole is the only physician in the House and has been selected to serve on the House Health Committee.

Rep. Cole is a military trained physician and combat surgeon with senior executive management experience in Occupational and Aerospace medicine. Cole earned his medical degree from the University of Arkansas and completed his surgical internship in general surgery at Walter Reed Army Medical Center. Cole is a highly decorated military veteran, with a history of service in several overseas missions. He held the position of Chief Medical Officer at Fox Army Health Center on Redstone Arsenal for four years before taking the position of Medical Director for Huntsville Hospital’s Occupational Health Group.

You are the medical director for Huntsville Hospitals Occupational Health Group.  What are some challenges facing your specialty and medicine in general in the Huntsville area?

I think the things facing my specialty is what’s facing all specialties in medicine in general.  Our academy had 33 students match in occupational medicine nationwide.  That’s not even 1 person per state.  I think all specialties would agree there are not enough of us.  In my specialty, we look at work injuries and ways to make the work environment safer.  Business in North Alabama is exploding and we are continuing to have more patients and we need to grow with it.  We are trying to hire more staff and recruit physicians just like any other specialty is trying to do. 

You were actively deployed in Iraq and Afghanistan as a medical doctor.  What was that experience like?  Thank you for your service!

It was different every time I went because I had different roles.  The first time in Iraq I was a brigade surgeon of a combat aviation brigade.  That job has several elements to it. The main one is to help plan and oversee air medical evacuation support.  The other part of my other job was to be the advisor to the commander on all medical aspects.  At the brigade level you are in charge of planning small movements and to make sure you have medical coverage for those operations. The first time I was in Afghanistan I was an infantry battalion surgeon.  We lived on top of mountains and went on foot patrols every day and did special visits to villages to provide training and care.  We trained PA’s in Afghanistan and were the very tip of the sphere.  The last time I was in Afghanistan, I was the Combined Joint Taskforce Surgeon for southeast Afghanistan and was General Abrams advisor to all medical assets in that region.  We had to coordinate with the Navy and other groups to make sure they had the supplies, personnel, and other tactical equipment. My last role was more macro unlike my previous jobs.  One of the things I enjoyed was as that I got to fly all the time. My favorite was air assault missions.

As a physician, what do you see as the biggest challenge in healthcare in Alabama?

Access. I don’t want to mistake that with lack of insurance.  I want to highlight that we need more medical physicians.  We have not done the greatest job of forecasting medical physician numbers in the last 15 years. We have been getting by, but the pandemic has shown us that we are not as robust as we thought we were.

What should the legislature prioritize for improving healthcare in Alabama?

I think the legislature should really look at how can we improve the number of physicians in our state which in turn will help with access for people to medical services. The more quality access we have, the better outcomes we have.  Chronic medical conditions are a problem in our state, and if we can treat the patients earlier, then that can save Alabama money. We need to be focusing on preventive medicine and medical services on the front end.

 You will actually be serving on the House health committee and are the only physician in the House.  Any specific healthcare priorities you are working on or bills that you are planning to file?

The Governor and the speaker have both indicated that they are supportive of improving mental health in Alabama.  I hope to help craft legislation and help them on that. The other issue Gov. Ivey has spoken of is improving the health of Alabama. I would like to partner with her and the senate to see how we can best tackle that. 

The Medical Association is an ardent supporter of the physician-led team in health care.  What are your thoughts on the numerous “scope creep” bills that are filed in the Legislature?

I haven’t seen any filed yet, but I know they are historically filed every year.  It goes back to training and education. However, if we are looking at expanding scope of practice, we should really need to look at increasing the physician workforce and fix that problem instead of putting a quick band-aid on it and not addressing the core issue. 

The Medical Associations 2023 Advocacy Agenda was recently released and one priority for the Association is to increase the physician workforce.  What are your ideas to recruit and retain physicians to Alabama?

There have been some previous incentives that have been passed. I would like to see if they have been effective and if they are not why. I would like to alternatively look at helping physicians starting new practices in places and communities that need those services

Healthcare costs continue to increase.  Besides addressing inflation, what are other ways the State could drive down the cost of care for the citizens of Alabama?

Increasing preventive care and increasing quality of care is really critical to driving down cost.  An example is untreated hypertension after decades, leading to the patient who may go on dialysis, which is very expensive.  So, if you can prevent those scenarios, it will drive down cost.  Much of healthcare is driven by federal policies, put it is prudent to look at how we can be effective with our care in the State.

The topic of physician burnout has become a major issue before and since the pandemic.  What are ways we can address that?

Great question.  Every article you read has a different answer on this. People are burnt out for different reasons.  Some people work too hard because they have too many patients, some have multiple complicated critical care patients, and some are in an environment that’s not helping them succeed as much as they should.  I would like to tell all physicians how much they are appreciated. The physicians that I know work tirelessly for all their patients, which has been the model in our training.  We sacrifice for the patient.  Part of today’s medicine needs to include what we would call self-care.  There’s lot of facilities that have different approaches. Most organizations recognize that there is an issue which is a significant change from 5 years ago.  Burnout has always existed, but wasn’t really studied until the pandemic.  Institutions and companies are starting to address that which is a great start.

Streamlining prior authorizations seems to be part of the physician burnout equation.  How can we better improve and streamline the prior authorization process?

I will tell you that most physicians consider it a curse word.  I think the reasoning behind prior authorizations is trying to make sure patients are aware of cost and I understand the intention.  But a lot of these electronic fillings gets dumped in the physician’s lap.  Physicians are tired of all the red tape and we need to take a look at it at the state level.  It has lots of layers, but it’s something that I will be willing to tackle.

Anything you would like to say the members of the Medical Association?

I would like to thank them for their support of my campaign and continued support while I serve our state.  It’s been humbling and I value the bond that our group has together.  The support we give each other is unbelievable.  I hope that during my time at the state house I can help them in their daily lives and struggles. 

2023 Advocacy Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the
Medical Association of the State of Alabama exists to serve, lead, and unite physicians in
promoting the highest quality of healthcare for the people of Alabama through advocacy,
information, and education

General Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine.  The Association  supports prohibiting deceptive healthcare advertising and requiring health professionals identify their license to patients.

The Association supports physician autonomy in patient care and medical practice decisions, fair reimbursement for services and reducing the volume of administrative tasks required by insurers which increase annual health spending and negatively impact patient health.     

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid.  The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee.  Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges, with emphasis on pipeline programs, tax credits and loan forgiveness proposals benefitting rural and underserved areas.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Policies Supported

For 2023 , the Association specifically supports:

• Streamlining the prior authorization process for physicians and patients
• Initiatives to grow Alabama’s physician workforce
• Increasing access to physician-led care in rural and underserved communities
• The ability of medical practices to set patient practice policies
• Increasing physician representation on state healthcare boards, task forces and committees

General Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians that would fracture the physician-led health team model, lower quality of care and/or increase costs.  The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery.  The Association also opposes any state-level increase of requirements for Maintenance of Certification.  Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Policies Opposed

For 2023, the Association specifically opposes:

• New lawsuit opportunities against physician employers and medical practices over employment policies
• Efforts to reduce and/or politicize physician involvement in health regulatory affairs
• Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement
• Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks

Discussions with Decision Makers: Rep. Frances Holk-Jones

Representative Frances Holk-Jones, a native of Foley, is the newly elected representative from the 95th district in Baldwin County. She is the first 4th generation State Farm agent in the country and is president of Frances Holk Insurance. Frances learned the importance of public service at an early age while watching both her grandfather and father serve as Mayor of Foley. Frances will serve as a committee member on the House Health Committee.

What first prompted you to consider running for office?

Politics has always intrigued me.  I learned the importance of public service, economic development, and community involvement at an early age watching both my grandfather and father serve as Mayors of my hometown of Foley, Alabama. 

How does your background help serve you in the Legislature?

Throughout my forty-four year career in the insurance industry as well as in my leadership roles on numerous federal, state, and local nonprofit and civic organizations, I’ve worked diligently to ensure that programs are available to enhance the quality of life for all Alabamians.

What are some of your legislative priorities next term?

Youth mental health is very close to my heart.  In my legislative role, I will advocate and work to improve the resources available for those with mental illness.  I would also love to see some progress made with our South Baldwin Workforce Development Authority to make sure we’re finding ways to have a substantial workforce and affordable housing so we can keep our great economic engine running.

What are some health-related issues important to your district and your constituents?

Not to sound like a broken record, but the issue of youth mental health is certainly a focus of mine.  Despite major strides within the mental health community, there remains a shortage of available resources, including mental health professional workforce and lack of coordinated systems of care. 

What do you think people understand the least about our health care system?

Just how crucial it is to have quality health care; access to good health services leads to better patient outcomes with less impact on our economy. 

If you could change anything about our state’s health care system, what would it be?

Ensuring that quality health care services are more accessible for those that live in the rural areas of our state.

How can the Medical Association – and physicians statewide – help you address Alabama’s health
challenges?

By working together with their legislators to advocate for public health-related policies which will help ensure quality health care services are provided throughout the state.

What is the one thing you would like to say to physicians in your district?

Thank you for being an advocate for your patients and your commitment to providing quality care despite the changes in health care delivery you see every day.

Stopping the Optometric Surgery Bill

For the 4^th installment of an in-depth look into each of the Medical Association’s “Top 10 Highlights” from the 2022 regular session, we will look at the Association’s opposition to allowing optometrists the ability to perform eye surgeries using scalpels and lasers as well as performing eye injections. 

Outgoing Senator Jim McClendon, an optometrist himself and chairman of the Senate Healthcare Committee, partnered with former Senate Pro Tem President Del Marsh to attempt to pass the optometric surgery bill. The bill would have allowed optometrists, who have not been trained in eye surgery, to perform surgeries and injections on the eye and would have given the Alabama Board of Optometry the sole power to define and regulate what is considered to be the practice of optometry. 

In the Senate, the bill was “passed” out of committee on a voice vote called by Sen. Jim McClendon despite opposition from the majority of other Senators on the Senate Healthcare Committee.  Weeks later, in the Upper Chamber, the bill was allowed to be voted on the Senate floor where after a few hours of contentious deliberation, the bill passed 17-12 and moved on to the House of Representatives.  

In the House, the bill was placed in the House Health Committee where the optometry group, including optometrists, inundated the State House on a regular basis – lobbying legislators and also bringing down many optometry students from UAB to fill the halls of the Legislature.  In the last month of the 2022 Regular Session, the Medical Association who partnered with the Alabama Academy of Ophthalmology and Alabama Dermatology Society throughout the Session, made countless phone calls, sent numerous emails and came to the State House to express the dangers this bill poses to patients in Alabama.  By the last two weeks of the Regular Session, an ophthalmologist was at the State House every day speaking with legislators against the legislation. On one of the last days of the Regular Session, the bill had a public hearing where ophthalmologists spoke against the legislation and the bill ultimately failed because the legislation was not seconded for a vote in Committee during the public hearing.

The Association would like to thank the many ophthalmologists and dermatologists who volunteered their time to come down to the State House, make phone calls and send emails to legislators.  The Medical Association’s grassroots effort against this bill was a big success and without this value of advocacy this dangerous “scope creep” bill may have become law.  The Association fully expects to see this bill filed again in the 2023 Regular Session and we will continue to work with Lawmakers in ensuring that patient safety be held to the highest standard of quality care in Alabama.