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.