HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 25 of doctors tomake sure that the next genera- tion of physicians and providers are coming in excited to work in this space because we need all the help we can get. What impact have you seen from the Dobbs decision as a physician? I can only speak for me and at our institu- tion. We never did selective abortions or elec- tive terminations of pregnancy at the Univer- sity ofArkansas. Certainly, there were people in the community that could serve that. Many people askme if I'mhaving a harder time recruiting providers due to that, and I'm really not. I think if you live in a state such as ours or if you are looking at working in a state such as ours, you understood these limi- tations well before the Dobbs decision. I still have fantastic residents that want to come in every year or medical students that want to become residents and stay in this field. I have residents that want to stay in practice here. From that aspect of it, I think they knowwhat they're getting into, and they knowwhat our limitations are. Quite often, I’m asked with regard to recruitment, physicians, and pro- viders, and I have not seen that aspect of it. We so appreciate your time and what you are doing. Is there a question you wish I would have asked? I think you've really hit the nail on the head. There are so many hardworking peo- ple working on this from politicians to peo- ple at DHS (Department of Human Services), Medicaid, Department of Health, providers, and people in this state that are now looking at things with a different lens. I'm very opti- mistic on the things that will come from this in the near future. I am, too, and I'm glad that you're in the position you are. You sound absolutely amazing. Thank you for your time. n You have the ear of the healthcare industry right now in Arkansas. Is there something important that you wish they knew about this topic? Oh, I feel like I'm telling them, every time I get a chance to, that we have to create sys- tems for moms to succeed, and that comes in lots of different ways. There has been a lot of discussion on extending postpartumMed- icaid to 12 months, and I'm a very large pro- ponent of that. Over 50% of the deliveries in our state are still covered byMedicaid. Med- icaid coverage on a pregnant mother runs out at 60 days. For anyone that's had a baby or been around a newborn, they know your life is upside down for those first few weeks. You're not thinking about yourself, you're thinking about the care of your infant, the other children under your household, your family. So, you are falling by the wayside. If I don't get them in 60 days, I do not have the ability to talk about things like mental health, contraception, or just making sure their healthcare diagnoses are being opti- mized such that when they get pregnant the next time, they're in better health and [get- ting] some of that preventative help that we do in these visits. Extending that to 12months would help tremendously on some of those aspects of the preventative health and con- traceptive management, as well as mental healthcare services. We have to take a close look at why our rural hospitals are closing their doors. In a state like Arkansas where we are largely rural, we need to support these rural hospi- tals in new and different ways. I don't have the answers for that, but I know there are lots of smart people in this state who are committed to finding ways to support these hospitals to keep their doors open, so each of these access points for these patients remains. Driving 50 miles for a prenatal care visit is cost-prohib- itive. It's cost-prohibitive for me. I can't ask my patients to do that and expect them to do it with the frequency that I need them to for their pregnancy. We have to look at how to support those hospitals. Then, I think we have to look at reimbursement and support “What we see as the top three to four diagnoses of maternal mortality are chronic hypertensive disease, cardiomyopathy … consequences of comorbidities. As we get older, those comorbidities become more apparent, and sometimes they have gone undiagnosed and are in a worse health condition when they're getting pregnant.” is it that we're diagnosing it more? Maybe. In residency, I operated on a BMI of 60 or 55 one or two times. We now see that all the time. A BMI of 65 that likely has another comorbidity is a much different delivery, much different care for that mother. There are somany other subsequent complications that can occur, not only with her health concern, but within that postpartumperiod. Not tomention, that level of obesity increases your risk of a cesarean section, diabetes, and other things.The acuity of these patients that we see is significantly more, and I think that's a representation of the health of our state.