Three people with ties to the Camas-Washougal area recently spent a few days in north-central Washington, to help individuals affected by the Okanogan complex fires.
Scott Jonason, a physician assistant, certified and owner of Lacamas Medical Group, in Camas and Vancouver; Jennifer Kaufmann, a Lacamas medical assistant for 12 years; and George Ryland, a former Camas resident, provided medical support to fire crews and residents of the Tunk Valley area — 20 miles north of Omak.
They were there from Aug. 30 to Sept. 3.
“We were equipped to provide advanced first aide, for wound care, insect bites, dehydration and respiratory illnesses like asthma or COPD flares,” Jonason said.
They also delivered supplies that had been donated from the Camas-Washougal community.
Supplies from this area included water and sport drinks, as well as snacks, such as protein and granola bars for firefighters.
School supplies were also donated.
“Immediate needs have been answered, but they will have ongoing needs,” Jonason said. “There are more humanitarian needs and livestock needs, for those who lost everything.
“The future needs include more sheltering and clothing, as well as food,” he added. “Most of the people are back in their houses and are self-sufficient.”
Additional undergarments, such a T-shirts, underwear and socks, are needed for firefighters, according to Jonason.
“Some of them have been in tents up there for a couple of weeks,” he said. “They could be there for another month.”
The Okanogan complex fires have grown into the largest wildfire in Washington history at more than 256,567 acres.
In addition to addressing medical needs, Jonason said he, Kaufmann and Ryland unloaded trucks of supplies and provided security checks in homes.
There had been some problems with looters, Jonason said.
“We stomped out a couple of hot spots,” he said. “We had shovels and picks in our trucks. We buried it or snuffed it out.”
Jonason grew up in Wenatchee, located approximately 120 miles from Tunk Valley.
His 22 years in the military included service in the Army, the Oregon Army National Guard and the Oregon Air National Guard.
“My feeling was, ‘if I can help, I should,” Jonason said, regarding his recent trip to the areas affected by fires.
Ryland has retired from the Oregon Army National Guard. He was an Army medic with Jonason 25 years ago.
The two friends have previously assisted victims of Hurricane Katrina, in New Orleans.
Kaufmann and Jonason have provided post-earthquake assistance, in Haiti.
Another old post from The Physician Executive with currency in today’s environment.
I was once a family physician delivering babies in an East Coast big city.
No, I am not a masochist, I was a family practice residency faculty.
Given the intense turf wars caused by an oversupply of competing specialists, it was an unpleasant environment to work. The concentration of specialty providers in big cities and urban areas poses some problems when it comes to costs. Frequently, one looks to mid-levels as a way of addressing problems in health care. Indeed Physician Assistants and Nurse Practitioners have a potentially important role to play in health care, but where?
Jason Shafrin at the Health Economist takes a look at midwives (included in the ranks of nurse practitioners for most of the latter part of the past century.)
I like midlevel providers like nurse practitioners and physician assistants because of their ability to bolster the ranks of primary care, the main engine of cost containment in health care. They can be invaluable in rural areas where it is difficult to entice specialists, even where there is a critical mass of demand for their services.
On the other hand, Jason’s post appears to be looking at midwives as a less costly alternative to obstetricians. A commenter on my site reminded me of Milton Friedman’s assertion that licensing leads to higher costs without assuring quality. In medicine, we have established a complicated and lengthy licensing process in the secure belief that the alternative was the chaos of snake-oil salesman that populated the United States at the turn of the last century. In other words, there was a compelling societal reason to limit and license people delivering health care.
I’m not sure what we accomplish by looking at mid levels as alternatives to established specialty providers. Moreover, specialists and midwives are equally maldistributed, being over-represented in metropolitan areas, where competition finds a way of increasing costs. Yes, health care acts strangely and higher concentrations of specialists tends to increase costs rather than reduce prices as one would expect.
On the other hand, finding an incentive to better distribute physicians may be a subtle way of improving physician incomes and health outcomes and reduce costs.
I want to make it clear once again, this is not a tirade against nurses or midwives. Nurses have saved my backside too often not to be collaborative and old school midwives working in labor and delivery taught me everything I know about delivering a baby.
I am questioning how we make policy in the face of a web of data and mess of potential starting points from which to approach the data.
Focus on the health of the population. In so doing, you will always be able to see the amount of value you are contributing to the communities where you work, no matter how little you actually get paid!
Focus on the fact that without generalist physicians, the goal of a safe, efficient, effective health care system cannot be achieved.
Focus on the fact that you need to work well with everyone in the allied health fields: PA’s, NP’s, pharmacists, home health aides, radiology technicians, lab porters… Medicine was never supposed to be a turf war and what you do depends on the contributions of so many, it is best to remember them in everything you do.
Remember that nothing makes competition irrelevant than a change in the landscape. Your competition is not against PA’s, NP’s, specialists and the like… it is with them you must work to improve the health of populations.
It is OK to say no to working more for less. There are settings where you can deliver better care with less effort and mean more to people. (And maybe make more money.)
Stay involved.Medical and specialty societies are both important. In this county the WAFP is not as strong as the WSMA, but there are other counties where the opposite is true. Get involved in both. It’s not about how they represent you, but rather that when you get involved, you start driving how it represents you. There is nothing more important to understanding how a new relationship between family medicine and the rest of medicine will work until you see how family physicians are getting involved all the way up to the AMA.