Dr. Angela is a founding board member of Santiam Community Health, a new non-profit operating from a new healthcare paradigm.
Since she has gotten many, many questions about it, below is her narration as to how it came to be....
Santiam Community Health: a local 501©3 non-profit
Where the heck did this idea come from?
Well, if things aren’t working, time to change it up.
By Dr. Angela Cortal
In order to explain where the idea for our non-profit Santiam Community Health came from, I need to provide you with a quick overview of the medical system, as I see it, from my entry into private practice in 2012 to today.
Going through medical school, my idea was always to be a family doctor, see all ages, treat the whole community. Well, it took a few years for that practice to become sustainable, but it is. I see patients at two clinics, and although I have a few clinical specialties (Regenerative Injection Therapy and hormonal balancing/treatment are the main ones), I see infants to elders, taking care of sore throats, sprained ankles, diabetes and everything in-between.
And I love what I do. I haven’t mentioned that yet, but I feel very fortunate that my career is one that is extremely fulfilling to me, intellectually and emotionally.
But there was this thing. The elephant in the room. Maybe it started out as a smaller creature.
The walrus in the room.
And it grew larger and larger, squishing us all up against the walls, and now we’re struggling to breathe.
That walrus is our deeply flawed and damaged healthcare system.
Over the six years I have been in private practice, I have always been a provider who has been “part of the system.” Most of my patients use their insurance to see me. And as far as my clinical practice is concerned, I don’t see this changing. At least not voluntarily, on the part of myself nor my patients (explanation to come).
With the continued growth of this walrus year-over-year (ok, maybe you’re getting sick of this allegory, but it’s entertaining me, so I’m sticking with it), insurance premiums got higher, deductibles got higher, co-pays got higher, caps got put on “alternative care” and Naturopathic care specifically (which is technically not legal in the state of Oregon, but I can tell you it still continues), insurance reimbursement to doctors (and all providers) have fallen over time, and if you need a Pre-Authorization for medical care, prescriptions or medical devices, God help you.
So now you’re all caught up; no one can hardly afford the skyrocketing insurance prices, the paltry coverage where you don't actually get the type of care you want, and doctors are scrambling to balance the budget on their end as well, every year holding their breath and seeing what new and awful changes will impact them and their patients. And the hits keep coming. I can tell you we are seeing 2019 roll-outs right now that will be disastrous for patients on certain insurance plans.
Healthcare is one of the few professions I can think of, where the service provider gets paid less and less over time. Can you imagine this happening in other industries? Does a haircut cost less now than in the 80s? How about a mechanic? Costs for everything increase over time, so why would any person or any insurance company think that the providers can just “make do” with getting paid less and less every year?
With this increasing restriction was the realization that the single most effective therapeutic tool I have, Regenerative Injection Therapies (namely Prolotherapy and Platelet-Rich Plasma Injections) are not covered by insurance at all. So now if prolotherapy might be the single most effective treatment for someone, the patient is paying their astronomical monthly premiums, co-pays and co-insurances for therapies that have not helped, and then they must pay out of pocket for prolotherapy.
If you’re not aware, I’m sorry to report that Regenerative Injection Therapies are relatively not inexpensive. And yes, they’re also super effective, which is why I love them. Past patients have cancelled scheduled joint surgeries, returned to levels of activity and exercise that they had given up on. Finally gotten out of chronic pain after many past providers and care had failed them.
It’s just that the price-tag out-prices most people, many who could benefit. I’d say $400-600 is pretty average for one prolotherapy appointment.
Does it need to be this expensive? Are doctors just being greedy?
In short, I’d answer “yes, unfortunately” and “no, or at least I don’t think so.” When I’ve added up the overhead, medical supplies and tools, staff, billing, increases in malpractice to perform these procedures, well… these therapies are expensive because the provider is passing along these increased costs to the patient.
From my financial standpoint, it would be very simple and cheap to just prescribe Ibuprofen to all my patients with joint pain (ala Kaiser), but it would also kill my soul (and prevent connective tissue regrowth, but that soap-box is for another day).
To top this all off, when I looked around my immediate environment, my immediate community, I realized that most around me do not even have health insurance at all. Most alternative medicine healthcare providers are independent practitioners, not employees with health insurance plan benefits. Ditto for many in the fitness world.
Looking around the clinics and fitness centers I was acquainted with, where I spend most of my day, I realized that on top of all the issues I’ve mentioned above, most of my colleagues and friends in the healthcare and fitness realms cannot afford the healthcare services they may be providing and recommending to their patients and clients.
If I sound negative or cynical, that is not my intention. This is the reality I work in daily with my patients, friends and co-workers. I’m attempting to describe the existential strife that caused the creation of Santiam Community Health.
I realized this “healthcare” system was not providing healthcare at all. Sickness-maintenance is more like it (at best). And expensive. Way too expensive for what we actually get.
So I took a hard look around and thought, “What can I change?” “What can I do?”
I started brainstorming a new model.
If I could offer a few key services, not a full-fledged clinic with all the bells and whistles, maybe I could offer provide some good on my own, outside of the system, and make it extremely affordable.
I’m not trying to compete with OHSU or the Salem Clinic.
They are the system.
What I’m trying to say is I’m attempting to create an anti-system.
Further into planning this model, if I could secure donations for medical supplies, and a little donated space to offer these services, then I could see just how many I can help without all the many, many added costs of the traditional healthcare model imposing itself on me and my patients.
Maybe this crazy idea could work.
So that’s what I did.
I grabbed a few similar-minded healthcare practitioners and laypeople to be our non-profit board. They are the guides and sounding board. They let me know when I’m getting too wild and crazy with ideas, though to their credit they also put a lot of trust in me.
Finding medical supply donations has been one of the easier parts to solve, since I am acquainted with many clinic owners and healthcare practitioners who are like-minded in their frustration with our current model, feel just as stuck with the status quo, and frankly, they’re quite interested in seeing how this project pans out.
Finding a like-minded space has been months in the planning. Not just anywhere would be the right fit for something like a “Prolotherapy Pop-Up Clinic.” Weird-sounding, I know. But I know a few folks at MCSF (shout out to Aron, he’s the man!), I have taught a few health and nutrition classes to their members and thought we might be a good fit, philosophy- and community-wise.
In addition, with my experience using Prolotherapy, I have found it for both my patients and myself personally a highly-valued addition to recovery from strength and conditioning training as well as the perfect fit to accelerate healing from minor sports injuries, so holding these at MCSF just made sense.
So that’s what we’re doing.
Over the next weeks to months, at MCSF we will hold our first set of Prolo Pop-Up nights. We will refine the process and the offerings. And hopefully do a lot of good along the way (without the insurance company gouging).
And this is about long enough, or too long rather, so we’ll leave the story here for now.
If you’re interested in hearing me rap more about my dissatisfaction with the economics of healthcare, well, I can’t help myself, so continue reading if you wish (you've been warned).
Why am I doing this? Why not do something easier?
I know, right?! What’s my problem?!
Why don’t I just charge more in my private practice, go to self-pay (cash practice) only or see more patients?
Well, the obvious answer to me is that capitalism is a failed method of operating healthcare.
I know, I know, socialized healthcare is by no means perfect.
You can take me out for a glass of wine some time and we can compare the merits and downsides of each.
But the fact remains that profit-based healthcare interests have priced us all out. My patients are not widgets, and I’m not a widget-maker.
Our capitalist free market economy has our health and finances in ruins? Why? Well, that's a really long answer (even longer than this article), but in short I believe it is because of a fundamental disconnect between economics and value.
I am reminded of this passage (with a few of my words thrown in) in Judith Schwartz's book, "Cows Save the Planet" (because in my spare time, I'm a would-be farmer):
"[There is a] discconect between the economy and the natural world (my substitute: "health"), a fantasy that we continue to believe at our peril. "The only true economies are nature's ecosystems," says Wes Jackson... [H]e means "economy" in the sense of "thrifty management of resources," for this is where ecological systems excel: self-sustaining, and self-regulating, responsive to change, nothing is wasted (in contrast with our industrial, capitalist economy, where waste is rife and unchecked). The decidedly unnatural ecology of industrial agriculture (sub. profit-based healthcare systems) is often justified in terms of "economies of scale."... [which are] economic fiction.
So no, me just charging more and more, or seeing more and more patients will not fix what is inherently broken.
“Free market economy” has no business dictating what a patient with diabetes or cancer has access to, its failure is self-evident to me, as a doctor in the trenches seeing this reality daily.
Added to this, the current system has no vested interest in actually reversing or curing diseases.
And that is basically all I am interested in.
That’s why I became a doctor.
To actually get my patient out of chronic pain and back to running.
Not to be indefinitely managed on medications.
Going back to my earlier point on intellectual and emotional fulfillment.
Or…Why don’t I just go the path of so many in the healthcare realms nowadays, particularly those in the alternative or functional medicine professions. I’m talking about virtual consults, online programs and concierge medicine (last one being essentially monthly memberships for some set amount of care or access to provider, if you’re not familiar). It sure seems like the popular thing to do.
In a simple answer, I don’t think that solves the above issues I mention for the vast majority of our community. I’m not an online health coach. If you need or want or have benefited from one, great. I’m just not that person. I’m trying do what little I can to lower barriers in accessing to healthcare, and to actually heal others. Not run a 30 day cleanse or sell you some supplements.
Concierge medicine sounds great for those who have the market and demand for that. But “my people” are those who I’m seeing make do without, not able to get the kind of care they want and need, not getting answers from what restricted care their insurance does cover.
I’m scrappy and I’m stubborn, and I don’t have $1,000 a month myself to pay for luxury health services (true story).
So to sum it up, I’d rather create a non-profit from scratch and give a middle finger to managed health care than buck the system and become a top-dollar health consultant.
I’d rather help 500 in my community feel better, rather than 50.
And last but not least, I’m pretty sure I can pull this off.
I just need to know, are you with me?
There are many ways to get involved. The SCH website has more information, but below you will find our application for patients to apply to participate with our non-profit work, as well as for those interested in hosting us, either for health classes/ workshops, or the Prolo Pop-Up clinics.
If you have any further questions about SCH's non-profit services, you can leave a comment below or the main email is santiamhealth (at) gmail.com