The White Coats For Change (WCC) project is a transformative initiative aimed at equipping and empowering health care providers to actively engage in civic activities and drive systemic change.

Often, education of our hospitalized patients occurs in the last few hours of their stay. And there are no standards for how to perform this critical work. This project was inspired by my Spanish-speaking patient, Jose. Jose was re-admitted to our hospital with cirrhosis and volume overload, a new diagnosis that was made just a few months prior to when I cared for him. In exploring what happened, he barely recognized the term “cirrhosis” let alone Lasix and the other medications that were prescribed to control his symptoms.

Medicaid patients remain in acute care settings (acute hospitals, long term acute care hospitals, skilled nursing facilities) because there are no safe, clinically appropriate discharge options. This results in an increased number of administrative or denied days because the patients are no longer clinically acute and are just awaiting placement. Patients who could be in an inpatient bed or in a skilled nursing facility are instead stuck boarding in the emergency department or an inpatient bed.

My CHIP project is Trauma Informed Transformation of a Student Health Center and Universal ACEs screening. I am currently an Assistant Professor of Clinical Obstetrics and Gynecology in USC Student Health. Prior to joining USC in 2018, for 10 years I was Chief physician of an Ob/Gyn department in a Federally Qualified Health Center in South Los Angeles. Our service planning area had some of LA County’s highest rates of STIs, Teen pregnancies, Preterm deliveries, Low birth weight babies, and all cause morbidity and mortality rates.

In January 2023 the DEA and SAMSHA announced elimination of the X-waiver as a requirement to prescribe Suboxone (buprenorphine/ naloxone) for opioid use disorder which presented an opportunity to reduce one barrier to treatment, access to X-waivered providers, among patients at a suburban community health center. This project looked at the willingness of primary care providers not previously X-waivered to begin prescribing Suboxone for patients on a stable dose before and after a peer-led training.

The COVID-19 pandemic illuminated longstanding vulnerabilities in public health disease response, lab reporting, technology, and our workforce capacity to address a surge in a novel respiratory virus. Prior to COVID, I had gained extensive experience leading data-driven HIV and STD programs in San Francisco and collaborating across siloes improve population health outcomes.

At the height of the COVID-19 surges, hospitals were overwhelmed as the number of patients seeking care surpassed bed capacity. A significant bottleneck to hospital discharges in San Francisco was the delay in transferring to post-acute facilities due to the required 10 to 20-day quarantine period and lack of SNF bed availability.

There is a severe shortage of licensed SNF beds even as demand for SNF beds is increasing. Since 2001, the number of licensed SNF beds has decreased by 43% in San Francisco.

Effective physician leadership at the front lines is critical to our health care system as it grapples with worsening workforce shortages, burnout, and attrition associated with the COVID-19 pandemic. The national workforce deficit is projected to be more than 45,000 for primary care and 87,000 for specialty care physicians (Bhardwaj, 2022), and the annual cost of one physician vacancy per year is up to $1 million or 2-3 times a physician’s annual salary (Shanafelt et al., 2017).

Los Angeles County (along with California and the remaining United States) is in the worse overdose crisis in our history, driven by fentanyl and methamphetamine. No community is unimpacted by overdose, which spares no racial, ethnic, socioeconomic status, or age group. The historic response to substance-related crisis – to encourage people who use drugs to seek substance use treatment – is a necessary but insufficient response with when not paired with robust prevention and harm reduction initiatives that reach the people most in need.

Development of a Behavioral Health and Wellness Center that would provide comprehensive services and coordinated Behavioral Health Care by establishing a Certified Community Behavioral Health Clinic (CCBHC) to reduce health disparities.