Daniel McQuillen, MD: [00:00:15] I'm pleased to be joined today by Congresswoman Lori Trahan, who represents the third District of Massachusetts, and Dr Kinna Thakarar, infectious disease and addiction medicine physician at Maine Medical Center, to discuss the bolstering infectious Outbreaks Bio Preparedness Workforce Act, which is new bipartisan legislation recently introduced in Congress by Representative Trahan and Representative McKinley of West Virginia. The bill is expected to be introduced soon by a bipartisan team in the Senate as well. Next, I'd like to share with you some society updates since the last Let's Talk ID aired for nearly two years. IDSA and its members have been focused on leading the response to COVID, and it's clear that COVID 19 will be part of the fabric of our lives for the foreseeable future. But we know that we must continue to move forward on key initiatives that have been and continue to be so important to our profession and our members. Some of those initiatives, such as compensation and ID workforces, are issues that only IDSA will take the lead on. And over the past months, the IDSA leadership has spent significant amount of time examining and realigning our strategic plan, which was developed prior to the pandemic, to account for the critical work we are doing in response to COVID and pandemic preparedness. At our board meeting in September, we finalized work streams and investments for the next 15 months to move us towards our five-year goals. During that process, we emphasized projects that have broad impact across our society priorities and have the potential for significant movement on multiple initiatives.
[00:01:59] At the conclusion of that meeting, the board approved a significant financial investment to rapidly advance our strategic initiatives, including advocating for the value of ID, improving compensation and fighting AMR. As part of this effort. We're committed to developing materials that document the full depth and breadth of the central and essential role ID professionals have played in responding to and leading us out of the pandemic. IDSA leaders are advising organizations from the CDC to the Health and Human Services Office of the Assistant Secretary of Preparedness and response to the White House Office of Science and Technology Policy that are assessing our pandemic response to date and forging a new plan to ready us to address and limit future pandemic threats. These groups are well aware of the key role our members play in the process through our advocacy with them. And in the midst of a pandemic that has disproportionately affected people of color and underserved communities. IDSA continues to be resolute in our goal to ensure the principles of inclusion, diversity, access and equity are woven into the fabric of everything we do. So welcome to both of you. Representative Trahan, on behalf of our more than 12,000 members and the patients and communities we serve, thank you for sponsoring the Bio Preparedness Workforce Act legislation that would help advance one of IDSA's strategic priorities. And thank you for leading the charge to pass this bill in Congress. Can you tell us how you became interested in health care workforce issues, and what drove you to lead this legislation?
Rep. Lori Trahan: [00:03:42] Massachusetts has long been a national and global leader in health care, innovation and advancement. And as the only Massachusetts member of Congress on the House Energy and Commerce Health Subcommittee, you know, I'm grateful for the unique opportunity that I have to support this leadership in my district and certainly across the state. So in terms of the legislation, the COVID 19 pandemic brought health care workforce issues to the forefront as it exposed gaps and weaknesses in our nation's preparedness for public health emergencies. You know, a common theme in my conversations with health care providers of all specialties is that existing workforce shortages were only made worse by the pandemic. So we've asked so much of our frontline workers who over the past 18 months have tirelessly delivered lifesaving care, and that has included dealing with the grief of unprecedented rates of patient fatalities, lack of proper personal protective equipment and immense burnout, all of which have exacerbated these shortages, these workforce shortages. So dedicated and talented care providers have been pushed out of the workforce due to a lack of support and resources. And this this issue is a focus of the bipartisan Pandemic Preparedness Caucus, which I founded and I currently co-chair. This caucus is aimed at bringing out the lessons of the last 19 months so that we're never caught flat footed again in the face of a public health crisis. And that includes, you know, moving our supply chain home, investing in genomic research, our lab structure and our talented pipeline of health care professionals. So when we met earlier this year and my team to talk about the challenges facing the infectious diseases and bio preparedness workforce, we saw it as an opportunity to lead by introducing bipartisan legislation that works to address these pressing issues and support our health care workers who have given us so much.
McQuillen: [00:05:48] And we really enjoyed meeting with your staff and the enthusiasm they had for this issue, which is near and dear to us as you as you know. Can you tell us what the Bio Preparedness Workforce Act would actually do?
Trahan: [00:05:59] So the bill would create a new loan repayment program for health care professionals who spend 50% of their time working in bio preparedness in health care facilities anywhere in the country. This repayment program would also be accessible to health care professionals who provide infectious disease care in underserved areas or federal facilities. So the bill ensures that contracts awarded by the Secretary of Health and Human Services help to increase the number of underrepresented minority individuals serving as bio preparedness or infectious disease physicians. And this this legislation is critical because we can't emphasize enough the value of a strong bio preparedness workforce that can mount a rapid, effective response. And we've seen what happens when we aren't as prepared as we could be for a public health crisis. And we have an obligation to make sure we're never caught unprepared again. So it's important that we have trained, experienced staff in health care facilities. That includes physicians, clinical pharmacists, physician assistants, advanced practice, registered nurses and lab professionals to develop and update response and surge capacity plans and protocols that execute readiness assessments, trained health care facility personnel perform infection prevention and control, and so much more. You know, even further data shows that average annual salaries for infectious disease physicians are below many other medical specialties contributing to these workforce shortages. So by investing in these frontline workers, the Bio Preparedness Workforce Act will act as one mechanism to make sure we're never blindsided by a serious public health crisis again.
McQuillen: [00:07:47] We completely agree with all of that. And I think one of the main things that's important about this bill is that it's so comprehensive. It's not just physicians. It's all the people that need to be involved. And it's a very comprehensive look at what the pandemic has shown us across the country, particularly in rural and underserved areas where the where the holes are and what we need to fill. Can you tell us how IDSA members and our colleagues can support efforts to pass this bill?
Trahan: [00:08:19] First, I just want to say once again thank you for the work you've already done to uplift and support this important legislation. You know, late last month, the Bio Preparedness Workforce Act was included in one of our House Energy and Commerce Health Subcommittee legislative hearings. That was an important and impactful first step. A number of our many endorsers have raised their support for the bill with the Energy and Commerce Committee, including a letter of support submitted for the record at the hearing from groups like yours. You know, this support is essential in making sure this legislation continues to be prioritized by sharing your firsthand boots on the ground experiences. You've helped us to understand just how important this issue is. So as we continue to move through the legislative process, I'll continue to serve as a strong advocate for our bill and for our urgent health care issues. It works to address. And I know you'll be standing alongside me making sure that we're educating all of our colleagues at the same time.
McQuillen: [00:09:25] So Dr Thakarar, as an ID physician in Maine, can you describe ID and bio preparedness workforce needs where you are, and are there enough ID specialists to meet the needs there?
Kinna Thakarar, DO: [00:09:37] Sure. Yeah. So the short answer is, sadly, there's definitely not enough physicians or experts in our state of Maine or in the United States. The longer answer is, you know, 80% of counties in the United States, they don't have a single physician. And that's particularly true in rural areas. So in a rural state like Maine, you know, we're constantly getting calls from smaller rural hospitals through the state and even across state borders. And I think before the pandemic, we knew that there was a shortage. Right? But the pandemic really just highlighted that there's a huge need for this more robust workforce within ID, And this is true not just for physicians but also for other personnel. Clinical microbiologists are important parts of our teams and infection Preventionists I think there was a recent some recent data showed that 25% of health care facilities had a vacant position for infection. Preventionists and over half of long-term care facilities reported that an infection preventionist has left in the past 24 months. And so that's really concerning, right, considering the amount of work that infection prevention is do for us and for our health systems. Having been a former director of infection control for one of our smaller hospitals in Maine, I know that there was a gap between our infection preventionist leaving and the next one coming, and it was really hard to piece together the work that was being done between surveillance and meeting with departments and dealing with outbreaks. It's a lot of work and I think we definitely need to address that shortage as well. And same for clinical microbiology positions. I think recently data show that there is 10% of vacant positions in the United States and about 70% of that workforce is set to retire in the next five years. And so there are also very important parts of our teams. And I think that addressing this shortage and building a robust network is really important and also I think will help prevent burnout in our field as well.
McQuillen: [00:11:30] One of the other things that this bill will actually help as well is there's a number of rural and non-rural areas, particularly in the south and actually in some areas in Massachusetts where there's a big shortage of HIV medicine expertise. And this bill will help to get better penetration into those areas as well. And it's one HIV is one of the priorities that have sort of fallen to the wayside with all the effort we've had to put into the COVID response. So this will also allow a comprehensive approach to that. Dr Thakarar, do you do you have thoughts about why this multidisciplinary approach is so important?
Thakarar: [00:12:12] I think physicians we do direct patient care. It involves a lot of complex infections, but also physicians take a lot of leadership roles, whether it's antibiotic stewardship positions or, you know, several of our docs are healthcare epidemiologists for their medical centers in our state. And I know that's true throughout the nation. So it's really important to be part of a multidisciplinary team and also importantly, our lab personnel. I think we all know how important testing and testing supplies during COVID was, but like the people behind the supplies is, are also very important. And I know our division director has worked very closely with our lab director every week. And also infectious disease pharmacists are key partners for working with physicians. They often co-lead antibiotic stewardship programs, which we all know can optimize patient outcomes and also help to reduce antibiotic resistance. And so there are just so important to our teams. I can't speak highly enough of pharmacists. We love our pharmacists here in Maine. I think I have them on speed dial. So, you know, they're just such an important part of the team. And also, you know, we work with many other professionals, whether it's advanced practice care providers or dentists. Et cetera. We work with a lot of teams myself. I work with a multidisciplinary endocarditis team which works to treat complex infections like endocarditis, also with a team of other professionals in our HIV clinics. So multidisciplinary work is what we do.
McQuillen: [00:13:39] And one other thing that is not very well publicized is that many of us in both urban and rural areas have taken leadership roles in spots where our public health departments don't have the capacity to cover helping our school systems stay open, advising colleges about how they can handle and keep their staff and students safe. And that's over and above everything else from your perspective. Dr Thakarar, why is loan repayment such an important tool to improve recruitment and retention for the ID and bio preparedness workforce?
Thakarar: [00:14:14] Financial challenges have always been a barrier for people entering the field of ID. There's always been a high level of interest in ID from medical students and residents, but understandably because of the level of medical debt that they're in, they end up going into other, more lucrative specialties. And even in 2020, with the Fauci effect, where, you know, there was a high level of interest in ID from students and residents, even then, only 75% of our fellowship programs filled their positions, you know, compared to other specialties where they either filled or they nearly filled. So loan repayment will really help make, you know, ID a more a financially feasible field for people and also, I think, incentivize people to work in geographic areas where they're needed, especially rural areas like our state here in Maine.
McQuillen: [00:15:01] And I think an important part of this legislation that I think both of you can speak to is that it would increase the number of individuals in ID and bio preparedness roles from populations that are currently underrepresented in medicine. I know that IDSA is extremely focused on diversity, equity and inclusion, and I do know that what we really need to do, particularly as evidenced in the response to even getting COVID vaccine into people, is to have people that look like and are members of the communities they serve in order to get accurate information out there and improve our penetration of accurate medical information to those populations. I'd ask either of you or both to respond to what you think that is in terms of importance.
Thakarar: [00:15:52] This is so important to have a diverse workforce. I think COVID really shed a light on the health inequities that we know have existed for many years. And, you know, people of color are disproportionately affected by COVID 19 and other infections like HIV. And so having this more diverse workforce is really important. And also just getting more distribution throughout the country will really be important for promoting health equity. And, you know, again, COVID has really shed a light on this issue, especially when we're really trying to get people vaccinated and tested for COVID. I think just highlights the need for a more diverse workforce.
Trahan: [00:16:31] Yeah, couldn't agree more. I mean, like Dr Thakarar said, Americans of color face high barriers in access to health care. At the same time, black, Latino, indigenous and other communities of color are underrepresented in medical professions. And throughout the pandemic, we've known that COVID-19 and other infectious diseases disproportionately impact underserved communities, including our communities of color. Many Americans, they just feel more comfortable seeking a provider who looks like them. As you know, as Dr McQuillen said, it understands their culture and their specific health challenges. So a more diverse infectious disease and bio preparedness workforce is critical to delivering culturally competent health care and advancing health equity. What we're proud of is that the Bio Preparedness Workforce Act works to make this a reality by authorizing HHS to award loan repayment contracts in a way that increases the number of minority individuals in in infectious disease and bio preparedness roles. You know, populations that are underrepresented in medicine tend to have higher student debt burdens. So offering loan repayment will help to reduce the financial barriers to pursuing careers in bio preparedness or ID so and strengthening the pipeline to create a more equitable infectious disease and bio preparedness workforce is an essential step to reach our most vulnerable patients and advance health equity across the country.
McQuillen: [00:18:08] Dr Thakara, you were instrumental in bringing the issue to the attention of Senator Collins from Maine, which resulted in her becoming the lead Republican champion of this bill in the Senate. Can you tell us a little bit more about your advocacy and why do you think it's so important for IDSA members to participate in that advocacy with Congress?
Thakarar: [00:18:25] Well, and also, I just want to thank the IDSA staff members who really made it a joy and easy to do advocacy, I think, within our organization. But I first became involved with advocacy as part of a workgroup that was really meant to help develop policy recommendations to prevent and treat infections related to injection drug use as an infectious disease and addiction medicine physician. This was something that was really important to me, and I just learned so much from that workgroup. My colleagues and the IDSA staff. And after that I did a Day on the Hill at IDWeek in D.C. a few years ago, which was super fun, was paired with Lisa Cox and also Dr Sandy Springer. And I learned so much from both of them and really just enjoyed meeting with the staffers and talking about the issues that we see in our everyday lives, you know, when we're working. And so after that, actually, one of the staffers got to visit our HIV clinic, which is really exciting. She got to see our work. And we told her all about the programs that we run and we just have developed a relationship since then. So it's just been a really nice experience. And most recently IDSA developed, you know, an advocacy liaison program. So I'm one of the liaisons for our region.
Thakarar: [00:19:35] And so through that, the IDSA staff asked me to join a Zoom meeting with Senator Collins and her staff. They scheduled everything. They also gave me the notes that I needed, and I pretty much just had to show up and share my experiences. It was super easy and the staffer was really engaged and was really just interested in learning about our experiences and spoke to the senator afterwards. And then she agreed to be one of the lead sponsors in Congress. It was super exciting. And what I have learned from this experience is just that our voices do make a difference. And again, this meeting took just 30 minutes out of my day. It was after HIV clinic and before my next meeting. And even that little amount of time, I think can truly make a difference. So I would just encourage more IDSA members to contact their representatives and ask them to support the Bio Preparedness Workforce Act. Again, it can just take a few minutes through email on the IDSA website or contact the IDSA staff member to schedule a short 30-minute meeting. But think no matter how big a role we play, I think we can all definitely do something as IDSA members.
McQuillen: [00:20:39] So I'd like to thank both of you for spending time with us today to talk about this Bio Preparedness Act. And if either of you has any last thoughts you'd like to give us, that'd be great.
Trahan: [00:20:51] It's wonderful to hear stories like the one Dr Thakarar just said in terms of the ease of advocating for common sense legislation, because, you know, I think right now we're living in a time where our politics is as divisive as it has ever been. And when folks who are on the ground with this unbelievable knowledge are able to sit with folks and walk them through, you know, just their day to day and showing where, like the lessons learned are, where, you know, we need to make improvements. That's the best that's the way we all participate in our democracy. And so but I also I'm super mindful of the fact that you're all busy. You're all, like stretched to the limit. And so look for making it as easy as possible to do this. It's such important work and I don't do it alone. Like I couldn't possibly get all of my colleagues, Republican or Democrat, to understand the importance of this legislation. But with you all, I've got a fighting chance of getting, you know, people to understand how critical it is and for us to move it in both the House and the Senate. So a big, huge thank you, but also feel really good about it because, you know, this is how our democracy is supposed to work. And at a time when we're doing everything we can to preserve it, it's great for folks to lean into it. Thank you.
Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.
If applicable, all relevant financial relationships have been mitigated.