Letter from Dr. Lisa Ladd, Chairman of the WCMS Foundation Board of Directors

September 12, 2018

Greetings, Western NC providers!

In the midst of change in our medical communities, there are always new opportunities to help patients become healthier.  In addition to access to care for the underserved and uninsured, there has been an ever increasing interest and focus on the social determinants of health. These are defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age.” (Click here for WHO’s definition of social determinants of health). In order to improve the health of an individual or population, these determinants, such as access to food, housing and transportation, must be addressed. This more comprehensive, or holistic, approach will greatly benefit our WCMS Project Access population.

Although less well documented, there are clear examples that these social determinants can negatively affect healthcare disparities causing an even greater gap in care as noted in the most recent National Healthcare Quality and Disparities Report.

Clearly the social determinants of health are important to address in our low income, uninsured populations.  However, it is not as clear as to who is going to address them and how. It seems as though the best point of access to the patient is in the provider’s office. But who has time? And if we gather information from our patients, who is going to address the needs once revealed? These questions are explored in this excellent article “Social Determinants of Health Are Important, but Who Is Responsible for Addressing Them?”

Another concern or “layer” to addressing the various aspects of the social determinants of health is burnout. Data collected in 2018 from WCMS membership on the topic of burnout revealed that 61% felt burned out because of their work. The top 4 causes of work-related burnout were as follows:

1.    Too many bureaucratic tasks at 55%
2.    Complex patients at 45%*
3.    Working too many hours at 39%
4.    Increasing computerization of practice at 37%

Complex patients were defined as patients who presented with multiple socio-economic issues that would probably impact the likelihood of successful treatment. Physicians and physician assistants described feeling frustrated that they were unable to help patients with non-medical barriers to health.

The staff of WCMS Project Access has started exploring ways in which they can help find answers to these very questions. Ultimately, it will need to be a collaborative effort within our communities in Western North Carolina. WCMS Project Access staff recently began screening Project Access patients at intake in regards to the social determinants of food security, transportation, housing, employment and domestic abuse.  Those eligible patients will be referred to appropriate resources. WCMS Project Access staff will track data and follow up with the referrals to insure the patient has been connected with resources, and to assess the needs and outcomes of overall health and well being.

As the current Board Chair of the WCMS Foundation, I am excited to move forward in improving the overall health of our Project Access Patients and grow to be a referral hub for our low income residents! There are so many clear examples of how the social determinants can affect one’s health:

  • Providing access to affordable fruits, vegetables and healthier food choices so a patient can follow a prescribed “healthy diet.”
  • Providing access to affordable and dependable transportation to go to office visits, get food and medicines to maintain health.
  • Providing a safe haven and counseling for patients and their family members who are experiencing the trauma of domestic abuse.

We hope to provide these services in an affordable way by collaborating and weaving our services together with those already helping the community with these needs.Our future goals will be to expand our screening services and geographic area. More information from your Medical Society will be forthcoming as we engage community partners and expand your scope of practice to include these basic social determinants of health variables in a manageable way.


Lisa Ladd MD
Chair WCMS Foundation Board