It’s time to make some summer stew. The ingredients for this dish begin with graduations and summer vacations. Related to medical training, we have the privilege of experiencing at least three stages, or phases, of graduation. For those graduating from medical school, it is time to begin preparing for the next phase of life’s journey, internships and residencies. For many that will mean moving. With this next phase, there will be new challenges, opportunities, and friends. Many of their new training mates will be from other states and likely other parts of the world. My advice is to welcome them all and learn together as members of the same family. I can assure the new graduates that this will be one of the most exciting and rewarding times in their medical journey. Take some deep breaths, relax, and enjoy the ride. We hope for many of them it will mean finding new homes here in Mississippi. I challenge these new graduates to continue to stay engaged in organized medicine, especially in their chosen discipline’s organizations, MSMA, and the AMA. The medical profession and their patients need them to stay involved and engaged in medicine’s future as well as in their communities.

As most of you know, we now have new residencies and fellowships scattered across our state, with more to come. For those that are in the residency and fellowship phase of their training, this is that time of the year when many of them will be completing said residency or fellowship. For some this phase may have included training out of state, and while it does not matter if they finalize this phase of training in state or out, we want to encourage them to consider either coming back to Mississippi or if they are completing this phase here, to stay and make our state their permanent home. Of course, I am using the term “completing your training” loosely. Residency and/or fellowships are just another step in medicine’s lifelong journey of learning. Medicine is a lifelong learning process, so one should never get the idea that their training is truly complete. At the same time, I do know how grateful many are that this important phase is now behind them. My deepest and most sincere congratulations and welcome to the family.

One thing is for sure, medical knowledge is continually changing, evolving, and advancing. One of the “hot topics” at all the recent meetings that I have attended is AI. To most, AI refers to artificial intelligence, but I prefer to refer to it as Augmented Intelligence. For clarity, no, I do not believe that AI will ever replace us as physicians. My opinion is that AI can be a great resource and can be used to augment our practices when used appropriately. Time will tell whether AI will be of significant benefit to us and our patients or another disaster. We must not only remain vigilant in staying abreast of educational changes, but we must also stay at the forefront of the advances and evolutions of medicine and technology as well. AI is yet another example of us developing new novel resources that offer to potentially broaden our knowledge base. As I mentioned previously, and yes, I will say it again, it is also vitally important for all of us to continue to stay engaged in organized medicine, especially in our chosen discipline’s organizations, MSMA, and AMA. One must find a way to become involved or stay involved and if someone needs some suggestions, please feel free to send me an email or give me a call.

I surely hate to bring up my last President’s Stew. With so much hope and promise, what spoiled the Stew? As I was writing the previous President’s Stew, it was in the waning days of the 2024 Legislative session. I was so hopeful that we were going to be able to bring Medicaid expansion across the finish line. But it wasn’t to be. The session had the ingredients to make one of the finest stews you could ever imagine, but I should know by now that these ingredients, called politics, can sour in a moment’s notice. My anticipated positive news on Medicaid expansion fell far short of what I had hoped and expected. On a positive note, Medicaid expansion was finally brought to the table for discussion and debate. These discussions were sincere and thoughtful. We can only hope that these discussions will continue throughout the summer and into the 2025 legislative session by both chambers. There have been statements made by both the Senate and House leadership that it will be one of the first items on the legislative agenda for the 2025 session. Currently Mississippi remains one of only 10 states failing to adopt some form of expansion. The ingredients for a great stew are still on the table, and new ones are being added so let’s hope we are feasting on that savory stew next spring.

Overall, this past legislative session was successful for medicine. There were, however, many factors that made it a bit more challenging than usual. The 2024 session saw many new faces, a little over twenty percent of the House were freshmen legislators and we also had a new speaker, Jason White. But even with this change, and to borrow a baseball analogy, the House came out of the gate swinging for the fence. The Senate saw much less change, and although they demonstrated some positive rhetoric, they just never got their horse out of the gate related to Medicaid expansion. These types of monumental challenges and changes are more akin to a relay race than a single leg sprint. We saw the first leg of the relay this past spring and the second leg will come in 2025. Preparation is always important as is the hand off. We can hope that there is much work and planning occurring for the next hand off so that it can be made more cleanly. So where did we fall short in 2024? It may have been in the hand off as it seemed to have been cumbersome or possibly even fumbled. With that shaky hand off there was just too much ground to cover between the house and senate for this leg of the race to have been won. In the end, we pick up the pieces and we live for another day. There will be a lot of preparation for that next sprint.

My year as your President is rapidly coming to an end. There will soon be a new chef in the kitchen. The MSMA annual session is in August, so please make plans to attend. It is never too early to start preparing for the new 2025 stew recipe (2025 Legislative session), so please help us make that the best one ever. There will be some of the old ingredients remaining but there will always be new one’s abounding. Please make plans to help MSMA find the absolute best ingredients that will serve us all well. There is much work to be done in preparation and we all need to find a way to be a part of the plan.

In closing, I had the privilege of attending the annual AMA session and congress. Your AMA Delegates worked hard carrying the Mississippi message to the congress. I assure you, Mississippi was well represented. Claude and I had the privilege to give a presentation during the AMA’s State Scope of Practice Partnership (SSOPP) session. It is no secret that scope of practice challenges abound across the U.S. Mississippi was chosen to be one of the presenters because of MSMA’s successes in holding the line in scope battles. The SSOPP is very helpful to state associations in these legislative battles.

I think you would be hard pressed to find anyone who believes more strongly in the “team” aspect of medical delivery than myself. I also strongly believe one should be able to practice to the max within the boundaries of one’s training. These two concepts are not contradictory. In medicine, like life, the sum of the whole is always greater than the individual parts. Most, if not all, well run and efficient organizations, be it sports, military, or business, must possess structure and there must be a leader. Medicine is very much a team-based process or at least it should be to deliver the best, most cost-efficient care to all. As I said, all teams must have a leader and in the medical concept, I firmly believe that should be the physician. I think the data supports this concept to be the safest, most effective, and most efficient model.

Speaker White has already made it clear that he sees things in a different light. So, the 2025 session will likely be very challenging when it comes to differing views on the value related to scope issues. There seems to be a rampant misconception that independent practice will solve all the access woes and cure the physician shortage. Yes, we surely do need more physicians, especially in the primary care workforce, and we are making great progress in that arena with the new primary care residencies across the state. We need significantly better distribution of physicians, primary care, and specialists. Financial issues also contribute to some of the maldistribution challenges. These issues won’t be addressed with scope of practice changes. More importantly, we must address the team-based concept more efficiently. Changing the rules from collaborative arrangements to independent practice for APRNs, PAs, or any of the other allied healthcare providers does not change the number of providers in our state, nor will it expand where practices are located. That is just a fact. Silo medicine is not effective or efficient.

All allied health professionals have experience and knowledge that adds to the care for patients. We must work together more collectively and collaboratively to reach our maximum potential. Physician-lead, team-based care is the most efficient and cost-effective model, no question.

Legislative contacts and relationships are critically important. There are currently no physicians in the Mississippi legislature. Get to know your legislators and strengthen those relationships. Personal relationships are the strongest voices medicine can have. We need to continue to educate our legislators on these misguided concepts and stress the importance of the physician-lead team, its cost effectiveness, quality, and safety. We as physicians must put action to these concepts and work more diligently to build stronger healthcare teams and explore ways of working together so that we can extend healthcare access to all areas within Mississippi.

Let me end by emphasizing the critical nature of participating in MMPAC. Your voice and your financial resources are critical to the care and safety of our patients and our physicians’ future. MMPAC gets your voice to the table to be heard. As my presidency draws near the end, I have enjoyed attending component society meetings across the state, your fellowship, and listening to your suggestions. If you are not a member of MSMA, become one, and if you are a member, find a way to engage and be more active. Mississippi medicine needs all of us working together.

Best wishes, joy, and peace.

John Mitchell