About Dr. Robert “Bob” Vadovic Dr. Robert "Bob" Vadovic is a Nurse Practitioner with a Ph.D. in Nursing Practice. He started as an Office Provider at Intermountain Healthcare and is currently the Medical Director for High Risk and APPs and Program Director for the APP...
Vaccines, the Future of Medical Education, and the Reality of Reimbursements: An Interview with Dr. Thomas d’Amato
Armed with an impressive scientific education, cardiovascular & thoracic specialty, and experience as Ship’s Surgeon on the USS Enterprise, Dr. Thomas d’Amato of Las Vegas has seen plenty of ups and downs in the medical community. However, no amount of training, experience, and notable repute could have prepared him and his colleagues for the COVID-19 pandemic. The year 2020 has been full of reflection on the past, present, and future – and Dr. d’Amato has valuable insight on how COVID-19 has affected his field, the current state of elective cases and vaccines, the future of medical education, and the reality of reimbursements.
Regarding the pandemic, coronavirus hit close to home. “I got COVID,” Dr. d’Amato shared in an interview. “It was very mild symptoms. I had monoclonal antibodies, so things continued to be mild… My symptoms were a little bit of fatigue and anosmia – inability to smell.” Dr. d’Amato explained how he had caught COVID right before Thanksgiving, a time where cases were spiking in the U.S. But even now, months later, he is still feeling the effects of the sickness. “It’s getting a little bit better,”
He said about his anosmia. “But we [in healthcare] are not immune to getting [COVID].”
However, for Dr. d’Amato, his own experience with the novel virus is the least of his worries. Amongst his concerns, he finds that current conditions make it increasingly challenging for doctors to establish a meaningful relationship with their patients during a time when patients need their doctors more than ever. Dr. d’Amato explained the strategy used to determine between essential and non-essential procedures: “You define cases…as elective, meaning someone can recover at home, whereas urgent is…where it’s probably unsafe to let them go home. Emergent is taking them to the operating room as soon as you can. And salvage is someone you’re not going to take to the emergency room and isn’t going to make it.” Because of COVID, many states are urging that people who would qualify as “elective cases” stay away from hospitals and doctors so as not to overwhelm hospital beds and to help slow the spread. However, with private practices such as Dr. d’Amato’s, this has become a challenge. “We are way behind with what you would call an elective case. [For example] we usually do a fair amount of aortic dissections, and we’re just not seeing that amount now.”
Additionally, Dr. d’Amato explained that many of his patients fall into the 3rd category of “emergent,” where “patients suffer life or limb loss if you don’t operate on them within the cardiovascular specialty.”
But even getting those patients into the hospital has proven to be complicated. He explains, “The challenge that all of us have is getting these patients into the hospital. There’s some supposition… that patients are dying at home where they’re ignoring symptoms because they’re afraid to come to the hospital.” He shared. “I think that’s challenging from both a fiscal and being-able-to-provide-good-patient-care standpoint.” However, the solution isn’t as easy as simply resuming practice as usual: “There’s different issues that occur, it can be hospital staffing, it can be hospital beds, it can be O.R. staffing, nursing staffing, any one of those things depends on where we are on the curve for this pandemic. It changes.”
Nonetheless, Dr. d’Amato is cautiously optimistic that the vaccine is a promise for better days ahead. “We want to start knocking out those elective cases as soon as possible, as soon as we have light at the end of the tunnel, and so far, it’s getting a little better.” He says, stressing the importance of treating elective cases before they worsen. “I think, since the vaccine’s coming, people are hoping it’ll make a big difference.”
Having received his Bachelors of Science in Microbiology & Cell Biology plus a Ph.D. in Biological Science, Dr. d’Amato is personally very interested in the mechanisms behind the COVID vaccines. “I keep up with some of this, I speak the language, and I’m not very concerned.” He said. When asked about people’s hesitations about the vaccines, he replied, “I’m a big proponent of the two vaccines which are out now [Moderna and Pfizer], but I can’t comment on all of them.” He went on to explain more about how the vaccine works: “I think it’s a very amazing, novel thing that they d regarding these RNA vaccines regarding Moderna and Pfizer. Our RNA’s are very fragile macromolecules that get chewed up very easily by enzymes that we have, and they’re ubiquitous all over…the lipid nanoparticles are just a way to get it into our muscle cells that translate into our mRNA and turn it into a protein, a spike protein. And we excrete the spike protein, which is foreign to our bodies, and we make antibodies against it.”
From his personal experience, the only people he knows who’ve had adverse reactions are people who’ve had COVID and have gotten sick for a few days, plus arm soreness. Other than that, though, he says, “I think enough people have had this to show it’s safe…what they’re putting in your arm will eventually go away. I’m encouraging people to get it.” However, Dr. d’Amato warns against an early victory and quickly returning to normal. Even with the vaccine, he asks, “Who knows how long immunity will last?… It will be interesting. Is it going to be the ‘be all that end all’? Probably not, but it’s going to slow it down.”
Will a COVID world of social distancing, quarantining, shutdowns, and online everything be the “new normal”? Dr. d’Amato doesn’t quite think so. “My opinion on that is very simplistic. I think that when I was a kid growing up, my mom used to tell me to wash my hands, don’t touch your face, stay away from people who are sick, wash your hands a lot. And I think we’ve lost those things. That’s what we need to teach our kids from the time they’re toddlers. That ought to be the new normal, to keep your environment, hands, face, food, drink – all that clean, and try to stay away from sick people.” He credits the low rate of influenza to people being more conscious about hygiene and cleanliness. “And I think that’s despite this year’s flu shot…why? I can speculate. People are washing their hands, staying away from sick people, not touching their faces, basic things. It’s amazing how those simple things might make a difference.”
As for technology, the online world, and virtual networking, Dr. d’Amato thinks those changes are here to stay, evolve, and revolutionize learning, particularly for the medical industry. Today, medical students are using technology, simulations, and the virtual world as a significant part of their education – even more than before with the rise of distance learning. For some, simulations and virtual experiments are entirely replacing the classroom. While this offers promising technological gain, it also has its downsides: “What worries me is some of the technology that we are using ends up being a crutch, and we end up not knowing how to do things… I hate to say this… the old fashioned way.” Dr. d’Amato warns. “When I was in academia, we had residents and students learning from us. And I would tell them I was going to ‘hit them with a secret weapon’ and they would ask me ‘what’s the secret weapon?’…It was the physical. [But now] we’re losing the hands-on part, and I’m not sure a lot of that is going to come back.”
“Learning will change.” Dr. d’Amato promises. “[Technology] is going to improve, it’s going to keep getting better…Management of people with stents has improved, medications have improved, you can’t deny the ethical value of some of the cholesterol-lowering drugs and those things.” He points to the COVID vaccine as yet another example of how incredibly beneficial technology has been and shares his hope that this is only the beginning. But on the other hand, he still wholeheartedly believes in the importance of real, hands-on work: “You’re not going to be able to do [everything] virtually. You can do simulations, but it’s not the same. Yes, some of the simulations are really good, and they do help. Sometimes I’m like, ‘Oh wow, I wish I had that,’ but you don’t come out of medical school knowing how to operate. And you’re certainly not going to have the judgment for that.” His biggest worry is that virtual will gradually chip away at the patient-doctor relationship, which has already been strained. “Nothing beats going to the patient bedside and learning from the patient. But that’s kind of gone away.”
Additionally, medical reimbursements have been a particular difficulty for doctors this year, adding to the already-challenging private practice field. Dr. d’Amato compares the medical business to an airline business – they’re both highly-reliable organizations held to high-quality standards. However, Dr. d’Amato notices a big difference: “We have biological entities in it.” He states. And in order to fulfill the high-quality standards and maintain the best patient-doctor relationship — “well, what’s disheartening is that all costs money.”
Dr. d’Amato explains that doctors cannot write off what they don’t collect, and overall reimbursements have gone down. “The reimbursements are incredibly much much lower than when I started and definitely lower than when my specialty started. And your big concern is that there’s going to be a massive collapse of private industry in medicine, and it’ll be completely controlled… for good or bad reasons.”
Dr. d’Amato foresees that if things don’t change soon, the private medical industry may indeed collapse: “It gets to a point where you won’t even be able to turn your lights on. It’s going to be almost impossible to do that in the future. [Private collapse] may not be the worst thing in the world if it’s done properly…but the whole quality issue, that’s hard.” Dr. d’Amato explains that physical location, loyalty to one’s practice, and doctors being stretched thin due to finances has been difficult for some private practices. “Higher tax burdens, lower reimbursements, these are negatively going to affect most of us.”
The fancy dream of the medical field being a life of luxury is no longer the case. “The billionaire doctor doesn’t exist anymore.” Dr. d’Amato says. The fact that medical school is so expensive and the real world is becoming increasingly costly adds up. And Dr. d’Amato is especially worried about how this too will affect patient-doctor relationships. “[Some doctors] have to see 35 patients a day to make ends meet, and they’re not bringing home a lot of money…but nonetheless, they can’t turn on the lights if they don’t see 35 patients a day. But how can you spend quality time with 35 patients a day? You can’t, and that’s worrisome.”
Like the entire world, the medical community is facing a significant change in the traditional status quo. New challenges, hopes, dreams, problems, and solutions are popping up left and right. From COVID to vaccines to technology to finances, doctors have had to juggle handfuls in 2020. Still, Dr. d’Amato believes that the transition from the usual to the new doesn’t have to be one of the challenges. “We need to have mentors, lifelong mentors, and colleagues that can mentor you,” He advises young people going into the medical community. “Mentorship programs, mentorship philosophy…everyone has something they can bring to the table.” He once again emphasizes the importance of the patient-doctor relationship, saying that it is a priority above all: “Nothing substitutes number of patients that you see and what you observe. That’s kind of my old-fashioned take on this. But it’s important… Haha! I hate to say it. I never thought I’d call myself old fashioned.”
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