PHYSICIAN
ASSISTANTS AND NURSE PRACTITIONERS IMPROVING THE HEALTH OF AMERICA’S
PROFESSIONAL TRUCK DRIVERS.
Over 26 million trucks operate each year in The United
States and each has a driver with limited access to healthcare providers;
physician assistants and nurse practitioners filling the healthcare gaps in the
trucking industry. You are listening to ReachMD XM 157, The Channel for
Medical Professionals. Welcome to the Clinician’s Roundtable. I am Lisa
D'andrea, your host, and with me today is Dr. John McElligot, founder of
Professional Driver Medical Depot in Knoxville, Tennessee, a clinic that serves
the trucking and trucking related profession only. Today, we are discussing
physician assistants and nurse practitioners improving the healthcare of
America’s professional truck drivers.
MS. D'ANDREA:
Hi, John, welcome to ReachMD.
DR. MCELLIGOT:
Hi, how are you doing today, Lisa.
MS. D'ANDREA:
I am doing well, thank you. John, can you tell us about
your medical background and how this concept of having medical facilities
available at travel centers for truckers came about.
DR. MCELLIGOT:
Well, I am a board certified internist and just happened to
have a Masters of Public Health and Occupational Health and Safety and got into
occupational health on a full-time basis after an illness and really got into
the trucking business and basically a gentleman named Bill Godman from Midland
Texas, we were out having a cold beer one night and he said, you know truckers
have no healthcare and as of now they come to my office all the time, but
anyway I got to look into it and 10 years later I said, you know, we got to do
something; these guys are down like <_____> that they just live to be 55
and they have every disease known to man, so that's what got me started.
MS. D'ANDREA:
You also have a history of being a physician assistant and
the majority of the cares provided by PAs and nurse practitioners. How does
your medical team handle that medical supervision and how does that work in
your team.
DR. MCELLIGOT:
Well, having been a PA, I am big fan of mid levels as well
as nurse practitioners and we have a medical director, who is usually
affiliated with the local hospital at every site and he oversees the nurse
practitioner or the physician assistant, and in most sites we have more than
one, and in some sites we have as many as four, depending on the state law and
we interface some with nurse practitioners and PAs because some of the laws are
good for PAs and some aren't and some are better for nurse practitioners, so we
kind of are using both liberally.
MS. D'ANDREA:
Is it difficult to recruit PAs or NPs to your facilities?
DR. MCELLIGOT:
It was in the beginning, it's not now. We have a strategic
plan and a gentleman named Jeff Heimerick, at Connecticut,who is a PA
and has a doctorate in education, was the former director of the GW Program,
was a full professor there, and he has come on as a strategic planner and he
started helping us kind of get the word out there, so now we've got lot of
people, who know what we are, what we do, and know that the cause is really
great and the pathology is unbelievable.
MS. D'ANDREA:
The truck drivers have very different medical needs, can you
highlight some of these and discuss their barriers to care?
DR. MCELLIGOT:
Lot of barriers to care is their on the road 28 days a
month, 57% of them couldn't get to the doctor in the preceding year when we did
our studies. In addition to that, they can’t get their medicines refilled.
They run out sometimes from months at a time, and their biggest barrier is they
are paid by the mile and they have hours of service and they cannot stop and it
is just a really difficult dilemma trying to get them into a hospital to get a
study done.
MS. D'ANDREA:
How do the depots operate? Do the truckers make
appointments?
DR. MCELLIGOT:
No they don't. They can walk in and we can take care of
them, you know, at that point in time. We also have a 24-hour call center
where we can direct them all over the country to hospitals that primarily are
teaching hospitals because the residents like <_____> pathology and our
PA students love it because these guys, some of them are just a great teaching
opportunity and they love people. It's a very lonely profession. So they like
the attention and we direct about 100 a week through our 24-hour call center,
plus we've seen 10,000 or so truckers in less than two years.
MS. D'ANDREA:
Do you utilize electronic medical records?
DR. MCELLIGOT:
Yes, we do, and we are working on that to perfect it. Every
driver that comes to us as has a card. We are working with the website people
to get it to where the family doctor can actually pull that record up, and
we're working with the HIPAA folks to make sure everything is protected, and by
giving your doctor your card, you in essence say, okay you can look at my
stuff, but we don’t want anybody that the driver doesn't want looking at his
medical record, so that's where the card comes in and they can carry from site
to site or to their family doctor and it should all be in place shortly.
MS. D'ANDREA:
What services do the depots offer?
DR. MCELLIGOT:
Primarily what we do is DOT, we can do anything DOT-wise
from the exams, breath alcohols. We have state-of-the-art hearing booths,
vision machines, and so all that's taken care of it. If there's an accident,
we can do post-accident drug screens. All of our technicians are certified.
All our sites are certified by an inspector to make sure we meet the DOT
requirements and we do that with an independent person who knows the DOT regs
and can point them out to us. We have probably 400 fleets that are signed up
and we have protocols in place for them. Our biggest population was
independent on our operators.
MS. D'ANDREA:
What happens if there is a need for hospitalization,
imaging, or referrals to a specialist?
DR. MCELLIGOT:
Well, that's why we have the affiliated hospitals and they
have a fast track set up for us, and usually it's run by a PA or nurse
practitioner. So we call them, we say okay, we've got a patient of the medical
director because once I go to the hospital, becomes his patient, is not ours,
and we say here's what we've got and we send the man, and we've had, you name
it we've had to send it in, we've sent probably close to 4000 people in the
last year to the hospital. Now, getting them to go is another issue, a lot of
them can’t go because they are paid by the mile. If they go in the hospital
and are admitted, they can lose their truck, their house, and that's where the
St. Christopher Fund comes in.
MS. D'ANDREA:
I will talk about that in a second. What have the truck
drivers done in the past for their medical care?
DR. MCELLIGOT:
Mostly go to the emergency room, that's their most frequent
stop. Sometimes they can get home, but it's on a Saturday or Friday night late
and Saturday and nobody is open. The veterans out there, the Veterans from
actually Vietnam they are in, now the new ones are coming back from Iraq that
become truck drivers, they can't get any healthcare and return to work with the
VA to get <_____> so least we can do urgent care when they are sick
because VAs are open 8 to 5.
MS. D'ANDREA:
Has there ever been a model like this before?
DR. MCELLIGOT:
There have and they have all failed because they were
operated by doctors who were at private practices and these things take time to
mature because when you open the doors, you start off, they don't trust you and
you start off with one driver then he tells ten more and they build up and now
our clinics are very busy. Some of the clinics we are going to have to go to 2
full-time providers and probably several part-time.
MS. D'ANDREA:
If you are just joining us, you are listening to the
Clinician’s Roundtable on ReachMD XM 157, The Channel for Medical
Professionals. I am Lisa D'andrea and I am speaking with Dr. McElligot,
founder of Professional Drivers Medical Depot in Knoxville, Tennessee, a clinic,
which serves the trucking and trucking related profession. We are discussing
physician assistants and nurse practitioners improving the health of America’s
professional truck drivers.
The lack of healthcare coverage is a problem for truckers
and in 2007 you cofounded the St. Christopher Fund, the not-for-profit
organization that provides financial assistance to the truck drivers, who have
medical problems and can’t afford their healthcare, can you tell us about that?
DR. MCELLIGOT:
Yes, they have <_____> Michael Barnes one of your cohorts
on the on XM Radio had this idea and I just sort of made it happen and had a
lawyer that didn't charge us anything, so we got it going. We presently have
helped 18 drivers just since last December and we probably have another couple when
works and what we try to do is we find people with catastrophic medical
problems that are going to lose their homes, there family is going to be
destitute and may be homeless; we have 20,000 drivers a year with their
families that do become homeless. So what we do is we bootstrap them. We
don’t give them fish, we teach him how to fish so to speak, and that we will go
to the doctor, the hospital, and we'll get things going with the help of
chemotherapy, on several we've got medications for people who've had just catastrophic
strokes or heart attacks, and we try to get them back on the road and rehab'd
and once they get on most of them go back to work and get their DOT card back
and then, believe it or not, they make a donation to the St. Christopher Fund,
it's really great.
MS. D'ANDREA:
Many truck drivers are independent operators and don’t have
health insurance. Can you tell us about the Professional Drivers Insurance
Program.
DR. MCELLIGOT:
We call PDIP, and it's really separate from PDMD, but we
went out and did focus groups and said, look, what do you need, and of course
they wanted a big 80-20, it cost, you know, lot of money, and we said okay
<_____> going to call us and then we said we can't afford this. So we
kept massaging the system until we got down to a limited service to where the
doctors got paid for their office visit within 48 to 72 hours. They had 8 or
10 paid for a year. They had up to 800 or 1000 dollars in labs and some
hospital stuff, pharmaceutical coverage, and it goes down to as low as 140
dollars a month and they like that so that’s what we did. We put several
levels in there because some of the truckers make a lot of money and some don’t
so we had to have a big range of services and some are very good, almost like
an 80-20 policy. The problems with the 80-20 policies in a truck drivers is
that they will spent 10,000 to 15,000 dollars getting up to the point where
they had coverage. So they are still almost all cash paying customers. So
they like this PDIP because it gives them access to their home doctor, they can
come to a PDMD Clinic as well.
MS. D'ANDREA:
You recently completed a healthcare survey with over 1600
truck drivers, what were some of the highlights of that survey.
DR. MCELLIGOT:
Well, the biggest thing was the lack of access, the lack of
education, the fact that we have an epidemic of obesity, sleep apnea, diabetes,
hypertension, the average driver are on about 3 medications and they are just
not surviving very long. The teamsters and one of the medical schools up in
Pennsylvania, I can't remember that, they did a study in the teamster retiring
at 63 only collects 20 retirement checks before he does, there is not very
many.
MS. D'ANDREA:
How do you manage wellness?
DR. MCELLIGOT:
We have lot of that. Primarily with our Novartis programs
that we do on XM 8 times a month and we have coffee with the doctor, walking
with a doctor, which is another 12 to 15 times a month that the drivers can
come and we do free consults and the whole point of what we are doing is
education, education then diet, which they don’t have access to and then the
medical people, which is primarily nurse practitioners and PAs and I will say
one thing that we can always work under a medical director, but this team approach
with the nurse practitioner and PA could be what's going to save this
profession.
MS. D'ANDREA:
So, how many clinics are there currently in operation?
DR. MCELLIGOT:
We have 4 open right now, 2 opening in the next month or
two. Then next year there will be 10 and the following year there would be 24
in addition to that.
MS. D'ANDREA:
What's your..
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