Dr. Hunter Jackson Smith Of Johns Hopkins University Berman Institute of Bioethics On 5 Things We Need To Do To Improve The US Healthcare System
An Interview With Jake Frankel
ADDRESS STAFFING SHORTAGES — The U.S. has suffered from significant shortages in physicians and nurses in recent years, which were exacerbated by mass exoduses following the COVID-19 pandemic. The U.S. will face a physician shortage of 86,000 by 2036 and full-time registered nurse shortage of 64,000 by 2032. Many hospitals and clinics across the country are unable to provide as much care as they could because of these shortages. If patients are forced to wait too long for care, then they may suffer complications unnecessarily.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement. In our interview series called “In Light of The Pandemic, Here Are The 5 Things We Need to Do to Improve the US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System. As a part of this series, I had the pleasure to interview Dr. Hunter Jackson Smith.
Hunter Jackson Smith, MD, MPH, MBE, FACPM is a preventive medicine physician and a Major in the U.S. Army Medical Corps. He is the Focus Area Lead for Antimicrobial Resistant Infections at the Department of Defense Global Emerging Infections Surveillance Branch and an Adjunct Assistant Professor at the Johns Hopkins Berman Institute of Bioethics. Dr. Smith also works with the American College of Preventive Medicine to support the implementation of preventive medicine priorities and promote health in forward-thinking and upstream ways.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
Thanks so much for having me! I’m thrilled to be here. My path started in high school where I conducted epidemiology projects on drug-resistant bacteria in dogs. That’s what first got me interested in medicine and public health. But once I got to college, I wanted to branch out a bit, so I studied philosophy and ethics in college. I found that the humanities coursework was both fascinating and felt incredibly important as a way to critically think about issues in the world. Along the way, I also felt a calling to serve my country in some capacity, so I joined the Army and received a scholarship to go to medical school. During medical school, I also got a degree in epidemiology because I found that so many clinical issues for individual patients could be better addressed more upstream at a larger public health level. At that time, I was searching for which medical specialty would be the best fit for me when I stumbled upon preventive medicine, and I immediately fell in love. It allowed me to blend all my passions — medicine, public health, and ethics — and work in that intersecting space every day. Nowadays, I can practice clinical medicine, work on population-level public health issues, and write about important ethical questions facing medicine and public health.
Can you share the most interesting story that happened to you since you began your career?
Just after I graduated residency in preventive medicine in 2020, I was sent to Kisumu, Kenya for 2 years to work on emerging infectious disease surveillance and research. That was during peak COVID-19 pandemic when there were so many unknowns about the disease and questions that needed answering. This was a truly intense time for those of us working in public health, and it was eye-opening seeing the different ways countries handled the pandemic and how their people responded to it. Working with my Kenyan colleagues to find out as much as we could about the disease and how we could best help people during that time was really rewarding, and I made some lifelong friendships along the way.
Are you working on any exciting new projects now? How do you think that will help people?
I’m currently working on tracking antimicrobial resistance patterns worldwide. Antimicrobial resistance happens when microorganisms like bacteria or viruses evolve to develop resistance to antibiotics. If someone becomes infected with an antibiotic-resistant bacteria, doctors might not be able to treat the infection, which can seriously hurt or even kill the infected patient. The United Nations General Assembly actually just adopted a political declaration on antimicrobial resistance, recognizing that is one of the gravest health threats in the world. Antimicrobial resistance is predicted to become one of the leading causes of death worldwide by 2050, so understanding where it is occurring and how it is developing is critically important so we can develop countermeasures against it. It is a constant battle against evolution — we can develop a new class of antibiotics and within a short period of time, we find resistance against it.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is one who is able to see the whole patient, make them feel heard, and effectively provide care to that person. To me, that means not just addressing one specific aspect of the patient’s primary health concern. It means understanding what the underlying issue might be for that concern, engaging meaningfully with the patient to see what their health needs are, and to provide preventive care and anticipatory guidance to ensure the person will stay healthy and limit future exacerbations of their health conditions.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle?
The COVID-19 pandemic put considerable stress on the U.S. healthcare system and highlighted weaknesses that were already there but were exacerbated during those trying times. One big issue was in the large disparities in health outcomes based on socioeconomic status, race/ethnicity, and a variety of other social considerations. We saw huge differences in health outcomes due, in part, to differences in access to care based on financial or geographic considerations, pre-existing health conditions, and other factors. We also saw that our medical supply chains were unable to keep up due to the increased demand. This manifested as shortages in masks and other personnel protective equipment for clinicians and hospital personnel. We continue to see examples of weaknesses in the supply chain today in the U.S. such as nationwide shortages of intravenous fluids and certain antibiotics. Challenges like these can arise if, for example, any one specific medical manufacturing plant falters due to a natural disaster or if a particular pharmaceutical company decides not to produce a certain medication anymore.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
The commitment, sacrifice, and bravery of healthcare professionals during the scariest days of the pandemic when no one knew just how transmissible or how deadly the virus was is beyond admirable. I had one friend who stayed at a hotel for weeks at a time while working in the intensive care unit treating COVID-19 patients so he wouldn’t put his family at risk at the beginning of the pandemic. The researchers who worked day and night to produce COVID-19 vaccines also saved millions of lives, and their efforts were critical. Another positive was the way that many hospitals and clinic systems were able to pivot and embrace telehealth for more routine medical care. Telehealth will continue to be important for accessing care for many Americans, particularly those living in rural areas and those with disabilities. The public health surveillance systems the U.S. implements also deserve praise. The laboratory side was able to develop tests to quickly and accurately diagnose a SARS-CoV-2 infection. Genomic sequencing technology proliferated rapidly to improve our abilities to monitor for and detect new variants of the virus. We were able to utilize new surveillance methods such as wastewater to track surges in SARS-CoV-2 at a population level. Our public health surveillance systems meaningfully contributed to our medical resource distribution strategies and other public health decision-making to respond to what was an ever-changing pandemic context.
As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system?
This is a huge question, and how we choose to structure our system is perhaps the most important issue facing healthcare today. Here are my top five changes:
- IMPROVE ACCESS TO CARE — Perhaps the most important change the U.S. can implement to improve its healthcare system is to increase access to care. The U.S. uses several different healthcare system models simultaneously, with a mix of private and public, nonprofit and for-profit insurers and providers. This has resulted in 25 million Americans completely uninsured and 43% of working-age adults inadequately insured. There are a variety of ways the U.S. can work to improve access to care for its citizens. One example is through single-payer universal health insurance. Currently, the U.S. is the only industrialized nation without universal health insurance. Despite spending vastly more on healthcare than any other country in the world, the U.S. performs poorly. In 2024, compared to 9 of the other wealthiest countries in the world, the U.S. ranked dead last. Two important potential benefits that may come from a universal healthcare system include: 1) All U.S. citizens who are sick or injured can get care, and everyone can access preventive care services to help stay healthy; 2) There are many potential economic savings for the country and individual Americans through a variety of mechanisms (e.g., pharmaceutical price negotiation, reduction of administrative fees, healthcare expenditure restructuring, etc.). There are many potential approaches the U.S. can pursue to increase access to care, but whichever course we choose, we must both ensure that people can get the care they need and do so in a cost-effective way.
- ADDRESS STAFFING SHORTAGES — The U.S. has suffered from significant shortages in physicians and nurses in recent years, which were exacerbated by mass exoduses following the COVID-19 pandemic. The U.S. will face a physician shortage of 86,000 by 2036 and full-time registered nurse shortage of 64,000 by 2032. Many hospitals and clinics across the country are unable to provide as much care as they could because of these shortages. If patients are forced to wait too long for care, then they may suffer complications unnecessarily.
- IMPROVE PUBLIC HEALTH INFRASTRUCTURE — Since the COVID-19 pandemic has faded into the back of people’s minds, public health infrastructure and support for public health have similarly faded. There has been deep polarization of proven public health interventions such as vaccination and important functions like health communications. This has combined with rampant misinformation and disinformation campaigns to erode public trust in public health. There has concurrently been a large exodus of public health professionals due to their poor treatment and feelings of burnout during the pandemic. If the U.S. does not revitalize its support for and confidence in public health, its health will suffer. Maintaining strong public health surveillance systems which drive public health interventions such as vaccination strategies, supply chain distributions, and health risk communications is a critical piece of this system.
- REDUCE HEALTH DISPARITIES — Health disparities refer to preventable differences in health outcomes, health status, disease burden, or access to healthcare between groups of people. In the U.S., this manifests in a variety of different ways including rural vs urban, by socioeconomic status, by sex and gender, and by race and ethnicity, to name a few. Health conditions, injuries, and illnesses can limit a person’s ability to pursue their goals, and this is occurring in preventable yet unequal proportions across the country both within and outside the U.S. healthcare system. If the American Dream is one in which any person regardless of background can pursue their goals, then we are betraying this dream by leaving health inequities unaddressed.
- ADDRESS UPSTREAM CAUSES OF POOR HEALTH — What will truly make the U.S. a country that focuses on promoting and maintaining health rather than reactively treating disease and illness after its occurred is to focus more upstream on the causes of disease. This is where public health and policy contribute by addressing factors such as social determinants of health. Social determinants of health include a wide variety of conditions that influence health such as the neighborhoods where people live, the education they attain, the environments where they work and play, economic stability, community context, and more. By promoting the conditions in which people can be healthy and thrive, we can better and more directly promote healthy conditions and behaviors. We must become a country focused on health care rather than sick care.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
The physician shortage in the U.S. looms large, especially in the context that much of the current physician workforce is aging and over 60 years-old. We need a systematic approach to increase the numbers of physicians in the country, including increasing the number of medical schools, increasing the number of medical student slots per medical school, and increasing the number of residency and fellowship trainings slots. A more upstream approach might involve a concerted outreach and mentorship effort to promote the occupation to high school and college students who might not have otherwise thought becoming a physician would be a possibility for them. Other systemic efforts might include restructuring the length of medical training or providing more flexibility for time off during residency and fellowship. Becoming a physician carries a serious responsibility in caring for someone’s health and life, and everyone wants to be seen by a physician they are confident in regarding their expertise, education, and training. There are also plenty of qualified candidates who are either dissuaded along their journey at some point or initially rejected due to medical school class size considerations who would make terrific physicians. We should identify and support those individuals.
How do you think we can address the issue of physician diversity?
I think it’s first important to clarify that there are a variety of different types of diversity: a person’s race/ethnicity, their sexual orientation and gender, their educational background, their socioeconomic status growing up, etc. Having a diverse physician workforce benefits patients as it allows for a range of different types of clinical experiences and perspectives. Ensuring that medical schools, residency programs, hospitals, and clinics see the value in maintaining a diverse student body and workforce when selecting their candidates is important. It’s also important for people from diverse backgrounds to want to become physicians, and that involves them being able to see themselves and people of their background represented as physicians both in medical settings and in the media. Developing and implementing outreach programs to promote and foster high school and college students from diverse backgrounds to become physicians would also help address this issue.
How do you think we can address the issue of physician burnout?
Physician burnout is a real problem for many doctors across many different specialties. Burnout is a feeling of depersonalization, emotional exhaustion, and lack of a sense of personal achievement caused by long-term stress. There are ways that physicians can reduce the effects of burnout at an individual level, but what is more interesting and important to me is what organizations and hospital systems can do to address physician burnout. These can include restructuring the organization to improve the workload, efficiency, and resources of the job. Some examples might include purchasing an electronic medical record system that is efficient and easy to work with, employing scribes to assist in note taking, and hiring support staff to manage administrative tasks. Some of the most common complaints physicians voice about working in today’s healthcare environment revolve around being taken away from direct patient care to instead slog through administrative burdens. I also think it is important to provide physicians with opportunities to voice their concerns and sources of burnout directly to hospital administration leadership. Those leaders must then take that feedback and ensure the organization can make changes to address those concerns and promote patients before paperwork.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I would be thrilled if people engaged with their local community on some project — whether it be hosting a neighborhood event, building a community garden, working on a park clean up, or whatever! Being around your community and working on a shared project allows people to interact with each other, share ideas with people they might not have otherwise talked to, and make something beneficial for everyone. I think we could use a great deal more shared understanding and positive teamwork in the country, and working together towards a common beneficial goal could go a long way to help that.
How can our readers further follow your work online?
They can find my academic profile at: https://bioethics.jhu.edu/people/profile/hunter-smith/
They can follow my writing and published work at: https://orcid.org/0000-0002-3591-588X
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Dr. Hunter Jackson Smith Of Johns Hopkins University Berman Institute of Bioethics On 5 Things We… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.