“Private physicians are on the front lines and are our partners in protecting public health.”
came to DSHS from Seton Healthcare Family, where he served as chief medi- cal officer. He spoke to Texas Medicine about his assessment of DSHS so far, how medicine can help the agency serve the state in its public health mission, and the challenges involved in anticipating and battling Zika virus.
Texas Medicine: What have you learned about DSHS during your initial months as commissioner, and what characterizes your vision for the department?
Dr. Hellerstedt: I learned just how really big and complex it is, and all the various programs that we have. The [health and human services] sys- tem is in a state of transition, so DSHS a few years from now will look very different than it looks today. We have everything from illness surveillance and response to, currently, the state psychiatric hospital system. The psy- chiatric hospital system will transfer to HHSC [the Texas Health and Hu- man Services Commission] in 2017, so that’s a big part of the agency. And that will, I think, prepare us to really concentrate on public health issues, i.e., detection and response to public health threats around the state.
Texas Medicine: What are the charac- teristics of an ideal working relation- ship between medicine and the state to improve public health, and what is TMA’s role in that relationship?
Dr. Hellerstedt: TMA’s role in that relationship, as it represents so many of the Texas physicians, is enormous. One of the models I want to carry for- ward is to be the convener of various stakeholders around public health issues. DSHS can’t have such vast re- sources that it does everything all by itself. What we need is the coopera- tion of other stakeholders in the com- munity. And of course, [speaking] as a physician myself, the cooperation and the knowledge and enthusiasm of the medical community for public health
58 TEXAS MEDICINE May 2016
issues is very, very important, and very much kind of a reflex way for me to think about it. Private physicians are on the front
lines and are our partners in protect- ing public health. We’re vitally depen- dent on them for disease recognition and reporting and to help us deliver messages directly to patients. We rec- ognize that and want to build on it.
Texas Medicine:What’s your assess- ment of DSHS’ resources as they cur- rently stand, particularly with regard to physician and other clinical sup- port? Have you been able to determine whether the department has the medi- cal expertise on staff that it needs to fulfill its mission?
Dr. Hellerstedt: We do have a re- markable number of clinicians avail- able. I know there’s been some con- cern expressed by TMA and other stakeholders that there are fewer people in clinical areas in the agency than there have been in the past. We don’t really necessarily classify all of our positions that way, so we don’t re- ally have an objective way to go out and quantify that. Obviously, some positions are
nurse positions, [and] some positions are physician positions. But as far as other parts of the agency, an assistant commissioner or someone like that, those aren’t necessarily posted as phy- sician positions. I would absolutely say again that as a physician, my incli- nation really is to have as many people as possible with a clinical background on my team. I certainly know throughout all of
the work I’ve done in the public sector or in an administrative role — both at HHSC when I was the Texas Medic- aid medical director and even as the chief medical officer for a large not- for-profit health care system — the decisionmaking at a policy level, when you’re dealing with health care issues, is absolutely best informed when you have clinicians that are going to be part of that team, part of that decision-
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