Grand Junction family physician sees the big picture in health reform

Michael Pramenko, MD, is a family physician and executive director for Primary Care Partners in Grand Junction, Colo., where he cares for patients of all ages. He is a prolific writer and regularly contributes to Grand Junction newspapers on topics related to health reform. Dr. Pramenko served as President of the Colorado Medical Society in 2011 and continues to be active in organized medicine at the local and state level. He and his wife, Karen, have three children.

1. Who inspired you to pursue medicine?

My mother helped inspire my initial interest in medicine. As a nurse, both in hospital settings and within Jefferson County Schools, she worked tirelessly to help her patients and students. Her inspirational efforts led to one of the first school-based underserved clinics in Jefferson County. In addition, during my undergraduate years at the University of Colorado, a course taught by Professor Prescott regarding the biology of the cancer cell further increased my interest in medicine. In particular, the course taught me how cancers could be prevented with improved public health measures. Professor Prescott noted the human behaviors and commercial products that cause so much morbidity and mortality amongst the population. Finally, my late father taught me the critical lesson of how one person can help facilitate change in society. We must be engaged to improve the lives of our children and grandchildren.

2. You often write about and speak of commercial determinants of health. What do you wish patients and physicians knew about CDoH?

The commercial determinants of health are, as defined in Lancet, “strategies and approaches used by the private sector to promote products and choices that are detrimental to health.” Patients, physicians and society do not fully appreciate the huge force of commercial determinants of health and the constant messaging that takes place with respect to products that harm our health. The commercial determinants of health need to be considered in the same light as the social determinants of health. In fact, some companies specifically target at-risk populations with their product advertisements thereby creating even larger discrepancies in health equity.

3. What would your ideal heath care system look like?

My ideal health care system would shift its focus from sick care to health care. As such, it would spend more resources on preventing disease than on treating disease. There are good reasons why life expectancy in Costa Rica is greater than the United States: social determinants of health factors, public health investments and commercial determinants of health. A public-private health care system that rewards healthy behavior to help prevent disease would translate to much greater value in health care. Simply compare the per capita cost of health care in the United States to other developed countries while looking at health outcomes and it is obvious that we have much work to do to create higher value for each health care dollar. The question remains, are we placing as much energy into public health and population health management as the commercial markets put into selling unhealthy products? The chronic disease trends of substance abuse, obesity and heart disease suggest that we are not meeting that challenge. A sustainable health care system will out-compete the commercial determinants of health. It will “market” healthy behavior. It will prioritize health care over sick care.

4. Why is CMS membership important to you?

CMS membership is critical for Colorado’s physicians. Physicians must have a strong, steady voice at the state capitol. While many physicians are also represented by specialty society organizations, the Colorado Medical Society is able to speak as one voice for Colorado’s physicians in manner and strength that separate specialty societies cannot. Our CMS is an essential tool to maintain physician autonomy, viability and wellbeing at a time when significant threats to our profession continue to occur.

5. What advice do you have for physicians-in-training?

My advice to physicians in training: Keep going. Caring for patients and practicing modern medicine is a wonderful job. However, ongoing work must continue to preserve our profession and our established relationship with our patients. As such, organized medicine is an important component of your professional life. Support your profession with membership dues and/or time devoted to the cause. Your efforts are a great way to maintain a sense of well-being during stressful times.

6. What do you enjoy doing outside of medicine?

Outside of medicine, I enjoy time with my family. Running, mountain biking, skiing are part or my recipe for wellbeing. My three children are growing up fast, and watching them play sports and dance continue to be great experiences.

The Colorado Medical Society's monthly member spotlight series offers CMS members the opportunity to share their passions and wisdom from medicine and life in general, and allows the medical society to highlight members from around the state. All CMS members are eligible to be featured; contact to self-nominate or to nominate one of your colleagues. It takes as little as 20 minutes of your time!

Categories: Communications, ASAP