Member of the Month: Lane Aiena, MD
Rural physician leader experiencing PPE shortage is hopeful for the future
By Kate Alfano
Lane Aiena, MD, is a family physician with Huntsville Family Medicine in Huntsville, Texas, 70 miles north of Houston. There are six providers in the practice, which serves a large rural population. He serves on the Huntsville Memorial Hospital Medical Executive Committee and is vice chair of the Patient Procedures Committee. He completed his residency at Conroe Medical Education Foundation where he was chief resident, and was awarded a medical degree by Texas Tech University Health Sciences Center School of Medicine where he was class president.
He is chair of the TAFP Leadership Development Committee, a graduate of the TAFP Family Medicine Leadership Experience and was the 2019 awardee of the TAFP Political Action Committee annual award. Aiena is active in volunteering and advocacy, having instituted the Clinical Institute Withdrawal Assessment of Alcohol Protocol, sponsored a Hard Hats for Little Heads event, volunteered with a shelter and clean-up following Hurricane Harvey, and much more.
What are the biggest challenges you’re facing during the COVID-19 pandemic?
Much like everywhere else, supplies are our biggest issue. Huntsville is a small community, so we are last on most lists to get supplies. The problem is we’re only a 70-mile straight shot from Houston, one of the hardest hit areas in Texas, so we could really use PPE. As of right now our clinic has a handful of surgical masks left and a handful of gowns; no N95s whatsoever. The hospital isn't fairing much better as they’re reusing what limited supplies they have. Luckily, when all of this broke I ordered a P100 painter's mask, so one other nurse and I have become the only "COVID testers" in our clinic to limit supply usage.
A close second on issues are the test kits. We were initially given five swabs that were supposed to last two weeks. You want to talk about rationing? We have no idea what the real number of COVID is. We finally switched lab companies as the one we had been using has been a total flop for supplies. We got Abbott test kits that could be performed on site, but no sooner that we got them we were told they were upgraded and no longer CLIA waived and were instructed to send them back. It has been beyond frustrating for us and our patients.
From a monetary standpoint, we’re doing okay so far. We started telemedicine around March 16, which has helped immensely. Also around that time all staff started taking two half days off, cutting our pay expenses by about 20%. While it all seems obvious now, the initial emergency meetings to come up with this got tense to say the least. Change is never easy; sudden, drastic change is far harder.
We have put in place multiple safety precautions for staff and patient safety. All visits are screened on the phone for COVID risk factors. If positive, we either do telemedicine, I personally room them from their car, or I see them in their car (has happened about three times). Patients wait in their cars and have their temperatures screened at the door. With the transition to telemedicine, the burden on the waiting room was already down, and the rest of the new strategies have taken it to zero. We do not have walk-ins at this time; all appointments must be screened and scheduled. Any staff member with risk factors (age, pregnancy, comorbidities) has been cross-trained on other tasks and is not rooming patients at this time.
Who or what inspired you to pursue family medicine originally?
I always saw myself as a "family medicine doc" when I was growing up wanting to be a doctor, but what really solidified it for me were my attendings and mentors at Texas Tech University Health Science Center School of Medicine Amarillo in the Family Medicine department, especially Jerry Kirkland, MD, and Rodney Young, MD. Dr. Kirkland was my mentor at the time and Dr. Young was the head of the department while I was there. Honestly I'm not sure they even know how big of an influence they were. All of the doctors in that department were always so happy, so incredibly good at their jobs, and their patients absolutely loved them. That strong relationship they had with their patients had obvious positive influences on outcomes given the trust they shared. Those were the doctors that I wanted to model my future career after.
Who or what keeps you going on the hard days?
I'm very blessed to have a wonderful, incredible, supportive wife. These have been some of the hardest days of all of our lives. No matter what mood I am in when I come home, she is always there to listen to me talk about my day, talk to me about the tough ones, and support me in the tough decisions. I absolutely could not do this without her. A close second are my children. Anyone who has kids can tell you nothing melts away a bad day like a "daddy!" exclamation when you walk in the door.
Is there anything else you’d like to share?
While these times are difficult, I am filled with hope and admiration watching my colleagues respond to this. Medicine has pulled together and done an incredible job leading in this pandemic. Despite a paucity of supplies and no real pandemic experience, the people of medicine jumped immediately into action to help our patients and keep our communities safe. Even though we're building this ship as we sail in it, it's a ship I'm proud to sail in.
My hope for the future is that family medicine comes out of this stronger than ever. TAFP has been incredible in its guidance during all of this. They are looking at ways to strengthen our field with smarter pay models given the flaws our current system has shown during this pandemic and have gone to extraordinary lengths to try and get us PPE (including driving to Mexico, driving back and personally passing out the PPE they found).
Also, I have been reminded of a physician's role as a community leader. Our patients look to us for answers in times like these and it is our responsibility to guide them with good information to keep them safe. Times are tough, but I am hopeful that we as family physicians will come out of this stronger leaders, better doctors and even better prepared for anything the future can throw at us.
TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at firstname.lastname@example.org or by phone at (512) 329-8666. View past Members of the Month here.