Internist and pediatrician Tyler Winkelman, M.D., M.S. completed the Clinical Scholars program in 2017. During his residency at the University of Minnesota, Winkelman cared for uninsured and Medicaid-covered patients in a federally-qualified health center located near a jail; many of his patients had recently been released or were on probation. Seeing some patients obtain insurance coverage, receive mental health and substance use treatment, and get back on their feet sparked his interest in studying the impact of public policies like the Affordable Care Act’s (ACA’s) Medicaid expansion on a broader scale.
Many people find the work I do unpleasant,” says Winkelman. “But there’s a real need for it. I’m interested in finding out if there’s a connection between having or not having medical insurance and ending up in the system.”
I’m interested in finding out if there’s a connection between having or not having medical insurance and ending up in the system.”
In looking for the best way to advance as both a clinician and a health services researcher, he found the Clinical Scholars Program. “I needed a concrete set of skills so I wouldn’t be limited to contributing to the work of others or relying on others to do the analysis. I wanted to learn to design and oversee a project start to finish.” Winkelman was impressed by the quality of Michigan’s program and the caliber of its scholars. “By far, Michigan offered the best learning environment for me,” he says. “There was no comparison.”
Reflecting on his experiences as a Clinical Scholar, Winkelman returns again and again to the importance of collaboration. “I’ve collaborated with faculty members, clinical scholars in my class and alumni of the program on a number of topics, not all related to my studies of the justice system. It’s an amazing network of people all anxious to work together.”
Winkelman has now returned to Minnesota, serving as an internist, pediatrician, and health services researcher at Hennepin County Medical Center – the nation’s only county-owned medical center. The center serves a large percentage of low income/high need patients, many of whom transition in and out of the county jail. Winkelman divides his time between seeing patients in the clinic and continuing his research. “The Clinical Scholars Program made finding the right position so much easier,” he says. “It was obvious to my future employer that I bring skills and experience that will benefit both their organization and their patients. It’s a great opportunity for me to continue to pursue the questions I want to answer.
THEORY IN PRACTICE
Health Insurance and the Justice System
As lead author of a study published in the Journal of General Internal Medicine, Winkelman has already demonstrated his ability to move the science forward. He and his colleagues compared national data on adults who were either arrested, given probation or paroled between 2008 and 2014 with data on adults with no justice system involvement during the same period.
The study confirmed that both private insurance exchanges and the ACA’s Medicaid expansion significantly reduced the number of uninsured within the justice system, although this group is still more likely to be uninsured than their cohorts in the general population. Surprisingly, the data also indicated that among those in the justice system with insurance, those with Medicaid were more likely to receive treatment for drug use or depression than those with private policies. “Studies like this are going to become even more important in the days ahead,” he says. “As we transition beyond the ACA, we need to continue to shed light on the problems and evaluate possible solutions.