From the Editor

OVER THE PAST SEVERAL YEARS, the American healthcare system has faced many changes and challenges that have impacted healthcare delivery, healthcare policy, and medical regulation. The COVID-19 public health emergency prompted changes in telehealth policy and healthcare delivery. There has been a significant rise in the for-profit corporate delivery of healthcare with medical regulatory implications. State medical boards are facing an increasing complexity of provider physical, mental health, and substance abuse concerns.This issue of JMR looks at how medical regulation and healthcare policy leaders analyze, reflect, and provide guidance on these increasing challenges.In the Commentary “Dual-Loyalty: The Wicked Problem of Corporatization of Health Professions,” (page 6) Zubin Austin and Aly Háji discuss the challenge for healthcare regulators on the impact of for-profit corporations delivering a greater portion of healthcare services. Many of the leaders in corporate healthcare structures are also licensed professionals who do not provide direct personal care to patients but establish corporate policies and practices. They have “dual loyalties” providing for the best interest of patients and corporate responsibility to maximize shareholder profit. With the rise of corporate driven healthcare comes the concern for patient safeguards and autonomy of professional judgement of employed professionals.Medical regulators face increasing concern for evaluating and managing health provider physical health, mental health, cognitive problems, and substance abuse. Physician Health Programs (PHPs) have evolved across the US to address and manage these concerns. In the article “Trends in Case Complexity and Implications for Physician Health Programs: An Analysis of Referrals to the Colorado Physician Health Program,” (page 14) Lori Crane and co-authors examine trends and challenges in the complexity of cases presenting to the Colorado Physicians Health Program. PHPs will need to prepare for an increase in complexity of cases, higher levels of monitoring, and increasing skill in addressing these health issues.The COVID-19 public health emergency demonstrated an increased need for healthcare services and resulted in emergency healthcare policies with expanded access to telehealth. In the original research article “Telehealth Policy Determinants during the COVID-19 Public Health Emergency,” (page 27) Antonios Koumpias and Mouhamadou Ndiaye conducted a retrospective, longitudinal analysis of state telehealth policy changes between January 2020 and December 2022. Their study demonstrated the adoption and maintenance of telehealth policy changes which were influenced by pre-existing healthcare supply policies, participation in Medicaid expansion under the Affordable Care Act, public health challenges affecting the elderly, and the state governor's political orientation. Socioeconomic conditions had a lesser impact on their research.Over the past several years, there has been a rise in ketamine clinics offering off-label treatment and expansion in ketamine compounded products. Many of these clinics are unregulated and this raises patient safety concerns. In the article “Ketamine and its Regulatory Implications: A Review,” (page 41) Amin Soin and co-authors provide an in-depth review of ketamine and its potential side-effects and regulatory concerns. The article helps provide insight for medical regulators and state medical boards to ensure patient safety and high-quality patient care.