With a deep sense of gratitude for her years of dedicated service to the Multiple Sclerosis community, the MS Alliance of Virginia presents this candid and informative farewell interview with Dr. Jill Cramer. As she embarks on a new chapter, Dr. Cramer graciously shares the personal reasons behind her transition, offers crucial guidance for her patients navigating this change, and reflects on her impactful journey. We extend our sincerest thanks to Dr. Cramer for her unwavering commitment and wish her the very best in all her future endeavors.
MS ALLIANCE: What factors led to your decision to transition from your neurology practice at this time?
DR. CRAMER: (1) God is calling me in a different direction, and (2) my family needs me in new ways that I cannot fulfill while working the extensive hours that I have had to work to run the business in addition to practicing medicine. Ultimately, running the medical office business is the part that is impossible to do any more, but practicing and the business go together, so when the business closes, I cannot stay.
MS ALLIANCE: We understand that your patients care deeply about your well-being. Is there anything you would like to share with them regarding your decision?
DR. CRAMER: Thank you for asking. No, I am not sick, and the cancer remains in remission.
MS ALLIANCE: Could you share more about your future academic pursuits?
DR. CRAMER: Separate from the business decision, I got into law school. I planned to go to law school and run the practice until recent developments made it impossible to continue my business. The decision to go to law school was actually made after I had to decide to close the business.
MS ALLIANCE: Will you continue to see patients at any other locations or institutions following your departure from this practice?
DR. CRAMER: I will have limited hours at Wytheville. I’ve been working there part-time for a year and enjoy going down there where I do not run the business and also see patients. The administrators who run the practice are lovely people who are patient oriented, and I appreciate working with them in that philosophy.
MS ALLIANCE: What is the process for patients to obtain their medical records after your departure?
DR. CRAMER: Request medical records by phone or fax request. We will fax records for free to physician’s offices. We will provide a copy of your records on CD for $6.50 if you pick it up or for $11.50 if you need it mailed to you. Our website will be updated after we close on May 31 in case you forget the details and need to reach us in the future.
MS ALLIANCE: What is the procedure for patients to obtain necessary prescription refills during and after this transition?
DR. CRAMER: After May 31, I am not able to refill any medications. Before May 31, please contact the office through phone call or portal message. We will send in as many refills as legally allowed for the medications that we prescribe. We are hearing that some pharmacies will not fill more than a 3 month supply of amphetamines (Adderall, Ritalin, and similar medications), but other controlled medicine we can refill for 6 months and non-controlled medicines we can refill for 12 months.
MS ALLIANCE: How will ongoing infusion treatments be managed for current patients?
DR. CRAMER: We will refer infusion patients to local infusion facilities. Carilion will not honor my prescriptions after May 31 unless you are already a Wytheville patient (that is a separate practice with separate rules). We are generally sending patients to the free standing infusion facility that their insurance prefers. Please check with your insurance and let us know where they will cover your infusions. We will write prescriptions for at least six months so you can get your infusions. You will work with Renee in my office to transfer the infusions.
MS ALLIANCE: What will happen with scheduled appointments after your departure date? Should patients expect them to be cancelled?
DR. CRAMER: The office closes after May 31. Appointments scheduled in the Salem or Christiansburg offices after May 31 will be cancelled. None of these answers apply to Wytheville, which is a completely separate practice.
MS ALLIANCE: Are you making specific referrals to other MS specialists or neurologists for your patients’ continued care?
DR. CRAMER: I am still working hard to bring in MS specialty care to the Salem office. I don’t know if we will be able to set this up, so I am not able to give details at this time. Anyone with MS will be notified if this arrangement happens. Otherwise, I am sending patients to the physicians on the MSAV MS Specialist List. Most of my MS patients need another MS experienced physician to manage their complex care. The closest specialist physicians who do this work are at University of Virginia.
MS ALLIANCE: Do I need to see a MS Specialist or can my primary care doctor or general neurologist handle my care? What guidance can you offer patients regarding the level of specialized neurological care they may require moving forward?
DR. CRAMER: Generally, a person who is prescribed disease modifying therapies needs an MS specialist. If you do not have disease modifying therapies, do not take amphetamines, and only have medicines for MS symptoms, some primary care will be comfortable refilling medications until hopefully the Roanoke area can recruit another MS specialist. It is up to the specific general neurologist whether they are familiar enough with your case and your specific treatments whether they can continue your care without an MS specialist.
As I noted previously, I am working with some MS specialists and a company to bring in physicians and an MS trained NP to take over MS care at the Roanoke Area MS Center facility at 431 Apperson Dr in Salem. The agreements have not been confirmed, so I have no further details at this time. Patients with MS will be notified if we are able to set up MS specialist care in that office.
MS ALLIANCE: What will be the role of other members of your team, such as Elena, the Physician Assistant, after your departure? Will they continue to see patients at this location?
DR. CRAMER: The entire office is closing May 31. This includes Elena, who will not be seeing patients in the Roanoke-Christiansburg area after May 31.
MS ALLIANCE: What is the anticipated future of the MS Center and the MS Alliance following your transition? Will there be any changes in their operation or services?
DR. CRAMER: The Roanoke Area MS Center building was purchased for the benefit of the MS Alliance. The building is still available for MS Alliance activities. What changes will occur depend partly on whether we are successful to bring in MS treating providers to use part of the building. The MS Alliance can discuss the changes they may make. Regardless of whether we are able to bring in MS treating providers for MS care, the building will be more available for MS Alliance activities, parties, meetings, sessions, etc. after August 1.
MS ALLIANCE: Reflecting on your time here, what are some of the key principles or approaches to patient care that you hope will be carried forward by your colleagues?
DR. CRAMER: An individualized approach in which the patient’s opinions and experiences are respected is very important. MSAV has built an incredible community of knowledgeable and involved individuals with MS. The original goal of the MS Center was to bring patient-centered care to the Roanoke area, and I would want anyone who comes to the area to provide the medical portion of that mission to continue that patient-centered philosophy. I also would want MS care to be delivered by MS-familiar neurologists, which is why I am generally referring MS patients to the MS specialized neurologists that MSAV has listed.
MS ALLIANCE: As you embark on your legal career, do you envision any potential intersections or ways your legal work might connect with the healthcare or disability advocacy fields in the future?
DR. CRAMER: I don’t know what God is setting up for me. I would love to advocate for patients injured by bad health insurance company decisions because I see the ways insurance companies act contrary to patients’ best interests all day long. I don’t even know that holding health insurance companies accountable is even a job. We will see where the training and future leads.
MS ALLIANCE: Based on your experience, what are some of the biggest challenges you see for individuals living with MS in our region, and what kind of support or changes do you feel are most needed?
DR. CRAMER: The absolute biggest challenge in my opinion and experience is the lack of resources. Not only do we not have a lot of MS-familiar neurologists, but the employers, systems, education programs … none are well equipped or educated to work with individuals who have MS. A hospital system that truly advocates for the MS community would be a huge benefit to patients with MS. I would like to see a strong treatment team come to the area.
MS ALLIANCE: What are some of the most significant advancements you’ve witnessed in MS treatment during your practice, and what are you hopeful for in the future of MS care?
DR. CRAMER: When I started clinical practice in 2002, we had five MS medications. The average life span of a person with MS was shortened by about 15 years. We now have over two dozen disease modifying therapies that are slowing disease and improving life expectancy for people living with MS. Community engagement, education, and understanding – while still needs work – has improved tremendously. I have been honored to be part of the incredible changes in MS care over the past 25 years and appreciate so much your taking this amazing journey with me.
MS ALLIANCE: Is there anything else you would like to say to your patients and the wider MS community who have supported you during your time here?
DR. CRAMER: I have appreciated so much the support and partnership that MSAV and patients living with MS have given to me in the almost 20 years we have been together. You are an amazing group, with incredible grit. I am so inspired by each and every one of you and your accomplishments, challenges, and attitudes. Thank you. Thank you a thousand times over. I will miss each and every one of you.