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Doctors in Demand
June 17, 2011
Friday,
June 17, 2011
By
Steven Syre
Globe
Columnist
syre@globe.com
(c)
Globe Newspaper Company
Health
care reform has had an impact on many things in Massachusetts, including the
ongoing shortage of primary care doctors. Everyone agrees we need more of
them.
The
shortage isn’t new or unique to Massachusetts. But the reform that led more
people to become covered by health insurance also created greater demand for
the same primary care doctors we were short of in the first place. The latest
Massachusetts Medical Society survey found patients waiting as long as 48 days
for nonurgent appointments with primary care doctors.
The
next wave of reform advocated by Governor Deval Patrick — and in fact already
taking shape in the health care world — will only intensify the need for more
primary care doctors. They will become key gatekeepers in medical systems that
receive a flat fee to care for a patient rather than billing for individual
tests and services.
So
what are we doing about the shortage? People certainly talk [and write] about
it a lot and a few are actually dedicating resources to the problem.New England
Patriots owner Robert Kraft and his family recently gave $20 million to giant
Partners HealthCare to develop a national center dedicated to leading and
training community health doctors. Bank of America put $5 million
into a fund that helps repay education loans for physicians who go into primary
care.
But
some of the community health institutions that have actually groomed many of
the state’s family care doctors for decades are losing money — big money for
them — trying to maintain their residency programs.
In
the past, money for those programs was cobbled together from small, obscure
buckets of state funds — an essential service trust fund here, another that
supports medical residencies there. Now practically all those buckets are dry.
I
suppose that shouldn’t come as any surprise. State government is cutting its
financial support for all kinds of things in the fourth year of a rotten
economic cycle. But state government added to the need for more primary care
doctors when it legislated health care reform. It needs to recognize some
responsibility for the cost of training those physicians.
“We
have created a [health care] system that is going to work better in the long
run, but you have to look at all the pieces of it,’’ says Frances Anthes,
president of Family Health Center of Worcester. “We have to be producing the
primary care workforce to do this job well.’’
Bob
Ingala, the chief executive of the Greater Lawrence Family Health Center,
points out that a small handful of institutions such as his have been doing
that for years.
“It
astounds me the state has not had the vision to say we have to go back and look
at access to primary care,’’ says Ingala. “We’re the solution, we’re not the
problem.’’
Community
health centers specialize in family medicine and make a point of training
residents in that practice. Family medicine accounts for just 3 percent of
first-year medical residencies in Massachusetts — a problem in itself — but a
majority of those doctors are trained in community health centers.
Two
dozen are working at the Lawrence center at the moment. Another dozen are
practicing at the Worcester center. Those two institutions have trained about
250 doctors over the years. Most of them stayed in family medicine after
completing residence programs and a majority remained in Massachusetts.
A
doctor in a residency program works hard but still costs money. This is one
important reason why health care is more expensive in Boston, where big
teaching hospitals dominate. Community health centers spend more than $200,000
to fund one family practice resident for a year.
The
residency programs in Lawrence and Worcester are each losing $1 million or more
a year now. That’s not a huge amount of money in the big picture, but it’s
serious financial trouble for any community health center. It’s certainly not
sustainable.
“We
expect to continue to have a deficit but we’re not sure what we can do about
it,’’ says Ingala.
The
shortage of primary care doctors didn’t happen overnight and no single solution
will take care of it.
But
community health centers have a long track record producing the kind of
physicians we need now. Someone should be able to find a way to pay for that.