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Doctors in Demand

June 17, 2011

Friday, June 17, 2011

By Steven Syre
Globe Columnist
(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. 

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