Is there a doctor in the house?
A recent Massachusetts Medical Society study that showed a serious shortage of doctors in the state came as no surprise to Dr. William Corbett, who, as vice president of community practices for UMass Memorial Medical Group, oversees 40 medical offices affiliated with the system in Central Massachusetts.
"In those sites, I presently have 10 physician openings, which is the most I've ever had," Corbett said.
Other hospital leaders in Central Massachusetts say they are seeing the same problem. And they are trying a number of new methods to deal with the shortage.
Triple whammy
According to the MMS study, community hospitals are particularly hard-hit by the lack of doctors, with 83 percent reporting trouble filling vacancies. That jibes with the experience of Daniel Moen, the president of Heywood Hospital in Gardner. He said Heywood has a hard time finding primary care physicians.
"I think we're going to have to do something in the long run that makes primary care more attractive to medical students," he said.
Echoing the study's findings, Moen said the combination of increasing malpractice suits, high cost of living and low reimbursement rates make it expensive for doctors to practice in Massachusetts.
"It's sort of a triple whammy," he said.
Corbett said the traditional way that insurers pay doctors is based on the number and type of procedures they do, not the time they spend with patients in office visits. That puts primary care physicians at a severe disadvantage, he said.
At UMass Memorial Medical Center, Julia Andrieni, vice chair of medicine for clinical services, is part of an effort to draw more emerging medical students into primary care. Already, she said, HMOs are beginning to address the issue of low reimbursement rates for general practitioners.
"I think that managed care is trying to address some of those challenges with certain kinds of incentives," she said. "It's certainly a big support to primary care that they are giving them incentives for their work and what they're doing."
But, she said, much more needs to be done.
Andrieni said one initiative the UMass system is looking at is expanding the training that medical students receive in outpatient care. She said the emphasis most medical schools place on hospital medicine makes it easy for students to go into that field, which, perhaps not incidentally, is the fastest growing category within internal medicine.
Primary training
Offering more training in an office setting could encourage more new doctors to enter primary care, she said, and the University of Massachusetts Medical School is particularly well suited to lead the way in that direction since it was founded to help produce primary-care doctors.
Yet at the same time, Corbett said, employing hospitalists (a doctor that works specifically in hospitals) can actually help medical centers attract primary care doctors. He said physicians who specifically want to spend time with patients in an office setting may choose hospitals where there are specialists in inpatient care, so they will not be pulled in both directions at once. In fact, Moen said, Heywood recently began hiring hospitalists.
Most doctors who work at Heywood are part of small group practices, but Moen said the hospital is happy to work with doctors in whatever way they want, including hiring them outright, or helping them start a new solo practice.
"We're very pragmatic," he said. "Whatever works for the physician works for us."
Just down the road, Athol Memorial Medical Center also does whatever it takes to bring new doctors to the area. Spokeswoman Marcia Malione Flynn said the hospital works closely with local group practices to recruit new physicians. Although the hospital actually hires few physicians, she said, in one case it put a doctor on staff for two years to give her time to start up a new practice in the area.
"I think hospitals, especially hospitals in rural areas, are looking for all kinds of creative ways to recruit," she said.
The results of those efforts have serious implications. Moen said most of the doctors associated with Heywood are currently too busy to take new patients. And the people who are not being served may not have better luck anywhere else in the area, he said.
"In some cases, I think patients end up forgoing some of the services they need, especially preventative care," he said.
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