Despite a state mandate that all Massachusetts residents have health insurance, flagging interest in the field among new doctors, and a recent shortage, Jamaica Plain now has a relatively healthy stock of primary care physicians (PCPs).
At least three of JP’s four community health centers are accepting new patients, as is the Urban Medical Group at 545 Centre St. The field is showing signs of strain, though. Wait times for new patients at the medical establishments vary from a week or two to over a month. At the offices with the shortest wait times, thousands of dollars have been invested in recruiting doctors, often from out of state.
“Jamaica Plain health centers still do have capacity,” as do health centers in other parts of Boston, said Tom Kieffer, director of the Southern Jamaica Plain Health Center (SJPHC) at 640 Centre St. “In other parts of the state, its different.”
“In and around Greater Boston, there tend to be physicians there, but the wait times can be lengthy,” said Richard Gulla, spokesperson for the Massachusetts Medical Society (MMS).
MMS puts out an annual state Physicians Workforce Study. The 2008 study, released in October, identifies PCPs among 12 specialties in short supply in the state.
MMS President Bruce Auerbach said the problem is basically that it is a bum deal to be a PCP. “They are at the lower end of the reimbursement scale and then you have to overlay that on top of significant debt from medical school that young physicians have to pay back.”
Additionally, a significant portion of the services PCPs provide do not get reimbursed by insurance providers. That includes providing preventative care and health counseling, coordinating patients healthcare when they have to see multiple specialists, and filling out volumes of paper work
“There is a sense amongst PCPs that they are not as appreciated by the system as other specialists and sub-specialists,” Auerbach said.
The shortage, identified in the report as a crisis, is especially acute in Western Mass. and on Cape Cod, Gulla said.
But local health centers struggling to remain fully staffed have felt the pinch. “Generally in the past when we have been looking to hire, we would just call the residents training program at the Boston Medical Center,” said Sue Kaufmann, director Urban Medical.
When Urban Medical made that call last year after two PCPs retired, there were about five residents (doctors completing their training) planning to go into primary care—usually there are about 50, Kaufmann said. “For the first time we had to hire a recruiter.”
While Urban Medical accepts patients of all ages, the group’s focus is on geriatric medicine, and the model it follows includes things like house calls and caring for patients when they are admitted to hospitals, Kauffman said. “We are all about following patients for all of their medical encounters.”
The recruiters Urban Medical hired initially said, “What you are looking for does not exist,” she said.
And it took a while to find suitable candidates. The office stopped accepting new patients between February and October of last year when it hired three new doctors and two new nurse practitioners. Two community health centers, Brookside and SJPHC, have also closed their roles to patients at imes in recent years.
While its rolls have stayed open, Martha Eliot Health Center (MEHC) at 75 Bickford St., across from the Bromley-Heath Housing Development, hired the last doctor it was looking for last week. “For the first time in five years we are fully staffed,” said MEHC executive director Jim Cote.
“We actually had to invest in a physicians recruiting firm to help us,” he said.
The new hires at Urban Medical and Martha Eliot mean that there is currently a relatively short wait time at those facilities. New patients can get appointments within two weeks at Martha Eliot, Cote said. Kauffman told the Gazette that appoints there were available, “within a week,” as of the last week of January.
The waits are longer at JP’s other health centers. It now takes about six to seven weeks to see a doctor for the first time at the Dimock Community Health Center at 55 Dimock St, said Myechie Minter-Jordon, chief medical officer at Dimock.
SJPHC tries to hold waits down to four weeks by only signing new patients up on the first day of the month. It generally enrolls between 10 and 30 new patients every month, Kieffer said.
Both Dimock and SJPHC are fully staffed, their directors said.
Dimock’s wait time for new patients is above the state average of about a 30-day wait for new patients seeking to meet their doctor for the first time, but Minter-Jordon said she feels Dimock is still doing “fairly well.” All of the local health centers are associated with major medical institutions—Dimock with Beth Israel Deaconess Medical Center; MEHC with Children’s Hospital Boston; and SJPHC with Brigham and Women’s Hospital. JP’s other community health center, Brookside, is also affiliated with Brigham and Women’s. Representatives from Brookside did not return Gazette calls for this article.
Minter-Jordon said those associations are key for maintaining staff at the centers. In the case of Dimock, staff members at the clinic are able to pursue academic appointments and research projects at Beth Israel, a teaching hospital affiliated with Harvard, she said.
Community health centers also benefit from a program offered through the Massachusetts League of Community Health Centers that offers to help pay off doctors’ student loans in exchange for work at the centers.
While such programs are useful, Auerbach said, they are not long-term solutions. “Loan forgiveness is one avenue we need to pursue,” he said, but payment reform is much more important. “PCPs need to be compensated for the things that they do. Currently [insurance company] reimbursements pay per unit of service, not for things that PCPs do that don’t fit into that rubric.”
The issue, not surprisingly, has been exacerbated by the addition of over 400,000 Massachusetts residents to the insurance roles since the implementation of health care reform in the state. “The supply was already insufficient, and when the demand increased it accentuated the supply problem.
Cote told the Gazette one issue MEHC is confronting is the exact opposite of that. In the last week in January, state funding was cut for MEHC’s outreach coordinator, who for the last three years has signed more than 2,000 people up for healthcare.
The state cuts will reduce cut MEHC’s outreach staff from two to one, he said, so people will still be able to apply for insurance on-site, he said.
But, MEHC Operations Manager Tasha Weaver said, the outreach staffers had been heading out into the field to sign people up. “We had been working with small business owners and heading out to Bromley-Heath and Stop & Shop.”
It is unclear whether that work will continue, Weaver said.