Massachusetts Faces Shortage in Primary Care

The reports of a shortage are no surprise to Dr. Dennis Dimitri, vice chair of the department of family medicine and community health at the University of Massachusetts in Worcester. Some family physicians on the university's medical staff have closed their practices to new patients, he said. And recruiting new physicians has been difficult.

He has even heard of instances in which local community health centers, the traditional safety net providers, have had to temporarily close their practices to new patients because of understaffing, Dr. Dimitri said.

Much of the problem comes down to how payments are aligned on a national level. The health care system disproportionately rewards procedural medicine instead of preventive services, said Dr. Dimitri, who is also president-elect of the Massachusetts Academy of Family Physicians.

“That plays a huge role in medical student choices,” he said.

When medical students are facing six-figure educational debt they are less likely to choose a lower earning primary care practice, Dr. Dimitri said.

States such as Massachusetts have been trying to deal with the problem locally, but a national approach will likely be necessary with the federal government taking a hard look at how it reimburses for physician services. “This crisis is going to be upon us in the next 5 years in a way that no one has previously anticipated,” Dr. Dimitri said.

Payment is the bottom line, agreed Dr. Barry Izenstein, governor of the Massachusetts chapter of the American College of Physicians and an endocrinologist in Springfield.

Medical students will continue to be attracted to procedural specialties as long as the payers continue to pay for volume of services and procedures, he said. While medical student debt reform is an important short-term solution, it will only provide a patch for the system. In the long term, the entire payment system needs to be reformed. Policy makers will need to consider new approaches, such as the patient-centered medical home, which has been endorsed by a number of primary care societies, he said.

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