Telegram & Gazette
By Michael F. Collins, M.D. and John G. O’Brien
October 13, 2011
Almost 98 percent of the commonwealth’s residents have health insurance now, according to studies by the Massachusetts Division of Health Care Finance and Policy. That is the highest rate in the country.
As debate around health care reform continues across the commonwealth and the nation, one crucial but often neglected fact stands out: Greater emphasis on primary care can bring costs down while improving quality.
Numerous studies have shown this, particularly seminal works by the late Barbara Starfield of Johns Hopkins University. Having just marked National Primary Care Week in Massachusetts, it is an ideal time to start focusing on how we can better support caregivers at all levels to improve our health care system.
In 2006, Massachusetts undertook major reforms that greatly expanded access to care. Almost 98 percent of the commonwealth’s residents have health insurance now, according to studies by the Massachusetts Division of Health Care Finance and Policy. That is the highest rate in the country.
But expanding the number of insured patients also led to greater demand for primary care, which could not be met in all cases. This trend is now one of reform’s central dilemmas.
It is more difficult to control costs without greater access to primary care. Primary care providers encourage prevention and serve an important role in better coordinating care.
Unfortunately, the PCP shortage is likely to continue or even grow. The most recent Massachusetts Medical Society annual physician workforce study found a shortfall of family physicians and general internists across the state for the fifth year in a row. A 2008 survey conducted by our own Center for the Advancement of Primary Care (CAPC) estimated an immediate need for at least 75 additional primary care physicians across Central Massachusetts alone, and predicted that the shortage would double within five years because of physician retirements.
Some reasons for the primary care shortage are beyond local control. As long as physicians are paid more for procedures they perform rather than for problem-solving complex cases, such as patients with a dual diagnosis of diabetes and high blood pressure, students and residents will continue to be attracted to the procedural specialties rather than primary care.
As medical student debt rises, this problem will be exacerbated.
Solutions are available, however. Tuition forgiveness programs, for example, are one way of mitigating the disparity in pay. In another important step, UMass Medical School increased its class size and expanded its residency programs in primary care. We strongly support further vigorous recruitment strategies like these.
Right here in Central Massachusetts, our CAPC is also developing cutting-edge approaches to providing primary care within “medical homes,” where the paperwork is less, access is improved, the payment system favors keeping patients healthy, the quality of care is assured, and both the doctors and the patients are happier.
We also have exceptional resources on hand. The University of Massachusetts Medical School is consistently rated within the top ten nationally for primary care. UMass Memorial Health Care, meanwhile, has a well-developed network of more than 500 primary care physicians practicing and teaching our medical students across Central Massachusetts.
Also, our state’s PCPs are still devoted and inspired. Another CAPC survey found that most were motivated by their relationships with their patients and say that if they had to choose again, they would select the same profession.
National Primary Care Week thus reminds us of both the lost opportunity and the tremendous potential for improving our health care system. Massachusetts stands, uniquely, at the cutting edge of health reform and primary care innovation.
So, as we take time to publicly celebrate the daily achievements of our great state’s dedicated PCPs, let us go one step further and press for reforms that will allow them a greater role in improving our health care system. Massachusetts has scored an A+ on extending health insurance, and we have a head start on the next critical phase of health reform. We need to remind ourselves that primary care will be a pivotal ingredient.
Michael F. Collins, M.D., is chancellor of the University of Massachusetts Medical School and senior vice president for health sciences at the University of Massachusetts. John G. O’Brien is president and CEO of UMass Memorial Health Care Inc.