Transcript for the Piece Audio version of A Crisis in Primary Care -- the Massachusetts Health Care Experiment

Suggested Intro: HEALTH REFORM IN MASSACHUSETTS HAS LED TO A DRAMATIC INCREASE IN THE NUMBER OF PEOPLE WITH HEALTH INSURANCE. BUT THERE'S AN UNINTENDED CONSEQUENCE. A SUDDEN DEMAND FOR PRIMARY CARE DOCTORS HAS OUTPACED THE SUPPLY. KAREN BROWN HAS THIS REPORT.

AMB: sounds of Emergency Room under this section

KAMELA CHRISTARA APPEARS AT THE TRIAGE WINDOW IN THE EMERGENCY ROOM AT COOLEY DICKINSON HOSPITAL IN NORTHAMPTON.
(fade up) KC: "I passed out last week."  Nurse: "could you fill one of these out." (fade under)

THE 47-YEAR-OLD SINGLE MOTHER HAS ADVANCED LYME DISEASE, AND SHE CAN'T FIND A PRIMARY CARE DOCTOR TO OVERSEE HER CARE. SHE'S CALLED HALF A DOZEN PRACTICES IN THREE TOWNS, AND NONE ARE ACCEPTING NEW PATIENTS.  SO WHEN PROBLEMS COME UP, EVEN ROUTINE ONES, SHE COMES TO THE EMERGENCY ROOM. EACH TIME, SHE GOES THROUGH HER MEDICAL HISTORY WITH THE INTAKE NURSE.

(fade up) KC: i have a lot of  neurological problems.  nurse: have you ever had a stroke or anything? KC: if you see on the records where i've been here, ... I was taking the wrong combination of medications that created two seizures...(fade down)

CHRISTARA IS WORRIED SHE'LL KEEP GETTING SICKER IF NO ONE DOCTOR  IS TRACKING HER HEALTH.  EVEN HER REGULAR PRESCRIPTIONS COME FROM THE EMERGENCY DEPARTMENT.

(fade up) i should be on thyroid medication but b/c i haven't been able to get blood work, b/c i don't have a primary care physician.  i would like to request that i get my free t3 & 4 checked today.  (fade under and out)

AT LEAST CHRISTARA DOESN'T HAVE TO PAY OUT OF POCKET FOR THIS E.R. VISIT. SHE HAS THE STATE'S MEDICAID INSURANCE, WHICH WAS EXPANDED UNDER THE LANDMARK HEALTH REFORM LAW PASSED IN 2006. IT REQUIRES ALL RESIDENTS TO HAVE HEALTH INSURANCE – EITHER THROUGH A STATE-SUBSIDIZED PLAN, AN EMPLOYER, OR PRIVATELY-BOUGHT INSURANCE. AS A RESULT, AN ESTIMATED 440,000 MORE PEOPLE HAVE HEALTH COVERAGE. AND THEY ALL NEED A PRIMARY CARE DOCTOR TO GET INTO THE SYSTEM.
JS:  i think it's great that people have insurance.  I'm wondering where they're getting their care.

DOCTOR JACQUELINE SPAIN IS MEDICAL DIRECTOR OF THE HOLYOKE HEALTH CENTER, A BUSY CLINIC THAT SERVES A MOSTLY LOW-INCOME COMMUNITY.
AMB: fade up under previous track...."good morning, internal medicine, may I help you? Can I have your date of birth?" (FADE DOWN)

SINCE THE REFORM LAW PASSED, THE HOLYOKE HEALTH CENTER HAS BEEN INUNDATED WITH CALLS FROM NEWLY-INSURED PEOPLE SEEKING A DOCTOR. MORE THAN 1600 PEOPLE ARE ON ITS WAITING LIST; DOCTOR SPAIN SAYS IT TAKES ABOUT FOUR MONTHS TO GET A FIRST APPOINTMENT.
SPAIN: it's entirely reasonable for somebody whose now got insurance & maybe has a whole list of things that's worried them & troubled them, ....maybe they know that they have diabetes & they haven't been getting the kind of wraparound services they need for that & now they have insurance. & of course they expect that they should be able to go out in the market & get all of that care.  there just aren't enough of us to give it to them. 

[abut/ATKINSON]  we get 5 or 10 calls a week, sometimes a day from patients who need a new doctor.  & literally people crying & begging to come into the practice. It's very stressful to keep saying no to people.

KATE ATKINSON IS A FAMILY DOCTOR IN AMHERST. SHE'S BECOME A NATIONAL ACTIVIST FOR IMPROVEMENTS IN THE PRIMARY CARE SYSTEM.
(ATKINSON) 18 primary care doctors of this area have left the practice of primary care in the past 2 years.  0:11:49.0 someone needs to ask why.

[AMBI available for this section if desired – office employees fielding phone calls from patients.]
FOR ONE, SHE SAYS -- MONEY. INSURANCE COMPANIES, MEDICAID AND MEDICARE PAY LESS FOR PRIMARY CARE THAN FOR SPECIALIST VISITS. AND NO ONE PAYS FOR THE TIME IT TAKES TO FILL OUT PAPERWORK OR TAKE SURVEYS FOR THE INSURANCE COMPANY OR WRITE SICK NOTES TO EMPLOYERS.
[ATKINSON] a urologist, in one procedure, makes more than I make in 2 days of seeing patients.
NORTHAMPTON-BASED DOCTOR DAN LEVY – WHO LEFT PRIMARY CARE FOR MEDICAL ADMINISTRATION – SAYS THAT'S ONLY GETTING WORSE WITH UNIVERSAL HEALTH CARE, SINCE NEWLY INSURED PATIENTS TEND TO COME WITH A PILE OF SAVED-UP COMPLAINTS. 
[LEVY] you don't get paid for complexity. you have someone on your hands w/ five separate medical problems, 15 minutes to see them, if you spend the extra half hour, you don't get paid for it, so the pressure is to refer them to a sub specialist.  it takes a lot the pleasure & fun out of doing medicine.

WESTERN MASSACHUSETTS IS CONSIDERED A RURAL AREA, WHERE REIMBURSEMENT RATES ARE LOWER THAN IN URBAN AREAS. THE DOCTOR SHORTAGE IS MORE ACUTE HERE THAN IN CITIES LIKE BOSTON.  BUT IT'S A PROBLEM EVERYWHERE. THE MASSACHUSETTS MEDICAL SOCIETY CONSIDERS THE PRIMARY CARE SHORTAGE "CRITICAL" -- IT'S MOST DIRE CATEGORY. AND IN A NATIONAL STUDY RELEASED THIS FALL BY dc-based THE PHYSICIANS FOUNDATION, 80 PERCENT OF PRIMARY CARE DOCTORS CALLED THE JOB UNREWARDING; HALF OF THEM PLAN TO SCALE BACK OR STOP PRACTICING WITHIN THREE YEARS. AT THE SAME TIME, MOST MEDICAL STUDENTS ARE CHOOSING SPECIALTY TRACKS, LIKE SURGERY OR PEDIATRICS. MEANWHILE, MOST MEDICAL STUDENTS ARE CHOOSING HIGHER-PAID SPECIALTY TRACKS OVER PRIMARY CARE. AND THIS TREND COULD HAVE SIGNIFICANT IMPACT ON THE FUTURE OF HEALTH REFORM, SINCE BASIC PREVENATIVE CARE IS CONSIDERED THE BEST WAY TO KEEP HEALTH COSTS DOWN. THAT'S WHY MASSACHUSETTS RECENTLY PASSED LEGISLATION TO ADDRESS THE PRIMARY CARE SHORTAGE. SENATOR RICHARD MOORE WAS A CO-SPONSOR.

we're looking at w/ 0:06:37.6 physicians & nurse practitioners to help them pay down their medical debt, if they'll stay in primary care.  to help them actually w/ first time home buyer mortgages if they go into & stay in primary care.  0:06:49.5 we're looking at payment reform, not only more money, to make them more competitive, but also paying for different things that really encourage managing a patients conditions more.

LOCAL DOCTORS WANT TO SEE CONDITIONS IMPROVED FOR THOSE IN THE PRIMARY CARE FIELD ALREADY – REDUCE THEIR PAPERWORK, FOR INSTANCE, OR OFFER PAID SABBATICALS. BUT NONE OF THESE CHANGES WILL BE EASY TO PAY FOR, ESPECIALLY IN THIS BUDGET CLIMATE. STILL, JOHN MCDONOUGH  SAYS THAT'S NO REASON TO GIVE UP ON UNIVERSAL HEALTH CARE. HE WAS ONE OF THE ARCHITECTS OF MASSACHUSETTS HEALTH REFORM AND IS NOW AN ADVISOR TO SENATOR TED KENNEDY.
what has happened is that Massachusetts health reform has put a spotlight on the work force shortages that doesn't get meaningfully talked about in just about any other state.

IN OTHER WORDS, MASSACHUSETTS IS MERELY THE FIRST TO TAKE ON A PROBLEM THE REST OF THE COUNTRY WILL SOON CONFRONT – ESPECIALLY IF MORE PEOPLE ARE GIVEN HEALTH INSURANCE...  I'M KAREN BROWN.