We often read about the Primary Care shortage across the country continuing to grow, especially in states like Massachusetts that have a higher proportion of specialists. Some will argue that its exaggerated but numbers do not lie. Call a local doctors office and find out how long it takes to be seen as a new patient- provided they are even accepting new patients. Well here comes Direct Primary Care with smaller patient panels of 600-1000 patients versus the 2500-3000 of typical insurance based panel sizes, and along with it comes the critics. “You are worsening access,” we are told. Well the reason access to good primary care is poor is because the system is driving medical students- all with plenty of debt- into higher paying specialties. The system is forcing good docs to leave medicine early- whether it’s to retire early, move into administrative positions, or even go work for insurers! I argue that Direct Care can fix this by providing a professionally gratifying, financially rewarding experience so that more students like the ones I teach from Tufts will actually want to go into the field.

Take my current 3rd year Tufts medical student Ian Murphy who states:  “I felt that a career in Primary Care would be rewarding but financially unsustainable and mentally draining. After being here for the past 3 weeks, I am now encouraged to look at and explore Primary Care more closely before making a career choice.”

And finally read this email from Salem resident Jennifer Kugel that I received a few months back (with her permission of course). She will be spending a day with me this week.

”

Hello,

I am a perspective medical school student looking to gain insight and experience into the world of medicine. I have an undergraduate degree in Sports Movement Science from Salem State University, and am planning to take the MCAT’s next April and apply by June.

I heard about Dr. Gold’s Direct Care initiative while listening to NPR a few weeks back. I was thrilled to hear that someone locally (I live in Salem) is trying to change the way healthcare is being run. When I got home I looked up his website and read through all of the pages and anecdotal stories. I was quite taken aback to find a doctor who was still interested in doing house-calls and practicing preventative medicine rather then dealing with problems as they come.

As with many people who want to become a doctor, I have envisioned it since I was a toddler. As I have gotten older and taken alternate paths to get my degree, I have continually asked myself why I want to BE a doctor. The answer is still simple; I want to help people. With healthcare operating the way it does, patients are not getting the attention they need, and problems are not caught soon enough. Too many decisions are based off of what people can or cannot afford, and not what is best for their life and lifestyle. To see that an established doctor wants to go out of his way to make the system work better for everyone involved is quite inspiring.

I would greatly appreciate an opportunity to shadow Dr. Gold and gain experience from someone with a vision of a better healthcare system. I am hoping that by the time I finish my medical school experience, that I may be able to take the vision and apply it to my own patient care.

Thank you for the consideration, and I look forward to hopefully meeting Dr. Gold in person soon.

Truly,
Jennifer Kugel

This…is how we actually fix the “access problem.”

So after battling with the state of Massachusetts since February, we finally got the okay to supply State Vaccines.

The vaccines which we can supply are:

• DTaP (Helps children develop immunity to three deadly diseases caused by bacteria: diphtheria, tetanus, and whooping cough aka pertussis.)
• Hep A (Used for prevention of  liver disease caused by the hepatitis A virus.)
• Hep B (Used for prevention of  liver disease caused by the hepatitis B virus.)
• HIB (Used for prevention of invasive disease caused by Haemophilus influenzae type b bacteria.)
• IPV (Used to combat poliomyelitis aka Polio.)
• PCV13 (Used to protect infants and toddlers from pneumococcal disease.)
• RV (Oral Dosage- Used to prevent Rotavirus which is a contagious virus that can cause gastroenteritis.)

These vaccines can be supplied to anyone under the age of 19.  However, we will not be supplying HPV or Menactra(Meningococcal Meningitis Vaccine).  We do have places we can send our patients to receive these vaccines at a cash price, or by using their insurance.

We will be implementing a $20 inoculation fee to help pay for the needles and syringes.  This is just a one time fee per visit, NOT per vaccination.

If you have any questions, or would like to set up an appointment, please call our office at 781-842-3961.

If you would like to know more about the vaccines, or what schedule your child should be on, you can visit the CDC website here.

Todays issue of the Boston Globe had a great article in the Business Section on the Rise of Retail Clinics and how they are rising to meet the needs of patients. The article is below for those who wish to read it and please read the comments, as they are always fantastic when it comes to articles on our  healthcare system.

The main question I ask in this blog entry is: Why are these clinics popping up everywhere and having success? It is actually a very simple answer- they are filling the void that our fractured, third-party based healthcare system has left in its path of destruction of the physician-patient relationship. They are the callus on the fracture, but they are not the cast that will keep it fixed for good!

Patients used to have access to their OWN doctor or nurse when and if they needed them, even if it were for a simple question. Now, because of a warped third party payment system and corporate run healthcare, patients feel as if they are nothing more than a number on a list. They would rather go see a doctor or NP that knows nothing about them at a pharmacy than their “in-network listed ‘PCP’ “. Why? Because they do not want to listen to a 5 minute list of menu options on a phone; they do not want to be on hold for ten; they do not want to wait to have their problem addressed for hours to days, especially when ill; they do not want to pay a copay or deductible for a rash that could be diagnosed with a picture; and most importantly they do not want to be rushed in and out in 10 minutes after waiting for 45! So do I begrudge companies like CVS for opening these clinics and do I begrudge patients for going to them? Absolutely not!

So whom do I have issue with? I have issue with a system that has been perpetuated for long enough to allow this fracture and pseudo-callus to form. The reason I call it a “pseudo-callus”- and this is in no way to be disparaging to the doctors and NPs who work at these clinics- is because they are not the patients OWN doctor. Are the “providers” at these clinics going to be there when that simple cough turns into a lung mass or emphysema? Are they going to be there when that simple UTI is actually a bladder cancer? No matter how excellent the quick care is, I ultimately believe that people still crave their OWN doctor. DPC not only fills this void, it is the cast that will allow this broken system to heal once and for all. And not only do you not have to “check with your insurer about coverage”,  my monthly fee is cheaper than the visits to these clinics. See here: CVS Minute Clinic Prices

It is time doctors and patients look for the cast rather than the band-aid.

Boston Globe Article: Minute Clinics Rising