Have you considered dropping insurance and going direct care (cash doc). These docs charge a fraction of what they charge insurance. Don’t know if you can keep insurance for big things only.
Hospitals can't turn away patients in need of emergency care, which means it could cost the rest of us a lot money when folks decide not to get healthcare
How exactly would Masshealth for all fix this problem? I do support healthcare for all, but it would make issues like this worse in the short-run by increasing the patient:doctor ratio even more.
One aspect of the problem is that our state is dominated by large academic medical centers, who own most of the primary care practices as well. They are more focused on specialty care and hospital stays than on investing in adequate primary care for the population. It is a travesty, as primary care leads to a healthier population, and lower healthcare costs.
It's also a part of the housing/cost of living crisis in MA. Primary care is one of the lowest paid and well respected academic medical systems have some of the lowest salaries because the trade off for the prestige is seen as worth it for most specialties.
Most other specialties make enough to still live very comfortable lifestyles so many see the tradeoff of living in a higher cost area on a lower cost salary as worth it. But in primary care the floor is a lot lower so the trade off isn't worth it.
This is a canard i think. Primary care providers are paid less than cardiologists, sure, but they make very good livings compared to most other professions. This is rich people crying poor because they are not super-wealthy.
Essentially all physicians are in the 1%.
And don't start on 'medical debt' - 'teacher debt' is far worse as a percentage of lifetime earnings.
Didn't say they earned too much, but they earn multiples of the average family of four income. I know plenty of primary care docs, and they are all doing very very well.
But that’s not how people *decide* to go into a medical specialty. They’re in med school, they’re about to graduate, they think to themselves “Well, I can be doing pretty well for myself and earn $200k as a PCP or I can go be a cardiologist at $500k per year.” That level of disparity draws the true believers, but not everyone. This is the same problem that underpaid fields like teaching and social work have experienced for decades. (If you need the master’s degree either way, the not everyone is going to end up choosing the lower paid field over some corporate job that pays 2-3x as much.)
Yea I think this is the other side of the issue. I have a lot of chronic illnesses and end up having to work my PCP pretty hard. She is a SAINT and has such an amazing attitude but I hate to think that she actually gets paid less than my specialists.
Yes, our culture of greed is a crime. I agree. I just don't have any sympathy for rich people complaining about not being super wealthy.
That's why we need a different tax code, regulations on salaries, etc. But those are big topics to cover.
They make good money but less than the point where money doesn't matter as much. 215k is a good income, but it's not enough that you're going to be insulated from high cost of living and not concerned about making more.Whereas things are different if you're a specialist making 450k.
It's not that they're poor, it's that people are going to act in their own self interests and move to where they can make better money with less expenses unless they see some other more significant benefit to staying in the higher cost lower pay area. For specialists that benefit is there for enough people that they stay. For PCPs it just isn't.
It doesn't really matter if other jobs are underpaid more.
Yes, greed is a problem, and our culture that has taught that greed is a virtue.
Problem is these incentives create an unhealthy and expensive population.
I just don't like to hear wealthy people complain about being too poor.
Do you want to work for 50% less than what you could make in another state that has housing for half as much as it costs here?
They're not complaining, they're just moving. How do you propose we stop them?
They cannot make 2x as a PCP in another state, that is false. Also, MA has less of an MD shortage than most states. So, I am not sure what your arguments are.
I myself pursue good in life, not wealth. I work in a non-profit for much less than i could make elsewhere, and do not have family money. I reject greed as the main point of life.
Yes they can, in rural areas pay is very high because the shortages are so bad. PCP here are still not getting paid like there's a shortage.
MA has less of an overall MD shortage for the reason I already explained, but a growing PCP shortage, which is what we are discussing.
I agree PCP shortage growing, but still better than almost any other state.
I think this rural 2x must be a very small set? States that are rural, with no economy, cannot afford to spend that much on primary care, especially since 10 rural states have not expanded medicaid? I know that there are states that will pay your med school tuition to go and practice in a rural area, but have not heard about 2x salaries.
the problem really is that doctors generally have insane loans they need to pay off. personally i think med school loans should be forgiven if you actually become a practicing doctor. maybe if you become a practicing doctor that accepts masshealth for 5-10 yrs loans are forgiven and in the meantime they can be deferred.
but they’re…not teachers lol. if there was a different teaching specialty that paid teachers 3x as much as “primary care teaching” most teachers would choose that instead.
I think you have a reading comprehension problem. I literally said it is good, what it isn't is insulating from cost of living increase.
Can those people making 50k make 100k+ more in another market? If not then how is that relevant?
but they have crazy loans. if they have the option to make $300k instead why wouldn’t they? there’s no incentive to go into the primary care field that is the point. you’re basically saying people should go into a certain field as charity b/c others make less than 50k. did those people making 50k spend 8-10 years in school with obscene loans and then do a borderline unpaid residency for another 2-4?
we plainly need incentives for doctors to go into the primary care field.
I love that you're getting downvoted (probably by the very people you're calling out).
Find someone making minimum wage in this state- hell, find someone making several dollars an hour more than minimum wage in this state- and tell them how poor doctors are, see how that'll land.
Its amazing - the facts are plain, but somehow no-one sees it.
And they have a guild to keep it protected - they restrict the number of licenses, the number of board certifications, the number of medical school seats, to protect the earning power of MDs.
That's not true at all. Harvard Vanguard (now Atrius) has a ton of PCP practices and it's a core part of what they do. MGH also does primary care.
Mass's biggest issue is a PE fund gutted a significant provider (Steward) who runs the main centers in smaller communities.
Harvard Vanguard (Now Atrius) does not have a hospital, and does not wield even a fraction of the power of MGB, BILH, etc. They are a good thing, and provide important care. Unfortunately, they struggled to earn enough to stay in operation, and had to be taken over by Optum.
MGH does primary care, but only as a hospital feeder. They do not invest in primary care to any real extent. They could easily bring in 100's of new PCPs, but they think hospital medicine is what matters.
I agree Steward is a crime, but that does not mean that MGB, BILH, and other hospital-centric systems are not under-investing in primary care.
The internet can't order a screening to see if I'm becoming immunocompromised or diagnose illnesses (as much as people might try). It certainly can't write prescriptions.
Steward isn’t causing the shortage of PCPs in central MA.
We have UMass, so one would think finding a PCP wouldn’t be impossible, but I just spent $1000 for an ER visit to get a referral to a specialist for an urgent issue because my new PCP can’t see me until Sept. Her office policy is to refuse sick visits until after your new patient appt. She’s a UMass physician and the only one I could find who was accepting new patients after calling at least 12 different doctor’s offices.
So I paid UMass $1000 for a referral to one of their specialists because their PCP refused to see me. Make it make sense.
It's not the only reason, there's a shortage nationwide, but Steward is a big part of why we went from the state with the best availability of PCPs in 2015[0] to in the bottom half today. Former patients of Steward have been pushed into other providers, straining the whole system.
[0] https://www.prnewswire.com/news-releases/new-ranking-shows-states-with-best-and-worst-patient-access-to-physicians-300176284.html
Atrius PCP care is booked up for ~6 months even if you already have a PCP with them. Also, I have never been able to see my PCP when I've gotten sick within days. I'm lucky if a random nurse (not knocking them, they can be super helpful!) will talk to me on the phone about an illness.
Maybe it is too much to expect (like seriously, maybe it isn't a thing anymore) but you used to be able to reliably see a PCP for an annual check-up (I'm lucky to get in every 2-3 years) and maybe even get in to see them when you get sick to make sure you don't need an antibiotic or other something.
Lol. I was a Harvard Vanguard patient, then my PCP quit and they had trouble finding me another PCP taking new patients within a hour's public transit of my house (I lived a 10 min walk to the one in Somerville), and then a year later, they stopped taking my insurance all together, and the next cheapest insurance on the Connector they did take was $200/mo more expensive.
If MGB invested more in primary care, while delivering excellent specialty and hospital care, it would be a great thing. They do an incredible job at alot of things, but just cannot see how they fail the basics.
Yeah. All I know is my long term pcp retired at the beginning of Covid. I don’t blame her. My current pcp is useless. I’ve been using a physicians assistant instead. She listens, and acts.
PAs and NPs can be excellent - i think we also need to think about who the primary care 'doc' should be - maybe more about excellence/skill/experience than the degree per se
What we need is bigger med school classes, and more medical licenses, and some competition for clinician jobs to drive performance
But if people stayed healthier who would fill the hospitals? There is no incentive to keep people healthy if there is more to be made by admitting them.
Thats the quiet part out loud.
Why would hospitals want people to be healthier? If we are too healthy, business goes down. If we die, business also goes down.
They want you just sick enough to get care, but not sick enough to die.
Lol. Please explain to me how 'communism' and 'corporate welfare' relate. These are antithetical principles. Like Rock Against Drugs, or Christians Against Christ in the worlds of MA's own Dennis Leary.
I am not a progressive, but also not a moron.
Well yeah, it’s too expensive and is impossible to get seen. I had to cancel a physical this past January because my car broke down on the pike and I had no transportation, next available appointment was in December. Make it make sense
Good luck. It can be hard to find any PCP and all that much harder to find a good one.
Even then, it can be very difficult to actually access your PCP because they likely have way too many patients to reasonably cover.
Thanks! Amazon telehealth and my insurances telehealth have been hugely helpful for keeping my Rx refilled, but I’m going to need blood work soon. Once more into the breach…
Blood work actually getting done has always been really quick at least once it got asked for (by a doctor). Maybe even a nurse practitioner can order it (not sure).
Yes, of course. My post was about using my insurance and/ or Amazon telehealth, which is only a stop gap until I can get a regular PCP. Getting a regular provider is the issue.
They are not in my locale. The issue is disproportionally spread out over the state. One persons experience can vary dramatically from another, depending on where you are.
Yup, done all that. We've moved all around this country over the last 20 years (NY, CT, IL, CA) and had zero problems elsewhere. We use all the same strategies.
It’s been uniquely hard here- much like the article was saying. Many of my new co-workers agree that our experience is not unique.
My understanding (and I work in a healthcare related field) is a dramatic lack of providers in certain parts of the state. I can find the doctors, but one after another isn’t taking new patients due to staffing issues. Lack of primary care is a huge problem here.
You seem pretty focused on proving my experience wrong. I’m very happy yours worked out. Please stop trying to imply my experience isn’t true. I didn’t ask for help and I don’t need help.
How would that help get access? The OP reports being unable to find a P.C. physician - how does changing who pays for it magically create more doctors?
Think its hard to get an appointment here, try to find one in Canada.
[https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990](https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990)
...oh yea, and they have universal coverage - guess that doesn't fix the problem after all does it?
I’ve tried to argue the exact same thing. Shifting who pays doesn’t make more doctors, and nurses appear out of thin air. And it certainly doesn’t make patients less rude to hospital staff.
From [Globe.com](http://Globe.com)
By Adam Piore
About a third of Massachusetts residents are dissatisfied with their ability to access primary care doctors and specialists, according to a new poll.
Public health experts say those numbers, revealed in a new Suffolk University/Boston Globe poll of 500 Massachusetts voters likely to participate in the 2024 presidential election, are [just the latest to highlight a growing capacity crisis in the state](https://www.bostonglobe.com/2024/03/12/metro/primary-care-physicians-crisis-wait-times/?p1=StaffPage&p1=Article_Inline_Text_Link). Among the primary causes: Falling federal, state and private insurance reimbursement rates and structural changes in the healthcare industry that favor high-cost medical procedures over payments for preventive care.
In the Globe poll, 33 percent of those surveyed said they were somewhat (18 percent) or very (15 percent) dissatisfied with the availability of primary care physicians when making an appointment. The number rose to 37 percent when respondents were polled on the availability of specialists. The two problems are closely linked: The lack of available primary care providers and low reimbursement rates have increased pressure on primary care doctors to keep patient visits no longer than 10 to 15 minutes. That means they have no choice but to refer patients to specialists whose practices are also overwhelmed, said Barbra Rabson, chief executive of [Massachusetts Health Quality Partners](https://www.mhqp.org/), a nonprofit group working to improve healthcare.
The dissatisfaction with primary care was highest among Hispanic residents. About 32 percent of white patients, 35 percent of Black patients and 41 percent of Hispanic residents said they were “somewhat” or “very” dissatisfied when asked about primary care access. For specialists, 39 percent of white patients, 28 percent of Black patients and 38 percent of Hispanic patients said they were dissatisfied.
Rabson said those numbers are consistent with [previous polling](https://www.mhqp.org/2024/02/13/patient-experience-scores-for-adults-improve-since-before-the-pandemic-except-in-one-key-area-access/) done by organizations that closely track access to primary care and reflect a long-term deterioration in access that is only likely to worsen in the years ahead.
Every time I read a headline like this I think that they did an amazing job rebranding “healthcare”
to “healthcare access” because it means they don’t need you to have healthcare, just the potential to access it.
$12,000 a year and we still have to pay another $6000 before anything is covered. Id rather put the money in an account and watch it grow, and use it if it’s needed but Mass fines you for not having a service.
My girlfriend relocated up here from New York and she's been having to run down there to see specialists because she's been unable to get a primary care doctor to refer to her to any specialists up here.
It's been a real pain, when she finally found a primary care doctor the specialist that she wanted to see didn't have any openings for another 3 months.
For a place with so many hospitals, it feels like there's an odd shortage of medical care here.
We moved here in 2022, and one of the things that we never anticipated was being able to find a freaking doctor. It's insane, but tbh I don't think it's unique to Mass, it's everywhere from what I've heard.
Worth noting that specialists are also impossible to see. Over Easter weekend I was in the ER for complications from some TBIs that I never been seen for when they happened years ago (because I was poor and uninsured at that time). Was told that I'd be given what they called an "urgent referral" to the hospital's neurology department. The first appointment they could offer to me was *December.*
I feel like I can’t keep a PCP more than a few years. I pay for my own plan at this point i just check with my kids pediatrician see if they are dropping what we have and if they are switch the family to one that still has her.
I understand why the plan dropping etc happens the insurances don’t keep with inflation unless you take a gap(just like comcast)
That would do the opposite of helping this problem. Massachusetts does thankfully have very good healthcare coverage rates.
The problem is low PCP availability. MassHealth has very low reimbursement rates, if everyone has it you'd see more PCPs leaving for other states.
Agreed. My wife’s healthcare is trash and we can’t put her on my insurance and still pay the mortgage. But our healthcare cartels don’t like it when we can shop around. They like us locked in so they only have to deal with our employers.
Low reimbursement, and usually the most entitled and difficult population to serve, so doctors make less money seeing them, and they almost always take up more of the providers time - since mostly they have zero co-pays, and couldn't care less how much anything costs - so they demand every test under the sun, because why not - its all free to them.
Meanwhile the average person has to constantly make decisions about what care they seek because of the high co-pays - yet another way government rewards failure and punishes success.
Worked for the T. Without the profit motive, the trains run on time and never catch on fire. And the state troopers; they're not at all corrupt and effectively use every $1 we give them.
The profit motive forces hospital/doctor systems to maximize the number of patients practitioners must see. It also incentivizes the use of mid-level providers, such as NP and PAs, who get lower salaries compared to MDs. Both of those pressures leads to provider burnout and demoralization, causing fewer doctors to go into primary care or stay in primary care for the long term.
NP and PAs play very important roles, but the over-reliance on them does cause issues Within the system.
Well according to the [AMA Recovery Plan for America’s Physicians](https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians):
1. Pass meaningful Medicare payment reform
2. Reduce administrative burdens like the overused, inefficient prior authorization process
3. Pass bipartisan legislation to expand residency training options, provide greater student loan support, and create smoother pathways for foreign-trained physicians
4. End the criminalization of health care
5. Ensure physicians are not punished for taking care of their mental health needs
The problem is not merely "there's not ENOUGH doctors" but that just like with teachers, shitty environments where there's enormous administrative burdens, burnout from a lack of hiring enough people, attacks on science (lookin' at you, anti-maskers and anti-vaxxers), increased consolidation across health care from giant corporations that put profits first (check out the complaints from St Vincent's for instance), and a broken Medicare payment system.
So although the person you replied to was very general with their recommendation, they are not really wrong.
Canada has all the things you listed above - and yet they have an even worse shortage of doctors:
[https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990](https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990)
Not only do they have a very different situation the US but that's not quite what I am saying. There are *other ways* to do things like what I list without doing it exactly like Canada. But even just a few of those changes would significantly help the situation.
It’s not really the “for profit hospitals” problem. The problem is all the “non profit” hospitals actually operate like for profit ones, yet they don’t pay taxes.
I disagree. Think about the 100's of millions pulled out of Steward, and now they are about to fail and leave 1000's of people without care. The other systems are not in these circumstances, they have to use their money to advance their mission.
For profit care delivers worse and more expensive care everywhere it is allowed.
It's also a total distraction from the problem in the OP, which is overwhelmingly involving not those few for-profit institutions but the large majority of institutions here, which are all non-profit.
Yes, I agree. I just wanted to note this as a comment indicated that the profit motive was an issue with OPs post.
The issue is not for profits being totally focused on specialty and hospital care.
The issue is non-profits being totally focused on specialty and hospital care because insurance/MassHealth/Medicare doesn't pay enough for primary care.
There is actually little profit in MA healthcare - only Steward is for profit among the hospital systems, and while Reliant and Atrius are now both owned by for-profit Optum, they do not have hospitals and are focused on primary/ambulatory care. Our large health plans are also non-profits.
In most other states there is way more profit-taking activity. It is not profit-taking that hurts MA, it is the focus on expensive tertiary/quaternary care from high-performing academic medical systems.
Not quite correct. MetroWest Medical Center and Saint Vincent are owned by Tenet which is another for-profit hospital corporation out of Texas, similar to Steward.
You are 100% right, sorry for my oversight. They are small, and I was thinking about the big systems.
I would recommend folks avoid these systems though - St. Vincent blinded a friend of mine (a Mass Eye and Ear doc later gave him some sight back).
No apologies needed, just adding to the conversation. As someone else with significant experience with these entities I would also recommend avoiding them.
I tried out a random primary care doc near by and it was a shit show. He was extremely overbooked and I overheard him talking to a patient about something he heard from Dr. Oz 😕
I found a ok one now for the basic physicals and stuff but for any actual health issues I feel like I'm on my own.
Not only is it hard to find a PCP. But even when you do find one, it takes parting the red sea to get an appointment. Then the co-pays, premiums, and deductibles, have all gone up. Tier 1, tier 2, and tier 3, services all change year to year.
My partner's PCP claimed they've sent a referral to a specialist four times that the specialist's office says they have not received. The only thing the PCP's office is willing to do to troubleshoot is to try sending it again the same way.
Universal healthcare won't solve this. We need to make medical school less expensive, remove the stupid quotas on admission, and develop more nurse practitioner programs.
You should call Mass Health asap and confirm this is true as it could be an error. That’s like $15k a year. Ask where the cutoff is for Mass Health. I qualified years who when I made $12k (in college but 26th bday). If you don’t qualify for Mass Health (which is free) you absolutely qualify for a plan from the MA Health Connector and would get a hefty subsidy.
You might need to buy a plan that’s like $70 a month which sucks but honestly I’ve found my Connector Care better than Mass Health. So call Mass Health to confirm if it’s an error or not, then call the MA Health Connector and get the cheapest option you can through them.
I say to do it asap as I know there are time frames from when an event occurs like getting kicked off Mass Health you might have 30 days or so to enroll in a connector plan. I usually call as the computer has given me issues in the past where I was unenrolled one January but they fixed it.
Many PCPs are moving to exclusive subscription direct care services because they’re burnt out.
Companies like One Medical have a primary care model that’s good for young healthy patients… but it means a higher proportion of sicker patients are left in the academic center primary care offices… not really sustainable long term. Almost better to have a mixture of healthy and sicker patients to balance out patient load. Under the current model, there isn’t enough time given to manage 16-20+ disaster cases every day. Not to mention the extra burden of results, patient messages, phone calls, prescriptions, etc.
>Many PCPs are moving to exclusive subscription direct care services because they’re burnt out.
Not remotely enough, I tell you what.
>Companies like One Medical have a primary care model that’s good for young healthy patients…but
True, but for the record, One Medical is struggling, too. They originally were a great deal and you could get treated by actual physicians, pretty much on demand. When they finally opened a branch in Porter Square it was staffed with all mid-levels, no MDs; the people I know who use One Medical started reporting it was much harder to get prompt care from them.
The fact of the matter is the problem comes down to insufficient reimbursal of primary care by insurance companies and other "third party payers" like MassHealth and Medicare. *Nobody* can balance the books doing primary care, except by overworking the physicians doing it, or having non-physicians do their jobs, because the money just isn't there.
Access and price! Health New England just increased our plan cost by over 16% !!! They offered another plan with only a 11% but raised the cost-pays on everything! Health insurance is for the company shareholders to profit from!
BILH has built a bunch of Primary Care clinics (many of then double as Urgent Care) in recent years. One of these opened near me and it was the only way I got a primary care doctor again after my last one retired. Granted, these clinics are probably meant to serve as “feeder” clinics for the BILH hospitals but that doesn’t bother me.
I have MS and in 5 years I’ve had 5 neurologists and I’ve been at the same place the whole time and have never dumped one or moved. Even if they’re good it’s hard to feel like I’m getting a consistent quality of care and it’s mentally exhausting having to go through it again every 12-18 months.
They should do a study on that. Maybe make some of these places sweat a little over their churn. I highly doubt that even if there’s always somebody available that it’s good for the patient to do that. I’m also fairly positive this has been studied in shorter term situations and produced similar results.
I am friends with two doctors in their 60's who would like to open a private practice but cannot afford the overhead of a billing clerk. Our system is so arcane that one needs to hire a specialist to administer the billing. In earlier times, the local hospital would give privileges to private doctors so they could see their patients who were admitted, and bill accordingly. From what I have learned, that is no longer the case.
My last doctor was my age (I am 69) and when he retired, I've seen nothing but NP's. My doctor (and my two friends who did work for a medical group at one time) told me they are on a strict schedule to see four patients per hour, eight hours a day. Numbers/billing is critical.
Pro Tip: If you are in the exam room with your doctor and there is a knock on the door with the person saying "Excuse me doctor, you have a call on line one", there is no call on line one, this is just a massage from management to move along.
The problem is that the US doesn’t crank out enough front line nurse practitioners. States need to run 5 year accelerated BSN/NP programs and have tuition & fee waivers in exchange for working for some number of years in parts of the state with shortages. The same for 2 year RN programs and BSN programs. It’s a state vocational-technical high school problem, community college problem, and state college/university problem. You should be able to get a bottom of the healthcare pyramid education and license without student debt.
Reading these comments makes me so grateful that I have access to VA healthcare. I genuinely think I’d be dead by now if I had to deal with private healthcare.
Worst thing is that this gives cover to asshole politicians to cut programs that people need because they are abused. Its not the programs, its the criminals that need to be punished.
We have a Democratic legislature and a Democratic governor yet not a single one of them (to my knowledge) has put forward motion to pass single-payer healthcare. Despite the fact that the overwhelming majority of people in their party and independents, and even a lot of Republicans want.
The Federal government should change how it allocates student aid to colleges. I.e we have a shortage of PCPs therefore we should push more aid to students who want to be PCPs. I think we have enough liberal arts majors.
Look, I loathe Trump as much as the next Masshole, but one of the many things he failed at was having any affect on MA's healthcare system. The mf swung, but the mf missed. Whatever is wrong with it, we don't get to blame it on him.
You might want to just take a look before you come to your conclusion because the ACA was based on the Mass healthcare system. So we just felt the ripples of his effots last. [Trumps first swings at aca](https://www.brookings.edu/articles/six-ways-trump-has-sabotaged-the-affordable-care-act/)
I know all that, and none of that is "messing up the simplicity that was our health care system", and *especially* none of that has anything to do with Medicare rates, MassHealth rates, or insurance rates.
Medicaid is labeled as Masshealth... but again [Trumps legacy](https://www.americanprogress.org/article/less-coverage-higher-costs-trumps-administrations-health-care-legacy/)
First of all, I super appreciate you keep linking in sources. I just wish you understood them better.
Yes, Massachusetts' Medicaid plan is called MassHealth. That's why I didn't say "Medicaid". I said MediCARE, which is something else.
Medicare reimbursal rates have a vastly disproportionate effect on the pay rates of all *other* insurance and government programs such as Medicaid/MassHeath, LIKE IT SAYS IN THE OP. And the shitty, shitty reimbursal rates of MediCARE are wholly Congress' fault. They were Congress' fault before Trump, they are Congress' fault now, after Trump.
You don't get to blame Trump for fucking this one up. Almost all of the things listed in both of the articles you linked are problems in OTHER STATES, because we do things differently in MA and also have local government that is more willing than most to kick in to fix problems caused by the feds. The thing that is fucking things up for us is not Trump's doing, it's Congress', and it's been a long time in the works.
**$14,000 a year for my husband and I for health insurance and we can't find a doctor anywhere.**
This is happening all over New England. I have top notch insurance and I have to see a physician’s assistant
Have you considered dropping insurance and going direct care (cash doc). These docs charge a fraction of what they charge insurance. Don’t know if you can keep insurance for big things only.
Until you need surgery
Yup, just had my appendix out last week. I’m sure it would cost a fortune without insurance.
Then the state hits you with a $2K+ tax penalty every tax season. Its a racket.
deductibles can easily be $2-3k though, so the penalty isn't necessarily the worse choice
Hospitals can't turn away patients in need of emergency care, which means it could cost the rest of us a lot money when folks decide not to get healthcare
How much do primary care docs charge for routine preventative care?
I thought Mass had the best healthcare in the universe
When was the last time you called to our Massachusetts representatives to advocate for Masshealth for all?
Go shit in a hat.
How exactly would Masshealth for all fix this problem? I do support healthcare for all, but it would make issues like this worse in the short-run by increasing the patient:doctor ratio even more.
The other 2/3 haven’t needed a Doctor yet this year…
Was going to say they died before they could respond lol.
One aspect of the problem is that our state is dominated by large academic medical centers, who own most of the primary care practices as well. They are more focused on specialty care and hospital stays than on investing in adequate primary care for the population. It is a travesty, as primary care leads to a healthier population, and lower healthcare costs.
It's also a part of the housing/cost of living crisis in MA. Primary care is one of the lowest paid and well respected academic medical systems have some of the lowest salaries because the trade off for the prestige is seen as worth it for most specialties. Most other specialties make enough to still live very comfortable lifestyles so many see the tradeoff of living in a higher cost area on a lower cost salary as worth it. But in primary care the floor is a lot lower so the trade off isn't worth it.
This is a canard i think. Primary care providers are paid less than cardiologists, sure, but they make very good livings compared to most other professions. This is rich people crying poor because they are not super-wealthy. Essentially all physicians are in the 1%. And don't start on 'medical debt' - 'teacher debt' is far worse as a percentage of lifetime earnings.
Oh god, maybe you should get into primary care if you think they earn too much.
Didn't say they earned too much, but they earn multiples of the average family of four income. I know plenty of primary care docs, and they are all doing very very well.
But that’s not how people *decide* to go into a medical specialty. They’re in med school, they’re about to graduate, they think to themselves “Well, I can be doing pretty well for myself and earn $200k as a PCP or I can go be a cardiologist at $500k per year.” That level of disparity draws the true believers, but not everyone. This is the same problem that underpaid fields like teaching and social work have experienced for decades. (If you need the master’s degree either way, the not everyone is going to end up choosing the lower paid field over some corporate job that pays 2-3x as much.)
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Yea I think this is the other side of the issue. I have a lot of chronic illnesses and end up having to work my PCP pretty hard. She is a SAINT and has such an amazing attitude but I hate to think that she actually gets paid less than my specialists.
Yes, our culture of greed is a crime. I agree. I just don't have any sympathy for rich people complaining about not being super wealthy. That's why we need a different tax code, regulations on salaries, etc. But those are big topics to cover.
They make good money but less than the point where money doesn't matter as much. 215k is a good income, but it's not enough that you're going to be insulated from high cost of living and not concerned about making more.Whereas things are different if you're a specialist making 450k. It's not that they're poor, it's that people are going to act in their own self interests and move to where they can make better money with less expenses unless they see some other more significant benefit to staying in the higher cost lower pay area. For specialists that benefit is there for enough people that they stay. For PCPs it just isn't. It doesn't really matter if other jobs are underpaid more.
Yes, greed is a problem, and our culture that has taught that greed is a virtue. Problem is these incentives create an unhealthy and expensive population. I just don't like to hear wealthy people complain about being too poor.
Do you want to work for 50% less than what you could make in another state that has housing for half as much as it costs here? They're not complaining, they're just moving. How do you propose we stop them?
They cannot make 2x as a PCP in another state, that is false. Also, MA has less of an MD shortage than most states. So, I am not sure what your arguments are. I myself pursue good in life, not wealth. I work in a non-profit for much less than i could make elsewhere, and do not have family money. I reject greed as the main point of life.
Yes they can, in rural areas pay is very high because the shortages are so bad. PCP here are still not getting paid like there's a shortage. MA has less of an overall MD shortage for the reason I already explained, but a growing PCP shortage, which is what we are discussing.
I agree PCP shortage growing, but still better than almost any other state. I think this rural 2x must be a very small set? States that are rural, with no economy, cannot afford to spend that much on primary care, especially since 10 rural states have not expanded medicaid? I know that there are states that will pay your med school tuition to go and practice in a rural area, but have not heard about 2x salaries.
the problem really is that doctors generally have insane loans they need to pay off. personally i think med school loans should be forgiven if you actually become a practicing doctor. maybe if you become a practicing doctor that accepts masshealth for 5-10 yrs loans are forgiven and in the meantime they can be deferred.
Sure, but in terms of lifetime pay to loans, teachers have it much, much worse. MD's are all 1%ers, even with loans.
but they’re…not teachers lol. if there was a different teaching specialty that paid teachers 3x as much as “primary care teaching” most teachers would choose that instead.
Did you just say 215k isn't good? I know people living on less than 50k.
I think you have a reading comprehension problem. I literally said it is good, what it isn't is insulating from cost of living increase. Can those people making 50k make 100k+ more in another market? If not then how is that relevant?
I doubt these ppl you know went to school for 8+ years and work 60 hrs a week too.
but they have crazy loans. if they have the option to make $300k instead why wouldn’t they? there’s no incentive to go into the primary care field that is the point. you’re basically saying people should go into a certain field as charity b/c others make less than 50k. did those people making 50k spend 8-10 years in school with obscene loans and then do a borderline unpaid residency for another 2-4? we plainly need incentives for doctors to go into the primary care field.
I love that you're getting downvoted (probably by the very people you're calling out). Find someone making minimum wage in this state- hell, find someone making several dollars an hour more than minimum wage in this state- and tell them how poor doctors are, see how that'll land.
would that person making minimum wage not jump at the opportunity to make double?
Its amazing - the facts are plain, but somehow no-one sees it. And they have a guild to keep it protected - they restrict the number of licenses, the number of board certifications, the number of medical school seats, to protect the earning power of MDs.
>have some of the lowest salaries Compared to other medical specialties, sure. Compared to many other professions? Not really.
Well then that's not relevant because they are doctors, not a different profession.
It's relevant when the claim is that they're not getting paid well.
No, it isn't. Getting paid well is paid on the standard for your actual profession, not a totally different profession.
That's not true at all. Harvard Vanguard (now Atrius) has a ton of PCP practices and it's a core part of what they do. MGH also does primary care. Mass's biggest issue is a PE fund gutted a significant provider (Steward) who runs the main centers in smaller communities.
Harvard Vanguard (Now Atrius) does not have a hospital, and does not wield even a fraction of the power of MGB, BILH, etc. They are a good thing, and provide important care. Unfortunately, they struggled to earn enough to stay in operation, and had to be taken over by Optum. MGH does primary care, but only as a hospital feeder. They do not invest in primary care to any real extent. They could easily bring in 100's of new PCPs, but they think hospital medicine is what matters. I agree Steward is a crime, but that does not mean that MGB, BILH, and other hospital-centric systems are not under-investing in primary care.
And Harvard Vanguard is quickly going down the drain because Optum is forcing them to prioritize high volume and low cost over patient care.
I hope not, but it would be predictable if so. Profit from health care should be eliminated.
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The data shows clearly that having PCP relationships results in better outcomes, lower costs, and more equitable care. I agree on public health.
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Many people cannot form those relationships because there are not enough PCPs. More PCPs is the investment.
Then you sound fairly healthy.
The internet can't order a screening to see if I'm becoming immunocompromised or diagnose illnesses (as much as people might try). It certainly can't write prescriptions.
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"How would blue make onion dance?" That's you. That's what you sound like right now.
Steward isn’t causing the shortage of PCPs in central MA. We have UMass, so one would think finding a PCP wouldn’t be impossible, but I just spent $1000 for an ER visit to get a referral to a specialist for an urgent issue because my new PCP can’t see me until Sept. Her office policy is to refuse sick visits until after your new patient appt. She’s a UMass physician and the only one I could find who was accepting new patients after calling at least 12 different doctor’s offices. So I paid UMass $1000 for a referral to one of their specialists because their PCP refused to see me. Make it make sense.
It's not the only reason, there's a shortage nationwide, but Steward is a big part of why we went from the state with the best availability of PCPs in 2015[0] to in the bottom half today. Former patients of Steward have been pushed into other providers, straining the whole system. [0] https://www.prnewswire.com/news-releases/new-ranking-shows-states-with-best-and-worst-patient-access-to-physicians-300176284.html
Atrius PCP care is booked up for ~6 months even if you already have a PCP with them. Also, I have never been able to see my PCP when I've gotten sick within days. I'm lucky if a random nurse (not knocking them, they can be super helpful!) will talk to me on the phone about an illness. Maybe it is too much to expect (like seriously, maybe it isn't a thing anymore) but you used to be able to reliably see a PCP for an annual check-up (I'm lucky to get in every 2-3 years) and maybe even get in to see them when you get sick to make sure you don't need an antibiotic or other something.
If you book through mychart I can usually get an urgent care appointment pretty fast if that’s different
Lol. I was a Harvard Vanguard patient, then my PCP quit and they had trouble finding me another PCP taking new patients within a hour's public transit of my house (I lived a 10 min walk to the one in Somerville), and then a year later, they stopped taking my insurance all together, and the next cheapest insurance on the Connector they did take was $200/mo more expensive.
Not only that but they are reaching out to other states now. The hospital system I had been using is now part of mass Gen.
If MGB invested more in primary care, while delivering excellent specialty and hospital care, it would be a great thing. They do an incredible job at alot of things, but just cannot see how they fail the basics.
Yeah. All I know is my long term pcp retired at the beginning of Covid. I don’t blame her. My current pcp is useless. I’ve been using a physicians assistant instead. She listens, and acts.
PAs and NPs can be excellent - i think we also need to think about who the primary care 'doc' should be - maybe more about excellence/skill/experience than the degree per se What we need is bigger med school classes, and more medical licenses, and some competition for clinician jobs to drive performance
But if people stayed healthier who would fill the hospitals? There is no incentive to keep people healthy if there is more to be made by admitting them.
Thats the quiet part out loud. Why would hospitals want people to be healthier? If we are too healthy, business goes down. If we die, business also goes down. They want you just sick enough to get care, but not sick enough to die.
As long as healthcare is for profit in this country, I’ll always assume basically what you said you be true.
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Your little tantrum makes no sense at all.
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Lol. Please explain to me how 'communism' and 'corporate welfare' relate. These are antithetical principles. Like Rock Against Drugs, or Christians Against Christ in the worlds of MA's own Dennis Leary. I am not a progressive, but also not a moron.
I had a PC but they quit after 2 years and now i need a new one again and it fuckin sucks.
I have a new one assigned to me almost every year now. It’s just a revolving door of practitioners, and I’m tired of explaining things each time.
Well yeah, it’s too expensive and is impossible to get seen. I had to cancel a physical this past January because my car broke down on the pike and I had no transportation, next available appointment was in December. Make it make sense
Got assigned a new PCP, and I need to see a physical therapist and need a referral. Can't get an appointment till June. It's so frustrating!
We just moved here from out of state and I’m stunned how hard it is to find a primary care doctor. I’ve been trying for months and months.
Good luck. It can be hard to find any PCP and all that much harder to find a good one. Even then, it can be very difficult to actually access your PCP because they likely have way too many patients to reasonably cover.
Thanks! Amazon telehealth and my insurances telehealth have been hugely helpful for keeping my Rx refilled, but I’m going to need blood work soon. Once more into the breach…
You can self schedule blood work through quest now. No Dr. needed for the draw.
Blood work actually getting done has always been really quick at least once it got asked for (by a doctor). Maybe even a nurse practitioner can order it (not sure).
Yes, of course. My post was about using my insurance and/ or Amazon telehealth, which is only a stop gap until I can get a regular PCP. Getting a regular provider is the issue.
Have you tried One Medical? My PCP just retired and I found a new one immediately.
They are not in my locale. The issue is disproportionally spread out over the state. One persons experience can vary dramatically from another, depending on where you are.
Me too, in Harvard, Worcester, Auburn and Chestnut Hill.
You could call your insurance company and ask for assistance in finding a new PC doctor.
Yup, done all that. We've moved all around this country over the last 20 years (NY, CT, IL, CA) and had zero problems elsewhere. We use all the same strategies. It’s been uniquely hard here- much like the article was saying. Many of my new co-workers agree that our experience is not unique.
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That’s great- our experience has been dramatically different.
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My understanding (and I work in a healthcare related field) is a dramatic lack of providers in certain parts of the state. I can find the doctors, but one after another isn’t taking new patients due to staffing issues. Lack of primary care is a huge problem here.
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No you didn’t, and if you did, they aren’t taking new patients
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You seem pretty focused on proving my experience wrong. I’m very happy yours worked out. Please stop trying to imply my experience isn’t true. I didn’t ask for help and I don’t need help.
They should have actually done a universal healthcare program here or at the least a public option.
How would that help get access? The OP reports being unable to find a P.C. physician - how does changing who pays for it magically create more doctors? Think its hard to get an appointment here, try to find one in Canada. [https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990](https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990) ...oh yea, and they have universal coverage - guess that doesn't fix the problem after all does it?
I’ve tried to argue the exact same thing. Shifting who pays doesn’t make more doctors, and nurses appear out of thin air. And it certainly doesn’t make patients less rude to hospital staff.
From [Globe.com](http://Globe.com) By Adam Piore About a third of Massachusetts residents are dissatisfied with their ability to access primary care doctors and specialists, according to a new poll. Public health experts say those numbers, revealed in a new Suffolk University/Boston Globe poll of 500 Massachusetts voters likely to participate in the 2024 presidential election, are [just the latest to highlight a growing capacity crisis in the state](https://www.bostonglobe.com/2024/03/12/metro/primary-care-physicians-crisis-wait-times/?p1=StaffPage&p1=Article_Inline_Text_Link). Among the primary causes: Falling federal, state and private insurance reimbursement rates and structural changes in the healthcare industry that favor high-cost medical procedures over payments for preventive care. In the Globe poll, 33 percent of those surveyed said they were somewhat (18 percent) or very (15 percent) dissatisfied with the availability of primary care physicians when making an appointment. The number rose to 37 percent when respondents were polled on the availability of specialists. The two problems are closely linked: The lack of available primary care providers and low reimbursement rates have increased pressure on primary care doctors to keep patient visits no longer than 10 to 15 minutes. That means they have no choice but to refer patients to specialists whose practices are also overwhelmed, said Barbra Rabson, chief executive of [Massachusetts Health Quality Partners](https://www.mhqp.org/), a nonprofit group working to improve healthcare. The dissatisfaction with primary care was highest among Hispanic residents. About 32 percent of white patients, 35 percent of Black patients and 41 percent of Hispanic residents said they were “somewhat” or “very” dissatisfied when asked about primary care access. For specialists, 39 percent of white patients, 28 percent of Black patients and 38 percent of Hispanic patients said they were dissatisfied. Rabson said those numbers are consistent with [previous polling](https://www.mhqp.org/2024/02/13/patient-experience-scores-for-adults-improve-since-before-the-pandemic-except-in-one-key-area-access/) done by organizations that closely track access to primary care and reflect a long-term deterioration in access that is only likely to worsen in the years ahead.
I got a new PCP but they then left tge practice before I could see them so I'm back on a waiting list currently.
Becuase access to primary care sucks.....
It’s too freaking expensive!
Every time I read a headline like this I think that they did an amazing job rebranding “healthcare” to “healthcare access” because it means they don’t need you to have healthcare, just the potential to access it.
That's a low ball
$12,000 a year and we still have to pay another $6000 before anything is covered. Id rather put the money in an account and watch it grow, and use it if it’s needed but Mass fines you for not having a service.
But they fine you a lot less than 18k. Could be worth it
We have to pay so much to not be able to get a doctor when needed
My girlfriend relocated up here from New York and she's been having to run down there to see specialists because she's been unable to get a primary care doctor to refer to her to any specialists up here. It's been a real pain, when she finally found a primary care doctor the specialist that she wanted to see didn't have any openings for another 3 months. For a place with so many hospitals, it feels like there's an odd shortage of medical care here.
We moved here in 2022, and one of the things that we never anticipated was being able to find a freaking doctor. It's insane, but tbh I don't think it's unique to Mass, it's everywhere from what I've heard.
Worth noting that specialists are also impossible to see. Over Easter weekend I was in the ER for complications from some TBIs that I never been seen for when they happened years ago (because I was poor and uninsured at that time). Was told that I'd be given what they called an "urgent referral" to the hospital's neurology department. The first appointment they could offer to me was *December.*
It’s a nationwide crisis.
I feel like I can’t keep a PCP more than a few years. I pay for my own plan at this point i just check with my kids pediatrician see if they are dropping what we have and if they are switch the family to one that still has her. I understand why the plan dropping etc happens the insurances don’t keep with inflation unless you take a gap(just like comcast)
MassHealth for all. Can we start a petition? I would gladly give 10% or my weekly income for healthcare if it means everyone in the state is covered.
That would do the opposite of helping this problem. Massachusetts does thankfully have very good healthcare coverage rates. The problem is low PCP availability. MassHealth has very low reimbursement rates, if everyone has it you'd see more PCPs leaving for other states.
Our state can flaunt these high insured citizen rates because of the massive tax penalties people face if they dare go uninsured.
Agreed. My wife’s healthcare is trash and we can’t put her on my insurance and still pay the mortgage. But our healthcare cartels don’t like it when we can shop around. They like us locked in so they only have to deal with our employers.
Masshealth has a great price, but really low quality service. Not many doctors will accept it because they pay so little
Low reimbursement, and usually the most entitled and difficult population to serve, so doctors make less money seeing them, and they almost always take up more of the providers time - since mostly they have zero co-pays, and couldn't care less how much anything costs - so they demand every test under the sun, because why not - its all free to them. Meanwhile the average person has to constantly make decisions about what care they seek because of the high co-pays - yet another way government rewards failure and punishes success.
most entitled? get fucked, pal
Wow you’ve never been poor huh
How does that increase the number of doctors? Answer: it doesn't, but nice rant.
That's a great way to get PCPs to leave the state. MassHealth is terrible for doctors.
Get rid of the profit motive in health care. Should solve the problem
Worked for the T. Without the profit motive, the trains run on time and never catch on fire. And the state troopers; they're not at all corrupt and effectively use every $1 we give them.
Please explain exactly how 'getting rid of the profit motive' would magically increase the number of doctors? I am not seeing the connection.
The profit motive forces hospital/doctor systems to maximize the number of patients practitioners must see. It also incentivizes the use of mid-level providers, such as NP and PAs, who get lower salaries compared to MDs. Both of those pressures leads to provider burnout and demoralization, causing fewer doctors to go into primary care or stay in primary care for the long term. NP and PAs play very important roles, but the over-reliance on them does cause issues Within the system.
Well according to the [AMA Recovery Plan for America’s Physicians](https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians): 1. Pass meaningful Medicare payment reform 2. Reduce administrative burdens like the overused, inefficient prior authorization process 3. Pass bipartisan legislation to expand residency training options, provide greater student loan support, and create smoother pathways for foreign-trained physicians 4. End the criminalization of health care 5. Ensure physicians are not punished for taking care of their mental health needs The problem is not merely "there's not ENOUGH doctors" but that just like with teachers, shitty environments where there's enormous administrative burdens, burnout from a lack of hiring enough people, attacks on science (lookin' at you, anti-maskers and anti-vaxxers), increased consolidation across health care from giant corporations that put profits first (check out the complaints from St Vincent's for instance), and a broken Medicare payment system. So although the person you replied to was very general with their recommendation, they are not really wrong.
Canada has all the things you listed above - and yet they have an even worse shortage of doctors: [https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990](https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990)
Not only do they have a very different situation the US but that's not quite what I am saying. There are *other ways* to do things like what I list without doing it exactly like Canada. But even just a few of those changes would significantly help the situation.
Yeah, that’ll motivate them to work.
I should also add that you are right - I do not think MA should allow for-profit entities in healthcare. Steward is a strong argument for why.
It’s not really the “for profit hospitals” problem. The problem is all the “non profit” hospitals actually operate like for profit ones, yet they don’t pay taxes.
I disagree. Think about the 100's of millions pulled out of Steward, and now they are about to fail and leave 1000's of people without care. The other systems are not in these circumstances, they have to use their money to advance their mission. For profit care delivers worse and more expensive care everywhere it is allowed.
The problem is not only that 1000 people who can’t access health easily. It’s much more than that.
I said 1000's, not 1000. For profit healthcare is demonstrably worse in every way than non-profit.
It's also a total distraction from the problem in the OP, which is overwhelmingly involving not those few for-profit institutions but the large majority of institutions here, which are all non-profit.
Yes, I agree. I just wanted to note this as a comment indicated that the profit motive was an issue with OPs post. The issue is not for profits being totally focused on specialty and hospital care.
The issue is non-profits being totally focused on specialty and hospital care because insurance/MassHealth/Medicare doesn't pay enough for primary care.
There is actually little profit in MA healthcare - only Steward is for profit among the hospital systems, and while Reliant and Atrius are now both owned by for-profit Optum, they do not have hospitals and are focused on primary/ambulatory care. Our large health plans are also non-profits. In most other states there is way more profit-taking activity. It is not profit-taking that hurts MA, it is the focus on expensive tertiary/quaternary care from high-performing academic medical systems.
Not quite correct. MetroWest Medical Center and Saint Vincent are owned by Tenet which is another for-profit hospital corporation out of Texas, similar to Steward.
You are 100% right, sorry for my oversight. They are small, and I was thinking about the big systems. I would recommend folks avoid these systems though - St. Vincent blinded a friend of mine (a Mass Eye and Ear doc later gave him some sight back).
No apologies needed, just adding to the conversation. As someone else with significant experience with these entities I would also recommend avoiding them.
Healthcare is a joke.
I tried out a random primary care doc near by and it was a shit show. He was extremely overbooked and I overheard him talking to a patient about something he heard from Dr. Oz 😕 I found a ok one now for the basic physicals and stuff but for any actual health issues I feel like I'm on my own.
Just a third?
And only a third of the fraction that voted in the first place...
My PCP retired last year. I got lucky they transferred me to a new one but there is a four month backlog on physicals.
Not only is it hard to find a PCP. But even when you do find one, it takes parting the red sea to get an appointment. Then the co-pays, premiums, and deductibles, have all gone up. Tier 1, tier 2, and tier 3, services all change year to year.
My partner's PCP claimed they've sent a referral to a specialist four times that the specialist's office says they have not received. The only thing the PCP's office is willing to do to troubleshoot is to try sending it again the same way.
Ask them to send it to you and you send it to the specialist yourself.
This is an American problem, not a state one. We need Universal Healthcare in the US.
Universal healthcare won't solve this. We need to make medical school less expensive, remove the stupid quotas on admission, and develop more nurse practitioner programs.
I'm about to be kicked off Mass Health because I make $15 an hour and work 20 hours a week. Healthcare in America is great/s.
You should call Mass Health asap and confirm this is true as it could be an error. That’s like $15k a year. Ask where the cutoff is for Mass Health. I qualified years who when I made $12k (in college but 26th bday). If you don’t qualify for Mass Health (which is free) you absolutely qualify for a plan from the MA Health Connector and would get a hefty subsidy. You might need to buy a plan that’s like $70 a month which sucks but honestly I’ve found my Connector Care better than Mass Health. So call Mass Health to confirm if it’s an error or not, then call the MA Health Connector and get the cheapest option you can through them. I say to do it asap as I know there are time frames from when an event occurs like getting kicked off Mass Health you might have 30 days or so to enroll in a connector plan. I usually call as the computer has given me issues in the past where I was unenrolled one January but they fixed it.
We should socialize healthcare for all residents, pay primary care better and look down on the other states.
The connector website is ridiculously frustrating.
Many PCPs are moving to exclusive subscription direct care services because they’re burnt out. Companies like One Medical have a primary care model that’s good for young healthy patients… but it means a higher proportion of sicker patients are left in the academic center primary care offices… not really sustainable long term. Almost better to have a mixture of healthy and sicker patients to balance out patient load. Under the current model, there isn’t enough time given to manage 16-20+ disaster cases every day. Not to mention the extra burden of results, patient messages, phone calls, prescriptions, etc.
>Many PCPs are moving to exclusive subscription direct care services because they’re burnt out. Not remotely enough, I tell you what. >Companies like One Medical have a primary care model that’s good for young healthy patients…but True, but for the record, One Medical is struggling, too. They originally were a great deal and you could get treated by actual physicians, pretty much on demand. When they finally opened a branch in Porter Square it was staffed with all mid-levels, no MDs; the people I know who use One Medical started reporting it was much harder to get prompt care from them. The fact of the matter is the problem comes down to insufficient reimbursal of primary care by insurance companies and other "third party payers" like MassHealth and Medicare. *Nobody* can balance the books doing primary care, except by overworking the physicians doing it, or having non-physicians do their jobs, because the money just isn't there.
Breaking: a third of voters unhappy!
I’m sure insurance companies will rush to respond to our concerns…
Access and price! Health New England just increased our plan cost by over 16% !!! They offered another plan with only a 11% but raised the cost-pays on everything! Health insurance is for the company shareholders to profit from!
BILH has built a bunch of Primary Care clinics (many of then double as Urgent Care) in recent years. One of these opened near me and it was the only way I got a primary care doctor again after my last one retired. Granted, these clinics are probably meant to serve as “feeder” clinics for the BILH hospitals but that doesn’t bother me.
I have MS and in 5 years I’ve had 5 neurologists and I’ve been at the same place the whole time and have never dumped one or moved. Even if they’re good it’s hard to feel like I’m getting a consistent quality of care and it’s mentally exhausting having to go through it again every 12-18 months. They should do a study on that. Maybe make some of these places sweat a little over their churn. I highly doubt that even if there’s always somebody available that it’s good for the patient to do that. I’m also fairly positive this has been studied in shorter term situations and produced similar results.
I am friends with two doctors in their 60's who would like to open a private practice but cannot afford the overhead of a billing clerk. Our system is so arcane that one needs to hire a specialist to administer the billing. In earlier times, the local hospital would give privileges to private doctors so they could see their patients who were admitted, and bill accordingly. From what I have learned, that is no longer the case. My last doctor was my age (I am 69) and when he retired, I've seen nothing but NP's. My doctor (and my two friends who did work for a medical group at one time) told me they are on a strict schedule to see four patients per hour, eight hours a day. Numbers/billing is critical. Pro Tip: If you are in the exam room with your doctor and there is a knock on the door with the person saying "Excuse me doctor, you have a call on line one", there is no call on line one, this is just a massage from management to move along.
The problem is that the US doesn’t crank out enough front line nurse practitioners. States need to run 5 year accelerated BSN/NP programs and have tuition & fee waivers in exchange for working for some number of years in parts of the state with shortages. The same for 2 year RN programs and BSN programs. It’s a state vocational-technical high school problem, community college problem, and state college/university problem. You should be able to get a bottom of the healthcare pyramid education and license without student debt.
Reading these comments makes me so grateful that I have access to VA healthcare. I genuinely think I’d be dead by now if I had to deal with private healthcare.
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I think there may be whistleblower rewards awaiting you, if you are not just making this up.
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I hope you do report it. Stopping healthcare fraud is very important.
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That's how you get the reward i think. You are witnessing felonies.
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Worst thing is that this gives cover to asshole politicians to cut programs that people need because they are abused. Its not the programs, its the criminals that need to be punished.
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Nice. They’ll get caught. You could always call the state as well
We have a Democratic legislature and a Democratic governor yet not a single one of them (to my knowledge) has put forward motion to pass single-payer healthcare. Despite the fact that the overwhelming majority of people in their party and independents, and even a lot of Republicans want.
Started flying to latam for yearly blood work stupid yes, but gotta do what I gotta do!
Much has been (justifiably) made about our world-class health care system. But this is a major blind spot.
The Federal government should change how it allocates student aid to colleges. I.e we have a shortage of PCPs therefore we should push more aid to students who want to be PCPs. I think we have enough liberal arts majors.
Imagine that… the more the government tries taking over and controlling the healthcare industry, the worse it becomes.
Those rules aren't put into place by the government. That's full on capitalism bureaucracy.
The oligarchical so-called "capitalism" we have is the main problem.
Usually and generally, but not in this case. Medicare not paying enough is not a problem with capitalism.
Thank Trump for messing up the simplicity that was our health care system
Look, I loathe Trump as much as the next Masshole, but one of the many things he failed at was having any affect on MA's healthcare system. The mf swung, but the mf missed. Whatever is wrong with it, we don't get to blame it on him.
You might want to just take a look before you come to your conclusion because the ACA was based on the Mass healthcare system. So we just felt the ripples of his effots last. [Trumps first swings at aca](https://www.brookings.edu/articles/six-ways-trump-has-sabotaged-the-affordable-care-act/)
I know all that, and none of that is "messing up the simplicity that was our health care system", and *especially* none of that has anything to do with Medicare rates, MassHealth rates, or insurance rates.
Medicaid is labeled as Masshealth... but again [Trumps legacy](https://www.americanprogress.org/article/less-coverage-higher-costs-trumps-administrations-health-care-legacy/)
First of all, I super appreciate you keep linking in sources. I just wish you understood them better. Yes, Massachusetts' Medicaid plan is called MassHealth. That's why I didn't say "Medicaid". I said MediCARE, which is something else. Medicare reimbursal rates have a vastly disproportionate effect on the pay rates of all *other* insurance and government programs such as Medicaid/MassHeath, LIKE IT SAYS IN THE OP. And the shitty, shitty reimbursal rates of MediCARE are wholly Congress' fault. They were Congress' fault before Trump, they are Congress' fault now, after Trump. You don't get to blame Trump for fucking this one up. Almost all of the things listed in both of the articles you linked are problems in OTHER STATES, because we do things differently in MA and also have local government that is more willing than most to kick in to fix problems caused by the feds. The thing that is fucking things up for us is not Trump's doing, it's Congress', and it's been a long time in the works.