Consider These Prescriptions for the Primary Care Crisis

Combining the strengths of public health and health care delivery

In addition to the physician practice-focused changes suggested by Dr. Hugh Taylor, president of the Massachusetts Medical Society, in his June 15 editorial (“Primary care is in crisis. Here’s how to fix it.”), there are opportunities at the more macro-systemic level to meaningfully address the primary care crisis. The United States is the only advanced country with almost complete separation between public health and health care delivery functions. This separation has clearly created challenges in our response to COVID-19.

Dr. Mandy Cohen, the new director of the Centers for Disease Control and Prevention, recently suggested that health care delivery and public health systems should work as a team to protect the health of our communities. In countries where public health and primary care are more collaborative, citizens benefit and overall health improves. A recent report from the National Academy of Medicine concluded: “Public health systems are the most powerful structure for combating chronic disease and equitably improving population health. »

Compared to all other Organization for Economic Cooperation and Development countries, the U.S. public health system is even more underfunded than the U.S. primary care system. This must change if we are to reap the maximum synergistic benefits from their collaboration. At the state level, bills are currently being considered by the legislature to strengthen our local public health systems. Their adoption would add significant value to the state and its residents.

Dr. Thomas A. Massaro

Marble head

Joanne G. Miller

Marble head

Miller is a retired member of the Marblehead Board of Health. Massaro was recently elected to serve in her position on the board of directors. The opinions expressed here are their own.

Lost in the Discussion: The Vital Role Advanced Practice Professionals Could Play

With Dr. Hugh Taylor’s opinion piece, we see yet another opinion piece on the primary care access crisis in Massachusetts, with no mention of the use of advanced practice professionals, such as physician associates (also known as physician assistants) and nurse practitioners, to alleviate the clinician shortage. Taylor presents some excellent points from a physician-centered perspective, including the lack of integration of services, outdated reimbursement models, oppressive technology, and the cost of medical education. Forgotten in the discussion has been the fact that increased use of APPs could significantly alleviate the shortage of primary care clinicians across all demographic groups. APPs are growing significantly in number, with a young, well-qualified workforce that could support physicians aging out of the profession (Taylor notes that more than a third of primary care physicians in this state are 60 or older ).

We face the same challenges with reimbursement, compensation, cost of training, and practice limitations. Solutions to this very real crisis in access to care, including any legislation, must include PPAs at the table.

Laurie Bayer

Jamaica Plain

The writer is a certified medical assistant.

Paving the way for doctors trained in other countries

Dr. Hugh Taylor has written about our current and looming primary care physician shortage. Another way to address the shortage is to create an alternative pathway for qualified doctors trained at medical schools in other countries to practice in Massachusetts. A number of states, including Massachusetts, have already passed or are in the process of proposing legislation to allow international medical graduates to intern for a certain period of time and then become licensed. This would speed up the admission of physicians who have difficulty being accepted into medical residency programs in the United States. States that do so also stipulate that doctors must then practice for a period of time in underserved areas.

These programs would be open only to doctors who are already legal permanent residents of the United States. We currently have talented refugee doctors in the Commonwealth who would qualify for a program like this.

Marianne Boswell

Wellfleet

The writer is the founder of the Lexington Refugee Assistance Program, a group that helps refugees become productive members of their communities.