Massachusetts
Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe
When Massachusetts is a national outlier in any policy, it’s worth asking why and whether that policy still makes sense.
Massachusetts today is one of only seven states that does not use Medicaid money to fund medical residencies, which provide the clinical training of new doctors after they complete medical school. Among the 10 states with the most teaching hospitals and physician residents, it is the only one that does not use Medicaid money to support graduate medical education, or GME, according to the Association of American Medical Colleges.
The main reason appears to be cost: Massachusetts did have a program, but policy makers cut it in 2010, according to the Executive Office of Health and Human Services, amid budget shortfalls due to the 2008 recession and as state officials prioritized implementing universal health insurance coverage.
Today, cost remains a barrier to reinstating the program. Yet given the shortage of primary care physicians, lawmakers should consider reinstating Medicaid GME in a targeted way that shores up needed services like primary care, behavioral health care, and community health centers.
Without the Medicaid money, residencies are mostly paid for by Medicare, which gave $16.2 billion in fiscal 2020 to GME programs nationwide.
Although it may seem like an arcane distinction, there are two good reasons to use Medicaid money to fund residencies beyond those funded by Medicare. One is that the federal government would match the state contribution, drawing new federal money. The second is that the state can narrowly tailor a Medicaid program to decide how much money to spend — and how to spend it.
This flexibility means state lawmakers could target money for residencies in specific specialties that Massachusetts needs more of.
There is a dire need to train more primary care physicians and keep them in Massachusetts. People are struggling to find doctors. Wait times at community health centers, which see many Medicaid patients, have recently been as long as 80 days for a new patient and up to 40 days for an existing patient, according to Michael Curry, president and CEO of the Massachusetts League of Community Health Centers.
According to the Milbank Memorial Fund’s primary care scorecard, 16.7 percent of adults in Massachusetts and 5.4 percent of children in 2021 lacked a usual source of health care, numbers that had grown since 2011. According to survey data from Massachusetts Health Quality Partners and the Center for Health Information and Analysis, adults were having a harder time accessing primary care in 2022 than in 2019. Massachusetts has a higher rate of doctors leaving primary care than the nation overall. One-third of Massachusetts doctors in 2020 were over 60 and fewer than one-quarter of Massachusetts medical school graduates are entering primary care, according to MHQP.
When someone cannot get an appointment with a primary care physician, they are more likely to become seriously ill and go to the emergency department, at a time when hospitals are experiencing capacity crunches.
Funding more residency training slots through Medicaid would not magically solve the problem. Seriously addressing the primary care shortage will require paying primary care doctors more and addressing the administrative burden that makes primary care such a hard job. Massachusetts officials are taking other steps to address the problem, like establishing student loan repayment programs.
But reestablishing Medicaid GME could allow hospitals and community health centers to train more doctors to work in badly needed fields. Because specialty care is more lucrative, without the added Medicaid incentive, hospitals are more likely to create residencies in specialty fields than primary care.
Multiple bills to reestablish Medicaid GME payments are pending in legislative committees, with advocacy by the League of Community Health Centers and the Massachusetts Health and Hospital Association. The details differ, but the basic idea is to pay for residencies in fields with shortages, including primary care and behavioral health care, in hospitals and community health centers. (Like primary care, behavioral health care is a field where worker shortages are severely impacting people’s ability to get timely care.) A program could also potentially fund training for non-physician clinicians, like nursing students.
The League of Community Health Centers is asking for $50 million in Medicaid funding over three years, half of which would be reimbursed by the federal government. According to the organization, that level of funding would pay to graduate 23 new family medicine doctors annually (with funding for three years of residency) and to fund 69 residency slots each year for nurse practitioners, assuming a cost of $185,000 per physician resident and $120,000 per nursing resident.
Most states use general fund money to pay for Medicaid GME, though some rely on municipal tax money or taxes on hospitals. Lawmakers will have to determine the best funding source.
But the money is likely to be a smart investment, and it will draw in federal money that the state is leaving on the table now. And if increased funding for residencies means more doctors go into primary or behavioral health care in Massachusetts, patients will be seen sooner and will get the care they need to remain healthy, lowering costs in the long term.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
As libraries across western Massachusetts celebrate National Library Week from April 19 to April 25, they are honoring “the last real third space where everyone is welcome,” in the words of Greenfield Public Library Assistant Director Lisa Prolman.
According to the American Library Association, National Library Week is “an annual celebration highlighting the valuable role libraries and library professionals play in transforming lives and strengthening our communities.” This year, several libraries in the region will be hosting events to highlight the roles they play in their communities.
The Athol Public Library is among the venues engaging in National Library Week festivities, with a whole host of events starting on Tuesday, April 21, with Silly Goose Story Time at 10:30 a.m. The library will hold multiple events each day, including “Free Book Friday” on April 24, which Assistant Director Robin Shtulman said is “really fantastic.”
Shtulman said the week celebrates and emphasizes the “freedom to read, community outreach and celebrating the staff, without whom nothing would happen.”
The Athol Public Library said in an event announcement that “whatever brings you joy, the library has something for everyone,” and that aspect is being emphasized this National Library Week. To name a few of the events on tap, on Tuesday, April 21, from 3:30 to 5:30 p.m., there’s a volunteer opportunity where teens will make greeting cards for senior citizens; “A Minecraft Movie” will be shown at the same date and time; and on Thursday, April 23, the library will host Scavenger Hunt Bingo for all ages. For a full list of events at the Athol Public Library, visit atholpubliclibrary.com.
In Shelburne Falls, the Arms Library will feature a gallery from the Carlos Heiligmann Collection, a series of photos of public libraries across western Massachusetts. Also in collaboration with the Arms Library, Pothole Pictures and the Shelburne Falls Area Women’s Club will partner for a screening of “Free For All: The Public Library” on Saturday, April 25, at 2 p.m. at the Shelburne Falls Theater at Memorial Hall.
The documentary focuses on the evolution of the public library from its origins in the 19th century and the challenges it faces today, with modern-day issues such as book bans, funding cuts and debates over censorship.
It also explores the role that women’s clubs, like the one in Shelburne Falls, played in creating the modern library system. To serve their communities, women’s clubs took the lead in fundraising, collecting books and advocating for library legislation.
“Our women’s club in this town started with a group of 60 women who were gathering for lessons. … Because of the support of women in the U.S., we established over 80% of the public libraries [in the country],” said Christin Couture, program chair for the Shelburne Falls Area Women’s Club. “This film … I hear it’s so fascinating.”
Following the film’s screening, there will be a panel of local librarians who will engage in “lively conversation” about the history and future of public libraries. Tickets are $6, though school-age children will be admitted for free.
In Charlemont, Tyler Memorial Library will host an open house on Saturday, April 25, from noon to 2 p.m. featuring refreshments, a tour of the library and sun catcher crafting.
The Greenfield Public Library, meanwhile, is taking National Library Week in a bit of a different direction, as it is offering a book repair demonstration with Tom Hutcheson on Thursday, April 23, at 3:30 p.m. The day marks William Shakespeare’s birthday.
Although the book repair session required registration and is currently full, those who are interested may be placed on a waiting list at greenfieldpl.libcal.com/event/16460179.
Greenfield Public Library Director Anna Bognolo recognized the hard work that everyone has put into making the library a success, offering a “huge thank you” to the volunteers and staff who make its varied offerings possible.
“Stop by and support your library,” Bognolo said.
“Libraries, especially in this economy, are more important than ever,” Prolman said. Referencing the library’s role as a place where community members can go that is not work or home, she added, “They are the last real third space where everyone is welcome, and we don’t charge you for being here.”
Massachusetts
New Bedford MS-13 Member, Illegal Alien Pleads Guilty to Role in Brutal Murders In Massachusetts, Virginia
Frankli
Police shot and killed a man who officials say rushed officers with a knife during a call in Lexington, Massachusetts, on Saturday.
Middlesex County District Attorney Marian Ryan said the situation started around 1:40 p.m. when Lexington police received a 911 call from a resident of Mason Street reporting that his son had injured himself with a knife.
Officers from the Lexington Police Department and officers from the Northeastern Massachusetts Law Enforcement Council (NEMLEC), who were already in town for Patriots’ Day events, responded to the call.
Police were able to escort two other residents out of the home, initially leaving a 26-year-old man inside. According to Ryan, while officers were setting up outside, the man ran out of the home and approached officers with a large kitchen knife.
She added that police tried twice to use non-lethal force, but it was not effective in stopping him. The man was shot by a Wilmington police officer who is a member of NEMLEC. The man was pronounced dead on scene and the officer who fired that shot was taken to a local hospital as a precaution.
The man’s name has not been released.
Ryan said typically in a call like this where someone was described as harming themselves, officers would first try to separate anyone else to keep them out of danger, which was done, and then standard practice would be to try to wait outside.
“It would be their practice to just wait for the person to come out. In the terrible circumstances of today, he suddenly rushed the officers, still clutching the knife,” Ryan said.
The investigation is still in the preliminary stages and more information is expected in time. Ryan said her office will request a formal inquest from the court to review whether any criminal conduct has occurred, which is the standard process.
This happened around the same time as the annual Patriots’ Day Parade, and just hours after a reenactment of the Battle of Lexington, which drew large crowds to town.
This is a developing story. Check back for updates.
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