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Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe

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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.

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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.

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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.

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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.





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Massachusetts

Snow, ice, rain to impact roads in Massachusetts – Boston News, Weather, Sports | WHDH 7News

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Snow, ice, rain to impact roads in Massachusetts – Boston News, Weather, Sports | WHDH 7News


Happy Tuesday! While today started off dry, we’re already looking at snow out there across the area. While this event will primarily stay as rain on the Cape and islands, it will be an icy mix of snow, ice and rain for the rest of us.

The rain/snow line will continue to advance from the south to the north as the evening progresses. Before the changeover, there will be a quick coating to 2 inches for most of our area.

The threshold between the snow and rain will feature sleet and freezing rain, leading to that icing.

For the rest of the night, there will primarily be rain with continued pockets of freezing rain, leading to increasing spotty ice accretion. Be extremely careful on roads, especially since switching between rain and freezing rain can wash off any road salt.

The rain and freezing rain will exit by 6 a.m. Wednesday, but temperatures will still be close to freezing during the morning commute, so watch out for some spotty black ice.

The rest of Wednesday will be really nice! Highs will warm up to the mid 50s with the help of ample sun.

Thursday we start off in the mid 20s and top off in the mid 40s. We’ll be partly sunny with another chance for some wintry weather Thursday night. This primarily looks like some rain and freezing rain, rather than the triple threat with snow too. We’ll keep an eye on that for you.

That will continue into Friday morning. The rest of Friday: cloudy with a chance for a spot shower and highs cooler again in the upper 30s. Saturday will be dry, breezy and cloudy but gorgeous near 50 degrees! There’s a chance for some rain showers Saturday night. Don’t forget to set your clocks forward an hour before you to go bed!

Sunday we start the day mild in the 40s and make it all the way into the upper 50s with more sun. Monday and Tuesday both look bright and in the 60s! Stay tuned.

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Massachusetts man awaits word from family in Iran after attacks

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Massachusetts man awaits word from family in Iran after attacks




Massachusetts man awaits word from family in Iran after attacks – CBS Boston

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Poya Sohrabi hasn’t heard from his family since they took shelter from attacks in Tehran. WBZ-TV’s Mike Sullivan reports.

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How will the Iran war impact gas prices in Massachusetts?

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How will the Iran war impact gas prices in Massachusetts?


With a widening conflict in the Middle East after the American and Israeli attack on Iran Saturday, global markets are bracing for a shakeup in the energy supply chain.

So, here at home, what can consumers expect at the gas pump?

An increase in oil prices is almost always followed by an increase in gas prices. And the oil market has already reacted to the war. NBC News reported on Sunday that U.S. crude oil initially spiked more than 10%, while Brent, the international oil benchmark, rose as much as 13%.

Early Monday morning, reports were coming in of black smoke rising from the U.S. embassy in Kuwait City.

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While Iran’s oil reserves supply less than an estimated 5% of global production, the main concern is the Strait of Hormuz. This maritime passageway borders Iran at the bottleneck of the Persian Gulf, and more than 20% of the world’s oil passes through. If Iran closes or restricts Hormuz, the oil market could face severe disruptions.

Gas prices rise about 2.5 cents for every dollar increase in crude oil prices. As of Sunday, U.S. crude oil prices had already increased by nearly $5 a barrel.

“I fully expect that by Monday night, you could credibly say that gas prices are being impacted by oil prices having gone up,” GasBuddy analyst Patrick De Haan told NBC News.

GasBuddy characterizes their expectations for price increases as “incremental” rather than “explosive”. The group said to anticipate a potential 10-15 cent increase over the next couple of weeks.

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