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Massachusetts’ primary-care crisis requires urgent action – The Boston Globe

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Massachusetts’ primary-care crisis requires urgent action – The Boston Globe


Slots for primary-care training, including family medicine, pediatrics, and internal medicine, also increased by 877 positions this year, offering up to 20,300 positions for the nation. This seems like promising news for a city like Boston, where the wait for a new patient to access primary care is at least 40 days, twice as long as in 15 other studied cities, and up to half of the primary-care workforce is close to retiring age. The most recent primary-care dashboard from Massachusetts Health Quality Partners, a measurement and reporting nonprofit organization, shows that these shortages are driving up visits to emergency departments, spiking Massachusetts’ total cost on health care, and disproportionately affecting low-income people and people of color, further aggravating our state’s health inequities.

The small increase in slots to train future primary-care physicians nationally will not come close to fixing our primary-care crisis in Massachusetts, however. In a state that has more physicians per capita than any other in the United States, only 22 percent of Massachusetts medical school graduates were providing primary care six to eight years later, as of 2023.

Further, not all primary-care training programs are equal in terms of generating practicing primary-care physicians. According to a recent study, 97 percent of family-medicine residents conclude their training in primary care, whereas only 54 percent of pediatric residents and 35 percent of internal medicine residents conclude their training in primary care. In other words, the vast majority of new primary-care physicians in the United States are family-medicine physicians. Given the robust training of family-medicine physicians, including caring for prenatal, postpartum, pediatric, adult, and geriatric patients, this workforce is crucial.

However, while 13.4 percent of first-year residency positions were in family medicine nationally, Massachusetts only provides 3.9 percent of its first-year residency slots in family medicine. Given that studies show the vast majority (68.7 percent) of family-medicine graduates continue to work in the state where they trained after graduation, this anemic number is a poor harbinger for our future.

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A significant barrier to training more family-medicine physicians is the lack of academic medical support. Apart from Boston Medical Center, there are no family-medicine departments in Boston’s academic medical centers, where the majority of graduate medical education occurs. The rationale often cited is that it is the responsibility of community-based institutions to train future primary-care and family-medicine doctors. However, it is exceedingly difficult for community-based hospitals and community health centers to take on this responsibility with already tight profit margins, a lack of internal infrastructure to support residency programs, and traditional residency program funding flowing to academic medical centers.

If Massachusetts wants to have adequate access to primary-care physicians, it needs to prioritize and organize state-level partnerships between large academic institutions and community-based institutions, particularly community health centers, to develop infrastructure and funding for new family-medicine residency programs. Academic medical centers must include investments in developing family medicine as part of their larger primary-care investment plans. Legislators must also reinstitute Medicaid Graduate Medical Education funding in Massachusetts that is targeted to support family-medicine training programs. Currently, Massachusetts is one of only seven states that does not fund residency programs through this program.

Furthermore, to attract more motivated and capable medical students to enter the field of family medicine, health care leaders, educators, and policy makers must work to make the job more sustainable. This includes actions such as statewide policies increasing reimbursements for family-medicine services from all payers, streamlining the number of health care metrics family-medicine physicians are accountable for, and reducing the administrative burden of family-medicine physicians by accelerating the use of AI to complete forms for items such as durable medical equipment, prior authorizations, and messages generated through electronic medical systems.

We are grateful to Governor Maura Healey for her recent remarks on prioritizing primary care; to the Legislature for the development of the Primary Care Task Force, which will focus on primary care access, delivery, and financial sustainability; and to the recent Massachusetts legislative hearings on Senator Cindy Friedman’s Primary Care for You bill. However, we cannot wait for the group’s recommendations to start addressing our state’s primary-care crisis. Legislators, payers, hospitals, and community health centers must work now to strengthen and grow the family-medicine workforce, build a stronger pipeline, and pay for a health care system that will build a healthier Commonwealth.






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Man cited for alleged wrong-way deadly crash

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Man cited for alleged wrong-way deadly crash


BOSTON, (WPRI) — A somerset man has been cited for allegedly causing a deadly wrong-way crash in Boston late Saturday night.

Just before midnight, troopers from the H9 Barracks were called for a report of a multi-vehicle crash on I-93 North before Exit 15A.

A preliminary investigation showed that the driver of a 2004 Cadillac Escalade, identified as 81-year-old Antone Carvalho, of Somerset, entered Route 93 North at Exit 15B and drove southbound in the northbound lanes.

Two vehicles, a Honda Odyssey and an Audi A4, attempted to avoid the Carvalho and crashed into each other.

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Four people in the Honda Odyssey, were taken to a Boston-area hospital for evaluation.

Shortly after the initial crash, police say Carvalho collided head-on with a Chevrolet Cruze.

Carvalho and the other driver were taken to Boston-area hospitals for their injuries

The driver of the Chevrolet Cruze, identified as a man in his 20’s from Haverhill, died from his injuries.

Carvalho will be issued a summons to appear in court at a later date.

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8 Picture-Perfect Main Streets In Massachusetts

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8 Picture-Perfect Main Streets In Massachusetts


Norman Rockwell painted Stockbridge so often that the real Main Street now looks like one of his canvases come to life. That is the trick these Massachusetts towns pull off. A whaling-era cobblestone lane on Nantucket and a Revolutionary common in Concord do the same thing in different accents. Each one packs its best landmarks into a few blocks you can cover on foot. The eight New England streets here all sit under 50,000 residents and earn their reputation the honest way.

Stockbridge

Red Lion Inn in Stockbridge, Massachusetts.

Fewer than 2,000 people live in Stockbridge, yet its Main Street may be the most recognizable in the state. Credit Norman Rockwell, who lived here and painted the view down the street so many times it lodged in the national memory. The white clapboard buildings, the old inns, and the big shade trees are all still right where he left them, and people still use them.

The Red Lion Inn has welcomed guests on this corner since 1773, and its long front porch is the street’s anchor in every sense. A short walk away, the Norman Rockwell Museum holds the largest collection of his work and even his relocated studio. Naumkeag adds a Gilded Age cottage with terraced gardens climbing the hillside. Come December, the town recreates Rockwell’s famous “Main Street at Christmas” scene with vintage cars parked along the curb, which is about as close as a real place gets to stepping into a painting.

Lenox

Downtown street in Lenox, Massachusetts.
Downtown street in Lenox, Massachusetts. Image credit Richard Cavalleri via Shutterstock

Edith Wharton built her dream house just outside Lenox, and the writer’s eye for proportion seems to have rubbed off on the whole town. The center is small enough to park once and walk, with bookshops, cafes, and galleries shoulder to shoulder under the trees. Under 10,000 people live here, and the place wears its Berkshire elegance lightly.

The Mount, Wharton’s 1902 estate, runs as a house museum and public garden and hosts readings and outdoor events all summer. Ventfort Hall, a Jacobean-style mansion built for a sister of J.P. Morgan, fills in more of the Gilded Age story. Just up the road, Tanglewood draws crowds every July and August as the summer home of the Boston Symphony Orchestra, so a quiet shopping street can be ten minutes from a world-famous concert lawn. Few towns this size balance that kind of culture against that little traffic.

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Concord

Main Street in the historic town center of Concord, Massachusetts.
Main Street in the historic town center of Concord, Massachusetts.

On April 19, 1775, the shot heard round the world was fired a short walk from where Concord shoppers now buy their morning coffee. That is the strange gift of this town. Its pretty village center sits below 20,000 residents, and its old houses, churches, and civic buildings look calm until you remember what happened among them.

Minute Man National Historical Park preserves the battle road and the fields where colonial militia turned back British regulars. Old North Bridge marks the spot itself, with Daniel Chester French’s Minute Man statue standing guard. Concord also raised more than its share of writers, and Louisa May Alcott’s Orchard House, where she wrote “Little Women,” still opens for tours. Two miles south, Walden Pond holds the woods Thoreau made famous, an easy swim or walk that closes the loop between the town’s history and its quieter ideas.

Marblehead

Marblehead, Massachusetts: Sites of historical homes and buildings in historical downtown district.
Marblehead, Massachusetts: Sites of historical homes and buildings in the historical downtown district. Dee Browning via Shutterstock

The streets in Marblehead’s Old Town were laid out for foot traffic and fishing nets, not cars, so they bend and narrow and dead-end at the water. The town tops 20,000 residents now, but the historic core feels far older and more intimate. Washington Street and the lanes around it run past brick sidewalks and preserved houses, with the harbor flashing into view between rooftops.

The Jeremiah Lee Mansion, a grand Georgian house built in 1768 for the wealthiest merchant in colonial Massachusetts, still keeps its original hand-painted English wallpaper. Old Burial Hill rises above town with weathered colonial gravestones and one of the best harbor views around. Abbot Hall, the brick town hall with the clock tower, houses the original “Spirit of ’76” painting. Walk the waterfront and the reason for the whole town becomes obvious. Marblehead grew up facing the sea, and it never turned away.

Newburyport

Downtown Newburyport, Massachusetts
Downtown Newburyport, Massachusetts. Image credit Heidi Besen via Shutterstock

Federal-era sea captains built their fortunes at the mouth of the Merrimack, and their three-story brick blocks still line the streets of downtown Newburyport. The Main Street feeling here spreads across several streets rather than one. Under 20,000 residents keep the center humming, with shops and restaurants filling old facades right down to the riverbank.

Market Square and State Street form the heart of it, a tight grid of brick that survived a great fire and a wave of 1970s urban renewal to come out the other side intact. The Custom House Maritime Museum, set in a granite 1835 building, tells the port’s seafaring story. Waterfront Park gives you a bench and a view of the boats. A few miles out on Plum Island, the Parker River refuge at Joppa Flats turns the same trip into prime birdwatching, so a downtown afternoon can end with herons instead of storefronts.

Rockport

Rockport, Massachusetts.
Rockport, Massachusetts. Editorial credit: Starmaro / Shutterstock.com.

A plain red fishing shack on a granite pier may be the most painted building in America, and it sits right in Rockport’s harbor. Locals call it Motif No. 1, after an art teacher who got tired of seeing his students paint it. The town runs under 10,000 residents and folds its best parts into a few tight blocks by the water.

Main Street leads to Bearskin Neck, a skinny peninsula crammed with galleries, candy shops, and lobster shacks that ends with the open Atlantic. Front Beach puts sand and water within a short stroll of the shops. The Shalin Liu Performance Center, opened in 2010, built a concert hall with a wall of glass behind the stage, so the ocean becomes the backdrop for a string quartet. You can wander from a storefront to a harbor view to a gallery without ever breaking stride.

Great Barrington

Rustic brick buildings along Railroad Street in the town of Great Barrington, Massachusetts
Rustic brick buildings along Railroad Street in the town of Great Barrington, Massachusetts. Editorial credit: Albert Pego / Shutterstock.com

Great Barrington wired the first downtown in the world lit entirely by alternating current, back in 1886, and the place has kept that forward lean ever since. Under 10,000 residents fill a center that feels genuinely busy, with restaurants, bookstores, and galleries spread along Main Street and Railroad Street. It looks like an old Berkshire town and behaves like a young one.

The Mahaiwe Performing Arts Center, a restored 1905 theater, books films, concerts, and live broadcasts year-round. The Housatonic River Walk threads a half-mile greenway along the water right behind Main Street, the work of volunteers who spent decades clearing a once-polluted bank. Just outside town, Monument Mountain offers a short climb to a quartzite ridge and a long view over the Housatonic River valley, the same trail Herman Melville and Nathaniel Hawthorne hiked together in 1850.

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Nantucket

Main Street in Nantucket, Massachusetts
Main Street in Nantucket, Massachusetts. Image credit Mystic Stock Photography via Shutterstock.

Whaling money built Nantucket’s Main Street, and the cobblestones laid to keep wagon wheels out of the mud are still there to rattle your suitcase. The island stays well under 50,000 year-round residents even at the height of summer. Brick sidewalks, weathered shingles, and window boxes give the downtown the texture of an old port rather than a new outdoor mall.

The Whaling Museum, set in an 1847 candle factory, explains how a small island once lit the lamps of the world, right down to a full sperm whale skeleton. Brant Point Lighthouse marks the harbor entrance and ranks among the most photographed beacons in New England. Straight Wharf keeps the working waterfront within steps of the shops, and the Oldest House, built in 1686, anchors the streetscape in the island’s first century. Every detail down to the gray shingles seems to point back to the same seafaring story.

Massachusetts Main Streets Worth Slowing Down For

What ties these eight together is not a shared look but a shared honesty. Stockbridge and Lenox lean on Berkshire culture, Concord carries the weight of 1775, and Great Barrington keeps reinventing itself. Marblehead, Newburyport, Rockport, and Nantucket all grew up facing salt water and never lost the habit. The best Main Streets here are not stage sets. They are working downtowns that happen to be worth a long, slow look.



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Battenfeld: AG Andrea Campbell’s errors sting Massachusetts voters

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Battenfeld: AG Andrea Campbell’s errors sting Massachusetts voters


No single person in Massachusetts bears more responsibility for denying voters the right to cast a ballot than inept Attorney General Andrea Campbell.

No rent control? Blame Campbell.

No state income tax cut? Blame Campbell.

No audit of the state Legislature? Blame Campbell.

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Again and again Campbell has screwed up or worse, been complicit, leaving Bay State voters without the ability to exercise their right to decide important issues.

No amount of fawning pieces in the Boston Globe or publicity-seeking lawsuits against President Trump can cover up that fact.

She is a disaster. Unfortunately we have to suffer through another four years of her bonehead decision-making because Republicans in Massachusetts are just as inept at fielding viable candidates.

Massachusetts voters had the best chance in two decades this fall to establish rent control with a referendum question capping rent increases at 5%. Polls showed the ballot question with a solid advantage.

But Campbell, a liberal Democrat, allowed language on the question giving exemptions from the rent limits to religious institutions, which in Massachusetts violates the Constitution. The Supreme Judicial Court voted unanimously to kick the referendum question off the ballot.

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This was not a case of political decision-making on Campbell’s part, since Democrats favored the rent control question. It was purely a rookie botch job, and a huge one at that, which will have major ramifications for renters, who will now be denied a much needed break from astronomical increases.

A simple reading of the Constitution should have caused Campbell to flag the question, and get the rent control advocates to strike the religious exemption. She admitted after she “got it wrong” — which is of no help to the renters in this state.

Apparently following the law, as Martin Short’s synchronized swimmer character would say, is not the Attorney General’s strong suit.

A similar error — or possibly an insidious political move — on Campbell’s part also blocked voters from getting a chance at lowering the state income tax from 5% to 4%.

The referendum question clearly had majority support, but was strongly opposed by Democrats like Campbell who argued it would have led to unconscionable cuts in social service programs to make up for the lost tax revenue.

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Campbell okayed fatally flawed language in the ballot question which again caused the SJC to punt it off the ballot. This one may not have been just a simple mistake, but a possible deliberate act by Campbell to poison the question.

Politics again played a role in Campbell’s moves around a 72% voter-approved legislative audit by Auditor Diana DiZoglio. By not enforcing the new law, Campbell is flagrantly keeping DiZoglio from auditing the books of the despised, free-spending Legislature.

Campbell — rather than do her job — will not represent DiZoglio in her efforts to secure the audit, but authorized her to seek outside counsel, which will cost millions.

So on one hand saying she’ll enforce the law, she’s done everything she can to block it.

So what does Campbell do exactly? She has sued the Trump administration 50 times already, on a pace to exceed even Gov. Maura Healey’s lawsuits against Trump back when she was AG.

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And she rarely ventures outside her Dartmouth, Mass. manse. Far from being the people’s lawyer, she stands against the people’s will.



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