Health Care Quiz

In its rush to condemn a shortage of doctors at top beantown teaching hospitals, what has the Globe omitted?

What can the new Democrat congress (they probably won't, but let's try to be charitable) learn from the omission?

Maybe our occasional reader in the Globe management ranks can feed back to her reporters and editors the suggestions that I expect to see in the comments.

Maybe the reporter should have talked to Uwe Reinhardt.

Anyway, sorry about the blogging hiatus and the long block quote to follow, but I had to give a taste of the article and how long one can go on while COMPLETELY MISSING THE POINT (and this is just the first 15% or so).

Most primary care physicians at Boston's top-tier teaching hospitals are so busy that they have officially closed their practices to new patients.

Callers to Massachusetts General Hospital's physician referral line, for example, are told that all, or almost all, of the hospital's 178 primary care physicians are not accepting more patients. All 42 internists at Boston Medical Center have had full lists since four months ago, and 108 of Brigham and Women's Hospital's 120 primary care doctors have closed their practices to new patients.
Determined patients, however, are getting in to see some of the city's best doctors through informal channels, from e-mailing doctors personally to asking family members and acquaintances to use their connections.

"There is a huge crisis in primary care right now," said Dr. Sherry Haydock, medical director of Internal Medicine Associates, a primary care practice at Mass. General. "If you have a family member already cared for at the hospital, you have a much higher likelihood that a doctor will take you. But as our [practices] have gotten to 150 percent the size they should be, a lot of us realize we have to say no even to family members."

Many doctors blame a national shortage of primary care doctors for the limited access, but the reasons are more complex and vary among hospitals. Many internists, especially women, are cutting back their hours to spend more time with their families. At the same time, the aging population and the increasing complexity of medicine mean that each patient requires more time and services -- reducing the number of patients some doctors can see.

At Boston teaching hospitals, patient demand appears to be growing dramatically, partly because primary care doctors sit at a crucial intersection -- when patients fall seriously ill, it's the primary care doctor who can get them seen by a top surgeon or specialist. And new programs that rate hospitals and doctors' groups on the quality of care they provide often award the highest marks to these institutions, attracting more potential patients.

But many teaching hospitals have trouble finding physicians to hire -- Mass. General averages fewer than two applicants for every opening, down from eight a decade ago. Or the hospitals do not have space to expand. Community hospitals, health centers, and doctors' practices in the suburbs also report difficulty hiring primary care doctors, but most can accept new patients.

Caught in the middle All of this leaves many doctors at teaching hospitals feeling caught in the middle and patients frustrated as they try any avenue to get into practices. About a dozen doctors interviewed by the Globe said that in the past few years, they have been fielding a growing number of requests from current patients, colleagues, neighbors, and friends asking whether they can squeeze in someone they know who needs a doctor. Many get dozens of requests a month. Occasionally, hospital executives also ask doctors to fit in major donors.
Doctors have to make uncomfortable decisions about which new patients to accept and which to turn away. The doctors say they turn down most because the more new patients they take on, the longer their current patients have to wait for appointments -- and the more hours they must work.

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