RI needs to heal its ailing primary care system | Opinion

Dr. Howard Schulman has been a general internist in Rhode Island for 28 years.

Just like commerce needs infrastructure (roads and bridges and railroads and ports), delivering primary health care needs infrastructure, and Rhode Island has ignored this for way too long.

First and foremost, the state needs a non-interim director of the Department of Health, and for that director to focus on how health care is delivered. The General Assembly needs to fix the problem of inadequate pay for the director, which is now less than the starting salary of almost every physician.

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Additionally, the payers and hospital systems and the state need to figure out a fair way to reimburse non-procedural physicians (primary care and others) who do the initial assessment of patients and counsel patients and guide patients and provide backup when the system’s shortcomings cause problems.

Strong primary care benefits everyone: patients, specialists, hospital systems and the payers. Rhode Island primary care pay is about 20% to 30% below the Massachusetts level, never mind way below most other specialties, so trainees don’t come here and established primary care doctors are leaving.

Within the hospital system 20 years ago, it quickly became clear that hospitalists, who do almost no procedures and therefore generate much less reimbursement, needed a hospital subsidy in order to attract a workforce. The same needs to happen with primary care in Rhode Island.

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“Pay for quality” is a failure. It has resulted in primary care physicians like myself spending way too much time and energy documenting certain aspects of patient care (using inadequate computer software) and focused way too much attention on a few, narrow aspects of patient care, often to the detriment of everything else.

The term “physician burnout” implies a problem physician, but I prefer to think of it as “job that no one wants to do.” Last year a large primary care group had two physicians leave; the group could not find replacements, so they discharged several thousand patients without any access to health care. Patients in my office tell me every day, statewide, how difficult it is to find a primary care physician.

The “burnout” problem has also resulted in a high turnover of physicians, which not only unsettles patients who have to find a new doctor and then form a trusting relationship, but also causes expensive disruptions in care. (Hint: The length of a primary care physician-patient relationship should be a “quality” indicator.)

Additionally, our federal and state politicians need to get serious about forcing electronic medical record companies and hospital systems to let patient records flow effortlessly from one doctor’s office to another to the emergency department to the hospital floor to out-of-state sites, especially in Massachusetts. We need a process to evaluate and rate the records, and then entice companies to improve ease of use and functionality, since once a health care group starts using one electronic medical company, it is extremely onerous to switch to another.

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Ordering labs and x-rays could easily occur through a centralized computer center. The tedious and frustrating process of dealing with insurance company rejected medications at the pharmacy can easily be fixed using a computer infrastructure.

Additionally, the Department of Health needs to start asking individual providers how they are doing, and about problems and opportunities. And then get to work finding solutions.

The state also needs to guard against the invasion of Wall Street financial firms buying up physician practices — and a good way to prevent this is to pay physicians adequately.

This article originally appeared on The Providence Journal: Strong primary care benefits everyone: patients, specialists, hospital systems and the payers.