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Massachusetts Health Care Reform Is a Pioneer Effort, but Complications Remain

Jennifer Fisher Wilson
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Potential Financial Conflicts of Interest: None disclosed.


Ann Intern Med. 2008;148(6):489-492. doi:10.7326/0003-4819-148-6-200803180-00029
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On 12 April 2006, Massachusetts introduced health care reform legislation “to provide access to affordable, quality, accountable health care” that became law in a bipartisan vote of 154 to 2 in the House of Representatives and 37 to 0 in the Senate. When then-governor Mitt Romney (R) signed the groundbreaking legislation, Chapter 58 of the Acts of 2006, he declared that “an achievement like this comes around once in a generation, and it proves that government can work when people of both parties reach across the aisle for the common good.” Over the course of the next year, policymakers, stakeholders, and the newly formed Commonwealth Health Insurance Connector Authority addressed difficult issues pertinent to the law while new governor, Deval Patrick (D), who took office in January 2007, provided continued gubernatorial backing.

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A new paradigm desperately needed to correct primary care physician shortage
Posted on December 19, 2008
Edward J. Volpintesta
No Affiliation
Conflict of Interest: None Declared

No one would disagree that there is a shortage of primary care doctors. Various governmental and medical organizations have been saying so for at least four decades. But there has been little serious action taken by any of them to address the shortage. And although health insurers have played their part in primary care's decline because of excessive paperwork and poor remuneration, medical schools too, have played a large role.

Specifically, for the past one hundred years they have been turning out medical scientists, not doctors. Clearly, our medical schools are basically research centers. Their research is responsible for some of the new procedures and medicines whose benefits we all enjoy.

But at the same time their zeal for research has created a medical culture that is indifferent towards general practice. One might call it benign tolerance. The intense focus on specialty medicine and research for all the good it has provided has also created in the health system a bankruptcy of primary care doctors.

One way to get more primary care doctors into the workforce would be to shorten their college and medical school years. The science courses could be shortened and made more practical. Most general practitioners do not need the in-depth concentration on the basic sciences that currently dominates the educational system. More intense focus on the sciences could be offered to those who choose to go on to careers in specialty medicine or in teaching where it is needed.

By tailoring college, medical school, and residency to a practical career in general practice, at least three years could be cut out of the traditional eleven required to produce a primary care doctor.

Opponents will say that lessening the intensity of the basic sciences will turn out inferior doctors. But there is no evidence to support that. Most primary care doctors will admit that the intensity of the demands made by calculus, physics, organic chemistry, biochemistry, and physical chemistry could have been lessened without any serious impact on their later careers as general practitioners.

Clearly a new paradigm for general practice is needed. The old approach is not working and has not worked for decades. Correcting it will require cultural changes in our medical schools and residency programs.

As irreverent and naive as it may sound, shortening the training time for general practitioners and making their education more practical will go a long way to solving the shortage.

Conflict of Interest:

None declared

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