Dr. Andrew Schamess is one of three major primary care physicians either leaving the area or cutting back services, causing thousands of patients to
Dr. Andrew Schamess is one of three major primary care physicians either leaving the area or cutting back services, causing thousands of patients to scramble for new providers. (Ben Garver / Berkshire Eagle Staff)
Saturday June 16, 2012

As three major providers of primary health care in the county prepare to close or scale back their practices, solutions are emerging to help prevent a mad scramble for an estimated 6,000 patients or more seeking new general practitioners.

Choices are limited, only a few practices remain open to new patients, and at some, insurance such as Medicare or state-subsidized Commonwealth Care are not welcome because their payments are lower and slower.

Wait times to see primary care physicians have increased to several months at some practices.

The Massachusetts Medical Society, in its most recent annual Physicians Work force Survey, described the shortage in Berkshire County as severe to critical, not only for internal medicine and family medicine -- primary caregivers -- but also for neurosurgery, orthopedics, psychiatry, urology, general surgery and dermatology.

Two internists at the 12-member Berkshire Medical Group in Pittsfield -- Dr. Noel Blagg and Dr. Harry Hartford -- are in transition to retirement and reducing their primary care patient loads.

"Unfortunately, only a few of the physicians have the availability to accept new patients," said the practice manager, Anne Shurtleff.

"We continue to actively recruit for primary care physicians and nurse practitioners as we have for the last year," she added. "But we continue to find it very challenging to fill those positions."

Suburban Internal Medicine in Lee, another practice still open, is filling up rapidly. No central resource listing physicians still accepting new patients exists on- or offline.

Dr. Andrew Schamess, who opened Lenox Internal Medi cine on Route 7 & 20 nearly six years ago and now has 2,730 patients, is relocating to Ohio, primarily for family reasons. But an announcement is likely soon that Community Health Programs (CHP), a federally subsidized family practice, will take over the facility, Schamess told The Eagle.

At Berkshire Health Systems, one physician is leaving Hill crest Family Health in Pitts field, but an experienced primary care doctor has been recruited to begin in Septem ber, said Thomas Romeo, vice president of physician services at BHS. Efforts to hire two new internists to replace departing doctors at BHS's Fairview Hospital facilities in Great Barrington are continuing, he added.

Citing a "dramatic national shortage" of primary care physicians that hits rural areas like the Berkshires especially hard, Dr. Gray Ellrodt, chief of medicine and director of the Internal Medicine Training Program at Berkshire Medical Center, said "we've had great success in recruiting primary care physicians."

As a community, he noted, "we've been in a primary care hole for quite a while, so we have a major problem in supply and demand. We have specific challenges in the Berk shires -- an aging population of patients and of primary care physicians. That's a bad combination."

Ellrodt pointed out that many general practitioners approaching retirement here came to the Berkshires when primary care was in its heyday in the 1950s and ‘60s -- "but that changed dramatically starting in the ‘70s and ‘80s. Now, older physicians want to cut back and there's no source to fill those positions. Any rural area is going to be hit hard."

Romeo explained that an intense recruitment effort, not only on behalf of BHS but also for independent practices around the county, has brought more than 200 physicians -- generalists as well as specialists -- into the county over the past 10 years.

He also cited BHS's hospitalist program, which employs primary care physicians at BMC, reducing the need for outside doctors to see patients who are being treated at the medical center. Romeo said BHS practices may be restructured to bring in more mid-level providers such as nurse-practitioners.

"We don't think of the shortage as a BHS-BMC issue," said Ellrodt. He noted that some of the 200 new physicians have been helped to start their own practices.

"We think of this as a community challenge and opportunity," he added. "We don't care where the primary care physicians are as long as they're high quality and ready to practice." The goal is to bring in physicians of comparable stature to the "outstanding quality of primary-care physicians we have."

His internal medicine training program reaches as far down as high schools to begin the process and to broaden the appeal of primary care to potential doctors.

"We're trying to identify people who want to stay in the community, and we actually have some high-school programs, summer college and pre-med programs to bring people in and expose them to the various aspects of primary care," he said.

As Dr. Schamess prepares to relocate to Columbus, Ohio -- where he will research policy issues and design a home-care program as a faculty member and team leader at the Ohio State University School of Medicine -- he explained that the catalyst for his departure is the declining health of his mother-in-law. (His wife, Re becca Flowers Schamess, is a writer; they have two daughters, Jane, 10, and Nophie, 7.)

"I set out to prove that it was possible to do a very old-fashioned sort of primary care," he said, "based on a relationship with the patient, on listening and communicating that you care, having sound diagnoses, a sound, conservative strategy for treating them and merging that with technology."

From the start, house calls were part of his mission-- "I'm very determined to go out there, and it's one of the more satisfying things I do." In return, he said, his patients, though saddened by his departure, have voiced gratitude over his highly personalized approach.

But financially, Schamess acknowledged candidly, his solo practice produced only marginal income.

"I managed to keep it going, I never missed a payroll and I did manage to support my family, but there's a lot of debt. We had to borrow to keep things going," he said.

He wondered whether he could have run the business more effectively; however, "what we as a society want from primary care physicians is one thing, but the way that we pay them is a totally different thing."

"Honestly, lying down on the highway with your hands tied behind your back is a better business model than primary care," the doctor said.

To reach Clarence Fanto:
cfanto@berkshireeagle.com,
or (413) 496-6247
On Twitter: @BE_cfanto

Key survey findings

The 10th annual Massachusetts Medical Society study of the physician work force confirms severe to critical shortages in Berkshire County among the following practices: internal medicine, family medicine, dermatology, general surgery, neurosurgery, orthopedics, psychiatry and urology.

The survey found that physicians are not only working long hours but also are spending considerable time on administrative activities -- "taking precious time away from delivering care to patients," as the 90-page report put it.

Some other key findings:

n Physicians work 53 hours a week, on average, statewide -- 35 of which are spent on patient care, the rest on administrative activities and related responsibilities. But 38 percent of the physicians surveyed work more than 60 hours a week.

n A majority of physicians are dissatisfied with the trade-off between patient care and administrative tasks (53 percent in 2011, up from 44 percent in 2009).

n 42 percent of the physicians surveyed are dissatisfied with the current practice environment.

n 20 percent find their salaries uncompetitive with colleagues in other states.

n For fear of being sued, one-half of primary care physicians and specialists, and one-third of pediatricians, have altered or limited their practice.

n Use of technology to improve efficiency and patient care is supported overwhelmingly: 83 percent of physicians surveyed are connected to electronic health records; two-thirds are connected electronically to academic teaching hospitals.

Source: Massachusetts Medical Society survey of 1,081 physicians plus 868 medical practices statewide.