: : : : : Health Report : : : : :
run health insurance programs for the
poor), and it allows adult children to
remain on their parents’ health insurance plans until age 26.
“There is
nothing I’ve
read in the
law that will
adversely
affect my
patients.
Nothing.”
—David Reuben, M. D.
primary care physician. “Yes, we have
a shortage of doctors, but now everything has settled down and everyone is
getting better care,” says Mario Motta,
M.D., president of the Massachusetts
Medical Society, the statewide professional organization of physicians.
In 2008 the state approved
unprecedented financial
incentives that made primary care careers more
attractive to new physicians and nurses. Class
sizes were expanded at
the University of Massachusetts Medical School, and
tuition was waived for students
who agreed to work as primary care
doctors in the state for four years after
they finished training. Today about 96
percent of the state’s population is insured, the highest rate in the nation.
Patients themselves can play an im-
portant role in ensuring access. “They
should be proactive and establish a
relationship with a doctor before they
get sick,” says David Reuben, M.D.,
chief of Geriatric Medicine at UCLA.
“Planning your health care is no dif-
ferent than any other investment you
make for the future. You want a prima-
ry care physician who knows you and
your health issues, and can guide your
care, including referrals to specialists
when appropriate.”
2. Seeing a specialist—
when you need to
Specialists currently dominate the
medical field—roughly 70 percent of
medical residents become orthopedists, gastroenterologists, or some other
specialist—so patient access to them has
been less of a problem than getting in to
see a primary care physician. That’s not
likely to change anytime soon. “Getting
into a hospital to have surgery is not going to be a problem, because our medical profession is overwhelmingly made
up of interventionists like surgeons,”
says Paul Torrens, M.D., professor of
Health Services at the UCLA School of
Public Health.
As health care reform takes hold, how-
ever, specialty care itself may change.
“We’re going to see changes in how
specialty care is provided, by online
or telephone consultations, or by the
primary care doctor consulting with a
specialist without the specialist actu-
ally seeing the patient,” Reuben says.
“In some managed care organi-
zations and large groups, this
is happening now.”
Telemedicine, as this
type of consultation is
called, is often used to de-
termine whether a patient
in a remote or underserved
region of the country needs to
see a specialist. In urban centers
where specialists are plentiful, though,
getting in to see a specialist will be part
of routine medical care, much as it is
now. And medical support, in the form
of technicians, can take the burden off
specialists, too. (CONTINUED ON PAGE 63)
