Despite Travails, Internist’s Practice Stays Open to New Patients

Richard Dupee, M.D., a Wellesley-based internist and geriatrician whose practice has about 10,000 patients, is among a dwindling segment of primary care physicians accepting new patients.

“It’s a matter of business survival,” explained Dr. Dupee, whose practice accepts several new patients every week, including MassHealth enrollees. “I need to keep [patient] volume up to stay in practice.”

Dr. Dupee also thinks closing a practice to new patients sends the wrong message to existing ones. “If you close a practice to new patients, some existing patients might wonder if you’re too busy to see them,” he said.

Of the many primary care physicians who have closed their practices to new patients (see the 2011 Patient Access to Health Care Study), Dr. Dupee said, “I think they’re interested in maintaining a more 9-to-5 lifestyle.” The same preferences motivate young physicians coming out of residency, “so they become employees, with guaranteed salaries, no nights, and no weekends,” he said.

Dr. Dupee is also an associate professor at Tufts University School of Medicine, where he teaches, among other courses, a small medical ethics seminar. “Most of those students are interested in primary care, but they get discouraged by the attitudes of the primary care doctors they work with who don’t love what they do…I love what I do.”

Having said that, Dr. Dupee is quick to itemize the daily travails of a small primary care practice: time wasted on paperwork and prior authorizations and low reimbursements. Increased pay for primary care may eventually come from savings due to better-coordinated care and stricter adherence to clinical guidelines. But in the short term, Dr. Dupee sees no solution to the pay disparity other than to rob Peter to pay Paul. “At some point, subspecialists may have to realize that some of those dollars will be maneuvered to primary care,” he said.

Dr. Dupee’s practice belongs to the New England Quality Care Alliance, a network of autonomous solo and group practices, IPAs, and academic physicians affiliated with Tufts Medical Center. His experience with payers as part of that alliance has convinced him that “global pay for Medicare patients makes sense.” What about the rationing that global-payment critics warn against? Dr. Dupee said that no matter what the payment or delivery system is, “doctors do not and will not deny appropriate care.”

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