Lack Of Doctors, Housing, Seen As Key Public Health Challenges

CHATHAM – In one of four public meetings last week that aim to identify barriers to healthy living on the Lower Cape, two problems rose to the fore: the lack of housing and a shortage of primary care physicians.

Health board member Ronald Broman and his wife moved to the Cape years ago. “We couldn’t find a doctor. And we still have not been able to find a primary doctor,” he said. Like others, the Bromans rely on a concierge doctor; such practices usually provide highly personalized service in exchange for a membership fee, but it’s “very, very expensive,” he said. Many people can’t afford this option. “I think that’s one of the big problems we have down here,” Broman said.

Pat Burke, a counselor with the SHINE program that helps seniors secure health insurance, said she directs many clients to Medicare Advantage programs, most of which require patients to have a primary care doctor.

“They get assigned a PCP and then they never see the PCP. They’ll see a nurse practitioner or physician’s assistant,” Burke said. While those practitioners do a great job, patients often need the care of a medical doctor as they age and their health needs become more complex. When that happens, “it’ll be a doctor they’ve never seen,” Burke said. The problem is regional, not limited to Chatham, she added.

Health board member Richard Edwards moved here and found a primary care doctor at Outer Cape Health Services. When that physician left, he was put in the care of a nurse practitioner “who is doing a very, very good job,” he said. He praised Outer Cape Health for providing a high level of service, and said that people should be comfortable with the idea of getting routine medical care from a nurse practitioner or physician’s assistant.

What is lacking are “medical homes,” which refer not to physical places but to a system of providing comprehensive and high quality primary care, health board member John Beckley said.

“It seems to me, from my perspective, that Cape Cod Healthcare needs to do a better job creating more openings for medical homes,” he said. Beckley said he was a patient in a primary care practice that converted into a concierge medical practice. “Now I’m paying every month,” he said.

While people also report problems getting specialist care on Cape Cod, and sometimes needing to wait months for an appointment, “PCP’s are really the problem,” health board member Noble Hansen said. “When the new ones come, they get sort of overwhelmed with patients and loads, and they seem to be unhappy and they leave,” he said.

“Part of the problem’s housing,” said Edwards, who recently spent time at Cape Cod Hospital. “They have all of these traveling nurses that are coming in and staying in motels and hotels because they can’t hire nurses, because they can’t find a house,” he said. “If you’re a nurse making $100,000 a year, you can’t buy a house,” he said. In places with older demographics like Chatham, most patients are on Medicare, which limits reimbursements to physicians, he added.

Transportation is another barrier to people seeking medical care. Beckley recently had to have surgery in Boston, and while family members drove him to one appointment, he had to hire a limo driver for the second trip. “He had to go up with me, sit and wait with me, wait for me to get out, and then drive me home. Bill? $450. Tip? $50,” he said. “How many times are you going to do that?”

Some at the meeting pointed out that the Cape Cod Regional Transit Authority provides transportation to Boston medical appointments, but that service is not widely known.

Health Agent Judy Giorgio said transportation is a challenge for those who find it too expensive to afford, or for those who lack the mental capacity to arrange it, “even just to get to Hyannis” for an appointment.

With regard to mental health resources, “there’s a lack of psychiatrists on Cape Cod,” said health board member Carol Boyce, who works in behavioral health care. There are resources available for people who are in recovery from addiction, “but if someone is just depressed or anxious, who are they going to go to?” she asked. “So they end up going to their PCP — if they can get a PCP.” And the primary care doctor will likely just write a prescription to address the problem, she said.

In a program authorized by town meeting voters, Chatham has a new behavioral health clinician, Diane Nash, who can assist people with mental health concerns and who also works closely with the police and fire departments and council on aging.

“Everyone works as a team,” she said. While there are psychiatrists in Hyannis who can take on patients, “it’s a process,” Nash said. “You can’t just go there and see a psychiatrist.”

The town is also working to hire its first youth behavioral health clinician, she said.

Substance use remains a key problem in town, with alcoholism a key concern among elders who may be living alone, Giorgio said. Other drugs are also a serious concern, as was highlighted by the recent arrest of an alleged drug trafficker at a Chatham home where two people were found dead, Hansen said.

“I think it surprised everybody,” he said. “I think people are wondering, do we have a problem here? How many overdoses do we have in a year? How much of it is in school? I don’t think people actually know much about it,” Hansen said.

The town has also hired a recovery coach who holds office hours at the police station every Wednesday, and the program has been successful, officials said.

Another barrier to wellness is nutrition, meeting participants said. Beckley said he was surprised to find that dozens of people attended a recent grab-and-go food distribution held by the Family Pantry of Cape Cod.

“I said, holy cow, there are that many people from Harwich, or that many people from Chatham, that show up voluntarily to get a box of food for free?” he said. The Chatham Food Pantry is also very active helping local residents, Edwards noted.

“Ten percent of Cape Codders are food insecure,” said select board member Shareen Davis, who is also active with Fishing Family Support Services. That organization helps people — both fishing families and others — access health insurance and various social services.

Together with comments given at similar meetings in Orleans, Harwich and Brewster, the information gathered at Chatham’s health needs assessment meeting will be used by a consultant to identify key regional public health needs. The towns will then work regionally to develop programs to address those problems, using state grant funds.