Rhode Island is a difficult market for recruiting primary care doctors, but Providence-based Coastal Medical, which added 10 new physicians Oct. 2, says its comprehensive approach to patient care relieves doctors’ administrative burdens, lets them focus on medicine and gives the primary care practice an edge in attracting doctors.
Coastal, Rhode Island’s largest physician-owned and physician-governed primary care practice, has attracted attention to its accountable-care-organization approach to medicine.
“Coastal Medical Group has demonstrated a commitment to transforming how care is delivered in Rhode Island and investing in their capabilities to manage the health of the communities they serve. We are proud to work with them and help their patients receive better, more personalized, connected care,” said Abraham Berman, vice president of network management for New England at UnitedHealthcare.
“Coastal has been aggressive on accountable care, and has been successful at it,” said Christopher Koller, president of the Milbank Memorial Fund and former R.I. health insurance commissioner.
ACOs organize doctors, hospitals and other health care providers to give coordinated, high-quality care to their Medicare patients. At Coastal, that means assigning each doctor a medical assistant and keeping the physician and various medical specialists up to date on patients’ care with other professionals.
The medical assistants work to keep the patient up to date on routine care such as flu shots and checkups, and reach out when appointments are missed or delayed. If a patient needs to be referred to a specialist, the medical professionals are all in-house, so scheduling is convenient, as is getting the results of tests and updates from the specialists. Pharmacy services are also provided in-house, said Dana Alexander Nolfe, Coastal’s director of marketing, communications and public relations.
“So, it’s really not a problem for them [doctors] to be successful,” said Meryl Moss, chief operating officer at Coastal Medical.
Moss said new physicians are deciding to move to Rhode Island before seeking out the primary care practice. The prime reason new doctors give when making the decision to sign on with Coastal, she said, is the practice’s strong infrastructure – the network of specialists, assistants and in-house pharmacy services that reduce a doctor’s day to patient care and little else.
“They really like that they can do the work that they’re trained for,” Moss said.
Another feature, she said, is continuity of care with Coastal’s 365 Clinic, which provides coverage for patients when a doctor isn’t available. The service assigns one of the doctor’s colleagues to their patients in their absence.
The practice also has a lighter patient-to-physician ratio than the national average. With 120,000 members and 130 providers, Coastal’s average physician cares for about 1,700 people, Moss said. The Medical Group Management Association reported in 2015 the average primary care physician cares for about 2,500 patients.
All of that may or may not be what’s luring physicians to Coastal Medical.
“There’s a market for primary care doctors just like there is for everything else,” said Koller. Perhaps, he said, Coastal is simply able to offer physicians higher pay.
Coastal is competitive on the compensation score, said Jane Hayward, president and CEO of the Rhode Island Health Center Association, who says recruiting new physicians is a tough job.
RIHCA’s nine health center members serve 161,000 Rhode Islanders at 33 locations around the state. Hayward said the health centers all operate on a team-based model, similar to Coastal’s collaborative approach.
“Our health centers have been successful, but it’s a heavy lift” to recruit and retain doctors, Hayward said. That’s largely due to the compensation they can offer opposed to other institutions.
“It is very likely that health centers do not have the resources to pay” on the same level primary care practices do, she said. Health centers compensate for that with loan-repayment programs for their doctors.
“It’s a fight just to be able to recruit and retain,” Hayward said.
Dr. Kristen Hubbard, a new hire at Coastal Medical practicing at the East Greenwich office at 1351 South County Trail, completed her residency at University of Connecticut Health Center, where she said she had a lot of experience with primary care practices.
An attractive feature of working for Coastal, she said, was the support it provides physicians. “I don’t think any other practice is set up and organized so well,” Hubbard said.
What was particularly appealing for her, she said, is the network of specialists and medical assistants who can keep her up to date on her patients that have serious illnesses requiring specialists’ care.
Dr. Matthew Propert, another Coastal Medical physician, agreed the support staff is a deal-making feature. “I was able to delegate the clerical work, the busy work,” Propert said.
He’d known about Coastal for a while, learning about the practice during his residency at Brown University when his wife worked for the practice.
“I was quite impressed. They’re a very well-run organization,” Propert said.
