Five Questions With: Dr. Michael Fine

Dr. Michael Fine, a leader in Rhode Island’s primary care community and chief physician officer of Hillside Family & Community Medicine in Pawtucket and Scituate, retired from his practice effective last Monday, leaving 2,700 patients to be cared for by other doctors.

Fine answered questions about his retirement, his plans and the health care system as he sees it.

PBN: How long have you practiced medicine, and what made you decide to leave active practice now?

FINE: A couple of things. I was tired. I’ve been working 16 to 18 hours per day for 15 years. I needed a break. I wanted more time to work on HealthAccessRI, which has attracted national attention and needs more attention from me, including lots of travel. Then, I’ve been working really hard to convince the state to build a primary care delivery system for a very long time – and I just don’t see that change on the horizon. … Plus medicine is a second career for me, after writing. When I started, I promised myself I’d do it for 25 years and then take a break; 25 years was four years ago. And finally, I thought about some of the arguments in my own book, “The Nature of Health,” particularly the observation that the U.S. health care system is a wealth extraction system, which has nothing to do with health. I wanted to do some thinking about how many good people got so far off the track, and how we can create a health care system that delivers health instead of making it impossible.

PBN: How much has primary care changed in the time you have been practicing?

FINE: It’s much more stressful, much more confined, with much more paperwork and bureaucracy. I used to write perhaps one prescription for each patient, one or two for people who are sick. Now everyone is on six, and each medicine needs two prescritions, one for the local pharmacy and one to mail away, and a certain number are denied by the insurance company, so it becomes my job to get a prior authorization. Half of these medicines probably don’t do much, and some are harmful. It’s way out of control.

I am also graded and judged on lots of stuff that doesn’t really matter, like microfilament tests for diabetics. I do it, but I never found it gave me new information I wouldn’t have had from talking to the person and listening to the answers.

PBN: You’re a big advocate of strong, comprehensive primary care. Can that still be done in today’s environment? Would you recommend primary care to a newly graduating doctor?

FINE: We have a chicken and egg problem. I don’t think primary care is going to be any fun until we have built a strong primary care infrastructure, and we can’t build a strong primary care infrastructure unless people chose primary care. I think the only way to break this open is to really put some focused attention onto it at either the state or national level.

PBN: Looking ahead, what are some of your plans and priorities?

FINE: I’d like to write a couple of books, and build HealthAccessRI into the disruptive innovation it can and should be. Once we find a way to package it with high-deductible major medical insurance, it will break the market wide open. We’ve got lots of national attention, so I’m going to be doing lots of traveling and building. I also want to spend some time in D.C. and work on a white paper about the role of the primary care and the delivery system in health care reform.

PBN: What are you looking forward to the most in your new life, and what do you expect to miss the most?

FINE: Miss the most – the people I love. I am looking forward to having time to think and write, to speak and listen – and to having fewer meetings about stuff that doesn’t matter.