On a typical day, staff at Wiscasset Family Medicine field maybe 200 calls a day. On Tuesday, it was closer to 500, and almost all callers had the same question: When are the vaccines coming?
“They are scared, frustrated, angry, confused,” Dr. Cortney Linville, the practice’s lead physician, said of her patients. “They see that people 70 and older are getting vaccinated this week but no one knows the rhyme or reason. So they ask us, but we don’t have vaccines at our office right now. And there is no secret back door number for us, no way to get even our most needy patients in the door.”
Many Mainers – older and more rural residents especially – funnel their health needs and questions through one person: Their primary care doctor. But many family practitioners like Linville say they feel sidelined by the state’s efforts to move into Phase 1B of COVID-19 vaccination efforts, which involves targeting older residents who are most at risk of dying from the virus.
“If small practices are going to be included, we need information on amounts (of vaccines) and dates of delivery,” Linville said. “But we’ve had no contact. Even if the answer from the state is ‘You’re never getting the vaccine,’ then I can say, ‘OK, let’s take our staff and put them on phones or find other ways to help our patients.’ We don’t even know that.”
There are about 50 independent primary care medical practices across the state that serve more than 200,000 patients – ranging from larger groups like Martin’s Point and Intermed to one-physician family practices in rural towns.
So far, doses of the approved vaccines by Pfizer and Moderna coming to Maine have gone to the retail pharmacy giants Walgreens and CVS, or to one of a handful of hospitals or major health organizations. Walgreens and CVS have been hosting vaccine clinics for staff and residents of long-term care facilities, although the state recently has stepped in and redirected some of those doses to independent pharmacies.
Hospitals received the first doses of vaccines because it was largely their employees who would be first in line to be inoculated and because they had the capacity to store doses. However, now that the state has opened up eligibility to older residents, some doctors are wondering why hospitals are still the ones handling the vaccines, particularly since many are still inundated with COVID-19 patients.
“We completely understand the immense pressure the (Center for Disease Control and Prevention) is under to get shots in arms as quickly as possible,” said Dan Morin, spokesman for the Maine Medical Association, which represents doctors. “But I think the intent, nationwide, was to get the doses to the locations that were best suited to store the vaccines. What that has turned into has been possession of the vaccine, so these hospitals are pretty much determining the capacity and how they are going to vaccinate their people and their patients.”
State and hospital officials have urged patience during the rollout of vaccines, which has been constrained by the limited supply. And the state also hasn’t had much advance notice about how much vaccine it’s getting each week. Officials announced Thursday that next week’s allotment is actually less than the current week.
Asked Thursday what role primary practices will have in vaccination efforts, Maine Department of Health and Human Services Commissioner Jeanne Lambrew did not offer specifics, saying: “We are hopeful that very soon we will continue to build out our distribution.”
She said state leaders continue to have discussions about how to bring vaccines to local communities while keeping in mind the goals of “efficiency and speed, as well as equity.”
DHHS spokeswoman Jackie Farwell said at this stage the vaccine is most efficient when distributed to health care organizations that “have the staffing, physical space, and cold storage to vaccinate large numbers of people quickly,” but said the smaller providers remain important.
Maine Center for Disease Control and Prevention Director Dr. Nirav Shah said that hospitals and eventually large-scale community clinics are not meant to replace doctor’s offices as vaccination sites but to supplement them. He likened it to a grocery store opening up many different checkout lanes when it’s busy.
Although most hospitals are making vaccinations available to patients regardless of whether they have some affiliation with the hospital or a medical practice under its umbrella, the reality is that many seniors’ first call is to their primary doctor.
Dr. Kathryn Galbraith, who with her husband, also a doctor, owns a practice in the rural York County town of Limerick that serves about 2,500 patients, said it has felt like the state’s announcement about moving older residents into Phase 1B “got out ahead of the logistics.”
“Many of my patients would much prefer to get the vaccine at their own doctor’s office,” she said. “For them, a trek to Portland is a big deal.”
Galbraith said she understands smaller practices might be involved in the future, but wonders, why not now?
“Now is the time we should be helping to lessen the load,” she said. “I may not be able to vaccinate thousands, but I can certainly help with progress on overall efforts. If we were given the opportunity to be involved, I think you’d see a lot rise to the occasion.”
Dr. Scott Schiff-Slater, a physician at Hallowell Family Practice, said his office was closed Monday for Martin Luther King Jr. Day, but that calls started flooding in first thing Tuesday morning from patients with questions like: When are vaccines coming in? When can I come in?
“The answer was: ‘Boy, we just don’t know yet,’” Schiff-Slater said. “But I think we could really help. We know our patients. We could easily give them vaccines if we’re provided them.
“I think the state deserves a lot of credit,” he continued. “But throughout the pandemic, it seems like the CDC has really had a focus on the big health care systems, for (personal protective equipment), for testing and now for vaccines. Primary care offices have been put at the bottom.”
The state also has begun planning for large-scale community clinics to come on line when the vaccine supply increases. But even that is being coordinated through major health networks. MaineHealth announced Thursday that it was in a partnership with the owners of the former Scarborough Downs to open a site at the shuttered racetrack.
The Maine CDC’s COVID-19 vaccine website lists 34 sites where those 70 and older can inquire about scheduling a vaccine. Of those, all but two are either a hospital or a clinic associated with a large network, such as MaineHealth or Northern Light Health. The other two are major private practices – Martin’s Point and InterMed.
Even when the state first started getting vaccine doses for health care workers back in December, physicians and staff of family practices were not among those first in line. In fact, it wasn’t until the Maine Medical Association began raising concerns publicly that health care providers who are not affiliated with major medical systems started to get vaccinated.
Similar concerns have played out in other states, which all have been following their own paths in the absence of a federal plan. That could change under the Biden administration.
In a letter this month to outgoing U.S. Health and Human Services Secretary Alex Azar, American Hospital Association President Richard Pollack called for a broader approach.
“Hospitals are committed to be a central part of the vaccination effort, but hospitals alone cannot do it, especially as we care for burgeoning numbers of critically ill COVID-19 patients, and struggle to maintain sufficient staffing,” he wrote.
In Maine, family practitioners are used to giving vaccines, including flu shots. Many even have cold storage freezers.
Linville, the Wiscasset doctor, said the experience highlights what she sees as a long-standing inequity between smaller practices and big health care organizations.
“When push came to shove, there was not a conversation about how to include us,” she said. “At the very least we can provide information about our patients, and no one is asking for it.”
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