It's nice w BZ Radio.
Well, we had a guest with us a couple of weeks ago who's joining us now for an hour to take some phone calls as well as to continue our conversation. Delighted to be joined again by doctor DEEB. Salem. I pronounced the last name correctly, doctor.
Just like they all right, thank you very.
Much, Senior vice president for Academic Integration and Tough's Medicine, former cardiologists and share of the Department of Medicine at Tough Medical Center. And we're talking about the Physician Pathway Act, which is now law in Massachusetts, assigned into law by the Governor in November. And what that piece of legislation is intended to do is to make more available more doctors. And I'm assuming prime merely you know PCP primary care
physicians available in Massachusetts. I think doctor Salem, you and I can agree that it's that that Massachusetts is the medical capital of the universe. I mean, people from all over the world come here to be treated at some of the great institutions that we have. We can agree on that, correct.
That absolutely, and the medical care in Massachusetts is probably the best in the country.
I'll say it's the best in the world because I see all of these folks from various and sundry points across the globe coming here for either special surgeries, special operations, or to be treated generally. And I think that the proof exists right there that people are not oftentimes you know, the the most influential and the most wealthy, and whether they're you know, singers, you know Adele or some of the singers who have had throat problems, or whether they
professional athletes or actors. We are the mecca for top medical care in my opinion. But the downside of that is that there are a lot of people in Massachusetts who are having a very difficult time finding a family practitioner where we call you know, family doctor PCP. Why, first of all, what's the problem with what cause has caused that problem? And then we can talk about what, hopefully the Physician Physician Pathway Act will do to solve or maybe at least alleviate that problem.
Yeah, hopefully you can alleviate it. The problem is multifold and it's happening all over the country. Uh. One, the population has gotten older, and the older you get, the more often you need medical care. Two, not enough physicians are going into primary care. When I was chair of medicine, early on, we had a large percentage of our doctors and internal medicine go into primary care. As the years go by gone by, we saw less and less doing that.
Why is it? It turns out that these days, the graduates of medical school often have a huge debt, and primary care in general is paid less than specialty care, and so more and more of the physicians to get it coming out of medical schools all over the country are not going into primary care. And that's really the thing. And I think I mentioned most time, it's gotten so bad that I have physicians calling me up asking me to help them find the primary care doctor in Massachusetts.
Well, there's nothing that I heard in our interview before which emphasized so clearly the problem. When you mentioned that there are doctors who obviously need to have a doctor for themselves, and they don't want to be the doctor for their family. They're looking for a family practice or a primary care physician. And this is a horrific situation. Is it worse in Massachusetts than other states around the country, Because I'd always thought, Hey, the places that don't have
doctors or places like Montana or Mississippi. Massachusetts, we have plenty of doctors. Is it just gotten worse everywhere or is it now just hitting Massachusetts.
I don't have the statistics, but I think it's as bad here, particularly outside of Boston in the rural Massachusetts. I don't think it's much worse anywhere else that I know of. Now.
There have been, you know, movies, and I think of, you know, like the movie Field of Dreams where the baseball player has one opportunity to play in the major leagues, but he goes home and is a lifetime doctor in his small town in Minnesota. Was in Field of Dreams, doctor Graham, And you think when you were growing up, I think anyone who thought for a moment they could be a doctor, there was sort of a romanticism involved that you would be a doctor in a small town.
You would know everyone in the town, you would be the most respected person in the town, you would tend to people in the twilight of their lives, and you would bring children into the world. And it was sort of what small town America was. But that apparently has gone away. So what I want to do is the physician act that we're talking about tonight, which the title of is the Physician Pathway Act is intended to remedy
this situation. Uh, it's just gone on the books, so it's not we're not going to have an overnight fix, but hopefully it will have over time a benefit, a benefit to the commonwealth. Instead of you starting to answer that for me right now, doctor, because I want to get a real thorough answer from you, let's let's just take a break. I have to take a news break in about a minute. Anyway, we'll take the break a
little early and we'll come back and we'll talk. Now we've outlined the problem, and now let's talk about the solution. Is that okay with you?
That's that's fine. I have plenty of times.
Yeah, I just don't want to interrupt your thoughts. And if if you have had problems, I'm finding a doctor here in Massagers our name of where our program is being heard right now, please give us a call. I I know I went through this if few years ago and it was not an easy task. I had a doctor for thirty five years who I revered fellow by the name of doctor Alan Cole. He had a practice in Natick. He was just an incredible, incredible human being and uh, you know, an incredible doctor. He you know,
I miss him to this day. But he got a little overwhelmed with a lot of the paperwork and also the onset of COVID and had reached a certain point in his life where he wanted to spend time with their grandchildren, which is understandable. We'll take a quick break if Alan, if you're listening tonight, I can't tell you how much they thank you for the care that you've provided me for thirty five years. Just an extraordinary physician.
Going to be back on Nightside, Uh, if you like to join this conversation six one, seven, two, five, four ten thirty six one seven, nine three one ten thirty, we'll be back on Nightside with my guest, doctor DEEB. Salem has an extraordinary career associated with Touft's Medical School, and we're going to talk about this Physician Pathway Act. And obviously there's some other solutions that I think doctor
Salem knows I'm very interested in. We'll talk about those as well, and from your solutions in addition, back on Nightside right after this.
Now back to Dan Ray Live from the Window World, night Side studios on WBZ News Radio.
All right, we are back and with me is my guest, doctor Deep Salem, Senior vice president of Academic Integration and Tough's Medicine, former cardiologist, chair of the Department of Medicine and Tough's Medical Center. Quite a resume, Doctor Salem, explain, if you will, the idea of the Physician Pathway Act, and is this legislation a piece of a legislation that is in effect in other states or is this a piece of legislation that is specific to Massachusetts.
I believe that there is one or two states that are trying this right now. One is Tennessee and the other is somewhere out west. So this is fairly new. And the problem is that the issue is that a number of physicians sometimes are forced to leave a country or come here because of political issues. And they may be excellent physicians, but are not able to get a medical license now unless they spent three years in a
residency program. And if you're you know, forty five years old and you have a family, you're not going to try to find the residency. So this I got involved with this through the as Medical Society and Governor Baker put together, a bunch of us together, including someone from the Board of Registration of Medicine, to say, what could we do to take physicians that know what they're doing, that are very experienced, and give them a pathway to
get a license in Massachusetts. That's what it's all about. We worked almost a year putting this together. And actually when we had the white paper sort of come out, it was the time that Mara Heally was becoming governor and I actually called her before she even started because I've known her and I told her about this and she got excited about it. So it's the nice thing about this. It's a bipartisan effort to help in this physician shortage issue.
Okay, now, what do you think realistically, if this is not going to happen overnight, how quickly do you think qualified physicians from other countries around the world either they have decided to come here. We don't want to obviously rob second and third world countries of their pool of their physicians pool. How much of a I guess, how large a group do you think we could eventually get on an annual basis? Are we talking about double digits physicians?
Twenty thirty four of you we're talking about a large album.
I'm thinking maybe close to one hundred, but I may be over excited. I guarantee you you can find, at least in our hospital. I've run into two physicians from foreign countries that are working as lab technicians to earn a living. And so I think you scan the Massachusetts or even outside of Massachusetts, you'll find that there are physicians that can't those have a license and will give anything to get one, and so they're around so known.
Yes, would there be more academic requirements or some sort of a test that these physicians who would present themselves as potential, you know, participants in this physician pathway program, that they would have to do something above and beyond just saying I am already licensed to practice in Lincolnstein or or Libya or wherever, and I want to just picking two countries that came to the top of my head.
I don't know why Lickenstein and Libya other than the fact that they both begin with the letter L. What have they got to do?
Once I think the I'm sorry, the qualifications would first be coming from a recognized medical school. Uh and you know so it the Board of Registration has a good idea of medical schools all over the world that are very,
very good, and that's number one. Number two, that the exams that they would have to pass the same way that our physicians are going into practice have to pass UH to get a license in Massachusetts, So that those two things are qualifiers, and they have to show that they've had experience, and the priority is for doctors that are going to be in primary care now UH, so that that will be in your You're right, it's not
going to happen overnight. I'm guessing it will take us about a year to get this going, and we're starting now to talk to see how we're going to The implementation is going to be interesting. But I'll just give you an idea of primary care doctors these days take care of maybe about fifteen hundred to two thousand patients. So if you think of it that way, the more
we have that will really help. It's not going to cure the problem, but if you're doing a thousand to two thousand patients at a time, you're helping a lot of people. And again, we're the focus on putting these physicians in areas that are underserved now, not in Boston, but you know, go in the more rural areas. And
the magic about this too. Let's say the physician is Hispanic, Well, put that person in an area that there are a lot of Hispanic people, then they're not only going to be doing a good job, they'll be doing a better job than people like myself who don't know the culture well and their language issues. So that's some of the nice things about this.
Okay, so let me ask you this as part and parcel of this. This is a state action by Massachusetts. How does this interact with the federal government? Are they given a visa and a pathway to citizenship if you're asking a physician from again, whatever country will stick with Lithuania, allows, we'll stick with the l theme here. Are they given a promise of if they want a athlete a citizenship and that can only be done I assume by the federal government.
Yeah, so that's not we have not looked at that. We've looked that this is set up now and they go in the future, But it's set up now for physicians that are already here and are already have citizenship or there. We're not into that now. It becomes if we become more desperate. That may be something, but none of the discussions I've been involved with have talked about that. They'd have to be people just like the people I've run into in our own hospitals that already have they're
working somewhere. Often they're working in some medical related issue. Some of them have actually didn't come nurses or or something else. But there are some that are working totally outside the field of medicine. But they have to already be eligible to stay in the country before this happens.
Yeah. I've been told by a friend of mine who has spent some time recently in being hospitalized, and she happens to be a former nurse, that she has met nurses in some of the facilities in which she's been treated, in which the nurses disclosed to her that they had been physicians in their homeland and they had come hard.
Yeah, well, they should be very happy. I love hearing that because it just tells us that there is And by the way, it's a shortage of nurses too. As this moves on, I think they'll be a move to do similar things for other health workers that have come to this country and can't get licensed now.
I don't want to just for a minute or two, and I want to talk about this more, but I also want to take phone calls. There are hundreds, literally hundreds or maybe thousands of Americans young people who are studying to secure medical degrees at countries literally all over
the world. Many of them in places like Antigua, Aruba, Belize, Cayman Islands, Curroso, Dominiqua, Guyana, Montsaret proably not Monsret because they had a tremendous volcanic eruption, Saint Kitts and Nevis, Saint Lucia, Saint Vincent, These are all in the Caribbean. These are some of our best and brightest who are bringing their medical degrees back from some very distinguished offshore
medical schools. Now, I know when we spoke last you told me that there's no room for these medical UH school graduates UH to be placed in a residency program. But that is a pool of people who I think we need to somehow incorporate into this They are not obviously focused on the this Physician Pathway Act. What can what can the medical societies here in America do about those students who maybe weren't able to get into Georgetown
or UMass or Boston University or TOPS. But they've gone to to Saint George's or Saint john some of these these schools in the Caribbean and elsewhere and are coming home with medical degrees.
Uh So that's a great question. But I will add to this UH that there are thousands of qualified uh people in the United States that uh and get into medical school. They're not foreigners. And by the way, many years ago, my sister describe what my sister did by my family. My sister and I were born in this country. Our parents were immigrants from Lebanon, and my sister couldn't get into medical school in the States in that era.
She went to the American University of Beirut and then came here and got a residency.
Uh.
So the point is it is a great limiting factor. There is not enough residency capacity to train more physicians in this country. And that the capacity. The medical schools loved to get more students because you know, the tuitions are pretty high, seventy thousand dollars a year. The problem
is to matriculate a physician, it's not just bookwork. They have to have a medical school, they have to go into a hospital, and be taught how to take care of patients, and that's usually in the third and fourth year. There are not enough teaching hospitals to support it. One of the needs we need to consider in a test.
For example, we have two community hospitals and one of them we're hoping to build it up to have the capacity to take medical students and if they if we do that, our medical school could have bring in more kids.
What happens to if I could ask doctor and then I get a break for news herein let me ask you the question and you can formulate the answer during the news break. My question is what happens to these American students who have graduated, sometimes from some of the greatest colleges in America, they're not able to get into an American based, US based medical school. They go off and they get a degree from some really fine medical schools. I assume and I know that some of them end
up practicing here. Maybe you can tell me. I mean, there's you know, Saint George's University School of Medicine or Ross University School of Medicine. These are all schools that you're familiar with, and they may not be toughs. They may not be Harvard, they may not be Boston University, they may not be Georgetown, but there's still great medical schools and some you know as well as I do someone they hone their craft, and I just want to make sure we don't miss this pool of potential physicians.
So I'm going to ask you that question when we come back right after the break here the bottom of the hour, and then we're going to get to phone calls and if you like to join the conversation and sill have a couple of open lines at six one, seven, two, five, four to ten thirty or six one, seven, nine three
ten thirty. We're coming right back with my guest, doctor DEEB. Salem, who has been at TOUGH for many many years, retired cardiologist, and he is trying to do something about getting more doctors available for all of us, as all of us every day get a little old, get a little older, a day at a time. Back on Nightside, right after this.
Night Side with Dan Ray on WBZY, Boston's news.
Radio, doctor Deeve Salem is with me and we are talking about what's called the physic the Massachusetts Physician Pathway Act. I just don't want to see the American students doctor Salem, who at the age of twenty three or twenty four go away to get a medical degree, forgotten about in this process. I and I hope that the leadership of the Mass Medical Society of other important groups remember these young people as well. That's that's my place.
So Dan, we do, I guess have to correct something. If and of my patients are listening. I still am seeing patients. I have a big one of tomorrow. I don't want them to free streak out.
I'm sorry, I I what was written for me was that you were a retired cardiologist. And if that is not so.
Uh yeah, I used to be chief of Cardiology. I retired that what I retired of is a lot of the administrative things.
Okay, so you're you're a current practicing cardiologist. My apologies and uh apologies, thank you for the correction.
Uh so the one you know, as I people that go outside the country, UH will compete to get residencies. The whole trick to getting the license is to get the residency in the United States. So the places you mentioned when I was chairing of Medicine, we would have we'd see Americans that had gone to couldn't get into medical schools in the US, go to a school outside the US show us that they're often brilliant people. It's just hard to figure out how they didn't get into
medical school. So they apply for residencies with everybody else. And so most teaching hospitals will have a percentage of their students whether they're Americans or not Americans apply for their residency. So that's how it's done. Main step is the residency.
I think that you and I know that all the greatest doctors in the world didn't go to the same single medical school, and that all the greatest baseball players didn't go to the same school. People mature and develop at certain ages. And I know that the best lawyers in the world that I know of, all of them went to different, you know, different law schools, and some of them went to law schools that you might say, well, you know that maybe wasn't quite Harvard, or there were
others that you know have done very well. So people mature at different agents. Okay, let's go to phone calls from my guest, doctor Dee Salim Salem, doctor Deep Salem. Let me go to Larry and Dennisport first, Larry first this hour and nice side welcome.
Thanks for taking on call, Dan and doctor. I'm not sure if this would be a solution to help the problem, but I've been going to the same I had the same doctor for over twenty years over in Cambridge. It was integrated medicine, had acupuncture, chiropractor, had everything. And when my primary he was getting ready to retire, he had a nice young woman sitting in who was actually a PA. And from what I understand, if in Massachusetts, as long as there is a MD in the practice, a PA
can become your PCP. And she was excellent. Unfortunately only last of the year, moved on to bigger and better things and I finally got a new doctor after two years.
But let's see if you're corrected that assumption, Larry. I'm not going to cut you off. Let me just see if that's if that is accurate, Doctor Salem.
PAS and nurse practitioners play a very big role, but there is uh, there's no way right now, and I actually would be totally against it that they are the sole caregivers. A lot of doctors can see more pay when they have a nurse practitioner and a PA with them. But uh, the chance of errors. Uh. And uh it's greater uh if there's no physician backing up and saying what's going on. And I can give you lots of stories about that. Uh. Tufts has a very strong PA school.
Uh and uh we said, people they're they're they're they're precious and they're earning greater salaries and we would have expected. So they play a role, but they can't be the sole caregiver. They have to have some backup.
All right, answers your question.
No, No, I was just gonna say, yes, I agree with the doctor. And the nice thing about at the Marina Center was the PA was the person that I would go into, but there was always a doctor there for her to consult with. So it was just a thought. Okay, subject, Thank you so much.
Take very quick break back with my guest, doctor DEEB Salem of Toughts Medical School. Right after these messages.
Now back to Dan Ray live from the Window World Night Side Studios. I'm WBZ News Radio.
My guest is doctor Deeve Salem of Tufts Medical School, and we're going to Jane and Shrewsbury next. Jane, you were next on Nights.
I welcome, Hi Dan and doctor Salem. I just wanted to say, I remember before COVID, the medical industry defeated the ballot question to have more nurses. And I was also really disappointed when it was on sixty minutes that the NYU langone Medical was going to offer free tuition to all students with no obligation to do any kind
of public service or primary care. And I contacted a medical ethicis professor there and he said, well, maybe they'll do it just out of the goodness of their heart, which doesn't make any sense.
So I'd like.
To about correct me. I are you in the medical field yourself?
No, I'm not.
No, Okay, fine, okay, I may have you mixed up with another call, but go right ahead, as you have a question.
I'd like to hear if doctor Salem could comment. I think there's at least fourteen medical schools that offer free tuition, and I really think there should be a commitment back for service.
Well, I don't know that number fourteen. In my experience, there are not many schools the way that at NYU that happened was a huge donor. The school teaching medical students is very expensive and so unless you have a huge endowment or you have a donor that gives you the money to do it. Our medical you know, tough charges. I think it's you know, close to seventy thousand dollars and the school barely breaks even in terms of all
the expenses there are in doing it. I uh, you know, when I graduated with I thought I had to take loans to get through medical school. But if you looked at how it was pennies compared to what these four kids have to go through. So there there's uh, there're state school Uh that uh the tuition is lower, my hew, massive tuition is lower than the other three medicals. Uh schools. But uh it's it's not anywhere. There's here and that there are some uh ways that people people can get
medical schools often weigh some money. Uh the people that have no money and and they give them loans and they have scholarships.
Uh.
We need more nurses and we need more doctors. There's no question about about that right now. And we need more pas Salem.
I think you might have misheard me. I was saying I think they should have an obligation to do some sort of public service if they're getting free tuition.
Uh, but how happy you do it? How can you force someone to do what they don't want to do.
It's not a.
Bad question, but if your heart's not in it, that's that's not But there are also shortages in other areas. UH, in specialties too, But.
I don't know. You know, you may had something if the sense would support UH people going into medical school pay their tuition.
And then say that you have to have for X number of years but this primary camp. But what happens, though, is then they don't go on to become specialists. There needs to be some money put into this to help solve the problem.
All right, Jane, thank you. I got a couple other calls, Jane. I'd like to sneak in here if I can. I think that doctor Salem has responded.
Thank you, Jane, Thank you.
All right, Hank in New Bedford, I'd love you to be quick for me so I can get Daryl from from New Brunswick and go ahead, Hank.
Sure.
I just want to comment about the difference between Boston and the so called rural other areas of the state. I live in New Bedford, Fall Rivers, almost a mirror community. That's two hundred thousand, and if you're take in the metropolitan areas, it's three hundred thousand people. You can't get a primary care around here. And it's very easy to verify that because it's just a few corporations control all
the primary care positions. It's just one call to make you get put on a list, and when your name comes up, you don't have any choice about who it is. You get who you get. Maybe the doctor would comment about that, well.
Well, I smiled, because I trained a number of physicians over the years that practice in that area. And there's some and I won't mention them, but there's some fabulous physicians. We train, both primary care and cardiologists. Every area is affected, Every area is affected. You have a high belief of Portuguese population in that area, and it would be nice if there were some physicians that would speak their language, if from Brazil or so there it's there's no it's
in Boston. Let me just go right down to the meat of this. In Boston, it is hard as hell to get a primary care doctor. UH. So all the areas are there. UH. The people that will come out of this program will hopefully end up in the UH.
The Uh, the areas.
That need the most help, and they're often the programs that are part of a hospital. They're just care areas.
Uh.
You know, we need a lot, a lot of more physicians right now.
No question, no question, Hank. Thank you for your question. I appreciate you. Thank you very much. Bye, Darryl. I got about a minute and a half for you. You got to be quick for me.
Pal go ahead, Darryl, Doctor Saloman Dan, great topic I'll go to. Even as a veteran, when I was looking for a physician, we had people from different countries not liking you because you smoked, and but at the same time, being deployed, you worked with physicians from other countries. And I had people from other countries as my physician for the last twenty years. And so therefore expedition of helping these people get to what we need is.
Cool. Yep. I think you're right in that you shouldn't be smoking now. General. I'm sure doctor Salem will tell you that, and I tell you that too.
Okay, I will take that under advisement.
All right, thank you, I'll talk soon. Really flat, Thank you very much, doctor Salem. I appreciate your time tonight. I just have a big advocate as you. As you know, I kind of let that go a little bit tonight, but a lot of good information from you. This was my easier time to do this, and we should do it again. We didn't have the pressure of the eight o'clock hour where we're limited to just a few minutes.
You've explained it well. I think we've explored the issue the topic very well, and we'll get back to it again. Thank you so much for joining us tonight, and best of luck with your clinics tomorrow.
Okay, thank you, and I enjoyed this a lot to thank you.
Thank you very much, doctor DEEB. Salem, amongst other things, tough Medical School, Chair of the Department of Medicine at Toughts Medical Center. When we get back, we're going to talk about a Boston City councilor who's in a heap of trouble under federal indictment. Should Tanua Fernandez Anderson resigned? I think, in fairness to her, she should, and I'll explain my feelings on that right after the ten o'clock news here at night Side