Dr. Ira Helfand is well-known locally, and nationally, as a co-founder of Physicians for Social Responsibility.
It’s an organization that primarily works against nuclear war and proliferation, from a medical and social perspective. But I thought Helfand might also have some interesting perspectives on health reform.
Helfand runs an urgent-care practice (and smaller primary care practice) in Springfield, MA. He used to run the Emergency Department at Cooley Dickinson hospital (full disclosure: he treated my son for midnight croupe, about ten years ago. He didn’t remember us, of course…)

Helfand’s clinic is an interesting response to the primary care crisis I’ve been reporting on. It’s a cross between an emergency room, and a primary care private practice. It’s partly a walk-in clinic that will treat any one off the street — so people who have urgent, but non-“emergency”, problems, such as minor injuries, acute illnesses, back pain, etc., can come in without an appointment and get care within an hour or so. Helfand says that frees up emergency rooms for the bigger emergencies, and it’s also much less of a hassle for the patient. Moreover, he offers more continuity of care than ER’s.In fact, he says he actually started to take on some of the walk-in patients AS primary care patients, because so many of them didn’t have primary care doctors already. (And he was very articulate about the primary care shortage, citing the same reasons as my other sources: inequitable pay, huge paperwork and overhead loads, shrinking job satisfaction.) But he says he had to stop taking new primary care patients because that was threatening to eat up all his time, and leave little extra for the walk-in service.

I sat in (with microphone) on one of Dr. Helfand’s visits with a walk-in patient. She was a middle-aged woman named Denise who had been suffering from a very unpleasant stomach bug and was worried she was dehydrated. She actually has a primary care doctor, but his office was so overbooked, they sent her intead to the urgent care practice. Dr. Helfand told her she was probably at the end of the virus; he checked her for dehydration, gave her advice on what to eat and how to care for herself.

Dr. Helfand says urgent-care clinics like his are not all that common in Massachusetts, but they do fill an important gap in community care. He’s adamant, however, that they are not the same as “retail clinics” — sometimes called “minute clinics” — which the state recently approved. Retail clinics are generally urgent care centers set up at CVS or Walmart, staffed by nurses or other para-professionals, for minor health issues. He is very much concerned about retail clinics for several reasons: the staff nurses are not always supervised by doctors and therefore less qualified than his practice; they are subject to fewer regulations than regular doctor’s offices or ERs; there is no continuity of care for patients; and he believes there is a clear conflict of interest when a pharmacy that makes its money off medications is paying the salary of medical staff. He says it’s reasonable to wonder if the nursing staff is under some pressure to prescribe medication….. whether or not that medication is necessary.

So far, no retail clinics have opened up in Western Massachusetts, but Helfand has heard of a nearby CVS that is considering starting one up….

On the broader issue of health reform, Dr. Helfand didn’t pull any punches. “First, kill all the insurance companies.” That’s an actual quote. He is very much a supporter of a single-payer, government run system, and while he acknowledges there could be pitfalls with putting all the power in one payer, he believes the advantages of eliminating the profit-seeking role of insurance companies would far outweigh any negatives. Having said that, he does think that Massachusetts should be commended with working within the current system to get more people covered by health insurance. He sees many of those people in his own medical practicem, and believes health reform probably has benefitted a number of individuals. But as far as system-wide change, the Mass efforts don’t go nearly far enough.