House calls? This doctor really cares

http://www.berkshireeagle.com
Clarence Fanto

The doctor is in the house — literally. At a time when primary-care physicians are scarce, especially in Berkshire County, it is surprising to find one who still makes house calls — not every day, but whenever an elderly patient is housebound, unable to travel and needs medical attention.

Following in the footsteps of the greatly admired and beloved Dr. William J. Carey of Dalton, a genuine country doctor who died April 10 at the age of 75, Dr. Andrew Schamess opened a single-physician practice, Lenox Internal Medicine, a year ago in a strip mall on Routes 7 & 20.

During a coffee break recently following his daily rounds at Berkshire Medical Center, Dr. Schamess explained why he is swimming upstream against the tide of corporate medicine, with treatment decisions being overseen by insurance companies and patients typically squeezed into 15-minute time slots.

“I’ve always been interested in doing things the right way rather than making money or doing things that are professionally advantageous,” he declared. “I feel like medical care is becoming very fragmented. People show up in a doctor’s office for a problem. Oftentimes they don’t see the same doctor twice, they’re seeing someone they’ve never met, if they go to a hospital, they’re seeing somebody else who’s not their primary care doctor. They see specialists, and everybody looks at them and does their own particular piece of the job. I know so many patients coming out of the system having had a million tests, a million office tests, and still with no idea what’s wrong, and nobody who’s sat them down and listened to their problems and answered their questions.

“I always was trained in the idea that the central theme of good primary care is the doctor-patient relationship. My feeling was, in a solo practice, I can foster that relationship; anybody who comes in the door, they’re going to see me, because I’m all there is. If I want to stay open late and see patients because they need to be seen late, I’ll do that; if I want to go to somebody’s house on the weekend to see them because that’s what they need, I’ll do that, and if they go to the hospital, they’ll see me. It is definitely bucking all kinds of trends; whether it can work is another question. It is a big experiment.”

Dr. Schamess, 44, started the practice to provide holistic, comprehensive primary care to South Berkshire, which is a federally designated rural underserved area. He renovated an existing building in a town that had no general practitioner.

As an internist who earned his medical degree at the University of Massachusetts Medical School in Worcester, his résumé includes four years at Dalton Medical Associates and a term as the medical director of the skilled nursing facility at BMC during 2003. As a passionate advocate for upgrading community health care, he has published articles and has served on numerous professional organizations and boards.

According to preliminary results from a survey conducted last spring among 79 area primary-care physicians by the American College of Physician’s Berkshire chapter, nearly half of the 66 respondents are “somewhat or very dissatisfied with their primary-care practice, 91 percent would have reservations about or would recommend against others going into primary care, and 46 percent have already reduced their clinical hours or are looking to get out.” All of the doctors participating in the survey have reported difficulty in finding qualified new primary-care physicians to join their practices “consistent with the startling disappearance of medical students and residents interested in primary care.”

A typical day for Dr. Schamess begins with 6:30 a.m. rounds at BMC, and he gets out of his own office 12 hours later, at best. That is on weekdays; many weekends involve on-call duty and wee-hour trips to the emergency room to care for patients.

Dr. Schamess figures his typical workload is 80 hours a week. With a family that includes his wife, Rebecca, an author, and 3- and 5-year old daughters, there is obvious sacrifice involved.

Nevertheless, he asserts, primary care is “what’s needed, and it’s where you can really make a difference. Economically, it’s very questionable, and if I had somebody going into medical school, it would be hard for me to say, ‘Go into primary care,’ because it’s hard work, long hours and everything comes back to you … and the pay is terrible. Honestly, this is no way to make a living, the hours that I work. But what you can do for patients as a primary-care physician is amazing.”

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