America / ARTICLES

The Boston Globe: “After two decades, there is a doctor in town”

SHIRLEY – The last time there was a doctor in Shirley, George H. W. Bush was president, Michael Jackson ruled the airwaves, and Russia was still part of the Union of Soviet Socialist Republics.

According to Meredith Marcinkewicz, curator of the Shirley Historical Museum, the town got its first physician in 1770, had resident medics throughout the 18th and 19th centuries, and doctors did house calls as late as the 1960s. By 1990, however, the town’s only clinic had shut down and the only medical office left was the dentist’s.

Now the dentist finally has a medical colleague.

Dr. Ralph Spada, an internist who used to treat inmates at the federal prison at Devens, has just opened Sun Medical Clinic at 228 Great Road, next door to the tooth specialist. Spada, who lives in Shirley, specializes in chronic conditions such as diabetes, depression, and heart disease, but he said he hopes to recruit a family doctor or a nurse practitioner to treat children and plans to open a medical lab where patients will be able to get blood work and vaccines.

“We should provide access to care in our community,” he said recently as he talked about opening his practice in a community that hasn’t had a doctor for nearly two decades.

While most Shirley residents travel to clinics in nearby Lunenburg and Leominster, the town’s growing number of seniors will appreciate having a local doctor’s office, said 80-year-old Harold Smith, chairman of Shirley’s Council on Aging. In particular, people who depend on others to drive them to appointments will enjoy the convenience, he said.

“It’s something Shirley’s been waiting for, for quite a while,” Smith said.

According to the 2000 Census, there were 586 residents 65 and older in Shirley at that time, and they made up 9 percent of the town’s population. Those numbers may be much higher today, since there were 478 people in the 55-65 age range in 2000.

“There’s a steady growth because of the baby boomers,” said Ann Towne, vice chairwoman of the Council on Aging, who estimates the town is home to approximately 1,000 seniors today.

One of them, 80-year-old Korean and Vietnam War veteran George Owens, counts himself among Dr. Spada’s patients. For 10 years, Owens drove 27 miles from his home to see a doctor who accepted his insurance program, the Uniformed Services Family Health Plan, a plan for retired military personnel. He lives only a mile from Dr. Spada’s new office and now can walk to his appointments.

“With the price of gas this past summer, I thought it’d be best for me to go to the nearest physician,” Owens said.

A private medical practice in a small town may be becoming a thing of the past though. A search on the Internet for local doctors found at least three communities in this area without a medical clinic: Boxborough, Carlisle, and Dunstable.

Dr. Deborah Dennis, the last doctor in Shirley before Spada, said she left because it was hard to make ends meet as a private practitioner. She is now in a group practice with 16 other doctors at the SJ Family Medical Centers in Nashua – but more than a dozen of her patients from Shirley and surrounding towns still drive up to see her, she said.

“It was financially difficult waiting for insurance to come, doing everything on my own. I just didn’t want to be on my own anymore,” she said, explaining that she had to pay three staff members – a receptionist, a nurse, and “somebody who did nothing but paperwork for insurance” – when she had her own practice. Now she shares these costs with the other physicians.

Dr. Mary Russell, a cardiologist who lives in Carlisle, agrees that operating a small medical office these days is “unthinkable” because of costs related to billing, insurance, scheduling, and laboratory services. When doctors work in groups, they can share these costs – as well as the responsibility of answering patients’ phone calls, she said.

“Small practices aren’t viable right now,” she said. “Everything adds up and the work is unbearable: Being on call every single day is unbearable.”

Carlisle’s only doctor, a pediatrician, retired several years ago, according to Russell.

The views of Dennis and Russell are shared by the president of the Massachusetts Medical Society, Dr. Bruce Auerbach, who said that private medical practices are becoming “an increasingly rare phenomenon.”

“The economics of solo practice are not favorable, so physicians like to be in a group setting [to] share overhead costs [such as] clerical and nursing support,” he said. “In communities like Shirley, when older physicians stop practicing, there’s rarely someone to fill the void.”

According to Dr. Robert Leslie Shelton, chairman of the department of surgery at the Health Alliance Hospital in Leominster, where Spada serves as chairman of the department of medicine, Spada routinely gives out his cellphone number to his patients – and goes without an answering service.

“He’s the only doctor I know who does that,” said Shelton, who estimates he knows some 250 physicians. “His patients love him.”

After he resigned from the prison hospital, Dr. Spada opened a practice in Leominster. As he was driving by one day, he saw the “for lease” sign near the dentist’s office in Shirley.

“I thought this would be a great place for a doctor’s office,” he said, noting that it’s perfect for the dentist and the physician to be next to each other.

Arthur Eddy, who has been Shirley’s only dentist for 25 years, said he is glad to have a physician next door.

Eddy said he sees an increasing number of elderly patients who don’t take good care of their teeth because they are depressed or have cavities because their blood pressure medication dries up their mouth.

He said he has already sent one of his patients, whose blood pressure was so high he could have had a heart attack or a stroke, to Spada.

“There will be medical problems that I see that I can refer to him and dental problems that he can refer to me,” Eddy said.

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