As Maine CDC Focuses On High-Volume Vaccination Sites, Independent Physicians Question Access Equity

Feb 10, 2021

Independent physicians in Maine say they’ve so far been left out of the COVID-19 vaccine rollout, as have their patients. Some say older patients are either unwilling or unable to go to larger vaccination sites.

Federally Qualified Health Centers are expressing similar concerns, and say although they are receiving vaccines, more doses should be directed to their community-based clinics, which work with underserved populations.

Dr. Kathryn Galbraith has 500 patients over the age of 70 at her primary care practice in Limerick. They’re eager to get the vaccine, she says, and she’s eager to administer doses. She says she’s registered Galbraith Family Medicine as a COVID-19 vaccination site. But as hundreds, even thousands of doses are sent every week to hospital systems, she says she hasn’t received any.

“There’s word that there may be a clinic that may be opening near my office through one of the bigger health facilities. But we’re already there and already set up. So I don’t understand why we can’t be involved. We want to be and our patients want us to be. So we’re feeling left out is the bottom line,” she says.

Dr. Scott Schiff-Slater of Hallowell Family Practice also feels excluded. His practice has about 400 patients over the age of 70, and many tell him they’d rather wait to get the vaccine from him than go to a large, unfamiliar clinic. And some patients, he says, struggle with online sign-ups and don’t have the time and energy to make countless phone calls to try to get an appointment.

“The system we have in place is kind of crazy and haphazard and not really fair to a lot of my patients,” he says.

Schiff-Slater says if he received a supply of vaccine, he could do the leg work and administer doses quickly.

“We can reach our patients in hours. And we can pull up our electronic medical records everybody over age 85 and call them in first, and then everyone over 80 and call them in the next day. And we can do that very quickly and very safely,” he says.

The director of the state CDC, Dr. Nirav Shah, says independent practices can play a role in distributing the vaccine. But because Maine is receiving a limited supply, roughly 20,000 first doses every week, now is not the time.

“Throughput is right now the name of the game. The higher throughput that we can achieve with our doses coming in, the more doses we can vaccinate week on week on week,” he says.

That means sending doses to hospital-run clinics that can burn through their weekly allocation as quickly as possible. Shah says the state is also directing doses to Federally Qualified Health Centers because they also can administer doses quickly.

But of these community-based clinics that have received the vaccine, most have been allocated no more than 100 doses a week. And some are frustrated by the state’s focus on higher-volume sites.

“There is this concern about equitable access to vaccines,” says Coleen Elias is CEO of Community Clinical Services in Lewiston, which serves a low-income and immigrant community.

Elias says Maine recently boosted its allocation to Federally Qualified Health Centers to about 1,000 doses a week. But there are 20 such health centers in Maine, and they serve a total of 23,000 patients over the age of 70.

At that rate, Elias says, it will take months to vaccinate everyone in that group.

“We are feeling frustrated,” says Darcy Shargo, CEO of the Maine Primary Care Association, which represents community health centers.

Shargo says high-volume clinics are important, but they’re not necessarily a realistic option for the patients community health centers serve. Many don’t have access to transportation or face other barriers.

“The primary frustration continues to be that there are going to be folks who just for various reasons cannot access those sites,” she says.

The Biden administration announced Tuesday that next week it will start sending doses directly to Federally Qualified Health Centers. The program will be phased in, and it’s unclear how much of a boost it will be for Maine.

Regardless of supply, some providers outside of hospital systems say greater participation in the rollout would quicken the pace of vaccinations, not slow them down.

“The old adage ‘Many hands make light work’ is being lost here,” says Dr. Galbraith in Limerick. “There are many small community facilities that are perfectly capable. Perfectly ready. Perfectly able to give vaccines. And just because I can’t give a lot of them doesn’t mean that all of us put together can’t be putting a giant dent in the vaccine process.”