Editor's Note: This is the first in a two-part series looking at the shortage of primary care doctors in western Massachusetts.
Almost every workforce survey in medicine right now shows a critical shortage of primary care doctors. In January, Massachusetts’ Health Policy Commission called the doctor supply a “state of extreme challenge.” And data shows it’s worse in western Mass than much of the state.
When NEPM asked community members to tell us if they’ve had trouble getting into see a primary care doctor, we were flooded by responses. While the stories differed in details, they all shared a similar frustration: There are simply not enough doctors — or appointments — available for all the people who need care.
"I left voicemails, nothing was available."
Take Kat Johnson, who moved to Easthampton, Mass., at the beginning of the pandemic.
“For that first year, I was not in a hurry to find a primary care doctor because I was 25 and thought I would be healthy forever,” they said.
But Johnson’s job became stressful and they started developing alarming symptoms, like fainting spells, brain fog and severe stomach pain. They wanted a doctor to examine them.
“I called around, I left voicemails, nothing was available,” they said.
So, like many without a doctor, Johnson ended up at the ER — at Cooley Dickinson Hospital in Northampton. Afterwards, the staff gave Johnson a phone number they said would lead to a primary care appointment.
“When I called that number, they asked who gave it to me because the wait-list for them was like more than a year out,” they said.
So Johnson started hunting through their insurance portal.
“Half of them were not actually primary care providers,” they said. “Most of them did not actually have new appointments. The ones that did it was like a six-month wait.”
Meanwhile, Johnson’s symptoms were getting worse. They developed an inflamed bladder, along with insomnia and anxiety. They had no one to write a prescription for blood pressure medication. They wanted to go on leave from work, but their employer required a primary care provider to write a letter.
Later Johnson found a lump in their breast and again had no option other than the emergency room. The ER doctor said the lump was benign.
“But that was a $200-plus visit, six hours of my time, to be told I'm fine, go home,” they said, “when I could have called [a primary care doctor] instead.”
"What do I do now?"
Other people told NEPM variations of the same Kafka-esque story.
“I have medical trauma,” said Ananda Martinez, a disability activist in Northampton who needed a primary care doctor. "So when they're like, ‘We're not taking patients or we'll take you in July of 2026,’ I would cry and be like, ‘What do I do now?’”
Martinez admitted she can be opinionated, which she said makes it even harder to find a doctor she relates to.
Then there’s Joanne Garland, who dutifully tried to stay healthy and out of her doctor’s office throughout the early years of the pandemic. But when she wanted to come back for an annual physical, she was told, “'because we haven't seen you in over three years, you will have to be considered a new patient,'” Garland recalled. “'And we are not accepting new patients.'”
Or Joanne Rome, whose 90-year old mother was moving north from Florida and needed a doctor. She’d had a stroke and was on blood thinners, but the first appointment she could find was 18 months out.
“And I just I'm like, ‘Okay, so who's going to be monitoring all of these meds? Who's going to be doing blood work?’” Rome said. “Who's going to be doing all of these things while we're waiting to be seen by the primary care?”
"There's no room at the inn"
One doctor we spoke to asked to keep her name confidential because she wasn’t approved to represent the health center where she works. She admitted her webpage says she’s taking new patients, even though her employer told her not to.
“It does feel bad to be told that we shouldn't be seeing new patients,” she said, adding that she also understands there’s limited capacity.
That said, she often comes up with ways to fit people in, including relatives of her current patients, by overbooking her own schedule without telling her bosses.
“I've described it as the infinite hotel before,” she said, “where there's no room at the inn, but there's always room at the inn.”
Except — for a lot of people — there’s no room. And it’s not a mystery why this shortage is getting so bad. One reason, experts say, is that primary care doctors are paid a half to a third as much as specialists like cardiologists or dermatologists. And many new doctors have huge school loans to pay back.
“It's not that primary care is paid so badly,” said Russ Phillips, who heads the Center for Primary Care at Harvard Medical School. “But relative to the training that we go through and the other options that medical students face, there are often compelling financial reasons that they might select another specialty.”
"We are not really catching up"
At the same time, primary care doctors have to do so much for patients, from referrals to filing prior authorization forms for medications. These tasks require hours of extra time even after a doctor goes home for the night.
And most providers have, on average, between 1200 and 2000 patients. As a result, many are retiring early or leaving the field — a phenomenon the pandemic made worse. And young doctors are failing to enter it in the first place.
“The population of the nation is growing and aging. And that means we need more and more physicians,” said Michael Dill, with the Association of American Medical Colleges, which puts out regular reports on the medical workforce. Last year’s report estimated the U.S. would have a shortage of 21,000 primary care doctors by 2026.
“While we are producing more and more physicians, we are not really catching up,” Dill said.
Seeking creative ways to see more patients with less
So existing practices are working on ways to retain their doctors and see more patients with fewer providers. But at the same time, some providers are asking for shorter schedules.
“Providers say that the work is more difficult and that they prefer more of a balance in their lives,” said Paul Carlan, who heads Valley Medical Group, a primary care practice with branches in Hampshire and Franklin counties.
He said the group is making more use of nurse practitioners and physician assistants, who are supervised by doctors. They now make up about two-thirds of Valley Medical’s providers.
“It's not a choice we've made,” Carlan said. “It's just the workforce that's available.”
Carlan says Valley Medical Group is trying creative methods to get more patients in, like group settings for wellness checks. Or texting rather than in-person. And using AI to write notes or do administrative tasks that would otherwise take up doctors’ time.
“That [extra work], honestly, is a big source of burnout for providers,” Carlan said.
But the experts say those workarounds cannot make up for the far-reaching effects of the doctor shortage. Michael Dill of the Association of American Medical Colleges says many people will skip care and their health will decline, “which causes need to go up. So it makes the shortage worse.”
Health reform — both in Massachusetts and nationally — has resulted in more people having insurance, but it has not resulted in more doctors.
State leaders are aware of the problem. Massachusetts Governor Maura Healey mentioned primary care in her state of the state address. The legislature is creating a primary care task force. Many experts have long supported a change in payment reimbursement to give more money to primary care or even conversion to a single-payer system.
But few believe any positive change will happen on the federal level under the Trump administration.
"I still have to diagnose whatever this is that's going on"
Kat Johnson finally did get a primary care appointment in Hadley. But after three years without a regular doctor, Johnson said their health has not fully recovered. They still get brain fog and dizzy spells.
But they’re hoping to make up for lost time.
At the first appointment with their new provider, “I opened my planner to this page I've been keeping of every medical issue I've been having since this started. And I went over my 16 item list,” Johnson said. “But there's still a lot of work to do. I still have to diagnose whatever this is that's going on with me.”
Johnson is crossing their fingers the new doctor doesn’t leave the practice — or the profession.
